Objective To examine risk of malignancy and death in patients with kidney transplant who receive the immunosuppressive drug sirolimus.Design Systematic review and meta-analysis of individual patient data.Data sources Medline, Embase, and the Cochrane Central Register of Controlled Trials from inception to March 2013.Eligibility Randomized controlled trials comparing immunosuppressive regimens with and without sirolimus in recipients of kidney or combined pancreatic and renal transplant for which the author was willing to provide individual patient level data. Two reviewers independently screened titles/abstracts and full text reports of potentially eligible trials to identify studies for inclusion. All eligible trials reported data on malignancy or survival. Results The search yielded 2365 unique citations. Patient level data were available from 5876 patients from 21 randomized trials. Sirolimus was associated with a 40% reduction in the risk of malignancy (adjusted hazard ratio 0.60, 95% confidence interval 0.39 to 0.93) and a 56% reduction in the risk of non-melanoma skin cancer (0.44, 0.30 to 0.63) compared with controls. The most pronounced effect was seen in patients who converted to sirolimus from an established immunosuppressive regimen, resulting in a reduction in risk of malignancy (0.34, 0.28 to 0.41), non-melanoma skin cancer (0.32, 0.24 to 0.42), and other cancers (0.52, 0.38 to 0.69). Sirolimus was associated with an increased risk of death (1.43, 1.21 to 1.71) compared with controls.Conclusions Sirolimus was associated with a reduction in the risk of malignancy and non-melanoma skin cancer in transplant recipients. The benefit was most pronounced in patients who converted from an established immunosuppressive regimen to sirolimus. Given the risk of mortality, however, the use of this drug does not seem warranted for most patients with kidney transplant. Further research is needed to determine if different populations, such as those at high risk of cancer, might benefit from sirolimus.

Posterior pericardiotomy is a simple, safe and effective method for reducing the incidence of postoperative pericardial effusion and related atrial fibrillation by improving pericardial drainage after coronary artery bypass grafting.

To compare the expression of two promising circulating micro-ribonucleic acids (miRNAs 21 and 221) in patients with prostate cancer to subjects without cancer and to evaluate their potential role as specific noninvasive molecular biomarkers for prostate cancer diagnosis, circulating miRNAs 21 and 221 expression profiles were analyzed in 20 men aged 50-75 years, presenting with lower urinary tract symptoms (LUTSs) and undergoing transrectal ultrasound (TRUS)-guided prostate biopsy based on either elevated serum prostate-specific antigen (PSA) (>4.0 ng/ml) or suspicious digital rectal examination (DRE). The performance of miRNAs 21 and 221 in differentiating prostate cancer from nonmalignant cases was evaluated and compared to DRE and elevated PSA. miRNA 21 was overexpressed in 90 % of group A vs. 10 % of group B, while miRNA 221 was overexpressed in 80 % of group A vs. 20 % of group B (p = 0.001). MiRNA 21 overexpression had the highest performance as a diagnostic test with a sensitivity of 90 % and a specificity 90 % (p = 0.02). No correlations were noted between Gleason score of prostate cancer cases and relative quantity (RQ) 21 (r = -0.355, p = 0.292) or RQ 221 (r = -0.044, p = 0.892). Our study showed that serum miRNAs 21 and 221 expression profiling tests may be used as specific noninvasive molecular biomarkers for prostate cancer diagnosis due to their higher sensitivity and specificity with a high negative predictive value leading to a decrease in the biopsies taken for patients with elevated serum PSA values.

Methodology: Forty patients were randomly allocated into 4 equal groups based on LA mixture used for scalp block: Group I:received 1.5 mg/kg bupivacaine 0.25% + 5 mg/kg lidocaine 1% with 1:200,000 epinephrine. Group II:same as Group I + 8 mg dexamethasone. Group III:same as Group I + 500 mgMgSO 4. Group IV:same as Group I + 8 mgdexamethasone + 500 mgMgSO 4. Dexmedetomidine was used for intraoperative sedation and paracetamol for postoperative analgesia. Results: Total intra-operative consumption of dexmedetomidine was highly significantly less in Group II (232 ± 21 µg) and Group III (241 ± 18 µg) compared to Group I (286 ± 27 µg). Group IV (162 ± 25 µg) was highly significantly less than other groups. Time to first paracetamol requirement was highly significantly longer in Group II (245 ± 32 min) and Group III (236 ± 28 min) compared to Group I (187 ± 17 min). Group IV (388 ± 14 min) showed a highly significant longer time than other groups. Group IV consumed highly significant less doses of paracetamol in the first postoperative day (POD1) (2.2 ± 0.1 g) than Group I (2.9 ± 0.4 g), Group II (2.7 ± 0.3 g) and Group III (2.8 ± 0.5 g).Pain in POD1 was significantly higher in Group I at after 3 h of surgery compared to other groups. VAS was comparable during the rest of the times of the study among the four groups. All patients were hemodynamically stable during times of the study. Blood glucose levels were within normal levels with no significant differences between the groups within 6 hof scalp block. Conclusion: Adding either 8 mg©dexamethasone or 500 mg©MgSO4 or both to bupivacainelidocaine for scalp block before awake craniotomy improves performance of the block with the best results when combined.

Background: Intraoperative mapping techniques maximize safety and efficacy during perirolandic glioma resection but may induce seizures and limit the procedure. We aim to report the incidence and predictors of stimulation-induced seizures during mapping either patient is awake or under general anesthesia (GA). Methods: Retrospective analysis of 64 patients (40 awake and 24 GA) with perirolandic glioma underwent resection using intraoperative mapping techniques between 2014 and 2019. Preoperative data, operative details, postoperative neurological status, and extent of resection (EOR) were analyzed. Predictors of intraoperative seizures were assessed. Results: The mean cortical and subcortical stimulation intensities needed to evoke motor responses were significantly lower in awake cases than in GA patients (4.9 ± 0.42 vs. 8.9 ± 1.2 mA) and (8.3 ± 0.62 vs. 12.1 ± 1.1 mA), respectively (P = 0.01). Incidence of intraoperative seizures was lower but statistically non-significant in awake cases (10% vs. 12.5%) (P = 0.76). Preoperative multiple antiepileptic drugs (AEDs) (P = 0.03) and low-grade glioma (P = 0.04) were statistically significant predictors for intraoperative seizures. Mean EOR in awake cases was 92.03% and 90.05% in GA cases (P = 0.23). Postoperative deficits were permanent after 3 months only in 5% of awake patients versus 8.3% of GA group (P = 0.59). Conclusion: Awake craniotomy with intraoperative mapping can be done safely for perirolandic gliomas with lower but statistically nonsignificant incidence of intraoperative seizures and this could be attributed to statistically significant lower stimulation intensities required for mapping. Preoperative multiple AEDs and low-grade glioma are significant predictors for intraoperative seizures.