Gender authorship in major American and European gastroenterology journals: the gap is still unfilled.

BACKGROUND: The gender gap in the authorship of scientific research may affect career advancement. Our aim was to assess the potential gender gap in gastrointestinal (GI) journals. METHODS: A systematic review was performed of the GI literature and ongoing research in the period 2020-2022. A total 10 GI journals and ongoing research on clinicaltrials.gov were selected for review. The gender gap in first and senior authorship was evaluated for each article and ongoing research project. Associations between the gender gap and possible predictors were measured and results are presented as odds ratios (ORs) with 95%CI. RESULTS: The number of first female authors (FFAs) and senior female authors (SFAs) in published articles were 1408/4207 (33.5%) and 911/4207 (21.7%), respectively. There were 781/2654 (29.4%) female principal investigators (PI)s for the ongoing research. On comparison of non-endoscopic vs. endoscopic topics, the latter were associated with the gender gap (hepatology, OR 2.15 [95%CI 1.83-2.55]; inflammatory bowel disease, OR 2.12 [95%CI 1.60-2.45]; upper and lower GI, OR 1.31 [95%CI 1.18-1.73]); as well as the type of article (original article vs. editorial, OR 1.92 [95%CI 1.58-2.33]). The type of research was also associated with the gender gap (clinical vs. preclinical studies, OR 0.88 [95%CI 0.66-0.91]). CONCLUSION: Our results demonstrated a correlation between the gender gap and the design and topic of the research. Future strategies for improving equity in career development in GI endoscopy should focus on closing the gender gap in equity of authorship.

Diagnostic Yield of Small Bowel Videocapsule Endoscopy in Patients with Iron Deficiency Anemia. A Systematic Review and meta-analysis.

BACKGROUND AND AIM: Gastrointestinal (GI) bleeding or malabsorption represents the most frequent aetiologies of iron deficiency anemia (IDA). The cause of IDA remains undetermined in ~10% to 20% of patients undergoing upper and lower GI endoscopies. In this scenario, a small bowel examination with videocapsule endoscopy (VCE) is recommended. We performed a systematic review with meta-analysis to evaluate the diagnostic yield of VCE in patients with IDA without overt bleeding, assessing the prevalence of either any lesion or lesions at high potential of bleeding. MATERIALS AND METHODS: A computerized literature search was performed using relevant keywords to identify all the pertinent articles published until March 2023. RESULTS: Twelve studies with a total of 1703 IDA patients (Males: 47%; age range: 19-92 y) were included in this systematic review. The diagnostic yield of VCE for overall lesions in the small bowel was 61% (95% CI=44-77; 95 CI=97.2-98.1; I2=97.7%). When analyzing only small bowel lesions likely responsible of IDA, the diagnostic yield was 40% (95% CI=27-53; 95% CI=95.3-97; I2=96.3%). CONCLUSION: VCE plays a relevant role in the diagnostic work-up of patients with IDA without overt bleeding with a satisfactory diagnostic yield.

Circulating plasma cells in newly diagnosed symptomatic multiple myeloma as a possible prognostic marker for patients with standard-risk cytogenetics.

Detection of circulating plasma cells (PCs) in multiple myeloma (MM) patients is a well-known prognostic factor. We evaluated circulating PCs by flow cytometry (FC) in 104 patients with active MM at diagnosis by gating on CD38(+)  CD45(-) cells and examined their relationship with cytogenetic risk. Patients had an average follow-up of 36 months. By using a receiver operating characteristics analysis, we estimated the optimal cut-off of circulating PCs for defining poor prognosis to be 41. Patients with high-risk cytogenetics (n = 24) had poor prognosis, independently of circulating PC levels [PC < 41 vs. PC ≥ 41: overall survival (OS) = 0% vs. OS = 17%, P = not significant (n.s.); progression-free survival (PFS) = 0% vs. 17%, P = n.s.]. Patients with standard-risk cytogenetics (n = 65) showed a better prognosis when associated with a lower number of circulating PCs (PC < 41 vs. PC ≥ 41: OS = 62% vs. 24%, P = 0·008; PFS = 48% vs. 21%, P = 0·001). Multivariate analysis on the subgroup with standard-risk cytogenetics confirmed that the co-presence of circulating PCs ≥ 41, older age, Durie-Salmon stage >I and lack of maintenance adversely affected PFS, while OS was adversely affected only by lactate dehydrogenase, older age and lack of maintenance. Our results indicate that the quantification of circulating PCs by a simple two-colour FC analysis can provide useful prognostic information in newly diagnosed MM patients with standard-risk cytogenetics.

