Search

To assess the comparative effectiveness and temporal changes in quality of life (QoL) outcomes after revascularisation, major lower extremity amputation (MLEA), and conservative management (CM) in chronic limb threatening ischaemia (CLTI).MEDLINE, Embase, PsycINFO, CINAHL, and Web of Science.A systematic review and meta-analysis were performed on QoL measured by any QoL instrument in adult patients with CLTI after open surgery (OS), endovascular intervention (EVI), MLEA, or CM. Randomised controlled trials and prospective observational studies published in any language between 1 January 1990 and 21 May 2021 were included. There was a pre-specified measurement time point of six months. Random effects meta-analysis was conducted on total scores for each QoL instrument. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations approach (PROSPERO registration: CRD42021253953).Fifty-five studies with 8 909 patients were included. There was significant heterogeneity in the methods used to measure QoL, and the study characteristics. In particular, 14 different QoL instruments were used with various combinations of disease specific and generic instruments within each study. A narrative summary is therefore presented. Comparative effectiveness data showed there was reasonable certainty that QoL was similar between OS and EVI at six months. Temporal outcomes suggested small to moderate improvements in QOL six months after OS and EVI compared with baseline. Limited data indicated that QoL can be maintained or slightly improved after MLEA or CM. Treatment effects were overestimated owing to small study effects, selective non-reporting, attrition, and survivorship bias.QoL after OS and EVI appears to be similar. Revascularisation may provide modest QoL benefits, while MLEA or CM can maintain QoL. However, certainty of evidence is generally low or very low, and interpretation is hampered by significant heterogeneity. There is a need for a CLTI specific QoL instrument and methodological standardisation in QoL studies.

To review and describe the available literature on cost-utility analysis of revascularization and non-revascularization treatment approaches in chronic limb-threatening ischemia.A systematic review was performed on cost-utility analysis studies evaluating revascularization (open surgery or endovascular), major lower extremity amputation, or conservative management in adult chronic limb-threatening ischemia patients. Six bibliographic databases and online registries were searched for English language articles up to August 2021. The outcome for cost-utility analysis was quality-adjusted in life years. Procedures were compared using incremental cost-effectiveness ratios which were converted to 2021 United States dollars. Study reporting quality was assessed using the 2022 Consolidated Health Economic Evaluation Reporting Standards statement. The study was registered in International Prospective Register of Systematic Reviews (CRD42021273602).Three trial-based and five model-based studies were included for review. Studies met between 14/28 and 20/28 criteria of the Consolidated Health Economic Evaluation Reporting Standards CHEERS statement. Only one study was written according to standardized reporting guidelines. Most studies evaluated infrainguinal disease, and adopted a health care provider perspective. There was a large variation in the incremental cost-effectiveness ratios presented across studies. Open surgical revascularization (incremental cost-effectiveness ratios: $3,678, $58,828, and $72,937), endovascular revascularization (incremental cost-effectiveness ratios: $52,036, $125,329, and $149,123), and mixed open or endovascular revascularization (incremental cost-effectiveness ratio: $8,094) maybe more cost-effective than conservative management.The application of cost-utility analyses in chronic limb-threatening ischemia is in its infancy. Revascularization in infrainguinal disease may be favored over major lower extremity amputation or conservative management. However, data is inadequate to support recommendations for a specific treatment. This review identifies short and long-term considerations to address the current state of evidence. Cost-utility analysis is an important tool in healthcare policy and should be encouraged amongst the vascular surgical community.

