BACKGROUND Chronic schistosomiasis causes multiple organ and multiple system diseases,especially the digestive system.Schistosome eggs are mainly deposited in the stomach,liver and colorectal,but a few eggs are deposi...BACKGROUND Chronic schistosomiasis causes multiple organ and multiple system diseases,especially the digestive system.Schistosome eggs are mainly deposited in the stomach,liver and colorectal,but a few eggs are deposited in the appendix and cause disease.At present,there are few studies on schistosomal appendicitis.AIM To explore the differences in epidemiological,clinical and pathological characteristics between schistosomal appendicitis and non-schistosomal appendicitis over the past decade in order to assess the impact of schistosomiasis on appendicitis.METHODS The differences of general data,clinical data and laboratory examination data of patients with appendicitis from October 2013 to October 2023 were retrospectively analyzed.All patients were divided into two groups for analysis.There were 136 patients in schistosomal appendicitis group and 5418 patients in non-schistosomal appendicitis group.RESULTS Schistosomal appendicitis accounted for 2.45%of all patients with appendicitis,and the annual proportion in the past decade was 2.2%,2.9%,1.8%,1.9%,3.4%,3.1%,1.9%,1.6%,3%,2.6%,respectively.The prevalence of schistosomal appendicitis was middle-aged and elderly males,with an average age of 61.73±15.335 years.The main population of non-schistosomal appendicitis was middle-aged men,with an average age of 35.8±24.013 years(P<0.001).The distribution of pathological types of appendicitis was different between the two groups(P<0.001).The incidence of acute suppurative appendicitis in non-schistosomal appendicitis was higher than that in schistosomal appendicitis[odds ratio(OR)=0.504;95%confidence interval(CI):0.349-0.728;P<0.001].The proportion of acute attack of chronic appendicitis in schistosomal appendicitis was higher than that in non-schistosomal appendicitis(OR=2.614;95%CI:1.815-3.763;P<0.001).The proportion of schistosomal appendicitis patients complicated with colorectal cancer was higher than that of nonschistosomal appendicitis patients(OR=5.087;95%CI:1.427-18.132;P=0.012).There was no difference in clinical symptoms between the two groups.In the laboratory examination,there was a significant difference in white blood cells between schistosomal appendicitis and non-schistosomal appendicitis.The level of white blood cells in schistosomal appendicitis group was slightly higher than the upper limit of the normal range.Other statistically significant indicators were in the normal range.CONCLUSION Schistosomal appendicitis is a severe condition that is often associated with intestinal malignancies,potentially leading to a poor prognosis.Schistosomal appendicitis is more likely to be misdiagnosed and missed diagnosed in clinical work because of its nonspecific clinical manifestations and laboratory examination.It is crucial to differentiate schistosomal appendicitis in middle-aged and elderly male patients presenting with appendicitis,and to ensure early detection and treatment.展开更多
Schistosomal appendicitis(SA)is a rare but serious complication of schistosomiasis,a parasitic disease affecting over 250 million people worldwide.A recent retrospective study by Wang et al provides important insights...Schistosomal appendicitis(SA)is a rare but serious complication of schistosomiasis,a parasitic disease affecting over 250 million people worldwide.A recent retrospective study by Wang et al provides important insights into the clinicopathological characteristics of SA.The study compared 136 cases of SA to 5418 cases of non-SA over a ten-year period.Key findings include a higher average age of SA patients(61.73 years vs 35.8 years for non-SA),a higher proportion of acute on chronic appendicitis(33.1%vs 16%),and a significantly higher incidence of colorectal cancer(11.7%vs 2.2%).Despite these differences,SA remains a diagnostic challenge due to its nonspecific clinical presentation and lack of specific laboratory findings.The study also highlights the persistent prevalence of SA,accounting for 1.6%-3.4%of all appendicitis cases each year from 2013 to 2023.These findings underscore the need for enhanced awareness,early detection,and prompt treatment of SA in endemic regions.Given the association with colorectal cancer,patients with SA require thorough screening and follow-up.Further research into the pathogenesis and diagnostic markers of SA is warranted.As the global battle against schistosomiasis continues,targeted efforts to diagnose and manage SA can significantly improve patient outcomes.展开更多
BACKGROUND Endoscopic retrograde appendicitis therapy(ERAT)offers an appendix-pre-serving approach;however,visual and specificity challenges persist.Conversely,endoscopic direct appendicitis therapy(EDAT)provides dire...BACKGROUND Endoscopic retrograde appendicitis therapy(ERAT)offers an appendix-pre-serving approach;however,visual and specificity challenges persist.Conversely,endoscopic direct appendicitis therapy(EDAT)provides direct visual observation with diagnostic and therapeutic capabilities.AIM To assess the efficacy and feasibility of EDAT and compare them with those of ERAT in uncomplicated appendicitis.METHODS In this retrospective cohort study,patients diagnosed with uncomplicated appendicitis and treated with ERAT or EDAT between January 2021 and November 2024 were reviewed.The primary outcome was intervention success.Secondary outcomes were guidewire use,stent placement,hospitalization duration,recurrence,and endoscopic direct-view features.Outcomes were compared between groups via appropriate statistical tests.RESULTS Of 170 patients,136 underwent EDAT and 34 ERAT.EDAT showed higher intervention success than ERAT(99.3%vs 82.4%,P<0.001),with less guidewire assistance and fewer stent placements(both P<0.001).Hospital stay was shorter with EDAT(P=0.039).The overall cumulative recurrence rates at 1 year were 10%in EDAT and 24%in ERAT;in the appendicolith subgroup,the recurrence rates were 5%and 14%in EDAT and ERAT,respectively.Findings were consistent in the propensity score-matched(PSM)cohort.CONCLUSION EDAT was demonstrated to be a more effective and feasible approach than ERAT,with a lower overall cumulative recurrence risk and within the appendicolith subgroup.Consistent results after PSM further supported the robustness of these findings.展开更多
Acute appendicitis(AAp)remains one of the most common abdominal emergencies,requiring rapid and accurate diagnosis to prevent complications and unnecessary surgeries.Conventional diagnostic methods,including medical h...Acute appendicitis(AAp)remains one of the most common abdominal emergencies,requiring rapid and accurate diagnosis to prevent complications and unnecessary surgeries.Conventional diagnostic methods,including medical history,clinical assessment,biochemical markers,and imaging techniques,often present limitations in sensitivity and specificity,especially in atypical cases.In recent years,artificial intelligence(AI)has demonstrated remarkable potential in enhancing diagnostic accuracy through machine learning(ML)and deep learning(DL)models.This review evaluates the current applications of AI in both adult and pediatric AAp,focusing on clinical data-based models,radiological imaging analysis,and AI-assisted clinical decision support systems.ML models such as random forest,support vector machines,logistic regression,and extreme gradient boosting have exhibited superior diagnostic performance compared to traditional scoring systems,achieving sensitivity and specificity rates exceeding 90%in multiple studies.Additionally,DL techniques,particularly convolutional neural networks,have been shown to outperform radiologists in interpreting ultrasound and computed tomography images,enhancing diagnostic confidence.This review synthesized findings from 65 studies,demonstrating that AI models integrating multimodal data including clinical,laboratory,and imaging parameters further improved diagnostic precision.Moreover,explainable AI approaches,such as SHapley Additive exPlanations and local interpretable model-agnostic explanations,have facilitated model transparency,fostering clinician trust in AI-driven decision-making.This review highlights the advancements in AI for AAp diagnosis,emphasizing that AI is used not only to establish the diagnosis of AAp but also to differentiate complicated from uncomplicated cases.While preliminary results are promising,further prospective,multicenter studies are required for large-scale clinical implementation,given that a great proportion of current evidence derives from retrospective designs,and existing prospective cohorts exhibit limited sample sizes or protocol variability.Future research should also focus on integrating AI-driven decision support tools into routine emergency care workflows.展开更多
BACKGROUND Non-operative management(NOM)for uncomplicated acute appendicitis(AA)has been gaining popularity in recent years.One of the major concerns with NOM is the recurrence rate of AA following NOM.AIM To investig...BACKGROUND Non-operative management(NOM)for uncomplicated acute appendicitis(AA)has been gaining popularity in recent years.One of the major concerns with NOM is the recurrence rate of AA following NOM.AIM To investigate the impact of the presence of an appendicolith and its specific characteristics on the recurrence rate of AA following NOM.METHODS A retrospective analysis identified all patients treated with NOM for AA,at our institute between 2016 and 2024.Patients with an appendicolith on imaging were identified and their course and outcomes were compared with patients who were treated with NOM without an appendicolith.The primary outcome was defined as a recurrence of AA.RESULTS During the study period,797 patients were treated with NOM for AA.Their mean age was 25.4 years±14.4 years,and 45.4%were females.Only 68 patients(8.5%)had an appendicolith identified on imaging.Patients with an appendicolith had a larger appendix diameter(10.2 mm±4 mm vs 8.5 mm±2.1 mm,P=0.001).There was no difference in the recurrence rate of patients with and without an appendicolith(26.5%vs 19.1%,P=0.14),however patients with an appendicolith presented with a shorter time to recurrence of appendicitis(3.9 months±10.4 months vs 5.9 months±8.1 months,P=0.04).In a sub analysis,the number of appendicoliths,its size,and its location,did not influence the recurrence rate.CONCLUSION This study demonstrates that patients with appendicoliths have a shorter time to recurrence after NOM of AA,but do not experience higher overall recurrence rates.展开更多
