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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.).

The role of gut microbiota in humans is of great interest, and metagenomics provided the possibilities for extensively analysing bacterial diversity in health and disease. Here we explored the human gut microbiome samples across 19 countries, performing compositional, functional and integrative analysis. To complement these data and analyse the stability of the microbiome, we followed 86 healthy Swedish individuals over one year, with four sampling times and extensive clinical phenotyping. The integrative analysis of temporal microbiome changes shows the existence of two types of species with a tendency to vary in abundance with time, here called outflow and inflow species. Importantly, the former tends to be enriched in disease, while the latter is enriched in health. We suggest that the decrease of disease-associated outflow and the increase of health-associated inflow species with time may be a fundamental albeit previously unrecognized aspect of the homeostasis maintenance in a healthy microbiome.

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.

To efficiently prolong analgesic effects, we developed osmotically balanced, large unilamellar liposomes (~6 μm in diameter) in which highly concentrated bupivacaine (up to 30 mg/mL) was encapsulated, and their sustained bupivacaine release was highly effective in relieving postoperative pain over 24 h in a rat model. Our reverse-phase evaporation method based on non-toxic alcohol, ethanol, enabled simple and cost-effective production of bupivacaine-loaded liposomes, of which osmotic pressure was readily balanced to improve the structural stability of the enlarged unilamellar liposomes along with extension of their shelf life (> a month). The in vitro release profile verified that the release duration of the bupivacaine-loaded liposomes extended up to six days. For the in vivo study, male Sprague-Dawley rats were used for the incisional pain model, simulating postoperative pain, and the mechanical withdrawal threshold (MWT) was measured using a von Frey filament. Compared to the control group that received intraplantar administration of normal saline, the group of liposomal bupivacaine showed that the initially increased MWT gradually decreased up to 24 h, and importantly, the analgesic effect of the liposomal bupivacaine was maintained 6 times longer than that of bupivacaine only, proving the potential of effective long-acting anesthetics.

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.

Purpose: Gender inequality is a barrier to education toward women and accessibility to health facilities, which are important for preventing vertical transmission. This study was conducted to analyze the impact of gender equity on vertically transmitted infections (hepatitis viruses, human immunodeficiency virus [HIV], and syphilis) using country-level indicators. Methods: The relationship between the Global Gender Gap Index (GGGI), which is indicator of gender equity, and vertical transmission was analyzed. GGGI scores were collected from 153 countries in 2020. Vertical transmission included 10 outcomes for hepatitis viruses, HIV, and syphilis. Generalized linear model (GLM) was used for analyzing the relationship. Other predictors included skilled birth attendant and country income. Results: The median GGGI score was 0.706 (interquartile range, 0.664–0.736). GLM showed that the GGGI score was significantly associated with the incidence of both chronic hepatitis B and C in under 5 years (both p

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.

Localized surface plasmon resonance (LSPR) is a powerful platform for detecting biomolecules including proteins, nucleotides, and vesicles. Here, we report a colloidal gold (Au) nanoparticle-based assay that enhances the LSPR signal of nanoimprinted Au strips. The binding of the colloidal Au nanoparticle on the Au strip causes a red-shift of the LSPR extinction peak, enabling the detection of interleukin-10 (IL-10) cytokine. For LSPR sensor fabrication, we employed a roll-to-roll nanoimprinting process to create nanograting structures on polyethylene terephthalate (PET) film. By the angled deposition of Au on the PET film, we demonstrated a double-bent Au structure with a strong LSPR extinction peak at ~760 nm. Using the Au LSPR sensor, we developed an enzyme-linked immunosorbent assay (ELISA) protocol by forming a sandwich structure of IL-10 capture antibody/IL-10/IL-10 detection antibody. To enhance the LSPR signal, we introduced colloidal Au nanocube (AuNC) to be cross-linked with IL-10 detection antibody for immunogold assay. Using IL-10 as a model protein, we successfully achieved nanomolar sensitivity. We confirmed that the shift of the extinction peak was improved by 450% due to plasmon coupling between AuNC and Au strip. We expect that the AuNC-assisted LSPR sensor platform can be utilized as a diagnostic tool by providing convenient and fast detection of the LSPR signal.

