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

In vitro evaluation of the effect of nicotine, cotinine, and caffeine on oral microorganisms

The aim of this in vitro study was to evaluate the effects of nicotine, cotinine, and caffeine on the viability of some oral bacterial species. It also evaluated the ability of these bacteria to metabolize those substances. Single-species biofilms of Streptococcus gordonii, Porphyromonas gingivalis, or Fusobacterium nucleatum and dual-species biofilms of S. gordonii - F. nucleatum and F. nucleatum - P. gingivalis were grown on hydroxyapatite discs. Seven species were studied as planktonic cells, including Streptococcus oralis, Streptococcus mitis, Propionibacterium acnes, Actinomyces naeslundii, and the species mentioned above. The viability of planktonic cells and biofilms was analyzed by susceptibility tests and time-kill assays, respectively, against different concentrations of nicotine, cotinine, and caffeine. High-performance liquid chromatography was performed to quantify nicotine, cotinine, and caffeine concentrations in the culture media after the assays. Susceptibility tests and viability assays showed that nicotine, cotinine, and caffeine cannot reduce or stimulate bacterial growth. High-performance liquid chromatography results showed that nicotine, cotinine, and caffeine concentrations were not altered after bacteria exposure. These findings indicate that nicotine, cotinine, and caffeine, in the concentrations used, cannot affect significantly the growth of these oral bacterial strains. Moreover, these species do not seem to metabolize these substances.54650150

Placement of Kuhlmanniodendron Fiaschi & Groppo in Lindackerieae (Achariaceae, Malpighiales) confirmed by analyses of rbcL sequences, with notes on pollen morphology and wood anatomy

The phylogenetic placement of Kuhlmanniodendron Fiaschi & Groppo (Achariaceae) within Malpighiales was investigated with rbcL sequence data. This genus was recently created to accommodate Carpotroche apterocarpa Kuhlm., a poorly known species from the rainforests of Espirito Santo, Brazil. One rbcL sequence was obtained from Kuhlmanniodendron and analyzed with 73 additional sequences from Malpighiales, and 8 from two closer orders, Oxalidales and Celastrales, all of which were available at Genbank. Phylogenetic analyses were carried out with maximum parsimony and Bayesian inference; bootstrap analyses were used in maximum parsimony to evaluate branch support. The results confirmed the placement of Kuhlmanniodendron together with Camptostylus, Lindackeria, Xylotheca, and Caloncoba in a strongly supported clade (posterior probability = 0.99) that corresponds with the tribe Lindackerieae of Achariaceae (Malpighiales). Kuhlmanniodendron also does not appear to be closely related to Oncoba (Salicaceae), an African genus with similar floral and fruit morphology that has been traditionally placed among cyanogenic Flacourtiaceae (now Achariaceae). A picrosodic paper test was performed in herbarium dry leaves, and the presence of cyanogenic glycosides, a class of compounds usually found in Achariaceae, was detected. Pollen morphology and wood anatomy of Kuhlmanniodendron were also investigated, but both pollen (3-colporate and microreticulate) and wood, with solitary to multiple vessels, scalariform perforation plates and other features, do not seem to be useful to distinguish this genus from other members of the Achariaceae and are rather common among the eudicotyledons as a whole. However, perforated ray cells with scalariform plates, an uncommon wood character, present in Kuhlmanniodendron are similar to those found in Kiggelaria africana (Pangieae, Achariaceae), but the occurrence of such cells is not mapped among the angiosperms, and it is not clear how homoplastic this character could be.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)FAPESP[2000/07401-0]FAPESP[2006/03170-0]Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade de São Paulo (USP)Universidade de São Paulo USP-ProIPCNPq (GDE)[200682/2006-7]Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Virginia Commonwealth University (VCU)Virginia Commonwealth University (VCU)Carl Tryggers StiftelseCarl Tryggers StiftelseHelge Axson Johnsons StiftelseHelge Axson Johnsons Stiftels

Produtividade e teor de sólidos solúveis de frutos de cultivares de morangueiro em ambiente protegido Yield and soluble solids contents of fruits of strawberry cultivars in protected cultivation

O cultivo protegido é uma alternativa para controlar variações climáticas em diferentes locais e épocas de plantio, entretanto, seus efeitos e interações com a cultura do morangueiro ainda são pouco conhecidos. O objetivo desse trabalho foi avaliar a influência de três sistemas de cultivo (túnel alto, túnel baixo e a campo) na produtividade, massa média de frutos e no teor de sólidos solúveis dos frutos das cultivares de morango Dover, Camarosa, Sweet Charlie e Oso Grande em Guarapuava-PR. Quanto à produtividade e massa média de frutos, a cultivar Camarosa foi a melhor nos cultivos em túnel, tanto alto quanto baixo, pelo seu excelente desempenho. Os frutos da cultivar Sweet Charlie apresentaram o maior teor de sólidos solúveis nos três ambientes de cultivo. A produtividade e a massa média dos frutos foram significativamente superiores nos cultivos em túneis, alto e baixo, quando comparados ao cultivo a campo. O ambiente que propiciou maior acúmulo de sólidos solúveis nos frutos foi o túnel alto, diferindo significativamente dos demais ambientes de cultivo.<br>Protected cultivation is an alternative to control the climatic effects in different places and times of planting, however, its effects and interactions with the strawberry crop are little known. The goal of this study was to evaluate the effects of three cropping systems (high tunnel, low tunnel and field) on yield, mean fruit mass and the soluble solids contents of strawberry cultivars Dover, Camarosa, Sweet Charlie and Oso Grande in Guarapuava. Camarosa cultivar presents an excellent performance regarding yield and mean fruit mass in high and low tunnel cultivation; hence, these cropping system can be indicated. Fruits of Sweet Charlie cultivar had the highest content of soluble solids in all the cultivation environments. Yield and mean fruit mass obtained from high and low tunnels were significantly higher than in the field. The environment high tunnel allowed greater accumulation of soluble solids, differing significantly from other evaluated environments