Notes

Unsupervised Subspace Understanding With Versatile Neighboring.
This review compares and contrasts the pathophysiology of microcirculatory dysfunction in septic versus dengue shock and the attendant effects of fluid administration during resuscitation.
Current practice to only prioritize hepatocellular carcinoma (HCC) that fulfill the Milan criteria (IN
) is changing, since it causes the exclusion of patients who could benefit from liver transplantation. To select patients outside MC (OUT
) for transplantation, we implemented extended selection criteria without up-front morphometric restrictions containing surrogate parameters of tumor biology.

OUT
patients were considered without restrictions of morphometrics and received locoregional treatment after interdisciplinary consultation. Our dynamic selection criteria for OUT
patients required (IN
) (1) treatment response over (2) at least 6 months and (3) alpha-fetoprotein ≤400 ng/mL over the entire evaluation period. Patients with IN
tumors served as control and internal validation cohort.

31 of 170 liver transplant candidates were OUT
. Of these, 8 dropped out. The remaining 23 patients met the selection criteria and underwent transplantation. Recurrence-free survival was higher in patients transplanted IN
compared to those OUT
IN
(92.2% vs. 70.8%;
= 0.026) after 5 years of follow-up. Overall survival showed no significant difference (
= 0.552). With dynamic selection of transplant candidates, recurrence could also be predicted for the IN
patients as internal validation cohort (c-index 0.896; CI 0.588-0.981,
= 0.005).

Dynamic selection criteria for the stratification of patients with OUT
HCCs is feasible and allows for excellent long-term results and acceptable tumor recurrence rates comparable to IN
patients.
Dynamic selection criteria for the stratification of patients with OUTMC HCCs is feasible and allows for excellent long-term results and acceptable tumor recurrence rates comparable to INMC patients.
As a result of well-publicized studies, the nonsurgical antibiotic therapy of uncomplicated acute appendicitis has been propagated since 2006. A final assessment regarding efficiency and long-term results is not possible; however, nonoperative therapy of acute appendicitis is actually being discussed more diversely and receives a lot of attention. It is still unknown how far this therapy has found its way into everyday clinical care.

An online questionnaire was sent to 1,400 randomly selected specialists for general/visceral surgery in Germany. Representativeness was achieved by a preselection according to the geographical origin and the care level of the hospitals.

14% of surgeons stated that they methodically treat appendicitis conservatively. 38.1% do so in exceptional cases, while 48.8% reject this therapy. For methodically use, sonography or computed tomography is demanded beforehand. Nonoperative therapy is performed more often in metropolitan areas and maximum-care/university hospitals. Patients' request for antibiotic therapy is an important factor for conservative treatment. The main argument against this therapy is "medical doubts." 26% of the surgeons would treat their own appendicitis conservatively. There are distinct associations between the application of conservative therapy, satisfaction with it, and expectations about future development. The response rate was 19.9%.

The nonoperative antibiotic therapy of appendicitis is part of clinical practice in Germany. There are differences in preconditions as well as in the acceptance of this therapeutic option with a high proportion of general rejection.
The nonoperative antibiotic therapy of appendicitis is part of clinical practice in Germany. There are differences in preconditions as well as in the acceptance of this therapeutic option with a high proportion of general rejection.
Little is known about the improvement in defecation frequently reported by women around menses. We aimed to describe clinical, physiological, and psychological correlates of this improvement in those with functional bowel disorders.

We recruited 478 consecutive premenopausal adult females with no indication of gynecologic or psychiatric disease, who were attending an outpatient functional bowel disorders clinic. Patients completed a Rome III questionnaire, psychological evaluation stool form, and a 10-point Likert scale for constipation, diarrhea, bloating, and abdominal pain. These patients underwent physiological tests, anorectal manometry, and colonic transit time and were classified according to the presence or the absence of improvement in defecation during menses. The reverse selection procedure was used for model selection during multivariate logistic regression where statistically significant variables (
< 0.01) remained in the adjusted model.

Ninety-seven patients (20%) reported easier defecation during menstruation. These patients were younger (
< 0.001) but had similar body mass indices and psychological profiles as the other patients. Clinically, they only reported more frequent irritable bowel syndrome (IBS) with constipation (
= 0.007), with harder stools (
= 0.005) and delayed left colon transit time (
= 0.002). No anorectal manometric parameter was different between the 2 groups.

