Sugammadex: su eficacia y seguridad en la reversión selectiva del vecuronio

Introducción: En 1979, con la monitorización del uso rutinario de los relajantes neuromusculares, se determinó incidencia en la relajación neuromuscular residual del 45%, con múltiples complicaciones respiratorias que incrementan la estancia hospitalaria. No es conocida la eficacia y seguridad del manejo del vecuronio y su reversión con el uso del sugammadex dentro del manejo rutinario de anestesia. Métodos: Revisión sistemática de artículos sobre el comportamiento del sugammadex cuando se realiza reversión para el efecto del vecuronio, por ser la primera droga que ha demostrado eficacia y seguridad frente a relajantes musculares no despolarizantes esteroideos, que ayuda a prevenir bloqueo residual en el posoperatorio. Resultados: Búsqueda en las bases de datos de EMBASE, EBSCO y MEDLINE y Pubmed (desde enero 2000-diciembre 2012), con palabras MeSH, sugammadex, vecuronium, binding reversal agents, neuromuscular blocking agents; artículos en idioma inglés de estudios clínicos controlados en pacientes humanos adultos en los cuales el sugammadex fue comparado con placebo u otro medicamento. Se aprecia disminución del tiempo de recuperación de la relajación neuromuscular en el bloqueo moderado con un rango de 1,5 a 2,3min con el sugammadex vs 18,9 a 66,2min con la neostigmine y en un bloqueo profundo desde 35,5-68,4min, con dosis de 0,5mgrs/kg de sugammadex hasta 1,4-1,7min con 8mgrs/kg. Discusión: Resultados favorables en el suministro de dosis mayores a 2mgrs/kg en pacientes que presentaban bloqueo neuromuscular moderado y mayores de 4mgrs/kg en bloqueo neuromuscular profundo. Existe necesidad de nuevos estudios clínicos que soporten estos hallazgos. Conclusión: La evidencia sugiere que sí existe una adecuada reversión de la relajación neuromuscular del vecuronio con el uso de sugammadex a 2mgrs/kg, con disminución importante del tiempo y mayor recuperación del paciente sin presencia de relajación residual.

Sugammadex versus neostigmina en la reversión de la relajación neuromuscular en neurocirugía. Experimento clínico. Reporte preliminar

Existen grupos quirúrgicos específicos donde es mandatorio el uso de relajantes neuromusculares no despolarizantes, como es el caso de los pacientes llevados a procedimiento de neurocirugía; debido a sus características particulares el rocuronio es una buena alternativa para este tipo de procedimientos, ya sea en bolos o en infusión. Sin embargo la relajación residual y los efectos adversos de los medicamentos para revertir la relajación neuromuscular deben tenerse en cuenta en este grupo de pacientes en particular. El presente trabajo busca comparar la reversión de la relajación de infusiones de rocuronio, con Neostigmina mas Atropina vs la reversión con Sugammadex en pacientes llevados a manejo quirúrgico de lesiones supratentoriales por parte del servicio de neurocirugía de la Fundación Cardioinfantil, evaluando complicaciones durante la administración de los medicamentos y 24 horas posoperatorias, así como los tiempos para extubación y salida de salas de cirugía. Estudio con características de experimento prospectivo, aleatorizado, ciego, controlado. En este documento se realiza un reporte preliminar descriptivo de 14 pacientes reclutados hasta la actualidad.

Violence and growth in colombia : a review of the quantitative literature

This is a critical review of the empirical literature on the relationship between violence and economic growth in Colombia: an interesting case study for social scientists studying violence, conflict, crime and development. We argue that, despite the rapid development of this literature and the increasing use of new techniques, there is still much room for research. After assessing the contribution of the most influential papers on the subject, we suggest directions for future research.

