Oversecretion and Overexpression of Nicotinamide Phosphoribosyltransferase/Pre-B Colony-Enhancing Factor/Visfatin in Inflammatory Bowel Disease Reflects the Disease Activity, Severity of Inflammatory Response and Hypoxia.

Nicotinamide phosphoribosyltransferase's (Nampt) association with inflammatory bowel disease (IBD) is unclear. The study was aimed at unraveling Nampt's clinical and diagnostic relevance. The serum concentration (Luminex-xMAP® technology) was measured in 113 patients with Crohn's disease (CD), 127 with ulcerative colitis (UC) and 60 non-IBD controls: 40 healthy individuals and 20 with irritable bowel syndrome (IBS). The leukocyte (44 CD/37 UC/19 IBS) and bowel expression (186 samples) was also evaluated (RT-qPCR). All were referred to IBD phenotype, activity, treatment, and inflammatory/nutritional/angiogenic/hypoxia indices. Serum-Nampt and leukocyte-Nampt were positively correlated and were more elevated in active-IBD than in IBS, with leukocyte-Nampt being a fair differential marker. Serum-Nampt in UC positively correlated with its clinical and endoscopic activity as well as with pro-inflammatory cytokines. Serum-Nampt ≤1.54 ng/mL was a good indicator of mucosal healing. The expression of Nampt was up-regulated both in inflamed and quiescent colon and reflected, similarly to leukocyte-Nampt, the clinical activity of IBD. Bowel-Nampt was independently associated with IL1B and hypoxia-inducible factor 1α (HIF1A) expression in inflamed bowel but with FGF2 expression in quiescent bowel. In summary, Nampt's elevation in IBD at local and systemic levels, and protein and mRNA levels, reflects IBD activity and is associated with inflammation, hypoxia (active) and tissue repair (inactive disease).

Clinical validation of nuclear factor kappa B expression in invasive breast cancer.

Breast cancer is the most commonly diagnosed cancer in Polish women. The expression of transcription nuclear factor kappa B, a key inducer of inflammatory response promoting carcinogenesis and cancer progression in breast cancer, is not well-established. We assessed the nuclear factor kappa B expression in a total of 119 invasive breast carcinomas and 25 healthy control samples and correlated this expression pattern with several clinical and pathologic parameters including histologic type and grade, tumor size, lymph node status, estrogen receptor status, and progesterone receptor status. The data used for the analysis were derived from medical records. An immunohistochemical analysis of nuclear factor kappa B, estrogen receptor, and progesterone receptor was carried out and evaluation of stainings was performed. The expression of nuclear factor kappa B was significantly higher than that in the corresponding healthy control samples. No statistical difference was demonstrated in nuclear factor kappa B expression in relation to age, menopausal status, lymph node status, tumor size and location, grade and histologic type of tumor, and hormonal status (estrogen receptor and progesterone receptor). Nuclear factor kappa B is significantly overexpressed in invasive breast cancer tissues. Although nuclear factor kappa B status does not correlate with clinicopathological findings, it might provide important additional information on prognosis and become a promising object for targeted therapy.

Physiological Hypoxia (Physioxia) Impairs the Early Adhesion of Single Lymphoma Cell to Marrow Stromal Cell and Extracellular Matrix. Optical Tweezers Study.

Adhesion is critical for the maintenance of cellular structures as well as intercellular communication, and its dysfunction occurs prevalently during cancer progression. Recently, a growing number of studies indicated the ability of oxygen to regulate adhesion molecules expression, however, the influence of physiological hypoxia (physioxia) on cell adhesion remains elusive. Thus, here we aimed: (i) to develop an optical tweezers based assay to precisely evaluate single diffuse large B-cell lymphoma (DLBCL) cell adhesion to neighbor cells (mesenchymal stromal cells) and extracellular matrix (Matrigel) under normoxia and physioxia; and, (ii) to explore the role of integrins in adhesion of single lymphoma cell. We identified the pronouncedly reduced adhesive properties of lymphoma cell lines and primary lymphocytes B under physioxia to both stromal cells and Matrigel. Corresponding effects were shown in bulk adhesion assays. Then we emphasized that impaired ß1, ß2 integrins, and cadherin-2 expression, studied by confocal microscopy, account for reduction in lymphocyte adhesion in physioxia. Additionally, the blockade studies conducted with anti-integrin antibodies have revealed the critical role of integrins in lymphoma adhesion. To summarize, the presented approach allows for precise confirmation of the changes in single cell adhesion properties provoked by physiological hypoxia. Thus, our findings reveal an unprecedented role of using physiologically relevant oxygen conditioning and single cell adhesion approaches when investigating tumor adhesion in vitro.

