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Remimazolam is a short‐acting benzodiazepine that was approved by the United States Food and Drug Administration (FDA) in 2020 for the induction and maintenance of procedural sedation in adults undergoing procedures lasting 30 min or less. Given its recent introduction, the use of remimazolam for general anesthesia and monitored anesthesia care (MAC) remains an area of ongoing investigation. In this report, we present the first documented case demonstrating that remimazolam can achieve hemodynamic stable burst suppression in a critically ill patient undergoing emergent craniectomy and aneurysm clipping. Additionally, this manuscript reviews the reported off‐label applications of remimazolam in both the operating room and the intensive care unit (ICU) settings.

Takotsubo cardiomyopathy (TCM) is a rare stress-induced condition that appears rarely in suspected acute myocardial infarction cases. It causes unexplained left ventricular failure, but most cases are reversible with supportive treatment. In this report, we present the case of a 70-year-old female who developed acute hypotension after a laparoscopic Toupet fundoplication on postoperative day one, requiring care in the surgical intensive care unit. Following consultation with the cardiology service and further imaging and tests, she was diagnosed with TCM. This report outlines the potential mechanisms and management of TCM in the intensive care unit, emphasizing the importance of prompt diagnosis and treatment.

Nerve guidance conduits (NGCs) have emerged from recent advances within tissue engineering as a promising alternative to autografts for peripheral nerve repair. NGCs are tubular structures with engineered biomaterials, which guide axonal regeneration from the injured proximal nerve to the distal stump. NGC design can synergistically combine multiple properties to enhance proliferation of stem and neuronal cells, improve nerve migration, attenuate inflammation and reduce scar tissue formation. The aim of most laboratories fabricating NGCs is the development of an automated process that incorporates patient-specific features and complex tissue blueprints (e.g. neurovascular conduit) that serve as the basis for more complicated muscular and skin grafts. One of the major limitations for tissue engineering is lack of guidance for generating tissue blueprints and the absence of streamlined manufacturing processes. With the rapid expansion of machine intelligence, high dimensional image analysis, and computational scaffold design, optimized tissue templates for 3D bioprinting (3DBP) are feasible. In this review, we examine the translational challenges to peripheral nerve regeneration and where machine intelligence can innovate bottlenecks in neural tissue engineering.

Objective: Sepsis is a life-threatening response to infection and a major cause of hospital mortality. Machine learning (ML) models have demonstrated better sepsis prediction performance than integer risk scores but are less widely used in clinical settings, in part due to lower interpretability. This study aimed to improve the interpretability of an ML-based model without reducing its performance in non-ICU sepsis prediction. Methods: A logistic regression model was trained to predict sepsis onset and then converted into a more interpretable integer point system, STEWS, using its regression coefficients. We compared STEWS with the logistic regression model using PPV at 90% sensitivity. Results: STEWS was significantly equivalent to logistic regression using the two one-sided tests procedure (0.051 vs. 0.051; p = 0.004). Conclusions: STEWS demonstrated equivalent performance to a comparable logistic regression model for non-ICU sepsis prediction, suggesting that converting ML models into more interpretable forms does not necessarily reduce predictive power.

Goal-directed fluid therapy (GDFT) is usually recommended in patients undergoing major surgery and is essential in enhanced recovery after surgery (ERAS) protocols. This fluid regimen is usually guided by dynamic hemodynamic parameters and aims to optimize patients' cardiac output to maximize oxygen delivery to their vital organs. While many studies have shown that GDFT benefits patients perioperatively and can decrease postoperative complications, there is no consensus on which dynamic hemodynamic parameters to guide GDFT with. Furthermore, there are many commercialized hemodynamic monitoring systems to measure these dynamic hemodynamic parameters, and each has its pros and cons. This review will discuss and review the commonly used GDFT dynamic hemodynamic parameters and hemodynamic monitoring systems.

Dercum's disease (DD), also described as adiposis dolorosa, is a poorly understood and rare adipose tissue disorder involving obesity and painful adipose tissue masses. Patients may have associated bruising and constitutional symptoms such as fatigue, difficulty concentrating, and sleep disturbance. DD was initially described in 1888 by Francis Xavier Dercum, and was classified into four subtypes, including generalized diffuse, generalized nodular, localized nodular, and juxta-articular subtypes. While this disease has been described for more than 130 years, its etiology and treatment remain elusive. We describe a case of a patient with DD who presented to Ochsner Medical Center, New Orleans, LA, for evaluation of treatment options. We review current knowledge on this rare disease and data on modern treatment methods.