BACKGROUND Acute appendicitis(AAp)is a prevalent medical condition characterized by inflammation of the appendix that frequently necessitates urgent surgical procedures.Approximately two-thirds of patients with AAp ex...BACKGROUND Acute appendicitis(AAp)is a prevalent medical condition characterized by inflammation of the appendix that frequently necessitates urgent surgical procedures.Approximately two-thirds of patients with AAp exhibit characteristic signs and symptoms;hence,negative AAp and complicated AAp are the primary concerns in research on AAp.In other terms,further investigations and algorithms are required for at least one third of patients to predict the clinical condition and distinguish them from uncomplicated patients with AAp.AIM To use a Stochastic Gradient Boosting(SGB)-based machine learning(ML)algorithm to tell the difference between AAp patients who are complicated and those who are not,and to find some important biomarkers for both types of AAp by using modeling to get variable importance values.METHODS This study analyzed an open access data set containing 140 people,including 41 healthy controls,65 individuals with uncomplicated AAp,and 34 individuals with complicated AAp.We analyzed some demographic data(age,sex)of the patients and the following biochemical blood parameters:White blood cell(WBC)count,neutrophils,lymphocytes,monocytes,platelet count,neutrophil-tolymphocyte ratio,lymphocyte-to-monocyte ratio,mean platelet volume,neutrophil-to-immature granulocyte ratio,ferritin,total bilirubin,immature granulocyte count,immature granulocyte percent,and neutrophil-to-immature granulocyte ratio.We tested the SGB model using n-fold cross-validation.It was implemented with an 80-20 training-test split.We used variable importance values to identify the variables that were most effective on the target.RESULTS The SGB model demonstrated excellent performance in distinguishing AAp from control patients with an accuracy of 96.3%,a micro aera under the curve(AUC)of 94.7%,a sensitivity of 94.7%,and a specificity of 100%.In distinguishing complicated AAp patients from uncomplicated ones,the model achieved an accuracy of 78.9%,a micro AUC of 79%,a sensitivity of 83.3%,and a specificity of 76.9%.The most useful biomarkers for confirming the AA diagnosis were WBC(100%),neutrophils(95.14%),and the lymphocyte-monocyte ratio(76.05%).On the other hand,the most useful biomarkers for accurate diagnosis of complicated AAp were total bilirubin(100%),WBC(96.90%),and the neutrophil-immature granulocytes ratio(64.05%).CONCLUSION The SGB model achieved high accuracy rates in identifying AAp patients while it showed moderate performance in distinguishing complicated AAp patients from uncomplicated AAp patients.Although the model's accuracy in the classification of complicated AAp is moderate,the high variable importance obtained is clinically significant.We need further prospective validation studies,but the integration of such ML algorithms into clinical practice may improve diagnostic processes.展开更多
BACKGROUND Endoscopic retrograde appendicitis therapy(ERAT)is an emerging technique.However,its efficacy remains uncertain,and postoperative complications often exacerbate inflammation,thereby increasing the difficult...BACKGROUND Endoscopic retrograde appendicitis therapy(ERAT)is an emerging technique.However,its efficacy remains uncertain,and postoperative complications often exacerbate inflammation,thereby increasing the difficulty of surgery.The use of ERAT in appendicitis remains contentious,prompting the presentation of this case report.CASE SUMMARY We report the case of a 43-year-old female patient presenting with intermittent right lower abdominal pain for one day.The patient had undergone ERAT six months previously.Examination revealed stent impaction in the appendix,leading to exacerbated inflammation.Subsequently,a solo single-incision laparo-scopic appendectomy(SSLA)was performed.The ERAT-related complications increased surgical difficulty and prolonged the operation time.Post-SSLA,the patient was hospitalized for one day and showed favorable recovery upon follow-up.CONCLUSION This case highlights the risks of ERAT.Thorough preoperative assessment,proper stent placement during surgery and regular postoperative follow-up are crucial in preventing complications,as their occurrence can increase surgical difficulty.Compared to ERAT,SSLA remains more widely used in clinical practice.Both techniques require further clinical data and research to optimize their application.展开更多
BACKGROUND Ovarian vein thrombosis(OVT)is a rare condition that most commonly affects postpartum women.It is particularly prevalent in the first 10 days postpartum,a period when women are more prone to developing this...BACKGROUND Ovarian vein thrombosis(OVT)is a rare condition that most commonly affects postpartum women.It is particularly prevalent in the first 10 days postpartum,a period when women are more prone to developing this condition.The right ovarian vein is often affected due to its tortuous nature and less competent valves.OVT presents similarly to acute abdominal conditions,such as acute appendicitis,especially when the right ovarian vein is involved.Given the overlap in clinical presentation,diagnosis requires high-quality imaging techniques and a high degree of suspicion.CASE SUMMARY Herein,we report a rare case of OVT in a young postpartum female who presented to the emergency department with signs and symptoms of acute abdomen.The patient had a history of pulmonary tuberculosis treatment.A provisional diagnosis of a perforated appendix was made,and a lower midline exploratory laparotomy was planned.During surgery,the appendix and inte-stines appeared normal,but a distended and thrombosed right ovarian vein was found.The affected ovarian vein was excised,and the patient was placed on anti-coagulants postoperatively.The recovery was unremarkable,and anticoagulants were continued for six months.CONCLUSION OVT is most commonly seen in the early postpartum period,especially within the first 10 days.Due to its anatomical characteristics,the right ovarian vein is more commonly involved.The clinical presentation of OVT can closely mimic acute abdomen or acute appendicitis,making diagnosis challenging.Accurate diagnosis requires a high index of suspicion and advanced imaging techniques to differentiate OVT from other conditions with similar presentations.展开更多
BACKGROUND Pediatric perforated appendicitis(PPA)is a severe acute condition requiring surgical intervention and postoperative antibiotic therapy.Antibiotic selection differs significantly among pediatric centers,and ...BACKGROUND Pediatric perforated appendicitis(PPA)is a severe acute condition requiring surgical intervention and postoperative antibiotic therapy.Antibiotic selection differs significantly among pediatric centers,and an ideal postoperative antiinfective approach for PPA management has yet to be established.AIM To examine the spectrum of pathogenic bacteria in pediatric PPA and to summarize the postoperative experience with carbapenem(CBP)and cephalosporin(CPS)antibiotics.METHODS We retrospectively analyzed medical records of 65 children(43 boys,22 girls;mean age 6.92±3.41 years)with PPA who underwent surgery at our hospital between December 2019 and August 2022.Data were collected in September 2023.Based on postoperative antibiotic selection,patients were divided into CBP(32 cases)and CPS(33 cases)groups.Chi-square and T-tests compared recovery outcomes,while univariate and multivariate regression models identified independent factors affecting postoperative recovery.RESULTS There were no significant differences between the two groups in gender,age,weight,height,body mass index,baseline ear temperature,or heart rate(P>0.05).Escherichia coli(40.00%)and Pseudomonas aeruginosa(24.62%)were the most common pathogens in PPA.Postoperative analysis showed significantly shorter C-reactive protein(CRP)recovery times in the CPS group than in the CBP group[(6.18±1.84)vs(8.12±3.48)days,P=0.009].Univariate logistic regression indicated CPS selection(OR=0.32,95%CI:0.10-0.97,P=0.044)was significantly associated with a higher CRP recovery rate within 7 days.Multivariate analysis confirmed CPS selection(OR=3.49,95%CI:1.19-10.24,P=0.023)as an independent factor affecting CRP recovery within 7 days postoperatively.CONCLUSION The choice of CBP or CPS independently affects CRP recovery within 7 days.CBP offers no advantage over CPS in treating PPA,with CPS also demonstrating favorable clinical outcomes.展开更多
BACKGROUND Acute appendicitis is common among pediatric patients,and postoperative infections and complications are significant factors that affect recovery.As a“forward-looking”nursing model,anticipatory care may r...BACKGROUND Acute appendicitis is common among pediatric patients,and postoperative infections and complications are significant factors that affect recovery.As a“forward-looking”nursing model,anticipatory care may reduce the incidence of postoperative wound infections and complications.AIM To explore the effects of anticipatory care on the management of postoperative infections and complications in pediatric patients diagnosed with acute appen-dicitis.METHODS This prospective randomized controlled study included data from 78 pediatric patients who underwent acute appendicitis surgery at Shijiazhuang Sixth Hos-pital(Hebei Province,China)between February 2021 and March 2024.Patients were divided into two groups:The intervention and control groups(n=39 each)were based on a random numbers table method.Both groups received routine postoperative nursing care,whereas the intervention group received additional anticipatory care.Statistical analyses were performed using independent sample t-tests,χ2 tests,analysis of variance,and rank-sum tests.RESULTS Postoperative pain scores and hospital length of stay were significantly lower in the intervention group than those in the control group(P<0.05 and P<0.001,respectively).Postoperative wound infection and overall complication rates were significantly lower in the intervention group than those in the control group(5.13%vs 23.08%,P<0.001;15.38%vs 46.15%,P<0.001,respectively).Furthermore,parental satisfaction scores were significantly higher in the intervention group than those in the control group(P<0.05).Logistic regression identified high C-reactive protein level as a risk factor for postoperative infections and complications,whereas proactive(i.e.anticipatory)nursing intervention was a protective factor.CONCLUSION This study provided a scientific basis for the implementation of anticipatory care in the postoperative management of pediatric patients experiencing acute appendicitis.展开更多
