Contemporary Epidemiology of and Risk Factors Associated with Removal of a Pathologically Normal Appendix in Children with Suspected Appendicitis

BackgroundThe goal of this study was to characterize contemporary performance benchmarks and risk factors associated with negative appendectomy (NA) in children with suspected appendicitis.MethodsA multicenter retrospective cohort analysis of children undergoing appendectomy for suspected appendicitis was performed using data from the 2016–2021 NSQIP-Pediatric Appendectomy Targeted Public Use Files. Multivariable regression was used to evaluate the influence of year, age, sex, and WBC count on NA rate, and to generate rate estimates for NA based on different combinations of demographic characteristics and WBC profiles.Results100,322 patients were included from 140 hospitals. The overall NA rate was 2.4%, and rates decreased significantly during the study period (2016: 3.1% vs. 2021: 2.3%, p < 0.001). In adjusted analyses, the highest risk for NA was associated with a normal WBC (<9000/mm³; OR 5.31 [95% CI: 4.87–5.80]), followed by female sex (OR 1.55 [95% CI: 1.42–1.68]) and age <5 years (OR 1.64 [95% CI 1.39, 1.94]). Model-estimated risk for NA varied significantly across demographic and WBC strata, with a 14.4-fold range in rates between subgroups with the lowest and highest predicted risk (males 13–17 years with elevated WBC [1.1%] vs. females 3–4 years with normal WBC [15.8%]).ConclusionsContemporary NA rates have decreased over time, however NA risk remains high in children without a leukocytosis, particularly for girls and children <5 years of age. These data provide contemporary performance benchmarks for NA in children with suspected appendicitis and identify high-risk populations where further efforts to mitigate NA risk should be targeted.Level of EvidenceIII.     

Premature Ticagrelor Discontinuation in Secondary Prevention of Atherosclerotic CVD: JACC Review Topic of the Week

Ticagrelor is a cornerstone of modern antithrombotic therapy alongside aspirin in patients with acute coronary syndrome and after percutaneous coronary intervention. Adverse effects such as bleeding and dyspnea have been associated with premature ticagrelor discontinuation, which may limit any potential advantage of ticagrelor over clopidogrel. The randomized trials of ticagrelor captured adverse events, offering the opportunity to more precisely quantify these effects across studies. Therefore, a meta-analysis of 4 randomized clinical trials of ticagrelor conducted between January 2007 and June 2017 was performed to quantify the incidence and causes of premature ticagrelor discontinuation. Among 66,870 patients followed for a median 18 months, premature ticagrelor discontinuation was seen in 25%; bleeding was the most common cause of discontinuation followed by dyspnea. Versus the comparators, the relative risk of dyspnea-related discontinuation during follow-up was 6.4-fold higher, the relative risk of bleeding was 3.2-fold higher, and the relative risk of discontinuation due to any adverse event was 59% higher for patients receiving ticagrelor. Understanding these potential barriers to adherence to ticagrelor is crucial for informed patient-physician decision making and can inform future efforts to improve ticagrelor adherence. This review discusses the incidence, causes, and biological mechanisms of ticagrelor-related adverse effects and offers strategies to improve adherence to ticagrelor.     

丹红注射液对急性冠脉综合征患者介入治疗术后炎性因子、血脂变化及早期心脏事件的影响

目的观察丹红注射液对急性冠脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)前后血清炎症反应标志物血清超敏反应蛋白(hs-CRP)、内皮素(ET)、纤维蛋白原(Fg)、低密度脂蛋白胆固醇(LDL-C)水平的影响,并探讨PCI治疗后加用丹红注射液治疗与早期心脏相关事件的关系。方法选择在我院行PCI治疗的91例患者,术后随机分为两组,对照组入院时给予常规治疗,丹红注射液组(治疗组)在常规治疗基础上加用丹红注射液静滴4周。所有患者于PCI前1d、术后第2d、术后4周分别测定hs-CRP、ET、Fg、血脂,并观察心脏事件发生率。结果两组hs-CRP、ET、Fg,在PCI术后第2d即明显升高,4周后炎性因子均低于术后2d(P<0.01),治疗组低于对照组(P<0.05),并且治疗组与对照组相比心脏事件发生率有降低的趋势(P=0.315)。结论ACS患者PCI术后应用丹红注射液可以有效抑制炎性因子的产生,明显降低LDL-C,可减少早期心脏事件的发生。     