The sediment trapping efficiency of the macro-tidal Daly Estuary, tropical Australia

Field studies were carried out on the water and sediment dynamics in the tropical, macro-tidal, Daly Estuary. The estuary is shallow, very-turbid, about 100 km long, and the entrance is funnel-shape. In the wet, high flow season, normal tidal ranges can be suppressed in the estuary, depending on inflow rates, and freshwater becomes dominant up to the mouth. At that time a fraction of the fine sediment load is exported offshore as a bottom-tagging nepheloid layer after the sediment falls out of suspension of the thin, near-surface, river plume. The remaining fraction and the riverine coarse sediment form a large sediment bar 10 km long, up to 6 m in height and extending across the whole width of the channel near the mouth. This bar, as well as shoals in the estuary, partially pond the mid- to upper-estuary. This bar builds up from the deposition of riverine sediment during a wet season with high runoff and can raise mean water level by up to 2 m in the upper estuary in the low flow season. This ponding effect takes about three successive dry years to disappear by the sediment forming the bar being redistributed all over the estuary by tidal pumping of fine and coarse sediment in the dry season, which is the low flow season. The swift reversal of the tidal currents from ebb to flood results in macro-turbulence that lasts about 20 min. Bed load transport is preferentially landward and occurs only for water currents greater than 0.6 m s(-1). This high value of the threshold velocity suggests that the sand may be cemented by the mud. The Daly Estuary thus is a leaky sediment trap with an efficiency varying both seasonally and inter-annually. (c) 2006 Elsevier Ltd. All rights reserved.

A global climatology of wind–wave interaction

Generally, ocean waves are thought to act as a drag on the surface wind so that momentum is transferred downwards, from the atmosphere into the waves. Recent observations have suggested that when long wavelength waves, characteristic of remotely generated swell, propagate faster than the surface wind momentum can also be transferred upwards. This upward momentum transfer acts to accelerate the near-surface wind, resulting in a low-level wave-driven wind jet. Previous studies have suggested that the sign reversal of the momentum flux is well predicted by the inverse wave age, the ratio of the surface wind speed to the speed of the waves at the peak of the spectrum. ECMWF ERA-40 data has been used here to calculate the global distribution of the inverse wave age to determine whether there are regions of the ocean that are usually in the wind-driven wave regime and others that are generally in the wave-driven wind regime. The wind-driven wave regime is found to occur most often in the mid-latitude storm tracks where wind speeds are generally high. The wave-driven wind regime is found to be prevalent in the tropics where wind speeds are generally light and swell can propagate from storms at higher latitudes. The inverse wave age is also a useful indicator of the degree of coupling between the local wind and wave fields. The climatologies presented emphasise the non-equilibrium that exists between the local wind and wave fields and highlight the importance of swell in the global oceans.

Antifungal activity of bacterium symbiotically associated with Steinernema abbasi towards Fusarium oxysporum

Fusarium oxysporum f.sp. lycopersici (Fol) is the causal agent of the Fusarium wilt disease of tomato. Soil fumigant (mainly methyl bromide) applications are in use for its control. With the increasing environmental awareness, biological control methods are under investigation for their effectiveness, including the use of antagonists. Pseudomonas oryzihabitans (=Flavimonas oryzihabitans), a symbiont of the entomopathogenic nematode Steinernema abbasi was investigated as an antagonism of a Fol isolate in two laboratory and two glasshouse experiments. Bacteria and cell-free filtrate antifungal activity were tested both in dual cultures and in broth culture. In pot experiments, suspensions of bacteria in five concentrations (106, 105, 104, 103 and 102 cells/ml) were tested for their ability to control the pathogen at 25±3°C. In all tests the bacterium significantly inhibited the growth of Fol mycelium in vitro. Similar results were obtained when the bacterium was also tested against Fusarium oxysporum f.sp. radicis lycopersici and against Rhizoctonia solani. Moreover, when it was introduced into the soil, it was able to suppress the Fusarium wilt of tomato.

Synthesis of fused cyclic systems containing medium-sized rings through tandem ROM-RCM of norbornene derivatives embedded in a carbohydrate template

A general approach for the synthesis of fused cyclic systems containing medium-sized rings (7-9) has been developed. The key steps involve a diastereoface-selective Diels-Alder reaction of the dienophiles 4a-d attached to a furanosugar with cyclopentadiene and ring opening (ROM)-ring closing metathesis (RCM) of the resulting norbornene derivatives 10a-d and 11a-d. Diels-Alder reaction of the dienophiles 4a-d with cyclopentadiene in the absence of a catalyst produced 10a-d as the major product arising through addition of the diene to the unhindered Si-face. The most interesting and new aspect of the Diels-Alder reaction of these dienophiles is the accessibility of the Re-face that was blocked by the alkenyl chains under Lewis acid catalysis producing the diastereoisomers 11a-d exclusively. The reversal of facial selectivity from an uncatalyzed reaction to a catalyzed one is unprecedented. The observed stereochemical dichotomy is attributed to rotation of the enone moiety along the or bond linking the sugar moiety during formation of the chelate 13. This makes the Re-face of the enone moiety in 4a-d unhindered. Diels-Alder reaction of the carbocyclic analogue 15 under Lewis acid catalysis produced a 1: 1 mixture of the adducts 16 and 17 confirming the participation of sugar ring oxygen in chelate formation. Finally ROM-RCM of 10a-d and 11a-d with Grubbs' catalyst afforded the cis-syn-cis and cis-anti-cis bicyclo-annulated sugars 21a-d and 23a-d, respectively, containing 7-9 membered rings.

