Citations

ABSTRACT The contemporary intensive care unit generates an overwhelming magnitude of high‐frequency, granular physiological data. However, conventional decision‐making for patients requiring temporary mechanical circulatory support (tMCS) remains tethered to reactive, threshold‐driven manual adjustments, underutilizing continuous data streams and failing to optimize the complex patient–machine interaction. This review examines the integration of deep neural networks (DNNs) as a candidate strategy for advanced clinical decision support. By identifying a continuous “digital phenotype,” hierarchical deep learning architectures signal a shift toward real‐time trajectory recognition in tMCS. We establish a four‐tier functional taxonomy—prognosticative, descriptive, predictive, and prescriptive—to categorize translational milestones from automated pump‐speed optimization to closed‐loop homeostatic regulation. Operational challenges are analyzed through the TEIP (Transparency, Explainability, Interpretability, and Performance) Core‐Lens Framework, navigating the dynamic equilibrium between computational density and clinical explainability. We further evaluate the evolving global regulatory landscape, advocating for a foundation on verified empirical safety and rigorous clinical trial validation over absolute mathematical transparency in high‐density architectures. Implementing a strategic roadmap including context‐specific validation, multimodal integration, and human‐centered design is quintessential to safely transform passive hardware into intelligent systems. As the field evolves, DNN technology offers a consequential opportunity to advance early cardiopulmonary failure recognition into a clinical reality.

Date presented: April 24, 2026 Primary Author and Speaker: Tamra Trenary, trenary.tamra@mayo.edu

Date presented: April 25, 2026 Primary Author and Speaker: Randi Bukovac Nagyvathy, rb@bukie.net

Background: Monitored anesthesia care (MAC) combined with regional anesthetic techniques is commonly used for open reduction and internal fixation (ORIF) of unstable ankle fractures. When compared to general anesthesia (GA), MAC with regional anesthesia has been associated with reduced systemic adverse effects and shorter recovery times, although regional anesthesia carries additional costs and potential complications of its own. A new technique involving the infiltration of high-volume, low-concentration (VL) local anesthetic was therefore developed. When used in conjunction with MAC, we refer to this technique as MAC-VL. This study evaluates outcomes and recovery metrics following outpatient ankle ORIF performed under GA vs MAC-VL without regional anesthesia. Methods: An IRB-approved retrospective cohort study was conducted including 159 adults who underwent outpatient ankle ORIF between February 1, 2023, and January 31, 2026. Patients were identified using standardized diagnostic and procedural codes and grouped according to anesthesia type. All patients received a standardized injection of local anesthetic around the proposed operative sites before the procedure; anesthesia type was MAC (n = 48) or GA (n = 111). The primary outcome was time to discharge, defined as the interval from incision closed to hospital discharge. Secondary outcomes were considered exploratory and included tourniquet, operative, anesthesia time, time in room, Post Anesthesia Care Unit length of stay, conversion from MAC to GA, reported postoperative nausea and vomiting, admissions, and postoperative emergency department visits. Results: Among 160 procedures for which no significant difference in case mix could be detected with the numbers available, MAC-VL was associated with a significantly shorter time to discharge—reducing discharge time by 55.2 minutes ( P < .001) following adjustment for demographic, clinical, and operative covariates—and shortened total anesthesia and operating room time compared with GA. With the numbers available, no significant difference was detected for the remaining secondary outcomes. Conclusion: The MAC-VL protocol was associated with shorter operating room and recovery times and may improve health care resource use. Level of Evidence: Level III, retrospective cohort study.

