Objective: To explore and analyze the effect of the WeChat platform combined with the PBL teaching method in the standardized training of anesthesia residents. Methods: 120 anesthesiology residents from January 2018 t...Objective: To explore and analyze the effect of the WeChat platform combined with the PBL teaching method in the standardized training of anesthesia residents. Methods: 120 anesthesiology residents from January 2018 to the end of December 2019 were selected, and divided into a control group and an observation group of 60 each according to the time sequence of admission. The control group adopted the conventional teaching mode, and the observation group adopted the WeChat platform combined PBL teaching method. The scores of theoretical knowledge and anesthesia skills operation after training, the scores of the teaching interest survey, and the satisfaction with the teaching mode between the two groups were compared. Results: The scores of theoretical knowledge and anesthesia skills operation in the observation group were significantly higher than those in the control group, and the indicators of teaching interest in the observation group were also higher than those in the control group. The differences were statistically significant (P < 0.05). The satisfaction degree of the observation group was significantly higher than that of the control group, and the difference was also statistically significant (P < 0.05). Conclusion: The WeChat platform combined with the PBL teaching method is beneficial to improve the training effect of anesthesiology residents, stimulating autonomous learning ability, ensuring the effective practice of theoretical knowledge, and promoting them to move towards a higher standard of anesthesia skills.展开更多
The current study aimed to compare the effects between remimazolam and propofol on hemodynamic stability during the induction of general anesthesia in elderly patients.We used propofol at a rate of 60 mg/(kg·h)in...The current study aimed to compare the effects between remimazolam and propofol on hemodynamic stability during the induction of general anesthesia in elderly patients.We used propofol at a rate of 60 mg/(kg·h)in the propofol group(group P)or remimazolam at a rate of 6 mg/(kg·h)in the remimazolam group(group R)for the induction.A processed electroencephalogram was used to determine whether the induction was successful and when to stop the infusion of the study drug.We measured when patients entered the operating room(T_(0)),when the induction was successful(T_(1)),and when before(T_(2))and 5 min after successful endotracheal intubation(T_(3)).We found that mean arterial pressure(MAP)was lower at T_(1–3),compared with T_(0) in both groups,but higher at T_(2) in the group R,whileΔMAP_(T0–T2) andΔMAP_(max) were smaller in the group R(ΔMAP_(T0–T2):the difference between MAP at time point T_(0) and T_(2),ΔMAP_(max):the difference between MAP at time point T_(0) and the lowest value from T_(0) to T_(3)).Cardiac index and stroke volume index did not differ between groups,whereas systemic vascular resistance index was higher at T_(1–3) in the group R.These findings show that remimazolam,compared with propofol,better maintains hemodynamic stability during the induction,which may be attributed to its ability to better maintain systemic vascular resistance levels.展开更多
The present study aimed to dynamically observe the segmental and global myocardial movements of the left ventricle during coronary artery bypass grafting by transesophageal speckle-tracking echocardiography,and to ass...The present study aimed to dynamically observe the segmental and global myocardial movements of the left ventricle during coronary artery bypass grafting by transesophageal speckle-tracking echocardiography,and to assess the effect of sevoflurane on cardiac function.Sixty-four patients scheduled for the off-pump coronary artery bypass grafting were randomly divided into a sevoflurane-based anesthesia(AS)group and a propofolbased total intravenous anesthesia(AA)group.The AS group demonstrated a higher absolute value of left ventricular global longitudinal strain than that of the AA group at both T1(after harvesting all grafts and before coronary anastomosis)and T_(2)(30 min after completing all coronary anastomoses)(P<0.05).Moreover,strain improvement in the segment with the highest preoperative strain was significantly reduced in the AS group,compared with the AA group at both T1 and T_(2)(P<0.01).The flow of the left internal mammary artery-left anterior descending artery graft was superior,and the postoperative concentration of troponin T decreased rapidly in the AS group,compared with the AA group(P<0.05).Compared with total intravenous anesthesia,sevoflurane resulted in a significantly higher global longitudinal strain,stroke volume,and cardiac output.Sevoflurane also led to an amelioration in the condition of the arterial graft.Furthermore,sevoflurane significantly reduced strain improvement in the segmental myocardium with a high preoperative strain value.The findings need to be replicated in larger studies.展开更多
The population aged 60 and over in China reached approximately 297 million in 2023 according to the National Bureau of Statistics,accounting for 21.1%of the national population.The population aged 65 and over was abou...The population aged 60 and over in China reached approximately 297 million in 2023 according to the National Bureau of Statistics,accounting for 21.1%of the national population.The population aged 65 and over was about 217 million,accounting for 15.4%[1].It is estimated that by 2035,China will have an elderly population of over 400 million,accounting for more than 30%of the total population,thereby entering a stage of severe aging.Aging brings many challenges to the society,especially in terms of medical care for elderly patients.The continuous advancement of science and technology,especially the breakthrough in basic research as well as new technologies and interdisciplinary integration,has brought new opportunities for the development of various professional fields.To better address the challenges of anesthesia and perioperative medicine in the aging era and to accelerate the rehabilitation of patients while maintaining life and health services,it is crucial to promote interdisciplinary integration.展开更多
Chaperone-mediated autophagy is one of three types of autophagy and is characterized by the selective degradation of proteins.Chaperone-mediated autophagy contributes to energy balance and helps maintain cellular home...Chaperone-mediated autophagy is one of three types of autophagy and is characterized by the selective degradation of proteins.Chaperone-mediated autophagy contributes to energy balance and helps maintain cellular homeostasis,while providing nutrients and support for cell survival.Chaperone-mediated autophagy activity can be detected in almost all cells,including neurons.Owing to the extreme sensitivity of neurons to their environmental changes,maintaining neuronal homeostasis is critical for neuronal growth and survival.Chaperone-mediated autophagy dysfunction is closely related to central nervous system diseases.It has been shown that neuronal damage and cell death are accompanied by chaperone-mediated autophagy dysfunction.Under certain conditions,regulation of chaperone-mediated autophagy activity attenuates neurotoxicity.In this paper,we review the changes in chaperone-mediated autophagy in neurodegenerative diseases,brain injury,glioma,and autoimmune diseases.We also summarize the most recent research progress on chaperone-mediated autophagy regulation and discuss the potential of chaperone-mediated autophagy as a therapeutic target for central nervous system diseases.展开更多
