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This study examines whether more capable managers affect the cost of equity capital. After controlling for standard risk factors and firm characteristics, we find that higher managerial ability is associated with a lower implied cost of equity. Moreover, our results show that the negative association between managerial ability and the cost of equity capital is more pronounced for firms with high information asymmetry among investors, with less institutional ownership, and with high capital intensity. The results are robust to a variety of sensitivity tests, including change specifications, an instrumental variable approach, and alternative measures of managerial ability. [ABSTRACT FROM AUTHOR]

Purpose: To compare the clinical efficacy and safety of arthroscopy-guided continuous suprascapular nerve block and ultrasound-guided continuous interscalene block in postoperative analgesia in patients undergoing arthroscopic rotator cuff repair.Methods: A prospective study was performed between March and November 2020. In total, 76 patients were enrolled and divided into 2 groups: in the 38 patients of group 1 (arthroscopy-guided continuous suprascapular nerve block), an indwelling catheter was introduced via the Neviaser portal under arthroscopic view before closing the portal at the end of the surgery; and in the 38 patients of group 2 (ultrasound-guided continuous interscalene block), an indwelling catheter was inserted and directed toward the interscalene brachial plexus prior to the surgery under ultrasound guidance. The primary outcome was the pain score measured by the visual analog scale at postoperative 24 hours during admission. Comparisons were conducted at different time points (postoperative 4, 8, 24, and 48 hours). The secondary outcome was any of these events: neurologic complications, such as sensory/motor change in the upper extremities; hemidiaphragmatic paresis; dyspnea; dysphonia; and Horner's syndrome. Opioid usage until postoperative 3 weeks was compared between the groups.Results: The visual analog scale scores in groups 1 and 2 were comparable at each postoperative time point (analysis of variance, P = .919; trends, P = .132). Neurologic deficits were more common in group 2 than in group 1 (8 vs 32 patients, P < .001). Decreased excursion of the diaphragm was more common in group 2 (partial or complete paresis of the hemidiaphragm: 1 vs 29 patients, P < .001). Opioid consumption was similar in both groups (morphine milligram equivalents per kilogram; 1.75 vs 1.55, P = .195).Conclusions: Our findings show that arthroscopy-guided continuous suprascapular nerve block is not inferior to ultrasound-guided continuous interscalene block for postoperative pain control after arthroscopic rotator cuff repair while showing fewer temporary neurologic complications.Level Of Evidence: Level II, prospective cohort study, interventional study. [ABSTRACT FROM AUTHOR]

The pleating technique is widely used in plication but is difficult to perform with thoracoscopy because of its complex procedure and the limited surgical space. Thus, the invaginating technique was introduced to facilitate thoracoscopic surgery and is now widely used in video-assisted thoracoscopic surgery (VATS) plication. However, the usefulness of the invaginating technique in children has not been established because of the lack of data on long-term outcomes after surgery using the technique. From March 2007 to December 2017, 21 patients who were surgically treated for congenital diaphragmatic eventration and phrenic nerve palsy after congenital cardiac surgery were divided into 2 groups according to the surgical method used (pleating technique: 10 patients, invaginating technique: 11 patients). We evaluated the patients for postoperative outcomes and recurrence of diaphragmatic eventration over 5 years. Postoperative recurrence of diaphragmatic eventration was confirmed by calculating the ratio of the eventration level between the eventrated and normal diaphragms. In the 21 patients who underwent diaphragmatic plication, the pleating and invaginating techniques were used in 10 and 11 patients, respectively. The mean follow-up duration was 63.4 ± 48.4 months (pleating group [P] vs invaginating group [I]: 89.1 ± 52.4 vs 40.1 ± 30.8 months, p = 0.022). The mean eventration rates in the 21 patients was 26.7% ± 9.1% (P vs I: 26.6% ± 6.1% vs 26.9% ± 11.3%, p = 0.945) before operation and − 2.1% ± 7.3% (− 2.8% ± 7.5% vs − 1.5% ± 7.4%, p = 0.695) in the immediate postoperative period. From the first to the fifth postoperative year, no recurrence of diaphragmatic eventration was found in any of the groups during the follow-up. The invaginating technique was easier to perform but showed a similar long-term result as compared with the pleating technique in terms of the growth and development of the chest cavity in the pediatric patients in this study. Thus, we recommend that the invaginating technique be applied in VATS plication for children as an alternative to the pleating technique. Level III. [ABSTRACT FROM AUTHOR]

