Inflammatory Response Scores Research Articles

THE ROLE OF INFLAMMATORY PARAMETERS AND SCORING SYSTEMS IN PREDICTING COMPLICATED ACUTE APPENDICITIS

Aim: To assess the complications associated with acute appendicitis (AA) and to evaluate how specific routine patient parameters influence disease severity. Materials and Methods: A retrospective study was carried out on patients diagnosed with AA who presented to the emergency department (ED) between January 1, 2019, and December 31, 2020. Data collected included demographic details, blood test results, and specific scoring systems utilized in the ED. Results: Of the 223 patients studied, 63.7% were male with a mean age of 37.5 ± 16.8 years. Patients with complicated appendicitis (CA) showed significantly elevated hematological parameters such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP), systemic immune inflammation index (SII), white blood cell count (WBC), and neutrophil levels. Conversely, decreased lymphocyte/C-reactive protein ratio (LCRP) and lymphocyte levels were noted. Furthermore, CA cases exhibited significantly greater Appendicitis Inflammatory Response (AIR) and Alvarado scores. In the context of diagnosing CA, the AIR score had a sensitivity of 85.9% and a specificity of 47.9% with a cut-off value of ≥6 (95% CI 0.675-0.821, Area Under the Curve (AUC): 0.748; p

Investigation of the Effects of N-acetylcysteine and Selenium on Vesicoureteral Reflux Nephropathy: An Experimental Study

IntroductionThis study aimed to investigate the effects of N-acetylcysteine (NAC) and selenium (Se) on vesicoureteral reflux (VUR) nephropathy. MethodsA total of 44 rabbits in 7 groups, namely group 1 (Control), group 2 (VUR + sterile urine), group 3 (VUR + sterile urine + NAC), group 4 (VUR + sterile urine + Se), group 5 (VUR + infected urine), group 6 (VUR + infected urine + NAC) and group 7 (VUR + infected urine + Se), were used. 99mTc Dimercaptosuccinic acid renal scan (DMSA), cystogram and urine culture were performed both at the beginning and end of the study. Left VUR was created surgically, and E. coli was inoculated in infected urine groups. NAC and Se were administered daily for 21 days. Malondialdehyde (MDA) measurement, inflammatory response scores (IRSs), and cicatrization response scores (CRSs) in renal tissues were evaluated. ResultsVUR did not reduce left renal uptake values in neither group 2 nor group 5. MDA levels of the left kidney were significantly higher in group 5 compared to group 1 (p = 0.001). There was no significant difference in MDA levels between group 5 and group 6, and between group 5 and group 7. Left kidney IRSs were found to be higher in all other groups except group 2 compared to the control group (p < 0.001). Left kidney CRSs were significantly higher in group 5 compared to group 2 (p = 0.026), group 6 (p < 0.001) and group 7 (p = 0.006). ConclusionA decrease in renal functions was not observed in VUR, even if there was infection. When CRSs were evaluated, NAC and Se had protective effects in terms of scar formation in VUR nephropathy. Type of StudyExperimental animal study. Levels of EvidenceN/A.

The Relationship Between Serum Albumin Levels and Sepsis in Patients Admitted to a Tertiary Care Center in India.

Introduction Sepsis poses a significant threat in Indian hospitals, with high mortality rates and complications. This study explores the correlation between serum albumin levels and sepsis outcomes in an intensive care unit (ICU) setting. The challenges of diagnosing tropical infections further complicate sepsis management in India. Methodology A longitudinal study was conducted at Vinayaka Mission's Kirupananda Variyar Medical College and Hospital, Salem, India. Adult patients admitted between July 2020 and March 2021 with sepsis were included. Serum albumin levels, demographic data, and clinical outcomes were analyzed. The study used a convenient sampling technique with a sample size of 102 patients. Results Among the 102 patients in the ICU, 22 have expired and the mortality rate in the study was 21.6%. Hypoalbuminemia was present in 56.9% (n = 58) of the patients. The mortality rate is higher among the sepsis patients with the occurrence of hypoalbuminemia (29.3%) compared to patients without hypoalbuminemia (11.4%) and the difference in proportion between the two groups was statistically significant (p-value = 0.029). The requirement of vasopressor support is higher among sepsis patients with the occurrence of hypoalbuminemia (56.9%) compared to patients without hypoalbuminemia (27.3%). The chi-square test reveals that the difference in proportion between the two groups was statistically significant (p-value = 0.005). No substantial impact on systemic inflammatory response scores, readmission to ICU, or progression to chronic illness was observed based on albumin levels. Conclusion This study underscores the predictive value of hypoalbuminemia in sepsis outcomes. Patients with decreased albumin levels showed higher mortality rates and increased vasopressor usage. While albumin levels did not significantly influence certain parameters, hypoalbuminemia may serve as an indicator of severity and adverse prognosis in sepsis, emphasizing the need for further research and tailored interventions.

