Value of Sentinel Lymph Node (SLN) Mapping and Biopsy using Combined Intracervical Radiotracers and Blue Dye Injections for Endometrial Cancer

Background: Lymphadenectomy, as part of the initial surgical staging of patients with endometrial carcinoma, remains a controversial topic in gynecologic oncology. Sentinel lymph node (SLN) mapping has become a well-accepted procedure for melanomas and breast cancer; a number of investigators have begun to explore the utility and accuracy of this technique with regard to endometrial cancer. Aim: This study was conducted to evaluate SLN mapping of early stage endometrial cancer with blue dye in conjunction with a radioactive tracer. Subjects and methods: In this prospective cross-sectional study, patients with stage I and II endometrial cancer who were candidates for systemic lymph node dissection during surgery were enrolled, some underwent lymph node mapping and SLN biopsy using combined intra cervical radiotracer and blue dye injections and some applying only an intra cervical radiotracer. SLNs and other lymph nodes were sent for pathological assessment. Sensitivity, specificity, the positive predictive value, and the negative predictive value were calculated as predictive values for the radiotracer and blue dye. Results: Pre-operative lymph node mapping showed SLN in 29 out of 30 patients. Intra operations in 29/30 patients, SLNs were harvested by gamma probe; in 13 out of 19 patients SLNs were detected by blue dye. The median number of SLNs per patient was 3 and the total number of SLNs detected was 81. Four patients had positive pelvic lymph nodes. All of the positive nodes were SLNs. Using this technique (radiotracer and blue dye) an overall detection rate of 96.7%, an NPV of 100%, a sensitivity of 100% and a specificity of 3.85% were achieved. Conclusion: Results of SLN research for endometrial cancer are promising and make feasible the possibility of avoiding unnecessary aggressive surgical procedures in near future by advances in SLN mapping.

Path analysis of relationship among personality, perceived stress, coping, social support, and psychological outcomes.

AIM: To provide a structural model of the relationship between personality traits, perceived stress, coping strategies, social support, and psychological outcomes in the general population. METHODS: This is a cross sectional study in which the study group was selected using multistage cluster and convenience sampling among a population of 4 million. For data collection, a total of 4763 individuals were asked to complete a questionnaire on demographics, personality traits, life events, coping with stress, social support, and psychological outcomes such as anxiety and depression. To evaluate the comprehensive relationship between the variables, a path model was fitted. RESULTS: The standard electronic modules showed that personality traits and perceived stress are important determinants of psychological outcomes. Social support and coping strategies were demonstrated to reduce the increasing cumulative positive effects of neuroticism and perceived stress on the psychological outcomes and enhance the protective effect of extraversion through decreasing the positive effect of perceived stress on the psychological outcomes. CONCLUSION: Personal resources play an important role in reduction and prevention of anxiety and depression. In order to improve the psychological health, it is necessary to train and reinforce the adaptive coping strategies and social support, and thus, to moderate negative personality traits.

Cognitive emotion regulation strategies in patients with functional dyspepsia and healthy controls - A comparative study.

BACKGROUND: Patients with functional dyspepsia (FD) may use specific coping strategies. Hence, the aim of the present study was to compare cognitive emotion regulation strategies in FD patients and healthy controls. MATERIALS AND METHODS: This was a descriptive observational study. The sample consisted of 86 individuals, 43 of whom were patients diagnosed with FD. The patients referred to the psychosomatic disorders clinic, Isfahan, Iran. The comparative sample included 43 healthy controls (without digestive diagnoses) matched with the patients by age and gender. Subjects completed data on demographic factors and cognitive emotion regulation questionnaire. RESULTS: The results indicated that there are significant differences between patients with FD and healthy controls according to using cognitive strategies. Scores of healthy controls in positive reappraisal and acceptance were significantly more than FD patients, and inversely, scores of FD patients in rumination and other-blame were meaningfully more than healthy controls. CONCLUSION: FD patients apply less adaptive strategies and more maladaptive strategies. It is seemed psychological interventions that focus on reducing maladaptive strategies and increasing adaptive strategies could be effective for FD patients.

The structural model of pain, cognitive strategies, and negative emotions in functional gastrointestinal disorders.

BACKGROUND: Patients with functional gastrointestinal disorders (FGIDs) may use specific coping strategies. We intend to provide a mediating role of the relationship between pain (intensity and acceptance), cognitive emotion regulation strategies, and negative emotions in patients with FGIDs. MATERIALS AND METHODS: Participants were 176 inpatients, all experiencing significant FGIDs symptomatology as confirmed by gastroenterologists. Patients completed data on cognitive emotion regulation questionnaire, short form of depression, anxiety, stress scale, chronic pain acceptance questionnaire-revised, and pain intensity scale. Data were analyzed using structural equation modeling method. RESULTS: The pain intensity had significantly direct effect on cognitive emotion regulation strategies and indirect effect on negative emotions. Besides, the mediating role of negative emotions in the relationship between the strategies and pain acceptance were supported, whereas indirect relationships between pain intensity and acceptance through cognitive strategies were not confirmed. CONCLUSION: The results of the study emphasize the role of pain intensity in the development of negative emotions through cognitive strategies and the role of the strategies in pain acceptance through negative emotions. In fact, cognitive strategies to be related to pain and emotions.