Conduit survival without significant dysfunction is important when selecting the right ventricular outflow tract conduit. We made an expanded polytetrafluoroethylene tricuspid valved conduit using a simplified technique. We aimed to investigate the midterm functional results and longevity of this conduit. Between November 2008 and December 2016, four hospitals in Korea implanted 145 valved conduits. We retrospectively analyzed their functional results and longevity. The patients' median age at operation was 36.6 months; the median body weight was 11.3 kg. The mean follow-up duration was 32.3 ± 24.5 months. There were four inhospital deaths and three late deaths, but there were no conduit-related deaths. The mean peak systolic pressure gradient across the conduit was 14.7 ± 8.3 mm Hg and 31.6 ± 17.7 mm Hg at discharge and last follow-up, respectively. Six patients (4.4%) had moderate or more conduit valve regurgitation at last follow-up. Conduit dysfunction was observed in 30 patients (21.9%), mainly caused by increased pressure gradient (24 of 30, 80%). Freedom from conduit dysfunction was 88.1% and 58.5% at 3 and 5 years, respectively. Lower freedom from conduit dysfunction was observed in small conduits. Eleven patients (7.8%) underwent conduit explantation, and freedom from explantation was 94.8% and 81.7% at 3 and 5 years, respectively. The main cause of explantation was conduit stenosis. Small conduits tended to have lower freedom from explantation. Functional results and longevity of our expanded polytetrafluoroethylene tricuspid valved conduit are acceptable. Although our conduits tend to have increasing pressure gradient over time, especially in small conduits, they have low incidence of moderate or more regurgitation. [ABSTRACT FROM AUTHOR]

Using the setting of chaebol industrial organizations in Korea, which allows for the study of a unique affiliation between a chaebol group and financial analysts, we examine whether investors react to an optimistic bias in affiliated analysts' recommendations. Our initial market return tests, abnormal trading volume tests and independent analysts' reaction tests suggest that investors and independent analysts recognize and discount an optimistic bias in chaebol-affiliated 'buy' recommendations. However, long-term market returns are more profitable in terms of affiliated analysts' 'buy' recommendations than independent analysts' recommendations, which suggests that investors excessively discount chaebol-affiliated 'buy' recommendations in the short-term. [ABSTRACT FROM AUTHOR]

We used a suture-and-open technique with a biatrial incision for primary sutureless repair of total anomalous pulmonary venous connection (TAPVC). With this technique, the common pulmonary venous sinus and its branching pulmonary veins are opened after completion of suturing of the left atrial incision to the pericardium around the common pulmonary venous sinus and its branching veins. The technique allows the primary sutureless repair of TAPVC to be done in a less bloody field under full-flow cardiopulmonary bypass. We have performed this technique in our recent 5 consecutive TAPVC patients without significant complications. [ABSTRACT FROM AUTHOR]

This paper presents a fisheye lens camera based surveillance system for wide area monitoring. The proposed system consists of: (i) digital anamorphic transformation, (ii) two layer panorama generation, and (iii) geometric transform invariant object detection and tracking for the fisheye camera based system. Since peripheral regions of acquired images are not used in the fisheye lens based imaging system, the proposed algorithm transforms a circular fisheye lens image into an anamorphic image using directional interpolation to maximize the usage of lost regions. In detecting and tracking objects, the proposed algorithm adopts a region based approach to provide robust feature points and object shapes against to various tracking challenges including geometric transformation, sub sampling, interpolation, and dynamic illumination. Experimental results demonstrate that the proposed method can successfully detect and track moving objects in the very wide field of view without using multiple cameras or an optical anamorphic lens [ABSTRACT FROM AUTHOR]

