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

Opere infrastrutturali e perequazione urbanistica: la variante alla via Emilia Est nel comune di Modena

L\u2019ipotesi di una modalit\ue0 applicativa della perequazione urbanistica al progetto di un nuovo asse infrastrutturale in variante alla Via Emilia Est viene analizzata considerando il processo virtuoso che essa potrebbe innescare in termini di valorizzazione territoriale dell\u2019area interessata, congiuntamente al finanziamento dell\u2019opera stessa ed alla realizzazione di opere di riqualificazione e salvaguardia ambientale, in questa ed in altre aree della citt\ue0

Polypodium phyllitidis L. (Polypodiaceaea): a fern with a high sucrose content

A partir del extracto metanólico de Polypodium phyllitidis L (Polypodiaceae) se obtuvo un precipitado sumamente abundante que se comprobó se trataba de sacarosa, lo que determinó su cuantificación por cromatografía gaseosa dado su posible valor económico.An abundant precipitate was obtained from the methanolic extract of Polypodium phyllitidis L. (Polypodiaceae), which was identified as sucrose and quantified by gas chromatography due to its possible economic irnportance.Colegio de Farmacéuticos de la Provincia de Buenos Aire

Polypodium phyllitidis L. (Polypodiaceaea): a fern with a high sucrose content

A partir del extracto metanólico de Polypodium phyllitidis L (Polypodiaceae) se obtuvo un precipitado sumamente abundante que se comprobó se trataba de sacarosa, lo que determinó su cuantificación por cromatografía gaseosa dado su posible valor económico.An abundant precipitate was obtained from the methanolic extract of Polypodium phyllitidis L. (Polypodiaceae), which was identified as sucrose and quantified by gas chromatography due to its possible economic irnportance.Colegio de Farmacéuticos de la Provincia de Buenos Aire

Valorizzazione del territorio e finanziamento di opere pubbliche: la variante alla via Emilia est nel comune di Modena

Il dibattito disciplinare degli ultimi anni ha focalizzato la propria attenzione sui limiti dell\u2019efficacia della pianificazione, evidenziando la necessit\ue0 di governare l\u2019evoluzione di sistemi urbani sempre pi\uf9 complessi attraverso strumenti flessibili; in questo contesto, il mutamento del modello di sviluppo urbano, dall\u2019espansione alla trasformazione, unitamente alla diffusione delle istanze ecologiche, porta la pianificazione ad orientarsi alla valorizzazione ed alla conservazione delle risorse economiche, sociali ed ambientali delle citt\ue0. A queste esigenze risponde la soluzione perequativa, che, oltre a perseguire l\u2019equit\ue0 sociale e l\u2019efficienza delle trasformazioni, assicura la tutela ecologica delle trasformazioni urbanistiche. Oggetto del presente studio \ue8 l\u2019esplicitazione di una modalit\ue0 applicativa della perequazione urbanistica attraverso l\u2019approfondimento di un caso che consiste nella valorizzazione di un\u2019area situata nel comune di Modena in prossimit\ue0 della Via Emilia Est, congiunta alla realizzazione di una nuova infrastruttura a servizio dell\u2019area stessa e dell\u2019intera citt\ue0

Características tumorais e sobrevida de cinco anos em pacientes com câncer de mama admitidas no Instituto Nacional de Câncer, Rio de Janeiro, Brasil Tumor characteristics and five-year survival in breast cancer patients at the National Cancer Institute, Rio de Janeiro, Brazil

Vários fatores vêm sendo estudados com respeito ao estabelecimento de critérios mais seguros que influenciam o prognóstico de pacientes com câncer de mama. Este estudo teve como objetivo avaliar as taxas de sobrevida de cinco anos e os principais fatores prognósticos relativos ao tumor em mulheres com carcinoma invasivo de mama submetidas à cirurgia no Instituto Nacional de Câncer, Rio de Janeiro, Brasil, entre maio de 1995 e julho de 1996. As variáveis estudadas foram: presença de linfonodo comprometido, tamanho do tumor, grau de agressividade e presença de receptores hormonais para estrogênio e progesterona. As funções de sobrevida foram calculadas por meio do método de Kaplan-Meier. Foi utilizado o modelo de riscos proporcionais de Cox para avaliação dos fatores prognósticos. A taxa de sobrevida em cinco anos foi de 75,0% para todas as pacientes e, de 64,0% para as com metástase para linfonodo. A análise multivariada identificou o comprometimento de linfonodo como o mais forte preditor do desfecho; ter receptor positivo para estrogênio se associou a um melhor prognóstico. Esses resultados mostram a necessidade de condução de estudos que investiguem novos fatores que, combinados aos já conhecidos, possam melhor orientar a conduta terapêutica.<br>Numerous factors have been studied to establish more secure prognostic criteria in breast cancer patients. This study estimates five-year survival rates and principal prognostic factors related to tumor characteristics in women with invasive breast cancer and submitted to surgery at the National Cancer Institute, Rio de Janeiro, Brazil, from May 1995 to July 1996. Study variables were: lymph node status, tumor size, aggressiveness grade, and presence of estrogen and progesterone receptors. Survival functions were calculated according to the Kaplan-Meyer method. The Cox proportional hazards model was used to evaluate prognostic factors. Five-year survival was 75% for all women and 64% for those with node involvement. Multivariate analyses identified node involvement as the strongest predictor of outcome; a positive estrogen receptor test was associated with a better prognosis. These findings highlight the need for studies to assess new variables to be added to known factors in order to better orient therapy for breast cancer