Mounting evidence indicates that imbalances in intestinal microenvironment homeostasis are a critical mechanism underlying CRC initiation and progression. The gut microbiome, which consists of a diverse array of microorganisms, plays a crucial role in the regulation of various biological processes such as metabolism, immune function, and intestinal barrier integrity. This chapter addresses the role of the gut microbiome in CRC, highlighting its contributions to carcinogenesis through mechanisms such as toxin production, inflammatory responses, and immune modulation. Additionally, it explores how microbiota-related factors influence CRC risk and pathogenesis, emphasizing the potential of microbial biomarkers in early detection, diagnosis, and prognostication of CRC. Furthermore, the chapter delves into the therapeutic implications of modifying the gut microbiome as a strategy for CRC prevention and treatment. It also discusses current research on microbiome-targeted therapies, including the use of probiotics, prebiotics, and faecal microbiota transplantation (FMT), as well as the future directions in microbiome-based cancer management.

OBJECTIVES:Vonoprazan was approved in China for reflux esophagitis (RE) in 2019; however, its real-world safety and effectiveness remain undetermined. We aimed to evaluate the safety of vonoprazan in patients and its effectiveness in patients with RE in a real-world setting. METHODS:In this prospective, non-interventional, real-world study, vonoprazan 20 mg was administered orally daily for 4 or 8 weeks. Primary endpoints were incidence rates of adverse events (AEs), serious AEs (SAEs), and adverse drug reactions (ADRs). Secondary endpoints included proportions of patients with RE without typical gastroesophageal reflux disease (GERD) symptoms (complete symptom relief) at baseline and Week 4, relief of heartburn/regurgitation symptoms (all day/nighttime) during Week 1, and mean change in GERD Questionnaire (GERDQ) score at Week 4. RESULTS:Of the 2829 patients with safety data, 488 (17.2%) reported ≥ 1 AE; 29 (1.0%) reported ≥ 1 SAE; and 129 (4.6%) reported ≥ 1 ADR. Of 1796 patients with RE and effectiveness data, the proportion without typical symptoms of GERD increased from 20.1% (95% confidence interval [CI] 18.29-22.05) at baseline to 55.2% (95% CI 52.63-57.79) at Week 4 (change: 35.1%, 95% CI 31.95-38.25). Complete relief from heartburn, nighttime heartburn, regurgitation, and nighttime regurgitation was observed in 32.3% (314/971), 43.8% (427/975), 27.0% (262/971), and 40.5% (395/976) patients, respectively, during Week 1. Mean change in GERDQ score (n = 1464) improved by Week 4 (-1.70). CONCLUSION:Vonoprazan is well tolerated through 8 weeks in patients and improves symptoms in patients with RE in the real-world setting in China (VIEW; NCT04501627).

BACKGROUND:Endoscopic resection (ER) is the main treatment for T1 superficial esophageal cancer (SEC). Additional surgical resection (ASR) is recommended to improve the prognosis of patients with non-curative resection who are at high risk of recurrence and metastasis. However, the survival benefit of ASR compared to non-ASR remains unclear. We conducted a systematic review and meta-analysis to quantify the survival benefits of ASR versus non-ASR, providing robust data for clinical decision-making. METHOD:We searched PubMed, Cochrane, Embase, and Web of Science databases for studies published before 24 February 2025. The primary outcome was overall survival (OS), recurrence-free survival (RFS), and disease-specific survival (DSS). Two independent reviewers screened and extracted the data and resolved disagreements by consensus. Risk of bias was assessed with Newcastle-Ottawa Scale. RESULTS:The review identified 15 retrospective studies involving 1348 patients. Analysis showed that patients with ASR had significant survival advantages over non-ASR patients in OS, RFS, and DSS. Hazard ratios (HRs) with 95% confidence intervals (CIs) were as follows: OS (HR = 3.06; 95% CI: 2.11-4.43), RFS (HR = 1.68; 95% CI: 1.16-2.41), and DSS (HR = 4.11; 95% CI: 1.64-10.28). Survival curves indicated that at 3, 5, and 10 years, the OS rates were 95.9% versus 88.0%, 91.4% versus 78.2%, and 86.7% versus 56.9% for the ASR and non-ASR groups, respectively. Similarly, the RFS rates were 93.4% versus 82.9%, 83.6% versus 73.8%, and 74.5% versus 57.5%. For DSS, the rates were 98.4% versus 94.5%, 97.8% versus 91.1%, and 97.8% versus 87.9%. Log-rank tests confirmed significance for all comparisons except 10-year DSS. CONCLUSIONS:For patients with T1 SEC who had non-curative ER, ASR therapy provides advantages over non-ASR therapy. However, within 5 years, the DSS difference between the ASR and non-ASR groups is likely to be minimal, with a range of approximately 4-6%.