Background Reconstruction of branch pulmonary arteries (PAs) can be demanding in redo congenital cardiac surgeries. Sutureless patch angioplasty could be a useful method to solve this problem, and we evaluated the feasibility of sutureless patch angioplasty for postoperative PA stenosis in patients who underwent congenital cardiac surgery. Methods We retrospectively reviewed 28 patients (19 males and 9 females) who underwent sutureless patch angioplasty for postoperative PA stenosis between November 2004 and April 2015. The median age was 7.3 months (range, 4.3 to 54.7), and the median weight was 7.2 kg (range, 5.3 to 12.2 kg). Right PA angioplasty was performed in 5, left PA angioplasty in 10, and both sides in 13 patients. The most common original diagnosis was hypoplastic left heart syndrome (n = 18 of 28, 64.3%). Concomitant surgeries were the bidirectional cavopulmonary shunt in 24 patients, the Fontan operation in 3, and the Rastelli operation in 1 patient. Results No operative death occurred. However, 2 late deaths were recorded, and both were unrelated to PA angioplasty. Mean follow-up duration was 60.9 ± 33.1 months. None of the patients had postoperative bleeding or thrombotic occlusion. No reoperation for PA restenosis was performed, and only 1 patient (3.6%) had a PA balloon angioplasty with a good result 12.9 months after the operation. Echocardiography or computed tomography angiography at the recent follow-up showed good branch PAs in all patients. Conclusions Sutureless patch angioplasty for postoperative PA stenosis could simplify PA angioplasty, and be a safe and effective method for PA reconstruction in patients who undergo congenital cardiac surgery. [ABSTRACT FROM AUTHOR]

Background In tetralogy of Fallot, whether relieving right ventricular outflow tract obstruction requires transannular patch enlargement (TAPE) of the pulmonary valve depends on pulmonary valvular annulus size. The z-score of pulmonary annulus is most commonly used as a predictor of the need for TAPE. However, the z-score is a complex value affected by height, body weight, body surface area, and different reference populations. Therefore, we hypothesized that the great artery annulus size ratio (pulmonary valvular annulus size to aortic valve annuls size [GA ratio]) may be a better predictor of the need for TAPE. Methods We analyzed 122 patients retrospectively who had undergone total correction of tetralogy of Fallot between January 2007 and March 2015. We categorized the patients into two groups, TAPE versus non-TAPE. Great arterial annuli sizes were evaluated in each group, and the GA ratio cutoff values for TAPE were calculated. Results In total, 40 patients (32.8%) required TAPE. Both GA ratios and z-scores were smaller in the TAPE group than in the non-TAPE group (0.51 versus 0.67, p < 0.0001, and −2.46 versus −0.85, p < 0.0001, respectively). In receiver operating characteristics analyses, the z-score and GA ratio cutoff values were −1.67 (area under the curve = 0.797) and 0.56 (area under the curve = 0.900), respectively, demonstrating that the GA ratio was a more powerful diagnostic tool as a predictor of TAPE ( p = 0.014). Conclusions Our results suggest that the GA ratio is a useful predictor for TAPE and can be applied readily and simply in clinical practice. [ABSTRACT FROM AUTHOR]

