tbuckley/cabot-search huggingface dataset:
TAS-116, an oral HSP90 inhibitor, in combination with nivolumab in patients with colorectal cancer and other solid tumors: An open-label, dose-finding, and expansion phase Ib trial (EPOC1704).
Authors: Akihito Kawazoe, Noboru Yamamoto, Daisuke Kotani, Yasutoshi Kuboki, Hiroya Taniguchi, Kenichi Harano, Yoichi Naito, Mitsuko Suzuki, Miki Fukutani, Hikari Shima, Tsukiko Higuchi, Masashi Wakabayashi, Shogo Nomura, Akihiro Sato, Hiroyoshi Nishikawa, Kohei Shitara
Journal: Journal of Clinical Oncology (2020)

4044 Background: Regulatory T cells (Tregs) potentially induce the resistance of anti-PD1/PD-L1 inhibitors (A-PD1). TAS-116, a novel HSP90 inhibitor, enhanced antitumor immunity via reducing Tregs in vitro and in vivo. Combination of TAS-116 plus A-PD1 showed a superior tumor growth suppression compared with either treatment alone in vivo. Based on the above, we investigated safety and efficacy of TAS-116 in combination with nivolumab in patients with solid tumors. Methods: Enrolled patients received TAS-116 plus nivolumab in a dose-finding part to estimate the maximum tolerated dose and the recommended phase 2 dose (RP2D). Additional patients were enrolled in a dose-expansion part. TAS-116 monotherapy (orally once daily, 80mg on level 1, 120mg on level 2, and 160mg on level 3) was administrated for 2 weeks followed by the combination with nivolumab (intravenously every 2 weeks, 3 mg/kg). The primary endpoint was dose-limiting toxicities (DLTs) during the first cycle (4 weeks). PD-L1 combined positive score (CPS) and tumor mutation burden (TMB) were assessed. We also conducted biomarker research using paired samples from repeated tumor biopsies and blood collections. Results: A total of 44 patients with colorectal cancer (CRC, n = 29), gastric cancer (GC, n = 8), sarcoma (n = 5), non-small cell lung cancer (NSCLC, n = 1) and melanoma (n = 1) after standard of cares were enrolled. One patient had MSI-H CRC, but all other patients had MSS tumors. No DLTs were observed at all levels and TAS-116 160 mg was determined as RP2D. The common grade 3 or worse treatment-related adverse included AST/ALT increased (7%), creatinine increased (5%) and platelet count decreased (5%). Objective tumor response was observed in 6 patients including 4 MSS CRC, 1 MSI-H CRC and 1 sarcoma, resulting in objective response rate (ORR) of 16% in MSS CRC without prior A-PD-1. PD-L1 CPS and TMB could be evaluated in 18 and 17 MSS CRC without prior A-PD-1, respectively. ORR was 27% in patients with CPS ≥1 and 0% in patients with CPS &lt; 1. ORR was 33% with TMB-high (median as the cut-off) and 12% with TMB-low. Analysis of tumor-infiltrating lymphocytes before treatment and after TAS-116 monotherapy demonstrated reduction of FoxP3 hi CD45RA − Tregs fraction in the tumor microenvironment. Conclusions: The combination of TAS-116 160mg plus nivolumab had manageable safety profiles and anti-tumor activity especially for MSS CRC patients, which warrants further investigations in a large cohort. Clinical trial information: UMIN000032801 .
OvarianTag biomarker panel in order guide treatment decisions cisplatin-based for women with epithelial ovarian cancer.
Authors: Leticia da Conceição Braga, Luciana Maria Silva, Matheus Gomes de Souza, Laurence Rodrigues do Amaral, Nara Rosana Andrade, Agnaldo Lopes da Silva-filho
Journal: Journal of Clinical Oncology (2020)

