Living donor liver transplantation has become an essential surgical option to address the shortage of deceased donor organs. Unlike recipients, donors are healthy individuals who accept substantial surgical risks solely for the benefit of others.Thus, perioperative anesthetic management must emphasize donor safety, minimize morbidity, and optimize recovery. Key priorities include maintaining stable hemodynamics with minimal blood loss, implementing enhanced recovery after surgery protocols, and delivering effective multimodal pain control strategies. This review integrates current evidence and experience from recent publications to highlight the anesthetic principles guiding minimally invasive living liver donor surgery.

Objective: To test the feasibility and usability of an artificial intelligence (AI)-guided mobile cognitive telerehabilitation program for patients with stroke or older adults with mild cognitive impairment (MCI). Methods: Thirteen participants with cognitive impairment (Mini-Mental State Examination [MMSE] score≤26; nine with stroke and four with MCI) were enrolled in the study. Each participant was provided with an AI-guided mobile cognitive rehabilitation program (Zenicog®). Participants were instructed to complete 24 sessions within 6 weeks, and those with sufficient adherence (≥70%, 17 sessions) were included in the analysis. Cognitive assessments included the MMSE, digit span, and Trail Making Tests A & B. The usability questionnaire investigated equitable use and flexibility in use, simple and intuitive use, perceptible information, tolerance for error, low physical effort, size and space for use, overall product quality, overall satisfaction. Results: Eleven participants completed the study, and 10 participants met adherence criteria. The MMSE score increased significantly from 24.00 [21.00, 25.75] at baseline to 27.50 [26.00, 28.75] after intervention. The overall product quality (Likert scale: 1–5) score was 4.00±0.87. The lowest score in the usability questionnaire was for tolerance for error. Female participants and participants with <12 years’ education gave lower scores for tolerance for error and equitable/ flexibility in use, respectively. Conclusion The AI-guided mobile cognitive telerehabilitation program is feasible and potentially beneficial for improving cognitive function in patients with stroke or older adults with MCI. Individuals who are less familiar with electronic devices require special consideration to improve their usability.

Purpose: This study aimed to compare the dose characteristics of the volumetric modulated arc therapy (VMAT) and dynamic conformal arc (DCA) techniques for metastatic brain tumor treatment using various indices to evaluate the quality of the plan and provide insights into the clinical implications of each approach. Methods: Twelve patients with single metastatic brain tumors treated with VMAT were retrospectively analyzed. For comparison with DCA, identical geometric parameters (excluding multileaf collimators) were applied. Dose coverage, normal tissue sparing, and treatment efficiencywere evaluated using indices such as CILIM98 , CIICRU , CIRTOG , QCRTOG , CISALT , HTCISALT , and CIPADDIC .These indices were statistically assessed to evaluate the differences between VMAT and DCA. Results: VMAT was superior to DCA in most indices for both small and large planning targetvolumes (PTVs). DCA plans for large PTVs showed a higher V12Gy , exceeding 10 mL and failing tomeet the recommended criteria (<10 mL). However, DCA required nearly half the monitor units(MUs) of VMAT, resulting in shorter treatment times. All indices, except for QCRTOG , demonstratedsignificant differences between VMAT and DCA. Conclusions Careful consideration is necessary for larger PTVs when deciding a plan becauseDCA can occasionally result in V12Gy of a brain minus PTV >10 mL. Conversely, DCA provides theadvantage of shorter treatment times because of its lower MU. This study highlights the importance of using a combination of indices to comprehensively assess treatment plan quality.

Purpose: This study aimed to compare the dose characteristics of the volumetric modulated arc therapy (VMAT) and dynamic conformal arc (DCA) techniques for metastatic brain tumor treatment using various indices to evaluate the quality of the plan and provide insights into the clinical implications of each approach. Methods: Twelve patients with single metastatic brain tumors treated with VMAT were retrospectively analyzed. For comparison with DCA, identical geometric parameters (excluding multileaf collimators) were applied. Dose coverage, normal tissue sparing, and treatment efficiencywere evaluated using indices such as CILIM98 , CIICRU , CIRTOG , QCRTOG , CISALT , HTCISALT , and CIPADDIC .These indices were statistically assessed to evaluate the differences between VMAT and DCA. Results: VMAT was superior to DCA in most indices for both small and large planning targetvolumes (PTVs). DCA plans for large PTVs showed a higher V12Gy , exceeding 10 mL and failing tomeet the recommended criteria (<10 mL). However, DCA required nearly half the monitor units(MUs) of VMAT, resulting in shorter treatment times. All indices, except for QCRTOG , demonstratedsignificant differences between VMAT and DCA. Conclusions Careful consideration is necessary for larger PTVs when deciding a plan becauseDCA can occasionally result in V12Gy of a brain minus PTV >10 mL. Conversely, DCA provides theadvantage of shorter treatment times because of its lower MU. This study highlights the importance of using a combination of indices to comprehensively assess treatment plan quality.

