Evaluation of the biological response of propofol in zebrafish (Danio rerio): Focusing on biochemical, transcriptional, and molecular level.

Simple Summary According to cancer research statistics, there are 7500 new ovarian cancer diagnoses in the UK each year. An earlier detection of ovarian cancer leads to a better prognosis; however, there is currently no screening programme for ovarian cancer, and detection using ultrasound examinations remains challenging. The use of artificial intelligence in gynaecological ultrasound examinations aims to improve the diagnostic accuracy of ultrasound for ovarian cancer and improve outcomes for patients. This review aims to collate current research on AI in the ultrasound diagnosis of ovarian cancer and suggests the usefulness of incorporating this into clinical care. Abstract Ovarian cancer is the sixth most common malignancy, with a 35% survival rate across all stages at 10 years. Ultrasound is widely used for ovarian tumour diagnosis, and accurate pre-operative diagnosis is essential for appropriate patient management. Artificial intelligence is an emerging field within gynaecology and has been shown to aid in the ultrasound diagnosis of ovarian cancers. For this study, Embase and MEDLINE databases were searched, and all original clinical studies that used artificial intelligence in ultrasound examinations for the diagnosis of ovarian malignancies were screened. Studies using histopathological findings as the standard were included. The diagnostic performance of each study was analysed, and all the diagnostic performances were pooled and assessed. The initial search identified 3726 papers, of which 63 were suitable for abstract screening. Fourteen studies that used artificial intelligence in ultrasound diagnoses of ovarian malignancies and had histopathological findings as a standard were included in the final analysis, each of which had different sample sizes and used different methods; these studies examined a combined total of 15,358 ultrasound images. The overall sensitivity was 81% (95% CI, 0.80–0.82), and specificity was 92% (95% CI, 0.92–0.93), indicating that artificial intelligence demonstrates good performance in ultrasound diagnoses of ovarian cancer. Further prospective work is required to further validate AI for its use in clinical practice.

Artificial Intelligence in Ultrasound Diagnoses of Ovarian Cancer: A Systematic Review and Meta-Analysis

http://www.bjaopen.org/article/S2772609623000278/pdf

Continuous cerebral blood flow monitoring: What should we do with these extra numbers?

Fertility-sparing surgery in ovarian cancer is an increasing need in gynecology-oncology clinical practice because of the frequent childbearing delay in developed countries. As the evidence in literature is based on observational studies, this review focuses on summarizing the most recent and relevant evidence for the conservative management of young patients with ovarian cancer.Staging surgery is mandatory in epithelial ovarian tumors. In sex cord-stromal tumors, fertility-sparing surgery is only recommended in FIGO stage IA. Due to its good prognosis, conservative treatment is possible in some cases of advanced disease of germ cell tumors and borderline tumors. Cystectomy is a reasonable option in serous borderline tumors but is not recommended in other tumor subtypes. Successful conception rates after fertility-sparing surgery ranges from 30 to 60%.Fertility-sparing surgery is a well tolerated option in young women with early-stage ovarian cancer with acceptable reproductive outcomes. 

Current limits of conservative treatment in ovarian cancer

Abstract Background: The neurotoxicity of general anesthesia (GA) on the developing human brain is a topic of ongoing debate. In this study, we aimed to assess the association between GA exposure before the age of 3 and the risk of intellectual disability (ID). Methods: We enrolled individuals aged 0 to 3 years who underwent GA and were hospitalized for more than one day in Taiwan between January 2004 and December 2014. The study's final follow-up date was December 31, 2021. Results: Using propensity score matching, we identified 15,036 infants and toddlers (7,518 in the GA group and 7,518 in the no GA group). Cox regression analysis showed that the adjusted hazard ratio (aHR) for ID in the GA group was 2.38 (95% confidence interval [CI]: 1.94-2.91) compared to the no GA group. Children who underwent GA once and more than once had aHRs of ID of 1.98 (95% CI: 1.03-2.64) and 2.86 (95% CI: 1.52-3.11), respectively. The aHRs of ID for children who received GA for less than 3 hours and 3 hours or more were 1.86 (95% CI: 1.13-1.98) and 2.77 (95% CI: 1.44-2.92), respectively. The IRs of ID for the no GA group and GA group were 15.34 and 36.05 per 10,000 person-years, respectively. Conclusions: Our findings suggest that GA exposure before the age of 3 is associated with an increased risk of ID. Furthermore, age at first GA, duration of GA, and number of GA exposures are all significant risk factors for ID. Running Head : ID Risk in Children after GA 

