人工智能在骨科术中导航的应用进展

骨科手术复杂而精细。骨科导航系统的开发旨在通过分析术前、术中和术后数据, 提供增强现实的三维可视化环境, 提高治疗效果。随着数字化技术的迅速发展及临床应用, 人工智能技术被引入到骨科术中导航系统中。人工智能与器械设备、成像技术相结合, 增强了骨科医生的可视化能力, 使他们在手术过程中获得实时反馈和指导, 进而提供最佳临床决策。人工智能在骨科术中导航的应用还能提高手术的可重复性, 降低了人为错误的发生率。本文综述了人工智能在骨科术中导航的应用现状, 并介绍人工智能的基本概念以及基于人工智能的图像配准、实时跟踪和三维可视化技术的发展, 对目前存在的局限和不足进行探讨。     

人工智能在甲状腺及甲状旁腺疾病外科诊疗中的研究进展

近年来人工智能技术正在赋能各个行业, 引领产业升级。人工智能在医学影像分析及外科手术导航定位等方面的进步, 正在为整个医学界带来革命性的变化, 并正在逐渐渗透进入甲状腺及甲状旁腺疾病的诊疗领域。本文着眼于人工智能在甲状腺及甲状旁腺疾病外科诊疗中的应用, 着重阐述基于深度学习的人工智能系统在术前评估、术中辅助决策和预测手术预后等方面的研究和应用进展, 并探讨未来的发展前景。     

人工智能(AI)在胸外科中的应用北大核心CSCD

人工智能作为一种新兴科技,将人的理论、技术等用于机器人,来研究、开发、学习、识别的技术。胸外科医生通过直接使用人工智能技术,或通过相关医学领域(放射学、病理学和呼吸医学)间接使用,可影响其日常实践。本文回顾了与胸外科相关的人工智能的应用现状和未来发展,人工智能相关肺癌的诊断、预后辅助决策项目及机器人手术等。虽然人工智能技术在许多领域取得了迅速进展,但医疗行业仅占人工智能使用的一小部分,目前人工智能技术在疾病的诊断、治疗、康复和护理中正在逐步广泛应用。胸外科已就人工智能进行了有价值的探索和实践,今后将会越来越多地受到人工智能技术的影响和推动。     

人工智能在血管外科的应用前景

正人工智能(artificial intelligence)是研究开发用于模拟、延伸和扩展人的智能的理论、方法、技术及应用系统的一门新的技术科学。随着技术的不断成熟,人工智能技术逐渐向"人工智能+"过渡,其开始在人们生活的各个领域延伸。医疗作为人们生活的重要部分,"人工智能+"医疗也逐渐走进人们的视野。由于影像识别、深度学习、神经网络、快速辅助决策等关键技术的突破,带动了人工智能的不断发展,医疗健康成为其中应用最热的     

数字智能化诊疗技术在解剖性肝切除中应用价值

数字智能化诊疗技术是以数字智能化高新技术和现代医学交叉结合为基础，涵盖多领域和多学科知识而形成的新型诊疗技术（包括三维可视化、3D打印、分子荧光成像、混合现实、光声成像、人工智能-影像组学和多模态图像实时手术导航等），为实现疾病的精确诊断、精准术前规划及术中导航等发挥了重要作用。南方医科大学珠江医院运用数字智能化技术，根据病人实际的血管分布进行研究，致力于个体化肝分段、体积计算、仿真手术、术前规划、混合现实、肿瘤边界界定和图像实时融合导航肝切除术等的研究，并运用于临床实践，最终实现了肝脏肿瘤解剖性、功能性、根治性肝切除术。     

人工智能辅助手术的麻醉管理

背景 随着微创外科在我国的发展,以达芬奇手术机器人系统为代表的人工智能辅助手术系统在临床外科的应用越来越广泛,已发展到可以进行复杂高难度的手术操作.长时间人工智能辅助手术增加了麻醉的复杂性,对麻醉提出了新挑战. 目的 对人工智能辅助手术系统的麻醉管理策略分析总结. 内容 对人工智能辅助手术患者的麻醉术前评估、麻醉方法的选择以及对患者术中呼吸、循环、内环境、中枢神经系统的管理等方面进行综述. 趋势 人工智能辅助手术是微创外科的重要进步,其手术中对呼吸、循环、神经系统的影响待进一步总结.     

人工智能在颅颌面外科中的应用

人工智能是指任何能感知环境并采取行动以最大程度实现目标的设备.近年来,人工智能在颅颌面外科中的应用日渐增多.人工智能已可用于辅助颅颌面相关疾病的诊断及外科治疗,如预测胚胎患唇腭裂的风险、早期诊断畸形综合征、治疗面部麻痹、预估术中出血量等.本文就以上内容进行分析评价,同时探讨人工智能在医疗行业发展的伦理、安全等问题.     

超声在气道管理中的应用进展

超声在气道管理领域的研究不断取得的进展,为临床上将超声应用于气道管理提供了理论依据和新思路,拓宽了超声在气道管理方面的应用范围。超声能够实时显影和测量全气道的几乎所有组织结构,保证气道解剖结构的准确定位及测量,为气道评估提供客观的理论支持。超声可实时成像的特点有助于引导气管插管、确定气管导管及喉罩位置、评估胃内容量等。人工智能提高了超声识别解剖结构的准确率和效率,促进超声在气道管理的拓展应用。本文简述超声在实时引导气管插管、确定气管插管位置、确认喉罩准确对位、预测成功拔管、预测困难气道、定位气道解剖结构、评估胃内容物误吸风险等方面的应用进展,并讨论超声结合人工智能在气道管理领域的应用。     

数字化智能化技术在颅颌面整形外科的应用

数字化技术广义上是指计算机技术、信息网络技术、精密设计制造技术、三维重建与可视化技术、手术模拟仿真、模型快速成型、手术实时导航、远程医疗、机器人辅助技术及人工智能等先进技术,近年来在颅颌面整形外科领域的应用日益增多,如影像资料处理、三维信息采集与储存、术前规划与手术模拟、模型的精确制造、个性化手术导板及修复体的定制、手术导航、机器人辅助手术、医学大数据处理、远程医疗等,该文就上述方面进行了梳理和评价。     

人工智能肝癌临床决策支持系统的开发、验证和应用价值

正人工智能(artificial intelligence,AI)是研究、开发用于模拟、延伸和扩展人智能的理论、方法、技术及应用系统的一门新技术科学,专门研究计算机模拟或实现人类的学习行为即机器学习,以获取新的知识或技能,重新组织已有的知识结构,使之不断改善自身的性能。机器学习是一门多领域交叉学科,涉及概率论、统计学、逼近论、凸分析、算法复杂度理论等多门学科。自2016年1月27日英国《自然》杂志发表的一篇文章报道谷歌的AI系统     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Immunomodulation in Transplantation with Photopheresis

Abstract: Photopheresis is a technique in which peripheral blood mononuclear cells, in the presence of a photoacti-vatable compound, are exposed extracorporeally to ultraviolet A light and reinfused, inducing a host autoregula-tory immune response. Experimental work and ongoing clinical studies are helping to define the role of this novel, safe, and non-toxic immunomodulating technology in the field of transplantation.