How to identify possible scientific partners
Follow these tips on how to find potential research collaborators.
Finding new potential collaborators and the exchange with colleagues to promote your research is crucial for GI specialists.
Pedro Rodrigues, a new member of the Young Talent Group in 2020, shares the most useful tips on how to identify a possible scientific partner.
Tip 1: Do attend the most important meetings in your field of expertise.
It is essential to attend the most relevant congresses in order to maximize the opportunity to meet new potential collaborators and to promote your own work. In this regard, attending UEG Week on a yearly basis and being actively involved in the several activities that are organized by UEG (Summer School, Basic Science Courses, Young Investigators Meeting, etc.) constitutes the perfect platform to meet new people and establish good partnerships.
Tip 2: Try to synergize with good people.
Don’t go only for the best, but for the friendly ones. It is important to be surrounded by good friends. Therefore, identify good collaborators not only by their area of expertise but also try to connect with easy-going and friendly people that will make your scientific life stronger, easier and straightforward.
Tip 3: Identify partners that complement your research and interests.
Selecting collaborators that are able to complement your research is key. Joint efforts between people with different perspectives helps us with overcoming our flaws and weaknesses and will greatly increase our success.
Tip 4: Engage researchers from different areas in order to create your own multidisciplinary network.
Collaborate with partners from different fields and topics, which may generate innovative and different ideas, and will allow you to develop richer and more complete projects . Diversity is the key to greater achievements. To help you get in touch with other researchers, UEG is establishing a dedicated platform, the UEG Researchers Network. You can already register to receive the latest information on EU funding calls and other opportunities
Tip 5: Collaborate with researchers that do not come with problems, but with solutions.
Your collaborators should add significant value to your research, instead of fomenting fights. Each one of your partners should be able to contribute with valuable ideas and projects.
Tip 6: Select partners from all over the world.
Including worldwide investigators in your network is key in order to increase the probability of identifying new research calls and to apply for funding with your collaborative group.
Tip 7: Don’t forget to move!!!
Mobility is one of the most important factors when you are considering the creation of your collaborative networks. Meeting people from other institutions and connect with other types of work will greatly enrich your CV and will allow you to select important partners to be included in your daily life. In this regard, the UEG Research Fellowship constitutes an excellent opportunity to visit a new research institution, to learn new techniques, to develop new projects and ideas and finally to effectively connect with new scientific partners.
Tip 8: Be involved in relevant associations and groups, and ask for help whenever necessary.
Contact and be actively involved in national and international gastroenterology associations, including UEG. By doing so, you will be able to meet people that might help you in your quest. Do not hesitate to contact them when you need help in finding new scientific partners. Thus, becoming part of UEG and diving into the UEG Talent Pool is key in getting to know new people and to interact with key potential collaborators.
Tip 9: Don´t be shy! Just do it.
If you are interested in establishing a new collaboration please make the first move! Approach people and make the first contact. Do not hesitate to introduce yourself and to try to establish a potential collaboration.
Liver biopsy for evaluation of fibrosis in chronic liver disease: Yes or no?
Two experts present their viewpoints
Chronic liver disease affects many millions of people worldwide and is a major cause of premature death. Assessing liver fibrosis in patients with chronic liver disease can determine disease stage and progression, and also response to therapy, but whether this is best performed via a liver biopsy or noninvasive methods is a matter for debate.
Here, two European experts present their opposing viewpoints on how to assess fibrosis in the setting of chronic liver disease.
Yes—Dina Tiniakos
Biopsy is the reference method for evaluating liver fibrosis and the ‘gold standard’ against which noninvasive methods are compared. The histological stage of fibrosis is one of the most important prognostic factors in patients with chronic liver disease, independent of aetiology. Advanced fibrosis is a strong prognostic factor in alcohol-related liver disease and the most important prognostic indicator in nonalcoholic fatty liver disease (NAFLD), where individual histological fibrosis stages are associated with distinct patient outcomes.
