Prediction of complicated appendicitis risk in children.

OBJECTIVE: We aimed to predict the risk of complicated appendicitis in children, constructing a risk-based prediction tool with the optimal combination of sensitivity and specificity outcomes. PATIENTS AND METHODS: This is a prospective study on a random sample of children with acute appendicitis who underwent appendectomy. Clinical examination, history, routine laboratory tests, Alvarado and pediatric appendicitis scores, operative and histopathological findings were taken into consideration. The predictive ability of the outcome variables was assessed by the Receiver Operating Characteristics (ROC) analysis. The overall predictive ability and determination of the best cut-off value (the higher sum of sensitivity plus specificity) were calculated. A Classification and Regression Tree (CRT) was used to create a multi-level classification algorithm. The model was set to predict the outcome of complicated appendicitis, considering as potential predictors the demographic characteristics, the clinical findings, and the outcome parameters. RESULTS: The various combinations of clinical and laboratory parameters did not improve their overall diagnostic ability. However, the CRT analysis resulted in a short classification algorithm based on the Pediatric appendicitis score, neutrophils percentage and the CRP. This model yielded a significantly better predictive ability than all the other combinations of the outcome parameters. The application of the model would predict complicated appendicitis with 90% sensitivity and 78.6% specificity. CONCLUSIONS: The constructed predictive model may be a useful tool for daily practical use by the clinician, especially in areas where modern diagnostic imaging facilities are absent or not always available. Clinical evaluation and close follow-up remain the more accurate preoperative method to decide the performance and timing of appendectomy.

Effect of root canal irrigant (sodium hypochlorite & saline) delivery at different temperatures and durations on pre-load and cyclic-loading surface-strain of anatomically different premolars.

AIM: To evaluate the effect of NaOCl (5%) and saline (control) irrigant delivery at different temperatures and durations on pre-load and cyclic-loading tooth-surface-strain (TSS) on anatomically different premolars. METHODOLOGY: Single-rooted premolars (n = 36), root-canal-prepared in standard manner, were randomly allocated to six irrigation groups: (A1) NaOCl-21 °C; (A2) NaOCl-60 °C; (A3) saline-21 °C then NaOCl-21 °C; (A4) saline-60 °C then NaOCl-21 °C; (A5) saline-21 °C then NaOCl-60 °C; (A6) saline-60 °C then NaOCl-60 °C. A1-2 received nine 10-min irrigation periods (IP) with NaOCl; A3-6 received nine 10-min IP with saline, followed by 9 IP with NaOCl at different temperature combinations. Premolars (n = 56) with single, fused or double roots prepared by standard protocol, were stratified and randomly allocated to: (B1) saline-21 °C; (B2) saline-80 °C; (B3) NaOCl-21 °C; (B4) NaOCl-80 °C. TSS (µÑ”) was recorded pre-irrigation, post-irrigation and pre-load for each IP and during cyclic loading 2 min after each IP, over 30-274 min, using strain-gauges. Generalised linear mixed models were used for analysis. RESULTS: Baseline TSS in double-rooted premolars was significantly (p=0.001) lower than in single/fused-rooted-premolars; and affected by mesial-wall-thickness (p=0.005). There was significant increase in loading-TSS (µÑ”) after NaOCl-21 °C irrigation (p=0.01) but decrease after NaOCl-60 °C irrigation (p=0.001). TSS also increased significantly (p = 0.005) after Saline-80 °C irrigation. Pre-load "strain-shift" was noted only upon first saline delivery but every-time with NaOCl. Strain-shift negatively influenced loading-TSS after saline or NaOCl irrigation (A3-6) but was only significant for saline-21 °C. CONCLUSIONS: Tooth anatomy significantly affected its strain characteristics, exhibiting limits within which strain changes occurred. Intra-canal introduction of saline or NaOCl caused non-random strain shifts without loading. Irrigation with NaOCl-21 °C increased loading tooth strain, as did saline-80 °C or NaOCl-80 °C but NaOCl-60 °C decreased it. A "chain-link" model was proposed to explain the findings and tooth biomechanics.

