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Introduction: In colorectal cancer, the presence of para-aortic lymph nodes (PALN) indicates extraregional disease. Appropriately selecting patients for whom PALN dissection will provide oncologic benefit remains challenging. This study identified factors to predict survival among patients undergoing PALN dissection for colorectal cancer. Methods: An institutional database was queried for patients who underwent curative-intent resection of clinically positive PALN for colorectal cancer between 2007 and 2020. Preoperative radiologic images were reviewed, and patients who did and did not have positive PALN on final pathology were compared. Survival analysis was performed to evaluate the impact of pathologically positive PALN on recurrence-free (RFS) and overall survival (OS). Results: Of 74 patients who underwent PALN dissection, 51 had PALN metastasis at the time of primary tumor diagnosis, whereas 23 had metachronous PALN disease. Preoperative chemotherapy ± radiotherapy was given in 60 cases (81.1%), and 28 (37.8%) had pathologically positive PALN. Independent factors associated with positive PALN pathology included metachronous PALN disease and pretreatment and posttreatment radiographically abnormal PALN. On multivariable analysis, pathologically positive PALN was significantly associated with decreased RFS (hazard ratio 3.90) and OS (HR 4.49). Among patients with pathologically positive PALN, well/moderately differentiated histology was associated with better OS, and metachronous disease trended toward an association with better OS. Conclusions: Pathologically positive PALN are associated with poorer RFS and OS after PALN dissection for colorectal cancer. Clinicopathologic factors may predict pathologic PALN positivity. Curative-intent surgery may provide benefit, especially in patients with well-to-moderately differentiated primary tumors and possibly metachronous PALN disease. [ABSTRACT FROM AUTHOR]

Background: For patients with synchronous liver metastases (LM) from rectal cancer, a consensus on surgical sequencing is lacking. We compared outcomes between the reverse (hepatectomy first), classic (primary tumor resection first), and combined (simultaneous hepatectomy and primary tumor resection) approaches. Methods: A prospectively maintained database was queried for patients with rectal cancer LM diagnosed before primary tumor resection who underwent hepatectomy for LM from January 2004 to April 2021. Clinicopathological factors and survival were compared between the three approaches. Results: Among 274 patients, 141 (51%) underwent the reverse approach; 73 (27%), the classic approach; and 60 (22%), the combined approach. Higher carcinoembryonic antigen level at LM diagnosis and higher number of LM were associated with the reverse approach. Combined approach patients had smaller tumors and underwent less complex hepatectomies. More than eight cycles of pre-hepatectomy chemotherapy and maximum diameter of LM > 5 cm were independently associated with worse overall survival (OS) (p = 0.002 and 0.027, respectively). Although 35% of reverse-approach patients did not undergo primary tumor resection, OS did not differ between groups. Additionally, 82% of incomplete reverse-approach patients ultimately did not require diversion during follow-up. RAS/TP53 co-mutation was independently associated with lack of primary resection with the reverse approach (odds ratio: 0.16, 95% CI 0.038–0.64, p = 0.010). Conclusions: The reverse approach results in survival similar to that of combined and classic approaches and may obviate primary rectal tumor resections and diversions. RAS/TP53 co-mutation is associated with a lower rate of completion of the reverse approach. [ABSTRACT FROM AUTHOR]

As a derivable modified hemicucurbituril, aniline-containing hemicucurbituril was synthesized in our previous report. Functionalization on the amino group of this aniline-containing hemicucurbituril was investigated, and a novel sulfonamide modified hemicucurbituril was obtained by sulfonation on the amino group with tosyl chloride, providing a novel hydrogen donor macrocycle. This macrocycle showed no interaction with aniline and benzoic acid and aminobenzoic acid by the 1H NMR study, but showed obvious interaction with these corresponding benzoate salts which was a class of preservative. These host-guest interaction properties made this system a potential acid-base controlling binding molecular device. The binding ratios and association constants between the macrocycle and these benzoate salts were investigated by 1H NMR Job's plot experiments and titration experiment. [ABSTRACT FROM AUTHOR]

NH4+ and Zn2+ are the most abundant cations detected in contaminated groundwater near municipal landfill sites. Remediation strategies were developed accordingly, such as permeable reactive barrier (PRB) that was reported as effective for single contaminant removal with porous reactive materials, including zeolite and activated carbon. However, considering the fact that multiple contaminants coexist in the groundwater, the removal effect of these porous materials and the competitive retention mechanisms between contaminants are unclear. Therefore, this study investigated the removal contributions of zeolite and activated carbon on NH4+ and Zn2+ under single and coexisting conditions. The priorities and competition mechanisms were clarified through batch and column transport tests, microscopic analyses, as well as geochemical reactive transport modeling by PHREEQC. The results indicated that zeolite performed well in removing both contaminants through ion exchange, while activated carbon was only effective in adsorbing Zn2+ through surface complexation. Mixed zeolite and activated carbon promoted each other in NH4+ removal, but inhibited the removal of Zn2+. With the increase of Zn2+ concentration, competitive adsorption occurred that influenced the breakthrough behaviors of both cations. Considering field applications as PRB reactive materials, it is suggested that pure zeolite will be appropriate if NH4+ is the main contaminant, and a mixture of adsorbents with zeolite content larger than 40% can be effective if considerable amounts of heavy metals coexist with NH4+. [ABSTRACT FROM AUTHOR]

The differences of flow characterization at the different stages of flame acceleration and transition to detonation in tubes with smooth walls, solid obstacles, and fluid jets are studied, especially the effects of flow instabilities on the process. The two-dimensional viscous unsteady reactive Navier–Stokes equations with a detailed chemistry model are solved numerically based on the structured adaptive mesh refinement technique in Adaptive Mesh Refinement Object-oriented C + + . During the ignition to a low-speed flame stage, it is found that initial pressure wave interactions with the wall and Rayleigh–Taylor instabilities, induced by the density and pressure gradient misalignment between the ignition region and unburned gas, accelerate the wrinkling and deformation of the flame surface. Consequentially, the flame wrinkles trigger Darrieus–Landau instabilities and as a result the flame accelerates. At the main acceleration stage, the Kelvin–Helmholtz instability formed in the wake of solid obstacles and the strong Kelvin–Helmholtz instability caused by the jets lead to the formation of strong turbulent structures in the flowfield and accelerate the flame propagation. Richtmyer–Meshkov instabilities caused by the interactions of reflected shock waves and the flame surface lead to flame acceleration in the case with solid obstacles. Compared to the tube with fluid jets, although the solid obstacles induce stronger Richtmyer–Meshkov instabilities, the effect of Kelvin–Helmholtz instabilities is not obvious. In general, Darrieus–Landau instabilities and Rayleigh–Taylor instabilities dominate at the initial flame-developing stage, and Kelvin–Helmholtz instabilities and Richtmyer–Meshkov instabilities play a more critical role in the flame acceleration due to interactions of the flame, the shock, solid obstacles, and vortices during the deflagration propagation stage. [ABSTRACT FROM AUTHOR]

