Articles: function.
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Minerva anestesiologica · May 2018
ReviewCommitted to be fit. The value of preoperative care in the perioperative medicine era.
In the era of perioperative medicine, important advances have been made in the perioperative care of patients, usually within those known as enhanced recovery after surgery (ERAS) protocols. These have led to a decrease in postoperative complications and the duration of hospital stays; however, there is still a lack of preoperative care, which could make perioperative medicine more prominent. Elderly patients, malnourished, anemic and ones with a low physical function before surgery are likely to have sub-optimal recovery from surgery. ⋯ Prehabilitation consists of exercise training and nutritional and psychological support, which increases the physiological reserve before surgical stress. The integration of exercise, adequate nutrition, anemia correction and psycho-social components, with multi-modal optimization in the preoperative period leads to an improvement in the functional capacity of the patients undergoing surgery, with the consequent improvement in terms of outcomes. The present article discusses specific aspects of preoperative care which are not well defined in the ERAS protocols and which represent fundamental shifts in surgical practice, including preoperative nutrition, management of preoperative anemia and prehabilitation.
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Hybrid imaging for ischemic heart disease refers to the fusion of information from a single or usually from multiple cardiovascular imaging modalities enabling synergistic assessment of the presence, the extent, and the severity of coronary atherosclerotic disease along with the hemodynamic significance of lesions and/or with evaluation of the myocardial function. A combination of coronary computed tomography angiography with myocardial perfusion imaging, such as single-photon emission computed tomography and positron emission tomography, has been adopted in several centers and implemented in international coronary artery disease management guidelines. Interest has increased in novel hybrid methods including coronary computed tomography angiography-derived fractional flow reserve and computed tomography perfusion and these techniques hold promise for the imminent diagnostic and management approaches of patients with coronary artery disease. In this review, we discuss the currently available hybrid noninvasive imaging modalities used in clinical practice, research approaches, and exciting potential future technological developments.
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Critical care medicine · May 2018
Long-Term Cognitive Outcome and Brain Imaging in Adults After Extracorporeal Membrane Oxygenation.
To investigate the presence of cognitive dysfunction and brain lesions in long-term survivors after treatment with extracorporeal membrane oxygenation for severe respiratory failure, and to see whether patients with prolonged hypoxemia were at increased risk. ⋯ Patients treated with extracorporeal membrane oxygenation for respiratory failure may have normal cognitive function years after treatment, if not affected by cerebrovascular lesions. Permissive hypoxemia was not correlated with long-term cognitive dysfunction in the present study. Further prospective studies with minimal loss to follow-up are direly needed to confirm our findings.
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Comparative Study
Benefit versus Severe Side Effects of Opioid Analgesia: Novel Utility Functions of Probability of Analgesia and Respiratory Depression.
Previous studies integrated opioid benefit and harm into one single function-the utility function-to determine the drug toxicity (respiratory depression) in light of its wanted effect (analgesia). This study further refined the concept of the utility function using the respiratory and analgesic effects of the opioid analgesic alfentanil as example. ⋯ The utility function was successfully further developed, allowing assessment of specific conditions in terms of wanted and unwanted effects. This approach can be used to compare the toxic effects of drugs relative to their intended effect and may be a useful tool in the development of new compounds to assess their advantage over existing drugs.
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Critical care medicine · May 2018
Urgent Chemotherapy in Sepsis-Like Shock Related to Hematologic Malignancies.
Hematologic malignancies may result in multiple organ involvement including pulmonary and renal dysfunctions, and the less common acute circulatory failure. We herein addressed the outcome of patients with sepsis-like shock related to aggressive hematologic malignancies. ⋯ Multiple organ dysfunction syndrome related to hematologic malignancies is associated with a dismal outcome. A chemotherapy trial may provide a fast prognostic assessment of the reversibility of organ failure.