Inflammatory response signature score model for predicting immunotherapy response and pan-cancer prognosis

BackgroundInflammatory responses influence the outcome of immunotherapy and tumorigenesis by modulating host immunity. However, systematic inflammatory response assessment models for predicting cancer immunotherapy (CIT) responses and survival across human cancers remain unexplored. Here, we investigated an inflammatory response score model to predict CIT responses and patient survival in a pan-cancer analysis. MethodsWe retrieved 12 CIT response gene expression datasets from the Gene Expression Omnibus database (GSE78220, GSE19423, GSE100797, GSE126044, GSE35640, GSE67501, GSE115821 and GSE168204), Tumor Immune Dysfunction and Exclusion database (PRJEB23709, PRJEB25780 and phs000452.v2.p1), European Genome-phenome Archive database (EGAD00001005738), and IMvigor210 cohort. The tumor samples from six cancers types: metastatic urothelial cancer, metastatic melanoma, gastric cancer, primary bladder cancer, renal cell carcinoma, and non-small cell lung cancer.We further established a binary classification model to predict CIT responses using the least absolute shrinkage and selection operator (LASSO) computational algorithm. FindingsThe model had high predictive accuracy in both the training and validation cohorts. During sub-group analysis, area under the curve (AUC) values of 0.82, 0.80, 0.71, 0.7, 0.67, and 0.64 were obtained for the non-small cell lung cancer, gastric cancer, metastatic urothelial cancer, primary bladder cancer, metastatic melanoma, and renal cell carcinoma cohorts, respectively. CIT response rates were higher in the high-scoring training cohort subjects (51%) than the low-scoring subjects (27%). The five-year survival rates in the high- and low score groups of the training cohorts were 62% and 21%, respectively, while those of the validation cohorts were 54% and 22%, respectively (P < 0·001 in all cases). Inflammatory response signature score derived from on-treatment tumor specimens are highly predictive of response to CIT in patients with metastatic melanoma. A significant correlation was observed between the inflammatory response scores and tumor purity. Regardless of the tumor purity, patients in the low score group had a significantly poorer prognosis than those in the high score group. Immune cell infiltration analysis indicated that in the high score cohort, tumor-infiltrating lymphocytes were significantly enriched, particularly effector and natural killer cells. Inflammatory response scores were positively correlated with immune checkpoint genes, suggesting that immune checkpoint inhibitors may have benefited patients with high scores. Analysis of signature scores across different cancer types from The Cancer Genome Atlas revealed that the prognostic performance of inflammatory response scores for survival in patients who have not undergone immunotherapy can be affected by tumor purity. Interleukin 21 (IL21) had the highest weight in the inflammatory response model, suggesting its vital role in the prediction mode. Since the number of metastatic melanoma patients (n = 429) was relatively large among CIT cohorts, we further performed a co-culture experiment using a melanoma cell line and CD8 + T cell populations generated from peripheral blood monocytes. The results showed that IL21 therapy combined with anti-PD1 (programmed cell death 1) antibodies (trepril monoclonal antibodies) significantly enhanced the cytotoxic activity of CD8 + T cells against the melanoma cell line. ConclusionIn this study, we developed an inflammatory response gene signature model that predicts patient survival and immunotherapy response in multiple malignancies. We further found that the predictive performance in the non-small cell lung cancer and gastric cancer group had the highest value among the six different malignancy subgroups. When compared with existing signatures, the inflammatory response gene signature scores for on-treatment samples were more robust predictors of the response to CIT in metastatic melanoma.

Effects of elevated emotional symptoms on metabolic disease development: a 10-year follow-up study.

In recent decades, the relationship between emotional disorders (i.e., depression and anxiety) and alterations in physiological functions (i.e., inflammation or metabolism) have been well supported. However, studies on a symptom-based approach have provided mixed results. Our study aims to gain insight into how subclinical statuses, featured by elevated depressive and/or anxious symptoms, may influence immunometabolic alterations in the concurrent relationship; and the development of metabolic diseases at 10-year follow-up: diabetes, hypertension and hypercholesterolemia. Data from 758 Greek adults [394 men (aged 41 ± 10 years) and 364 women (aged 37 ± 12 years)] were used. Four groups were created according to the levels of depressive and anxiety symptoms: (1) control group (CG), (2) depressive group (DG), (3) anxiety group (AG) and (4) depressive and anxiety group (DAG). Multi-indicator multi-causes (MIMIC) modeling was used to estimate metabolic function and inflammatory response scores, on a wide selection of blood biomarkers. Finally, a binary logistic regression was carried out to study the influence of symptoms on the development of the aforementioned metabolic diseases on a 10-year follow-up. Group membership was not associated with metabolic function score. Conversely, DAG membership was related with higher inflammatory response score (B = 0.20, CI95 = 0.01, 0.40), with respect to the CG (p < 0.05). Both age and sex were significant variables in the calculation of both scores. Regarding disease at 10-year follow-up effect, risk of developing diabetes, hypertension and hypercholesterolemia was associated with age and socioeconomic status. Moreover, DG membership was significant for diabetes risk (OR = 2.08, CI95 = 1.00, 4.22) and DAG for hypercholesterolemia (OR = 1.68, CI95 = 1.16, 2.43). Data on anti-inflammatory drugs and psychopharmacological medication were not collected in this study. Elevated symptoms of depression and anxiety accounts for inflammatory alterations at concurrent relationship and a higher risk of 10-year follow-up metabolic diseases.

