Effect of Guided Imagery Meditation During Laparoscopic Cholecystectomy on Reducing Anxiety: A Randomized Controlled Trial.

BACKGROUND: Up to 90% of patients still experience pain after abdominal surgery, which also affects their physical recovery and psychological anxiety. AIM: To evaluate the effects of guided imagery meditation on ameliorating anxiety, improving the quality of sleep, and relieving postoperative pain in patients after laparoscopic cholecystectomy surgery. METHOD: In the general surgical ward of a teaching hospital, patients were randomly assigned to usual care (n = 34) and guided imagery meditation intervention (n = 34) groups, using the method. The measuring outcomes included their anxiety score, quality of sleep, and pain control. RESULTS: In terms of the anxiety difference, the experimental group scored 0.42 (standard deviation [SD] = 0.97), while the control group scored 4.79 (SD = 7.56), which indicates a statistically significant difference (F = 8.04, p = .01, partial eta2 = 0.11). In terms of quality of sleep, the mean score of the experimental group was 2.67 (SD = 1.96), while the control group scored 7.55 (SD = 3.81), which indicates a significant difference (F = 39.99, p = .001, partial eta2 = 0.39). The mean of the degree of postoperative pain was 2.11 points (SD = 1.39), and the score of the control group was 4.00 points (SD = 1.62), which indicates a significant difference (p = .001). CONCLUSIONS: Guided imagery meditation is a simple, non-invasive, non-pharmacologic intervention measure. It can reduce anxiety and postoperative pain, and improve the quality of sleep. Thus, it should be promoted in clinical practice.

Lipid raft-associated stomatin enhances cell fusion.

Membrane fusions that occur during vesicle transport, virus infection, and tissue development, involve receptors that mediate membrane contact and initiate fusion and effectors that execute membrane reorganization and fusion pore formation. Some of these fusogenic receptors/effectors are preferentially recruited to lipid raft membrane microdomains. Therefore, major constituents of lipid rafts, such as stomatin, may be involved in the regulation of cell-cell fusion. Stomatin produced in cells can be released to the extracellular environment, either through protein refolding to pass across lipid bilayer or through exosome trafficking. We report that cells expressing more stomatin or exposed to exogenous stomatin are more prone to undergoing cell fusion. During osteoclastogenesis, depletion of stomatin inhibited cell fusion but had little effect on tartrate-resistant acid phosphatase production. Moreover, in stomatin transgenic mice, increased cell fusion leading to enhanced bone resorption and subsequent osteoporosis were observed. With its unique molecular topology, stomatin forms molecular assembly within lipid rafts or on the appositional plasma membranes, and promotes membrane fusion by modulating fusogenic protein engagement.-Lee, J.-H., Hsieh, C.-F., Liu, H.-W., Chen, C.-Y., Wu, S.-C., Chen, T.-W., Hsu, C.-S., Liao, Y.-H., Yang, C.-Y., Shyu, J.-F., Fischer, W. B., Lin, C.-H. Lipid raft-associated stomatin enhances cell fusion.

Testosterone administration in females modulates moral judgment and patterns of brain activation and functional connectivity.

Morality is defined as prescriptive norms regarding how people should treat one another, and includes concepts of fairness, justice, and rights. One recent study with moral dilemmas suggested that testosterone administration increases utilitarian judgments, which depends on second-to-fourth (2D: 4D) digit ratio, as a proxy of prenatal priming. However, the neural mechanism by which acute testosterone modulates moral reasoning remains to be determined. Using a placebo-controlled within-subject design, the current study examined the neuromodulatory effect of testosterone in young females by combining moral dilemmas, 2D: 4D, functional magnetic resonance imaging (fMRI), and subjective ratings of morally laden scenarios. Results showed that testosterone administration elicited more utilitarian responses to evitable dilemmas. The high 2D: 4D group scored more punishments for moral evaluation, whereas the low 2D: 4D group did the opposite. The activity in the amygdala, anterior insular cortex, and dorsolateral prefrontal cortex (dlPFC) was increased when participants evaluated morally unorthodox actions (intentional harm). The activity in the posterior superior temporal sulcus/temporoparietal junction (pSTS/TPJ) to accidental harm was decreased, specific to the high 2D: 4D group. The functional connectivity between the amygdala and dlPFC was reduced. The activity in the pSTS/TPJ to perceived agency predicted utilitarian responses to evitable dilemmas. The findings demonstrate the acute effect of testosterone on neural responses associated with moral judgment, and provide evidence to support that prenatal sex-hormones priming could be important for early neurodevelopment, which plays a crucial role in the neural and behavioral manifestations of testosterone on adult moral reasoning. Hum Brain Mapp 37:3417-3430, 2016. © 2016 Wiley Periodicals, Inc.

