Patrinia scabiosaefolia, as traditional food and medicine plant, was used to treat appendicitis, enteritis, and hepatitis for thousand years in China. Patrinoside and patrinoside A isolated from P. scabiosaefolia could significantly improve insulin resistance (IR) by activating PI-3 K/AKT signaling pathway in our previous study. Since IR is closely related to inflammation, their anti-inflammatory activities in RAW264.7 inflammatory model induced by LPS and in 3 T3-L1 IR inflammatory model induced by TNF-α were evaluated to identify whether the effects on improving IR related to anti-inflammatory activity. In RAW264.7 cells, patrinoside and patrinoside A significantly inhibited the transcription and secretion of inflammatory mediators NO, TNF-α, and IL-6. Western blot analysis showed that the significant inhibition of phosphorylation of IκB and P65 and P38, ERK and JNK suggested that the effects were exerted through NF-κB pathway and MAPK pathway. In 3 T3-L1 cells, patrinoside and patrinoside A also inhibited the activation of NF-κB and MAPK pathways through inhibiting the transcriptions of inflammatory cytokines IL-6 and chemokines MCP-1 and MIP-1α. These events resulted in the inhibition of macrophages migration to adipocytes. In addition, patrinoside and patrinoside A ameliorated oxidative stress by inhibiting ROS release in LPS-stimulated RAW264.7 cells. In conclusion, patrinoside and patrinoside A could active PI-3 K/AKT pathway, inhibit NF-κB pathway, MAPK pathway, and improve oxidative stress, which showed multipathways on improving IR. These results provided the scientific basis for material basis and mechanism on improving IR of P. scabiosaefolia.

Our patient was a 69-year-old man being treated for hyperlipidemia. He was admitted to our hospital with the chief complaint of vomiting and abdominal pain. Abdominal computed tomography(CT)showed dilation of the distal small intestines, a small amount of ascites in the small intestines near the right pelvis, and a closed loop of the small intestine. Enhanced abdominal CT was performed to evaluate intestinal ischemia. Given the adequate blood flow to the wall, the small intestines forming the closed loop, and no increase in ascites, the patient was treated conservatively. Diagnostic laparoscopy was performed because of the narrowed lumen and incomplete obstruction observed on the abdominal CT and contrast- enhanced imaging of the ileal tube. The tip of the appendix adherent to the mesentery of the small intestines, approximately 80 cm from the ileum, and the omentum adherent to the bottom of the right pelvis caused the obstruction. A cord dissection and appendectomy were performed. Making the diagnosis was difficult because there was no history of appendicitis and the small intestinal obstruction was caused by adhesions in 2 places with no history of laparotomy.

A 49-year-old male patient, who presented with abdominal pain, was suspected of having acute appendicitis. Abdominal computed tomography revealed a swollen appendix, accompanied by a 40 mm low-density mass located behind the appendix. He was diagnosed with an appendiceal mucinous neoplasm, and laparoscopic ileocecal resection was performed. A soft tumor was found proximal to the swollen appendix and was adhered tightly to the iliopsoas muscle. The tumor cells were exfoliated carefully, and the tumor was excised en bloc without any injury. Histopathological examination revealed a low- grade appendiceal mucinous neoplasm(LAMN)accompanied by extra-appendiceal mucin extrusion due to the lack of epithelial lining. Because LAMN is potentially malignant, surgical excision was performed as first-line therapy. In the surgical management of LAMN, preventing intraoperative rupture is essential to avoid pseudomyxoma peritonei. To achieve this, a magnified laparoscopic surgery may be useful. Although no definitive guidelines describing the indications of lymph node dissection or the appropriate extent of resection exist, laparoscopic ileocecal resection may be used to manage cases of LAMN.

Background: Whether the positive associations of smoking and alcohol consumption with gastrointestinal diseases are causal is uncertain. We conducted this Mendelian randomization (MR) to comprehensively examine associations of smoking and alcohol consumption with common gastrointestinal diseases.

Acute appendicitis is the most common surgical emergency in children. However, it is uncommon in neonates and infants. Often it can be challenging to diagnose acute appendicitis in children due to atypical clinical presentation and nonspecific symptoms. This is particularly true in neonates and infants. A high level of clinical suspicion is needed to diagnose infantile appendicitis. Delayed diagnosis is associated with higher perforation rates and increased disease-related morbidity. Imaging plays a key role in the prompt diagnosis of acute appendicitis and its complications. We report two cases of perforated appendicitis in babies <6 months old.

Gut malrotation may result in failure of descent of the cecum to the right iliac fossa, resulting in the anomaly where the cecum and appendix are situated in the subhepatic/gallbladder region. Although the true incidence of subhepatic cecum or appendix is not known, there is a handful of case reports in the literature describing the diagnosis and management of subhepatic appendicitis and associated challenges. Some case reports describe subhepatic appendicitis, where the cecum is in a normal position, but the subhepatic tip of the long appendix gets perforated or inflamed, resulting in the process being in the subhepatic region. We report a patient with subhepatic appendicitis, who had multiple episodes of abdominal pain for almost one year, treated with antibiotics, but was never diagnosed properly. The case was diagnosed by abdominal sonography and was managed successfully in our institution.

