Evidence from multiple studies shows that the appendix may play a significant role in the pathogenesis of ulcerative colitis (UC). These findings have sparked interest in the possibility of appendicectomy as a potential adjunctive strategy in UC. This narrative review was conducted by synthesizing data from meta-analyses, immunological research, surgical case studies, population data reports, and prospective trials published since 2000. The evidence was appraised with a focus on appendicectomy and its clinical outcomes in UC, risks and limitations, as well as possible future directions. Observational studies show a reduced risk of colectomy and UC-related hospital admissions when appendicectomy is performed before UC diagnosis. On the other hand, appendicectomy post UC diagnosis in the presence of appendiceal inflammation has shown increased risk of colectomy. But if an appendicectomy is performed in the absence of inflammation, it might not correlate to the risk or reduce the risk of relapse and complications. Evidence also shows that patients with refractory UC may benefit from appendicectomy and may show longer periods of remission. However, some studies show appendicectomy might increase the colorectal cancer risk due to alterations in immunity and microbiota. While medical management remains the first line, appendicectomy may act as an adjunct surgical option in carefully selected cases before escalating to a colectomy. Large multicenter studies and randomized clinical trials are required to identify strategies for patient selection, potential complications, durability of response, and long-term outcomes.

Patients with chronic obstructive pulmonary disease (COPD) often suffer episodes of exacerbation (ECOPD). Respiratory syncytial virus (RSV) is an increasingly recognised cause of illness in adults. Yet the prevalence of RSV during ECOPD and its association with clinically relevant outcomes remain insufficiently defined. The RECODE study sought to determine the prevalence of RSV infection in patients with ECOPD and to assess the association between RSV and hospitalisation, length of stay, acute cardiovascular events and/or death.

Colonic diverticulitis is rare in the pediatric population and often presents with nonspecific symptoms that may be misdiagnosed as other causes of acute abdominal pain, such as appendicitis, leading to diagnostic uncertainty and variability in management. We report a case of pediatric colonic diverticulitis and present a systematic review to characterize its clinical presentation, diagnostic challenges and management. Clinical data for the index patient were retrospectively reviewed, and parental consent was obtained. A structured literature search was performed using PubMed, Scopus, and Embase. Studies reporting patients younger than 18 years were included. A 16-year-old male presented with right lower quadrant pain. CT suggested cecal diverticulitis. Worsening symptoms prompted diagnostic laparoscopy, revealing an inflamed diverticulum adjacent to a normal appendix. The postoperative course was uneventful. The review identified 27 studies including 101 patients. Median age was 14 years (IQR 12-16; range 3-17), with 57% male preponderance. Most cases involved a solitary right-sided diverticulum. CT correctly identified diverticulitis in 85%. Complicated disease occurred in 17%. In conclusion, in the pediatric age diverticulitis often arises from a solitary cecal diverticulum and can closely mimic appendicitis. Awareness may improve diagnosis, and uncomplicated cases can be treated conservatively with careful follow-up and appropriate clinical monitoring.

A perforated duodenal ulcer is a potentially life-threatening surgical emergency that may present with generalized peritonitis and require prompt operative management. Although most cases are related to peptic ulcer disease, clinical presentation following blunt abdominal trauma can create diagnostic uncertainty, particularly when imaging findings are non-specific or suggest an alternative intra-abdominal source. We report the case of a 68-year-old man with no significant medical history who presented with progressive abdominal pain four days after a ground-level fall. Physical examination revealed generalized peritoneal irritation, while contrast-enhanced computed tomography demonstrated large-volume free intraperitoneal fluid, diffuse bowel distension, and findings suspicious for acute appendicitis, without clear preoperative localization of the gastrointestinal perforation site. Emergent exploratory laparotomy revealed approximately 2 L of gastroduodenal contents, extensive fibrinous exudate, dense interloop adhesions, and a 1 cm perforation on the anterior wall of the first portion of the duodenum. The appendix was also enlarged, erythematous, and edematous. Biopsies of the ulcer margins were obtained, followed by primary duodenal repair, appendectomy, extensive peritoneal lavage, and drain placement. The postoperative course was uncomplicated, with gradual diet advancement and discharge on postoperative day 7. Histopathology showed perforated duodenal tissue with ischemic necrosis and edema, without dysplasia or malignancy, and confirmed acute appendicitis with mucosal ulceration and hemorrhagic changes. This case highlights that, in patients with generalized peritonitis, the decision for urgent surgical exploration should be driven primarily by clinical findings and the need for timely source control, while preoperative imaging may assist diagnosis but may not always precisely localize the perforation site.

