Laryngotracheal Resection After B-Raf Proto-oncogene Inhibition for Anaplastic Thyroid Carcinoma.

Anaplastic thyroid carcinoma is a rare but aggressive neoplasm that often presents as advanced inoperable disease. Patients with B-Raf proto-oncogene (BRAF) v600e mutated anaplastic thyroid carcinoma who receive neoadjuvant dabrafenib/trametinib have improved rates of microscopically margin-negative resection and durable locoregional control. However this has not been evaluated in the setting of tracheal resection and primary reconstruction. Here we demonstrate the safety and efficacy of laryngotracheal resection and reconstruction after dabrafenib/trametinib for locoregionally advanced BRAF v600e mutated anaplastic thyroid carcinoma.

Consensus for Thoracoscopic Lower Lobectomy: Essential Components and Targets for Simulation.

BACKGROUND: Despite demonstration of its clear benefits relative to open approaches, a video-assisted thoracic surgery technique for pulmonary lobectomy has not been universally adopted. This study aims to overcome potential barriers by establishing the essential components of the operation and determining which steps are most useful for simulation training. METHODS: After randomly selecting experienced thoracic surgeons to participate, an initial list of components to a lower lobectomy was distributed. Feedback was provided by the participants, and modifications were made based on anonymous responses in a Delphi process. Components were declared essential once at least 80% of participants came to an agreement. The steps were then rated based on cognitive and technical difficulty followed by listing the components most appropriate for simulation. RESULTS: After 3 rounds of voting 18 components were identified as essential to performance of a video-assisted thoracic surgery for lower lobectomy. The components deemed the most difficult were isolation and division of the basilar and superior segmental branches of the pulmonary artery, isolation and division of the lower lobe bronchus, and dissection of lymphovascular tissue to expose the target bronchus. The steps determined to be most amenable for simulation were isolation and division of the branches of the pulmonary artery, the lower lobe bronchus, and the inferior pulmonary vein. CONCLUSIONS: Using a Delphi process a list of essential components for a video-assisted thoracic surgery for lower lobectomy was established. Furthermore 3 components were identified as most appropriate for simulation-based training, providing insights for future simulation development.

Analyzing depression coping strategies of patients with epilepsy: a preliminary study.

PURPOSE: To determine whether individuals with epilepsy who are depressed have different coping reactions, such as increased use of disengagement-type coping reactions, compared to those who are not. METHODS: We surveyed 200 patients with epilepsy and obtained demographic and clinical information. We used the Neurological Institute Disorders Depression Inventory for Epilepsy (NIDDI-E) to determine those patients who had a major depression (NIDDI-E score >15) and administered the Quality of Life in Epilepsy-10 Inventory (QOLIE-10), Beliefs About Medicines Questionnaire-Specific, Sheehan Disability Scale, a screening question for health literacy ("How confident are you filling out medical forms by yourself?"), and the Brief Coping with Problems Experienced (Brief-COPE). Using univariate analysis, we determined those demographic and clinical variables that were associated with depression. We also determined the coping reactions more frequently utilized by individuals with depression, and using multivariate analysis, determined whether those coping reactions retained statistical significance. We performed subgroup analysis of depressed epilepsy patients to determine whether coping reactions they preferentially utilized were associated with seizure frequency and quality of life. RESULTS: Seventy-one patients had a major depression while 128 did not. On univariate analysis, not driving, not working, higher seizure frequency, experiencing convulsions, poorer quality of life, and higher disability scores were significantly associated with major depression. These individuals used denial more often as a coping reaction. On multiple linear regression, the association between the use of denial and being depressed retained statistical significance. The mean denial coping scores were higher among depressed patients with more frequent seizures. However, this did not reach statistical significance. CONCLUSION: Individuals with epilepsy who have a major depression utilize denial more often as a coping reaction. Realizing this is of value to caregivers as they help patients deal with their stressful situation. This also provides additional impetus to more effectively and aggressively treatment depression in the epilepsy population.

Determining the coping strategies of individuals with epilepsy.

PURPOSE: The purpose of the present study was to determine whether the coping styles of patients with epilepsy are associated with certain demographic, clinical, and psychosocial variables. METHODS: A survey of 200 patients using several tests including the Brief-COPE was conducted. RESULTS: Nine subscales of the Brief-COPE achieved acceptable internal consistency and were employed in study analysis. Using principal component analysis, six subscales correlated well with one another, representing engagement-type coping strategies. The other three also correlated well, representing disengagement-type strategies. As a group, our patients favored engagement-type strategies. On univariate analysis, increased age, being African-American, receiving disability benefits, and work status were associated with the use of engagement-type strategies, while on multiple linear regression, only age and race were independently associated. Low BMQ-S scores, low income level, and not driving were associated with the use of disengagement-type strategies both on univariate and multivariate analyses. CONCLUSION: Among patients with epilepsy, certain demographic and psychosocial variables are associated with particular coping styles.

The relationships of 'ecstasy' (MDMA) and cannabis use to impaired executive inhibition and access to semantic long-term memory.

