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.     

我国老年人认知水平变化轨迹及其分化

目的 探究影响我国老年人认知水平的变化趋势，分离出年龄、队列效应。方法 基于CLHLS（2002—2018）多重队列追踪数据，以Stata16.0软件为工具，运用分层生长曲线模型进行统计分析。结果 本研究发现，个体行为生活方式、社会经济地位、性别、慢性病数量对认知水平均具有统计学意义；年龄、队列对认知水平的变化具有独立效应；随着年龄的增长，我国老年人认知水平下降，认知水平的城乡、性别差异明显；较年轻出生队列的老年人认知水平较好，认知水平的城乡差异随着队列的年轻化而变大，性别差异在较年轻队列有略微缩小的趋势。结论 影响认知水平因素复杂，认知障碍会增加医疗成本及照护负担，因此需准确把握老年认知水平的变化规律与作用路径，从而为卫生服务、养老保障、长期医疗照护的资源配置提供科学依据。     

2035年中国入围科技期刊“世界第一方阵”:基础、差距与推进思路

【目的】 在“中国科技期刊卓越行动计划”实施三周年之际,有必要对我国科技期刊2035年迈入“世界第一方阵”目标的具体任务进行重新审视和预判,以进一步明确发展方向,动态调整推进思路。【方法】 采用国内外科技期刊、科技论文、科技期刊评价成果的系统性发展数据对科技期刊“世界第一方阵” 国家(或地区)在高水平科技期刊数量与质量层面的入围标准进行界定,在深入总结现有基础和优势的同时,对我国科技期刊综合实力与“世界第一方阵”国家(或地区)的现实差距进行逐一梳理和剖析,并对实现目标的可行性和推进思路进行研判和设计。【结果】 必须继续加强高水平英文科技期刊创办和培育力度、持续加大优秀中文科技期刊的建设强度、快速推进国内外科技期刊论文等质同效评价制度的建设与引导,并积极探索建立科学家和科研机构办好一流科技期刊的责任制度和贡献激励机制、创新发展编辑人才队伍培养与激励管理思路、深入实践灵活多样的期刊出版市场资本运作模式、稳步推进期刊出版市场机制和管理制度改革,为我国科技期刊事业的高质量发展提速增效。【结论】 虽然当前阶段目标任务艰巨,但迈入“世界第一方阵”未来可期。     

微创治疗方法在输尿管上段结石中应用进展

输尿管上段结石为临床中常见泌尿系结石类型之一,如不能及时诊治,可引起重度积水、泌尿系感染,甚至脓毒血症,对患者肾功能、健康造成严重影响。随着微创治疗技术在泌尿系结石中应用,微创治疗方法能降低对患者造成治疗性创伤,降低相关并发症发生率,促进患者康复,了解临床中微创治疗输尿管上段结石方法,对临床中合理治疗输尿管上段结石有重要价值。     

Elección informada en el cribado del cáncer de mama: el papel del nivel educativo

ObjectiveTo evaluate the effect of receiving information about the benefits and harms of breast cancer screening in informed choice, according to educational level.MethodSecondary analysis of a randomized, controlled study, in four screening programs, in Catalonia and the Canary Islands (Spain). We analyzed 400 women who were going to be invited to participate for the first time. The intervention group received a decision aid that showed the benefits and harms of screening. The control group received a standard brochure that recommended participating in the screening program. Educational level was grouped into two categories, low and high. The primary outcome was informed choice defined as adequate knowledge and consistency between attitudes and intentions.ResultsThe intervention produced a greater increase in knowledge in women with a high educational level compared to those with a lower educational level. Among women who received the intervention, informed choice was almost three times higher in those with a high educational level (27% versus 11%). No differences were observed between educational levels in decisional conflict, confidence in the decision, anxiety and worry about breast cancer, in the intervention and control groups.ConclusionsA decision aid for breast cancer screening had much more impact on informed choice among women with a high educational level. In women with low educational level, the attitude towards screening improved and there was an increase in the intention to be screened.     