Management of proctitis in ulcerative colitis and the place of biological therapies.

INTRODUCTION: Approximately 20-30% of the patients with ulcerative colitis (UC) may present with isolated proctitis. Ulcerative proctitis (UP) is a challenging condition to manage due to its significant burden in terms of disabling symptoms. AREAS COVERED: PubMed was searched up to March 2024 to identify relevant studies on UP. A comprehensive summary and critical appraisal of the available data on UP are provided, highlighting emerging treatments and areas for future research. EXPERT OPINION: Patients with UP are often undertreated, and the disease burden is often underestimated in clinical practice. Treat-to-target management algorithms can be applied to UP, aiming for clinical remission in the short term, and endoscopic remission and maintenance of remission in the long term. During their disease, approximately one-third of UP patients require advanced therapies. Escalation to biologic therapy is required for refractory or steroid dependent UP. For optimal patient care and management of UP, it is necessary to include these patients in future randomized clinical trials.

Endoscopic Resection for Duodenal Neuroendocrine Neoplasms between 10 and 20 mm-A Systematic Review and Meta-Analysis.

Background. The optimal management of duodenal neuroendocrine neoplasms (dNENs) sized 10-20 mm remains controversial and although endoscopic resection is increasingly performed instead of surgery, the therapeutic approach in this setting is not fully standardized. We performed a systematic review of the literature and a meta-analysis to clarify the outcomes of endoscopic resection for 10-20 mm dNENs in terms of efficacy (i.e., recurrence rate) and safety. Methods. A computerized literature search was performed using relevant keywords to identify pertinent articles published until January 2023. Results. Seven retrospective studies were included in this systematic review. The overall recurrence rate was 14.6% (95%CI 5.4-27.4) in 65 patients analyzed, without significant heterogeneity. When considering studies specifically focused on endoscopic mucosal resection, the recurrence rate was 20.5% (95%CI 10.7-32.4), without significant heterogeneity. The ability to obtain the free margin after endoscopic resection ranged between 36% and 100%. No complications were observed in the four studies reporting this information. Conclusions. Endoscopic resection could be the first treatment option in patients with dNENs sized 10-20 mm and without evidence of metastatic disease. Further studies are needed to draw more solid conclusions, particularly in terms of superiority among the available endoscopic techniques.

Endoscopic resection of non-ampullary duodenal adenomas: Is cold snaring the promised land?

Due to the high risk of morbidity and mortality associated with surgical resection in this tract, endoscopic resection (ER) has taken the place of surgical resection as the first line treatment for non-ampullary duodenal adenomas. However, due to the anatomical characteristics of this area, which enhance the risk of post-ER problems, ER in the duodenum is particularly difficult. Due to a lack of data, no ER technique for superficial non-ampullary duodenal epithelial tumours (SNADETs) has yet been backed by strong, high-quality evidence; yet, traditional hot snare-based techniques are still regarded as the standard treatment. Despite having a favourable efficiency profile, adverse events during duodenal hot snare polypectomy (HSP) and hot endoscopic mucosal resection, such as delayed bleeding and perforation, have been reported to be frequent. These events are primarily caused by electrocautery-induced damage. Thus, ER techniques with a better safety profile are needed to overcome these shortcomings. Cold snare polypectomy, which has already been shown as a safer, equally effective procedure compared to HSP for treatment of small colorectal polyps, is being increasingly evaluated as a potential therapeutic option for non-ampullary duodenal adenomas. The aim of this review is to report and discuss the early outcomes of the first experiences with cold snaring for SNADETs.

Effect of SARS CoV2-Neutralizing Monoclonal Antibody on Hospitalization and Mortality in Long-Term Care Facility Residents.

