Younger Patients Do Not Develop More Advanced Polyps on Surveillance Colonoscopy Than Their Index Colonoscopy When Compared With Older Patients.

BACKGROUND AND GOALS: Colonic polyp surveillance guidelines are based on data from patients 50 and above. Given the recent lowering for colorectal cancer (CRC) screening to age 45, the aim of this study was to assess whether existing colonic polyp surveillance guidelines are appropriate to use in younger patients. MATERIALS AND METHODS: We performed a retrospective cohort study of patients who underwent 2 colonoscopies within a 10-year period. Five Risk Stratification Groups (RSG) were developed based on surveillance colonoscopy interval times recommended by the US Multi-Society Task Force (USMSTF) on CRC, and changes in RSG from index to surveillance colonoscopy were compared between 3 age cohorts-those below 45, those 45 to 49, and those 50 and above. Further analysis was performed for patients whose RSG worsened from index to surveillance colonoscopy, as this was defined as an inappropriate surveillance interval. RESULTS: A total of 1895 patients were included in the final analysis. A multivariate regression model showed that a worsened RSG was not significantly associated with age group, both when comparing below 45 to those 50 and above [odds ratio (OR)=0.840, 95% confidence interval (CI): 0.504-1.399, P=0.50] and when comparing those 45 to 49 to those 50 and above (OR=1.416, 95% CI: 0.905-2.216, P=0.13). Only being female was found to be statistically associated with worsened RSG after controlling for other variables (OR=0.652, 95% CI: 0.486-0.875, P<0.01). CONCLUSIONS: Our study found that younger cohorts of patients, both below 45 and those 45 to 49, are not statistically more likely to develop more advanced polyps necessitating a shorter time to surveillance colonoscopy compared with patients 50 years and above. This finding supports using existing colonic polyp surveillance colonoscopy guidelines that were developed for patients 50 years and above in both patients below 45 and those 45 to 49 years old.

Learning the Language of Medical Device Innovation: A Longitudinal Interdisciplinary Elective for Medical Students.

PROBLEM: Physicians are playing a growing role as clinician-innovators. Academic physicians are well positioned to contribute to the medical device innovation process, yet few medical school curricula provide students opportunities to learn the conceptual framework for clinical needs finding, needs screening, concept generation and iterative prototyping, and intellectual property management. This framework supports innovation and encourages the development of valuable interdisciplinary communication skills and collaborative learning strategies. APPROACH: Our university offers a novel 3-year-long medical student Longitudinal Interdisciplinary Elective in Biodesign (MSLIEB) that teaches medical device innovation in 4 stages: (1) seminars and small-group work, (2) shared clinical experiences for needs finding, (3) concept generation and product development by serving as consultants for biomedical engineering capstone projects, and (4) reflection and mentorship. The MSLIEB objectives are to: create a longitudinal interdisciplinary peer mentorship relationship between undergraduate biomedical engineering students and medical students, and encourage codevelopment of professional identities in relation to medical device innovation. OUTCOMES: The MSLIEB enrolled 5 entering cohorts from 2017 to 2021 with a total of 37 medical student participants. The first full entering cohort of 12 medical students produced 8 mentored biomedical engineering capstone projects, 7 of which were based on clinical needs statements derived from earlier in the elective. Medical student participants have coauthored poster and oral presentations; contributed to projects that won WolfieTank, a university-wide competition modeled after the television show Shark Tank; and participated in the filing of provisional patents. Students reflecting on the course reported a change in their attitude towards existing medical problems, felt better-equipped to collaboratively design solutions for clinical needs, and considered a potential career path in device design. NEXT STEPS: The MSLIEB will be scaled up by recruiting additional faculty, broadening clinical opportunities to include the outpatient setting, and increasing medical student access to rapid prototyping equipment.

Cell separation by countercurrent centrifugal elutriation: recent developments.

Countercurrent centrifugal elutriation (CCE) is a cell separation technique that separates particles predominantly according to their size, and to some degree according to their specific density, without a need for antibodies or ligands tagging cell surfaces. The principles of this technique have been known for half a century. Still, numerous recent publications confirmed that CCE is a valuable supplement to current cell separation technology. It is mainly applied when homogeneous populations of cells, which mirror an in vivo situation, are required for answering scientific questions or for clinical transplantation, while antibodies or ligands suitable for cell isolation are not available. Currently, new technical developments are expanding its application toward fractionation of healthy and malignant tissue cells and the preparation of dendritic cells for immunotherapy.