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Recent randomized clinical trial was conducted to evaluate the efficacy of intraoperative esketamine in reducing postpartum depression (PPD) among women undergoing cesarean delivery. The trial was carried out at The First Affiliated Hospital of Chongqing Medical University in China, from March 2023 to February 2024. The participants included pregnant patients admitted for cesarean delivery, with exclusions for those having intellectual dysfunction or contraindications to esketamine. A total of 308 women were enrolled and randomly assigned to either the esketamine group (154 participants) or the control group receiving saline (154 participants) in a 1:1 ratio, following the intention-to-treat principle.

Intervention Details

The intervention for the esketamine group involved a 20-minute infusion of 0.25 mg/kg esketamine in saline, whereas the control group received saline only. The primary outcome of interest was the incidence of PPD at 6 weeks postpartum, which was measured using the Edinburgh Postnatal Depression Scale (EPDS). A secondary outcome included the incidence of PPD at 1 week postpartum and assessment of pain levels using a numerical rating scale (NRS) postoperatively.

Results Summary

Results indicated a significantly lower incidence of PPD at 6 weeks postpartum in the esketamine group (10.4%) compared to the control group (19.5%), yielding a relative risk (RR) of 0.53 with a 95% confidence interval of 0.30 to 0.93 (P = .02). Conversely, no significant difference was observed at 1 week postpartum, where incidences were 15.6% for the esketamine group and 24.0% for the control group (RR=0.64; P = .06). At 6 weeks postpartum, EPDS scores also reflected this trend, with lower median scores in the esketamine group (5 vs 6; P = .02), indicating less depressive symptom severity. The findings suggested that esketamine may effectively reduce the incidence of PPD among women undergoing cesarean delivery when assessed at a 6-week follow-up, but not at 1 week postpartum. Stratified analyses did not reveal significant advantages of esketamine in reducing PPD across various subgroups, nor did it impact pain scores after surgery. However, there was a noted reduction in the frequency of patient-controlled intravenous analgesia (PCIA) bolus administration among the esketamine group, which may indicate potential benefits for managing postoperative pain.

Adverse Events and Monitoring

Despite the promising results, the trial noted some adverse events associated with esketamine use, including dizziness, trance-like states, and dream-like sensations. While these effects were transient, they highlighted the need for careful monitoring of patients receiving esketamine. The trial also pointed out that a better understanding of the optimal dosing and administration routes for esketamine could help mitigate adverse reactions and enhance its effectiveness.

Conclusion and Future Research

In conclusion, this trial provided evidence for the potential use of esketamine as a preventive measure against PPD in women who have undergone cesarean delivery, though further research is warranted to confirm these findings and explore the broader clinical implications. Large-scale, multicenter studies are necessary to validate these results and enhance understanding of esketamine’s role in postpartum mental health care.

Key Points

– A randomized clinical trial involving 308 women undergoing cesarean delivery was conducted to assess the efficacy of intraoperative esketamine on postpartum depression (PPD), with participants divided equally into esketamine and control groups.

– The intervention for the esketamine group included a 20-minute infusion of 0.25 mg/kg esketamine in saline, while the control group received only saline. The primary outcome measured was the incidence of PPD at 6 weeks postpartum, using the Edinburgh Postnatal Depression Scale (EPDS).

– At 6 weeks postpartum, the esketamine group showed a significantly lower incidence of PPD (10.4%) compared to the control group (19.5%), with a relative risk of 0.53 (95% CI: 0.30 to 0.93, P = .02). No significant difference was recorded at 1 week postpartum, with incidences of 15.6% for esketamine and 24.0% for control (RR=0.64; P = .06).

– EPDS scores reflected improved outcomes at 6 weeks, with the esketamine group reporting lower median scores (5 vs 6, P = .02), indicating reduced depressive symptom severity. Stratified analyses showed no significant differences in PPD reduction across demographic subgroups. – Participants in the esketamine group experienced fewer demands for patient-controlled intravenous analgesia (PCIA) boluses post-surgery, suggesting potential benefits in postoperative pain management, although pain scores did not significantly differ between groups.

– Adverse effects such as dizziness and dream-like sensations were recorded with esketamine use, emphasizing the importance of monitoring. The need for further research, including large-scale multicenter studies, was identified to validate the findings and explore optimal dosing and administration for improved safety and efficacy in managing postpartum mental health.

