다중혈관 관상동맥 환자에서 y-문합을 이용하여 양쪽 내흉동맥만을 사용한 우회술의 조기 성적

Acute kidney injury (AKI) is a complex disorder for which currently there is no accepted definition. Having a uniform standard for diagnosing and classifying AKI would enhance our ability to manage these patients. Future clinical and translational research in AKI will require collaborative networks of investigators drawn from various disciplines, dissemination of information via multidisciplinary joint conferences and publications, and improved translation of knowledge from pre-clinical research. We describe an initiative to develop uniform standards for defining and classifying AKI and to establish a forum for multidisciplinary interaction to improve care for patients with or at risk for AKI. Members representing key societies in critical care and nephrology along with additional experts in adult and pediatric AKI participated in a two day conference in Amsterdam, The Netherlands, in September 2005 and were assigned to one of three workgroups. Each group's discussions formed the basis for draft recommendations that were later refined and improved during discussion with the larger group. Dissenting opinions were also noted. The final draft recommendations were circulated to all participants and subsequently agreed upon as the consensus recommendations for this report. Participating societies endorsed the recommendations and agreed to help disseminate the results. The term AKI is proposed to represent the entire spectrum of acute renal failure. Diagnostic criteria for AKI are proposed based on acute alterations in serum creatinine or urine output. A staging system for AKI which reflects quantitative changes in serum creatinine and urine output has been developed. We describe the formation of a multidisciplinary collaborative network focused on AKI. We have proposed uniform standards for diagnosing and classifying AKI which will need to be validated in future studies. The Acute Kidney Injury Network offers a mechanism for proceeding with efforts to improve patient outcomes.

Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury

The detection of psychiatric illness by questionnaire

Endoscopic sphincterotomy complications and their management: an attempt at consensus

We propose a novel attention gate (AG) model for medical imaging that automatically learns to focus on target structures of varying shapes and sizes. Models trained with AGs implicitly learn to suppress irrelevant regions in an input image while highlighting salient features useful for a specific task. This enables us to eliminate the necessity of using explicit external tissue/organ localisation modules of cascaded convolutional neural networks (CNNs). AGs can be easily integrated into standard CNN architectures such as the U-Net model with minimal computational overhead while increasing the model sensitivity and prediction accuracy. The proposed Attention U-Net architecture is evaluated on two large CT abdominal datasets for multi-class image segmentation. Experimental results show that AGs consistently improve the prediction performance of U-Net across different datasets and training sizes while preserving computational efficiency. The code for the proposed architecture is publicly available.

/pdf/attention-u-net-learning-where-to-look-for-the-pancreas-m4jojwwu76.pdf

Attention U-Net: Learning Where to Look for the Pancreas

Methods of gallbladder dissection for laparoscopic cholecystectomy

P8 3d biological scaffolds obtained from discarded human livers as a platform for tissue engineering and regenerative medicine

recent Darzi report1 to see that patientrelated outcomes, and quality of life in particular, are likely to become more dominant within our clinical practice. We believe that as our understanding of this type of data increases, so too will their clinical applications. Mr Lee is right to raise concerns about the length of time needed after surgery for some groups of colorectal cancer patients to resolve issues with respect to their quality of life. Addressing the psychosocial needs of patients is of paramount importance to those with incurable cancer, but as our work (confined to patients with potentially curable disease) shows, other groups of patients might also benefit from accessing similar services. Younger patients and those with stomas or low rectal anastomoses were identified as more likely to report lower than expected quality of life. More focused quality of life assessment, with psychosocial support offered appropriately, may help to minimize the impact of colorectal cancer and its treatment on the lives of these patients and their families. The wider use of quality of life data will inevitably help to identify vulnerable patients and guide appropriate intervention. T. R. Wilson and D. J. Alexander York Hospital, Wigginton Road, York YO31 8HE, UK DOI: 10.1002/bjs.6564

https://bjssjournals.onlinelibrary.wiley.com/doi/pdf/10.1002/bjs.6566

Authors' reply: Systematic review of randomized controlled trials on the effectiveness of virtual reality training for laparoscopic surgery (Br J Surg 2008; 95: 1088–1097)

Chronic liver disease is on the rise. According to WHO cirrhosis now accounts for almost 1.8% of all deaths in Europe causing around 170,000 death per year. Liver disease poses a significant challenge to surgery, particularly with advanced stages of illness. The physiological changes with the development of cirrhosis have a significant impact on both morbidity and mortality of surgery. Careful preoperative evaluation and risk assessment will identify high-risk patients allowing pre-operative optimisation and targeted post-operative care. The decision to proceed with surgery depends on the severity of liver disease, the necessity of the proposed procedure and the magnitude of intervention. Risk assessment and pre-operative optimisation aim to reduce risk in those in whom surgery is likely to be beneficial and to advise against surgical intervention in those in whom the severity of liver disease and the extent of surgery makes intervention futile. Here we provide a summary of risk assessment in chronic liver disease and the preoperative steps required to optimise patient care. An overview of risk assessment in hepatic and non-hepatic surgery is followed by an outline of risk evaluation for individual procedures.

Surgery in Liver Disease

This paper presents a novel, low cost, organ perfusion machine designed for use in research. The modular and versatile nature of the system allows for additional sensing equipment to be added or adapted for specific use. Here we introduce the system and present its preliminary evaluation by assessing its ability to maintain a predetermined input pressure. A proportional-integral-derivative (PID) controller was implemented and tested on a porcine liver to maintain input pressure to the hepatic artery and compared to bench tests. The results confirmed the effectiveness of the controller for maintaining input through the hepatic artery (HA) in a timely manner. Clinical Relevance—Machine Perfusion (MP) is proving to be an invaluable adjunct in clinical practice. With its ongoing success in the transplant arena, we propose MP for use in research. A cost-effective, versatile system that can be modified for specific research use to test new pharmacological therapies, imaging techniques or develop simulation training would be beneficial.

Brian R. Davidson

Papers

Methods of gallbladder dissection for laparoscopic cholecystectomy

P8 3d biological scaffolds obtained from discarded human livers as a platform for tissue engineering and regenerative medicine

Authors' reply: Systematic review of randomized controlled trials on the effectiveness of virtual reality training for laparoscopic surgery (Br J Surg 2008; 95: 1088–1097)

Surgery in Liver Disease

Evaluation of A Novel Organ Perfusion Research Platform