To measure the association between intravenous administration of monoclonal antibody bamlanivimab (LY-CoV555) to long-term care facility (LTCF) residents recently diagnosed with pre-symptomatic, mild-to-moderate COVID-19 and are considered high risk for disease progression with mortality, hospitalization, and adverse effects. A retrospective analysis of LTCF residents with confirmed COVID-19, pre-symptomatic, mild to moderate disease, who were treated with bamlanivimab (LY-CoV555) were compared to similar LTCF residents who did not receive monoclonal antibody treatment. Dependent variables investigated included mortality and hospitalization as primary outcomes with adverse effects as the secondary outcome. A total of 107 residents from three LTCFs were diagnosed with pre-symptomatic, mild-to-moderate COVID-19 between November 1, 2020, and December 31, 2020. Of the 107 study participants, 44 residents provided consent to treatment, of which 39 received a single intravenous infusion of neutralizing monoclonal antibody, bamlanivimab 700mg, early in the disease, and 5 received an incomplete dose. Of the 39 residents who received the full dose of bamlanivimab, 5 (12.8%) were admitted to the hospital and 4 (10.3%) died. Conversely, of the 63 residents who did not receive the monoclonal antibody, 26 (41.3 %) were admitted to the hospital and 18 (28.6%) died. Relative risk for hospitalization and death were statistically significantly lower for those residents who received the full bamlanivimab treatment. No serious adverse effects were documented on any patient. Intravenous administration of monoclonal antibody bamlanivimab (LY-CoV555) to LTCF residents recently diagnosed with pre-symptomatic, mild to moderate COVID-19 was significantly associated with reduced mortality and hospitalization. The monoclonal antibody was well-tolerated.

A three-year accelerated medical school curriculum designed to encourage and facilitate primary care careers.

For the past decade there has been declining medical student interest in primary care. The cause of this trend is multifactorial and includes issues of salary and indebtedness. Educational leaders have called for careful selection of medical students and the creation of three-year medical school curricula to counter these factors. On April 30, 2006, the American Osteopathic Association Commission on College Accreditation voted to approve a new accelerated curriculum at the Lake Erie College of Osteopathic Medicine (LECOM) in Erie, Pennsylvania. This pathway accelerates the traditional four-year medical school curriculum into three calendar years. In addition to reducing the time necessary to complete medical training as a primary care physician, this pathway reduces the expense involved in obtaining a medical education. This paper describes how LECOM positioned itself to address key strategies believed to be at the heart of rekindling student interest in primary care. In the accelerated curriculum, summer vacation between the first and second medical school year is eliminated. Clinical education is streamlined by focusing on 16 rotations relevant to primary care and eliminating elective experiences. Primary care mentors are assigned at the start of medical school. Case-based capstone sessions are added throughout the clinical years to reinforce primary care concepts. Students in this curriculum are designated "primary care scholars" to recognize the fact that they are engaged in a rigorous, goal-directed curriculum. Consistent with published recommendations for increasing medical students' choice of generalist careers, a detailed description of the LECOM accelerated curriculum effort is provided.

The accelerated physician assistant pathway: a three-year medical school curriculum for physician assistants to obtain DO degrees.

PROBLEM: To address physician shortages, many have called for medical schools to increase their applicant pool size by broadening their selection criteria. Physician assistants (PAs) are one group that has demonstrated competency and medical knowledge. However, financial and time barriers exist to their applying to traditional four-year programs. APPROACH: The authors designed a three-year accelerated curriculum for PAs to obtain DO degrees. Over the summer, after their first year of didactic instruction, students complete two 4-week primary care clinical clerkships. The second year of didactic study is followed by additional clinical clerkships, for a total of 138 weeks of instruction-82 weeks of didactic instruction, which is identical to that of the traditional curriculum, and 56 weeks of clinical clerkships. OUTCOMES: The inaugural class of 7 students matriculated in July 2011. In the first three years, 25 students joined the program. Mean age at matriculation is 31.8 years compared with the national mean of 25 years. Mean length of clinical practice before matriculation is 5.4 years. The inaugural class completed the COMLEX-USA Level 1 exam, achieving a 100% pass rate with a mean score 96 points above the national mean. NEXT STEPS: The authors will assess students' residency placements to gauge the medical community's reaction to the accelerated curriculum. They also recommend that alternatives to the existing admission requirements be considered. This program removes many barriers to PAs returning to medical school and expands the applicant pool by adding candidates with clinical experience, helping to address primary care physician shortages.

Preliminary outcomes of the Lake Erie College of Osteopathic Medicine's 3-year Primary Care Scholar Pathway in osteopathic predoctoral education.

