Hasil untuk "Anesthesiology"

R. Caplan, K. Posner, R. Ward et al.

J. Wang, L. A. Nauss, John E. Thomas

M. Hollmann, M. Durieux

Naomi P. O’Grady, M. Alexander, Lillian A Burns et al.

Dongling Gu, Yi Feng, Hongyan Li et al.

Immunotherapy plays a crucial role in cancer treatment, but its efficacy varies among patients, with some showing suboptimal responses. Recent studies indicate that radiotherapy not only kills tumor cells locally but also induces immunogenic cell death and modulates the tumor immune microenvironment, acting like an “in situ vaccine.” This provides a strong biological basis for combining radiotherapy and immunotherapy. However, challenges remain, including individual variability in responses, complex treatment regimens, and overlapping toxicities. Artificial intelligence (AI), especially through machine learning, presents new solutions by processing high-dimensional multi-omics data. This article explores how AI enhances radiotherapy and immunotherapy combinations by optimizing synergistic effects, developing predictive biomarkers, and elucidating the regulatory mechanisms of radiotherapy on the immune microenvironment, while also discussing future directions for AI in oncology.

D. Yarnitsky, L. Arendt-Nielsen, D. Bouhassira et al.

João Paulo Machado Bergamaschi, Ariel Falbel Lugão, Rangel Roberto de Assis et al.

Xu Liu, Shilei Dai, Yiyang Jin et al.

Abstract Optoelectronic synapses can be crucial for advancing artificial intelligence and visual systems. Optoelectronic synapses based on organic field-effect transistors have been widely studied but still face significant challenges including obvious programming nonlinearity, restricted response wavelength, high operation voltage, and limited storage memory. Organic electrochemical transistors can be another candidate but lack intensive studies. Additionally, wafer-scale photolithographic fabrication on optoelectronic synapses responding to near-infrared (NIR) light is highly desirable but rarely reported. Here, we propose the NIR organic photoelectrochemical transistor (OPECT) array capable of low voltage multi-level memories fabricated by photolithography. Based on NIR photo-induced electrochemical doping mechanism, the OPECTs enable linear weight programming with ultra-low nonlinearity (−0.015) over a wide range (47.3). We further demonstrate OPECTs arrays for image sensing, memorization, and visualization. Eventually, a convolutional computing system is constructed, executing accurate recognition of noisy handwritten digits. This work offers a promising insight into neuromorphic sensory computing applications.

Paul Sang Lee, Yasuko M. Mano, Brian M. Hom et al.

Background: Although single injections with anesthetics are commonly administered given their safety, their short-acting nature limits pain control. Liposomal bupivacaine represents a promising alternative to plain bupivacaine in interscalene nerve blocks. The goal of our study was to determine whether an interscalene block with liposomal bupivacaine provides superior analgesia and reduces opioid requirements compared to plain bupivacaine in patients undergoing arthroscopic rotator cuff repair (ARCR). Methods and Materials: A single-center, double-blinded, randomized controlled trial of patients undergoing ARCR was performed. Patients received a single-shot interscalene nerve block with plain bupivacaine or liposomal bupivacaine. Visual analog scale pain scores at rest and with activity, as well as morphine milligram equivalents, were recorded in postoperative recovery and on postoperative days 1, 2, 3, and 7. Comparisons between groups were made using descriptive statistics; the significance level was set at P < 0.05. Results: A total of 41 patients were randomized into the liposomal bupivacaine (n = 18 patients) and plain bupivacaine (n = 23 patients) groups. The differences in visual analog scale and morphine milligram equivalents between the two groups were not significant, with or without movement, on all postoperative days assessed. Conclusion: There was no difference in the visual analog scale or morphine milligram equivalents after arthroscopic rotator cuff repair with interscalene blocks using liposomal bupivacaine versus plain bupivacaine. Given the increased cost associated with liposomal bupivacaine use and the variation in multimodal pain regimens worldwide, multicenter clinical trials are necessary to examine the clinical benefit and cost-effectiveness of liposomal bupivacaine in patients undergoing rotator cuff repair.

