Breeding records and the detection of nesting predators of wild-release red-crowned cranes into non-breeding areas of the Yancheng National Nature Reserve, China

The western population of the red-crowned crane Grus japonensis in mainland China has been decreasing in the past few decades and wild population enhancement programmes have been launched in this country. First, 14 captive-bred red-crowned cranes were released into the core area of Yancheng National Nature Reserve for Rare Birds (YNNR), one of the most important wintering areas of this species, in 2013 (seven individuals) and 2015 (seven individuals) and then 8 more captive-bred cranes were released into YNNR from February 2022 to February 2023. We used satellite positioning and drone monitoring to study the status of released cranes. The results showed that two individuals (No. BJZ001 and BJZ008) from the first group of released cranes were found breeding in 6 of 7 years in the YNNR from 2017 to 2023. Three individuals (No. WNNR022, WNNR025 and WNNR026) from the second group of released cranes were recorded breeding in YNNR in 2023. All released cranes lived in the YNNR year round and did not migrate with wild cranes. Raccoon dogs, Nyctereutes procyonoides, were first recorded as red-crowned crane nest predators in the YNNR. Although these released cranes breed successfully in the YNNR, nestlings might face the threat of predators in non-traditional breeding areas. Further research is needed to determine whether offsprings of released individuals migrate with wild cranes and if breeding in their original wintering grounds is truly beneficial for population growth.

The native reed-specific bird, reed parrotbill, has been detected in exotic smooth cordgrass

After the smooth cordgrass Spartina alterniflora invaded coastal China, native birds started avoiding the green desert, and bird diversity declined. After many years, a few passerine birds began to enter and use smooth cordgrass, but only birds with a nonspecialised habitat. In this study, we found that a native reed-specific bird, the parrotbill Calamornis heudei, flocked and sang in a smooth cordgrass habitat throughout the overwintering period near Sheyang Port in Yancheng, Jiangsu Province. This observation suggests that native obligate birds may be forced to adapt to exotic smooth cordgrass habitats after long-term coexistence, which would, obviously, affect the distribution, feeding and reproduction of birds. The concern is that this could be an ecological trap, leading to unknown consequences. More research is required to examine the process occurring along the Chinese coast.

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

BACKGROUND

Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation.

METHODS

WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109.

FINDINGS

Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0-4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2-6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital.

INTERPRETATION

In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates.

FUNDING

European Society of Intensive Care Medicine, European Respiratory Society.

Unblinding at disease progression in double-blinded randomized controlled cancer drug clinical trials: A controversy requires more attention

Unblinding at disease progression in double-blinded randomized controlled cancer drug clinical trials is ethical to the patient by ensuring optimal subsequent treatment, but the effect of study treatment on overall survival may be confounded. The views of science and ethics in this issue are controversial and the unblinding procedures should be well-designed. In real world settings, a lack of use of this unblinding process in protocol was observed in the analysis of 134 double-blind randomized controlled anticancer drug clinical trials conducted in China from 2018 to 2021. Unblinding at disease progression was allowed in only 26 (18.2%) trials. Among them, Only 9 (34.6%) trials involved patient-level unblinding. None of the 134 included trials accounted for the risk of blind-maintenance after disease progression. Based on the analysis and case studies, we believe that unblinding at disease progression should be stated in the protocol when the treatment assignment directly affected the choice of subsequent regimen, in which the drug category, control group design, standard of care of further-line therapy and primary endpoint together play a role. When unblinding at disease progression is adopted, the sensitivity analytics are recommended to understand the true effect of study drug on overall survival. The notification of treatment allocation after unblinding and the informed consent also require attention. A decision-making framework is established to help understand this controversy, which should be carefully discussed by the investigator and the sponsor.

The application of skin external expander to postburn advanced scar contracture

In recent years, the universally used internal expansion by implanting a silicone elastomer balloon into the soft tissue under the skin has shown certain disadvantages, i.e., certain complications associated with the operation, high cost, and the fact that the materials cannot be recycled. That the materials are used only once adds to the operating cost. In view of these disadvantages, we have designed and developed a kind of mechanical external skin expander, which is composed of (1) an adjustable tractor, (2) preserving splints, and (3) a traction frame. The tractor is used to grip the contracted skin in order to make the soft tissue of the skin expand with the lapse of time and increase in traction weight. The external skin expansion has the following advantages compared with internal expansion: avoiding the complications caused by implanting the soft-tissue expander beneath the skin; simplicity and efficiency of operation; and the fact that the equipment can be reused, reducing the operating which is suitable for these basic units. The data of the expanded skin area can be calculated through the computer. Since June of 1993, a satisfactory curative effect has been obtained in 44 patients suffering from advanced postburn scars. Thirty-two patients among them were treated for more than half a year, with the scar becoming normal in both appearance and function. External skin expansion provides a new method for expansion of skin soft tissue. It has a bright future in its clinical application.