Expression of Smad4, E-cadherin and beta-catenin in advanced colorectal cancer: a retrospective study.

PURPOSE: To correlate the expression of E-cadherin and beta-catenin with alterations of expression of Smad4 in advanced colorectal cancer (CRC). METHODS: Tissue specimens from 75 colorectal cancer cases (Dukes stage C and D) were tested for Smad4, E-cadherin and beta-catenin by the Avidin-Biotin immunoperoxidase method. The results were correlated with patients' clinicopathological parameters. RESULTS: Smad4 expression was lost or reduced in roughly 1 out of every 3 Dukes C and D CRCs. Association of Smad4 expression with other clinicopathological parameters was not noted. Association of expression of E-cadherin with other clinicopathological parameters was not noted, apart from tumor location. Expression of beta-catenin was not associated with clinicopathological parameters. Lack of expression of Smad4 was associated with lack of expression of both E-cadherin (<0.000) and beta-catenin (p<0.000). As regards the relation between E-cadherin and beta-catenin, the expression of each seemed to parallel the expression of the other (p<0.000). Beta-catenin was overexpressed in 68.5% of the specimens studied. CONCLUSION: Clinically advanced CRC is associated with a reduced or complete lack of expression of Smad4. Ecadherin and beta-catenin are expressed in parallel with each other and also with Smad4. This tumor suppressor role of Smad4 by affecting both E-cadherin and beta-catenin may indicate a novel pathway for metastatic tumor via cellular reshaping. The precise underlined mechanism(s) and the clinical significance of these findings remain to be determined.

Factors that influence Greeks' decision to register as potential bone marrow donors.

Hemopoietic stem cells can be used from bone marrow or blood or umbilical cord blood of matched siblings or appropriately matched unrelated volunteers. Today, large bone marrow registries have been established to help identify volunteer unrelated bone marrow donors for patients lacking a family donor. Despite there being almost 10 million registered potential bone marrow donors (PBMD) worldwide, only 50% of white patients have a suitable bone marrow match. Growth in the number of PBMD increases the likelihood of finding a compatible donor for a patient. The attitudes and knowledge of 250 registered PBMD and 315 not registered PBMD toward bone marrow donation, tissues and organs donation, and blood donation were surveyed, using a questionnaire with 27 items. Multivariate logistic regression identified gender (females more often than males), regular blood donation, having a relative or a friend who has already been registered as PBMD, having a relative or a friend who needs bone marrow transplantation, family discussion about tissue and organ donation, knowledge about bone marrow transplantation, information about bone marrow transplantation, and trust in health professionals were independent predictive factors influencing people's decision to register as PBMD. Knowledge of these factors is important to target recruitment efforts.

The effect of interactive multimedia on preoperative knowledge and postoperative recovery of patients undergoing laparoscopic cholecystectomy.

OBJECTIVES: Aim of this study is the evaluation of the impact of a multimedia CD (MCD) on preoperative anxiety and postoperative recovery of patients undergoing elective laparoscopic cholecystectomy (LC). METHODS: Sixty consecutive candidates for elective LC were randomly assigned to four groups. Group A included 15 patients preoperatively informed regarding LC through the MCD presented by Registered Nurse (RN). Patients in group B (n = 15) were informed through a leaflet. Patients in group C (n = 15) were informed verbally from a RN. Finally, the control Group D included 15 patients informed conventionally by the attending surgeon and anesthesiologist, as every other patient included in groups A, B, and C. Preoperative assessment of knowledge about LC was performed after each informative session through a questionnaire. Evaluation of preoperative anxiety was conducted using APAIS scale. Postoperative pain and nausea scores were measured using an NRS scale, 16 hours after the patient had returned to the ward. RESULTS: Statistical processing of the results (single linear regression) showed that patients in groups A, B, and C achieved a higher knowledge score, less preoperative anxiety score and less postoperative pain and nausea, compared to Group D. In multiple regression analysis, group A had a higher knowledge score compared to the four groups (p < 0.001 r(2) = 0.41). CONCLUSION: Informative sessions using MCD is an effective means of improving patient's preoperative knowledge, especially in day-surgery cases, like LC.

