Outcome of Stapled Hemorrhoidopexy: Experience of 90 Cases

Hemorrhoidal disease is one of the commonest anorectal problems in worldwide. Stapled hemorrhoidopexy is the treatment choice due to less post-operative pain and early recovery. The aim of this study was to assess outcomes after Stapled hemorrhoidopexy (SH). This cross-sectional prospective study was performed in Shaheed Suhrawardy Medical College Hospital, Dhaka from January 2016 to December 2017. Ninety patients with symptomatic hemorrhoidal diseases were included in this study. Data collected in data collection sheet regarding demographic data, severity of symptoms, post-operative complains of patient and outcome of patients which were then analyzed. Total 90 patients were included in this study. Age ranged from 18-50 years. Male were 59(65.56%) and female were 31(34.44%). 2° hemorrhoids were 11(12.22%), 3° hemorrhoids were 63(70%), 4° hemorrhoids were 16(17.78%). Post-operative complications were mild pain 73(81.11%), moderate pain 13(14.45%), severe pain 4(4.44%), early bleeding 23(25.56%), retention of urine 16(17.78%), early urgency 15(16.67%), infection 4(4.44%), constipation 9(10%), late recurrence 4(4.44%). Outcomes of stapled hemorrhoidopexy were satisfactory in most patients. Early recovery, low complication rate, minimal post-operative pain was encountered in treatment of symptomatic hemorrhoids by stapled hemorrhoidopexy.

Three RNA polymerase II carboxyl-terminal domain kinases display distinct substrate preferences

CDK7, CDK8, and CDK9 are cyclin-dependent kinases (CDKs) that phosphorylate the C-terminal domain (CTD) of RNA polymerase II. They have distinct functions in transcription. Because the three CDKs target only serine 5 in the heptad repeat of model CTD substrates containing various numbers of repeats, we tested the hypothesis that the kinases differ in their ability to phosphorylate CTD heptad arrays. Our data show that the kinases display different preferences for phosphorylating individual heptads in a synthetic CTD substrate containing three heptamer repeats and specific regions of the CTD in glutathione S-transferase fusion proteins. They also exhibit differences in their ability to phosphorylate a synthetic CTD peptide that contains Ser-2-PO(4). This phosphorylated peptide is a poor substrate for CDK9 complexes. CDK8 and CDK9 complexes, bound to viral activators E1A and Tat, respectively, target only serine 5 for phosphorylation in the CTD peptides, and binding to the viral activators does not change the substrate preference of these kinases. These results imply that the display of different CTD heptads during transcription, as well as their phosphorylation state, can affect their phosphorylation by the different transcription-associated CDKs.

Human and rodent transcription elongation factor P-TEFb: interactions with human immunodeficiency virus type 1 tat and carboxy-terminal domain substrate

The human immunodeficiency virus type 1 transcriptional regulator Tat increases the efficiency of elongation, and complexes containing the cellular kinase CDK9 have been implicated in this process. CDK9 is part of the Tat-associated kinase TAK and of the elongation factor P-TEFb (positive transcription elongation factor-b), which consists minimally of CDK9 and cyclin T. TAK and P-TEFb are both able to phosphorylate the carboxy-terminal domain (CTD) of RNA polymerase II, but their relationships to one another and to the stimulation of elongation by Tat are not well characterized. Here we demonstrate that human cyclin T1 (but not cyclin T2) interacts with the activation domain of Tat and is a component of TAK as well as of P-TEFb. Rodent (mouse and Chinese hamster) cyclin T1 is defective in Tat binding and transactivation, but hamster CDK9 interacts with human cyclin T1 to give active TAK in hybrid cells containing human chromosome 12. Although TAK is phosphorylated on both serine and threonine residues, it specifically phosphorylates serine 5 in the CTD heptamer. TAK is found in the nuclear and cytoplasmic fractions of human cells as a large complex (approximately 950 kDa). Magnesium or zinc ions are required for the association of Tat with the kinase. We suggest a model in which Tat first interacts with P-TEFb to form the TAK complex that engages with TAR RNA and the elongating transcription complex, resulting in hyperphosphorylation of the CTD on serine 5 residues.