Background
Low skeletal muscle index (SMI) in metastatic colorectal cancer (mCRC) patients is associated with poor outcomes. The prognostic impact of SMI changes during consecutive palliative ...systemic treatments is unknown.
Methods
This is a retrospective analysis of the phase 3 CAIRO3 study. The CAIRO3 study randomized 557 patients between maintenance capecitabine + bevacizumab (CAP‐B) or observation, after six cycles capecitabine + oxaliplatin + bevacizumab (CAPOX‐B). Upon first disease progression (PD1), CAPOX‐B was reintroduced until second progression (PD2). SMI was assessed by computed tomography (CT) (total 1355 scans). SMI and body mass index (BMI) changes were analyzed for three time‐periods; p1: during initial CAPOX‐B, p2: randomization to PD1, and p3: PD1 to PD2. The association between absolute and change in SMI and BMI (both per 1 standard deviation) during p1‐p3, with PD1, PD2, and survival was studied by Cox regression models.
Results
This analysis included 450 of the 557 patients randomized in the CAIRO3 study. Mean SMI decreased during p1: mean −0.6 SMI units 95% CI −1.07;‐0.26 and p3: −2.2 units −2.7;‐1.8, whereas during p2, SMI increased + 1.2 units 0.8‐1.6. BMI changes did not reflect changes in SMI. SMI loss during p2 and p3 was significantly associated with shorter survival (HR 1.19 1.09‐1.35; 1.54 1.31‐1.79, respectively). Sarcopenia at PD1 was significantly associated with early PD2 (HR 1.40 1.10‐1.70). BMI loss independent of SMI loss was only associated with shorter overall survival during p3 (HR 1.35 1.14‐1.63).
Conclusions
In mCRC patients, SMI loss during palliative systemic treatment was related with early disease progression and reduced survival. BMI did not reflect changes in SMI and could not identify patients at risk of poor outcome during early treatment lines.
Coronavirus disease 2019 (COVID-19) has negatively affected the delivery of respiratory diagnostic services across the world due to the potential risk of disease transmission during lung function ...testing. Community prevalence, reoccurrence of COVID-19 surges and the emergence of different variants of SARS-CoV-2 have impeded attempts to restore services. Finding consensus on how to deliver safe lung function services for both patients attending and for staff performing the tests are of paramount importance. This international statement presents the consensus opinion of 23 experts in the field of lung function and respiratory physiology balanced with evidence from the reviewed literature. It describes a robust roadmap for restoration and continuity of lung function testing services during the COVID-19 pandemic and beyond. Important strategies presented in this consensus statement relate to the patient journey when attending for lung function tests. We discuss appointment preparation, operational and environmental issues, testing room requirements including mitigation strategies for transmission risk, requirement for improved ventilation, maintaining physical distance and use of personal protection equipment. We also provide consensus opinion on precautions relating to specific tests, filters, management of special patient groups and alternative options to testing in hospitals. The pandemic has highlighted how vulnerable lung function services are and forces us to re-think how long-term mitigation strategies can protect our services during this and any possible future pandemic. This statement aspires to address the safety concerns that exist and provide strategies to make lung function tests and the testing environment safer when tests are required.
In an attempt to reduce the work of breathing (WOB) and the risk of respiratory failure, preterm infants are increasingly treated with nasal synchronised biphasic positive airway pressure (BPAP) via ...the Infant Flow SiPAP system. However, the relatively high resistance of the generator limits the pressure amplitude (PA) and pressure build-up (PB) of this system. This in vitro study investigates the impact of a new generator with improved fluid mechanics on the WOB, PA and PB during BPAP.
Using a low compliance lung model, WOB, PA and PB, were measured during BPAP using the old and the new Infant Flow generators. Airway resistance (tube sizes 2.5 mm, 3.0 mm and 3.5 mm), nasal interface sizes (small, medium and large) and four different ventilator settings were used to mimic different clinical conditions.
Compared with the old generator, the new generator significantly reduced the WOB between 10% and 70%, depending on the measurement configuration. The maximum PA was higher when using the new (6-7 cm H2O) generator versus the old (3-4 cm H2O) generator. During the first 100 ms of inspiration, the new generator reached between 33% and 40% of the peak pressure compared with 11-20% for the old generator.
This in vitro study shows that a new generator of the Infant Flow SiPAP device results in a significant reduction in WOB and an increase in PA and PB during BPAP. The results of this study need to be confirmed under variable clinical conditions in preterm infants.
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