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BACKGROUND AND AIMS: Multitarget stool DNA (MT-sDNA) testing is used in primary care as a screening test for colon cancer. Test effectiveness and patient compliance were examined in clinical practice. METHODS: We assessed outcomes of MT-sDNA testing in a cohort study conducted in a large integrated healthcare system comprising 15 hospitals and 150 outpatient clinics using advanced electronic data capture (Clarity2 [Epic, Verona, Wisc, USA] and REDCap [Encinitas, Calif, USA]) followed by manual chart review to confirm MT-sDNA test results and to monitor the outcomes of subsequent colonoscopy. RESULTS: A total of 6835 MT-sDNA tests were performed over 1 year between 2017 and 2018. Of 1242 patients (18%) who tested positive, 1109 (89%) were referred for colonoscopy, and 905 of them (73%) underwent colonoscopy. Eleven patients (<1%) with a positive test had colorectal cancer, 215 (17%) had advanced adenomas, 110 (9%) had serrated adenomas, and 546 (60%) patients had an adenoma. Of the 6835 patients tested, adenoma or cancer was found in 557 patients (8%). An advanced adenoma or cancer was found in 226 of 1242 patients with a positive test (18%). Nonadherence with colonoscopy after a positive test was high (21%), and the cost to detect 1 advanced adenoma or cancer was $38,849. CONCLUSIONS: The frequency of adenoma detection by an MT-sDNA screening strategy is low, and many positive tests are not associated with significant findings at colonoscopy. Failure to follow a positive test with colonoscopy is a significant problem that needs to be considered when this screening strategy is adopted.

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BACKGROUND: Evaluation of differences in neuropsychological outcomes in patients undergoing surgical clipping (SC) vs endovascular coiling (EC) for unruptured cerebral aneurysms is essential in guiding patients seeking treatment of asymptomatic cerebral aneurysms. OBJECTIVE: To perform a prospective longitudinal analysis of neuropsychological outcomes in patients who underwent microsurgery or coiling for unruptured cerebral aneurysms. METHODS: SC (50 patients), EC (35 patients), and healthy controls (43 individuals) were included. A detailed neuropsychological evaluation was performed at baseline and at 2 wk, 3 mo, 6 mo, and 12 mo. Student's t-test was utilized for comparing neuropsychological outcomes among the 3 groups. A mixed-effects model allowed for evaluation of neuropsychological outcome changes among the groups over time. RESULTS: Both the SC and EC groups had nonsignificant differences in procedure-related complications. SC patients had the greatest initial declines in short-term memory, fine motor control, and executive functioning; however, these patients also recovered to a greater degree in neuropsychological functionality. Over the next year, all groups achieved similar neuropsychological outcomes with no significant differences among groups. CONCLUSION: Whereas the initial decline in neuropsychological functioning was greater for SC patients, 1 yr after treatment there was no significant difference in neuropsychological outcome among the SC, EC, and healthy control groups.

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BACKGROUND: Ewing sarcoma, a rare cause of cord compression, is predominantly of osseous origin but can also originate in soft tissues. Soft-tissue manifestations account for <15% of all Ewing sarcoma tumors, and even fewer cases of Ewing sarcoma originating in the epidural space have been documented. CASE REPORT: A 19-year-old female presented to the emergency department for worsening low-back pain during the previous 6 months and numbness and weakness in her legs during the prior 2 weeks. Magnetic resonance imaging revealed an epidural mass at the L4-L5 level. Intravenous steroids were started for a presumed diagnosis of lymphoma. Orthopedic surgery consultants deferred computed tomography-guided biopsy of the mass out of concern for tumor seeding. Compression symptoms worsened to include foot drop and saddle anesthesia, prompting urgent radiation therapy. After the patient showed poor response to appropriate treatment for lymphoma, other malignant and infectious causes were considered. Biopsy was performed on day 3 of the patient's hospital stay, and by day 7, preliminary cytology results revealed Ewing sarcoma. Subsequent laminectomy and tumor resection produced immediate relief of pain, along with a gradual return of strength and sensation. The mass was found to be of soft-tissue origin and was classified as an extraosseous Ewing sarcoma. The patient was referred to a pediatric oncologist to complete the appropriate chemotherapy after diagnosis. CONCLUSION: This case demonstrates how an uncommon manifestation of a rare disease can mimic a classic presentation of cord compression. Our aim is to bring awareness to this disease and to emphasize the importance of timely biopsy of any mass.

