Minimally invasive colectomies can be performed with similar outcomes to open counterparts for colorectal cancer emergencies: a propensity score matching analysis utilizing ACS-NSQIP.

PURPOSE: The safety and feasibility of minimally invasive surgery (MIS) in the setting of colorectal cancer emergencies have been debated. We sought to compare postoperative outcomes of MIS with open techniques in the setting of colorectal cancer emergencies from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. METHODS: We included patients undergoing colectomy for colorectal cancer emergency between 2012 and 2019 "2012-2019" from the ACS-NSQIP dataset. We compared short-term morbidity, mortality, short-term oncological outcomes, and secondary outcomes for MIS vs open colectomies using propensity score matching. We then evaluated the trends of MIS versus open colectomies using linear regression analysis. RESULTS: We examined a total of 5544 patients (open n = 4070; MIS n = 1474) and included 1352 patients for our postoperative outcome analyses after propensity score matching 1:1 (open n = 676; MIS n = 676). Within the matched cohort, mortality was significantly higher in the open group (open 6.95% vs MIS 3.99%, OR 1.8, p = 0.023). Anastomotic leak rates were comparable between the  two groups (open 4.46% vs MIS 4.02%, OR 1.12, p = 0.787). Pulmonary complications were significantly higher after open surgery (open 10.06% vs MIS 4.73%, OR 2.25, p < 0.001). Rates of ileus were significantly higher amongst open patients (open 29.08% vs MIS 19.94%, p < 0.001). Patients stayed on average 1 day longer in the hospital after open surgery (p < 0.001). Rates of MIS for early tumors (N0 and T1/T2, n = 289) did not significantly change over 7 years (p = 0.597, rate = - 0.065%/year); however, utilization of MIS for late tumors (N1 or T3/T4, n = 4359) increased by 2.06% per year (p < 0.001). CONCLUSIONS: This study demonstrates that MIS was associated with superior postoperative outcomes compared to open surgery without compromising oncological outcomes in patients undergoing emergency colectomy for colon cancer. Within the matched cohort, MIS was associated with lower rates of mortality, pulmonary complications, ileus, and shorter postoperative length of stay.

Targeted endodontic microsurgery and endodontic microsurgery: a surgical simulation comparison.

AIM: To compare surgical time, bevel angle and site volumetric profiles of osteotomy and resection accomplished by targeted endodontic microsurgery (TEMS) and traditional endodontic microsurgery (EMS) in a surgical simulation model. METHODOLOGY: An 80x80-mm cone beam computed tomography (CBCT) file was imported into Mimics software where artificial periapical lesions were created encompassing twelve root apices. Maxillary and mandibular models were 3D-printed. TEMS surgical guides were designed and 3D-printed for each surgical site. Three board-certified endodontists used the original CBCT to plan and perform EMS on models of six maxillary and six mandibular teeth. Next, the same endodontists performed TEMS on duplicate 3D-printed models for the same teeth. All surgeries were timed. Postoperative CBCT images of experimental models were made and imported into Amira software for measurement of bevel angle and site volumetric profiles. Paired t-tests compared the mean differences between EMS and TEMS groups. A Bonferroni correction determined data to be significant at P < 0.004. RESULTS: TEMS significantly reduced surgical time (P < 0.00001), had bevel angles more closely approaching zero degrees (P < 0.01) and had significantly less volume of over-resection (P < 0.001) and length of root resection (P < 0.01). CONCLUSIONS: In this surgical simulation scenario, TEMS provided more efficient completion of osteotomy and resection, with a more appropriate root-end resection volume and bevel angle.

If 'A-B' does not predict heart disease, why bother with it? A comment on Ivancevich & Matteson.

A recent article by Ivancevich & Matteson notes many problems with research into the 'A-B' personality but recommends continued research into the construct. It is pointed out that these authors omit consideration of much of the relevant literature and that, when the omitted work is included, the 'A-B' construct must be viewed as a false trail which should now be abandoned.

Authoritarianism as a cause of heart disease: reply to Byrne, Reinhart & Heaven.