Insulin-induced enhancement of MCF-7 breast cancer cell response to 5-fluorouracil and cyclophosphamide.

The study was designed to evaluate the potential use of insulin for cancer-specific treatment. Insulin-induced sensitivity of MCF-7 breast cancer cells to chemotherapeutic agents 5-fluorouracil and cyclophosphamide was evaluated. To investigate and establish the possible mechanisms of this phenomenon, we assessed cell proliferation, induction of apoptosis, activation of apoptotic and autophagic pathways, expression of glucose transporters 1 and 3, formation of reactive oxygen species, and wound-healing assay. Additionally, we reviewed the literature regarding theuse of insulin in cancer-specific treatment. We found that insulin increases the cytotoxic effect of 5-fluorouracil and cyclophosphamide in vitro up to two-fold. The effect was linked to enhancement of apoptosis, activation of apoptotic and autophagic pathways, and overexpression of glucose transporters 1 and 3 as well as inhibition of cell proliferation and motility. We propose a model for insulin-induced sensitization process. Insulin acts as a sensitizer of cancer cells to cytotoxic therapy through various mechanisms opening a possibility for metronomic insulin-based treatments.

Osteopontin splice variants are differential predictors of breast cancer treatment responses.

BACKGROUND: Osteopontin is a marker for breast cancer progression, which in previous studies has also been associated with resistance to certain anti-cancer therapies. It is not known which splice variants may mediate treatment resistance. METHODS: Here we analyze the association of osteopontin variant expression before treatment, differentiated according to immunohistochemistry with antibodies to exon 4 and to the osteopontin-c splice junction respectively, with the ensuing therapy responses in 119 Polish breast cancer patients who presented between 1995 and 2008. RESULTS: We found from Cox hazard models, logrank test and Wilcoxon test that osteopontin exon 4 was associated with a favorable response to tamoxifen, but a poor response to chemotherapy with CMF (cyclophosphamide, methotrexate, fluorouracil). Osteopontin-c is prognostic, but falls short of being a significant predictor for sensitivity to treatment. CONCLUSIONS: The addition of osteopontin splice variant immunohistochemistry to standard pathology work-ups has the potential to aid decision making in breast cancer treatment.

An in-vitro study to compare the temperature rise in the pulp chamber by direct method using three different provisional restorative materials.

STATEMENT OF PROBLEM: The provisional restorative materials in fixed prosthodontics are basically bis-GMA resins which releases exothermic temperature while polymerization which can damage the pulp. Intrapulpal temperature exceeding 42.5°C found to result in irreversible damage to the pulp. The remaining thickness of dentine after tooth preparation control the conduction of heat released by the resins. PURPOSE: (1) To quantify the temperature changes in the pulp chamber using different provisional restorative materials. (2) To evaluate the peak temperature time of different materials used. (3) To compare the intrapulpal temperature changes with a variation in the width of the finish line. METHODOLOGY: Two intact mandibular molars were selected and designated as Specimen A and B. Tooth preparation was done to prepare a finish line of 1.2 mm and 1 mm width, respectively. Three provisional restorative materials were considered and they were grouped as Group I-Cool temp, Group II-Protemp-4, Group III-Integrity. A J thermocouple probe was placed into the pulp chamber to determine the rise in temperature. The temperature was recorded during polymerization at 30-s intervals until the peak temperature was reached. The same procedure was repeated for fabricating remaining provisional crowns. A total of 45 provisional crowns were fabricated for each specimen. RESULTS: Kruskal-Wallis test revealed that there was a significant difference in the temperature changes associated with the provisional restorative materials used. All the three provisional restorative materials were compared for 1.2 mm and 1 mm wide finish line. Integrity produced the highest temperature rise and the maximum temperature recorded was 40.2°C in 1.2 mm wide finish line. However, for a 1 mm wide finish line, Protemp-4 produced the highest temperature rise and the maximum temperature recorded was 40.3°C. It was observed that peak temperatures with Specimen B were more when compared with Specimen A. CONCLUSION: Cool temp showed least temperature rise in the pulp chamber. The order of rise in intrapulpal temperature in tested provisional materials using direct technique would be Cool temp, Integrity, and Protemp-4.

A Review of Pseudomyxoma Peritonei: Insights Into Diagnosis, Management, and Prognosis.

