Cholangiopancreatoscopy and endoscopic ultrasound for indeterminate pancreaticobiliary pathology.

BACKGROUND: Techniques to confirm suspected pancreaticobiliary (PB) malignancy when index sampling is non-diagnostic include cholangiopancreatoscopy (CP) and endoscopic ultrasound (EUS). However, comparative data are lacking. AIM: The purpose of this study was to compare the yield of EUS and CP for the diagnosis of PB pathology. METHODS: Consecutive patients with indeterminate PB pathology who underwent both CP and EUS within 3 months of each other were retrospectively identified. For CP, tissue sampling included biopsy under direct inspection (cholangioscopy-directed biopsy), biopsy following CP with fluoroscopic guidance (cholangioscopy-assisted biopsy), or brush cytology. For EUS-FNA, lesions included ductal strictures or hypoechoic masses. A comparison of operating characteristics between CP and EUS utilizing tissue confirmation or 12-month clinical course consistent with either benign or malignant disease was performed. RESULTS: Between February 2000 and June 2007, 66 (33 males, 33 females, median age 64.5) patients with indeterminate PB pathology who had undergone both CP and EUS within 3 months of each other were included. Lesions amenable to sampling were noted in 59 CP and 50 EUS patients. On follow-up, 39 patients had neoplasia and 27 were benign. The sensitivity/specificity for the diagnosis of neoplasia for CP and EUS was 48.7/96.3 % and 33.3/96.3 %, respectively (comparison of sensitivities, P = 0.183). The combined (CP and EUS) sensitivity/specificity was 66.7/96.3 % (P = 0.0064 and P = 0.0001 comparing combined sensitivity vs. sensitivity of either CP alone or EUS alone, respectively). CONCLUSIONS: In patients who undergo both EUS and CP for indeterminate PB pathology, the combined yield of EUS and CP to detect neoplasia appears to be higher than either examination alone.

A cluster analytic investigation of school violence victimization among diverse students.

Despite nationwide improvements in school safety, victimization at school continues and affects the well-being of a significant number of students. This study uses the California Healthy Kids Survey, a statewide surveillance instrument administered to students in grades 7, 9, and 11 in California (N = 70,600) to address the multiple victimization experiences of students at school. The authors identify subgroups of students based on victimization experience; assess how perceptions of being targeted due to bias relate to cluster membership; and relate victimization to perceptions of school safety, depression, grades, truancy, and internal assets. Victimization rates are given across grade, gender, and ethnicity. Cluster analysis reveals five victimization subgroups--nonvictims, polyvictims, and victims who are predominantly sexually harassed, predominantly physically victimized, and predominantly teased. Compared to nonvictims, students who are victimized report worse outcomes on measures of psychosocial adjustment, with polyvictims faring the worst. Victims are more likely to perceive that they are targeted due to their gender or perceived sexual orientation. Implications for research and practice are provided.

Prior cigarette smoking initiation predicting current alcohol use: evidence for a gateway drug effect among California adolescents from eleven ethnic groups.

Gateway drug theory provides a useful framework for understanding drug use among adolescent populations. Studies have reported a gateway effect of cigarette smoking on alcohol use among adolescents; but there is a lack of knowledge regarding ethnic differences in this effect. Using data from a cross-sectional survey in California, 11,239 subjects (46.3% male) from 31 high schools with at least 25% of total enrollment of Asian and at least 200 students with Asian ancestry entered the analysis. Among them, 6016 were ninth graders (mean age=14.3, S.D.=0.49) and 5223 were twelfth graders (mean age=17.3, S.D.=0.54). After controlling for seven variables, the risk ratio of last 30-day alcohol use among prior smoking initiators vs. noninitiators was 5.82 for non-Hispanic Whites, 4.25 for Blacks, 8.37 for Asian Indians, 3.99 for Chinese, 3.45 for Filipinos, 3.48 for Japanese, 5.41 for Koreans, 7.57 for Vietnamese, 4.02 for Mexicans, 2.64 for South/Central Americans, and 5.95 for adolescents with multiethnic background. Comparison of the 11 ethnic groups indicated that adolescents from different ethnic groups but with similar cultural background had a similar risk level; such pattern existed after controlling for acculturation, parents' monitoring, and school performance. The risk ratio did not differ by gender and grade. There is an association between prior cigarette smoking initiation and current alcohol use among adolescents from different ethnic backgrounds, including those of multiethnicity, which supports the generalizability of gateway drug effect of cigarette smoking on alcohol use. Studies should be conducted to investigate factors attributable to the ethnic variations of this association.