The Role of Serum Interleukin-6 Levels in Prognosticating Postoperative Complications After Cytoreductive Surgery for Ovarian Cancers: A Prospective Observational Study

Background: Interleukin-6 (IL-6), a pro-inflammatory cytokine, has been associated with adverse prognosis in ovarian cancer. Cytoreductive surgery for ovarian cancer has a higher risk of postoperative surgical complications (POCs). We aimed to find out if serum IL-6 is elevated preoperatively in patients undergoing cytoreductive surgery for ovarian cancer and if it can predict POCs. We also compared its trend with serum C-reactive protein (CRP) in the early postoperative period. Materials and Methods: Fifty-one patients between 18–75 years, posted for elective ovarian cytoreductive surgery at a tertiary cancer hospital were included after taking informed consent. Serum IL-6 and CRP were done the day before surgery and repeated 24 and 72 hours post-surgery. All parameters that affect POCs were captured. POCs were graded using the Clavein Dindo classification. We recorded the length of the intensive care unit (ICU), hospital stay, and 30-day mortality. Appropriate statistical tests were used and p value <0.05 was considered significant. Results: Out of 51 enrolled patients, 46 were included for data analysis after exclusions. The mean age of patients in this study was 49.76 +/- 12.42 years with a mean surgical duration of 302.39 +/- 127.04 minutes and mean blood loss of 332.6 +/- 274.71 mL. The incidence of POCs in our study was 21.7% (10/46 patients). Preoperative IL-6 was raised and was able to predict POCs with 70% sensitivity and 86% specificity at a cutoff value of 23.56 pg./mL (R2 = 0.71; AUC = 0.79). In patients who developed POCs, IL-6 values (1196.7+/-1461.4 pg./mL) peaked at 24 hours whereas CRP values (360 +/- 430.1 mg/L) peaked at 72 hours; thus, allowing early prognostication with IL-6. The cut-off value of serum IL-6 at 24 hours to predict POCs is 480 pg./mL (R2 = 0.50; AUC = 0.79) with 80% sensitivity and 89% specificity. Two patients died - on postoperative days 5 and 28 respectively. Conclusion: Preoperative IL-6 is raised in patients with ovarian cancer posted for cytoreductive surgery. A cut-off value of 23.56 pg./mL preoperatively and 480 pg./mL at 24 hours after surgery could predict postoperative surgical complications

Assessing the impact of body mass index on insulin resistance and metabolic risk factors in pre-diabetic individuals: A comprehensive cross-sectional study

Background: Insulin resistance plays a crucial role in the onset of type 2 diabetes, with body mass index (BMI) being a significant determinant. Aims and Objectives: This study examines the link between BMI and insulin resistance in pre-diabetic individuals to inform strategies for early diabetes intervention. Materials and Methods: This cross-sectional study involved 100 pre-diabetic participants. Data on demographic characteristics, BMI, insulin resistance (measured by the Homeostatic Model Assessment for Insulin Resistance, HOMA-IR), lipid profiles, and blood pressure (BP) were collected. Participants were categorized into normal weight, overweight, and obese groups to explore the relationship between BMI and insulin resistance and its impact on metabolic and cardiovascular health. Results: The average participant age was 45.8 years (SD=12.3), with a slight majority being female (52%) and an average BMI of 28.4 kg/m² (SD=4.5). A significant positive correlation (r=0.64, P<0.001) between BMI and the HOMA-IR index highlighted the association between increased BMI and insulin resistance. Obese individuals had a notably higher HOMA-IR index (3.5±1.3) compared to those overweight (2.5±1.0) and of normal weight (1.9±0.8). In addition, the study found worsening lipid profiles and increased BP with higher BMI categories. Gender did not significantly affect insulin resistance, whereas a slight increase in HOMA-IR with age was noted (r=0.23, P=0.02). Conclusion: The findings highlight the strong correlation between higher BMI and increased insulin resistance in pre-diabetics. They emphasize the importance of managing body weight to mitigate the risk of diabetes and cardiovascular diseases

Comparative study on cartilage tissue collected from less- and severely-affected region of osteoarthritic knee

