Анестезиологическое обеспечение пациентов с диссекцией аорты типа А

«It is type of surgery that is not for the lone operator… Team is of course essential in the operating theater, where in addition to the surgical and nursing assistants, the anesthesiologist plays a part of fundamental importance which deserves a special tribute.»  Russel C. Brock, 1949 Deep hypothermic circulatory arrest (DHCA) for the adult aortic arch repair is still associated with significant mortality and morbidity. Furthermore, there is significant variation in the conduct of this complex perioperative technique. The variation in the practice of DHCA has not been adequately characterized and may offer multiple therapeutic opportunities for outcome enhancement and reduction of procedural risk. The International Aortic Arch Study Group (IAASSG) was recently organized to investigate an optimal neuroprotection during the thoracic aortic reconstruction.«Этот тип хирургического вмешательства не предназначен для одного хирурга … В операционной важна, несомненно, команда, в которой, помимо ассистентов-хирургов и хирургических сестер, анестезиолог играет основополагающую роль, что заслуживает особой награды.»  Рассел К. Брок, 1949Глубокая гипотермическая остановка кровообращения (ГГОК) для хирургической коррекции дуги аорты у взрослых все еще ассоциируется с высоким уровнем летальности и осложнений. Кроме того, имеются существенные расхождения в выполнении этой сложной периоперативной техники. Вариации в практике ГГОК не были адекватно охарактеризованы и могут предоставить множество терапевтических возможностей для улучшения исхода и снижения риска процедуры. Недавно была создана Международная группа по исследованию дуги аорты, задачей которой является изучение оптимальной нейропротекции во время реконструкции грудного отдела аорты

XXXIV. The effect of linear redshift-space distortions in photometric galaxy clustering and its cross-correlation with cosmic shear

CONTEXT: The cosmological surveys that are planned for the current decade will provide us with unparalleled observations of the distribution of galaxies on cosmic scales, by means of which we can probe the underlying large-scale structure (LSS) of the Universe. This will allow us to test the concordance cosmological model and its extensions. However, precision pushes us to high levels of accuracy in the theoretical modelling of the LSS observables, so that no biases are introduced into the estimation of the cosmological parameters. In particular, effects such as redshift-space distortions (RSD) can become relevant in the computation of harmonic-space power spectra even for the clustering of the photometrically selected galaxies, as has previously been shown in literature. AIMS: In this work, we investigate the contribution of linear RSD, as formulated in the Limber approximation by a previous work, in forecast cosmological analyses with the photometric galaxy sample of the Euclid survey. We aim to assess their impact and to quantify the bias on the measurement of cosmological parameters that would be caused if this effect were neglected. METHODS: We performed this task by producing mock power spectra for photometric galaxy clustering and weak lensing, as is expected to be obtained from the Euclid survey. We then used a Markov chain Monte Carlo approach to obtain the posterior distributions of cosmological parameters from these simulated observations. RESULTS: When the linear RSD is neglected, significant biases are caused when galaxy correlations are used alone and when they are combined with cosmic shear in the so-called 3 × 2 pt approach. These biases can be equivalent to as much as 5σ when an underlying ΛCDM cosmology is assumed. When the cosmological model is extended to include the equation-of-state parameters of dark energy, the extension parameters can be shifted by more than 1σ

Euclid preparation XXXIV. The effect of linear redshift-space distortions in photometric galaxy clustering and its cross-correlation with cosmic shear

Context. The cosmological surveys that are planned for the current decade will provide us with unparalleled observations of the distribution of galaxies on cosmic scales, by means of which we can probe the underlying large-scale structure (LSS) of the Universe. This will allow us to test the concordance cosmological model and its extensions. However, precision pushes us to high levels of accuracy in the theoretical modelling of the LSS observables, so that no biases are introduced into the estimation of the cosmological parameters. In particular, effects such as redshift-space distortions (RSD) can become relevant in the computation of harmonic-space power spectra even for the clustering of the photometrically selected galaxies, as has previously been shown in literature. Aims. In this work, we investigate the contribution of linear RSD, as formulated in the Limber approximation by a previous work, in forecast cosmological analyses with the photometric galaxy sample of the Euclid survey. We aim to assess their impact and to quantify the bias on the measurement of cosmological parameters that would be caused if this effect were neglected. Methods. We performed this task by producing mock power spectra for photometric galaxy clustering and weak lensing, as is expected to be obtained from the Euclid survey. We then used a Markov chain Monte Carlo approach to obtain the posterior distributions of cosmological parameters from these simulated observations. Results. When the linear RSD is neglected, significant biases are caused when galaxy correlations are used alone and when they are combined with cosmic shear in the so-called 3 × 2 pt approach. These biases can be equivalent to as much as 5σ when an underlying ΛCDM cosmology is assumed. When the cosmological model is extended to include the equation-of-state parameters of dark energy, the extension parameters can be shifted by more than 1σ

Perioperative Assessment of Patients With Cardiac Implantable Electronic Devices

Worldwide, nearly 4 million patients currently have cardiac implantable electronic devices. Due to the increasing number of candidates to receive either pacemakers or implantable cardiac defibrillators, there is no doubt that primary care physicians or anesthesiologists are very likely to interact and deal with this particular patient population. However, besides technologic advancements, several factors have been frequently reported to cause confusion regarding their perioperative care. Therefore, it has become extremely valuable to understand the basic functions and operation of these devices, as well as their functional limitations, to prevent iatrogenic complications and detect potential failure in an early stage. Mt Sinai J Med 79:25–33, 2012. © 2012 Mount Sinai School of Medicin

Anesthetic Management of Patients with a Type A Aortic Dissection

«It is type of surgery that is not for the lone operator… Team is of course essential in the operating theater, where in addition to the surgical and nursing assistants, the anesthesiologist plays a part of fundamental importance which deserves a special tribute.»  Russel C. Brock, 1949 Deep hypothermic circulatory arrest (DHCA) for the adult aortic arch repair is still associated with significant mortality and morbidity. Furthermore, there is significant variation in the conduct of this complex perioperative technique. The variation in the practice of DHCA has not been adequately characterized and may offer multiple therapeutic opportunities for outcome enhancement and reduction of procedural risk. The International Aortic Arch Study Group (IAASSG) was recently organized to investigate an optimal neuroprotection during the thoracic aortic reconstruction