To review quality of life (QOL) instruments for chronic limb-threatening ischemia (CLTI) patients and informal carers, and their use in QOL and cost-utility analysis (CUA) studies.CLTI is a global health problem with significant morbidity affecting patients and informal carers. QOL is increasingly measured for holistic outcomes assessment and CUA. However, measurement instruments in CLTI are poorly understood.MEDLINE, EMBASE, PsycINFO, CINAHL, COSMIN, PROQOLID, CEA registry, and NHS EED databases were searched for all English language studies up to May 2021. Features of instruments, evidence of measurement property appraisal, and trends in use were assessed. Prospective protocol registration (Open Science Framework: https://doi.org/10.17605/OSF.IO/KNG9U ).A total of 146 studies on QOL instruments (n=43), QOL outcomes (n=97), and CUA (n=9) were included. Four disease-specific QOL instruments are available for lower extremity arterial disease (intermittent claudication or CLTI). VascuQoL-25 and VascuQoL-6 have been used in CLTI. There is no CLTI-specific instrument. Of 14 generic instruments, SF-36, EQ-5D-3L, NHP, and WHOQOL-BREF were most common. Studies reporting partial measurement property appraisal favored VascuQoL-25, VascuQoL-6, and SF-36. Feasibility considerations include mode of administration and responder burden. None of 4 available carer-specific instruments have been used in CLTI. Since 1992, the number of QOL studies has increased considerably, but CUA studies are scarce. Informal carers have not been assessed.This review provides a comprehensive reference for QOL measurement in CLTI that helps end-users with instrument selection, use, and interpretation. However, a CLTI-specific instrument is needed. There is an opportunity to benefit society through future CUA studies and evaluation of QOL in informal carers.

Background and aims Randomized clinical trials have proven the efficacy and safety of Food and Drug Administration (FDA) approved anti-obesity medications (AOMs) for long-term use. It is unclear whether these outcomes can be replicated in real-world clinical practice where clinical complexities arise. The aim of this study was to evaluate the effectiveness and side effects of these medications in real-world multidisciplinary clinical practice settings. Methods We reviewed the electronic medical records (EMR) of patients with obesity who were prescribed an FDA-approved AOM for long-term use in academic and community multidisciplinary weight loss programs between January 2016 and January 2020. Intervention We assessed percentage total body weight loss (%TBWL), metabolic outcomes, and side effect profile up to 24 months after AOM initiation. Results The full cohort consisted of 304 patients (76% women, 95.2% White, median age of 50 years old [IQR, 39-58]). The median follow-up time was 9.1 months [IQR, 4.2-14.1] with a median number of 3 visits [IQR, 2-4]. The most prescribed medication was phentermine/topiramate extended-release (ER) (51%), followed by liraglutide (26.3%), bupropion/naltrexone sustained-release (SR) (16.5%), and lorcaserin (6.2%). %TBWL was 5.0%, 6.8%, 9.3%, 10.3%, and 10.5% at 3, 6, 12, 18, and 24 months. 60.2% of the entire cohort achieved at least 5% TBWL. Overall, phentermine/topiramate-ER had the most robust weight loss response during follow-up, with the highest %TBWL at 12 months of 12.0%. Adverse events were reported in 22.4% of patients. Only 9% of patients discontinued the medication due to side effects. Conclusions AOMs resulted in significant long-term weight loss, that was comparable to outcomes previously reported in clinical trials.

The National Health and Nutrition Examination Survey (NHANES) of America has been running for more than 60 years and has achieved many significant achievements with international influence. The application of modern information technologies in NHANES provides a supplementary tool for the project's high quality and refined implementation. This paper introduces the information system of NHANES from seven aspects: project management, survey participant interview, physical examination, laboratory examination, field follow-up, data sharing, and social services. The construction and application prospects of the China National Health Survey Information System, suitable for China's native conditions, are also discussed in this article.美国健康与营养调查项目（NHANES）已历时六十余年，取得了许多具有国际影响力的重要成果。现代信息技术在NHANES中的应用为项目的高质量精细化实施提供了补充工具。本文从项目管理、受试者调查、体格检查、实验室检查、现场随访、数据共享和社会服务7个维度介绍NHANES的信息化系统应用状况，并进一步探讨了适合我国国情的国民健康调查信息化系统的建设与应用前景。.

Multi-dimensional aerodynamic database technology is widely used, but its model often has the curse of dimensionality. In order to solve this problem, we need projection to reduce the dimension. In addition, due to the lack of traditional method, we have improved the traditional flow field reconstruction method based on artificial neural networks, and we proposed an array neural network method.In this paper, a set of flow field data for the target problem of the fixed Mach number is obtained by the existing CFD method. Then we arrange all the sampled flow field data into a matrix and use proper orthogonal decomposition (POD) to reduce the dimension, whose size is determined by the first few modals of energy. Therefore, significantly reduced data are obtained. Then we use an arrayed neural network to map the flow field data of simplified target problem and the flow field characteristics. Finally, the unknown flow field data can be effectively predicted through the flow field characteristic and the trained array neural network.At the end of this paper, the effectiveness of the method is verified by airfoil flow fields. The calculation results show that the array neural network can reconstruct the flow field of the target problem more accurately than the traditional method, and its convergence speed is significantly faster. In addition, for the case of high angle flow field, the array neural network also performs well. There are no obvious jumps, and huge errors are found in results. In general, the proposed method is better than the traditional method.