The Avatar Acceptability Study: Survivor, Parent and Community Willingness to Use Patient-Derived Xenografts to Personalize Cancer Care.

BACKGROUND: Using patient-derived xenografts (PDXs) to assess chemosensitivity to anti-cancer agents in real-time may improve cancer care by enabling individualized clinical decision-making. However, it is unknown whether this new approach will be met with acceptance by patients, family and community. METHODS: We used a cross-sectional structured survey to investigate PDX acceptability with 1550 individuals across Australia and New Zealand (648 survivors of adult and childhood cancer, versus 650 community comparisons; and 48 parents of childhood cancer survivors versus 204 community parents). We identified factors influencing willingness-to-use PDXs, willingness-to-pay, maximum acceptable wait-time, and maximum acceptable number of mice used per patient. FINDINGS: PDXs were highly acceptable: >80% of those affected by cancer felt the potential advantages of PDXs outweighed the disadvantages (community participants: 68%). Survivors' and survivors' parents' most highly endorsed advantage was 'increased chance of survival'. 'Harm to animals' was the least endorsed disadvantage for all groups. Cancer survivors were more willing to use PDXs than community comparisons [p < ·001]. Survivors and survivors' parents were willing to pay more [p < ·001; p = ∙004 respectively], wait longer for results [p = ·03; p = ∙01], and use more mice [p = ·01; p < ∙001] than community comparisons. Male survivors found PDXs more acceptable [p = ·01] and were willing to pay more [p < ·001] than female survivors. Survivors with higher incomes found PDXs more acceptable [p = ·002] and were willing to pay more [p < ·001] than survivors with lower incomes. Mothers found PDXs more acceptable [p = ·04] but were less willing to wait [p = ·02] than fathers. INTERPRETATION: We found significant attitudinal support for PDX-guided cancer care. Willingness-to-pay and maximum acceptable number of mice align well with likely future usage. Maximum acceptable wait-times were lower than is currently achievable, highlighting an important area for future patient education until technology has caught up.

Calcineurin inhibitors and male fertility after renal transplantation - a review.

Renal transplantation and restoration of renal function are associated with significant favourable changes regarding the reproductive capacity of male patients with previous end-stage renal disease. However, there is evidence that some of the immunosuppressive agents may impair male fertility after all. Calcineurin inhibitors (CNIs), cyclosporine A and tacrolimus (FK506), which constitute the cornerstone of immunosuppression regimen following renal transplantation, have been implicated in causing an overall decline in the fertilisation capacity of male renal transplant recipients (RTRs). In this review, data from human clinical studies are collectively presented in an effort to estimate the potential adverse effects of CNIs on the masculine reproductive organs, the hormonal axis of males, the process of spermatogenesis and generally the male RTRs capacity to fertilise.

An examination of the rapid automatized naming-reading relationship using functional magnetic resonance imaging.

Rapid automatized naming (RAN) has been established to be a strong predictor of reading. Yet, the neural correlates underlying the RAN-reading relationship remain unknown. Thus, the purpose of this study was to determine: (a) the extent to which RAN and reading activate similar brain regions (within subjects), (b) whether RAN and reading are directly related in the shared activity network outlined in (a), and (c) to what extent RAN neural activation predicts behavioral reading performance. Using functional magnetic resonance imaging (fMRI), university students (N=15; Mean age=20.6 years) were assessed on RAN (letters and digits) and single-word reading (words and non-words). The results revealed a common RAN-reading network that included regions associated with motor planning (cerebellum), semantic access (middle temporal gyrus), articulation (supplementary motor area, pre-motor), and grapheme-phoneme translation (supramarginal gyrus). We found differences between RAN and reading with respect to percent signal change (PSC) in phonological and orthographic regions, but not in articulatory regions. Significant correlations between the neural RAN and reading parameters were found primarily in motor/articulatory regions. Further, we found a unique relationship between in-scanner reading response time and RAN PSC in the left inferior frontal gyrus. Taken together, these findings support the notion that RAN and reading activate similar neural networks. However, the relationship between RAN and reading is primarily driven by commonalities in the motor-sequencing/articulatory processes.

