Rectal injury during robot-assisted radical prostatectomy: incidence and management.

Purpose: Rectal injury during robot-assisted radical prostatectomy is a rare but significant complication. Since the Clavien grading classification of complications does not include intraoperative injury without further sequelae, rectal injury may be underreported in the literature. We present what is to our knowledge the largest retrospective review to date of rectal injury and subsequent management.

Bladder neck plication stitch: a novel technique during robot-assisted radical prostatectomy to improve recovery of urinary continence.

Background And Purpose: Efforts to improve postprostatectomy incontinence have led to many modifications in surgical technique. We present our experience with a novel technique to improve continence outcomes in patients who are undergoing robot-assisted radical prostatectomy (RARP).

Patients And Methods: A consecutive series of 159 patients after initiation of a bladder neck plication stitch was compared with the most recent group before the change.

Examining factors associated with (in)stability in social information processing among urban school children: a latent transition analytic approach.

There is compelling evidence for the role of social information processing (SIP) in aggressive behavior. However, less is known about factors that influence stability versus instability in patterns of SIP over time. Latent transition analysis was used to identify SIP patterns over one year and examine how community violence exposure, aggressive behavior, and behavior regulation relate to (in)stability in SIP.

Dose-dependent increases in flow-mediated dilation following acute cocoa ingestion in healthy older adults.

An inverse relation exists between intake of flavonoid-rich foods, such as cocoa, and cardiovascular-related mortality. Favorable effects of flavonoids on the endothelium may underlie these associations. We performed a randomized, double-blind, placebo-controlled study to test the hypothesis that acute cocoa ingestion dose dependently increases endothelium-dependent vasodilation, as measured by an increase in brachial artery flow-mediated dilation (FMD), in healthy older adults.

Accentuation of Individual Differences in Social Competence During the Transition to Adolescence.

Using a sample of individuals (277 males, 315 females) studied since birth in the NICHD Study of Early Child Care and Youth Development, the present study investigated how early pubertal maturation and school transition alter youth trajectories of social competence during the transition to adolescence. Social competence showed strong continuity, with the most socially competent children remaining so in adolescence. Early pubertal maturation and school transitions accentuate individual differences, increasing social competence among more competent youth, but further diminishing social competence among less competent individuals.

Targeting the IL-6 pathway in multiple myeloma and its implications in cancer-associated gene hypermethylation.

Aberrant methylation of tumor suppressor genes (TSG) is an important epigenetic event in cancer, including multiple myeloma (MM). Interleukin-6 (IL-6), which plays a significant role in the pathogenesis of MM, also regulates DNA methylation. However, attempts to bring IL-6 blockade to the clinic have had limited success.

Success of ablation for atrial fibrillation in isolated left ventricular diastolic dysfunction: a comparison to systolic dysfunction and normal ventricular function.

Background: The efficacy of radiofrequency ablation for atrial fibrillation (AF) in patients with left ventricular (LV) systolic dysfunction and isolated diastolic dysfunction is uncertain.

Methods And Results: A prospective cohort of patients with normal and abnormal LV function underwent ablation for antiarrhythmic drug (AAD)-refractory AF. Three groups were compared: 111 patients with systolic dysfunction, defined as LV ejection fraction (LVEF) ≤40%; 157 patients with isolated diastolic dysfunction but preserved LVEF ≥50%; and 100 patients with normal LV function.

Revisiting the impact of part-time work on adolescent adjustment: distinguishing between selection and socialization using propensity score matching.

The impact of part-time employment on adolescent functioning remains unclear because most studies fail to adequately control for differential selection into the workplace. The present study reanalyzes data from L. Steinberg, S.

Pelvic anatomy on preoperative magnetic resonance imaging can predict early continence after robot-assisted radical prostatectomy.

Background And Purpose: Postoperative incontinence is multifactorial after radical prostatectomy. Using endorectal coil MRI, we examined features of the male urethra and accompanying muscular sphincter to predict continence after robot-assisted radical prostatectomy (RARP).

Patients And Methods: 80 patients underwent preoperative 1.