Introduction: Lower socioeconomic status (SES) is associated with shorter overall survival (OS) in patients with locoregional colon cancer. We aimed to estimate: (1) the proportion of SES-based OS disparities mediated by disparities in the quality and location of surgical treatment in patients with resected stage I–III colon cancer and (2) the relative importance of components of surgical quality. Patients and Methods: We examined patients ages 18–80 years with resected stage I–III colon adenocarcinoma using the 2010–2016 National Cancer Database. SES was defined at the zip code level. Inverse odds weighting mediation analysis was used to estimate the proportion mediated (PM) for nine treatment quality-related and facility-related factors and composite PMs in models including all nine mediators. Models compared high SES patients with each lower SES stratum. Results: Among 171,009 patients, 5-year OS increased from 70.4% in low SES patients to 78.1% in high SES. When high SES patients were compared with low, lower-middle, and upper-middle SES patients, PM ranges among lower SES strata were: minimally invasive surgery 16.0–16.6%, lymph nodes examined 7.7–9.6%, positive margins 3.8–6.5%, length of stay 16.7–28.1%, readmissions insignificant to 3.7%, treatment at > 1 CoC facility 2.7–3.1%, facility type insignificant to 7.3%, facility volume 2.9–8.2%, and adjusted facility 90-day mortality rates 33.2–42.8%. Composite PMs were 76.9% (95% CI 61.3%, 92.4%) for low SES, 68.7% (95% CI 56.4%, 81.1%) for lower-middle SES, and 60.9% (95% CI 43.1%, 78.6%) for upper-middle SES. Conclusions: These data suggest that improving the quality of the surgical episode for disadvantaged patients undergoing resection for locoregional colon cancer could decrease SES-based survival disparities by over half. [ABSTRACT FROM AUTHOR]

Every choice we make in health professions education has a cost, whether it be financial or otherwise; by choosing one action (e.g., integrating more simulation, studying more for a summative examination) we lose the opportunity to take an alternative action (e.g., freeing up time for other teaching, leisure time). Economics significantly shapes the way we behave and think as educators and learners and so there is increasing interest in using economic ways of thinking and approaches to examine and understand how choices are made, the influence of constraints and boundaries in educational decision making, and how costs are felt. Thus, in this article, we provide a brief historical overview of modern economics, to illustrate how the core concepts of economics-scarcity (and desirability), rationality, and optimization-developed over time. We explain the important concept of bounded rationality, which explains how individual, meso-factors and contextual factors influence decision making. We then consider the opportunities that these concepts afford for health professions education and research. We conclude by proposing that embracing economic thinking opens up new questions and new ways of approaching old questions which can add knowledge about how choice is enacted in contemporary health professions education. [ABSTRACT FROM AUTHOR]

Background: Several factors can affect the risk of recurrence after curative resection of colorectal cancer (CRC). We aimed to develop a risk model for recurrence after definitive treatment of Stage I–III CRC using data from a nationally representative database and to develop an individualized web-based risk calculator. Methods: A random sample of patients who underwent resection for Stage I–III CRC between 2006 and 2007 at Commission on Cancer (CoC) accredited centers were included. Primary data regarding first recurrence was abstracted from medical records and merged with the National Cancer Database. Multivariable cox regression analysis was used to test for factors associated with cancer recurrence, stratified by stage. Model performance was tested by c statistic and calibration plots. Hazard Ratios were utilized to develop an individualized web-based recurrence prediction tool. Results: A total of 8249 patients from 1175 CoC centers were included. Of these, 1656 (20.1%) patients had a recurrence during 5 years of follow-up. Median time to recurrence was 16 months. The final predictive models displayed excellent discrimination and calibration with concordance indexes of 0.7. The online calculator included 12 variables, including tumor site, stage, time since surgery, and surveillance intensity. Output is displayed numerically and graphically with an icon array. Conclusions: Using primarily abstracted recurrence data from a random sample of patients treated for CRC at CoC accredited centers across the United States, we successfully created an individualized CRC recurrence risk assessment tool. This web-based calculator can be used by physicians and patients in shared decision making to guide management discussions. Trial Registration: ClinicalTrials.gov Registration Number: NCT02217865. [ABSTRACT FROM AUTHOR]

Advancements in clinical practice usually require level one evidence from clinical trials that directly compare new approaches to standard of care. While clinical trials have provided data to guide advances in practices across surgical oncology, all too often accrual to clinical trials is slower than anticipated, and once results are presented and published, adoption in clinical practice is slow. Why and how can surgeons be successfully involved with clinical trials? An expert panel discusses the basic infrastructure of clinical trials, investigator-initiated trials, the National Clinical Trials Network, and opportunities for surgeon involvement. Two national clinical trials, NSABP B-51/RTOG 1304 and PROSPECT N1048, are discussed to highlight the role of the surgical oncologist. [ABSTRACT FROM AUTHOR]

Multigene panel tests for hereditary cancer syndromes are increasingly utilized in the care of colorectal cancer (CRC) and polyposis patients. However, widespread availability of panels raises a number of questions including which patients should undergo testing, which genes should be included on panels, and the settings in which panels should be ordered and interpreted. To address this knowledge gap, key questions regarding the major issues encountered in clinical evaluation of hereditary CRC and polyposis were designed by the Collaborative Group of the Americas on Inherited Gastrointestinal Cancer Position Statement Committee and leadership. A literature search was conducted to address these questions. Recommendations were based on the best available evidence and expert opinion. This position statement addresses which genes should be included on a multigene panel for a patient with a suspected hereditary CRC or polyposis syndrome, proposes updated genetic testing criteria, discusses testing approaches for patients with mismatch repair proficient or deficient CRC, and outlines the essential elements for ordering and disclosing multigene panel test results. We acknowledge that critical gaps in access, insurance coverage, resources, and education remain barriers to high-quality, equitable care for individuals and their families at increased risk of hereditary CRC. [ABSTRACT FROM AUTHOR]