e18075 Background: Ovarian cancer (OC) represents the most lethal gynecologic cancer. Late-stage diagnosis associated with a lack of effective markers to detect chemotherapy resistance contributes to high mortality and poor prognosis of epithelial ovarian cancer (EOC). OvarianTag Biomarkers Panel was developed as biopsy-based gene expression assay to discriminate prognosis in EOC patients, to understand the aggressiveness and relapse causes of these patients. Methods: Patients were admitted into this study in two phases. First, 45 women were included prospectively, and RNA was obtained from fresh normal ovarian (NO) tissues (n = 18), ovarian serous cystadenoma tumors (n = 11) and EOC (n = 16). The total RNA content was quantified and quantitative PCR (qRT-PCR) was performed to determine relative gene expression, starting set genes related to apoptosis and necroptosis regulated cell death pathway. Machine Learning algorithms were used to classify patient’s data associated and to characterize molecular targets as prognostic markers, named OvarianTag panel. Later, others 55 EOC patients, attended between 2008 and 2016, were included. Within this cohort, tissues were obtained from 106 FFPE samples and shared into primary and metastatic EOC, and from the same NO tissues (as control). RNA was extracted and qRT-PCR determined the OvarianTag panel expression level from each sample. Then, hierarchical clustering allowed us to classify the samples using the cut off obtained by classifier algorithm. Results: Significant differences in gene expression profile were observed between patients’ groups. Molecular classifier algorithm proved the prognostic value of genes evaluated. Decisions trees and biomarker clusters were constructed. In the full training, were obtained 90% of correct classifications and in cross-validation, 89%. In the second phase, the classifier reported specificity of 100% and sensibility of 79% to predict tumor recurrence and platinum resistance. Conclusions: OvarianTag panel is a putative prognosis biomarker of EOC subgroups and could be considered to drive the clinical practice of EOC treatment options, improving outcomes because providing an opportunity for guide clinical intervention for increasing survival rates. Besides of that, it will be allowed include patients in clinical trials of new target drugs or for repositioning of target drugs that have already been tested in humans.
Efficacy and tolerability of weekly 40mg/m² cisplatin radiosensitizing modified regimen for locally-advanced head and neck squamous cell carcinoma radical treatment with chemoradiotherapy: A university hospital experience.
Authors: Bruna Bighetti, José Tristão Neto, Renata do Socorro Monteiro Pereira, LAÍS CRISTHINE SOUZA, Ilka Lopes Santoro, Hakaru Tadokoro, Christian Ribas, Ramon Andrade De Mello
Journal: Journal of Clinical Oncology (2020)

e18512 Background: Cisplatin-based chemoradiotherapy (CRT) is a well-established regimen used for adjuvant and/or head-and-neck squamous cell carcinoma (HNSCC) radical treatment. The most classic protocol for chemoradiotherapy remains the administration of Cisplatin 100mg/m² EV D1 q3-week period, 3 cycles. The objective of this study is to assess the efficacy and tolerability of the weekly 40mg/m² cisplatin regimen. Methods: we conducted a retrospective study from 2007-2020 with 102 patients treated at a national reference institution. All of them with HNSCC received concurrent CRT with weekly cisplatin 40mg/m² EV D1. We analyzed the overall survival (OS), local recurrence and tolerability in this scheme. Results: The median cisplatin cumulative dose received by our patients was 240mg/m². Hence, we divided them in two groups for the analysis: Group A (41 patients) received less than 240mg/m² cisplatin total dose and Group B (61 patients) received more or equal 240mg/m² cisplatin total dose. Both groups were equally balanced between sex, clinic stage, histologic grade and clinic status. We found that the Group A experienced 5 deaths (12.2%) while the Group B experienced 6 deaths (9.8%). The mean time to recurrence disease in the Group A was 45.68 months and in Group B 60.22 months (p = 0.958). The estimated overall survival in the Group A was 150 months and in the Group B was 116.4 months (p = 0.443). Conclusions: The weekly cisplatin dose regimen showed to be feasible, more tolerable, and less toxic and with no difference in terms of OS then the classic 3-week cisplatin protocol in the CRT setting. Our group suggests that the 240mg/m² cumulative cisplatin weekly schedule should be a better option for CRT treatments then the classic cisplatin regimen. A phase III clinical trial is warranted to further understanding of this framework. Key-words: head and neck cancer, cisplatin, radiotherapy
Treating patients of unilateral benign thyroid disease with hemithroidectomy
Authors: Jian Xu, Yuanjiang Zhang, Ke Jin
Journal: BMJ (2014)

According to operative modalities, 128 patients with unilateral benign thyroid disease were divided into hemithyroidectomy group (n=68) and subtotal thyroidectomy group (n=60). The operative duration of hemithyroidectomy group was (63±14) min, intraoperative blood loss (54±15) ml, postoperative drainage volume (64±10) ml and hospitalization stay (5.9±0.8) days. The hospital charge of (8 335±278) yuan was less than that of subtotal thyroidectomy group (P 0.05). But the postoperative recurrence rate of hemithyroidectomy was significantly lower than that of subtotal thyroidectomy group (P<0.05). Treating patients of unilateral benign thyroid disease with hemithyroidectomy yield excellent efficacies. It is worthy of wider clinical application.