Human T-lymphotropic virus type 1 (HTLV-1) is associated with immune dysregulation, opportunistic infections, and, less commonly, lymphoproliferative and inflammatory disorders. We report the case of a young woman presenting with acute appendicitis, hyperkeratotic skin lesions, onychodystrophy, and subsequent facial diplegia. Investigation revealed HTLV-1 infection and crusted scabies, supporting an underlying immunosuppressed state. Histopathological examination of the appendix showed a transmural, angiocentric lymphocytic infiltrate involving small- and medium-sized vessels, without fibrinoid necrosis or leukocytoclasia. Immunohistochemical analysis demonstrated a predominance of CD4+ T lymphocytes with low proliferative index, consistent with a reactive process. These findings support a diagnosis of lymphocytic vasculitis presenting as acute appendicitis. Although a causal relationship cannot be definitively established, the clinicopathological and immunophenotypic features suggest a potential association with HTLV-1 infection, which has not been previously reported in this setting.

Appendiceal neuroendocrine tumors (NETs), historically referred to as carcinoid tumors, are the most common primary neoplasms of the appendix and are frequently diagnosed incidentally following surgery for suspected acute appendicitis. Preoperative diagnosis is uncommon because their clinical presentation often mimics inflammatory appendiceal disease. We report the case of a 30-year-old male who presented with a 48-hour history of right lower quadrant abdominal pain, nausea, vomiting, and fever, consistent with acute appendicitis. Due to clinical suspicion of complicated appendicitis, the patient underwent emergency exploratory laparotomy. Intraoperative exploration revealed a firm heterogeneous mass measuring approximately 6 cm involving the appendix, cecum, and ileocecal valve, prompting en bloc surgical resection with protective ileostomy. Gross examination demonstrated an exophytic appendiceal mass with irregular contours. Histopathological analysis confirmed a well-differentiated appendiceal neuroendocrine tumor with negative surgical margins. Postoperative thoracoabdominopelvic computed tomography showed no evidence of lymph node involvement, local recurrence, or distant metastases. The patient experienced an uneventful postoperative recovery and was referred for oncologic follow-up. This case highlights the importance of considering appendiceal neoplasms in patients presenting with acute appendicitis and underscores the role of intraoperative assessment, histopathological evaluation, and appropriate surgical management in achieving favorable outcomes.

The increasing incidence of early-onset cancers is a growing concern. Using newly released Surveillance Epidemiology and End Results (SEER) data incorporating 2023 incidence rates, we evaluated emerging trends by comparing 5-year average annual percent changes (AAPC) in incidence rates for 2018-2022 and 2019-2023 across the 22 most common cancer types in individuals under 50 years of age. The AAPC changed significantly for liver and intrahepatic bile duct cancer from 2.6% (non-significant) in 2018-2022 to 3.7% (increasing) in 2019-2023. For non-Hodgkin lymphoma and lung and bronchus cancer, AAPCs changed from -0.5% to 1.1% and from -2.0% to 0.3%, respectively (decreasing to non-significant). A continuous increase in incidence rates was observed for cancers including but not limited to colorectal cancer (excluding appendix) and ovarian cancer. These findings underscore the need for robust cancer registry data to support surveillance research and inform prevention and control efforts in younger populations.

Illegal wildlife trade and other forms of wildlife crime pose significant threats to global biodiversity. Accurate species identification of wildlife products is crucial for effectively combating illegal wildlife trade. In recent years, forensic species identification using molecular methods has gained increasing attention. Here, we report a case involving 1777 trafficked fish maws and 18,170 trafficked shark fins. We employed DNA barcoding for forensic species identification and a large-sample inference strategy for population estimation. A total of 325 samples (197 fish maws and 128 shark fins) were randomly selected for DNA testing based on their pre-classified morphological categories. Two DNA barcodes (COI and 16S) were used, and sequence alignment was conducted using the NCBI GenBank and BOLD systems. Phylogenetic analyses were performed based on sequences detected from the samples and reference sequences, with results consistent with the sequence alignment. Consequently, seven species were identified, four of which, corresponding to approximately 17,351 to 18,170 specimens, are listed in Appendix II of the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES).

During human B cell maturation, immature transitional (T1) cells transit from bone marrow into the blood. At the subsequent immature T2 stage, a separation into IgM[hi] (T2M[hi]) and IgM[lo] (T2M[lo]) developmental trajectories has been proposed. Here, we isolate T1, T2M[hi] and T2M[lo] cells from human adult and cord blood for bulk and single-cell ATAC-seq, CUT&RUN, RNA-seq and CITE-seq to profile their transcriptomic and epigenetic differences. We identify accessible chromatin domains discriminating between T2M[hi] and T2M[lo] cells in peripheral B cell development, with signatures persisting during the differentiation of T2M[lo] to naïve B cells. Similarly, memory and marginal zone B cells retain epigenetic hallmarks of their T2M[lo] and T2M[hi] precursors, coupled with transcriptional diversity. Imaging mass cytometry with RNAscope of spleen, appendix and tonsil further validates the spatial relationships of expressed genes. Our study thus provides insights into B lineage T2 bifurcation and describes epigenetic signatures of B cell developmental pathways.