Mast cell tryptase and proteinase-activated receptor 2 induce hyperexcitability of guinea-pig submucosal neurons

Mast cells that are in close proximity to autonomic and enteric nerves release several mediators that cause neuronal hyperexcitability. This study examined whether mast cell tryptase evokes acute and long-term hyperexcitability in submucosal neurons from the guinea-pig ileum by activating proteinase-activated receptor 2 (PAR2) on these neurons. We detected the expression of PAR2 in the submucosal plexus using RT-PCR. Most submucosal neurons displayed PAR2 immunoreactivity, including those colocalizing VIP. Brief (minutes) application of selective PAR2 agonists, including trypsin, the activating peptide SL-NH2 and mast cell tryptase, evoked depolarizations of the submucosal neurons, as measured with intracellular recording techniques. The membrane potential returned to resting values following washout of agonists, but most neurons were hyperexcitable for the duration of recordings (> 30 min-hours) and exhibited an increased input resistance and amplitude of fast EPSPs. Trypsin, in the presence of soybean trypsin inhibitor, and the reverse sequence of the activating peptide (LR-NH2) had no effect on neuronal membrane potential or long-term excitability. Degranulation of mast cells in the presence of antagonists of established excitatory mast cell mediators (histamine, 5-HT, prostaglandins) also caused depolarization, and following washout of antigen, long-term excitation was observed. Mast cell degranulation resulted in the release of proteases, which desensitized neurons to other agonists of PAR2. Our results suggest that proteases from degranulated mast cells cleave PAR2 on submucosal neurons to cause acute and long-term hyperexcitability. This signalling pathway between immune cells and neurons is a previously unrecognized mechanism that could contribute to chronic alterations in visceral function.

Synoptic scale disturbances of the Indian Summer Monsoon as simulated in a high resolution climate model

Hamburg atmospheric general circulation model ECHAM3 at T106 resolution (1.125' lat.Aon.) has considerable skill in reproducing the observed seasonal reversal of mean sea level pressure, the location of the summer heat low as well as the position of the monsoon trough over the Indian subcontinent. The present-day climate and its seasonal cycle are realistically simulated by the model over this region. The model simulates the structure, intensity, frequency, movement and lifetime of monsoon depressions remarkably well. The number of monsoon depressions/storms simulated by the model in a year ranged from 5 to 12 with an average frequency of 8.4 yr-', not significantly different from the observed climatology. The model also simulates the interannual variability in the formation of depressions over the north Bay of Bengal during the summer monsoon season. In the warmer atmosphere under doubled CO2 conditions, the number of monsoon depressions/cyclonic storms forming in Indian seas in a year ranged from 5 to 11 with an average frequency of 7.6 yr-', not significantly different from those inferred in the control run of the model. However, under doubled CO2 conditions, fewer depressions formed in the month of June. Neither the lowest central pressure nor the maximum wind speed changes appreciably in monsoon depressions identified under simulated enhanced greenhouse conditions. The analysis suggests there will be no significant changes in the number and intensity of monsoon depressions in a warmer atmosphere.

Geophysical characterization of the complex dynamics of groundwater and seawater exchange in a highly stressed aquifer system linked to a coastal lagoon (SE Spain)

Anthropogenic pressure influences the two-way interactions between shallow aquifers and coastal lagoons. Aquifer overexploitation may lead to seawater intrusion, and aquifer recharge from rainfall plus irrigation may, in turn, increase the groundwater discharge into the lagoon. We analyse the evolution, since the 1950s up to the present, of the interactions between the Campo de Cartagena Quaternary aquifer and the Mar Menor coastal lagoon (SE Spain). This is a very heterogeneous and anisotropic detrital aquifer, where aquifer–lagoon interface has a very irregular geometry. Using electrical resistivity tomography, we clearly identified the freshwater–saltwater transition zone and detected areas affected by seawater intrusion. Severity of the intrusion was spatially variable and significantly related to the density of irrigation wells in 1950s–1960s, suggesting the role of groundwater overexploitation. We distinguish two different mechanisms by which water from the sea invades the land: (a) horizontal advance of the interface due to a wide exploitation area and (b) vertical rise (upconing) caused by local intensive pumping. In general, shallow parts of the geophysical profiles show higher electrical resistivity associated with freshwater mainly coming from irrigation return flows, with water resources mostly from deep confined aquifers and imported from Tagus river, 400 km north. This indicates a likely reversal of the former seawater intrusion process.

