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BACKGROUND/AIM There are no clinically significant cutoff values of serum vitamin D levels and time points to predict the prognosis of colon cancer, particularly in patients who underwent curative surgical resection. PATIENTS AND METHODS We retrospectively analyzed serum vitamin D levels in 795 patients with stages I to III colon cancer who underwent curative surgical resection. RESULTS Patients with vitamin D levels below 12 ng/ml at one year after surgical resection demonstrated a significantly reduced disease-free survival (DFS) than those who did not have vitamin D deficiency (p=0.01). In the multivariate analysis, an age of 70 years or older [hazard ratio (HR)=1.992; p=0.001], pathologic stage (HR=3.739; p

Assays for cancer diagnosis via the analysis of biomarkers on circulating extracellular vesicles (EVs) typically have lengthy sample workups, limited throughput or insufficient sensitivity, or do not use clinically validated biomarkers. Here we report the development and performance of a 96-well assay that integrates the enrichment of EVs by antibody-coated magnetic beads and the electrochemical detection, in less than one hour of total assay time, of EV-bound proteins after enzymatic amplification. By using the assay with a combination of antibodies for clinically relevant tumour biomarkers (EGFR, EpCAM, CD24 and GPA33) of colorectal cancer (CRC), we classified plasma samples from 102 patients with CRC and 40 non-CRC controls with accuracies of more than 96%, prospectively assessed a cohort of 90 patients, for whom the burden of tumour EVs was predictive of five-year disease-free survival, and longitudinally analysed plasma from 11 patients, for whom the EV burden declined after surgery and increased on relapse. Rapid assays for the detection of combinations of tumour biomarkers in plasma EVs may aid cancer detection and patient monitoring.

An isolated tibial component revision could be a treatment option for isolated tibial side loosening; however, few studies have proved its efficacy. This study aimed to compare the clinical and radiological outcomes between isolated (tibial component) and total (femoral and tibial component) revision total knee arthroplasty (TKA).Between January 2008 and February 2017, 31 patients underwent revision TKA for isolated tibial side loosening; 14 underwent an isolated tibial component revision (isolated group) and 17 underwent total (both femoral and tibial components) revision surgery (total group). The postoperative range of motion (ROM), Western Ontario and McMaster Universities osteoarthritis (WOMAC) index, Knee Society knee score (KSKS), Knee Society function score (KSFS), and mechanical axis (MA) were compared between the two groups. The intraoperative tourniquet time and amount of blood drainage were also compared.The mean follow-up durations in the isolated and total groups were 40.7 and 56.1 months, respectively. Both groups had similar postoperative ROM, WOMAC index, KSKS, KSFS, and MA; however, significantly shorter tourniquet time (105.2 vs. 154.6 min, P 0.001) and less blood drainage (417.2 vs. 968.1 ml, P 0.001) were noted in the isolated group than in the total group.Isolated tibial component revision TKA for tibial component loosening showed comparable clinical and radiological outcomes to those of total revision TKA. The advantages of the isolated tibial component revision surgery were short operation time and small blood loss.Level III, Retrospective comparative study.

Background/Aims Belching disorder (BD) is clinically distinct from gastroesophageal reflux disease (GERD) with belching. Supragastric belching (SGB) is closely associated with reflux episodes. This study investigates belch characteristics in association with reflux, compared between patients with BD and those who had GERD with belching. Methods Impedance pH monitoring data from 10 patients with BD and 10 patients with GERD who exhibited belching were retrospectively analyzed. Belches were considered “isolated“ or “reflux-related” and acidic/non-acidic. Belch characteristics were compared between patients with BD and those with GERD. Results Symptomatic belches were more frequent in patients with BD than in patients with GERD (median, 160.5 vs 56.0, P < 0.05). SGB was the most common type in both groups; common subtypes comprised “isolated“ in patients with BD and “isolated during the reflux period” in patients with GERD. Reflux-related SGB was more common in patients with GERD than in BD (78.3% vs 45.2%, P < 0.005). Both “preceding belching” including the reflux period and acidic SGB were more common in patients with GERD than in BD (31.8% vs 8.6% and 38.1% vs 8.9%, both P < 0.05). Supragastric belch number positively correlated with all reflux episodes in patients with GERD (adjusted R2 = 0.572, P = 0.007). Conclusions BD is characterized by more belching, compared to GERD. SGB is more frequently associated with reflux in GERD than in BD; acidity may be related to GERD. In BD, SGB is typically non-acidic and unrelated to reflux. Distinct SGB characteristics may reflect different pathogenic mechanisms of reflux and associated symptoms.

Purpose: We analyzed the safety and feasibility of preoperative short-course radiotherapy (SCRT) followed by consolidation chemotherapy for patients with locally advanced rectal cancer (LARC).Methods: From April 2018 to May 2019, 19 patients with LACR were treated with SCRT followed by three cycles of consolidation chemotherapy with leucovorin, fluorouracil, and oxaliplatin (FOLFOX6) before surgery. Adjuvant chemotherapy relied on oxaliplatin. Tumor response, patient compliance, and toxicities were analyzed.Results: The median age was 60 years (range 44–71), and 16 of the patients were male. The median tumor height was 5 cm (range 0–9) from anal verge. All patients received a total dose of 25 Gy in five fractions. The number of cycles of FOLFOX6 before surgery was three in 17, four in one, five in one. Five patients required dose reductions in consolidation chemotherapy. The median interval between initiation of SCRT and surgery was 10.6 weeks (range 8.6–16.4). A pathologic complete response was seen in two patients (11%). Grade III toxicities to the preoperative treatment were seen in five patients (26%): diarrhea in two, a decreased white blood cell count in one, and anemia in two. Postoperative complications arising within 30 days developed in five patients (26%). During the median follow-up period of 20.4 months, there was no tumor recurrence. Conclusion: Preoperative SCRT followed by oxaliplatin-based consolidation chemotherapy showed acceptable toxicity and feasibility in patients with LARC. Prospective randomized trials are warranted to verify the efficacy and safety of this treatment strategy compared with conventional long-course concurrent chemoradiotherapy.

A standardized small bowel (SB) cleansing scale is currently not available. The aim of this study was to develop an automated calculation software for SB cleansing score using deep learning. Consecutively performed capsule endoscopy cases were enrolled from three hospitals. A 5-step scoring system based on mucosal visibility was trained for deep learning in the training set. Performance of the trained software was evaluated in the validation set. Average cleansing score (1.0 to 5.0) by deep learning was compared to clinical grading (A to C) reviewed by clinicians. Cleansing scores decreased as clinical grading worsened (scores of 4.1, 3.5, and 2.9 for grades A, B, and C, respectively, P P P

Mineral wool is an insulation material commonly used in passive fire protection (PFP) systems on offshore installations. Insulation materials have only been considered functional materials for thermal analysis in the conventional offshore PFP system design method. Hence, the structural performance of insulation has yet to be considered in the design of PFP systems. However, the structural elements of offshore PFP systems are often designed with excessive dimensions to satisfy structural requirements under external loads such as wind, fire and explosive pressure. To verify the structural contribution of insulation material, it was considered a structural material in this study. A series of material tensile tests was undertaken with two types of mineral wool at room temperature and at elevated temperatures for fire conditions. The mechanical properties were then verified with modified methods, and a database was constructed for application in a series of nonlinear structural and thermal finite-element analyses of an offshore bulkhead-type PFP system. Numerical analyses were performed with a conventional model without insulation and with a new suggested model with insulation. These analyses showed the structural contribution of the insulation in the structural behaviour of the PFP panel. The results suggest the need to consider the structural strength of the insulation material in PFP systems during the structural design step for offshore installations.