Lynch syndrome (LS), a hereditary cancer syndrome, accounts for approximately 3% of colorectal cancers (CRC). Positive health behaviors and surveillance are preventive strategies, but research on whether recommended behavioral guidelines are followed by individuals with LS is limited. Additional health education and promotion could be beneficial to the improved survivorship of CRC survivors. Explore health and lifestyle behaviors in CRC survivors with and without LS. We conducted a case-control study of CRC survivors with and without LS using a mailed questionnaire. Recruitment was conducted via patient registries at The University of Texas MD Anderson Cancer Center (cases n = 33; controls n = 75) and through social media (cases n = 42). CRC survivors with and without LS in our study had substantially lower smoking prevalence (5.5% and 2.7%) compared to national prevalence (18.0%). However, they had higher levels of alcohol consumption (36.8% and 10.3% for male and female LS survivors, respectively, and 35.8% and 22.0% for male and female sporadic survivors, respectively) compared to national prevalence of 13.88% for males and 6.02% for females. Both groups of CRC survivors participate in negative health behaviors that impact survivorship. More research is needed to examine the relationship between personal engagement in preventive behaviors and patient–provider relationships to improve health behaviors and explore strategies for intervention. Additionally, better health education and lifestyle change recommendations would promote and reinforce positive health outcomes in the CRC population and especially in LS survivors. [ABSTRACT FROM AUTHOR]

Lifestyle factors related to energy balance, such as excess body weight, poor diet, and physical inactivity, are associated with risk of sporadic endometrial cancer (EC) and colorectal cancer (CRC). There are limited data on energy balance-related lifestyle factors and EC or CRC risk among individuals with lynch syndrome, who are at extraordinarily higher risk of developing EC or CRC. We conducted a systematic review of evidence related to weight status, weight change, dietary habits, and physical activity on EC and CRC risk among individuals with lynch syndrome. Findings are reported narratively. We searched Medline, EMBASE, CENTRAL, PubMed, and clinicaltrials.gov up to June 14th, 2018. In total, 1060 studies were identified and 16 were included. Three studies were related to EC and 13 to CRC. Overall, evidence suggests that weight status/weight change may not be associated with EC risk and multivitamin and folic-acid supplementation may be associated with decreased EC risk. Early-adulthood overweight/obese weight-status and adulthood weight-gain may be associated with increased CRC risk, whereas multivitamin supplementation, tea and high fruit intake, and physical activity may be associated with decreased CRC risk. Current evidence proposes that recommendations related to weight, some dietary habits, and physical activity recommended for the general public are also relevant to individuals with lynch syndrome. More research is needed, specifically prospective cohorts and randomized controlled trials, to determine if tailored recommendations are needed among individuals with lynch syndrome. [ABSTRACT FROM AUTHOR]

In this paper, we are interested in studying the existence of the nonstationary solutions in the global attractor of the 2D Navier–Stokes equations with constant energy and enstrophy. We particularly focus on a subclass of these solutions that the geometric structures have a supplementary stability property which were called "chained ghost solutions" in Tian and Zhang (Indiana Univ Math J 64:1925–1958, 2015). By solving a Galerkin system of a particular form, we show the nonexistence of the chained ghost solutions for certain cases. [ABSTRACT FROM AUTHOR]

Purpose: Patients with Lynch syndrome (LS) have a significantly elevated lifetime risk of developing biliary tract cancers (BTCs) compared to the general population. However, few studies have characterized the clinical characteristics, genetic features, or long-term outcomes of mismatch-repair deficient (dMMR) cholangiocarcinomas associated with LS.Methods: A retrospective review of a prospectively maintained Familial High-Risk GI Cancer Clinic database identified all patients with BTCs evaluated from 2006 to 2016 who carried germline mutations in MLH1, MSH2, MSH6, or PMS2.Results: Eleven patients with BTCs were identified: four perihilar, four intrahepatic, one extrahepatic, one gallbladder, and one ampulla of Vater. All patients had underlying germline mutations and a personal history of a LS-associated malignancy, most commonly (63.3%) colorectal cancer. Ten (90.9%) patients were surgically explored, and margin negative resection was possible in seven (63.3%). Chemotherapy (90.9%) and/or chemoradiation (45.5%) was administered to most patients. Among the seven patients presenting with non-metastatic disease who underwent surgical resection with curative intent, the 5-year overall survival rate was 53.3%. The median overall survival for the four patients not treated with curative intent was 17.2 months.Conclusions: dMMR biliary tract cancers associated with LS are rare but long-term outcomes may be more favorable than contemporaneous cohorts of non-Lynch-associated cholangiocarcinomas. Given the emerging promise of immunotherapy for patients with dMMR malignancies, tumor testing for dMMR followed by confirmatory germline testing should be considered in patients with BTC and a personal history of other LS cancers. [ABSTRACT FROM AUTHOR]

Background: The optimal treatment sequence for patients with advanced rectal cancer and synchronous resectable liver metastases is controversial. We examined the outcomes associated with an individualized selection of classic, reversed, or combined approaches. Methods: Between 1999 and 2014, 268 patients with rectal cancer and synchronous liver-only metastases underwent curative-intent multimodality therapy. Demographics and tumor and treatment details were reviewed. Survival outcomes were examined across treatment sequences and time periods (1999-2003, 2004-2008, and 2009-2014). Results: Overall, 150 (56.0%) patients underwent primary tumor resection first ('classic' approach), 44 (16.4%) patients underwent simultaneous resection of the primary and liver metastases ('combined' approach), and 74 (27.6%) patients underwent liver resection first ('reversed' approach). Patients who underwent the reversed approach had more liver metastases (3 [2-5]) at presentation (vs. 1 [1-2.5] in the combined approach or 1 [1-3] in the classic approach; p < 0.001). Over time (from 1999 to 2003, to 2009 to 2014), both patients undergoing curative-intent treatment (62-122 patients) and the relative proportion of patients undergoing the reversed approach (6.4-37.7%) significantly increased. Despite higher disease burden, the 5-year overall survival (OS) was higher for patients treated in 2009-2014 versus those treated in 1999-2003 (76% vs. 45%; p < 0.002). Two hundred and ten patients (78%) were rendered free of disease; however, 58 were not due to disease progression or treatment complications, and their 5-year OS was poor at 6%. Conclusions: Individualized selection of treatment sequence based on the liver metastases and primary tumor disease burden allowed most patients to complete resection of all gross disease, and is associated with a 5-year OS rate approaching that for stage III rectal cancer in the most recent era. [ABSTRACT FROM AUTHOR]

