2021 Covers & Artwork

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February 2021, Volume 132, Issue 2

This month's cover art depicts central musculature, as loss of central muscle mass is now recognized as a biomarker of frailty, and as a risk factor for poor outcomes after surgery. Loss of muscle mass and function—sarcopenia—is a common degenerative disease of the elderly. Its causes are complex, multifactorial, and inter-connected. At the systems level, hormonal changes, inflammation, oxidant stress, and lifestyle contribute to sarcopenia. Cellular senescence and a toxic senescence associated secreted phenotype affects many cells, including skeletal muscle stem cells (satellite cells) which become dysfunctional with aging, limiting muscle repair and regeneration. At the subcellular level, mitochondrial dysfunction is a major contributor to sarcopenia and lysosome dysfunction also plays a role. Molecular mechanisms underlying all these contributing pathologic processes have been identified, but effective pharmacologic treatment of sarcopenia is not yet available. The most effective way to prevent and treat sarcopenia remains exercise.

Marie Csete MD, PhD

Cover art composed by
Naveen Nathan, MD
Cover Editor and Illustrator

January 2021, Volume 130, Issue 1

This month's cover art shows the evolution of humans that includes the acquisition of tools during this continuum that culminates in an individual with severe obesity as a possibility when the prevalence of this disease is rising worldwide. The medical profession faces unresolved questions and opportunities to better understand the disease and care for these patients. Schumann and colleagues focus on 4 topics in their narrative review that are of interest to practitioners caring routinely for patients with obesity. Ultrasound can help us "see" gastric content and plan accordingly. Blood pressure monitoring accuracy is more complex and a challenge in patients with obesity, but solutions may soon be emerging. The appropriate dosing of antibiotics, heparins and vasoactive drugs has unique considerations and a dosing scalar where one size fits all remains elusive. The review concludes with the issue of preoxygenation and airway management at in- and extubation of the trachea. These are core concerns for the anesthesiologist, and informed optimization of management strategies for these patients will improve safety and outcomes.

Roman Schumann, MD, FASA

Cover art composed by
Naveen Nathan, MD
Cover Editor and Illustrator