The impact of oceanic heat transport on the atmospheric circulation

A general circulation model of intermediate complexity with an idealized Earth-like aquaplanet setup is used to study the impact of changes in the oceanic heat transport on the global atmospheric circulation. Focus is on the atmospheric mean meridional circulation and global thermodynamic properties. The atmosphere counterbalances to a large extent the imposed changes in the oceanic heat transport, but, nonetheless, significant modifications to the atmospheric general circulation are found. Increasing the strength of the oceanic heat transport up to 2.5 PW leads to an increase in the global mean near-surface temperature and to a decrease in its equator-to-pole gradient. For stronger transports, the gradient is reduced further, but the global mean remains approximately constant. This is linked to a cooling and a reversal of the temperature gradient in the tropics. Additionally, a stronger oceanic heat transport leads to a decline in the intensity and a poleward shift of the maxima of both the Hadley and Ferrel cells. Changes in zonal mean diabatic heating and friction impact the properties of the Hadley cell, while the behavior of the Ferrel cell is mostly controlled by friction. The efficiency of the climate machine, the intensity of the Lorenz energy cycle and the material entropy production of the system decline with increased oceanic heat transport. This suggests that the climate system becomes less efficient and turns into a state of reduced entropy production as the enhanced oceanic transport performs a stronger large-scale mixing between geophysical fluids with different temperatures, thus reducing the available energy in the climate system and bringing it closer to a state of thermal equilibrium.

Dysregulation of granulosal bone morphogenetic protein receptor 1B density is associated with reduced ovarian reserve and the age-related decline in human fertility

Reproductive ageing is linked to the depletion of ovarian primordial follicles, which causes an irreversible change to ovarian cellular function and the capacity to reproduce. The current study aimed to profile the expression of bone morphogenetic protein receptor, (BMPR1B) in 53 IVF patients exhibiting different degrees of primordial follicle depletion. The granulosa cell receptor density was measured in 403 follicles via flow cytometry. A decline in BMPR1B density occurred at the time of dominant follicle selection and during the terminal stage of folliculogenesis in the 23-30 y good ovarian reserve patients. The 40+ y poor ovarian reserve patients experienced a reversal of this pattern. The results demonstrate an association between age-induced depletion of the ovarian reserve and BMPR1B receptor density at the two critical time points of dominant follicle selection and pre-ovulatory follicle maturation. Dysregulation of BMP receptor signalling may inhibit the normal steroidogenic differentiation required for maturation in older patients.

Role of SOCS-1 Gene on Melanoma Cell Growth and Tumor Development

Melanoma is the most aggressive form of skin cancer, and its incidence has increased dramatically over the years. The murine B16F10 melanoma in syngeneic C57Bl/6 mice has been used as a highly aggressive model to investigate tumor development. Presently, we demonstrate in the B16F10-Nex2 subclone that silencing of SOCS-1, a negative regulator of Jak/Stat pathway, leads to reversal of the tumorigenic phenotype and inhibition of melanoma cell metastasis. SOCS-1 silencing with short hairpin RNA affected tumor growth and cell cycle regulation with arrest at the S phase with large-sized nuclei, reduced cell motility, and decreased melanoma cell invasion through Matrigel. A clonogenic assay showed that SOCS-1 acted as a modulator of resistance to anoikis. In addition, down-regulation of SOCS-1 decreased the expression of epidermal growth factor receptor ( mainly the phosphorylated-R), Ins-R alpha, and fibroblast growth factor receptor. In vivo, silencing of SOCS-1 inhibited subcutaneous tumor growth and metastatic development in the lungs. Because SOCS-1 is expressed in most melanoma cell lines and bears a relation with tumor invasion, thickness, and stage of disease, the present results on the effects of SOCS-1 silencing in melanoma suggest that this regulating protein can be a target of cancer therapy.

