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The genetic risk for prostate cancer has been governed by a few rare variants with high penetrance and over 150 commonly occurring variants with lower impact on risk; however, most of these variants have been identified in studies containing exclusively European individuals. People of non-European ancestries make up less than 15% of prostate cancer GWAS subjects. Across the globe, incidence of prostate cancer varies with population due to environmental and genetic factors. The discrepancy between disease incidence and representation in genetics highlights the need for more studies of the genetic risk for prostate cancer across diverse populations. To better understand the genetic risk for prostate cancer across diverse populations, we performed PrediXcan and GWAS in a case-control study of 4,769 self-identified African American (2,463 cases and 2,306 controls), 2,199 Japanese American (1,106 cases and 1,093 controls), and 2,147 Latin American (1,081 cases and 1,066 controls) individuals from the Multiethnic Genome-wide Scan of Prostate Cancer. We used prediction models from 46 tissues in GTEx version 8 and five models from monocyte transcriptomes in the Multi-Ethnic Study of Atherosclerosis. Across the three populations, we predicted 19 gene-tissue pairs, including five unique genes, to be significantly (lfsr < 0.05) associated with prostate cancer. One of these genes, NKX3-1, replicated in a larger European study. At the SNP level, 110 SNPs met genome-wide significance in the African American study while 123 SNPs met significance in the Japanese American study. Fine mapping revealed three significant independent loci in the African American study and two significant independent loci in the Japanese American study. These identified loci confirm findings from previous GWAS of prostate cancer in diverse populations while PrediXcan-identified genes suggest potential new directions for prostate cancer research in populations across the globe. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study is to estimate the global burden of pancreatic cancer from 1990 to 2019. Methods: We reconstructed the Global Burden of Diseases (GBD) study results for pancreatic cancer across 204 countries and territories. Our study generated estimates for key disease burden indicators, including incidence, prevalence, mortality, and disability-adjusted life years (DALYs), and cost. Linear regression analysis of the natural logarithm of age-standardized outcomes was used to calculate annual percent change. Results: In 2019, there were a total of 530,296 incident and 442,101 prevalent cases of pancreatic cancer, resulting in 531,107 deaths and 11.5 million DALYs lost. The age-standardized incidence and prevalence of pancreatic cancer has increased from 5.22 (95% CI 4.97–5.40) to 6.57 (CI 6.00–7.09) per 100,000 people per year, and 4.1 (95% CI 3.95–4.26) to 5.4 (CI 4.96–5.87), respectively. This equated to 10 million (95% CI 9.5 to 10.4 million) incident cases of pancreatic cancer. The number of DALYs lost as a result of pancreatic cancer was 225 million years (95% CI 216–234 million years). Mortality from pancreatic cancer increased over the study period from 3.7 (95% CI 3.54–3.83) to 6.9 (95% CI 6.36–7.32). Incidence, prevalence, DALYs, and mortality were higher in countries with a higher socio-demographic index. Conclusions: Pancreatic cancer is rising around the world and is associated with a high economic burden. Programs aimed at reducing modifiable risk factors are needed. [ABSTRACT FROM AUTHOR]

An obituary for medical officer Graeme Kian Giap Lim is presented.

This study examined the impact of computer simulation and supported science learning on a teacher's understanding and conceptual knowledge of current electricity. Pre/Post tests were used to measure the teachers' concept attainment. Overall, there was a significant and large knowledge difference effect from Pre to Post test. Two interesting interactions were observed during the data analysis. The first was the difference between Elementary and Secondary teachers. Both groups had significant gains, with large effect sizes, but the Elementary teachers (Pre-Mean = 3.70, Post-Mean = 7.51) started lower and ended higher exhibiting a significantly larger gain than the Secondary teachers (Pre-Mean = 4.96, Post-Mean = 6.71). The second interaction was the impact of gender. Both groups showed significant gains, with large effect sizes, but females (Pre-Mean = 3.90, Post-Mean = 7.21) gained significantly more than males (Pre-Mean = 5.13, Post-Mean = 7.01). These results confirm that computer simulation supported science learning can have a positive effect on concept attainment in teachers. [ABSTRACT FROM AUTHOR]

Background/Aim: Endoscopic retrograde cholangiopancreatography (ERCP) training requires varying degrees of staff assistance regarding operation of the fluoroscopy machine via a foot pedal. Efficiency is important to acquire during this training due to radiation risks. In this study, we evaluate the effect of controlling endoscopy and fluoroscopy unit on duct cannulation rates (CRs) and total fluoroscopy time (FT) for fellows in training. Methods: 204 patients undergoing ERCP were randomized to one of two groups: 1) "Endoscopist Driven" group in which the endoscopist controlled the foot pedal for fluoroscopy, and 2) "Assistant Driven" group in which attending or fellow controlled the foot pedal while the other team member controlled the endoscope. Various measures including selective duct CR and total FT were recorded. Results: There was no significant difference in mean procedure duration between the two groups (32 minutes vs. 33 minutes, p=0.70). There was also no statistically significant difference in CR (83.7% vs. 77.4%, p=0.25) or FT (3.27 minutes vs. 3.54 minutes, p=0.48). Conclusions: ERCP is a technically challenging procedure which requires extensive supervision. This study demonstrates that CR and FT are not affected by who controls the fluoroscopy. [ABSTRACT FROM AUTHOR]