Pseudomyxoma peritonei (PMP) is a rare and complex clinical syndrome characterized by the accumulation of mucinous ascites within the peritoneal cavity, typically associated with mucinous tumours of appendiceal origin. Despite its rarity, PMP poses significant challenges in diagnosis and management due to its indolent yet locally aggressive nature. This comprehensive review provides insights into the diagnosis, management, and prognosis of PMP, synthesizing current evidence and emerging trends in the field. Challenges and opportunities in PMP management are discussed, along with recommendations for clinical practice emphasizing the importance of a multidisciplinary approach and specialized care. Despite ongoing challenges, advances in surgical techniques, perioperative chemotherapy, and emerging therapies offer hope for improved outcomes and quality of life for PMP patients.

A Case of Well-Differentiated Endometrial Adenocarcinoma in a Postmenopausal Woman.

Endometrial adenocarcinoma is a prevalent malignancy among postmenopausal women, often presenting with symptoms such as abnormal vaginal bleeding and pelvic pain. We present a case of a 60-year-old postmenopausal female who exhibited abnormal vaginal bleeding for three months, accompanied by pelvic pain and unintentional weight loss. Clinical evaluation, including physical examination, imaging studies, and histopathological examination, led to the diagnosis of well-differentiated endometrial adenocarcinoma. The patient underwent an abdominal hysterectomy with bilateral salpingo-oophorectomy, and histopathological analysis confirmed invasive tumor involvement in the lower uterine segment and cervix. The final pathological tumor, node, and metastasis (TNM) staging was reported as pT1b No Mx, FIGO (International Federation of Gynecology and Obstetrics) stage II. This case underscores the importance of considering endometrial adenocarcinoma in the differential diagnosis of postmenopausal bleeding and highlights the significance of timely diagnosis and multidisciplinary management for optimizing patient outcomes.

Beyond the Norm: Navigating a Unique Papillary Carcinoma Journey in Breast Cancer.

The presence of papillary structures inside the tumor is a unique and uncommon characteristic of breast cancer, and it is known as papillary carcinoma. In contrast to other forms of breast cancer, this variant usually manifests as a well-defined mass in imaging investigations and is frequently linked to a good prognosis. We present a case of a 72-year-old female with papillary carcinoma of the breast identified after presenting with a palpable breast lump. Following a left simple mastectomy and adjuvant treatment, the presence of papillary structures inside the tumor was verified by a histopathological study. Understanding the clinical and pathological characteristics of breast papillary carcinoma is crucial for precise diagnosis and suitable therapy strategizing. More research is required to further understand the molecular traits and best practices for treating this uncommon subtype of breast cancer.

Efficacy and safety of intravenous ulinastatin versus placebo along with standard supportive care in subjects with mild or severe acute pancreatitis.

BACKGROUND: Ulinastatin is reported to inhibit pro-inflammatory markers and also inhibits coagulation and fibrinolysis. The drug is available in East Asia for the treatment of acute pancreatitis. AIM: To study the effect of addition of ulinastatin to standard care on mortality and morbidity in Indian subjects with acute pancreatitis. DESIGN: Randomized, double-blind, placebo-controlled, multi-centre trial across 15 centres in India. METHODS: Subjects, aged 18 to 70 years, with acute pancreatitis and elevated serum C-reactive protein (CRP) levels, were eligible for enrolment. Acute pancreatitis was diagnosed if the patient had at least two of the following criteria: suggestive abdominal pain, serum amylase and/or lipase > 3 times upper limit of normal, and imaging findings of acute pancreatitis. Subjects were classified as having mild or severe acute pancreatitis on the basis of the APACHE II score (< 8 mild, > or = 8 severe). Standard care was given to all subjects as per the treating physician's protocol. Eligible subjects were randomized to receive intravenous infusion of 200,000 IU ulinastatin or placebo in 100 mL of 0.9% saline given over one hour every 12 hours for 5 days. RESULTS: Of 135 randomized subjects, 129 completed the study (mild 62, severe 67). Pancreatitis was due to alcohol intake in a majority (81%) of subjects. Baseline characteristics were similar between the ulinastatin and placebo groups. Efficacy was evaluated in subjects who had received at least 3 days (6 doses) of ulinastatin/placebo. One subject with severe pancreatitis in the ulinastatin group versus six in the placebo group died (p = 0.048). New organ dysfunction developed in 5 ulinastatin vs 4 placebo group subjects (p = 0.744) with mild pancreatitis and 12 ulinastatin vs 29 placebo group subjects (p = 0.0026) with severe pancreatitis. Adverse events were significantly lower in subjects with severe pancreatitis in the ulinastatin group as compared to the placebo group (p = 0.00001). Reduction in serum CRP was not different between the groups. Median hospitalization was shorter by one day in the ulinastatin group; the difference was not significant. There was no infusion-related adverse event. CONCLUSIONS: Ulinastatin prevents new organ dysfunction and reduces mortality in subjects with severe pancreatitis.