Biodritin microencapsulated human islets of langerhans and their potential for type 1 diabetes mellitus therapy

Background. Microencapsulation of pancreatic islets with polymeric compounds constitutes an attractive alternative therapy for type 1 diabetes mellitus. The major limiting factor is the availability of a biocompatible and mechanically stable polymer. We investigated the potential of Biodritin, a novel polymer constituted of alginate and chondroitin sulfate, for islet microencapsulation. Methods. Biodritin microcapsules were obtained using an air jet droplet generator and gelated with barium or calcium chloride. Microencapsulated rat insulinoma RINm5F cells were tested for viability using the [3-(4,5-dimetyl-thiazol-2-yl)-2,5-diphenyl-tetrazoliumbromide] [MTT] colorimetric assay. Microencapsulated rat pancreatic islets were coincubated with macrophages derived from mouse peritoneal liquid to assess the immunomodulatory potential of the microcapsules, using quantitative real time-PCR (qPCR). Biodritin biocompatibility was demonstrated by subcutaneous injection of empty microcapsules into immunocompetent Wistar rats. Insulin secretion by microencapsulated human pancreatic islets was evaluated using an electrochemoluminescent assay. Microencapsulated human islets transplanted into chemically induced diabetic mice were monitored for reversal of hyperglycemia. Results. The metabolic activity of microencapsulated RINm5F cells persisted for at least 15 days. Interleukin-1 beta expression by macrophages was observed during coculture with islets microencapsulated with Biodritin-CaCl2, but not with Biodritin-BaCl2. No statistical difference in glucose-stimulated insulin secretion was observed between nonencapsulated and microencapsulated islets. Upon microencapsulated islet transplantation, the blood glucose level of diabetic mice normalized; they remained euglycemic for at least 60 days, displaying normal oral glucose tolerance tests. Conclusion. This study demonstrated that Biodritin can be used for islet microencapsulation and reversal of diabetes; however, further investigations are required to assess its potential for long-term transplantation.

Spectroscopic and theoretical studies of some N,N-diethyl-2-[(4 `-substituted)phenylsulfonyl]acetamides

The analysis of the IR carbonyl band of the N,N-diethyl-2-[(4`-substituted)phenylsulfonyl]acetamides Et(2)NC(O)CH(2)S(O)(2)-C(6)H(4)-Y (Y = OMe 1, Me 2,1-13, Cl 4, Br 5, NO(2) 6) supported by B3LYP/6-31G(d,p) calculations for 3, indicated the existence of three pairs (anti and syn) of cis (c) and gauche (g(1) and g(2)) conformers in the gas phase, being the gauche conformers significantly more stable than the cis ones. The anti geometry is more stable than the syn one, for each pair of cis and gauche conformers. The summing up of the orbital (NBO analysis) and electrostatic interactions justifies quite well the populations and the v(CO) frequencies of the anti and syn pairs of c, g(1) and g(2) conformers. The IR higher carbonyl frequency component whose population is ca. 10%, in CCl(4), may be ascribed to the least stable and most polar cis conformer pair (in the gas phase) and the lower frequency component whose population is ca. 90%, to the summing up of the populations of the two most stable and least polar gauche conformer pairs (g(1) and g(2)) (in the gas phase). The reversal of the cis(c)/gauche (g(1) + g(2)) population ratio observed in chloroform ca. 60% (cis)/40% (gauche) and the occurrence of the most polar cis(c) conformer only, in acetonitrile, strongly suggests the coalescence of the two gauche components in a unique carbonyl band in solution. A further support to this rationalization is given by the single point PCM solvation model performed by HF/6-31G(d,p) method, which showed a progressive increase of the c/(g(1) + g(2)) ratio going from gas to CCl(4), to CHCl(3) and to CH(3)CN. X-ray single crystal analysis of 4 indicates that this compound assumes, in the solid state, the syn-clinal (gauche) conformation with respect to the [O=C-CH(2)-S] moiety, and the most stable anti geometry relative to the [C(O)N(CH(2)CH(3))(2)] fragment. In order to obtain larger energy gain from the crystal packing the molecules of 4 are linked in centrosymmetric dimers through two C-H center dot center dot center dot O interactions (C-H([O-Ph])center dot center dot center dot O([SO2])) forming a step ladder. (C) 2011 Elsevier B.V. All rights reserved.