Role of ventricular assist devices in the German heart allocation system

The Eurotransplant (ET) allocation algorithm, newly implemented in 2000, gives priority for heart transplantation (HTx) to patients with high urgency (HU) status, but now this status is rescinded upon ventricular assist device (VAD) implantation and only regained if severe complications occur during mechanical circulatory support (MCS). We studied the effects of this change on the patients in our institute who were waiting for HTx with MCS. The median duration of MCS until HTx in adult patients gradually increased from 3.1 months in 1994, reaching a peak of 16.7 months in 2000, and then gradually decreased to 6.0 months in 2003. Among the patients with VAD implantation as a bridge to HTx, two patients were on MCS for more than 1 year (the longest duration of MCS being 1.6 years) at the end of 1999, and this figure increased to nine patients and a maximum MCS duration of 3.7 years at the end of 2003. These data imply that the patients in whom a complication occurred in the early phase of MCS and who had overcome this complication underwent HTx early with HU status, and those who were stable during MCS waited a long time for HTx. Furthermore, the number of patients in the latter group is increasing. The new allocation algorithm imposes on patients with MCS waiting for HTx who are relatively young and free from complications and serious coexisting disease, very long-term MCS without an end to VAD bridging, which is almost equivalent to destination therapy. Part of this paper was presented at the 42nd JSAO Conference (Tokyo, October 5–7, 2004)     

The effect of encasings on quality of life in adult house dust mite allergic patients with rhinitis, asthma and/or atopic dermatitis

BACKGROUND: Environmental control has been put forward as an integral part of the management of house dust mite (HDM) allergy in sensitized patients. To validate this statement allergic disorders involved in HDM allergy--allergic asthma, rhinitis and atopic eczema/dermatitis syndrome (AEDS)--should be taken together and studied in terms of the efficacy of environmental control. Because a generic quality of life questionnaire exceeds the border of disease, this may be used as major outcome parameter. RESEARCH OBJECTIVE: To study the effects of bedding encasings in HDM allergic patients with asthma, rhinitis and AEDS. MATERIAL AND METHODS: A total of 224 adult HDM allergic patients with rhinitis and/or asthma and/or dermatitis were randomly allocated impermeable or nonimpermeable encasings for mattress, pillow and duvet. Short form 36 (SF-36) was filled in at baseline and after 12 months. Results: Lower physical (P = 0.01) and emotional (P < 0.001) sumscores were seen in females. Also, the presence of asthma resulted in lower physical sumscore (P = 0.01). However, no effect was seen of encasings on either sumscore. CONCLUSION: Bedding encasings do not improve quality of life in a mixed population of subjects with combinations with rhinitis, asthma and atopic dermatitis and sensitized to HDMs.     

江苏省护理院卫生资源配置现状和效率研究

目的:分析江苏省护理院卫生资源配置现状与效率,并提出完善对策。方法:应用描述性统计方法分析2013~2019年护理院卫生资源配置和利用情况,采用数据包络分析法评价卫生资源投入产出效率,采取TOPSIS法综合评估床位利用效率。结果:2019年江苏省护理院为246家,其中71.95%集中在城市地区;2019年护理院床位数为38274张,床位医生比和床位护士比分别为1:0.06和1:0.18,床位使用率为72.32%,平均住院天数比2013年缩短20.5天。数据包络分析结果显示,2016~2018年综合技术效率值均为1.0,2019年为0.990。TOPSIS法评估结果显示,2013~2017年床位利用效率逐年上升,2018和2019年有所下降。结论:护理院城乡分布不均衡,人员配置不足,近年来投入产出效率为相对有效或弱有效,但床位总体利用率偏低。今后合理规划设置护理机构,增加人力资源配置,提升护理院服务质量,最大限度发挥护理院卫生资源的作用。     