Purpose: This study aimed to compare the dose characteristics of the volumetric modulated arc therapy (VMAT) and dynamic conformal arc (DCA) techniques for metastatic brain tumor treatment using various indices to evaluate the quality of the plan and provide insights into the clinical implications of each approach. Methods: Twelve patients with single metastatic brain tumors treated with VMAT were retrospectively analyzed. For comparison with DCA, identical geometric parameters (excluding multileaf collimators) were applied. Dose coverage, normal tissue sparing, and treatment efficiencywere evaluated using indices such as CILIM98 , CIICRU , CIRTOG , QCRTOG , CISALT , HTCISALT , and CIPADDIC .These indices were statistically assessed to evaluate the differences between VMAT and DCA. Results: VMAT was superior to DCA in most indices for both small and large planning targetvolumes (PTVs). DCA plans for large PTVs showed a higher V12Gy , exceeding 10 mL and failing tomeet the recommended criteria (<10 mL). However, DCA required nearly half the monitor units(MUs) of VMAT, resulting in shorter treatment times. All indices, except for QCRTOG , demonstratedsignificant differences between VMAT and DCA. Conclusions Careful consideration is necessary for larger PTVs when deciding a plan becauseDCA can occasionally result in V12Gy of a brain minus PTV >10 mL. Conversely, DCA provides theadvantage of shorter treatment times because of its lower MU. This study highlights the importance of using a combination of indices to comprehensively assess treatment plan quality.

Purpose: This study aimed to compare the dose characteristics of the volumetric modulated arc therapy (VMAT) and dynamic conformal arc (DCA) techniques for metastatic brain tumor treatment using various indices to evaluate the quality of the plan and provide insights into the clinical implications of each approach. Methods: Twelve patients with single metastatic brain tumors treated with VMAT were retrospectively analyzed. For comparison with DCA, identical geometric parameters (excluding multileaf collimators) were applied. Dose coverage, normal tissue sparing, and treatment efficiencywere evaluated using indices such as CILIM98 , CIICRU , CIRTOG , QCRTOG , CISALT , HTCISALT , and CIPADDIC .These indices were statistically assessed to evaluate the differences between VMAT and DCA. Results: VMAT was superior to DCA in most indices for both small and large planning targetvolumes (PTVs). DCA plans for large PTVs showed a higher V12Gy , exceeding 10 mL and failing tomeet the recommended criteria (<10 mL). However, DCA required nearly half the monitor units(MUs) of VMAT, resulting in shorter treatment times. All indices, except for QCRTOG , demonstratedsignificant differences between VMAT and DCA. Conclusions Careful consideration is necessary for larger PTVs when deciding a plan becauseDCA can occasionally result in V12Gy of a brain minus PTV >10 mL. Conversely, DCA provides theadvantage of shorter treatment times because of its lower MU. This study highlights the importance of using a combination of indices to comprehensively assess treatment plan quality.

Purpose: This study aimed to compare the dose characteristics of the volumetric modulated arc therapy (VMAT) and dynamic conformal arc (DCA) techniques for metastatic brain tumor treatment using various indices to evaluate the quality of the plan and provide insights into the clinical implications of each approach. Methods: Twelve patients with single metastatic brain tumors treated with VMAT were retrospectively analyzed. For comparison with DCA, identical geometric parameters (excluding multileaf collimators) were applied. Dose coverage, normal tissue sparing, and treatment efficiencywere evaluated using indices such as CILIM98 , CIICRU , CIRTOG , QCRTOG , CISALT , HTCISALT , and CIPADDIC .These indices were statistically assessed to evaluate the differences between VMAT and DCA. Results: VMAT was superior to DCA in most indices for both small and large planning targetvolumes (PTVs). DCA plans for large PTVs showed a higher V12Gy , exceeding 10 mL and failing tomeet the recommended criteria (<10 mL). However, DCA required nearly half the monitor units(MUs) of VMAT, resulting in shorter treatment times. All indices, except for QCRTOG , demonstratedsignificant differences between VMAT and DCA. Conclusions Careful consideration is necessary for larger PTVs when deciding a plan becauseDCA can occasionally result in V12Gy of a brain minus PTV >10 mL. Conversely, DCA provides theadvantage of shorter treatment times because of its lower MU. This study highlights the importance of using a combination of indices to comprehensively assess treatment plan quality.