BACKGROUND Acute abdominal pain is often easy to be diagnosed because of acute abdomen,and can be treated reasonably and effectively.It is more difficult to establish the cause of chronic abdominal pain,and some patie...BACKGROUND Acute abdominal pain is often easy to be diagnosed because of acute abdomen,and can be treated reasonably and effectively.It is more difficult to establish the cause of chronic abdominal pain,and some patients repeatedly visit several hos-pitals and still cannot be diagnosed.Chronic abdominal pain caused by chronic appendicitis is such a case.If the degree of abdominal pain is mild and there is no sign of peritonitis,chronic appendicitis is not performed unless the patient re-quests it.CASE SUMMARY We report an extremely rare case of chronic appendicitis caused by a foreign body in the appendix in a 35-year-old woman.The patient had a long-term abdominal pain of unclear cause,and she was repeatedly treated in several hospitals.After antibiotic treatment,the abdominal pain was gradually relieved,but abdominal pain often recurs.We conducted abdominal computed tomography examination,and upon the advice of radiologists,we considered the possibility of foreign bodies in the appendix,and excluded other causes of abdominal pain.The patient requested and consented to laparoscopic appendectomy,and a chicken bone was found in the appendiceal cavity by postoperative incision of the appendiceal spe-cimen.Histopathological examination confirmed chronic appendicitis with fo-reign body giant cell reaction.The patient recovered and was discharged from the hospital.After 2 months of follow-up,abdominal pain did not recur,and the patient had a complete recovery.Core Tip:We report an extremely rare case of chronic appendicitis caused by a chicken bone in the appendix.The patient was 35-year-old woman,and had a long-term abdominal pain of unknown cause.Abdominal computed tomography examination suggested foreign bodies in the appendix,and laparoscopic appendectomy was performed.The postoperative specimen revealed chicken bones in the appendix cavity,and histopathological examination confirmed chronic appendicitis with giant cell reaction of foreign bodies.The patient recovered and was followed up for two months without abdominal pain.Citation:Huang T,Li SK,Wang W,Zhang R.Chronic abdominal pain caused by foreign bodies in the appendix:A case report.World INTRODUCTION Appendicitis is one of the common diseases that cause abdominal pain[1].Appendicitis can be diagnosed and treated effectively when patients with acute abdominal pain are admitted to hospital because of factors such as blockage and infection of appendicitis[2,3].However,the diagnosis of chronic appendicitis is difficult.Acute appendicitis caused by foreign bodies in the appendix is easy to diagnose because of the final surgical treatment[4-6],while chronic appendicitis caused by foreign bodies in the appendix is more difficult to diagnose because of the mild degree of abdominal pain.We here report an extremely rare case of chronic appendicitis caused by foreign bodies in the appendix.The patient had a long-term abdominal pain of unclear cause,and she was repeatedly treated in several hospitals.Abdominal color ultrasound examination indicated a coprolith in the appendiceal cavity and the appendix was normal,so the patient could not be treated with surgery.We conducted abdominal computed tomography(CT)examination,and upon the advice of radiologists,we considered the possibility of foreign bodies in the appendix,and excluded other causes of abdominal pain.The patient requested and consented to laparoscopic appendectomy,and a chicken bone was found in the appendiceal cavity by postoperative incision of the appendiceal specimen.The patient recovered and was discharged from hospital.After 2 months of follow-up,abdominal pain did not recur and the patient had a full recovery.展开更多
BACKGROUND Gastrointestinal surgical acute abdomen conditions.These conditions not only cause significant suffering to patients but also increase psychological stress for both patients and their families.AIM To invest...BACKGROUND Gastrointestinal surgical acute abdomen conditions.These conditions not only cause significant suffering to patients but also increase psychological stress for both patients and their families.AIM To investigate communication characteristics in gastrointestinal surgical acute abdomen cases(such as appendicitis and pancreatitis)and explore optimization pathways.METHODS Eighty-two patients with gastrointestinal surgical acute abdomen(including appendicitis and pancreatitis)admitted to the hospital between November 2022 and June 2024 were selected.Physician-patient communication characteristics were analyzed.Patients were randomly divided into two groups(41 each)using a random draw method.The control group received conventional physician-patient communication.The observation group received an optimized communication model based on the conventional method.The two groups were compared for treatment efficacy and outcomes,psychological status,coping strategies,sleep quality,and compliance.RESULTS Significant differences were observed between the two groups in terms of time to ambulation and duration of hospital stay(P<0.05),whereas hospitalization costs were not significantly different(P>0.05).After the intervention,the psychological status scale scores in both groups decreased significantly(P<0.05),with significant differences between the groups(P<0.05).Following the intervention,the facing subscale scores of the medical coping questionnaire increased,while the avoidance and submission subscale scores decreased(P<0.05),with significant differences between the groups(P<0.05).The observation group had lower scores on the sleep quality scale(P<0.05).The compliance rate was higher in the observation group(97.56%vs 80.49%,P<0.05).CONCLUSION Physician-patient communication presented contradictions between professionalism and laymen’s expression and rigid communication methods.Optimizing communication models can improve sleep quality,coping strategies,patient compliance,and treatment outcomes and reduce negative emotions.展开更多
BACKGROUND Acute appendicitis,a common condition with a higher prevalence among men,has shown an increasing incidence in recent years owing to lifestyle changes.It is characterized by right lower quadrant abdominal pa...BACKGROUND Acute appendicitis,a common condition with a higher prevalence among men,has shown an increasing incidence in recent years owing to lifestyle changes.It is characterized by right lower quadrant abdominal pain,rebound tenderness,and rapid onset.Its pathogenesis is complex and potentially linked to infection,environment,and genetics.Timely intervention is crucial to prevent complications.While surgery is the primary treatment,it carries risks,including postoperative infections that may necessitate re-operation.Gram-negative bacteria release endotoxin(ETX),which induces inflammation and is recognized by toll-like receptor 4(TLR4).This study evaluated ETX and TLR4 levels in patients with acute appendicitis to assess the risk of postoperative incision infections,aiding in prevention and treatment.AIM To explore ETX and TLR4 expression in the blood of patients with acute appendicitis and its association with in postoperative incision infection.METHODS A total of 153 patients with acute appendicitis treated at our hospital between April 2022 and March 2024(n=153)were included in the study.Patients were categorized into infected(n=36)and uninfected(n=117)groups according to the development of postoperative incision infections.General characteristics and blood levels of ETX and TLR4 were compared,and the factors influencing postoperative infection were identified using multivariate logistic regression.ETX and TLR4 predictive values were analyzed using receiver operating characteristic curves.RESULTS No statistically significant differences were observed between the two groups in terms of sex,age,or other general characteristics(P>0.05).Compared to the uninfected group,the infected group had a higher proportion of patients with suppurative or gangrenous appendicitis,longer surgical times,longer incision lengths,and elevated ETX and TLR4 levels(P<0.05).Multivariate logistic regression analysis identified pathological type,surgical method,surgical time,and incision length as factors influencing postoperative incision infection in acute appendicitis.Receiver operating characteristic curve analysis revealed that both ETX and TLR4 levels were predictive factors for postoperative incision infection,with higher prediction efficiency when combined.CONCLUSION Pathological type,surgical method,surgical time,and incision length significantly influence postoperative incision infection risk in patients with acute appendicitis.Elevated ETX and TLR4 levels serve as valuable predictors of post-appendectomy infections.展开更多
