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Recent series have raised concerns about the oncologic outcomes of transanal total mesorectal excision for mid and low rectal cancer. There is a paucity of large datasets from the United States to contribute to the ongoing international discourse.

To investigate the rate of local recurrence and other oncologic outcomes in patients undergoing transanal total mesorectal excision for rectal adenocarcinoma.

Retrospective review of patients undergoing transanal total mesorectal excision for primary rectal cancer from January 2014 to December 2019.

Single academic tertiary care medical center in the United States.

Consecutive patients age ≥ 18 years undergoing surgical resection for primary rectal cancer.

The transanal total mesorectal excision procedures were performed utilizing a two-team approach.

Primary outcomes were pathologic quality, local and distant recurrence, treatment-related complications, and overall- and cancer-specific survival.

Seventy-nine consecutive patients were included. The mcologic outcomes of this cohort support the use of transanal total mesorectal excision in the surgical management of mid- to low-rectal cancer at centers with appropriate expertise. See Video Abstract at http//links.lww.com/DCR/B723 .

As a chronic condition, pilonidal disease affects a young population and the surgical procedures performed to treat this condition require a recovery time with time off work. Therefore, the search for ideal treatment is still ongoing.

The aim of this study is to compare early and late results of two minimally invasive treatment options used to treat pilonidal disease.

This study is designed as a two parallel group randomized clinical trial.

The study consists of two groups curettage+platelet rich plasma and curettage+phenol.

Patients with pilonidal disease were evaluated for the study, and enrolled if they met inclusion criteria and gave informed consent.

Patients in the platelet rich plasma group were treated using curettage+platelet rich plasma gel. In Phenol group patients were treated using curettage+crystallized phenol.

The primary study end point was the time to achieve healing; the secondary outcome was recurrence rate.

In the platelet rich plasma group, 96% of cases achieved healing afnd minimal time off work. See Video Abstract at http//links.lww.com/DCR/B722.This trial was registered to clinical trials with ID NCT03070028. The full protocol can be found at https//clinicaltrials.gov/ct2/show/NCT03070028.

Degenerative aortic stenosis (AS) is one of the most prevalent heart valve diseases in the adult population. The understanding of AS pathophysiology and involved risk factors have recently undergone a great advance, with low-density lipoprotein cholesterol (LDL-C), lipoprotein (a) [Lp(a)] and other clinical conditions taking on a relevant role. Although little is known about the prevention of AS, we can progressively find more evidence of the possible use of drugs to control risk factors as tools that may delay the progression to severe AS and aortic valve replacement.

Several factors have shown to be solid predictors of the development of AS. Mendelian randomization and observational studies on risk factors specifically lipid factors, such as hypercholesterolemia, Lp(a), proprotein convertase subtilisin/kexin type 9 and hypertension have provided meaningful new information. The SAFEHEART study has significantly contributed to define the role of LDL-C and Lp(a) in AS.

In this review we discuss the interrelationship of dyslipidemia, especially hypercholesterolemia and Lp(a) in the development and prognosis of valvular AS. New imaging tools may contribute to its early detection. Future studies with proprotein convertase subtilisin/kexin type 9 inhibitors and specific therapies to lower Lp(a) might contribute to delay AS development.

In this review we discuss the interrelationship of dyslipidemia, especially hypercholesterolemia and Lp(a) in the development and prognosis of valvular AS. New imaging tools may contribute to its early detection. Future studies with proprotein convertase subtilisin/kexin type 9 inhibitors and specific therapies to lower Lp(a) might contribute to delay AS development.The aim of the study was to examine the effect of nursing students' smartphone addiction and phubbing behaviors on their communication skills. This study was conducted with 587 undergraduate nursing students. Sociodemographic data were evaluated using percentages and means. The relationship between smartphone addiction and communication skills and the relationship between phubbing behaviors and communication skills were evaluated with Pearson's correlation analysis. The effect of nursing students' smartphone addiction and phubbing behaviors on their communication skills was evaluated using multiple regression analysis. The mean age of the nursing students in the study was 20.47 ± 1.91 years, and 69.3% (n = 407) of the students were female. When the relationship between the communication skills of undergraduate nursing students and other variables was analyzed, it was found that there was a moderate, significant, and negative correlation with smartphone addiction (β = -0.314, P less then .001) as well as with the status of phubbing behaviors (β = -0.503, P less then .001). It was determined that there was a significant negative relationship between the communication skills of undergraduate nursing students and their smartphone addiction and the status of phubbing behaviors.

Posttraumatic stress disorder (PTSD) has been related to accelerated biological aging processes, but objective evidence for this association is limited. DNA methylation (DNAm) age acceleration is a novel measure of biological aging which may help clarify if PTSD is related to biological aging processes. We aim to examine whether PTSD is associated with biological aging using a comprehensive set of DNAm age acceleration markers, and to what extent the unshared environment contributes to the association.