Continual learning (CL) has been a critical topic in contemporary deep neural network applications, where higher levels of both forward and backward transfer are desirable for an effective CL performance. Existing CL strategies primarily focus on task models — either by regularizing model updates or by separating task-specific and shared components — while often overlooking the potential of leveraging inter-task relationships to enhance transfer. To address this gap, we propose a transferability-aware task embedding, termed H-embedding, and construct a hypernet framework under its guidance to learn task-conditioned model weights for CL tasks. Specifically, H-embedding is derived from an information theoretic measure of transferability and is designed to be online and easy to compute. Our method is also characterized by notable practicality, requiring only the storage of a low-dimensional task embedding per task and supporting efficient end-to-end training. Extensive evaluations on benchmarks including CIFAR-100, ImageNet-R, and DomainNet show that our framework performs prominently compared to various baseline and SOTA approaches, demonstrating strong potential in capturing and utilizing intrinsic task relationships. Our code is publicly available at \url{https://github.com/viki760/H-embedding-Guided-Hypernet}.

BACKGROUND AND AIMS:An increasing number of patients with rectal cancer who respond well to neoadjuvant chemoradiotherapy (nCRT) are being considered for organ preservation programs. However, due to the lack of high-level evidence, the survival outcomes of the organ preservation programs are still full of controversy and uncertainty. METHODS:To assess the effects of total mesorectal excision (TME) surgery, watch-and-wait (W&W), and local excision (LE) on long-term outcomes after nCRT, we searched PubMed, Embase, and Web of Science for articles published between 1 January 2010, and 31 December 2023. RESULTS:We found 7029 pieces of literature, of which 26 studies met the inclusion criteria, and recruited 2778 participants in the network meta-analysis. Risk of bias assessment showed that most included studies had a low risk of bias. Low-certainty evidence suggests that the TME group was significantly superior to all other interventions for the 2-year local regrowth rate. (W&W group [OR, 0.20; 95% CI, 0.12-0.35], LE group compared with TME group [3.00; 1.60-5.80]). There was no significant difference in the 2-year local regrowth rate between W&W and LE group (OR, 0.60; 95% CI, 0.32-1.20). There was high to moderate certainty evidence that at 3 years, the W&W group had a significant advantage in overall survival compared with the TME group (OR, 0.37; 95% CI, 0.09-0.95). After 5 years, no significant difference in overall survival was found between the 3 treatment modalities. CONCLUSIONS:We concluded that TME achieved the most significant reduction in 2-year local regrowth rates. However, the W&W strategy and LE demonstrated noninferiority to TME in long-term survival outcomes.

BACKGROUND:To improve medical students' preclinical skills and enable them to quickly comprehend the procedure of posterior pharyngeal flap surgery, our teaching team developed a surgical simulator specifically for pharyngeal flap surgery. STUDY DESIGN:Thirteen undergraduate students and 8 first-year residents trained from March to May 2023 participated in simulated surgical training. Initially, multimedia were used to explain and demonstrate to them relevant anatomy, surgical principles, and procedural steps. This was followed by independent simulated surgeries by the students, culminating in the completion of a questionnaire. Independent samples t test was used for statistical analysis. RESULTS:Before the simulated surgery, the residents had a greater understanding of the surgical design compared with the undergraduate students. After the simulated surgery, the residents showed not only significantly greater levels of understanding of the surgical design but also increased familiarity with the surgical process and enhanced confidence in independent surgery compared with the undergraduate students. Both groups showed a notable increase in familiarity with the surgical process and confidence in performing surgery independently after the simulated surgery. CONCLUSIONS:The surgical simulator demonstrates high clinical fidelity and provides tactile feedback that closely resembles reality. It significantly enhances the understanding and mastery of surgical techniques for young doctors, ultimately improving their surgical skills.

