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Optimizing artificial intelligence in sepsis management: Opportunities in the present and looking closely to the future

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Journal of Intensive Medicine 2024年第1期4卷 34-45页

作者： Darragh O’Reilly Jennifer McGrath ignacio martin-loeches Department of Intensive Care Medicine Multidisciplinary Intensive Care Research Organization(MICRO)St James’HospitalDublinIreland Department of Respiratory Intensive care Hospital ClinicUniversitat de BarcelonaIDIBAPSCIBERESBarcelonaSpain

Sepsis remains a major challenge internationally for healthcare systems.Its incidence is rising due to poor public awareness and delays in its recognition and subsequent management.In sepsis,mortality increases with every hour left untreated.Artificial intelligence(AI)is transforming worldwide healthcare delivery at present.This review has outlined how AI can augment strategies to address this global disease burden.AI and machine learning(ML)algorithms can analyze vast quantities of increasingly complex clinical datasets from electronic medical records to assist clinicians in diagnosing and treating sepsis earlier than traditional methods.Our review highlights how these models can predict the risk of sepsis and organ failure even before it occurs.This gives providers additional time to plan and execute treatment plans,thereby avoiding increasing complications associated with delayed diagnosis of sepsis.The potential for cost savings with AI implementation is also discussed,including improving workflow efficiencies,reducing administrative costs,and improving healthcare outcomes.Despite these advantages,clinicians have been slow to adopt AI into clinical practice.Some of the limitations posed by AI solutions include the lack of diverse data sets for model building so that they are widely applicable for routine clinical use.Furthermore,the subsequent algorithms are often based on complex mathematics leading to clinician hesitancy to embrace such technologies.Finally,we highlight the need for robust political and regulatory frameworks in this area to achieve the trust and approval of clinicians and patients to implement this transformational technology。

关键词： Artificial intelligence Data science Machine learning Intensive care unit(ICU) Critical care Sepsis

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Effects of a school-based karate intervention on academic achievement,psychosocial functioning,and physical fitness:A multi-country cluster randomized controlled trial

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Journal of Sport and Health Science 2024年第1期13卷 90-98页

作者： Tania Pinto-Escalona Erica Gobbi Pedro L.Valenzuela Simon J.Bennett Pierluigi Aschieri Manuel martin-loeches Antonio Paoli Oscar martinez-de-Quel Faculty of Education Complutense University of MadridMadrid 28040Spain Department of Biomolecular Sciences University of Urbino“Carlo Bo”Urbino 61029Italy Department of Systems Biology University of AlcaláMadrid 28805Spain Research Institute for Sport and Exercise Sciences Faculty of ScienceLiverpool John Moores UniversityLiverpoolL33AFUK Italian Judo WrestlingKarate and Martial Arts FederationRome 00122Italy Psychobiology&Methods for the Behavioural Sciences Department Complutense University of MadridMadrid 28040Spain Department of Biomedical Sciences University of PaduaPadua 35122Italy

Purpose:To examine the effects of a school-based karate intervention on academic achievement,psychosocial functioning,and physical fitness in children aged 7-8 years.Methods:Twenty schools in 5 different European countries(2 second-grade classrooms per school)participated in a cluster randomized controlled trial(Sport at School trial).Participants were assigned to either a control group,which continued with their habitual physical education lessons,or to an intervention group,which replaced these lessons with a 1-year karate intervention(Karate Mind and Movement program).A total of 721 children(344 girls and 377 boys,7.4±0.5 years old,mean±SD)completed the study,of which 333 and 388 were assigned to the control group and intervention group,respectively.Outcomes included academic performance(average grade),psychosocial functioning(Strengths and Difficulties Questionnaire for parents),and different markers of physical fitness(cardiorespiratory fitness,balance,and flexibility).Results:The intervention provided small but significant benefits compared to the control group for academic achievement(d=0.16;p=0.003),conduct problems(d=-0.28;p=0.003),cardiorespiratory fitness(d=0.36;p0.05).Conclusion:A 1-year school-based karate intervention was effective in improving academic achievement,conduct problems,and physical fitness in primary school children.The results support the inclusion of karate during physical education lessons.