基于熵权-TOPSIS结合RSR法的山东省卫生资源 配置地区性差异研究

目的 分析山东省卫生资源配置地区差异性,为优化区域卫生资源配置提供参考。方法 采用熵权-TOPSIS(Entropy weight TOPSIS)法与秩和比(RSR)法综合评价2015—2019年山东省卫生资源配置情况。结果 根据熵权-TOPSIS法可得2015—2019年鲁东、鲁中、鲁西南地区卫生资源配置综合评价平均水平分别为0.403、0.520、0.264;RSR法分档结果为好（ Ci >0.542）、中（0.092< Ci <0.542）、差（ Ci <0.092）三类,其中鲁东地区在三档中占比为2/3、4/12、0;鲁中地区占比为1/3、3/12、1/2;鲁西南地区占比为0、5/12、1/2。方差分析结果显示 F =18.755, P ＜0.001,说明分档结果具有统计学意义。结论 山东省卫生资源配置存在明显地区差异,鲁东、鲁中地区卫生资源配置情况较好,鲁西南地区较差。政府应发挥主导作用,完善人才激励机制,缩小卫生资源区域配置差异,提高人群健康水平。     

Less Is Better: How Nutrition and Low-Carbon Labels Jointly Backfire on the Evaluation of Food Products

(1) Background: Labeling is one of the significant strategies to guide sustainable consumption behaviors. Nowadays, multi labels being displayed on the front-of-pack of food products is a common phenomenon. However, labels seldom operate solo, and competition or complement effects may be exerted on different labels. Therefore, the research objective is to explore the interaction effect when nutrition and low-carbon labels appear simultaneously; (2) Methods: Across four scenario-based experiments, including ice cream, yogurt, steak, and toast, this study manipulated the separate and joint occurrences of low-carbon and nutrition labels, the interaction effect of joint labels was tested, and the serial mediation model, which includes resource allocation and anticipated enjoyment of food consumption, was verified; (3) Results: Results show that people have a positive preference for the nutrition label and the carbon label, respectively, while these two labels working simultaneously attenuate the positive effect of the single label. When facing nutrition and carbon labels simultaneously, people would infer partial resources are allocated to healthy and environmental aspects so they have a lower anticipated enjoyment from food consumption. Thus, these two labels working simultaneously attenuate the positive effect of the single label, and consumers have a lower evaluation of food products. In addition, the joint backfire on the effect is only exerted on people with a higher level of zero-sum bias and only when joint labels have a high consistency of labels; (4) Conclusions: This study solved the contradictory problem of the joint effect of positive labels. The findings in this research contribute to promote sustainable food consumption. We suggest that similar labels should be avoided in the same front-of-pack of food, and manufacturers need to use ads to bring down consumers’ zero-sum bias.     

基于Group-Lasso天麻品质形成关键因子的分析

目的 为提高人工种植天麻的质量,基于Group-Lasso变量筛选构建随机森林回归模型分析影响天麻品质形成的关键因子。方法 基于Group-Lasso法,对2007—2022年天麻质量研究文献中天麻素含量及产地环境变量等数据进行变量筛选,并在筛选出的变量基础上建立随机森林回归模型及计算变量重要性得分。结果 最终选择了产区、生长状况、种质类型、产地气候类型、产地土壤类型、最热月均温、产地年降水量、产地年日照时数和无霜期9个变量,基于被选变量与天麻素含量建立随机森林回归模型,模型的均方误差（mean square error,MSE）和平均绝对百分误差（mean absolute percentage error,MAPE）分别为0.103 2和14.08%,特征重要性排序显示天麻素含量的最大影响因素是产地年降水量,其次是产地土壤类型、无霜期和产地年日照时数。结论 随机森林回归模型有相对较低的误差和较高的预估精度,更适合用于对天麻种植环境的分析和天麻素含量的估算,为人工种植天麻提供参考。     

Substituting imputation of HLA antigens for high-resolution HLA typing: Evaluation of a multiethnic population and implications for clinical decision making in transplantation