The aim of this study is to review illness perceptions (IPs) in chronic limb-threatening ischemia (CLTI) patients undergoing revascularization (open surgical or endovascular), major lower extremity amputation, or conservative management.MEDLINE, EMBASE, PsycINFO, CINAHL, WOS, and Scopus databases were searched from inception to August 20, 2021 for studies evaluating IP in CLTI according to Leventhal's common sense model (CSM). Since only 1 study was identified, a post hoc secondary literature search of MEDLINE was performed for reviews of IP in cardiovascular disease and diabetes to identify potential learning points for future research. All studies underwent narrative synthesis guided by tabulated data.One study and 7 reviews were included from the primary and secondary literature searches, respectively. Timeline and controllability were the main aspects of IP that predict prosthetic use in CLTI patients, more so at 6 months than 1 month. Other reviews in cardiovascular disease and diabetes identified important targets for future research: (1) factors that affect IP and whether IP can be used as an outcome measure, (2) relationship between IP and clinician-reported and patient-reported outcomes, and (3) methods to educate and change maladaptive IP. The importance of using valid and reliable measures of IP that encompass all components of Leventhal's' CSM was stressed.Knowledge of IP in CLTI patients is severely limited in contrast to other fields in cardiovascular disease and diabetes. This review helps to close this gap by raising awareness of IP and its importance within the vascular surgical community, and by providing a framework for future studies.

Cohort study has emerged as an essential tool for gaining knowledge about risk factors and prevention of diseases. The studies related to cohort population have been progressing more than 60 years in our country, while different types and numbers in cohort studies have increased dramatically with the key programs special for the cohort study were approved firstly by the Ministry of Science and Technology of China since 2016. With typical study design, cohort study is currently needed to use the latest multidisciplinary resources and methods in order to be more systematic and accurate on association analysis and causal inference of diseases. For the cohort study of general population in Beijing, Tianjin and Hebei province, the core principles and concepts of study design, progress and the key issues targeting implementation were introduced. In addition, opportunities, bottlenecks and solutions facing us were also explored.队列研究是探索病因和疾病防治知识发现的最有效工具之一。队列研究在我国已有60余年的工作基础，尤其自2016年科技部首次对队列研究专门立项以来，我国队列研究的种类和数量急剧增加。现代队列研究需要在经典的队列研究设计原则基础上，充分应用现代多学科资源和技术方法，以使暴露与结局关联分析和病因推断更加系统和精准。本文介绍了京津冀自然人群队列研究设计的理念、研究进展和挑战，以及在实施中应对的关键问题，可为国内队列研究及其随访机制建设提供参考。.

This study aimed to investigate whether percutaneous vertebral augmentation (PVA) was associated with clinical and radiological subsequent adjacent fractures in patients with osteoporotic vertebral compression fractures.The systematic review was performed following PRISMA guidelines. Data were retrieved from PubMed, EMBASE, Cochrane Library, Google Scholar, Web of Science, and ClinicalTrial.gov, from database inception to March 2020. Eligible studies were those that assessed subsequent adjacent fractures after PVA in comparison with conservative treatment (CT). The number of patients with adjacent secondary vertebral fractures was calculated, and the pooled risk ratio (RR) with its 95% confidence intervals (95% CI) was used. Moreover, heterogeneity, sensitivity, and publication bias analyses were performed.Twenty-four studies were included finally. Moreover, 20/421 (4.75%) patients from the PVA group and 25/359 (6.96%) patients from the CT group had clinical subsequent adjacent fractures, and 46/440 (10.45%) patients from the PVA group and 36/444 (8.10%) patients from the CT group had radiological subsequent adjacent fractures. Both had no significant difference between the two groups (RR = 0.67, 95% CI [0.38, 1.19], p = 0.17)/(RR = 1.13, 95% CI [0.75, 1.70], p = 0.576). However, the number of fractured vertebrae was higher in the PVA group than in the CT group (RR = 1.41, 95% CI [1.03, 1.93], p = 0.03). A sensitivity analysis did not identify specific trials that seriously deflected. No obvious publication bias was identified.The systematic review revealed that PVA did not increase the incidence for subsequent adjacent fractures regardless of whether they were clinical or radiological fractures. However, PVA can increase the number of subsequent fractures at adjacent vertebral levels.

