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

An improved baculovirus insecticide producing occlusion bodies that contain Bacillus thuringiensis insect toxin

Baculovirus occlusion bodies, large proteinaceous structures which contain virions, have recently been engineered to incorporate foreign proteins. The major constituent protein of occlusion bodies from the baculovirus Autographa californica nucleopolyhedrovirus is polyhedrin, and assembly of recombinant occlusion bodies which incorporate a foreign protein depends on an interaction between native polyhedrin and a polyhedrin–foreign protein fusion. This technology has now been applied to the generation of a recombinant baculovirus (ColorBtrus) that produces occlusion bodies incorporating the Bacillus thuringiensis (Bt) insecticidal Cry1Ac toxin protein. ColorBtrus coexpresses native polyhedrin and a fusion protein in which polyhedrin is fused to the Bt toxin, which is in turn fused to green fluorescent protein (GFP). Analysis of ColorBtrus occlusion bodies confirmed that they include both Bt toxin and GFP, yet still incorporate virions. Bioassay of ColorBtrus demonstrated that its speed of action and pathogenicity are strikingly enhanced compared to wild-type virus. ColorBtrus represents a novel, powerful biological insecticide that combines positive attributes of both Bt toxin and baculovirus based systems

Long-term Study of Sialodochoplasty for Preventing Submandibular Sialolithiasis Recurrence

ObjectivesThe transoral removal of stones by sialodochoplasty has been popularized in the treatment of submandibular sialolithiasis. However, the effectiveness of sialodochoplasty is controversial, and there are no reports on the long-term outcomes of this procedure. The purpose of this study was to assess the effectiveness and long-term outcomes of sialodochoplasty in patients with submandibular sialolithiasis.MethodsWe conducted a cross-sectional study that included retrospective chart reviews and prospective telephone or interview surveys of 150 patients treated for submandibular sialolithiasis from March 2001 to January 2008. The patients were treated with two different procedures by two different surgeons. One surgeon performed a transoral sialolithectomy without sialodochoplasty in 107 patients (SS group), and the other surgeon performed a transoral sialolithectomy with sialodochoplasty in 43 patients (SP group).ResultsThe success rate of transoral sialolithectomy was 98.1% in the SS group and 93% in the SP group. The recurrence rates of symptoms or stones were 1.9% and 4.7% in the SS and SP groups, respectively. The incidence of postoperative transient hypoesthesia was 13.1% in the SS group and 34.9% in the SP group. The mean operating times were 29.79 and 47.44 minutes in the SS and SP groups, respectively. The mean percentage of general anesthesia was 42.1% in the SS group and 83.7% in the SP group.ConclusionSialodochoplasty in addition to transoral sialolithectomy for submandibular sialolithiasis did not affect the rate of symptom or stone recurrence, but did increase the postoperative hypoesthesia incidence and general anesthesia percentage

Development of an easy-to-handle murine model for the characterization of radiation-induced gross and molecular changes in skin

Background Radiation-induced skin injury is a dose-limiting complication of radiotherapy. To investigate this problem and to develop a framework for making decisions on treatment and dose prescription, a murine model of radiation-induced skin injury was developed. Methods The dorsal skin of the mice was isolated, and irradiation was applied at single doses of 15, 30, and 50 Gy. The mice were followed for 12 weeks with serial photography and laser Doppler analysis. Sequential skin biopsy samples were obtained and subjected to a histological analysis, immunostaining against transforming growth factor beta (TGF-β), and Western blotting with Wnt-3 and β-catenin. Increases in the levels of TGF-β, Wnt, and β-catenin were detected after irradiation. Results All tested radiation doses caused progressive dermal thickening and fibrosis. The cause of this process, however, may not be radiation alone, as the natural course of wound healing may elicit a similar response. The latent appearance of molecular and histological markers that induce fibrosis in the 15 Gy group without causing apparent gross skin injuries indicates that 15 Gy is an appropriate dose for characterizing the effects of chronic irradiation alone. Thus, this model best mimics the patterns of injury that occur in human subjects. Conclusions This animal model can be used to elucidate the gross and molecular changes that occur in radiation-induced skin injury and provides an effective platform for studying this adverse effect without complicating the process of wound healing

Linear Magnetoelectric Phase in Ultrathin MnPS₃ Probed by Optical Second Harmonic Generation

The transition metal thiophosphates MPS₃ (M=Mn, Fe, Ni) are a class of van der Waals stacked insulating antiferromagnets that can be exfoliated down to the ultrathin limit. MnPS₃ is particularly interesting because its Néel ordered state breaks both spatial-inversion and time-reversal symmetries, allowing for a linear magnetoelectric phase that is rare among van der Waals materials. However, it is unknown whether this unique magnetic structure of bulk MnPS₃ remains stable in the ultrathin limit. Using optical second harmonic generation rotational anisotropy, we show that long-range linear magnetoelectric type Néel order in MnPS₃ persists down to at least 5.3 nm thickness. However an unusual mirror symmetry breaking develops in ultrathin samples on SiO₂ substrates that is absent in bulk materials, which is likely related to substrate induced strain