Deficiency of S100A8/A9 attenuates pulmonary microvascular leakage in septic mice

BackgroundWe have reported a positive correlation between S100 calcium-binding protein (S100) A8/S100A9 and sepsis-induced lung damage before. However, limited knowledge exists concerning the biological role of S100A8/A9 in pulmonary vascular endothelial barrier dysfunction, as well as the diagnostic value of S100A8/A9 in sepsis.MethodsSepsis was induced in C57BL/6J mice and S100A9-knockout (KO) mice through the cecal ligation and puncture (CLP). Pulmonary vascular leakage was determined by measuring extravasated Evans blue (EB). Reverse transcription polymerase chain reaction and the histological score were used to evaluate inflammation and lung injury, respectively. Recombinant S100A8/A9 (rhS100A8/A9) was used to identify the effects of S100A8/A9 on endothelial barrier dysfunction in human umbilical vein endothelial cells (HUVECs). Additionally, the diagnostic value of S100A8/A9 in sepsis was assessed using receiver operating characteristic.ResultsS100A8/A9 expression was up-regulated in the lungs of CLP-operated mice. S100A9 KO significantly reversed CLP-induced hypothermia and hypotension, resulting in an improved survival rate. S100A9 KO also decreased the inflammatory response, EB leakage, and histological scores in the lungs of CLP-operated mice. Occludin and VE-cadherin expressions were decreased in the lungs of CLP-operated mice; However, S100A9 KO attenuated this decrease. Moreover, CLP-induced signal transducer and activator of transcription 3 (STAT3) and p38/extracellular signal-regulated kinase (ERK) signalling activation and apoptosis were mitigated by S100A9 KO in lungs. In addition, rhS100A8/A9 administration significantly decreased occludin and VE-cadherin expressions, increased the phosphorylated (p)-ERK/ERK, p-p38/p38, and B-cell leukaemia/lymphoma 2 protein (Bcl-2)-associated X protein/Bcl-2 ratios in HUVECs.ConclusionThe present study demonstrated S100A8/A9 aggravated sepsis-induced pulmonary inflammation, vascular permeability, and lung injury. This was achieved, at least partially, by activating the P38/STAT3/ERK signalling pathways. Moreover, S100A8/A9 showed the potential as a biomarker for sepsis diagnosis.

Comparison of the Laparoscopic Appendicitis (LAPP) score with the Alvarado and Appendicitis Inflammatory Response(AIR) scores and computed tomography and pathology results

Background: Acute appendicitis is the most commonly encountered and operated group among general surgery emergency patients. Various scoring and algorithms are used in diagnosis and treatment. This study aimed to compare the Laparoscopic Appendicitis (LAPP) score, which is used to reduce negative appendectomy, according to the pathology and preoperative computed tomography results and investigate its correlation with other clinical scoring systems. Methods: Patients who underwent appendectomy in our clinic between June 2020 and March 2021 were retrospectively reviewed. The obtained LAPP scores were compared with the preoperative imaging results, Alvarado score, appendicitis inflammatory response (AIR) score, and pathology results. Results: The study included a total of 109 patients, of whom 22 (20.18%) had a pathology result that was not consistent with appendicitis. The LAPP score was determined as 1.41 for this 22 patients who underwent negative appendectomy (p&lt;0.001), 2.45 for 74 patients with suppurative appendicitis (p&lt;0.001), and 3.54 for 13 patients with gangrenous or perforated appendicitis (p&lt;0.001). Conclusions: The purpose of the LAPP score is to reduce the rate of negative appendectomy. Appendectomy is also performed in some patients who may have spontaneous resolution if they present to the hospital in the early period. We also consider that the frequency of familial Mediterranean fever in Turkey may be another reason for the high rate of negative appendectomy. In addition, the correlation of high Alvarado and AIR scores with a high LAPP score indicates that it is more reliable in the diagnosis of complicated appendicitis.

