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

Acute Toxicity and Genotoxic Evaluation of Metlin ® and Metlos ® (Organic Agave Fructans)

ABSTRACT The aim of the study was to contribute to the information on agave soluble fibers since research has been focused on chicory fiber but not in agave products; thus we assess the acute toxicity and genotoxicity of two organic and high purity dietary soluble fibers from agave, Metlin ® and Metlos ® . We performed an acute toxicity assay in Hsd:ICR mice and Hsd:Wistar rats and an in vivo genotoxic test. Results showed that there are no deaths at any doses or genotoxicity, so it can be concluded that these products are non-toxic, at the administrated doses and none showed a cytotoxic, clastogenic or aneuploidic effect

Registration of ‘CI0947bmr’ Sorghum

The sorghum [Sorghum bicolor (L.) Moench] cultivar CI0947bmr (Reg. No. CV-137, PI 672153) was jointly developed and released by the Centro Nacional de Tecnología Agropecuaria y Forestal (CENTA) research program in El Salvador and the Texas A&M Agrilife Research sorghum breeding program in 2013. CI0947bmr is a brown midrib (bmr), dual-purpose sorghum selected for productivity in Central American environments. CI0947bmr was developed from a pedigree breeding program, and it was derived from a BC1F2 population of the pedigree B03292bmr/Tortillero//Tortillero. All generation advancement and selection were completed in San Andres, El Salvador. To confirm performance of the line, CI0947bmr was evaluated in replicated yield trials in 10 Central American environments ranging from Panama to Guatemala in 2010 and 2011. Compared with Sureno (a non-bmr dual-purpose sorghum cultivar grown in the region), CI0947bmr is similar in maturity, dry biomass yield, grain yield, and composition, with lower concentration of lignin and higher in vitro dry matter digestibility and total digestible nutrients. Given these characteristics, CI0947bmr can be used for forage production (grazing and silage) or for grain production with the post-harvest plant residue suitable as forage. In addition, producers can save seed for replanting. This cultivar is designed to provide small livestock producers and dairies in Central America with access to sorghum forage with improved forage quality without sacrificing dry matter yield, grain yield, or grain quality

Patients with Crohn's disease have longer post-operative in-hospital stay than patients with colon cancer but no difference in complications' rate

BACKGROUNDRight hemicolectomy or ileocecal resection are used to treat benign conditions like Crohn's disease (CD) and malignant ones like colon cancer (CC).AIMTo investigate differences in pre- and peri-operative factors and their impact on post-operative outcome in patients with CC and CD.METHODSThis is a sub-group analysis of the European Society of Coloproctology's prospective, multi-centre snapshot audit. Adult patients with CC and CD undergoing right hemicolectomy or ileocecal resection were included. Primary outcome measure was 30-d post-operative complications. Secondary outcome measures were post-operative length of stay (LOS) at and readmission.RESULTSThree hundred and seventy-five patients with CD and 2,515 patients with CC were included. Patients with CD were younger (median = 37 years for CD and 71 years for CC (P &lt; 0.01), had lower American Society of Anesthesiology score (ASA) grade (P &lt; 0.01) and less comorbidity (P &lt; 0.01), but were more likely to be current smokers (P &lt; 0.01). Patients with CD were more frequently operated on by colorectal surgeons (P &lt; 0.01) and frequently underwent ileocecal resection (P &lt; 0.01) with higher rate of de-functioning/primary stoma construction (P &lt; 0.01). Thirty-day post-operative mortality occurred exclusively in the CC group (66/2515, 2.3%). In multivariate analyses, the risk of post-operative complications was similar in the two groups (OR 0.80, 95%CI: 0.54-1.17; P = 0.25). Patients with CD had a significantly longer LOS (Geometric mean 0.87, 95%CI: 0.79-0.95; P &lt; 0.01). There was no difference in re-admission rates. The audit did not collect data on post-operative enhanced recovery protocols that are implemented in the different participating centers.CONCLUSIONPatients with CD were younger, with lower ASA grade, less comorbidity, operated on by experienced surgeons and underwent less radical resection but had a longer LOS than patients with CC although complication's rate was not different between the two groups