Assessment of prescription pattern of under-five diarrhea cases in Western Odisha.

Introduction: Diarrhea is the second leading cause of death among under-five children. Prescription review by the authorities of the health facilities every month for the improvement of the quality of prescription writing of Medical practitioners is very essentials. With this background, the present study was conducted to assess the prescription patterns of healthcare providers for under-five diarrhea cases and to study the factors responsible for nonadherence to protocol of prescription patterns. Methodology: This cross-sectional study was conducted in the health facilities of two aspirational districts of Odisha. All secondary- and tertiary-level health institutions with 2-3 randomly selected PHCs of that blocks of the two districts were the study units. Mixed methods were used for data collection. Primary data were collected by in-depth interview of doctor and pharmacist. Secondary data were collected by review of records such as OPD ticket, IPD ticket, OPD register, dispensing register, and stock registers. Results: Of the 64 health facilities visited, a total of 516 prescriptions [217 (42%)] scanned/carbon copy of OPD ticket, 238 (46%) data from register on drug prescription, and 61 (11.8%) IPD record data were collected. Duration of diarrhea illness was not mentioned in any of the prescriptions which is important criteria for classifying the type of diarrhea and treatment. Signs of dehydration and degree of dehydration were mentioned in very few prescriptions of both the district. For the treatment of diarrhea cases, 2 to 4 medicines were prescribed in majority of 146 (67.3%), followed by more than four medicines in 38 (17.5%) prescriptions, and less than two medicines were prescribed in 33 (15.2%) cases. All prescriptions from MCH and SDH had ORS and zinc. Though all of them knew about the management protocol as per IMNCI, to be on the safe onside they used to prescribe more medicines to under-five diarrhea cases. None had the knowledge on five types of management plan. Conclusion: For under-five diarrhea cases, care should be taken to write the detail examination finding, weight of the child, associated comorbid condition, and advice on feeding in the prescription.

Effects of the menstrual cycle phases on the tilt testing results in vasovagal patients.

PURPOSE: The aim of the study was to assess the distribution of positive tilt testing (TT) throughout the menstrual cycle and to determine if the phase of menstrual cycle contributes to the duration of the loss of consciousness. METHODS: TT results of 183 premenopausal women, aged 29.5 ± 9.8 years, were studied. The menstrual cycle was divided into four phases based on the first day of the last menstrual bleeding: perimenstrual (M), preovulatory (F), periovulatory (O) and postovulatory (L). RESULTS: Positive TT results were equally distributed. In patients with TT in O phase, the highest percentage of NTG provocation was needed. Patients in L phase had significantly lower incidence of cardioinhibitory reaction. The longest duration of loss of consciousness was in the M phase. Multiple regression analysis revealed that the duration of loss of consciousness during positive TT was significantly associated with higher number of syncopal events, TT performed in M phase and lower heart rate at TT termination. Cardiodepressive type of neurocardiogenic reaction was more frequent during M and O phase than during L phase. CONCLUSIONS: The distribution of positive TT results as well as syncope and presyncope does not differ throughout the menstrual cycle. Diagnostic TT in premenopausal women with unexplained syncope could be performed irrespective of the phase of menstrual cycle. TT has similar sensitivity throughout the menstrual cycle. During the postovulatory phase, cardioinhibitory reaction is less frequent than in M and O phases. The duration of loss of consciousness is longer during the M phase of the menstrual cycle independently of the higher syncope number and lower heart rate at TT termination.

Knowledge, attitude, behavioural response and use of preventive measures regarding pandemic H1N1 influenza outbreak among dental students in Udaipur city, India.

PURPOSE: To assess the knowledge, attitude, behavioural response and use of preventive measures regarding a pandemic H1N1 influenza outbreak among dental students. MATERIALS AND METHODS: In a cross-sectional study, a total of 448 dental students (118 in preclinical categories, 330 in clinical categories) were surveyed using a self-administered, structured questionnaire pretested through a pilot survey. RESULTS: Out of 448 dental students, 92.6% had heard about swine flu, whereas only 64.3% of them knew about the H1N1 virus. More than 50% of dental students showed a positive response towards swine flu attitude, and pandemic H1N1 influenza modified the behaviour of dental students. Respondents rated hand washing and face masks as the most effective measures for the prevention of pandemic influenza. CONCLUSION: Half of the dental students had enough information and showed a positive attitude towards a H1N1 pandemic influenza outbreak. However, the behavioural response of the participants was poor.

