Pelvic Recurrence After Curative Resection for Rectal Adenocarcinoma: Impact of Surgery on Survival.

BACKGROUND/AIM: Rectal cancer (RC) represents 30% of colon cancers. Despite the progress achieved in integrated chemoradiotherapy and surgical multidisciplinary treatments, the rate of local recurrence (LR) is 3.7-13%. Multivisceral resections allow many patients with pelvic recurrence to be treated in a curative manner. The purpose of this work is to assess the impact of surgery for rectal cancer patients with pelvic recurrence. PATIENTS AND METHODS: In a retrospective study from 2013 to 2018, data was collected from patients who had undergone rectal resection for adenocarcinoma. We compared perioperative data, postoperative outcomes, oncological results, and survival rates. RESULTS: 106 rectal cancer patients (40-87 years old) requiring surgery were included. The local recurrence rate was 15% (15 patients). LR patients requiring intervention were nine (56%) who underwent sphincter sparing surgeries, and 6 (44%) who underwent surgeries with sphincter resection. There was no statistically significant difference (p=0.416) in the 5-year overall survival rate of patients without recurrence compared to those with pelvic recurrence. CONCLUSION: Curative surgery for local recurrence from rectal cancer is safe and feasible and should be considered in selected cases as it seems to provide acceptable surgical and oncological outcomes.

Motivations for personal financial management: A Self-Determination Theory perspective.

Financial knowledge and sound financial decision making are now broadly recognized to be important determinants of both personal and societal prosperity, but research has yet to examine how distinct qualities of motivation may be associated with the way people manage their money. In two studies we applied the framework of Self-Determination Theory (SDT) to examine people's autonomous (volitional) and controlled (pressured) motivation for understanding and managing their finances, as well as their amotivation (lack of motivation) for doing so, and the differential associations these motives have with financial knowledge and financial well-being. American participants (Study 1, N = 516; Study 2, N = 534) completed detailed demographic surveys and questionnaires assessing the financial variables of interest. As hypothesized, SDT's motivational constructs were associated with financial outcomes over and above participants' age, gender, income, household wealth, and educational attainment. Autonomous motivation was positively associated with a host of positive financial behaviors and characteristics (e.g., saving/investing and financial self-efficacy, well-being, and self-awareness). Controlled motivation was negatively associated with financial well-being. Amotivation was positively associated with overspending and negatively associated with financial self-efficacy and well-being. These findings support the relevance of SDT's framework in this domain and suggest that interventions aimed at promoting financial knowledge and wellness may benefit by adopting evidence-supported strategies for optimizing more autonomous motivations and addressing amotivations.

Medial prefrontal activity during self-other judgments is modulated by relationship need fulfillment.

The medial prefrontal cortex (MPFC) plays an important role in representing semantic self-knowledge. Studies comparing semantic self-judgments with judgments of close others suggest that interpersonal closeness may influence the degree to which the MPFC differentiates self and other. We used optical neuroimaging to examine if support for competence, relatedness, and autonomy from relationship partners moderates MPFC activity during a personality judgment task. Participants (N = 109) were asked to judge the descriptive accuracy of trait adjectives for both themselves and a friend. Participants who reported lower need fulfillment with their friend showed elevated activity only in the self-judgment condition; in contrast, participants who reported higher need fulfillment with their friend showed similarly high levels of MPFC activity across the conditions. These results are consistent with the idea that the MPFC differentially represents others on the basis of the need fulfillment experienced within the relationship.

Interpersonal traits and the neural representations of cognitive control in the prefrontal cortex.

Adaptive interpersonal functioning relies on the effectiveness of behavioral and neural systems involved in cognitive control. Whether different subcomponents of cognitive control and their neural representations are associated with distinctive interpersonal dispositions has yet to be determined. The present study investigated the relationships between prefrontal cortex (PFC) activation associated with two subcomponents of cognitive control and individual differences in interpersonally relevant traits and facets within the Five-Factor Model of personality. Undergraduate participants (n = 237) provided self-ratings of interpersonal traits and underwent functional near-infrared spectroscopy to measure activation in regions-of-interest linked to subcomponents of cognitive control: the right lateral PFC and its involvement in response selection and inhibition/suppression (RS) during a go/no-go task, and the left lateral PFC associated with goal selection, updating, representation, and maintenance (GS) on a tower planning task. Multilevel models revealed that during both RS and GS, Neuroticism and Extraversion were associated with lower and higher levels of activation, respectively. Higher Agreeableness was related to lower activation during RS but also with greater activation during GS. More narrowly defined interpersonal facets subsumed within the broader trait domains were differentially associated with RS- and GS-related neural responses. Taken together, these findings highlight potential avenues of future research to better understand the ways in which the neural processes that subserve cognitive control may underlie interpersonal dispositions.