Design and Performance Evaluation of a Novel Automatic Stapling Device for Knotless Barbed Suture in Laparoscopic Surgery.

This study developed a novel automatic stapling device for improving the speed and stability of suturing in laparoscopic surgery. The stapling device included 3 components: driver module, actuator module, and transmission module. A negative water leakage test of the in vitro intestinal defect model preliminarily demonstrated the safety of the new automatic stapling device. The suturing time for skin and peritoneal defects through the automatic stapling device was significantly shorter than that through the ordinary needle-holder suture (P < .05). These 2 suture methods had good tissue alignment. The automatic suture showed less inflammatory cell infiltration and lower inflammatory response scores at the tissue incision on days 3 and 7 after surgery compared with the ordinary needle-holder suture, with statistically significant differences (P < .05). In the future, the device needs to be further optimized and the experimental needs to be supplemented to provide some evidence for clinical use. This novel automatic stapling device for knotless barbed suture designed in this study has advantages of shorter suturing time and milder inflammatory responses than the ordinary needle-holder suture, safe and feasible in laparoscopic surgery.

Hair follicle-MSC-derived small extracellular vesicles as a novel remedy for acute pancreatitis.

Hair follicle-derived mesenchymal stem cell (HF-MSC)-based therapies protect against acute pancreatitis (AP). However, accumulating evidence suggests that MSC-based therapy mainly involves the secretion of MSC-derived small extracellular vesicles (MSC-sEVs) through paracrine effects. Thus, the present research investigated the therapeutic effect of HF-MSC-sEVs in AP and the underlying mechanisms. SEVs were purified from cultured HF-MSC supernatant. The effects of sEVs in vitro were analyzed on caerulein-simulated pancreatic acinar cells (PACs). The therapeutic potential of sEVs in vivo was examined in a caerulein-induced AP model. The organ distribution of sEVs in mice was determined by near-infrared fluorescence (NIRF) imaging. Serum specimens and pancreatic tissues were collected to analyze the inhibition of inflammation and pyroptosis in vivo, as well as the appropriate infusion route: intraperitoneal (i.p.) or intravenous (i.v.) injection. HF-MSC-sEVs were taken up by PACs and improved cell viability in vitro. In vivo, sEVs were abundant in the pancreas, and the indicators of pancreatitis, including amylase, lipase, the inflammatory response, myeloperoxidase (MPO) expression and histopathology scores, in sEV-treated mice were markedly improved compared with those in the AP group, especially via tail vein injection. Furthermore, we revealed that sEVs observably downregulated the levels of crucial pyroptosis proteins in both PACs and AP tissue. We innovatively demonstrated that HF-MSC-sEVs could alleviate inflammation and pyroptosis in PACs in AP, suggesting a refreshing cell-free remedy for AP.

Elevated serum ferritin levels are associated with severity and prognosis of severe acute pancreatitis: a preliminary cohort study

BackgroundSerum ferritin (SF), as an acute-phase response protein, is used to reflect the degree of oxidative stress and systemic inflammatory responses. This study was designed to assess the effect of elevated SF levels on the severity of acute pancreatitis (AP).MethodsFrom January 2013 to December 2020, 200 consecutive patients with AP were retrospectively reviewed to analyze the relationships among the etiologies of pancreatitis, the severity of the disease and SF levels. The receiver operating characteristic (ROC) curve and logistic regression analysis were used to assess whether elevated SF levels could predict the onset of organ failure in AP.Results92 (46%) had high SF levels (> 275 ng/ml). SF levels were not associated with the etiology of AP disease. Among patients with high SF levels, there was a significant increase in the proportion of patients with severe AP (23.1% vs. 76.9%) and a higher proportion of systemic inflammatory response scores (25.9% vs. 44.6%) in comparison to patients with normal SF levels. The area under the ROC curve for SF in predicting persistent organ failure was 0.812 [95% confidence interval 0.721–0.904].ConclusionsF concentrations were positively correlated with the severity of AP, and quantitative assessment of SF can predict disease severity and organ failure in patients with AP.

Intrauterine Ureaplasma is associated with small airway obstruction in extremely preterm infants.