关键词： Academic performance Cardiorespiratory fitness Conduct problems Karate Physical fitness

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神经重症监护患者的液体治疗:ESICM专家共识及临床实践推荐

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国际脑血管病杂志 2019年第2期27卷 84-97页

作者： Mauro Oddo Daniele Poole Raimund Helbok Geert Meyfroidt Nino Stocchetti Pierre Bouzat Maurizio Cecconi Thomas Geeraerts ignacio-martin loeches Herve Quintard Fabio Silvio Taccone Romergryko G. Geocadin Claude Hemphill Carole Ichai David Menon Jean-Francois Payen Anders Perner martin Smith Jose Suarez Walter Videtta Elisa R. Zanier Giuseppe Citerio 何毅华(译) 常远(译) 王晓蔷(译) 潘速跃(译) Department of Medic al-Surgical Intensive Care Medicine Faculty of Biology and Medicine Centre Hospitalier Universitaire VauDOIs (CHUV) Lhiversity of Lausanne Rue du Bugnon 46 B4 08.623 1011 Lausanne Switzerland Department of Intensive Care Medicine St James's Lhiversity Hospital James's St Ushers P.O. Box 580 Dublin & Ireland Service de Reanimation Medic o-chirurgic ale Hopital Pasteur 2 UniversiteCote d'Azur CHU de Nice 06000 Nice France Unite CNRS 7275 Sophia-Antipolis France Department of Intensive Care Erasme Hospital University Libre de Bruxelles Brussels Belgium Neurosciences Critical Care Departments of Anesthesiology and Critical Care Medicine Neurology and Neurosurgery Johns Hopkins Lhiversity Baltimore MD USA Department of Neurology University of California San Francisco San Francisco CA LKA Service de Reanimation Polyvalente Hopital Pasteur 2 CHU de Nice 30 Voie Romaine CS 51069 06001 Nice Cedex 1 France Division of Anaesthesia University of Cambridge Addenbrooke's Ffospital Box 93 Hfills Road Cambridge Cambridgeshire CB2 2QQ UK Department of Intensive Care 4131 Copenhagen University Hospital- Rigshospitalet Copenhagen Denmark Department of Neuroanesthesia and Neurocritic al Care The National Ffospital for Neurosurgery and Neurology Lhiversity College London Hospitals London UK Anesthesia and Intensive Care Operative th it S. Martino Hospital Belluno Italy Hospital Nacional Professor Alejandro Posadas Buenos Aires Argentina Department of Neurosciences IRCCS-Istituto di Ricerche Farmacotogiche Mario Negri Milan Italy School of Medicine and Surgery University of Milan-Bicocca Milan Italy Neurointensive Care San Gerardo Hospital ASST-Monza 20900 Monza Italy 南方医科大学南方医院神经内科广州510515 Neurological Intensive Care Lhit Department of Neurology Medical University of Innsbruck Innsbruck Austria Department of Intensive Care Medicine University Hospitals Leuven Louvain Belgium Neuroscience Intensive Care Unit Department of Anesthesia and C

目的发布欧洲重症医学学会(European Society of Intensive Care Medicine, ESICM)关于神经重症监护患者液体治疗的专家共识和临床实践推荐意见。设计在2016年10月召开的ESICM LIVE 2016会议上召集了一个由22名国际专家组成的共识委员会... 详细信息

目的发布欧洲重症医学学会(European Society of Intensive Care Medicine, ESICM)关于神经重症监护患者液体治疗的专家共识和临床实践推荐意见。设计在2016年10月召开的ESICM LIVE 2016会议上召集了一个由22名国际专家组成的共识委员会,随后委员会成员通过电话会议和在线讨论制定本专家共识。方法回顾人群、干预、对比和结局(population, intervention,comparison, and outcomes, PICO)问题,根据需要进行更新并得到证据概要。本共识关注3个主要议题:(1)神经重症监护患者的液体复苏和维持;(2)高渗液体在颅内压控制中的应用;(3)蛛网膜下腔出血后迟发性脑缺血的液体管理。经过广泛的文献检索,应用推荐分级的评估、制订与评价(Gradingof Recommendations Assessment, Development and Evaluation, GRADE)系统原则评估证据质量(从高到极低),制定治疗推荐(强或弱),并在适用时发布最佳实践声明。基于文献和专家意见提供的综合证据,应用改良德尔菲方法(使用序贯方法以避免偏倚和误解)产生最终共识声明。结果最终共识包含总共32条声明,其中13条为强推荐,17条为弱推荐,另外2条声明未提供推荐意见。结论我们发布了一份关于神经重症监护患者液体治疗的共识声明和临床实践推荐。

关键词：循证医学指南液体治疗创伤性脑损伤蛛网膜下腔出血脑出血卒中甘露醇高渗神经重症监护

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Coagulation Factor XII Congenital Deficiency in Women with Recurrent Miscarriage

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International Journal of Clinical Medicine 2011年第4期2卷 469-472页

