Brain Biochemistry and Personality: A Magnetic Resonance Spectroscopy Study

To investigate the biochemical correlates of normal personality we utilized proton magnetic resonance spectroscopy (1H-MRS). Our sample consisted of 60 subjects ranging in age from 18 to 32 (27 females). Personality was assessed with the NEO Five-Factor Inventory (NEO-FFI). We measured brain biochemistry within the precuneus, the cingulate cortex, and underlying white matter. We hypothesized that brain biochemistry within these regions would predict individual differences across major domains of personality functioning. Biochemical models were fit for all personality domains including Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness. Our findings involved differing concentrations of Choline (Cho), Creatine (Cre), and N-acetylaspartate (NAA) in regions both within (i.e., posterior cingulate cortex) and white matter underlying (i.e., precuneus) the Default Mode Network (DMN). These results add to an emerging literature regarding personality neuroscience, and implicate biochemical integrity within the default mode network as constraining major personality domains within normal human subjects

Describing current use, barriers, and facilitators of patient portal messaging for research recruitment: Perspectives from study teams and patients at one institution

Abstract Introduction: The electronic health record (EHR) and patient portal are used increasingly for clinical research, including patient portal recruitment messaging (PPRM). Use of PPRM has grown rapidly; however, best practices are still developing. In this study, we examined the use of PPRM at our institution and conducted qualitative interviews among study teams and patients to understand experiences and preferences for PPRM. Methods: We identified study teams that sent PPRMs and patients that received PPRMs in a 60-day period. We characterized these studies and patients, in addition to the patients’ interactions with the PPRMs (e.g., viewed, responded). From these groups, we recruited study team members and patients for semi-structured interviews. A pragmatic qualitative inquiry framework was used by interviewers. Interviews were audio-recorded and analyzed using a rapid qualitative analysis exploratory approach. Results: Across ten studies, 35,037 PPRMs were sent, 33% were viewed, and 17% were responded to. Interaction rates varied across demographic groups. Six study team members completed interviews and described PPRM as an efficient and helpful recruitment method. Twenty-eight patients completed interviews. They were supportive of receiving PPRMs, particularly when the PPRM was relevant to their health. Patients indicated that providing more information in the PPRM would be helpful, in addition to options to set personalized preferences. Conclusions: PPRM is an efficient recruitment method for study teams and is acceptable to patients. Engagement with PPRMs varies across demographic groups, which should be considered during recruitment planning. Additional research is needed to evaluate and implement recommended changes by study teams and patients

Review of available national guidelines for obstetric anal sphincter injury.

INTRODUCTION AND HYPOTHESIS: Obstetric anal sphincter injuries (OASIs) are the most severe form of perineal trauma with potentially devastating effects on a mother's quality of life. There are various national guidelines available for their management. The aim of this study was to review and compare recommendations from published national guidelines regarding management and prevention of OASI. METHODS: We searched the PUBMED, EMBASE, MEDLINE, CINAHL and COCHRANE databases from January 2008 till October 2019 using relevant Medical Subject Headings (MeSH), including all subheadings. The guideline characteristics were mapped and methodological quality assessed with the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool by three independent reviewers. To compare the methodological quality of the guidelines, the interpretation of the six domain scores were taken into consideration. By consensus of the authors, a score of 70% was taken as a cut-off, and scores above this were considered 'high quality'. RESULTS: Thirteen national guidelines on perineal trauma were included and analysed. Nine of these were specific to OASI. There is wide variation in methodological quality and evidence used for recommendations. AGREE scores for overall guideline assessment were > 70% in eight of the guidelines, with Australia-Queensland, Canada, the UK and USA scoring highest. CONCLUSIONS: The wide variation in methodological quality and evidence used for recommendations suggests that there is a need for an agreed international guideline. This will enable healthcare practitioners to follow the same recommendations, with the most recent evidence, and provide evidence-based care to all women globally

Lymph Node Positive Cutaneous Non-Melanoma Skin Cancer: A Poor Prognosis Disease In Need of Treatment Intensification