Liver biopsy is the only way to diagnose nonalcoholic steatohepatitis (NASH) and, generally, offers the added value of assessing disease severity, highlighting possible concurrent disease and evaluating fibrosis progression or regression in paired biopsy samples. The known limitations of sampling and interobserver variability are minimized by high-quality biopsy techniques (using ≤16-gauge needles, core length >15 mm) and evaluation by expert hepatopathologists. Recently, digital image analysis and second harmonic generation technology have enabled objective quantitative and qualitative assessment of liver tissue collagen and can highlight subtle differences in fibrosis between biopsy samples.
Noninvasive methods of assessing liver fibrosis are widely used with increasing accuracy for diagnosing the absence of fibrosis or presence of severe fibrosis/cirrhosis and, therefore, are helpful to select patients for liver biopsy. However, noninvasive methods cannot distinguish intermediate stages of fibrosis and some serum marker measurements may reflect fibrotic processes in other organs. Failure of application (2–5%), unreliable results (11–15%) and false-positive results in acute inflammation, cholestasis or liver congestion are known limitations of transient elastography, while the patented serum markers have limited availability. While noninvasive tests reduce the need for liver biopsy for fibrosis evaluation they cannot replace it.
References
- Almpanis Z, Demonakou M and Tiniakos D. Evaluation of liver fibrosis: "Something old, something new…". Ann Gastroenterol 2016; 29: 445–453.
- Lackner C and Tiniakos D. Fibrosis and alcohol-related liver disease. J Hepatol 2019; 70:294–304.
No–Laurent Castera
Over the past decade, there has been growing interest in novel noninvasive strategies for the evaluation of fibrosis, given the well-known limitations of taking liver biopsy samples — invasiveness, limited patient acceptance, rare but potentially life threatening complications, sampling variability, pathologist experience, and cost. Taking liver biopsy samples also appears unrealistic considering the magnitude of the nonalcoholic fatty liver disease (NAFLD) epidemic, with around 25% of the general population affected in Western countries.
Noninvasive testing currently relies on two different but complementary approaches: measuring the levels of serum biomarkers and estimating liver stiffness using ultrasound-based elastography techniques, with transient elastography (FibroScanTM) being the pioneer. Although these two approaches are complementary, they are based on different rationales and concepts. Transient elastography measures liver stiffness related to elasticity, which corresponds to a genuine and intrinsic physical property of the liver parenchyma. By contrast, serum biomarkers are combinations of several, not strictly liver-specific, blood parameters that are optimized to predict the stages of fibrosis as assessed by liver biopsy.
The most validated noninvasive biomarker tests are FIB-4, AST to platelet ratio index (APRI), NAFLD fibrosis score (nonproprietary formula) and FibroTestTM (proprietary), while FibroScanTM is the most validated elastography technique. All these tests are better at ruling severe fibrosis-cirrhosis out than ruling it in. They also have prognostic value in the context of cirrhosis. For instance, they are able to identify the subgroup of NAFLD patients at high risk of developing liver-related complications and death. As a result, noninvasive tests are now widely used in routine clinical practice and included in national and international guidelines.
References
- European Association for the Study of the Liver and Asociacion Latinoamericana para el Estudio del Higado. EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol 2015; 63: 237–264.
- Castera L, Friedrich-Rust M and Loomba R. Noninvasive assessment of liver disease in patients with nonalcoholic fatty liver disease. Gastroenterology 2019; 156: 1264–281.
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An elusive lesion in the colon
How to ensure detection of subtle lesions during screening colonoscopy?