社科领域期刊作者贡献声明政策的调研与建议

【目的】 对国内外社科领域期刊作者贡献声明(Author Contribution Statement,ACS)政策进行调研,为国内社科领域期刊编辑部制定和完善ACS政策提供借鉴和参考。【方法】 调研国内外社科领域期刊网站上发布的ACS政策,调查内容包括:是否有ACS强制性要求及理由;提交ACS的时间与方式;ACS呈现形式;写作格式;ACS要素术语等。【结果】 在国外的17个社科领域内,都有期刊制定并实施了ACS,而ACS在我国社科期刊中没有得到普及。782种CSSCI收录的社科期刊中只有18种期刊有ACS政策,占比仅2.3%,涉及的领域包括中国文学、考古学、新闻学与传播学和图书馆、情报与文献学。国外期刊采用自由文本和采用CRediT受控词汇的期刊约各占一半。国内社科期刊都是采用自由文本表述形式,没有采用CRediT受控词汇表述方法。国内期刊ACS政策存在ACS表述较为简单、没有规定提交时间与方式、呈现形式不统一、写作格式不统一等问题,可从建立分层ACS政策、鼓励作者提交ACS,采用CRediT贡献分类法为基础规范表达ACS,与ORCID建立关联3个方面进行补充完善。【结论】 我国社科期刊很少制定实施ACS政策。建议社科期刊编辑部采用分层政策来推广实施ACS,采用规范的作者贡献要素术语,提高作者贡献的透明性和可获取性。     

科技论文中通信作者和末位作者重要性的比较

【目的】 试图解决论文作者署名中通信作者与末位作者谁是最重要的作者的问题。【方法】 以Science期刊为研究对象,收集该刊论文的作者署名信息和作者贡献声明信息,提取贡献要素并进行规范化分类,结合作者贡献声明和作者署名位置、署名角色进行比较分析。【结果】 在论文作者署名位置的分布中,末位作者通常同时是通信作者。在论文研究中,通信作者往往比末位作者发挥更重要的作用。对于不是通信作者的末位作者,其对研究的贡献往往较低。【结论】 结合作者贡献声明能够合理地判断作者的重要性。学术界对于作者署名位置应该有更加统一的认识,建议在科技期刊中推行作者贡献声明政策,完善学术期刊作者贡献声明规范。     

5种中草药提取物对大鼠的减肥降脂作用

目的　检验 5种中草药提取物 (5 ECH)对大鼠的减肥降脂作用及其机制。方法　喂饲高脂饲料制备肥胖高脂大鼠模型 ,5 ECH各设两个剂量为实验组 ,曲美和血脂康为阳性对照组 ,羧甲基纤维素钠为阴性对照组 ,各组均 ig相应药物。 TACHI- 7170 A自动生化分析仪测定血浆甘油三酯 (TG)和总胆固醇 (TC)含量 ;分光光度法和同位素法测定脂肪酸合成酶 (FAS)及脂酰辅酶 A合酶 (ACS)活性。常规称重法测定各组大鼠体重增长指数(BWI)、脂肪质量 (BF)及摄食量 (FI)。结果　 5 ECH对大鼠 BWI、BF、TG、TC和 FI具有剂量依赖性抑制作用 ;并剂量依赖性地抑制 FAS活性、提高 ACS活性。BWI与 FI具有高度相关性 ,TG和 TC水平与 FAS及 ACS具有高度相关性 ,BF与 FI及两种酶的活性具有高度相关性。结论　 5 ECH通过抑制食欲、抑制 FAS活性和促进 ACS活性而对高脂饮食诱导的肥胖大鼠具有显著的剂量依赖性减肥降脂作用。     

急性冠状动脉综合症药物治疗（综述）

目的:对急性冠状动脉综合征的治疗进展作一综述.方法:查阅近2～3年国内外最新研究进展进行分析、汇总.结果:近年来,急性冠状动脉综合征的介入治疗一直是一个有争议的课题.一种是保守策略,另一种是早期有创干预策略.近期临床研究一致显示,对中、高危的急性冠状动脉综合征患者宜实行早期有创干预策略.结论:对急性冠状动脉综合征患者宜进行早期诊断,及时危险分层和合理的临床干预.     

