Challenges of bringing a new sedative to market!

Purpose of review The current review examines the success and failures of the development of new hypnotic compounds for the human market. One of the important aspects is that one of the key present agents, propofol, is considered by many anaesthesiologists as 'the ideal'. However, all drugs have adverse or side-effects. Recent findings The last 30 years since the introduction of propofol has seen many new compounds evaluated; but as at the present time, only three agents may achieve a pivotal position in the market – fospropofol (a sedative agent which may have a role in endoscopic surgery); remimazolam (a short-acting benzodiazepine) whose development is also being focused on the sedation rather than anaesthesia market; and the pregnane steroid, alfaxalone (an anaesthetic agent first introduced in 1972, but withdrawn in 1984 because of adverse allergic reactions to the solvent, Cremophor EL) now solvented in a cyclodextrin. Summary Studies of these three agents thus far have shown that none of them has any major adverse side-effects; all have properties which warrant further clinical evaluation. Correspondence to John W. Sear, 6 Whites Forge, Abingdon, Appleton OXON OX13 5LG, UK. E-mail: john.sear@gtc.ox.ac.uk Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Recent advances in respiratory monitory in nonoperating room anesthesia

Purpose of review Sedation for nonoperating room procedures is experiencing a considerable increase in demand. Respiratory compromise is one of the most common adverse events seen in sedation. Capnography is a modality that has been widely adopted in this area, but may not be well suited to the special demands of nonoperating room sedation. This review is an assessment of new technologies that may improve outcomes beyond those achievable with capnography. Recent findings New devices for detecting the onset of apnea and for assessing respiratory depression have emerged which have advantages over conventional capnography for detecting apnea without excessive false positive and false negative rates. In addition, monitors that assess respiratory drive have become available, and these may prove useful in regulating depth of sedation. Summary No single monitor is ideal for all settings. During brief endoscopic sedation, detection of apnea is paramount, while during longer procedures, avoiding excessive respiratory depression is more critical. The clinician must choose the appropriate monitor based on an understanding of the challenges of the particular environment. Correspondence to Jeff E. Mandel, Assistant Professor of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, 7003 Dulles Building, 3400 Spruce Street, Philadelphia, PA 190103, USA. E-mail: mandelj@uphs.upenn.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Epigenetics of pain mediators

Purpose of review The field of epigenetics continues its influential rise as a means to better understand an organism's unique developmental identity over a lifespan. Whereas a genome is constant and unchanging, an epigenome is dynamic and alterable. Epigenetic changes are in response to innumerable internal and external influences including environmental changes such as diet, exercise, disease, toxins, and stress. Epigenetics is of particular interest in the medical research community both for the potential to cause disease and as a target for therapeutic interventions. This article provides a succinct explanation of the potential for epigenetics to influence the understanding of pain as well as a review of relevant research on the topic. Recent findings Studies on epigenetics and pain remain largely preclinical and investigate the theoretical ability of epigenetics to alter the nociceptive pathways both in the periphery and centrally. Significant evidence now exists for the ability of epigenetics to modify broadly categorized pain types, including inflammatory, neuropathic, visceral, and cancer related. Summary Both patients and providers recognize that novel medications for the treatment of both acute and chronic pain conditions are sorely needed. The understanding of epigenetics and its influence on nociception remains in relative infancy but early evidence is strong for potential therapeutic benefits to treat these conditions. Correspondence to Daniel W. Odell, MD, Division of Pain Medicine, Department of Anesthesiology, University of Utah and Supportive Oncology and Survivorship, Huntsman Cancer Hospital, 30 N 1900 E Room 3C444, Salt Lake City, UT 84132-2501, USA. Tel: +1 801 581 6393; fax: +1 801 581 4367; e-mail: daniel.odell@hsc.utah.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Calculations of consciousness: electroencephalography analyses to determine anesthetic depth

Purpose of review Electroencephalography (EEG) was introduced into anesthesia practice in the 1990s as a tool to titrate anesthetic depth. However, limitations in current analysis techniques have called into question whether these techniques improve standard of care, or instead call for improved, more ubiquitously applicable measures to assess anesthetic transitions and depth. This review highlights emerging analytical approaches and techniques from neuroscience research that have the potential to better capture anesthetic transitions to provide better measurements of anesthetic depth. Recent findings Since the introduction of electroencephalography, neuroscientists, engineers, mathematicians, and clinicians have all been developing new ways of analyzing continuous electrical signals. Collaborations between these fields have proliferated several analytical techniques that demonstrate how anesthetics affect brain dynamics and conscious transitions. Here, we review techniques in the following categories: network science, integration and information, nonlinear dynamics, and artificial intelligence. Summary Up-and-coming techniques have the potential to better clinically define and characterize altered consciousness time points. Such new techniques used alongside traditional measures have the potential to improve depth of anesthesia measurements and enhance an understanding of how the brain is affected by anesthetic agents. However, new measures will be needed to be tested for robustness in real-world environments and on diverse experimental protocols. Correspondence to Sarah L. Eagleman, PhD, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Grant Building, 300 Pasteur Dr, S288, Palo Alto, CA 94305–5117, USA. Tel: +650 725 5851; fax: +650 725 8544; e-mail: seagle@stanford.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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How The West Was Won

No abstract available

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Who were the Nataruk people? Mandibular morphology among late Pleistocene and early Holocene fisher-forager populations of West Turkana (Kenya)

Publication date: Available online 29 May 2018
Source:Journal of Human Evolution
Author(s): Aurélien Mounier, Maria Correia, Frances Rivera, Federica Crivellaro, Ronika Power, Joe Jeffery, Alex Wilshaw, Robert A. Foley, Marta Mirazón Lahr
Africa is the birthplace of the species Homo sapiens, and Africans today are genetically more diverse than other populations of the world. However, the processes that underpinned the evolution of African populations remain largely obscure. Only a handful of late Pleistocene African fossils (∼50-12 Ka) are known, while the more numerous sites with human fossils of early Holocene age are patchily distributed. In particular, late Pleistocene and early Holocene human diversity in Eastern Africa remains little studied, precluding any analysis of the potential factors that shaped human diversity in the region, and more broadly throughout the continent. These periods include the Last Glacial Maximum (LGM), a moment of extreme aridity in Africa that caused the fragmentation of population ranges and localised extinctions, as well as the 'African Humid Period', a moment of abrupt climate change and enhanced connectivity throughout Africa. East Africa, with its range of environments, may have acted as a refugium during the LGM, and may have played a critical biogeographic role during the heterogene`ous environmental recovery that followed. This environmental context raises a number of questions about the relationships among early Holocene African populations, and about the role played by East Africa in shaping late hunter-gatherer biological diversity. Here, we describe eight mandibles from Nataruk, an early Holocene site (∼10 Ka) in West Turkana, offering the opportunity of exploring population diversity in Africa at the height of the 'African Humid Period'. We use 3D geometric morphometric techniques to analyze the phenotypic variation of a large mandibular sample. Our results show that (i) the Nataruk mandibles are most similar to other African hunter-fisher-gatherer populations, especially to the fossils from Lothagam, another West Turkana locality, and to other early Holocene fossils from the Central Rift Valley (Kenya); and (ii) a phylogenetic connection may have existed between these Eastern African populations and some Nile Valley and Maghrebian groups, who lived at a time when a Green Sahara may have allowed substantial contact, and potential gene flow, across a vast expanse of Northern and Eastern Africa.



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From Improved Diagnostics to Presurgical Planning: High-Resolution Functionally Graded Multimaterial 3D Printing of Biomedical Tomographic Data Sets

3D Printing and Additive Manufacturing, Ahead of Print.


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