INTRODUCTION: Laryngeal mask airway (LMA), which is used in difficult airway maintenance conditions during emergencies, is rarely used in prolonged surgery despite its advantages over endotracheal tube (ETT). In this study, we conducted a comparative analysis of intraoperative gas exchanges between second-generation LMA and ETT during prolonged laparoscopic abdominal surgery. METHODS: Prolonged surgery was defined as a surgery lasting more than 2 h. In total, 394 patients who underwent laparoscopic liver resection via either second-generation LMA or ETT were retrospectively analysed. The following parameters were compared between the two groups of patients: end-tidal pressure of carbon dioxide (ETCO₂), tidal volume (TV), respiratory rate (RR), peak inspiratory pressure (PIP), arterial partial pressure of carbon dioxide (PaCO₂), pH and ratio of arterial partial pressure of oxygen to fractional inspired oxygen (PFR) during surgery. In addition, the incidence of postoperative pulmonary complications (PPCs), including pulmonary aspiration, was compared. RESULTS: The values of ETCO₂, TV, RR and PIP during pneumoperitoneum were comparable between the two groups. Although PaCO₂ at 2 h after induction was higher in patients in the LMA group (40.5 vs. 38.5 mmHg, P < 0.001), the pH and PFR values of the two groups were comparable. The incidence of PPC was similar. CONCLUSION During prolonged laparoscopic abdominal surgery, second-generation LMA facilitates adequate intraoperative gas exchange and may serve as an alternative to ETT.
Humans ; Laryngeal Masks ; Carbon Dioxide ; Retrospective Studies ; Intubation, Intratracheal ; Laparoscopy/adverse effects* ; Postoperative Complications/etiology* ; Oxygen

Background: : This study aims to report the development process of a communication training program targeting residents and nurses in a university hospital and discuss the results of the analysis of questionnaire responses received from the participants. Methods : A training program comprising a lecture on prescription principles, team communication, role-playing using cases based on medical errors related to prescriptions was developed. This two-hour program was conducted four times from September to December in 2022, with 31 residents and 37 nurses. After the program, the participants completed a questionnaire about program satisfaction. Results : An analysis of the questionnaire responses received from 28 residents and 37 nurses revealed that participants had an average satisfaction score ranging from 4.18 to 4.44 for each item. No difference was found between the residents’ and nurses’ responses. The participants shared positive opinions regarding the efficiency of the role-playing experience. The areas highlighted as those requiring improvement were the inclusion of various cases, improvement of teamwork, and a reduction in lecture volume. Conclusion : The participants reported being satisfied with the two-hour program to improve prescribing-related communication for residents and nurses. Future research should improve the program contents by reflecting on the opinions of the participants, and grasp the efficacy of the program by using a tool to measure communication skills or attitudes toward interprofessional collaboration before and after the program.

Background: To deliver therapeutics into the brain, it is imperative to overcome the issue of the blood-brain-barrier (BBB). One of the ways to circumvent the BBB is to administer therapeutics directly into the brain parenchyma. To enhance the treatment efficacy for chronic neurodegenerative disorders, repeated administration to the target location is required. However, this increases the number of operations that must be performed. In this study, we developed the IntraBrain Injector (IBI), a new implantable device to repeatedly deliver therapeutics into the brain parenchyma. Methods: We designed and fabricated IBI with medical grade materials, and evaluated the efficacy and safety of IBI in 9 beagles. The trajectory of IBI to the hippocampus was simulated prior to surgery and the device was implanted using 3D-printed adaptor and surgical guides. Ferumoxytol-labeled mesenchymal stem cells (MSCs) were injected into the hippocampus via IBI, and magnetic resonance images were taken before and after the administration to analyze the accuracy of repeated injection. Results: We compared the planned vs. insertion trajectory of IBI to the hippocampus.With a similarity of 0.990 ± 0.001 (mean ± standard deviation), precise targeting of IBI was confirmed by comparing planned vs. insertion trajectories of IBI. Multiple administrations of ferumoxytol-labeled MSCs into the hippocampus using IBI were both feasible and successful (success rate of 76.7%). Safety of initial IBI implantation, repeated administration of therapeutics, and long-term implantation have all been evaluated in this study. Conclusion Precise and repeated delivery of therapeutics into the brain parenchyma can be done without performing additional surgeries via IBI implantation.