This study aimed to examine the relationship between the consumption of ecstasy (3,4-methylenedioxymethamphetamine (MDMA)) and cannabis, and performance on the random letter generation task which generates dependent variables drawing upon executive inhibition and access to semantic long-term memory (LTM). The participant group was a between-participant independent variable with users of both ecstasy and cannabis (E/C group, n = 15), users of cannabis but not ecstasy (CA group, n = 13) and controls with no exposure to these drugs (CO group, n = 12). Dependent variables measured violations of randomness: number of repeat sequences, number of alphabetical sequences (both drawing upon inhibition) and redundancy (drawing upon access to semantic LTM). E/C participants showed significantly higher redundancy than CO participants but did not differ from CA participants. There were no significant effects for the other dependent variables. A regression model comprising intelligence measures and estimates of ecstasy and cannabis consumption predicted redundancy scores, but only cannabis consumption contributed significantly to this prediction. Impaired access to semantic LTM may be related to cannabis consumption, although the involvement of ecstasy and other stimulant drugs cannot be excluded here. Executive inhibitory functioning, as measured by the random letter generation task, is unrelated to ecstasy and cannabis consumption.

Love styles, shyness, and patterns of emotional self-disclosure.

Previous research has shown a relationship between love styles and shyness. This study explored the possibility that this effect may be due to differences in patterns of self-disclosure associated with shyness. University student participants (N = 143) completed the Love Attitudes Scale, the Emotional Self-Disclosure Scale, and the Revised Cheek and Buss Shyness Scale. Correlations between the measures were calculated and significant results ranged from r = .18 to .30. Findings supported previous research in showing significant relationships between shyness and love styles; self-disclosure showed no relationship with shyness but did show some direct associations with love style scores. Results are discussed in relation to the importance of self-disclosure in relationship development.

The effects of shyness on love styles and relationship status.

As prior research has indicated that shyness is associated with social anxiety, inhibition, and generally less fulfilling social relationships, this study examined the possible affect of shyness on one specific type of relationship, romantic love. Participants (N = 124) completed the Revised Cheek-Buss Shyness Scale and the Love Attitudes Scale, and provided basic information about themselves and their current romantic relationships. A chi-square test showed no significant association between high or low Shyness scores and whether participants were currently involved in a romantic relationship, but there were significant positive correlations between these scores and those on two of the six love styles, Storge and Mania. In interpreting the results, the effects of shyness on relationships, social expectations, and love attitudes are discussed.

Task characteristics and performance in interpersonal cognitive problem solving.

The authors examined the extent to which performance on interpersonal cognitive problem-solving (ICPS) tasks is affected by whether the goals within the dilemmas to be addressed are sex typed. Fifty children, aged 7-8 years old, were tested for the core ICPS skills of Alternative Solutions Thinking (AST) and Consequential Thinking (CT) on a series of 8 social problem-solving tasks, 4 having goals characteristically more attractive to boys and 4 with goals more attractive to girls. A 2 x 2 MANOVA was used to compare the performances of boys and girls on each set of sex-typed tasks with the 3 dependent variables of liking for the tasks, number of alternative solutions suggested, and the number of consequences anticipated. As expected, liking for the tasks was higher if the activities were characteristically associated with the participant's own gender (p < .001), although the different tasks did not produce any significant gender differences in the numbers of AST or CT suggestions they prompted. Gender differences in children's peer relationships were considered, and the implications of these results for the format of ICPS interventions are noted.

Post-traumatic stress and self-disclosure.

Post-traumatic stress (PTS) is a significant clinical problem in the general population. However, only a portion of those exposed to trauma develop PTS. Patterns of emotional self-disclosure have the potential to explain some of the individual differences in the development and continuation of symptoms. In this study, the authors investigated the links between emotional self-disclosure, as measured by the Emotional Self-Disclosure Scale (ESDS; W. E. Snell, R. S. Miller, & S. S. Belk, 1988). and a post-trauma psychological state, as measured by the Trauma Symptom Inventory (TSI; J. Briere, 1995). Their results showed that, in general, men engaged in less emotional self-disclosure than did women, and as TSI scores increased, the men were significantly less willing to disclose emotions of happiness. For women, as TSI scores increased they were significantly more willing to engage in talk about emotions related to anxiety but less willing to talk about emotions related to fear. The authors considered these data within current understandings of the role of emotional self-disclosure in the processing of traumatic experiences.

Food sharing and perceptions of the status of a relationship.

This study examined how individuals may form an impression of the closeness of the relationship between two individuals based on an observation of them sharing food. An opportunity sample of 72 participants watched a video clip of young adults in same-sex or mixed-sex dyads eating a meal together. In the experimental conditions, each member of the dyad also offered or fed a morsel of food to the other person. Analysis showed that food sharing was seen as indicative of familiarity between the members of a dyad. Actually feeding the other person a morsel of food was seen as an indicator of intimacy in male dyads but not in mixed-sex or female dyads. Results are discussed in terms of expectations of intimacy in male and female relationships.

A study of posttraumatic stress in a student population.

The authors examined the incidence of posttraumatic stress (PTS), with respect to levels of exposure to traumatic events, in a British student population. Respondents (N = 700) completed a standard questionnaire booklet that contained a posttraumatic stress disorder interview. The questionnaire collected personal demographic information and was used by researchers to ascertain whether respondents had experienced a traumatic event. Consistent with previous American studies, PTS was found to be relatively common; 23.3% of the sample showed either current or past PTS. Female participants had a significantly higher incidence of PTS than did male participants, although the latter were more likely to report having experienced a traumatic event. The experience of trauma was significantly associated with the likelihood of PTS. The authors discuss implications of their results in terms of long-term consequences of unresolved trauma.