Notes

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To improve resource allocation in face of the COVID-19 pandemic, hospitals around the country are restricting the performance of elective surgery to preserve ventilators, operating rooms, ICU beds and protect anesthesiologists. For patients with severe aortic stenosis, efforts to bring treatment to symptomatic patients amid this pandemic might lead to favored use of catheter based management using minimalist techniques that do not require these elements. In this context, some patients with well tested surgical indications for valve replacement may be treated by catheter-based methods. It is important that outcomes for these cases are followed closely both at respective sites and in national registries. As we recover from this pandemic, surgical cases should once again be driven by multi-disciplinary discussion and clinical trial data, and not a mentality of crisis management. © 2020 Wiley Periodicals, Inc.We hereby describe a rare case of coronary artery involvement in a patient with periaortitis which was mimicking an aortic aneurysm on computed tomography (CT). This case also highlights the role of CT in differentiating aortic pathologies to guide the management and also the importance of coronary evaluation in such patients. © 2020 Wiley Periodicals, Inc.A 49-year-old man was admitted to our department 6 months after emergent surgery for type-A acute aortic dissection. A chest computed tomography-scan revealed a huge aneurysm originating from the proximal aortic arch, strongly adherent to the upper part of the sternum. Extracorporeal circulation was instituted first, and chest was reopened in circulatory arrest. The mass was a giant pseudoaneurysm originating from a laceration at the base of the innominate artery. Due to tissue fragility and complete distortion of the origin of right carotid and subclavian arteries, we performed an extra-anatomic ascending aorta-to-right carotid artery bypass, followed by Teflon-reinforced suture of the proximal artery stumps. The postoperative course was uneventful. © 2020 Wiley Periodicals, Inc.BACKGROUND Pain control in pediatric patients undergoing cardiac surgery presents a unique challenge. Postoperatively, many of these patients require long-term opioid infusions and sedation leading to need for prolonged weaning from opioids and longer hospital stays. this website We hypothesized that intravenous methadone as the sole opioid in children having cardiac surgery with cardiopulmonary bypass would improveperioperative pain control anddecrease overall perioperative use of opioid analgesics and sedatives. METHODS We instituted a practice change involvingpediatric patients age 30 days to 18 years). Our primary outcome was intraoperative and postoperative opioid requirements measured in morphine equivalents intraoperatively, during the first 24 hour postoperatively, and up to postoperative day 7. Secondary outcomes included extubation rates in the OR, pain and sedation scores, sedation requirements and time to start of oxycodone. RESULTS Patients in both groups had similar demographics. In neonatal patients, the post-interventiongroup required significantly lower doses of intraoperative opioids. There was no statistically significant difference in postoperative opioid use. In non-neonatal patients, the post-interventiongroup required significantly less intraoperative opioids. Postoperatively, those in the post-interventiongroup required significantly less opioids in the first 24 hours. CONCLUSION Use of intraoperative methadone appears to be a reasonable alternative to the use of fentanyl with potential other benefits both intra- and postoperatively of decreased total dose of opioids and other sedatives. Future studies will assess for any improvement in total postoperative opioid requirements during the total hospital stay, and potential use of methadone by the ICU team. This article is protected by copyright. All rights reserved.BACKGROUND AND AIMS The effect of solid debris on walled-off necrosis (WON) drainage remains unknown. Our study evaluated the role of solid debris in EUS-guided drainage of WON compared lumen-apposing metal stent (LAMS) with double-pigtail plastic stent (DPPS). METHODS We retrospectively evaluated consecutive patients with WON underwent EUS-guided drainage in our endoscopic center over a 9-year period. The amount of solid debris in WON was assessed with CT/MRI and EUS images. RESULTS From 2011 to 2019, 84 WON patients were included. In WON with 40% (OR, 0.11; 95% CI, 0.02-0.62; P=0.01) were the predictors for failure of resolution of WON after adjusting for age and cyst size. The number of DPPSs used was significantly higher than LAMSs in managing WONs (P less then 0.001). CONCLUSIONS For WON with less then 20% solid debris, LAMSs might superior to DPPSs in terms of efficacy and safety. This article is protected by copyright. All rights reserved.Grain size is one of the essential components determining rice yield and a target for both domestication and artificial breeding. Gibberellins (GAs) are diterpenoid phytohormones influencing diverse aspects of plant growth and development. Several quantitative trait loci (QTLs) have been identified to control grain size through phytohormone regulation. However, little is known about the role of GAs in the control of grain size. Here, we report the cloning and characterization of a QTL, GW6 (GRAIN WIDTH 6), which encodes a gibberellin-regulated GAST family protein and positively regulates grain width and weight. GW6 is highly expressed in the young panicle and increases grain width by promoting cell expansion in the spikelet hull. The knockout of GW6 exhibits reduced grain size and weight, whereas the overexpression of GW6 results in increased grain size and weight. GW6 is induced by GA and its knockout down-regulates the expression of GA biosynthesis genes and decreases GA contents in the young panicle. We found that a natural variation in the cis element CAAT-box in the promoter of GW6 is associated with its expression level and grain width and weight. Furthermore, introduction of GW6 to an O. indica variety HJX74 can lead to a 10.44% increase in rice grain yield, indicating that GW6 has great potential to improve grain yield in rice. This article is protected by copyright. All rights reserved.
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