Euro Surveill. 2025 Apr;30(15). doi: 10.2807/1560-7917.ES.2025.30.15.2500237.
NO ABSTRACT
PMID:40248885 | DOI:10.2807/1560-7917.ES.2025.30.15.2500237
Tag: nevin manimala
Appl Immunohistochem Mol Morphol. 2025 Apr 18. doi: 10.1097/PAI.0000000000001260. Online ahead of print.
ABSTRACT
High-grade serous carcinoma is categorized based on p53 mutation status. A relationship is known to exist between p53 mutations and p53 immunoexpression patterns, including overexpression, complete absence, cytoplasmic, and wild-type patterns. The ubiquitin ligases WWP1 and PARC, known to regulate p53 activation, are hypothesized to influence the pathogenesis of serous ovarian tumors. This retrospective study examined 7 low-grade serous carcinomas, 38 high-grade serous carcinomas, and 15 serous cystadenomas, with immunohistochemical analyses performed for WWP1, PARC, and p53. High-grade serous carcinoma cases were classified into wild-type, cytoplasmic, complete absence, or overexpression categories based on p53 immunohistochemistry. PARC and WWP1 expressions were compared across p53 categories and diagnoses. Results showed a statistically significant reduction in WWP1 and PARC expression in serous carcinomas, with the most pronounced loss observed in high-grade cases. Among morphologically classified high-grade carcinomas, 17 overexpression, 11 complete absence, 6 wild-type, and 4 cytoplasmic p53 cases were identified. A statistically significant relationship was found between PARC, WWP1, and p53 status. Higher expression levels of PARC and WWP1 were detected in p53 wild-type cases, whereas lower expression levels were associated with cases exhibiting p53 overexpression and complete absence. This study suggests that PARC and WWP1 play a role in the pathogenesis of high-grade serous ovarian carcinoma, potentially mediated by p53, making them promising targets for treatment and prognostic markers in serous ovarian cancer.
PMID:40248870 | DOI:10.1097/PAI.0000000000001260
Front Surg. 2025 Apr 3;12:1563256. doi: 10.3389/fsurg.2025.1563256. eCollection 2025.
ABSTRACT
INTRODUCTION: Intracranial arteriovenous malformations (AVMs) classified as Spetzler-Martin (SM) grades III-V present significant therapeutic challenges due to their complex angioarchitecture and high risk of morbidity. Stereotactic radiosurgery (SRS) is a minimally invasive modality for nidus obliteration, often combined with embolization to reduce nidus size and address high-risk vascular features. However, the impact of pre-SRS embolization on obliteration rates, post-SRS hemorrhage, and mortality remains controversial. This systematic review and meta-analysis aim to evaluate the effects of embolization on SRS outcomes in high-grade AVMs.
METHODS: Following PRISMA guidelines, a comprehensive search of PubMed, ScienceDirect, Cochrane, and Google Scholar was conducted. Studies comparing SRS alone versus SRS with embolization in SM grade III-V AVMs were included. Primary outcomes were obliteration rates, post-SRS hemorrhage, and mortality. Data extraction and quality assessment were performed using the Newcastle-Ottawa Scale, and pooled analysis was conducted using Review Manager (RevMan) software.
RESULTS: Out of 4,186 identified studies, five high-quality cohort studies met inclusion criteria. Pooled analysis showed that SRS alone resulted in higher obliteration rates than SRS with embolization (OR: 2.06, 95% CI: 0.92-4.65; p=0.08), though not statistically significant. Post-SRS hemorrhage rates were comparable (OR: 3.07, 95% CI: 0.72-13.08; p = 0.13), and mortality rates showed no significant difference (OR: 0.21, 95% CI: 0.01-4.62; p = 0.32).
DISCUSSION: Although embolization aids in nidus volume reduction, it may hinder radiosurgical efficacy by altering nidus architecture and introducing shielding effects. SRS alone demonstrated superior obliteration rates with fewer technical concerns. Individualized treatment planning remains essential, balancing embolization benefits against its potential drawbacks. Future studies should explore advancements in embolic agents and imaging techniques to optimize multimodal strategies for high-grade AVMs.
PMID:40248814 | PMC:PMC12003381 | DOI:10.3389/fsurg.2025.1563256
Front Surg. 2025 Apr 3;12:1513695. doi: 10.3389/fsurg.2025.1513695. eCollection 2025.