Objectives: Postoperative left pulmonary artery (LPA) kinking is problematic in repair of tetralogy of Fallot (TOF). We used angioplasty of the proximal LPA with an anterior wall flap of the main pulmonary artery (MPA) to prevent this problem. Methods: We have used an anterior wall of the MPA as a flap for LPA angioplasty in 42 patients with TOF and pulmonary stenosis (26 males and 16 females) since February 2007. During the same period, 116 patients underwent total repair of TOF with pulmonary stenosis. The median age was 7.1 months (range, 3-88.8), and the median weight was 8.4 kg (range, 5-27). The indications for LPA angioplasty were acute-angle proximal LPA in 17 (40.5%), proximal LPA stenosis in 6 (14.3%), acute-angle and stenotic proximal LPA in 18 (43%), and short and small distal MPA in 1 patient. The patches used for MPA and LPA reconstruction were glutaraldehyde-treated autologous pericardium in 34 and bovine pericardium in 8 patients. Results: No operative or late death occurred. The mean follow-up duration after surgery was 26.4 ± 18.6 months (range, 0.5-67). During the follow-up period, reoperation for LPA stenosis or kinking was not required in any patient; however, balloon angioplasty was performed with good results in 4 patients (9.5%). No postoperative kinking of the proximal LPA occurred. Echocardiography or computed tomography angiography at the recent follow-up visit demonstrated good branch pulmonary arteries in all patients. Conclusions: Angioplasty of the proximal LPA using an anterior wall flap of the MPA in the patients with TOF and pulmonary stenosis is an effective method in the management of acute angle and/or stenosis of LPA without postoperative kinking. [ABSTRACT FROM AUTHOR]

Background: Airway compression caused by an enlarged right pulmonary artery (RPA) in patients with a large shunt can usually be managed with intracardiac repair and concomitant anterior aortopexy. However, anterior aortopexy can be less effective or even dangerous in patients with coexisting arch anomaly due to excessive tension at the arch repair site. We have adopted anterior translocation of RPA without aortic transection in the group of patients with a high risk of postoperative airway compression. We reviewed the early and midterm results of this technique. Methods: From February 2006 to January 2013, 8 patients underwent RPA anterior translocation as a concomitant procedure in one-stage repair of ventricular septal defect (VSD) and aortic arch anomaly to avoid postoperative airway problems. The enlarged RPA was disconnected from the main pulmonary artery (MPA) at its origin and was relocated anterior to the ascending aorta, and subsequently reimplanted to the U-shaped trapdoor incision at the anterolateral MPA wall. The mean age at operation was 34 days (median, 14 days, 6 to 77 days), and the mean body weight was 3.6 kg (2.15 to 5.5 kg). All patients had coarctation of the aorta and VSD except 1 who had aortic arch interruption. Five patients were dependent on a ventilator preoperatively. Six patients had evidence of preoperative bronchial compression (left; 4, right and left; 2), and 2 had a high probability of postoperative bronchial compression due to unusual anterior location of the descending aorta. Results: There was no early or late death. There were no postoperative airway problems such as reintubation or left lung atelectasis. Widely patent RPA was confirmed on postoperative computed tomographic angiography in all patients. The mean follow-up duration was 54.0 ± 17.1 months. One patient required balloon angioplasty for mild stenosis at the clamping site 3 years after the operation. All patients had no RPA stenosis at the latest follow-up evaluation. Conclusions: Anterior translocation of the RPA as a concomitant procedure in one-stage repair of VSD and arch anomaly is a safe and effective procedure to avoid postoperative airway problems in high-risk patients. [Copyright &y& Elsevier]

Abstract: Aim: We analyzed the results of acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) necessitating extracorporeal membrane oxygenation (ECMO), and investigated for the associated risk factors for poor clinical outcomes. Methods: We retrospectively reviewed the medical records of 27 patients who required ECMO for AMI associated with CS between April 2006 and July 2010. Mean age was 63.7±11.0 (range: 45–81) years, and there were 16 males (59.3%). Results: The mean duration of ECMO support was 30.2±30.1 (range: 1–141)h. Cardiopulmonary resuscitations (CPR) were performed in 21 patients (77.8%) before ECMO initiation. Twenty-two patients (81.5%) were successfully weaned off ECMO, and 16 patients (59.3%) survived to discharge. The 30-day mortality was 37.0% (10/27 patients). Complications developed in 17 patients (63.0%: pneumonia in 10 patients, acute renal failure in 10 patients, massive bleeding in 4 patients, and thromboembolic event in 1 patient). The period between CPR initiation and ECMO commencement was a significant risk factor for ECMO weaning failure. High pre-ECMO serum lactate level was identified as a significant risk factor for poor survival on univariated and multivariated analysis. Conclusion: ECMO support could improve survival in patients who suffer AMI associated with CS, and early ECMO initiation yields better outcomes (successful ECMO weaning). [Copyright &y& Elsevier]

