Comparison of the effect of oxygen supplementation using flow-by or a face mask on the partial pressure of arterial oxygen in sedated dogs

AIMS To compare the effect of oxygen supplementation using flow-by or a face mask on the partial pressure of arterial oxygen (PaO₂) in sedated dogs. METHODS Twenty healthy dogs weighing >15 kg, of mixed sex and breed, were enrolled in a randomised cross-over study. Each dog was sedated with I/M 0.015 mg/kg medetomidine and 0.5 mg/kg methadone. Twenty minutes later dogs were exposed to two 5-minute treatment periods of oxygen supplementation separated by a 15-minute washout period during which dogs were allowed to breathe room air. During the treatment periods, oxygen was delivered at a flow rate of 3 L/minute either through a face mask (face mask oxygenation), or via a tube held 2 cm from the dog's nares (flow-by oxygenation). The order in which the treatments were administered was randomised. Arterial blood was collected for blood gas analysis and rectal temperature measured at four times: prior to commencing treatments, after each treatment, and at the end of the 15 minutes washout period between treatments. RESULTS The mean PaO₂ in arterial samples taken from the dogs after face mask oxygen supplementation was 371.3 (SE 13.74) mmHg which was higher than in samples taken after they received flow-by oxygen supplementation (182.2 (SE 6.741) mmHg; p<0.001). The mean PaO₂ in samples taken after receiving either form of oxygen supplementation was higher than in samples taken after the dogs had been breathing room air (82.43 (SE 2.143) mmHg; p<0.001). There was no association between sex, age, weight or breed of dogs and blood gas parameters or rectal temperature (p>0.05). CONCLUSIONS Oxygen supplementation delivered using a face mask was more effective at increasing PaO₂ than flow-by oxygen supplementation. Flow-by oxygen supplementation at a distance of 2 cm from the nose may be a suitable alternative when the use of a face mask is not tolerated by the patient.

Vistusertib (dual m-TORC1/2 inhibitor) in combination with paclitaxel in patients with high-grade serous ovarian and squamous non-small-cell lung cancer

Background

We have previously shown that raised p-S6K levels correlate with resistance to chemotherapy in ovarian cancer. We hypothesised that inhibiting p-S6K signalling with the dual m-TORC1/2 inhibitor in patients receiving weekly paclitaxel could improve outcomes in such patients.

Patients and methods

In dose escalation, weekly paclitaxel (80 mg/m2) was given 6/7 weeks in combination with two intermittent schedules of vistusertib (dosing starting on the day of paclitaxel): schedule A, vistusertib dosed bd for 3 consecutive days per week (3/7 days) and schedule B, vistusertib dosed bd for 2 consecutive days per week (2/7 days). After establishing a recommended phase II dose (RP2D), expansion cohorts in high-grade serous ovarian cancer (HGSOC) and squamous non-small-cell lung cancer (sqNSCLC) were explored in 25 and 40 patients, respectively.

Results

The dose-escalation arms comprised 22 patients with advanced solid tumours. The dose-limiting toxicities were fatigue and mucositis in schedule A and rash in schedule B. On the basis of toxicity and pharmacokinetic (PK) and pharmacodynamic (PD) evaluations, the RP2D was established as 80 mg/m2 paclitaxel with 50 mg vistusertib bd 3/7 days for 6/7 weeks. In the HGSOC expansion, RECIST and GCIG CA125 response rates were 13/25 (52%) and 16/25 (64%), respectively, with median progression-free survival (mPFS) of 5.8 months (95% CI: 3.28-18.54). The RP2D was not well tolerated in the SqNSCLC expansion, but toxicities were manageable after the daily vistusertib dose was reduced to 25 mg bd for the following 23 patients. The RECIST response rate in this group was 8/23 (35%), and the mPFS was 5.8 months (95% CI: 2.76-21.25).

Discussion

In this phase I trial, we report a highly active and well-tolerated combination of vistusertib, administered as an intermittent schedule with weekly paclitaxel, in patients with HGSOC and SqNSCLC.

Clinical trial registration

ClinicialTrials.gov identifier: CNCT02193633.

Proton Beam Therapy - the Challenges of Delivering High-quality Evidence of Clinical Benefit

The use of proton beam therapy (PBT) offers the opportunity to improve greater conformality of radiotherapy treatment delivery in some patients. However, it is associated with a high capital cost and the need to build new dedicated facilities. We discuss how the global radiotherapy community can respond to the challenge of producing high-quality evidence of clinical benefit from PBT in adult patients. In the UK, the National Cancer Research Institute-funded Clinical and Radiotherapy Translational group has established the PBT Clinical Trial Strategy Group. An eight-point framework is described that can assist the development and delivery of high-quality clinical trials.

Effect of insemination site and diameter of the pre-ovulatory follicle on the odds of pregnancy in heifers using sexed or non-sexed semen

OBJECTIVE

To determine if insemination site or pre-ovulatory follicle diameter at fixed-time artificial insemination (FTAI) affects the odds of pregnancy when heifers are inseminated with sexed semen.

METHODS

The study was conducted in 422 Holstein heifers enrolled into 531 inseminations. Inseminations were randomly allocated to 1 of 16 treatment combinations involving three variables: semen type (sexed vs non-sexed), insemination site (uterine horn vs uterine body) and one of four sires. Ovaries were examined by transrectal ultrasound prior to FTAI to determine the follicle diameter and location. AI technician, times bred, age, weight and temperature-humidity index were also recorded. Pregnancy diagnosis was conducted 29 days post-insemination. Follicle diameter and body weight were categorised according to arbitrary cut-points. Each variable was analysed by logistic regression to determine the effect on pregnancy per AI and compare between sexed and non-sexed inseminations.

RESULTS

Insemination site did not affect pregnancy per AI for either sexed (P = 0.528) or non-sexed (P = 0.886) inseminations. Heifers with an 18-22 mm follicle had better odds of pregnancy than heifers that did not (odds ratio (OR) 1.45, 95% confidence interval (CI) 1.004-2.09), although no effect was detected for only sexed or only non-sexed inseminations. Heifers weighing 310-370 kg had a higher pregnancy per AI than heifers weighing > 370 kg for non-sexed inseminations (P = 0.004) and sexed semen from sire 4 caused lower odds of pregnancy than semen from sire 1 (OR 0.40, 95% CI 0.18-0.89).

CONCLUSION

Insemination site did not affect pregnancy per AI, but heifers with an 18-22 mm pre-ovulatory follicle at insemination had better odds of pregnancy for both sexed and non-sexed inseminations.