Characteristics of Early-Onset vs Late-Onset Colorectal Cancer: A Review.

The incidence of early-onset colorectal cancer (younger than 50 years) is rising globally, the reasons for which are unclear. It appears to represent a unique disease process with different clinical, pathological, and molecular characteristics compared with late-onset colorectal cancer. Data on oncological outcomes are limited, and sensitivity to conventional neoadjuvant and adjuvant therapy regimens appear to be unknown. The purpose of this review is to summarize the available literature on early-onset colorectal cancer. Within the next decade, it is estimated that 1 in 10 colon cancers and 1 in 4 rectal cancers will be diagnosed in adults younger than 50 years. Potential risk factors include a Westernized diet, obesity, antibiotic usage, and alterations in the gut microbiome. Although genetic predisposition plays a role, most cases are sporadic. The full spectrum of germline and somatic sequence variations implicated remains unknown. Younger patients typically present with descending colonic or rectal cancer, advanced disease stage, and unfavorable histopathological features. Despite being more likely to receive neoadjuvant and adjuvant therapy, patients with early-onset disease demonstrate comparable oncological outcomes with their older counterparts. The clinicopathological features, underlying molecular profiles, and drivers of early-onset colorectal cancer differ from those of late-onset disease. Standardized, age-specific preventive, screening, diagnostic, and therapeutic strategies are required to optimize outcomes

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

Von Intersektionalität zu Differenz in der Schulforschung. Erziehungswissenschaftliche Fokussierungen

Soziale Differenz ist zu einem Bezugspunkt der Gestaltung institutionalisierter pädagogischer Praxis geworden. In pädagogischen Ansätzen wird dafür ein Wissen um soziale Unterschiede bedeutsam. Referenzen auf Kategorien bzw. Kategorisierungen pädagogischer Adressat*innen kommen dabei eine konstituierende Funktion für pädagogische Beobachtungen zu. Gegenüber der Annahme, der Zusammenhang von sozialen Unterscheidungen und pädagogischen Bezugnahmen sei einfach gegeben, versteht die differenztheoretische Forschung diesen Zusammenhang als ein epistemologisches Problem. Gegenüber einem Identitäten tendenziell fixierenden Gebrauch sozialer Unterscheidungen, wie er aufgrund ihrer ungleichheitstheoretischen Grundannahmen auch in Intersektionalitätsansätzen solange zu beobachten ist, wie Kategorien in der Beobachtung Anwendung finden, fragt die differenztheoretisch informierte Schul- und Unterrichtsforschung nach den Aktualisierungen von Differenz an den Übergängen des Schulsystems und im Unterricht. Anders als dies in Ansätzen der Intersektionalitätsforschung überwiegt, wird gesellschaftliche Ungleichheit nicht kategorial bestimmt, sondern in ihren situativ variierenden Graduierungen und ihrer Bedeutungserzeugung in pädagogischen Praktiken untersucht

Foramen arcuale: a rare morphological variation located in atlas vertebrae

To investigate the incidence of foramen arcuale in dry atlas vertebrae which may cause clinical problems