Purpose: Surveillance after colorectal cancer (CRC) treatment is routine, but intensive follow-up may offer little-to-no overall survival benefit. Given the growing population of CRC survivors, we aimed to systematically evaluate the literature for the patient perspective on two questions: (1) How do CRC patients perceive routine surveillance following curative treatment and what do they expect to gain from their surveillance testing or visits? (2) Which providers (specialists, nursing, primary care) are preferred by CRC survivors to guide post-treatment surveillance?Methods: Systematic searches of PubMed MEDLINE, Embase, the CENTRAL Register of Controlled Trials, CINAHL, and PsycINFO were conducted. Studies were screened for inclusion by two reviewers, with discrepancies adjudicated by a third reviewer. Data were abstracted and evaluated utilizing validated reporting tools (CONSORT, STROBE, CASP) appropriate to study design.Results: Citations (3691) were screened, 91 full-text articles reviewed, and 23 studies included in the final review: 15 quantitative and 8 qualitative. Overall, 12 studies indicated CRC patients perceive routine surveillance positively, expecting to gain reassurance of continued disease suppression. Negative perceptions described in six studies included anxiety and dissatisfaction related to quality of life or psychosocial issues during follow-up. Although 5 studies supported specialist-led care, 9 studies indicated patient willingness to have follow-up with non-specialist providers (primary care or nursing).Conclusions: Patients' perceptions of follow-up after CRC are predominantly positive, although unmet needs included psychosocial support and quality of life.Implications For Cancer Survivors: Survivors perceived follow-up as reassuring, however, surveillance care should be more informative and focused on survivor-specific needs. [ABSTRACT FROM AUTHOR]

Traditional germline sequencing and deletion/duplication analysis does not detect Lynch syndrome-causing mutations in all individuals whose colorectal or endometrial tumors demonstrate mismatch repair (MMR) deficiency. Unique inversions and other rearrangements of the MMR genes have been reported in families with Lynch syndrome. In 2014, a recurrent inversion of MSH2 exons 1-7 was identified in five families suspected to have Lynch syndrome. We aimed to describe our clinical experience in identifying families with this specific inversion. Four probands whose Lynch syndrome-associated tumors demonstrated absence of MSH2/MSH6 staining and who had negative MMR germline testing were evaluated for the MSH2 inversion of exons 1-7, offered during initial genetic workup or upon routine clinical follow-up. All four probands tested positive for the MSH2 inversion. Proband cancer diagnoses included colon and endometrial adenocarcinoma and sebaceous adenoma. A variety of Lynch syndrome-associated cancers were reported in the family histories, although only one family met Amsterdam II criteria. Thirteen at-risk relatives underwent predictive testing. MSH2 inversion of exons 1-7 was found in four probands previously suspected to have Lynch syndrome based on family history and tumor testing. This testing should be offered routinely to patients with tumors demonstrating loss of MSH2/MSH6 staining. [ABSTRACT FROM AUTHOR]

Atmospheric pressure chemical vapour deposition was employed to deposit graphene thin films on thermally oxidized p-silicon substrates. Raman spectroscopy and energy dispersive spectroscopy revealed the multilayer nature and the composition of the grown graphene films respectively. The defective nature and the defect density of the graphene films were determined from the Raman experiments. Field effect scanning electron microscopy, transmission electron microscopy and atomic force microscopy were used to study the surface morphology of the multilayer graphene films. The film topography was sensitive to temperature and time of growth. A suitable growth mechanism has been proposed to explain the topographical observations. The large surface area of the multilayer films was found to be suitable for hydrogen sensor applications and the sensing results were correlated with the morphology of the grown films. [ABSTRACT FROM AUTHOR]

This paper presents a multiple-layered microwave absorber using rice husk and carbon nanotube composite. The dielectric properties of each layer composite were measured and analysed. The different layer of microwave absorber enables to control the microwave absorption performance. The microwave absorption performances are demonstrated through measurements of reflectivity over the frequency range 2-18 GHz. An improvement of microwave absorption <−20 dB is observed with respect to a high lossy composite placed at bottom layer of multiple layers. Reflectivity evaluations indicate that the composites display a great potential application as wideband electromagnetic wave absorbers. [ABSTRACT FROM AUTHOR]

A route information based driving control algorithm was developed for an RE-EV which consists of two motorgenerators, MG1 and MG2. A threshold power which controls the engine on/off to charge the battery was obtained by an optimization process using route information, such as the vehicle velocity and altitude. The threshold power allows the vehicle to travel to the final destination while making the final battery SOC close to SOC. Using the threshold power, route based control (RBC) was proposed by considering the driver's characteristics and traffic conditions using the driving data base. In addition, a relationship between the threshold power and various initial battery SOC was obtained by off-line optimization. The performance of the RBC was evaluated by simulation and human-in-the-loop simulation (HILS) for city driving. It was found from the simulation and HILS results that the RBC achieved approximately 4 % to 12 % reduction in fuel consumption compared to the existing charge depleting/charge sustaining (CD/CS) driving control. [ABSTRACT FROM AUTHOR]

Constitutional mismatch repair deficiency syndrome (CMMRD) is a rare autosomal recessive predisposition to colorectal polyposis and other malignancies, often childhood-onset, that is caused by biallelic inheritance of mutations in the same mismatch repair gene. Here, we describe a patient with a clinical diagnosis of CMMRD based on colorectal polyposis and young-onset endometrial cancer who was identified to have two alterations in trans in PMS2: one known pathogenic mutation (c.1831insA; p.Ile611Asnfs*2) and one novel variant of uncertain significance (c.505C>G; p.Arg169Glu), a missense alteration. We describe the clinical and molecular features in the patient harboring this novel alteration c.505C>G, who meets clinical criteria for CMMRD and exhibits molecular evidence supporting a diagnosis of CMMRD. Although experimental validation is needed to confirm its pathogenicity, PMS2 c.505C>G likely has functional consequences that contributes to our patient's phenotype based on the patient's clinical presentation, tumor studies, and bioinformatics analysis. [ABSTRACT FROM AUTHOR]

