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Context: Objective Structured Clinical Examinations (OSCEs) are an increasingly popular evaluation modality for medical students. While the face-to-face interaction allows for more in-depth assessment, it may cause standardization problems. Methods to quantify, limit or adjust for examiner effects are needed. Methods: Data originated from 3 OSCEs undergone by 900-student classes of 5th- and 6th-year medical students at Université Paris Cité in the 2022-2023 academic year. Sessions had five stations each, and one of the three sessions was scored by consensus by two raters (rather than one). We report OSCEs' longitudinal consistency for one of the classes and staff-related and student variability by session. We also propose a statistical method to adjust for inter-rater variability by deriving a statistical random student effect that accounts for staff-related and station random effects. Results: From the four sessions, a total of 16,910 station scores were collected from 2615 student sessions, with two of the sessions undergone by the same students, and 36, 36, 35 and 20 distinct staff teams in each station for each session. Scores had staff-related heterogeneity (p<10-15), with staff-level standard errors approximately doubled compared to chance. With mixed models, staff-related heterogeneity explained respectively 11.4%, 11.6%, and 4.7% of station score variance (95% confidence intervals, 9.5-13.8, 9.7-14.1, and 3.9-5.8, respectively) with 1, 1 and 2 raters, suggesting a moderating effect of consensus grading. Student random effects explained a small proportion of variance, respectively 8.8%, 11.3%, and 9.6% (8.0-9.7, 10.3-12.4, and 8.7-10.5), and this low amount of signal resulted in student rankings being no more consistent over time with this metric, rather than with average scores (p=0.45). Conclusion: Staff variability impacts OSCE scores as much as student variability, and the former can be reduced with dual assessment or adjusted for with mixed models. Both are small compared to unmeasured sources of variability, making them difficult to capture consistently. [ABSTRACT FROM AUTHOR]

Background: Bacterial peritonitis (BP) in patients with gastrointestinal (GI) cancer has been poorly described, and its prevalence is unknown. Objectives: This study aimed to evaluate in patients with both GI cancer and ascites the prevalence of BP, associated features, mechanisms, prognosis, and the diagnostic performance of neutrophil count in ascites. Design: A retrospective, multicenter, observational study. Methods: All patients with GI cancer and ascites who underwent at least one paracentesis sample analyzed for bacteriology over a 1-year period were included. BP was defined by a positive ascites culture combined with clinical and/or biological signs compatible with infection. Secondary BP was defined as BP related to a direct intra-abdominal infectious source. Results: Five hundred fifty-seven ascites from 208 patients included were analyzed. Twenty-eight patients had at least one episode of BP and the annual prevalence rate of BP was 14%. Among the 28 patients with BP, 19 (65%) patients had proven secondary BP and 17 (59%) patients had multi-microbial BP, mainly due to Enterobacterales. A neutrophil count greater than 110/mm3 in ascites had negative and positive predictive values of 96% and 39%, respectively, for the diagnosis of BP. The median survival of patients with BP was 10 days (interquartile range 6–40) after the diagnosis. Conclusion: BP is not rare in patients with GI cancer and is associated with a poor short-term prognosis. When a patient with GI cancer is diagnosed with BP, a secondary cause should be sought. Further studies are needed to better define the best management of these patients. [ABSTRACT FROM AUTHOR]

Gastrointestinal stromal tumours (GISTs) are defined as CD117-positive primary, spindled or epithelioid, mesenchymal tumours of the gastrointestinal tract, omentum, or mesentery. While computed tomography (CT) is the recommended imaging modality for GISTs, overlap in imaging features between GISTs and other gastrointestinal tumours often make radiological diagnosis and subsequent selection of the optimal therapeutic approach challenging. Cinematic rendering is a novel CT post-processing technique that generates highly photorealistic anatomic images based on a unique lighting model. The global lighting model produces high degrees of surface detail and shadowing effects that generate depth in the final three-dimensional display. Early studies have shown that cinematic rendering produces high-quality images with enhanced detail by comparison with other three-dimensional visualization techniques. Cinematic rendering shows promise in improving the visualization of enhancement patterns and internal architecture of abdominal lesions, local tumour extension, and global disease burden, which may be helpful for lesion characterization and pretreatment planning. This article discusses and illustrates the application of cinematic rendering in the evaluation of GISTs and the unique benefit of using cinematic rendering in the workup of GIST with a specific emphasis on tumour characterization and preoperative planning. [ABSTRACT FROM AUTHOR]

