Xiaoyan Lidan formula ameliorates cholecystitis by regulating cholesterol transportation and water permeability of the gall bladder through the activation of LXRβ.

Left-sided gall bladder (LSGB) is a rare anatomical variant that increases the risk of bile duct injury, particularly when combined with other gall bladder pathology. A 57-year-old male with a several-year history of intermittent post-prandial epigastric pain had hepatic steatosis and gall bladder polyps (largest 9 mm) on ultrasound, and hepatobiliary scintigraphy showed a reduced gall bladder ejection fraction consistent with biliary dyskinesia. Elective laparoscopic cholecystectomy was performed; at laparoscopy, the gall bladder was unexpectedly located to the left of the falciform ligament, confirming true LSGB. Ports were placed slightly lower than usual, and an epigastric port was alternated across the falciform ligament. Intraoperative ultrasound delineated a short cystic duct entering the common hepatic duct, and the critical view of safety was obtained. The cystic duct and artery were clipped close to the gall bladder, which was removed without bile spillage; recovery was uneventful and histology showed chronic cholecystitis without dysplasia. True LSGB with polyps and biliary dyskinesia can be managed safely by laparoscopy when surgeons adhere to the critical view of safety and use adjunctive imaging.

Endoscopic Transpapillary Gallbladder Stenting for Complicated Cholecystitis in Patients With Cirrhosis and High Surgical Risk: An Observational Study.

Introduction: Mismatch Repair (MMR) proteins are essential in correcting DeoxyRibo Nucleic Acid (DNA) replication errors, including point mutations, to maintain genetic stability. Among atleast seven MMR proteins in humans, four- MLH1 (MutL homolog 1), MSH2 (MutS homolog 2), MSH6 (MutS homolog 6), and PMS2 (Postmeiotic segregation increased 2) are most significant in cancer biology, particularly in Colorectal Carcinoma (CRC), gastric, endometrial, and ovarian cancers. Deficiencies in these genes can lead to Microsatellite Instability (MSI), which promotes tumourigenesis. Aim: The present study done to assess the expression of MMR proteins and their association with clinicopathological features in solid tumours like colon, liver, stomach, gall bladder and others. Materials and Methods: The present retrospective and comparative study was conducted at a North Indian Cancer Centre at Jaipur, Rajasthan, India for three years, 55 cases of various solid tumours were examined for the expression of MMR proteins using immunohistochemistry. The cases were categorised into two groups: proficient (normal expression of MMR proteins, low MSI probability) and deficient (loss of MMR proteins, high MSI probability). The immunophenotypic expression was analysed in relation to clinical and pathological parameters by tabulating the data in Microsoft Excel sheet and statistical analysis was done by using the Statistical Package for Social Sciences (SPSS) statistics software windows version 22.0 released 2013. Results: Results showed that 8 (14.5%) out of 55 patients had a loss of MMR protein expression. Of these cases, 5 (62.5%) displayed a combined loss of MLH1 and PMS2, while 3 (37.5%) showed a combined loss of MSH2 and MSH6. All cases with MMR deficiency were located proximal to the splenic flexure and exhibited mucinous differentiation along with high levels of Tumour-infiltrating Lymphocytes (TILs). The mean age in the proficient group (59.4 years) was higher compared to the deficient group (54.5 years), with males {5 (62.5%) in MMRd and 25 (53.2%) MMRp} being more commonly affected than females {3 (37.5%) in MMRd and 22 (46.5%) in MMRp} in both groups. Adenocarcinoma was the predominant histological type in both groups {5 (62.5%) in MMRd and 30 (63.8%) in MMRp}. Conclusion: The study highlights the importance of MMR protein testing, particularly for CRC patients aged around 50 years with low-grade tumours. However, given the limited sample size, larger studies are needed to further explore the relationship between MMR protein deficiencies and clinicopathological features in various cancers.