Decreased expression of stomatin predicts poor prognosis in HER2-positive breast cancer.

BACKGROUND: Human epidermal growth factor receptor-2 (HER2) is a transmembrane tyrosine kinase receptor that is overexpressed in 25 to 30 % of human breast cancers and is preferentially localized in lipid rafts. Stomatin is a membrane protein that is absent from the erythrocyte plasma membrane in patients with congenital stomatocytosis and is the major component of the lipid raft. RESULTS: In a total of 68 clinical cases of HER2-positive breast cancer, the absence of stomatin expression was associated with a decreased 5-year survival (65 % vs. 93 %, p = 0.005) by survival analysis. For stage I-III HER2-positive breast cancer, the absence of stomatin expression was associated with a decreased 5-year disease-free survival (57 % vs. 81 %, p = 0.016) and was an independent prognostic factor by multivariate analysis. Negative stomatin expression predicts distant metastases in a hazard ratio of 4.0 (95 % confidence interval from 1.3 to 12.5). CONCLUSIONS: These results may suggest that stomatin is a new prognostic indicator for HER2-positive breast cancer.

Testosterone modulates preattentive sensory processing and involuntary attention switches to emotional voices.

Testosterone is capable of altering facial threat processing. Voices, similar to faces, convey social information. We hypothesized that administering a single dose of testosterone would change voice perception in humans. In a placebo-controlled, randomly assigned, double-blind crossover design, we administered a single dose of testosterone or placebo to 18 healthy female volunteers and used a passive auditory oddball paradigm. The mismatch negativity (MMN) and P3a in responses to fearfully, happily, and neutrally spoken syllables dada and acoustically matched nonvocal sounds were analyzed, indicating preattentive sensory processing and involuntary attention switches. Results showed that testosterone administration had a trend to shorten the peak latencies of happy MMN and significantly enhanced the amplitudes of happy and fearful P3a, whereas the happy- and fearful-derived nonvocal MMN and P3a remained unaffected. These findings demonstrated acute effect of testosterone on the neural dynamics of voice perception. Administering a single dose of testosterone modulates preattentive sensory processing and involuntary attention switches in response to emotional voices.

Stomatin modulates adipogenesis through the ERK pathway and regulates fatty acid uptake and lipid droplet growth.

Regulation of fatty acid uptake, lipid production and storage, and metabolism of lipid droplets (LDs), is closely related to lipid homeostasis, adipocyte hypertrophy and obesity. We report here that stomatin, a major constituent of lipid raft, participates in adipogenesis and adipocyte maturation by modulating related signaling pathways. In adipocyte-like cells, increased stomatin promotes LD growth or enlargements by facilitating LD-LD fusion. It also promotes fatty acid uptake from extracellular environment by recruiting effector molecules, such as FAT/CD36 translocase, to lipid rafts to promote internalization of fatty acids. Stomatin transgenic mice fed with high-fat diet exhibit obesity, insulin resistance and hepatic impairments; however, such phenotypes are not seen in transgenic animals fed with regular diet. Inhibitions of stomatin by gene knockdown or OB-1 inhibit adipogenic differentiation and LD growth through downregulation of PPARγ pathway. Effects of stomatin on PPARγ involves ERK signaling; however, an alternate pathway may also exist.

Prognostic value of postoperative serum carcinoembryonic antigen levels in colorectal cancer patients with chronic kidney disease.

BACKGROUND: Chronic kidney disease (CKD) can increase serum carcinoembryonic antigen (CEA) levels. We thus aimed to evaluate the impact of CKD on CEA prognostic accuracy in colorectal cancer. METHODS: Altogether, 429 patients who underwent curative resection for stages I-III colorectal adenocarcinoma were grouped according to postoperative CEA levels and history of CKD. RESULTS: Three-year disease-free survival (DFS) was higher in patients with normal postoperative CEA (group A, 83.4%) than in those with elevated postoperative CEA (group B, 64.3%) (p < 0.001). CKD patients had higher postoperative CEA levels than non-CKD patients (odds ratio 3.27, 95% confidence interval 1.78-5.99, p < 0.001). In multivariable analysis, postoperative CEA level was an independent prognostic factor for DFS in non-CKD, but not CKD, patients. CONCLUSIONS: CKD can increase postoperative CEA levels in colorectal cancer patients. Elevated postoperative CEA levels were associated with shorter DFS in non-CKD, but not CKD, patients.

