The Theatre Recovery and Anaesthetic nurse Capnography Education (TRACE) project.

The Theatre Recovery and Anaesthetic Nurse Capnography Education (TRACE) project is a multidisciplinary quality improvement project. The overall aim is to educate anaesthetic and recovery nurses on the correct use of capnography and educate non-consultant hospital doctors on the guidelines on Preventing Unrecognised Oesophageal Intubation from the Project for Universal Management of Airways group. This project addresses technical aspects of task performance such as correct waveform identification and interpretation, troubleshooting abnormal waveforms and establishing routine checks of capnography both pre-induction and post-intubation. The pre-induction verification of the correct function of capnography is an essential component of this project. In addition, the project focuses on team aspects of task performance with an emphasis on team psychological safety, empowering nurses to speak up using graded assertiveness and flattening hierarchies. As a result of the project, our nurses' knowledge about capnography and waveform identification improved to over 80% correct answers six months after completion of the project. In addition, over 90% of participants reported feeling confident in speaking up to both consultants and non-consultant hospital doctors when a waveform was not present before induction of anaesthesia or after attempted tracheal intubation.

Identification of a novel, functional role for S100A13 in invasive lung cancer cell lines.

The S100 family is a group of small, calcium-binding proteins with at least 20 distinct members in humans. Several of these have been associated with cancer invasion or metastasis in recent studies. Transcriptional analysis of gene expression in a panel of lung cancer-derived cell lines identified S100A13 as being associated with a more aggressive invasive phenotype in vitro. Hierarchical clustering grouped this gene with several others that have established functional roles in this phenotype both in vitro and in vivo (ICAM1, CD34, EFNB2 and HGF) as well as genes involved in processes such as angiogenesis (TEM7, JAG2). Depletion of cellular S100A13 mRNA levels by RNAi in highly invasive lung cancer cell lines resulted in a 50-80% decrease in their invasive potential in an in vitro assay. This reduction could not be accounted for by reduced cellular proliferation. Conversely, transient overexpression of exogenous S100A13 in less invasive cell lines had no impact on invasive potential suggesting that upregulation of S100A13 expression alone is insufficient to induce the phenotype. We conclude that S100A13 is involved in but not capable of inducing invasion, since elevated S100A13 mRNA expression correlates with a more invasive phenotype and in vitro invasion can be inhibited by reduced S100A13 expression.

Expression and prognostic relevance of Mcl-1 in breast cancer.

BACKGROUND: Bcl-2, an anti-apoptotic protein, is frequently associated with favourable prognosis in breast cancer. The potential role of mcl-1, another bcl-2 family member, in breast cancer has not yet been defined. PATIENTS AND METHODS: This study examined the expression of mcl-1 and bcl-2 in 170 cases of invasive primary breast carcinoma, using reverse-transcriptase polymerase chain reaction and immunohistochemical analyses. RESULTS: Expression of bcl-2 mRNA and protein were found to be favourably associated with outcome for patients, supporting a prognostic role for bcl-2 in breast cancer, whereas mcl-1 expression, at the mRNA or protein level, did not correlate with tumour size, grade, lymph node or ER status, age of patient at diagnosis, or disease outcome. CONCLUSION: As these analyses of mcl-1 expression may have co-detected mcl-1(S/deltaTM) (a more recently identified, shorter variant, that may be pro-apoptotic) with the anti-apoptotic wild-type of mcl-1, it is possible that future studies may indicate some significant clinical correlations if the isoforms can be independently investigated.

Survivin: role in normal cells and in pathological conditions.

Survivin, an inhibitor of apoptosis (IAP) containing one baculovirus IAP repeat (BIR) domain, has been reported to be capable of regulating both cellular proliferation and apoptotic cell death. Survivin splice variants, survivin-DeltaEx3 and survivin-2B, have apparently retained and lost anti-apoptotic potential, respectively. As survivin was first discovered due to its high homology with effector cell protease receptor (EPR-1), a protein involved in blood coagulation, it has been suggested (but not proven) that EPR-1 may act as a natural anti-sense to survivin in cells. Survivin homologs have been found in non-human species. Survivin expression has been described during embryonic development and in adult cancerous tissues, with greatly reduced expression in adult normal differentiated tissues, particularly if their proliferation index is low. Survivin has been defined as a universal tumor antigen and as the fourth most significant transcriptosome expressed in human tumors. Although survivin is usually located in the cell cytoplasmic region and associated with poor prognosis in cancer, nuclear localisation, indicative of favorable prognosis, has also been reported. Survivin expression has also been reported in a number of proliferating normal adult tissues. Extensive research has been conducted, aimed at increasing our understanding of survivin, by determining its sub-cellular structure and location, mechanism(s) of action and control of expression. While much important information on this molecule has been accumulated, there are still many areas of controversy or limited information. Further research may enable exploitation of survivin overexpression in cancer compared to normal tissues, making survivin a potentially attractive target for cancer therapeutics.

Prognostic importance of survivin in breast cancer.

Survivin is a member of the inhibitor of apoptosis (IAP) family, and is also involved in the regulation of cell division. Survivin is widely expressed in foetal tissues and in human cancers, but generally not in normal adult tissue. This study examined the expression of surviving protein in a series of 293 cases of invasive primary breast carcinoma. Survivin immunoreactivity was assessed using two different polyclonal antibodies, and evaluated semiquantitatively according to the percentage of cells demonstrating distinct nuclear and/or diffuse cytoplasmic staining. Overall, 60% of tumours were positive for survivin: 31% demonstrated nuclear staining only, 13% cytoplasmic only, and 16% of tumour cells demonstrated both nuclear and cytoplasmic staining. Statistical analysis revealed that survivin expression was independent of patient's age, tumour size, histological grade, nodal status, and oestrogen receptor status. In multivariate analysis, nuclear survivin expression was a significant independent prognostic indicator of favourable outcome both in relapse-free and overall survival (P<0.001 and P=0.01, respectively). In conclusion, our results show that survivin is frequently overexpressed in primary breast cancer. Nuclear expression is most common and is an independent prognostic indicator of good prognosis.

The suitability of expanded PTFE for carotid patch angioplasty.

From June 1985 to December 1988, 175 consecutive patients underwent 204 carotid endarterectomies with routine use of expanded PTFE patch angioplasty. Two patients (1%) suffered strokes and there were no transient ischemic attacks or deaths in the immediate postoperative period. All carotid endarterectomies were performed with an intraluminal shunt without cerebral monitoring. The indications for carotid endarterectomy were symptoms (83% of patients) or no symptoms of internal carotid artery atherosclerotic stenoses (12.7% of patients). Neurological assessment, Doppler and real-time ultrasound were performed at six months, twelve months and then annually. Over the follow-up period there were one asymptomatic occlusion and two high grade symptomatic stenoses which required reoperation.