Radiotherapy may be suggested for pregnant cancer patients when treatment cannot be delayed, with careful targeting to minimize fetal dose. Considering that a successful case for a pregnant patient treated with proton beam craniospinal irradiation (CSI) was reported, carbon therapy can be also considered applicable for the CSI treatment to pregnant patients. We investigated fetal organ doses from carbon beam CSI during pregnancy by performing Monte Carlo dose calculations. We employed the high-quality pregnant female phantom series developed by University of Florida (UF) for eight gestational ages (8, 10, 15, 20, 25, 30, 35, and 38weeks). The phantoms were converted into DICOM-RT CT images and implemented in a treatment planning system (TPS) with the prescribed relative biological effectiveness (RBE)-weighted dose of 36Gy. A carbon CSI plan created from TPS was used to perform TOPAS MC dose calculations after commissioned to the carbon beam measurement data. Fetal organ absorbed doses for 28 organs considered radiosensitive were calculated and compared with those estimated for proton therapy in a previous study. The organ/tissue doses for 35weeks showed the largest variation, ranging from 13.2 mGy (esophagus) to 88.3 mGy (lens), whereas those for 8weeks showed the smallest variation, ranging from 21.0 mGy (gall bladder) to 30.3 mGy (brain). The fetal whole-body doses decreased from early to mid-gestational ages, but increased again during the later stage as the fetus grew predominantly in the superior direction, reducing the overall distance to the beam field. Considering the significant attention to carbon therapy, as a first dedicated effort, the result would be clinically informative to estimate the fetal dose from carbon therapy during pregnancy.

Situs inversus totalis (SIT) is an uncommon congenital condition in which the thoracic and abdominal organs are arranged in a complete mirror image configuration. To date, roughly 60 cases of laparoscopic cholecystectomy(LC) performed in patients with situs inversus have been documented. Performing laparoscopic cholecystectomy in these patients is technically more challenging, as it requires surgeons to adapt their visuomotar coordination and operative orientation to the left upper abdominal quadrant. We report a case of a 46 years old lady with pain in left upper abdomen for last 6 months. Diagnosis of situs inversus totalis was confirmed with ultrasound with presence of multiple gall bladder stones with no intra or extrabiliary duct dilatation. The patient underwent laparoscopic cholecystectomy by a right-handed surgeon standing at the right side of patient with the other ports in mirror image of the standard procedure. The duration of surgery was around 90 minutes and the patient was discharged uneventfully in 48 hours and was well on one-week follow-up. It requires an experienced surgeon, re-training of visual-motor coordination and modification of surgical steps.

Background: Gallstone disease, common in India, can lead to carcinoma gallbladder due to chronic mucosal irritation. The rate of incidental carcinoma found after cholecystectomy differs by region, highlighting the importance of early detection for improved prognosis. The present study aimed to determine incidence of carcinoma gall bladder in patients undergoing cholecystectomy and its correlation with clinicopathological profile of patients. Methodology: This prospective observational study was conducted in department of general surgery at Pt. JNM medical college from January 2016 to August 2022, including 149 patients with symptomatic, ultrasonography confirmed gallstone disease undergoing elective cholecystectomy. Data on clinical, demographic, and histopathological parameters were analyzed to determine the incidence and associations of incidental gallbladder carcinoma. Results: The rate of incidental carcinoma of gall bladder in our setting was found to be 0.67. Out of 149 patients, 1(0.67%) patients had gall bladder polyp and 148(99.33%) patients didn’t had gallbladder polyp. 91(61.07%) had gall bladder wall thickness of 2-3mm and 58 (38.93%) patients had gall bladder wall thickness of 3-5mm. 4 (2.7%)patients had tenderness per abdomen,4(2.7%) patients had guarding, 2(1.3%) patients had rigidity,4(2.7%) patients had rebound tenderness,4(2.7%) patients had Murphy’s sign positive, and 3(2.0%) patients had abdominal distension. Conclusion: We concluded that most common histopathological finding in patients undergoing cholecystectomy was chronic cholecystitis with cholelithiasis. The one case diagnosed with carcinoma gall bladder was adenocarcinoma in histopathological types. As our data might not be sufficient for correlation of various variables but given that early diagnosis in carcinoma gallbladder can drastically change outcome in patients, Histopathological analysis of all gallbladder specimen in elective as well as emergency cholecystectomy should be mandatory.