Background: As much as 80% of US adults search online for health related information. The value of the information is limited by the patients’ ability to comprehend it. Despite the recommendation by the American Medi...Background: As much as 80% of US adults search online for health related information. The value of the information is limited by the patients’ ability to comprehend it. Despite the recommendation by the American Medical Association (AMA) to provide all patient education materials (PEMs) at a 6th grade reading level, many online sources do not conform. This study aims to evaluate the readability of PEMs from major online sources for anesthesiology. Methods: We determined the readability of PEMs from five major anesthesiology organizations and twelve brochures from the American Society of Anesthesiologists (ASA) using ten validated readability scales. PEMs from the various anesthesiology websites were compiled into a single word document for analysis. The twelve patient education brochures from the ASA were downloaded and analyzed separately. We then grouped the twelve documents into one sample and compared it to the other anesthesiology association websites. Results: All of the PEMs provided by the ASA were determined to be higher than a 6th grade reading level with nine being at a 12th grade reading level or above. The PEMs of the five major anesthesiology association websites were beyond the 6th grade reading level with four out of five at greater than the 12th grade reading level. Conclusion: The results showed that the readability of PEMs provided by five major anesthesiology associations and the ASA was beyond the 6th grade. Therefore, the PEMs with improved readability in anesthesiology are needed.展开更多
BACKGROUND There is concern regarding potential long-term cardiotoxicity with systemic distribution of metals in total joint arthroplasty(TJA)patients.AIM To determine the association of commonly used implant metals w...BACKGROUND There is concern regarding potential long-term cardiotoxicity with systemic distribution of metals in total joint arthroplasty(TJA)patients.AIM To determine the association of commonly used implant metals with echocardiographic measures in TJA patients.METHODS The study comprised 110 TJA patients who had a recent history of high chromium,cobalt or titanium concentrations.Patients underwent two-dimensional,three-dimensional,Doppler and speckle-strain transthoracic echocardiography and a blood draw to measure metal concentrations.Age and sex-adjusted linear and logistic regression models were used to examine the association of metal concentrations(exposure)with echocardiographic measures(outcome).RESULTS Higher cobalt concentrations were associated with increased left ventricular end-diastolic volume(estimate 5.09;95%CI:0.02-10.17)as well as left atrial and right ventricular dilation,particularly in men but no changes in cardiac function.Higher titanium concentrations were associated with a reduction in left ventricle global longitudinal strain(estimate 0.38;95%CI:0.70 to 0.06)and cardiac index(estimate 0.08;95%CI,-0.15 to-0.01).CONCLUSION Elevated cobalt and titanium concentrations may be associated with structural and functional cardiac changes in some patients.Longitudinal studies are warranted to better understand the systemic effects of metals in TJA patients.展开更多
AIM To examine whether high-flow nasal oxygen(HFNO) availability influences the use of general anesthesia(GA) in patients undergoing endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic ultrasound(EUS) ...AIM To examine whether high-flow nasal oxygen(HFNO) availability influences the use of general anesthesia(GA) in patients undergoing endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic ultrasound(EUS) and associated outcomes.METHODS In this retrospective study, patients were stratified into 3 eras between October 1, 2013 and June 30, 2014 based on HFNO availability for deep sedation at the time of their endoscopy. During the first and last 3-mo eras(era 1 and 3), no HFNO was available, whereas it was an option during the second 3-mo era(era 2). The primary outcome was the percent utilization of GA vs deep sedation in each period. Secondary outcomes included oxygen saturation nadir during sedation between periods, as well as procedure duration, and anesthesia-only time between periods and for GA vs sedation cases respectively.RESULTS During the study period 238 ERCP or EUS cases were identified for analysis. Statistical testing was employed and a P < 0.050 was significant unless the Bonferroni correction for multiple comparisons was used. General anesthesia use was significantly lower in era 2 compared to era 1 with the same trend between era 2 and 3(P = 0.012 and 0.045 respectively). The oxygen saturation nadir during sedation was significantly higher in era 2 compared to era 3(P < 0.001) but not between eras 1 and 2(P = 0.028) or 1 and 3(P = 0.069). The procedure time within each era was significantly longer under GA compared to deep sedation(P ≤ 0.007) as was the anesthesia-only time(P ≤ 0.001).CONCLUSION High-flow nasal oxygen availability was associated with decreased GA utilization and improved oxygenation for ERCP and EUS during sedation.展开更多
The progress of modern medicine would be impossible without the use of general anesthetics(GAs).Despite advancements in refining anesthesia approaches,the effects of GAs are not fully reversible upon GA withdrawal.Neu...The progress of modern medicine would be impossible without the use of general anesthetics(GAs).Despite advancements in refining anesthesia approaches,the effects of GAs are not fully reversible upon GA withdrawal.Neurocognitive deficiencies attributed to GA exposure may persist in neonates or endure for weeks to years in the elderly.Human studies on the mechanisms of the long-term adverse effects of GAs are needed to improve the safety of general anesthesia but they are hampered not only by ethical limitations specific to human research,but also by a lack of specific biological markers that can be used in human studies to safely and objectively study such effects.The latter can primarily be attributed to an insufficient understanding of the full range of the biological effects induced by GAs and the molecular mechanisms mediating such effects even in rodents,which are far more extensively studied than any other species.Our most recent experimental findings in rodents suggest that GAs may adversely affect many more people than is currently anticipated.Specifically,we have shown that anesthesia with the commonly used GA sevoflurane induces in exposed animals not only neuroendocrine abnormalities(somatic effects),but also epigenetic reprogramming of germ cells(germ cell effects).The latter may pass the neurobehavioral effects of parental sevoflurane exposure to the offspring,who may be affected even at levels of anesthesia that are not harmful to the exposed parents.The large number of patients who require general anesthesia,the even larger number of their future unexposed offspring whose health may be affected,and a growing number of neurodevelopmental disorders of unknown etiology underscore the translational importance of investigating the intergenerational effects of GAs.In this mini review,we discuss emerging experimental findings on neuroendocrine,epigenetic,and intergenerational effects of GAs.展开更多
Objective:To investigate the anti-angiogenic effect of tea polyphenols(TPS)on breast cancer and normal tissues in a mouse model.Methods:Breast cancer was successfully implanted into 48 BALB/c mice,which were then rand...Objective:To investigate the anti-angiogenic effect of tea polyphenols(TPS)on breast cancer and normal tissues in a mouse model.Methods:Breast cancer was successfully implanted into 48 BALB/c mice,which were then randomly divided into a TP oral gavage group,a TP local injection group,a ginsenoside Rg3 group,and a model control group according to a random number table.The tumor inhibitory rates of each group were calculated,while microvessel density(MVD)and the expression of vascular endothelial growth factor(VEGF),basic fibroblast growth factor(bFGF),and tissue inhibitor of metalloproteinase(TIMP-2)were detected by immunohistochemistry.Results:TPs could inhibit the growth of breast cancer xenografts in the mouse model.The tumor inhibition rates of the TP oral gavage and TP local injection groups were 37.43%and 40.94%,respectively.Compared with the model control group,MVD and VEGF and bFGF expression was downregulated(all P<.05),whereas TIMP-2 expression was elevated in the TP oral gavage and TP local injection groups(P=.015 and P=.032).TPs showed no significant effect on MVD and VEGF and TIMP-2 expression in the heart,brain,and kidney of the mouse model.Conclusion:TPs can restrict the growth of breast cancer by specifically inhibiting the angiogenesis of breast tumor tissue while having little effect on the normal tissue of important organs including the heart,brain,and kidney.展开更多