The Role of Positive Personality Traits in Emotion Regulation of Patients with Irritable Bowel Syndrome (IBS).

BACKGROUND: Personality traits and emotion regulation processes play an important role in human health. The purpose of this study was to investigate the role of positive personality traits (psychological hardiness and interpersonal forgiveness) in emotion regulation of patients with Irritable Bowel Syndrome. METHODS: The research was a cross-sectional study. Statistical population included all of IBS patients referred to the Subspecialty Center of Psychiatry in Isfahan in 2013. Overall, 123 subjects (100 women, 83.3%, and 30 men, 16.7%) were selected by census method, according to criteria of research and during a particularperiod. To collect data, the Difficulties in Emotion Regulation Scale (DERS), Lang and Goulet Hardiness Scale (LGHS) and Interpersonal forgiveness Inventory (IFI) were used. Data was analyzed using Pearson's correlation coefficient and Multivariate and Binary Logistic regression analyses. RESULTS: Mean age of patients was 33.82±10.45 years and 83.3% (100) of them were female. Regression analyses showed that both personality traits of hardiness and forgiveness were as protective factors for emotional dysregulation with OR, 95% CI: 0.93 and 0.96 sequentially, with adjusting demographic variables (age, gender, and education level and disease duration). CONCLUSION: Patients who are more hardy and forgiving toward others, are likely more successful at adaptive emotion regulation. It emphasizes the positive and beneficial role of the personality traits in regulating of emotional problems of IBS patients. Hence, these variables should be considered as effective factors in the treatment process of the patients.

The association of personality traits and coping styles according to stress level.

BACKGROUND: Some personality traits and coping styles could be as risk factors in stressful situations. This study aimed to investigate the association of personality traits and coping styles according to the stress level. METERIALS AND METHODS: This cross-sectional study was performed in 2011. A total of 4628 individuals over 20 years were selected by random sampling from nonacademic employees that working in 50 different centers across Isfahan province. Data were collected using 12-item General Health Questionnaire (GHQ-12), Big Five Personality Inventory Short Form and coping strategies scale, and individuals were divided into high and low-stress groups in term of GHQ-12. To analyze the data, a binary logistic regression analysis was conducted. RESULTS: Mean age of participants was 36.3 ± 7.91 years and 56.26% (2604) of them were female. Neuroticism with adjusting covariates of demographic characteristics and the rest of personality traits was a risk factor for stress level with odds ratios (OR) OR:1.24; but other personality traits were protective. Also, active coping styles were protective factors for OR of stress level with adjusting covariates of demographic characteristics and the rest of coping styles, and positive reinterpretation and growth was the most effective of coping style with OR:0.84. CONCLUSION: Some personality traits are associated with passive copings and cause high-stress level. So, it could be concluded that improve and strengthen effective coping strategies in individual with maladaptive traits should be considered as a crucial component of prevention and control programs of stress.

Psychometric Properties of the Persian Version of the Difficulties in Emotion Regulation Scale) DERS-6 & DERS-5- Revised (in an Iranian Clinical Sample.

OBJECTIVE: The purpose of this study was to determine the construct validity and reliability of the two forms of the Persian version of the Difficulties in Emotion Regulation Scale (DERS-6 & DERS-5-revised) in a clinical sample. METHODS: The clinical sample consisted of 181 patients diagnosed with Functional GI Disorders (FGID) who referred to the digestive psychosomatic clinic in Isfahan in 2012. They were selected by census method (In a given period of time). The Persian version of the DERS, the short form of the DASS, and the TAS-20 were used to collect data. RESULTS: The results of the factor structure or construct validity using principal components analysis with varimax rotation recognized 7 factors for the DERS-6 (Goals, Awarness, Impalse, Non Acceptance, Strategy, Clarity, Recognition), and 6 factors for the DERS-5- revised (Non Acceptance, Goals, Impalse, Strategy, Clarity, Recognition) in the clinical sample. They showed the common variance of 59.51% and 59.15%, respectively. Also, the results showed that the concurrent validity of both forms of the DERS and most of their factors, and their reliability in terms of Cronbach-Alpha were favorable. DISCUSSION: Considering the factor structure and favorable psychometric properties of the two scales of DERS-6 & DERS-5-revised, the scales can be used in clinical samples.

Difficulties in Emotion Regulation and Mindfulness in Psychological and Somatic Symptoms of Functional Gastrointestinal Disorders.

