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  1. The Triumvirate

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Many of the Thorax readership will have been in short trousers when the Rocky Horror Picture Show first hit the screens in 1975. Although panned by the critics on its release, the film has gathered a cult following—with cinema goers dressing as characters from the film and extensive audience participation. The film is still shown in cinemas, making it the longest-running theatrical release in film history (though no match for Thorax which is 75 this year). This month we bring you a “Rocky Horror Airwaves”. As you read it, feel free to dress in character…

“I’ve been making a man…”

The preposterous plot of the Rocky Horror Show involves Dr Frank-N-Furter who has been creating “Rocky” (a muscular creature) in his lab. The muscle bulk of current and former smokers is the subject of a paper by Mason and colleagues in this month’s journal (see page 554). The authors measured pectoralis muscle bulk (on CT) in almost 6000 current and former smokers and found that acute exacerbations of COPD are associated with accelerated skeletal muscle loss. Pulmonary rehabilitation appears to protect individuals from excess muscle decline. There is no rehabilitation option for Rocky at the end of the movie. He climbs to the top of the RKO tower and plunges to his death!

Time warp

The most infectiously danceable number form the Rocky Horror Show is of course “the Time Warp”. (“It’s just a jump to the left, And then a step to the right…”) Shift workers might well feel they have entered a time warp when they wake in a groggy haze and prepare for a night’s work. In this issue of Thorax, Blaikley and colleagues (see page 601) show that shift work is not only associated with respiratory disease, diabetes and cancer but also with COVID-19. Occupational data from half a million people in the UK Biobank were linked to COVID-19 PCR results from secondary care. Using multivariate logistic regression, the authors show that night shift work is associated with a 2–3 fold increase in the risk of COVID-19 infection. When the authors compared shift workers and non-shift workers, who shared the same type of job, shift workers had a higher rate of COVID-19. Let’s not do the time warp again…

Dammit Janet

There are a number of decisions we regret in life, like agreeing to write Airwaves to a Rocky Horror theme, however the decisional regret felt by Brad and Dammit Janet having approached the castle was now doubt considerably worse. It will come as no surprise to readers of Thorax that decisional regret can be measured. In this issue of Thorax the Decisional Regret Scale and the Feelings About genomiC Testing Results Questionnaire were used to assess the impact of screening and genetic testing on undiagnosed first-degree relatives of patients with pulmonary fibrosis (see page 621). Findings were generally supportive with most patients reporting no, or mild decisional regret even in the presence of short telomeres. However, the finding of some impaired lung function or ILAs did increase decisional regret slightly. Therefore, counselling before screening is likely to be beneficial but with regards to screening itself, please don’t tell them to can it, Janet.

The Sword of Damocles

“The Sword of Damocles is hanging over my head, And I've got the feeling someone’s gonna be cutting the thread”, may be feeling that is familiar to many people with pulmonary fibrosis. So, what should be done about it Dionysius? In this issue of Thorax, Tikellis and colleagues (see page 575) describe their results of a priority setting exercise for patients with pulmonary fibrosis. 196 patients gave 560 questions and 14 research themes. The number one research priority was to reverse established fibrosis followed by improving lung function and alleviating symptoms. Hopefully, with the research priorities identified researchers can swap the scarring in the lung with the hair that holds the Sword of Damocles and make everybody breathe a little easier.

Don’t judge a book by its cover

When Brad and Janet first met Dr Frank-N-Furter at the Annual Transylvanian Convention he requested they ‘don’t judge a book by its cover’ explaining ‘he had the secret to life itself’. Survival and survivorship is key to those patients who have experienced critical illness and Van Aerde and colleagues (see page 561) investigated the 5 year outcome of ICU survivors. This was the secondary analysis of the EPaNIC cohort study. The investigators found that respiratory muscle weakness was observed in 37% patients at ICU discharge and but this was not associated with 5 year mortality. However, those survivors with respiratory muscle weakness demonstrated worse physical function and morbidity. We should not judge a book by its cover with regard ICU outcomes as respiratory muscle weakness at ICU discharge was only associated with 5 year morbidity but not mortality. We will need to ask Dr Frank-N-Furter about the ‘secret of life itself’.

In just seven days, I can make you man

It is fairly obvious that Dr Frank-N-Furter worked as part of a multidisciplinary team with the support of physiotherapists and occupational therapist. Indeed, with clear goal setting over week, the MDT were focused on making ‘a strong man’ by doing ‘press ups and chin ups’ ‘to build up his shoulders, his chest, arms, and legs’. Dr Frank-N-Furter did not register his trial and he does not provide the details on whether this was supervised or unsupervised exercise. Taylor and colleagues (see page 591) focused on the efficacy of unsupervised exercise in adults with COPD. This systematic review and meta-analysis reports the clinical benefits of unsupervised exercise interventions on health-related quality of life in patients with COPD and suggests high-quality randomised trials are needed. We can only hope that Dr Frank-N-Furter registers his trials going forward or he will struggle to get his work published.

“Why don’t you come up to the lab and see what’s on the slab?”

We are not told whether Frank-N-Furter used silver nitrate in the lab when creating “Rocky”. However, the hazards of silver nitrate in the airway are shown here and on page 632 of this month’s Thorax.

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