M. Meng, K. Arendt, J. Banayan et al.

The pregnancy-related mortality rate in the United States is excessively high. The American Heart Association is dedicated to fighting heart disease and recognizes that cardiovascular disease, preexisting or acquired during pregnancy, is the leading cause of maternal mortality in the United States. Comprehensive scientific statements from cardiology and obstetrics experts guide the treatment of cardio-obstetric patients before, during, and after pregnancy. This scientific statement aims to highlight the role of specialized cardio-obstetric anesthesiology care, presenting a systematic approach to the care of these patients from the anesthesiology perspective. The anesthesiologist is a critical part of the pregnancy heart team as the perioperative physician who is trained to prevent or promptly recognize and treat patients with peripartum cardiovascular decompensation. Maternal morbidity is attenuated with expert anesthesiology peripartum care, which includes the management of neuraxial anesthesia, inotrope and vasopressor support, transthoracic echocardiography, optimization of delivery location, and consideration of advanced critical care and mechanical support when needed. Standardizing the anesthesiology approach to patients with high peripartum cardiovascular risk and ensuring that cardio-obstetrics patients have access to the appropriate care team, facilities, and advanced cardiovascular therapies will contribute to improving peripartum morbidity and mortality.

V. Lomivorotov, S. Efremov, M. Kirov et al.

Lichy Han, Danton S. Char, N. Aghaeepour

Artificial intelligence applications have great potential to enhance perioperative care. This article explores promising areas for artificial intelligence in anesthesiology; expertise, stakeholders, and infrastructure for development; and barriers and challenges to implementation.

Bijia Song, Ming Zhou, Junchao Zhu

The rapid development of artificial intelligence (AI) technology is due to the significant progress in big data, databases, algorithms, and computing power, and medical research is a vital application direction of AI. The integrated development of AI and medicine has improved medical technology, and the efficiency of medical services and equipment has enabled doctors to better serve patients. The tasks and characteristics of the anesthesia discipline also make AI necessary for its development, and AI has also been initially applied in different fields of anesthesia. Our review aims to clarify the current situation and challenges of AI application in anesthesiology to provide clinical references and guide the future development of AI in anesthesiology. This review summarizes progress in the application of AI in perioperative risk assessment and prediction, deep monitoring and regulation of anesthesia, essential anesthesia skills operation, automatic drug administration systems, and teaching and training in anesthesia. Also discussed herein are the accompanying risks and challenges of applying AI in anesthesia: patient privacy and information security, data sources, and ethical issues, lack of capital and talent, and the “black box” phenomenon.

Rakesh Kumar, Ruchi Pathak, Swati Chhabra

Sławomir Zacha, Katarzyna Kotrych, Wojciech Zacha et al.

Osteosarcoma is the most common primary malignant bone tumor in children and adolescents. The standard and most effective treatment is wide resection of the tumor combined with neoadjuvant chemotherapy. Adolescent idiopathic scoliosis (AIS) is a genetically determined three-dimensional spinal deformity, which occurs in teenage patients and is mostly progressive. The basic management strategy is surgical treatment when the curve exceeds 50 degrees. However, the indications are different in oncologic patients. The aim of this study was to describe a case of adolescent scoliosis with osteosarcoma of the pelvis. The authors conducted a scoping review using PubMed and Embase to analyze the state of knowledge. The presented paper is the first report of pelvis osteosarcoma coexisting with adolescent idiopathic scoliosis. Treatment for this complex case finished with very good results, with no recurrence observed during the nine-year follow-up.

Ruifen Xu, Xiaoyu Yang, Tong Yi et al.

