Improvements in Extracorporeal Membrane Oxygenation for Primary Graft Failure After Heart Transplant

BackgroundSevere primary graft failure is a life-threatening complication of heart transplantation that may require venoarterial extracorporeal membrane oxygenation (VA-ECMO) support. Surgical practices and management strategies regarding VA-ECMO vary between and within centers.MethodsWe performed a single-center retrospective cohort study on adult patients who received VA-ECMO for primary graft failure between 2013 and 2020. Clinical data were obtained from chart review and national databases. Patients were stratified by transplantation before or after 2017, when our center adopted additional objective criteria for VA-ECMO, adopted partial-flow support, and changed from central cannulation to chimney graft arterial cannulation of brachiocephalic, axillary, or aorta. The primary outcome was survival to device weaning. Secondary outcomes were survival to discharge, survival to 1 year, complications on support, and time to sedation weaning and extubation.ResultsFrom 276 heart transplant recipients, 39 severe primary graft failure patients requiring VA-ECMO were identified. Incidence of graft failure was 13% (n = 18 of 135) pre-2017 and 15% (n = 21 of 141) post-2017. Survival at all time points improved significantly after 2017, with greatest difference in survival to device weaning (61% pre-2017 vs 100% post-2017). After controlling for other factors in multivariable Cox regression modeling, transplantation after 2017 was a predictor of reduced mortality (hazard ratio, 0.209; 95% CI, 0.06-0.71; P = .01). Significant differences were not observed in other secondary outcomes of recovery.ConclusionsThe new VA-ECMO strategy displayed reasonable survival and a remarkable improvement from the prior system.     

国家医药卫生领域科学数据共享网建设目的与现状

医药卫生科学数据共享工程由中国医学科学院等多家权威医学机构联合申请建设，其目标是是建立一个“在物理上合理分布、层次分明，在逻辑上高度统一、充分共享”的医药卫生科学数据管理与共享服务系统。目前已经展开了关于共享政策与机制、资源规划、标准规范、技术平台的研究，并建设形成了具有学科的专业数据中心。     

四川省西昌市吸毒人群HCV感染及其危险因素研究

目的　了解四川省西昌市吸毒人群吸毒方式及性行为特征与HCV感染的关系。方法　于2 0 0 4 - 0 5 / 0 7,调查四川省西昌市吸毒人群的社会人口学、吸毒方式及性行为特征与HCV感染的关系。采集血样进行HCV和梅毒抗体检测。结果　在调查的吸毒人群6 19人中,HCV感染率为5 5 .9% (346 / 6 19) ,其中静脉吸毒者的HCV感染率为71 9% (2 35 / 32 7)。在单因素和多因素分析中,曾经静脉注射吸毒(OR =2 .6 3;95 %CI为1 .79～3 .89,P <0 .0 0 1)和曾经共用针头或注射器具吸毒(OR =2 .98,95 %CI为1 .78～5 . 0 0 ,P <0 . 0 0 1)与HCV感染有统计学意义。结论　吸毒人群HCV感染与其高危吸毒行为有关。     

共用注射器静脉吸毒与HIV感染关系的研究

目的探讨吸毒人群共用注射器静脉吸毒与HIV感染的关系。方法于2004-05/07,采用横断面研究调查四川省西昌市吸毒人群的社会人口学、吸毒频率、共用注射器静脉吸毒的次数和伙伴人数以及性行为特征。同时采集血样进行HIV和抗体检测。结果调查吸毒人群451人,HIV感染率为15.1%(68/451),其中静脉吸毒人群HIV感染率为17.8%(66/370)。在多因素Logistic回归模型分析中,与HIV感染关系有统计学意义的变量是彝族(OR=2.91;95%CI,1.67～5.10)、至今共用注射器具静脉吸毒的总次数(1～19次OR=4.67;95%CI,2.35～9.26;20次及以上OR=4.20;95%CI,1.52～11.61)和至今共用注射器具静脉吸毒的伙伴人数7人及其以上(OR=2.17;95%CI,1.01～4.68)。结论吸毒人群共用注射器具静脉吸毒的社会网络大小与其HIV感染有关,需通过降低共用注射器具静脉吸毒的次数和伙伴人数来控制HIV的传播流行。     

基于自主许可的医疗数据共享研究

个人医疗数据只有在隐私保护的基础上才能实现真正的共享和利用。现简要介绍医疗数据共享中的隐私保护,提出个人自主许可的医疗数据共享思路,设计包括政策许可、个人许可以及机构需求协同工作的医疗数据共享模型。同时对医疗数据共享中注意的问题做初步探讨。     

Outcome of pediatric heart transplantation in blood culture positive donors in the United States

Active donor infection at the time of organ procurement poses a potential infection risk and may increase post‐transplant morbidity and mortality in recipients. Our hypothesis was that pediatric heart transplant recipients from blood culture positive donors (BCPD) would have increased morbidity and mortality compared to non‐blood culture positive donors (NBCPD). A retrospective analysis of pediatric heart transplant recipients using the organ procurement and transplant network (OPTN) between 1987 and 2015 was conducted. Recipient as well as donor data were analyzed. Propensity score matching with 1:2 ratios was performed for recipient variables. Post‐transplant morbidity and mortality were compared for recipients of BCPD and NBCPD. Among 9618 heart transplant recipients, 450 (4.7%) were from culture positive donors. Recipients of BCPD had longer duration of listing as Status 1; diagnosis of congenital heart disease or restrictive cardiomyopathy and required support (IV inotropes, Inhaled NO and LVAD) prior to transplant. Post‐transplant survival between the 2 groups was not different. Propensity‐matched recipients had similar length of stay; stroke rate; need for dialysis; pacemaker implantation and treated rejection episodes in the first year post‐transplant. Careful acceptance of BCPD may have the potential to increase availability of donor hearts in the pediatric population.     

Enabling the sharing of neuroimaging data through well-defined intermediate levels of visibility

The sharing of neuroimagery data offers great benefits to science, however, data owners sharing their data face substantial custodial responsibilities, such as ensuring data sets are correctly interpreted in their new shared context, protecting the identity and privacy of human research participants, and safeguarding the understood order of use. Given choices of sharing widely or not at all, the result will often be no sharing, due to the inability of data owners to control their exposure to the risks associated with data sharing. In this context, data sharing is enabled by providing data owners with well-defined intermediate levels of data visibility, progressing incrementally toward public visibility. In this paper, we define a novel and general data sharing model, Structured Sharing Communities (SSC), meeting this requirement. Arbitrary visibility levels representing collaborative agreements, consortium memberships, research organizations, and other affiliations are structured into a policy space through explicit paths of permissible information flow. Operations enable users and applications to manage the visibility of data and enforce access permissions and restrictions. We show how a policy space can be implemented in realistic neuroinformatic architectures with acceptable assurance of correctness, and briefly describe an open source implementation effort.     

The rate of hepatic artery complications is higher in pediatric liver transplant recipients with metabolic liver diseases than with biliary atresia

Background

Liver transplantation (LT) is an excellent treatment option for patients with biliary atresia (BA) who fail portoenterostomy surgery. LT is also increasingly performed in patients with metabolic liver diseases. This study compared the outcomes in pediatric patients who underwent LT for metabolic liver diseases and BA.