Notes

Workflows with regard to Rapid Practical Annotation regarding Varied Arthropod Genomes.
A 79-year-old man, with a history of atrial fibrillation, presented with a sudden onset of intermittent claudication of the left lower limb. The angiogram revealed a thrombotic total occlusion in the left superficial femoral artery (SFA). A 10-Fr sheath was antegradely inserted into the left common femoral artery (CFA), and the guidewire penetrated the lesion. Thrombo-aspiration using the 8-Fr long sheath into the 10-Fr short sheath was performed repeatedly. Intravenous anticoagulant was administrated immediately after the endovascular treatment. Follow-up angiogram performed 12 days after the procedure confirmed the absence of any residual thrombus in the SFA. Thrombo-aspiration, using a large-diameter catheter, is a feasible strategy for the treatment of acute and subacute limb ischemia, and is cost-effective.
Postoperative pain management in thoracotomy patients often is difficult. Furthermore, pediatric patients present more challenges because of their inability to effectively communicate their pain intensity. The purpose of this study was to evaluate the use of continuous field block through intercostal muscles as postoperative pain management in pediatric thoracotomy.

Between 2014 and 2018, 11 patients underwent an ASD closure using a cardiopulmonary bypass via a mini-right thoracotomy through the fourth intercostal space. At the time of chest closure, a single-shot field block via the fourth intercostal muscles was performed with levobupivacaine (0.6 mg/kg). The first five patients were only given the single-shot field block (Single group). The remaining six patients were given levobupivacaine continuously (0.1 mg/kg/hr) through an indwelling catheter until the chest tube removal (Continuous group). The groups' vital signs, total amounts of acetaminophen used, postoperative courses were compared.

Although the heart rate did not differ between the groups, the respiratory rate was significantly higher in the Single group versus the Continuous group at 16 and 32 hr post-surgery (35.6±9.7/min vs. 18.5±4.7/min; p=0.007, 43.0±10.4 vs. 25.3±3.1; p=0.042, respectively). The accumulated dosage of acetaminophen given by postoperative day 2 was significantly higher in the Single group versus the Continuous group (55.3±22.1 mg/kg vs. 7.8±17.4 mg/kg; p=0.012).

Continuous field block via intercostal muscles after ASD closure via a mini-right thoracotomy in children was effective to stabilize the vital signs and reduce the analgesic medication use.
Continuous field block via intercostal muscles after ASD closure via a mini-right thoracotomy in children was effective to stabilize the vital signs and reduce the analgesic medication use.We assessed the relationship between disease severity and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) load, IgG antibody levels, and prognostic indicators. Twenty-one patients hospitalized with COVID-19 were classified as having severe or mild disease based on their average respiratory rate during hospitalization (severe ≥22 breaths/min; mild less then 22 breaths/min). The viral load in nasopharyngeal samples, and blood levels of C-reactive protein (CRP), lymphocytes, and D-dimer on admission and plasma immunoglobulin G (IgG) index on Day 7 ±2 from symptom onset were compared according to disease severity. Of the participants, 7 had severe and 14 had mild disease. Participants with severe disease had a significantly higher IgG index (median 3.75 vs 0.56, p=0.01), CRP (median 8.6 vs 1.0 mg/dL, p less then 0.001), and D-dimer levels (median 1.65 vs 0.75μg/mL; p=0.002), and a significantly lower lymphocyte count (median 1176 vs 666 cells/μL, p=0.005) and viral load (median 8.7×106 vs 2.3×104 copies/mL, p=0.005). Furthermore, time from symptom onset to virus disappearance was significantly longer (median 24 vs 17 days, p=0.03). A high IgG index in the early phase of the disease may be associated with disease severity and might serve as a prognostic indicator.A 64-year-old female was admitted to the hospital with constant abdominal pain. She had been previously hospitalized five times in 2 years with similar symptoms. Computed tomography revealed dilatation and fecal impaction from the ileum to the transverse colon. Talabostat A barium enema and simultaneous ileus tube radiography demonstrated a segment of narrow descending-sigmoid colon. Colonoscopy did not show any mucosal change. These symptoms did not improve with conservative therapy when a descending and sigmoid colectomy was performed. In terms of histology, there was a disappearance of ganglion cells, and axon of Meissner' s plexuses was present along with a decrease in the number of Auerbach' s plexuses. The definite diagnosis given was segmental hypoganglionosis (SH) of the colon. The postoperative course was uneventful, and the functional result was positive following 1 year postoperatively. SH is extremely rare; however, surgical intervention is expected to be of benefit. Therefore, it is important to keep SH in mind when treating patients with chronic obstruction in the left side of the colon as it can cause SH.
The incidence and risk factors of postoperative nausea and vomiting (PONV) and early PONV (ePONV) was evaluated in patients who underwent breast surgery with volatile anesthesia.

In this retrospective study, we used a multivariate logistic regression to investigate the incidence and risk factors of PONV.

Among 928 patients, 166 (18%) and 220 (24%) had ePONV and PONV, respectively. In the multivariate analysis, the anesthesia duration and the use of desflurane were independent risk factors for ePONV. For PONV, the anesthesia duration and Apfel score were the independent risk factors.

Although many previous studies have shown that PONV is a multifactorial event, our results indicate that desflurane use can be considered a main cause of ePONV. However, in the delayed phase, a higher Apfel score was the main predictor. In the early and delayed phases, a long duration of anesthesia was related to a high risk of PONV. Accordingly, avoiding a long duration of anesthesia and desflurane use is recommended for patients at a high risk of developing PONV, particularly for those with high Apfel scores.
Although many previous studies have shown that PONV is a multifactorial event, our results indicate that desflurane use can be considered a main cause of ePONV. However, in the delayed phase, a higher Apfel score was the main predictor. In the early and delayed phases, a long duration of anesthesia was related to a high risk of PONV. Accordingly, avoiding a long duration of anesthesia and desflurane use is recommended for patients at a high risk of developing PONV, particularly for those with high Apfel scores.
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