BACKGROUND Transversus abdominis plane block(TAPB)is a block of the abdominal afferent nerve fibers between the internal oblique muscle and the transverse abdominal muscle achieved with local anesthetics.It can effect...BACKGROUND Transversus abdominis plane block(TAPB)is a block of the abdominal afferent nerve fibers between the internal oblique muscle and the transverse abdominal muscle achieved with local anesthetics.It can effectively block the conduction of the anterior nerve of the abdominal wall and exert a good analgesic effect.However,the effect of combining the block with remimazolam on anesthesia in patients undergoing gastrointestinal tumor surgery is still unclear.AIM To examine the effects of combining TAPB with remimazolam on the stress response and postoperative recovery of gastrointestinal tumor surgery patients.METHODS A retrospective analysis was conducted on the clinical data of 102 individuals diagnosed with gastrointestinal malignancies who underwent laparoscopic surgery under general anesthesia between April 2020 and June 2023.The patients were categorized into a control group(n=51),receiving remimazolam for general anesthesia,and an observation group(n=51),receiving TAPB combined with remimazolam for general anesthesia.A comparison was made between both groups in terms of hemodynamic parameters,stress markers,pain levels,recovery quality,analgesic effects,and adverse reactions during the perioperative period.RESULTS The observation group had significantly higher heart rates at time points 1 min after induction and upon leaving the operating room than the control group(P<0.05).The mean arterial pressure at time point T1 in the observation group was significantly higher than that in the control group(P<0.05).Five minutes after extubation,the levels of the hormones adrenaline and noradrenaline in the observation group were considerably lower than those in the control group(P<0.05).At 12 h,24 h,and 48 h following surgery,the visual analog scale scores of the observation group were considerably lower than those of the control group(P<0.05).The observation group had shorter awakening and extubation times and lower Riker sedation-agitation scale scores than the control group(P<0.05).The observation group exhibited considerably fewer effective pump presses,lower fentanyl dosages,and lower incidences of rescue analgesia within 24 h following surgery than the control group(P<0.05).CONCLUSION The application effect of TAPB combined with remimazolam general anesthesia in anesthesia of patients undergoing gastrointestinal tumor surgery is good,which is helpful to promote faster recovery after operation.展开更多
Objective:Tto investigate the effects of positive end-expiratory pressure(PEEP)ventilation on central venous pressure(CVP)and intraoperative blood loss in patients undergoing laparoscopic hepatectomy.Methods:46 cases ...Objective:Tto investigate the effects of positive end-expiratory pressure(PEEP)ventilation on central venous pressure(CVP)and intraoperative blood loss in patients undergoing laparoscopic hepatectomy.Methods:46 cases of patients undergoing laparoscopic hepatectomy,25 cases of male,female 21 cases,ASAⅠ~Ⅲlevel,were randomly divided into two groups.In group A tidal volume was set to 6 ml/kg(Predicted Body Weight,PBW)and PEEP was set to 0 cmH2O.The tidal volume of group B was set as group A,PEEP was set to 8 cmH2O.CVP,MAP,and Ppeak were recorded in the supine position after intubation(T0),supine position after pneumoperitoneal(T1),anti-trendelenberg position after pneumoperitoneal(T2),supine position after surgery(T3),and Ddyn was calculated.The amount of nitroglycerin and the amount of blood loss were recorded.Results:Compared with group A,the CVP of group B was significantly increased at T1 and T2(P<0.05).Compared to T2 with T1 in group A and group B,CVP was decreased significantly(P<0.05).At T3,Cdyn in group B was significantly higher than that in group A(P<0.05).The amount of nitroglycerin in group B was significantly higher than that in group A(P<0.05).There was no significant difference in intraoperative fluid rehydration and blood loss between the two groups(P>0.05).Conclusion:PEEP with 8cmH2O can improve Ddyn in patients undergoing laparoscopic hepatectomy,but increased CVP.It requires more use of controlled low central venous pressure techniques to reduce intraoperative blood loss.展开更多
Methicillin-resistant Staphylococcus aureus(MRSA)has remained a major threat to healthcare;in both hospital and community settings over the past five decades.With the current use of antibiotics for a variety of infect...Methicillin-resistant Staphylococcus aureus(MRSA)has remained a major threat to healthcare;in both hospital and community settings over the past five decades.With the current use of antibiotics for a variety of infections,including MRSA,emerging resistance is a major concern.Currently available treatments have restrictions limiting their use.These issues include,but are not limited to,side effects,cross-resistance,lack of understanding of pharmacokinetics and clinical pharmacodynamics,gradual increment in minimal inhibitory concentration over the period(MIC creep)and ineffectiveness in dealing with bacterial biofilms.Despite availability of various therapeutic options for MRSA,the clinical cure rates remain low with high morbidity and mortality.Given these challenges with existing treatments,there is a need for development of novel agents for MRSA.Along with prompt infection control strategies and strict implementation of antibiotic stewardship,cautious use of newer anti-MRSA agents will be of utmost importance.This article reviews the treatments and limitations of MRSA management and highlights the future path.展开更多
Study Objective: To assess the accuracy of respiration rate measurements and the ability to detect apnea by capnometry, impedance pneumography and a new method, acoustic respiration rate monitoring, in anesthetized pa...Study Objective: To assess the accuracy of respiration rate measurements and the ability to detect apnea by capnometry, impedance pneumography and a new method, acoustic respiration rate monitoring, in anesthetized patients undergoing gastrointestinal endoscopy procedures. Design: Prospective observational study. Setting: Endoscopy procedures laboratory. Patients: 98 patients scheduled for upper gastrointestinal endoscopy with propofol-based anesthesia. Interventions: Patients were monitored for respiration rate with acoustic respiration rate monitoring, capnometry and impedance pneumography and values were compared to the manual counting of breaths by observation of chest wall movements. Additionally, when any respiration rate monitor indicated a cessation of breathing for 30 seconds or greater, the presumed apnea was confirmed by direct observation of the patient for absence of chest wall movements. Measurements and Main Results: Bias and precision for respiration rate measurement was 0 ± 1.0 bpm for acoustic monitoring, 4.8 ± 15.1 bpm for capnometry and 0.4 ± 5.9 bpm for impedance pneumography. Sensitivity and specificity for detection of apnea was 73% and 93% for acoustic monitoring, 73% and 12% for capnometry and 45% and 93% for impedance pneumography. Conclusions: Acoustic respiration rate monitoring was found to be accurate for assessment of respiration rate and to have similar or better sensitivity and specificity for detection of apnea compared to capnometry and impedance pneumography in the setting of upper GI endoscopy.展开更多