The long-term follow-up of lung function (LF) in extremely preterm (EP) infants with bronchopulmonary dysplasia (BPD) has shown a worldwide increase in small airway obstructions (SAO). We investigated the relationships between intrauterine Ureplasma infection in EP infants and bubbly/cystic lung, BPD, and SAO at school age. Placental pathology, placental Ureaplasma DNA (pU-DNA), and cord blood immunoglobulin M (IgM) (C-IgM) were investigated in 360 EP infants born from 1981 to 2004. Maternal amniotic inflammatory response (M-AIR) scores and hemosiderin deposition (HD) were estimated in the chorioamnion. The study subjects were divided into groups based on their M-AIR scores. Their LF at school age was compared with those of 33 healthy siblings. pU-DNA and C-IgM were significantly related to SAO at school age (p < 0.012). M-AIR score 3 and pU-DNA >1000 units had an odds ratio (OR) of 35 (95% confidence interval: 10-172) and 18 (5.6-67) for bubbly/cystic lung, and 11 (3.1 - 43) and 31 (4.5-349) for severe BPD, and 5.3 (2.1-11) and 12 (2.4-74) for SAO, respectively. The ORs of surfactant treatment, BPD grade III, O2 at 40 weeks, HD, and C-IgM >30 mg/dl for SAO were 0.21 (0.075-0.58), 5.3 (2.1-15), 2.5 (1.4-4.6), 3.6 (1.5-9.1) and 2.5 (1.0-5.2). 84% (90/107) SAO infants showed no or mild BPD in infancy, and 61% of infants had no severe CAM. Our long-term cohort study of LF in EP infants revealed that intrauterine Ureaplasma was associated with bubbly/cystic lung, severe BPD, and SAO at school age.

Predicting complicated appendicitis based on clinical findings: the role of Alvarado and Appendicitis Inflammatory Response scores

PurposeThe pre-interventional differentiation between complicated and uncomplicated appendicitis is decisive for treatment. In the context of conservative therapy, the definitive diagnosis of uncomplicated appendicitis is mandatory. This study investigates the ability of clinical scoring systems and imaging to differentiate between the two entities.MethodsThis is a retrospective analysis of two cohorts from two tertiary referral centers in Switzerland and Germany. All consecutive patients underwent appendectomy between January 2008 and April 2013 (in the first cohort) or between January 2017 and June 2019 (the second cohort). Exclusion criteria did not apply as all patients found by the database search and received an appendectomy were included. Diagnostic testing and calculation of a receiver operating curve were performed to identify a cutoff for clinical scores that resulted in a minimum sensitivity of 90% to detect complicated appendicitis. The cutoff was combined with additional diagnostic imaging criteria to see if diagnostic properties could be improved.ResultsNine hundred fifty-six patients were included in the analysis. Two hundred twenty patients (23%) had complicated appendicitis, and 736 patients (77%) had uncomplicated appendicitis or no inflammation. The complicated appendicitis cohort had a mean Alvarado score of 7.03 and a mean AIR of 5.21. This compared to a mean Alvarado of 6.53 and a mean AIR of 4.07 for the uncomplicated appendicitis cohort. The highest Alvarado score with a sensitivity of > 90% to detect complicated appendicitis was ≧ 5 (sensitivity = 95%, specificity 8.99%). The highest AIR score with a sensitivity of > 90% to detect complicated appendicitis was ≧ 3 (sensitivity 91.82%, specificity 18.53). The analysis showed that additional CT information did not improve the sensitivity of the proposed cut-offs.ConclusionAIR and Alvarado scores showed limited capability to distinguish between complicated and uncomplicated appendicitis even with additional imaging in this retrospective cohort. As conservative management of appendicitis needs to exclude patients with complicated disease reliably, appendectomy seems until now to remain the safest option to prevent undertreatment of this mostly benign disease.

Comparison of Diagnostic Accuracy of Appendicitis Inflammatory Response Score and Alvarado Score in Diagnosis of Acute Appendicitis Taking Histopathology as Gold Standard

Objective: To compare the diagnostic accuracy of appendicitis inflammatory response score and Alvarado score in diagnosis of acute appendicitis taking histopathology as gold standard. Study Design: It is a Cross Sectional Study Study setting and Duration: This study conducted at the Department of General Surgery, Abbasi Shaheed Hospital, Karachi from September 2018 To March 2019. Methods: Alvarado and Appendicitis inflammatory response scores were used to evaluate all patients. For the Alvarado scoring system, a score of 7 or more was considered a high chance of acute appendicitis, while the AIR scoring system required a score of 9 or higher. The findings of the histopathology lab were compared to the test results. Both tests' results were analysed to determine their sensitivity, specificity, and diagnostic accuracy. Results: For Alvarado score Sensitivity (80.1%), Specificity (92.3%) and accuracy was 81.7%. For AIR score Sensitivity (72.6%), Specificity (94.2%), and accuracy was 75.5%. There were 66.9% male and 33.1% female patients. Right iliac fossa pain was 76.8%, pain migration to right iliac fossa was 63.5%, anorexia was 90.9%. Conclusion: Higher sensitivity and specificity of the Appendicitis inflammatory response score and the Alvarado score were found to outperform the histological findings in appendicitis. Keywords: Appendicitis, Appendicitis Inflammatory Response Score, Diagnostic Accuracy, Acute Appendicitis, Histopathology, Alvarado Score,