Prevalence of dental caries and treatment needs among the orphan children and adolescents of Udaipur district, Rajasthan, India.

OBJECTIVE: The study was to examine the prevalence of dental caries and treatment needs among the orphan children and adolescents of Udaipur district, Rajasthan, India. METHODS: A descriptive cross-sectional study was conducted to assess the oral health status and treatment needs of orphan children. The lists obtained comprised of 13 orphanages consisting of 923 inmates including both sexes. The survey proforma was prepared using a self-administered structured questionnaire written in English validated through a pretested survey. The statistical software namely SPSS 15.0 was used for the analysis of the data. RESULTS: The prevalence of dental caries in primary teeth was found to be 49.6% and in permanent teeth was 41%. Most of the children need one surface filling followed by pulp care. CONCLUSION: The unmet needs for decayed teeth were also found to be high indicating a very poor accessibility and availability of any oral health care. Clearly, it can be concluded that this community has experienced a low utilization of preventive or therapeutic oral health services. CLINICAL SIGNIFICANCE: Orphanage children in India are usually taken care by NGOs or social workers who do not realize that dental care and oral health forms an integral part of children well-being. So, this paper enlighten the prevalence of dental caries and treatment needs among the orphan children and adolescents.

Parathyroid Hormone Secretion and Related Syndromes.

In this article, we will get to know about the parathyroid hormone and the parathyroid gland. Its anatomy, physiology, and pathology will be delved into. There will be a brief discussion about its secretion and also about various clinical syndromes related to it. Parathormone, the parathyroid glands, regulate normal calcium and phosphorus levels in the body. An increase in the secretion of parathormone results in increased calcium uptake from the kidney, intestine, and bones, hence elevating the blood calcium level. A few mechanisms of action of this hormone are increased by the presence of vitamin D. The increase in the secretion of this hormone as compared to the normal levels is termed hyperparathyroidism. Incidence is maximum after 60 years of age. The ratio of females to males is 2:1. There are three types of hyperparathyroidism which will be described in this article. Clinical manifestations of hyperparathyroidism include skeletal disease, renal involvement, GI manifestations, psychiatric diseases, decreased neuro-muscular irritability, decreased deep tendon reflexes, muscular weakness, and atrophy. Assessment for hyperparathyroidism can be done by various diagnostic tests which are described further in this article. Medical/surgical management to cure this is also well-established nowadays. The decrease in the secretion of this hormone as compared to normal levels is termed hypoparathyroidism. Serum calcium levels are very low, serum phosphate levels are very high, and tetany can develop. The incidence is that females are more prone than males. Assessment for acute hypoparathyroidism will show positive Chvostek sign and trousseau sign, hyperactive deep tendon reflexes, and paresthesia. Assessment of chronic hypoparathyroidism will show lethargy, weakness, fatigue, cataracts, brittle nails, dry scaly skin, personality changes, and can even cause permanent brain damage. The normal secretion process of this hormone and diseases when its secretion becomes abnormal and why that happens are briefed in this article.

Study of Histopathological Changes in the Placenta in Preeclampsia.

Pregnancy disorders include, most commonly, hypertensive disorders, which include gestational hypertension, preeclampsia, and chronic hypertension with superimposed preeclampsia. Various etiological factors prove to be both risks as well as protective factors, which include genetic factors, maternal smoking (it is inversely related to preeclampsia; that is, smoking decreases the incidence of preeclampsia), and other medical comorbidities such as hypertension, diabetes, asthma, and others, including older maternal age and high body mass index. Usually, high maternal and fetal mortality rates are seen with the diagnosis of hypertensive disorders in pregnancy, and severe morbidity is seen in cases of preeclampsia, eclampsia, and HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count), along with raised levels of liver enzymes and blood disorders such as low platelet counts. Preeclampsia is considered one of the most serious consequences of pregnancy. These disorders are often presented as newly diagnosed high blood pressure and proteinuria during the last trimester. But it can prove to be fatal for both the mother and the fetus. Though the causative factors of preeclampsia are still unknown, specific clinical and histopathological researchers propose that preeclampsia can be due to pathological changes in the placenta. The basic aim of this article is to discuss various histopathological changes in the placenta due to preeclampsia, but minor topics that affect the pathophysiology of the placenta due to preeclampsia are also mentioned. Furthermore, the effective management of maternal syndrome complications in pregnancy has also been discussed.