A comparative study of sutured versus bovine pericardium mesh abdominal closure after open abdominal aortic aneurysm repair.

BACKGROUND: Open abdominal aortic aneurysm (AAA) repair is followed by a high rate of incisional herniation. The purpose of this study was to evaluate whether this postoperative complication could be avoided by a prophylactic implantation of a biological mesh. METHODS: In a prospective randomized clinical study, patients electively treated by open AAA repair were allocated equally to routine abdominal suture closure or to prophylactic placement of bovine pericardium mesh above the fascia. The study end points were postoperative complications and incidence of incisional hernia at a 3-year follow up. RESULTS: Forty patients with a mean age of 74.3 (SD ± 5.8) years were studied. All patients had a successful operation and a quite uneventful postoperative course. The mean operative time in the mesh group was longer compared to the control group (p < 0.001). Two patients in the mesh group developed wound seroma postoperatively. Six patients (30%) in the control group developed incisional hernia comparing to none in the mesh group. Cumulative proportion of freedom from incisional hernia was 100% for mesh group at 3 years and 74.4% (SE 9.9%) for control group at 2 years (p < 0.008). In five patients (83%), the incisional hernia was diagnosed by the second postoperative year. One patient underwent incisional hernia repair. CONCLUSION: The bovine pericardium mesh reinforcement of fascia closure in patients undergoing open AAA repair showed effectiveness and low complication rate in prophylaxis from incisional herniation. It should be considered as an alternative mesh material in selected patients.

Active terahertz beam steering by photo-generated graded index gratings in thin semiconductor films.

We demonstrate active beam steering of terahertz radiation using a photo-excited thin layer of gallium arsenide. A constant gradient of phase discontinuity along the interface is introduced by an spatially inhomogeneous density of free charge carriers that are photo-generated in the GaAs with an optical pump. The optical pump has been spatially modulated to form the shape of a planar blazed grating. The phase gradient leads to an asymmetry between the +1 and -1 transmission diffracted orders of more than a factor two. Optimization of the grating structure can lead to an asymmetry of more than one order of magnitude. Similar to metasurfaces made of plasmonic antennas, the photo-generated grating is a planar structure that can achieve large beam steering efficiency. Moreover, the photo-generation of such structures provides a platform for active THz beam steering.

Photo-generated THz antennas.

Electromagnetic resonances in conducting structures give rise to the enhancement of local fields and extinction efficiencies. Conducting structures are conventionally fabricated with a fixed geometry that determines their resonant response. Here, we challenge this conventional approach by demonstrating the photo-generation of THz linear antennas on a flat semiconductor layer by the structured optical illumination through a spatial light modulator. Free charge carriers are photo-excited only on selected areas, which enables the realization of different conducting antennas on the same sample by simply changing the illumination pattern, thus without the need of physically structuring the sample. These results open a wide range of possibilities for the all-optical spatial control of resonances on surfaces and the concomitant control of THz extinction and local fields.

The role of pelvic bone anatomy in the pathogenesis of inguinal hernia.

