BACKGROUND: Acute appendicitis is the most common surgical condition presented in emergency departments worldwide. Clinical scoring systems, such as the Alvarado and modified Alvarado scoring systems, were developed w...BACKGROUND: Acute appendicitis is the most common surgical condition presented in emergency departments worldwide. Clinical scoring systems, such as the Alvarado and modified Alvarado scoring systems, were developed with the goal of reducing the negative appendectomy rate to 5%–10%. The Raja Isteri Pengiran Anak Saleha Appendicitis(RIPASA) scoring system was established in 2008 specif ically for Asian populations. The aim of this study was to compare the modif ied Alvarado with the RIPASA scoring system in Kuwait population.METHODS: This study included 180 patients who underwent appendectomies and were documented as having "acute appendicitis" or "abdominal pain" in the operating theatre logbook(unit B) from November 2014 to March 2016. The sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV), diagnostic accuracy, predicted negative appendectomy and receiver operating characteristic(ROC) curve of the modified Alvarado and RIPASA scoring systems were derived using SPSS statistical software.RESULTS: A total of 136 patients were included in this study according to our criteria. The cut-off threshold point of the modif ied Alvarado score was set at 7.0, which yielded a sensitivity of 82.8% and a specif icity of 56%. The PPV was 89.3% and the NPV was 42.4%. The cut-off threshold point of the RIPASA score was set at 7.5, which yielded a 94.5% sensitivity and an 88% specif icity. The PPV was 97.2% and the NPV was 78.5%. The predicted negative appendectomy rates were 10.7% and 2.2% for the modif ied Alvarado and RIPASA scoring systems, respectively. The negative appendectomy rate decreased significantly, from 18.4% to 10.7% for the modified Alvarado, and to 2.2% for the RIPASA scoring system, which was a signif icant difference(P<0.001) for both scoring systems.CONCLUSION: Based on the results of this study, the RIPASA score is a simple scoring system with better sensitivity and specif icity than the modif ied Alvarado scoring system in Asian populations. It consists of 14 clinical parameters that can be obtained from a good patient history, clinical examination and laboratory investigations. The RIPASA scoring system is more accurate and specific than the modif ied Alvarado scoring system for Kuwait population.展开更多
The purpose of this study is to investigate effects of gastrodin and sodium nitroprusside on circulatory mechanics and hemodynamics.The modified Windkessel model was used to calculate arterial vascular compliance and ...The purpose of this study is to investigate effects of gastrodin and sodium nitroprusside on circulatory mechanics and hemodynamics.The modified Windkessel model was used to calculate arterial vascular compliance and inertance of blood flow in the arterial vessels.Blood pressure,cardiac output,peripheral resistance,inertance of blood flow in the arterial vessels,and proximal and distal compliance etc in 20 dogs were measured and calculated before and after gastrodin and sodium nitroprusside ad-ministration.The results show that gastrodin is efficient in decreasing the blood pres-sure(P<0.001)and peripheral resistance(P<0.01),and increasing the proximal(P<0.05)and distal arterial vascular compliance(P<0.01),and inertance of blood flow in the arterial vessels(P=0.054).Sodium nitroprusside strongly de·eases bloood pres-sure and peripheral resistance(P<0.001),and increases distal arterial compliance(P<0.001)and inertance of blood flow in the arterial vessels(P<0.01).Comparing with sodium nitropursside,gastrodin is moderate in reducing blood pressure,but it reduces systolic blood pressure is relatively stronger than it does diastolic blood pressure.Fur-thermore,gastrodin is stronger than sodium nitroprusside and some of other vasodila-tors in increasing proximal arterial compliance,i.e.,gastrodin has the beneficial ef-fect of improving arterial vascular,particularly aorta and large artery,elasticity.Gas-trodin,as a traditional Chinese medicine,can be used to cure the elderly hypertension.展开更多
In the United States,1 in 10 infants are born preterm.The majority of neonatal deaths and nearly a third of infant deaths are linked to preterm birth.Preterm birth is initiated when the quiescent state of the uterus e...In the United States,1 in 10 infants are born preterm.The majority of neonatal deaths and nearly a third of infant deaths are linked to preterm birth.Preterm birth is initiated when the quiescent state of the uterus ends prematurely,leading to contractions and parturition beginning as early as 32 weeks,though the origins are not well understood.To enable research and discovery of therapeutics with potential to better address preterm birth,the capability to study isolated cell processes of pregnant uterine tissue in vitro is needed.Our development of an in vitro model of the myometrium utilizing human uterine smooth muscle cells(uSMCs)responsible for contractions provides a methodology to examine cellular mechanisms of late-stage pregnancy potentially involved in preterm birth.We discuss culture of uSMCs on a flexible polydimethylsiloxane(PDMS)substrate functionalized with cationic poly-L-lysine(PLL),followed by extracellular matrix(ECM)protein coating.Previous work exploring uSMC behavior on PDMS substrates have utilized collagen-I coatings,however,we demonstrated the first exploration of human uSMC response to strain on fibronectin-coated flexible membranes,importantly reflecting the significant increase of fibronectin content found in the myometrial ECM during late-stage pregnancy.Using the model we developed,we conducted proof-of-concept studies to investigate the impact of substrate strain on uSMC cell morphology and gene expression.It was found that PLL and varied ECM protein coatings(collagen I,collagen III,and fibronectin)altered cell nuclei morphology and density on PDMS substrates.Additionally,varied strain rates applied to uSMC substrates significantly impacted uSMC gene expression of IL-6,a cytokine associated with instances of preterm labor.These results suggest that both surface and mechanical properties of in vitro systems impact primary human uSMC phenotype and offer uSMC culture methodologies that can be utilized to further the understanding of cellular pathways involved in the uterus under mechanical load.展开更多
