Delayed appendectomy versus early appendectomy in the treatment of acute appendicitis: a retrospective study

BACKGROUND: The controversy still exists about the timing of operation for appendicitis. The aim of this study was to compare the outcomes between early appendectomy and delayed appendectomy and assess the feasibility of delayed operation. METHODS: The medical records of patients with acute appendicitis who received operation between January 1, 2011 and December 31, 2011, were retrospectively reviewed. Outcome measures were white blood cell (WBC) count at postoperative first day, time to soft diet, complication rate, surgical site infection (SSI) rate, length of hospital stay, and readmission within 30 days. RESULTS: During the study period, a total of 478 patients underwent appendectomies, and 145 patients were excluded, leaving 333 who met inclusion criteria. Based on the time from arrival at hospital to incision, they were divided into two groups: 177 (53.2%) in group A and 156 (46.8%) in group B. There were no significant differences in preoperative demographics and clinical data between two groups. The mean WBC count at postoperative first day of group B were lower than that of group A (p = 0.0039). There were no significant differences in time to soft diet, length of postoperative hospital stay, complication rate, and readmission rate between two groups. SSI including intra-abdominal abscess was also shown no significant difference (Group A, 1.7% and Group B, 3.9%; p = 0.3143). CONCLUSIONS: This study revealed that delayed appendectomy was safe and feasible for adult patient although the clinical outcomes of delayed appendectomy were not superior to those of early appendectomy. We suggest that surgeons would decide the appropriate timing of appendectomy with consideration other situations such as available hospital resources

Maximizing The Impact Of Improvement Efforts On Customer Satisfaction

When a customer satisfaction survey consists of a large number of attributes (questionnaire items), determination of critical attributes that would make the biggest impact on customers’ overall satisfaction could be important, but very tedious and time-consuming process. Even though the critical attributes are identified, the improvement efforts toward these attributes are often misdirected and wasted because of the mismatch between the improvement efforts and the critical needs of the affected customer group. This paper introduces a method with which improvement efforts can be tailored to the needs of the customer group who could bring the most impactful influence on improving customer satisfaction. For the critical attribute considered, the percentage of customers who assigned a specific satisfaction rating is obtained, and the cumulative percentages of customers are examined and the target group of customers to whom the improvement efforts would be tailored is identified. The piecewise linear approximation method is also discussed to estimate the non-linear relationship of the attribute, which also may help determine the target customer group. The overall shape of the piecewise function and the slopes at the line segments may be used in determining which attributes are satisfaction-maintaining or satisfaction-enhancing, and where and how the improvement efforts should be focused in order to maximize the effectiveness of the improvement efforts

Protein kinase CK2 phosphorylates and activates p21-activated kinase 1

Activation of the p21-activated kinase 1 (PAK1) is achieved through a conformational change that converts an inactive PAK1 dimer to an active monomer. In this paper, we show that this change is necessary but not sufficient to activate PAK1 and that it is, rather, required for CK2-dependent PAK1S223 phosphorylation that converts a monomeric PAK1 into a catalytically active form. This phosphorylation appears to be essential for autophosphorylation at specific residues and overall activity of PAK1. A phosphomimetic mutation (S223E) bypasses the requirement for GTPases in PAK1 activation, whereas the constitutive activity of the PAK1 mutant (PAK1H83,86L), postulated to mimic GTPase-induced structural changes, is abolished by inhibition of S223 phosphorylation. Thus, S223 is likely accessible to CK2 upon conformational changes of PAK1 induced by GTPase-dependent and GTPase-independent stimuli, suggesting that S223 phosphorylation may play a key role in the final step of the PAK1 activation process. The physiological significance of this phosphorylation is reinforced by the observations that CK2 is responsible for epidermal growth factor–induced PAK1 activation and that inhibition of S223 phosphorylation abrogates PAK1-mediated malignant transformation of prostate epithelial cells. Taken together, these findings identify CK2 as an upstream activating kinase of PAK1, providing a novel mechanism for PAK1 activation