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Journal of Food Protection Jun 2024The 2021 FSIS Stabilization Guidelines for Meat and Poultry Products (Appendix B) Option 1.2 limits Phase 1 cooling from 48.8-26.7°C in uncured meats to 1 hour....
The 2021 FSIS Stabilization Guidelines for Meat and Poultry Products (Appendix B) Option 1.2 limits Phase 1 cooling from 48.8-26.7°C in uncured meats to 1 hour. However, this time restriction is impractical to achieve in large diameter whole muscle products. The objective of this study was to compare the inhibitory effect of commercial dry vinegars (DV) and cultured sugar-vinegar blends (CSV) on Clostridium perfringens and Bacillus cereus in uncured beef and poultry products during extended cooling. Treatments (beef: 72-73% moisture, pH 6.2-6.3, 0.85-0.95% NaCl; turkey: 76-77% moisture, pH 6.5-6.7, 1.3-1.6% NaCl) included Controls without antimicrobials, and four DV and four CSV, each tested at 0.75 and 1.25%. Batches were inoculated with 2.5-log C. perfringens or B. cereus spores, vacuum-packaged, and cooked to 73°C. Packages were cooled from 48.8-27°C (Phase 1) in 3, 4, or 5 hours; Phase 2 (27-12.8°C) and Phase 3 (12.8-4°C) were standardized for 5-h cooling each. Pathogens were enumerated on selective agar in triplicate samples assayed at pre-cook, post-cook, and at the end of Phase 1, 2, and 3 cooling. Experiments were conducted twice. B. cereus did not grow (<0.5-log increase) in any treatment when Phase 1 cooling was extended to 5 hours. C. perfringens grew rapidly (2.5 to > 4.5 log) in Control treatments when Phase 1 cooling was extended to > 3 hours. All 1.25% DV ingredients limited C. perfringens growth to < 1-log when Phase 1 cooling was extended to 3 hours but supported a >1-log increase when Phase 1 cooling was extended to 5 hours. All 1.25% CSV inhibited growth under 3-h Phase 1 cooling; 1.25% CSV-A and ≥0.75% CSV-D inhibited growth in turkey during 5-h Phase 1 cooling, but inhibition with 1.25% CSV-C was inconsistent in beef. This study revealed that formulating uncured meats with 1.25% DV or certain CSV can extend Phase 1 cooling to 3 hours. Although all ingredients inhibited growth when used at 0.75% or greater compared to a control, greater variability of inhibition was observed among CSV than for DV.
PubMed: 38878899
DOI: 10.1016/j.jfp.2024.100317 -
Surgical Case Reports Jun 2024Neoplasms derived from remnant appendix are rarely described, with most cases arising from the appendiceal "stump". Here, we present two surgical cases of appendiceal...
BACKGROUND
Neoplasms derived from remnant appendix are rarely described, with most cases arising from the appendiceal "stump". Here, we present two surgical cases of appendiceal neoplasms derived from appendiceal "tip" remnants.
CASE PRESENTATION
The first patient was a 71-year-old man who had undergone laparoscopic appendectomy for acute appendicitis 12 years prior. During appendectomy, the appendiceal root was ligated, but the appendix was not completely removed due to severe inflammation. At the most recent presentation, computed tomography (CT) was performed to examine choledocholithiasis, which incidentally revealed a cystic lesion of approximately 90 mm adjacent to the cecum. A retrospective review revealed that the cystic lesion had increased in size over time, and laparoscopic ileocecal resection was performed. Pathology revealed no continuity from the appendiceal orifice to the cyst, and a diagnosis of low-grade appendiceal mucinous neoplasm (LAMN) was made from the appendiceal tip remnant. The patient was discharged without complications. The second patient was a 65-year-old man who had undergone surgery for peritonitis due to severe appendicitis 21 years prior. During this operation, the appendix could not be clearly identified due to severe inflammation; consequently, cecal resection was performed. He was referred to our department with a chief complaint of general fatigue and loss of appetite and a cystic lesion of approximately 85 mm close to the cecum that had increased over time. CT showed irregular wall thickening, and malignancy could not be ruled out; therefore, laparoscopic ileocecal resection with D3 lymph node dissection was performed. The pathological diagnosis revealed mucinous adenocarcinoma (TXN0M0) arising from the remnant appendiceal tip. The patient is undergoing follow-up without postoperative adjuvant chemotherapy, with no evidence of pseudomyxoma peritonei or cancer recurrence for 32 months postoperatively.