Background: Surgery for locally advanced rectal cancers beyond the plane of total mesorectal excision (TME) or extramesorectal nodal involvement should include complete resection. This study evaluated the oncologic feasibility and safety of robot-assisted surgery for rectal cancer beyond the TME plane. Methods: The study analyzed the operative, perioperative, and oncologic outcomes for all patients who underwent robot-assisted extended rectal cancer surgery from April 2009 to February 2015. Results: Of 36 patients, 22 underwent multivisceral en bloc resection, and 18 underwent extramesorectal lymph node (EMRLN) dissection. The median tumor location was 5 cm [interquartile range (IQR), 2.2-9.0 cm] from the anal verge. A total of 32 patients underwent neoadjuvant chemoradiation therapy. The median body mass index of the patients was 26.8 kg/m (IQR, 24.0-31.9 kg/m). Conversion was required for one patient because of inability to tolerate the Trendelenburg position. All the resections were R0, and there were no incomplete TMEs. The vagina and prostate or periprostatic structures were the most commonly resected ( n = 13/22), and the lateral pelvic nodes were the most common EMRLNs ( n = 16/18). The median numbers of examined mesorectal lymph nodes and EMRLNs were respectively 20 (IQR, 18.0-28.0) and 2.5 (IQR, 1.0-6.0). The median hospital stay was 4 days (IQR, 3.0-5.5 days). Six patients experienced Clavien-Dindo grade 3 complications, the most common of which was deep abscess ( n = 5, 13.8 %). The 5-year actuarial local recurrence rate was 3.6 %. Conclusions: Minimally invasive resection for rectal cancer can be performed with extended lymph node dissection or en bloc multivisceral resection using the surgical robot in selected patients. This technique is feasible and has acceptable morbidity. [ABSTRACT FROM AUTHOR]

Upregulation of the embryonic M2 isoform of pyruvate kinase (PKM2) emerges as a critical player in the cancer development and metabolism, yet the underlying mechanism of PKM2 overexpression remains to be elucidated. Here we demonstrate that IGF-1/IGF-IR regulates PKM2 expression by enhancing HIF-1α-p65 complex binding to PKM2 promoter. PKM2 expression is regulated by miR-148a/152 suppression. PKM2 directly interacts with NF-κB p65 subunit to promote EGR1 expression for regulating miR-148a/152 feedback circuit in normal cells, but not in cancer cells because of the DNA hypermethylation of miR-148a and miR-152 gene promoters. The silencing of miR-148a/152 contributes to the overexpression of PKM2, NF-κB or/and IGF-IR in some cancer cells. We show that disruption of PKM2/NF-κB/miR-148a/152 feedback loop can regulate cancer cell growth and angiogenesis, and is also associated with triple-negative breast cancer (TNBC) phenotype, which may have clinical implication for providing novel biomarker(s) of TNBC and potential therapeutic target(s) in the future. [ABSTRACT FROM AUTHOR]

A novel flower-like photocatalyst CNTs/BiOBr was successfully prepared by a facile hydrothermal method. The morphology and the physicochemical properties of the prepared samples were investigated using scanning electron microscopy (SEM), X-ray diffraction (XRD), energy dispersive X-ray spectrometry (EDX), and UV-visible diffuse reflectance spectroscopy (UV-vis DRS). The photocatalytic activity was evaluated by degradation of Rhodamin B (RhB) dye. It was demonstrated that CNTs/BiOBr photocatalyst could effectively photodegrade RhB under visible light (VL) irradiation. [ABSTRACT FROM AUTHOR]

Malignant transformation of normal hematopoietic transplants induced by residual leukemia cells is considered as a pivotal mechanism of donor cell leukemia (DCL). The effects of leukemia cell-derived microvesicles (MVs) in this transformation were examined. We found that MVs derived from K562 leukemia cells contained the breakpoint cluster region-Abelson leukemia gene human homolog 1 (BCR-ABL1) mRNA. Following incubation with BCR-ABL1-positive MVs, mononuclear cells derived from normal transplants exhibited a leukemia-like malignant phenotype both in vitro and in vivo. Horizontal transfer of BCR-ABL1 mRNA from MVs into the recipient cells was critical to the transformation. Relative genomic instability was observed and considered the main mechanism in the recipient cells. MVs contributed to genomic instability by two distinct pathways: via consequent overexpression of activation-induced cytidine deaminase and reactive oxygen species, which mediated DNA breakage and recombination; and via upregulation of methyltransferases and global DNA hypermethylation. We demonstrated that BCR-ABL1-positive MVs could initiate malignant transformation of normal hematopoietic transplants through genomic instability, which might serve as a convenient and operable model for investigating leukemogenesis, especially for DCL. Furthermore, MVs themselves could act as an early warning indicator and a novel tool to detect and prevent the occurrence of DCL. [ABSTRACT FROM AUTHOR]

Background: Radical resection is the primary treatment for rectal cancer. When anastomosis is possible, a temporary ileostomy is used to decrease morbidity from a poorly healed anastomosis. However, ileostomies are associated with complications, dehydration, and need for a second operation. We sought to evaluate the impact of ileostomy-related complications on the treatment of rectal cancer. Methods: We conducted a retrospective study of patients who underwent sphincter-preserving surgery between January 2005 and December 2010 at a tertiary cancer center. The primary outcome was the overall rate of ileostomy-related complications. Secondary outcomes included complications related to ileostomy status, ileostomy closure, anastomotic complications at primary resection, rate of stoma closure, and completion of adjuvant chemotherapy assessed by multivariate logistic regression. Results: Of 294 patients analyzed, 32 % ( n = 95) were women. Two hundred seventy-one (92 %) received neoadjuvant chemoradiation. The median tumor distance from the anal verge was 7 cm (interquartile range 5-10 cm). Two hundred eighty-one (96 %) underwent stoma closure at a median of 7 months (interquartile range 5.4-8.3 months). The most common complication related to readmission was dehydration ( n = 32-11 %). Readmission within 60 days of primary resection was associated with delay in initiating adjuvant chemotherapy (odds ratio 3.01, 95 % confidence interval 1.42-6.38, p = 0.004). Conclusions: Diverting ileostomies created during surgical treatment of rectal cancers are associated with morbidity; however, this is balanced against the risk of anastomosis-related morbidity at rectal resection. Given the potential benefit of fecal diversion, patient-oriented interventions to improve ostomy management, particularly during adjuvant chemotherapy, can be expected to yield marked benefits. [ABSTRACT FROM AUTHOR]

Background: Current evidence supports the curative resection of colorectal cancer and synchronous liver and lung metastases in selected patients.1,2 This video shows simultaneous left colectomy, bilobar liver resection, and lung metastasectomy via a transdiaphragmatic approach for stage IV colorectal cancer.3 Patient: A 57-year-old man with a stage IV colonic adenocarcinoma was considered for simultaneous resection of primary, liver, and lung metastases without thoracic incision. The tumor mutational status was KRAS, NRAS, and BRAF wild-type, and the patient underwent preoperative chemotherapy. Technique: After performing a midline laparotomy, atypical liver resection of segments 8/4a was performed under the guidance of intraoperative ultrasonography and intermittent Pringle maneuver using the two-surgeon's technique. A small capsular lesion in segment 3 also was intraoperatively detected and resected. Lung metastasectomy of the right lower lobe was performed via a transdiaphragmatic approach using an endoscopic stapler. Sigmoid colectomy with transanal circular-stapled anastomosis was performed. Duration of surgery and blood loss were 358 min and 400 ml, respectively. Histopathological examination showed metastatic colonic adenocarcinoma with negative surgical margins and final stage was T3N2aM1b. The patient was discharged on postoperative day 6 without complication. He was alive and free of disease at 90-day follow-up. Conclusions: Simultaneous colon, liver, and lung resection via a transdiaphragmatic approach is a feasible and safe surgical strategy in selected patients with peripheral lung metastases and favorable tumor biology.4 This surgical strategy avoids thoracic incision, multiple operations, and may reduce the healthcare costs and the recovery time to early implement postoperative therapy. [ABSTRACT FROM AUTHOR]

