Recent Publications by CFE Educators

PURPOSE OF REVIEW

The Milan criteria have been considered the gold standard for the selection of patients with hepatocellular cancer (HCC) for liver transplantation. However, there is growing evidence that tumor burden is just one of many factors that predict HCC recurrence after liver transplantation.

RECENT FINDINGS

Modest expansion beyond Milan criteria, including the University of California, San Francisco and up-to-7 criteria, appear to yield acceptable posttransplantation outcomes, but their implementation should achieve a minimal survival threshold to not harm non-HCC patients awaiting liver transplantation. Down-staging of HCC patients into Milan criteria appears to produce excellent posttransplant outcomes similar to those always within Milan criteria. Incorporating α-fetoprotein into the selection scheme may further improve posttransplant outcome. Response to local regional therapy (LRT) may help identify candidates who would do well after liver transplantation even if their initial tumor burden exceeds Milan criteria. Conversely, tumor progression despite LRT is a poor prognostic factor for tumors within or beyond Milan criteria. Under the 'ablate and wait' principle, a sufficient length of time to observe tumor behavior is essential to avoid transplanting those with aggressive tumors too quickly, as these patients would likely do poorly after liver transplantation.

SUMMARY

Tumor size and number tell only a partial tale of the characteristics that predict posttransplant outcomes. To this end, successful down-staging appears to carry equivalent posttransplantation outcomes to those always within Milan criteria. Accounting for tumor biology with α-fetoprotein and response to LRT as well as assessing modifiable risk factors such as wait time is crucial to improve selection criteria and improve posttransplantation outcomes.

CONTEXT

Over nearly two decades, a wealth of literature describing the various capabilities, uses and adaptations of virtual microscopy (VM) has been published. Many studies have investigated the effects on and benefits to student learning of VM compared with optical microscopy (OM).

OBJECTIVES

This study statistically aggregated the findings of multiple comparative studies through a meta-analysis in order to summarise and substantiate the pedagogical efficacy of teaching with VM.

METHODS

Using predefined eligibility criteria, teams of paired researchers screened the titles and abstracts of VM studies retrieved from seven different databases. After two rounds of screening, numerical and thematic data were extracted from the eligible studies for analysis. A summary effect size and estimate of heterogeneity were calculated to determine the effects of VM on learner performance and the amount of variance between studies, respectively. Trends in student perceptions were also analysed and reported.

RESULTS

Of the 725 records screened, 72 studies underwent full-text review. In total, 12 studies were viable for meta-analysis and additional studies were reviewed to extract themes relating to learners' perceptions of VM. The meta-analysis detected a small yet significant positive effect on learner performance (standardised mean difference 0.28, 95% confidence interval 0.09-0.47; p = 0.003), indicating that learners experience marked knowledge gains when exposed to VM over OM. Variation among studies was evident as high heterogeneity was reported. An analysis of trends in learner perceptions noted that respondents favoured VM over OM by a large margin.

CONCLUSIONS

Although many individual studies have reported non-significant findings in comparisons of VM and OM, the enhanced power afforded by meta-analysis revealed that the pedagogical approach of VM is modestly superior to that of OM and is preferred by learners.

There is growing concern about lack of scientific rigor and transparent reporting across many preclinical fields of biological research. Poor experimental design and lack of transparent reporting can result in conscious or unconscious experimental bias, producing results that are not replicable. The Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) public-private partnership with the U.S. Food and Drug Administration sponsored a consensus meeting of the Preclinical Pain Research Consortium for Investigating Safety and Efficacy (PPRECISE) Working Group. International participants from universities, funding agencies, government agencies, industry, and a patient advocacy organization attended. Reduction of publication bias, increasing the ability of others to faithfully repeat experimental methods, and increased transparency of data reporting were specifically discussed. Parameters deemed essential to increase confidence in the published literature were clear, specific reporting of an a priori hypothesis and definition of primary outcome measure. Power calculations and whether measurement of minimal meaningful effect size to determine these should be a core component of the preclinical research effort provoked considerable discussion, with many but not all agreeing. Greater transparency of reporting should be driven by scientists, journal editors, reviewers, and grant funders. The conduct of high-quality science that is fully reported should not preclude novelty and innovation in preclinical pain research, and indeed, any efforts that curtail such innovation would be misguided. We believe that to achieve the goal of finding effective new treatments for patients with pain, the pain field needs to deal with these challenging issues.

A growing body of literature supports the use of laparoscopic pyloroplasty as a minimally invasive treatment of refractory gastroparesis that has failed conservative measures and for benign gastric outlet obstruction. Endoscopic pyloric dilation, stent placement, and Botox have been described for similar indications, but often with transient or mixed results. Per-oral pyloromyotomy has recently been proposed as an endoscopic alternative to surgical pyloroplasty or pylormyotomy because it is less invasive by its nature and potentially more durable than current endoscopic treatments.