Post-transcriptional switches are flexible effectors of dynamic changes in gene expression. Here we report a new post-transcriptional switch that dictates the spatiotemporal and mutually exclusive expression of two alternative gene products from a single transcript. Expression of primate-specific exonic microRNA-198 (miR-198), located in the 3'-untranslated region of follistatin-like 1 (FSTL1) messenger RNA, switches to expression of the linked open reading frame of FSTL1 upon wounding in a human ex vivo organ culture system. We show that binding of a KH-type splicing regulatory protein (KSRP, also known as KHSRP) to the primary transcript determines the fate of the transcript and is essential for the processing of miR-198: transforming growth factor-β signalling switches off miR-198 expression by downregulating KSRP, and promotes FSTL1 protein expression. We also show that FSTL1 expression promotes keratinocyte migration, whereas miR-198 expression has the opposite effect by targeting and inhibiting DIAPH1, PLAU and LAMC2. A clear inverse correlation between the expression pattern of FSTL1 (pro-migratory) and miR-198 (anti-migratory) highlights the importance of this regulatory switch in controlling context-specific gene expression to orchestrate wound re-epithelialization. The deleterious effect of failure of this switch is apparent in non-healing chronic diabetic ulcers, in which expression of miR-198 persists, FSTL1 is absent, and keratinocyte migration, re-epithelialization and wound healing all fail to occur.
Hydrocele of the canal of Nuck is a rare condition in females. It results from the failure of obliteration of the distal portion of evaginated parietal peritoneum within the inguinal canal which forms a sac containing fluid. Patients generally present with inguinal swelling. We present a case of left sided cyst of canal of Nuck with left inguinal hernia in a 28-year-old female, which was diagnosed on ultrasonography. Patient underwent laparoscopic excision of cyst of canal of nuck with hernioplasty. Histopathology confirmed the diagnosis. To our knowledge, this is the first reported case of laparoscopic excision of a cyst (encysted hydrocele) of the canal of Nuck.
Laparoscopic Cholecystectomy is the gold standard treatment for gallbladder diseases. However, for various reasons there is a finite chance of conversion to open cholecystectomy in some patients. To assess preoperative factors which might predict the chances of conversion and the intraoperative reason which resulted in the conversion. The SAGAR APOLLO HOSPITAL patient database was searched for patients who underwent laparoscopic cholecystectomy between July 2003 and November 2006. Sagar Apollo hospital is an urban tertiary care hospital. The records of 526 patients who underwent laparoscopic cholecystectomy were reviewed retrospectively. 14 (2.6%) of the 526 patients were converted to open cholecystectomy. Preoperative Alkaline phosphatase values were raised in patients who underwent conversion and were found to be statistically significant. The most common intraoperative reason for conversion was difficulty in delineating the anatomy at the Calot's triangle. It is difficult to preoperatively predict the factors responsible for conversion.
Incisional hernias and other ventral hernias are common surgical problems. It is estimated that incisional hernia complicates about 2 % to 10 % of laparotomies. Ventral and incisional hernia repairs are among the common surgeries done by a general surgeon. It is proven beyond any doubt that suture repair of these hernias should not be done as recurrence rates are unacceptably high, some series reporting as high as 54 % on long-term follow-up. A prosthetic mesh should always be used in ventral hernia repair (VHR). Now, the polypropylene mesh (PPM) has become the prosthetic mesh of choice in the repair of hernias, including inguinal hernia. However, with the advent of laparoscopic repair where the mesh is placed intraperitoneally, concerns regarding safety of PPM are raised. Newer meshes are introduced, claiming lesser complication rate. Many types of newer meshes are available now. Newer meshes are invariably costlier than PPM by 15-20 times. Is this extra cost worth? We looked in to available literature for an answer.
Psychological status does play a role in post-operative recovery. This result opens up scope for counselling patients towards a healthy and comfortable recovery from surgery.
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