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Minimally invasive surgery (MIS) is increasingly being utilized for the resection of gastrointestinal cancers. National trends for perioperative and oncologic outcomes of MIS for gastrointestinal stromal tumors (GIST) are unknown. We hypothesized that with increased use of MIS, the perioperative outcomes and survival for GIST are preserved.The National Cancer Database (2010-2016) was utilized to assess perioperative and oncologic outcomes for GIST of the stomach and small bowel. Kaplan-Meier method and log rank test were used to compare survival outcomes.Data from 8923 gastric and 3683 small bowel resections were analyzed. Over the study period, MIS became the prevalent modality for gastrectomies (2010: robotic: 2.4%, laparoscopic: 26.1%, open: 71.5% vs. 2016: robotic: 9.6%, laparoscopic: 48.8%, open: 41.6%; p 0.001), with a smaller increase in enterectomies (2010: robotic: 1%, laparoscopic: 17.3%, open: 81.6% vs. 2016: robotic: 3.9%, laparoscopic: 27.2%, open: 68.9%; p 0.001). Age and Charlson comorbidity index were similar among groups. MIS approaches were associated with fewer readmissions and lower 90 day mortality for gastrectomies and similar rates for enterectomies. MIS did not compromise patient survival even in patients who underwent neoadjuvant treatment or harbored tumors ≥ 10 cm.Minimally invasive surgery is increasingly being utilized for resection of gastric and small bowel GIST, with improved postoperative outcomes. In this retrospective review, overall survival after minimally invasive or open surgery was comparable, even in challenging scenarios of neoadjuvant treatment or large tumors (≥ 10 cm).

Previous research demonstrates that exposure to adverse childhood experiences (ACEs) is associated with development of obesity. The same mechanisms mediating this relationship could theoretically affect attempts to lose weight in adulthood. However, it is unclear whether or not exposure to ACEs impacts the effectiveness of bariatric surgery. The present study aimed to examine the association of exposure to ACEs to postoperative weight loss outcomes. One hundred ninety-eight patients undergoing bariatric surgery were evaluated for their exposure to ACEs, determined by a presurgical questionnaire and recorded as an ACEs score. Percent total weight loss (%TWL) was calculated to evaluate postoperative weight loss at 1-, 3-, and 6-month intervals postoperatively. One hundred forty-two participants were available for follow-up at the 6-month postoperative interval. The sample consisted of 167 women and 31 men with a mean age of 47.7. Twenty-five percent of participants experienced high exposure to ACEs, defined as experiencing ≥ 4 ACEs. The average %TWL at 6 months was 16.52%. Multilevel modeling found no significant relationship between ACEs score and %TWL at any of the postoperative time intervals, both before and after adjusting for age, sex, and race. High exposure to ACEs was not associated with poorer weight loss outcomes, and participants with a large number of ACEs generally lost the anticipated amount of weight.

Background Complex ventral incisional hernia repair represents a challenging clinical condition in which biologically derived graft reinforcement is often utilized, but little long-term data inform that decision. Urinary bladder matrix (UBM) has shown effectiveness in diverse clinical settings as durable reinforcement graft material, but it has not been studied over a long term in ventral incisional hernia repair. This study evaluates the clinical, radiographic, and histological outcome of complex incisional hernia repair using UBM reinforcement with 12–70 months of follow-up. Methods A single-arm, retrospective observational study of all ventral incisional hernia repairs utilizing UBM reinforcement over a 6-year time frame by a single surgeon was performed. Patients were assessed in long-term follow-up clinically and with the Carolina Comfort Scale. A subset of patients was assessed with abdominal wall ultrasound or CT scan. Three patients had abdominal wall fascial biopsies years after the incisional hernia repair with UBM graft, and the histology is analyzed. Results 64 patients underwent repair of complex incisional hernias with UBM graft reinforcement by a single surgeon. 42 patients had concomitant procedures including large or small bowel resection, excision of infected mesh, evacuation of abscess or hematoma, cholecystectomy, or panniculectomy with abdominoplasty. 16 patients had ostomies at the time of repair. Median follow-up time is 36 months, with a range of 12–70 months. Nine patients (14%) have required surgical repair of a recurrent hernia, and a tenth patient has a recurrence that is managed non-surgically, for a total recurrence rate of 15.6% over the entire time frame. Median time to recurrence was 32 months, and a Kaplan–Meier freedom from recurrence curve is depicted. 28 patients have undergone ultrasound or CT assessments of the abdominal wall which demonstrate radiographic fascial integrity 12–70 months after repair. Three patients have been re-explored for unrelated reasons in the years following ventral incisional hernia repair with UBM, and full thickness fascial biopsies demonstrate a robust remodeling response histologically similar to native myofascial tissue. No patients have developed graft infection, fistulization to the graft, or required graft explantation. Carolina Comfort Scale assessment of 45 patients 3 years after the repair averaged 16 out of a possible 115. Conclusion In 64 patients undergoing complex ventral incisional hernia repair with UBM reinforcement, all have experienced successful resolution of complex clinical conditions and 15.6% of these repairs have recurred at a median follow-up of 3 years. Three full-thickness biopsies of the repaired fascia years later shed light on a promising remodeling response which may signal strength and durability comparable to native fascia.

