Duplicated gallbladder with acute cholecystitis:a case of unusual presentation and diagnostic challenges

Anomalies in the gallbladder can lead to misidentifying anatomical structures,heightening the risk of complications in laparoscopic and open cholecystectomy procedures.Failure to recognize these variations increases the chances of iatrogenic bile duct injuries and other complications.

Magnetic resonance imaging evaluation of head and neck involvement in IgG4-related disease

Objective:To evaluate the radiological features of IgG4-related disease(IgG4-RD)in the head and neck region.Methods:In this radiology-based study,radiological features,clinical,laboratory,pathological findings,and prognosis of nine patients with head and neck involvement diagnosed with IgG4-RD were investigated retrospectively.Results:The median age of the patients was 38 years(range:2.5-79 years),and there were six males and three females.The most common symptoms and clinical findings of the patients were eyelid and lacrimal gland swelling,painless exophthalmos,and ophthalmoplegia.The most common site of involvement on MRI was the orbit.Orbital involvement was followed by branches of the trigeminal nerve,sinonasal cavity,cervical lymph nodes,and dural involvement.The most common and remarkable imaging features were T2 hypointensity and diffuse homogeneous contrast enhancement.Conclusions:Head and neck involvement of the IgG4-RD,has specific imaging features that can help with diagnosis.Thus,early diagnosis and better outcomes can be achieved with increasing awareness of these features of this relatively new pathology.

Management of diabetic foot ulcers and the challenging points:An endocrine view

Diabetic foot ulcers(DFU)are one of the most challenging complications of diabetes.Up to one-third of patients with diabetes mellitus(DM)may suffer from DFUs during their life.DFU is one of the leading causes of morbidity in patients with DM.The treatment period is challenging,and the recurrence rate of DFUs is high.Hence,establishing prevention strategies is the most important point to be emphasized.A multidisciplinary approach is necessary in the prevention and treatment of DFUs.Patients at risk should be identified,and prevention measures should be taken based on the risk category.Once a DFU is formed,the appropriate classification and evidence-based treatment interventions should be executed.Glycemic control,diagnosis and treatment of vascular disease,local wound care,diagnosis,and treatment of infection should be addressed along with the proper evaluation and management of general health status.

Evaluation of penile hemodynamic status and adjustment of treatment alternatives in Peyronie's disease

Aim:Erectile dysfunction may be observed in up to 80%of patients with Peyronis's disease.An objective evaluation of the erectile function is attempted to work out in patients with Peyronie's disease.Methods:Penile deformity,sexual function and penile vascular status were analyzed in 123patients with Peyronis's disease,who had not received any pertinent treatment.Results:Penile edformity,palpable plaque and pain on erection were seen in112(91%),97(78.8%)and27(21.9%)of the123patients,respectively.Of the 76patients evaluated by color Doppler ultrasounography,veno-occlusive dysfunction as the vascular component for erectile dysfunction was found in 17(22.3%),arterial insufficiency in10(13.1%)and a mixed picture in 23(30.2%).Conclusion:The documentation of penile erectile function and the determination of the vascular status using color Doppler ultrasonography can guide the appropriate therapeutic choice.

A novel mutation of SGK-1 gene in central serous chorioretinopathy

AIM: To investigate the association of serum glucocorticoid kinase gene-1(SGK-1) DNA variants with chronic central serous chorioretinopathy(CSC).METHODS: We enrolled 32 eyes of 32 patients who were diagnosed with chronic CSC and composed 32 normal eyes as a control group. Peripheral blood was used for DNA extraction and polymerase chain reaction amplification. SGK1 gene was sequenced by using Big Dye Terminator v3.1 cycle sequencing Kit(Applied Biosystems, Foster City, CA, USA). The SGK-1 gene and its variants were investigated in CSC patient group and control group.RESULTS: We identified a new polymorphism M32 V in two person in the patient group [Minor allele frequency(MAF) =0.009] on the region of 1-60 amino acids. The rs1057293 was located in the encoder region of the SGK- 1 gene but not associated with CSC(P =0.68). An intrinsic rs1743966 is also not associated(P =0.28).CONCLUSION: The new polymorphism M32 V is located on the region of 1-60 amino acids which is necessary for localization to the mitochondria in CSC patient. This mutation is probably important for the energy metabolism and plays an important role in the cellular response to hyperosmotic stress and other stress stimuli. Both rs1057293 and rs1743966 are not associated with CSC.