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Primary neuroendocrine tumors of the colon are usually very rare and difficult to spot on a nonfunctional imaging. Metastatic lesions are mostly hypervascular, with only a small percentage appearing as cystic or hypovascular lesions. We present a case of a 34-year-old Hispanic female with a history of dull aching upper abdominal pain lasting for a few months. Initial abdominal ultrasound revealed multiple cystic lesions replacing the hepatic parenchyma concerning for a hydatid disease. Liver biopsy was obtained due to negative serology for hydatid disease, which surprisingly revealed a metastatic neuroendocrine tumor of unknown etiology. The primary disease was depicted within the sigmoid colon on a whole-body Octreotide single-photon emission computed tomography-computed tomography done following the biopsy.

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Although perceived ethnic/racial discrimination is well established as a risk factor for depressive symptoms in ethnic minority youth, few studies have examined their longitudinal relationship over time. This study examined whether a negative attributional style, positive ethnic/racial affect, and emotional reactivity moderated the longitudinal relationship of perceived peer or adult discrimination and depressive symptoms in a sample of African American and Latino high school students (n = 155). African American and Latino youth who experienced increases in perceived peer discrimination also reported greater depressive symptoms over time, but positive ethnic/racial affect buffered the longitudinal association. Emotional reactivity also served as a significant moderator but only of the baseline association between perceived peer discrimination and depressive symptoms. Thus, perceived ethnic/racial discrimination appears to play a significant role in the development of depressive symptoms for ethnic minority youth, especially those who start high school with lower levels of positive ethnic/racial affect.

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OBJECTIVES: Patterns of parent-adolescent conflict differ between immigrant and nonimmigrant families living in the United States (Fuligni, 1998). Despite this, there is limited empirical literature examining the nuanced nature of parent-adolescent conflict in immigrant families. To fill this gap, the current study examined the role of 2 types of conflict (i.e., general and acculturation) in predicting psychosocial outcomes (i.e., depressive symptoms and ethnic identity) among Latino adolescents, and whether these relationships differ within the context of peer discrimination. METHOD: All survey administration was completed in the participating school's cafeteria. The sample consisted of 7th through 10th graders (n = 172) with a mean age of 14.01 years (SD = 1.32.) The sample consisted of 53% females, and was primarily Mexican in origin (78%). RESULTS: As hypothesized, parent-adolescent acculturation conflict uniquely predicted greater depressive symptoms and lower ethnic private regard, even when controlling for parent-adolescent general conflict. However, acculturation conflict predicted lower ethnic private regard only in the presence of greater peer discrimination. More specifically, peer discrimination moderated the relation between acculturation conflict and ethnic private regard such that adolescents who reported the highest levels of acculturation conflict and peer discrimination reported the lowest levels of ethnic private regard. CONCLUSIONS: These results suggest that for Latino youth and their families, acculturation conflict may be particularly problematic, as compared with general conflict. In addition, youth who face ethnicity-based stressors in both familial and school contexts are especially at risk in their ethnic identity development. (PsycINFO Database Record

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Depressive symptoms in Latino youth have been related to both culturally-universal and culturally-based stressors. However, few studies have examined the unique contributions of culturally-based stressors above and beyond other types of stressors. Moreover, no past studies with Latinos have examined the role of culturally-based stressors within a hopelessness model of depressive symptoms, a cognitive model with the strongest empirical support in adolescence. The current study examined these issues in a sample of 171 Latino adolescents (7th-10th grades; mean age = 14; 46 % male). The Latino adolescents were primarily Mexican-American (78 %) and born in the United States (60 %). Students completed measures during a school period on their experiences of parent-child conflict, economic stress, discrimination from peers, and acculturative stress as well as depressive symptoms and attributional style. The results indicated that culturally-based stressors (e.g., acculturative stress and discrimination) predicted greater depressive symptoms even when controlling for culturally-universal stressors (e.g., parent-child conflict, economic stress). Moreover, a negative attributional style moderated the relationship between culturally-universal stressors and depressive symptoms, but this was not the case for culturally-based stressors. Culturally-based stressors play an important role in depressive symptoms among Latino youth. These stressors predicted greater symptomatology even when controlling for other types of stressors and a negative attributional style. These findings suggest that there may be other cognitive risk factors associated with culturally-based stressors.

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