Nursing manpower development and strategic planning in Greece.

PURPOSE: A national study to register all working nursing personnel and nursing students; to estimate the nursing needs of the Greek population beyond the year 2000; to design a nursing resource master plan for the nursing needs of Greece. DESIGN: First, a questionnaire was distributed to register all nursing personnel. Second, required personnel were estimated according to the population of each of the country's regions. Third, a master plan for developing nursing personnel to the year 2010 was developed. RESULTS: The number of nursing personnel was found to be 35,715 which included 11,497 RNs and health visitors, 22,318 assistant nurses, 1,900 midwives. The number of students was 9,252. The majority of nursing personnel work in areas with the highest population. The need for nursing personnel was estimated to be 62,000: 36,300 RNs, 21,700 assistant nurses and 4,000 midwives. CONCLUSIONS: There is a serious shortage of RNs in the Greek health services resulting in a downgrading of nursing care quality.

Prevention of post-oophorectomy bone loss with Tibolone.

The results of a 1-year placebo-controlled study in 25 women who had hysterectomy and bilateral oophorectomy receiving a daily oral dose of 2.5 mg of Tibolone (Org OD 14) are presented. Tibolone is a steroid compound with mild oestrogenic in additional to progestagenic effects. Post-oophorectomy bone loss has been reported to accelerate, at least during the first year after surgery. The efficacy of Tibolone to prevent this accelerated bone loss is questionable. All patients were scheduled to participate in the study before oophorectomy. Patients had a detailed pre-operative examination, including measurement of forearm bone density with an SP2 Lunar single photon absorptiometer and haematological and biochemical investigation. After surgery, patients were randomly allocated in two groups; 15 women received an oral dose of 2.5 mg of Tibolone and 1000 mg of Calcium, while 10 women had only 1000 mg of calcium daily. Patients were examined at the end of 6 and 12 months of observation. Bone density of the radial shaft was found to decrease significantly in the calcium group up to 6.12% (P < 0.01) at the end of 6 months and 12.4% (P < 0.001) at the end of 12 months. On the other hand, bone density of the radial shaft remained unchanged in the Tibolone-treated group during the 12 months of treatment. Bone density of the distal radius was found to decrease in the calcium-treated group up to 10.2% (P < 0.014) at the end of 6 months and up to 15.8% (P < 0.002) at the end of 12 months. Bone density of the distal radius remained almost unchanged in the Tibolone-treated group during the whole period of treatment. Urine hydroxyproline/creatinine ratio was found to increase in the calcium group at the end of 6 and 12 months (P < 0.009) and to decrease significantly (P < 0.05) in the Tibolone-treated group. It is concluded that Tibolone is effective in the prevention of the post-ovariectomy accelerated bone loss and in retaining the initial premenopausal bone mass, at least during the first post-oophorectomy year. As this period is the most crucial in developing osteoporosis, it seems that Tibolone is effective in preventing the post-oophorectomy bone loss. HRT is not obligatory in these patients, as Tibolone seems to cover the whole spectrum of post-oophorectomy consequences.

Nursing absenteeism--one determining factor for the staffing plan.

The purpose of the present study was to quantify factors which contribute to the absenteeism of nursing personnel and affect staffing patterns. Absenteeism in a general hospital was studied for the period 1975-1990 in relation to the number and level of nursing personnel, the number of discharged patients in the same period, and the existing relevant policy. The variables were analyzed by the multiple regression method having an initial estimator the existing situation in 1990 and what is expected for the year 2000. The results showed that the mean value days of absenteeism for each registered and assistant nurse in 1975 was 22.4 days and in 1990, 51.9 days, sickness raised from 12.6 days in 1975 to 16.6 in 1990, maternity from 9.1 in 1975 to 25.3 in 1990, educational leave for registered nurses was 0.02 in 1975 and 3.8 in 1990 and for assistants 2.1 in 1985 and 17.3 in 1990 due to the new policy, and social fringe benefits raised from 0.71 days in 1975 to 3.65 in 1990. The expected rate of absenteeism by the year 2000 will be 67 to 83 days per person, an increase by 56% in relation to 1990 data.