Genome engineering and disease modeling via programmable nucleases for insulin gene therapy;promises of CRISPR/Cas9 technology

Targeted genome editing is a continually evolving technology employing programmable nucleases to specifically change,insert,or remove a genomic sequence of interest.These advanced molecular tools include meganucleases,zinc finger nucleases,transcription activator-like effector nucleases and RNA-guided engineered nucleases(RGENs),which create double-strand breaks at specific target sites in the genome,and repair DNA either by homologous recombination in the presence of donor DNA or via the error-prone non-homologous end-joining mechanism.A recently discovered group of RGENs known as CRISPR/Cas9 gene-editing systems allowed precise genome manipulation revealing a causal association between disease genotype and phenotype,without the need for the reengineering of the specific enzyme when targeting different sequences.CRISPR/Cas9 has been successfully employed as an ex vivo gene-editing tool in embryonic stem cells and patient-derived stem cells to understand pancreatic beta-cell development and function.RNA-guided nucleases also open the way for the generation of novel animal models for diabetes and allow testing the efficiency of various therapeutic approaches in diabetes,as summarized and exemplified in this manuscript.

Development of therapeutic options on type 2 diabetes in years:Glucagon-like peptide-1 receptor agonist’s role intreatment; from the past to future

Diabetes mellitus (DM) is a chronic metabolic disease characterized by hyperglycemia.Type 2 diabetes (T2DM) accounting for 90% of cases globally.The worldwide prevalence of DM is rising dramatically over the last decades,from 30 million cases in 1985 to 382 million cases in 2013.It’s estimated that 451 million people had diabetes in 2017.As the pathophysiology was understood over the years,treatment options for diabetes increased.Incretin-based therapy is one of them.Glucagon-like peptide-1 receptor agonist (GLP-1 RA) not only significantly lower glucose level with minimal risk of hypoglycemia but also,they have an important advantage in themanagement of cardiovascular risk and obesity.Thus,we will review here GLP-1 RAsrole in the treatment of diabetes.

Surgical results of the slipped medial rectus muscle after hang back recession surgery

AIM: To analyze the surgical results of a slipped medial rectus muscle(MRM) after hang back recession surgery for esotropia.METHODS: Twenty-one patients who underwent reexploration for diagnosed slipped muscle after hang back recession surgery were included in this retrospective study. Dynamic magnetic resonance imaging was performed to identify the location of the slipped muscle.Ocular motility was evaluated with assessment with prism and cover test in gaze at cardinal positions. The operations were performed by the same consultant.Intraoperative forced duction test was performed under general anesthesia. The empty sheath of the slipped MRM was resected and the muscle was advanced to the original insertion site in all patients.RESULTS: The average age of 21 patients who had consecutive exotropia with a slipped MRM at the time of presentation was 17.4±5.4y(5-50y). The average duration between the first operation and the diagnosis of the slipped muscle was 25mo(12 to 36mo). The mean follow up after the corrective surgery was 28 mo. The mean preoperative adduction limitation in the field of action of the slipped muscle was-2.26(ranging from-1 to-4). All patients had full adduction postoperatively.CONCLUSION: The diagnosis of the slipped muscle should be confirmed during the strabismus surgery. The slipped muscle may be caused due to insufficient suture and excessive rubbing of the eye. When divergent strabismus is observed after the recession of the MRM, a slipped muscle should be considered in the differential diagnosis.