A 55-year-old female patient with no family history of colorectal cancer (CRC) underwent a scheduled screening colonoscopy. The colonoscopy was performed by an experienced endoscopist (adenoma detection rate [ADR] of 54%), using a high-resolution colonoscope with narrow-band imaging (NBI) cabaility. Carbon dioxide was used for bowel insufflation. The patient was sedated with midazolam and propofol, with adequate oxygen supplementation and continuous monitoring of her blood pressure and oxygen saturation. The video shows the colonoscopy and two photos (figure 1) are provided of the ascending colon and of the area near the hepatic flexure during withdrawal of the scope.
Figure 1 | Images of the ascending colon and of the area near the hepatic flexure during withdrawal of the colonoscope under conventional white-light and narrow-band imaging conditions. Case Question 1:
Which of the following statements is correct?A. There is a serrated lesion without dysplasia
B. There is a serrated lesion with dysplasia
C. There is an adenoma with low-grade dysplasia
D. There is an adenoma with high-grade dysplasia
Case Question 2:
What is the minimum length of time you should spend inspecting the right colon (including the cecum, ascending colon and hepatic flexure)?A. 3 minutes
B. 4 minutes
C. 5 minutes
D. 6 minutes
Case Question 3:
Which of the following is more likely to increase the adenoma detection rate (ADR)?A. Better training
B. Chromoendoscopy
C. A mucosal exposure device/cap
D. All of the above
ESNM Hands-on Course for Gastrointestinal Motility Training
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Mistakes in... booklet 2019 out!
The booklet in 2019 contains eight most recent Mistakes in… articles, covering a wide range of topics.
Mistakes in... session at UEG Week 2019
Learn from experts about mistakes in the gastroenterology field and how to avoid them.
Mistakes in decompensated liver cirrhosis and how to avoid them
Protecting against future decompensation episodes is key
Patients with early stages of chronic liver disease and even those with compensated cirrhosis can present without any clinical symptoms, which means that liver disease and ongoing liver damage can remain unidentified for many years. However, morbidity and mortality drastically increase once the stage of ‘decompensated cirrhosis’ has been reached.1,2 Decompensated cirrhosis describes the development of clinically overt signs of portal hypertension and/or impairment of hepatic function (e.g. variceal bleeding, ascites or overt hepatic encephalopathy). The first hepatic decompensation event significantly increases the risk that further complications of liver cirrhosis and decompensation episodes will occur.2 Moreover, individuals who have advanced stages of liver cirrhosis are four times more susceptible to infection, which is, in turn, the most frequent trigger of hepatic decompensation.3,4
Optimal management is required to sufficiently treat patients who have decompensated liver cirrhosis, to protect them from future decompensation episodes and prevent further deterioration of hepatic function. However, decompensated liver cirrhosis is a highly complex disease and there are many pitfalls that may occur with regard to comorbidities, management of acute complications and appropriate medication.
In this article, we cover some of the mistakes frequently made when managing decompensated liver cirrhosis and ways to prevent them. The discussion is based on the available evidence and our personal clinical experience.
ERCP
Enhance your knowledge about ERCP
Gastrointestinal Neuroendocrine Tumours
Learn about NETs
What not to do at UEG Week
Most common things you should avoid when attending UEG Week, to help you get the most out of your congress participation.
Attending international conferences is important to stay up to date in the world of digestive health. For junior specialists, a big congress like UEG Week can be overwhelming. Henriette Heinrich is Gastroenterology Consultant in the Stadtspital Triemli, Zuerich, Switzerland, and incoming chair of the Young Talent Group. She has summarised the most common things you should avoid when attending UEG Week, to help you get the most out of your congress participation.
1. Not attending!
The biggest mistake you could make, of course, is not attending UEG Week at all. But fear not, if wild animals, bosses or other commitments keep you from attending, there is still the opportunity to access all the important talks from this year’s UEG Week and all previous UEG Weeks. Watch the content you missed any time, any place, anywhere via UEG Week 24/7. But still... you should really attend UEG Week.
2. Not planning ahead @UEG Week
This is probably one of the major pitfalls! First of all, try to make sure you benefit from early bird registration and if you are an undergraduate student, trainee or PhD student from reduced fees for registration.