Molecular mismatch analysis for assessment of histocompatibility in transplantation requires high-resolution HLA typing. Algorithms to “guesstimate” high-resolution from low-resolution typing exist, but their accuracy remains unknown. We converted high-resolution, sequence-based, HLA typing of 310 subjects from an ethnically heterogeneous population to low-resolution equivalents and tested the ability of the NMDP HaploStats and HLA Matchmaker programs to impute/reproduce the measured high-resolution HLA type, using the more common “winner-takes-all” approach. Only 35.6% of the HaploStats imputed HLA-A, -B, -C, -DRB1, and -DQB1 haplotypes had no mistakes, and the accuracy was significantly lower for non-Caucasians (29.1%) compared to Caucasians (45.2%) (odds ratio [OR], 0.5; 95% confidence interval [CI], 0.3-0.8; P = .004). HLA Matchmaker was not able to provide high-resolution haplotypes for 45.2% of Caucasian subjects and 63.5% of non-Caucasian subjects (P = .002). Of those with an imputed result, only 10.3% of Caucasians and 4.8% of non-Caucasians had accurate 10-allele high-resolution output. Eplet analysis revealed additional, inaccurate eplets in 37% of individuals, with 22.5% showing at least 2 additional, inaccurate eplets; incorrect eplets were more common among non-Caucasians (OR, 1.8; 95% CI, 1.1-2.9; P = .018). Given this high error rate, caution should be taken before using imputation tools for clinical or research purposes, especially for non-Caucasian individuals.     

Cost-effectiveness of using hepatitis C viremic hearts for transplantation into HCV-negative recipients

Outcomes following hepatitis C virus (HCV)-viremic heart transplantation into HCV-negative recipients with HCV treatment are good. We assessed cost-effectiveness between cohorts of transplant recipients willing and unwilling to receive HCV-viremic hearts. Markov model simulated long-term outcomes among HCV-negative patients on the transplant waitlist. We compared costs (2018 USD) and health outcomes (quality-adjusted life-years, QALYs) between cohorts willing to accept any heart and those willing to accept only HCV-negative hearts. We assumed 4.9% HCV-viremic donor prevalence. Patients receiving HCV-viremic hearts were treated, assuming $39 600/treatment with 95% cure. Incremental cost-effectiveness ratios (ICERs) were compared to a $100 000/QALY gained willingness-to-pay threshold. Sensitivity analyses included stratification by blood type or region and potential negative consequences of receipt of HCV-viremic hearts. Compared to accepting only HCV-negative hearts, accepting any heart gained 0.14 life-years and 0.11 QALYs, while increasing costs by $9418/patient. Accepting any heart was cost effective (ICER $85 602/QALY gained). Results were robust to all transplant regions and blood types, except type AB. Accepting any heart remained cost effective provided posttransplant mortality and costs among those receiving HCV-viremic hearts were not >7% higher compared to HCV-negative hearts. Willingness to accept HCV-viremic hearts for transplantation into HCV-negative recipients is cost effective and improves clinical outcomes.     

Comparison of donor scores in bilateral lung transplantation—A large single-center analysis

Objectifying donor lung quality is difficult and currently there is no consensus. Several donor scoring systems have been proposed in recent years. They all lack large-scale external validation and widespread acceptance. A retrospective evaluation of 2201 donor lungs offered to the lung transplant program at the Medical University of Vienna between January 2010 and June 2018 was performed. Five different lung donor scores were calculated for each offer (Oto, ET, MALT, UMN-DLQI, and ODSS). Prediction of organ utilization, 1-year graft survival, and long-term outcome were analyzed for each score. 1049 organs were rejected at the initial offer (group I), 209 lungs declined after procurement (group II), and 841 lungs accepted and transplanted (group III). The Oto score was superior in predicting acceptance of the initial offer (AUC: 0.795; CI: 0.776–0.815) and actual donor utilization (AUC: 0.660; CI: 0.618–0.701). Prediction of 1-year graft survival was best using the MALT score, Oto score, and UMN-DLQI. Stratification of early outcome by MALT was significant for length of mechanical ventilation (LMV), PGD3 rates, ICU stay and hospital stay, and in-hospital-mortality, respectively. To the best of our knowledge, this study is the largest validation analysis comparing currently available donor scores. The Oto score was superior in predicting organ utilization, and MALT score and UMN-DLQI for predicting outcome after lung transplantation.