Locoregionally advanced non-melanoma skin cancer (NMSC) has an aggressive clinical course characterized by high rates of treatment failure and poor survival compared to localized skin cancers. Our goal is to investigate multi-modality therapy for lymph node (LN) positive NMSC. LN positive NMSC patients who underwent surgery and adjuvant therapy were retrospectively reviewed from 2000–2012 from a single tertiary cancer center. Median follow-up was 1.8 years (range, 0.5–8.5). Overall survival (OS) and progression free survival (PFS) were calculated using the Kaplan-Meier method. Chi-squared test and logistic regression was used to determine the association of locoregional control (LRC) and the following variables: evidence of extracapsular extension, number of LN positive, largest involved LN, presence of a positive margin, and use of concurrent chemoradiation (CRT). A total of 46 patients were evaluated. Thirteen (28%) received adjuvant CRT. CRT patients were younger (p<0.0001) and had a significantly greater number of positive lymph nodes (p=0.016) than patients who received adjuvant radiation alone. At 5 years, LRC was 76%, PFS was 65%, and OS was 49%. Univariate analysis demonstrated that CRT (p = 0.006), largest LN measurement (p=0.039), and ≥3 involved LN (p=0.001) predicted local recurrence. CRT (p=0.035, OR 0.2 [95% CI 0.05–0.9]) and ≥3 involved LN (p = 0.017, OR 0.07 [95% CI 0.01–0.62]) remained significant on multivariate analysis. CRT was well tolerated. No grade ≥3 toxicities observed except one asymptomatic grade 4 thrombocytopenia. Patients with LN positive NMSC do poorly. Patient selection for adjuvant therapy intensification needs clarification

Lymph-node-positive cutaneous nonmelanoma skin cancer: a poor-prognosis disease in need of treatment intensification.(ONLINE EXCLUSIVES)

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Dysplasia at the margin? Investigating the case for subsequent therapy in \u27low-risk\u27 squamous cell carcinoma of the oral tongue.

PURPOSE: This is a retrospective analysis of the impact of moderate dysplasia at the resection margin for early stage cancer of the oral tongue. MATERIALS AND METHODS: Patients with T1-2N0 oral tongue cancer treated with surgery alone at Fox Chase Cancer Center (FCCC) from 1990 to 2010 were reviewed. Tumor and margin characteristics were abstracted from the pathology report. Overall survival (OS), disease-free survival (DFS) and local control (LC) were calculated using the Kaplan Meier method. Predictors of LC, OS and DFS were analyzed. RESULTS: 126 Patients met the inclusion criteria. Dysplasia was present at the final margin in 36% of the cases (severe: 9%, moderate: 15%, mild: 12%). Median follow-up was 52 months. 3 and 5-year actuarial LC for the entire cohort was 77% and 73%, respectively. Actuarial 5-year LC and DFS were significantly worse for patients with moderate or severe dysplasia at the margin vs. none or mild dysplasia at the margin (49% vs 82%, p=0.005 and 49% vs 80%, p=0.008, respectively); 3-year comparisons were not significant. When analyzed separately, the detrimental local effect of moderate dysplasia at the margin persisted (p=0.02) and the effect of severe dysplasia at the margin was approaching significance (p=0.1). Mild dysplasia at the margin did not significantly impair LC or DFS. Multivariate analysis demonstrated worse LC (HR: 2.99, p=0.006) and DFS (HR: 2.84, p=0.008) associated with severe or moderate dysplasia at the margin. CONCLUSIONS: Both severe and moderate dysplasia at the margin appear to be correlated with inferior LC and DFS. Additional therapy may be justified, despite added morbidity

Demographic variables for the sample.

<p>Table legend: SD  =  standard deviation; FSIQ  =  Full Scale Intelligence Quotient.</p

Bivariate Correlations between N-acetylaspartate, Creatine, and Choline across all voxel locations.

<p>Bold/italic font: Correlation is significant at p<0.05 level (2-tailed).</p><p>NAA  =  N-acetylaspartate; Cre  =  Creatine; Cho  =  Choline; 1 =  right frontal white matter; 2 =  anterior cingulate cortex; 3 =  left frontal white matter; 4 =  right parietal white matter; 5 =  posterior cingulate cortex; 6 =  left parietal white matter</p