Practical Guidance for Measuring and Reporting Surgical Margins in Vulvar Cancer.

Surgical resection with free surgical margins is the cornerstone of successful primary treatment of vulvar squamous cell carcinoma (VSCC). In general reexcision is recommended when the minimum peripheral surgical margin (MPSM) is <8 mm microscopically. Pathologists are, therefore, required to report the minimum distance from the tumor to the surgical margin. Currently, there are no guidelines on how to make this measurement, as this is often considered straightforward. However, during the 2018 Annual Meeting of the British Association of Gynaecological Pathologists (BAGP), a discussion on this topic revealed a variety of opinions with regard to reporting and method of measuring margin clearance in VSCC specimens. Given the need for uniformity and the lack of guidance in the literature, we initiated an online survey in order to deliver a consensus-based definition of peripheral surgical margins in VSCC resections. The survey included questions and representative diagrams of peripheral margin measurements. In total, 57 pathologists participated in this survey. On the basis of consensus results, we propose to define MPSM in VSCC as the minimum distance from the peripheral edge of the invasive tumor nests toward the inked peripheral surgical margin reported in millimeters. This MPSM measurement should run through tissue and preferably be measured in a straight line. Along with MPSM, other relevant measurements such as depth of invasion or tumor thickness and distance to deep margins should be reported. This manuscript provides guidance to the practicing pathologist in measuring MPSM in VSCC resection specimens, in order to promote uniformity in measuring and reporting.

Altered electroencephalography resting state network coherence in remitted MDD.

Individuals with remitted depression are at greater risk for subsequent depression and therefore may provide a unique opportunity to understand the neurophysiological correlates underlying the risk of depression. Research has identified abnormal resting-state electroencephalography (EEG) power metrics and functional connectivity patterns associated with major depression, however little is known about these neural signatures in individuals with remitted depression. We investigate the spectral dynamics of 64-channel EEG surface power and source-estimated network connectivity during resting states in 37 individuals with depression, 56 with remitted depression, and 49 healthy adults that did not differ on age, education, and cognitive ability across theta, alpha, and beta frequencies. Average reference spectral EEG surface power analyses identified greater left and midfrontal theta in remitted depression compared to healthy adults. Using Network Based Statistics, we also demonstrate within and between network alterations in LORETA transformed EEG source-space coherence across the default mode, fronto-parietal, and salience networks where individuals with remitted depression exhibited enhanced coherence compared to those with depression, and healthy adults. This work builds upon our currently limited understanding of resting EEG connectivity in depression, and helps bridge the gap between aberrant EEG power and brain network connectivity dynamics in this disorder. Further, our unique examination of remitted depression relative to both healthy and depressed adults may be key to identifying brain-based biomarkers for those at high risk for future, or subsequent depression.

Memory distortion for orthographically associated words in individuals with depressive symptoms.

While major depressive disorder has been associated with increased veridical memory for negative information, prior false memory literature has linked high depressive symptoms to increased false memory for negative information. We tested whether these contradictory findings may be due to semantic and emotional cohesion inflating false alarm rates in the most commonly used false memory paradigm - the Deese-Roediger-McDermott (DRM). In Experiment 1, healthy controls and depressive participants completed two emotional false memory tasks: the DRM, using semantically associated words, and an adaptation using orthographically associated words. Participants encoded words associated with neutral or negative critical lures. During subsequent recognition memory testing, errors were greater for negative than neutral semantic critical lures, but the opposite pattern was observed for orthographic critical lures. These findings support that orthographically associated stimuli provide a non-confounded method to test emotional false memory. In Experiment 2, we deployed the orthographic paradigm with simultaneous electroencephalography (EEG) and a state measure of negative mood (Positive and Negative Affective Scale) to better understand neurocognitive components of emotional false memory. Replicating Experiment 1, we found fewer false alarms for negative than neutral novel orthographically associated words. The EEG data showed significant differences in two memory-related event-related potentials: the familiarity-related N400, and the recollection-related late positive component (LPC). N400 amplitudes were larger for true versus false endorsements. For LPC, increasing depressive symptoms predicted greater amplitude differences for true versus false negative items and reduced differences for neutral items. However, increasingly negative mood predicted reduced amplitude differences for negative items, and greater amplitude differences for neutral items. Although depressive symptoms and negative mood state are highly correlated, they may inform differentially influence shifts in memory retrieval strategies, with depressive symptoms predicting reduced false alarms for negative information, and negative mood state predicting increased recollection errors for negative information.

Sleep disturbances precede depressive symptomatology following traumatic brain injury.

The purpose of the present study was to evaluate the impact of sleep disturbances on subsequent depressive symptomatology among a representative sample of patients following traumatic brain injury (TBI). Within a retrospective cohort design, our sample included 305 individuals from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot (TRACK-TBI Pilot; NINDS-OD09-004) database. At 3-months post-TBI, symptoms of insomnia were reported by 34% of patients, and symptoms of hypersomnia were reported by 39% of patients. For the vast majority of individuals, sleep complaints were likely to persist through 6-month follow-up. Symptoms of hypersomnia but not insomnia at three months were associated with worsened depressive symptomatology at six months. These results highlight the importance of sleep disturbances in recovery from TBI and suggest targeted sleep treatments as a pathway to improve outcomes and quality of life following TBI.

The effect of Twitter exposure on false memory formation.

Social media sites such as Facebook and Twitter have increased drastically in popularity. However, information on these sites is not verified and may contain inaccuracies. It is well-established that false information encountered after an event can lead to memory distortion. Therefore, social media may be particularly harmful for autobiographical memory. Here, we tested the effect of Twitter on false memory. We presented participants with a series of images that depicted a story and then presented false information about the images in a scrolling feed that bore either a low or high resemblance to a Twitter feed. Confidence for correct information was similar across the groups, but confidence for suggested information was significantly lower when false information was presented in a Twitter format. We propose that individuals take into account the medium of the message when integrating information into memory.