BACKGROUND An oxaliplatin-based chemotherapy regimen improves the survival outcomes of patients with stage III colon cancer. However, its complications are well-known. OBJECTIVE The purpose of this study was to distinguish between the survival outcomes of patients who underwent curative resection for stage III colon cancer with oxaliplatin chemotherapy and those who underwent such resection without oxaliplatin chemotherapy. DESIGN This was a retrospective analytical study based on prospectively collected data. SETTINGS This study used data on patients who underwent surgery at our hospital between January 2010 and December 2014. PATIENTS A cohort of 254 consecutive patients who underwent curative resection for stage III colon cancer was included in this study. The patients were divided into 2 groups: patients with isolated pericolic lymph node metastasis (n = 175) and those with extrapericolic lymph node metastasis (n = 79). MAIN OUTCOME MEASURES Clinicopathologic features and 3-year survival outcomes were analyzed with and without oxaliplatin therapy in the pericolic lymph node group. RESULTS The pericolic lymph node group showed significantly improved overall survival compared with the extrapericolic lymph node group at a median follow-up of 48.5 months (95.8% vs 77.8%; p < 0.001). In contrast, there was no significant difference in overall survival (99.0% vs 92.0%; p = 0.137) and disease-free survival (89.1% vs 88.2%; p = 0.460) between the oxaliplatin and nonoxaliplatin subgroups of the pericolic lymph node group. Multivariate analysis showed that the administration of oxaliplatin chemotherapy to the pericolic lymph node group did not lead to a significant difference in the overall survival (p = 0.594). LIMITATIONS The study was limited by its retrospective design and single institutional data analysis. CONCLUSIONS This study suggests that the anatomic extent of metastatic lymph nodes could affect patient prognosis, and the effect of oxaliplatin-based adjuvant chemotherapy may not be prominent in stage III colon cancer with isolated pericolic lymph node metastasis.

BACKGROUND The optimal lymph node dissection with central vascular ligation is an important part for oncological outcomes after laparoscopic right-sided colon cancer surgery. Few studies have examined the clinical value of indocyanine green fluorescence imaging-guided D3 dissection for right-sided colon cancer. OBJECTIVES We assessed the clinical value of indocyanine green fluorescence imaging-guided laparoscopic surgery in improving the radicality of lymph node dissection for right-sided colon cancer by comparing the outcomes of conventional laparoscopic surgery. DESIGN The data were retrospectively reviewed and analyzed. SETTING This study was conducted at a single university hospital. PATIENTS A 1:2 matched case-control study included 25 patients undergoing fluorescence imaging-guided laparoscopic surgery and 50 patients undergoing conventional laparoscopic surgery for clinical T3 or T4 right-sided colon cancer between June 2016 and December 2017. MAIN OUTCOME MEASURES The extent of D3 dissection and pathological results (tumor stage, lymph node yield, and number of metastatic lymph nodes) were analyzed. RESULTS The 2 groups were similar in baseline characteristics. The numbers of harvested pericolic and intermediate lymph nodes were not different between the 2 groups. The numbers of central lymph nodes (14 vs 7, p < 0.001) and total harvested lymph nodes (39 vs 30, p = 0.003) were significantly higher in the fluorescence group than in the conventional group. In the multivariate analysis, the use of indocyanine green fluorescence imaging was an independently related factor for the retrieval of higher numbers of overall and central lymph nodes. The number of metastatic lymph nodes was not significantly different between the 2 groups. LIMITATIONS The results of this study were limited by its small patient numbers and retrospective nature. CONCLUSIONS Real-time indocyanine green fluorescence imaging of lymph nodes may improve the performance of more radical D3 lymph node dissection during laparoscopic right hemicolectomy for advanced right-sided colon cancer. See Video Abstract at http://links.lww.com/DCR/B150. LA CIRUGIA LAPAROSCOPICA GUIADA POR IMAGENES DE FLUORESCENCIA VERDE INDOCIANINA PODRIA LOGRAR UNA DISECCION RADICAL D3 EN PACIENTES CON CANCER DE COLON AVANZADO DEL LADO DERECHO: La diseccion optima de los ganglios linfaticos con ligadura vascular central es una parte importante para los resultados oncologicos despues de la cirugia laparoscopica de cancer de colon del lado derecho. Pocos estudios han examinado el valor clinico de la diseccion D3 guiada por imagenes de fluorescencia verde indocianina para el cancer de colon del lado derecho.Evaluamos el valor clinico de la cirugia laparoscopica guiada por imagen de fluorescencia verde indocianina para mejorar la radicalidad de la diseccion de ganglios linfaticos para el cancer de colon del lado derecho mediante la comparacion de los resultados de la cirugia laparoscopica convencional.Los datos se revisaron y analizaron retrospectivamente.Este estudio se realizo en un solo hospital universitario.Un estudio de casos y controles emparejado 1:2 incluyo a 25 pacientes sometidos a cirugia laparoscopica guiada por imagenes de fluorescencia y 50 pacientes sometidos a cirugia laparoscopica convencional para cancer de colon derecho clinico T3 o T4 entre Junio de 2016 y Diciembre de 2017.Se analizo el alcance de la diseccion D3 y los resultados patologicos (estadio tumoral, rendimiento de los ganglios linfaticos y numero de ganglios linfaticos metastasicos).Los dos grupos fueron similares en las caracteristicas basicas. El numero de ganglios linfaticos pericolicos e intermedios recolectados no fue diferente entre los dos grupos. El numero de ganglios linfaticos centrales (14 vs 7, p < 0.001) y el total de ganglios linfaticos recolectados (39 vs 30, p = 0.003) fueron significativamente mayores en el grupo de fluorescencia que en el grupo convencional. En el analisis multivariante, el uso de imagenes de fluorescencia verde indocianina fue un factor independiente relacionado para la recuperacion de un mayor numero de ganglios linfaticos centrales y globales. El numero de ganglios linfaticos metastasicos no fue significativamente diferente entre los dos grupos.Los resultados de este estudio fueron limitados por su pequeno numero de pacientes y su naturaleza retrospectiva.Las imagenes de fluorescencia verde indocianina en tiempo real de los ganglios linfaticos pueden mejorar el rendimiento de la diseccion mas radical de los ganglios linfaticos D3 durante la hemicolectomia derecha laparoscopica para el cancer de colon avanzado del lado derecho. Consulte Video Resumen en http://links.lww.com/DCR/B150.

Introduction There are several medical elective programs for low-income countries especially in medically vulnerable places. The Hospital Central de Quelimane (HCQ) is a regional hospital in Quelimane, capital city of the province of Zambezia in Mozambique. The HCQ serves as a regional base hospital for urgent and severe patients. Methods Four emergency medicine (EM) residents participated in our 2017-2018 rotational program for HCQ, to share medical knowledge with the local medical doctors and support the demands of medical equipment skills and educational programs. We determined the current capabilities of HCQ and designed a rotational program in accordance with the demands in the following areas: resuscitation, trauma, critical care, and radiology. We also introduced continuous education programs and administrative methods for future development of education. Results Throughout the four rotations of our EM residents, we conducted daily education and several practical lessons based on the demands of the local doctors and equipment operation. The educational program was administered by an educational administrator who was responsible for updating the medical and technical knowledge of doctors. With our programs, the doctors of HCQ were able to perform resuscitation and critical protocols, including manipulating equipment such as mechanical ventilator and defibrillator. Conclusion The rotation program by the four residents was successful, in terms of sharing medical knowledge and equipment management, and filling gaps identified in the operation of a modern hospital.