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.

A simple, sequence-specific DNA detection method, utilizing a fluorescent 2-aminopurine (2-AP) nucleobase analogue-containing split G-quadruplex as the key detection component, is described. In the sensor, the 2-AP-containing G-quadruplex is split into two segments and linked to a target-specific overhang sequence. The separate G-quadruplex sequences form an active G-quadruplex structure only in the presence of a complementary target DNA, which leads to a significant increase in the intensity of fluorescence from the 2-AP fluorophore. This simple, one-step, homogenous assay was successfully employed to detect target DNA with a high selectivity. In addition, the practical applicability of the detection method was demonstrated by its use in analyzing target DNAs in human serum. To the best of our knowledge, this is the first time that an investigation was carried out in which a fluorescent nucleobase analogue was incorporated into a split G-quadruplex structure and this structure was utilized as the foundation for a specific DNA sensor.

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.

In this study, we investigated playground equipment related injuries in preschool-aged children. This was a retrospective observational study using Emergency Department based Injury In-depth Surveillance, (2011–2014). We included the preschool-aged children with playground equipment related injuries. We surveyed the mechanism and incidence of injuries, and estimated the odds ratio (OR) of traumatic brain injury (TBI) and upper/lower extremities fracture. There were 6,110 patients, mean age was 4.14 ± 1.95 years old. Slide and swing related injuries were 2,475 (40.5%) and 1,102 (18.0%). Fall down (48.5%) was the most common mechanism. The OR of TBI in children 0–2 years old was 1.88 times higher than children 3–7 years old, and in swing was 4.72 (OR, 4.72; 95% confidence interval [CI], 2.37–9.40) times higher than seesaw. The OR of upper extremity fracture in children 3–7 years old was 3.07 times higher than children 0–2 years old, and in climbing was 2.03 (OR, 2.03; 95% CI, 1.63–2.52) times higher than swing. The OR of lower extremity fractures in horizontal bars, tightropes, and trampolines was 2.95 (OR, 2.95; 95% CI, 1.55–5.61) times higher than swing. The most common mechanism and playground equipment were fall down and slide. TBI was associated to younger children (0–2 years old) and swing. Fracture of upper extremities was associated to older children (3–7 years old) and climbing. Fracture of lower extremities was associated to others such as horizontal bars, tightropes, and trampolines., Graphical Abstract

Gastrointestinal (GI) bleeding is a life-threatening complication in critically ill patients. The aim of this study was to determine the efficacy of bedside endoscopy in an intensive care unit (ICU) setting, and to compare the outcomes of early endoscopy (within 24 hours of detecting GI bleeding) with late endoscopy (after 24 hours).We retrospectively reviewed the medical records of patients who underwent bedside endoscopy for nonvariceal upper GI bleeding and lower GI bleeding that occurred after ICU admission at Seoul National University Hospital from January 2010 to May 2015.Two hundred and fifty-three patients underwent bedside esophagogastroduodenoscopy (EGD) for upper GI bleeding (early, 187; late, 66) and 69 underwent bedside colonoscopy (CS) for lower GI bleeding (early, 36; late, 33). Common endoscopic findings were peptic ulcer, and acute gastric mucosal lesion in the EGD group, as well as ischemic colitis and acute hemorrhagic rectal ulcers in the CS group. Early EGD significantly increased the rate of finding the bleeding focus (82% vs. 73%,Early EGD may be effective for diagnosis and hemostatic treatment in ICU patients with GI bleeding. However, early CS should be carefully performed after adequate bowel preparation.

