Exploring the surgical personality.

Surgery is a demanding field, requiring determination and emotional stability. This review explores the surgical personality, addressing international personality differences between surgical and non-surgical specialties. Across the globe, surgically-interested individuals (i.e., medical students, residents, surgeons) generally scored higher on conscientiousness, open mindedness, and extraversion, and lower on neuroticism compared to non-surgically-interested contemporaries. Extraversion was inversely correlated to burnout in surgical residents and open mindedness to reduced competence in giving feedback. Although additional region- and/or country-specific research is warranted, being or becoming a surgeon appears to correlate to personality traits such as high conscientiousness and low neuroticism.

The big five: Studying the surgical personality.

BACKGROUND: The challenging nature of performing surgery on a personal and professional level demands specific characteristics. Personality traits play an important role in the nature and behavior of humans, which are studied using the five-factor model. Therefore, we investigated the personality of 3 surgical generations. METHODS: Three distinct surgical populations were approached. The Dutch Big Five Inventory-2 was sent out online to 126 surgical residents (response: n = 69) and 104 surgeons (response: n = 60) in a teaching region in the Netherlands. Moreover, medical students interested in surgery were approached via the students' surgical society (response: n = 54). To obtain a normative Dutch population sample, the Longitudinal Internet studies for the Social Sciences panel was used, creating groups of the following age categories: 18 to 25 (n = 84), 26 to 35 (n = 101), 36 to 67 (n = 432). One-way analysis of variance with Bonferroni correction was used to assess differences in personality scores. RESULTS: Individuals interested in surgery (ie, surgically-oriented medical students, surgical residents, and surgeons) generally scored significantly higher on extraversion, conscientiousness, agreeableness, open-mindedness, and lower on negative emotionality compared with the normative population sample. Across the surgical generations, surgical residents scored significantly lower on open-mindedness (3.60) compared with surgeons (3.92) and surgically-oriented medical students (3.82). Surgically-oriented medical students scored significantly higher in negative emotionality (2.44) compared with surgical residents (2.12) and surgeons (2.07). CONCLUSION: Being a surgeon demands particular levels of determination and emotional stability. The surgical population shows a distinct personality pattern compared with the normative population, and more modest differences exist between persons in different stages of their surgical career.

[A patient with abnormal skin discolouring around a colostomy]. / Een vrouw met een huidverkleuring rondom het stoma.

In this article we present a case of a 83-year-old female patient with an abnormal skin discolouring around the colostomy, which we diagnosed as ectopic parastomal varices due to underlying primary biliary cirrhosis.

Genome-scale discovery of DNA-methylation biomarkers for blood-based detection of colorectal cancer.

BACKGROUND: There is an increasing demand for accurate biomarkers for early non-invasive colorectal cancer detection. We employed a genome-scale marker discovery method to identify and verify candidate DNA methylation biomarkers for blood-based detection of colorectal cancer. METHODOLOGY/PRINCIPAL FINDINGS: We used DNA methylation data from 711 colorectal tumors, 53 matched adjacent-normal colonic tissue samples, 286 healthy blood samples and 4,201 tumor samples of 15 different cancer types. DNA methylation data were generated by the Illumina Infinium HumanMethylation27 and the HumanMethylation450 platforms, which determine the methylation status of 27,578 and 482,421 CpG sites respectively. We first performed a multistep marker selection to identify candidate markers with high methylation across all colorectal tumors while harboring low methylation in healthy samples and other cancer types. We then used pre-therapeutic plasma and serum samples from 107 colorectal cancer patients and 98 controls without colorectal cancer, confirmed by colonoscopy, to verify candidate markers. We selected two markers for further evaluation: methylated THBD (THBD-M) and methylated C9orf50 (C9orf50-M). When tested on clinical plasma and serum samples these markers outperformed carcinoembryonic antigen (CEA) serum measurement and resulted in a high sensitive and specific test performance for early colorectal cancer detection. CONCLUSIONS/SIGNIFICANCE: Our systematic marker discovery and verification study for blood-based DNA methylation markers resulted in two novel colorectal cancer biomarkers, THBD-M and C9orf50-M. THBD-M in particular showed promising performance in clinical samples, justifying its further optimization and clinical testing.

Periodic acid Schiff loops and blood lakes associated with metastasis in cutaneous melanoma.

Aggressive melanoma cells are able to form alternative routes for angiogenesis. The formation of extracellular matrix-rich vasculogenic-like networks [periodic acid Schiff (PAS) loops] and expression of endothelial-associated genes [allowing direct contact of erythrocytes (blood lakes)] are forms of vasculogenic mimicry (VM). The detection of these alternative routes may be used as an additional staging factor for cutaneous melanoma and predicts the route of metastasis in melanoma. We studied the association of the presence of VM with metastasis (lymphogenous and/or haematogenous) in patients diagnosed with cutaneous malignant melanoma in het Groene Hart Hospital, the Netherlands, between 1995 and 2000. Tumour tissue samples of 123 patients were assessed on PAS loops and blood lakes and correlated to clinical data. VM was detected in 42 (34%) and proven metastasis developed in 23 patients (18.7%). VM was associated with shorter survival (P<0.001). In 36 tumours, PAS loops were detected. PAS loops were correlated with the presence of lymphogenous as well as haematogenous metastasis (P=0.062 and 0.013). In 20 tumours, blood lakes were detected and correlated with haematogenous metastasis (P<0.001). In multivariate analyses, the detected blood lakes were significantly associated with haematogenous metastasis (P<0.001, adjusted odds ratio 6.8, 95% confidence interval 1.47-31). Blood lakes were strongly correlated with haematogenous metastasis of cutaneous melanoma and were an independent determinant for survival. These interesting findings need further investigation, although we believe that implementation of this detection can directly lead to better staging of cutaneous melanoma.