Prognostic features of gastro-entero-pancreatic neuroendocrine neoplasms in primary and metastatic sites: Grade, mesenteric tumour deposits and emerging novelties.

Updates in classification of gastro-entero-pancreatic neuroendocrine neoplasms better reflect the biological characteristics of these tumours. In the present study, we analysed the characteristics of neuroendocrine tumours that could aid in a more precise stratification of risk groups. In addition, we have highlighted the importance of grade (re)assessment based on investigation of secondary tumour lesions. Two hundred and sixty-four cases of neuroendocrine tumours of gastro-entero-pancreatic origin from three centres were included in the study. Tumour morphology, mitotic count and Ki67 labelling index were evaluated in specimens of primary tumours, lymph node metastases and distant metastases. These variables were correlated with overall survival (OS) and relapse-free survival (RFS). Tumour stage, number of affected lymph nodes, presence of tumour deposits and synchronous/metachronous metastases were tested as possible prognostic features. Mitotic count, Ki-67 labelling index, primary tumour site, tumour stage, presence of tumour deposits and two or more affected lymph nodes were significant predictors of OS and RFS. At the same time, mitotic count and Ki-67 labelling index can be addressed as continuous variables determining prognosis. We observed a very high correlation between the measures of proliferative activity in primary and secondary tumour foci. The presence of isolated tumour deposits was identified as an important determinant of both RFS and OS for pancreatic (hazard ratio [HR] = 7.61, 95% confidence interval [CI] = 3.96-14.6, P < 0.0001 for RFS; HR = 3.28, 95% CI = 1.56-6.87, P = 0.0017 for OS) and ileal/jejunal neuroendocrine tumours (HR = 1.98, 95% CI = 1.25-3.13, P = 0.0036 for RFS and HR 2.59, 95% CI = 1.27-5.26, P = 0.009 for OS). The present study identifies the presence of mesenterial tumour deposits as an important prognostic factor for gastro-entero-pancreatic neuroendocrine tumours, provides evidence that proliferative parameters need to be treated as continuous variables and further supports the importance of grade determination in all available tumour foci.

Corrigendum: Effortless Willpower? The Integrative Self and Self-Determined Goal Pursuit.

[This corrects the article DOI: 10.3389/fpsyg.2021.653458.].

Recurrent Leiomyosarcoma of the Small Bowel: A Case Series.

BACKGROUND/AIM: Leiomyosarcoma is an extremely rare, small bowel neoplasm (2% of all gastrointestinal tumours). Early diagnosis is challenging due to the slow growth of the cancer. The biological behaviour of this group of tumours is aggressive, and the first-line treatment is surgical resection. PATIENTS AND METHODS: This is a report of 4 cases of small bowel leiomyosarcoma that were treated in the last ten years at Hospital San Martino: one involving the jejunum and three involving the ileum (age range=69-86 years). Three patients underwent surgical resection and one was treated with chemotherapy. RESULTS: All patients who were eligible for surgery underwent radical resection with R0 margins. Mean overall survival was 33 months (range=8-84 months). CONCLUSION: Specific guidelines for small bowel leiomyosarcoma do not currently exist and these rare cases should be discussed in a multidisciplinary context. The first treatment approach is surgery, and in some cases, multivisceral resection may be needed to obtain free margins, even in recurrent cases.

Inferior vena cava resection without reconstruction for retroperitoneal malignancies.

Inferior vena cava (IVC) involvement in retroperitoneal malignancies is a rare occurrence and radical surgery with major vascular resection represents the only potential curative treatment. IVC replacement after resection is still controversial and only small series and few prospective data are available. We report a series of three patients affected by retroperitoneal masses involving IVC treated with vena cava resection without replacement. All patients were treated by a radical R0 surgical procedure associated with infrarenal IVC resection and no reconstruction. Based on preoperative radiologic imaging and intraoperative findings, one patient also underwent right nephrectomy, while another patient underwent left renal vein ligation without nephrectomy. Neither early nor late severe post-operative complications related to the absence of IVC outflow were observed. Resection without replacement of the infrarenal IVC results in acceptable morbidity, thus specific risks related to the use of prosthetic grafts can be avoided.