The most effective treatment for postoperative pain is to reduce it by preventing or reducing the sensitivity and sensory disturbance on the central nervous system during the operation,prolonging the pain-relief time ...The most effective treatment for postoperative pain is to reduce it by preventing or reducing the sensitivity and sensory disturbance on the central nervous system during the operation,prolonging the pain-relief time and reducing the use of analgesics.Preemptive analgesia refers to the intervention of central neuraxis sensitization and peripheral sensitization to prevent the expansion and spread of pain,so as to achieve postoperative pain-relief.In postoperative patient-controlled analgesia,preemptive analgesia has become a common treatment method for anesthesiologists.However,the clinical specifications for advanced analgesia are still lacking.Based on this,this paper reviews the use of advanced analgesia drugs and their clinical applications.展开更多
Although antipsychotics that act via monoaminergic neurotransmitter modulation have considera ble therapeutic effect,they cannot completely relieve clinical symptoms in patients suffering from psychiatric disorde rs.T...Although antipsychotics that act via monoaminergic neurotransmitter modulation have considera ble therapeutic effect,they cannot completely relieve clinical symptoms in patients suffering from psychiatric disorde rs.This may be attributed to the limited range of neurotransmitters that are regulated by psychotropic drugs.Recent findings indicate the need for investigation of psychotropic medications that target less-studied neurotransmitte rs.Among these candidate neurotransmitters,lactate is developing from being a waste metabolite to a glial-neuronal signaling molecule in recent years.Previous studies have suggested that cerebral lactate levels change considerably in numerous psychiatric illnesses;animal experiments have also shown that the supply of exogenous la ctate exerts an antidepressant effect.In this review,we have described how medications targeting newer neurotransmitte rs offer promise in psychiatric diseases;we have also summarized the advances in the use of lactate(and its corresponding signaling pathways)as a signaling molecule.In addition,we have described the alterations in brain lactate levels in depression,anxiety,bipolar disorder,and schizophrenia and have indicated the challenges that need to be overcome before brain lactate can be used as a therapeutic target in psychopharmacology.展开更多
Intravenous(IV)vasopressors are essential in the management of hypotension and shock.Initiation of oral vasoactive agents to facilitate weaning of IV vasopressors to liberate patients from the intensive care unit is c...Intravenous(IV)vasopressors are essential in the management of hypotension and shock.Initiation of oral vasoactive agents to facilitate weaning of IV vasopressors to liberate patients from the intensive care unit is common despite conflicting evidence regarding the benefits of this practice.While midodrine appears to be the most frequently studied oral vasoactive agent for this purpose,its adverse effect profile may preclude its use in certain populations.In addition,some patients may require persistent use of IV vasopressors for hypotension refractory to midodrine.The use of additional and alternative oral vasoactive agents bearing different mechanisms of action is emerging.This article provides a comprehensive review of the pharmacology,clinical uses,dosing strategies,and safety considerations of oral vasoactive agents and their application in the inten-sive care setting.展开更多
BACKGROUND With advancements in the diagnosis and treatment of lung diseases,lung segment surgery has become increasingly common.Postoperative rehabilitation is critical for patient recovery,yet challenges such as com...BACKGROUND With advancements in the diagnosis and treatment of lung diseases,lung segment surgery has become increasingly common.Postoperative rehabilitation is critical for patient recovery,yet challenges such as complications and adverse outcomes persist.Incorporating humanized nursing modes and novel treatments like nitric oxide inhalation may enhance recovery and reduce postoperative complications.AIM To evaluate the effects of a humanized nursing mode combined with nitric oxide inhalation on the rehabilitation outcomes of patients undergoing lung surgery,focusing on pulmonary function,recovery speed,and overall treatment costs.METHODS A total of 79 patients who underwent lung surgery at a tertiary hospital from March 2021 to December 2021 were divided into a control group(n=39)receiving a routine nursing program and an experimental group(n=40)receiving additional humanized nursing interventions and atomized inhalation of nitric oxide.Key indicators were compared between the two groups alongside an analysis of treatment costs.RESULTS The experimental group demonstrated significant improvements in pulmonary function,reduced average recovery time,and lower total treatment costs compared to the control group.Moreover,the quality of life in the experimental group was significantly better in the 3 months post-surgery,indicating a more effective rehabilitation process.CONCLUSION The combination of humanized nursing mode and nitric oxide inhalation in postoperative care for lung surgery patients significantly enhances pulmonary rehabilitation outcomes,accelerates recovery,and reduces economic burden.This approach offers a promising reference for improving patient care and rehabilitation efficiency following lung surgery.展开更多
Widespread implementation of electronic health records has led to the increased use of artificial intelligence(AI)and computer modeling in clinical medicine.The early recognition and treatment of critical illness are ...Widespread implementation of electronic health records has led to the increased use of artificial intelligence(AI)and computer modeling in clinical medicine.The early recognition and treatment of critical illness are central to good outcomes but are made difficult by,among other things,the complexity of the environment and the often non-specific nature of the clinical presentation.Increasingly,AI applications are being proposed as decision supports for busy or distracted clinicians,to address this challenge.Data driven“associative”AI models are built from retrospective data registries with missing data and imprecise timing.Associative AI models lack transparency,often ignore causal mechanisms,and,while potentially useful in improved prognostication,have thus far had limited clinical applicability.To be clinically useful,AI tools need to provide bedside clinicians with actionable knowledge.Explicitly addressing causal mechanisms not only increases validity and replicability of the model,but also adds transparency and helps gain trust from the bedside clinicians for real world use of AI models in teaching and patient care.展开更多
BACKGROUND With the recent change in the definition(Sepsis-3 Definition)of sepsis and septic shock,an electronic search algorithm was required to identify the cases for data automation.This supervised machine learning...BACKGROUND With the recent change in the definition(Sepsis-3 Definition)of sepsis and septic shock,an electronic search algorithm was required to identify the cases for data automation.This supervised machine learning method would help screen a large amount of electronic medical records(EMR)for efficient research purposes.AIM To develop and validate a computable phenotype via supervised machine learning method for retrospectively identifying sepsis and septic shock in critical care patients.METHODS A supervised machine learning method was developed based on culture orders,Sequential Organ Failure Assessment(SOFA)scores,serum lactate levels and vasopressor use in the intensive care units(ICUs).The computable phenotype was derived from a retrospective analysis of a random cohort of 100 patients admitted to the medical ICU.This was then validated in an independent cohort of 100 patients.We compared the results from computable phenotype to a gold standard by manual review of EMR by 2 blinded reviewers.Disagreement was resolved by a critical care clinician.A SOFA score≥2 during the ICU stay with a culture 72 h before or after the time of admission was identified.Sepsis versions as V1 was defined as blood cultures with SOFA≥2 and Sepsis V2 was defined as any culture with SOFA score≥2.A serum lactate level≥2 mmol/L from 24 h before admission till their stay in the ICU and vasopressor use with Sepsis-1 and-2 were identified as Septic Shock-V1 and-V2 respectively.RESULTS In the derivation subset of 100 random patients,the final machine learning strategy achieved a sensitivity-specificity of 100%and 84%for Sepsis-1,100%and 95%for Sepsis-2,78%and 80%for Septic Shock-1,and 80%and 90%for Septic Shock-2.An overall percent of agreement between two blinded reviewers had a k=0.86 and 0.90 for Sepsis 2 and Septic shock 2 respectively.In validation of the algorithm through a separate 100 random patient subset,the reported sensitivity and specificity for all 4 diagnoses were 100%-100%each.CONCLUSION Supervised machine learning for identification of sepsis and septic shock is reliable and an efficient alternative to manual chart review.展开更多