For first-time visitors and the curious serial attendee, watch out for this year’s scavenger hunt at the Young GI Lounge to help you find your way around! Be prepared to be overwhelmed by the sheer magnitude of what the UEG Week programme has to offer, no matter how many times you’ve attended. It’s like a GI candy store — and you have an unlimited budget.
If you do not plan ahead, you will be torn between all the exciting, cutting-edge, hot-off-the press scientific presentations, the networking and the educational events like the Postgraduate Teaching (PGT) Programme. You will be an overexcited, highly disoriented, happily zooming-around butterfly, but completely exhausted and queuing for a taxi at the end of the day to go back to your hotel and sleep (missing out on various networking social events that we’ll cover later).
But fear not, we can fix you up.
Use the UEG Week Mobile App to structure your day and the UEG Week Pathways to help tailor your perfect programme. If you are absolutely torn between two parallel sessions, stay calm and watch the session you missed online later. Because your registration for UEG Week conveniently gives you free access to the UEG Library, which features UEG Week 24/7!
And if you really are not a person to use a smart phone or computer, there is always the programme wall on-site in Hall 8.0 where pathways are signposted day by day to help you find your way. Furthermore, it is a great meeting spot.
3. Not paying a visit to the Young GI Lounge (Hall 8.0)
If you are young or already a seasoned clinician and scientist in the GI field, a visit to the Young GI Lounge to recharge and connect is highly recommended (and actually mandatory!). Not only are coffee, tea, cookies and other snacks on offer, you can also charge your phone or computer, meet interesting people and most of all attend cutting-edge events tailored to the needs of young GIs.
From checking your CV, to tips for getting your article published in UEG Journal and getting on-the-spot mentoring from experts in the field, the Young GI Lounge is the place to be.
4. Not jumping into the UEG Talent Pool
Kickstart or refresh your career by jumping into the (heated) UEG Talent Pool, which is not only open during UEG Week, but all year round! Maybe next year you’ll be faculty? So, don’t forget your swimming gear and goggles…
5. Not attending the Young GI Network event "Let’s meet!"
One of the worst things to happen is to be left queuing in front of the venue because you haven’t got a ticket to mingle, network and party with basically anyone who matters in the GI world (see pitfall number two). You could call it the MET Gala of Gastroenterology. Be there or be square.
6. Not checking out the Education Booth (Hall 8.0)
Well, if you don't check out the Education Booth, you will basically be missing out on all the educational resources that will get you through the year until the next UEG Week. Like the image hub, the “Mistakes in…” series, the online courses, the UEG Library and UEG Week 24/7. Or the guideline repositories. This year, there’ll also be a fun memory game showcasing some of the images from the image hub, so why not go and try your luck to see if you can get the fastest time!
7. Staying offline
Rookie mistake. Of course, it's great to be somewhere in person, but staying offline means you’ll be missing out on things designed to enhance your enjoyment of the meeting:
- The UEG Week Mobile App (see pitfall number two)
- Online content to watch or rewatch (again, see pitfall number two)
- The UEG Week live video chats, during which surgeons and gastroenterologists battle it out and we explore the compatibility of having a job and a family. YOUR ONLINE INPUT AND QUESTIONS ARE HIGHLY APPRECIATED!
- Missing the news updates about UEG Week on Twitter, Instagram and Facebook
8. Missing out on seriously important events on research funding for scientists
There are several events at UEG Week that focus on research funding opportunities. Not attending these events will deliver a serious blow to your research ambitions! Be there or get left behind ;-)
Events to look out for:
- EU funded Cooperation Networks in GI: How to get involved?
- Fellowships and grants: How UEG can help your career
- EU funding opportunities and strategy in digestive health
9. Not bringing your team
Seriously? There is no I in team and gastroenterology is teamwork! And what could be better for team spirit than a trip to Barcelona?!