The number of digital healthcare mobile applications in the market is exponentially increasing owing to the development of mobile networks and widespread usage of smartphones. However, only few of these applications have been adequately validated. Like many mobile applications, in general, the use of healthcare applications is considered safe; thus, developers and end users can easily exchange them in the marketplace. However, existing platforms are unsuitable for collecting reliable data for evaluating the effectiveness of the applications. Moreover, these platforms reflect only the perspectives of developers and experts, and not of end users. For instance, typical clinical trial data collection methods are not appropriate for participant-driven assessment of healthcare applications because of their complexity and high cost. Thus, we identified the need for a participant-driven data collection platform for end users that is interpretable, systematic, and sustainable, as a first step to validate the effectiveness of the applications. To collect reliable data in the participatory trial format, we defined distinct stages for data preparation, storage, and sharing. The interpretable data preparation consists of a protocol database system and semantic feature retrieval method that allow a person without professional knowledge to create a protocol. The systematic data storage stage includes calculation of the collected data reliability weight. For sustainable data collection, we integrated a weight method and a future reward distribution function. We validated the methods through statistical tests involving 718 human participants. The results of a validation experiment demonstrate that the compared methods differ significantly and prove that the choice of an appropriate method is essential for reliable data collection, to facilitate effectiveness validation of digital healthcare applications. Furthermore, we created a Web-based system for our pilot platform to collect reliable data in an integrated pipeline. We compared the platform features using existing clinical and pragmatic trial data collection platforms.

We aimed to evaluate whether a short distal resection margin (p p = 0.008). Subgroup analysis revealed that a distal resection margin of p = 0.001). A distal resection margin of

Lateral pelvic node dissection has significant technical difficulty and a high incidence of surgical morbidity. A steep learning curve is anticipated in performing lateral pelvic node dissection. However, no study has previously analyzed the learning curve and surgical skill acquisition for this complex procedure.We aimed to evaluate the learning process for performing robotic total mesorectal excision with lateral pelvic node dissection in patients with rectal cancer.This is a retrospective analysis of a prospectively collected database.This study was conducted at a tertiary cancer center.A total of 100 patients who underwent robotic total mesorectal excision with lateral pelvic node dissection between 2011 and 2017 were included.A cumulative sum analysis was calculated based on the number of unilateral retrieved lateral pelvic nodes. Operative time, estimated bloodloss, lateral pelvic node metastatic rate, postoperative morbidities, and local recurrence were also analyzed.Cumulative sum modeling suggested 4 learning phases: learning I (33 patients), learning II (19 patients), consolidation (30 patients), and competence (18 patients). In the consolidation and competence phases, we adopted fluorescence imaging and standardized the surgical procedure on the basis of anatomical planes. The competence phase had the greatest number of unilateral retrieved lateral pelvic nodes (12.8 vs 4.9, 8.2, and 10.4; p0.001). Urinary complications, including urinary retention and postoperative α-blocker usage, were more frequently observed in learning phase I than in the competence phase (39.4% vs 16.7%, p = 0.034). During the median follow-up of 44.2 months, local recurrence in the pelvic sidewall was observed in 4 patients from learning phase I and in 1 patient from learning phase II.This study was limited by its retrospective design.Completeness of the lateral pelvic node dissection procedure increased with the surgeon's experience and as new imaging systems and surgical technique standardization were implemented. Further studies are warranted to determine the oncologic outcomes associated with each phase. See Video Abstract at http://links.lww.com/DCR/B774.ANTECEDENTES:La disección linfática pélvica lateral tiene una dificultad técnica significativa y una alta incidencia de morbilidad quirúrgica. Se prevé una curva de aprendizaje muy pronunciada al realizar la disección linfática pélvica lateral. Sin embargo, ningún estudio ha analizado previamente la curva de aprendizaje y la adquisición de habilidades quirúrgicas para este procedimiento.OBJETIVOS:Nuestro objetivo fue evaluar el proceso de aprendizaje para realizar la escisión total de mesorrecto robótica con disección linfática pélvica lateral en pacientes con cáncer de recto.DISEÑO:Este es un análisis retrospectivo de una base de datos recopilada prospectivamente.AJUSTE:Este estudio se realizó en un centro oncológico terciario.PACIENTES:Un total de 100 pacientes fueron sometidos a escisión total de mesorrecto robótica con disección linfática pélvica lateral entre 2011 y 2017.PRINCIPALES MEDIDAS DE DESENLACE:Se calculó un análisis de suma acumulativa basado en el número unilateral de ganglios pélvicos laterales recuperados. También se analizaron el tiempo operatorio, la pérdida de sangre estimada, la tasa de metástasis ganglionares pélvicas laterales, las morbilidades postoperatorias y la recidiva local.RESULTADOS:El modelado total acumulativo sugirió cuatro fases de aprendizaje: aprendizaje I (33 pacientes), aprendizaje II (19 pacientes), consolidación (30 pacientes) y competencia (18 pacientes). En las fases de consolidación y competencia, adoptamos imágenes de fluorescencia y estandarizamos el procedimiento quirúrgico basado en planos anatómicos, respectivamente. La fase de competencia tuvo el mayor número de ganglios pélvicos laterales recuperados unilateralmente (12,8 frente a 4,9, 8,2 y 10,4; p0,001). Las complicaciones urinarias, incluida la retención urinaria y el uso posoperatorio de bloqueadores beta, se observaron con más frecuencia en la fase de aprendizaje I que en la fase de competencia (39,4% frente a 16,7%, p = 0,034). Durante la mediana de seguimiento de 44,2 meses, se observó una recidiva local en la pared lateral pélvica en cuatro pacientes de la fase de aprendizaje I y en un paciente de la fase de aprendizaje II.LIMITACIONES:Este estudio estuvo limitado por su diseño retrospectivo.CONCLUSIÓNES:La completitud del procedimiento de disección linfática pélvica lateral aumentó con la experiencia del cirujano y a medida que se implementaron nuevos sistemas de imágenes y estandarización de técnicas quirúrgicas. Se necesitan más estudios para determinar los resultados oncológicos asociados con cada fase. Consulte Video Resumen en http://links.lww.com/DCR/B774.

The manual reading of capsule endoscopy (CE) videos in small bowel disease diagnosis is time-intensive. Algorithms introduced to automate this process are premature for real clinical applications, and multi-diagnosis using these methods has not been sufficiently validated. Therefore, we developed a practical binary classification model, which selectively identifies clinically meaningful images including inflamed mucosa, atypical vascularity or bleeding, and tested it with unseen cases. Four hundred thousand CE images were randomly selected from 84 cases in which 240,000 images were used to train the algorithm to categorize images binarily. The remaining images were utilized for validation and internal testing. The algorithm was externally tested with 256,591 unseen images. The diagnostic accuracy of the trained model applied to the validation set was 98.067%. In contrast, the accuracy of the model when applied to a dataset provided by an independent hospital that did not participate during training was 85.470%. The area under the curve (AUC) was 0.922. Our model showed excellent internal test results, and the misreadings were slightly increased when the model was tested in unseen external cases while the classified ‘insignificant’ images contain ambiguous substances. Once this limitation is solved, the proposed CNN-based binary classification will be a promising candidate for developing clinically-ready computer-aided reading methods.