Different Features of Tumor-Associated NK Cells in Patients With Low-Grade or High-Grade Peritoneal Carcinomatosis.

Peritoneal carcinomatosis (PC) is a rare disease defined as diffused implantation of neoplastic cells in the peritoneal cavity. This clinical picture occurs during the evolution of peritoneal tumors, and it is the main cause of morbidity and mortality of patients affected by these pathologies, though cytoreductive surgery with heated intra-peritoneal chemotherapy (CRS/HIPEC) is yielding promising results. In the present study, we evaluated whether the tumor microenvironment of low-grade and high-grade PC could affect the phenotypic and functional features and thus the anti-tumor potential of NK cells. We show that while in the peritoneal fluid (PF) of low-grade PC most CD56dim NK cells show a relatively immature phenotype (NKG2A+KIR-CD57-CD16dim), in the PF of high-grade PC NK cells are, in large majority, mature (CD56dimKIR+CD57+CD16bright). Furthermore, in low-grade PC, PF-NK cells are characterized by a sharp down-regulation of some activating receptors, primarily NKp30 and DNAM-1, while, in high-grade PC, PF-NK cells display a higher expression of the PD-1 inhibitory checkpoint. The compromised phenotype observed in low-grade PC patients corresponds to a functional impairment. On the other hand, in the high-grade PC patients PF-NK cells show much more important defects that only partially reflect the compromised phenotype detected. These data suggest that the PC microenvironment may contribute to tumor escape from immune surveillance by inducing different NK cell impaired features leading to altered anti-tumor activity. Notably, after CRS/HIPEC treatment, the altered NK cell phenotype of a patient with a low-grade disease and favorable prognosis was reverted to a normal one. Our present data offer a clue for the development of new immunotherapeutic strategies capable of restoring the NK-mediated anti-tumor responses in association with the CRS/HIPEC treatment to increase the effectiveness of the current therapy.

Single-Port Versus Conventional Laparoscopic Cholecystectomy: Better Cosmesis at the Price of an Increased Incisional Hernia Rate?

Background: The incidence of trocar site hernia (TSH) in single-port laparoscopic cholecystectomy (SPC) is still a debated issue. Aim of this retrospective study was to compare the incidence of postoperative hernia and cosmetic results among patients undergoing SPC and multiport laparoscopic cholecystectomy (MPC) performed at a single institution. Methods: A series of 60 SPC and 60 MPC patients operated on between July 2016 and May 2018 were compared. Primary endpoint was to assess the incidence of TSH at long term. All the patients were admitted as outpatients for physical examination and scar measurement. Secondary endpoints were the cosmetic results assessed by a cosmesis score (CS) and the body image questionnaire (BIQ). Results: After a median 18-month follow-up (range: 6-29 months), a hernia in umbilical trocar site was detected in 4 (7.1%) SPC patients and 1 (2%) MPC patient, the difference not being statistically significant (P = .216). BIQ was almost equivalent in SPC and MPC groups (5.15 versus 5.27; P = .518), respectively. Statistically significant differences in favor of SPC were found in CS (22.3 versus 19.72; P = .001) and in total length of scars (1.2 cm versus 4 cm; P < .001). Conclusions: SPC technique has proved to be safe and effective in experienced hands. Superior cosmesis of SPC over MPC is confirmed, but close attention to fascial closure is a vital component of SPC, and surgeons performing single-site surgery need to be aware of this increased potential for hernia formation.

Current state of the art and emerging pharmacotherapy for uterine leiomyosarcomas.