Purpose: Early gastrointestinal tumors can be removed by endoscopic procedures. Endoscopic mucosal dissection (ESD) requires submucosal fluid injection to provide mucosal elevation and prevent intraoperative perforation. However, the clinically applied normal saline mucosal elevation height is low for a short time, which often requires multiple intraoperative injections that increase the inconvenience and procedure time. In addition, recently researched submucosal injection materials (SIM) suffer from complex preparation, poor economy, and poor biocompatibility. Therefore, there is an urgent need for a new type of SIM that can provide long, safe and effective mucosal elevation in support of the endoscopic procedures.Methods: The FS hydrogel is based on polyethylene-polypropylene glycol (F-127) mixed with sodium alginate (SA). The different physicochemical properties of FS hydrogels were characterized through various experiments. Afterward, various biosafety assessments were carried out. Finally, the performance of FS hydrogels was evaluated by in vitro submucosal injection and in vivo swine ESD.Results: The experimental results show that the FS hydrogel is liquid at room temperature, making it easy to inject, and when injected under the mucosa, it undergoes temperature-induced cross-linking, transforming from a liquid to a solid state to provide long-lasting mucosal augmentation. At the same time, the FS hydrogel exhibits controllable gelation, stability, and biocompatibility. The results of in vitro submucosal injections and in vivo ESD procedures showed that FS achieves high mucosal augmentation and provides good submucosal cushioning in the long term.Conclusion: In summary, the F-127/SA hydrogel is simple to synthesize, cost-effective, safe, easy to store, and able to assist ESD well from the perspective of practical clinical problems, indicating that the FS hydrogel can be an ideal potent submucosal injection substitution.

G. Gross, Lisa Eisert, H. Doerr et al.

The present guidelines are aimed at residents and board‐certified specialists in the fields of dermatology, ophthalmology, ENT, pediatrics, neurology, virology, infectious diseases, anesthesiology, general medicine and any other medical specialties involved in the management of patients with herpes zoster. They are also intended as a guide for policymakers and health insurance funds. The guidelines were developed by dermatologists, virologists, ophthalmologists, ENT physicians, neurologists, pediatricians and anesthesiologists/pain specialists using a formal consensus process (S2k).

MD PhD Maria Loreto Alvarez-Nebreda, MD MA Nathalie Bentov, MD h Richard D. Urman et al.

Frailty is an age-related, multi-dimensional state of decreased physiologic reserve that results in diminished resiliency and increased vulnerability to stressors. It has proven to be an excellent predictor of unfavorable health outcomes in the older surgical population. There is agreement in recommending that a frailty evaluation should be part of the preoperative assessment in the elderly. However, the consensus is still building with regards to how it should affect perioperative care. The Society for Perioperative Assessment and Quality Improvement (SPAQI) convened experts in the fields of gerontology, anesthesiology and preoperative assessment to outline practical steps for clinicians to assess and address frailty in elderly patients who require elective intermediate or high risk surgery. These recommendations summarize evidence-based principles of measuring and screening for frailty, as well as basic interventions that can help improve patient outcomes.

D. Andropoulos

Luigi La Via, Filippo Sanfilippo, Carlotta Continella et al.

Abstract Background Capillary Refill Time (CRT) is a marker of peripheral perfusion usually performed at fingertip; however, its evaluation at other sites/position may be advantageous. Moreover, arm position during CRT assessment has not been fully standardized. Methods We performed a pilot prospective observational study in 82 healthy volunteers. CRT was assessed: a) in standard position with participants in semi-recumbent position; b) at 30° forearm elevation, c and d) at earlobe site in semi-recumbent and supine position. Bland–Altman analysis was performed to calculate bias and limits of agreement (LoA). Correlation was investigated with Pearson test. Results Standard finger CRT values (1.04 s [0.80;1.39]) were similar to the earlobe semi-recumbent ones (1.10 s [0.90;1.26]; p = 0.52), with Bias 0.02 ± 0.18 s (LoA -0.33;0.37); correlation was weak but significant (r = 0.28 [0.7;0.47]; p = 0.01). Conversely, standard finger CRT was significantly longer than earlobe supine CRT (0.88 s [0.75;1.06]; p < 0.001) with Bias 0.22 ± 0.4 s (LoA -0.56;1.0), and no correlation (r = 0,12 [-0,09;0,33]; p = 0.27]. As compared with standard finger CRT, measurement with 30° forearm elevation was significantly longer (1.17 s [0.93;1.41] p = 0.03), with Bias -0.07 ± 0.3 s (LoA -0.61;0.47) and with a significant correlation of moderate degree (r = 0.67 [0.53;0.77]; p < 0.001). Conclusions In healthy volunteers, the elevation of the forearm significantly prolongs CRT values. CRT measured at the earlobe in semi-recumbent position may represent a valid surrogate when access to the finger is not feasible, whilst earlobe CRT measured in supine position yields different results. Research is needed in critically ill patients to evaluate accuracy and precision at different sites/positions.