OBJECTIVE: Attention-deficit/hyperactivity disorder (ADHD) is associated with an increased smoking prevalence and impairments in executive function, which may negatively affect the validity of self-reported smoking rates. This study compares the utility of self-reported smoking with salivary cotinine in adult smokers and non-smokers with and without ADHD. METHODS: Participants (N = 82) were adult smokers and nonsmokers with and without ADHD (n = 35 ADHD and n = 47 controls) from an observational study. Odds ratios (ORs) for accuracy of self-reported smoking compared to salivary cotinine were calculated using diagnosis (ADHD versus control), gender, age, education, employment, and number of cigarettes per day as predictors. Post-hoc analysis stratified sensitivity, specificity, and accuracy of self-reported smoking in individuals with ADHD and without ADHD. RESULTS: The initial analysis identified education as a significant independent predictor of odds of accuracy OR = 6.22, p = .013, after adjusting for diagnosis, gender, age, employment, and cigarettes per day. Post-hoc analysis revealed that sensitivity, specificity and accuracy of self-reported smoking was 100% for individuals with ADHD who had more than high school education compared to those with high school or less, which was 83.3%, 45.5%, and 65.2%, respectively. Self-reported smoking of control participants with greater than a high school education had a sensitivity of 85.7%, a specificity of 91.7%, and an accuracy of 88.5%. Control participants with a high school or lower education had a sensitivity of 54.6%, a specificity of 90%, and an accuracy of 71.4% for their self-reported smoking. CONCLUSION: Individuals with ADHD and high school or lower education showed the lowest specificity and accuracy in their self-reported smoking, which may affect documented smoking prevalence rates. This is a secondary analysis of data collected as part of a clinical trial registered as Clinicaltrials.gov Identifier at www.clinicaltrials.gov.

Colorectal cancer (CRC) responds poorly to immuno-mediated cytotoxicity. Underexpression of corticotropin-releasing-hormone-receptor-2 (CRHR2) in CRC, promotes tumor survival, growth and Epithelial to Mesenchymal Transition (EMT), in vitro and in vivo. We explored the role of CRHR2 downregulation in CRC cell resistance to Fas/FasL-mediated apoptosis and the underlying molecular mechanism. CRC cell sensitivity to CH11-induced apoptosis was compared between Urocortin-2 (Ucn2)-stimulated parental and CRHR2-overexpressing CRC cell lines and targets of CRHR2/Ucn2 signaling were identified through in vitro and ex vivo analyses. Induced CRHR2/Ucn2 signaling in SW620 and DLD1 cells increased specifically their sensitivity to CH11-mediated apoptosis, via Fas mRNA and protein upregulation. CRC compared to control tissues had reduced Fas expression that was associated with lost CRHR2 mRNA, poor tumor differentiation and high risk for distant metastasis. YY1 silencing increased Fas promoter activity in SW620 and re-sensitized them to CH11-apoptosis, thus suggesting YY1 as a putative transcriptional repressor of Fas in CRC. An inverse correlation between Fas and YY1 expression was confirmed in CRC tissue arrays, while elevated YY1 mRNA was clinically relevant with advanced CRC grade and higher risk for distant metastasis. CRHR2/Ucn2 signaling downregulated specifically YY1 expression through miR-7 elevation, while miR-7 modulation in miR-7