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Background Serrated polyposis syndrome (SPS) is a growing health concern with up to 1 in 125 universal screening program participants meeting diagnostic criteria. Conversely, SPS in inflammatory bowel disease (IBD) is rarely described in the literature, despite the predisposition for serrated epithelial change and serrated polyps in this population. Purpose To describe a case of World Health Organization (WHO) criterion I SPS in a patient with IBD, and discuss the existing literature on this rare occurrence. Method Case report and review of the literature. Result(s) Case Report A 53-year-old female with ulcerative colitis (UC; Phenotype: Left-sided; Duration of disease: 40 years; Medical therapy: sulfasalazine) undergoing regular endoscopic surveillance was recently found to have multiple serrated-class lesions including 6 in the sigmoid colon ranging between 8-30mm in size; this included 3 sessile serrated lesions (SSLs) between 20-30mm removed by piecemeal cold snare resection without complication and 2 residual large SSLs for staged endoscopic resection. No endoscopic disease activity was appreciated (Mayo 0), with histopathology of the sigmoid colon and rectum demonstrating chronic inactive colitis. Literature Review From 2008 to 2021, there are eleven reported cases of SPS in IBD. Six patients had UC and most were in remission for several decades at the time of SPS diagnosis. Most SPS cases met WHO criteria and fit within described phenotypes. While the case above meets WHO criterion I for SPS, the presence of large distal lesions is atypical, raising the question of whether chronic disease activity contributed to the development of these serrated lesions, given the known predisposition for serrated epithelial change and serrated lesions in patients with colonic IBD. Image Conclusion(s) SPS in patients with IBD is rare. Questions remain about the role of chronic disease activity contributing to the formation of serrated lesions, its clinical relevance, and optimal management strategy. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Background Extranodal NK/T-cell lymphoma (ENKTL) is a rare and aggressive form of non-Hodgkin lymphoma. ENKTL are predominantly localized to nasal and upper aerodigestive sites, but extranasal involvement including gastrointestinal tract are rarely seen. Small and large intestines are primary sites of gastrointestinal ENKTL. Gastric involvements are exceedingly rare accounting for less than 5% of all gastrointestinal ENKTL. Purpose We present a literature review on gastrointestinal ENKTL and a case report of gastrointestinal bleed secondary to ENKTL involving stomach and left orbit. Method Case report and literature review. Result(s) 33-year-old female was admitted to a tertiary hospital with 3-week history of epigastric pain and left periorbital swelling. Abdominal CT showed edema and thickening of gastric folds. Head CT showed grossly enlarged left lateral rectus muscle and periorbital soft tissue swelling suggestive of left orbital pseudotumor. Esophagogastroduodenoscopy revealed multifocal Forrest classification II-C ulcerations throughout her stomach and duodenum. Biopsies from stomach showed gastric mucosa with extensive infiltration by an atypical lymphoid cell population. Immunohistochemistry demonstrated high grade lymphoid cells with uniform expression of CD2, CD3, CD30, CD56, TIA1, perforin and granzyme B. EBV-encoded small RNA in-situ hybridization (EBER ISH) was strongly positive. Findings were consistent with gastric ENKTL. Left orbital biopsy revealed similar morphology and phenotypic features consistent with concurrent ENKTL involvement of her orbit. Patient was initiated on intravenous corticosteroids, but unfortunately developed hemorrhagic shock secondary to gastrointestinal bleeding from gastric ulcer and passed away. Gastrointestinal ENKTL is a rare presentation of a rare disease. Gastric involvement is especially rare and described only in few case reports. Gastrointestinal ENKTL are often initially asymptomatic but can progress to abdominal pain, bleeding and even bowel perforation. Due its nonspecific clinical features and rarity, diagnosis can be difficult and requires careful examination by an experienced pathologist. This aggressive lymphoma is characterized by positive CD2, CD3, CD30, CD56, TIA, granzyme B, perforin and EBER ISH. Optimal treatment approach remains unclear due to lack of prospective clinical studies. Currently, treatment modalities used for other lymphomas including radiotherapy and non-anthracycline-based chemotherapy are used. Despite treatment, prognosis is grim with median overall survival period of 7-8 months. Image Conclusion(s) We present a case of gastric and orbital ENKTL with gastric ulcer bleeding. Gastric ENKTL disease is a rare presentation of a rare disease. Due to non-specific clinical features, diagnosis is often difficult and relies on careful pathology examination by experienced pathologist. Prognosis is poor without optimal treatment approach due to rarity of disease and lack of validated data. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared INFLAMMATORY BOWEL DISEASES MECHANISMS AND TREATMENTS