CONCLUSIONS
If appendicitis-associated inflammation is sufficiently severe that accurate identification of the appendix is difficult, it may remain on the apical side of the appendix, even if the root of the appendix is ligated and removed. If the appendectomy is terminated incompletely, it is necessary to check for the presence of a residual appendix postoperatively and provide appropriate follow-up.
PubMed: 38867137
DOI: 10.1186/s40792-024-01936-4 -
Science Advances Jun 2024Mucosal-associated invariant T (MAIT) cells are antimicrobial T cells abundant in the gut, but mechanisms for their migration into tissues during inflammation are poorly...
Mucosal-associated invariant T (MAIT) cells are antimicrobial T cells abundant in the gut, but mechanisms for their migration into tissues during inflammation are poorly understood. Here, we used acute pediatric appendicitis (APA), a model of acute intestinal inflammation, to examine these migration mechanisms. MAIT cells were lower in numbers in circulation of patients with APA but were enriched in the inflamed appendix with increased production of proinflammatory cytokines. Using the patient-derived appendix organoid (PDAO) model, we found that circulating MAIT cells treated with inflammatory cytokines elevated in APA up-regulated chemokine receptors, including CCR1, CCR3, and CCR4. They exhibited enhanced infiltration of -pulsed PDAO in a CCR1-, CCR2-, and CCR4-dependent manner. Close interactions of MAIT cells with infected organoids led to the PDAO structural destruction and death. These findings reveal a previously unidentified mechanism of MAIT cell tissue homing, their participation in tissue damage in APA, and their intricate relationship with mucosal tissues during acute intestinal inflammation in humans.
Topics: Humans; Appendicitis; Mucosal-Associated Invariant T Cells; Inflammation; Cytokines; Acute Disease; Lymphocyte Activation; Organoids; Cell Movement; Child; Male; Female; Intestinal Mucosa; Appendix
PubMed: 38865451
DOI: 10.1126/sciadv.adn6331 -
Cureus May 2024The presence of a supernumerary subserosal muscle layer of the bowel is an extremely unusual congenital development. The following is a report of diffuse involvement of...
The presence of a supernumerary subserosal muscle layer of the bowel is an extremely unusual congenital development. The following is a report of diffuse involvement of the intestine with a supernumerary subserosal muscle coat. The current patient, a 29-year-old male, was evaluated in January 2022 for a long-standing history of subacute intestinal obstruction (SAIO). A preoperative CT scan of the abdomen and pelvis suggested mild dilatation and clumping of ileal loops in the right iliac fossa, with a subtle wall thickening of up to 5 mm. Intraoperatively, dense adhesions were noted between clumped bowel loops and the anterior abdominal wall. Following adhesiolysis, ileocecal resection with ileocolic anastomosis was done. The histopathological examination of the resected bowel segment showed irregular hypertrophy of circular and longitudinal muscle layers with the presence of an additional smooth muscle coat outer to the outer longitudinal layer that was seen in the ileum as well as the appendix. No evidence of vacuolar degeneration was noted, and ganglion cells were seen to be adequately present. The presence of additional smooth muscle bundles in the subserosa was confirmed with positive actin immunostaining. Additionally, CD117 staining was done that revealed a normal network of interstitial cells of Cajal. No evidence of active inflammation was noted in the resected bowel segment. Findings from the current case bring to light an extremely rare malformation of the muscularis propria of the intestine, namely a supernumerary subserosal muscle coat.