Pathophysiological Association Between Diabetes Mellitus and Alzheimer's Disease.

Worldwide elderly people are being affected by diabetes mellitus (DM) and dementia. The risk for the development of dementia is higher in people with DM. DM causes a marked cognitive reduction and increases the risk of dementia, most commonly vascular dementia and Alzheimer's disease. People affected by DM and dementia seem to be at higher risk for intense hypoglycemia. Hypoglycemia, the complication of DM treatment, is believed as an independent risk factor for dementia in people with DM. Both Alzheimer's disease and DM are linked with decreased insulin secretion, reduced uptake of glucose, raised oxidative stress, angiopathy, activation of the apoptotic pathway, aging, abnormal peroxidation of lipids, increased production of advanced glycation end products and tau phosphorylation, brain atrophy, and decreased fat metabolism. In this paper, we will review the association between Alzheimer's disease and DM. In addition, we will discuss the agents that enhance the risk for dementia in elderly people with DM and how to prevent the development of cognitive dysfunction in DM.

Transcutaneous electrical acupoint stimulation to reduce opioid consumption in patients undergoing inguinal hernia repair: protocol for a randomized controlled trial.

BACKGROUND: The purpose of this study is to evaluate the efficacy and safety of transcutaneous electrical acupoint stimulation (TEAS) in the postoperative treatment of patients undergoing inguinal hernia repair compared with sham and no treatment group. METHODS: This study is a protocol for a three-armed, single-blinded, placebo-controlled randomized controlled trial. Ninety participants scheduled for inguinal hernia repair will be randomly assigned to the TEAS group (n = 30), sham group (n = 30), and control group (n = 30). The TEAS group will receive treatment using four portable coin-sized electro-stimulators at both local and distal acupuncture points. The sham group will receive sham treatment with mock electrostimulation. The treatment groups will receive mixed frequency stimulation (alternating at 2 and 100 Hz every 3 s) in continuous mode for 30 min at intervals of 2 h for 24 h postoperatively. The control group will receive postoperative pain control using patient-controlled analgesia (PCA) device. The primary outcome is the total morphine dose received in the postoperative period (mg) using PCA 24 h after surgery. The number of PCA demands (i.e., times the button will be pressed) and delivered bolus doses, score on the Visual Analogue Scale, opioid-related side effects, the requirement for supplemental medications, score on the Hospital Anxiety and Depression Scale (HADS), and blood levels of stress hormones cortisol and prolactin. DISCUSSION: The results of this trial will determine whether TEAS with intensified stimulation protocol is a safe and effective option for reducing analgesic consumption and postoperative pain. TRIAL REGISTRATION: ISRCTN76428396. Registered on 05 October 2020. https://www.isrctn.com/ISRCTN76428396.

The risk for syncope and presyncope during surgery in surgeons and nurses.

BACKGROUND: Surgeons and nurses are exposed to orthostatic stress. AIMS: To assess the lifetime incidence of syncopal and presyncopal events during surgery in operation room staff and reveal the predicting factors. METHODS AND RESULTS: The study included 317 subjects (161 F, 156 M) aged 43.9 ± 9.6; 216 surgeons and 101 instrumenters. The study included filling of an anonymous questionnaire on the syncope and presyncope history. RESULTS: At least one syncopal event during operation was reported by 4.7% and presyncope by 14.8% of the studied population. All but one subject reported prodromal symptoms before syncope. In the medical history, syncope outside the operating room was reported by 11% of the studied group. Syncope and presyncope during operation was related to syncope in the medical history outside the operation room, respectively: odds ratio (OR) 20.2 95% confidence interval (CI): 2.0-70.5 and OR 10.8; CI: 5.0-23.4 and to presyncope in the medical history, respectively: OR 23.5; CI: 7.4-74.4 OR 8.9; CI: 3.6-11.2 (P < 0.001). CONCLUSIONS: (1) Syncope and presyncope may occur during surgery in the staff of the operating room. (2) Syncope in the operating room is usually preceded by prodromal symptoms and has vasovagal origin. (3) Both lower then expected occurrence of syncope in the operating room staff and absence of any difference between genders in this regard indicate preselection in the process of choosing profession and specialization. (4) Syncope and presyncope outside the operating room in medical history increases the risk of syncope and presyncope inside the operation room.