Treatment of patients with metastatic colorectal cancer and poor performance status: current evidence and challenges

Patients with unresectable metastatic colorectal cancer live for a median of three years when treated with standard therapies. While the evidence guiding cancer-directed treatment of this disease comes from phase III trials that have mostly enrolled patients with good performance status, some patients present with poor clinical conditions. The best treatment for these patients remains to be determined. We performed a systematic review of the treatment outcomes of patients with metastatic colorectal cancer and poor performance status, defined as Eastern Cooperative Oncology Group performance status X2. Eligible articles were prospective or retrospective studies or case reports published in English, Portuguese or Spanish. We searched PubMed, EMBASE, LILACS and the Cochrane Library from onset until October 2017 using specific keywords for each search. We found a total of 18 publications, mostly case reports and retrospective studies (14 articles). One was an uncontrolled prospective trial, two were observational studies and one was an individual patient meta-analysis. Although some studies suggested benefits in terms of symptomatic response with standard chemotherapy, with good safety profiles when dose-reduced regimens were administered, a true survival gain could not be demonstrated. The scientific evidence for treating metastatic colorectal cancer patients with poor performance status is scarce, and more studies evaluating treatment for this population are necessary since this condition is not uncommon in clinical practice, particularly in the public healthcare system and developing countries and among destitute populations

Bioelectrical impedance analysis of body composition for the anesthetic induction dose of propofol in older patients

BACKGROUND: Older people are currently the fastest growing segment of the worldwide population. The present study aimed to estimate propofol dose in older patients based on size descriptors measured by bioelectrical impedance analysis (BIA). METHODS: A cross sectional study in adult and older patients with body mass index equal to or lower than 35 kg/m2 was carried out. BIA and Clinical Frail Scale scoring were performed during pre-operative evaluation. Propofol infusion was started at 2000 mg/h until loss of consciousness (LOC) which was defined by "loss of eye-lash reflex" and "loss of response to name calling". Total dose of propofol at LOC was recorded. Propofol plasma concentration was measured using gas chromatography/ion trap-mass spectrometry. RESULTS: Forty patients were enrolled in the study. Total propofol dose required to LOC was lower in Age ≥ 65 group and a higher plasma propofol concentration was measured in this group. 60% of old patients were classified as "apparently vulnerable" or "frail" and narrow phase angle values were associated with increasing vulnerability scores. In the Age ≥ 65 group, the correlation analysis showed that the relationship between propofol dose and total body weight (TBW) scaled by the corresponding phase angle value is stronger than the correlation between propofol dose and TBW or fat free mass (FFM). CONCLUSIONS: This study demonstrates that weight-based reduction of propofol is suitable in older patients; however FFM was not seen to be more effective than TBW to predict the propofol induction dose in these patients. Guiding propofol induction dose according to baseline frailty score should also be considered to estimate individualized dosage profiles. Determination of phase angle value appears to be an easy and reliable tool to assess frailty in older patients.Financial support from the “Fundo para a Investigação e Desenvolvimento do Centro Hospitalar do Porto” is gratefully acknowledge. The medical technology and services company Medtronic™ provided BIS brain monitoring sensors. Fresenius Medical Care Portugal™ made available BCM monitor during the study period. None of the funding sources participated in the design of the study, collection, analysis and interpretation of data, or in writing of the manuscript.info:eu-repo/semantics/publishedVersio

Evapotranspiração de um pomar de mangueiras irrigadas na região do Submédio São Franscisco.

O presente trabalho objetivou determinar aevapotranspiração durante o ciclo produtivo da mangueira,variedade ?Tommy Atknis`, cultivada nas condições declima e solo da região do Submédio São Francisco

Evapotranspiração da videira festival sob diferentes intermitências de irrigação.

Dados de experimentos conduzidos no Campo Experimental de Bebedouro, pertencente à Empresa Brasileira de Pesquisa Agropecuária foram usados na determinação da evapotranspiração da cultura da videira, variedade Festival sem semente, sob diferentes intermitências de irrigação por gotejamento, pelo método do balanço hídrico no solo, para ciclos de produção nas estações: seca e chuvosa. O ciclo de produção foi dividido em oito estádios fenológicos distintos, como segue: período de brotação (PB); desenvolvimento vegetativo (DV); pré e plena floração (PFF); primeira fase de crescimento do fruto (1 a FCF); parada de crescimento do fruto (PCF); segunda fase de crescimento do fruto (2 a FCF); maturação final do fruto (MFF); e repouso fisiológico (RF). Os resultados indicaram que a evapotranspiração (ETc) para o ciclo de produção da videira Festival sem sementes varia de 432 a 510 mm a medida que a intermitência de irrigação de I-I a I-4 durante a estação seca e de 243 a 382 mm durante a estação chuvosa. Evidenciaram também que o aumento do número de intermitências de irrigação conduz a uma redução significativa das perdas de água por percolação profunda, ou seja, reduções médias em relação à testemunha da ordem de 20,46, 46,26 e de 79,80%, para as intermitências II, III e IV, respectivamente

Balanço de energia em parreirais cultivados na região do Submédio do Rio São Francisco.

O objetivo principal deste estudo compreendeu a determinação do balanço de energia num parreiral consorciado com culturas destinadas à adubação orgânica

Monitoramento das helmintoses gastrintestinais em rebanho leiteiro criado em sistema de produção orgânica na Fazendinha Agroecológica.

O objetivo oi utilizar técnicas parasitológicas para monitorar o grau de parasitismo como subsídio para a criação de programas de controle das infecções por nematóides gastrintestinais em vacas leiteiras criadas em sistema orgânico na Fazendinha Agroecológica, convênio Embrapa/ Universidade Federal Rural do Rio de Janeiro (UFRuralRJ)/ Pesagro-Rio.bitstream/item/39144/1/DOC261-09.pd