Reference –

Li Ren et al. (2025). Intraoperative Esketamine And Postpartum Depression Among Women With Cesarean Delivery. *JAMA Network Open*, 8. https://doi.org/10.1001/jamanetworkopen.2024.59331.

A simple urine test could accurately show the recurrence of kidney cancer at an early stage, potentially sparing patients invasive scans and enabling faster access to treatment, new research has shown.

The findings are presented today [Monday 24 March 2025] at the European Association of Urology (EAU) Congress in Madrid and have been accepted for publication in European Urology Oncology.

The test analyses the distinctive profiles of certain types of sugar molecules, called glycosaminoglycans which are found in urine. These profiles are known as the GAGome.

The international AURORAX-0087A (AUR87A) study is assessing whether a GAGome test can accurately detect the return of clear cell renal cell carcinoma (ccRCC) following surgery. This is the most common form of kidney cancer and accounts for up to 90% of cases. There are around 400,000 patients diagnosed with ccRCC worldwide each year.

Around one-fifth of ccRCC patients who have surgery to remove their cancer will see it return within five years – the majority within the first two years. Currently, the only way to monitor patients is through a scan – usually a CT scan – every 6 to 12 months, with the frequency depending on their level of risk.

The study’s initial cohort involved 134 patients treated at 23 hospitals across the UK, EU, USA and Canada. The patients were all diagnosed with ccRCC which had not spread beyond the kidney, and which was treated with surgery. Most had their kidney completely removed. All patients continued to have CT scans as standard monitoring after surgery, alongside a urine test every 3 months. Each urine sample was analysed using mass spectrometry to produce a score out of 100, called the GAGome score.

After up to 18 months of follow up, 15% of patients had seen their cancer return. The GAGome test was extremely sensitive in picking up recurrence, correctly identifying 90% of patients whose cancer had returned, while correctly ruling out just over half of those who remained cancer-free. These results were based on a GAGome score threshold optimised at 12/100. A score above 12 was counted as positive, and 12 or below as negative.

A positive result in the study yielded a 26% chance the patient actually had a recurrence. More importantly, a negative GAGome score resulted in a highly reliable 97% chance that the patient did not have a recurrence. The higher the GAGome score, the more likely the positive result correctly identified recurrence.

This level of accuracy is similar to CT scans and offers advantages to using scans alone, according to lead researcher on the study, Saeed Dabestani, Associate Professor at Lund University and Consultant Urologist at Kristianstad Central Hospital, Sweden.

“CT scans often pick up small lesions that aren’t large enough to biopsy, and we currently don’t know whether they are a sign of the cancer returning or not,” he explained. “Our only option is to do more frequent scans to monitor more closely, which is unpleasant for patients and often brings little benefit.

“If you have a urine test that can accurately show whether the cancer has actually returned then you can better assess risk levels and reduce the frequency of the scans required. Based on the results we have so far, it’s likely that we could safely halve the number of scans that patients have to undergo.”

Dr Carmen Mir Maresma, Consultant Uro-Oncologist from University Hospitals La Ribera in Valencia, Spain, and member of the EAU Scientific Congress Office said: “Developing biomarkers for kidney cancer is a major challenge and this study provides a stepping stone towards that goal. The results are really interesting, in that the test showed a high negative predictive value. If the test comes back negative, you can be more or less sure there is no cancer recurrence, but if it’s positive, then we need to look further. The test is also based on a suite of biomarkers, rather than just one molecule, which provides a more robust basis for making decisions on treatment.

“We don’t know yet whether finding recurrence sooner will save patients’ lives – more research is needed to determine that. There are also changes in post-operative treatment underway, with some countries licensing the immunotherapy pembrolizumab for kidney cancer. More research will also be needed to understand how this biomarker interacts with that therapy.”

The international team involved in the AUR87A study is nearing final recruitment of the second cohort of patients, the results from which will be used to validate the findings from the first cohort. These results are expected towards the end of this year.

The GAGome test used in the AUR87A study is under development by Swedish diagnostics company, Elypta, for whom Dabestani also acts as a medical adviser. The test has not yet been approved for clinical use in diagnostic procedures and further research will be required to confirm its effectiveness in clinical practice.