Abstract: Background/Purpose: The endothelin receptor B (EDNRB) signaling pathway, which is the second major susceptible gene for Hirschsprung''s disease (HSCR), is crucial for the development of the enteric nervous system. The allele frequency of polymorphisms was mostly tested in the American and European population, but the data of an ethnically diverse, non-Caucasian population are unclear. To further investigate the variants and haplotypes of the EDNRB gene, this study examined sequence variations in Korean patients with sporadic HSCR. Methods: All 8 exons and intron/exon boundaries of the EDNRB gene in 18 Korean patients with sporadic HSCR and 84 healthy individuals were screened using PCR amplification and direct sequencing. Results: A total of 8 different nucleotide substitutions were identified. Of these, 4 were new variants (promoter-116C>T; 5′UTR-121G>T; IVS4+62C>A; IVS5+121G>C) and the others were previously described variants. The distribution of variations was even different from that reported for Chinese and Japanese subjects as well as other ethnic groups. This study also analyzed the haplotypes for an association between the variants identified with HSCR. Conclusions: This study identified additional sequence variants of the EDNRB gene, but the estimated EDNRB haplotypes did not show any disease risk. [Copyright &y& Elsevier]

Purpose We aimed to study the utilization patterns of lipid-lowering treatment (LLT), including treatment modification, adherence, and possible statin intolerance, in patients with atherosclerotic cardiovascular disease (ASCVD) or diabetes using national claims data in South Korea. Methods A retrospective cohort study was conducted using data from the Korean Health Insurance Review & Assessment Service claims database. Patients aged ≥18 years with >1 outpatient pharmacy claim for a statin and/or ezetimibe dated January 1, 2012, to December 31, 2014, were identified and categorized into the following cohorts: patients with ASCVD, and patients with diabetes mellitus without ASCVD. LLT modification, adherence to index LLT, and possible statin intolerance were explored during the 12 months after the date of first prescription for a statin and/or ezetimibe. Findings Among 1,399,872 patients who met the eligibility criteria, 807,547 (57.7%) were patients with ASCVD and 592,325 (42.3%) were patients with diabetes without ASCVD. About half of the patients had no modification in their index treatment (46.2% in the ASCVD cohort and 48.9% in the diabetes cohort), and the most common modification was permanent discontinuation (19.6% in the ASCVD cohort and 21.4% in the diabetes cohort). The mean medication possession ratios were 0.77 in the ASCVD cohort and 0.73 in the diabetes cohort and showed a decreasing trend during the 12-month follow-up period. Among patients who initiated a statin and/or ezetimibe, possible statin intolerance was observed in 53,921 patients (6.7%) in the ASCVD cohort and 42,172 patients (7.1%) in the diabetes cohort. Implications In South Korea, a high rate of permanent discontinuation of statin therapy in patients with ASCVD or diabetes places these patients at high risk for cardiovascular events in the future. A decreasing trend of adherence to LLT implies that more intensive education and management are required to improve therapeutic effect and reduce the risk for ASCVD. The high rate of possible statin intolerance highlights an unmet need in the prevention and management of ASCVD in South Korea. [ABSTRACT FROM AUTHOR]

A selective regional cerebral perfusion has been widely adopted for brain protection in neonatal or infant aortic arch surgeries. The anastomosis of the small polytetrafluoroethylene tube graft to the innominate artery has been used for the selective regional cerebral perfusion in many institutions. We have developed a specially designed cannula tip that allows bidirectional blood flow and provides secure positioning of the polytetrafluoroethylene tube graft at the innominate artery. Innominate artery cannulation using this device reduces arterial clamping time and permits us to perform the arterial cannulation in a much easier and secure manner. [ABSTRACT FROM AUTHOR]

