A new video laryngoscope combined with flexible laryngeal mask insertion: A prospective randomized study.

BACKGROUND: The video laryngoscope (VLS) has been proven to be an effective insertion device for airway management. However, no laryngoscope has been specifically designed for the placement of the laryngeal mask airway (LMA). We improved the current VLS and developed a novel VLS method. This study aimed to evaluate the clinical efficacy of an improved VLS for inserting a flexible laryngeal mask airway (F-LMA) compared with the standard blind method. METHODS: One hundred and fifty-seven patients who underwent F-LMA insertion under general anesthesia were randomly assigned to either the standard blind insertion technique (group B) or VLS -assisted insertion (group VL). First attempt success rates were recorded. Secondary outcomes included oropharyngeal leakage pressure (OLP), fiberoptic view, insertion time, position adjustment, reinsertion rate, and postoperative airway morbidity. RESULTS: The first-attempt success rate was higher in group VL than that in group B (99% vs. 86%; p = 0.002). The OLP was significantly higher in the VLS-guided technique (26.4 ± 5.1 vs 23.8 ± 4.4 cmH2O, p = 0.002). The fiberoptic view was significantly better in the group VL (p < 0.001) and required less readjustment and reinsertion to establish an effective airway (p < 0.001). The insertion time was shorter in the group B than that in group VL (33.9 vs 41.3 s, p < 0.001). Hemodynamic stress responses and postoperative airway complications did not differ between the two groups. CONCLUSIONS: The new VLS-guided insertion technology has a high success rate, achieves greater OLP, and provides an ideal anatomical position with minimal adjustment, without increasing the risk of hemodynamic stress or adverse events. TRIAL REGISTRATION: Chinese Clinical Trial Registry (registration number: ChiCTR2300075866; https://www.chictr.org.cn).

[Quercetin induces apoptosis of human breast cancer cells by activiting PTEN and inhibiting PI3K/AKT and JNK signaling pathways].

Objective To investigate the effect of quercetin on cell proliferation and apoptosis of MCF-7 human breast cancer cells, and effects of signaling pathways of PTEN/PI3K/AKT and c-Jun N-terminal kinase (JNK) signaling pathway. Methods MCF-7 cells were treated with quercetin (0, 20, 40, 60, 80, 100 µmol/L) CCK-8 assay was used to detect the cell proliferation, and cell apoptosis was assayed by flow cytometry. Hochesst33342 staining was used to observe the changes of nuclear number and karyotype, and flow cytometry was employed to detect cell apoptosis. The expression of PTEN and phosphorylated JNK (p-JNK) were detected by immunofluorescence cytochemistry, and the protein levels of PTEN, phosphorylated PI3K (p-PI3K), p-JNK and phosphorylated AKT (p-AKT) were detected by Western blot analysis. After treated with PI3K/AKT pathway inhibitor LY294002, the cell apoptosis and related protein expression were detected by the above methods again. Results With increased quercetin concentration, cell activity decreased and cell growth was inhibited in a concentration dependent manner; the nuclear concentration and apoptosis also increased. High concentration of quercetin significantly enhanced the expression and distribution of PTEN protein, decreased the levels of p-PI3K and p-AKT protein, and inhibited the expression of p-JNK protein. After adding LY294002 to inhibit PI3K/AKT, the apoptosis rate increased for cells treated with both LY294002 and quercetin; the expression of PTEN protein also showed an increase. Quercetin could significantly enhance the effect of LY294002 on p-PI3K/AKT/PTEN protein. Conclusion Quercetin can signeristically inhibit cell viability and induce cell apoptosis on MCF-7 cells, by up-regulating the expression of PTEN and down-regulating PI3K/AKT and JNK pathways.