Retrospective Analysis of Emergency Department Ultrasound for Acute Appendicitis

OBJECTIVES: To determine whether emergency physicians (EPs) who have skills in the other applications of ultrasound can apply these in appendicitis diagnosis. METHODS: EPs did not have focused training in bedside ultrasound for appendicitis. We identified patients receiving an ED bedside ultrasound evaluation for appendicitis from our ultrasound log. Criterion reference was radiology ultrasound (RUS), CT scan, or pathology report. RESULTS: We performed 155 ED ultrasounds for appendicitis. There were 27/155 cases where the ED ultrasound was true positive and agreed with pathology (sensitivity = 39%, 95% CI 28 – 52%). In 42/155 (27%) the ED ultrasound was non-diagnostic (false negative) with pathology positive. In 77 cases the ED ultrasound was true negative with non-visualization of the appendix in concert with non-visualization by RUS or CT scan (specificity = 90%, 95% CI 81-95%). In nine cases (6%), ED ultrasound was falsely positive, compared to CT scan with surgical consult. CONCLUSION: ED ultrasound by EPs prior to focused appendicitis ultrasound training is insufficiently accurate

Vision based referee sign language recognition system for the RoboCup MSL league

In RoboCup Middle Size league (MSL) the main referee uses assisting technology, controlled by a second referee, to support him, in particular for conveying referee decisions for robot players with the help of a wireless communication system. In this paper a vision-based system is introduced, able to interpret dynamic and static gestures of the referee, thus eliminating the need for a second one. The referee's gestures are interpreted by the system and sent directly to the Referee Box, which sends the proper commands to the robots. The system is divided into four modules: a real time hand tracking and feature extraction, a SVM (Support Vector Machine) for static hand posture identification, an HMM (Hidden Markov Model) for dynamic unistroke hand gesture recognition, and a FSM (Finite State Machine) to control the various system states transitions. The experimental results showed that the system works very reliably, being able to recognize the combination of gestures and hand postures in real-time. For the hand posture recognition, with the SVM model trained with the selected features, an accuracy of 98,2% was achieved. Also, the system has many advantages over the current implemented one, like avoiding the necessity of a second referee, working on noisy environments, working on wireless jammed situations. This system is easy to implement and train and may be an inexpensive solution

Effects of a novel method of anesthesia combining propofol and volatile anesthesia on the incidence of postoperative nausea and vomiting in patients undergoing laparoscopic gynecological surgery

AbstractBackgroundWe investigated the effects of a novel method of anesthesia combining propofol and volatile anesthesia on the incidence of postoperative nausea and vomiting in patients undergoing laparoscopic gynecological surgery.MethodsPatients were randomly divided into three groups: those maintained with sevoflurane (Group S, n=42), propofol (Group P, n=42), or combined propofol and sevoflurane (Group PS, n=42). We assessed complete response (no postoperative nausea and vomiting and no rescue antiemetic use), incidence of nausea and vomiting, nausea severity score, vomiting frequency, rescue antiemetic use, and postoperative pain at 2 and 24h after surgery.ResultsThe number of patients who exhibited a complete response was greater in Groups P and PS than in Group S at 0–2h (74%, 76% and 43%, respectively, p=0.001) and 0–24h (71%, 76% and 38%, respectively, p<0.0005). The incidence of nausea at 0–2h (Group S=57%, Group P=26% and Group PS=21%, p=0.001) and 0–24h (Group S=62%, Group P=29% and Group PS=21%, p<0.0005) was also significantly different among groups. However, there were no significant differences among groups in the incidence or frequency of vomiting or rescue antiemetic use at 0–24h.ConclusionCombined propofol and volatile anesthesia during laparoscopic gynecological surgery effectively decreases the incidence of postoperative nausea. We term this novel method of anesthesia “combined intravenous-volatile anesthesia (CIVA)”

ジュツゴ ノ オウキ オウト : センタクテキ ニューロキニン １ ジュヨウタイ キッコウヤク ガ オヨボス エイキョウ

Post-operative nausea and vomiting（PONV）remains the most frequently reported patients complaint after anesthesia, and for patients, it is of greater concern than postoperative pain. PONV has four main risk factors including : female gender, history of PONV or motion sickness, nonsmoking, and the use of postoperative opioids. Primary control of nausea and vomiting arises from the central pattern generator for vomiting located in the medulla oblongara. Traditionally, the most common anti-emetics used to treat PONV include serotonin ５-hydroxytryptamine type３antagonists such as ondansetron, corticosteroids, like dexamethasone, or droperidol, which is a neuroleptic. However, these anti-emetics are not completely reliable and only reduce the incidence of PONV by～２６％. Adding additional anti-emetics could further lower the incidence of PONV. PONV can result in several post-surgical complications. Neurokinin-１（NK-１）receptors are found in gastrointenstinal vagal afferents and within the central nervous system vomiting reflex pathways. NK-１receptors are activated by Substance P, which is a regulatory peptide and preferred endogenous ligand. We investigated whether NK-１antagonism can effectively diminish PONV in patients undergoing laparoscopic gynecological surgery. Forty two patients were randomized into two groups : NK-１ group which received an oral NK-１antagonist, aprepitant at８０mg, and a control that did not receive any anti-emetic. PONV incidence at２hours was present in both control and NK-１groups and was ８１％ and５２％, respectively. At２４hours PONV was present in the control group, but was absent in the NK１group（２７％ and０％，respectively）. PONV is associated with dissatisfaction after anesthesia and surgery, can result in several postsurgical complications. NK-１receptor antagonism effectively lowered PONV, and expedited recovery in patients undergoing laparoscopic gynecological surgery