Early Childhood General Anesthesia and Intellectual Disability: A Pediatric Cohort Study

Fertility Sparing Surgery (FSS) appears to be a safe means of treating early-stage ovarian cancer based on relatively limited evidence. However, there is currently insufficient evidence to aid women in counselling about their potential fertility outcomes. The aim of this study was to assess the reproductive outcomes and prognosis of women who have undergone FSS for ovarian malignancy. Between 1 June 2008 and 1 June 2018, a retrospective review of a clinical database was conducted to identify all consecutive patients who underwent FSS in a central London gynaecological oncology centre. All patients with a histological diagnosis of ovarian malignancy (excluding borderline ovarian tumours) were eligible. All identified patients were then prospectively called into a follow up and asked to complete a questionnaire about their fertility outcomes. A total of 47 women underwent FSS; 36 were included in this study. The mean age was 30.3 years (95% Confidence Interval [CI]: 27.6 to 33.0 years). During the study period, 17/36 (47.2%) of the women had attempted to conceive following surgery, with a successful live birth rate of 52.9% (9/17). The mean time of recurrence was 125.3 months (95% CI: 106.5–144.1 months). The mean time to death was 139.5 months (95% CI: 124.3–154.8). The cancer grade, tumour stage and use of Assisted Reproductive Technology (ART) were the main factors significantly associated with the risk of recurrence and death. In conclusion, this study suggests that a large proportion of women will not attempt to conceive following FSS. For those who do attempt to conceive, the likelihood of achieving a live birth is high. However, careful counselling about the higher risk of recurrence and worse survival for women with high grade cancer, disease Stage > IA and potentially those who undergo ART is essential before contemplating FFS.

/pdf/fertility-preserving-surgery-outcomes-for-ovarian-malignancy-1g00gw20.pdf

Fertility Preserving Surgery Outcomes for Ovarian Malignancy: Data from a Tertiary Cancer Centre in Central London

Thirty years ago, neurotoxicity induced by general anaesthetics in the developing brain of rodents was observed. In both laboratory-based and clinical studies, many conflicting results have been published over the years, with initial data confirming both histopathological and neurodevelopmental deleterious effects after exposure to general anaesthetics. In more recent years, animal studies using non-human primates and new human cohorts have identified some specific deleterious effects on neurocognition. A clearer pattern of neurotoxicity seems connected to exposure to repeated general anaesthesia. The biochemistry involved in this neurotoxicity has been explored, showing differential effects of anaesthetic drugs between the developing and developed brains. In this narrative review, we start with a comprehensive description of the initial concerning results that led to recommend that any non-essential surgery should be postponed after the age of 3 yr and that research into this subject should be stepped up. We then focus on the neurophysiology of the developing brain under general anaesthesia, explore the biochemistry of the observed neurotoxicity, before summarising the main scientific and clinical reports investigating this issue. We finally discuss the GAS trial, the importance of its results, and some potential limitations that should not undermine their clinical relevance. We finally suggest some key points that could be shared with parents, and a potential research path to investigate the biochemical effects of general anaesthesia, opening up perspectives to understand the neurocognitive effects of repetitive exposures, especially in at-risk children. 

Safety of general anaesthetics on the developing brain: are we there yet?

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Fertility Preserving Surgery Outcomes for Ovarian Malignancy: Data from a Tertiary Cancer Centre in Central London

Safety of general anaesthetics on the developing brain: are we there yet?