WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis

Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA is challenging; a variable combination of clinical signs and symptoms has been used together with laboratory findings in several scoring systems proposed for suggesting the probability of AA and the possible subsequent management pathway. The role of imaging in the diagnosis of AA is still debated, with variable use of US, CT and MRI in different settings worldwide. Up to date, comprehensive clinical guidelines for diagnosis and management of AA have never been issued. In July 2015, during the 3rd World Congress of the WSES, held in Jerusalem (Israel), a panel of experts including an Organizational Committee and Scientific Committee and Scientific Secretariat, participated to a Consensus Conference where eight panelists presented a number of statements developed for each of the eight main questions about diagnosis and management of AA. The statements were then voted, eventually modified and finally approved by the participants to The Consensus Conference and lately by the board of co-authors. The current paper is reporting the definitive Guidelines Statements on each of the following topics: 1) Diagnostic efficiency of clinical scoring systems, 2) Role of Imaging, 3) Non-operative treatment for uncomplicated appendicitis, 4) Timing of appendectomy and in-hospital delay, 5) Surgical treatment 6) Scoring systems for intra-operative grading of appendicitis and their clinical usefulness 7) Non-surgical treatment for complicated appendicitis: abscess or phlegmon 8) Pre-operative and post-operative antibiotics.Peer reviewe

Electroweak measurements in electron–positron collisions at w-boson-pair energies at lep

Contains fulltext : 121524.pdf (preprint version ) (Open Access

Distribution, mobility, and pollution assessment of Cd, Cu, Ni, Pb, Zn, and Fe in intertidal surface sediments of Sg. Puloh mangrove estuary, Malaysia

Sungai Puloh mangrove estuary supports a large diversity of macrobenthic organisms and provides social benefits to the local community. Recently, it became a major recipient of heavy metals originating from industries in the hinterland as a result of industrialization and urbanization. This study was conducted to evaluate mobility and pollution status of heavy metals (Cd, Cu, Ni, Pb, Zn, and Fe) in intertidal surface sediments of this area. Surface sediment samples were collected based on four different anthropogenic sources. Metals concentrations were analyzed using an atomic absorption spectrophotometer (AAS). Results revealed that the mean concentrations were Zn (1023.68 ± 762.93 μg/g), Pb (78.8 ± 49.61 μg/g), Cu (46.89 ± 43.79 μg/g), Ni (35.54 ± 10.75 μg/g), Cd (0.94 ± 0.29 μg/g), and Fe (7.14 ± 0.94 %). Most of the mean values of analyzed metals were below both the interim sediment quality guidelines (ISQG-low and ISQG-high), except for Pb concentration (above ISQG-low) and Zn concentration (above ISQG-high), thus suggesting that Pb and Zn may pose some environmental concern. Cadmium, Pb, and Zn concentrations were above the threshold effect level (TEL), indicating seldom adverse effect of these metals on macrobenthic organisms. Pollution load index (PLI) indicated deterioration and other indices revealed the intertidal surface sediment is moderately polluted with Cd, Pb, and Zn. Therefore, this mangrove area requires urgent attention to mitigate further contamination. Finally, this study will contribute to data sources for Malaysia in establishing her own ISQG since it is a baseline study with detailed contamination assessment indices for surface sediment of intertidal mangrove area