[Comparison of Cookgas and Fastrach intubating laryngeal mask airway with fiberoptic bronchoscope in anticipated difficult airway management].

OBJECTIVE: To compare the clinical effectiveness of fiberoptic bronchoscope (FOB)-guided intubation through the Cookgas intubating laryngeal airway(CILA)and the Fastrach intubating laryngeal mask airway (FT-LMA) in the management of anticipated difficult airways. METHODS: Sixty patients with all three difficult intubation criterion (thyromental distance<60 mm, interincisor distance<35 mm, and Mallampati class 3 or 4) undergoing elective plastic surgery under general anesthesia were randomly allocated into CILA group (n=30) and FT-LMA group (n=30). After anesthesia being induced and CILA or FT-LMA being inserted, the patients were treated with FOB-guided intubation through CILA or FT-LMA. The success of the intubating laryngeal airway(ILA)insertion and FOB-guided intubation, the number of attempts, and the duration of the successful attempt were recorded. RESULTS: The ILA was inserted successfully in 30 patients from CILA group and 27 patients from FT-LMA group. Three failed cases in FT-LMA group were inserted successfully with CILA. In CILA group, the first FOB-guided intubation attempt succeeded in 26 patients, and 4 cases were intubated at the second attempt. In 27 patients of FT-LMA group, 20 cases were intubated successfully at the first attempt, 4 cases at the second attempt, and 3 cases failed; of these three failed patients, two patients were intubated smoothly with FOB through CILA at the first attempt, one was intubated by FOB via CILA at the second attempt. The duration of FT-LMA insertion [(35.3±12.8)s] was significantly longer when compared with CILA [(23.9±17.5)s] (P<0.05). However, the duration of FOB-guided intubation through CILA and FT-LMA [(48.6±13.5)s vs.(53.2±14.2)s] and the time of ILA removal [(40.4±10.2)s vs. (38.5±11.3)s] were not significantly different between these two groups (P>0.05). The adverse events during and after intubtion were not significantly different between these two groups. CONCLUSIONS: FOB-guided intubation through CILA and FT-LMA is safe and feasible for the management of anticipated difficult airways. However, in patients with severe scar contracture of face and neck and those with huge expander in neck, the CILA insertion and FOB-guided intubation via CILA is superior to FT-LMA.

CD105/Ki67 coexpression correlates with tumor progression and poor prognosis in epithelial ovarian cancer.

AIM: To analyze the expression patterns of CD105 and Ki67 in human epithelial ovarian cancer (EOC) and to evaluate the clinical significance of these two markers in the progression and prognosis in EOC. MATERIALS AND METHODS: The CD105 and Ki67 protein expression patterns in paraffin-embedded specimens gathered from 166 patients with EOC were detected by immunohistochemistry analysis. The association of CD105 and Ki67 protein expression with the prognosis in EOC was subsequently assessed. RESULTS: The CD105 and Ki67 proteins were positively expressed in 101/166 (60.8%) and 129/166 (77.7%) of EOC patients, respectively. The CD105 tumors are more likely to have higher tumor grade (P = 0.02). Patients with positive Ki67 staining are more likely to be at the advanced stage of the disease (P = 0.008). Marker CD105 was positively correlated with Ki67 (r = 0.66, P = 0.01). In addition, Ki67 (hazards ratio [HR], 4.8; confidence interval [CI], 1.2-16.6; P = 0.008) and CD105⁺ (HR, 4.1; CI, 1.0-15.2; P = 0.01) were both independent prognostic factors for poor overall survival in EOC patients. Furthermore, combined CD105/Ki67 expression was significantly related to unfavorable overall survival (HR, 16.6; CI, 1.2-128.9; P < 0.001). CONCLUSIONS: Our results suggest that the CD105 and Ki67 expressions might be involved in the progression of EOC and patient prognosis. A combined detection of CD105/Ki67 coexpression may benefit us in predicting the prognosis in EOC.

Expression level of wild-type survivin in gastric cancer is an independent predictor of survival.

AIM: Survivin is a novel antiapoptotic gene in which three splicing variants have been recently cloned and characterized. Survivin has been found to be abundantly expressed in a wide variety of human malignancies, whereas it is undetectable in normal adult tissues. We aimed to study the expression of three survivin splicing variants in gastric cancer, and to evaluate the prognostic significance of the expression of survivin variants in gastric cancer. METHODS: Real time quantitative RT-PCR was performed to analyze the expression of survivin variants in 79 paired tumors and normal gastric mucosa samples at the mRNA level. Proliferative and apoptotic activity was measured using Ki-67 immunohistochemical analysis and the TUNEL method, respectively. RESULTS: All the cases tested expressed wild-type survivin mRNA, which was not only the dominant transcript, but also a poor prognostic biomarker (P = 0.003). Non-antiapoptostic survivin-2B mRNA was correlated with tumor stage (P = 0.001), histological type (P = 0.004), and depth of tumor invasion (P = 0.041), while survivin-DeltaEx3 mRNA showed a significant association with apoptosis (P = 0.02). CONCLUSION: Wild-type survivin mRNA expression levels are of important prognostic value and significant participation of survivin-2B and survivin-DeltaEx3 is suggested in gastric cancer development.

[Elevated expression level of wild-type survivin in gastric cancer promotes in vitro docetaxel-resistance].

OBJECTIVE: To study the expression of three survivin splicing variants in gastric cancer and to evaluate the significant correlation between survivin variants' expression and chemoresistance in gastric cancer. METHODS: Real time quantitative RT-PCR was used to analyze the mRNA expression of survivin variants in 39 gastric tumor specimens resected during operation. The clinical resistance to anticancer agents [CDDP, MMC, 5-Fu, docetaxel (Taxotere TXT), and GEM] was analyzed by histoculture drug-response assay (HDRA). RESULTS: Among the 39 tumor samples, survivin expression was detected in all tumor samples (39/39); 79.5% (31/39) of the samples demonstrated survivin-2B expression and 66.7% (26/39) of the samples had survivin-Delta Ex3 expression. HDRA showed that the in vitro efficacy rates of CDDP, MMC, 5Fu, TXT, and GEM were 36.8% (14/38), 31.2% (10/32), 23.1% (9/39), 20.5% (8/39), and 12.5% (4/32) respectively, equivalent to the previous HDRA studies and historical clinical studies in gastric cancer patients. The expression rate of wild-type survivin was significantly higher in the group of chemoresistance to TXT than in the group sensitive to docetaxel (P = 0.021). CONCLUSION: Elevated expression level of wild-type survivin promotes docetaxel-resistance in patients with gastric cancer.