BACKGROUND: a small number of reports have suggested that inpatients with inguinal hernia, certain pelvic anatomical traits prevail, which are characterized by the low position of the groin, resulting in a marked verticality of the inguinal fold.Based on this notion we investigated a possible correlation of this anatomical characteristic with hernia development, by applying a simple clinical research protocol. METHODS: two groups were formed. A study group including 25 adult patients with a history of inguinal hernia or aclinically proven inguinal hernia and a control group of 10 individuals of the same age and sex distribution with the study group, but with no history of inguinal hernia. On anteroposteriorpelvic plain x-rays, we measured Radoievitch'€™s angle which is formed by the interspinal line and the line passing from the anterior superior iliac spine and the pubic tubercle.Mean values of Radoievitch'€™s angle were then compared between the two groups. RESULTS: patients with inguinal hernia had greater values concerning Radoievitchâ€'s angle in a statistically significant manner when compared to controls (p=0.004). CONCLUSIONS: individual variability in the configuration of the adult bony pelvis is an important factor in the development of inguinal hernia. Pelvimetry could affect the choice of hernia repair and radiological pelvimetry could be included in the preoperative planning of hernia repair.

Appendiceal diverticulitis in a femoral hernia causing necrotizing fasciitis of the right inguinal region: report of a unique case.

De Garengeot's hernia--a rare finding occurring mostly in women--is defined by the presence of the vermiform appendix within the sac of a femoral hernia. The incidence of appendicitis is rarer still, with less than a 100 cases reported to date. We present a unique case of an 84-year-old male patient with perforated appendiceal diverticulitis within a De Garengeot's hernia causing abscess and necrotizing infection of the overlying soft tissues.

Prognostic and predictive factors of invasive ductal breast carcinomas.

PURPOSE: To investigate the significance of certain immunohistochemical markers, namely estrogen (ER) and progesterone receptors (PgR), c-erbB-2 oncogene, p53 tumor suppressor gene and E-cadherin adhesion molecule, in invasive ductal breast carcinomas. METHODS: A series of 102 primary breast carcinomas of the ductal type and a standard immunohistochemical technique was used to detect the aforementioned biological markers. The findings were related to various clinical and pathological tumor characteristics, including lymph node metastases. RESULTS: ER and E-cadherin were expressed more commonly in tumors of low histological grade and small number (< or =3) of metastatic lymph nodes, whereas c-erbB-2 and the p53 gene were usually expressed in breast tumors of high histological grade and increased number (>3) of metastatic lymph nodes. PgR, on the other hand, was detected frequently in patients with early menarche and metastases in <3 lymph nodes, but this tendency was not statistically significant. CONCLUSION: The use of these biomarkers, preferably in combination, may provide additional prognostic and therapeutic information which may be proved useful in planning breast cancer treatment.

Affinity maturation of an anti-V antigen IgG expressed in situ through adenovirus gene delivery confers enhanced protection against Yersinia pestis challenge.

Genetic transfer of neutralizing antibodies (Abs) has been shown to confer strong and persistent protection against bacterial and viral infectious agents. Although it is well established that for many exogenous neutralizing Abs increased antigen affinity correlates with protection, the effect of antigen affinity on Abs produced in situ after adenoviral gene transfer has not been examined. The mouse IgG2b monoclonal Ab, 2C12.4, recognizes the Yersinia pestis type III secretion apparatus protein, LcrV (V antigen), and confers protection in mice when administered as an IgG intraperitoneally or after genetic immunization with engineered, replication-defective serotype 5 human adenovirus (Ad). The 2C12.4 Ab was expressed as a single-chain variable fragment (scFv) in Escherichia coli and was shown to display an equilibrium dissociation constant (K(D))=3.5 nM by surface plasmon resonance analysis. The 2C12.4 scFv was subjected to random mutagenesis, and variants with increased affinity were isolated by flow cytometry using the anchored periplasmic expression bacterial display system. After a single round of mutagenesis, variants displaying up to 35-fold lower K(D) values (H8, K(D)=100 pM) were isolated. The variable domains of the H8 scFv were used to replace those of the parental 2C12.4 IgG encoded in the Ad vector, AdalphaV, giving rise to AdalphaV.H8. The two adenoviral vectors resulted in similar titers of anti-V antigen Abs 3 days after immunization, with 10(9), 10(10) or 10(11) particle units (pu). After intranasal challenge with 363 LD(50) (lethal dose, 50%) of Y. pestis CO92, 54% of the mice immunized with 10(10) pu of AdalphaV.H8 survived through the 14 day end point compared with only 15% survivors for the group immunized with AdalphaV expressing the lower-affinity 2C12.4 (P<0.04; AdalphaV versus AdalphaV.H8). These results indicate that affinity maturation of a neutralizing Ab delivered by genetic transfer may confer increased protection not only for Y. pestis challenge but also possibly for other pathogens.