G-language genome analysis environment with REST and SOAP web service interfaces

G-language genome analysis environment (G-language GAE) contains more than 100 programs that focus on the analysis of bacterial genomes, including programs for the identification of binding sites by means of information theory, analysis of nucleotide composition bias and the distribution of particular oligonucleotides, calculation of codon bias and prediction of expression levels, and visualization of genomic information. We have provided a collection of web services for these programs by utilizing REST and SOAP technologies. The REST interface, available at http://rest.g-language.org/, provides access to all 145 functions of the G-language GAE. These functions can be accessed from other online resources. All analysis functions are represented by unique universal resource identifiers. Users can access the functions directly via the corresponding universe resource locators (URLs), and biological web sites can readily embed the functions by simply linking to these URLs. The SOAP services, available at http://www.g-language.org/wiki/soap/, provide language-independent programmatic access to 77 analysis programs. The SOAP service Web Services Definition Language file can be readily loaded into graphical clients such as the Taverna workbench to integrate the programs with other services and workflows

A case where rocuronium was unable to achieve neuromuscular block immediately after sugammadex administration

We present a case where immediatemuscle relaxation was needed following sugammadex administration. A 72 year-old female underwent surgery for a cerebral artery aneurysm. Upon conclusion of the operation sugammadex (9.3 mg/kg) was administered and the patient was noted to have left hemiplegia. Rocuronium (1.2 mg/kg 2 doses) was given in order to gain neuromuscular block approximately 25 minutes after sugammadex had been injected. Although TOF monitoring was not utilized in this case and assessing residual muscular block was difficult, spontaneous respirations continued and breathing had to be controlled with sevoflurane and remifentanil. Sugammadex is a potent reversal agent for rocuronium-induced neuromuscular block, however, certain situations require immediate neuromuscular blockade following sugammadex. In this case, rocuronium was unable to induce neuromuscular blockade immediately after sugammadex and that higher concentrations were necessary in addition to intravenous analgesics and inhaled anesthetics

USO DE TRES MÉTODOS PARA EVALUAR EL MANATI AMAZÓNICO (Trichechus inunguis) EN EL ÁREA DE CONSERVACIÓN REGIONAL TAMSHIYACU TAHUAYO, LORETO, PERÚ

The Amazon manatee (Trichechus inunguis) is endemic to the Amazon Basin, with limited information on population dynamics and currently listed as Vulnerable by the Red List of the International Union for the Conservation of Nature (IUCN). The aim of this study was to compare three methodologies: visual detection (VD), side scan sonar technology (SBL), and surveys to local communities; to detect the presence of the Amazonian manatee and assess the use of these methods for future studies along the species distribution range. The study was carried out within the Tamshiyacu Tahuayo Communal Regional Conservation Areain Iquitos, Peru. The VD resulted in zero sightings at both seasons after a sampling effort of 30 and 29 hours during the rainy and dry seasons respectively. After using the SBL, two individuals were recorded in August, after a total sampling of 103.38 km in the dry season (0.02 ind/km). Surveys to artisanal fishermen in three neighboring communities indicated the presence of manatees and the perception of reduction in sightings within the protected area during 2018 (previous year of this study). We discussed the advantages and disadvantages of each methodology, the logistics associated with its use in complex habitats, and its effectiveness and potential use to detect manatees in future studies in the area.El manatı́ amazónico (Trichechus inunguis) es endémico de la cuenca amazónica, cuenta con una limitada información de dinámica poblacional y actualmente está categorizado como Vulnerable por la Lista Roja de la Unión Internacional para la Conservación de la Naturaleza (UICN). El presente estudio tiene como objetivo comparar tres metodologıá s: registro visual (RV), sonar de barrido lateral (SBL) y encuestas en comunidades locales; para detectar la presencia de la especie y evaluar su aplicación para futuros estudios en su zona de distribución. El estudio fue llevado a cabo dentro del&nbsp;Área de Conservación Regional Comunal Tamshiyacu Tahuayo en Iquitos, Perú. El RV resultó en cero avistamientos en ambas estaciones luego de un esfuerzo de muestreo de 30 y 29 horas en la estación creciente y vaciante respectivamente.&nbsp;Tras el uso del SBL, dos individuos se registraron en agosto, luego de un recorrido total de 103,38 km en la estación vaciante (0,02 ind/km). Las encuestas realizadas a los pescadores artesanales en tres comunidades aledañas indicaron lapresencia de la especie, ası́ como la percepción de una reducción en avistamientos en el área protegida durante el 2018 (año previo a las encuestas).Se discute las ven‑ tajas y desventajas de cada metodología , la logística asociada a su uso en hábitats complejos, y su efectividad y uso potencial para la detección de manatíes en futuros&nbsp;estudios en la zon

General anesthesia for electroconvulsive therapy with Brugada electrocardiograph pattern

Brugada syndrome is characterized by an electrocardiograph pattern of right bundle-branch block and has an increased risk for cardiac arrest due to malignant arrhythmia. We describe the successful anesthetic management for electroconvulsive therapy in a patient with Brugada electrocardiograph pattern. Patients with Brugada ECG pattern are not recommended to use neostigmine which augments ST elevation. Sugammadex was administered as a neuromuscular reversal agent in this case. Sugammadex provides rapid reversal of profound rocuronium-induced neuromuscular blockade under propofol anesthesia