Key words: 
Thyroid neoplasms; Thyroidectomy
Serum vitamin D levels in tuberculosis patients with different blood glucose status
Authors: Xin Zhao, Yanli Yuan, Yunlong Bai, Tiejuan Zhang, Guangxu Yang, Meng Wang, Zhixian Xie
Journal: BMJ (2018)

Objective
To investigate serum vitamin D levels in tuberculosis (TB) patients with different blood glucose status.


Methods
Two hundred and forty seven TB patients were recruited from tuberculosis clinics in Jilin province and 80 normal subjects who underwent health check up in Beijing Hospital served as controls. Blood samples were collected, fasting blood glucose (FBG) and serum vitamin D [25(OH)D] levels were measured.


Results
FBG results showed that there were 95 patients with normal FBG, 69 with pre-diabetes (pre-DM) and 83 with diabetes mellitus (DM). Vitamin D measurement showed that 25(OH)D level in TB patients with normal FBG, pre-DM and DM was 16.1(10.7, 26.2) μg/L, 12.9(9.6, 20.1) μg/L and 12.4(10.4, 16.9) μg/L, respectively, (χ2=19.608, P<0.001) and were much lower than that in the normal controls (20.5 μg/L) (χ2=21.701, P<0.001). Proportion of TB patients with 25(OH)D sever deficiency(<10.0 μg/L)in patients with normal FBG, pre-DM and DM was 20.0% (19/95), 31.9% (22/69), and 24.1% (20/83) respectively (χ2=6.376, P<0.05); proportion of 25(OH)D deficiency(10.0-19.9 ng/ml)in three groups was 41.1% (39/95), 40.6% (28/69), and 57.8% (48/83), respectively (χ2=15.141, P<0.05); sufficient 25(OH)D(≥30.0 μg/L)was 14.7% (14/95), 7.2% (5/69), and 1.2% (1/83), respectively (χ2=19.118; P<0.05). While the proportion of TB patient with 25(OH)D insufficiency(20.0-29.9 ng/ml)was 24.2% (23/95), 20.3% (14/69), and 16.9% (14/48) respectively (χ2=0.933, P=0.627). In TB patients with normal FBG, risk factors for 25(OH)D deficiency were smoking (OR=5.619, 95%CI: 1.293-24.424, P=0.021), cold season (OR=14.402, 95%CI: 4.070-50.965, P<0.001) and smear negative TB (OR=6.194, 95%CI: 1.873-20.481, P=0.003). Living in rural area (OR=3.429, 95%CI: 1.040-11.299, P=0.043) was the risk factor for 25(OH)D deficiency in TB patients with pre-DM and age≥ 60 years (OR=2.474, 95%CI: 1.086-5.623, P=0.031) was risk factor for 25(OH)D deficiency in those with DM.


Conclusions
Vitamin D level is lower in TB patients than that in normal controls. The diabetic TB patients have the lowest 25(OH)D level and have highest proportion of vitamin D deficiency and sever deficiency, particularly for elderly patients.


Key words: 
Vitamin D; Tuberculosis; Diabetes mellitus
Cardiotoxicity associated with immune checkpoint inibitors: A systemic review and meta-analysis.
Authors: Sheeba Habeeb Ba Aqeel, Prasanth Lingamaneni, Shristi Upadhyay Banskota, Muhammad Zain Farooq, Rayli Pichardo, Ishaan Vohra, Ankit Mangla
Journal: Journal of Clinical Oncology (2020)

