Sorting of proteins to vacuoles in plant cells

for correspondence

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

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Nanodiamond-rich layer across three continents consistent with major cosmic impact at 12,800 cal BP

A major cosmic-impact event has been proposed at the onset of the Younger Dryas (YD) cooling episode at ≈12,800 ± 150 years before present, forming the YD Boundary (YDB) layer, distributed over 150 million km2 on four continents. In 24 dated stratigraphic sections in 10 countries of the Northern Hemisphere, the YDB layer contains a clearly defined abundance peak in nanodiamonds (NDs), a major cosmic-impact proxy. Observed ND polytypes include cubic diamonds, lonsdaleite-like crystals, and diamond-like carbon nanoparticles, called n-diamond and i-carbon. The ND abundances in bulk YDB sediments ranged up to ≈500 ppb (mean: 200 ppb) and that in carbon spherules up to ≈3700 ppb (mean: ≈750 ppb); 138 of 205 sediment samples (67%) contained no detectable NDs. Isotopic evidence indicates that YDB NDs were produced from terrestrial carbon, as with other impact diamonds, and were not derived from the impactor itself. The YDB layer is also marked by abundance peaks in other impact-related proxies, including cosmic-impact spherules, carbon spherules (some containing NDs), iridium, osmium, platinum, charcoal, aciniform carbon (soot), and high-temperature melt-glass. This contribution reviews the debate about the presence, abundance, and origin of the concentration peak in YDB NDs.We describe an updated protocol for the extraction and concentration of NDs from sediment, carbon spherules, and ice, and we describe the basis for identification and classification of YDB ND polytypes, using nine analytical approaches. The large body of evidence now obtained about YDB NDs is strongly consistent with an origin by cosmic impact at ≈12,800 cal BP and is inconsistent with formation of YDB NDs by natural terrestrial processes, including wildfires, anthropogenesis, and/or influx of cosmic dust