ABSTRACT
INTRODUCTION: Evidence suggests that hiatal hernia should be repaired if found during laparoscopic sleeve gastrectomy (LSG), either to prevent new-onset post-operative gastro-esophageal reflux disease (GERD), or to treat pre-existing reflux symptoms. There is interest in performing laparoscopic Nissen’s fundoplication (LNF) along with hiatal hernia repair (HHR) during LSG. This study aimed to determine whether hiatal crural repair alone is adequate for symptomatic control. We compared operative time, body mass index (BMI), and reflux symptoms between those undergoing LSG with HHR vs. LSG with HHR and LNF.
MATERIALS AND METHODS: We retrospectively analyzed clinical data of patients who underwent LSG with HHR. This cohort was divided into those with LNF (group 1) and without LNF (group 2). We collected patients’ pre-operative BMI and GERD Questionnaire (GERD-Q) scores. We then compared pre-operative BMI and GERD-Q values with post-operative indices at 1-month, 3-months, and 6-months. The patients’ medical records for operative findings and time between both groups was analyzed. Statistical analyses included Independent Samples T-tests, Paired T-tests, and correlation analysis.
RESULTS: In this study, 978 bariatric surgeries were performed. Of 431 LSG patients, 73 fulfilled the study criteria. Both groups showed significant reduction in BMI and GERD-Q scores post-operatively. Group 1 had a decrease in BMI from an average pre-operative value of 38.03-32.17 at 6 months (p < 0.001), and GERD-Q scores from 12.25 to 6.47 (p < 0.001). Group 2 showed a BMI decrease from 39.63 to 31.67 (p < 0.001) and GERD-Q scores from 11.54 to 6.93 (p < 0.001) at 6 months. Average operative time was similar in both groups, 76.41 and 79.15 min for group 1 and 2, respectively (p = 0.621).
CONCLUSION: Our research with short-term results reports similar improvement in BMI and GERD symptoms in patients with LSG and HHR with or without LNF. A sound repair of hiatal crura combined with LSG leads to comparable outcomes to crural repair combined with LNF and LSG for weight loss and reflux resolution. Our short-term results do not support LNF in combination with LSG and HHR. Further research is essential to determine the long-term outcomes.
PMID:40248813 | PMC:PMC12003324 | DOI:10.3389/fsurg.2025.1513695
J Anaesthesiol Clin Pharmacol. 2025 Apr-Jun;41(2):345-350. doi: 10.4103/joacp.joacp_121_24. Epub 2024 Nov 15.
ABSTRACT
BACKGROUND AND AIMS: Point-of-care ultrasound conducted by anesthesiologists plays a crucial role in ensuring the safety of anesthesia. This study aims to evaluate the interobserver reliability of ultrasound measurements of the inferior vena cava (IVC) and aorta diameters in fasting pediatric patients undergoing spontaneous and controlled ventilation. Despite the prevalent use of indices for intravascular volume assessment, their accuracy varies depending on the observer’s expertise, particularly in pediatric cases. This research seeks to provide valuable insights into the interobserver reliability of ultrasound measurements in pediatric patients.
MATERIAL AND METHODS: A single-center prospective observational study was conducted involving pediatric patients aged 1-12 years undergoing elective surgery. Ethical approval and written consent were obtained, with exclusions for major cardiovascular issues. Ultrasound measurements of IVC and aorta were performed by two observers during spontaneous and controlled ventilation in the subxiphoid transabdominal long-axis view. Reliability was assessed through statistical analyses, including the intraclass correlation coefficient and Bland-Altman analysis.
RESULTS: Mean values of IVC and aorta diameters were summarized for both observers during different ventilation modes. The intraclass correlation coefficient indicated excellent to good agreement between the observers for both spontaneous and controlled ventilation scenarios. Bland-Altman analysis revealed no fixed or proportional errors, confirming the reliability of the measurements.
CONCLUSIONS: This study establishes the reliability of ultrasound measurements for assessing IVC and aorta in subxiphoid transabdominal long-axis view. The findings highlight the potential of this technique in pediatric anesthesia, even after brief training, providing valuable insights for clinical practice.
PMID:40248806 | PMC:PMC12002677 | DOI:10.4103/joacp.joacp_121_24
J Anaesthesiol Clin Pharmacol. 2025 Apr-Jun;41(2):318-322. doi: 10.4103/joacp.joacp_5_24. Epub 2024 May 23.