e15131 Background: Immune checkpoint inhibitors (ICI) are associated with multiple immune related adverse events (irAE). Cardiotoxicities are rare but fatal complications. Since PD-1 and PD-L1 are expressed on human cardiomyocyte, there is an increased risk of cardiotoxicity with use of ICI. We performed a systematic review and meta-analysis to assess cardiotoxicities associated with PDL1 and CTLA4 inhibitors. Methods: The Embase, Ovid, Pubmed and Scopus were searched from inception to 2019 by two independent reviewers. All Phase II and III clinical trials reporting cardiotoxicities with the combination of, or monotherapy with anti-PD-1/PD-L1 and/or anti-CTLA4 were included. Our primary outcome was assessment of cardiotoxicity of all grades that included, hypertension, arrythmias, pericardial effusion, myocardial infarction, myocarditis, cardiomyopathy and cardiac arrest. Statistical heterogeneity was quantified using I 2 statistics. The publication bias was assessed with Eggers regression test. The estimates were reported as odds Ratio (OR) with 95% confidence intervals (CI) using random effect model. Results: A total of 2,876 trials retrieved in the initial database search were analyzed according to PRISMA guidelines. Twenty trials met the inclusion criteria and were included in the final analysis. A total of 8,905 patients were included in these trials. There was no statistically significant difference in reported overall cardiotoxicity with ICI compared to placebo or standard of care (OR 0.953 95% CI 0.542-1.675, I 2 89.49 p &lt; 0.001). Also, no statistical significance associated with myocardial infarction (OR 0.76, 95% CI 0.76-3.298 I2 0%, P = 0.83), pericardial effusion (OR 1.44, 95% CI 0.72-2.90. I 2 = 0%, P = 0.613) or hypertension (OR 0.543, 95% CI 0.219-1.346. I2 = 94.98, P &lt; 0.001). Myocarditis was reported in 8 patients with a statistically non-significant increased risk compared to standard of care or placebo (OR 2.16, 95% CI 0.719-6.828 I 2 = 0%, P = 0.885). Other reported cardiac irAE included cardiac arrest in 4 patients, QT prolongation in 2 patients and cardiac tamponade in 1 patient. Conclusions: The overall risk of cardiac related irAE is not significantly higher with ICI when compared with placebo or standard of care. The reported events of severe cardiac irAE like myocarditis and cardiac arrest are very low in the reported trials.
Covid-19: Questions of conscience and duty for scientific advisers
Authors: Kamran Abbasi
Journal: BMJ (2020)

England is abandoning lockdown and possibly hope of containing a second wave of covid-19. From 1 June schools will open to children other than those of key workers. Outdoor markets and car showrooms will reopen. In two weeks, it will be the turn of all non-essential retailers. This is meant to be a moment of optimism, a green recovery, centred on the health of people and the planet (doi:10.1136/bmj.m2077, doi:10.1136/bmj.m2076), backed by an effective system of testing and contact tracing and possibly informed by a public inquiry (doi:10.1136/bmj.m2052).

Instead, England arrives here in a state of utter confusion (doi: …
感染性腹泻的诊断与治疗
Authors: 陈志海
Journal: BMJ (2009)

陈志海:感染性腹泻是临床常见病,尤其在夏、秋季.广义上讲,所有病毒、细菌、真菌、寄生虫等病原微生物感染引起的腹泻都属于感染性腹泻.但在传染病防治法里面的丙类传染病,也叫感染性腹泻,是指除伤寒、副伤寒、细菌性痢疾(菌痢)、阿米巴痢疾、霍乱等之外的腹泻,我们可以称之为狭义的感染性腹泻。
Ipilimumab challenge/re-challenge in metastatic urothelial carcinoma (mUC) and other genitourinary (GU) tumors treated with cabozantinib+nivolumab (CaboNivo) or cabozantinib+nivolumab+ipilimumab (CaboNivoIpi).
Authors: Scot Anthony Niglio, Daniel da Motta Girardi, Amir Mortazavi, Primo Lara, Sumanta K. Pal, Biren Saraiya, Lisa M. Cordes, Lisa Ley, Olena Sierra Ortiz, Jacqueline Cadena, Carlos Diaz, Mohammadhadi H. Bagheri, Seth M. Steinberg, Rene Costello, Howard Streicher, John Wright, Howard L. Parnes, Yang-Min Ning, Donald P. Bottaro, Andrea B. Apolo
Journal: Journal of Clinical Oncology (2020)