肌钙蛋白及心电图对非ST段抬高急性冠脉综合征患者预后预测的意义

目的评估肌钙蛋白测定及心电图变化对非ST段抬高急性冠脉综合征患者预后预测的价值。方法收集资料完整的非ST段抬高的急性冠状动脉综合征患者238例,入院后即刻行12导联心电图检查及抽取静脉血做血清肌钙蛋白Ⅰ(TnⅠ)检测,并根据心电图变化及TnⅠ水平分组,观察各组住院期间主要心血管事件,并随访1个月￣6个月。结果ST段压低组的反复心绞痛发作及复合心血管事件较正常心电图组明显增多。所有非ST段抬高心肌梗死及31.9%不稳定性心绞痛患者的TnⅠ阳性,TnⅠ阳性组有明确冠心病诊断者较TnⅠ阴性组多,非致命性心肌梗死发生率增高,反复心绞痛发作增加,心血管事件增多。对复合心血管事件的预测,TnⅠ阳性因素较ST段压低因素的敏感性高(P<0.01)。多因素Logistic回归分析显示,TnⅠ阳性较ST段压低因素对患者复合心血管事件有较高的独立预测价值。结论肌钙蛋白测定及心电图变化对非ST段抬高的急性冠脉综合征患者预后预测具有重要意义,而且TnⅠ阳性因素可能具有更高的独立预测性。     

Trauma centre patient volume and inpatient mortality risk reconsidered

BackgroundSeveral studies have examined the relationship between injury volumes and trauma centre outcomes, with varying results attributable to differences in the measurement of volume's effect on mortality and differences in how characteristics are addressed as potential confounders.MethodsThis analysis includes all trauma cases reported to the NTDB 2012. The effect of trauma centre volume on patient mortality risk was measured in three different contexts: as a linear function of trauma centre volume, as a dichotomous function comparing patients in trauma centres with and without 1200 or more cases, and as a non-linear function of trauma centre volume. Multivariable weighted Hierarchical Generalized Linear Models were used to account for the combined effects of facility level and patient level covariates. Patient level mortality risk was assessed using the ACS Trauma Quality Improvement Programme methodology.ResultsTrauma centre volume was not a statistically significant predictor (at the α = 0.01 level) of patient mortality risk, in any of the three models. Comprehensive adjustments for patient level risk were obtained, with excellent discrimination between survivor and decedent cases. The addition of trauma volume to baseline patient mortality risk yielded no improvement in the accuracy of any model. These results were not sensitive to the inclusion of Level II trauma centres. Equivalent results were obtained by repeating the analysis for the Level I subpopulation only.ConclusionsCase volume may be a reasonable standard for determining whether adequate numbers of injured patients are available to support training needs and experience requirements of a Level I trauma centre. However, case volume is not a useful predictor of patient mortality in individual facilities. Trauma centre volume has no independent effect, after accounting for the patient level characteristics that predominantly influence mortality.     

Secondary Prevention of Cardiovascular Disease in Older Adults

Atherosclerotic cardiovascular disease is extremely common in older adults and the potential benefits of secondary prevention are perhaps greater in this population than in younger patients. While there is good evidence that secondary prevention efforts are justified in patients up to 80 years of age, limited data are available on secondary prevention in octogenarians and there is no evidence to guide treatment in patients ≥ 90 years of age. Further, the value of secondary prevention may be confounded by prevalent comorbidities, polypharmacy, and limited life expectancy. It is therefore essential that all management decisions be made in relation to individual preferences and goals of care, with understanding by patients that benefits as well as risks may increase with age. Furthermore, research is needed to refine markers to better delineate which older adults are most likely to benefit from preventive therapies.