Low-temperature heat capacity C( T) of the weakly electron-correlated SrNiGe 122-layer compound undergoes a superconducting transition with onset at 1.4 K and a bulk T=0.75 K, where heat-capacity jump ratio ΔC( T)/ γT=0.88-1.05. A small average superconducting energy gap E(ave)=2.21 kT=0.14 meV is derived for this multi-gap superconductor. Similar results for isostructural SrPdGe include T(onset)=3.5 K, bulk T of 2.92 K, ΔC( T)/ γT=0.70 and E(ave)=2.54 kT=0.64 meV. The higher T onset could be associated with stoichiometric 1:2:2 grains in the polycrystalline samples. In addition, deviations of E/ kT from the BCS ratio of 3.5 suggest that, just like their iron-based counterpart, these 122-layer germanides may also exhibit an unconventional, fully-opened multi-gap s-wave superconductivity. [ABSTRACT FROM AUTHOR]

Background: With increasing interest in neuroendocrine tumors (NETs), three staging systems for NETs of the colon and rectum have been published. Their prognostic relevance has not been examined and compared in an independent clinical database. Methods: From the National Cancer Database (NCDB), 5457 patients diagnosed with colorectal neuroendocrine tumor (CRNETs) between 1998 and 2002 were staged according to the staging systems from (1) European Neuroendocrine Tumor Society (ENETS, 2006; n = 1537); (2) American Joint Committee on Cancer (AJCC, 2009; n = 1140); and (3) location-specific staging systems from the Surveillance Epidemiology and End Results (SEER, 2008; n = 942). Stage-stratified overall survival (OS) and Cox-specific concordance indices were calculated for each system. Independent prognostic factors were identified by multivariate analysis. Results: Five-year OS for stage I, II, III, and IV CRNETs as defined by the ENETS staging system were 90.8, 77.3, 53.1, and 14.8 %, respectively. For well-differentiated CRNETs, the 5-year OS for stage I, II, III, and IV as defined by the AJCC staging system were superior: 90.6, 83.9, 64.8, and 24.9 %, respectively. Both staging systems had a concordance index of 0.72. After specifying location in the colon versus rectum, all three systems demonstrated acceptable performance. Histologic grade was a significant independent predictor of OS not currently incorporated in the staging systems. Conclusions: The three staging systems showed comparable prognostic stratification of CRNETs, while the AJCC and ENETS systems are the most parsimonious. The current analysis supports the use of the AJCC for well-differentiated disease and ENETS systems for all CRNETs until there is further evidence for modification. [ABSTRACT FROM AUTHOR]

Aims/hypothesis: The loss of beta cell function is a critical factor in the development of type 2 diabetes. Glucotoxicity plays a major role in the progressive deterioration of beta cell function and development of type 2 diabetes mellitus. Here we demonstrate that microRNA (miR)-30a-5p is a key player in early-stage glucotoxicity-induced beta cell dysfunction. Methods: We performed northern blots, RT-PCR and western blots in glucotoxicity-exposed primary rat islets and INS-1 cells. We also measured glucose-stimulated insulin secretion and insulin content. In vivo approaches were used to evaluate the role of miR-30a-5p in beta cell dysfunction. Results: miR-30a-5p expression was increased in beta cells after exposure to glucotoxic conditions, and exogenous miR-30a-5p overexpression also induced beta cell dysfunction in vitro. miR-30a-5p directly suppressed expression of Beta2/NeuroD (also known as Neurod1) by binding to a specific binding site in its 3′-untranslated region. After restoration of Beta2/NeuroD expression by knockdown miR-30a-5p or transfection of the Beta2/NeuroD gene, beta cell dysfunction, including decreased insulin content, gene expression and glucose-stimulated insulin secretion, recovered. Glucose tolerance and beta cell dysfunction improved on direct injection of Ad-si30a-5p into the pancreas of diabetic mice. Conclusions/interpretation: Our data demonstrate that miR-30a-5p-mediated direct suppression of Beta2/NeuroD gene expression is an important initiation step of glucotoxicity-induced beta cell dysfunction. [ABSTRACT FROM AUTHOR]

Background: Proctectomy after hepatectomy, or the reverse approach, is an alternative to traditional sequencing for advanced liver metastases with asymptomatic colorectal primary tumors. We sought to evaluate the surgical morbidity of proctectomy for colorectal cancer after previous liver surgery. Methods: A single-institution colorectal database was queried for patients treated with proctectomy after previous hepatectomy from 2003 to 2011. Reverse-approach patients ( n = 31) were matched 1:2 with a cohort of standard proctectomy patients ( n = 62) using operation, age, gender, and surgeon. Perioperative factors were analyzed by univariate/multivariate models for associations with complications graded by Dindo-Clavien criteria. Results: Thirty-one patients with adenocarcinoma ≤20 cm from the anal verge underwent proctectomy after hepatectomy. Median time from hepatectomy to proctectomy was 5.1 months. Median tumor distance was 8.5 cm. Before proctectomy, patients underwent 28 (90 %) major hepatectomies and 7 (22 %) portal vein embolizations. There were no perioperative deaths. Reverse-approach patients did not differ from control patients in operation, demographics, body mass index (BMI), comorbidities, tumor distance, operative time, estimated blood loss, length of stay, or complication rates ( p > 0.05). Grade 2 or higher complications developed in 42 % of reverse-approach and 27 % of standard proctectomies ( p = 0.17). Grade 3 or higher complications developed in 10 % and 8 %, respectively ( p = 1.00). Independent predictors of complications of grade 2 or higher were BMI ≥30 kg/m ( p = 0.007), operative time ≥300 min ( p = 0.012), intraoperative transfusion ( p = 0.044), concurrent procedures ( p = 0.024), and age ≥50 years ( p = 0.030). Conclusions: Risk factors for morbidity of staged proctectomy are similar to those for standard proctectomy. In selected patients, the reverse-approach proctectomy is safe with acceptable morbidity. [ABSTRACT FROM AUTHOR]

