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Appendicoliths are commonly found obstructing the lumen of the appendix at the time of appendectomy. To identify factors that might contribute to their formation we investigated the composition of appendicoliths using laser ablation inductively coupled plasma mass spectroscopy, gas chromatography, polarized light microscopy, X-ray crystallography and protein mass spectroscopy. Forty-eight elements, 32 fatty acids and 109 human proteins were identified within the appendicoliths. The most common elements found in appendicoliths are calcium and phosphorus, 11.0 ± 6.0 and 8.2 ± 4.2% weight, respectively. Palmitic acid (29.7%) and stearate (21.3%) are the most common fatty acids. Some stearate is found in crystalline form-identifiable by polarized light microscopy and confirmable by X-ray crystallography. Appendicoliths have an increased ratio of omega-6 to omega-3 fatty acids (ratio 22:1). Analysis of 16 proteins common to the appendicoliths analyzed showed antioxidant activity and neutrophil functions (e.g. activation and degranulation) to be the most highly enriched pathways. Considered together, these preliminary findings suggest oxidative stress may have a role in appendicolith formation. Further research is needed to determine how dietary factors such as omega-6 fatty acids and food additives, redox-active metals and the intestinal microbiome interact with genetic factors to predispose to appendicolith formation.

BackgroundOlder aged adults and those with pre-existing conditions are at highest risk for severe COVID-19 associated outcomes.MethodsUsing a large dataset of genome-wide RNA-seq profiles derived from human dermal fibroblasts (GSE113957) we investigated whether age affects the expression of pattern recognition receptor (PRR) genes and ACE2, the receptor for SARS-CoV-2.ResultsExtremes of age are associated with increased expression of selected PRR genes, ACE2 and four genes that encode proteins that have been shown to interact with SAR2-CoV-2 proteins.ConclusionsAssessment of PRR expression might provide a strategy for stratifying the risk of severe COVID-19 disease at both the individual and population levels.

Urbanization in low-income countries represents an important inflection point in the epidemiology of disease, with rural populations experiencing high rates of chronic and recurrent infections and urban populations displaying a profile of noncommunicable diseases. To investigate if urbanization alters the expression of genes encoding mitochondrial proteins, we queried gene microarray data from rural and urban populations living in Morocco (GSE17065). The R Bioconductor packages edgeR and limma were used to identify genes with different expression. The experimental design was modeled upon location and sex. Nuclear genes encoding mitochondrial proteins were identified from the MitoCarta2.0 database. Of the 1158 genes listed in the MitoCarta2.0 database, 847 genes (73%) were available for analysis in the Moroccan dataset. The urban-rural comparison with the greatest environmental differences showed that 76.5% of the MitoCarta2.0 genes were differentially expressed, with 97% of the genes having an increased expression in the urban area. Enrichment analysis revealed 367 significantly enriched pathways (adjusted p value

Introduction: One of the most common emergent surgical diseases encountered within the active duty (AD) military population is acute appendicitis, yet the rate of perforation among military members is lower than age-matched civilians in the USA. Among all demographics, a delay in presentation to surgical care has been associated with an increase in perforation rates and postoperative complications. A subset of the U.S. military population, the Marine Corps recruits (MCRs), are subjected to a unique and vigorous training environment which may result in delayed medical care. This retrospective study aims to evaluate if there is a delay in presentation and to investigate the surgical outcomes in MCR as compared with AD personnel and military health system beneficiaries with appendicitis.Materials and methods: A retrospective review was conducted on all MCRs, AD military personnel, and military health system beneficiaries between the ages of 17 and 25 who underwent surgical treatment of appendicitis between October 2006 and June 2013 at a single military hospital. Data collected included demographics, time from symptom onset to presentation, clinical and pathologic severity of appendicitis, postoperative complications, and length of stay. The primary outcome was the clinical severity of appendicitis. Secondary outcomes include length of stay and postoperative complications. An analysis of the data was performed using basic statistical methods, to include Fisher's exact, one-way ANOVA, and Kruskal-Wallis.Results: Of the 577 patients that were reviewed, there were 393 (68%) AD military and reserve members, 139 (24%) military health system beneficiaries, and 45 (8%) MCR. The population was 67% male and 68% Caucasian. The mean age was 21.6 years (SD 2.2). The rate of perforated appendicitis was significantly higher among MCR than among AD and beneficiaries (25% vs. 7% vs. 6%, respectively; p < 0.0001). MCR experienced significantly longer hospital lengths of stay (3.1 days vs. 1.7 days, p < 0.0001). Rates of readmission (20% vs. 6% vs. 4%; p = 0.002) and complications (40% vs. 8% vs. 9%; p < 0.0001) were higher among MCR. Among patients with perforated appendicitis (n = 47), MCR had longer delay to presentation for treatment than AD and beneficiaries, but this was not statistically significant (59.4 hours vs. 45.7 hours vs. 35 hours, respectively; p = 0.2).Conclusion: This retrospective review identifies that MCRs have a higher incidence of perforated appendicitis as compared with AD members and military health system beneficiaries. This distinguishes a unique health care disparity found within MCR which military health care providers must recognize. Identification of potential social factors, education of military health care providers, and earlier surgical evaluation may lead to improved outcomes. [ABSTRACT FROM AUTHOR]

We were also pleased to hear that the OReCS document was useful in assessing children's surgical care in a high-income setting. To scale up surgical care in LMICs, several countries have created national surgical, obstetrics and anesthesia plans (NSOAPs) and many more are in the process of developing such plans, but children's surgical care is not being included in most. An important role for the OReCS document is to help countries developing NSOAPS to identify what resources are needed to care for children with surgical problems. [Extracted from the article]

Sepsis is a major clinical challenge, with therapy limited to supportive interventions. Therefore, the search for novel remedial approaches is of great importance. We addressed whether hyperbaric oxygen therapy (HBOT) could improve the outcome of sepsis using an acute experimental mouse model. Sepsis was induced in male CD-1 mice by cecal ligation and puncture (CLP) tailored to result in 80-90% mortality within 72 h of the insult. After CLP, mice were randomized into two groups receiving HBOT or not at different times after the initial insult or subjected to multiple HBOT treatments. HBOT conditions were 98% oxygen pressurized to 2.4 atmospheres for 1 h. HBOT within 1 h after CLP resulted in 52% survival in comparison with mice that did not receive the treatment (13% survival). Multiple HBOT at 1 and 6 h or 1, 6, and 21 h displayed an increase in survival of >50%, but they were not significantly different from a single treatment after 1 h of CLP. Treatments at 6 or 21 h after CLP, excluding the 1 h of treatment, did not show any protective effect. Early HBO treatment did not modify bacterial counts after CLP, but it was associated with decreased expression of TNF-α, IL-6, and IL-10 expression in the liver within 3 h after CLP. The decrease of cytokine expression was reproduced in cultured macrophages after exposure to HBOT. Early HBOT could be of benefit in the treatment of sepsis, and the protective mechanism may be related to a reduction in the systemic inflammatory response.