Apurinic apyrimidinic endonuclease (APE1)/redox effector factor 1 (Ref-1), which is a multifunction protein involved in both transcriptional regulation of gene expression during adaptive cellular responses to oxidative stress and in the base excision repair pathway of DNA lesions generated as a consequence of oxidant-induced base damage, contributes to the maintenance of genome stability. APE1/Ref-1 is normally localized in the nucleus; cytoplasmic localization observed in several tumors has been correlated with a poor prognosis. Hepatocellular carcinoma (HCC) grading is an essential tool to predict the risk of relapse and patient prognosis, particularly in patients undergoing liver transplantation (OLT). The aim of this study was to identify the role of APE1/Ref-1 in predicting a posttransplant HCC relapse. We studied 48 patients transplanted for HCC to define grading as well as nuclear and cytoplasmic APE1/Ref-1 expression within neoplastic versus nonneoplastic parenchyma. We defined a cutoff of 60% of cytoplasmic APE1/Ref-1 expression to identify positive cases. At a minimum of 1.5-year follow-up after transplantation, 32 patients are alive and 16 patients are deceased after HCC relapse. Among low-grade HCC (grades 1 and 2), 76% of cases are alive; only 34% showed cytoplasmic APE1/Ref-1 immunoreactivity. Among the high-grade cases (grades 3 and 4), 50% were alive with 64% showing cytoplasmic immunoreactivity. Nuclear reactivity was generally similar either in neoplastic or in cirrhotic livers, irrespective of the grade. These data seemed to support the hypothesis of a predictive role of APE1/Ref-1 for HCC risk of relapse, which together with tumor grade by analysis of a pretransplant needle biopsy should aid decision making for OLT.

Baccarani, U.; Rossetto, A.; Lorenzin, D.; Musolino, C.; Comuzzi, C.; Bresadola, V.; Adani, G. L. Author Information

Day Surgery (DS) and prehospitalization emerged in Italy--as it had previously in the United States and other European countries--as able to improve healthcare and reduce costs. The purpose of this study was to evaluate the impact of the Nurse Case Manager (NCM) Model on patients undergoing DS procedures. The study assessed the intensity of pain, anxiety, and stress factors, and the level of discomfort experienced. The quasi-experimental study design involved two groups of patients (at two different DS hospital centers): one using the NCM model (Ward A) the other based on team nursing (Ward B). All patients undergoing DS for (a) varicose veins, (b) inguinal hernia, (c) breast biopsy, and (d) hemorrhoids were included. A valid questionnaire interview based on 22 questions was used (1) the morning before surgery, (2) the evening after surgery, and (3) 48 hr after the operation, by telephone. Of the 145 patients that were involved, 66 were from Ward A (45.5%) and 79 from Ward B (54.5%). When patient care was based on the NCM Model (Ward A), it seemed that (a) the pathway before DS was more efficient; (b) they perceived lower levels of perioperative anxiety and pain; and (c) they recognized the DS center as a unique point of reference for all postoperative problems.

Several factors contribute to the ill defined concept of complexity: critical patients, emergency situations, severity, intensity of care, dependency. The aim of this work is to assess nurses' perception of surgical patients' complexity, to obtain bottom-up data to validate a new model (of the Federazione Nazionale Collegi IPASVI) that measures the patients complexity. Data were collected over two months, by interviewing 64 nurses caring for surgical patients in 8 wards of the Friuli Venezia Giulia region. Patients' complexity (Low, Medium and High) and the explicit criteria adopted for the process of qualification, are formulated according to a priority ranking. Nurses were interviewed in 8 index days over 2 months. Criteria were independently classified by 3 nurses and any discrepancies discussed. Data on 1287 patients collected. 729 patients (56.6%) were classified as low complexity; 393 (30.6%) medium and 165 (12.8%) highly complex. The judgement is influenced by patients' age (p<0.01) but not sex. An high complexity score was assigned to patients with abdominal, soft tissues and vascular and gastrointestinal oncological surgery. 1291 different criteria were reported (2.89 +/- 1.88--range 1-15--for patient). The more frequent criteria were dependency in ADLs, need of strict monitoring/surveillance; presence of devices (such as cvc, pumps etc), and type of illness. The criteria expressed, only partially fit in the reference model. The judgement of complexity is based more on clinical problems and patients' dependency than on patients' ability to adapt to the illness and participate to his/her care.