Topical, immunomodulatory epoxy-tiglianes induce biofilm disruption and healing in acute and chronic skin wounds

Bacterial biofilms pose a therapeutic challenge to managing chronic wounds and contribute to antimicrobial resistance. Here, Powell et al. investigated the structure/activity relationships of epoxy-tigliane compounds derived from the blushwood tree with respect to their role in wound healing. The compounds interacted with the cell wall of bacteria but showed variable permeabilization in Gram-negative versus Gram-positive cultures. They disrupted established biofilms by interacting with the extracellular polymeric substance matrix, activated immune cells to induce reactive oxygen species, and promoted wound healing in infected thermal injuries in calves when applied topically. In chronic wounds in diabetic mice, the semisynthetic compound EBC-1013 up-regulated host-defense peptides, altered cytokine expression, activated immune cells, and led to greater wound closure. Results help uncover the mechanism by which epoxy-tiglianes promote wound healing and support further development of EBC-1013

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