Appendix redux: a stone unturned

Costa, Alan de

doi:10.1111/ans.16018

Cited by 5 publications

(5 citation statements)

References 47 publications

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“…Finally, we did not analyze bacterial proteins found within the appendicoliths. With interest in the role of the intestinal microbiome in the pathogenesis of acute appendicitis growing [54][55][56] , this would be a fertile area for future research.…”

Section: Discussionmentioning

confidence: 99%

Elemental, fatty acid, and protein composition of appendicoliths: Clues for understanding the pathogenesis of acute appendicitis

Prieto

Wang

Halbach

et al. 2022

Preprint

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Appendicoliths are commonly found obstructing the lumen of the appendix at the time of appendectomy. To identify factors that might contribute to their formation we investigated the composition of appendicoliths using laser ablation inductively coupled plasma mass spectroscopy, gas chromatography, polarized light microscopy, X-ray crystallography, and protein mass spectroscopy. Forty-eight elements, 32 fatty acids, and 109 human proteins were identified within the appendicoliths. The most common elements found in appendicoliths are calcium and phosphorus, 11.0 + 6.0 and 8.2 + 4.2 % weight, respectively. Palmitic acid (29.7%) and stearate (21.3%) are the most common fatty acids. Some stearate is found in crystalline form—identifiable by polarized light microscopy and confirmable by X-ray crystallography. Appendicoliths have an increased ratio of omega-6 to omega-3 fatty acids (ratio 22:1). Analysis of 16 proteins common to the appendicoliths analyzed showed antioxidant activity and neutrophil functions (e.g., activation and degranulation) to be the most highly enriched pathways. Considered together, these preliminary findings suggest oxidative stress may have a role in appendicolith formation. Further research is needed to determine how dietary factors such as omega-6 fatty acids and food additives, redox-active metals, and the intestinal microbiome interact with genetic factors to predispose to appendicolith formation.

show abstract

Section: Discussionmentioning

confidence: 99%

Elemental, fatty acid, and protein composition of appendicoliths: Clues for understanding the pathogenesis of acute appendicitis

Prieto

Wang

Halbach

et al. 2022

Preprint

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show abstract

Section: Discussionmentioning

confidence: 99%

Elemental, fatty acid, and protein composition of appendicoliths

Prieto

Wang

Halbach

et al. 2022

Sci Rep

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Appendicoliths are commonly found obstructing the lumen of the appendix at the time of appendectomy. To identify factors that might contribute to their formation we investigated the composition of appendicoliths using laser ablation inductively coupled plasma mass spectroscopy, gas chromatography, polarized light microscopy, X-ray crystallography and protein mass spectroscopy. Forty-eight elements, 32 fatty acids and 109 human proteins were identified within the appendicoliths. The most common elements found in appendicoliths are calcium and phosphorus, 11.0 ± 6.0 and 8.2 ± 4.2% weight, respectively. Palmitic acid (29.7%) and stearate (21.3%) are the most common fatty acids. Some stearate is found in crystalline form—identifiable by polarized light microscopy and confirmable by X-ray crystallography. Appendicoliths have an increased ratio of omega-6 to omega-3 fatty acids (ratio 22:1). Analysis of 16 proteins common to the appendicoliths analyzed showed antioxidant activity and neutrophil functions (e.g. activation and degranulation) to be the most highly enriched pathways. Considered together, these preliminary findings suggest oxidative stress may have a role in appendicolith formation. Further research is needed to determine how dietary factors such as omega-6 fatty acids and food additives, redox-active metals and the intestinal microbiome interact with genetic factors to predispose to appendicolith formation.

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“…It also retains a rich microorganism-generated and protective biofilm that can replenish healthy gut microflora following gastrointestinal disturbances. 7 Increasing reported rates of appendicitis in newly industrialised countries 8 coincide with improved diagnostic tests, the shift towards 'Western' lifestyle with lower fibre diets and environmental triggers that accompany urbanisation. 8 Rates and outcomes of appendicitis are partially determined by geography and socioeconomic factors.…”

Section: Introductionmentioning

confidence: 99%

“…Once considered to be a vestigial organ, the appendix contains lymphocyte aggregates and submucosal follicles indicating immune function. It also retains a rich microorganism‐generated and protective biofilm that can replenish healthy gut microflora following gastrointestinal disturbances 7 . Increasing reported rates of appendicitis in newly industrialised countries 8 coincide with improved diagnostic tests, the shift towards ‘Western’ lifestyle with lower fibre diets and environmental triggers that accompany urbanisation 8…”

Section: Introductionmentioning

confidence: 99%

Appendicitis in Far North Queensland: a new take on an old story

Swift

Thompson

Roeder

et al. 2021

ANZ Journal of Surgery

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Background Appendicitis is a leading cause of surgical hospital admission. To date, there have been no published epidemiological studies describing appendicitis in tropical and remote Australia and none specifically documenting appendicitis in Indigenous Australians. This descriptive study used available state data to investigate appendicitis across Far North Queensland (FNQ). Methods Queensland Health hospital admission data for FNQ was analysed to explore appendicitis epidemiology and outcomes in FNQ, 2012–2018. Population data for the same time period provided rates. Results Over the study period, 3458 hospital presentations for appendicitis were available for analysis. Mean incidence was 178 per 100 000/yr. Median age was 27 years with 50.1% female patients. The annual rate of appendicitis was higher in the Indigenous population. Most patients had a laparoscopic procedure with a low rate of conversion to open surgery (2.6%). More than 80% of patients were discharged from hospital in less than 3 days. Intensive care (ICU) admission rate was low overall (1.1%) although higher for Indigenous people (2.4%). Following discharge, the hospital re‐admission rate was 3.8% and all‐cause mortality was 0.03%. Conclusion The incidence of appendicitis in FNQ is higher than that reported in the rest of Australia in both Indigenous and non‐Indigenous populations. Despite logistical challenges of health care, clinical outcomes are in line with best practice across the country. Clinicians in FNQ should maintain a high index of suspicion for diagnosing appendicitis in rural and remote settings.

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Appendix redux: a stone unturned

Abstract: Recent advances in understanding of the biology of appendicitis are reviewed. Immunological aspects are discussed in the setting of a changing microbiome. Implications for practice are summarized.

Cited by 5 publications

References 47 publications

Elemental, fatty acid, and protein composition of appendicoliths: Clues for understanding the pathogenesis of acute appendicitis

Elemental, fatty acid, and protein composition of appendicoliths: Clues for understanding the pathogenesis of acute appendicitis

Elemental, fatty acid, and protein composition of appendicoliths

Appendicitis in Far North Queensland: a new take on an old story

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