INTRODUCTION: Uterine leiomyosarcomas (ULMS) account for 1% of all uterine malignancies and for 30% of all uterine sarcomas. The preoperative diagnosis of ULMS is challenging for the physicians, as the symptoms of these tumors are often vague and nonspecific. Moreover, as ULMS have an aggressive biologic behavior, affected women frequently have very poor prognosis. AREAS COVERED: The aim of this review is to describe the current pharmacotherapy for ULMS, including the ongoing clinical trials. EXPERT OPINION: Surgery is the standard treatment for patients with early-stage ULMS. In this setting, the role of adjuvant therapies is still unclear. In the case of advanced, persistent, or recurrent ULMS, chemotherapy is the standard care with the most frequently used drug being doxorubicin. As the outcomes for patients with the currently available conventional single or combined regimens are far from being satisfactory, new alternative and innovative medical compounds have or are being evaluated. Recently, pazopanib, and olaratumab, two innovative targeted drugs, have been approved by the Food and Drug Administration (FDA) for treating advanced soft-tissue sarcoma, including ULMS. However, further clinical investigations into new and innovation therapeutic options are warranted.

Self-Other Agreement in Personality Reports: A Meta-Analytic Comparison of Self- and Informant-Report Means.

Self-report questionnaires are the most commonly used personality assessment despite longstanding concerns that self-report responses may be distorted by self-protecting motives and response biases. In a large-scale meta-analysis ( N = 33,033; k = 152 samples), we compared the means of self- and informant reports of the same target's Big Five personality traits to examine the discrepancies in two rating sources and whether people see themselves more positively than they are seen by others. Inconsistent with a general self-enhancement effect, results showed that self-report means generally did not differ from informant-report means (average δ = -.038). Moderate mean differences were found only when we compared self-reports with stranger reports, suggesting that people are critical of unacquainted targets. We discuss implications of these findings for personality assessment and other fields in which self-enhancement motives are relevant.

Investigational PI3K/AKT/mTOR inhibitors in development for endometrial cancer.

INTRODUCTION: Endometrial cancer (EC) is the most common neoplasm of the female genital tract in developed countries. Despite the progress in early detection and treatment, a significant number of cases of advanced ECs are still diagnosed. These patients have few treatment options and a poor prognosis. Our understanding of EC pathogenesis and progression has been enhanced by recent genomic studies. Among the relevant biological pathways, phosphatidylinositol 3-kinase/AKT (PIK3/AKT)-mammalian target of rapamycin (mTOR) signaling is frequently upregulated in this cancer. AREAS COVERED: This review covers investigational EC therapeutics acting on the PI3K/AKT/mTOR pathway. The authors review the results of clinical studies and highlight ongoing trials. EXPERT OPINION: Several new agents are under evaluation for treating patients with metastatic, recurrent, and persistent EC. Clinical trials investigating PI3K/AKT/mTOR inhibitors have yielded controversial results. In the near future, new studies with dual inhibitors or multi-pathways inhibitors as mono or combination therapies with conventional chemotherapy (CT) or other targeted drugs may provide more promising data. Moreover, the evaluation of new serum and histological biomarkers is an attractive strategy for patient selection.

Peritoneal carcinomatosis from ovarian paraganglioma: Report of a rare case and systematic review of the literature.

Paraganglioma is one of the rarest neoplasms involving the ovary, with only 10 previous reports. We present a case of peritoneal carcinomatosis from primary ovarian paraganglioma and a systematic review of the literature. Clinical information was retrieved from medical records, and a systematic review of the literature was performed according to meta-analysis of observational studies in epidemiology guidelines. A 33-year-old woman presented with a 12-month history of hypertension and weight loss. She was diagnosed with ovarian paraganglioma and was treated with extensive debulking surgery to no residual disease after three cycles of neoadjuvant chemotherapy. She recurred after 6 months and was started on somatostatin-analogue. Following further disease progression with bone metastasis (treated with palliative radiotherapy), a trial with Sunitinib was started. The patient died 30 months after initial diagnosis. Of the cases reported to date, only one had peritoneal metastasis at presentation but none of them had such an ominous prognosis. Ovarian paraganglioma is an extremely rare condition. We report the first case of primary malignant ovarian paraganglioma with an exceptionally aggressive behavior. Clinicopathological correlation with immunohistochemistry is essential to avoid misdiagnosis. A standard treatment is not recommended yet but cytoreductive surgery seems to be a favorable approach to prolong survival.

The Signs and Significance of Personality Coherence in Personal Stories and Strivings.

