Location of Cardiac Arrests in the Public Access Defibrillation Trial

Background. The Public Access Defibrillation (PAD) Trial found an overall doubling in the number of out-of-hospital cardiac arrest (CA) survivors when a lay responder team was equipped with an automated external defibrillator (AED), compared with cardiopulmonary resuscitation (CPR) alone. Objectives. To describe the types of facilities that participated in the trial andto report the incidence of CA andsurvival in these different types of facilities. Methods. In this post-hoc analysis of PAD Trial data, the physical characteristics of the participating facilities andthe numbers of presumed CAs, treatable CAs, andsurvivors are reported for each category of facilities. Results. There were 625 presumed CAs at 1,260 participating facilities. Just under half (n = 291) of the presumed CAs were classified as treatable CAs. Treatable CAs occurred at a rate of 2.9 per 1,000 person-years of exposure; rates were highest in fitness centers (5.1) andgolf courses (4.8) andlowest in office complexes (0.7) andhotels (0.7). Survival from treatable CA was highest in recreational complexes (0.5), public transportation sites (0.4), andfitness centers (0.4) andlowest in office complexes (0.1) andresidential facilities (0.0). Conclusions. During the PAD Trial, the exposure-adjusted rate of treatable CA was highest in fitness centers andgolf courses, but the incidence per facility was low to moderate. Survival from treatable cardiac arrest was highest in recreational complexes, public transportation facilities, andfitness centers.     

Prognostic Factors for Short-term Recovery of Independence in a Multistate Model for Patients With a Hip Fracture

ObjectivesThis study investigates the transitions of community-dwelling patients with a proximal femoral fracture towards recovery of independence using multistate modeling. The prognostic value of factors affecting the short-term rate of recovery of independence in activities of daily living was assessed for the resilient portion of the population.DesignAn inception cohort was recruited between 2016 and 2019.Setting and ParticipantsOnly community-dwelling older patients admitted with a proximal femoral fracture were included.MeasuresFollow-up was performed at 6 weeks and 3 months, when the patients' living situation and level of independence were recorded. Multistate modeling was used to study the transition rates of the population through prespecified states of the recovery process. Using this model, prognostic factors for the recovery of independence were identified for resilient patients (defined as those patients who managed to return home at any point in the follow-up after discharge).ResultsA total of 558 patients were included, and 218 (40.9%) recovered to prefracture levels of independence. Of the resilient patients, 20.7% were discharged home directly, and 79.3% via a rehabilitation home. In this patient group, a more favorable American Society of Anesthesiologists classification, better prefracture mobility, and the absence of a prefracture fear of falling were statistically significantly associated with a successful recovery. A low level of prefracture independence was inversely associated, meaning that patients with a low level of prefracture independence had a higher chance of successful recovery.Conclusions and ImplicationsThis study identified 4 factors with an independent prognostic value for the recovery of independence in resilient patients after a proximal femoral fracture. These factors could be used to construct clinical profiles that contribute to the assessment of the patient's post-acute care needs and recovery capacity. In addition, multistate modeling has been shown to be an effective and versatile tool in the study of recovery prognostics.     