BACKGROUND: Negative emotions are the best predictors for psychological and physical health. OBJECTIVES: We aimed to investigate the role of difficulties in emotion regulation and mindfulness on psychological and somatic symptoms of patients with functional gastrointestinal disorders (FGID). PATIENTS AND METHODS: In this cross-sectional study, the studied sample was selected using census method. A total of 167 patients with FGID completed a demographic questionnaire, difficulties in emotion regulation scale (DERS), mindful attention awareness scale (MAAS), depression, anxiety and stress scale (DASS), and gastrointestinal symptom rating scale (GSRS). To examine the relationship between studied variables, Pearson correlation coefficients and multiple regression analyses were used. RESULTS: The findings of the study indicate that difficulties in emotion regulation and mindfulness are significantly correlated to both increased psychological and somatic symptoms. Some factors of difficulties in emotion regulation positively predicted those symptoms. Among these factors, only lack of awareness was not significantly correlated with both symptoms as well as decreased mindfulness. CONCLUSIONS: The findings suggest some potential targets to reduce symptoms. Patients with FGID may benefit from treatments that facilitate emotional experience, functional status, and ability to control impulsive behaviors and behave according to the goals when experiencing negative emotions.

Comparison between the effect of liothyronine and piracetam on personal information, orientation and mental control in patients under treatment with ECT.

OBJECTIVE: The study aimed to compare the effect of liothyronine and piracetam on three subscales of the Wechsler memory test on patients under treatment with ECT. MATERIALS AND METHODS: In a double blind clinical trial, 60 of 99 patients between 20 and 45 years old, under treatment with ECT were studied in three groups. Patients in the allocation groups received liothyronine, piracetam, or placebo, from the first session of ECT until 1 month after the last session of ECT. Personal information, orientation, and mental control were tested in the participants at first, fourth, and last session of ECT and 1 month after the last session of ECT. Data were analyzed with Repeated measure ANOVA using SPSS 13. RESULTS: There wasn't any significant difference among three groups in demographic characteristics before the study and number of ECT sessions (P=0.684). After intervention, a significant difference in memory scores was seen in third and fourth assessment sessions (0.002). Orientation subscales showed a significant difference among four assessment sessions (P=0.001). Personal information and mental control never decreased in the liothyronine group. There was no significant difference among three studied groups in personal information, orientation, and mental control (P>0.05). CONCLUSION: Memory changes due to ECT may be limited to some parts of memory like orientation. More powerful studies for comparison between the effect of liothyronine and placebo are necessary.

Alexithymia and functional gastrointestinal disorders (FGID).

NTRODUCTION: The purpose of this study was to examine alexithymia symptoms, demographic variables and the severity of gastrointestinal symptoms in a sample of patients with functional gastrointestinal disorders (FGID) and a comparative sample of healthy controls. MATERIALS AND METHODS: The sample consisted of 237 individuals, 129 of whom were patients diagnosed with FGIDs. The patients referred to the psychosomatic disorders clinic_of Nour Hospital, Isfahan, Iran. The controlled group included 108 healthy individuals (without digestive diagnosis) matched with the patients by age, gender, marital and educational status. The Toronto Alexithymia Scale (TAS-20) and the Gastrointestinal Symptoms Rating Scale (GSRS) were used to collect data. Data was analyzed using multivariate analysis of variance (MANOVA), correlation coefficients and Fisher's z. RESULTS: There was a significant difference between patients with FGIDs and healthy controls in terms of number of alexithymia symptoms and severity of gastrointestinal symptoms. The results also indicated the existence of a relationship between educational level and alexithymia as well as its dimensions (difficulty identifying feelings and difficulty describing feelings) in both groups. However, no significant differences were found between the two groups in this regard. CONCLUSION: The findings of this study indicated that compared to the healthy control group, patients with FGIDs had higher scores of alexithymia and more severe somatic symptoms. Furthermore, higher educational levels were associated with decreased risk of alexithymia. Such finding might be due to higher ability to describe and identify emotions in patients with higher levels of education.

Experiences of patients with multiple sclerosis from group counseling.

BACKGROUND: Group counseling is one of the most important methods in somatic and psychological rehabilitation of the multiple sclerosis (M.S.) patients. Knowing these patients' experiences, feelings, believes and emotion based on learning in group is necessary to indicate the importance of group discussion on quality of life of the patients. This study was done to achieve experiences of M.S. patients from group training. METHODS: This was a qualitative study using phenomenological method. The samples were selected using purposeful sampling. Ten patients from M.S. society who had passed group training were included in the study. The group training was done through seven sessions weekly and voluntarily. The participants were interviewed using in-depth interview. The average time of each interview was between 30-50 minutes which has been recorded digitally and moved to a compact disc to transcribe and analysis. RESULTS: The data analyzed using 7-step Colaizzi method. The data were transformed into 158 codes, 12 sub-concepts and 4 main concepts including emotional consequences, communication, quality of life and needs. CONCLUSIONS: M.S can lead to multiple problems in patients such as somatic, behavioral, emotional and social disorders. Group psychotherapy is one of the methods which can decrease these problems and improve rehabilitation of the patients. Group discussion helps patients to overcome adverse feelings, behaviors and thoughts and guides them to move in a meaningful life. It also can improve quality of life and mental health of the patients.