ABSTRACT
BACKGROUND AND AIMS: Liver resection is a complex surgery, and optimizing recovery is critical to ensure that patients can promptly regain their health and quality of life. The authors present a retrospective cohort study on Enhanced Recovery After Surgery (ERAS) in liver resection aimed at correlating compliance with ERAS elements to length of stay (LOS) and the incidence of complications in a tertiary-level cancer hospital in Eastern India.
MATERIAL AND METHODS: In total, 44 hepatectomy patients were assessed retrospectively from June 2022 to May 2023. Data were collected from electronic medical records and patient charts.
RESULTS: The overall compliance was 77.7%. Individual component compliance varied. Lower compliance rates were seen with some aspects such as fasting and carbohydrate loading, minimally invasive surgical techniques used, and avoidance or early removal of the drain. The cohort was divided into two groups. Group 1 had compliance to ≥75% of 21 elements of ERAS, and group 2 had compliance to <75%. Statistical analysis showed higher ERAS compliance and reduced complications, although LOS differences were not statistically significant (group 1 and group 2 with an LOS difference of 1 day). Severe complications such as re-exploration and death were noted in the group of patients with compliance to less than 75% of the components.
CONCLUSION: With increased ERAS compliance, the patients benefited clinically and financially.
PMID:40248802 | PMC:PMC12002699 | DOI:10.4103/joacp.joacp_5_24
J Anaesthesiol Clin Pharmacol. 2025 Apr-Jun;41(2):236-242. doi: 10.4103/joacp.joacp_462_23. Epub 2025 Feb 22.
ABSTRACT
BACKGROUND AND AIMS: Desflurane helps in prompt awakening when discontinued. Since desflurane has a lesser blood: gas solubility than nitrous oxide, we hypothesized that use of air with desflurane would result in a rapid recovery compared to desflurane with nitrous oxide.
MATERIALS AND METHODS: After approval from the institutional ethical committee was obtained, this prospective, nonrandomized study (CTRI/2017/11/010558) was conducted. This study included 110 American Society of Anesthesiologists I-II patients aged 18-60 years, of either sex, undergoing general anesthesia using desflurane with air or nitrous oxide for elective surgery. The primary objective was to compare the time taken to achieve a modified Aldrete score of 9/10. The secondary objectives were to compare time to spontaneous respiration, time to extubation, time to verbal response, time to orientation, intraoperative opioid consumption, and incidence of explicit recall between groups. P <0.05 was considered significant.
RESULTS: The time required to achieve modified Aldrete score of 9/10 was higher in those who received nitrous oxide (899.09 ± 426.85 s) compared to those who received air (464.27 ± 190.28 s; P < 0.01). Time taken for spontaneous respiration, extubation, verbal response, and orientation was significantly higher with the use of desflurane with nitrous oxide compared to use of air. The intraoperative opioid requirement was statistically significant, but clinically not significant. Explicit recall was not seen in any of the patients.
CONCLUSION: Nitrous oxide delays the elimination of desflurane compared to air, thus delaying extubation and recovery and mitigating the beneficial effects of desflurane.
PMID:40248797 | PMC:PMC12002682 | DOI:10.4103/joacp.joacp_462_23
J Anaesthesiol Clin Pharmacol. 2025 Apr-Jun;41(2):323-332. doi: 10.4103/joacp.joacp_26_24. Epub 2024 Aug 16.
ABSTRACT
BACKGROUND AND AIMS: Preclinical studies in rodents and primates have shown that anesthesia was neurotoxic to the developing brain after exposure in the neonatal period. Sevoflurane a commonly used inhalational anesthetic, especially in pediatric surgery, might cause behavioral impairment in the developing brain. Although favored for its rapid onset and minimal airway disturbance, sevoflurane has been implicated in neurotoxic effects such as anesthesia-induced developmental neurotoxicity in rodents, through various mechanisms. One of the mechanisms was disturbances in methylation metabolism which can be easily treated if it is proved. This study aims to evaluate the levels of S-adenosylmethionine [SAM] following sevoflurane anesthesia in neonates and to correlate the duration of sevoflurane exposure and S-adenosylmethionine levels.
MATERIAL AND METHODS: Sixty neonates were included in the study under general anesthesia. Pre- and postsevoflurane exposure arterial blood samples were collected in ethylenediamine tetraacetic acid vacutainers. Each sample was centrifuged at 1000 rpm for 10 min. Plasma was separated and stored at -80°C, then subjected to S-adenosylmethionine enzyme-linked immunoassay test for preand postsevoflurane exposure levels of SAM.
