Endoscopic Localization of Colon Cancer Is Frequently Inaccurate.

BACKGROUND: Colonoscopic location of a tumor can influence both the surgical procedure choice and overall treatment strategy. AIMS: To determine the accuracy of colonoscopy in determining the location of colon cancer compared to surgical localization and to elucidate factors that predict discordant colon cancer localization. METHODS: We conducted a retrospective cross-sectional study of colon cancers diagnosed on colonoscopy at two academic tertiary-care hospitals and two affiliated community hospitals from 2012 to 2014. Colon cancer location was obtained from the endoscopic and surgical pathology reports and characterized by colon segment. We collected data on patient demographics, tumor characteristics, endoscopic procedure characteristics, surgery planned, and surgery performed. Univariate analyses using Chi-squared test and multivariate analysis using forward stepwise logistic regression were performed to determine factors that predict discordant colon cancer localization. RESULTS: There were 110 colon cancer cases identified during the study period. Inaccurate endoscopic colon cancer localization was found in 29% (32/110) of cases. These included 14 cases (12.7%) that were discordant by more than one colonic segment and three cases where the presurgical planned procedure was significantly changed at the time of surgery. On univariate analyses, right-sided colon lesions were associated with increased inaccuracy (43.8 vs 24.4%, p = 0.04). On multivariate analysis, right-sided colon lesions remained independently associated with inaccuracy (OR 1.74, 95% CI 1.03-2.93, p = 0.04). CONCLUSIONS: Colon cancer location as determined by colonoscopy is often inaccurate, which can result in intraoperative changes to surgical management, particularly in the right colon.

The effect of charge display on cost of care and physician practice behaviors: a systematic review.

BACKGROUND: While studies have been published in the last 30 years that examine the effect of charge display during physician decision-making, no analysis or synthesis of these studies has been conducted. OBJECTIVE: We aimed to determine the type and quality of charge display studies that have been published; to synthesize this information in the form of a literature review. METHODS: English-language articles published between 1982 and 2013 were identified using MEDLINE, Web of Knowledge, ABI-Inform, and Academic Search Premier. Article titles, abstracts, and text were reviewed for relevancy by two authors. Data were then extracted and subsequently synthesized and analyzed. RESULTS: Seventeen articles were identified that fell into two topic categories: the effect of charge display on radiology and laboratory test ordering versus on medication choice. Seven articles were randomized controlled trials, eight were pre-intervention vs. post-intervention studies, and two interventions had a concurrent control and intervention groups, but were not randomized. Twelve studies were conducted in a clinical environment, whereas five were survey studies. Of the nine clinically based interventions that examined test ordering, seven had statistically significant reductions in cost and/or the number of tests ordered. Two of the three clinical studies looking at medication expenditures found significant reductions in cost. In the survey studies, physicians consistently chose fewer tests or lower cost options in the theoretical scenarios presented. CONCLUSIONS: In the majority of studies, charge information changed ordering and prescribing behavior.

Impact of brain tissue filtering on neurostimulation fields: a modeling study.

Electrical neurostimulation techniques, such as deep brain stimulation (DBS) and transcranial magnetic stimulation (TMS), are increasingly used in the neurosciences, e.g., for studying brain function, and for neurotherapeutics, e.g., for treating depression, epilepsy, and Parkinson's disease. The characterization of electrical properties of brain tissue has guided our fundamental understanding and application of these methods, from electrophysiologic theory to clinical dosing-metrics. Nonetheless, prior computational models have primarily relied on ex-vivo impedance measurements. We recorded the in-vivo impedances of brain tissues during neurosurgical procedures and used these results to construct MRI guided computational models of TMS and DBS neurostimulatory fields and conductance-based models of neurons exposed to stimulation. We demonstrated that tissues carry neurostimulation currents through frequency dependent resistive and capacitive properties not typically accounted for by past neurostimulation modeling work. We show that these fundamental brain tissue properties can have significant effects on the neurostimulatory-fields (capacitive and resistive current composition and spatial/temporal dynamics) and neural responses (stimulation threshold, ionic currents, and membrane dynamics). These findings highlight the importance of tissue impedance properties on neurostimulation and impact our understanding of the biological mechanisms and technological potential of neurostimulatory methods.

Pancreatic fluid collection drainage by endoscopic ultrasound: an update.