Improvement of constipation during menses is mainly associated with younger age and constipation-IBS phenotype and not with functional constipation.
Improvement of constipation during menses is mainly associated with younger age and constipation-IBS phenotype and not with functional constipation.
The aim of modern medicine is to safely classify diseases for successful therapy without invasive measures. Sonography, computed tomography (CT), and magnetic resonance imaging (MRI) are potent imaging techniques. However, without contrast medium, the informative value of the 3 native methods is limited. The advantages of sonography are no radiation exposure or previously known physically harmful interactions with tissue, proportionate disappearance of a contrast agent risk, no (probably irreversible) contrast agent deposits, and no risk of renal insufficiency. But, is that enough to compete with of even exceed CT and MRI?

In this review, the state of the art of contrast-enhanced ultrasound (CEUS) in the abdominal cavity is presented. The remarkable diagnostic possibilities can unfortunately only be demonstrated here in a small number of impressive, typical case studies underpinned by the literature, so that, from one's own perspective, the full spectrum of CEUS can be used by oneself or initiated. Withinnd thyroid exposure or excluded deposits.
Sonography very often enables reliable diagnostics. The introduction of a contrast agent in sonography has led to a quantum leap similar to that of other imaging techniques. Already natively, the real-time representation of dynamic events leads to a certain superiority, i.e., complete observation of the inflow and outflow phases of the contrast medium and the resulting diagnostic; tissue-specific differentiation options provide a unique selling point. Further advantages of the first-choice imaging diagnostic method are a lack of radiation exposure, repeatability of the examination at any time, local independence, a negligible allergy rate compared to the contrast agents of other methods, and a lack of kidney and thyroid exposure or excluded deposits.
A surgeon's technical skills are an important factor in delivering optimal patient care. Most existing methods to estimate technical skills remain subjective and resource intensive. Robotic-assisted surgery (RAS) provides a unique opportunity to develop objective metrics using key elements of intraoperative surgeon behavior which can be captured unobtrusively, such as instrument positions and button presses. Recent studies have shown that objective metrics based on these data (referred to as objective performance indicators [OPIs]) correlate to select clinical outcomes during robotic-assisted radical prostatectomy. However, the current OPIs remain difficult to interpret directly and, therefore, to use within structured feedback to improve surgical efficiencies.

We analyzed kinematic and event data from da Vinci surgical systems (Intuitive Surgical, Inc., Sunnyvale, CA, USA) to calculate values that can summarize the use of robotic instruments, referred to as OPIs. These indicators were mapped to broader tthodology to create interpretable metrics for key technical skills during clinical-like tasks when performing RAS. Using this framework for evaluating technical skills, we believe that surgical trainees can better understand both what can be improved and how to improve.
We define and validate a methodology to create interpretable metrics for key technical skills during clinical-like tasks when performing RAS. Using this framework for evaluating technical skills, we believe that surgical trainees can better understand both what can be improved and how to improve.
Multiple types of surgical cameras are used in modern surgical practice and provide a rich visual signal that is used by surgeons to visualize the clinical site and make clinical decisions. This signal can also be used by artificial intelligence (AI) methods to provide support in identifying instruments, structures, or activities both in real-time during procedures and postoperatively for analytics and understanding of surgical processes.

In this paper, we provide a succinct perspective on the use of AI and especially computer vision to power solutions for the surgical operating room (OR). The synergy between data availability and technical advances in computational power and AI methodology has led to rapid developments in the field and promising advances.

With the increasing availability of surgical video sources and the convergence of technologies around video storage, processing, and understanding, we believe clinical solutions and products leveraging vision are going to become an important component of modern surgical capabilities. However, both technical and clinical challenges remain to be overcome to efficiently make use of vision-based approaches into the clinic.
With the increasing availability of surgical video sources and the convergence of technologies around video storage, processing, and understanding, we believe clinical solutions and products leveraging vision are going to become an important component of modern surgical capabilities. However, both technical and clinical challenges remain to be overcome to efficiently make use of vision-based approaches into the clinic.
Artificial intelligence (AI) has recently achieved considerable success in different domains including medical applications. Although current advances are expected to impact surgery, up until now AI has not been able to leverage its full potential due to several challenges that are specific to that field.

This review summarizes data-driven methods and technologies needed as a prerequisite for different AI-based assistance functions in the operating room. Potential effects of AI usage in surgery will be highlighted, concluding with ongoing challenges to enabling AI for surgery.

AI-assisted surgery will enable data-driven decision-making via decision support systems and cognitive robotic assistance. The use of AI for workflow analysis will help provide appropriate assistance in the right context. selleck chemicals The requirements for such assistance must be defined by surgeons in close cooperation with computer scientists and engineers. Once the existing challenges will have been solved, AI assistance has the potential to improve patient care by supporting the surgeon without replacing him or her.
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