The American Association for Thoracic Surgery (AATS) 2022 Expert Consensus Document: The use of mechanical circulatory support in lung transplantation

ObjectiveThe use of mechanical circulatory support (MCS) in lung transplantation has been steadily increasing over the prior decade, with evolving strategies for incorporating support in the preoperative, intraoperative, and postoperative settings. There is significant practice variability in the use of these techniques, however, and relatively limited data to help establish institutional protocols. The objective of the AATS Clinical Practice Standards Committee (CPSC) expert panel was to review the existing literature and establish recommendations about the use of MCS before, during, and after lung transplantation.MethodsThe AATS CPSC assembled an expert panel of 16 lung transplantation physicians who developed a consensus document of recommendations. The panel was broken into subgroups focused on preoperative, intraoperative, and postoperative support, and each subgroup performed a focused literature review. These subgroups formulated recommendation statements for each subtopic, which were evaluated by the entire group. The statements were then developed via discussion among the panel and refined until consensus was achieved on each statement.ResultsThe expert panel achieved consensus on 36 recommendations for how and when to use MCS in lung transplantation. These recommendations included the use of veno-venous extracorporeal membrane oxygenation (ECMO) as a bridging strategy in the preoperative setting, a preference for central veno-arterial ECMO over traditional cardiopulmonary bypass during the transplantation procedure, and the benefit of supporting selected patients with MCS postoperatively.ConclusionsAchieving optimal results in lung transplantation requires the use of a wide range of strategies. MCS provides an important mechanism for helping these critically ill patients through the peritransplantation period. Despite the complex nature of the decision making process in the treatment of these patients, the expert panel was able to achieve consensus on 36 recommendations. These recommendations should provide guidance for professionals involved in the care of end-stage lung disease patients considered for transplantation.     

会所康复模式在女性精神分裂症恢复期病人中的应用

目的:探讨会所康复模式在女性精神分裂症恢复期病人中的应用效果。方法:选取2019年2月—2020年3月精神科收治的100例女性精神分裂恢复期病人作为研究对象,按随机数字表法分为对照组、观察组各50例,对照组采取常规康复治疗,观察组在常规康复治疗基础上应用会所多维度康复治疗模式。采用阳性和阴性症状量表(PANSS)、疾病家庭负担量表(FBS)、日常生活能力量表(ADL)、生活满意度指数B量表(LSIB)评价两组病人干预前、干预3个月、干预6个月精神症状、家庭负担、日常生活能力、生活自理能力。结果:两组病人干预3个月、干预6个月PANSS、FBS、ADL及LSIB评分比较差异有统计学意义(P<0.05);两组组内干预前后PANSS、FBS、ADL及LSIB评分比较差异有统计学意义(P<0.05)。结论:女性精神分裂症病人在恢复阶段应用会所康复模式进行干预可改善其精神症状,缓解其家庭负担,调节其日常生活能力和生活自理能力,提升其生活满意度。     

Effectiveness of anabolic steroids in improving outcomes for post-operative hip fracture patients: A randomized controlled trial

BackgroundPost-operative elderly hip fracture patients require significant rehabilitation. Nandrolone is an anabolic steroid used to promote muscle growth. This study aims to examine the effect of nandrolone in improving rehabilitation and quality of life in elderly female patients with hip fractures undergoing hemiarthroplasty.MethodsThis is a double-blinded prospective randomized-controlled-trial consisting of female patients above the age of 65 with an isolated neck of femur fracture planned for a hip hemiarthroplasty. Participants were randomized into two arms of the study – 50 mg intramuscular nandrolone vs normal saline placebo administered on post-operative day 0, and weeks 2, 6 and 12. The participants were followed up across a 1-year period following the surgery. Clinical outcomes such as time taken to achieve rehabilitation milestones, distance of ambulation and thigh muscle girth, and functional scoring with SF-36 questionnaire were recorded at intervals of 2, 6 and 12 weeks, 6 months and 1 year following the surgery.ResultsThere were a total of 23 subjects with 11 in the steroid group and 12 in the placebo group. There was no significant difference in demographics and injury patterns between both groups. There was no significant difference for time taken to achieve various rehabilitation milestones and distance of ambulation. SF-36 scores on discharge and at 1-year follow-up mark were comparable. There was no difference in the complication rate between both groups.ConclusionIntra-muscular Nandrolone after hip surgery in elderly female patients does not result in short to mid-term improved rehabilitation or functional outcomes. Nandrolone did not result in increased short-term complications after hip surgery.Level of evidenceI.     