Purpose: We evaluated clinical features and survival outcomes among patients with signet ring and mucinous histologies of colorectal adenocarcinoma by using data from the National Cancer Data Base (NCDB). Methods: Patients aged 18-90 years with colorectal adenocarcinoma diagnosed between 1998 and 2002 were identified from the NCDB. Site-stratified (colon vs. rectum) survival analysis was performed by multivariate relative survival adjusted for multiple clinicopathologic and treatment variables. Results: The study included 244,794 patients: 25,546 (10%) with mucinous, 2,260 (1%) with signet ring, and 216,988 (89%) with nonmucinous, non-signet ring adenocarcinoma. Mucinous and signet ring cancers were more frequently right-sided (60% and 62%, respectively) than were nonmucinous, non-signet ring adenocarcinomas (42%, P < 0.001). Signet ring histology was associated with a higher stage ( P < 0.001), and 77.2% of signet ring tumors were high-grade lesions, compared with 20% of mucinous and 17% of non-signet ring, nonmucinous adenocarcinomas ( P < 0.001). After adjustment for covariates, signet ring histology was independently associated with higher risk of death [hazard ratio (HR) 1.42, 95% confidence interval (CI) 1.33-1.51, and HR 1.57, CI 1.38-1.77, for tumors located in the colon and rectum, respectively]. Mucinous tumors of the rectum (HR 1.22, CI 1.16-1.29), but not the colon (HR 1.03, CI 1.00-1.06), were associated with increased risk of death. Conclusions: Signet ring cell adenocarcinomas of the colon and rectum and mucinous adenocarcinomas of the rectum are associated with poorer survival. These aggressive histologic variants of colorectal adenocarcinoma should be targeted for research initiatives to improve outcomes. [ABSTRACT FROM AUTHOR]

Attempts to associate methylenetetrahydrofolate reductase (MTHFR) gene C677T polymorphism with hypertension have been extensively evaluated, but mostly in Caucasians. We therefore meta-analysed this polymorphism in association with hypertension and hypertension-in-pregnancy (HIP) among Chinese subjects. A random-effects model was applied irrespective of between-study heterogeneity, which was evaluated by subgroup and meta-regression analyses. Study quality was assessed in duplicate. Publication bias was weighed using Egger's test and funnel plot. Data on 20 qualified studies totalling 4461 Chinese subjects were meta-analysed. In overall allelic/genotypic models, carriers of 677T or 677TT were consistently at significantly increased risk of developing hypertension and HIP. No between-study heterogeneity was identified for all genetic models, with the exception for contrast of allele 677T versus 677C in hypertension association studies (P=0.03), and the dominant contrast in HIP association studies (P=0.025). Both the subgroup and meta-regression analyses indicated that study design was a potential source of between-study heterogeneity. Funnel plot and Egger's test suggested no evidence of publication bias. Taken together, our results supported the notion that carriers of 677T or 677TT were at significantly increased risk of developing hypertension and HIP, but indicated caution in interpreting this result, because the study design made marginal significant contribution to the heterogeneity. [ABSTRACT FROM AUTHOR]

We conducted a retrospective study to evaluate the outcome of 94 consecutive patients with high-risk hematological malignancies who received allo-PBSCT, following idarubicin (IDA)-intensified BUCY2 (IDA-BUCY2) myeloablative conditioning regimens (n=53) and BUCY2 conditioning regimens (n=41). IDA 15 mg/m2 once daily was administered by continuous infusion on days −11 to −9, followed by BU, 3.2 mg/kg in divided doses daily, on days −6 to −4, and i.v. injection of CY, 1.8 g/m2 once daily on days −3 to −2 in the IDA-BUCY2 group. The relapse rate in patients in the IDA-BUCY2 and BUCY2-conditioning regimens group was 18.9 and 39%, respectively (P=0.030). There was no significant difference in terms of TRM. The cumulative probabilities of OS and disease-free survival at 2 years for patients conditioned with the IDA-BUCY2 and BUCY2 regimens were 65.3% vs 46.8% (P=0.038), and 63.5% vs 43.4% (P=0.025), respectively. Multivariate analysis showed that IDA-BUCY2 regimens and limited chronic GVHD were the only two factors resulting in improved survival and reduced relapse rate. This retrospective study suggests that IDA-intensified BUCY2 may be substituted for BUCY2 as conditioning regimen for patients with high-risk hematological malignancies. [ABSTRACT FROM AUTHOR]

Background: Recent population-based studies have highlighted a disproportionate increase in the incidence of rectal cancer among adults younger than aged 50 years. To determine whether different intervention and surveillance strategies might be needed for younger patients, the patterns of care and oncologic outcomes among adults younger than aged 50 years with rectal cancer were investigated. Methods: A cohort of 333 young (<50 years) patients with sporadic rectal cancer was compared to a contemporaneous cohort of 675 older (>65 years) patients for differences in disease pattern, treatments received, and long-term disease-free survival (DFS). Results: Patient and tumor characteristics did not differ between groups except for an increased presence of signet-ring and mucinous histology in young patients. Younger patients presented with more advanced-stage disease (stages III and IV: 59.4% vs. 46.4%; p = 0.016). More young patients received sphincter-preservation procedures (63.4 vs. 55.4%; p = 0.016), radiation (61.6 vs. 42.1%; p < 0.001), and chemotherapy (67.3 vs. 47.6%; p < 0.001). Fewer young patients were free from recurrent disease at the last follow-up (72.1 vs. 82.5%; p < 0.001). The stage-specific 5-year DFS did not differ between the young and older cohorts. Only stage and the need for chemotherapy independently predicted poor DFS. Conclusions: Young patients present at a later stage and a greater proportion develop distant disease recurrence over time. However, their stage-specific oncologic outcomes appear similar to those in older-onset patients. To have the greatest impact on long-term oncologic outcomes in patients with young-onset rectal cancer, future interventions should target strategies to diagnosis rectal cancer earlier, and once diagnosed, closer surveillance for recurrence may be warranted. [ABSTRACT FROM AUTHOR]