Background Malakoplakia is a rare inflammatory condition, commonly affecting the genitourinary system of immunocompromised patients. Gastrointestinal malakoplakia has been reported in the literature, with previous endoscopic findings mimicking mass lesions. Purpose To describe a case of colonic malakoplakia after referral for endoscopic management of a large non-pedunculated colorectal polyp. Method Case report and review of the literature. Result(s) Case Report An 80-year-old male with chronic kidney disease and remote renal transplant on immunosuppressive therapy (mycophenolate mofetil, tacrolimus, prednisone) was referred for endoscopic resection for a large non-pedunculated colorectal polyp in the cecum. Original presenting symptoms included chronic diarrhea, iron deficiency anemia, and fecal immunochemical test (FIT) positivity. A repeat colonoscopy demonstrated a 40mm Paris 0-IIA plaque-like lesion in the cecum with optical features not in keeping with adenomatous or serrated histopathology. Biopsies were performed with histopathology demonstrating normal colonic mucosa with confluent sheets of histiocytes with concentrically layered cytoplasmic inclusions, in keeping with malakoplakia. Literature review Malakoplakia, Greek for “soft plaque”, is a rare inflammatory condition characterized by impaired dysfunction in macrophages leading to the accumulation of incompletely degraded bacteria in phagolysosomes. Histologically, this appears as concentrically layered cytoplasmic inclusions, comprising the pathognomonic Michaelis-Gutmann bodies. Many bacterial organisms have been implicated in the development of malakoplakia, with E. coli being the most common; specifically in immunocompromised patients, whether from immunosuppressive medications, immunodeficiency syndromes, or clinical conditions precluding effective immune function. Malakoplakia commonly presents as a mass-like lesion and has been found in all organs, most commonly in the genitourinary system. Diagnosis is made by biopsy and allows for appropriate treatment, which is most commonly a reduction in immunosuppressive therapy and antibiotic therapy. Image Conclusion(s) Malakoplakia is rare but should be considered when a lesion with atypical optical evaluation features is found in immunocompromised individuals or those with recurrent infections. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Background Endoscopic resection techniques have become the primary treatment strategy for the vast majority of large (≥ 20mm) non-pedunculated colonic polyps (LNPCPs). Despite this, surgery is still commonly performed with evidence suggesting an increasing trend over time. There is limited Canadian data confirming the effectiveness and safety of an endoscopic management strategy for LNPCPs. Purpose To investigate clinical outcomes of patients referred for endoscopic management of a LNPCP. Method Retrospective single-centre analysis of patients referred to a single endoscopist for the management of LNPCPs within a tertiary referral practice. LNPCPs were further subdivided into non-complicated (NC-LNPCP) or complicated (C-LNPCP) defined as those involving the ileocecal valve, appendiceal orifice, circumferential or previously attempted. Performance outcomes were evaluated by the frequencies of technical success (removal of all polypoid tissue during index procedure) and need for colorectal surgery. Safety was evaluated by the frequencies of clinically significant intraprocedural bleeding (CSIPB), clinically significant post-endoscopic resection bleeding (CSPEB), intra-procedural perforation and delayed perforation. Recurrence (either endoscopic or histologic) was evaluated at first surveillance colonoscopy (SC1). Continuous variables were summarized using median (IQR). Categorical variables were summarized as frequencies (%). To test for association between categorical variables, the Pearson χ2 or the Fisher exact test were used, where appropriate. For continuous variables, the Mann-Whitney U test was used. A probability (p) value of Result(s) Between January 2021 to March 2022, 263 LNPCP were referred for endoscopic resection and 41 LNPCP were excluded (23 pedunculated, 14 optical evaluation suggestive of deeply invasive cancer, 4 other). 222 LNPCP (188 NC-LNPCP, 34 C-LNPCP) underwent endoscopic resection. Median size was 25mm (IQR 20-30mm) with the majority undergoing cold snare resection (115, 51.8%). Polyposis (Adenomatous or serrated) was present in 23 (12.6%) cases respectively. Technical success was 97.3%. Cancer was present in 5 (2%). Clinically significant bleeding (CSPEB) occurred in 2.7%, DMI IV in 1.8% and there were no delayed perforations. Recurrence occurred in 4 (3.5%) at SC1 and 11 (5%) required surgery due to technical failure, submucosal invasion on pathology and clinically significant bleeding. Image Conclusion(s) Endoscopic resection as the primary treatment strategy for LNPCPs offers a safe and effective alternative to surgery in British Columbia. