Background: Capecitabine and oxaliplatin (CAPOX) and infusional 5-fluouracil, folinic acid, and oxaliplatin (FOLFOX) are the two chemotherapy regimens in current clinical use for the adjuvant treatment of colorectal cancer (CRC). Many centers in Newfoundland lack the resources to support the home infusion program required for FOLFOX, leaving CAPOX as the sole treatment option. This study aimed to review if Newfoundland patients receiving CAPOX experience greater treatment-induced toxicities. Methods: A multicenter retrospective cohort study of 93 Stage III CRC patients. The frequency and severity of toxicities, healthcare resource utilization, and treatment completion rates were compared between the two treatment options. Results: Grade 3 diarrhea and grade 1 or 2 nausea/vomiting were more common in CAPOX compared to FOLFOX-treated patients (26.9% versus 2.99%, p = 0.002; 61.5% versus 31.8%; p = 0.048, respectively). Grade 1 or 2 mucositis was more common with FOLFOX (35.8% versus 3.9%, p = 0.002). CAPOX was associated with higher rates of severe toxicity (53.9% versus 25.4%, p = 0.009), while rates of grade 1 and 2 toxicities were not significantly different between groups. CAPOX-treated patients were greater than twice as likely to require emergency department treatment secondary to toxicity (mean 0.692 visits per patient versus 0.313 in FOLFOX patients, p < 0.001) and the proportion of patients that were hospitalized secondary to CAPOX toxicity was greater. Significantly more FOLFOX patients were able to finish their prescribed treatment plans compared to CAPOX patients (89.5% versus 53.8%; p < 0.001). Conclusions: Compared to FOLFOX-treated patients, CAPOX patients are more likely to experience toxicities of greater severity, require emergency services secondary to treatment-related toxicity, and to discontinue therapy. This reflects a reduced standard of care that may decrease patient safety and quality of life.

Prior to transcutaneous aortic valve replacement (TAVR), a CT is performed (TAVR-CT). With modification, the CT exam can measure myocardial extracellular volume (ECV). A small increase in ECV occurs in severe aortic stenosis. A large increase in ECV occurs when transthyretin cardiac amyloidosis (ATTR-CA) co-exists. We sought to determine the prognostic potential of ECV in severe aortic stenosis and test the utility of threshold ECV to instigate screening for ATTR-CA. This was a prospective observation study of consecutive severe AS patients undergoing CT -TAVR. A delayed cardiac acquisition was acquired 5 min post TAVR-CT. Pre-contrast and delayed -images were used to determine ECV. When ECV ≥ 31 % ^99mTc-pyrophosphate (PYP) imaging was performed. The primary end point was all cause mortality. During the study, 161 patients underwent aortic valve replacement and were included in the analysis. Mean age was 81.6 (±6.2) years. During median follow up of 29 (21–36) months, 24 deaths occurred. In 30 patients ECV ≥ 31 %, 2 had positive ^99mTc-PYP imaging for ATTR-CA. On Cox regression analysis increased ECV associated with increased risk of all cause mortality (HR 2.54 (95 % CI 1.09–5.93) and was incremental to age, LV function and renal impairment (p = 0.03). In severe AS, elevated ECV was a risk for all cause mortality, but this was not related to co-existent ATTR-CA. Threshold-ECV testing for ATTR-CA demonstrated a low yield. Threshold testing may therefore not be warranted in all severe AS patients with an ECV ≥ 31 %.

Purpose. The link between moderate‐ to vigorous‐intensity physical activity (MVPA) and cardiorespiratory fitness in individuals with multiple sclerosis (MS) remains unclear. This study examined the relationship between self‐reported MVPA and objectively assessed cardiorespiratory fitness, emphasizing sex differences. Methods. 107 adults with MS (77 females), aged (mean ± standard deviation) 47.2 ± 10.2 years, were recruited from a local MS clinic. Fitness was measured as maximal oxygen uptake (V̇O_2max) during a graded maximal exercise test using a recumbent stepper. MVPA (24‐hour recall) was estimated as the duration of activities ≥ 3 MET (metabolic equivalent of task). MET‐minutes were calculated by multiplying MET by duration. We explored sex differences in self‐reported MVPA, cardiorespiratory fitness, and disability; examined sex differences in associations between these variables; and investigated whether MET‐minutes of MVPA predicted V̇O_2max in females and males. Results. Mean V̇O_2max was 24.79 mL·kg^-1·min^-1, indicating poor cardiorespiratory fitness levels, despite high levels of self‐reported MVPA (mean = 412.5 MET‐minutes). Fifty‐three percent of males and 40% of females had V̇O_2max levels below the 20^th age‐ and sex‐standardized population percentile, indicating poor cardiorespiratory fitness. There were statistically significant associations between MVPA and V̇O_2max (Rho = 0.27, p = .01), as well as disability and V̇O_2max (Rho = −0.35, p = .02), in females but not males. A regression model using sex, age, body mass, disability, and MVPA to estimate V̇O_2max was valid in predicting V̇O_2max values that were statistically equivalent to those measured in the laboratory in females but not males. However, the inclusion of MVPA did not add to the predictive value of this equation. Conclusions. Despite reporting high levels of MVPA, people with MS had poor cardiorespiratory fitness. MVPA, fitness, and disability were associated in females only, indicating that sex differences should be considered in fitness appraisal. Self‐reported MVPA did not predict fitness, suggesting 24‐hour recall may not be representative of true activity or fitness levels in persons with MS. Future work should examine sex differences in associations between MVPA and fitness using objective measures such as accelerometry.