The concept of personality coherence refers to the extent of psychological unity and wholeness embodied within each individual. In the present research, we examined the extent to which the narrative, functional, and organismic conceptualizations of personality coherence interrelate, as well as their associations with psychological abilities and personal adjustment. College students ( N = 391) narrated accounts of three personal memories; listed five personal strivings that they subsequently compared and evaluated; completed performance measures of their intelligence, wisdom, and creativity; and rated their hedonic and eudaimonic well-being. Individuals who coherently organized their autobiographical memories were protected against feeling pressured or compelled in their personal strivings and against being steered toward need-detracting futures. Narrative indicators of coherence were otherwise independent of the functional and organismic indicators, although all indicators of personality coherence correlated with personal adjustment. Wisdom and creativity predicted narrative coherence, which partially mediated the associations they demonstrated with eudaimonic well-being.

The Emerging Neuroscience of Intrinsic Motivation: A New Frontier in Self-Determination Research.

Intrinsic motivation refers to people's spontaneous tendencies to be curious and interested, to seek out challenges and to exercise and develop their skills and knowledge, even in the absence of operationally separable rewards. Over the past four decades, experimental and field research guided by self-determination theory (SDT; Ryan and Deci, 2017) has found intrinsic motivation to predict enhanced learning, performance, creativity, optimal development and psychological wellness. Only recently, however, have studies begun to examine the neurobiological substrates of intrinsic motivation. In the present article, we trace the history of intrinsic motivation research, compare and contrast intrinsic motivation to closely related topics (flow, curiosity, trait plasticity), link intrinsic motivation to key findings in the comparative affective neurosciences, and review burgeoning neuroscience research on intrinsic motivation. We review converging evidence suggesting that intrinsically motivated exploratory and mastery behaviors are phylogenetically ancient tendencies that are subserved by dopaminergic systems. Studies also suggest that intrinsic motivation is associated with patterns of activity across large-scale neural networks, namely, those that support salience detection, attentional control and self-referential cognition. We suggest novel research directions and offer recommendations for the application of neuroscience methods in the study of intrinsic motivation.

Basic psychological needs and neurophysiological responsiveness to decisional conflict: an event-related potential study of integrative self processes.

Fulfillment of the basic psychological needs for competence, relatedness, and autonomy is believed to facilitate people's integrative tendencies to process psychological conflicts and develop a coherent sense of self. The present study therefore used event-related potentials (ERPs) to examine the relation between need fulfillment and the amplitude of conflict negativity (CN), a neurophysiological measure of conflict during personal decision making. Participants completed a decision-making task in which they made a series of forced choices according to their personal preferences. Three types of decision-making situations were created on the basis of participants' unique preference ratings, which were obtained prior to ERP recording: low-conflict situations (choosing between an attractive and an unattractive option), high-conflict approach-approach situations (choosing between two similarly attractive options), and high-conflict avoidance-avoidance situations (choosing between two similarly unattractive options). As expected, CN amplitudes were larger in high- relative to low-conflict situations, and source localization analyses suggested that the anterior cingulate cortex was the generating structure of the CN. Most importantly, people reporting higher need fulfillment exhibited larger CN amplitudes in avoidance-avoidance situations relative to low-conflict situations; to a lesser extent, they also exhibited larger CN amplitudes in approach-approach situations relative to low-conflict situations. By contrast, people reporting lower need fulfillment exhibited CN amplitudes that poorly discriminated the three decision situations. These results suggest that need fulfillment may promote self-coherent functioning by increasing people's receptivity to and processing of events that challenge their abilities to make efficient, self-congruent choices.

Linking trait-based phenotypes to prefrontal cortex activation during inhibitory control.

Inhibitory control is subserved in part by discrete regions of the prefrontal cortex whose functionality may be altered according to specific trait-based phenotypes. Using a unified model of normal range personality traits, we examined activation within lateral and medial aspects of the prefrontal cortex during a manual go/no-go task. Evoked hemodynamic oxygenation within the prefrontal cortex was measured in 106 adults using a 16-channel continuous-wave functional near-infrared spectroscopy system. Within lateral regions of the prefrontal cortex, greater activation was associated with higher trait levels of extraversion, agreeableness and conscientiousness, and lower neuroticism. Higher agreeableness was also related to more activation in the medial prefrontal cortex during inhibitory control. These results suggest that personality traits reflecting greater emotional stability, extraversion, agreeableness and conscientiousness may be associated with more efficient recruitment of control processes subserved by lateral regions of the prefrontal cortex. These findings highlight key links between trait-based phenotypes and neural activation patterns in the prefrontal cortex underlying inhibitory control.