作者： martin-loeches Mariano Pallas Yadira Abad Ana Lloret Manuel Lopez-Galvez Jose Jesús 不详

Factor XII (Hageman factor) is an important protease that plays a major role in the initiation of the intrinsic pathway of blood coagulation and fibrinolysis and kinin formation. It is still unclear whether factor XII deficiency causes any disorders during pregnancy. Because the main clinical feature in patients with factor XII deficiency is thrombosis rather than bleeding, low dose aspirin would be expected to prevent first trimester miscarriage and a decrease in factor XII level itself was found to be an independent risk factor in recurrent miscarriage. The woman in a 31-year-old patient, with personal and family antecedents without interest and preceding obstetrics of two spontaneous abortions in the first quarter of the pregnancy without apparent cause. In the study of infertility practiced emphasizes a partition of not more than one centimetre of length in the uterine found by hysteroscopy exploration and in the study of hipercoagulability a light deficiency of the factor XII. Himself guideline processing with low dose of aspirin (125 mgr/day) and preconception folic acid (5 mgr/day), remains expectant mother and in the week 12 of her third pregnancy itself guideline antitrombotic prophylaxis with heparin of low molecular weight by subcutaneous way. The pregnancy reaches the week 39 without incidents of interest and the expectant mother give birth of spontaneous form to health boy. Repeated abortions may be associated with reduced level of factor XII activity of unknown origin and low-dose aspirin may prevent miscarriage caused for decreased factor XII levels in patients with a history of recurrent first trimester miscarriage.

关键词： Factor XII Recurrent Miscarriage Thrombofilia Pregnancy Loss

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A multivariate analysis of the factors that influence the modification of sexual desire in oral hormonal contraceptive (OC) users

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Open Journal of Obstetrics and Gynecology 2011年第3期1卷 131-135页

作者： Mariano martin-loeches Yadira Pallas Pedro Lopez Sanchez Manuel Lloret Jose Jesús Lopez-Galvez 不详

Objective. This work studied the influencing factors of age, level of education, family planning awareness, relationship with partner, the age at which sexual relationships were initiated, parity, the method of contraceptive previously used, the type of contraceptive pill used and the duration of oral hormonal contraception (OC) use in relation to the modification of sexual desire in OC users. Materials and Methods. Prospective study of 760 OC users at the Family Planning Center “Marina Alta” in Alicante (Spain). A logistical regression analysis was carried out to study the relative risk of reduction in libido, taking other risk factors into account. Results. In the simple analysis, women who initiated sexual relationships between 18 and 25 years of age had a lower sexual desire in comparison with women who were sexually active before the age of 18 (OR = 2.11;CI: 1.15 - 3.91). Nulliparous women had a reduced sexual desire compared with those women that had given birth (OR = 2.32;CI: 1.41 - 3.82). An OC use of between 6 months and 1 year reduced sexual desire in comparison with a use of less than 6 months (OR = 0.24;CI: 0.09 - 0.64). In the multivariate analysis, age (OR = 1.12;CI: 1.01 - 1.21) and the use of OC within an initial 6 month to a year period (OR = 0.24;CI: 0.09 - 0.64) presented a statistically significant relationship with the modification of sexual desire. The level of education, family planning awareness, relationship with partner, the method of contraception previously used and the type of contraceptive pill prescribed showed no statistical significance with the modification of sexual desire in OC users. Conclusions. Sexual desire in OC users decreases as a woman’s age increases and in an early stage of use in the first six months after beginning OC treatment.

关键词： Oral Contraceptive Sexual Desire Sex Hormones

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Ventilation practices in burn patients—an international prospective observational cohort study

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Burns & Trauma 2021年第1期9卷 47-57页