UEG is proud to offer special fees for allied healthcare professionals and nurses as well as the UEG Week programme for nurses, so the whole team really can get involved!
Why students should attend UEG Week
3 medical students reveal how they experienced UEG Week.
Ivelina Georgieva, Giusi Sciume and Nikolay Manov study medicine in Italy and Bulgaria and attended UEG Week for the first time in 2018. In this video, they tell Radislav Nakov and Gianluca Ianiro why attending a big international congress can be helpful for undergraduate students’ careers as well and what they liked most about UEG Week.
Undergraduate students benefit from our special fees and can attend the whole congress (incl. Postgraduate Teaching, Hands-on Area and Young GI Network programme) for only € 60. Register for UEG Week!
Mistakes in chronic hepatitis B management and how to avoid them
All patients require long-term monitoring.
Hepatitis B virus (HBV) infection is the most common chronic viral infection in the world. Despite the availability of a preventative vaccine, more than 250 million people worldwide are chronically infected with HBV. The complications of chronic HBV infection—cirrhosis and hepatocellular cancer (HCC)—account for more than 850,000 deaths per year.1 HBV is transmitted haematogenously and sexually, with the majority of HBV infections being transmitted vertically (or perinatally) in high prevalence regions.2 HBV infection acquired at birth or in early childhood results in chronicity in >95% of cases, whereas only 5–10% of those who are infected in adulthood will progress to chronic infection.
Treatment options for chronic hepatitis B (CHB) are mostly non-curative. Although antiviral therapy can provide adequate viral suppression, cases of functional cure (or hepatitis B surface antigen [HBsAg] loss) are limited and therefore long-term therapy is required. CHB is a dynamic disease, which means that all patients with CHB require long-term monitoring to inform treatment and management decisions. The treatment paradigm in CHB is undergoing rapid change—a number of novel agents are entering the clinical trial pipeline with the therapeutic goal of HBsAg loss or functional cure. It will be important to optimise patient management in advance of these clinical trials, and maintaining viral suppression will be an important prerequisite for many of them. In addition, viral suppression is mandated in a number of patient groups, especially those with advanced disease and cirrhosis, to prevent the complications of CHB.
Here we highlight some of the mistakes frequently made by clinicians when managing CHB and provide an evidence and experience-based approach to its management.
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Mistakes in the management of ECF and how to avoid them
Gl fistulae can be one of the most challenging complications of intestinal disease to manage
Gastrointestinal fistulae can be one of the most challenging complications of intestinal disease to manage. These abnormal tracts connect the epithelialised gut surface to either another part of the gut, another organ or tissue, or to the skin (table 1). This connection can cause enteric contents to bypass important absorptive surfaces, resulting in insidious malnutrition or overt diarrhoea, infection within other organs or the exquisitely embarrassing occurrence of having faeculant material in a woman’s vagina or on a person’s skin. Understandably, this can have a major impact on a person’s quality of life and psychological wellbeing and hamper overall prognosis in terms of general health and wellbeing. Through careful multidisciplinary management of the situation much can be done to address the fears and expectations of patients: careful stoma management, medical therapies to control output, nutritional support and consideration of the central role that surgery plays in resolving a fistula.
Enterocutaneous and enteroatmospheric fistulae both connect the gut to the skin, but the difference between them is whether there is skin around the fistula opening (enterocutaneous) or the fistula opens onto a laparostomy wound (enteroatmospheric). Most enterocutaneous fistulae develop following surgical intervention; however, fistulae can occur spontaneously. Spontaneous fistulae typically arise with mucosal inflammation such as that occurring with Crohn’s disease, but they can also appear in patients with neoplasia, following radiation treatment, or in the presence of foreign bodies or infections (e.g. tuberculosis or actinomycosis).
Here, we focus on the errors that can be made when managing enterocutaneous fistulae, based on our clinical experience and the available evidence.
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