Fretting damage is caused by small relative displacement between two bodies. It can result in loosening of fasteners or fatigue cracks. The traditional mode of fretting fatigue loading is to add a fixed normal load on the fretting pad and a corresponding fatigue load on the free end of the specimen. A new fretting fatigue loading method is proposed to simulate the actual working condition of spline coupling. A 3D finite element model is implemented to simulate the contact state in the process of bending fretting fatigue. The influence of cyclic bending load on the stress and strain of contact surface is studied. The new model is proved to be correct and effective.

Aims. The expression for the shock Mach number used by Ravishankar and Michalek (2020, A&A, 638, A42) is incorrect. We wish to provide a correct expression so they can redo their analyses. Methods. Coronal mass ejection (CME) shocks are fast magnetosonic shocks and not intermediate Alfvén shocks. We give the steps for calculating the shock normal, shock velocity, and, thus, the shock Mach number. We also mention that the shock properties, such as being quasi-perpendicular or quasi-parallel, are another important parameter for the shock acceleration of energetic particles. Results. We have corrected the errors existing in the Astronomy and Astrophysics literature concerning the mathematical expression for the Mach number for a CME shock. Hopefully, future authors will use the now-correct expression for the Mach number. Conclusions. The correct shock Mach number expression has been given to Ravishankar and Michalek. It is hoped that they will redo their calculations (including using other shock properties) to see if their 2020 conclusions still hold true or not.

在医学实践中，预防医学与临床医学的裂痕由来已久，其根源性因素在于两类学科一直并行发展，弱化了对医学生大健康意识的培养，固化了医学生的思维。近些年，国际上提出群医学概念，为弥补这一裂痕提出了思路。本文通过回顾群医学的定义、发展、学科建设、人才培养及实践情况，认为当前我国实施健康中国战略，必须通过群医学学科建设推动"以治病为中心"向"以人民健康为中心"的转变，具体措施包括建立完整的涵盖学历教育、毕业后教育、继续教育的群医学教育培训体系，在临床及公共卫生实践中灌输群医学理念，建立群医学示范基地，并开展宣传倡导推动群医学学科在全国发展。.

A High-Granularity Timing Detector (HGTD) is proposed based on the Low-Gain Avalanche Detector (LGAD) for the ATLAS experiment to satisfy the time resolution requirement for the up-coming High Luminosity at LHC (HL-LHC). We report on beam test results for two proto-types LGADs (BV60 and BV170) developed for the HGTD. Such modules were manufactured by the Institute of High Energy Physics (IHEP) of Chinese Academy of Sciences (CAS) collaborated with Novel Device Laboratory (NDL) of the Beijing Normal University. The beam tests were performed with 5 GeV electron beam at DESY. The timing performance of the LGADs was compared to a trigger counter consisting of a quartz bar coupled to a SiPM readout while extracting reference SiPM by fitting with a Gaussian function. The time resolution was obtained as 41 ps and 63 ps for the BV60 and the BV170, respectively. To meet the timing resolution requirement of up-coming High Luminosity LHC (HL-LHC), a new detector based on the Low-Gain Avalanche Detector(LGAD), High-Granularity Timing Detector (HGTD), is under intensive research in ATLAS. Two types of IHEP-NDL LGADs(BV60 and BV170) for this update is being developed by Institute of High Energy Physics (IHEP) of Chinese Academic of Sciences (CAS) cooperated with Novel Device Laboratory (NDL) of Beijing Normal University and they are now under detailed study. These detectors are tested with $5GeV$ electron beam at DESY. A SiPM detector is chosen as a reference detector to get the timing resolution of LGADs. The fluctuation of time difference between LGAD and SiPM is extracted by fitting with a Gaussian function. Constant fraction discriminator (CFD) method is used to mitigate the effect of time walk. The timing resolution of $41 \pm 1 ps$ and $63 \pm 1 ps$ are obtained for BV60 and BV170 respectively.