IMPORTANCE Proponents of novel transanal total mesorectal excision (TME) suggest the procedure overcomes the technical and oncologic challenges of conventional approaches for treating rectal cancer. Recently, however, there has been controversy regarding the oncologic safety of the procedure. OBJECTIVE To assess the association of transanal TME with the incidence of local recurrence (LR) of cancer and the probability of remaining free of LR during follow-up. DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study used data from 8 highvolume rectal cancer academic institutions from across Canada on all consecutive patients with primary rectal cancer treated by transanal TME at the participating centers. The study was conducted

IntroductionAcute kidney injury (AKI) is a potentially fatal complication of cardiac surgery. The inability to predict cardiac surgery-associated AKI is a major barrier to prevention and early treatment. Current clinical risk models for the prediction of cardiac surgery-associated AKI are insufficient, particularly in patients with preexisting kidney dysfunction.MethodsTo identify intraoperative variables that might improve the performance of a validated clinical risk score (Cleveland Clinic Score, CCS) for the prediction of cardiac surgery-associated AKI, we conducted a prospective cohort study in 289 consecutive elective cardiac surgery patients at a tertiary care center. We compared the area under the receiver operator characteristic curve (AUC) of a base model including only the CCS with models containing additional selected intraoperative variables including mean arterial pressure, hematocrit, duration of procedure, blood transfusions, and fluid balance. AKI was defined by the Kidney Disease Improving Global Outcomes 2012 criteria.ResultsThe CCS alone gave an AUC of 0.72 (95% confidence interval, 0.62–0.82) for postoperative AKI. Nadir intraoperative hematocrit was the only variable that improved AUC for postoperative AKI when added to the CCS (AUC = 0.78; 95% confidence interval, 0.70–0.87; P = 0.002). In the subcohort of patients without preexisting chronic kidney disease (n = 214), where the CCS underperformed (AUC, 0.60 [0.43–0.76]), the improvement with the addition of nadir hematocrit was more marked (AUC, 0.74 [0.62–0.86]). Other variables did not improve discrimination.DiscussionNadir intraoperative hematocrit is useful in improving discrimination of clinical risk scores for AKI, and may provide a target for intervention.

Purpose – The purpose of this paper is to investigate the contribution of personality factors, especially hostility, as they related to traumatic stress and mental health symptoms in firefighters. Design/methodology/approach – A group of paid-professional firefighters (n=94) completed a questionnaire study that included a demographic questionnaire, the Impact of Event Scale-Revised, the NEO Five-Factor Inventory-Revised, the Framingham Type A Scale, and the Symptom Checklist-90. Multiple regressions were used to evaluate the relationship between neuroticism or lack of agreeableness with hostility, controlling for Type A, years of service and age. Subsequently, hostility was used to predict traumatic stress and mental health symptoms, controlling for Type A, years of service, age, neuroticism, and lack of agreeableness. Findings – Both neuroticism and lack of agreeableness were determined to be significant predictors of hostility. Further, hostility positively predicted somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, paranoid ideation, psychoticism, Global Severity Index, Positive Symptom Distress Index, and Positive Symptoms Total. Although not significant, trends that hostility also predicted traumatic stress and phobic anxiety were evident. Originality/value – To the knowledge, this is the first study to specifically investigate the impact of hostility on mental health of paid-professional firefighters. In addition, the findings suggest that interventions to screen for and subsequently reduce hostility in firefighters may be beneficial for overall mental health (e.g. anger management training, etc.).