NPU Scheduler Tiling memory transactions between internal memories and external memories Communicating with AP Host and other processing units

Objective Smart glasses can provide sonographers with real-time ultrasound images. In the present study, we aimed to evaluate the utility of smart-glasses for ultrasound-guided peripheral venous access. Methods In this randomized, crossover-design, simulation study, 12 participants were recruited from the emergency department residents at a university hospital. Each participant attempted ultrasound-guided peripheral venous access on a pediatric phantom at intervals of 5 days with (glasses group) or without (non-glasses group) the use of smart glasses. In the glasses group, participants confirmed the ultrasound image through the lens of the smart glasses. In the non-glasses group, participants confirmed the ultrasound image through the display viewer located next to the phantom. Procedure time was regarded as the primary outcome, while secondary outcomes included the number of head movements for the participant, number of skin punctures, number of needle redirections, and subjective difficulty. Results No significant differences in procedural time were observed between the groups (non-glasses group: median time, 15.5 seconds; interquartile range [IQR], 10.3 to 27.3 seconds; glasses group: median time, 19.0 seconds; IQR, 14.3 to 39.3 seconds; P=0.58). The number of head movements was lower in the glasses group than in the non-glasses group (glasses group: median, 0; IQR, 0 to 0; non-glasses group: median, 4; IQR, 3 to 5; P

Background The purpose of this study was to investigate the safety of laparoscopic cytoreductive surgery versus open surgery for patients with limited peritoneal metastases from colorectal cancer. Methods Laparoscopic surgery for patients with colorectal cancer with peritoneal metastases has been performed at our institution since December 2004. We retrospectively evaluated data from patients with colorectal cancer metastatic to the peritoneum, with a peritoneal cancer index ≤10. We compared short-term operative and survival outcomes in the laparoscopic cytoreductive surgery group and open cytoreductive surgery group. Results A total of 21 patients underwent open cytoreductive surgery and 42 underwent laparoscopic cytoreductive surgery, of whom 6 (14%) required open conversion. Clinicopathologic characteristics and operative outcomes were comparable between the groups. Complete cytoreduction was achieved in all patients in the laparoscopic cytoreductive surgery group and in 19 patients (91%) in the open cytoreductive surgery group (P = .042). Both the mean hospital stay and use of postoperative narcotics were significantly less in the laparoscopic cytoreductive surgery group than in the open cytoreductive surgery group. The type of operation (open cytoreductive surgery versus laparoscopic cytoreductive surgery) was not related to survival outcomes. Conclusion With careful selection by experienced laparoscopic surgeons, laparoscopic cytoreductive surgery was technically feasible and safe to treat colorectal cancer patients with limited peritoneal metastases.

To date only few data have been available relating to the oncologic safety of intersphincteric resection in such advanced tumors.This study aimed to elucidate the oncologic outcomes and clinical factors affecting the long-term survival of patients who underwent preoperative chemoradiotherapy followed by intersphincteric resection for locally advanced rectal cancers.This was a retrospective analysis of prospectively collected departmental data.The study was conducted at a department of colorectal surgery in a tertiary care teaching hospital between January 2009 and September 2015.A cohort of 147 consecutive patients with low rectal cancer undergoing intersphincteric resection after preoperative chemoradiotherapy was included.Kaplan-Meier analyses were used to evaluate the 3-year disease-free survival and local recurrence rates. Logistic regression analyses were used to analyze the influence of tumor response and other prognostic factors on survival outcomes.Median follow-up was 34 months (range, 8-94 mo). The estimated overall 3-year disease-free survival and local recurrence rates were 64.9% and 11.7%. Circumferential resection margin involvement and pathologic T stage (ypT stage) were significant predictors of cancer relapse. The 3-year disease-free survival was 47.4% for patients with ypT3 tumors compared with 82.0% for those with ypT0-2 tumors (p = 0.001). The 3-year disease-free survival was 36.5% for patients with involved circumferential resection margins compared with 69.7% for those with a noninvolved circumferential resection margin (p = 0.003). On multivariate analysis, ypT stage, ymrT stage, and circumferential resection margin status were associated with worse disease-free survival. Clinical T-stage and pathologic distal margin status were not independent factors affecting oncologic outcomes.This study is limited with respect to its retrospective design.In these patients with locally advanced low rectal cancers, intersphincteric resection after preoperative chemoradiotherapy was associated with acceptable oncologic outcomes. See Video Abstract at http://links.lww.com/DCR/A941.

Capsule endoscopy (CE) is a preferred diagnostic method for analyzing small bowel diseases. However, capsule endoscopes capture a sparse number of images because of their mechanical limitations. Post-procedural management using computational methods can enhance image quality. Additional information, including depth, can be obtained by using recently developed computer vision techniques. It is possible to measure the size of lesions and track the trajectory of capsule endoscopes using the computer vision technology, without requiring additional equipment. Moreover, the computational analysis of CE images can help detect lesions more accurately within a shorter time. Newly introduced deep leaning-based methods have shown more remarkable results over traditional computerized approaches. A large-scale standard dataset should be prepared to develop an optimal algorithms for improving the diagnostic yield of CE. The close collaboration between information technology and medical professionals is needed.

Of late, deep neural networks have become ubiquitous in mobile applications. As mobile devices generally require immediate response while maintaining user privacy, the demand for on-device machine learning technology is on the increase. Nevertheless, mobile devices suffer from restricted hardware resources, whereas deep neural networks involve considerable computation and communication. Therefore, the implementation of a neural-network specialized hardware accelerator, generally called neural processing unit (NPU), has started to gain attention for the mobile application processor (AP). However, NPUs for commercial mobile AP face two challenges that are difficult to realize simultaneously: execution of a wide range of applications and efficient performance. In this paper, we propose a flexible but efficient NPU architecture for a Samsung flagship mobile system-on-chip (SoC). To implement an efficient NPU, we design an energy-efficient inner-product engine that utilizes the input feature map sparsity. We propose a re-configurable MAC array to enhance the flexibility of the proposed NPU, dynamic internal memory port assignment to maximize on-chip memory bandwidth utilization, and efficient architecture to support mixed-precision arithmetic. We implement the proposed NPU using the Samsung 5nm library. Our silicon measurement experiments demonstrate that the proposed NPU achieves 290.7 FPS and 13.6 TOPS/W, when executing an 8-bit quantized Inception-v3 model [1] with a single NPU core. In addition, we analyze the proposed zero-skipping architecture in detail. Finally, we present the findings and lessons learned when implementing the commercial mobile NPU and interesting avenues for future work.

