Huang, Steven Y.

Abstract Gastrostomy tubes provide essential long-term enteral nutritional support for trauma patients unable to tolerate oral intake or if prohibited due to associated injuries. This review aims to explore the indications and special considerations unique to gastrostomy tube placement and management for patients following trauma. The specific special considerations addressed in this article are timing of gastrostomy tube placement, timing of gastric tube feeding, technique, indications for postpyloric feeding tubes, concomitant corticosteroid use, safety in patients with an open abdomen, overcoming an inability to pass a nasogastric tube, and considerations for postgastrostomy tube management.

Background and Objectives: Interstitial lung disease (ILD) is a common manifestation of connective tissue disease (CTD). (a) Pulmonary rehabilitation (PR) can be utilised to improve dyspnoea and quality of life in patients with chronic lung conditions, including both obstructive and restrictive lung diseases. (b) This study aims to determine if PR can be a useful therapy to improve functional capacity and self-reported measures of dyspnoea in patients with CTD-ILD. Methods: Patients with a diagnosis of CTD-ILD at a tertiary centre were prospectively enrolled to receive PR in this study. The primary outcome was a change in the 6-minute walk test (6MWT) between baseline and 8 weeks after PR. The secondary outcome measures included pulmonary function tests (PFTs) and Patient-Reported Outcomes Measurement Information System (PROMIS→) Dyspnoea, St George’s Respiratory Questionnaire (SGRQ), and Leicester Cough Questionnaire (LCQ), which were collected before and at 8 weeks after PR. P < .05 was considered statistically significant. Results: Twenty-one patients were included in the data analysis. The baseline characteristics are shown in Table 1 . Following PR, there was a statistically significant improvement in the 6MWT ( Figure 1 ). Improvement in scores was observed in LCQ and the symptom domain of the SGRQ. Trends towards improvement were noted in PROMIS → Dyspnoea scores. Conclusion: In CTD-ILD patients, an 8-week course of PR led to improvements in functional capacity (6MWT) and certain quality of life domains (LCQ and symptom domain of SGRQ). Future studies are required to determine the longer-term benefit of PR in CTD-ILD patients and if these improvements are sustained.

Abstract Purpose: Intratumorally injected Clostridium novyi-NT (nontoxic; lacking the alpha toxin), an attenuated strain of C. novyi, replicates within hypoxic tumor regions resulting in tumor-confined cell lysis and inflammatory response in animals, which warrants clinical investigation. Patients and Methods: This first-in-human study (NCT01924689) enrolled patients with injectable, treatment-refractory solid tumors to receive a single intratumoral injection of C. novyi-NT across 6 dose cohorts (1 × 104 to 3 × 106 spores, 3+3 dose-escalation design) to determine dose-limiting toxicities (DLT), and the maximum tolerated dose. Results: Among 24 patients, a single intratumoral injection of C. novyi-NT led to bacterial spores germination and the resultant lysis of injected tumor masses in 10 patients (42%) across all doses. The cohort 5 dose (1 × 106 spores) was defined as the maximum tolerated dose; DLTs were grade 4 sepsis (n = 2) and grade 4 gas gangrene (n = 1), all occurring in three patients with injected tumors &gt;8 cm. Other treatment-related grade ≥3 toxicities included pathologic fracture (n = 1), limb abscess (n = 1), soft-tissue infection (n = 1), respiratory insufficiency (n = 1), and rash (n = 1), which occurred across four patients. Of 22 evaluable patients, nine (41%) had a decrease in size of the injected tumor and 19 (86%) had stable disease as the best overall response in injected and noninjected lesions combined. C. novyi-NT injection elicited a transient systemic cytokine response and enhanced systemic tumor-specific T-cell responses. Conclusions: Single intratumoral injection of C. novyi-NT is feasible. Toxicities can be significant but manageable. Signals of antitumor activity and the host immune response support additional studies of C. novyi-NT in humans.