Reference:

Urine test could halve post-op scans for kidney cancer, European Association of Urology, Meeting: EAU25 European Association of Urology Congress.

Researchers at the University of Jyväskylä’s Faculty of Sport and Health Sciences have found that women who exhibit disturbed eating behaviours and engage in low physical activity tend to have more central body fat and a higher risk of metabolic low-grade inflammation. This condition increases the risk of cardiovascular diseases, which become more prevalent after menopause. However, the combined effect of exercise and healthy eating behaviour offers the most effective protection against inflammation and may also reduce it after menopause.

Body fat distribution changes as menopause progresses and estrogen levels decrease, causing the adipose tissue concentrated in the hips and thighs to gradually shift to the midsection as harmful visceral fat. This predisposes women to low-grade inflammation and cardiovascular diseases, which increase significantly after menopause.

A study by the University of Jyväskylä investigated the connection between health behaviours and low-grade inflammation. Health behaviours in this study include sleeping, eating and physical activity and related disorders. For example, disordered eating behaviour refers to a situation in which a person may restrict their eating to control their weight or body shape. They may also have a limited understanding of ​​what they are allowed to eat or what their body should look like.

“In line with previous studies, a higher amount of visceral fat was, as expected, associated with low-grade inflammation,” says Hannamari Lankila, a doctoral researcher at the Faculty of Sport and Health Sciences. “Visceral fat accumulated in the midsection secretes cytokines that increase inflammation, and this can increase the risk of metabolic diseases.”

The results show that those individuals who exhibit more disordered eating behaviour, as well as those who were physically less active, had more visceral fat, and thus the risk of low-grade inflammation was also higher.

When eating and physical activity behaviours were examined together, higher physical activity was associated with lower visceral fat, especially in those women who did not display disordered eating behaviour.

“The connection was weaker, meaning that the protective effect of even a high amount of exercise was less if the individual had eating-related difficulties,” Lankila continues. “Surprisingly, sleep was not a significant factor in this equation.”

Previous research has shown that both exercise and various diets and foods are associated with low-grade inflammation to some extent, but the combined effects of health behaviours during menopause have not previously been studied. The menopause phase is significant, however, as women live more than a third of their lives after menopause on average. During this period, the risk of metabolic and cardiovascular diseases increases significantly.

The study highlighted the link between visceral fat and inflammation, especially in women with low physical activity. Both physical activity and flexible eating behaviour can help reduce visceral fat, but the effect is likely to be more effective when the two are combined.

“It’s good to remember that even after menopause, it is possible to reduce the accumulation of harmful visceral fat and thus prevent metabolic and cardiovascular diseases that may result from it,” Lankila concludes.

The study also assessed sleep duration and perceived sleep quality as well as physical activity with the help of self-report questionnaires. Eating behaviour was assessed with the Eating Disorder Examination Questionnaire (EDE-Q), which consisted of 28 questions. The questionnaire can be used to assess whether a person restricts their eating and whether they have specific concerns about their eating, weight or body shape. In addition, the participants’ age, income level and use of menopausal hormone therapy were considered.

Reference:

Lankila, H., Kekäläinen, T., Hietavala, EM. et al. A mediating role of visceral adipose tissue on the association of health behaviours and metabolic inflammation in menopause: a population-based cross-sectional study. Sci Rep 15, 1999 (2025). https://doi.org/10.1038/s41598-025-85134-8

Recent study investigates the effectiveness of the El-Ganzouri risk index (EGRI) and skin-to-epiglottis distance (SED) as predictors of difficult laryngoscopy, which is a critical component of airway management in anesthesia. Conducted on 129 patients classified as American Society of Anesthesiologists (ASA) class I or II, aged between 25 and 70, the research focused on comparing these two assessment methods prior to tracheal intubation. Various preoperative assessments were performed, including EGRI, which incorporates factors such as mouth opening, thyromental distance, head and neck movements, obesity, and previous intubation difficulties. The study sought to correlate these preoperative findings with laryngoscopic views classified by the Cormack-Lehane (CL) grading system, which determines the visibility of the glottis during intubation. Results indicated that the EGRI exhibited a sensitivity of 88.9%, specificity of 6.7%, positive predictive value (PPV) of 33.3%, and negative predictive value (NPV) of 99%. In contrast, the SED demonstrated superior diagnostic performance with a sensitivity of 96%, specificity of 100%, PPV of 100%, and NPV of 99% when a threshold of 18 mm was applied. These findings underscore the utility of sonographically measured SED as a more reliable parameter for anticipating challenging intubations.