Spontaneous breaking of mirror symmetry beyond critical doping in Pb-Bi2212

Identifying ordered phases and their underlying symmetries is the first and most important step toward understanding the mechanism of high-temperature superconductivity; critical behaviors of ordered phases are expected to be correlated with superconductivity. Efforts to find such ordered phases have been focused on symmetry breaking in the pseudogap region while the Fermi liquid-like metal region beyond the so-called critical doping $p_{c}$ has been regarded as a trivial disordered state. Here, we used rotational anisotropy second harmonic generation and uncovered a broken mirror symmetry in the Fermi liquid-like phase in (Bi,Pb)$_{2}$Sr$_{2}$CaCu$_{2}$O$_{8+\delta}$ with $p = 0.205 > p_{c}$. By tracking the temperature evolution of the symmetry-breaking response, we verify an order parameter-like behavior with the onset temperature $T_{up}$ at which the strange metal to Fermi liquid-like-metal crossover takes place. Complementary angle-resolved photoemission study showed that the quasiparticle coherence between $\mathrm{CuO_{2}}$ bilayers is enhanced in proportion to the symmetry-breaking response as a function of temperature, indicating that the change in metallicity and symmetry breaking are linked. These observations contradict the conventional quantum disordered scenario for over-critical-doped cuprates and provide new insight into the nature of the quantum critical point in cuprates.Comment: 8 pages, 4 figure

Adrenoleukodystrophy 1례

We describe a 9-year-old boy who showed typical neurologic manifestations i.e., progressive behavioral changes, intellectual impairment, visual disturbances and hearing loss, cerebellar and pyramidal signs with characteristic neuroimaging features, which led us to make a clinical deagnosis of ALD. It was confirmed later by demonstration of increased VLCFA levels in RBC membrane using HPLC. He has no family history of neurologic or endocrine disorder. Prophylactic antiepileptic medicaion could not prevent the development of seizure disorder

Crossed Cerebellar Diaschisis in Cerebral Infarction: Correlation of SPECT and Clinical Features

Patients with supratentorial cerebral infarction frequently show depressed metabolic activity in the contralateral cerebellar hemisphere which is known as crossed cerebellar diaschtsisfCt.D). In order to investigate the relationship between this phenomenon and the characteristics of the supratentorial lesion, we retrospectively evaluated the findings of 99mTc-HMPAO single photon emission computed tomography(SPECT) in 26 patients with a single supratentorial infarction lesion. A cerebellar asymmetry index (AIcbll), percent difference between both cerebellar hemispherestzx'Scbll],SPECT volume deficit (SVD), and magnetic resonance volume deficit (MVD) were quantitated. A CCD, defined as AIcbll >12%, was observed in 12 of the 26 patients (46.2%). No correlation was found between the ~%cbll and duration of disease, SVD, or MVD. SVD and MVD values showed no significant difference between CCD positive and negative groups (71+47ml \IS. 70+68ml and 90+84ml \IS. 67+77ml, respectively). Patients with frontoparietal lobe or deep middle cerebral artery territory infarctions showed a significantly higher incidence of CCD and lower ~%cbll values. Patients with severe hemiparesis had a higher incidence of CCD and lower ~%cbll values than those with milder or no hemiparesis (incidence, 5/5 \IS. 6/18, p=0.008; ~ %cbll,-21. 4+3.8% \IS -8. 3±11. 1%, p=O. 014). None of the 12 patients with CCD showed clinical signs of cerebellar dysfunction. In conclusion, the location rather than the extent of the lesion appears to be the major determinant for the occurrence and magnitude of CCD in stroke patients

Prefoldin 6 mediates longevity response from heat shock factor 1 to FOXO in C-elegans

Heat shock factor 1 (HSF-1) and forkhead box O (FOXO) are key transcription factors that protect cells from various stresses. In Caenorhabditis elegans, HSF-1 and FOXO together promote a long life span when insulin/IGF-1 signaling (IIS) is reduced. However, it remains poorly understood how HSF-1 and FOXO cooperate to confer IIS-mediated longevity. Here, we show that prefoldin 6 (PFD-6), a component of the molecular chaperone prefoldin-like complex, relays longevity response from HSF-1 to FOXO under reduced IIS. We found that PFD-6 was specifically required for reduced IIS-mediated longevity by acting in the intestine and hypodermis. We showed that HSF-1 increased the levels of PFD-6 proteins, which in turn directly bound FOXO and enhanced its transcriptional activity. Our work suggests that the prefoldin-like chaperone complex mediates longevity response from HSF-1 to FOXO to increase the life span in animals with reduced IIS.11Ysciescopu