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With more than 900,000 confirmed cases worldwide and nearly 50,000 deaths during the first 3 months of 2020, the coronavirus disease 2019 (COVID-19) pandemic has emerged as an unprecedented health care crisis. The spread of COVID-19 has been heterogeneous, resulting in some regions having sporadic transmission and relatively few hospitalized patients with COVID-19 and others having community transmission that has led to overwhelming numbers of severe

OA and negative-pressure techniques improve the care of trauma patients, but closure must be achieved early to avoid complications.

To investigate whether chest-wall mechanics could affect the total respiratory system pressure-volume (P-V) curve in patients with acute respiratory failure (ARF), and particularly the lower inflection point (LIP) of the curve, we drew the total respiratory system, lung, and chest-wall P-V curves (P-Vrs, P-VL, and P-VW, respectively) for 13 patients with ARF, using the supersyringe method together with the esophageal balloon technique. Measurements were randomly repeated at four different levels of positive end-expiratory pressure (PEEP) (0, 5, 10, 15 cm H2O) and from each P-V curve we derived starting compliance (Cstart), inflation compliance (Cinf), and end compliance (Cend). With PEEP of 0 cm H2O (ZEEP), an LIP on the P-Vrs curve was observed in all patients (7.5 +/- 3.9 cm H2O); in two patients an LIP was detected only on the P-VL curve (8.6 and 8.7 cm H2O, respectively); whereas in seven patients an LIP was observed only on the P-VW curve (3.4 +/- 1.1 cm H2O). In four patients, an LIP was detected on both the P-VL and P-VW curves (8.5 +/- 3.4 and 2.2 +/- 1.0 cm H2O, respectively). The LIP was abolished by PEEP, suggesting that a volume-related mechanism was responsible for the observed LIP on both the P-VL and P-VW curves. At high levels of PEEP, an upper inflection point (UIP) appeared on the P-Vrs and P-VL curves (11.7 +/- 4.9 cm H2O and 8.9 +/- 4.2 cm H2O above PEEP, respectively) suggesting alveolar overdistension. In general, PaO2 increased with PEEP (from 81.7 +/- 35.5 mm Hg on ZEEP to 120 +/- 43.8 mm Hg on PEEP 15 cm H2O, p < 0.002); however, the increase in PaO2 with PEEP was significant only in patients with an LIP on the P-VL curve (from 70.5 +/- 16.2 mm Hg to 117.5 +/- 50.7 mm Hg, p < 0.002), the changes in PaO2 in patients without an LIP on the P-VL curve not being significant (from 91.3 +/- 45.4 mm Hg to 122.2 +/- 41.1 mm Hg). We conclude that in ventilator-dependent patients with ARF: (1) the chest-wall mechanics can contribute to the LIP observed on the P-Vrs curve; (2) the improvement in PaO2 with PEEP is significant only in patients in whom LIP is on the lung P-V curve and not on the chest wall curve; (3) high levels of PEEP may overdistend the lung, as reflected by the appearance of a UIP; (4) measurement of P-Vrs alone may be misleading as a guide for setting the level of PEEP in some mechanically ventilated patients, at least in the supine position, although it helps to prevent excessive alveolar overdistension by indicating the inflection volume above which UIP may appear.

Introduction:for the management of patients referred to respiratory triage during the early stages of the SARS-CoV-2 pandemic, either chest radiograph (CXR) or computed tomography (CT) were used as first-line diagnostic tools. The aim of this study was to compare the impact on triage, diagnosis and prognosis of patients with suspected COVID-19 when clinical decisions are derived from reconstructed CXR or from CT.Methods:we reconstructed CXR (r-CXR) from high-resolution CT (HRCT) scan. Five clinical observers independently reviewed clinical charts of 300 subjects with suspected COVID-19 pneumonia, integrated with either r-CXR or HRCT report in two consecutive blinded and randomised sessions: clinical decisions were recorded for each session. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and prognostic value were compared between r-CXR and HRCT. The best radiological integration was also examined to develop an optimised respiratory triage algorithm.Results:interobserver agreement was fair (Kendall's W=0.365; p<0.001) by r-CXR-based protocol and good (Kendall's W=0.654; p<0.001) by CT-based protocol. NPV assisted by r-CXR (31.4%) was lower than that of HRCT (77.9%). In case of indeterminate or typical radiological appearence for COVID-19 pneumonia, extent of disease on r-CXR or HRCT were the only two imaging variables that were similarly linked to mortality by adjusted multivariable modelsConclusions:the present findings suggest that clinical triage is safely assisted by CXR. An integrated algorithm using first-line CXR and contingent use of HRCT can help optimise management and prognostication of COVID-19.

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We investigated a number of biological markers, evaluated under strict intralaboratory quality control conditions, in terms of their role in predicting clinical outcome of patients with colon cancer treated with 5-FU-containing regimens. Colon cancer tissue from 263 patients enrolled onto two randomised clinical trials were studied for their cytofluorimetrically determined DNA content and their immunohistochemically evaluated microvessel density, vascular endothelial growth factor expression, thymidylate synthase expression and tumour lymphocyte infiltration. Disease-free survival and overall survival of patients were analysed as a function of the different variables. At a median follow up of 57 months, age, gender and Dukes' stage showed an impact on disease-free survival, whereas no biological marker emerged as an indicator of better or worse disease-free survival. Only histological grade and Dukes' stage were found to influence overall survival. The different biological variables, studied with particular attention for determination reliability, proved to have no impact on the clinical outcome of patients with colon cancer. Therefore, other markers must be identified to complement clinico-pathological variables in the management of this disease. British Journal of Cancer (2002) 87 , 868–875. doi: 10.1038/sj.bjc.6600569 www.bjcancer.com © 2002 Cancer Research UK

The results from this randomized clinical study indicate that patients with node-negative, rapidly proliferating tumors significantly benefit from adjuvant CMF.