An amygdala-centered hyper-connectivity signature of threatening face processing predicts anxiety in youths with autism spectrum conditions.

Anxiety is exceedingly prevalent among individuals with an autism spectrum condition (ASC). While recent literature postulates anxiety as a mechanism encompassing an underlying amygdala-related elevated baseline level of arousal even to nonthreatening cues, whether this same mechanism contributes to anxiety in those with an ASC and supports the transdiagnostic nature of anxiety remains elusive. In this case-control study of 51 youths (26 ASC), we assessed autism and anxiety via the Autism-Spectrum Quotient and the State-Trait Anxiety Inventory, respectively. Hemodynamic responses, including amygdala reactivity, to explicit and implicit (backwardly masked) perception of threatening faces were acquired using functional Magnetic Resonance Imaging (fMRI). For explicit fear, ASC individuals showed significantly greater negative correlations between the amygdala and the attentional deployment-parietal network. For implicit fear, ASC individuals showed significantly stronger correlations of the amygdala with the prefrontal networks, temporal pole, and hippocampus. Additionally, an fMRI-based neurologic signature for anxiety in ASCs was identified via the LibSVM machine learning model using amygdala-centered functional connectivity during the emotional processing of explicit and implicit stimuli. Hypervigilance to implicit threat in ASCs comorbid with anxiety might exacerbate explicit threat reactivity; hence the use of attentional avoidance patterns to restrict affective hyperarousal for explicitly perceived socioemotional stimuli. Consequently, developing an attention-independent behavioral/neural marker identifying anxiety in ASCs is highly warranted. LAY SUMMARY: This study identifies a dissociation of amygdala reactivity dependent on explicit and implicit threat processing. Implicit anxiety in individuals with an autism spectrum condition (ASC) could outweigh explicitly induced threat. When explicitly perceiving socioemotional stimuli, ASC individuals with anxiety might use attentional avoidance patterns to restrict affective hyperarousal.

Postoperative serum carcinoembryonic antigen levels cannot predict survival in colorectal cancer patients with type II diabetes.

BACKGROUND: Most clinical guidelines recommend measuring postoperative carcinoembryonic antigen (CEA) levels to predict the prognosis of colorectal cancer. However, type II diabetes can increase serum CEA levels which may bias the prognosis. Thus, we aimed to evaluate the impact of type II diabetes on CEA prognostic accuracy in colorectal cancer. METHODS: This retrospective cohort study included 407 patients who underwent curative resection for stage I to III colorectal adenocarcinoma in a single institution between January 2010 and June 2018. The patients were categorized into two groups according to their postoperative serum CEA levels: group A <5.0 ng/mL (n = 341) and group B ≥5.0 ng/mL (n = 66). Patients were also categorized into two subgroups according to their history of type II diabetes: patients with type II diabetes mellitus (n = 112) and patients without type II diabetes (n = 295). RESULTS: The 3-year disease-free survival (DFS) rates were significantly higher in patients with normal postoperative CEA (group A, 83.8%) than in patients with elevated preoperative and postoperative CEA (group B, 63.6%) (p < 0.001). However, although patients with type II diabetes mellitus had higher postoperative CEA levels than those without type II diabetes mellitus (3.1 vs 2.5 ng/mL, p < 0.001), group B patients with type II diabetes mellitus had a significantly higher 3-year DFS rate than those without type II diabetes mellitus (80.0% vs 55.6%, p = 0.003). CONCLUSION: Type II diabetes was associated with higher preoperative and postoperative CEA levels in patients with colorectal cancer. Consequently, elevated postoperative CEA level was not associated with shorter 3-year DFS in patients with type II diabetes, as opposed to patients without type II diabetes. Therefore, colorectal cancer patients with type II diabetes may need alternative tumor markers to be used during the surveillance strategy after curative surgery.

The Multifaceted Effects of Serotonin Transporter Polymorphism (5-HTTLPR) on Anxiety, Implicit Moral Attitudes, and Harmful Behaviors.

