Laparoscopic cholecystectomy for left-sided gallbladder (sinistroposition).

Transposition of the gallbladder to the left side without situs inversus viscerum is rare. These gallbladders are situated under the left lobe of the liver between Segment III and IV or on Segment III to the left of the falciform ligament. Because routine preoperative studies may not detect the anomaly, it may provide the surgeons with an unusual surprise during laparoscopy. Awareness of the unpredictable confluence of the cystic duct into the common bile duct and selective use of intraoperative cholangiography aid in the safe laparoscopic management of this unusual problem.     

Does multi-vessel off-pump coronary artery bypass grafting reduce post operative morbidity compared to on-pump CABG?

Background Cardiopulmonary bypass (CPB) may contribute to the complications and it is assumed that eliminating cardiopulmonary bypass has the potential of reducing post operative morbidity after coronary artery bypass grafting (CABG). The study was carried out to compare mortality and morbidity in the off-pump and on-pump CABG groups. Methods We prospectively analysed 200 patients undergoing CABG. Group A consists of 100 patients underwent multi-vessel off-pump CABG and group B consists of 100 patients underwent CABG with CPB. The incidence of complications (mortality, re-exploration for bleeding, myocardial infarction, atrial fibrillation, neurological events, new onset renal failure (s. creatinine>1.6 mg/dL) pulmonary complications, length of ICU stay and hospital stay were recorded, analysed and compared. Results OPCAB patients received 2.73±0.61 grafts/patient and on-pump CABG patients received 3.39±0.75 grafts/patient (p value<0.00001). There was no significant statistical difference in mortality, incidence of stroke between OPCAB and CABG with CPB patients. Length of ICU stay was 32.84±4.22 vs 44.85±7.18 hrs (p value<0.00001) and hospital stay was 6.52±0.69 vs 7.94±0.92 days (p value<0.00001) between group A and group B respectively. Incidence of atrial fibrillation was less in OPCAB group 7% vs 12% although it was statistically not significant (p value 0.33). It was observed in our study that there was no significant deference in worsening of existing renal failure between on-pump CABG and OPCAB 6% vs 2% (P value 0.28). Blood utilization was significantly less in OPCAB group (p value<0.001). Conclusion There was no statistically significant difference in terms of mortality, incidence of stroke and new onset renal failure in both groups. But there was lesser incidence of post operative atrial fibrillation, worsening of existing renal failure in off-pump group though statistically not significant. There was significant reduction in blood utilization, length of ICU and hospital stay in OPCAB group.     

Localized echo-volume imaging methods for functional MRI

To perform true three-dimensional activation experiments in the human brain, dedicated localized echo-volume imaging (L-EVI) methods were developed. Three-dimensional acquisition allows generation of activation maps with minimal vascular enhancement related to inflow effects. The rapid acquisition of the L-EVI (～100 msec) reduces signal instabilities caused by motion, facilitating the detection of the small intensity changes expected with brain activation. Single-shot L-EVI was performed on normal volunteers at 1.5 T, imaging a three-dimensional predefined volume (240 × 45 × 45 mm³) in the superior portion of the brain with a spatial resolution of 3.75 × 5 × 5 mm³. Increased brain coverage was achieved with a multi-volume imaging (three-shot) version, which simultaneously achieved effective suppression of signals from cerebrospinal fluid. In addition, both asymmetric spin-echo (ASE) and spin-echo (SE) versions of the technique were used to detect blood oxygenation level dependent (BOLD) signal changes in the motor cortex with a finger-tapping paradigm. Images obtained by the L-EVI sequence were qualitatively comparable to standard multislice two-dimensional echo-planar images. Both ASE and SE functional MRI (fMRI) experiments showed consistent activation in the contralateral primary sensorimotor cortex. Furthermore, significant differences in location and magnitude of activation was observed between the two methods, confirming theoretical predictions.     

Self-inflicted specific pattern burns in psychiatric patients

Self-inflicted burns represent a major social and medical problem for society. Differences have been demonstrated between patients who attempt suicide and those who deliberately harm themselves without any intention of killing themselves. These self-inflicted injuries may resemble injuries that are intentionally inflicted by others and may require investigation by protective services. Little is known about these specific pattern burn injuries in psychiatric patients.     

Voltage-sensor movements in the Eag Kv channel under an applied electric field

Voltage-dependent ion channels regulate the opening of their pores by sensing the membrane voltage. This process underlies the propagation of action potentials and other forms of electrical activity in cells. The voltage dependence of these channels is governed by the transmembrane displacement of the positive charged S4 helix within their voltage-sensor domains. We use cryo-electron microscopy to visualize this movement in the mammalian Eag voltage-dependent potassium channel in lipid membrane vesicles with a voltage difference across the membrane. Multiple structural configurations show that the applied electric field displaces S4 toward the cytoplasm by two helical turns, resulting in an extended interfacial helix near the inner membrane leaflet. The position of S4 in this down conformation is sterically incompatible with an open pore, thus explaining how movement of the voltage sensor at hyperpolarizing membrane voltages locks the pore shut in this kind of voltage-dependent K⁺ (K_v) channel. The structures solved in lipid bilayer vesicles detail the intricate interplay between K_v channels and membranes, from showing how arginines are stabilized deep within the membrane and near phospholipid headgroups, to demonstrating how the channel reshapes the inner leaflet of the membrane itself.