5039 Background: We investigated challenging/re-challenging pts with ipilimumab (ipi) after progression on CaboNivo or CaboNivoIpi. Methods: In a phase I expansion study, patients with mUC post-platinum chemotherapy and other GU tumors patients who progressed on Cabo 40 mg daily plus nivolumab, 3 mg/kg every 21 days (CaboNivo) alone or with ipi, 1 mg/kg every 21 days for 4 cycles (CaboNivoIpi)-and achieved a PR or SD≥6 mo, were challenged/re-challenged with ipi, 1 mg/kg every 21 days for up to 4 cycles. Restaging scans were done every 6 wks for the first 12 wks, then every 8 wks and evaluated by RECIST 1.1. Results: In total, 24 patients were evaluated: 18 pts (8 UC (5 bladder and 3 upper tract), 4 clear cell renal cell carcinoma (RCC), 3 urachal adenocarcinoma (adeno), 2 bladder adeno, and 1 sarcomatoid clear cell RCC) who progressed on CaboNivo were challenged with ipi. In the challenge group, median (m) follow-up was 21.2 months. One pt achieved a PR in the LNs, but was found to have brain metastases before the next restaging, 13 had SD and 4 had PD. Median duration of PR or SD was 3.6 months (95% CI: 1.4 – 7.8 months). The mOS from start of ipi challenge was 13.9 months (95% CI: 5.8 months- not estimable); mPFS was 4.6 months (95% CI: 1.9 – 8.7 months). Grade 1/2 treatment related adverse events (AEs) occurred in all 18 pts (100%) and ≥Grade 3 (G≥3) AEs occurred in 11 pts (61%). The most common G≥3 AEs were hypophosphatemia (22%), hypertension (6%), adrenal insufficiency (6%), increased AST (6%), and ALT (6%). Six patients (3 bladder UC, 1 penile squamous cell (SCC) carcinoma, 1 urethral SCC, and 1 clear cell RCC with sarcomatoid features) who progressed on CaboNivoIpi were re-challenged with Ipi. On re-challenge, mfollow-up was 20.9 months. There were no PRs, 3 SDs and 3 PDs. mOS from start of re-challenge was 4.0 months (95% CI: 2.2 – 23.3 months) and mPFS was 1.9 months (95% CI: 1.1 – 2.6 months). Grade 1/2 treatment related AEs occurred in all 6 pts (100%) and ≥Grade 3 (G≥3) AEs occurred in 2pts (33%). G≥3 AEs included 1 hypertension (17%) and 1 hyperphosphatemia (17%). Conclusions: Ipi challenge/re-challenge showed low response rates in pts previously treated with CaboNivo or CaboNivoIpi. However, pts treated with CaboNivo who were challenged with ipi had a better OS than patients who had progressed on CaboNivoIpi and were re-challenged with ipi. Larger trials are warranted testing the ipi challenge in pts progressing on CaboNivo. Clinical trial information: NCT02496208 .
Primary tumor (p-bx) versus metastatic tumor (m-bx) tissue versus liquid biopsy (lb) in intrahepatic cholangiocarcinoma (IHCC): A comparative comprehensive genomic profiling (CGP) study.
Authors: Jeffrey S. Ross, Ethan Sokol, Dean Pavlick, Jo-Anne Vergilio, Jonathan Keith Killian, Douglas I. Lin, Erik Abraham Williams, Natalie Danziger, Shakti H. Ramkissoon, Eric Allan Severson, Amanda Hemmerich, Claire I. Edgerly, Richard Huang, Russell Madison, Alexa Betzig Schrock, Brian Michael Alexander, Jeffrey Venstrom, Venkataprasanth P. Reddy, Kimberly McGregor, Julia Andrea Elvin
Journal: Journal of Clinical Oncology (2020)