文摘Objective: To explore and analyze the effect of the WeChat platform combined with the PBL teaching method in the standardized training of anesthesia residents. Methods: 120 anesthesiology residents from January 2018 to the end of December 2019 were selected, and divided into a control group and an observation group of 60 each according to the time sequence of admission. The control group adopted the conventional teaching mode, and the observation group adopted the WeChat platform combined PBL teaching method. The scores of theoretical knowledge and anesthesia skills operation after training, the scores of the teaching interest survey, and the satisfaction with the teaching mode between the two groups were compared. Results: The scores of theoretical knowledge and anesthesia skills operation in the observation group were significantly higher than those in the control group, and the indicators of teaching interest in the observation group were also higher than those in the control group. The differences were statistically significant (P < 0.05). The satisfaction degree of the observation group was significantly higher than that of the control group, and the difference was also statistically significant (P < 0.05). Conclusion: The WeChat platform combined with the PBL teaching method is beneficial to improve the training effect of anesthesiology residents, stimulating autonomous learning ability, ensuring the effective practice of theoretical knowledge, and promoting them to move towards a higher standard of anesthesia skills.
文摘The current study aimed to compare the effects between remimazolam and propofol on hemodynamic stability during the induction of general anesthesia in elderly patients.We used propofol at a rate of 60 mg/(kg·h)in the propofol group(group P)or remimazolam at a rate of 6 mg/(kg·h)in the remimazolam group(group R)for the induction.A processed electroencephalogram was used to determine whether the induction was successful and when to stop the infusion of the study drug.We measured when patients entered the operating room(T_(0)),when the induction was successful(T_(1)),and when before(T_(2))and 5 min after successful endotracheal intubation(T_(3)).We found that mean arterial pressure(MAP)was lower at T_(1–3),compared with T_(0) in both groups,but higher at T_(2) in the group R,whileΔMAP_(T0–T2) andΔMAP_(max) were smaller in the group R(ΔMAP_(T0–T2):the difference between MAP at time point T_(0) and T_(2),ΔMAP_(max):the difference between MAP at time point T_(0) and the lowest value from T_(0) to T_(3)).Cardiac index and stroke volume index did not differ between groups,whereas systemic vascular resistance index was higher at T_(1–3) in the group R.These findings show that remimazolam,compared with propofol,better maintains hemodynamic stability during the induction,which may be attributed to its ability to better maintain systemic vascular resistance levels.
基金supported by Jiangsu Province Hospital(the First Affiliated Hospital of Nanjing Medical University)Clinical Capacity Enhancement and was awarded to the first author,Chanjuan Gong(Grant No.JSPH-MC-2022-4).
文摘The present study aimed to dynamically observe the segmental and global myocardial movements of the left ventricle during coronary artery bypass grafting by transesophageal speckle-tracking echocardiography,and to assess the effect of sevoflurane on cardiac function.Sixty-four patients scheduled for the off-pump coronary artery bypass grafting were randomly divided into a sevoflurane-based anesthesia(AS)group and a propofolbased total intravenous anesthesia(AA)group.The AS group demonstrated a higher absolute value of left ventricular global longitudinal strain than that of the AA group at both T1(after harvesting all grafts and before coronary anastomosis)and T_(2)(30 min after completing all coronary anastomoses)(P<0.05).Moreover,strain improvement in the segment with the highest preoperative strain was significantly reduced in the AS group,compared with the AA group at both T1 and T_(2)(P<0.01).The flow of the left internal mammary artery-left anterior descending artery graft was superior,and the postoperative concentration of troponin T decreased rapidly in the AS group,compared with the AA group(P<0.05).Compared with total intravenous anesthesia,sevoflurane resulted in a significantly higher global longitudinal strain,stroke volume,and cardiac output.Sevoflurane also led to an amelioration in the condition of the arterial graft.Furthermore,sevoflurane significantly reduced strain improvement in the segmental myocardium with a high preoperative strain value.The findings need to be replicated in larger studies.
文摘The population aged 60 and over in China reached approximately 297 million in 2023 according to the National Bureau of Statistics,accounting for 21.1%of the national population.The population aged 65 and over was about 217 million,accounting for 15.4%[1].It is estimated that by 2035,China will have an elderly population of over 400 million,accounting for more than 30%of the total population,thereby entering a stage of severe aging.Aging brings many challenges to the society,especially in terms of medical care for elderly patients.The continuous advancement of science and technology,especially the breakthrough in basic research as well as new technologies and interdisciplinary integration,has brought new opportunities for the development of various professional fields.To better address the challenges of anesthesia and perioperative medicine in the aging era and to accelerate the rehabilitation of patients while maintaining life and health services,it is crucial to promote interdisciplinary integration.
基金supported by the National Nature Science Foundation of China,Nos.81871603(to XZ)and 82171322(to ZF)Discipline Boost Program of the First Affiliated Hospital of Air Force Military Medical University,No.XJZT21J08(to XZ)the Natural Science Foundation of Shaanxi Province of China,No.2022KJXX-102(to ZF)。
文摘Chaperone-mediated autophagy is one of three types of autophagy and is characterized by the selective degradation of proteins.Chaperone-mediated autophagy contributes to energy balance and helps maintain cellular homeostasis,while providing nutrients and support for cell survival.Chaperone-mediated autophagy activity can be detected in almost all cells,including neurons.Owing to the extreme sensitivity of neurons to their environmental changes,maintaining neuronal homeostasis is critical for neuronal growth and survival.Chaperone-mediated autophagy dysfunction is closely related to central nervous system diseases.It has been shown that neuronal damage and cell death are accompanied by chaperone-mediated autophagy dysfunction.Under certain conditions,regulation of chaperone-mediated autophagy activity attenuates neurotoxicity.In this paper,we review the changes in chaperone-mediated autophagy in neurodegenerative diseases,brain injury,glioma,and autoimmune diseases.We also summarize the most recent research progress on chaperone-mediated autophagy regulation and discuss the potential of chaperone-mediated autophagy as a therapeutic target for central nervous system diseases.