Background: Dengue infection is a major public health concern with clinical manifestations ranging from mild febrile illness to life-threatening shock syndrome. Early prediction of disease progression is vital for reducing morbidity and mortality. This study aimed to document the clinical profile of pediatric patients and evaluate the correlation of liver enzymes, viral serotypes, and abdominal ultrasonographic findings with the severity and outcome of dengue infection. Methods: A prospective observational study was conducted over a period of 20 months involving 65 children (n=65) aged 1 month to 18 years admitted with confirmed dengue infection. Clinical features, liver function tests (AST, ALT, ALP), serotypes and abdominal ultrasound findings were analyzed. Statistical analysis was used to correlate these findings with disease severity. Results: The majority of the study population were males (58.46%) with the highest incidence in the 1–5 year age group (35.38%). Fever was universally present, while hepatomegaly was observed in 20% of cases. DENV-2 was the predominant serotype (49.23%). Significant statistical differences were noted in Alkaline Phosphatase (ALP) and alanine transaminase (ALT) levels among different serotypes (p<0.05). Ultrasonography revealed warning signs such as ascites (36.9%) and gall bladder edema (30.7%). A statistically significant association was found between dengue severity and ultrasound warning signs (p<0.0000001), with an area under the ROC curve of 0.96. Conclusions: Ultrasound warning signs are strong predictors of dengue severity in children. While liver enzyme levels vary significantly by serotype, abdominal ultrasonography serves as a highly sensitive and reliable non-invasive tool for the early prediction of severe dengue infection and timely management of pediatric dengue patients.

Patients with unresectable Gastrointestinal cancers (GI) including advanced colorectal cancer (CRC) and gall bladder cancer (GBC) have limited treatment options. Treatment with chemotherapy is associated with limited success resulting from therapeutic resistance. Immune checkpoint inhibitors are effective for a subset of metastatic CRC (5% with MSI-H status) and up to 30% of patients with GBC. Therefore, there is an urgent unmet need to discover new predictive biomarkers to aid patient selection for ICIs with a demonstrated clinical value in a challenging patient population. We highlight the utility of a liquid biopsy approach to aid selection of GI cancer patients harbouring rare POLE mutations for immunotherapy, leading to complete metabolic response in addition to radiologic responses and extended survival in all three patients. This study advocates for specialised multi-disciplinary teams performing shared clinical decision making to advance personalised care and improve outcomes of a subset of GI cancer patients with a poor prognosis.

This report presents a case of a middle-aged man who was incidentally diagnosed with a gallbladder (GB) mass. Though he had some features of Cushing syndrome (CS), including those due to mineralocorticoid effects (persistent hypokalaemia), the classical features were absent. Abdominal CT scan showed a large mass arising from the GB with liver and lymph node metastasis. Biochemical evaluation confirmed adrenocorticotropic hormone (ACTH)-dependent CS. A biopsy from the mass revealed a poorly differentiated neuroendocrine carcinoma. The patient was started on ketoconazole and appropriate management for other complications. Chemotherapy was poorly tolerated and hence discontinued. The patient eventually succumbed to his illness. This case illustrates how the absence of classical Cushingoid features can mask ectopic ACTH secretion, with persistent unexplained hypokalaemia serving as a key diagnostic clue in our case. It also emphasises the difficulty of identifying a neuroendocrine tumour arising from a rare, unsuspected primary site.

Total reflection X-ray fluorescence (TXRF) analysis was used to determine element concentrations in blood serum samples of patients receiving parenteral nutrition. The concentrations of elements were measured in the serum samples two times, namely in the first day (measurement I) of the treatment and on the seventh day (measurement II) after nutrient supplementation. For comparison purposes, also serum samples of 50 patients without nutritional disorders, admitted to a planned cholecystectomy (surgical procedure of the gall bladder removal), were analyzed and treated as the control group. Descriptive statistics of measured concentrations of P, S, Cl, K, Ca, Cr, Fe, Cu, Zn, Se, and Br were determined both for the studied and control groups. Statistical analysis of the results concentrates on verifying the type of element concentration distributions. Next, the comparison of element concentration between groups of women and men was done. Parenteral nutrition resulted in a significant increase in supplemented Se and a decrease in Cu concentrations between measurement I and II. Parametric as well as nonparametric approaches were applied to verify the hypothesis. Additionally, it was found out that for some elements differences between the studied and control groups can be observed (P, S, Ca, Fe, Cu, Zn, Se, Br). The analyses were also performed taking into account the gender of the patients. Correlation coefficients were calculated for the studied and control groups as regards the determined elements. It was observed that in all groups positive correlations were obtained between S and Ca, and for Zn and Se. In studied and control groups a negative correlation between Ca and Cr was obtained. This paper discusses also prediction of trace element concentrations following seven days of parenteral nutrition therapy, based on the knowledge of various anthropometric, biochemical and immunological parameters describing the patient's condition. The procedure is discussed for Br concentration.