Stature estimation for Saudi men based on different combinations of upper limb part dimensions

Estimating stature based on body/limb parts can help define the characteristics of unidentified bodies. The most studied upper limb part is the hand, although few studies have examined whether stature can be estimated using fingers plus other hand dimensions. Moreover, there is paucity in anthropometric studies that determined whether bilateral whole limb parts (e.g., arms, forearms, and hands) are related to stature among the living subjects.This prospective cross-sectional study aimed to evaluate the relationship between different upper limb measurements and the stature of Saudi men. Furthermore, I assessed whether upper limb asymmetry was present, and developed regression models to estimate stature based on different available measurements. Stature and 13 upper limb parameters were measured for 100 right-handed Saudi men who were 18 to 24 years old.All measurements were positively correlated with stature (P < .001), and the best single predictor was the bilateral ulnar length. Asymmetry was more pronounced in the hand measurements. A multiparameter model provided reasonable predictive accuracy (±3.77–5.68 cm) and was more accurate than single-parameter models. Inclusion of the right-side fingers improved the model''s accuracy.This study developed potential models for estimating stature during the identification of bodies of Saudi men.     

Is low or high body mass index in patients operated for oral squamous cell carcinoma associated with the perioperative complication rate?

The aim of this study was to analyse the effect of body mass index (BMI), both low and high values, on the perioperative complication rate in patients with oral squamous cell carcinoma (OSCC). The medical records of 259 patients operated between 2014 and 2017 for OSCC were reviewed. Univariate and multivariate analyses were performed. Sixty of the 259 patients developed 87 complications. Low or high BMI was not associated with the perioperative complication rate. A longer operating time and increased blood loss were associated with a higher perioperative complication rate and higher Clavien–Dindo grade. Low BMI, American Society of Anesthesiologists score 2 and 3, a longer operating time, and increased blood loss were associated with a longer hospital stay. Low BMI was associated with a longer hospital stay. Neither low nor high BMI was associated with the perioperative complication rate. A longer operating time and increased blood loss were associated with a higher perioperative complication rate and higher Clavien–Dindo grade.     

Efficacy of recombinant Marek’s disease virus vectored vaccines with computationally optimized broadly reactive antigen (COBRA) hemagglutinin insert against genetically diverse H5 high pathogenicity avian influenza viruses

The genetic and antigenic drift associated with the high pathogenicity avian influenza (HPAI) viruses of Goose/Guangdong (Gs/GD) lineage and the emergence of vaccine-resistant field viruses underscores the need for a broadly protective H5 influenza A vaccine. Here, we tested experimental vector herpesvirus of turkey (vHVT)-H5 vaccines containing either wild-type clade 2.3.4.4A-derived H5 inserts or computationally optimized broadly reactive antigen (COBRA) inserts with challenge by homologous and genetically divergent H5 HPAI Gs/GD lineage viruses in chickens. Direct assessment of protection was confirmed for all the tested constructs, which provided clinical protection against the homologous and heterologous H5 HPAI Gs/GD challenge viruses and significantly decreased oropharyngeal shedding titers compared to the sham vaccine. The cross reactivity was assessed by hemagglutinin inhibition (HI) and focus reduction assay against a panel of phylogenetically and antigenically diverse H5 strains. The COBRA-derived H5 inserts elicited antibody responses against antigenically diverse strains, while the wild-type-derived H5 vaccines elicited protection mostly against close antigenically related clades 2.3.4.4A and 2.3.4.4D viruses. In conclusion, the HVT vector, a widely used replicating vaccine platform in poultry, with H5 insert provides clinical protection and significant reduction of viral shedding against homologous and heterologous challenge. In addition, the COBRA-derived inserts have the potential to be used against antigenically distinct co-circulating viruses and future drift variants.