文摘Background: As much as 80% of US adults search online for health related information. The value of the information is limited by the patients’ ability to comprehend it. Despite the recommendation by the American Medical Association (AMA) to provide all patient education materials (PEMs) at a 6th grade reading level, many online sources do not conform. This study aims to evaluate the readability of PEMs from major online sources for anesthesiology. Methods: We determined the readability of PEMs from five major anesthesiology organizations and twelve brochures from the American Society of Anesthesiologists (ASA) using ten validated readability scales. PEMs from the various anesthesiology websites were compiled into a single word document for analysis. The twelve patient education brochures from the ASA were downloaded and analyzed separately. We then grouped the twelve documents into one sample and compared it to the other anesthesiology association websites. Results: All of the PEMs provided by the ASA were determined to be higher than a 6th grade reading level with nine being at a 12th grade reading level or above. The PEMs of the five major anesthesiology association websites were beyond the 6th grade reading level with four out of five at greater than the 12th grade reading level. Conclusion: The results showed that the readability of PEMs provided by five major anesthesiology associations and the ASA was beyond the 6th grade. Therefore, the PEMs with improved readability in anesthesiology are needed.
基金Supported by The National Institutes of Health,No.R01HL147155 and No.R01AG060920.
文摘BACKGROUND There is concern regarding potential long-term cardiotoxicity with systemic distribution of metals in total joint arthroplasty(TJA)patients.AIM To determine the association of commonly used implant metals with echocardiographic measures in TJA patients.METHODS The study comprised 110 TJA patients who had a recent history of high chromium,cobalt or titanium concentrations.Patients underwent two-dimensional,three-dimensional,Doppler and speckle-strain transthoracic echocardiography and a blood draw to measure metal concentrations.Age and sex-adjusted linear and logistic regression models were used to examine the association of metal concentrations(exposure)with echocardiographic measures(outcome).RESULTS Higher cobalt concentrations were associated with increased left ventricular end-diastolic volume(estimate 5.09;95%CI:0.02-10.17)as well as left atrial and right ventricular dilation,particularly in men but no changes in cardiac function.Higher titanium concentrations were associated with a reduction in left ventricle global longitudinal strain(estimate 0.38;95%CI:0.70 to 0.06)and cardiac index(estimate 0.08;95%CI,-0.15 to-0.01).CONCLUSION Elevated cobalt and titanium concentrations may be associated with structural and functional cardiac changes in some patients.Longitudinal studies are warranted to better understand the systemic effects of metals in TJA patients.
基金Supported by The Department of Anesthesiology and Perioperative Medicine,Tufts Medical Center,Boston,United States
文摘AIM To examine whether high-flow nasal oxygen(HFNO) availability influences the use of general anesthesia(GA) in patients undergoing endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic ultrasound(EUS) and associated outcomes.METHODS In this retrospective study, patients were stratified into 3 eras between October 1, 2013 and June 30, 2014 based on HFNO availability for deep sedation at the time of their endoscopy. During the first and last 3-mo eras(era 1 and 3), no HFNO was available, whereas it was an option during the second 3-mo era(era 2). The primary outcome was the percent utilization of GA vs deep sedation in each period. Secondary outcomes included oxygen saturation nadir during sedation between periods, as well as procedure duration, and anesthesia-only time between periods and for GA vs sedation cases respectively.RESULTS During the study period 238 ERCP or EUS cases were identified for analysis. Statistical testing was employed and a P < 0.050 was significant unless the Bonferroni correction for multiple comparisons was used. General anesthesia use was significantly lower in era 2 compared to era 1 with the same trend between era 2 and 3(P = 0.012 and 0.045 respectively). The oxygen saturation nadir during sedation was significantly higher in era 2 compared to era 3(P < 0.001) but not between eras 1 and 2(P = 0.028) or 1 and 3(P = 0.069). The procedure time within each era was significantly longer under GA compared to deep sedation(P ≤ 0.007) as was the anesthesia-only time(P ≤ 0.001).CONCLUSION High-flow nasal oxygen availability was associated with decreased GA utilization and improved oxygenation for ERCP and EUS during sedation.
基金Supported by National Institutes of Health,No.R01NS091542National Natural Science Foundation of China,No.81771149,No.U1704165。
文摘The progress of modern medicine would be impossible without the use of general anesthetics(GAs).Despite advancements in refining anesthesia approaches,the effects of GAs are not fully reversible upon GA withdrawal.Neurocognitive deficiencies attributed to GA exposure may persist in neonates or endure for weeks to years in the elderly.Human studies on the mechanisms of the long-term adverse effects of GAs are needed to improve the safety of general anesthesia but they are hampered not only by ethical limitations specific to human research,but also by a lack of specific biological markers that can be used in human studies to safely and objectively study such effects.The latter can primarily be attributed to an insufficient understanding of the full range of the biological effects induced by GAs and the molecular mechanisms mediating such effects even in rodents,which are far more extensively studied than any other species.Our most recent experimental findings in rodents suggest that GAs may adversely affect many more people than is currently anticipated.Specifically,we have shown that anesthesia with the commonly used GA sevoflurane induces in exposed animals not only neuroendocrine abnormalities(somatic effects),but also epigenetic reprogramming of germ cells(germ cell effects).The latter may pass the neurobehavioral effects of parental sevoflurane exposure to the offspring,who may be affected even at levels of anesthesia that are not harmful to the exposed parents.The large number of patients who require general anesthesia,the even larger number of their future unexposed offspring whose health may be affected,and a growing number of neurodevelopmental disorders of unknown etiology underscore the translational importance of investigating the intergenerational effects of GAs.In this mini review,we discuss emerging experimental findings on neuroendocrine,epigenetic,and intergenerational effects of GAs.
基金National Natural Science Foundation of China(30472280)and Independent innovation project of Capital Medical Development Research Fund/Traditional Chinese Medicine(SF-2009-III-13).