BACKGROUND Appendicitis is an abdominal medical emergency and can be of various types.It can lead to a series of gastrointestinal symptoms and can affect health status.Therefore,attention should be paid to the diagnos...BACKGROUND Appendicitis is an abdominal medical emergency and can be of various types.It can lead to a series of gastrointestinal symptoms and can affect health status.Therefore,attention should be paid to the diagnosis of appendicitis to improve prognosis.AIM To assess the value of transabdominal superficial ultrasonography(TASU)in the clinical diagnosis of various types of appendicitis.METHODS A total of 100 patients suspected to have acute appendicitis that were admitted to our hospital between July 2022 and July 2024 were selected for this study.All of them underwent conventional abdominal ultrasonography and TASU.Taking surgical pathology as the gold standard,the diagnostic efficacy of the two ultrasonographic examinations was compared,and the ultrasonographic features of patients with different types of appendicitis were analyzed.RESULTS Comparison with the gold standard showed that among the 100 patients suspected of appendicitis,72 cases were diagnosed as appendicitis while 28 cases were deemed to be normal.Compared with conventional abdominal ultrasonography,TASU displayed a higher diagnostic efficiency(P<0.05).Among the 72 patients with acute appendicitis,22 cases were diagnosed as simple appendicitis,26 cases as suppurative appendicitis,and 24 cases as gangrenous appendicitis.TASU was more effective in the diagnosis of the various types of appendicitis,and the difference was significant between groups(P<0.05).Ultrasonography radiographs revealed an enlarged appendix with a tubular anechoic area,a widened lumen,with a visible occlusion or stercoral shadow and a cystic mass in the parenchyma.CONCLUSION TASU can accurately diagnose appendicitis and also be used to identify the various types of appendicitis,thereby having application value.展开更多
In the present study,data mining and network pharmacology were utilized to explore the principles and mechanisms of traditional Chinese medicine(TCM)in treating acute appendicitis.The goal was to provide a scientific ...In the present study,data mining and network pharmacology were utilized to explore the principles and mechanisms of traditional Chinese medicine(TCM)in treating acute appendicitis.The goal was to provide a scientific basis for clinical treatment and further research on this disease.First,we searched the National Patent Database for Chinese herbal compound prescriptions used to treat acute appendicitis.We then applied frequency analysis,character and taste meridian analysis,association rule analysis,and hierarchical cluster analysis to identify the patterns of TCM treatment for acute appendicitis,selecting key combinations of Chinese medicines.Next,we screened the main active components of these key TCM based on quality markers.Using databases such as SwissTargetPrediction,SymMap,ETCM,and STRING,we analyzed the pharmacological mechanisms of these key TCM in treating acute appendicitis.Key active components and targets were further verified through molecular docking.We identified a total of 129 patents involving 316 Chinese medicines,with 24 being frequently used.The results indicated that most Chinese herbs used for acute appendicitis were heat-clearing drugs,blood-activating and stasis-removing drugs,and purging drugs.The primary active ingredients of the Rhubarb-cortex moutan-flos lonicerae combination for treating acute appendicitis included Emodin,Paeonol,Physcion,Chlorogenic acid,Chrysophanol,Rhein acid,and Aloe-emodin.These ingredients targeted key proteins such as ALB,TP53,BCL2,STAT3,IL-6,and TNF,and were involved in cellular responses to lipopolysaccharides,cell composition,and various cytokine-mediated biological processes.They also interacted with signaling pathways like AGE-RAGE,TNF,IL-17,and FoxO.Based on patent data,this study analyzed medication patterns in the treatment of acute appendicitis,discussed the possible mechanisms of key TCM combinations,and provided a scientific basis and new perspectives for the diagnosis and treatment of the disease.展开更多
Appendicoliths are frequently encountered in acute appendicitis(AA)and historically considered a risk factor for treatment failure in nonoperative management(NOM).However,the impact of appendicoliths on recurrence rat...Appendicoliths are frequently encountered in acute appendicitis(AA)and historically considered a risk factor for treatment failure in nonoperative management(NOM).However,the impact of appendicoliths on recurrence rates in uncomplicated AA remains controversial.This editorial critically appraises the study by Kupietzky et al,which explored the relationship between appendicolith characteristics and NOM outcomes.Kupietzky et al conducted a retrospective analysis of 797 patients with uncomplicated AA,comparing recurrence rates between those with and without appendicoliths.The study focused on long-term follow-up(median 44.2 months)and subgroup analyses of stone characteristics.The study revealed no significant difference in overall recurrence rates between groups(26.5%vs 19.1%,P=0.14).However,patients with appendicoliths experienced earlier recurrence(3.9 months vs 5.9 months,P=0.04)and had larger appendix diameters(10.2 mm vs 8.5 mm,P=0.001).Subgroup analyses showed no correlation between stone size,location,or number and recurrence risk.Appendicoliths do not independently increase the overall recurrence risk after NOM for uncomplicated AA but may accelerate recurrence timelines.Clinical decisions should prioritize individualized risk assessment,considering patient age,symptom severity,and radiological features.These findings challenge traditional paradigms and advocate for shared decision-making between clinicians and patients.展开更多
Objective:To analyze the effects of combined spinal-epidural anesthesia and epidural anesthesia in patients undergoing appendicitis surgery.Methods:Seventy-eight patients who underwent surgical treatment for appendici...Objective:To analyze the effects of combined spinal-epidural anesthesia and epidural anesthesia in patients undergoing appendicitis surgery.Methods:Seventy-eight patients who underwent surgical treatment for appendicitis from February 2022 to February 2025 were selected as samples and randomly divided into two groups.The study group received combined spinal-epidural anesthesia,while the control group received epidural anesthesia.Anesthesia indicators,vital signs,and complication indicators were compared between the two groups.Results:The onset time of anesthesia in the study group was shorter than that in the control group,the visual analog scale(VAS)score was lower than that in the control group,and the highest plane of anesthesia block was lower than that in the control group(P<0.05).At 15 minutes after anesthesia induction and at the end of surgery,the heart rate(HR),mean arterial pressure(MAP),and blood oxygen saturation(SPO2)in the study group were significantly different from those in the control group(P<0.05).The complication rate in the study group was lower than that in the control group(P<0.05).Conclusion:Combined spinal-epidural anesthesia for appendicitis surgery can reduce the impact of anesthesia on vital signs,shorten the onset time of anesthesia,and is highly effective and feasible.展开更多
BACKGROUND Laparoscopic surgery has emerged as the preferred treatment for acute appendicitis,a common acute abdominal condition.Despite surgical advances,postoperative gastrointestinal dysfunction and delayed recover...BACKGROUND Laparoscopic surgery has emerged as the preferred treatment for acute appendicitis,a common acute abdominal condition.Despite surgical advances,postoperative gastrointestinal dysfunction and delayed recovery continue to negatively impact rehabilitation outcomes and patient quality of life.Laser acupuncture represents a promising emerging complementary therapy with potential benefits for promoting functional recovery.AIM To evaluate the clinical efficacy of laser acupuncture in enhancing gastrointestinal function recovery following laparoscopic appendectomy and to investigate its potential applications in postoperative rehabilitation.METHODS This retrospective controlled clinical study selected 120 acute appendicitis patients who underwent laparoscopic appendectomy from January 2022 to December 2023 at a tertiary hospital.Patients were randomly divided into two groups:Routine treatment group(n=60)and laser acupuncture intervention group(n=60).There were no significant statistical differences in baseline characteristics(age,gender,body mass index,appendicitis severity)between the two groups.The routine treatment group received standard postoperative care,while the laser acupuncture intervention group received additional laser acupuncture treatment on top of standard care.Key observation indicators included time to first exhaust,time to first bowel movement,time to gastrointestinal function recovery,and postoperative complication rates.RESULTS Patients in the laser acupuncture intervention group showed significantly faster gastrointestinal function recovery compared to the routine treatment group.Specifically,time to first exhaust was significantly shortened(intervention group:12.5±2.3 hours vs control group:18.7±3.1 hours,P<0.05),time to first bowel movement was earlier(intervention group:36.4±4.6 hours vs control group:48.2±5.7 hours,P<0.05),postoperative complication rate was significantly reduced(intervention group:8.3%vs control group:20.0%,P<0.05),postoperative pain score was significantly lower(intervention group:3.2±1.1 vs control group:4.7±1.5,P<0.05),and intestinal motility recovery was faster and more effective.CONCLUSION Laser acupuncture,as an auxiliary treatment method,can significantly promote gastrointestinal function recovery in patients after laparoscopic appendectomy,reduce complications,and improve postoperative comfort.This technique has advantages such as minimal invasiveness,rapid recovery,and few side effects,making it worthy of further clinical promotion and application.展开更多
