Search Results (5)

The development and adoption of minimally invasive techniques has revolutionized various surgical disciplines and has also been introduced into cardiac surgery, offering patients less invasive options with reduced trauma and faster recovery time compared to traditional open-heart procedures with sternotomy. This article provides a comprehensive overview of the anesthesiologic management for minimally invasive cardiac surgery (MICS), focusing on preoperative assessment, intraoperative anesthesia techniques, and postoperative care protocols. Anesthesia induction and airway management strategies are tailored to each patient’s needs, with meticulous attention to maintaining hemodynamic stability and ensuring adequate ventilation. Intraoperative monitoring, including transesophageal echocardiography (TEE), processed EEG monitoring, and near-infrared spectroscopy (NIRS), facilitates real-time assessment of cardiac and cerebral perfusion, as well as function, optimizing patient safety and improving outcomes. The peripheral cannulation techniques for cardiopulmonary bypass (CPB) initiation are described, highlighting the importance of cannula placement to minimize tissue as well as vessel trauma and optimize perfusion. This article also discusses specific MICS procedures, detailing anesthetic considerations and surgical techniques. The perioperative care of patients undergoing MICS requires a multidisciplinary approach including surgeons, perfusionists, and anesthesiologists adhering to standardized treatment protocols and pathways. By leveraging advanced monitoring techniques and tailored anesthetic protocols, clinicians can optimize patient outcomes and promote early extubation and enhanced recovery. Full article

From a basic refrigerator to a self-driving car, emerging technologies are increasingly involving various facets of our daily lives. These bring together many regularly used devices, each with its own characteristics, to communicate and collaborate within the same system. Computer network experts regard this so-called structure as a heterogeneous network made up of several connected objects that do not speak the same language. Communication is therefore ensured by additional types of nodes, such as gateways or converters. In this case, we can detect an increased complexity and a decreased level of security. And thus, the need to adopt a common slang for these kinds of networks has been brought to life. In this work, we compare two different routing protocols: optimized link-state routing (OLSR) and the multipath heterogeneous ad hoc network OLSR (MHAR-OLSR). The latter is an OLSR extension with new functionalities: nodes identification, paths calculation, paths classification, and paths choice that we designed for heterogeneous ad hoc networks composed of MANET, VANET, and FANET devices; it ensures direct communication between these diverse components. We verify and explain all the elements of our solution using colored Petri nets. We also present a global evaluation of Packet Delivery Ratio (PDR), End-To-End Delay, and energy consumption as QoS measures with different numbers of nodes in a heterogeneous scenario. To do this, we use NS-3 and BonnMotion as a tool-set of simulation. Experimental results show improvement in performance when compared to the classical routing protocol. Full article

Dementia affects approximately 50 million people in the world today, the majority suffering from Alzheimer’s disease (AD). The availability of long-term patient data is one of the most important prerequisites for a better understanding of diseases. Worldwide, many prospective, longitudinal cohort studies have been initiated to understand AD. However, this approach takes years to enroll and follow up with a substantial number of patients, resulting in a current lack of data. This raises the question of whether clinical routine datasets could be utilized to extend collected registry data. It is, therefore, necessary to assess what kind of information is available in memory clinic routine databases. We did exactly this based on the example of the University Hospital Bonn. Whereas a number of data items are available in machine readable formats, additional valuable information is stored in textual documents. The extraction of information from such documents is only applicable via text mining methods. Therefore, we set up modular, rule-based text mining workflows requiring minimal sets of training data. The system achieves F1-scores over 95% for the most relevant classes, i.e., memory disturbances from medical reports and quantitative scores from semi-structured neuropsychological test protocols. Thus, we created a machine-readable core dataset for over 8000 patient visits over a ten-year period. Full article

Patients with primary central nervous system lymphoma (PCNSL) not fulfilling inclusion criteria for clinical trials represent an underreported population. Thirty-four consecutive PCNSL patients seen at our center between 2005 and 2019 with exclusion criteria for therapeutic trials were analyzed (non-study patients) and compared with patients from the G-PCNSL-SG-1 (German PCNSL Study Group 1) study (study patients), the largest prospective multicenter trial on PCNSL, comprising 551 patients. Median follow up was 68 months (range 1–141) in non-study patients and 51 months (1–105) in study patients. Twenty-seven/34 (79.4%) non-study patients received high dose methotrexate (HDMTX), while seven/34 (20.6%) with a glomerular filtration rate (GFR) < 50 mL/min did not. Median overall survival (OS) was six months (95% confidence interval [CI] 0–21 months) in those 34 non-study patients. The 27 non-study patients treated with HDMTX were compared with 526/551 G-PCNSL-SG-1 study patients who had received HDMTX as well. Median OS was 20 months (95% CI 0–45)/21 months (95% CI 18–25) in 27 non-study/526 study patients (p = 0.766). Favorable prognostic factors in non-study patients were young age, application of HDMTX and early response on magnet resonance imaging (MRI). If HDMTX-based chemotherapy can be applied, long-term disease control is possible even in patients not qualifying for clinical trials. Initial response on early MRI might be useful for decision on treatment continuation. Full article

Diarrhea, soil-transmitted helminth infection and malnutrition are leading causes of child mortality in low- and middle-income countries (LMICs). To reduce the prevalence of these diseases, effective interventions for adequate water, sanitation, and hygiene (WaSH) should be implemented. This paper describes the design of a cluster-randomized controlled trial that will compare the efficacy of four school-based WaSH interventions for improving children’s health literacy, handwashing, and nutrition. Interventions consisted of (1) WaSH policy reinforcement; (2) low-, medium-, or high-volume health education; (3) hygiene supplies; and (4) WaSH facilities (e.g., toilets, urinals, handwashing basins) improvements. We randomly allocated school clusters from the intervention arm to one of four groups to compare with schools from the control arm. Primary outcomes were: children’s health literacy, physical growth, nutrition status, and handwashing prevalence. Secondary outcomes were: children’s self-reported health status and history of extreme hunger, satisfaction with WaSH facilities, and school restrooms’ WaSH adequacy. We will measure differences in pre- and post-intervention outcomes and compare these differences between control and intervention arms. This research protocol can be a blueprint for future school-based WaSH intervention studies to be conducted in LMICs. Study protocols were approved by the ethics committees of the University of Bonn, Germany, and the University of the Philippines Manila. This trial was retroactively registered, ID number: DRKS00021623. Full article