文摘Objective:To investigate the anti-angiogenic effect of tea polyphenols(TPS)on breast cancer and normal tissues in a mouse model.Methods:Breast cancer was successfully implanted into 48 BALB/c mice,which were then randomly divided into a TP oral gavage group,a TP local injection group,a ginsenoside Rg3 group,and a model control group according to a random number table.The tumor inhibitory rates of each group were calculated,while microvessel density(MVD)and the expression of vascular endothelial growth factor(VEGF),basic fibroblast growth factor(bFGF),and tissue inhibitor of metalloproteinase(TIMP-2)were detected by immunohistochemistry.Results:TPs could inhibit the growth of breast cancer xenografts in the mouse model.The tumor inhibition rates of the TP oral gavage and TP local injection groups were 37.43%and 40.94%,respectively.Compared with the model control group,MVD and VEGF and bFGF expression was downregulated(all P<.05),whereas TIMP-2 expression was elevated in the TP oral gavage and TP local injection groups(P=.015 and P=.032).TPs showed no significant effect on MVD and VEGF and TIMP-2 expression in the heart,brain,and kidney of the mouse model.Conclusion:TPs can restrict the growth of breast cancer by specifically inhibiting the angiogenesis of breast tumor tissue while having little effect on the normal tissue of important organs including the heart,brain,and kidney.
文摘BACKGROUND Transversus abdominis plane block(TAPB)is a block of the abdominal afferent nerve fibers between the internal oblique muscle and the transverse abdominal muscle achieved with local anesthetics.It can effectively block the conduction of the anterior nerve of the abdominal wall and exert a good analgesic effect.However,the effect of combining the block with remimazolam on anesthesia in patients undergoing gastrointestinal tumor surgery is still unclear.AIM To examine the effects of combining TAPB with remimazolam on the stress response and postoperative recovery of gastrointestinal tumor surgery patients.METHODS A retrospective analysis was conducted on the clinical data of 102 individuals diagnosed with gastrointestinal malignancies who underwent laparoscopic surgery under general anesthesia between April 2020 and June 2023.The patients were categorized into a control group(n=51),receiving remimazolam for general anesthesia,and an observation group(n=51),receiving TAPB combined with remimazolam for general anesthesia.A comparison was made between both groups in terms of hemodynamic parameters,stress markers,pain levels,recovery quality,analgesic effects,and adverse reactions during the perioperative period.RESULTS The observation group had significantly higher heart rates at time points 1 min after induction and upon leaving the operating room than the control group(P<0.05).The mean arterial pressure at time point T1 in the observation group was significantly higher than that in the control group(P<0.05).Five minutes after extubation,the levels of the hormones adrenaline and noradrenaline in the observation group were considerably lower than those in the control group(P<0.05).At 12 h,24 h,and 48 h following surgery,the visual analog scale scores of the observation group were considerably lower than those of the control group(P<0.05).The observation group had shorter awakening and extubation times and lower Riker sedation-agitation scale scores than the control group(P<0.05).The observation group exhibited considerably fewer effective pump presses,lower fentanyl dosages,and lower incidences of rescue analgesia within 24 h following surgery than the control group(P<0.05).CONCLUSION The application effect of TAPB combined with remimazolam general anesthesia in anesthesia of patients undergoing gastrointestinal tumor surgery is good,which is helpful to promote faster recovery after operation.
基金Young Medical Professionals of Jiangsu Commission of Health(No.QNRC2016586).
文摘Objective:Tto investigate the effects of positive end-expiratory pressure(PEEP)ventilation on central venous pressure(CVP)and intraoperative blood loss in patients undergoing laparoscopic hepatectomy.Methods:46 cases of patients undergoing laparoscopic hepatectomy,25 cases of male,female 21 cases,ASAⅠ~Ⅲlevel,were randomly divided into two groups.In group A tidal volume was set to 6 ml/kg(Predicted Body Weight,PBW)and PEEP was set to 0 cmH2O.The tidal volume of group B was set as group A,PEEP was set to 8 cmH2O.CVP,MAP,and Ppeak were recorded in the supine position after intubation(T0),supine position after pneumoperitoneal(T1),anti-trendelenberg position after pneumoperitoneal(T2),supine position after surgery(T3),and Ddyn was calculated.The amount of nitroglycerin and the amount of blood loss were recorded.Results:Compared with group A,the CVP of group B was significantly increased at T1 and T2(P<0.05).Compared to T2 with T1 in group A and group B,CVP was decreased significantly(P<0.05).At T3,Cdyn in group B was significantly higher than that in group A(P<0.05).The amount of nitroglycerin in group B was significantly higher than that in group A(P<0.05).There was no significant difference in intraoperative fluid rehydration and blood loss between the two groups(P>0.05).Conclusion:PEEP with 8cmH2O can improve Ddyn in patients undergoing laparoscopic hepatectomy,but increased CVP.It requires more use of controlled low central venous pressure techniques to reduce intraoperative blood loss.
文摘Methicillin-resistant Staphylococcus aureus(MRSA)has remained a major threat to healthcare;in both hospital and community settings over the past five decades.With the current use of antibiotics for a variety of infections,including MRSA,emerging resistance is a major concern.Currently available treatments have restrictions limiting their use.These issues include,but are not limited to,side effects,cross-resistance,lack of understanding of pharmacokinetics and clinical pharmacodynamics,gradual increment in minimal inhibitory concentration over the period(MIC creep)and ineffectiveness in dealing with bacterial biofilms.Despite availability of various therapeutic options for MRSA,the clinical cure rates remain low with high morbidity and mortality.Given these challenges with existing treatments,there is a need for development of novel agents for MRSA.Along with prompt infection control strategies and strict implementation of antibiotic stewardship,cautious use of newer anti-MRSA agents will be of utmost importance.This article reviews the treatments and limitations of MRSA management and highlights the future path.
文摘Study Objective: To assess the accuracy of respiration rate measurements and the ability to detect apnea by capnometry, impedance pneumography and a new method, acoustic respiration rate monitoring, in anesthetized patients undergoing gastrointestinal endoscopy procedures. Design: Prospective observational study. Setting: Endoscopy procedures laboratory. Patients: 98 patients scheduled for upper gastrointestinal endoscopy with propofol-based anesthesia. Interventions: Patients were monitored for respiration rate with acoustic respiration rate monitoring, capnometry and impedance pneumography and values were compared to the manual counting of breaths by observation of chest wall movements. Additionally, when any respiration rate monitor indicated a cessation of breathing for 30 seconds or greater, the presumed apnea was confirmed by direct observation of the patient for absence of chest wall movements. Measurements and Main Results: Bias and precision for respiration rate measurement was 0 ± 1.0 bpm for acoustic monitoring, 4.8 ± 15.1 bpm for capnometry and 0.4 ± 5.9 bpm for impedance pneumography. Sensitivity and specificity for detection of apnea was 73% and 93% for acoustic monitoring, 73% and 12% for capnometry and 45% and 93% for impedance pneumography. Conclusions: Acoustic respiration rate monitoring was found to be accurate for assessment of respiration rate and to have similar or better sensitivity and specificity for detection of apnea compared to capnometry and impedance pneumography in the setting of upper GI endoscopy.