Background: Care of patients with locally recurrent rectal cancer (LRRC) requires careful patient selection. While curative resection offers survival benefits, significant trade-offs exist for the patient. Knowledge of patient-reported outcomes will help inform treatment decisions. Methods: Quality of life (QOL) and pain were prospectively assessed in 105 patients treated for LRRC at a single institution, using the validated Functional Assessment of Cancer Therapy-Colorectal (FACT-C) and Brief Pain Inventory (BPI) questionnaires. In 54 patients enrolled and followed from diagnosis of LRRC, relationship between pretreatment pain, QOL, and overall survival (OS) were examined. Results: Patients underwent curative surgical resection (C, 59%), noncurative surgery (NC, 12%) or nonsurgical treatment (NS, 28%). Median OS was 7.1, 1.4, and 1.9 years, respectively (C versus NC: p < 0.001; C versus NS: p = 0.006; NC versus NS: p = 0.261). Physical well-being QOL differed over time ( p = 0.042), with greatest difference between C and NC surgery patients ( p = 0.049). The remaining QOL domain scores and pain scores demonstrated no significant time or treatment effect. For the 54 patients assessed from diagnosis, median OS was independently predicted by treatment group (C, NC, NS: 4.3, 1.7, versus 2.4 years; p < 0.001) and pretreatment pain intensity (score ≤ 4 versus > 4: 3.8 versus 2.0 years; p = 0.001). Conclusion: Curative surgery offered prolonged survival, but significant pain exists among long-term survivors and should be a focus of survivorship care. Noncurative surgery did not offer apparent advantages over nonsurgical palliation. Patient's pretreatment pain has prognostic value, and should be assessed, treated, and considered in treatment decisions. [ABSTRACT FROM AUTHOR]

Patients with Peutz-Jeghers syndrome (PJS) require lifelong multidisciplinary care for gastrointestinal polyposis and increased risk of cancer. Their long-term morbidities and causes of mortality are unknown. Patients with a definitive diagnosis of PJS ( n = 54) were retrospectively reviewed for disease course and outcome. Operative details, pathology and complications were noted for those treated surgically ( n = 33). Median follow-up was 7.0 years (interquartile range: 2-20). Two malignancies were found intra-operatively (duodenal and rectal adenocarcinoma). In the long-term, 42% underwent additional operations; 1 patient developed short bowel syndrome, while another, chronic partial bowel obstruction and pain. Twenty-one additional cancers were treated in 19 patients: gynecologic (11), lung (3), and prostate (2) being the most common. 16 patients (30%) were deceased, at a median age of 51 years. The cause of death was unknown in 4 patients, but was due exclusively to malignancies in all other patients, most commonly due to metastatic gynecologic cancer (5). The overall survival of PJS patients was significantly shorter than the expected survival of an age-and gender-matched reference population ( P < 0.001). Given the morbidities associated with repeated operations and the risk for cancer-related mortality in the long-term, efforts should focus on minimizing the need for surgical intervention and optimizing cancer detection, treatment and prevention. [ABSTRACT FROM AUTHOR]

Heme oxygenase-1 (HO-1) has been shown to exert immunosuppressive, anti-inflammatory, anti-apoptotic and anti-proliferative effects. Its unique positive effects indicate that this enzyme might be a potential therapeutic target for psoriasis. To determine the effect of pharmacologic up-regulation of HO-1 on psoriasis, we generated a guinea pig model of psoriasiform skin lesions using propranolol induction. In this in vivo model, the 3-week propranolol challenge generated the psoriasiform pathological changes on the ears of guinea pigs. And then, guinea pigs were intraperitoneally injected with 5 mg/kg cobalt protoporphyrin (CoPP), a potent HO-1 inducer, 20 mg/kg zinc protoporphyrin, an inhibitor of HO-1, or PBS as controls, once a week from 9 weeks of age to 14 weeks old. CoPP induced notably HO-1 expression at both mRNA and protein levels. Moreover, CoPP treatment led to a significant reduction of the psoriasiform histopathological changes and remarkable amelioration of the psoriasiform skin lesions, compared with PBS treatment, with a concomitant reduction in proliferating cell nuclear antigen expression. Additionally, CoPP treatment resulted in a decreased TNF-α and significantly increased IL-10 release. Our results suggest that HO-1 induction therapy ameliorates the psoriasiform skin lesions by suppressing keratinocyte hyperproliferation and attenuating production of inflammatory responses. [ABSTRACT FROM AUTHOR]

A novel blue–green emitting phosphor Ba2ZnSi2O7: Eu2+ was prepared by a combustion synthesis (CS) method. An efficient green emission under conditions ranging from ultraviolet to visible light was observed. The emission spectrum shows a single intensive band centered at 503 nm, which corresponds to the 4 f65 d1→4 f7 transition of Eu2+. The excitation spectrum is a broad band extending from 260 to 465 nm, which matches the emission of ultraviolet light-emitting diodes (UV-LEDs). The critical quenching concentration of Eu2+ in Ba2ZnSi2O7:Eu2+ phosphor is about 0.05 mol. The corresponding concentration quenching mechanism is verified to be a dipole–dipole interaction. The value of the critical transfer distance is calculated as 19 Å, which is in good agreement with the value (20 Å) derived from the experimental data. [ABSTRACT FROM AUTHOR]

Laparoscopic assisted (LA) colectomy has significant patient benefits but is technically challenging. Hand-assisted laparoscopic surgery (HALS) allows tactile feedback because the surgeon’s hand assists in retraction and dissection. This may decrease the technical difficulty and shorten the learning curve associated with performing laparoscopic colectomy. We investigated the patient selection and short-term clinical outcomes of HALS and LA since the introduction of HALS to our minimally invasive colorectal practice. Prospectively collected data on 258 patients undergoing HALS ( n = 109) or LA colectomy ( n = 149) during a calendar year (2004) were analyzed. Patient and disease characteristics, operative parameters, and perioperative outcomes were compared. HALS patients were similar to LA patients in age (51 vs. 54 yrs), gender (56 vs. 52% male), body mass index (26 vs. 26 kg/m2), comorbidities (84 vs. 85% with one or more), and diagnosis (83 vs. 80% benign), but differed in incidence of previous surgery (49 vs. 30%; P = 0.008). A significantly greater proportion of HALS patients underwent complex procedures and extensive resections. Conversion rates (15 vs. 11%, P = 0.44), intraoperative complications (4 vs. 1%, P = 0.17), 30-day morbidity (18 vs. 11%, P = 0.12) and surgical reinterventions (2 vs. 1%, P = 0.58) did not differ. Recovery measured by days to flatus was not different [mean (standard deviation) 3(2) vs. 3(2) days, P = 0.26], however HALS patients had longer operative times [276(96) vs. 211(107) minutes P < 0.0001] and 1 day longer stay in hospital [6(3) vs. 5 (3) days, P = 0.0009)]. Patients undergoing HALS underwent more-complex procedures than LA patients but retained the short-term benefits associated with LA colectomy. HALS facilitates expansion of a minimally invasive colectomy practice to include more challenging procedures while maintaining short-term patient benefits. [ABSTRACT FROM AUTHOR]