Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Sommerxylon spiralosus from Upper Triassic in southernmost Paraná Basin (Brazil): a new taxon with taxacean affinity

The anatoical description of silici?ed Gymnospermae woods from Upper Triassic sequences of southernmost Paraná Basin (Brazil) has allowed the identi?cation of a new taxon: Sommerxylon spiralosus n.gen. et n.sp. Diagnostic parameters, such as heterocellular medulla composed of parenchymatous and sclerenchymatous cells, primary xylem endarch, secondary xylem with dominant uniseriate bordered pits, spiral thickenings in the radial walls of tracheids, medullar rays homocellular, absence of resiniferous canals and axial parenchyma, indicate its relationship with the family Taxaceae, reporting on the first recognition of this group in the Triassic on Southern Pangea. This evidence supports the hypothesis that the Taxaceae at the Mesozoic were not con?ned to the Northern Hemisphere.<br>A descrição anatômica de lenhos silicificados de Gymnospermae em seqüência do Triássico Superior no sul da Bacia do Paraná (Brasil), possibilitou a identificação de um novo taxon: Sommerxylon spiralosus n.gen. et n.sp. Parâmetros diagnósticos tais como medula heterocelular, composta por células parenquimáticas e esclerenquimáticas, xilema primário endarco, xilema secundário com pontoações areoladas unisseriadas dominantes, espessamentos espiralados nas paredes radiais dos traqueídeos, raios lenhosos homocelulares, ausência de canais resiníferos e de parênquima axial, indicam a sua vinculação à família Taxaceae, constituindo-se em reconhecimento inédito da presença deste grupo no Triássico Superior no sul do Pangea. Esta evidência suporta a hipótese de que a família Taxaceae não estava confinada ao Hemisfério Norte durante o Mesozóico