文摘The most effective treatment for postoperative pain is to reduce it by preventing or reducing the sensitivity and sensory disturbance on the central nervous system during the operation,prolonging the pain-relief time and reducing the use of analgesics.Preemptive analgesia refers to the intervention of central neuraxis sensitization and peripheral sensitization to prevent the expansion and spread of pain,so as to achieve postoperative pain-relief.In postoperative patient-controlled analgesia,preemptive analgesia has become a common treatment method for anesthesiologists.However,the clinical specifications for advanced analgesia are still lacking.Based on this,this paper reviews the use of advanced analgesia drugs and their clinical applications.
基金financially supported by the National Nature Science Foundation of China,Nos.82271508(to YC)82001384(to YC)82271316(to HG)。
文摘Although antipsychotics that act via monoaminergic neurotransmitter modulation have considera ble therapeutic effect,they cannot completely relieve clinical symptoms in patients suffering from psychiatric disorde rs.This may be attributed to the limited range of neurotransmitters that are regulated by psychotropic drugs.Recent findings indicate the need for investigation of psychotropic medications that target less-studied neurotransmitte rs.Among these candidate neurotransmitters,lactate is developing from being a waste metabolite to a glial-neuronal signaling molecule in recent years.Previous studies have suggested that cerebral lactate levels change considerably in numerous psychiatric illnesses;animal experiments have also shown that the supply of exogenous la ctate exerts an antidepressant effect.In this review,we have described how medications targeting newer neurotransmitte rs offer promise in psychiatric diseases;we have also summarized the advances in the use of lactate(and its corresponding signaling pathways)as a signaling molecule.In addition,we have described the alterations in brain lactate levels in depression,anxiety,bipolar disorder,and schizophrenia and have indicated the challenges that need to be overcome before brain lactate can be used as a therapeutic target in psychopharmacology.
文摘Intravenous(IV)vasopressors are essential in the management of hypotension and shock.Initiation of oral vasoactive agents to facilitate weaning of IV vasopressors to liberate patients from the intensive care unit is common despite conflicting evidence regarding the benefits of this practice.While midodrine appears to be the most frequently studied oral vasoactive agent for this purpose,its adverse effect profile may preclude its use in certain populations.In addition,some patients may require persistent use of IV vasopressors for hypotension refractory to midodrine.The use of additional and alternative oral vasoactive agents bearing different mechanisms of action is emerging.This article provides a comprehensive review of the pharmacology,clinical uses,dosing strategies,and safety considerations of oral vasoactive agents and their application in the inten-sive care setting.
文摘BACKGROUND With advancements in the diagnosis and treatment of lung diseases,lung segment surgery has become increasingly common.Postoperative rehabilitation is critical for patient recovery,yet challenges such as complications and adverse outcomes persist.Incorporating humanized nursing modes and novel treatments like nitric oxide inhalation may enhance recovery and reduce postoperative complications.AIM To evaluate the effects of a humanized nursing mode combined with nitric oxide inhalation on the rehabilitation outcomes of patients undergoing lung surgery,focusing on pulmonary function,recovery speed,and overall treatment costs.METHODS A total of 79 patients who underwent lung surgery at a tertiary hospital from March 2021 to December 2021 were divided into a control group(n=39)receiving a routine nursing program and an experimental group(n=40)receiving additional humanized nursing interventions and atomized inhalation of nitric oxide.Key indicators were compared between the two groups alongside an analysis of treatment costs.RESULTS The experimental group demonstrated significant improvements in pulmonary function,reduced average recovery time,and lower total treatment costs compared to the control group.Moreover,the quality of life in the experimental group was significantly better in the 3 months post-surgery,indicating a more effective rehabilitation process.CONCLUSION The combination of humanized nursing mode and nitric oxide inhalation in postoperative care for lung surgery patients significantly enhances pulmonary rehabilitation outcomes,accelerates recovery,and reduces economic burden.This approach offers a promising reference for improving patient care and rehabilitation efficiency following lung surgery.
文摘Widespread implementation of electronic health records has led to the increased use of artificial intelligence(AI)and computer modeling in clinical medicine.The early recognition and treatment of critical illness are central to good outcomes but are made difficult by,among other things,the complexity of the environment and the often non-specific nature of the clinical presentation.Increasingly,AI applications are being proposed as decision supports for busy or distracted clinicians,to address this challenge.Data driven“associative”AI models are built from retrospective data registries with missing data and imprecise timing.Associative AI models lack transparency,often ignore causal mechanisms,and,while potentially useful in improved prognostication,have thus far had limited clinical applicability.To be clinically useful,AI tools need to provide bedside clinicians with actionable knowledge.Explicitly addressing causal mechanisms not only increases validity and replicability of the model,but also adds transparency and helps gain trust from the bedside clinicians for real world use of AI models in teaching and patient care.
文摘BACKGROUND With the recent change in the definition(Sepsis-3 Definition)of sepsis and septic shock,an electronic search algorithm was required to identify the cases for data automation.This supervised machine learning method would help screen a large amount of electronic medical records(EMR)for efficient research purposes.AIM To develop and validate a computable phenotype via supervised machine learning method for retrospectively identifying sepsis and septic shock in critical care patients.METHODS A supervised machine learning method was developed based on culture orders,Sequential Organ Failure Assessment(SOFA)scores,serum lactate levels and vasopressor use in the intensive care units(ICUs).The computable phenotype was derived from a retrospective analysis of a random cohort of 100 patients admitted to the medical ICU.This was then validated in an independent cohort of 100 patients.We compared the results from computable phenotype to a gold standard by manual review of EMR by 2 blinded reviewers.Disagreement was resolved by a critical care clinician.A SOFA score≥2 during the ICU stay with a culture 72 h before or after the time of admission was identified.Sepsis versions as V1 was defined as blood cultures with SOFA≥2 and Sepsis V2 was defined as any culture with SOFA score≥2.A serum lactate level≥2 mmol/L from 24 h before admission till their stay in the ICU and vasopressor use with Sepsis-1 and-2 were identified as Septic Shock-V1 and-V2 respectively.RESULTS In the derivation subset of 100 random patients,the final machine learning strategy achieved a sensitivity-specificity of 100%and 84%for Sepsis-1,100%and 95%for Sepsis-2,78%and 80%for Septic Shock-1,and 80%and 90%for Septic Shock-2.An overall percent of agreement between two blinded reviewers had a k=0.86 and 0.90 for Sepsis 2 and Septic shock 2 respectively.In validation of the algorithm through a separate 100 random patient subset,the reported sensitivity and specificity for all 4 diagnoses were 100%-100%each.CONCLUSION Supervised machine learning for identification of sepsis and septic shock is reliable and an efficient alternative to manual chart review.
