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

The morphological basis of the development of the chick embryo immune system

The chick immune system is a fundamental model in basic immunology. In birds, the bone marrow derived pluripotent stem cells after entering the circulation, migrate to bursa of Fabricius to benefit from a microenvironment which supports the differentiation and maturation of B lymphocytes by the help of its resident cells and tissues. Delivering sufficient functional B cells is required to maintain their peripheral population and normal peripheral humoral responses. Additionally, bursa acts as an active site for the generation of antibody diversity through gene conversion. Being consisted of 98% B lymphocytes, the organ is occupied by other cell types including T cells, macrophages, eosinophils and mast cells. Thymus, which is an epithelial organ is the main site of T cell development where positive and negative selections contribute to the development of functional and not autoreactive T cell repertoire. Bursectomy and thymectomy are surgical exercises through which the involvement of cells of specific immunity including B cells and T cells can be determined

Constraints on dark matter annihilations from diffuse gamma-ray emission in the Galaxy

Recent advances in gamma-ray cosmic ray, infrared and radio astronomy have allowed us to develop a significantly better understanding of the galactic medium properties in the last few years. In this work using the DRAGON code, that numerically solves the GR propagation equation and calculating gamma-ray emissivities in a 2-dimensional grid enclosing the Galaxy, we study in a self consistent manner models for the galactic diffuse gamma-ray emission. Our models are cross-checked to both the available CR and gamma-ray data We address the extend to which dark matter annihilations in the Galaxy can contribute to the diffuse gamma-ray flux towards different directions on the sky. Moreover we discuss the impact that astrophysical uncertainties of non DM nature. have on the derived gamma-ray limits. Such uncertainties are related to the diffusion properties on the Galaxy, the interstellar gas and the interstellar radiation field energy densities. Light similar to 10 GeV dark matter annihilating dominantly to hadrons is more strongly constrained by gamma-ray observations towards the inner parts of the Galaxy and influenced the most by assumptions of the gas distribution; while TeV scale DM annihilating dominantly to leptons has its tightest constraints from observations towards the galactic center avoiding the galactic disk plane, with the main astrophysical uncertainty being the radiation field energy density. In addition, we present a method of deriving constraints on the dark matter distribution profile from the diffuse gamma-ray spectra. These results critically depend on the assumed mass of the dark matter particles and the type of its end annihilation products