English

BACKGROUND Accurate clinical diagnosis and timely surgical intervention are the two important events that help the surgeon in the management of acute appendicitis. Two diagnostic score systems that help in avoiding the removal of normal appendix are reviewed in this study. The purpose of this study was to evaluate the sensitivity and specificity of Alvarado score (AS) and Appendicitis inflammatory response scores (AIRS) in the diagnosis of acute appendicitis (AA) and correlate their efficacy in the management of acute appendicitis as per the diagnostic scores used. METHODS This was a cross-sectional clinical study. 73 patients who attended the emergency ward for clinical features of acute appendicitis were included in the study. Clinical examination included the diagnostic tools 1. The Alvarado score, 2. Appendicitis Inflammatory Response score. Based on their score a provisional diagnosis was made among the patients. All the data was classified and analysed. RESULTS The positive predictive value was 63/73 (86.30 %) with Alvarado diagnostic tool and 66/73 (90.41 %) with AIS diagnostic tool. The false positive values using Alvarado system was 06.84 % and 04.10 % with AIS system. The true negative rate of diagnosis of acute appendicitis in this study was 09.58 %. CONCLUSIONS Both Alvarado and AIS diagnostic tools were simple and accurate in the early diagnosis of acute appendicitis in the adult population. Both the tools are highly sensitive and specific in nature. KEYWORDS Appendix, Acute Appendicitis, Perforation, USG, Laparotomy and Alvarado Score

Can Patient Triaging with Clinical Scoring Systems Reduce CT Use in Adolescents and Young Adults Suspected of Having Appendicitis?

Background There are ongoing efforts to reduce CT radiation exposure for the diagnosis of appendicitis. Recent guidelines recommend using clinical scoring systems to triage patients who need imaging examinations. Purpose To determine whether patient triaging with scoring systems can reduce CT use without a loss of diagnostic accuracy in adolescents and young adults suspected of having appendicitis. Materials and Methods This retrospective study used data from a previous multicenter randomized controlled trial conducted between December 2013 and August 2016. Five scoring systems (adult appendicitis, appendicitis inflammatory response, modified Alvarado, Broek, and Christian scores) were used to categorize patients into low-, intermediate-, or high-probability groups. CT use was simulated for only the intermediate-probability group. The primary outcomes were CT reduction rate, sensitivity, and specificity. The CT reduction rate was defined as the proportion of patients in low- and high-probability groups who would not have to undergo CT among all patients. Sensitivity and specificity were calculated in the overall diagnostic pathway using each scoring system and subsequent CT. As a secondary analysis, to maintain the diagnostic accuracy to a level of when CT was used for all patients with suspected appendicitis, new cutoff values for probability group stratification targeting 97.6% sensitivity and 94.9% specificity were applied for each of the scoring systems. Results A total of 2888 patients (mean age ± standard deviation, 28 years ± 9; 1580 women and 1308 men) with suspected appendicitis were evaluated, of whom 1088 had and 1800 did not have appendicitis. The CT reduction rates of the five scoring systems ranged from 55.6% (1606 of 2888 patients) to 71.1% (2053 of 2888), but at the cost of sensitivity (range, 48.7% [530 of 1088] to 81.2% [883 of 1088]) and specificity (range, 79.0% [1422 of 1800] to 97.8% [1761 of 1800]). Targeting 97.6% sensitivity and 94.9% specificity, the CT reduction rates of all five scoring systems were 0% (0 of 2888). Conclusion Using clinical scoring systems in triaging patients for selective CT use led to a considerable loss of diagnostic accuracy. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Mellnick in this issue.

Predictive Value of Alvarado, Acute Inflammatory Response, Tzanakis and RIPASA Scores in the Diagnosis of Acute Appendicitis

