Physicians may soon have a new way to screen patients for Barrett’s esophagus, a precancerous condition usually caused by chronic exposure to stomach acid. Researchers at the Wellman Center for Photomedicine at Massachusetts General Hospital (MGH) have developed an imaging system enclosed in a capsule about the size of a multivitamin pill that creates detailed, microscopic images of the esophageal wall. The system has several advantages over traditional endoscopy.“This system gives us a convenient way to screen for Barrett’s that doesn’t require patient sedation, a specialized setting and equipment, or a physician who has been trained in endoscopy,” says Gary Tearney of the Wellman Center and the Pathology Department at MGH, a Harvard affiliate, a professor of pathology at Harvard Medical School and the corresponding author of the report receiving online publication in Nature Medicine. “By showing the three-dimensional, microscopic structure of the esophageal lining, it reveals much more detail than can be seen with even high-resolution endoscopy.”The system developed by Tearney and his colleagues involves a capsule containing optical frequency domain imaging (OFDI) technology — a rapidly rotating laser tip emitting a beam of near-infrared light and sensors that record light reflected back from the esophageal lining. The capsule is attached to a stringlike tether that connects to the imaging console and allows a physician or other health professional to control the system. After the capsule is swallowed by a patient, it is carried down the esophagus by normal contraction of the surrounding muscles. When the capsule reaches the entrance to the stomach, it can be pulled back up by the tether. OFDI images are taken throughout the capsule’s transit down and up the esophagus.An inch-long endomicroscopy capsule contains a rotating infrared laser and sensors for recording reflected light.The researchers tested the system in 13 unsedated participants, six known to have Barrett’s esophagus and seven healthy volunteers. The physicians operating the system were able to image the entire esophagus in less than a minute and a procedure involving four passes — two down the esophagus and two up — could be completed in around six minutes. A typical endoscopic examination requires that the patient stay in the endoscopy unit for approximately 90 minutes. The detailed microscopic images produced by the OFDI system revealed subsurface structures not easily seen with endoscopy and clearly distinguished the cellular changes that signify Barrett’s esophagus. Study participants who had previously undergone endoscopy indicated they preferred the new procedure.“The images produced have been some of the best we have seen of the esophagus,” says Tearney, an MGH Research Scholar. “We originally were concerned that we might miss a lot of data because of the small size of the capsule; but we were surprised to find that, once the pill has been swallowed, it is firmly ‘grasped’ by the esophagus, allowing complete microscopic imaging of the entire wall. Other methods we have tried can compress the esophageal lining, making it difficult to obtain accurate, three-dimensional pictures. The capsule device provides additional key diagnostic information by making it possible to see the surface structure in greater detail.”Current recommendations for diagnosis of Barrett’s esophagus, which is uncommon in women, call for endoscopic screening of men with chronic, frequent heartburn and other symptoms of gastroesophageal reflux disease. Harvard Associate Professor of Medicine Norman Nishioka of the Wellman Center and MGH Gastroenterology, one of the study co-authors, notes, “An inexpensive, low-risk device could be used to screen larger groups of patients, with the hope that close surveillance of patients found to have Barrett’s could allow us to prevent esophageal cancer or to discover it at an earlier, potentially curable stage. But we need more studies to see if that hope would be fulfilled.”Additional co-authors of the Nature Medicine report are the lead author Michalina Gora, Robert Carruth, Kevin Gallagher, Lauren Kava, Mireille Rosenberg, and Brett Bouma of the Wellman Center; Jenny Sauk, MGH Gastroenterology; and Melissa Suter, MGH Pulmonology. Support for the study included National Institutes of Health grants.
Census Day is here and officials are continuing to work to make sure USC students understand the importance of being counted.Thursday is Census Day — the day the government will use to take a snapshot of the country’s demographics. Residents across the country are asked to fill out the 10-question Census form based on where they are on April 1 and mail it back.The Census Bureau has made an effort to ensure students know how to participate, but many students still say they are unclear about the census process or don’t feel the need to participate.“I don’t really know what it entails — I haven’t really thought about it,” said Alex Beltran, a senior majoring in history.The Constitution requires the national population to be counted every 10 years; the government uses these numbers to distribute federal funds for education, housing and health care programs. The census totals also determine the balance of power in Congress, since each state is allocated a number of seats based on its population.The Census Bureau estimated that undercounting Californians in the 1990 Census cost the state more than $2 billion over the decade. Current trends indicate California might not gain any seats for the first time since it joined the union in 1850, and if the undercount is bad enough this year, it might even lose one.“The census is extremely important for USC, as it helps to decide the allocation of federal financial aid, as well as funding for programs to improve the neighborhood surrounding USC,” said Marilyn Katzman, a junior majoring in international relations and psychology and an intern for the Census Bureau.To enhance its awareness efforts at USC, the Census Bureau recently set up a table in Leavey Library to answer students’ questions.Andrew Wright, a senior majoring in theatre and a Census Bureau employee, said about 20 students visit the table during the course of a day. He said the most common question students have is whether they should be counted at home or at school.“It says so explicitly on the form they should be counted here,” Wright said.This goes for international students as well, though many are unaware they need to participate in the census.“The [international students] don’t count towards the congressional seats, but they do count towards how many people are using facilities,” Wright said.Tony Tambascia, assistant dean for student affairs and executive director of the Office of International Services, said OIS has been working to create awareness about the census among USC’s international community through announcements on its website, Facebook page and weekly e-mail newsletter.Still, some say they are not sure they will participate.“If someone asked me, I’d probably do it, but no one’s asked me to fill out a survey,” said Natalia Dhirani, a senior majoring in fine arts who is originally from India.Dhirani said she hasn’t seen any e-mails or ads and right now does not intend to participate.Other students, however, said they will participate.Mansour Alsaleh, a first-year graduate student from Saudi Arabia studying industrial and systems engineering, said he is used to filling out the census because he has done it in Saudi Arabia.“I received their mail in my inbox,” he said. “I did this in my country. They count the number of people in the country to do a certain level of planning for the future.”