Endoscopic management of symptomatic pancreatic fluid collections (PFCs) is now considered to be first line therapy. Expanded use of endoscopic ultrasound (EUS) techniques has resulted in increased applicability, safety, and efficacy of endoscopic transluminal PFC drainage. Steps include EUS-guided trangastric or transduodenal fistula creation into the PFC followed by stent placement or nasocystic drain deployment in order to decompress the collection. With the remarkable improvement in the available accessories and stents and development of exchange free access device; EUS drainage techniques have become simpler and less time consuming. The use of self-expandable metal stents with modifications to drain PFC has helped in overcoming some previously encountered challenges. PFCs considered suitable for endoscopic drainage include collection present for greater than 4 weeks, possessing a well-formed wall, position accessible endoscopically and located within 1 cm of the duodenal or gastric walls. Indications for EUS-guided drainage have been increasing which include unusual location of the collection, small window of entry, nonbulging collections, coagulopathy, intervening varices, failed conventional transmural drainage, indeterminate adherence of PFC to the luminal wall or suspicion of malignancy. In this article, we present a review of literature to date and discuss the recent developments in EUS-guided PFC drainage.

Proton pump inhibitor use in the U.S. ambulatory setting, 2002-2009.

BACKGROUND AND AIMS: Anecdotal reports and studies of select populations suggest that the use of proton pump inhibitors (PPIs) has increased since their introduction. We sought to determine recent trends in PPI use in the U.S. outpatient setting and characteristics of patients and physicians that may predict their use. METHODS: We used data from the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) to estimate the prevalence of visits in which patients used PPIs from 2002 to 2009. We tested for associations between PPI use and patient, physician, and practice characteristics using data from 2009. We also estimated the prevalence of visits in which PPIs were used by patients without gastrointestinal complaints, diagnoses, or other indications for their use and tested for associations between patient and physician characteristics and PPI use in patients with no documented indication. RESULTS: PPIs were used in 4.0% of visits in 2002 and 9.2% in 2009 (p<0.001 for trend across years). The use of omeprazole (0.9% in 2002 to 3.9% in 2009, p<0.001), esomeprazole (0.9% in 2002 to 2.3% in 2009, p<0.001), and pantoprazole (0.6% in 2002 to 1.6% in 2009, p<0.001) increased significantly over the study period. Among visits by patients using PPIs, 62.9% documented no gastrointestinal complaints, gastrointestinal diagnoses, or other indicated reason for their use. CONCLUSIONS: We found that PPI use increased significantly from 2002 to 2009 as did documented indications for their use. Newly-prescribed PPI use did not change from 2006 to 2009. More research is needed to determine whether PPIs are overused in the U.S. outpatient setting.

Pancreatic fluid collection drainage by endoscopic ultrasound: new perspectives.

Since the introduction of endoscopic ultrasonography (EUS), many centers have utilized this imaging modality for transmural pancreatic fluid collection (PFC) drainage. The expanded use of EUS has resulted in increased safety and efficacy of endoscopic PFC drainage. The major procedural steps include EUS-guided transgastric or transduodenal fistula creation into the PFC, and stent placement or nasocystic drain deployment to decompress the collection. In this and other applications, EUS has become a major therapeutic advancement in the field of endoscopy and has figured in myriad diagnostic applications. Recent research indicates a number of situations in which EUS-guided PFC drainage is appropriate. These include unusual location of the collection, small window of entry, non-bulging collections, coagulopathy, intervening varices, or failed conventional transmural drainage. In this study, we discuss the EUS-guided technique and review current literatures.

Shape conveyed by visual-to-auditory sensory substitution activates the lateral occipital complex.

The lateral-occipital tactile-visual area (LOtv) is activated when objects are recognized by vision or touch. We report here that the LOtv is also activated in sighted and blind humans who recognize objects by extracting shape information from visual-to-auditory sensory substitution soundscapes. Recognizing objects by their typical sounds or learning to associate specific soundscapes with specific objects do not activate this region. This suggests that LOtv is driven by the presence of shape information.

Lateral hypothalamic acetylcholinesterase-immunoreactive neurons co-express either orexin or melanin concentrating hormone.

The lateral hypothalamic area (LHA) contains a large population of neurons that express the enzyme acetylcholinesterase (AChE), but are not themselves cholinergic. Some of these neurons have been shown to contain melanin-concentrating hormone (MCH), a neuropeptide implicated in regulating feeding, but the identities of the remaining neurons are unknown. We now report that nearly all AChE-immunoreactive neurons in the LHA express immunoreactivity for either MCH or for orexin, a peptide implicated in regulating wakefulness. Furthermore, most orexin neurons and MCH neurons appear to contain AChE. AChE immunoreactivity appears to be a key feature of nearly all of the diffusely-projecting cortical systems.