不同机种军事飞行员运动心肺功能研究

目的了解不同机种军事飞行员运动心肺功能有无差异。方法飞行员分为高性能战斗机和普通战斗机两组,采用意大利COSMED运动心肺功能测试仪,选择自行车功率计运动方式,以25 W/min功率递增速率极量运动方案,进行运动心肺功能测试,比较两组运动心肺功能数据的主要指标。结果两组飞行员各207例完成运动心肺功能测试,两组的年龄、身高、体质量和体质量指数差异均无统计学意义(P均>0.05)。两组数据的主要指标中,除了峰值氧脉搏[高性能战斗机组(15.36±2.43)mL/bpm,普通战斗机组(14.95±2.13)mL/bpm]差异有统计学意义(P=0.038),其他差异均无统计学意义,而且各指标差异幅度均较小,高性能战斗机飞行员组的峰值氧脉搏高于普通战斗机组2.74%。结论综合比较,高性能战斗机和普通战斗机飞行员的运动心肺功能无明显差异,提示两组飞行员日常有氧运动训练效果一致,在转换飞行机种时,可以不受运动心肺功能的限制。     

前列腺癌根治术患者采用围术期康复干预对尿失禁的预防效果

目的分析前列腺癌根治术患者采用围术期康复干预对尿失禁的预防效果。方法 42例行前列腺癌根治术的患者,随机分为研究组与对照组,每组21例。对照组患者给予常规干预,研究组患者采取围术期康复干预。对比两组患者的尿失禁发生率,下尿路症状改善情况,生活质量。结果研究组患者的尿失禁发病率14.29%明显低于对照组的47.62%,差异具有统计学意义(P<0.05)。干预后,两组患者的下尿路症状评估量表(LUTS)评分均低于本组干预前,且研究组患者的LUTS评分(10.25±2.02)分明显低于对照组的(15.63±2.59)分,差异具有统计学意义(P<0.05)。研究组患者的生理功能、情感职能、社会功能、总体健康评分分别为(75.14±4.28)、(76.67±4.31)、(74.98±4.25)、(75.87±4.26)分,均高于对照组的67.21±4.35)、(68.22±4.39)、(66.58±4.37)、(68.01±4.36)分,差异具有统计学意义(P<0.05)。结论前列腺癌根治术患者采用围术期康复干预可以有效降低术后并发症发生率,改善患者临床症状,提高患者生活质量,效果显著,值得在临床上进一步推广应用。     

弹性抗阻运动对慢性阻塞性肺疾病康复疗效的Meta分析

目的 系统评价弹性抗阻运动(弹力带/弹力管)对慢性阻塞性肺疾病(COPD)患者康复疗效的影响。方法 检索Cochrane Library、PubMed、Web of Science、中国知网、维普、万方和生物医学文献数据库中关于弹性抗阻运动治疗COPD患者的临床随机对照试验,检索时限自建库至2020年9月。最后纳入文献11篇,其中英文9篇,中文2篇,共485例患者。采用Cochrane风险偏倚评估工具及物理治疗证据数据库量表进行质量评价,采用RevMan 5.2软件进行分析。这一系统评价在PROSPERO(CRD42020208659)上登记。结果 弹性抗阻运动组与传统抗阻运动组(如举重训练机、体重训练) 6 min步行试验距离(6WMD) (MD = 1.19, 95%CI -7.02~9.39, P = 0.78)、COPD患者自我评估测试(CAT) (MD = -0.43, 95%CI -2.42~1.57, P = 0.68)和肌力(MD = 0.23, 95%CI -1.06~1.52, P = 0.73)无显著性差异,两组间异质性不高。弹性抗阻运动组与非抗阻运动组6MWD (MD = 18.30, 95%CI -8.92~45.52, P = 0.19)和CAT (MD = -0.59, 95%CI -3.78~2.60, P = 0.72)无显著性差异,研究间异质性较高。结论 弹性抗阻运动也许是一种潜在的替代传统抗阻训练的方法,但弹性抗阻运动对运动耐力、生活质量、肺功能的影响尚不明确。