Objective To identify barriers and facilitators to changing provider's current approaches to evaluation and treatment decision-making for velopharyngeal insufficiency (VPI). Design Cross-sectional qualitative study. Setting Medium and large multidisciplinary cleft teams in the USA and Canada engaged in clinical research. Participants Twenty-eight surgeons and 16 speech-language pathologists from 12 cleft teams. Interventions Semi-structured interviews were conducted exploring perceived barriers and facilitators to changing VPI evaluation and treatment decision-making. Interviews were analyzed using a thematic approach guided by the Consolidated Framework for Implementation Research. Results Providers indicated that adoption of new approaches to VPI evaluation and decision-making would require evidence demonstrating improved speech outcomes or reduced risk of obstructive sleep apnea. Characteristics of persuasive evidence included prospective study design, comparable patient groups, standardized speech evaluations, and long-term follow-up. Providers favored applying new approaches to complex cases or defined subgroups, rather than broad adoption. Providers raised concerns about additional preoperative testing, perceiving it could increase treatment burden. When reflecting on prior changes in care delivery, providers indicated they started by discussing the potential change informally with team members to share information, gather input, and build consensus; in larger teams, discussions also occurred in formal meetings or through administrative hierarchies. Implementation decisions were consensus-based, although the pace of implementation varied among providers. Conclusions Providers have processes for implementing changes in their VPI evaluation and treatment decision-making, and criteria by which they make the decision to implement. These findings can inform the design of implementation strategies to accelerate clinical uptake of research findings.

Background: The natural history of vestibular schwannoma (VS) is variable, with concerns about observation management rather than hearing loss. Shrinkage is well documented, with an undetermined hearing outcome. Case Description: We report the case of a 62-year-old female followed in our clinic with a left cerebellopontine angle mass with radiological features of a VS. The mass underwent spontaneous total resolution while serviceable hearing was maintained for over 13 years, and we discuss the related pathophysiology. Conclusion: Spontaneous shrinkage of VSs is well documented in the literature. We present a rare case of complete spontaneous involution and loss of contrast enhancement, with preservation of serviceable hearing over a very long-term follow-up (13 years).

Abstract Provided herein are novel compounds as TREM2 agonists, pharmaceutical compositions, use of such compounds in treating Parkinson’s disease, Alzheimer’s disease, amyotrophic lateral sclerosis, frontotemporal dementia, Nasu-Hakola disease and stroke, and processes for preparing such compounds.

BACKGROUND: Anemia affects more than two billion people worldwide and is common among surgical patients. Despite growing recognition of the risks associated with preoperative anemia, we have limited understanding of the epidemiology of anemia development and recovery. METHODS: This is an observational cohort study of adults undergoing surgery at a large tertiary care medical center from August 2012 to July 2023. Hemoglobin concentrations were obtained preoperatively, during postoperative hospitalization, and through 12 months after surgery. Anemia was defined primarily using World Health Organization criteria (hemoglobin <12 g/dL in women, <13 g/dL in men) and secondarily with a gender-neutral threshold of <13 g/dL. Descriptive analyses summarize preoperative anemia prevalence, postoperative anemia prevalence and incidence, and post-hospitalization anemia recovery across demographic, clinical, and surgical features. RESULTS: 281,217 patients undergoing 423,066 procedures (51.9% among women) were included. Among those with available preoperative hemoglobin assessments (n = 308,959), 28.9% had anemia, with similar prevalence in men (29.5%) and women (28.4%) using World Health Organization (WHO) definitions, but with prevalence increasing to 51.0% in women when using the gender-neutral anemia definition. Preoperative anemia was most common in Black patients (44.0%) and in those ≥75 years (39.6%). Surgical subspecialties showed wide variation in preoperative anemia prevalence, ranging from 18.6% in spine surgery to 45.8% in vascular surgery. Among previously nonanemic patients admitted to the hospital postoperatively, 76.9% developed new postoperative anemia, with the highest incidence in cardiac surgery (97.5%). Women experienced more severe postoperative anemia than men. Overall, 81.1% of patients were anemic at hospital discharge. Recovery was gradual and incomplete: among those discharged with mild, moderate, or severe anemia, 28.5%, 51.9%, and 66.3%, respectively, remained anemic at 12 months. Among patients who were nonanemic preoperatively but developed new postoperative anemia, 29.3% remained anemic at 12 months. CONCLUSIONS: Preoperative and postoperative anemia are highly prevalent, and anemia frequently persists for months after hospitalization. Older adults, women, and Black patients bear a disproportionate burden. Despite this, anemia evaluations and treatments remain underutilized. These findings highlight substantial opportunities for patient blood management (PBM) programs to improve perioperative anemia detection, optimization, and post-discharge management.