Variation in use of surveillance colonoscopy among colorectal cancer survivors in the United States

<p>Abstract</p> <p>Background</p> <p>Clinical practice guidelines recommend colonoscopies at regular intervals for colorectal cancer (CRC) survivors. Using data from a large, multi-regional, population-based cohort, we describe the rate of surveillance colonoscopy and its association with geographic, sociodemographic, clinical, and health services characteristics.</p> <p>Methods</p> <p>We studied CRC survivors enrolled in the Cancer Care Outcomes Research and Surveillance (CanCORS) study. Eligible survivors were diagnosed between 2003 and 2005, had curative surgery for CRC, and were alive without recurrences 14 months after surgery with curative intent. Data came from patient interviews and medical record abstraction. We used a multivariate logit model to identify predictors of colonoscopy use.</p> <p>Results</p> <p>Despite guidelines recommending surveillance, only 49% of the 1423 eligible survivors received a colonoscopy within 14 months after surgery. We observed large regional differences (38% to 57%) across regions. Survivors who received screening colonoscopy were more likely to: have colon cancer than rectal cancer (OR = 1.41, 95% CI: 1.05-1.90); have visited a primary care physician (OR = 1.44, 95% CI: 1.14-1.82); and received adjuvant chemotherapy (OR = 1.75, 95% CI: 1.27-2.41). Compared to survivors with no comorbidities, survivors with moderate or severe comorbidities were less likely to receive surveillance colonoscopy (OR = 0.69, 95% CI: 0.49-0.98 and OR = 0.44, 95% CI: 0.29-0.66, respectively).</p> <p>Conclusions</p> <p>Despite guidelines, more than half of CRC survivors did not receive surveillance colonoscopy within 14 months of surgery, with substantial variation by site of care. The association of primary care visits and adjuvant chemotherapy use suggests that access to care following surgery affects cancer surveillance.</p

Decreased Reward Sensitivity in Rats from the Fischer344 Strain Compared to Wistar Rats Is Paralleled by Differences in Endocannabinoid Signaling

BACKGROUND: The aim of the present study was to examine if differences in the endocannabinoid (ECB) system might be linked to strain specific variations in reward-related behavior in Fischer344 (Fischer) and Wistar rats. METHODOLOGY/PRINCIPAL FINDINGS: Two rat strains, the Fischer and the Wistar strain, were tested for different aspects of reward sensitivity for a palatable food reward (sweetened condensed milk, SCM) in a limited-access intake test, a progressive ratio (PR) schedule and the pleasure-attenuated startle (PAS) paradigm. Additionally, basic differences in the ECB system and cannabinoid pharmacology were examined in both rat strains. Fischer rats were found to express lower reward sensitivity towards SCM compared to Wistar rats. These differences were observed for consummatory, motivational and hedonic aspects of the palatable food reward. Western blot analysis for the CB1 receptor and the ECB degrading enzyme fatty acid amide hydrolase (FAAH) revealed a lower expression of both proteins in the hippocampus (HPC) of Fischer rats compared to the Wistar strain. Furthermore, increased cannabinoid-stimulated extracellular-regulated kinase (ERK) phosphorylation was detected in Wistar rats compared to the Fischer strain, indicating alterations in ECB signaling. These findings were further supported by the pharmacological results, where Fischer rats were found to be less sensitive towards the effects of the CB1 receptor antagonist/inverse agonist SR141716 and the cannabinoid agonist WIN 55,212-2. CONCLUSIONS/SIGNIFICANCE: Our present findings indicate differences in the expression of the CB1 receptor and FAAH, as well as the activation of ECB signaling pathways between Fischer and Wistar rats. These basic differences in the ECB system might contribute to the pronounced differences observed in reward sensitivity between both rat strains

Effects of sowing date on severity of blight caused by Ascochyta rabiei and yield components of five chickpea cultivars grown under two climatic conditions in Tunisia

