Background The Alvarado score is a clinical scoring system used in the diagnosis of acute appendicitis. This study aimed to compare the reliability of the Alvarado score and clinical judgment and to refine the score to make it easier to use. Methods In this prospective, randomized study, patients presenting at the authors' outpatient department with suspected appendicitis during a 1-year period were assigned in weekly alternation to either group A or group B. The group A patients were treated on the basis of their Alvarado score, and the group B patients underwent treatment based on clinical judgment. The correctness of the methods was assessed by evaluation of the final histology. Statistical comparison of the data was performed using SPSS 20. Results The study investigated 269 patients (131 in group A and 138 in group B). The groups were homogeneous in terms of mean age, gender, body mass index, and American Society of Anesthesiologists score. The number of negative appendectomies was 12 (9.16 %) in group A versus 5 (3.6 %) in group B (p = 0.063). The clinical judgment had better specificity and sensitivity than the Alvarado score. For that reason, the specificity of the Alvarado score was refined using statistical methods, with weighting of certain clinical data and inclusion of new ones (e.g., ultrasound investigation). Consequently, the area under the curve by receiver operating characteristic analysis gradually increased, and the Alvarado score became more accurate. Conclusion The study findings showed clinical judgment to be more reliable in the diagnosis of acute appendicitis than the Alvarado score, but the score is a useful diagnostic aid, especially for young colleagues. The use of the new scoring system has become easier. It includes fewer criteria as well as an important and sensitive predictor: the ultrasound investigation.Acute appendicitis is the most common urgent surgical condition, with 9 % of the population affected [1]. Its differential diagnosis is extremely difficult, especially for the elderly, children, and fertile-age women, in whom it can mimic numerous gynecologic and urogenital conditions [2]. The lethality of the condition is about 0.7 %, which means that it causes the death of almost 100 patients in Hungary each year [3]. Furthermore, the number of negative appendectomies remains in the approximate range of 5-10 %, although the negative appendectomy rate (NAR) has decreased in recent decades due to better diagnostic techniques (i.e., ultrasound and preoperative computed tomography [CT]) [4].The diagnosis of acute appendicitis is based on the medical history, the physical examination, and the laboratory analysis, but imaging techniques (ultrasound and CT scan) also may be helpful. The ultrasound scan is easy to perform and inexpensive, but its result is examiner-and patientdependent. With its help, however, the number of negative appendectomies can be decreased by 10 % [5]. The CT scan

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Matrix metalloproteinase (MMP)‐7, unlike many MMPs, is typically expressed in epithelial cells. It has been linked to epithelial responses to infection, injury, and tissue remodeling including the progression of a number of cancers. We have now examined how MMP‐7 expression changes in the progression to esophageal adenocarcinoma (EAC), and have studied mechanisms regulating its expression and its functional significance. Immunohistochemistry revealed that MMP‐7 was weakly expressed in normal squamous epithelium adjacent to EAC but was abundant in epithelial cells in both preneoplastic lesions of Barrett's esophagus and EAC particularly at the invasive front. In the stroma, putative myofibroblasts expressing MMP‐7 were abundant at the invasive front but were scarce or absent in adjacent tissue. Western blot and ELISA revealed high constitutive secretion of proMMP‐7 in an EAC cell line (OE33) that was inhibited by the phosphatidylinositol (PI) 3‐kinase inhibitor LY294002 but not by inhibitors of protein kinase C, or MAP kinase activation. There was detectable proMMP‐7 in cultured esophageal myofibroblasts but it was undetectable in media. Possible metabolism of MMP‐7 by myofibroblasts studied by proteomic analysis indicated degradation via extensive endopeptidase, followed by amino‐ and carboxpeptidase, cleavages. Myofibroblasts exhibited increased migration and invasion in response to conditioned media from OE33 cells that was reduced by MMP‐7 knockdown and immunoneutralization. Thus, MMP‑7 expression increases at the invasive front in EAC which may be partly attributable to activation of PI 3‐kinase. Secreted MMP‐7 may modify the tumor microenvironment by stimulating stromal cell migration and invasion.

In this study, the Weather Research and Forecasting (WRF) model is used to produce short-term regional climate simulations with several configurations for the Carpathian Basin region. The goal is to evaluate the performance of the model and analyze its sensitivity to different physical and dynamical settings, and input data. Fifteen experiments were conducted with WRF at 10 km resolution for the year 2013. The simulations differ in terms of configuration options such as the parameterization schemes, the hydrostatic and non-hydrostatic dynamical cores, the initial and boundary conditions (ERA5 and ERA-Interim reanalyses), the number of vertical levels, and the length of the spin-up period. E-OBS dataset 2 m temperature, total precipitation, and global radiation are used for validation. Temperature underestimation reaches 4–7 °C for some experiments and can be reduced by certain physics scheme combinations. The cold bias in winter and spring is mainly caused by excessive snowfall and too persistent snow cover, as revealed by comparison with satellite-based observations and a test simulation without snow on the surface. Annual precipitation is overestimated by 0.6–3.8 mm day−1, with biases mainly accumulating in the period driven by large-scale weather processes. Downward shortwave radiation is underestimated all year except in the months dominated by locally forced phenomena (May to August) when a positive bias prevails. The incorporation of downward shortwave radiation to the validation variables increased the understanding of underlying problems with the parameterization schemes and highlighted false model error compensations.