Introduction: There are limited studies revealing the association between serum albumin concentrations and acute kidney injury (AKI) in critically ill children. Methods: This was a multicenter retrospective study. Children consecutively admitted to four pediatric surgical intensive care units (PSICUs) between January 2016 and December 2020 were screened for analysis. Patients without recorded albumin values during the PSICU stay were excluded. Data were extracted from the electronic medical records systems of the hospitals. AKI was de fined according to the Kidney Disease Improving Global Outcome (KDIGO) guidelines. The associations between serum albumin levels and AKI were assessed by using logistic regression models. Results: A total of 7802 children were included in the analysis. The median age of the children was 1.0 (interquartile range (IQR), 0.0-4.0) years. There were 3214 (41.2 %) children who developed AKI. In the univariate logistic regression model, serum albumin levels were associated with AKI (odds ratio (OR) = 1.04, 95 % con fidence interval (CI) 1.04-1.05). After adjusting for covariates, serum albumin showed an independent association with AKI (OR = 1.04, 95 % CI 1.03-1.05). Albumin levels above 39.43 g/L (OR = 1.036, 95 % CI 1.002-1.070) were associated with AKI in the unadjusted cubic spline. In the adjusted cubic spline, albumin levels above 40.41 g/L (OR = 1.061, 95 % CI 1.003-1.122) were associated with AKI. Conclusion: High serum albumin was associated with AKI in critically ill children in the PSICU. Further studies are needed to validate our findings. Type of study: Prognostic Study. Level of evidence: LEVEL II. (c) 2023 Elsevier Inc. All rights reserved.

BACKGROUND:Whether body mass index (BMI) is a risk factor for poor bowel preparation is controversial, and the optimal bowel preparation regimen for people with a high BMI is unclear.METHODS:We prospectively included 710 individuals with high BMIs (≥ 24 kg/m2) who were scheduled to undergo colonoscopy from January to November 2021 at 7 hospitals. Participants were randomly allocated into 3 L split-dose polyethylene glycol (PEG) group (n=353) and 2 L PEG group (n=357). The primary outcome was the rate of adequate bowel preparation, and the secondary outcomes included Boston Bowel Preparation Scale (BBPS) score, polyp detection rate, cecal intubation rate, and adverse reactions during bowel preparation. Furthermore, we did exploratory subgroup analyses for adequate bowel preparation.RESULTS:After enrollment, 15 individuals didn't undergo colonoscopy, finally 345 participants took 3 L split-dose PEG regimen, and 350 participants took 2 L PEG regimen for colonoscopic bowel preparation. 3 L split-dose PEG regimen was superior to 2 L PEG regimen in the rate of adequate bowel preparation (81.2% vs. 74.9%, P = 0.045), BBPS score (6.71±1.15 vs. 6.37±1.31, P < 0.001), and the rate of polyp detection (62.0% vs. 52.9%, P = 0.015). The cecal intubation rate was similar in both groups (99.7%). Regarding adverse reactions, individuals were more likely to feel nausea in the 3 L PEG group (30.9% vs. 19.3%; P = 0.001); however, the degree was mild. In the subgroup analysis for adequate bowel preparation, 3 L split-dose PEG regimen performed better than 2 L PEG regimen in the overweight (BMI 25-29.9 kg/m2 ) (P = 0.006) and individuals with constipation (P = 0.044), while no significant differences were observed in relatively normal (BMI 24-24.9 kg/m2) (P = 0.593) and obese individuals (BMI ≥ 30 kg/m2) (P = 0.715).CONCLUSIONS:3 L split-dose PEG regimen is superior to 2 L PEG regimen for colonoscopic Bowel Preparation in relatively high-BMI individuals, especially overweight individuals (BMI 25-29.9 kg/m2 ).TRIAL REGISTRATION:This trial was registered in the Chinese Clinical Trials Registry (ChiCTR2000039068). The date of first registration, 15/10/2020, http://www.chictr.org.cn.