Neoadjuvant therapy in gall bladder cancer improves resectability and survival: a prospective study.

Total reflection X-ray fluorescence (TXRF) analysis was used to determine element concentrations in blood serum samples of patients receiving parenteral nutrition. The concentrations of elements were measured in the serum samples two times, namely in the first day (measurement I) of the treatment and on the seventh day (measurement II) after nutrient supplementation. For comparison purposes, also serum samples of 50 patients without nutritional disorders, admitted to a planned cholecystectomy (surgical procedure of the gall bladder removal), were analyzed and treated as the control group. Descriptive statistics of measured concentrations of P, S, Cl, K, Ca, Cr, Fe, Cu, Zn, Se, and Br were determined both for the studied and control groups. Statistical analysis of the results concentrates on verifying the type of element concentration distributions. Next, the comparison of element concentration between groups of women and men was done. Parenteral nutrition resulted in a significant increase in supplemented Se and a decrease in Cu concentrations between measurement I and II. Parametric as well as nonparametric approaches were applied to verify the hypothesis. Additionally, it was found out that for some elements differences between the studied and control groups can be observed (P, S, Ca, Fe, Cu, Zn, Se, Br). The analyses were also performed taking into account the gender of the patients. Correlation coefficients were calculated for the studied and control groups as regards the determined elements. It was observed that in all groups positive correlations were obtained between S and Ca, and for Zn and Se. In studied and control groups a negative correlation between Ca and Cr was obtained. This paper discusses also prediction of trace element concentrations following seven days of parenteral nutrition therapy, based on the knowledge of various anthropometric, biochemical and immunological parameters describing the patient’s condition. The procedure is discussed for Br concentration.

A Study to Identify Patterns of Care among Gall Bladder Carcinoma Patients in Real-World Setting Presenting at a Tertiary Cancer Care Center in North India

Outcome of Neo-adjuvant Chemotherapy in Locally Advanced Gall Bladder Cancer: An Overview from a North-Eastern Cancer Care Center

Background: Laparoscopic cholecystectomy (LC) is the gold standard for gallstone diseases. Preoperative ultrasonography findings can have a significant impact on the perioperative and postoperative outcomes. This study aimed to evaluate the influence of preoperative gallbladder (GB) wall thickness, measured by ultrasonography, on the perioperative outcomes of patients undergoing elective LC. Methods: This prospective, cross-sectional study was conducted at a tertiary care center and included 60 patients undergoing LC. Preoperative GB wall thickness was measured via ultrasonography, and patients were stratified into four groups: <2 mm, 2-4 mm, 4-6 mm, and >6 mm. Intraoperative complications, postoperative complications, and the duration of hospital stay were prospectively documented and correlated with GB wall thickness. Statistical analysis was performed using ANOVA and chi-square tests to compare outcomes among the four groups. Results: The mean age was 44±13 years, and 68.3% were female. A GB wall thickness of 2-4 mm was the most common finding (40%), followed by <2 mm (30%). Patients with a thicker GB wall had significantly more intraoperative complications (p=0.001). Thicker GB wall was significantly associated with postoperative bile leak (p=0.007) and wound infection (p=0.041). The mean hospital stay was also significantly longer for patients with a thicker GB wall (p=0.001). Conclusions: Preoperative GB wall thickness on ultrasonography is a strong predictor of operative difficulty, postoperative complications, and prolonged hospitalization following LC. Incorporating this simple, non-invasive measure into routine preoperative assessment may improve risk stratification and surgical planning.

The green sunfish, Lepomis cyanellus, is a common centrarchid that has been previously reported to harbor several myxosporeans. In May 2022, six L. cyanellus were collected from the Caddo River, Montgomery County, Arkansas, USA, and had their gills, gall bladders, urinary bladders, fins, integument, other major organs, and musculature examined for myxosporeans. A single individual was found to harbor a new species of Myxobolus infecting the soft dorsal fin. A qualitative and quantitative morphological description was based on fresh plasmodia and myxospores. Elliptoid to obovoid myxospores of Myxobolus picassoi sp. n. are asymmetrical, 12.2 µm long × 9.1 µm wide, with two broadly pyriform to broadly ovoid subequal polar capsules. Molecular data consisted of a 2042 base pair sequence of the partial small subunit rRNA gene (SSU). Phylogenetic analysis revealed that M. picassoi sp. n. is a member of a clade of myxosporean species that predominately infect centrarchid sunfishes from North America. This is the fifth report of a Myxobolus from L. cyanellus, but the first report of a species infecting the soft dorsal fin. This article was registered in the Official Register of Zoological Nomenclature (ZooBank) as urn:lsid:zoobank.org:pub:146D21D1-E416-41C7-A1F6-8AB2AC6D9260.