Introduction. The diagnosis of acute appendicitis (AA), as the most common cause of acute abdominal pain, has changed in the past decade by introducing scoring systems in addition to the use of clinical, laboratory parameters, and radiological examinations. This study aimed to assess the significance of the four scoring systems (Alvarado, Appendicitis Inflammatory Response (AIR), Raya Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Tzanakis) in the prediction of delayed appendectomy. Materials and methods. The study included 100 respondents, who were diagnosed with AA in the period from January 2018 to February 2019 and were also operated on. In addition to the clinical, laboratory, and ultrasonographic examinations, four scoring systems (Alvarado, AIR, RIPASA, and Tzanakis) were used to diagnose AA. According to the obtained histopathological (HP) findings, the patients were divided into 3 groups: timely appendectomy, delayed appendectomy and unnecessary appendectomy. Using the sensitivity and specificity of all 4 scoring systems, ROC analysis was performed to predict delayed appendectomy. Results. In the study that included 100 patients (58% men, 42% women), after the appendectomy was performed, the resulting HP showed that 74% had a timely appendectomy, while 16% had delayed and 10% had an unnecessary appendectomy. For the prediction of delayed appendectomy, the area under the ROC curve showed a value of 0.577 for the Alvarado score, 0.504 for the AIR, 0.651 for the RIPASA, and 0.696 for the Tzanakis. Sensitivity and specificity for the Alvarado score was 54% and 62%, for RIPASA 62.5% and 63.5%, for Tzanakis 69% and 60.8%, respectively. Combining the three scoring systems (Alvarado, RIPASA, and Tzanakis), the surface area under the ROC curve was 0.762 (95% CI 0.521–0.783), with a sensitivity of 85% and a specificity of 62%. Conclusion. In our study, the diagnostic accuracy of RIPASA and Tzanakis showed better results than Alvarado, while AIR cannot be used to predict delayed appendectomy in our population. However, the simultaneous application of all three scoring systems, RIPASA, Tzanakis and Alvarado, has shown much better discriminatory ability, with higher sensitivity and specificity, as opposed to their use alone. Combining scoring systems should help in proper diagnosis to avoid negative appendectomy, but additional studies with a larger number of patients are needed to support these results.

Prognostic effect of systemic inflammation in patients undergoing surgery for hepatocellular carcinoma: comparison of composite ratios and cumulative scores.

BackgroundThe systemic inflammatory has been suggested to predict the prognosis of cancer patients. There are two kinds of methods for evaluating the systemic inflammatory response, namely, composite ratios and cumulative scores. The aim of our study was to compare the prognostic effect of scores and ratios in patients undergoing surgery for liver cancer.MethodsWe retrospectively enrolled patients who underwent curative resection for hepatocellular carcinoma (HCC) performed between January 2015 to December 2017 in Fudan University Shanghai Cancer Center (FUSCC). Preoperative lymphocyte, monocyte, neutrophil and platelet counts, and CRP and albumin of liver cancer patients were recorded. The relationships among composite ratios, including the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR), and C-reactive protein albumin ratio (CAR); cumulative scores, including the neutrophil-lymphocyte score (NLS), platelet-lymphocyte score (PLS), neutrophil-platelet score (NPS), and modified Glasgow prognostic score (mGPS); clinicopathological characteristics; and overall survival (OS) were explored.ResultsA total of 595 patients were enrolled. When multivariate analysis was adjusted according to TNM, PLR >150, LMR >2.4, CAR >0.22, NLS =1, PLS =1, NPS =1, and mGPS =1 were significantly associated with postoperative OS, except for NLR.ConclusionsBoth cumulative scores and composite ratios had prognostic effect independent of TNM stage, in patients with liver cancer. However, cumulative scores, basing on normal reference ranges, are simpler and more stable for clinical use.

Effects of alcohol and nicotine consumption on the development of apical periodontitis in rats: a correlative micro-computed tomographic, histological and immunohistochemical study.

To evaluate the effects of alcohol and nicotine, when used alone or simultaneously, in the development of apical periodontitis induced in rats, using a correlative analytic approach with micro-CT, histological and immunohistochemical analysis. Twenty-eight male Wistar rats were arranged into four groups: Control, Nicotine, Alcohol and Alcohol+Nicotine. The alcohol groups were exposed to self-administration of a 25% alcohol solution, whilst the other groups drunk only filtered water. The nicotine groups received daily intraperitoneal injections of a solution with 0.19μL of nicotine per mL, whilst the other groups received saline solution. The pulps of the left mandibular first molars were exposed for 28days to induce periapical lesions. Throughout the experiment, drug administration was maintained, and the animals had their weight and solid and liquid consumption measured. After euthanasia, the mandibles were removed and the area, volume and major diameter of the periapical lesions were measured using micro-computed tomography images. The samples were submitted to histopathological evaluation and immunohistochemistry for RANKL and PTHrP. Statistical analysis was undertaken with a significance level of 5%. Nonparametric data were analysed using the Kruskal-Wallis test followed by Dunn's test, whilst one-way anova followed by Tukey's test was performed for parametric data. The alcohol groups had lower solid and liquid consumption and gained less weight when compared to the nonalcohol groups (P<0.05). The Alcohol+Nicotine group had lesions with significantly larger volume and area when compared to the other groups (P<0.05), whilst the Alcohol or Nicotine groups had significantly larger lesions than the control group (P<0.05). There was no significant difference in the largest diameter of the lesions amongst groups (P>0.05). The experimental groups had greater inflammatory response scores than the control group (P<0.05), and the representative samples had more pronounced immunoreaction against RANKL and PTHrP antibodies. Alcohol and nicotine consumption exacerbated the inflammatory response and the development of periradicular lesions in rats. The association of both substances enhanced their harmful effects.