局限性肺切除对比肺叶切除治疗Ⅰ期非小细胞肺癌的Meta分析

目的系统评价局限性肺切除(包括肺段切除和楔形切除)与肺叶切除治疗I期非小细胞肺癌后总生存期和复发率。方法计算机检索Pubmed和EMBASE数据库,纳入比较局限性肺切除与肺叶切除治疗I期非小细胞肺癌后总生存期和复发的随机临床研究和非随机研究。结果最终纳入25篇文献,病例数8 968。对于I期非小细胞肺癌,局限性肺切除较肺叶切除术后总生存期差(HR=1.34,95%CI 1.15-1.56,P=0.0002),总体复发率(OR=1.41,95%CI 1.05-1.89,P=0.02)和局部复发率(OR=2.64,95%CI 1.77-3.93,P<0.00001)高;肺段切除与肺叶切除术后总生存期(HR=1.25,95%CI 0.98-1.58,P=0.07)和总体复发率(OR=1.20,95%CI 0.74-1.94,P=0.46)比较差异无统计学意义,但具有更高的局部复发率(OR=2.08,95%CI 1.13-3.83,P=0.02)。对于Ia期≤2 cm的非小细胞肺癌,局限性肺切除与肺叶切除的术后总生存期(HR=1.07,95%CI 0.93-1.23,P=0.34)、总体复发率(OR=0.55,95%CI 0.09-3.43,P=0.52)和局部复发率(OR=2.28,95%CI 0.34-15.41,P=0.40)差异无统计学意义。结论对于I期非小细胞肺癌,肺段切除有较好的总生存期,但面临局部复发率高的风险;对于Ia期≤2 cm的非小细胞肺癌,局限性肺切除与肺叶切除总生存期和复发率相当。     

Cancer incidence,survival and mortality: Explaining the concepts

Cancer incidence, survival and mortality are essential population‐based indicators for public health and cancer control. Confusion and misunderstanding still surround the estimation and interpretation of these indicators. Recurring controversies over the use and misuse of population‐based cancer statistics in health policy suggests the need for further clarification. In our article, we describe the concepts that underlie the measures of incidence, survival and mortality, and illustrate the synergy between these measures of the cancer burden. We demonstrate the relationships between trends in incidence, survival and mortality, using real data for cancers of the lung and breast from England and Sweden. Finally, we discuss the importance of using all three measures in combination when interpreting overall progress in cancer control, and we offer some recommendations for their use.     

Metabolic Repair of Premutational Damage in Paramecium

The problems of experimental analysis of the post-irradiation processes leading to mutation are considered in some detail. In particular, methods for separating the effects of various modifiers on the rate of these processes from the effects on the time available for them to occur are discussed. Data are presented for recessive lethal mutations in Paramecium to show that all metabolic inhibitors tried (caffeine, iodoacetate, chloramphenicol and streptomycin) decrease the rate of loss of premutational damage and decrease mutation only because they increase the time available for loss. The results are shown to fit the hypothesis of metabolic repair of radiation-induced lesions of the chromosomes.     

Myocardial protection in reperfusion with postconditioning

Reperfusion is the definitive treatment for coronary occlusive disease. However, reperfusion carries the potential to exacerbate lethal injury, termed ‘reperfusion injury’. Studies have suggested that reperfusion injury events are triggered during the early moments of reflow, and determine, in part, the severity of downstream manifestations of postischemic injury, including endothelial dysfunction, infarction and apoptosis. The application of brief iterative episodes of reflow (reoxygenation) and reocclusion (ischemia, hypoxia) at the immediate onset of reperfusion, which has been termed ‘postconditioning’ by the authors, reduces many manifestations of postischemic injury, notably infarct size, apoptosis, coronary vascular endothelial injury and reperfusion arrhythmias. Cardioprotection with postconditioning has been reported to be comparable with that observed using the gold standard maneuver ischemic preconditioning. In contrast to preconditioning, which exerts its effects primarily during the index ischemia, postconditioning appears to exert its effects during reperfusion alone. Postconditioning modifies the early phase of reperfusion in ways that are just beginning to be understood. It appears to first: reduce the oxidant burden and consequent oxidant-induced injury; secondly, attenuate the local inflammatory response to reperfusion; and thirdly, engage end effectors and signaling pathways implicated in other cardioprotective maneuvers, such as ischemic and pharmacologic preconditioning. Postconditioning seems to trigger the upregulation of survival kinases principally known to attenuate the pathogenesis of apoptosis and possibly necrosis. The postconditioning phenomenon has been reproduced by a number of independent laboratories and has been observed in both large and small animal in vivo models, as well as in ex vivo and cell culture models. In contrast to preconditioning, postconditioning may have widespread clinical application because it can be applied during reperfusion at the point of service for angioplasty, stenting, cardiac surgery and organ transplantation.