Elevated trajectories of externalizing problems are associated with lower awakening cortisol levels in midadolescence.

A growing body of research suggesting a negative association between basal levels of cortisol and persistent antisocial behavior has emerged. The present study examined relations between awakening cortisol levels and antisocial trajectories from ages 5 to 15 years among individuals in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. Antisocial behavior was defined by semiparametric group modeling techniques, which revealed antisocial patterns parallel to Moffitt's (1993) taxonomy of antisocial trajectories.

Changes in self-control problems and attention problems during middle school predict alcohol, tobacco, and marijuana use during high school.

Although deficits in impulse control have been linked to adolescent use of alcohol and illicit drugs, less attention has been given to variability in change in impulse control across adolescence and whether this variability may be a signal of risk for early substance use. The goals of the current study were to examine growth in two aspects of impulse control, self-control problems and attention problems, across middle adolescence, and to test the prospective effects of level and change in these variables on levels and change over time in substance use. Data are from a community sample of 955 adolescents interviewed (along with their parents and teachers) annually from 6th to 11th grade.

Renin Angiotensin Aldosterone System Blockade: Little to No Rationale for ACE Inhibitor and ARB Combinations.

Our understanding of the complexities and inter-related pathways of the renin-angiotensin-aldosterone system continues to evolve. Which drugs to use, when, and how, are everyday questions faced by clinicians in the ambulatory setting. Combining these classes, for the purpose of enhancing renin-angiotensin-aldosterone system blockade and incremental blood pressure, nephroprotective, and cardioprotective effects, logically has emerged as an area for scientific inquiry and clinical use.

Esophageal adenocarcinoma after Nissen's fundoplication for Barrett's esophagus: report of a case.

It remains unclear whether surgical treatment of gastro-esophageal reflux disease (GERD) and Barrett's esophagus (BE) decreases the long-term risk of lower esophagus malignancy; yet, proposed reductions in Barrett's epithelial transformation have been used as a rationale for antireflux surgery. We report the case of a 63-year-old woman with a 40-year history of GERD, whose symptoms returned after a Nissen fundoplication. A gastroscopy done 3 years later revealed BE.

Adrenergic mechanisms do not contribute to age-related decreases in calf venous compliance.

Limb venous compliance decreases with advancing age, even in healthy humans. To test the hypothesis that adrenergic mechanisms contribute to age-associated reductions in limb venous compliance, we measured calf venous compliance before and during acute systemic α- and β-adrenergic blockade in eight young (27 ± 1 yr old, mean ± SE) and eight older healthy men (67 ± 2 yr old). Calf venous compliance was determined in supine subjects by inflating a thigh-collecting cuff to 60 mmHg for 8 min and then decreasing it (1 mmHg/s) to 0 mmHg while calf volume was indexed with a strain gauge.

Somatic p16(INK4a) loss accelerates melanomagenesis.

Loss of p16(INK4a)-RB and ARF-p53 tumor suppressor pathways, as well as activation of RAS-RAF signaling, is seen in a majority of human melanomas. Although heterozygous germline mutations of p16(INK4a) are associated with familial melanoma, most melanomas result from somatic genetic events: often p16(INK4a) loss and N-RAS or B-RAF mutational activation, with a minority possessing alternative genetic alterations such as activating mutations in K-RAS and/or p53 inactivation. To generate a murine model of melanoma featuring some of these somatic genetic events, we engineered a novel conditional p16(INK4a)-null allele and combined this allele with a melanocyte-specific, inducible CRE recombinase strain, a conditional p53-null allele and a loxP-stop-loxP activatable oncogenic K-Ras allele.

Metastasis in an orthotopic murine model of melanoma is independent of RAS/RAF mutation.

Melanoma is the most lethal skin tumor in large part because of a propensity for early metastasis. Good models of this most clinically relevant feature of melanoma are lacking. Here, we report the development of an in-vivo model of metastasis that relies on orthotopic injection of green fluorescent protein-tagged lines in immunodeficient mice, serial intravital imaging of tumor progression, and quantification of distant spread by two-photon laser scanning microscopy, immunohistochemistry, and real-time PCR analysis.