BACKGROUND Venous invasion is a poor prognostic factor in colon cancer but is often underreported with significant variability. OBJECTIVES We aimed to determine the impact of an elastin stain on venous invasion detection in colon cancer and evaluate the value of venous invasion in predicting disease recurrence in combination with lymph node status and other prognostic factors. DESIGN This is a retrospective analysis of a prospectively collected database. SETTING This study was conducted at a tertiary cancer center. PATIENTS A total of 418 patients who underwent curative resection for stage I to III colon cancer and routinely adopted an elastin stain were evaluated. MAIN OUTCOME MEASURES Venous invasion detection rate after adopting elastin stain, prognostic factors influencing disease recurrences by multivariate Cox regression models, and survival were measured. The zones of lymph node metastasis were defined as LNZ1, LNZ2, and LNZ3, corresponding to metastases in the pericolic, intermediate, and apical nodes. RESULTS Venous invasion detection rate increased from 11.3% to 35.4% compared with the previous period in which only hematoxylin and eosin stain was performed. Cox regression analysis showed venous invasion (HR, 3.856; 95% CI, 1.249-11.910; p = 0.019) and lymph node metastases (HR, 3.156; 95% CI, 1.094-9.108; p = 0.034) in all stages and LNZ 2, 3 (HR, 2.649; 95% CI, 1.244-5.640; p = 0.012) in stage III to be significantly associated with poor disease-free survival. When stratifying all patients by these 3 factors, patients with stage III [LNZ1/venous invasion (-)] had disease-free survival comparable with stage I, but significantly better disease-free survival than those with stage II [venous invasion (+)] (p = 0.018). Patients with stage II [venous invasion (+)] had better disease-free survival by using adjuvant chemotherapy (p < 0.001). LIMITATIONS This study was limited by its retrospective design. CONCLUSION Elastin stain contributed to a considerable increase in venous invasion detection. Venous invasion can be a powerful predictor of poor disease-free survival beyond lymph node metastases when limited to the pericolic area and is useful for deciding the use of adjuvant chemotherapy in stage II colon cancer. See Video Abstract at http://links.lww.com/DCR/B573. EL VALOR PRONSTICO DE LA INVASIN VENOSA DETECTADA POR LA TINCIN DE ELASTINA PUEDE SUPERAR EL ESTADO DE LOS GANGLIOS LINFTICOS EN EL CNCER DE COLON ANTECEDENTES:Invasion venosa (IV) es un factor de mal pronostico en el cancer de colon, que frecuentemente no se informa con una variabilidad significativa.OBJETIVOS:Nuestro objetivo fue determinar el impacto de tincion de elastina en la deteccion de IV en el cancer de colon y evaluar el valor de IV en la prediccion de la recurrencia de la enfermedad en combinacion con el estado de los ganglios linfaticos y otros factores pronosticos.DISENO:Este es un analisis retrospectivo de una base de datos recopilada prospectivamente.ENTORNO CLINICO:Este estudio se realizo en un centro oncologico de referencia de tercer nivel.PACIENTES:Se valoraron un total de 418 pacientes sometidos a reseccion curativa por cancer de colon en estadio I-III utilizando de manera rutinaria una tincion de elastina.PRINCIPALES MEDIDAS DE VALORACION:Se midieron la tasa de deteccion de IV despues de adoptar la tincion de elastina, los factores de pronostico que influyen en las recurrencias de la enfermedad mediante modelos de regresion de Cox multivariados y la supervivencia. La zona de metastasis ganglionares se definio como, LNZ1, LNZ2 y LNZ3, correspondientes a las metastasis en los ganglios pericolicos, intermedios y apicales, respectivamente.RESULTADOS:La tasa de deteccion de IV aumento de 11,3% a 35,4% en comparacion con el periodo anterior en el que solo se realizo tincion con hematoxilina y eosina. El analisis de regresion de Cox mostro VI (razon de riesgo, 3.856; intervalo de confianza [IC] del 95%, 1.249-11.910, p = 0.019) y metastasis en los ganglios linfaticos (razon de riesgo, 3.156; IC del 95%, 1.094-9.108, p = 0.034) en todos los estadios y LNZ 2, 3 (cociente de riesgo, 2.649; IC del 95%, 1.244-5.640, p = 0.012) en el estadio III se asociaron significativamente con una pobre supervivencia libre de enfermedad. Al estratificar a todos los pacientes segun estos tres factores, los pacientes con estadio III [LNZ1 / VI (-)] tuvieron una sobrevivencia sin enfermedad (SSE) comparable con el estadio I, pero una supervivencia libre de enfermedad significativamente mejor que aquellos con estadio II [VI (+)] (p = 0,018). Pacientes en estadio II [VI (+)] tuvieron una mejor supervivencia sin enfermedad mediante el uso de quimioterapia adyuvante (p

BACKGROUND The long-term oncologic efficacy of robotic surgery for patients with rectal cancer is unknown. OBJECTIVE The aim of the study was to investigate survival outcomes of robotic total mesorectal excision for mid/low rectal cancer compared with those of laparoscopic surgery. DESIGN We performed a single-center retrospective analysis. SETTING The data of a tertiary academic institution was reviewed. PATIENTS A total of 705 patients underwent laparoscopic (n = 415) or robotic (n = 118) low anterior resection for stage I to III mid/low rectal cancer. A total of 118 patients in each group were selected from the original data set by using propensity score matching. MAIN OUTCOME MEASURES The main outcomes were 5-year disease-free survival, distant recurrence, and local recurrence. RESULTS The 2 groups were balanced in terms of basic characteristics, perioperative treatment, and pathological stage. The 5-year disease-free survival rate was 80.5% in the laparoscopic group and 87.6% in the robotic group (p = 0.118). The 5-year distant recurrence rate and local recurrence rate were 19.0% and 4.2% in the laparoscopic group and 10.0% and 3.7% in the robotic group (p = 0.048 and p = 0.846). In a subgroup of patients who received preoperative chemoradiation and had ypT3/4 tumors, the 5-year distant recurrence and local recurrence rates were 44.8% and 5.0% in the laparoscopic group and 9.8% and 9.8% in the robotic group (p = 0.014 and p = 0.597). LIMITATIONS The retrospective nature of the study, potential selection bias with distinct demographics between the groups, and relatively small number of cases are limitations. CONCLUSIONS Robotic surgery for mid/low rectal cancer shows similar long-term oncologic outcomes with laparoscopic surgery but is beneficial to a certain group of patients with advanced rectal cancer with poor response to neoadjuvant chemoradiation. Additional studies are required to confirm our results. See Video Abstract at http://links.lww.com/DCR/B546. LA CIRUGA ROBTICA MUESTRA RESULTADOS ONCOLGICOS A LARGO PLAZO SIMILARES A LA CIRUGA LAPAROSCPICA EN CASOS DE CNCER DE RECTO MEDIO / BAJO, PERO ES VENTAJOSA EN CASOS YPT POSTQUIMIORADIOTERAPIA PREOPERATORIA ANTECEDENTES:Se desconoce la eficacia oncologica a largo plazo de la cirugia robotica en pacientes con cancer de recto.OBJETIVO:La finalidad de nuestro estudio fue el investigar los resultados de supervivencia de la escision mesorrectal total robotica en casos de cancer de recto medio / bajo en comparacion con los de la cirugia laparoscopica.DISENO:Realizamos un analisis retrospectivo mono-centrico.AJUSTE:Se revisaron los datos de una institucion academica terciaria.PACIENTES:705 pacientes fueron sometidos a reseccion anterior baja laparoscopica (n = 415) o robotica (n = 118) para cancer de recto medio / bajo en estadio I-III. Se selecciono un total de 118 pacientes en cada grupo del conjunto de datos original utilizando el emparejamiento por puntuacion de propension.RESULTADOS PRINCIPALES:Estos fueron, la supervivencia libre de enfermedad a 5 anos, la recurrencia a distancia y la recurrencia local.RESULTADOS:Los dos grupos estaban equilibrados en cuanto a caracteristicas basicas, tratamiento peri-operatorio y estadio patologico. La tasa de sobrevida libre de enfermedad a 5 anos fue del 80,5% en el grupo laparoscopico y del 87,6% en el grupo robotico (p = 0,118). La tasa de recurrencia a distancia a 5 anos y la tasa de recurrencia local fueron 19,0% y 4,2% en el grupo laparoscopico y 10,0% y 3,7% en el grupo robotico, respectivamente (p = 0,048 y p= 0,846). En el subgrupo de pacientes que recibieron quimio-radioterapia pre-operatoria y tenian tumores ypT3-4, las tasas de recidiva a distancia a 5 anos y recidiva local fueron 44,8% y 5,0% en el grupo laparoscopico y 9,8% y 9,8% en el grupo robotico, respectivamente (p = 0.014 y p = 0.597).LIMITACIONES:La naturaleza retrospectiva del estudio, el posible sesgo en la seleccion con datos demograficos distintos entre los grupos y un numero relativamente pequeno de casos son limitaciones importantes.CONCLUSIONES:La cirugia robotica para el cancer de recto medio / bajo muestra resultados oncologicos a largo plazo similares con la cirugia laparoscopica, pero es mas beneficiosa en ciertos grupos de cancer de recto avanzado con mala respuesta a la quimio-radioterapia neoadyuvante. Se requieren mas estudios para confirmar nuestros resultados. Consulte Video Resumen en http://links.lww.com/DCR/B546.).