FGF-2 is required to prevent astrogliosis in the facial nucleus after facial nerve injury and mechanical stimulation of denervated vibrissal muscles

Recently,we have shown that manual stimulation of paralyzed vibrissal muscles after facial-facial anastomosis reduced the poly-innervation of neuromuscular junctions and restored vibrissal whisking.Using gene knock outs,we found a differential dependence of manual stimulation effects on growth factors.Thus,insulin-like growth factor-1 and brain-derived neurotrophic factor are required to underpin manual stimulation-mediated improvements,whereas FGF-2 is not.The lack of dependence on FGF-2 in mediating these peripheral effects prompted us to look centrally,i.e.within the facial nucleus where increased astrogliosis after facial-facial anastomosis follows "synaptic stripping".We measured the intensity of Cy3-fluorescence after immunostaining for glial fibrillary acidic protein(GFAP) as an indirect indicator of synaptic coverage of axotomized neurons in the facial nucleus of mice lacking FGF-2(FGF-2^(-/-) mice).There was no difference in GFAP-Cy3-fluorescence(pixel number,gray value range17-103) between intact wildtype mice(2.12± 0.37×10~7) and their intact FGF-2^(-/-) counterparts(2.12±0.27×10~7) nor after facial-facial anastomosis +handling(wildtype:4.06±0.32×10~7;FGF-2^(-/-):4.39±0.17×10~7).However,after facial-facial anastomosis,GFAP-Cy3-fluorescence remained elevated in FGF-2^(-/-)-animals(4.54±0.12×10~7),whereas manual otimulation reduced the intensity of GFAP-immunofluorescence in wild type mice to values that were not significantly different from intact mice(2.63±0.39×10).We conclude that FGF-2 is not required to underpin the beneficial effects of manual stimulation at the neuro-muscular junction,but it is required to minimize astrogliosis in the brainstem and,by implication,restore synaptic coverage of recovering facial motoneurons.

Diabetes-induced changes in cardiac voltage-gated ion channels

Diabetes mellitus affects the heart through various mechanisms such as microvascular defects,metabolic abnormalities,autonomic dysfunction and incompatible immune response.Furthermore,it can also cause functional and structural changes in the myocardium by a disease known as diabetic cardiomyopathy(DCM)in the absence of coronary artery disease.As DCM progresses it causes electrical remodeling of the heart,left ventricular dysfunction and heart failure.Electrophysiological changes in the diabetic heart contribute significantly to the incidence of arrhythmias and sudden cardiac death in diabetes mellitus patients.In recent studies,significant changes in repolarizing K+currents,Na+currents and L-type Ca^(2+)currents along with impaired Ca^(2+ )homeostasis and defective contractile function have been identified in the diabetic heart.In addition,insulin levels and other trophic factors change significantly to maintain the ionic channel expression in diabetic patients.There are many diagnostic tools and management options for DCM,but it is difficult to detect its development and to effectively prevent its progress.In this review,diabetes-associated alterations in voltage-sensitive cardiac ion channels are comprehensively assessed to understand their potential role in the pathophysiology and pathogenesis of DCM.

Trace elements in diabetic cardiomyopathy:An electrophysiological overview

There is a growing body of evidence that Diabetes Mellitus leads to a specific cardiomyopathy apart from vascular disease and bring about high morbidity and mortality throughout the world.Recent clinical and experimental studies have extensively demonstrated that this cardiomyopathy causes impaired cardiac performance manifested by early diastolic and late systolic dysfunction.This impaired cardiac performance most probably have emerged upon the expression and activity of regulatory proteins such as Na+/Ca2+exchanger,sarcoplasmic reticulum Ca2+-ATPase,ryanodine receptor and phospholamban.Over years many therapeutic strategies have been recommended for treatment of diabetic cardiomyopathy.Lately,inorganic elements have been suggested to have anti-diabetic effects due to their suggested ability to regulate glucose homeostasis,reduce oxidative stress or suppress phosphatases.Recent findings have shown that trace elements exert many biological effects including insulin-mimetic or antioxidant activity and in this manner they have been recommended as potential candidates for treatment of diabetes-induced cardiac complications,an effect based on their modes of action.Some of these trace elements are known to play an essential role as component of enzymes and thus modulate the organ function in physiological and pathological conditions.Besides,they can also manipulate redox state of the channels via antioxidant properties and thus contribute to the regulation of [Ca2+]i homeostasis and cardiac ion channels.On account of little information about some trace elements,we discussed the effect of vanadium,selenium,zinc and tungstate on diabetic heart complications.

Primary pancreatic hydatid disease associated with acute pancreatitis

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