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Background Histological remission is an important target for Ulcerative Colitis (UC) treatment; however, scoring of histological images is time-consuming and prone to inter and intra-observer variability. Thus, a need exists for an accurate, reproducible, and reliable automated method. Previously, we demonstrated an Artificial Intelligence (AI) Tool using image processing and machine learning algorithms to measure histological disease activity using the Nancy index consistently and accurately.1 Here, we aim to enhance the capabilities of the AI Tool, by adding substantially more population-diversified training data while maintaining accuracy and robustness of results. Methods Eight global sites submitted 600 UC histological images. These were added to the 200 images previously used to train and validate the AI Tool. The 800-image dataset was divided into 2 groups: 90% used for training, 10% for testing. The novel AI algorithms were trained using state-of-the-art image processing and machine learning techniques based on deep learning and feature extraction. Cell and tissue regions of each training image were manually annotated, measured, and assigned a Nancy Index independently by 3 histopathologists, and used to further train the AI using over 43,000 characterisations. The AI Tool fully characterises histological images, identifying tissue types, cell types, cell numbers and locations, and automatically measures the Nancy Index for each image. Intra Class Correlation (ICC) and Confusion Matrix analyses were performed to evaluate the AI Tool and assess accuracy. Results The average ICC was 92.1% among the histopathologists and 91.1% between histopathologists and AI Tool, compared with 88.3% and 87.2% in the previous study.1 Confusion matrix analysis (Table 1) demonstrated the strongest correlation at the extremes of the Nancy Index, with 80% correlation between predicted and true labels for Nancy Scores of 0 or 4. When 2 adjacent scores were combined, correlations were stronger: 96% for a true Nancy score of 0 being predicted as 0 or 1, and 100% for a true Nancy score of 2 being predicted as 2 or 3. Conclusion By adding a larger number of images to the AI Tool training data, the robustness of the AI Tool was substantially improved while maintaining accuracy. The continued high correlation of AI Tool performance with the histopathologists reinforces the potential role for the AI Tool for IBD clinical applications. Fully characterising whole slides could standardise and validate an AI-driven scoring system for histology slides in IBD, eliminating the subjectivity of the human pathologist in assessment of disease activity. References: 1. Peyrin-Biroulet L, et al. J Crohn's and Colitis. 2022;16(Suppl 1):i105.

OBJECTIVE: To study the trend of surgical type, surgical procedure and etiological distribution of upper urinary tract repair in recent 10 years. METHODS: The preoperative and perioperative variables and follow-up data of upper urinary tract reconstruction surgery in RECUTTER (Reconstruction of Urinary Tract: Technology, Epidemiology and Result) database from 2010 to 2021 were searched, collected and analyzed. The surgical type, surgical procedure, duration of hospitalization, time of operation, incidence of short-term complications, and proportion of the patients undergoing reoperations were compared between the two groups of 2010-2017 period and 2018-2021 period. RESULTS: A total of 1 072 patients were included in the RECUTTER database. Congenital factors and iatrogenic injuries were the main causes of upper urinary tract repair. Among them, 129 (12.0%) patients had open operation, 403 (37.6%) patients had laparoscopic surgery, 322 (30.0%) patients had robot-assisted laparoscopic surgery and 218 (20.3%) patients had endourological procedure. In the last decade, the total number of surgeries showed a noticeable increasing annual trend and the proportion of robot-assisted laparoscopic surgery in 2018-2021 was significantly higher than that in 2010-2017 (P < 0.001). The 1 072 patients included 124 (11.6%) cases of ileal ureter replacements, 440 (41.1%) cases of pyeloplasty, 229 (21.4%) cases of balloon dilation, 109 (10.2%) cases of ureteral reimplantation, 49 (4.6%) cases of boari flap-Psoas hitch surgery, 60 (5.6%) cases of uretero-ureteral anastomosis, 61 (5.7%) cases of lingual mucosal onlay graft ureteroplasty or appendiceal onlay flap ureteroplasty. Pyeloplasty and balloon dilatation had been the main types of surgery, while the proportion of lingual mucosal onlay graft ureteroplasty plus appendiceal onlay flap ureteroplasty had increased significantly in recent years (P < 0.05). In addition, the time of operation was significantly increased (P < 0.05) after 2018, which was considered to be related to the sharp increase in the proportion of robot-assisted laparoscopic surgery. We found that minimally invasive surgery (endourological procedure and robot-assisted laparoscopic surgery) as an independent risk factor (P=0.050, OR=0.472) could reduce the incidence of short-term post-operative complications. CONCLUSION: We have justified the value of the RECUTTER database, created by the Institute of Urology, Peking University in data support for clinical research work, and provided valuable experience for the construction of other multi-center databases at home and abroad. In recent 10 years, we have observed that, in upper urinary tract reconstruction surgery, the surgery type tends to be minimally invasive and the surgery procedure tends to be complicated, suggesting the superiority of robot-assisted laparoscopic surgery.