CONTEXT: In 2007, the Lake Erie College of Osteopathic Medicine initiated its Primary Care Scholar Pathway (PCSP), a 3-year osteopathic predoctoral education curriculum. OBJECTIVE: To assess preliminary outcomes of the PCSP curriculum. METHODS: Scores for the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) Levels 1 and 2-Cognitive Evaluation (CE) and pass rates for Level 2-Performance Evaluation (PE) were obtained for individuals who graduated from the PCSP program in 2010, 2011, and 2012. Scores for Levels 1 and 2-CE were compared with national mean scores. Acceptance rates for residency programs were also recorded. RESULTS: Nineteen PCSP graduates were included in the study: 3 graduated in 2010, 6 graduated in 2011, and 10 graduated in 2012. Scores for PCSP students were not significantly different than national average scores for COMLEX-USA Levels 1 and 2-CE (P>.05). All 19 PCSP graduates passed the COMLEX-USA Level 2-PE on the first attempt, and all graduates were accepted into primary care residency programs. CONCLUSION: The COMLEX-USA scores of PCSP graduates were similar to national mean scores, suggesting that it is possible for osteopathic medical students to attain the same level of education as students of 4-year programs in less time. A 3-year osteopathic predoctoral education curriculum would allow students to complete their education at a reduced cost. This potential reduction in debt burden could encourage more students to pursue a primary care career and thus could help address the shortage of primary care physicians in the United States.

Developmental overfeeding alters hypothalamic neuropeptide mRNA levels and response to a high-fat diet in adult mice.

It has been suggested that nutritional manipulations during the first weeks of life can alter the development of the hypothalamic circuits involved in energy homeostasis. We studied the expression of a large number of the hypothalamic neuropeptide mRNAs that control body weight in mice that were overfed during breastfeeding (mice grown in a small litter, SL) and/or during adolescence (adolescent mice fed a high-fat diet, AHF). We also investigated possible alterations in mRNA levels after 50 days of a high-fat diet (high-fat challenge, CHF) at 19 weeks of age. Both SL and AHF conditions caused overweight during the period of developmental overfeeding. During adulthood, all of the mouse groups fed a CHF significantly gained weight in comparison with mice fed a low-fat diet, but the mice that had undergone both breast and adolescent overfeeding (SL-AHF-CHF mice) gained significantly more weight than the control CHF mice. Of the ten neuropeptide mRNAs studied, only neuropeptide Y (NPY) expression was decreased in all of the groups of developmentally overfed adult mice, but CHF during adulthood by itself induced a decrease in NPY, agouti-related protein (AgRP) and orexin (Orx) mRNA levels. Moreover, in the developmentally overfed CHF mice NPY, AgRP, galanin (GAL) and galanin-like peptide (GalP) mRNA levels significantly decreased in comparison with the control CHF mice. These results show that, during adulthood, hypothalamic neuropeptide systems are altered (NPY) and/or abnormally respond to a high-fat diet (NPY, AgRP, GAL and GalP) in mice overfed during critical developmental periods.

The challenges of primary care and innovative responses in osteopathic education.

Numerous reports predict U.S. primary care physician shortages, with deficits of 20,000-46,000 doctors projected by 2020-25. Doctors of osteopathic medicine (DOs) could help fill some of the gap alongside their medical doctor (MD) colleagues. Many osteopathic schools have undertaken initiatives to reinvigorate primary care career choices among students. This paper describes these developments, and it highlights as examples early-stage innovations at Lake Erie College of Osteopathic Medicine and A.T. Still University School of Osteopathic Medicine in Arizona. It will be several years before the changes can be assessed. The final outcome awaits coordinated national design changes in primary care support and training and in health care coverage.

Lake Erie College of Osteopathic Medicine's preclinical problem-based learning pathway program: an alternative medical school curriculum design.

In 1999, the American Osteopathic Association approved plans for "substantive change" to the medical curriculum at Lake Erie College of Osteopathic Medicine (LECOM) in Erie, Pa. In addition to the school's traditional, lecture-based curriculum, LECOM sought to create alternative--but distinct--learning pathways: independent study (described elsewhere) and problem-based learning (PBL). After selecting a long-standing, successful PBL program to guide our efforts and after a 1-year period of planning, developing, piloting, and refining the program, we introduced PBL in the 2000-2001 academic year. This learning pathway consists of carefully constructed cases that allow for progressive disclosure across group-tutorial sessions, from patient presentation to diagnosis and management. With more than 5 years of data on student performance and evaluations, LECOM can investigate the merits of its three basic science learning pathways. The description of LECOM's longitudinal database will allow program evaluators to assess and compare each of the three basic science learning pathways.