Attachment of vermiform appendix to the right lobe of liver through a fibrous band - a rare observation.

Vermiform appendix is a highly variable organ, which is an enigma to the surgeon in terms of its position, size and symptoms. Attachment of its tip to the surrounding organs is relatively rare. Here we present a rare variation of vermiform appendix. The appendix was 12cm long and was in retrocecal and retrocolic position. Its tip was attached to the right lobe of the liver through a fibrous band which was 2cm long. This variation might pose difficulties in appendicular resection, renal and hepatic surgeries.

Unusual contribution of the first jejunal vein in the formation of the portal vein.

Jejunum is drained into superior mesenteric vein through a series of jejunal veins. The way in which the first jejunal vein terminates is of great importance in upper abdominal surgery and radiological procedures. Knowledge of its variations is particularly important in surgical procedures like orthotropic hepatic transplantation, hepatic vein reconstruction, pancreatic surgery and surgical procedures of duodenojejunal junction. We saw a first jejunal vein opening directly into the portal vein. Further, the inferior mesenteric vein drained into the first jejunal vein. This case could be useful to gastroenterologists, general surgeons and radiologists.

Innervation of the scrotum by the anterior division of the obturator nerve - a rare variation.

The scrotum is supplied by ilioinguinal, genital branch of genitofemoral, perineal branch of the posterior cutaneous nerve of the thigh and the posterior scrotal branches of the pudendal nerve. We report an extremely rare innervation of the anterior part of the scrotum by the anterior division of the right obturator nerve. The genital branch of genitofemoral nerve did not reach the scrotum. The ilioinguinal nerve did not supply the scrotum. The anterior division of the obturator nerve gave a branch which ascended superomedially in the thigh, crossed superficial to the spermatic cord and communicated with the right ilioinguinal nerve. As it crossed the spermatic cord, it gave a scrotal branch which descended over the spermatic cord and ramified to supply the anterior part of the scrotum. Knowledge of this variation could be important to anaesthesiologists, urologists and surgeons in general.

Variant formation of left common iliac vein by the confluence of four veins.

Common iliac vein variations are relatively rare compared to the variations of external and internal iliac veins. A rare pattern of formation of common iliac vein by the confluence of four veins is being reported here. The left common iliac vein was formed by the union of left external iliac vein, internal iliac vein, iliolumbar vein and a common trunk formed by the obturator and vesical veins. External iliac vein and obturator veins were connected by a communicating vein. Both external and common iliac veins were respectively medial to the external and common iliac arteries. Knowledge of this variant formation of common iliac vein could be useful to radiologists, gynecologists and orthopedic surgeons.

Complete enclosure of gall bladder inside the lesser omentum - a rare anomaly.

Gall bladder is known for many congenital anomalies such as duplication, intrahepatic position, floating position etc. Most of its anomalies can be detected in ultrasound examination and radiography. We report an extremely rare congenital anomaly of gall bladder as observed in a male cadaver during dissection classes. The gall bladder was totally enclosed in the right free margin of the lesser omentum, in front of the usual contents of the right free margin of lesser omentum. The size, shape and blood supply of the gall bladder were normal. Though this anomaly might not cause any functional disturbances, it might result in complications during laparoscopic cholecystectomy.

Accessory slip of flexor digitorum accessorius (Quadratus plantae) muscle surrounding the lateral plantar nerve and vessels.

Flexor digitorum accessorius (quadratus plantae) is a muscle of second layer of the sole of the foot. Though it is not a very important muscle in terms of movements or stability of foot, it could pose problems when it presents variations. We observed a novel, accessory slip of flexor digitorum accessorius. The slip arose from the fascia covering abductor digiti minimi muscle and got inserted into the tendon of the flexor digitorum longus muscle. It was supplied by a branch from lateral plantar nerve. The proximal part of this accessory slip surrounded the lateral plantar nerve and vessels. Compression of lateral plantar nerve by this accessory slip might produce symptoms similar to that of tarsal tunnel syndrome and lead to misdiagnosis. The case could be of importance to foot and ankle surgeons and radiologists.

Obstruction of BRAFV600E transcription by complementary PNA oligomers as a means to inhibit BRAF-mutant melanoma growth.

Peptide nucleic acid (PNA) oligomers are DNA mimics, which are capable of binding gene sequences 1000-fold more avidly than complementary native DNA by strand invasion and effectively obstruct transcription. Irreversibly obstructing the transcription or replication of a gene sequence, such as BRAFV600E, offers a potential route to specifically target the cancer cell itself. We have employed PNA oligomers to target BRAFV600E in a sequence-specific complementary manner. These PNAs have been modified by appending configurationally stabilizing cationic peptides in order to improve their cellular delivery and target avidity. Our results indicate that exposure of the melanoma cell lines to a modified PNA-peptide conjugate complementary to BRAFV600E mutation sequence results in a concentration-dependent and time-dependent inhibition of cell growth that is specific for the BRAFV600E-mutant melanoma cell lines with inhibition of mRNA and protein expression. Xenograft mouse trials show increased tumor growth delay and necrosis with the BRAFV600E-complementary PNA-peptide conjugates as compared with the saline and scrambled PNA sequence controls. Similarly, quantitative measurement shows a 2.5-fold decrease in Ki67 and a 3-fold increase in terminal deoxynucleotidyl transferase dUTP nick end labeling expression with this approach. PNA-delivery peptide conjugates represent a novel way to target BRAFV600E and represent a new approach in targeting selective oncogenes that induce tumor growth.