Background: A simple classification for the relevance of lesions (P0, P1, and P2; no bleeding potential, less likely to bleed, and more likely to bleed, respectively) based on capsule endoscopy (CE) findings has been used. This study aimed at investigating rebleeding rates and predictive factors of P0 and P1 lesions after obtaining negative findings in both, CE and computed tomography (CT), for patients with obscure gastrointestinal bleeding (OGIB). Methods: Among 193 patients resulted in negative CE findings defined as P0 or P1 lesions, 84 patients with negative results on CT images were enrolled in this study. The rebleeding rates and predictive factors were assessed in the P0 and P1 groups. Results: Overall rebleeding rate in patients with negative CT and CE was 17.9%; 18.4% in the P0 group; 17.4% in the P1 group within a median follow-up duration of 18.5 months. In the P0 and P1 groups, the cumulative rebleeding rates were 9.2%, 25.4%, and 25.4%, and 6.9%, 11.8%, and 18.6% at 12, 24, and 60 months, respectively (p = 0.97). There were no independent rebleeding associated factors in the P0 group, whereas Charlson comorbidity index (CCI) (hazard ratio (HR) = 2.019, 95% confidence interval (CI): 1.158–3.519, p = 0.013), and initial low hemoglobin (Hb) level (p = 0.037) were independent predictive factors responsible for rebleeding in the P1 group. Conclusions: Despite having negative findings on CT and CE, patients with OGIB have a significant potential rebleeding risk. Although there was no significant difference in rebleeding rates between the P0 and P1 groups on CE, the P1 group, with CCI or low initial Hb level, should be cautiously observed after the first bleeding episode.

On-device machine learning is critical for mobile products as it enables real-time applications (e.g. AI-powered camera applications), which need to be responsive, always available (i.e. do not require network connectivity) and privacy preserving. The platforms used in such situations have limited computing resources, power, and memory bandwidth. Enabling such on-device machine learning has triggered wide development of efficient neural-network accelerators that promise high energy and area efficiency compared to general-purpose processors, such as CPUs. The need to support a comprehensive range of neural networks has been important as well because the field of deep learning is evolving rapidly as depicted in Fig. 9.5.1. Recent work on neural-network accelerators has focused on improving energy efficiency, while obtaining high performance in order to meet the needs of real-time applications. For example, weightzero-skipping and pruning have been deployed in recent accelerators [2] –[7]. SIMD or systolic array-based accelerators [2] –[4], [6] provide flexibility to support various types of compute across a wide range of Deep Neural Network (DNN) models.

Magnetically assisted capsule endoscopy (MACE) is a noninvasive procedure and can overcome passive capsule movement that limits gastric examination. MACE has been studied in many trials as an alternative to upper endoscopy. However, to increase diagnostic accuracy of various gastric lesions, MACE should be able to provide stereoscopic, clear images and to measure the size of a lesion. So, we conducted the animal experiment using a novel three-dimensional (3D) MACE and a new hand-held magnetic controller for gastric examination. The purpose of this study is to assess the performance and safety of 3D MACE and hand-held magnetic controller through the animal experiment. Subsequently, via the dedicated viewer, we evaluate whether 3D reconstruction images and clear images can be obtained and accurate lesion size can be measured. During real-time gastric examination, the maneuverability and visualization of 3D MACE were adequate. A polypoid mass lesion was incidentally observed at the lesser curvature side of the prepyloric antrum. The mass lesion was estimated to be 10.9 x 11.5 mm in the dedicated viewer, nearly the same size and shape as confirmed by upper endoscopy and postmortem examination. Also, 3D and clear images of the lesion were successfully reconstructed. This animal experiment demonstrates the accuracy and safety of 3D MACE. Further clinical studies are warranted to confirm the feasibility of 3D MACE for human gastric examination.

This paper focuses on the design of a thinned array antenna using microstrip patch, which is a novel task in recent years. The aim of thinned array antenna synthesis is to obtain a desired radiation pattern with a minimum number of antenna elements. For uniform spacing array antenna, a certain number of elements can be removed, while maintaining a desired radiation pattern using genetic algorithm optimization. Parameters such as beamwidth and side lobe level are evaluated for proposed thinned array antenna by comparison with those obtained for different types of uniform array antennas. Numerical examples are presented to show the high energy efficiency of the proposed thinned array antenna.

Objective The primary objective of this study was to investigate adverse effects of ambient particulate matter of various sizes on the incidence of the prevalent autoimmune rheumatic diseases (AIRDs): RA, AS and SLE. Methods We investigated 230 034 participants in three metropolitan cities of South Korea from the National Health Insurance Service–National Sample Cohort (NHIS-NSC). Starting from January 2010, subjects were followed up until the first event of prevalent AIRDs, death, or December 2013. The 2008–2009 respective averages of particulate matter2.5 ( Results Adjusted for age, sex, region, and household income, in the two-pollutant model, RA incidence was positively associated with the 10 μg/m³ increment of particulate matter2.5 (aHR = 1.74, 95% CI: 1.06, 2.86), but not with particulate mattercoarse (aHR = 1.27, 95% CI: 0.87, 1.85). In the one-pollutant model, the elevated incidence rate of RA was slightly attenuated (particulate matter2.5 aHR = 1.61, 95% CI: 0.99, 2.61; particulate mattercoarse aHR = 1.13, 95% CI: 0.80, 1.61), with marginal statistical significance for particulate matter2.5. The RA incidence was also higher in the 4th quartile group of particulate matter2.5 compared with the first quartile group (aHR = 1.83, 95% CI: 1.07, 3.11). Adverse effects from particulate matter were not found for AS or SLE in either the one- or two-pollutant models. Conclusion The important components of particulate matter10 associated with RA incidence were the fine fractions (particulate matter2.5); no positive association was found between particulate matter and AS or SLE.

A clinical trial protocol defines the procedures that should be performed during a clinical trial. Every clinical trial begins with the design of its protocol. While designing the protocol, most researchers refer to electronic databases and extract protocol elements using a keyword search. However, state-of-the-art retrieval systems only offer text-based searches for user-entered keywords. In this study, we present an interactive retrieval system with a context-dependent and protocol-element-selection function for successfully designing a clinical trial protocol. To do this, we first introduce a database for a protocol retrieval system constructed from individual protocol data extracted from 184,634 clinical trials and 13,210 frame structures of clinical trial protocols. The database contains various semantic information that enables the protocols to be filtered during the search operation. Based on the database, we developed a web application called the clinical trial protocol database system (CLIPS; available at https://corus.kaist.edu/clips), which enables an interactive search by utilizing protocol elements. CLIPS provides the options to select the next element according to the previous element in the form of a connected tree, thus enabling an interactive search for combinations of protocol elements. The validation results show that our method achieves better performance than existing databases in predicting phenotypic features.

Background The introduction of complete mesocolic excision (CME) with central vascular ligation (CVL) for right-sided colon cancer has improved the oncologic outcomes. Recently, we have introduced a modified CME (mCME) procedure that keeps the same principles as the originally described CME but with a more tailored approach. Some retrospective studies have reported the favourable oncologic outcomes of laparoscopic mCME for right-sided colon cancer; however, no prospective multicentre study has yet been conducted. Methods This study is a multi-institutional, prospective, single-arm study evaluating the oncologic outcomes of laparoscopic mCME for adenocarcinoma arising from the right side of the colon. A total of 250 patients will be recruited from five tertiary referral centres in South Korea. The primary outcome of this study is 3-year disease-free survival. Secondary outcome measures include 3-year overall survival, incidence of surgical complications, completeness of mCME, and distribution of metastatic lymph nodes. The quality of laparoscopic mCME will be assessed on the basis of photographs of the surgical specimen and the operation field after the completion of lymph node dissection. Discussion This is a prospective multicentre study to evaluate the oncologic outcomes of laparoscopic mCME for right-sided colon cancer. To the best of our knowledge, this will be the first study to prospectively and objectively assess the quality of laparoscopic mCME. The results will provide more evidence about oncologic outcomes with respect to the quality of laparoscopic mCME in right-sided colon cancer. Trial registration ClinicalTrials.gov ID: NCT03992599 (June 20, 2019). The posted information will be updated as needed to reflect protocol amendments and study progress.