The appendix is a vermiform-like organ that extends from the cecum and has been thought of as having a rudimentary immunologic function. However, the appendix can become distended and mucus-filled, classifying it as a mucocele appendix. Mucoceles can be found in various locations in the body, including the colon and the appendix, and have malignancy potential. We report a case of a 48-year-old male that presented to the ED with a history of two days of abdominal pain. Upon arriving at the ED, he had a CT scan showing a 9.5 x 4.2 x 6.4 cm fluid collection in the right lower quadrant (RLQ) juxtaposed to the cecum, suggesting appendicitis or an abscess. Initially, a laparoscopic approach was taken, which was then converted to an open laparotomy. The mass was excised and a right hemicolectomy was performed along with an ileocolonic anastomosis due to extensive involvement of the large intestine. Pathology reported a low-grade appendiceal mucinous neoplasm resected with negative margins and 16 negative lymph nodes.

Stump appendicitis is a rare, delayed complication of appendectomy. It is seen following both open and laparoscopic appendectomy and may occur weeks to years following the initial appendectomy. We report two cases of stump appendicitis seen at our hospital. Both cases were diagnosed based on radiological findings and successfully managed conservatively with antibiotics. Although the usually recommended treatment for stump appendicitis is completion appendectomy, conservative management may be suitable for some patients. This report highlights the possibility of utilizing a conservative approach in the management of stump appendicitis compared to the recommended operative intervention. Awareness of the possibility of stump appendicitis is crucial for early diagnosis and treatment, to prevent potentially catastrophic complications.

This study aimed to observe the impact of the COVID-19 outbreak on acute general surgery in the first German "hotspot" regions of Heinsberg and Aachen, during the first months of the pandemic. The incidence and severity of acute appendicitis, acute cholecystitis and mechanical bowel obstruction, were compared between March and May 2020 and a control period (same months of the previous three years). Pre-, intra- and postoperative data was compared between three regional hospitals of Heinsberg and the closest maximum care, university hospital. A total of 592 operated patients were included, 141 belonging to the pandemic cohort and 451 to the historic cohort. The pandemic group showed higher rates of clinical peritonitis (38% vs. 27%, p = 0.015), higher rates of mean white blood cell count (13.2±4.4 /nl vs. 12.3±4.7 /nl, p = 0.044) and mean C-reactive protein (60.3±81.1 mg/l vs. 44.4±72.6 mg/l, p = 0.015) preoperatively. Specifically in patients with acute appendicitis, there were less patients with catarrhal appendicitis (23% vs. 35%, p = 0.021) and a tendency towards more advanced histological findings in the pandemic cohort. In the university hospital, a 42% reduction in acute operated cases was observed at the onset of the pandemic (n = 30 in 2020 vs. n = 52 in 2019), whereas in the peripheral hospitals of Heinsberg there was only a 10% reduction (n = 111 in 2020 vs. n = 123 in 2019). The onset of the COVID-19 pandemic in our region was accompanied by advanced preoperative and intraoperative findings in patients undergoing emergency general surgery. A greater reduction in acute operated surgical cases was observed at the university hospital, in contrast to the smaller hospitals of Heinsberg, suggesting a possible shift of emergency patients, requiring immediate operation, from maximum care hospital to the periphery.

Mounting evidence suggests that acute appendicitis (AA) is not one but two diseases: complicated appendicitis, which is associated with necrosis leading to perforation or periappendicular abscess, and uncomplicated appendicitis, which does not necessarily result in perforation. Even though AA is the most frequent cause of surgery from abdominal pain, little is known about the origins and etiopathogenesis of this disease, much less regarding the different disease types. In this study, we investigated the microbiome (inter-domain amplicon and metagenome sequencing) of samples from the appendix, rectum and peritoneum of 60 children and adolescents with AA to assess the composition and potential function of bacteria, archaea and fungi. The analysis of the appendix microbial community revealed a shift depending on the severity of the AA. This shift was reflected by two major community state types that represented the complicated and uncomplicated cases. We could demonstrate that complicated, but not uncomplicated, appendicitis is associated with a significant local expansion of oral, bacterial pathogens in the appendix, most strongly influenced by necrotizing Fusobacterium spp., Porphyromonas and Parvimonas. Uncomplicated appendicitis, however, was characterized by gut-associated microbiomes. Our findings support the hypothesis that two disease types exist in AA, which cannot be distinguished beyond doubt using standard clinical characterization methods or by analysis of the patient's rectal microbiome. An advanced microbiome diagnosis, however, could improve non-surgical treatment of uncomplicated AA.