Adolescents' exposure to sexy media does not hasten the initiation of sexual intercourse.

It is widely believed that exposure to sexy content in the mass media leads teenagers to become sexually active. Although most research linking sexy media exposure to adolescents' sexual behavior is cross-sectional, several recent, well-publicized longitudinal studies purport to find a causal connection, which has alarmed the public and prompted criticism of the entertainment industry for its corrupting influence on youth. One problem in research on media effects on sexual activity, however, is that outcomes that are presumed to result from media exposure may actually be due to factors that differentially predispose adolescents to have different degrees of media exposure and are themselves related to sexual activity.

Mitigation of hematologic radiation toxicity in mice through pharmacological quiescence induced by CDK4/6 inhibition.

Total body irradiation (TBI) can induce lethal myelosuppression, due to the sensitivity of proliferating hematopoietic stem/progenitor cells (HSPCs) to ionizing radiation (IR). No effective therapy exists to mitigate the hematologic toxicities of TBI. Here, using selective and structurally distinct small molecule inhibitors of cyclin-dependent kinase 4 (CDK4) and CDK6, we have demonstrated that selective cellular quiescence increases radioresistance of human cell lines in vitro and mice in vivo.

Long-term outcome of atrial fibrillation ablation: impact and predictors of very late recurrence.

Introduction: Ablation eliminates atrial fibrillation (AF) in studies with 1 year follow-up, but very late recurrences may compromise long-term efficacy. In a large cohort, we sought to describe the determinants of delayed recurrence after AF ablation.

Methods And Results: Seven hundred and seventy-four patients with AF (428 paroxysmal [PAF, 55%] and 346 persistent or longstanding persistent [PersAF, 45%]) underwent wide area circumferential ablation (WACA, 62%) or pulmonary vein isolation (38%).

Long-term quality of life after ablation of atrial fibrillation the impact of recurrence, symptom relief, and placebo effect.

Objectives: We sought to determine the relationship between atrial fibrillation (AF) ablation efficacy, quality of life (QoL), and AF-specific symptoms at 2 years.

Background: Although the primary goal of AF ablation is QoL improvement, this effect has yet to be demonstrated in the long term.

Methods: A total of 502 symptomatic AF ablation recipients were prospectively followed for recurrence, QoL, and AF symptoms.

Nonreentrant supraventricular tachycardia misdiagnosed as inappropriate sinus tachycardia.

We report a case of a woman with incessant palpitations initially misdiagnosed as inappropriate sinus tachycardia that proved refractory to β-blockers. At the time of electrophysiologic testing, a sustained narrow-complex tachycardia with a 1:2 atrioventricular relationship was repeatedly initiated by a posterior fascicle depolarization induced by means of a timed ventricular extrastimulus. The tachycardia was repeatedly terminated with a timed atrial extrastimulus, which excluded junctional bigeminy and confirmed the diagnosis of nonreentrant supraventricular tachycardia.

Is adolescence-onset antisocial behavior developmentally normative?

Largely because of the influence of Moffitt's useful distinction between adolescence-limited and life-course persistent antisocial behavior, it has become increasingly common to view problem behavior that makes its first appearance in adolescence as developmentally normative. This study prospectively examined the lives of individuals in the NICHD Study of Early Child Care and Youth Development whose patterns of antisocial behavior varied with respect to age of onset and stability from kindergarten through age 15. Consistent with past research, early-onset, persistently deviant youth experienced more contextual adversity and evinced higher levels of intraindividual disadvantages than their peers from infancy through midadolescence.

The effects of visitation on incarcerated juvenile offenders: how contact with the outside impacts adjustment on the inside.

The present study investigates how visitation from parents impacts youths' mental health in the first two months of incarceration in a secure juvenile facility. A diverse sample of 276 male, newly incarcerated serious adolescent offenders (14-17 years) was interviewed over a 60-day period. Results indicate that youth who receive visits from parents report more rapid declines in depressive symptoms over time compared to youth who do not receive parental visits.