Touch imprint cytological diagnosis of nodal Langerhans cell histiocytosis.

Touch imprint cytological diagnosis of nodal Langerhans cell histiocytosis. Langerhans cell histiocytosis (LCH) is a rare neoplasm of the mononuclear phagocytic immunoregulatory system of unknown aetiology. Nodal involvement is uncommon. Cytological findings have seldom been described. A case study of LCH, arising in a submandibular node of a 42-year-old female, is reported. Fine needle aspiration smears were highly cellular and composed of a mixed cell population including eosinophils, lymphocytes, neutrophils, and macrophages. Imprint slides from the surgical specimen of the excised node exhibited Langerhans cells with nuclear grooves, leading to a diagnosis suggestive of LCH. Immunohistochemical staining of the node sections with CD1a and S-100 confirmed this diagnosis. In conclusion, cytology may favorably contribute to the diagnosis of LCH.

Accessory parotid gland carcinoma ex pleomorphic adenoma. Case study diagnosed by fine needle aspiration.

OBJECTIVE: The accessory parotid gland is salivary tissue separated from the main parotid gland and lying on masseter muscle. It has secondary duct emptying into the Stensen's duct. The accessory parotid gland exists in 21-61% of individuals. However, the appearance of an accessory parotid tumor is rare, with a reported frequency of 1-7.7% of all parotid gland tumors. Carcinoma ex pleomorphic adenoma arises from a pre-existing benign mixed tumor. Most of these tumors will have malignant epithelial component, but not malignant stromal component. Reports of Fine Needle Aspiration Cytological (FNAC) diagnosis of malignant mixed tumor are uncommon and have been limited to cases arising in the parotid. We report a case of carcinoma ex pleomorphic adenoma of the accessory lobe of the parotid, and address the cytopathology features and pitfalls of this condition. CASE: A 73 aged female presented with a right nontender midcheek mass. The lesion had been present 18 months, with a recent increase in size. FNA was performed and the smears demonstrated features indicative of pleomorphic adenoma admixed with findings indicative of a poorly differentiated carcinoma. CONCLUSION: FNAC can accurately diagnose carcinoma ex pleomorphic adenoma when strongly fixed requirements are implemented.

Neck nodal metastases from unknown primary: case series.

BACKGROUND: Neck nodal metastases from occult primary constitute about 5%-10% of all hosts harboring carcinoma of unknown primary site. Metastases in the upper and middle neck (levels I-II-III-IV-V) are generally attributed to head and neck cancers, whereas the lower neck (level IV) involvement is often associated with primaries below the clavicles. Diagnostic procedures include a careful clinical evaluation and a fiberoptic endoscopic examination of the head and neck mucosa, biopsies from all suspicious sites or blindly from the sites of possible origin of the primary, computerized tomography (CT) scan, and magnetic resonance radiology (MRI). The most frequent histological finding is squamous cell carcinoma, particularly when the upper neck is involved. SETTINGS: We report three cases of patients presented with nodal metastases of the neck from unknown primary site and we also describe the diagnostic and therapeutic approach employed in each one. RESULTS: One patient harbored a neuroendocrine metastatic deposit, the second patient a poorly differentiated carcinoma and the third one a malignant melanoma. CONCLUSIONS: Diagnostic procedures should be aimed at clarifying the histology of the nodal metastases and detecting the primary tumor site.