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Content available remote MicroRNAs in diabetes - are they perpetrators in disguise or just epiphenomena?
MicroRNAs (miRNA) are non-coding RNAs, the majority of which are 22 nucleotide in size. They regulate gene transcription and control more than 50% of the mammalian genome. Although functional significance and targets of several miRNAs are yet to be identified, they may be regarded as controller of cellular physiology and function. Through such regulation they play vital roles in normal and diseased states. In the context of diabetes and chronic diabetic complications, recent research has identified alterations of a significant number of miRNAs. However, in a complex chronic disease like diabetes, multiple transcripts may also change in a temporal fashion depending on the disease progression and activation of counter-regulatory mechanisms. Hence, it is also possible that some miRNA changes may not be causally related to the disease pathogenesis and represent epiphenomena. To date, over 500 studies have addressed the role of miRNAs in the pathogenesis of type 1 and type 2 diabetes and chronic diabetic complications. Majority of the altered miRNAs appear to have pathogenetic roles. In this review, we have tried to identify alterations of specific miRNAs and the pathways they may regulate. We have also tried to identify whether some of these miRNA alterations may form basis of potential treatments
Introduction: Bile duct injuries (BDIs) still occur during laparoscopic cholecystectomy. Although management of such complications is challenging, a collaboration of a multidisciplinary team and development of treatment methods and materials often lead to successful treatment. Materials and methods: Medical records of 67 patients who have experienced bile duct injuries after laparoscopic cholecystectomy were retrospectively reviewed. All injuries were classified according to the European Association for Endoscopic Surgery ATOM classification and investigated by the manifestation of the injury, surgical repair technique, early and late complications. Results: In 28 (41.8 %) patients with partial divisions, the surgical treatment of BDI was completed with endoscopic retrograde cholangiopancreatography (ERCP) and stenting while in 14 (20.1%) cases, the defect of bile duct was closed by suture. End-to-end ductal anastomosis was performed for 6 (13.4%) patients with complete division while 19 (28.3%) patients underwent hepaticojejunostomy. We followed up 58 (92.1%) of 63 patients. The mean follow-up duration was 25.7 (3 - 123) months. Twenty-three (39.7%) patients were found to have structures. Discussion: Intraoperative detection and management of BDIs are crucial to achieving good results. The routine intraoperative cholangiography and possibilities of repair by initial surgeons in peripheral hospitals remain controversial. Stenting with a covered self-expanding metal stent is promising for the patients with partial divisions of bile ducts. Initial hepaticojejunostomy is often a preferred treatment for transected bile ducts because of a lower rate of anastomosis strictures. However, an end-to-end anastomosis is more physiological, and endoscopy allows successful management of the strictures, we suggest choosing this treatment when possible Recommendation for paperwork content: Classifying bile duct injuries according to the new ATOM classification may be useful in choosing the most appropriate treatment in each case.
Varicocele has been regarded a curable cause of infertility for dozens of years. The impact of varicocele treatment in terms of increase in pregnancy rates is a debated issue. We evaluate data from a 10-year cohort of results from laparoscopic operative treatment of varicocele patients according to pregnancy rate, complication rate, and satisfaction with varicocele repair. Ninety seven patients were treated by means of laparoscopy between 1993 and 1996. Ten years after operation questionnaires were sent to all patients. Answers were obtained from 49/97 pts. (50,5%). Details connected with marital status, pregnancy rate, addictions and scrotal pain discomfort were collected. Statistical analysis was performed using chi-square independence test and Spearman’s rank correlation coefficient. After 10 years, 75.5% who answered the questionnaire were fully satisfied with the results of treatment, 12.3% pts of patients were partially satisfied; 63.3% of patients fathered 1 to 3 children. Married patients and those who fathered children were found to be the most satisfied with the operation. We also found the statistically significant negative dependency between smoking addiction and number of children. There were no major complications intra- or postoperatively. No harmful consequences of testicular artery ligation were found. In conclusion, long-time 10 years follow-up enables better estimation of the results of laparoscopic treatment in patients with varicocele. Pregnancy rate may depend not only on varicocele repair but on smoking addiction as well. There is still no evidence of harmful consequences due to testicular artery ligation after varicocele repair
Content available remote Current approach to episiotomy: Inevitable or unnecessary?
An episiotomy is a surgical incision through the perineum made to provide sufficient area for the delivery of the infant. About 10 to 95% of women who deliver will have episiotomy depending on which part of the world they are having delivery. Too early episiotomy causes extensive bleeding and too late episiotomy causes the excessive stretching of a pelvic floor and lacerations could not be prevented. According to widely accepted arguments, there are many benefits of episiotomy for the neonate: prevention of injuries, shoulder dystocia and mental retardation of the infant. Benefits for the mother are: reduction of severe lacerations, prevention of sexual dysfunction, prevention of urinary and fecal incontinence. But those things could also be complications of episiotomy, if it is being used nonrestrictively. Some other complications are also extensive bleeding, hematoma or infection. There are many different opinions in literature about using episiotomy restrictively or routinely, so it is the right doubt arisen: is it inevitable or unnecessary? There is a wide variation in episiotomy practice, and the decision of performing it or not depends of actual clinical situation. There is still a great need for continuous obstetrics education according to the evidence based guidelines for the patient’s safety.
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