Math anxiety remains a critical issue affecting student performance and confidence across grade levels, including pre-service elementary teacher education. Given the potential impact teachers' math anxiety might have on their learning as well as that of their future students, one unique purpose of this research is to investigate how achievement goals relate to math anxiety among 182 pre-service teachers enrolled in undergraduate elementary education math methods courses. While low self-efficacy is a significant predictor of math anxiety, our results indicate that taking into account pre-service teachers' achievement goals increases our ability to predict math anxiety over that afforded by their level of self-efficacy alone. In particular, students adopting either mastery-avoidance or performance-avoidance goals while learning mathematics, may be particularly susceptible to math anxiety. Further, self-efficacy does not moderate the relationship between achievement goals and math anxiety, so the relationship between achievement goals and math anxiety is consistent across levels of self-efficacy. [ABSTRACT FROM AUTHOR]

This study investigated a feedback exchange activity for engaging pre-service teachers and the nature of such feedback in two undergraduate classes, a distance learning (DL) and a face-to-face (F2F) class. The research question asked if the nature of peer feedback was different between F2F and DL class formats. Students’ work samples were collected during class time to examine feedback function ratings. Participants also completed an online questionnaire to examine the nature of expectations of the feedback given. For both the nature of expectations and feedback function ratings, results for chi-square analyses demonstrated no statistically significant difference between the two modes of instruction (F2F versus DL), and the peer feedback categories. However, provision of feedback was significantly favoured in the F2F class over the DL class. Implications for course curriculum and future research are discussed. [ABSTRACT FROM PUBLISHER]

Background: Endoluminal radiofrequency ablation (RFA) is a palliative treatment for patients suffering from malignant biliary obstruction (MBO). We aimed to conduct a meta-analysis to evaluate the impact of RFA on stent patency, patient survival, and adverse events., Methods: Major databases were searched through December 2023 for patients who had undergone stenting with or without RFA for extrahepatic MBO. A random-effects model was used for analysis, with results expressed as relative risk ratios (RRs) with 95%CIs., Results: Nine RCTs involving 750 subjects with MBO (374 RFA plus stent vs. 376 stent only) were included. Meta-analysis revealed similar risks of stent patency at 3 months (RR 1.01, 95%CI 0.92-1.11; I 2 = 4%) for RFA plus stenting vs. stent only. Meta-analysis showed improved survival at 6 months (RR 0.84, 95%CI 0.73-0.96; I 2 = 21%; P = 0.01) for RFA plus stenting vs. stent only. Subgroup analysis comparing plastic vs. uncovered metal stents showed that stent patency was unaffected at 3 months (RR 1.06, 95%CI 0.91-1.23; I 2 = 17%). Subgroup analysis showed that patients with cholangiocarcinoma experienced an overall survival benefit with RFA plus stenting vs. stenting alone ( P < 0.001); however, stent patency remained unaffected ( P = 0.08). An increased incidence of cholecystitis was noted with RFA plus stenting vs. stenting alone (5.1% [95%CI 3.1%-7.8%] vs. 0.3% [95%CI 0.01%-1.5%], respectively)., Conclusion: Combining endoluminal RFA and stenting may improve overall survival in patients with MBO. RFA did not significantly impact stent patency., Competing Interests: S.F. Crinò has received a grant from Steris Endoscopy. B. Mangiavillano has received lecture fees from Taewoong. M. Khashab is a consultant for Boston Scientific, Medtronic, Olympus, Pentax, GI Supply, and Apollo; he receives research support from Boston Scientific and royalties from Elsevier and UpToDate. D. Ramai, M. Maida, E.R. Smith, Y. Wang, M. Spadaccini, M. Previtera, S. Chandan, Y. Huang, S. Tokmak, P. Bhandari, J. Dubroff, C. Ko, J.D. Morris, G. Marasco, and A. Facciorusso declare that they have no conflict of interest., (Thieme. All rights reserved.)

Competing Interests: J.D. Morris is a consultant for Boston Scientific. J. DuBroff and D. Ramai declare that they have no conflict of interest.