A 28.7-month-old male child who had undergone a Norwood operation and bidirectional cavopulmonary shunt at the age of 5 days and 6.6 months, respectively, underwent the extracardiac conduit Fontan operation. After the operation, high-volume resuscitation was needed, which led to high central venous pressure (CVP) and low arterial oxygen saturation. Venoatrial extracorporeal membrane oxygenation (ECMO) was initiated between the superior vena cava and the right atrium with one third of the expected normal cardiac output. This low-flow venoatrial ECMO immediately terminated the vicious cycle caused by high venous pressure in the Fontan circulation. He was weaned from ECMO and discharged home. [ABSTRACT FROM AUTHOR]

Objectives We evaluated our clinical experiences on rehabilitation of native pulmonary arteries (PAs) with a central shunt using an expanded polytetrafluoroethylene (ePTFE) tube graft in management of pulmonary atresia with ventricular septal defect (VSD) and major aortopulmonary collateral arteries (MAPCAs) with diminutive PAs. Methods From March 1993 to June 2013, a total of 28 consecutive patients underwent surgery for pulmonary atresia with VSD and MAPCAs. We identified 15 patients who underwent a central shunt procedure using an ePTFE tube graft. Median age and weight at the initial operation were 1.91 months and 5.22 kg, respectively. Ligation of MAPCAs was performed in 3 patients concomitantly. The techniques used were a U-shaped central shunt in 13 patients, and a side-to-side aorto-ePTFE tube graft anastomosis in 2 patients. Results There was no surgical mortality, and no shunt occlusion. The mean follow-up duration was 70.7 ± 67.1 months. Complete repair was achieved in 13 patients (13 of 14 of the follow-up patients; 92.9%), and the remaining patient is waiting for complete repair. The median age at complete repair was 19.4 months. The mean PA index before the initial central shunt procedure was 22.7 ± 13.2 mm 2 /m 2 , which increased to 149.4 ± 86.6 mm 2 /m 2 at the final recordings before shunt division, and 185.9 ± 84.0 mm 2 /m 2 before complete repair. There were 2 late mortality cases. The overall survival rates were 92.9%, 82.5%, and 82.5%, at 1, 5, and 10 years, respectively. Conclusions A central shunt, using an ePTFE tube graft, is an effective initial palliative procedure for rehabilitation of the diminutive PAs in patients with pulmonary atresia with VSD and MAPCAs. [ABSTRACT FROM AUTHOR]

Several methods of making expanded polytetrafluoroethylene valved conduit have been reported, but these techniques are complicated and less reproducible. We have developed a new simplified technique for making a tricuspid expanded polytetrafluoroethylene valved conduit for right ventricular outflow tract reconstruction and have been using this conduit for approximately 3 years with excellent results. Our technique is straightforward and reproducible, and the cusps in the conduit are durable due to the use of a specialized suturing technique. [ABSTRACT FROM AUTHOR]

Airway compression by dilated right pulmonary artery (RPA) in infants with congenital heart disease can cause severe respiratory insufficiency and increase postoperative morbidity. Anterior aortopexy can be a good solution. However, in a case in which aortic arch repair is required, anterior aortopexy might not be effective or can be dangerous. Anterior translocation of the RPA can be a good option to avoid postoperative airway obstruction. We adopted this technique in a one-stage complete repair of distal aortopulmonary window, aortic origin of the RPA, interrupted aortic arch, and ventricular septal defect in a neonate with compression of both main bronchi. After 37 months of follow-up, no problem was encountered with her airway or RPA. We describe the technique used and the results obtained. [ABSTRACT FROM AUTHOR]