BACKGROUND Single-port laparoscopic appendectomy is an advanced minimally invasive surgery that involves the use of upgraded instruments and equipment.We previously modified single-port laparoscopic appendectomy with ...BACKGROUND Single-port laparoscopic appendectomy is an advanced minimally invasive surgery that involves the use of upgraded instruments and equipment.We previously modified single-port laparoscopic appendectomy with needle-type grasping forceps(mSLAN)for patients with simple appendicitis,but the feasibility and safety of our modified procedure need further evaluation in a highquality clinical study.AIM To compare the short-term clinical outcomes of mSLAN with those of conventional three-port laparoscopic appendectomy(CLA)for patients with acute uncomplicated appendicitis.METHODS This single-center,single-blind,prospective,randomized controlled trial included patients who underwent emergency laparoscopic appendectomy for acute uncomplicated appendicitis at our center between April 2024 and August 2024.Patients were randomly divided into the mSLAN group or the CLA group via computergenerated randomization.The primary endpoint was the 24-hour postoperative visual analog scale(VAS)score,and the secondary endpoints included the operative time,24-hour postoperative inflammatory response biomarkers(including white blood cells,the neutrophil ratio,interleukin-6,and C-reactive protein),time to first postoperative exhaust,time to first out-of-bed activity,postoperative length of hospital stay,cost of hospitalization,and incidence of postoperative complications.RESULTS A total of 72 patients were enrolled and randomly divided into 2 groups:The mSLAN group(n=36)and the CLA group(n=36).The 24-hour VAS scores,24-hour postoperative inflammatory response marker levels,first postoperative exhaust times,first out-of-bed activity times,postoperative lengths of hospital stay,operative times,or hospitalization costs did not significantly differ between the two groups.No postoperative complications,including incision infection or hernia,abdominal abscess or intestinal obstruction,were observed during the 1-month postoperative follow-up in either group.CONCLUSION Compared with the CLA protocol,the mSLAN protocol for acute uncomplicated appendicitis yielded comparable short-term clinical outcomes,with a similar operative time and better cosmetic outcomes,indicating its potential for clinical application and superiority for patients with high cosmetic requirements.Further research is needed to evaluate the long-term outcomes.展开更多
文摘BACKGROUND Chronic schistosomiasis causes multiple organ and multiple system diseases,especially the digestive system.Schistosome eggs are mainly deposited in the stomach,liver and colorectal,but a few eggs are deposited in the appendix and cause disease.At present,there are few studies on schistosomal appendicitis.AIM To explore the differences in epidemiological,clinical and pathological characteristics between schistosomal appendicitis and non-schistosomal appendicitis over the past decade in order to assess the impact of schistosomiasis on appendicitis.METHODS The differences of general data,clinical data and laboratory examination data of patients with appendicitis from October 2013 to October 2023 were retrospectively analyzed.All patients were divided into two groups for analysis.There were 136 patients in schistosomal appendicitis group and 5418 patients in non-schistosomal appendicitis group.RESULTS Schistosomal appendicitis accounted for 2.45%of all patients with appendicitis,and the annual proportion in the past decade was 2.2%,2.9%,1.8%,1.9%,3.4%,3.1%,1.9%,1.6%,3%,2.6%,respectively.The prevalence of schistosomal appendicitis was middle-aged and elderly males,with an average age of 61.73±15.335 years.The main population of non-schistosomal appendicitis was middle-aged men,with an average age of 35.8±24.013 years(P<0.001).The distribution of pathological types of appendicitis was different between the two groups(P<0.001).The incidence of acute suppurative appendicitis in non-schistosomal appendicitis was higher than that in schistosomal appendicitis[odds ratio(OR)=0.504;95%confidence interval(CI):0.349-0.728;P<0.001].The proportion of acute attack of chronic appendicitis in schistosomal appendicitis was higher than that in non-schistosomal appendicitis(OR=2.614;95%CI:1.815-3.763;P<0.001).The proportion of schistosomal appendicitis patients complicated with colorectal cancer was higher than that of nonschistosomal appendicitis patients(OR=5.087;95%CI:1.427-18.132;P=0.012).There was no difference in clinical symptoms between the two groups.In the laboratory examination,there was a significant difference in white blood cells between schistosomal appendicitis and non-schistosomal appendicitis.The level of white blood cells in schistosomal appendicitis group was slightly higher than the upper limit of the normal range.Other statistically significant indicators were in the normal range.CONCLUSION Schistosomal appendicitis is a severe condition that is often associated with intestinal malignancies,potentially leading to a poor prognosis.Schistosomal appendicitis is more likely to be misdiagnosed and missed diagnosed in clinical work because of its nonspecific clinical manifestations and laboratory examination.It is crucial to differentiate schistosomal appendicitis in middle-aged and elderly male patients presenting with appendicitis,and to ensure early detection and treatment.
文摘Schistosomal appendicitis(SA)is a rare but serious complication of schistosomiasis,a parasitic disease affecting over 250 million people worldwide.A recent retrospective study by Wang et al provides important insights into the clinicopathological characteristics of SA.The study compared 136 cases of SA to 5418 cases of non-SA over a ten-year period.Key findings include a higher average age of SA patients(61.73 years vs 35.8 years for non-SA),a higher proportion of acute on chronic appendicitis(33.1%vs 16%),and a significantly higher incidence of colorectal cancer(11.7%vs 2.2%).Despite these differences,SA remains a diagnostic challenge due to its nonspecific clinical presentation and lack of specific laboratory findings.The study also highlights the persistent prevalence of SA,accounting for 1.6%-3.4%of all appendicitis cases each year from 2013 to 2023.These findings underscore the need for enhanced awareness,early detection,and prompt treatment of SA in endemic regions.Given the association with colorectal cancer,patients with SA require thorough screening and follow-up.Further research into the pathogenesis and diagnostic markers of SA is warranted.As the global battle against schistosomiasis continues,targeted efforts to diagnose and manage SA can significantly improve patient outcomes.
基金Supported by Guangdong Province Clinical Teaching Base Teaching Reform Research Project,No.2021JD086.
文摘BACKGROUND Endoscopic retrograde appendicitis therapy(ERAT)offers an appendix-pre-serving approach;however,visual and specificity challenges persist.Conversely,endoscopic direct appendicitis therapy(EDAT)provides direct visual observation with diagnostic and therapeutic capabilities.AIM To assess the efficacy and feasibility of EDAT and compare them with those of ERAT in uncomplicated appendicitis.METHODS In this retrospective cohort study,patients diagnosed with uncomplicated appendicitis and treated with ERAT or EDAT between January 2021 and November 2024 were reviewed.The primary outcome was intervention success.Secondary outcomes were guidewire use,stent placement,hospitalization duration,recurrence,and endoscopic direct-view features.Outcomes were compared between groups via appropriate statistical tests.RESULTS Of 170 patients,136 underwent EDAT and 34 ERAT.EDAT showed higher intervention success than ERAT(99.3%vs 82.4%,P<0.001),with less guidewire assistance and fewer stent placements(both P<0.001).Hospital stay was shorter with EDAT(P=0.039).The overall cumulative recurrence rates at 1 year were 10%in EDAT and 24%in ERAT;in the appendicolith subgroup,the recurrence rates were 5%and 14%in EDAT and ERAT,respectively.Findings were consistent in the propensity score-matched(PSM)cohort.CONCLUSION EDAT was demonstrated to be a more effective and feasible approach than ERAT,with a lower overall cumulative recurrence risk and within the appendicolith subgroup.Consistent results after PSM further supported the robustness of these findings.
文摘Acute appendicitis(AAp)remains one of the most common abdominal emergencies,requiring rapid and accurate diagnosis to prevent complications and unnecessary surgeries.Conventional diagnostic methods,including medical history,clinical assessment,biochemical markers,and imaging techniques,often present limitations in sensitivity and specificity,especially in atypical cases.In recent years,artificial intelligence(AI)has demonstrated remarkable potential in enhancing diagnostic accuracy through machine learning(ML)and deep learning(DL)models.This review evaluates the current applications of AI in both adult and pediatric AAp,focusing on clinical data-based models,radiological imaging analysis,and AI-assisted clinical decision support systems.ML models such as random forest,support vector machines,logistic regression,and extreme gradient boosting have exhibited superior diagnostic performance compared to traditional scoring systems,achieving sensitivity and specificity rates exceeding 90%in multiple studies.Additionally,DL techniques,particularly convolutional neural networks,have been shown to outperform radiologists in interpreting ultrasound and computed tomography images,enhancing diagnostic confidence.This review synthesized findings from 65 studies,demonstrating that AI models integrating multimodal data including clinical,laboratory,and imaging parameters further improved diagnostic precision.Moreover,explainable AI approaches,such as SHapley Additive exPlanations and local interpretable model-agnostic explanations,have facilitated model transparency,fostering clinician trust in AI-driven decision-making.This review highlights the advancements in AI for AAp diagnosis,emphasizing that AI is used not only to establish the diagnosis of AAp but also to differentiate complicated from uncomplicated cases.While preliminary results are promising,further prospective,multicenter studies are required for large-scale clinical implementation,given that a great proportion of current evidence derives from retrospective designs,and existing prospective cohorts exhibit limited sample sizes or protocol variability.Future research should also focus on integrating AI-driven decision support tools into routine emergency care workflows.