Morality is fundamentally human in nature. Regardless, and even when moral norms seem to work toward the common goal of human cooperation, which morally contentious behaviors are permitted and which are prohibited vary across populations. Because of this occurrence, much scientific debate has revolved around the notion that this phenomenon might be explained by the interaction between genes and environment. Alongside, whether the principles cementing the bases of morality are intuition- or reason-based is another question that has been raised. However, previous research addressing these topics used explicit measures to probe moral attitudes, thus being the participants able to intentionally modify or disguise their honest responses. What's more, while the 5-HTT gene was found to be associated with anxiety, morality, and even cultural structures, a single genotype-phenotype linkage cannot be established without considering the multifaceted effects of the 5-HTT gene on gene-behavior interactions. In order to explore the role of genetics on modeling moral attitudes and behaviors, we genotyped the 5-HTTLPR in 114 healthy volunteers and subsequently assessed their explicit justice sensitivity (Justice Sensitivity Inventory) and moral permissibility judgments, as well as their implicit moral attitudes [moral implicit association task (mIAT)]. Results revealed that 5-HTTLPR short-allele carriers had significantly lower mIAT reaction times when answering correctly and were less compliant on harming another person even when harm or death would inevitably occur anyway to this other individual. With these preliminary results, we can first see how it does not have to be a matter of vouching for a rationalist versus an intuitionist model of moral judgment, but rather being moral judgment an outcome of the different variants of the 5-HTTLPR polymorphism affecting the way in which individuals engage contrastingly with moral issues.

An integrative analysis of 5HTT-mediated mechanism of hyperactivity to non-threatening voices.

The tonic model delineating the serotonin transporter polymorphism's (5-HTTLPR) modulatory effect on anxiety points towards a universal underlying mechanism involving a hyper-or-elevated baseline level of arousal even to non-threatening stimuli. However, to our knowledge, this mechanism has never been observed in non-clinical cohorts exhibiting high anxiety. Moreover, empirical support regarding said association is mixed, potentially because of publication bias with a relatively small sample size. Hence, how the 5-HTTLPR modulates neural correlates remains controversial. Here we show that 5-HTTLPR short-allele carriers had significantly increased baseline ERPs and reduced fearful MMN, phenomena which can nevertheless be reversed by acute anxiolytic treatment. This provides evidence that the 5-HTT affects the automatic processing of threatening and non-threatening voices, impacts broadly on social cognition, and conclusively asserts the heightened baseline arousal level as the universal underlying neural mechanism for anxiety-related susceptibilities, functioning as a spectrum-like distribution from high trait anxiety non-patients to anxiety patients.

Prognostic value of postoperative serum carcinoembryonic antigen levels in colorectal cancer patients who smoke.

Serum carcinoembryonic antigen (CEA) levels can help predict the prognosis of colorectal cancer patients. Accordingly, high preoperative CEA levels that is not restored after surgery are indicative of a worse outcome. On the other hand, smoking can increase serum CEA levels independently of the disease status. Thus, we aimed to evaluate the impact of smoking on the prognostic value of serum CEA levels. This retrospective cohort study included 273 patients who underwent curative resection for stage I-III colorectal adenocarcinoma at a single institution, between January 2010 and December 2017. Patients were grouped as follows: group A, normal preoperative and postoperative CEA levels (n = 152); group B, elevated preoperative CEA levels that returned to reference values after surgery (n = 69); and group C, elevated postoperative serum CEA levels (n = 52). Patients were also grouped according to their smoking history: group S (current smokers, n = 79) and group NS (never and former smokers, n = 194). Group A showed a higher 3-year disease-free survival (DFS) rate (84.9%) than groups B (75.4%) and C (62.0%) (p < 0.001). Postoperative serum CEA levels were significantly higher in the S group than in the NS group (2.6 vs. 3.1 ng/mL, p = 0.009), whereas preoperative levels were similar (3.8 vs. 4.1, p = 0.182). Further, smokers showed higher 3 year-DFS rates than nonsmokers in group C (83.3% vs. 43.9%, p = 0.029). This suggests that while elevated postoperative CEA levels are associated with lower DFS rates in never and former smokers, they are not associated with lower DFS rates in current smokers. We conclude that persistent smoking alters the prognostic value of postoperative serum CEA levels in colorectal cancer patients and that, consequently, alternative surveillance strategies need to be developed for colon cancer patients with smoking habits.

miR-187* Enhances SiHa Cervical Cancer Cell Oncogenicity Via Suppression of WWOX.