Using a cross-sectional co-twin control study design, we investigated the association of the clinical diagnosis and symptom severity of posttraumatic stress disorder with six measurements of DNAm age acceleration based on epigenome-wide data derived from peripheral blood lymphocytes of 296 male twins from the Vietnam Era Twin Registry.

Twins with current PTSD had significantly advanced DNAm age acceleration compared with twins without PTSD for five out of six measures of DNAm age acceleration. Across almost all measures of DNAm age acceleration, twins with current PTSD were "epigenetically older" than their twin brothers without PTSD estimated differences ranged between 1.6 (95% confidence interval 0.0 to 3.1) to 2.7 (95% confidence interval 0.5 to 4.8) biological age year-equivalents. A higher CAPS score was also associated with a higher within-pair DNAm age acceleration. Results remained consistent after adjustment for behavioral and cardiovascular risk factors.

PTSD is associated with epigenetic age acceleration, primarily through unshared environmental mechanisms as opposed to genetic or familial factors. selleck compound These results suggest that PTSD is related to systemic processes relevant to biological aging.

PTSD is associated with epigenetic age acceleration, primarily through unshared environmental mechanisms as opposed to genetic or familial factors. These results suggest that PTSD is related to systemic processes relevant to biological aging.

Information on the oral health outcomes of childhood maltreatment in adulthood is limited and reliant on retrospective questionnaires that are subject to recall bias. There are no data from prospective studies using maltreatment reports to statutory agencies. We therefore assessed the effect on dental outcomes and oral health care at 30-year follow-up using both prospective agency notifications and retrospective self-reports of child maltreatment in the same birth cohort.

There were 2456 adults with data on dental outcomes and oral health care at follow-up. Information on self-reported abuse was collected using the Child Trauma Questionnaire and linked to child maltreatment notifications to statutory agencies.

The prevalence of self- and agency-reported maltreatment was 599 (24.4%) and 142 (5.8%) respectively. At follow-up, 850 participants (34.6 %) had undergone a dental extraction for infection or decay, and 810 had experienced significant dental pain over their lifetime. One third had not visited a dental clinic in the previous two years and 40% failed to brush their teeth at least twice daily. On adjusted analyses, both self- and agency-reported maltreatment showed significant associations with dental extraction (OR = 1.47; 95%CI = 1.21-1.80 and OR = 1.44; 95%CI = 1.01-2.06 respectively). There were similar results for brushing frequency, while self-reported maltreatment was associated with dental pain. However, associations were weaker for dental clinic visits and some child maltreatment subtypes.

Child maltreatment is associated with adverse oral health consequences in adulthood, and is thus a dental, as well as wider public health issue.

Child maltreatment is associated with adverse oral health consequences in adulthood, and is thus a dental, as well as wider public health issue.

Lung cancer remains the number one cause of cancer-related mortality worldwide, but less known is that lung cancer patients are among the most psychologically disabled of all cancer groups. Patients with stage-IV non-small cell lung cancer (NSCLC) were studied to test the hypothesis that trajectories of depression and/or anxiety symptoms following diagnosis would show an adverse relationship with survival, beyond relevant controls.

Patients with stage-IV NSCLC (N = 157) were enrolled (ClinicalTrials.gov Identifier NCT03199651) at diagnosis and completed validated measures for depressive symptoms (Patient Health Questionnaire-9; PHQ9) and anxiety symptoms (Generalized Anxiety Disorder-7; GAD7). Patients were reassessed every 1-to 2-months thru 24-months (16 assessments; 80% average completion rate) and survival monitored. Joint statistical models provided simultaneous modeling of longitudinal (psychological) and time-to-event (survival) processes. Control variables were age, sex, marital status, education,ological symptoms, assessed from diagnosis through 24 months, and cancer survival. New data show the continuation of depressive and anxiety symptoms through treatment and thereafter. Immunotherapy and targeted therapies have dramatically improved survival for patients with advanced NSCLC, however novel data suggest their benefit may be constrained by depressive symptoms.

Hospital-specific template matching is a newer method of hospital performance measurement that may be fairer than regression-based benchmarking. However, it has been tested in only limited research settings.

The objective of this study was to test the feasibility of hospital-specific template matching assessments in the Veterans Affairs (VA) health care system and determine power to detect greater-than-expected 30-day mortality.

Observational cohort study with hospital-specific template matching assessment. For each VA hospital, the 30-day mortality of a representative subset of hospitalizations was compared with the pooled mortality from matched hospitalizations at a set of comparison VA hospitals treating sufficiently similar patients. The simulation was used to determine power to detect greater-than-expected mortality.

A total of 556,266 hospitalizations at 122 VA hospitals in 2017.

A number of comparison hospitals identified per hospital; 30-day mortality.

Each hospital had a median of 38 comparison hospitals (interquartile range 33, 44) identified, and 116 (95.