文摘BACKGROUND Non-operative management(NOM)for uncomplicated acute appendicitis(AA)has been gaining popularity in recent years.One of the major concerns with NOM is the recurrence rate of AA following NOM.AIM To investigate the impact of the presence of an appendicolith and its specific characteristics on the recurrence rate of AA following NOM.METHODS A retrospective analysis identified all patients treated with NOM for AA,at our institute between 2016 and 2024.Patients with an appendicolith on imaging were identified and their course and outcomes were compared with patients who were treated with NOM without an appendicolith.The primary outcome was defined as a recurrence of AA.RESULTS During the study period,797 patients were treated with NOM for AA.Their mean age was 25.4 years±14.4 years,and 45.4%were females.Only 68 patients(8.5%)had an appendicolith identified on imaging.Patients with an appendicolith had a larger appendix diameter(10.2 mm±4 mm vs 8.5 mm±2.1 mm,P=0.001).There was no difference in the recurrence rate of patients with and without an appendicolith(26.5%vs 19.1%,P=0.14),however patients with an appendicolith presented with a shorter time to recurrence of appendicitis(3.9 months±10.4 months vs 5.9 months±8.1 months,P=0.04).In a sub analysis,the number of appendicoliths,its size,and its location,did not influence the recurrence rate.CONCLUSION This study demonstrates that patients with appendicoliths have a shorter time to recurrence after NOM of AA,but do not experience higher overall recurrence rates.
文摘BACKGROUND Acute appendicitis(AAp)is a prevalent medical condition characterized by inflammation of the appendix that frequently necessitates urgent surgical procedures.Approximately two-thirds of patients with AAp exhibit characteristic signs and symptoms;hence,negative AAp and complicated AAp are the primary concerns in research on AAp.In other terms,further investigations and algorithms are required for at least one third of patients to predict the clinical condition and distinguish them from uncomplicated patients with AAp.AIM To use a Stochastic Gradient Boosting(SGB)-based machine learning(ML)algorithm to tell the difference between AAp patients who are complicated and those who are not,and to find some important biomarkers for both types of AAp by using modeling to get variable importance values.METHODS This study analyzed an open access data set containing 140 people,including 41 healthy controls,65 individuals with uncomplicated AAp,and 34 individuals with complicated AAp.We analyzed some demographic data(age,sex)of the patients and the following biochemical blood parameters:White blood cell(WBC)count,neutrophils,lymphocytes,monocytes,platelet count,neutrophil-tolymphocyte ratio,lymphocyte-to-monocyte ratio,mean platelet volume,neutrophil-to-immature granulocyte ratio,ferritin,total bilirubin,immature granulocyte count,immature granulocyte percent,and neutrophil-to-immature granulocyte ratio.We tested the SGB model using n-fold cross-validation.It was implemented with an 80-20 training-test split.We used variable importance values to identify the variables that were most effective on the target.RESULTS The SGB model demonstrated excellent performance in distinguishing AAp from control patients with an accuracy of 96.3%,a micro aera under the curve(AUC)of 94.7%,a sensitivity of 94.7%,and a specificity of 100%.In distinguishing complicated AAp patients from uncomplicated ones,the model achieved an accuracy of 78.9%,a micro AUC of 79%,a sensitivity of 83.3%,and a specificity of 76.9%.The most useful biomarkers for confirming the AA diagnosis were WBC(100%),neutrophils(95.14%),and the lymphocyte-monocyte ratio(76.05%).On the other hand,the most useful biomarkers for accurate diagnosis of complicated AAp were total bilirubin(100%),WBC(96.90%),and the neutrophil-immature granulocytes ratio(64.05%).CONCLUSION The SGB model achieved high accuracy rates in identifying AAp patients while it showed moderate performance in distinguishing complicated AAp patients from uncomplicated AAp patients.Although the model's accuracy in the classification of complicated AAp is moderate,the high variable importance obtained is clinically significant.We need further prospective validation studies,but the integration of such ML algorithms into clinical practice may improve diagnostic processes.
基金Supported by National Key R and D Program of China-Key Special Project on Diagnostic and Therapeutic Equipment and Biomedical Materials,No.2023YFC2412005。
文摘BACKGROUND Endoscopic retrograde appendicitis therapy(ERAT)is an emerging technique.However,its efficacy remains uncertain,and postoperative complications often exacerbate inflammation,thereby increasing the difficulty of surgery.The use of ERAT in appendicitis remains contentious,prompting the presentation of this case report.CASE SUMMARY We report the case of a 43-year-old female patient presenting with intermittent right lower abdominal pain for one day.The patient had undergone ERAT six months previously.Examination revealed stent impaction in the appendix,leading to exacerbated inflammation.Subsequently,a solo single-incision laparo-scopic appendectomy(SSLA)was performed.The ERAT-related complications increased surgical difficulty and prolonged the operation time.Post-SSLA,the patient was hospitalized for one day and showed favorable recovery upon follow-up.CONCLUSION This case highlights the risks of ERAT.Thorough preoperative assessment,proper stent placement during surgery and regular postoperative follow-up are crucial in preventing complications,as their occurrence can increase surgical difficulty.Compared to ERAT,SSLA remains more widely used in clinical practice.Both techniques require further clinical data and research to optimize their application.
文摘BACKGROUND Ovarian vein thrombosis(OVT)is a rare condition that most commonly affects postpartum women.It is particularly prevalent in the first 10 days postpartum,a period when women are more prone to developing this condition.The right ovarian vein is often affected due to its tortuous nature and less competent valves.OVT presents similarly to acute abdominal conditions,such as acute appendicitis,especially when the right ovarian vein is involved.Given the overlap in clinical presentation,diagnosis requires high-quality imaging techniques and a high degree of suspicion.CASE SUMMARY Herein,we report a rare case of OVT in a young postpartum female who presented to the emergency department with signs and symptoms of acute abdomen.The patient had a history of pulmonary tuberculosis treatment.A provisional diagnosis of a perforated appendix was made,and a lower midline exploratory laparotomy was planned.During surgery,the appendix and inte-stines appeared normal,but a distended and thrombosed right ovarian vein was found.The affected ovarian vein was excised,and the patient was placed on anti-coagulants postoperatively.The recovery was unremarkable,and anticoagulants were continued for six months.CONCLUSION OVT is most commonly seen in the early postpartum period,especially within the first 10 days.Due to its anatomical characteristics,the right ovarian vein is more commonly involved.The clinical presentation of OVT can closely mimic acute abdomen or acute appendicitis,making diagnosis challenging.Accurate diagnosis requires a high index of suspicion and advanced imaging techniques to differentiate OVT from other conditions with similar presentations.
基金Supported by Jiaxing Science and Technology Plan Project,No.2024AD30035.
文摘BACKGROUND Pediatric perforated appendicitis(PPA)is a severe acute condition requiring surgical intervention and postoperative antibiotic therapy.Antibiotic selection differs significantly among pediatric centers,and an ideal postoperative antiinfective approach for PPA management has yet to be established.AIM To examine the spectrum of pathogenic bacteria in pediatric PPA and to summarize the postoperative experience with carbapenem(CBP)and cephalosporin(CPS)antibiotics.METHODS We retrospectively analyzed medical records of 65 children(43 boys,22 girls;mean age 6.92±3.41 years)with PPA who underwent surgery at our hospital between December 2019 and August 2022.Data were collected in September 2023.Based on postoperative antibiotic selection,patients were divided into CBP(32 cases)and CPS(33 cases)groups.Chi-square and T-tests compared recovery outcomes,while univariate and multivariate regression models identified independent factors affecting postoperative recovery.RESULTS There were no significant differences between the two groups in gender,age,weight,height,body mass index,baseline ear temperature,or heart rate(P>0.05).Escherichia coli(40.00%)and Pseudomonas aeruginosa(24.62%)were the most common pathogens in PPA.Postoperative analysis showed significantly shorter C-reactive protein(CRP)recovery times in the CPS group than in the CBP group[(6.18±1.84)vs(8.12±3.48)days,P=0.009].Univariate logistic regression indicated CPS selection(OR=0.32,95%CI:0.10-0.97,P=0.044)was significantly associated with a higher CRP recovery rate within 7 days.Multivariate analysis confirmed CPS selection(OR=3.49,95%CI:1.19-10.24,P=0.023)as an independent factor affecting CRP recovery within 7 days postoperatively.CONCLUSION The choice of CBP or CPS independently affects CRP recovery within 7 days.CBP offers no advantage over CPS in treating PPA,with CPS also demonstrating favorable clinical outcomes.