BACKGROUND/AIM: Cervical cancer is one of the most common cancers worldwide and a major cause of cancer-related mortality among women. Previous studies have reported that microRNA-miR-187*, which is one of the non-coding parts of the genome producing small conserved ribonucleic acids, is associated with various cancers. In this study, we explored the function of miR-187* in cervical cancer cells. MATERIALS AND METHODS: miR-187* mimic, WWOX reporter constructs, siRNA and overexpression constructs were transfected into SiHa cells to investigate the function and regulatory mechanisms of miR-187*. RESULTS: Exogenous miR-187* was found to increase the oncogenic phenotypes of SiHa cells. The tumor suppressor gene WWOX is a novel target of miR-187* in SiHa cells. WWOX siRNA suppressed endogenous WWOX expression and increased the oncogenic phenotypes of SiHa cells. Exogenous WWOX expression was able to suppress the oncogenic phenotypes of SiHa cells and rescue cells from miR-187*-induced migration. CONCLUSION: miR-187* seems to enhance SiHa cervical cancer cell oncogenicity via suppression of the WWOX pathway.

Taxane-Induced Peripheral Neuropathy: Objective and Subjective Comparison Between Paclitaxel and Docetaxel in Patients With Breast Cancer.

BACKGROUND: Taxane-induced peripheral neuropathy (TIPN) is caused by the neurotoxicity of paclitaxel and docetaxel, but the differences between paclitaxel- and docetaxel-induced peripheral neuropathy are understudied. OBJECTIVES: The purpose of this study is to compare TIPN between docetaxel and paclitaxel in patients with breast cancer and to examine the consistency of measuring TIPN between researchers and patients. METHODS: Secondary data were analyzed from a cross-sectional study that included 64 patients with breast cancer from two teaching hospitals in Taiwan. Objective and subjective TIPN were measured. FINDINGS: Results indicated significant differences in objective TIPN, sensory sum score, and motor sum score between groups. No significant difference was detected in subjective TIPN between groups.

miR-376c promotes carcinogenesis and serves as a plasma marker for gastric carcinoma.

Gastric carcinoma is highly prevalent throughout the world. Understanding the pathogenesis of this disease will benefit diagnosis and resolution. Studies show that miRNAs are involved in the tumorigenesis of gastric carcinoma. An initial screening followed by subsequent validation identified that miR-376c is up-regulated in gastric carcinoma tissue and the plasma of patients with the disease. In addition, the urinary level of miR-376c is also significantly increased in gastric carcinoma patients. The plasma miR-376c level was validated as a biomarker for gastric carcinoma, including early stage tumors. The induction of miR-376c was found to enrich the proliferation, migration and anchorage-independent growth of carcinoma cells and, furthermore, the repression of the expression of endogenous miR-376c was able to reduce such oncogenic phenotypes. ARID4A gene is a direct target of miR-376c. Knockdown of endogenous ARID4A increased the oncogenicity of carcinoma cells, while ARID4A was found to be drastically down-regulated in tumor tissue. Thus, expression levels of miR-376c and ARID4A mRNA tended to be opposing in tumor tissue. Our results demonstrate that miR-376c functions by suppressing ARID4A expression, which in turn enhances the oncogenicity of gastric carcinoma cells. It seems likely that the level of miR-376c in plasma and urine could act as invaluable markers for the detection of gastric carcinoma.

Interleukin-4 receptor-targeted liposomal doxorubicin as a model for enhancing cellular uptake and antitumor efficacy in murine colorectal cancer.

Our previous studies showed that colorectal tumor has high interleukin-4 receptor α (IL-4Rα) expression, whereas adjacent normal tissue has low or no IL-4Rα expression. We also observed that human atherosclerotic plaque-specific peptide-1 (AP1) can specifically target to IL-4Rα. In this study, we investigated the therapeutic efficacy and systemic toxicity of AP1-conjuagted liposomal doxorubicin. AP1 bound more strongly to and was more efficiently internalized into IL-4Rα-overexpressing CT26 cells than CT26 control cells. Selective cytotoxicity experiment revealed that AP1-conjugated liposomal doxorubicin preferentially killed IL-4Rα-overexpressing CT26 cells. AP1-conjugated liposomal doxorubicin administered intravenously into mice produced significant inhibition of tumor growth and showed decreased cardiotoxicity of doxorubicin. These results indicated that AP1-conjugated liposomal doxorubicin has a potent and selective anticancer potential against IL-4Rα-overexpressing colorectal cancer cells, thus providing a model for targeted anticancer therapy.