Objective: Endoscopic retrograde cholangiopancreatography (ERCP) may be unsuccessful in patients with duodenal stenosis or malignant ampullary infiltration. Endoscopic ultrasound-guided biliary drainage (EUS-BD) has been proposed as an alternative. We aimed to assess the efficacy and safety of EUS-BD for malignant distal bile duct obstruction using the newly introduced smaller caliber 6 or 8 mm cautery-enhanced lumen-apposing metal stent., Methods: A multicenter retrospective study was performed on patients with unresectable malignant distal bile duct obstruction who underwent EUS-BD between 2021 and 2022 after unsuccessful ERCP., Results: Thirty-two patients were included [7 (53.13%) males], with a mean age of 72.2 ± 12.5 years. The technical success rate was 100%. Altered anatomy was present in 2 (6.25%). The indication for drainage was biliary obstruction from pancreatic cancer in 26 patients (84.5%), cholangiocarcinoma in 3 (9.4%), and ampullary mass in 3 (9.4%). The procedure was performed mostly in an outpatient setting (n = 19, 59.38%). The clinical success rate was 92.3% [bilirubin: 14.1 (SD: 8.9) preprocedure vs 4.9 (SD: 1.1) postprocedure; P = 0.0001]. There was one early adverse event of a perforation, which was closed endoscopically and drained percutaneously. Delayed adverse events included food impaction of the stent (n = 1), which was resolved with a repeat procedure and insertion of a double pigtail stent., Conclusion: This study demonstrates the feasibility of EUS-BD drainage using smaller caliber 6 or 8 mm lumen-apposing metal stent to relieve malignant distal bile duct obstruction in patients who fail conventional ERCP., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background and Objective: Accessory spleen (AS) may be encountered as an intrapancreatic lesion on EUS. This can look similar to other pancreatic pathologies and may lead to unnecessary interventions. The goal of this study was to evaluate the accuracy of EUS in distinguishing intrapancreatic AS (IPAS) from other pancreatic lesions., Materials and Methods: Twelve sets of endoscopic images of the spleen and various pancreatic lesions confirmed on histology or cytology were gathered. Ten endosonographers were asked to characterize and identify the lesions. The responses were analyzed via Excel and the interobserver agreement was analyzed using Gwet's agreement coefficient statistic via Stata I/C v15., Results: In our sample, the interobserver agreement was 0.37 (-+1-1; 0-0.2 poor, 0.2-0.4 fair, 0.4-0.6 moderate, 0.6-0.8 substantial, and 0.8-1.0 almost perfect) for determining whether or not the pancreatic lesion is IPAS. The reviewers were able to correctly determine IPAS endosonographically with a sensitivity of 77%, specificity of 74%, and positive and negative predictive values of 50% and 92%, respectively., Conclusion: There is a moderate-to-substantial interobserver agreement in describing the sonographic characteristics of the pancreatic lesions, such as the shape, echogenicity compared to spleen, echotexture, and border of the lesions. However, the interobserver agreement is only fair when deciding if the pancreatic lesion is an IPAS. The similar profile of IPAS and pancreatic neuroendocrine tumor could confound the diagnosis of IPAS, thus contributing to the decreased interobserver agreement. This study demonstrates that EUS criteria alone are not accurate for IPAS diagnosis. Fine-needle aspiration (FNA) may be required for a confirmatory diagnosis., Competing Interests: None

Gallstone disease is a common gastrointestinal pathology that may result in surgical intervention. While cholecystectomy has relatively minimal risks, surgical clip migration is a rare complication that can cause severe morbidity and mortality. This report describes a rare phenomenon of a biliary stone forming onto a migrated surgical clip 14 years after cholecystectomy causing an obstructive jaundice. This case illustrates the importance of keeping a migrated surgical clip on the differential when encountering patients with symptoms of cholangitis after cholecystectomy.

Background: High-resolution impedance manometry (HRiM) is the test of choice to diagnose esophageal motility disorders and is particularly useful for identifying achalasia subtypes, which often guide therapy. HRiM is typically performed without sedation in the office setting. However, a substantial number of patients fail this approach. We report our single-center experience on endoscopy-assisted HRiM under monitored anesthesia care (MAC) in adults to demonstrate the feasibility and effectiveness of this approach., Methods: Patients who had failed prior HRiM attempts received propofol under MAC. Patients then underwent an upper endoscopy, followed immediately by passage of a Diversateck HRiM motility catheter through the nares and under direct visualization into the stomach, often using the tip of the endoscope to guide the catheter. We then awakened the patients and asked them to perform 10 saline swallows., Results: We successfully completed HRiM studies in 14 consecutive patients. Six patients had achalasia; two had esophagogastric junction outflow obstruction; two had absent contractility; one had distal esophageal spasm; one had ineffective esophageal motility; and one had a normal study. The majority of these patients were treated successfully with targeted interventions, including per oral endoscopic myotomy, gastrostomy, botox injection, medical therapy, and dietary modifications.