Objective. Studies comparing magnetic resonance enterography (MRE) and capsule endoscopy (CE) for the assessment of small bowel (SB) Crohn’s disease (CD) are scarce in Korea. In addition, there is no Korean experience of patency capsule (PC) examination prior to CE. The primary aim of this study was to compare diagnostic yields of MRE and CE for the assessment of SB CD. Secondary objectives were to compare the detection rate of proximal SB lesions by each modality in the Montreal classification and evaluate the safety and feasibility of PC in Korean CD patients. Methods. MRE was performed as the first examination to assess SB CD. PC examination and CE were then performed. Diagnostic yields of active SB disease by MRE and CE were then analyzed. Results. Disintegration of the patency capsule was shown in 5 patients out of 26 patients, who did not undergo CE. These 5 patients were accounted as negative CE findings. Overall, MRE and CE detected 80.8% and 65.4% of active SB lesions of CD in 26 patients, respectively (P=0.212). MRE and CE detected 0% (0/26) and 19.2% (5/26) (P=0.051) of jejunal lesions, 30.8% (8/26) and 42.3% (11/26) (P=0.388) of proximal ileal lesions, and 80.8% (21/26) and 53.8% (14/26) (P=0.039) of terminal ileal lesions, respectively. According to the Montreal classification, MRE and CE independently detected proximal disease (L4) in 30.8% (8/26) and 53.8% (14/26) (P=0.092), respectively. Conclusions. The diagnostic yields of MRE and CE for the assessment of SB CD including proximal SB lesions were similar. MRE is a more objective tool for detecting clinically relevant stricture than PC although PC examination could be performed safely before CE to prove the patency of SB. This trial is registered with KCT0004305.

The number of digital healthcare mobile apps on the market is increasing exponentially owing to the development of the mobile network and widespread usage of smartphones. However, only a few of these apps have undergone adequate validation. As with many mobile apps, healthcare apps are generally considered safe to use, making them easy for developers and end-users to exchange them in the marketplace. The existing platforms are not suitable to collect reliable data for evaluating the effectiveness of the apps. Moreover, these platforms only reflect the perspectives of developers and experts, not of end-users. For instance, data collection methods typical of clinical trials are not appropriate for participant-driven assessment of healthcare apps because of their complexity and high cost. Thus, we identified a need for a participant-driven data collection platform for end-users that is interpretable, systematic, and sustainable —as a first step to validate the effectiveness of the apps. To collect reliable data in the participatory trial format, we defined distinct stages for data preparation, storage, and sharing. Interpretable data preparation consists of a protocol database system and semantic feature retrieval method to create a protocol without professional knowledge. Collected data reliability weight calculation belongs to the systematic data storage stage. For sustainable data collection, we integrated the weight method and the future reward distribution function. We validated the methods through statistical tests conducted on 718 human participants. The validation results demonstrate that the methods have significant differences in the comparative experiment and prove that the choice of the right method is essential for reliable data collection. Furthermore, we created a web-based system for our pilot platform to collect reliable data in an integrated pipeline. We validate the platform features with existing clinical and pragmatic trial data collection platforms. In conclusion, we show that the method and platform support reliable data collection, forging a path to effectiveness validation of digital healthcare apps.

Transversus abdominis plane (TAP) block is considered a reliable locoregional technique for pain control after laparoscopic colorectal surgery. However, no clear benefit of TAP block over wound infiltration has been demonstrated by the current literature. This multicenter randomized clinical trial tested the non-inferiority of wound infiltration (WI) compared to WI plus laparoscopic-assisted TAP block (L-TAP). All patients with colorectal cancer and diverticular disease scheduled for laparoscopic resection at the Division of General and Hepatobiliary Surgery, University of Verona Hospital Trust, Verona, Italy and at the Colorectal Cancer Center, Kyungpook National University Medical Center, Kyungpook National University, Daegu, Korea, between April 2018 and March 2019 were considered for the trial. Patients were randomly allocated to either the WI group or the WI plus L-TAP group in a 1:1 allocation ratio. In total, 108 patients entered the study and 102 patients were analyzed; 50 patients received WI plus L-TAP and 52 patients received WI. The primary end point was the efficacy in pain control at 6 h measured according to Numeric Rating Scale (NRS). Secondary aims evaluated pain control at 12, 24, 48 and 72 h and other short-term results related to pain management. Estimation of pain intensity at 6 h was comparable between the two groups (p = 0.16) with a mean (95% CI) difference in pain scores of 0.94 (− 0.13 to 2.02). No differences in pain scores were observed at other interval times or considering analgesic consumption, return of bowel function, postoperative complications and length of hospital stay. This study suggests that adding TAP block to WI does not affect pain control, amount of analgesics and other short-term outcomes. NCT03376048 ( https://www.clinicaltrials.gov ).

Unlike wired endoscopy, capsule endoscopy requires additional time for a clinical specialist to review the operation and examine the lesions. To reduce the tedious review time and increase the accuracy of medical examinations, various approaches have been reported based on artificial intelligence for computer-aided diagnosis. Recently, deep learning–based approaches have been applied to many possible areas, showing greatly improved performance, especially for image-based recognition and classification. By reviewing recent deep learning–based approaches for clinical applications, we present the current status and future direction of artificial intelligence for capsule endoscopy.

Purpose Redo surgery in patients with a persistent anastomotic failure (PAF) is a rare procedure, and data about this procedure are lacking. This study aimed to evaluate the surgical outcomes of redo surgery in such patients. Methods Patients who underwent a redo anastomosis for PAF from January 2004 to November 2016 were retrospectively evaluated. Data from a prospective colorectal database were analyzed. Success was defined as the combined absence of any anastomosis-related complications and a stoma at the last follow-up. Results A total of 1,964 patients who underwent curative surgery for rectal cancer during this study period were included. Among them, 32 consecutive patients underwent a redo anastomosis for PAF. Thirteen patients of those 32 had major anastomotic dehiscence with a pelvic sinus, 12 had a recto-vaginal fistula, and 7 had anastomosis stenosis. There were no postoperative deaths. The median operation time was 255 minutes (range, 80–480 minutes), and the median blood loss was 80 mL (range, 30–1,000 mL). The overall success rate was 78.1%, and the morbidity rate was 40.6%. Multivariable analyses showed that the primary tumor height at the lower level was the only statistically significant risk factor for redo surgery (P = 0.042; hazard ratio, 2.444). Conclusion In our experience, a redo anastomosis is a feasible surgical option that allows closure of a stoma in nearly 80% of patients. Lower tumor height (

Capsule endoscopy can be a diagnostic option for patients with esophageal diseases who cannot tolerate esophagogastroduodenoscopy.Functional modifications of the capsule allow for thorough examination of the esophagus. Esophageal capsule endoscopy has so farfailed to show sufficient performance to justify the replacement of traditional endoscopy for the diagnosis of esophageal diseasesbecause the esophagus has a short transit time and common pathologies appear near the esophagogastric junction. However,technological improvements are being introduced to overcome the limitations of capsule endoscopy, which is expected to become agood alternative to conventional endoscopy.

