Making the diagnosis of acute appendicitis is difficult, and is important for preventing perforation of the appendix and negative appendectomy results. Ultrasound and clinical scoring systems are very helpful in making the diagnosis. Ultrasound is non-invasive, available and cost-effective, and can accomplish more than CT scans. However, there is no certainty about its effect on the clinical outcomes of patients, and it is operator dependent. Counting the neutrophils as a parameter of the Alvarado Scale is not routine in many laboratories, so we decided to evaluate the diagnostic value of the Modified Alvarado Scaling System (MASS) by omitting the neutrophil count and ultrasonography.

Despite increasing trend in single incision laparoscopic cholecystectomy (SILC), there is still controversy regarding its global acceptance as a routine practice. Our study aimed to compare surgical events, early in-hospital and later outcomes of SILC with conventional multiport laparoscopic cholecystectomy (LC). Through a randomized controlled trial (RCT) between June and December 2011, 90 consecutive patients with documented biliary diseases waiting for LC were equally allocated to 3-port, 4-port, and single incision LC group. Operative time, surgical adverse events, postoperative pain according to visual analogue scale (VAS), total morphine administration, length of hospital stay, and cosmetic outcomes were compared between these three groups. A total of 27 males (30%) and 63 females (70%) were enrolled in this study. The average patients' age and BMI were 42.6 ± 12.1 years and 26.2 ± 2.7 kg/m(2), respectively. Operative time in SILC group was significantly longer than other groups. Total intraoperative adverse events and postoperative complications did not differ significantly between the three groups. Mean ± SD VAS score at rest was significantly lower (p < 0.05) in SILC group. The average VAS at coughing was significantly lower in SILC group in all time intervals except the first 6 hr (p < 0.05). In addition, total morphine dose showed significantly lower amount in SILC group (p = 0.02). 12-month follow-up did not reveal significant difference between the study groups (p > 0.05). SILC is associated with less postoperative pain in later hours, reduces in-hospital analgesic dosages, has longer procedure time, but does not increase intraoperative and postoperative adverse events It seems that SILC has no obvious advantages in terms of later outcomes.

Promoter methylation in a number of tumor-suppressor genes (TSGs) can play crucial roles in the development of thyroid carcinogenesis. The focus of the current meta-analysis was to determine the impact of promoter methylation of eight selected candidate TSGs on thyroid cancer and to identify the most important molecules in this carcinogenesis pathway. A comprehensive search was performed using Pub Med, Scopus, and ISI Web of Knowledge databases, and eligible studies were included. The methodological quality of the included studies was evaluated according to the Newcastle Ottawa scale table and pooled odds ratios (ORs); 95% confidence intervals (CIs) were used to estimate the strength of the associations with Stata 12.0 software. Egger’s and Begg’s tests were applied to detect publication bias, in addition to the “Metatrim” method. A total of 55 articles were selected, and 135 genes with altered promoter methylation were found. Finally, we included eight TSGs that were found in more than four studies (RASSF1, TSHR, PTEN, SLC5A, DAPK, P16, RARβ2, and CDH1). The order of the pooled ORs for these eight TSGs from more to less significant was CDH1 (OR = 6.73), SLC5 (OR = 6.15), RASSF1 (OR = 4.16), PTEN (OR = 3.61), DAPK (OR = 3.51), P16 (OR = 3.31), TSHR (OR = 2.93), and RARβ2 (OR = 1.50). Analyses of publication bias and sensitivity confirmed that there was very little bias. Thus, our findings showed that CDH1 and SCL5A8 genes were associated with the risk of thyroid tumor genesis.