The dawn of a new era in knowledge management due to information explosion is making old habits of modeling knowledge and decision-making inadequate. In the search for new modeling paradigms, we expect ontologies to play a big role. One of the critical challenges we face is the scarcity of semantically rich, properly populated, ontologies in most application domains in chemical and materials engineering. Developing such ontologies is a very challenging task requiring considerable investment in time, effort, and expert knowledge. One needs automation tools that can assist an ontology engineer to quickly develop and curate domain-specific ontologies. We consider our conceptual framework in this paper, a general approach for populating scientific ontologies, and its implementation as the prototype HOLMES, as an early attempt towards such an automated knowledge management environment. Our approach integrates a variety of machine learning and natural language processing methods to extract information from journal articles and store them semantically in an ontology. In this work, identification of key terms (such as chemicals, drugs, processes, anatomical entities, etc.) from abstracts, and the classification of these terms into 25 classes are presented. Two methods, a multi-class classifier (SVM) and a multi-label classifier (HOMER), were tested on an annotated data set for the pharmaceutical industry. The test was done using two different versions of the same data set, one using the BIO notation and the other not. The F1 scores for HOMER, were better in the BIO notation (63.6% vs 48.5%) while SVM performed better in the non-BIO version (54.1% vs 53.2%). However, the standard metrics did not consider the effect of the multiple answers that the multi-label classifier is allowed to obtain. As the results of our computational experiments show, while the performance of multi-label classifier is encouraging, much more remains to be done in order to develop a practically viable automated ontology-based knowledge management system. [ABSTRACT FROM AUTHOR]

Summary: An electrophoretic karyotype of Korean Flammulina velutipes was obtained using contour-clamped homogeneous electric field (CHEF) gel electrophoresis. The monokaryotic progenies (4019-20 and 4019-18) and a dikaryotic strain (4019-2018) had 6–8 chromosomes, with sizes ranging from 1.6 to 5.8 megabase (Mb) pairs. Among the 3 strains that were examined, strain 4019-20 resolved into at least 7 chromosomes, with a total genome size of approximately 26.7Mb. We selected several chromosome-specific genes from the cDNA library of F. velutipes using Southern hybridization analysis. In order to determine the whole genome sequence, we constructed a bacterial artificial chromosome (BAC) library of the 4019-20 strain. The BAC library comprised 3840 clones, and the insert size ranged from 60 to 228kb, with an average size of 136kb. [Copyright &y& Elsevier]

Study Objective: Evidence suggests that administering appropriate volumes of perioperative fluid replacement therapies can decrease the incidence of postoperative nausea and vomiting (PONV). However, the relative effects of colloids and crystalloids on PONV are still unclear. The objective of this systematic review was to determine whether administering colloids to adults undergoing noncardiac surgery significantly reduces PONV incidence and rescue antiemetic use, compared with administering crystalloids.Design: This study has been registered in PROSPERO (ID: CRD42016036174). We performed a meta-analysis of randomized controlled trials that compared the incidence of PONV and rescue antiemetic use in surgical patients randomized to receive colloid or crystalloid fluids. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was explored through I2 statistics.Patients: Nine randomized trials that included a total of 843 surgical patients met the inclusion criteria.Measurements: The primary outcome of interest was the incidence of overall PONV. Secondary outcomes included the incidence of postoperative nausea (PON), postoperative vomiting (POV), and rescue antiemetic use.Main Results: Compared with crystalloid fluids, perioperative colloid administration did not reduce the incidence of overall PONV (RR 0.802; 95% CI: 0.561, 1.145; I2 = 57.168%). However, the colloid infusion group (RR 0.625; 95% CI: 0.440, 0.888) had reduced PONV compared with the crystalloid infusion group (RR 1.244; 95% CI: 0.742, 2.085), in the subgroup with anesthesia duration >3 h and who underwent major surgery. Meta-regression analysis also showed that the slope was significant (p = 0.04215) for duration of anesthesia.Conclusions: Colloid administration reduced the incidence of PONV in adults undergoing elective, noncardiac, major surgery under general anesthesia for >3 h. However, clinical studies performed in larger cohorts are required to determine the impact of colloids on PONV. [ABSTRACT FROM AUTHOR]