Role of W181 in modulating kinetic properties of Plasmodium falciparum hypoxanthine guanine xanthine phosphoribosyltransferase.

Hypoxanthine-guanine-xanthine phosphoribosyltransference (HGXPRT), a key enzyme in the purine salvage pathway of the malarial parasite, Plasmodium falciparum (Pf), catalyses the conversion of hypoxanthine, guanine, and xanthine to their corresponding mononucleotides; IMP, GMP, and XMP, respectively. Out of the five active site loops (I, II, III, III', and IV) in PfHGXPRT, loop III' facilitates the closure of the hood over the core domain which is the penultimate step during enzymatic catalysis. PfHGXPRT mutants were constructed wherein Trp 181 in loop III' was substituted with Ser, Thr, Tyr, and Phe. The mutants (W181S, W181Y and W181F), when examined for xanthine phosphoribosylation activity, showed an increase in Km for PRPP by 2.1-3.4 fold under unactivated condition and a decrease in catalytic efficiency by more than 5-fold under activated condition as compared to that of the wild-type enzyme. The W181T mutant showed 10-fold reduced xanthine phosphoribosylation activity. Furthermore, molecular dynamics simulations of WT and in silico W181S/Y/F/T PfHGXPRT mutants bound to IMP.PPi.Mg2+ have been carried out to address the effect of the mutation of W181 on the overall dynamics of the systems and identify local changes in loop III'. Dynamic cross-correlation analyses show a communication between loop III' and the substrate binding site. Differential cross-correlation maps indicate altered communication among different regions in the mutants. Changes in the local contacts and hydrogen bonding between residue 181 with the nearby residues cause altered substrate affinity and catalytic efficiency of the mutant enzymes. Proteins 2016; 84:1658-1669. © 2016 Wiley Periodicals, Inc.

Slow ligand-induced conformational switch increases the catalytic rate in Plasmodium falciparum hypoxanthine guanine xanthine phosphoribosyltransferase.

P. falciparum (Pf) hypoxanthine guanine xanthine phosphoribosyltransferase (HGXPRT) exhibits a unique mechanism of activation where the enzyme switches from a low activity (unactivated) to a high activity (activated) state upon pre-incubation with substrate/products. Xanthine phosphoribosylation by unactivated PfHGXPRT exhibits a lag phase, the duration of which reduces with an increase in concentration of the enzyme or substrate, PRPP·Mg(2+). Activated PfHGXPRT does not display the lag phase and exhibits a ten-fold drop in the Km value for PRPP·Mg(2+). These observations suggest the involvement of ligand-mediated oligomerization and conformational changes in the process of activation. The dipeptide Leu-Lys in the PPi binding site of human and T. gondii HG(X)PRT that facilitates PRPP·Mg(2+) binding by isomerization from trans to cis conformation is conserved in PfHGXPRT. Free energy calculations using the well-tempered metadynamics technique show the ligand-free enzyme to be more stable when this dipeptide is in the trans conformation than in the cis conformation. The high rotational energy barrier observed for the conformational change from experimental and computational studies permits delineation of the activation mechanism.

Kinetic mechanism of Plasmodium falciparum hypoxanthine-guanine-xanthine phosphoribosyltransferase.

Plasmodium falciparum hypoxanthine-guanine-xanthine phosphoribosyltransferase (PfHGXPRT) exhibits a kinetic mechanism that differs from that of the human homolog. Human HGPRT follows a steady-state ordered mechanism, wherein PRPP binding precedes the binding of hypoxanthine/guanine and release of product IMP/GMP is the rate limiting step. In the current study, initial velocity kinetics with PfHGXPRT indicates a steady-state ordered mechanism, wherein xanthine binding is conditional to the binding of PRPP. The value of the rate constant for IMP dissociation is greater by 183-fold than the kcat for hypoxanthine phosphoribosylation and this results in the absence of burst in progress curves from pre-steady-state kinetics. Further, IMP binding is 1000 times faster (4s(-1) at 0.5µM IMP) when compared to the kcat (3.9±0.2×10(-3)s(-1)) for the reverse IMP pyrophosphorolysis reaction. These results lend support to the fact that in both forward and reverse reactions, the process of chemical conversion (formation of IMP/hypoxanthine) is slow and the events of ligand association and dissociation are faster.