ROC Analysis

The study employed a receiver operating characteristic (ROC) analysis to evaluate the predictive capabilities of both EGRI and SED. The area under the ROC curve (AUC) for SED was significantly higher at 0.995, compared to 0.662 for EGRI, suggesting that SED measurements provide more accurate predictions of difficult laryngoscopy. Furthermore, a new cut-off for SED was proposed based on ROC analysis, setting the optimal threshold at 15 mm for enhanced predictive value, despite the study utilizing 18 mm as the operational cut-off.

Patient Assessment

During the assessment, patients were positioned appropriately to simulate the conditions of real intubation, and trained anesthesia personnel performed ultrasound measurements to determine SED at the level of the thyrohyoid membrane. The laryngoscopic evaluation revealed that 24 patients (18.6%) experienced difficult laryngoscopy, as classified under CL grades III and IV.

Methodology Comparison

The analysis also drew comparisons to existing airway assessment methods, accentuating the limitations of solely clinical parameters and the variability in their predictive performance due to confounding factors such as inter-observer differences. The superior accuracy of ultrasound-based measurements suggests a shift towards integrating sonographic techniques in routine preoperative airway assessments.

Conclusion and Future Directions

In conclusion, the findings establish that sonologically assessed SED surpasses EGRI in sensitivity and specificity for predicting difficult laryngoscopy, emphasizing its role as a critical adjunct to conventional clinical tests. The proposed combined scoring system, integrating SED and EGRI, aims to further refine the predictive ability regarding laryngoscopy difficulties, although further research with larger sample sizes is warranted to validate these results and the proposed scoring methodology. The study advocates for the adoption of SED in clinical practice to enhance preoperative airway management strategies.

Key Points –

– **Study Design and Population**: The investigation involved 129 patients classified as ASA class I or II, aged 25 to 70. The focus was on comparing the effectiveness of the El-Ganzouri risk index (EGRI) and skin-to-epiglottis distance (SED) in predicting difficult laryngoscopy prior to tracheal intubation.

– **Predictive Performance of EGRI and SED**: Results indicated that EGRI had a sensitivity of 88.9%, specificity of 6.7%, a positive predictive value (PPV) of 33.3%, and a negative predictive value (NPV) of 99%. In contrast, SED demonstrated significantly higher performance with sensitivity of 96%, specificity of 100%, PPV of 100%, and NPV of 99%, especially when using a threshold of 18 mm.

– **ROC Analysis Findings**: Receiver operating characteristic (ROC) analysis showed that the area under the ROC curve (AUC) for SED was 0.995, indicating excellent predictive capability, while EGRI’s AUC was only 0.662. A new optimal cut-off for SED was suggested at 15 mm for enhanced predictive ability.

– **Ultrasound Measurement Methodology**: Patients were accurately positioned for real intubation scenarios, and trained anesthesia personnel utilized ultrasound to measure SED at the thyrohyoid membrane level. Difficult laryngoscopy (CL grades III and IV) was observed in 18.6% of the subjects during laryngoscopic evaluations.

– **Limitations of Existing Assessments**: The study highlighted limitations found in existing airway assessment methods, particularly emphasizing the inadequacies of relying solely on clinical parameters, which can be affected by inter-observer variability. Ultrasound-based measurements provide a more objective and reliable approach.

– **Conclusion and Recommendations**: Findings support that sonologically assessed SED is superior to EGRI for predicting difficult laryngoscopy and propose a combined scoring system incorporating both factors for improved accuracy. The study recommends the integration of SED into clinical practice for better preoperative airway management, while also calling for further research with larger samples to validate the results.

Reference –

Fareeda Karimbanakkal et al. (2025). Comparison Between El-Ganzouri Risk Index And Sonologically Measured Skin-To-Epiglottis Distance For Predicting Difficult Laryngoscopy: A Prospective Observational Study. *Indian Journal Of Anaesthesia*. https://doi.org/10.4103/ija.ija_896_24.