Five chickpea cultivars, Chitoui, Neyer, Kasseb, Beja 1 and Bouchra, were planted on three sowing dates at two Experimental Stations in Tunisia: Bou Salem in the north and the more southerly Mornag, where the climate is drier. Severity of blight, caused by Ascochyta rabiei, was measured on a 1–9 scale (defined) on vegetative parts and on pods as percent infected and percent infected that were empty. At both locations, disease was essentially absent on plants sown on the third dates but present on plants sown on the two earlier dates. At Bou Salem, disease severity was highest for the second sowing date whereas at Mornag it was highest for the first sowing date; but for each sowing date, disease severity was lower at Mornag than at Bou Salem. Yield components were measured as number of pods per plant, number of seeds per plant, number of seeds per 100 pods, 100 seed weight and weight of seeds per plant. Both disease severity and yield differed significantly among sowing dates (differently at each location) and also among cultivars for each sowing date, these differences depending both on sowing date and location. A lower yield was always associated with a higher disease severity, although the quantitative relationship differed between cultivars and locations. Cultivar Beja 1 had the lowest vegetative disease scores at both locations and both sowing dates 1 and 2. Beja 1 also scored well for all yield components. Plants sown on the third (latest) date gave the highest yields for all cultivars at both locations (except for an unusually high yield of Neyer at Mornag on sowing date 2), in some instances being more than double those from the earlier sowing dates. Thus, in contrast to other studies, late sowing did not result in yield loss

Estrogen’s Effects on Excitatory Synaptic Transmission Entail Integrin and TrkB Transactivation and Depend Upon β1-integrin function

Estradiol (E2) perfusion rapidly increases the strength of fast excitatory transmission and facilitates long-term potentiation in the hippocampus, two effects likely related to its memory-enhancing properties. Past studies showed that E2's facilitation of transmission involves activation of RhoA signaling leading to actin polymerization in dendritic spines. Here we report that brief exposure of adult male hippocampal slices to 1 nM E2 increases the percentage of postsynaptic densities associated with high levels of immunoreactivity for activated forms of the BDNF receptor TrkB and β1-integrins, two synaptic receptors that engage actin regulatory RhoA signaling. The effects of E2 on baseline synaptic responses were unaffected by pretreatment with the TrkB-Fc scavenger for extracellular BDNF or TrkB antagonism, but were eliminated by neutralizing antisera for β1-integrins. E2 effects on synaptic responses were also absent in conditional β1-integrin knockouts, and with inhibition of matrix metalloproteinases, extracellular enzymes that generate integrin ligands. We propose that E2, acting through estrogen receptor-β, transactivates synaptic TrkB and β1-integrin, and via mechanisms dependent on integrin activation and signaling, reversibly reorganizes the spine cytoskeleton and thereby enhances synaptic responses in adult hippocampus

Internationalisation and Consolidation of the Container Port Industry: Assessment of Channel Structure and Relationships

The international consolidation of the container port industry is a relatively recent, yet radical trend in international shipping and logistics. Global strategies of vertical and horizontal integration evolving around port ownership and operations are undertaken by a variety of market players, both within and outside the international shipping and logistics markets. However, while much of the available literature on the subject has focused on the bases and various motives behind the change, little work has addressed the impacts on channel structure and relationships, including such aspects as control, power and conflict. By channel, we refer to an organised network of institutions that form the combined physical and non-physical path taken by goods and services as they move from original supplier to final consumer. However, in the context of this paper, the scope of the distribution channel is reduced to active members of the international shipping and logistics industry, that is, shippers, ocean carriers, ports, agents and intermediaries. This paper investigates the extent of channel power, conflict, role, performance and strategic concentration of shipping lines as international container terminal operators. A structural equations model is used to assess the impacts of global factors and consolidation on the container port industry, and test whether the direction of change would result in an increasing or decreasing risk of commoditisation and footloose mobility. Maritime Economics & Logistics (2007) 9, 35–51. doi:10.1057/palgrave.mel.9100170

Innovations of wireless capsule robots in gastrointestinal endoscopy: a review

Gastrointestinal endoscopy as crucial observation procedure for detecting numerous critical disorders has many limitations with current tethered devices. Specialists recommended further investigation by Wireless Capsule Endoscopy (WCE) in which they investigate gastrointestinal tract by a capsule-sized robot equipped with out-body image transmitter. WCE is utilized in further observation of the small bowel for different disorders such as tumors, polyps, bleeding, and Crohn’s disease. Although numerous advances have been done in the last decade and the technology progress is so fast, some restrictions still remained in terms of visioning issues, orientation, drug delivery, biopsy, and others. Using passive motion, very time-consuming process, localization, and lack of movement control are the main challenges of researchers in this criteria. In this article, recent technological advancements in the area of WCE inspection are highlighted. As WCE inspection generally become the top priority for finding of gastrointestinal tract disorders, a comprehensive review has been considered to evaluate technologies and limitations in terms of technical specifications