Digestive neuroendocrine neoplasms (NEN) are rare tumors, but their incidence is increasing. The term "neuroendocrine tumor" (NET) is restricted to well--differentiated tumors. Because of their relatively indolent nature, patients with low-grade NET have a prolonged survival, even at the metastatic stage. -Optimal follow-up of patients with NET relies on the complementarity of -biological markers, such as chromogranin A or urinary 5HIAA, and morphological and functional imaging examinations. The management of NNE in France relies on expert networks, such as the TENPATH anatomopathological network. The clinical management of these tumors also requires expertise, in particular a good knowledge of the carcinoid syndrome and its risks. The treatment of localized NET is mainly based on surgical resection, with the exception of certain pancreatic incidentalomas and certain gastric NETs in specific settings. As for other digestive neoplasia, combined treatments are often preferred in advanced NET. Finally, the management of intestinal NET requires vigilance regarding nutritional and vascular risks. [ABSTRACT FROM AUTHOR]

Peptide receptor radionuclide therapy (PRRT) is a key treatment in the management of advanced digestive neuroendocrine tumors (NETs). Following the results of the NETTER-1 and OCLURANDOM trials, the French National Authority for Health (HAS) recommends the treatment with 177Lutetium-oxodotreotide for advanced grade 1 and 2 NETs expressing somatostatin receptors. It is recommended in the second line for intestinal tumors and after exposure to all therapies for pancreatic NETs. There are promising results for PRRT in the neoadjuvant setting and also for the treatment of grade 3 neuroendocrine neoplasms, although there is no marketing authorization for these indications to date due to the lack of randomized studies. PRRT treatment requires careful monitoring to limit the risk of complications, particularly hematological ones (cytopenias in the acute phase and rare secondary hematological disorders in the late phase). Also the radiobiological effects of 177Lutetium-oxodotreotide extend over time, well beyond the end of treatment. Regarding the post-treatment follow-up schedule, there is no unanimous recommendation, but it is generally accepted not to perform morphological follow-up during PRRT (unless there is suspicion of progression), and to conduct examinations between 2 weeks and 3 months post-PRRT, then at 6 months post-PRRT, and subsequently every 4 to 6 months depending on individual cases and center practices. [ABSTRACT FROM AUTHOR]

Gastrointestinal stromal tumors (GISTs) are defined as mesenchymal tumors of the gastrointestinal tract that express positivity for CD117, which is a c- KIT proto-oncogene antigen. Expression of the c- KIT protein, a tyrosine kinase growth factor receptor, allows the distinction between GISTs and other mesenchymal tumors such as leiomyoma, leiomyosarcoma, schwannoma and neurofibroma. GISTs can develop anywhere in the gastrointestinal tract, as well as in the mesentery and omentum. Over the years, the management of GISTs has improved due to a better knowledge of their behaviors and risk or recurrence, the identification of specific mutations and the use of targeted therapies. This has resulted in a better prognosis for patients with GISTs. In parallel, imaging of GISTs has been revolutionized by tremendous progress in the field of detection, characterization, survival prediction and monitoring during therapy. Recently, a particular attention has been given to radiomics for the characterization of GISTs using analysis of quantitative imaging features. In addition, radiomics has currently many applications that are developed in conjunction with artificial intelligence with the aim of better characterizing GISTs and providing a more precise assessment of tumor burden. This article sums up recent advances in computed tomography and magnetic resonance imaging of GISTs in the field of image/data acquisition, tumor detection, tumor characterization, treatment response evaluation, and preoperative planning. [ABSTRACT FROM AUTHOR]

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The incidence of esophageal squamous cell carcinoma (ESCC) has been divided by 3 in France over the last 30 years, but this tumor remains associated with a poor prognosis. The main prognostic factor is the tumor stage at the time of diagnosis. ESCC does not cause any symptom in its early stages and is often diagnosed at an advanced stage: less than 10 % of ESCCs are diagnosed at a localized stage (≤ T2). No screening program exists in France nationwide or in high-risk individuals. Early (T1) ESCCs are eligible for endoscopic resection by endoscopic submucosal dissection (ESD), which is as effective as surgery in terms of overall survival and recurrence-free survival, and associated with a much lower morbidity and mortality. ESD is considered curative in case of an en-bloc resection, histologically complete, and with a limited metastatic risk, as evaluated based on histopronostic factors present on the resection specimen. In case of positive deep resection margins, deep submucosal invasion, poorly differentiated tumor, or lymphatic and/or vascular invasion, the resection is considered non-curative and further treatment should be considered. After each ESD for superficial ESCC, the need for further treatment is discussed at a dedicated tumor board, weighting the risk of metastases against the patient's age and co-morbid conditions, and the risks associated with the treatment. [ABSTRACT FROM AUTHOR]