Asunto(s)
Analgésicos Opioides , Bloqueantes Neuromusculares , Intubación e Inducción de Secuencia Rápida , Remifentanilo , Aspiración Respiratoria , Humanos , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/farmacología , Analgésicos Opioides/uso terapéutico , Anestésicos Intravenosos , Presión Sanguínea/efectos de los fármacos , Frecuencia Cardíaca/efectos de los fármacos , Intubación Intratraqueal/efectos adversos , Intubación Intratraqueal/métodos , Bloqueantes Neuromusculares/administración & dosificación , Bloqueantes Neuromusculares/farmacología , Bloqueantes Neuromusculares/uso terapéutico , Intubación e Inducción de Secuencia Rápida/efectos adversos , Intubación e Inducción de Secuencia Rápida/métodos , Remifentanilo/administración & dosificación , Remifentanilo/farmacología , Remifentanilo/uso terapéutico , Aspiración Respiratoria/etiología , Aspiración Respiratoria/prevención & control , RiesgoRESUMEN
AIM: To evaluate the effect of sugammadex compared with neostigmine on speed and quality of recovery after rocuronium neuromuscular blockade (NMB) in geriatric patients undergoing posterior lumbar spine surgery. METHODS: This randomized controlled study at a tertiary academic medical center involved 40 patients (age ≥65 years, ASA PS II/III) scheduled for elective surgery under general anesthesia. Patients were randomized to sugammadex or neostigmine for reversal of moderate NMB with rocuronium. The primary outcome was recovery time from NMB after surgery to a train-of-four (TOF) ratio ≥0.9 measured at the adductor pollicis (TOF-Watch® SX). Secondary outcomes included hemodynamic change after administration of reversal agent (heart rate, blood pressure, dysrhythmia), time to extubation, pain medication requirement, time to first ambulation, and length of postanesthesia care unit (PACU) and total hospital stay. RESULTS: Sugammadex (4±2.2 min) compared with neostigmine reversal (26.3±17.5 min) was on average 22 min faster (95% CI 14.1-30.5; P≤0.001) with less variability (range 2-11 min vs 5-72 min). The groups significantly differed in time for tracheal extubation, response to verbal commands (open eyes, squeeze hand, lift head), and operating room exit. However, they had similar PACU stay, time to first ambulation, total hospital stay, postoperative pain, and opioid use. Sugammadex had less hemodynamic variability than neostigmine. No patient developed treatment-emergent dysrhythmias. CONCLUSION: Sugammadex reversal significantly hastened NMB recovery compared with neostigmine reversal in geriatric patients. It significantly decreased operating room time but not PACU time or hospital stay.
Asunto(s)
Bloqueo Neuromuscular , Fármacos Neuromusculares no Despolarizantes , Anciano , Humanos , Neostigmina , Rocuronio , SugammadexRESUMEN
Ovarian cancer is the leading cause of cancer associated mortality in the female reproductive system. Interleukin (IL)33 and its receptor IL 1 receptor like 1 (also termed ST2) are expressed by many cell types including epithelial cells. The role of IL33 in the pathogenesis of neoplasia remains controversial. The authors previously demonstrated that IL33 inhibits the growth of pancreatic cancer cells. The present study was performed to explore if IL33 has any direct effects on ovarian cancer cells. A clonogenic survival assay, immunohistochemistry (IHC), proliferation kit and caspase3 activity kit were all used to evaluate the direct effects of IL33 on cell proliferation and apoptosis of a widely studied ovarian cancer cell line, A2780. The possible molecular mechanisms were further evaluated with reverse transcriptionpolymerase chain reaction and IHC. It was demonstrated that the percentage of colonies and the optical density value of cancer cells were all increased in the presence of IL33; however, the relative caspase3 activity in cancer cells was decreased in the presence of IL33. Molecular mechanism studies revealed that the proproliferative effect of IL33 on cancer cells was associated with decreased levels of p27, and the antiapoptotic effect of IL33 was associated with levels of Fas cell surface death receptor (Fas) and tumor necrosis factorrelated apoptosisinducing ligand receptor 1 (TRAILR1). Therefore, IL33 promoted proliferation and inhibited apoptosis of ovarian cancer cells by downregulation of p27, Fas and TRAILR1. Contrary to previous studies demonstrating an antitumor effort in pancreatic cancer, the results of the present study indicated that IL33 exhibited a significant oncopromoting effect on ovarian cancer. Accordingly, the inhibition of IL33 may be a promising therapeutic strategy for ovarian cancer.
Asunto(s)
Interleucina-33/metabolismo , Neoplasias Ováricas/patología , Apoptosis , Línea Celular Tumoral , Proliferación Celular , Inhibidor p27 de las Quinasas Dependientes de la Ciclina/metabolismo , Regulación hacia Abajo , Femenino , Humanos , Receptor Activador del Factor Nuclear kappa-B/metabolismo , Receptores del Ligando Inductor de Apoptosis Relacionado con TNF/metabolismo , Receptor fas/metabolismoRESUMEN
Interleukin-33 (IL-33), a damage-associated molecular pattern molecule, is a cytokine within the IL-1 interleukin family that binds to the plasma membrane receptor suppression of tumorigenicity 2 on numerous cell types. IL-33 has been extensively studied in its role in autoimmune diseases, host responses to pathogens and allergens, and has been associated with tumorigenic effects in cancer research. The present study was performed to investigate the effects of IL-33 on colon cancer cells, based off the previous data that have demonstrated an anti-tumor effect of IL-33 on pancreatic cancer cells. The effects of IL-33 on proliferation, cell survival and apoptosis on human HCT-116 colon cancer cells were examined using clonogenic survival assays, proliferation and caspase-3 activity kits, terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling staining and immunocytochemistry. It was determined that the HCT-116 cells demonstrated an notable decrease in optical density value upon incubation with IL-33, along with a decrease in the number of colonies, compared with the controls. It was further determined that the anti-proliferative effect of IL-33 on HCT-116 cells was associated with downregulation of the pro-proliferative molecules cyclin B, cyclin D and cyclin dependent kinase 2. An apoptosis-inducing effect of IL-33 on HCT-116 cells was associated with downregulation of the anti-apoptotic molecules Flice-like inhibitory protein and B-cell lymphoma 2. Taken together, the results indicated that IL-33 inhibits the growth of colon cancer by suppressing cellular proliferation, whilst simultaneously promoting apoptosis.