文摘BACKGROUND Acute appendicitis is common among pediatric patients,and postoperative infections and complications are significant factors that affect recovery.As a“forward-looking”nursing model,anticipatory care may reduce the incidence of postoperative wound infections and complications.AIM To explore the effects of anticipatory care on the management of postoperative infections and complications in pediatric patients diagnosed with acute appen-dicitis.METHODS This prospective randomized controlled study included data from 78 pediatric patients who underwent acute appendicitis surgery at Shijiazhuang Sixth Hos-pital(Hebei Province,China)between February 2021 and March 2024.Patients were divided into two groups:The intervention and control groups(n=39 each)were based on a random numbers table method.Both groups received routine postoperative nursing care,whereas the intervention group received additional anticipatory care.Statistical analyses were performed using independent sample t-tests,χ2 tests,analysis of variance,and rank-sum tests.RESULTS Postoperative pain scores and hospital length of stay were significantly lower in the intervention group than those in the control group(P<0.05 and P<0.001,respectively).Postoperative wound infection and overall complication rates were significantly lower in the intervention group than those in the control group(5.13%vs 23.08%,P<0.001;15.38%vs 46.15%,P<0.001,respectively).Furthermore,parental satisfaction scores were significantly higher in the intervention group than those in the control group(P<0.05).Logistic regression identified high C-reactive protein level as a risk factor for postoperative infections and complications,whereas proactive(i.e.anticipatory)nursing intervention was a protective factor.CONCLUSION This study provided a scientific basis for the implementation of anticipatory care in the postoperative management of pediatric patients experiencing acute appendicitis.
文摘BACKGROUND Acute abdominal pain is often easy to be diagnosed because of acute abdomen,and can be treated reasonably and effectively.It is more difficult to establish the cause of chronic abdominal pain,and some patients repeatedly visit several hos-pitals and still cannot be diagnosed.Chronic abdominal pain caused by chronic appendicitis is such a case.If the degree of abdominal pain is mild and there is no sign of peritonitis,chronic appendicitis is not performed unless the patient re-quests it.CASE SUMMARY We report an extremely rare case of chronic appendicitis caused by a foreign body in the appendix in a 35-year-old woman.The patient had a long-term abdominal pain of unclear cause,and she was repeatedly treated in several hospitals.After antibiotic treatment,the abdominal pain was gradually relieved,but abdominal pain often recurs.We conducted abdominal computed tomography examination,and upon the advice of radiologists,we considered the possibility of foreign bodies in the appendix,and excluded other causes of abdominal pain.The patient requested and consented to laparoscopic appendectomy,and a chicken bone was found in the appendiceal cavity by postoperative incision of the appendiceal spe-cimen.Histopathological examination confirmed chronic appendicitis with fo-reign body giant cell reaction.The patient recovered and was discharged from the hospital.After 2 months of follow-up,abdominal pain did not recur,and the patient had a complete recovery.Core Tip:We report an extremely rare case of chronic appendicitis caused by a chicken bone in the appendix.The patient was 35-year-old woman,and had a long-term abdominal pain of unknown cause.Abdominal computed tomography examination suggested foreign bodies in the appendix,and laparoscopic appendectomy was performed.The postoperative specimen revealed chicken bones in the appendix cavity,and histopathological examination confirmed chronic appendicitis with giant cell reaction of foreign bodies.The patient recovered and was followed up for two months without abdominal pain.Citation:Huang T,Li SK,Wang W,Zhang R.Chronic abdominal pain caused by foreign bodies in the appendix:A case report.World INTRODUCTION Appendicitis is one of the common diseases that cause abdominal pain[1].Appendicitis can be diagnosed and treated effectively when patients with acute abdominal pain are admitted to hospital because of factors such as blockage and infection of appendicitis[2,3].However,the diagnosis of chronic appendicitis is difficult.Acute appendicitis caused by foreign bodies in the appendix is easy to diagnose because of the final surgical treatment[4-6],while chronic appendicitis caused by foreign bodies in the appendix is more difficult to diagnose because of the mild degree of abdominal pain.We here report an extremely rare case of chronic appendicitis caused by foreign bodies in the appendix.The patient had a long-term abdominal pain of unclear cause,and she was repeatedly treated in several hospitals.Abdominal color ultrasound examination indicated a coprolith in the appendiceal cavity and the appendix was normal,so the patient could not be treated with surgery.We conducted abdominal computed tomography(CT)examination,and upon the advice of radiologists,we considered the possibility of foreign bodies in the appendix,and excluded other causes of abdominal pain.The patient requested and consented to laparoscopic appendectomy,and a chicken bone was found in the appendiceal cavity by postoperative incision of the appendiceal specimen.The patient recovered and was discharged from hospital.After 2 months of follow-up,abdominal pain did not recur and the patient had a full recovery.
基金Supported by the Graduate Research and Practice Innovation Program of Jiangsu Province,No.KYCX233374.
文摘BACKGROUND Gastrointestinal surgical acute abdomen conditions.These conditions not only cause significant suffering to patients but also increase psychological stress for both patients and their families.AIM To investigate communication characteristics in gastrointestinal surgical acute abdomen cases(such as appendicitis and pancreatitis)and explore optimization pathways.METHODS Eighty-two patients with gastrointestinal surgical acute abdomen(including appendicitis and pancreatitis)admitted to the hospital between November 2022 and June 2024 were selected.Physician-patient communication characteristics were analyzed.Patients were randomly divided into two groups(41 each)using a random draw method.The control group received conventional physician-patient communication.The observation group received an optimized communication model based on the conventional method.The two groups were compared for treatment efficacy and outcomes,psychological status,coping strategies,sleep quality,and compliance.RESULTS Significant differences were observed between the two groups in terms of time to ambulation and duration of hospital stay(P<0.05),whereas hospitalization costs were not significantly different(P>0.05).After the intervention,the psychological status scale scores in both groups decreased significantly(P<0.05),with significant differences between the groups(P<0.05).Following the intervention,the facing subscale scores of the medical coping questionnaire increased,while the avoidance and submission subscale scores decreased(P<0.05),with significant differences between the groups(P<0.05).The observation group had lower scores on the sleep quality scale(P<0.05).The compliance rate was higher in the observation group(97.56%vs 80.49%,P<0.05).CONCLUSION Physician-patient communication presented contradictions between professionalism and laymen’s expression and rigid communication methods.Optimizing communication models can improve sleep quality,coping strategies,patient compliance,and treatment outcomes and reduce negative emotions.
文摘BACKGROUND Acute appendicitis,a common condition with a higher prevalence among men,has shown an increasing incidence in recent years owing to lifestyle changes.It is characterized by right lower quadrant abdominal pain,rebound tenderness,and rapid onset.Its pathogenesis is complex and potentially linked to infection,environment,and genetics.Timely intervention is crucial to prevent complications.While surgery is the primary treatment,it carries risks,including postoperative infections that may necessitate re-operation.Gram-negative bacteria release endotoxin(ETX),which induces inflammation and is recognized by toll-like receptor 4(TLR4).This study evaluated ETX and TLR4 levels in patients with acute appendicitis to assess the risk of postoperative incision infections,aiding in prevention and treatment.AIM To explore ETX and TLR4 expression in the blood of patients with acute appendicitis and its association with in postoperative incision infection.METHODS A total of 153 patients with acute appendicitis treated at our hospital between April 2022 and March 2024(n=153)were included in the study.Patients were categorized into infected(n=36)and uninfected(n=117)groups according to the development of postoperative incision infections.General characteristics and blood levels of ETX and TLR4 were compared,and the factors influencing postoperative infection were identified using multivariate logistic regression.ETX and TLR4 predictive values were analyzed using receiver operating characteristic curves.RESULTS No statistically significant differences were observed between the two groups in terms of sex,age,or other general characteristics(P>0.05).Compared to the uninfected group,the infected group had a higher proportion of patients with suppurative or gangrenous appendicitis,longer surgical times,longer incision lengths,and elevated ETX and TLR4 levels(P<0.05).Multivariate logistic regression analysis identified pathological type,surgical method,surgical time,and incision length as factors influencing postoperative incision infection in acute appendicitis.Receiver operating characteristic curve analysis revealed that both ETX and TLR4 levels were predictive factors for postoperative incision infection,with higher prediction efficiency when combined.CONCLUSION Pathological type,surgical method,surgical time,and incision length significantly influence postoperative incision infection risk in patients with acute appendicitis.Elevated ETX and TLR4 levels serve as valuable predictors of post-appendectomy infections.
文摘BACKGROUND Appendicitis is an abdominal medical emergency and can be of various types.It can lead to a series of gastrointestinal symptoms and can affect health status.Therefore,attention should be paid to the diagnosis of appendicitis to improve prognosis.AIM To assess the value of transabdominal superficial ultrasonography(TASU)in the clinical diagnosis of various types of appendicitis.METHODS A total of 100 patients suspected to have acute appendicitis that were admitted to our hospital between July 2022 and July 2024 were selected for this study.All of them underwent conventional abdominal ultrasonography and TASU.Taking surgical pathology as the gold standard,the diagnostic efficacy of the two ultrasonographic examinations was compared,and the ultrasonographic features of patients with different types of appendicitis were analyzed.RESULTS Comparison with the gold standard showed that among the 100 patients suspected of appendicitis,72 cases were diagnosed as appendicitis while 28 cases were deemed to be normal.Compared with conventional abdominal ultrasonography,TASU displayed a higher diagnostic efficiency(P<0.05).Among the 72 patients with acute appendicitis,22 cases were diagnosed as simple appendicitis,26 cases as suppurative appendicitis,and 24 cases as gangrenous appendicitis.TASU was more effective in the diagnosis of the various types of appendicitis,and the difference was significant between groups(P<0.05).Ultrasonography radiographs revealed an enlarged appendix with a tubular anechoic area,a widened lumen,with a visible occlusion or stercoral shadow and a cystic mass in the parenchyma.CONCLUSION TASU can accurately diagnose appendicitis and also be used to identify the various types of appendicitis,thereby having application value.
