RESUMEN
BACKGROUND: Oral squamous cell carcinoma (OSCC), which is the most common head and neck cancer, accounts for 1%-2% of all human malignancies and is characterized by poor prognosis and reduced survival rates. WNT1-inducible signaling pathway protein 1 (WISP1), a cysteine-rich protein belonging to the Cyr61, CTGF, Nov (CCN) family of matricellular proteins, has many developmental functions and may be involved in carcinogenesis. This study investigated WISP1 single-nucleotide polymorphisms (SNPs) to elucidate OSCC susceptibility and clinicopathologic characteristics. METHODOLOGY/PRINCIPAL FINDINGS: Real-time polymerase chain reaction was used to analyze 6 SNPs of WISP1 in 900 OSCC patients and 1200 cancer-free controls. The results showed that WISP1 rs2929970 polymorphism carriers with at least one G allele were susceptible to OSCC. Moreover, compared with smokers, non-smoker patients with higher frequencies of WISP1 rs2929970 (AG + GG) variants had a late stage (stages III and IV) and a large tumor size. In addition, OSCC patients who were betel quid chewers and carried WISP1 rs16893344 (CT + TT) variants had a low risk of lymph node metastasis. CONCLUSION: Our results demonstrate that a joint effect of WISP1 rs2929970 with smoking as well as WISP1 rs16893344 with betel nut chewing causally contributes to the occurrence of OSCC. WISP1 polymorphism may serve as a marker or a therapeutic target in OSCC.
Asunto(s)
Proteínas CCN de Señalización Intercelular/genética , Carcinoma de Células Escamosas/metabolismo , MicroARNs/metabolismo , Neoplasias de la Boca/metabolismo , Proteínas Proto-Oncogénicas/genética , Sitios de Unión , Proteínas CCN de Señalización Intercelular/metabolismo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proteínas Proto-Oncogénicas/metabolismo , Transducción de SeñalRESUMEN
We investigated the association between interleukin-18 (IL-18) polymorphisms and the susceptibility and clinicopathological state of hepatocellular carcinoma (HCC). In total, 901 participants, including 559 healthy controls and 342 patients with HCC, were recruited. The allelic discrimination of -607A/C (rs1946518) and -137G/C (rs187238) polymorphisms of IL-18 was assessed through real-time polymerase chain reaction by performing the TaqMan assay. The IL-18 -137G/C polymorphism but not the -607A/C polymorphism showed a significant association with the risk of HCC. Participants carrying the IL-18 -137 polymorphism with heterozygous G/C and homozygous CC genotypes showed a 1.987-fold increase (95% CI = 1.301-3.032; p = 0.001) in the risk of HCC compared with those homozygous for wild-type G/G. The 342 patients with HCC carrying the IL-18 -137G/C polymorphism were positive for hepatitis B virus (HBV) infection with an adjusted odds ratio of 1.668. Moreover, the 142 HBV positive patients with HCC and the IL-18 -137 polymorphism were positive for at least one C genotype and showed significant vascular invasion (p = 0.018). Furthermore, the level of α-fetoprotein was high in the patients carrying the IL-18 -137 polymorphism with GC+CC alleles (p = 0.011). In conclusion, the IL-18 -137G/C polymorphism with a GC+CC genotype could be a factor that increases the risk of HCC. Furthermore, the correlation between the IL-18 -137G/C polymorphism and HCC-related HBV infection is a risk factor for vascular invasion and has a synergistic effect that can further enhance HCC prognosis.
Asunto(s)
Carcinoma Hepatocelular/genética , Estudios de Asociación Genética , Interleucina-18/genética , Neoplasias Hepáticas/genética , Adulto , Alelos , Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/virología , Femenino , Predisposición Genética a la Enfermedad , Genotipo , Virus de la Hepatitis B/patogenicidad , Humanos , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/virología , Masculino , Persona de Mediana Edad , Polimorfismo de Nucleótido Simple , Factores de Riesgo , alfa-Fetoproteínas/genéticaRESUMEN
STUDY OBJECTIVE: To analyze the reasons for postponement or cancellation of surgery in the operating room (OR), and to determine the effect on patient outcomes. DESIGN: Retrospective analysis. SETTING: University-affiliated hospital. MEASUREMENTS: Over a 5-year period, 45,663 surgeries requiring anesthesia occurred. Surgery was postponed or cancelled in the OR for 67 patients (0.15%). Airway problems, change in medical condition, and change in surgical condition were the reasons recorded. Each patient's surgical result was audited using medical charts and telephone calls for at least 6 months. MAIN RESULTS: 33 cases (49.3%) were postponed from one day to 6 months (range, one to 165 days; median, 8 days). The scheduled surgeries for 21 (31.3%) patients were never performed; and 9 patients (13.4%) died during their hospitalization (range, one to 20 days; mean, 12.7 days). CONCLUSIONS: Surgery was postponed or cancelled in the OR mainly for changes in medical condition (70.2%); either medical risk outweighed the benefits of surgery, or alternative treatments were used.
Asunto(s)
Hospitales Universitarios/estadística & datos numéricos , Quirófanos/estadística & datos numéricos , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Adulto , Anciano , Femenino , Humanos , Masculino , Auditoría Médica , Persona de Mediana Edad , Calidad de la Atención de Salud , Estudios Retrospectivos , Factores de TiempoRESUMEN
BACKGROUND: Smooth and successful insertion of a laryngeal mask airway (LMA) during etomidate induction requires a proper mouth opening and efforts to minimize airway reflexes such as gagging, coughing, or laryngospasm. We hypothesized that the concurrent use of fentanyl or succinylcholine with etomidate, the induction agent, could reduce the occurrence of airway reflexes and increase the success rate of LMA. METHODS: Sixty adult patients, ASA class I-II, scheduled for surgery under general anesthesia, were randomly allocated into three groups: group I in which patients were given etomidate 0.3 mg/kg alone; group 2 in which patients were given fentanyl 2 microg/kg and etomidate 0.3 mg/kg; groups 3 in which patients were give etomidate 0.3 mg/kg and succinylcholine 1 mg/kg. All patients were premedicated with atropine 0.01 mg/kg. When induction of anesthesia began we recorded the time from administering the designated regiminal agent or agents to the time of relaxation of jaw (the ease of mouth opening) and checked the patient for any excitatory movement after administering the induction agents. After inserting the LMA, we checked for signs of airway reflexes. Student's t test, Chi-square and Fisher's exact test were used to analyze the data. A value of P < 0.05 was considered significant. RESULTS: There were no significant differences in demographic data among the the three groups. The concurrent use of fentanyl or succinylcholine with etomidate during induction could significantly reduce the occurrence of excitatory movements and airway reflexes after LMA insertion, and increase the success rate of LMA insertion in comparison with using etomidate alone. Comparing the two adjutant agents, the concurrent use of succinylcholine could provide a significantly better jaw relaxation, shorten the time to insert the LMA and increase the success rate of LMA insertion. CONCLUSIONS: As an induction agent to facilitate insertion of LMA, etomidate alone was far from perfect. The concurrent use of 2 microg/kg of fentanyl with etomidate might significantly reduce the occurrence of airway reflexes in response to LMA insertion and increase the success rate of insertion. However, concurrent use of 1 mg/kg succinylcholine with etomidate might provide better results in terms of shortened time for the LMA insertion, jaw relaxation, and the success rate of LMA insertion than that of fentanyl.