ABCG2 localizes to the nucleus and modulates CDH1 expression in lung cancer cells.

Breast cancer resistance protein [BCRP/ATP-binding cassette subfamily G member 2 (ABCG2)] is a member of the ATP-binding cassette transporter family. The presence of ABCG2 on the plasma membrane in many kinds of human cancer cells contributes to multidrug resistance during chemotherapy, and it has been used as the side population marker for identifying cancer stem cells in lung cancers. We report here that, in addition to the membranous form, ABCG2 proteins are also found inside the nucleus, where they bind to the E-box of CDH1 (E-cadherin) promoter and regulate transcription of this gene. Increased expression of ABCG2 causes an increase of E-cadherin and attenuates cell migration, whereas knockdown of ABCG2 downregulates E-cadherin and enhances cell motility. In mice, xenografted A549 cells that have less ABCG2 are more likely to metastasize from the subcutaneous inoculation site to the internal organs. However, for the cancer cells that have already entered the blood circulation, an increased level of ABCG2, and correspondingly increased E-cadherin, may facilitate circulating cancer cells to colonize at a distant site and form a metastatic tumor. We propose a novel role for nuclear ABCG2 that functions as a transcription regulator and participates in modulation of cancer metastasis.

Peritoneal carcinomatosis and lymph node metastasis are prognostic indicators in patients with Borrmann type IV gastric carcinoma.

BACKGROUND/AIMS: Having observed a lower survival rate of patients with Borrmann type IV gastric cancer, we attempted to determine its prognostic indicators. METHODOLOGY: A total of 103 patients with Borrmann type IV gastric cancer were evaluated; 604 patients with Borrmann types I, II and III were used as references. RESULTS: The results showed that Borrmann type IV gastric cancer were larger, had deeper invasion, more lymphatic and vascular invasions, predominant diffuse type and scirrhous stromal reaction, extensive lymph node metastases and peritoneal carcinomatosis. The 5-year survival rate (11.3%) was significantly lower than that of others (44.7%, P < 0.001). Univariate and multivariate analyses of survival showed that peritoneal carcinomatosis and lymph node metastasis were independently associated with a relative risk of 1.8 and 1.4, respectively. The survival rates of 46 patients with potential curative disease were similar, regardless of various extents of resection. CONCLUSIONS: Peritoneal carcinomatosis and lymph node metastases are prognostic indicators in patients with Borrmann type IV gastric cancer. Optimal surgical strategy for Borrmann type IV gastric cancer remains unclear.

Bacteriology of acute appendicitis and its implication for the use of prophylactic antibiotics.

BACKGROUND: To prevent surgical site infection (SSI) after appendectomy, antibiotic prophylaxis has been recommended for all patients, but this approach is based largely on bacteriologic findings that are decades old. The objective of this study was to reevaluate the bacteriology of acute appendicitis in order to assess the usefulness of current antibiotic prophylaxis. METHODS: Between January 1 and December 31, 2010, 117 patients with pathology-proved acute appendicitis were recruited. Antibiotic prophylaxis was given according to national guidelines. Immediately after operation, the luminal contents of the appendices were swabbed for bacterial culture. The charts of the patients were surveyed retrospectively for postoperative complications until June 30, 2011. RESULTS: Bacteria were isolated from 115 of 117 specimens sent for culture (98%). Of the 115 samples that yielded bacteria, all gave rise to aerobic isolates and five yielded mixed aerobic and anaerobic isolates. The most common aerobic organism was Escherichia coli, which was present in 100 of 117 patients who had pathology-proved acute appendicitis (85%). Less frequent organisms were Klebsiella pneumoniae (30 cases; 26%), Streptococcus spp. (29 cases; 25%), Enterococcus spp. (21 cases; 18%), and Pseudomonas aeruginosa (18 cases; 15%). All P. aeruginosa isolates were sensitive to amikacin, ceftazidime, and cefepime; but seven of the eight were resistant to cefuroxime. Eight patients were identified as having had a postoperative SSI, and P. aeruginosa was isolated from five of these cases. The isolation of P. aeruginosa correlated significantly with SSI (p=0.002). CONCLUSIONS: The most commonly identified aerobic bacteria associated with acute appendicitis were E. coli, followed by K. pneumoniae, Streptococcus, Enterococcus, and P. aeruginosa. Pseudomonas aeruginosa frequently was not covered by the prophylactic antibiotics chosen and might be associated with SSI.