PubMed: 38860074
DOI: 10.7759/cureus.60096 -
Cureus May 2024Appendicitis is one of the most common gastrointestinal conditions a person can develop. Throughout the years of assessing the different focuses of appendicitis, such as... (Review)
Review
Appendicitis is one of the most common gastrointestinal conditions a person can develop. Throughout the years of assessing the different focuses of appendicitis, such as origin, symptoms, labs, diagnosis, treatment, and complications, there have been mere mentions of sex differences. One of the most known sex differences in appendicitis is the fact that males are significantly more likely to develop appendicitis compared to females. Another postulated difference is that males may be more likely to develop a perforated appendix. These differences significantly affect the various aspects of diagnosing and treating appendicitis and may even influence the outcome of appendicitis. Sex difference analysis of conditions has been widely researched over the last two decades, and sex can influence and impact conditions from initial presentation to the outcome of treatment. This paper evaluates the sex differences in appendicitis concerning incidence, risk factors, symptoms, diagnosis technique, treatment, and outcomes across ages. Following PRISMA guidelines, this systematic review reviewed PubMed, ScienceDirect, and ProQuest databases for articles pertaining to sex differences in appendicitis. The original article count was 21,121, which was narrowed down to 28 publications. It was found that, as previously described, males had a significantly higher rate of appendicitis, as well as were at significant risk of perforated appendicitis. No official risk factors were found to differ between the sexes, but males were more likely to complain of symptoms like right lower quadrant cramps/tenderness/pain and loss of appetite. Scores such as the pediatric appendicitis score (PAS) and Ohmann have been used to diagnose appendicitis, but the PAS was significantly more accurate for females, and the Ohmann resulted in significantly fewer negative appendectomies in females as well. Ultrasound and computed tomography (CT) are still the gold standards for diagnosis; however, while time to CT was significantly delayed in females, they were more likely to undergo extensive imaging, possibly to rule out other conditions. Males were more likely to undergo open appendectomies compared to females, who more frequently underwent laparoscopic appendectomy, yet females were more likely to experience complications. Further research should evaluate the influences that can predict postoperative outcomes following appendectomies between sexes and how to prevent/reduce their occurrence.
PubMed: 38854248
DOI: 10.7759/cureus.60055 -
Annals of Oncology : Official Journal... Jun 2024Upfront primary tumor resection (PTR) has been associated with longer overall survival (OS) in patients with synchronous unresectable metastatic colorectal cancer (mCRC)...
Upfront resection versus no resection of the primary tumor in patients with synchronous metastatic colorectal cancer: the randomized phase 3 CAIRO4 study conducted by the Dutch Colorectal Cancer Group and the Danish Colorectal Cancer Group.
BACKGROUND
Upfront primary tumor resection (PTR) has been associated with longer overall survival (OS) in patients with synchronous unresectable metastatic colorectal cancer (mCRC) in retrospective analyses. The aim of the CAIRO4 study was to investigate whether the addition of upfront PTR to systemic therapy resulted in a survival benefit in patients with synchronous mCRC without severe symptoms of their primary tumor.
PATIENTS AND METHODS
This randomized phase 3 trial was conducted in 45 hospitals in The Netherlands and Denmark. Eligibility criteria included previously untreated mCRC, unresectable metastases, and no severe symptoms of the primary tumor. Patients were randomized (1:1) to upfront PTR followed by systemic therapy or systemic therapy without upfront PTR. Systemic therapy consisted of first-line fluoropyrimidine-based chemotherapy with bevacizumab in both arms. Primary endpoint was OS in the intention-to-treat population. The study was registered at ClinicalTrials.gov, NCT01606098.
RESULTS
Between August 2012 and February 2021, 206 patients were randomized. In the intention-to-treat analysis, 204 patients were included (n= 103 without upfront PTR, n=101 with upfront PTR) of whom 116 were men (57%) with median age of 65 years (IQR 59-71). Median follow-up was 69.4 months. Median OS in the arm without upfront PTR was 18.3 months (95% CI 16.0-22.2) compared to 20.1 months (95% CI 17.0-25.1) in the upfront PTR arm (p = 0.32). The number of grade 3-4 events was 71 (72%) in the arm without upfront PTR and 61 (65%) in the upfront PTR arm (p=0.33). Three deaths (3%) possibly related to treatment were reported in the arm without upfront PTR and four (4%) in the upfront PTR arm.
CONCLUSION
of upfront PTR to palliative systemic therapy in patients with synchronous mCRC without severe symptoms of the primary tumor does not result in a survival benefit. This practice should no longer be considered standard of care.