Three-dimensional (3D) reconstruction of capsule endoscopic images has been attempted for a long time to obtain more information on small bowel structures. Due to the limited hardware resources of capsule size and battery capacity, software approaches have been studied but have mainly exhibited inherent limitations. Recently, stereo camera-based capsule endoscopy, which can perform hardware-enabled 3D reconstruction, has been developed. We aimed to evaluate the feasibility of newly developed 3D capsule endoscopy in clinical practice. This study was a prospective, single-arm, feasibility study conducted at two university-affiliated hospitals in South Korea. Small bowel evaluation was performed using a newly developed 3D capsule endoscope for patients with obscure gastrointestinal bleeding, suspected or established Crohn’s disease, small bowel tumors, and abdominal pain of unknown origin. We assessed the technical limitations, performance, and safety of the new capsule endoscope. Thirty-one patients (20 men and 11 women; mean age: 44.5 years) were enrolled. There was no technical defect preventing adequate visualization of the small bowel. The overall completion rate was 77.4%, the detection rate was 64.5%, and there was no capsule retention. All capsule endoscopic procedures were completed uneventfully. In conclusion, newly developed 3D capsule endoscopy was safe and feasible, showing similar performance as conventional capsule endoscopy. Newly added features of 3D reconstruction and size measurement are expected to be useful in the characterization of subepithelial tumours.

Background With the increasing incidence of colorectal cancer (CRC), its accurate diagnosis is critical and in high demand. However, conventional methods are not ideal due to invasiveness and low accuracy. Herein, we aimed to identify efficient CRC mRNA markers in a non-invasive manner using CRC-derived extracellular vesicles (EVs). The expression levels of EV mRNAs from cancer cell lines were compared with those of a normal cell line using quantitative polymerase chain reaction. Eight markers were evaluated in plasma EVs from CRC patients and healthy controls. The diagnostic value of each marker, individually or in combination, was then determined using recessive operating characteristics analyses and the Mann-Whitney U test. Results Eight mRNA markers (MYC, VEGF, CDX2, CD133, CEA, CK19, EpCAM, and CD24) were found to be more abundant in EVs derived from cancer cell lines compared to control cell lines. A combination of VEGF and CD133 showed the highest sensitivity (100%), specificity (80%), and accuracy (93%) and an area under the curve of 0.96; hence, these markers were deemed to be the CRC signature. Moreover, this signature was found to be highly expressed in CRC-derived EVs compared to healthy controls. Conclusions VEGF and CD133 mRNAs comprise a unique CRC signature in EVs that has the potential to act as a novel, non-invasive, and accurate biomarker that would improve the current diagnostic platform for CRC, while also serving to strengthen the value of EV mRNA as diagnostic markers for myriad of diseases.

Background/aims Capsule endoscopy (CE) is widely used for the diagnosis of small bowel diseases. The clinical performance and complications of small bowel CE, including completion rate, capsule retention rate, and indications, have been previously described in Korea. This study aimed at estimating the recent changes in clinical performance and complications of small bowel CE based on 17-year data from a Korean Capsule Endoscopy Registry. Methods CE registry data from 35 hospitals were retrospectively analyzed. Clinical information, including completion rate, capsule retention rate, and indications, was collected and analyzed. In addition, the most recent 5-year data for CE examinations were compared with the previous 12-year data. Results A total of 4,650 CE examinations were analyzed. The most common indication for CE was obscure gastrointestinal bleeding (OGIB). The overall incomplete examination rate was 16% and the capsule retention rate was 3%. Crohn's disease was a risk factor for capsule retention. Inadequate bowel preparation was significantly associated with capsule retention and incomplete examination. An indication other than OGIB was a risk factor for incomplete examination. A recent increasing trend of CE diagnosis of Crohn's disease was observed. The most recent 5-year incomplete examination rate for CE examinations decreased compared with that of the previous 12 years. Conclusion The 17-year data suggested that CE is a useful and safe tool for diagnosing small bowel diseases. The incomplete examination rate of CE decreased with time, and OGIB was consistently the main indication for CE. Inadequate bowel preparation was significantly associated with capsule retention and incomplete examination.