Background & Aims-We previously reported that the NS2 protein of hepatitis C virus (HCV) inhibits the expression of reporter genes driven by a variety of cellular and viral promoters. The aim of the study was to determine whether the broad transcriptional repression is caused by endoplasmic reticulum (ER) stress.

WHAT'S KNOWN ON THIS SUBJECT: Currently, the false-positive rate of appendicitis in children is #5%. Abdominal imaging and blood tests (particularly leukocytosis) help minimize the negative appendectomy rate, but appendicitis is not always associated with an elevated white blood cell count. WHAT THIS STUDY ADDS:Reducing the threshold of leukocytosis as a criterion for appendicitis to 8000 to 9000 white blood cells per mL improves specificity (negative appendectomy: ,1%) while only marginally decreasing sensitivity. abstract BACKGROUND: Despite increased utilization of laboratory, radiologic imaging, and scoring systems, negative appendectomy (NA) rates in children remain above 3% nationwide. We reviewed the clinical data of patients undergoing appendectomy to further reduce our NA rate. METHODS:A retrospective review was conducted of all appendectomies performed for suspected appendicitis at a tertiary children' s hospital during a 42-month period. Preoperative clinical, laboratory, and radiographic data were collected. Variables absent or normal in more than half of NAs were further analyzed. Receiver operating characteristic curves were constructed for continuous variables by using appropriate cutoff points to determine sensitivity and falsepositive rates. The results were validated by analyzing the 12 months immediately after the establishment of these rules. RESULTS:Of 847 appendectomies performed, 22 (2.6%) had a pathologically normal appendix. The only variables found to be normal in more than half of NAs were white blood cell (WBC) count (89%) and neutrophil count (79%). A receiver operating characteristic curve indicates that using WBC cutoffs of 9000 and 8000 per mL yielded sensitivities of 92% and 95%, respectively, and reduction in NA rates by 77% and 36%, respectively. Results observed in the subsequent 12 months confirmed these expected sensitivities and specificities.CONCLUSIONS: Absence of an elevated WBC count is a risk factor for NA. Withholding appendectomy for WBC counts ,9000 and 8000 per mL reduces the NA rate to 0.6% and 1.2%, respectively. Missed true appendicitis in patients with normal WBC counts can be mitigated by a trial of observation in those presenting with early symptom onset.

Background Triple-negative subtype (TNBC) and young patient age are both associated with an increased risk of local recurrence (LR) and distant recurrence (DR). In young women with TNBC, it is unclear whether subtype or patient age is driving prognosis. Methods Patients treated for primary TNBC from 1998 to 2011 were identified from the breast surgery database. Clinico-pathological characteristics, treatment, and outcomes were compared between patients < 40 and ≥ 40 years of age at diagnosis. Multivariate models were used to identify factors independently associated with LR and DR. Results Among 1930 patients with TNBC, 289 (15%) were < 40 and 1641 (85%) were ≥ 40 years of age at diagnosis. Younger patients were more likely to present with higher stage disease and more likely to receive mastectomy (p<0.01), axillary node dissection (p<0.01) and chemotherapy (p<0.01). At a median follow-up of 74 months (0-201.1) there was no difference in LR or disease-free survival (DFS) by age group (5 yr LR = 3.9% (95% CI 1.5-6.2) vs 4.5% (95% CI 3.5-5.6) and 5yr DFS = 75.3% (95% CI 70.2-80.7) vs. 77.7% (95% CI 75.6-79.8), p=0.94) in patients < 40 and ≥ 40 years respectively. On multivariate analysis, larger tumor size, lymphovascular invasion, and nodal positivity were associated with increased risk of DR. Age and type of surgery were not significantly associated with either outcome. Conclusion Young age at diagnosis is not an independent risk factor for LR or DR in patients with TNBC.

Women with DM with lower adherence had higher rates of NICU admission and worse glycemic control. Most outcomes among women with GDM with lower adherence were similar.