人工耳蜗植入（CI）是治疗重度或者极重度感音神经性聋患者唯一的办法，CI在提高这类患者听力的同时，对耳鸣也有积极疗效，一系列研究均证实了这个发现，本文试对该研究领域的文献进行总结，并对其耳鸣治疗原理、疗效及影响因素进行分析归纳，以期更好指导临床工作。.

The aviation industry faces the challenge of offering aircraft that are lighter, more economical, and safer. One of the solutions is to increase the use of composites. For these materials, adhesive bonding has proven to be the appropriate joining technology. To check these adhesive joints, costly and time-consuming maintenance measures are carried out. An intelligent Structural Health Monitoring (SHM) system can extend these intervals and allow the use of a predictive maintenance system. This paper describes the method of Ultrasonic Lamb Waves for monitoring a adhesively bonded Carbon Fiber Reinforced Polymer (CFRP) aircraft fuselage. Prior to this, the production of a segment of a fuselage and the characterization of the materials (CFRP and adhesive) is shown. Afterwards the method of Ultrasonic Lamb Waves with the use of piezoelectric transducers and signal processing based on the Reconstruction Algorithm for Probabilistic Inspection of Damage (RAPID) algorithm are explained. At the end, the experimental evaluation of an undamaged and a damaged fuselage structure is done. The results have shown the possibility of RAPID algorithm for damage detection on adhesive. An outlook on future work is given.

Osteosarcoma is characterized by high malignancy and high metastasis rate, resulting in high mortality and disability. MiR-663a has been reported in a variety of tumors to promote tumorigenesis. However, miR-663a has not been reported in the pathogenesis of osteosarcoma. Bioinformatics analysis and experiments including real-time quantitative polymerase chain reaction (RT-qPCR), luciferase reporter, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, Western blot, RNA immunoprecipitation, and flow cytometry assay were applied to explore the function and mechanism of miR-663a in MG63, U2OS, Saos-2, SF-86, and hFOB1.19 cells. In this study, we found that miR-663a is highly expressed in osteosarcoma. At the same time, we discovered that miR-663a facilitates cell proliferation and migration, whereas suppresses cell apoptosis in osteosarcoma. Through a series of biological experiments, it was found that miR-663a regulates the cellular process in osteosarcoma by modulating the expression of MYL9. In addition, we also found that long noncoding RNA (lncRNA) GAS5 serves as a molecular sponge for miR-663a and regulates the progression of osteosarcoma via the ceRNA mechanism. We uncover that miR-663a promotes osteosarcoma development through targeting MYL9, which was regulated by lncRNA GAS5.

OBJECTIVE: To investigate the secondary structure, physicochemical properties and antibacterial activity of Brevinin- 2GHk (BR2GK), an antimicrobial peptide from frog skin, and explore its antibacterial mechanism. METHODS: BR2GK was synthesized, purified with high performance liquid chromatography (HPLC) and identified using mass spectrometry. Circular dichroism was used to determine the secondary structure and physicochemical properties of BR2GK. Two-fold dilution method was used to determine the antibacterial activity of BR2GK, and its antibacterial mechanism was explored using laser scanning confocal microscopy (LSCM) and scanning electron microscopy (SEM). The hemolytic activity of BR2GK was analyzed in red blood cells. Isothermal titration calorimetry (ITC) and surface plasmon resonance imaging (SPRi) were employed to detect the binding of BR2GK to lipopolysaccharide (LPS), and the antioxidant activity of BR2GK was evaluated using biochemical kits. RESULTS: The synthesized BR2GK, with a purity exceeding 95% after purification, had the basic characteristics of cationic antimicrobial peptides. BR2GK consisted mainly of α-helical structure in SDS solution and exhibited a broad-spectrum antibacterial activity. Antibacterial activity assay showed that BR2GK had inhibitory and killing activity against a variety of strains with a minimum inhibitory concentration (MIC) of 2.76 μmol/L against Staphylococcus aureus. Observation with LSCM and SEM showed that BR2GK at an active concentration caused bacterial cell membrane damage, cell swelling, contraction, deformation, and massive exudation of intracellular contents without causing hemolysis. ITC showed that the binding affinity K(D) of BR2GK to LPS was 18.2±0.8 μmol/L. The antioxidant test showed that BR2GK was capable of effectively scavenging NO, ABTS and DPPH. CONCLUSION: BR2GK, as a broad-spectrum antibacterial peptide with also a strong antioxidant capacity, does not cause hemolysis and is capable of binding to LPS. BR2GK has an important value for future design and synthesis of antimicrobial peptides with stronger antibacterial activity and lower cytotoxicity.