基金Henan Province Special Research Project of Tra ditional Chinese Medicine(Grant No.2022ZY1090).
文摘In the present study,data mining and network pharmacology were utilized to explore the principles and mechanisms of traditional Chinese medicine(TCM)in treating acute appendicitis.The goal was to provide a scientific basis for clinical treatment and further research on this disease.First,we searched the National Patent Database for Chinese herbal compound prescriptions used to treat acute appendicitis.We then applied frequency analysis,character and taste meridian analysis,association rule analysis,and hierarchical cluster analysis to identify the patterns of TCM treatment for acute appendicitis,selecting key combinations of Chinese medicines.Next,we screened the main active components of these key TCM based on quality markers.Using databases such as SwissTargetPrediction,SymMap,ETCM,and STRING,we analyzed the pharmacological mechanisms of these key TCM in treating acute appendicitis.Key active components and targets were further verified through molecular docking.We identified a total of 129 patents involving 316 Chinese medicines,with 24 being frequently used.The results indicated that most Chinese herbs used for acute appendicitis were heat-clearing drugs,blood-activating and stasis-removing drugs,and purging drugs.The primary active ingredients of the Rhubarb-cortex moutan-flos lonicerae combination for treating acute appendicitis included Emodin,Paeonol,Physcion,Chlorogenic acid,Chrysophanol,Rhein acid,and Aloe-emodin.These ingredients targeted key proteins such as ALB,TP53,BCL2,STAT3,IL-6,and TNF,and were involved in cellular responses to lipopolysaccharides,cell composition,and various cytokine-mediated biological processes.They also interacted with signaling pathways like AGE-RAGE,TNF,IL-17,and FoxO.Based on patent data,this study analyzed medication patterns in the treatment of acute appendicitis,discussed the possible mechanisms of key TCM combinations,and provided a scientific basis and new perspectives for the diagnosis and treatment of the disease.
文摘Appendicoliths are frequently encountered in acute appendicitis(AA)and historically considered a risk factor for treatment failure in nonoperative management(NOM).However,the impact of appendicoliths on recurrence rates in uncomplicated AA remains controversial.This editorial critically appraises the study by Kupietzky et al,which explored the relationship between appendicolith characteristics and NOM outcomes.Kupietzky et al conducted a retrospective analysis of 797 patients with uncomplicated AA,comparing recurrence rates between those with and without appendicoliths.The study focused on long-term follow-up(median 44.2 months)and subgroup analyses of stone characteristics.The study revealed no significant difference in overall recurrence rates between groups(26.5%vs 19.1%,P=0.14).However,patients with appendicoliths experienced earlier recurrence(3.9 months vs 5.9 months,P=0.04)and had larger appendix diameters(10.2 mm vs 8.5 mm,P=0.001).Subgroup analyses showed no correlation between stone size,location,or number and recurrence risk.Appendicoliths do not independently increase the overall recurrence risk after NOM for uncomplicated AA but may accelerate recurrence timelines.Clinical decisions should prioritize individualized risk assessment,considering patient age,symptom severity,and radiological features.These findings challenge traditional paradigms and advocate for shared decision-making between clinicians and patients.
文摘Objective:To analyze the effects of combined spinal-epidural anesthesia and epidural anesthesia in patients undergoing appendicitis surgery.Methods:Seventy-eight patients who underwent surgical treatment for appendicitis from February 2022 to February 2025 were selected as samples and randomly divided into two groups.The study group received combined spinal-epidural anesthesia,while the control group received epidural anesthesia.Anesthesia indicators,vital signs,and complication indicators were compared between the two groups.Results:The onset time of anesthesia in the study group was shorter than that in the control group,the visual analog scale(VAS)score was lower than that in the control group,and the highest plane of anesthesia block was lower than that in the control group(P<0.05).At 15 minutes after anesthesia induction and at the end of surgery,the heart rate(HR),mean arterial pressure(MAP),and blood oxygen saturation(SPO2)in the study group were significantly different from those in the control group(P<0.05).The complication rate in the study group was lower than that in the control group(P<0.05).Conclusion:Combined spinal-epidural anesthesia for appendicitis surgery can reduce the impact of anesthesia on vital signs,shorten the onset time of anesthesia,and is highly effective and feasible.
文摘BACKGROUND Laparoscopic surgery has emerged as the preferred treatment for acute appendicitis,a common acute abdominal condition.Despite surgical advances,postoperative gastrointestinal dysfunction and delayed recovery continue to negatively impact rehabilitation outcomes and patient quality of life.Laser acupuncture represents a promising emerging complementary therapy with potential benefits for promoting functional recovery.AIM To evaluate the clinical efficacy of laser acupuncture in enhancing gastrointestinal function recovery following laparoscopic appendectomy and to investigate its potential applications in postoperative rehabilitation.METHODS This retrospective controlled clinical study selected 120 acute appendicitis patients who underwent laparoscopic appendectomy from January 2022 to December 2023 at a tertiary hospital.Patients were randomly divided into two groups:Routine treatment group(n=60)and laser acupuncture intervention group(n=60).There were no significant statistical differences in baseline characteristics(age,gender,body mass index,appendicitis severity)between the two groups.The routine treatment group received standard postoperative care,while the laser acupuncture intervention group received additional laser acupuncture treatment on top of standard care.Key observation indicators included time to first exhaust,time to first bowel movement,time to gastrointestinal function recovery,and postoperative complication rates.RESULTS Patients in the laser acupuncture intervention group showed significantly faster gastrointestinal function recovery compared to the routine treatment group.Specifically,time to first exhaust was significantly shortened(intervention group:12.5±2.3 hours vs control group:18.7±3.1 hours,P<0.05),time to first bowel movement was earlier(intervention group:36.4±4.6 hours vs control group:48.2±5.7 hours,P<0.05),postoperative complication rate was significantly reduced(intervention group:8.3%vs control group:20.0%,P<0.05),postoperative pain score was significantly lower(intervention group:3.2±1.1 vs control group:4.7±1.5,P<0.05),and intestinal motility recovery was faster and more effective.CONCLUSION Laser acupuncture,as an auxiliary treatment method,can significantly promote gastrointestinal function recovery in patients after laparoscopic appendectomy,reduce complications,and improve postoperative comfort.This technique has advantages such as minimal invasiveness,rapid recovery,and few side effects,making it worthy of further clinical promotion and application.
基金Supported by the Natural Science Foundation of Liaoning Province,No.2023-MS-354the Science and Technology Project for Youth of Chaoyang Central Hospital,China Medical University,Liaoning Province,China.
文摘BACKGROUND Single-port laparoscopic appendectomy is an advanced minimally invasive surgery that involves the use of upgraded instruments and equipment.We previously modified single-port laparoscopic appendectomy with needle-type grasping forceps(mSLAN)for patients with simple appendicitis,but the feasibility and safety of our modified procedure need further evaluation in a highquality clinical study.AIM To compare the short-term clinical outcomes of mSLAN with those of conventional three-port laparoscopic appendectomy(CLA)for patients with acute uncomplicated appendicitis.METHODS This single-center,single-blind,prospective,randomized controlled trial included patients who underwent emergency laparoscopic appendectomy for acute uncomplicated appendicitis at our center between April 2024 and August 2024.Patients were randomly divided into the mSLAN group or the CLA group via computergenerated randomization.The primary endpoint was the 24-hour postoperative visual analog scale(VAS)score,and the secondary endpoints included the operative time,24-hour postoperative inflammatory response biomarkers(including white blood cells,the neutrophil ratio,interleukin-6,and C-reactive protein),time to first postoperative exhaust,time to first out-of-bed activity,postoperative length of hospital stay,cost of hospitalization,and incidence of postoperative complications.RESULTS A total of 72 patients were enrolled and randomly divided into 2 groups:The mSLAN group(n=36)and the CLA group(n=36).The 24-hour VAS scores,24-hour postoperative inflammatory response marker levels,first postoperative exhaust times,first out-of-bed activity times,postoperative lengths of hospital stay,operative times,or hospitalization costs did not significantly differ between the two groups.No postoperative complications,including incision infection or hernia,abdominal abscess or intestinal obstruction,were observed during the 1-month postoperative follow-up in either group.CONCLUSION Compared with the CLA protocol,the mSLAN protocol for acute uncomplicated appendicitis yielded comparable short-term clinical outcomes,with a similar operative time and better cosmetic outcomes,indicating its potential for clinical application and superiority for patients with high cosmetic requirements.Further research is needed to evaluate the long-term outcomes.