Is the qSOFA more reliable than SIRS in detecting post-operative PCNL patients requiring escalation of care?

Aims Percutaneous nephrolithotomy is known to have a significant risk of sepsis and traditionally the systemic inflammatory response score has been used to identify post-operative patients requiring higher levels of care. Recently, the quick Sepsis Related Organ Failure Assessment score has been developed as a rapid and easy tool to assess patients likely to deteriorate from sepsis. We aim to evaluate the quick Sepsis Related Organ Failure Assessment system against the established systemic inflammatory response score criteria in identifying patients at risk of intensive care unit admission following percutaneous nephrolithotomy. Patients and Methods A retrospective review of 157 patients undergoing percutaneous nephrolithotomy between May 2015 and November 2018 at our institution was performed. Patient demographics of age, sex and American Society of Anesthesiologists’ score were collected. Quick Sepsis Related Organ Failure Assessment and systemic inflammatory response scores were calculated at 24 hours and 7 days post-operatively. Primary outcome was admission to an intensive care unit. Specificity, sensitivity, positive and negative predictive values were calculated for the systemic inflammatory response and quick Sepsis Related Organ Failure Assessment scores. Results Of 157 patients undergoing percutaneous nephrolithotomy, eight (5.1%) and 52 (33.1%) scored positively for quick Sepsis Related Organ Failure Assessment and systemic inflammatory response score criteria within 24 hours. Quick Sepsis Related Organ Failure Assessment scoring had a higher specificity (98.7%: 95% confidence interval 98.6–98.7%) and positive predictive value (75.0: 95% confidence interval 74.0–75.0%) than systemic inflammatory response score criteria (69.5%: 95% confidence interval 69.3–69.7%), (11.5%; 95% confidence interval 1.2–11.8%) in predicting intensive care unit admission following percutaneous nephrolithotomy. Quick Sepsis Related Organ Failure Assessment correlated strongly with intensive care unit admission and overall length of stay, whereas systemic inflammatory response score correlated weakly with both parameters. Conclusion Quick Sepsis Related Organ Failure Assessment demonstrated a statistically significant improvement in predicting intensive care unit admission and overall length of stay versus systemic inflammatory response score criteria following percutaneous nephrolithotomy. Further multi-centre studies are required to validate these findings, which are the first to be published in a urology-specific patient population. Level of Evidence: 4

Clinical and Survival Outcomes Using Percutaneous Cholecystostomy Tube Alone or Subsequent Interval Cholecystectomy to Treat Acute Cholecystitis

BackgroundPercutaneous cholecystostomy (PCT) is a safe method of gallbladder drainage in the setting of severe or complicated acute cholecystitis (AC), particularly in patients who are high-risk surgical candidates. Small case series suggest that PCT aids resolution of acute cholecystitis in up to 90% of patients. However, reluctance is observed in utilising PCT more frequently, due to concerns that we are committing comorbid patients to an interval surgical procedure for which they may not be suitable. AimThe aim of this study was to assess the clinical and survival outcomes of PCT use, with particular emphasis on a subgroup of patients who did not proceed to cholecystectomy. MethodsA retrospective analysis was performed of all patients with severe acute cholecystitis who required PCT insertion in a tertiary referral hospital from 2010 to 2015. Patient demographics and clinical data including systemic inflammatory response (SIRS) scores at presentation, readmissions and clinical and survival outcomes were analysed. Statistical analysis was performed using SPSS v.22 and GraphPad Prism v.7. ResultsIn total, 157 patients (59% males) with AC underwent PCT insertion during the study period. Median age at presentation was 71 years (range 29–94). A median SIRS score of 3 was noted at presentation. Patients required a median of two cholecystostomy tube changes/replacements (range 1–10) during treatment. Transhepatic tube placement was the preferred approach (69%) with 31% of tubes being placed via transabdominal approach. Only 55% proceeded to interval cholecystectomy. Of the 70 patients treated with PCT alone, their median age was 75 years. In this subgroup, only 12.9% (n = 9) developed recurrent biliary sepsis necessitating readmission following initial resolution of symptoms and tube removal. All episodes of recurrent biliary sepsis presented within 6 months of index presentation, and definitive PCT removal in this group was performed at a median of 3 months. No difference in survival was observed between both groups. ConclusionAlmost 90% of patients with AC who are managed definitively with a PCT will recover uneventfully without recurrent sepsis following PCT removal. This is a viable option for older, comorbid patients who are unfit for surgical intervention and is not associated with significantly increased mortality.