A preliminary study to determine the diagnostic reference level using dose-area product for limited-area cone beam CT.

OBJECTIVES: The aim of this study was to measure the dose-area product (DAP) of limited-area cone beam CT (CBCT) units used by dental offices, and to evaluate the rationale of the DAP with an aid of optically stimulated luminescence (OSL) dosemeter in measuring radiation dose. METHOD: The DAPs of 21 CBCT units used in the dental offices of Tokyo and the surrounding areas from five different manufacturers were measured using OSL nanoDot dosemeter. An assembly of OSL dosemeters with an X-ray film was exposed by CBCT units at exposure parameters commonly used in each dental office. DAP values were then calculated as expressed in mGy cm(2). RESULTS: DAP values ranged from 126.7 mGy cm(2) to 1476.9 mGy cm(2), depending on the units used. CONCLUSION: OSL dosemeter coupled with film can be utilized for a large-scale study to measure DAP. The DAP values for individual CBCT units depend not only on the field of view, but also on the exposure parameters adapted by the dental offices.

Caregivers burden of patients with schizophrenia and bipolar disorder: a sectional study.

BACKGROUND: Caregiving has been identified as a basic component of human nature and a primary element of close relationship. This study aims to assess the extent and pattern of burden felt by the caregivers of patients with schizophrenia in comparison with bipolar disorder. MATERIALS AND METHODS: Fifty-two patients with schizophrenia and fifty-one patients with bipolar disorder attending the outpatient department were assessed in the study. The burden among the caregivers was assessed using Burden Assessment Schedule. RESULTS: The caregivers of schizophrenia group had significantly higher total burden score as compared to caregivers of bipolar disorder. Caregivers of schizophrenia experienced significantly higher burden in area of external support, caregivers routine, and other relations. CONCLUSION: The extent of burden among families of schizophrenic patients is more than those of bipolar disorder. The families of patients with bipolar disorder do also experience considerable burden. The pattern of burden among families of schizophrenia and bipolar disorder is almost identical in most of the domains except for external support, caregivers routine, and other relations.

Duration of first admission and its relation to the readmission rate in a psychiatry hospital.

BACKGROUND: Most psychiatric illnesses have a chronic relapsing course. It is estimated that the readmission rate for discharged patients is approximately 40-50% within one year of their discharge from the hospital. The current emphasis in mental health service is on brief hospitalization and providing community-based services. AIM: To understand the relationship between the duration of first hospital admission and the rates of readmission in a psychiatry hospital. MATERIALS AND METHODS: All the patients admitted at Asha hospital, Hyderabad for the first time between16 September, 2003 to 15 March, 2004, were included in the study. The hospital records of these patients were examined and the data was collected on various variables, which included demographic variables, duration of hospital stay, diagnosis, and the number of readmissions for a period of approximately three-and-a-half years. The duration of the first hospital stay was divided into four categories, Group 1:1-7 days, Group 2:8 to 14 days, Group 3:15 to 30 days, and Group 4: More than 30 days. RESULTS: The sample consisted of 516 patients, out of whom 17 were excluded because of insufficient data. Two hundred and fifty patients belonged to Group 1 (1 to 7 days), 206 patients in Group 2 (8 to 14 days), Group 3 (15 to 30 days) constituted 35 patients, and eight patients were in Group 4 ( > 30 days). CONCLUSION: The length of the initial hospital stay is important to prevent future hospitalization. There are no definite predictors for readmission that could be detected, except for the length of the initial admission in the study.

A 60-year-old woman with agitation and psychosis following ingestion of dextromethorphan and opioid analgesics.

A patient presented with agitation, paranoia, and psychosis following ingestion of dextromethorphan, propoxyphene, and hydrocodone, a previously unreported combination. Symptoms resolved with antipsychotics and cessation of offending drugs. The pharmacodynamics of dextromethorphan and the opioids, including drug interactions are discussed, and several potential mechanisms for the production of the patient's symptoms are proposed.

Repair of spondylolytic defect with a cable screw reconstruction.

We present the clinical and radiological results of surgical repair for refractory spondylolysis in 20 patients at a minimum follow-up of 2 years. Seventeen of them were reassessed after 5 years. The Oswestry scores revealed good to excellent results in 90% (18/20 patients), indicating a good outcome with surgical repair using two techniques: the Scott procedure or pedicle screw and wire technique. Radiological pseudarthosis was 10%, which was quite consistent with reported series. CT scanning of the 14 patients after a mean of 13 months revealed complete healing of the fracture in 7 patients, partial in 2 and frank non-union in 5. Overall, CT examination with reversed gantry showed only 7/14 (50%) healing, indicating that radiological healing on plain X-ray is not always suggestive of complete bony healing. However, CT healing is not a sine qua non of good to excellent clinical outcome.