In voltage-dependent ion channels, the transmembrane voltage determines whether the pore opens. At the same time, the flow of ions through the open pore alters the membrane voltage by charging the membrane capacitance. This recursive regulation of ion channel activity by membrane voltage is the fundamental process at the heart of cellular electricity. As described by Hodgkin and Huxley (1), voltage-dependent membrane permeability to Na⁺ and K⁺ (ion channels as molecular entities had not yet been discovered) generates the action potential, which is by far the most rapid form of information transfer across long distances in cells. Voltage-dependent ion channels underlie many other aspects of cell signaling as well, including the initiation of muscle contraction by voltage-dependent Ca²⁺ channels (2, 3) and the control of cardiac and neuronal pacemaker frequency by the hyperpolarization-activated cyclic nucleotide–gated (HCN) channel (4, 5).Voltage-dependent ion channels contain structural domains called voltage sensors that control pore opening by membrane voltage. Whether in K⁺, Na⁺, Ca²⁺, or cation channels like HCN channels or transient receptor potential (TRP) channels, voltage sensors have a conserved structure comprising four transmembrane helices, named S1, S2, S3, and S4 (3, 6, 7). The fourth helix, S4, contains repeats of the amino acid triplet (RXX)_n, where R stands for arginine, sometimes substituted by lysine, X for hydrophobic amino acid, and n varies widely among different channels. At the center of voltage sensors, inside the membrane’s interior, a constellation of negative charged amino acids, aspartate or glutamate, and a phenylalanine residue forms a gating-charge transfer center that stabilizes the positive charged side chains of arginine and lysine as they cross the membrane (8, 9). In some voltage sensors, S4 undergoes a transition from an α to a 3₁₀ helix to direct the arginine and lysine side chains of S4 into the gating-charge transfer center (8–11). The displacement of S4 across the membrane is detectable as a nonlinear capacitive current, called gating current in electrophysiology experiments (9, 12), and is ultimately responsible for voltage control of a voltage-dependent ion channel’s pore.So far, voltage-dependent ion channel structures have been determined in crystals, detergent micelles, or nanodiscs without a voltage difference across them (8, 13–19). Under such conditions, most voltage sensors adopt a depolarized conformation, which is expected in a membrane at 0 mV. Chemical cross links, metal affinity bridges, mutations, and toxins have been used to capture or stabilize voltage sensors in conformations thought to mimic the hyperpolarized (i.e., negative voltage inside) condition (10, 11, 20–23). Here, we present a cryo-electron microscopy (cryo-EM) analysis of the mammalian Eag voltage-dependent K⁺ (K_v) channel in lipid membrane vesicles with a voltage generated across the membrane using K⁺ ion gradients in the presence of valinomycin. Doing so allows us to not only visualize how the voltage sensors respond to the applied electric field but also to see how the lipid membrane near the channel, which is intimately tied to the function of voltage-dependent ion channels, is reshaped by these conformational changes.     

Multi-walled carbon nanotube-induced inhalation toxicity: Recognizing nano bis-demethoxy curcumin analog as an ameliorating candidate

Human beings and ecosystems are being possibly exposed to CNTs, as there is a rise in global production rate of carbon nanotubes (CNTs). This may affect the health of humans and increases the environmental risk. We have already reported the pulmonary toxicity due to the inhalation of MWCNTs. We claim that a compound with anti-inflammatory and antioxidant activity may ameliorate the CNT-induced toxic effect. With this view, we have investigated the ameliorative effect of intravenously-administered nano bis-demethoxy curcumin analog (NBDMCA) against MWCNTs-induced inhalation toxicity by examining the lung histopathology for inflammatory cell dynamics, pulmonary remodeling and estimating the inflammatory biomarkers in the broncho-alveolar lavage fluid. We observed that NBDMCA could ameliorate the injury as evidenced by the decline in the levels of markers of inflammation, cell damage, and the histopathological changes induced by MWCNTs. We conclude that NBDMCA may be used to reduce the risk of MWCNTs-induced inhalation toxicity.     

Identification of coagulase negative staphylococcal species from bovine mastitis in India

Background:Staphylococcal mastitis is a major cause of concern to the dairy industry in India and several countries worldwide. Though Staphylococcus aureus is the major cause, coagulase negative staphylococcal species (CoNS) are being increasingly reported in recent years. Aims:To investigate the incidence of coagulase negative staphylococcal species in bovine mastitis. Methods:Isolation of staphylococci was carried out from 237 milk samples of cows and She buffaloes with clinical and subclinical mastitis from different regions of Andhra Pradesh and Karnataka. CoNS isolates were identified by tube coagulase test using fresh rabbit plasma and coagulase gene PCR. We employed the biochemical test scheme published elsewhere previously for identification of the CoNS isolates up to species and subspecies levels. Seven representative isolates were identified by 16S rDNA sequencing to check the accuracy of biochemical test based identification. Results:The CoNS constitute the majority of the staphylococcal isolates from mastitis (80/125, 64%) in this region. Using biochemical test scheme, the CoNS isolates from bovine mastitis were identified as S. cohnii sub sp. cohnii, S. simulans, S. capitis sub sp. capitis, S. cohnii sub sp. xylosus, and S. lugdunensis. The CoNS species S. schleiferi, S. haemolyticus, S. sciuri, S. xylosus, S. chromogenes, and Macrococcus epidermidis were identified by 16S rDNA sequencing. Conclusion:The 16S rDNA sequencing is the appropriate method for the identification of CoNS species. This study highlighted coagulase negative staphylococcal species as possible etiological agents of mastitis.Key Words: 16S rDNA sequencing, Biochemical test scheme, Coagulase negative staphylococci, Species identification