Laparoscopic cholecystectomy (LC) is now considered the gold standard for the treatment of symptomatic cholelithiasis. However, conversion to open surgery is occasionally required due to intraoperative difficulties and complications. Early preoperative identification of difficult LC cases can be of help in surgical preparedness and patient counselling. To evaluate the sensitivity, specificity, and predictive value of a preoperative scoring system in the prediction of difficult LC. A prospective cohort study was conducted on 150 patients undergoing elective LC at Deen Dayal Upadhyay Hospital, New Delhi, India. Each patient was scored preoperatively based on age, sex, history of hospitalization, BMI, abdominal scars, palpable gallbladder, gallbladder wall thickness, pericholecystic fluid, and impacted stones based on the scoring system proposed by Randhawa and Pujahari. Intraoperative findings were recorded to classify cases as easy, difficult, or very difficult based on parameters that include time of surgery, bile/stone spillage, duct/artery injury, conversion to open surgery, difficulties in port access, Calot's triangle dissection, and gall bladder extraction. Statistical analysis included sensitivity, specificity, predictive values of the preoperative score, and logistic regression analysis. The mean preoperative score was 2.55 ± 2.55. Intraoperatively, 72% of cases were classified as easy, 24.7% as difficult, and 3.3% as very difficult, with a conversion rate to open surgery of 3.3%. Thickened gallbladder wall (>4 mm), presence of pericholecystic fluid, impacted stones, and a BMI >27.5 were found to be significantly associated with increased operative difficulty (p < 0.05). The scoring system demonstrated a sensitivity of 57.14% and a specificity of 79.51%, while the positive predictive value and negative predictive value were 39% and 89%, respectively. The proposed scoring system is a reliable, simple tool for predicting difficult LC preoperatively. Incorporation of this tool can assist in preoperative planning and improve surgical outcomes by better preparing and minimizing unexpected conversions.

The present investigation aims to study the histological and histochemical details of the gall bladder in four different age groups viz.2,6,12 and 18 week-old Siruvidai chicken, an indigenous poultry ecotype of Tamil Nadu. Six healthy birds from each group were used. Gall bladder tissues were collected, fixed in various fixatives, processed by paraffin embedding, sectioned at 5–6 µm and subjected to histological and histochemicalstaining techniques. The gall bladder had three tunics. The innermost tunica mucosa was folded, forming short villous-like projections. It was lined by simple columnar epithelium which was PAS-positive and also showed alcianophilic reaction. The middle tunica muscularis consisted of circularly arranged smooth muscle fibres, while the outermost tunic, serosa in the free surface and adventitia in the attached surface of the gall bladder. Significant difference was observed in the mean thickness of all the three tunics and epithelial cell height across all the four age groups under study.

Heterotopic pancreas, is also known as ectopic pancreas, pancreatic Choristoma, pancreatic rest, and aberrant pancreas. Ectopic Pancreas is a rare congenital anomaly defined as normal pancreatic tissue located outside its normal anatomical site without anatomical, vascular and neural continuity with the pancreas in the retroperitoneum. The overall incidence of ectopic pancreas at different locations is in decimals. Its occurrence in the gallbladder is rare and rarely reported in the literature. Ectopic pancreatic tissues are usually identified in an alive individual during cholecystectomy for gallstones, acute or chronic cholecystitis, or gallbladder polyps. They do not have a specific symptom. However, they mimic the symptoms of gallstones and acute or chronic cholecystitis. The clinical significance of this pathology is unclear. In this case, we report a 36-year-old female who was suffering from right upper quadrant pain for a year, which had the characteristics of biliary colic. She had a planned laparoscopic cholecystectomy as a day case procedure. The gallbladder specimen showed there were no stones postoperatively, and the specimen was sent for histological examination. The histology report identified an ectopic pancreatic tissue in the neck of the gallbladder near the cystic duct. The histological confirmation revealed that the ectopic pancreas was mimicking a gallbladder polyp and was producing symptoms of biliary colic. International Journal of Human and Health Sciences Vol. 10 No. 01 Jan’26 Page: 61-63