PubMed: 38852675
DOI: 10.1016/j.annonc.2024.06.001 -
Metabolism: Clinical and Experimental Jun 2024The spectrum of cardiorenal and metabolic diseases comprises many disorders, including obesity, type 2 diabetes (T2D), chronic kidney disease (CKD), atherosclerotic... (Review)
Review
The spectrum of cardiorenal and metabolic diseases comprises many disorders, including obesity, type 2 diabetes (T2D), chronic kidney disease (CKD), atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), dyslipidemias, hypertension, and associated comorbidities such as pulmonary diseases and metabolism dysfunction-associated steatotic liver disease and metabolism dysfunction-associated steatohepatitis (MASLD and MASH, respectively, formerly known as nonalcoholic fatty liver disease and nonalcoholic steatohepatitis [NAFLD and NASH]). Because cardiorenal and metabolic diseases share pathophysiologic pathways, two or more are often present in the same individual. Findings from recent outcome trials have demonstrated benefits of various treatments across a range of conditions, suggesting a need for practice recommendations that will guide clinicians to better manage complex conditions involving diabetes, cardiorenal, and/or metabolic (DCRM) diseases. To meet this need, we formed an international volunteer task force comprising leading cardiologists, nephrologists, endocrinologists, and primary care physicians to develop the DCRM 2.0 Practice Recommendations, an updated and expanded revision of a previously published multispecialty consensus on the comprehensive management of persons living with DCRM. The recommendations are presented as 22 separate graphics covering the essentials of management to improve general health, control cardiorenal risk factors, and manage cardiorenal and metabolic comorbidities, leading to improved patient outcomes.
PubMed: 38852020
DOI: 10.1016/j.metabol.2024.155931 -
The Lancet. Planetary Health Jun 2024
Topics: Climate Change; Reproductive Health; Humans; Sexual Health; Research; Human Rights; Reproductive Rights
PubMed: 38849174
DOI: 10.1016/S2542-5196(24)00093-7 -
Annals of Medicine and Surgery (2012) Jun 2024Amyand's hernia, a rare condition where the appendix becomes lodged in the inguinal canal, poses diagnostic challenges due to its varied clinical presentations and lack...
INTRODUCTION
Amyand's hernia, a rare condition where the appendix becomes lodged in the inguinal canal, poses diagnostic challenges due to its varied clinical presentations and lack of distinctive radiological features. This case underscores the importance of early detection and comprehensive diagnostic evaluation.
CASE PRESENTATION
A 30-year-old male presented with a 2-year history of right inguinoscrotal swelling, culminating in agonizing symptoms and irreducible masses over the inguinoscrotal area. Despite the absence of significant medical history, diagnostic imaging confirmed a complete right inguinoscrotal hernia and bilateral hydrocele with internal echoes.
CLINICAL DISCUSSION
The case illustrates the difficulties in preoperative diagnosis of Amyand's hernia, emphasizing the reliance on imaging modalities and clinical assessment. Successful surgical intervention involving appendectomy and hernioplasty highlights the necessity for prompt diagnosis and management.
CONCLUSION
This case exemplifies the challenges and complexities associated with Amyand's hernia, emphasizing the importance of early recognition and comprehensive surgical planning. Moving forward, increased clinical vigilance and awareness are essential to ensure optimal patient outcomes in cases of inguinoscrotal pathology.
PubMed: 38846902
DOI: 10.1097/MS9.0000000000002137 -
Cureus May 2024A 74-year-old man who presented with upper abdominal pain was found to have an incidental appendiceal mass on cross-sectional imaging. He underwent a laparoscopic...
A 74-year-old man who presented with upper abdominal pain was found to have an incidental appendiceal mass on cross-sectional imaging. He underwent a laparoscopic appendicectomy with histopathological examination confirming a completely resected appendiceal gastrointestinal stromal tumour (GIST). Appendiceal GISTs are rare. Therefore, there is limited evidence to guide risk stratification and management with extrapolation of prognosis from data on GISTs at other sites. This paper highlights the rarity of these tumours and presents another case which correlates well with the existing but limited literature. There is a need to maintain a registry of this rare disease entity with the maintenance of longer-term follow-up data.
PubMed: 38846198
DOI: 10.7759/cureus.59780