Byrne, Reinhart & Heaven (1989) report a study which replicates many findings of the present author. They interpret their findings, however, to create the impression that they somehow undermine a theory advanced by the present author. Reasons for this are explored and important omissions are noted.

Delinquency and attitude to authority: a comment on Reicher and Emler.

In their study of self-reported delinquency, Reicher & Emler (1985) use an ad hoc scale to measure attitudes to authority rather than one of the well-validated scales already in the literature. The items they finally used were almost all anti-authority--thus rendering their results susceptible of an explanation in terms of acquiescent response bias. It is shown that such an explanation would indeed provide a powerful account of what they found. Their work is therefore of uncertain meaning.

Smoking and intelligence in Australia.

It is difficult to test the link between intelligence and smoking directly. A hypothetico-deductive approach is therefore used and it is hypothesized that members of the Mensa club will have low rates of smoking. A postal survey of 402 Australian Mensa members revealed incidence rates of 22% for males and 15% for females. This is roughly half the general population incidence rate in both Australia and the U.K. It is concluded that the results do support the view of smoking as a sign of general social disadvantage.

Machiavellianism, forced-choice formats and the validity of the F scale: a rejoinder to Bloom.

Bloom has defended the forced-choice form of the Machiavellianism scale from observations by Ray that such scales have intrinsic validity problems--particularly with social desirability. Bloom also has shown that the failure of the F scale to predict authoritarian behavior does not necessarily deprive it of all claims to validity. It is pointed out that Bloom's observations contain nothing new and ignore important considerations. The validity problems of forced-choice format are elaborated by means of examples, and it is pointed out that Bloom appears to lack criteria for ever allowing the F scale to be shown as invalid.

Is authoritarianism the main element of the coronary-prone personality?

Clients at the Sydney Coronary Heart Disease Prevention Programme were screened for actual CHD and sufferers were compared with non-suffers on four personality scales to measure, respectively, A-B, dominance, achievement motivation and 'freneticism'. There were 112 sufferers and 201 controls. Sufferers were found to have significantly higher scores on dominance-the Ray (1976) Directiveness scale-but also to have significantly lower scores on the A-B measure. This latter reversal of the usual relationship was an artifact of the fact that older people are both more CHD prone and get lower A-B scores. When age was controlled for there was no relationship between A-B type and CHD. This left the authoritarian style of dominance measured by the Directiveness scale as the sole predictor of CHD. This was held to be a belated vindication of claims made in the pioneering work of Dunbar (1943).

Toward a definitive alienation scale.

Alienation is one of the most widely used constructs in sociology. Unfortunately, it is not clear that it is always the same construct as a wide diversity of scales is used to measure it. In the present work an attempt has been made to gather together all items of published scales said to measure alienation and see what they had in common: 168 items were collected and administered to a diverse community sample and were found to form a highly reliable scale which could be reduced to only 20 central items with little loss of reliability.

Authoritarianism, dominance and assertiveness.

It is shown that there are definitions of the three constructs of authoritarianism, dominance and assertiveness which read very similarly; so much so that no distinction is immediately evident. It is proposed that authoritarianism might be conceived as aggressive dominance and at least some types of assertiveness as nonaggressive dominance. A new scale of Dominance suitable for general population use was produced, and compared with the existing Ray (1976) behavior inventory of authoritarianism. Both scales showed highly significant correlations with peer rated dominance and submission (the latter being negative in sign) but only the authoritarianism scale showed significant correlations with rated aggressiveness and rigidity. It was concluded that the new definitions could be operationalized into valid scales.

Dissecting the A-B personality type.

It is suggested that 'freneticism' might be an appropriate name for the type of personality said by Rosenman, Friedman and Jenkins to be at risk from coronary heart disease. In study 1 the measure of this personality type (the JAS) was given a uniform answer format and, as such, was found to give improved reliability. It was administered to a random postal sample of Australians. A short form of 24 items was also produced. In study 2 a similar sample received the 24-item form and scales to measure achievement motivation, dominance and extraversion. 'A' types were found to be very much achievement motivated and dominant. A factor analysis showed these two traits as the main components of the A-B concept with only a third factor of 'freneticism'. This factor was measured in a third study which showed that the factor could be used as a scale in its own right.