Culture expanded chondrocytes isolated from non-load bearing region of osteoarthritic (OA) joint has been used to construct tissue engineered cartilage for treatment purposes. The aim of the study was to compare the histological properties of the cartilage tissue and morphological properties of the chondrocytes isolated from less and severely affected OA knee. Human articular cartilage was obtained as redundant tissue from consented patients with late-stage OA undergoing total knee replacement surgery at Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Articular cartilage was graded according to Dougados and Osteoarthritis Research Society International (OARSI) classification. Articular cartilage was classified into less affected (LA; Grade 0-1) and severely affected (SA; Grade 2-3). Cartilage tissue from less and severely affected region was stained with Safranin O staining. Isolated chondrocytes from each group were cultured until passage 4 (P4). Their growth patterns, cell areas, and circularity were compared. LA-cartilage tissue shows uniform spread of safranin O staining indicating intact extracellular matrix (ECM) component. However, SA-cartilage shows significant reduction and unstable staining due to its degraded ECM. LA-chondrocytes showed an aggregated growth compared to SA-chondrocyte that remains monolayer. Moreover, LA-chondrocytes have significantly higher cell area with wider spreading at passage 0 and 4 compared to SA-chondrocytes. It was also found that chondrocyte circularity increased with passage, and circularity of LAchondrocytes was significantly higher than that of the SA-chondrocytes at passage 3. This study demonstrated the considerable difference in the cellular properties for less and severely affected chondrocytes and implication of these differences in cell-based therapy needed to be explored

Willingness to work in rural areas and the role of intrinsic versus extrinsic professional motivations - a survey of medical students in Ghana

<p>Abstract</p> <p>Background</p> <p>Retaining health workers in rural areas is challenging for a number of reasons, ranging from personal preferences to difficult work conditions and low remuneration. This paper assesses the influence of intrinsic and extrinsic motivation on willingness to accept postings to deprived areas among medical students in Ghana.</p> <p>Methods</p> <p>A computer-based survey involving 302 fourth year medical students was conducted from May-August 2009. Logistic regression was used to assess the association between students' willingness to accept rural postings and their professional motivations, rural exposure and family parental professional and educational status (PPES).</p> <p>Results</p> <p>Over 85% of students were born in urban areas and 57% came from affluent backgrounds. Nearly two-thirds of students reported strong intrinsic motivation to study medicine. After controlling for demographic characteristics and rural exposure, motivational factors did not influence willingness to practice in rural areas. High family PPES was consistently associated with lower willingness to work in rural areas.</p> <p>Conclusions</p> <p>Although most Ghanaian medical students are motivated to study medicine by the desire to help others, this does not translate into willingness to work in rural areas. Efforts should be made to build on intrinsic motivation during medical training and in designing rural postings, as well as favour lower PPES students for admission.</p

Morphological study of the antennal sensilla in Gerromorpha (Insecta: Hemiptera: Heteroptera)

The external morphology and distribution of the antennal sensilla of 21 species from five families of semiaquatic bugs (Gerromorpha) were examined using scanning electron microscopy. Nine main types were distinguished based on their morphological structure: sensilla trichoidea, sensilla chaetica, sensilla leaflike, sensilla campaniformia, sensilla coeloconica, sensilla ampullacea, sensilla basiconica, sensilla placoidea and sensilla bell-mouthed. The specific morphological structure of one type of sensilla (bell-mouthed sensilla) was observed only in Aquarius paludum. Several subtypes of sensilla are described, differentiated by number, location and type of sensillum characteristic for each examined taxon. The present study provides new data about the morphology and distribution of the antennal sensilla in Gerromorpha

Mammalian Target of Rapamycin Is a Therapeutic Target for Murine Ovarian Endometrioid Adenocarcinomas with Dysregulated Wnt/β-Catenin and PTEN

Despite the fact that epithelial ovarian cancers are the leading cause of death from gynecological cancer, very little is known about the pathophysiology of the disease. Mutations in the WNT and PI3K pathways are frequently observed in the human ovarian endometrioid adenocarcinomas (OEAs). However, the role of WNT/β-catenin and PTEN/AKT signaling in the etiology and/or progression of this disease is currently unclear. In this report we show that mice with a gain-of-function mutation in β-catenin that leads to dysregulated nuclear accumulation of β-catenin expression in the ovarian surface epithelium (OSE) cells develop indolent, undifferentiated tumors with both mesenchymal and epithelial characteristics. Combining dysregulated β-catenin with homozygous deletion of PTEN in the OSE resulted in development of significantly more aggressive tumors, which was correlated with inhibition of p53 expression and cellular senescence. Induced expression of both mTOR kinase, a master regulator of proliferation, and phosphorylation of its downstream target, S6Kinase was also observed in both the indolent and aggressive mouse tumors, as well as in human OEA with nuclear β-catenin accumulation. Ectopic allotransplants of the mouse ovarian tumor cells with a gain-of-function mutation in β-catenin and PTEN deletion developed into tumors with OEA histology, the growth of which were significantly inhibited by oral rapamycin treatment. These studies demonstrate that rapamycin might be an effective therapeutic for human ovarian endometrioid patients with dysregulated Wnt/β-catenin and Pten/PI3K signaling

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030