Percutaneous Cholecystostomy in Severe Acute Cholecystitis: An Observational Study From a Single Institute.

Background Although percutaneous cholecystostomy (PC) is generally accepted as a bridge to definitive therapy for acute cholecystitis (AC), which remains cholecystectomy, some patients did not undergo cholecystectomy, mainly due to contraindications to surgery. Here, we aimed to investigate the predictors of recurrence and the outcome after PC. Methods This is a retrospective study from a single general hospital at Tunbridge Wells, United Kingdom. One hundred twenty-six patients who presented with AC grade 3 and were initially managed with PC were included. In addition, the proportion of patients who did not undergo subsequent laparoscopic cholecystectomy (LC) and their characteristics were analyzed. Results The mean age of the study cohort was 72 (36-98) years, and the median length of drain insertion was 39.5 days. The majority (52%) presented with severe AC grade 3 with failed medical treatment to control the disease, while 7% had an emphysematous gallbladder. Eighty percent of patients did not develop any further attacks of AC after PC removal. The most common comorbidity was hypertension (35%). The mean age-adjusted Charlson comorbidity score was 3.72. Thirty-six percent (45/126) of the study cohort underwent LC, while the remaining patients did not receive any surgical intervention. Nine percent were deemed unfit for surgery. Forty-one patients (33%) were managed conservatively as they did not have a further attack of cholecystitis after PC removal or had a mild attack managed with antibiotics. In addition, 22% experienced procedural complications, including a blocked stent, pain, and cellulitis around the tube. The 30-day mortality rate of patients who did not undergo LC was 5%. Predictors of interval cholecystectomy were younger age, calculus cholecystitis, low Charslson index score, and uncomplicated and shorter length of hospital stay with PC. Conclusion Most severe AC patients treated initially with PC did not undergo subsequent LC. Therefore, PC in high-surgical-risk patients with AC could be a definitive treatment.

Nucleolar targeting in an early-branching eukaryote suggests a general mechanism for ribosome protein sorting.

The compartmentalised eukaryotic cell demands accurate targeting of proteins to the organelles in which they function, whether membrane-bound (like the nucleus) or non-membrane-bound (like the nucleolus). Nucleolar targeting relies on positively charged localisation signals and has received rejuvenated interest since the widespread recognition of liquid-liquid phase separation (LLPS) as a mechanism contributing to nucleolus formation. Here, we exploit a new genome-wide analysis of protein localisation in the early-branching eukaryote Trypanosoma brucei to analyse general nucleolar protein properties. T. brucei nucleolar proteins have similar properties to those in common model eukaryotes, specifically basic amino acids. Using protein truncations and addition of candidate targeting sequences to proteins, we show both homopolymer runs and distributed basic amino acids give nucleolar partition, further aided by a nuclear localisation signal (NLS). These findings are consistent with phase separation models of nucleolar formation and physical protein properties being a major contributing mechanism for eukaryotic nucleolar targeting, conserved from the last eukaryotic common ancestor. Importantly, cytoplasmic ribosome proteins, unlike mitochondrial ribosome proteins, have more basic residues - pointing to adaptation of physicochemical properties to assist segregation.

Superior mesenteric vein and portal vein thrombosis in a patient with COVID-19: a rare case.

A 68-year-old man was referred to the general surgeons on account of his abdominal pain of unknown cause. He had contracted COVID-19, 9 days prior. CT chest abdomen and pelvis revealed an extensive thrombus extending from the portal vein to the superior mesenteric vein. Further investigation ruled out haematological causes, and COVID-19 was determined to be the cause. He was treated with an extended course of therapeutic dose low molecular weight heparin under the guidance of the haematology team. He was discharged once he was clinically stable and pain-free, with a plan to be followed up by both the surgeons and haematologists. This case highlights the different ways in which COVID-19 presents, and the need for clearer guidance on the treatment and prevention of thromboembolism in COVID-19.