RESULTS: The difference between the pre- and post-SAM values is not statistically significant and also with increasing the duration of sevoflurane exposure there was no reduction in the SAM levels (r = 0.17), and the correlation was not significant (P = 0.18).
CONCLUSION: Single exposure to sevoflurane does not impact SAM levels in neonates undergoing general anesthesia.
PMID:40248795 | PMC:PMC12002701 | DOI:10.4103/joacp.joacp_26_24
J Anaesthesiol Clin Pharmacol. 2025 Apr-Jun;41(2):250-256. doi: 10.4103/joacp.joacp_232_24. Epub 2025 Jan 29.
ABSTRACT
BACKGROUND AND AIMS: Postoperative pain is a major cause of discomfort after laparoscopic surgeries and thus necessitates prevention and treatment. This study aims to evaluate and compare two different doses of intraperitoneally nebulized (aerosol size: 0.4-4.5 micrometers) dexamethasone for the prevention of postoperative pain.
MATERIAL AND METHODS: In this double-blind, randomized control study, 135 patients undergoing laparoscopic surgeries were randomly assigned to three groups after obtaining ethical committee clearance and CTRI registration. Intraperitoneal nebulization was performed using the Aeroneb device, with group A receiving 16 mg dexamethasone, group B receiving 8 mg dexamethasone, and group C receiving 0.9% normal saline. The primary outcome was assessed by measuring visceral, somatic, and referred pain using a visual analog scale (VAS) at 6 hours postoperatively. Secondary outcomes included VAS at 1 and 24 hours, the hemodynamic response to pneumo-peritoneum, 24-hour anti-emetics, and opioid consumption.
RESULTS: VAS score at 6 hours was 0.9 ± 1.06 in group A, 1.7 ± 1.45 in group B, and 2.3 ± 1.87 in group C for referred pain; the values were statistically significant (P = 0.01). VAS score was 0.7 ± 0.76 in group A, 1.7 ± 1.82 in group B, and 2.2 ± 2.06 in group C for dull aching pain; the results were statistically significant at 24 hours (P = 0.001). None of the values at any time point were statistically significant (P < 0.05) for incisional pain. The rise in heart rate after 5 minutes of pneumoperitoneum was the least in group A compared to group C (P = 0.01). Group C had the highest consumption of anti-emetics and rescue analgesics (P = 0.001).
CONCLUSIONS: Intraperitoneal dexamethasone nebulization of 16 mg and 8 mg both are equi-effective in decreasing the severity of pain after laparoscopic surgeries compared to normal saline nebulization (P = 0.001).
PMID:40248791 | PMC:PMC12002692 | DOI:10.4103/joacp.joacp_232_24
J Anaesthesiol Clin Pharmacol. 2025 Apr-Jun;41(2):286-291. doi: 10.4103/joacp.joacp_88_24. Epub 2025 Mar 24.
ABSTRACT
BACKGROUND AND AIMS: Postoperative hypotension is common in adults receiving epidural analgesia. Although risk factors have been reported in the literature, prognostic models have not been developed or validated. We aimed to develop and validate a multivariable, prognostic model for postoperative hypotension in patients receiving epidural analgesia.
MATERIAL AND METHODS: We retrieved retrospective cohort data of adults undergoing abdominal or thoracic surgery at five hospitals between 2014 and 2023 who received epidural analgesia for at least 24 hours after surgery. A systematic literature search helped define a priori candidate exposures. The primary outcome was postoperative hypotension during the first 72 hours after surgery. Multiple logistic regression was performed to evaluate a multivariable model. Exposures identified as statistically significant were used for logistic regression, linear discriminant analysis, and decision-tree model of random forest. Classification error was used to compare models, and variable importance was used for random forest analysis.
RESULTS: In total, 829 participants were included. The incidence of postoperative hypotension was 38.8%. Multivariable analysis identified the following independent prognostic factors: male sex, white race, body mass index, intraoperative hypotension, use of arterial line, bupivacaine concentration of 0.125% (vs. lower concentrations), and anesthesia duration. The error misclassification rate was 67% for multiple logistic regression, 27% for linear discriminant analysis, and 33.4% for random forest model.
CONCLUSION: Using retrospective cohort data, a prognostic model of hypotension produced the best performance results using linear discriminant analysis, with an error misclassification rate of 27%. Further studies are required to perform model optimization for future clinical use.
PMID:40248788 | PMC:PMC12002708 | DOI:10.4103/joacp.joacp_88_24