4579 Background: Genomic alterations (GA) characteristic of IHCC are well known. We queried whether GA from Pbx would differ from Mbx and Lbx in IHCC. Methods: Hybrid-capture based CGP was performed on 1,268 tissue samples of advanced stage IHCC using Pbx in 1,048 cases and Mbx from 220 cases and 364 Lbx cases (solid tissue: 318-327 genes, Lbx: 72 genes). Tumor mutational burden (TMB) was determined on 0.8-1.1 Mbp of sequenced DNA. PD-L1 expression in tumor cells (Dako 22C3) was measured by IHC. Results: Mbx sites included: lymph nodes (63), soft tissues (47), peritoneum (34), lung/pleura (27), omentum (15), bone (10), abdomen (7), GYN tract (5), liver (4), brain (2), Upper GI (2), colon (2), bladder (1), and adrenal (1). The GA/sample and biomarkers of immuno-oncology (IO) drug response were similarThe KRAS mutation frequency including G12C alterations was doubled in Mbx compared to Pbx and Lbx (p &lt; 0.001). Frequencies of untargetable GA were similar overall. IDH1 (p &lt; 0.001) and FGFR2 GA known to be enriched in IHCC were less frequent in Mbx than Pbx. Both IDH1 and FGFR2 were identified in Lbx. GA in STK11 (p &lt; 0.001) and SMAD4 (p = 0.0016) were more frequently identified in Mbx. Conclusions: GA found in Pbx vs Mbx and Lbx in IHCC are significantly different; the Mbx cohort features greater KRAS and lower IDH1 and FGFR2 GA. Lbx detected more IDH1 GA than Mbx. This suggests that the Mbx group may contain non-IHCC cases whose metastatic lesions were actually derived from other primary sites and incorrectly assigned the diagnosis of IHCC. [Table: see text]
Impact of type of salvage therapy (ST) and response to bridging therapy (BT) on CAR-T therapy outcomes for relapsed/refractory aggressive B-cell non-Hodgkin lymphoma (NHL).
Authors: Arushi Khurana, Abdullah S. Al Saleh, Sangeetha Gandhi, Tuan Truong, Eva Brandes, Breanna Estby, Gina Lange, Jose Caetano Villasboas, Jonas Paludo, N. Nora Bennani, Stephen M. Ansell, Patrick B. Johnston, Yi Lin
Journal: Journal of Clinical Oncology (2020)

e15020 Background: Durable responses were seen in registration trials for CAR-T in NHL across poor prognostic groups including early relapse post stem cell transplant (ASCT). Multi-center reports of real-world practice noted patients who received BT prior to CAR-T had decreased survival. The impact of last ST and response to BT on clinical outcome are examined here. Methods: Retrospective chart review was performed on 47 patients who received axicabtagene ciloleucel from June 2016 – September 2019 at Mayo Clinic, Rochester. ST was defined as last therapy prior to leukapheresis and grouped into categories – non-ASCT (chemotherapy, and immunotherapy), and ASCT. BT was defined as therapy given between leukapheresis and CAR-T. Response to therapy was evaluated using 2014 Lugano criteria. Event free survival (EFS) was defined as time from CAR-T infusion to progression, next treatment, or death. Results: The ST distribution was 77% non-ASCT [chemo 66% (31), and immunotherapy 11% (5)], and 23% (11) ASCT. EFS was significantly prolonged for the ASCT (median not reached) vs non-ASCT (median 3.8 months, p = 0.03) despite no difference in median prior lines of therapy. This may reflect more aggressive disease in the non-ASCT arm, as time from start of ST to leukapheresis was shorter (median non-ASCT 2.2 months vs. ASCT 4.4 months, p = 0.0008). Patients received BT if there were concerns for symptomatic progression during CAR-T manufacturing that would reduce the likelihood to receive CAR-T. Sixty-two percent (29) patients received BT (11 chemo, and 18 immunotherapy). The EFS did not differ between the type of BT. However, patients who progressed after BT had worse EFS than those who achieved stable disease or partial response (median 2.8 vs 8.7 months, p = 0.03). Conclusions: Patients who received CAR-T as the next treatment after ASCT had better EFS than those after other types of ST. While patients who received BT have worse survival than those who didn’t, having some control of lymphoma progression with BT was associated with better EFS than those who continued to have progressive disease.
Thinking of community clinical reception for patient with abdominal pain who seek medical treatment repeatedly
Authors: Wenxiu Wu, Yue Jiang, Yue Sha
Journal: BMJ (2018)

报道1例在多家三级医院反复就诊，完善多项检查没有特殊阳性发现，初步治疗效果不佳的腹痛患者在社区卫生服务中心的就诊过程。接诊过程中充分运用全科医学的理念，强化以患者为中心的接诊方法，最后取得令患者满意的疗效。
Literature review of nitrous oxide-induced disease
Authors: Xiaoqing Wang, Yuewen Ma
Journal: BMJ (2019)

Nitrous oxide (N2O) is an anesthetic which is also known to have abuse potential. Nitrous oxide-induced disease is occasionally encountered in the clinic, and there have been only several case reports about nitrous oxide-induced disease. In this article we review the reported cases of severe nerve injury following N2O abuse.

Key words: 
Nitrous oxide; Neurotoxicity syndromes