文摘BACKGROUND: Acute appendicitis is the most common surgical condition presented in emergency departments worldwide. Clinical scoring systems, such as the Alvarado and modified Alvarado scoring systems, were developed with the goal of reducing the negative appendectomy rate to 5%–10%. The Raja Isteri Pengiran Anak Saleha Appendicitis(RIPASA) scoring system was established in 2008 specif ically for Asian populations. The aim of this study was to compare the modif ied Alvarado with the RIPASA scoring system in Kuwait population.METHODS: This study included 180 patients who underwent appendectomies and were documented as having "acute appendicitis" or "abdominal pain" in the operating theatre logbook(unit B) from November 2014 to March 2016. The sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV), diagnostic accuracy, predicted negative appendectomy and receiver operating characteristic(ROC) curve of the modified Alvarado and RIPASA scoring systems were derived using SPSS statistical software.RESULTS: A total of 136 patients were included in this study according to our criteria. The cut-off threshold point of the modif ied Alvarado score was set at 7.0, which yielded a sensitivity of 82.8% and a specif icity of 56%. The PPV was 89.3% and the NPV was 42.4%. The cut-off threshold point of the RIPASA score was set at 7.5, which yielded a 94.5% sensitivity and an 88% specif icity. The PPV was 97.2% and the NPV was 78.5%. The predicted negative appendectomy rates were 10.7% and 2.2% for the modif ied Alvarado and RIPASA scoring systems, respectively. The negative appendectomy rate decreased significantly, from 18.4% to 10.7% for the modified Alvarado, and to 2.2% for the RIPASA scoring system, which was a signif icant difference(P<0.001) for both scoring systems.CONCLUSION: Based on the results of this study, the RIPASA score is a simple scoring system with better sensitivity and specif icity than the modif ied Alvarado scoring system in Asian populations. It consists of 14 clinical parameters that can be obtained from a good patient history, clinical examination and laboratory investigations. The RIPASA scoring system is more accurate and specific than the modif ied Alvarado scoring system for Kuwait population.
文摘The purpose of this study is to investigate effects of gastrodin and sodium nitroprusside on circulatory mechanics and hemodynamics.The modified Windkessel model was used to calculate arterial vascular compliance and inertance of blood flow in the arterial vessels.Blood pressure,cardiac output,peripheral resistance,inertance of blood flow in the arterial vessels,and proximal and distal compliance etc in 20 dogs were measured and calculated before and after gastrodin and sodium nitroprusside ad-ministration.The results show that gastrodin is efficient in decreasing the blood pres-sure(P<0.001)and peripheral resistance(P<0.01),and increasing the proximal(P<0.05)and distal arterial vascular compliance(P<0.01),and inertance of blood flow in the arterial vessels(P=0.054).Sodium nitroprusside strongly de·eases bloood pres-sure and peripheral resistance(P<0.001),and increases distal arterial compliance(P<0.001)and inertance of blood flow in the arterial vessels(P<0.01).Comparing with sodium nitropursside,gastrodin is moderate in reducing blood pressure,but it reduces systolic blood pressure is relatively stronger than it does diastolic blood pressure.Fur-thermore,gastrodin is stronger than sodium nitroprusside and some of other vasodila-tors in increasing proximal arterial compliance,i.e.,gastrodin has the beneficial ef-fect of improving arterial vascular,particularly aorta and large artery,elasticity.Gas-trodin,as a traditional Chinese medicine,can be used to cure the elderly hypertension.
文摘In the United States,1 in 10 infants are born preterm.The majority of neonatal deaths and nearly a third of infant deaths are linked to preterm birth.Preterm birth is initiated when the quiescent state of the uterus ends prematurely,leading to contractions and parturition beginning as early as 32 weeks,though the origins are not well understood.To enable research and discovery of therapeutics with potential to better address preterm birth,the capability to study isolated cell processes of pregnant uterine tissue in vitro is needed.Our development of an in vitro model of the myometrium utilizing human uterine smooth muscle cells(uSMCs)responsible for contractions provides a methodology to examine cellular mechanisms of late-stage pregnancy potentially involved in preterm birth.We discuss culture of uSMCs on a flexible polydimethylsiloxane(PDMS)substrate functionalized with cationic poly-L-lysine(PLL),followed by extracellular matrix(ECM)protein coating.Previous work exploring uSMC behavior on PDMS substrates have utilized collagen-I coatings,however,we demonstrated the first exploration of human uSMC response to strain on fibronectin-coated flexible membranes,importantly reflecting the significant increase of fibronectin content found in the myometrial ECM during late-stage pregnancy.Using the model we developed,we conducted proof-of-concept studies to investigate the impact of substrate strain on uSMC cell morphology and gene expression.It was found that PLL and varied ECM protein coatings(collagen I,collagen III,and fibronectin)altered cell nuclei morphology and density on PDMS substrates.Additionally,varied strain rates applied to uSMC substrates significantly impacted uSMC gene expression of IL-6,a cytokine associated with instances of preterm labor.These results suggest that both surface and mechanical properties of in vitro systems impact primary human uSMC phenotype and offer uSMC culture methodologies that can be utilized to further the understanding of cellular pathways involved in the uterus under mechanical load.