作者： Gerie J.Glas Janneke Horn Markus W.Hollmann Benedikt Preckel Kirsten Colpaert Manu Malbrain Ary Serpa Neto Karim Asehnoune Marcello Gamma de Abreu ignacio martin-loeches Paolo Pelosi Folke Sjoerg Jan M.Binnekade Berry Cleffken Nicole P.Juffermans Paul Knape Bert G.Loef David P.Mackie Perenlei Enkhbaatar Nadia Depetris Anders Perner Eva Herrero Lucia Cachafeiro Marc Jeschke Jeffrey Lipman Matthieu Legrand Johannes Horter Athina Lavrentieva Alex Kazemi Anne Berit Guttormsen Frederik Huss Mark Kol Helen Wong Therese Starr Luc De Crop Wilson de Oliveira Filho Joa Manoel Silva Junior Cintia M.C.Grion Marjorie Burnett Frederik Mondrup Francois Ravat Mathieu Fontaine Renan Le Floch Mathieu Jeanne Morgane Bacus Maite Chaussard Marcus Lehnhardt Bassem Daniel Mikhail Jochen Gille Aidan Sharkey Nicole Trommel Auke C.Reidinga Nadine Vieleers Anna Tilsley Henning Onarheim Maria Teresa Bouza Alexander Agrifoglio Filip Fredén Tina Palmieri Lynda E.Painting Marcus J.Schultz LAMiNAR investigators Academic Medical Center University of AmsterdamAmsterdamAZ 1105The Netherlands Department of Anaesthesia and Intensive Therapy Medical University of Lublin Aleje Racklawickie 1–20-059 Lublin–Poland AZ JAN PALFIJN GENT Watersportlaan 5–9000 Gent–Belgium ABC Medical School SaPauloBangúSP 5001Brazil Service d’Anesthésie Réanimation Chirurgicale Nantes 44093France University Hospital Carl Gustav Carus Dresden 01307Germany St James University Hospital Dublin D08 NHY1Ireland University of Genoa GenoaGE 16128Italy Linkoing University Hospital Linkoing 58185Sweden Maasstad Hospital RotterdamDZ 3079The Netherlands Red Cross Hospital BeverwijkLE 1942The Netherlands martini Hospital GroningenNT 9728The Netherlands University of Texas Medical Branch GalvestonTX 77555USA Turin CTO Burn Center TurinTO 10126Italy Rigshospitalet Copenhagen 2100Denmark La Paz University Hospital Madrid 28046Spain Ross Tilley Burn Centre Sunnybrook Health Sciences CentreToronto M4N 3M5Canada Royal Brisbane and Women’s Hospital Queensland UniversityHerstonQLD 4029Australia Australian and New Zealand Intensive Care Research Centre.Monash University MelbourneVIC 3004Australia GH St-Louis-Lariboisière APHPParis 75010France BG Klinik Ludwigshafen Ludwigshafen 67071Germany Papanikoalou Hospital Thessaloniki 54621Greece Middlemore Hospital OtahuhuAuckland 2025New Zealand Haukeland University Hospital Bergen 5021Norway Uppsala University Hospital Uppsala 75185Sweden Concord Repatriation General Hospital NSW University of SydneyConcord 2139Australia Ziekenhuis Netwerk Antwerpen-Stuivenberg Antwerpen 2060Belgium Universidade de Sao Paulo Sao Paulo 01246-903Brazil Universidade Estadual de Londrina Londrina 86057-970Brazil Sunnybrook Health Sciences Centre Toronto M4N 3M5Canada CHU Lyon St Luc Lyon 69007France CHU Nantes Service dánesthesie reanimation chirugicale Nantes 44093France Hopital Roger Salengro CHRU LilleLille 59037France Saint-Louis Hospital Paris 75010France BG University Hospital Bergmannsheil Bo

Background:It is unknown whether lung-protective ventilation is applied in burn patients and whether they benefit from it.This study aimed to determine ventilation practices in burn intensive care units(ICUs)and investigate the association between lung-protective ventilation and the number of ventilator-free days and alive at day 28(VFD-28).Methods:This is an international prospective observational cohort study including adult burn patients requiring mechanical ventilation.Low tidal volume(V_(T))was defined as V_(T)≤8 mL/kg predicted body weight(PBW).Levels of positive end-expiratory pressure(PEEP)and maximum airway pressures were collected.The association between V_(T) and VFD-28 was analyzed using a competing risk model.Ventilation settings were presented for all patients,focusing on the first day of ventilation.We also compared ventilation settings between patients with and without inhalation trauma.Results:A total of 160 patients from 28 ICUs in 16 countries were included.Low V_(T) was used in 74%of patients,median V_(T) size was 7.3[interquartile range(IQR)6.2–8.3]mL/kg PBW and did not differ between patients with and without inhalation trauma(p=0.58).Median VFD-28 was 17(IQR 0–26),without a difference between ventilation with low or high V_(T)(p=0.98).All patients were ventilated with PEEP levels≥5 cmH_(2)O;80%of patients had maximum airway pressures<30 cmH_(2)O.Conclusion:In this international cohort study we found that lung-protective ventilation is used in the majority of burn patients,irrespective of the presence of inhalation trauma.Use of low V_(T) was not associated with a reduction in VFD-28.Trial registration:Clinicaltrials.gov NCT02312869.Date of registration:9 December 2014.

关键词： Mechanical ventilation Inhalation trauma Lung-protective Critical care

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