Objective Limited evidence is available on rebleeding due to nonsteroidal anti-inflammatory drugs (NSAIDs)-induced enteropathy. Previous studies have primarily analyzed endoscopic findings. Therefore, there is a need to evaluate their clinical implications for patients. This study aimed to evaluate the rebleeding rate and its related risk factors in patients with NSAIDs-induced enteropathy. Methods Of 402 patients with obscure gastrointestinal bleeding who were evaluated with capsule endoscopy, 49 were diagnosed with NSAIDs-induced enteropathy. The clinical characteristics of the patients were retrospectively analyzed. The Charlson comorbidity index was used to stratify the comorbidities. For patients who used additional drugs that influenced their tendency to bleeding, the odds ratio was calculated and used for a quantitative comparison. Results The rebleeding rate in patients with NSAIDs-induced enteropathy was 20.4%, within a mean duration of 23.4 months. Age ≥65 years (hazard ratio [HR] 8.628, 95% confidence interval [CI] 1.152-64.625), no additional use of mucoprotective agents (HR 11.712, 95% CI 1.278-76.098) and the continuation of NSAIDs after the first bleeding episode (HR 9.861, 95% CI 1.395-98.344) were independently related to rebleeding due to NSAIDs-induced enteropathy. The underlying comorbidities, drug-related rebleeding risk scores and therapeutic use of proton pump inhibitors were not significantly different (P = 0.209, 0.212 and 0.720, respectively). Conclusions Approximately one-fifth of patients with NSAIDs-induced enteropathy showed rebleeding within 2 years. A careful long-term follow-up should be offered to elderly patients with NSAIDs-induced enteropathy who need continuous NSAID treatment without the additional use of mucoprotective medications.

This study attempted to reveal the prognostic impact of microsatellite instability-high (MSI-H) colon cancer with tumor-infiltrating immune cells (TIICs) and immune checkpoint protein expression, which are good candidates for immunotherapy. The study included 89 patients with MSI-H colon cancer who underwent curative surgery at Kyungpook National University Chilgok Hospital. The expression status of specific inhibitory receptors, such as CD274 (programmed death-ligand 1, PD-L1), PDCD1 (programmed cell death 1, PD-1), cytotoxic T-lymphocyte-associated protein 4 (CTLA4), lymphocyte-activation gene 3 (LAG3), and indolamine 2′3′-dioxygenase 1 (IDO1), was retrospectively analyzed using immunohistochemistry (IHC). Among the 89 patients, CD274, LAG3, and IDO1 expressions in TIICs were observed in 68.6% (61 cases), 13.5% (12), and 28.1% (25) of patients, respectively. Meanwhile, CD274, CTLA4, and IDO1 were expressed in tumor cells of 24.7% (22 cases), 4.5% (4), and 72.0% (64) of patients, respectively. During the median follow-up duration of 39 months, 14 (15.7%) patients experienced disease recurrence. Among the five immune checkpoint proteins, CD274, LAG3, and IDO1 expressions in TIICs were significantly associated with a better disease-free survival (DFS) in a univariate analysis (P = 0.028, 0.037, and 0.030 respectively). Moreover, co-expression of CD274, LAG3, and IDO1 in TIICs showed an even better survival for DFS (P = 0.010). In a multivariate survival analysis, CD274, LAG3, and IDO1 expressions in TIICs remained as independent prognostic factors for a better DFS. CD274, LAG3, and IDO1 expressions in TIICs showed a better prognosis for patients with MSI-H colon cancer. Thus, the potential therapeutic implications of these immune checkpoint molecules should be further investigated.

The aim of this study was to assess the appropriate time interval to identify the association between the fecal calprotectin (FC) test and endoscopic activity, and to evaluate whether the time interval affects the therapeutic plan adjustment in patients with ulcerative colitis (UC). This study included 103 patients who underwent FC tests and endoscopic examinations within the past three months. The FC test results classified cases into three groups as follows: moderate to severe (>200, >250, or >300 μg/g), mild (100–200, 100–250, or 100–300 μg/g), and inactive (

Lateral pelvic lymph node dissection (LPND) is a challenging procedure due to its technical difficulty and higher incidence of surgical morbidity. We compared short-term outcomes between laparoscopic and robotic LPND in patients with rectal cancer. Between May 2006 and December 2014, prospectively collected data from consecutive patients undergoing robotic or laparoscopic total mesorectal excision (TME) with LPND were retrospectively compared. Patients’ demographics, perioperative outcomes, functional results, and initial oncologic outcomes were analyzed. Fifty and 35 patients underwent robotic or laparoscopic TME with LPND, respectively. Bilateral LPND was performed in 10 patients (20%) in the robotic group and 6 (17.1%) in the laparoscopic group. For unilateral pelvic dissection, the mean operative time was not significantly different between groups (robotic vs. laparoscopic group, 41.0 ± 15.8 min vs. 35.3 ± 13.4 min; P = 0.146), but the EBL was significantly lower in the robotic group (34.6 ± 21.9 mL vs. 50.6 ± 23.8 mL; P = 0.002). Two patients (4.0%) in the robotic group and 7 (20.0%) in the laparoscopic group underwent Foley catheter reinsertion for urinary retention postoperatively (P = 0.029). The mean number of harvested lateral pelvic lymph nodes (LPNs) was 6.6 (range 0–25) in the robotic group and 6.4 (range 1–14) in the laparoscopic group. Pathologic LPN metastatic rate was not different between groups (robotic vs. laparoscopic group, 28.0 vs. 41.2%; P = 0.243). During the median follow-up of 26.3 months, overall recurrence rate was not different between groups (robotic vs. laparoscopic group, 30.0 vs. 31.2%; P = 0.850). Three patients (6.0%) in the robotic group and 4 (11.4%) in the laparoscopic group developed local recurrence (P = 0.653). Robotic TME with LPND is safe and feasible with favorable short-term surgical outcomes.

// Hye Jin Kim 1 , Gyu-Seog Choi 1 , Jun Seok Park 1 , Soo Yeun Park 1 , Seung Hyun Cho 2 , Soo Jung Lee 3 , Byung Woog Kang 3 and Jong Gwang Kim 3 1 Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea 2 Department of Radiology, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea 3 Department of Oncology/Hematology, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea Correspondence to: Gyu-Seog Choi, email: kyuschoi@mail.knu.ac.kr Keywords: lateral pelvic lymph node dissection, locally advanced rectal cancer, preoperative chemoradiation Received: May 24, 2017 Accepted: July 29, 2017 Published: August 10, 2017 ABSTRACT Background: Although lateral pelvic lymph node (LPN) metastasis is a major cause of local recurrence in patients with rectal cancer, controversy still remains on the treatment of suspected LPN metastasis, “suspicious LPN”. We aimed to determine the optimal treatment strategies for suspicious LPN, in patients with locally advanced rectal cancer who underwent preoperative chemoradiotherapy (CRT). Materials and Methods: Of 377 patients who received preoperative CRT for rectal cancer between 2006 and 2013, 84 (22.3%) had suspicious LPNs on pretreatment MRI. Patients’ characteristics, MRI findings, operative and pathologic findings, and oncologic outcomes were analyzed retrospectively. Results: Of 84 patients with suspicious LPNs, 61 showed good response to CRT on posttreatment MRI (short-axis LPN diameter < 5 mm). Among them, 31 patients underwent TME alone (group A), and 30 underwent TME plus LPND (group B). The remaining 23 patients had persistently suspicious LPNs on post-CRT MRI and underwent TME plus LPND (group C). Pathologic LPN metastasis was confirmed in five patients (16.7%) in group B and 15 (62.5%) in group C. Local recurrence developed in 7 (22.6%), 0 (0%), and 4 (17.4%) patients in groups A, B, and C, respectively. Five patients (16.1%) in group A developed in situ LPN recurrences. The 3-year disease-free survival rates were 53.7%, 74.2%, and 46.9% in groups A, B, and C, respectively. Conclusions: Study findings suggested that LPND cannot be omitted for patients with suspicious LPNs on pretreatment MRI even with good response to CRT. Findings from pretreatment MRI should be considered to determine whether LPND is indicated.