Background and Aims Patients with T1 colorectal cancer (CRC) are at high risk for lymph node metastasis and recurrence after local resection (LR) and need surgical resection (SR) for additional lymph node dissection to improve prognosis. However, the net benefits of SR and LR are still unquantified. Methods We conducted a systematic search for studies in which survival analysis among high-risk T1 CRC patients undergoing LR and SR was performed. Overall survival (OS), recurrence-free survival (RFS), and disease-specific survival (DSS) data were extracted. Hazard ratios (HRs) and fitted survival curves for OS, RFS, and DSS were used to estimate the long-term clinical outcomes of patients in the 2 groups. Results This meta-analysis included 12 studies. Compared with those in the SR group, patients in the LR group had higher risks of death (HR, 2.06; 95% confidence interval [CI], 1.59-2.65), recurrence (HR, 3.51; 95% CI, 2.51-4.93), and cancer-related mortality (HR, 2.31; 95% CI, 1.17-4.54) in the long term. Fitted survival curves for the LR and SR groups revealed the 5-year, 10-year, and 20-year rates for OS (86.3% and 94.5%, 72.9% and 84.4%, and 61.8% and 71.1%), RFS (89.9% and 96.9%, 83.3% and 93.9%, and 29.6% and 90.8%), and DSS (96.7% and 98.3%, 86.9% and 97.1%, and 86.9% and 96.4%). Log-rank tests showed significant differences among all outcomes except 5-year DSS. Conclusions For high-risk T1 CRC patients, the net benefit of DSS appears to be significant when the observation period exceeds 10 years. A long-term net benefit may exist but may not be applicable to all patients, especially high-risk patients with comorbidities. Therefore, LR may be a reasonable alternative for individualized treatment for some high-risk T1 CRC patients.

The aim of this study was to evaluate the performance of the four scoring tools in predicting mortality in pediatric intensive care units (PICUs) in western China. This was a multicenter, prospective, cohort study conducted in six PICUs in western China. The performances of the scoring systems were evaluated based on both discrimination and calibration. Discrimination was assessed by calculating the area under the receiver operating characteristic curve (AUC) for each model. Calibration was measured across defined groups based on mortality risk using the Hosmer-Lemeshow goodness-of-fit test. A total of 2034 patients were included in this study, of whom 127 (6.2

Abstract For deep learning networks used to segment organs at risk (OARs) in head and neck (H&N) cancers, the class-imbalance problem between small volume OARs and whole computed tomography (CT) images results in delineation with serious false-positives on irrelevant slices and unnecessary time-consuming calculations. To alleviate this problem, a slice classification model-facilitated 3D encoder–decoder network was developed and validated. In the developed two-step segmentation model, a slice classification model was firstly utilized to classify CT slices into six categories in the craniocaudal direction. Then the target categories for different OARs were pushed to the different 3D encoder–decoder segmentation networks, respectively. All the patients were divided into training (n = 120), validation (n = 30) and testing (n = 20) datasets. The average accuracy of the slice classification model was 95.99%. The Dice similarity coefficient and 95% Hausdorff distance, respectively, for each OAR were as follows: right eye (0.88 ± 0.03 and 1.57 ± 0.92 mm), left eye (0.89 ± 0.03 and 1.35 ± 0.43 mm), right optic nerve (0.72 ± 0.09 and 1.79 ± 1.01 mm), left optic nerve (0.73 ± 0.09 and 1.60 ± 0.71 mm), brainstem (0.87 ± 0.04 and 2.28 ± 0.99 mm), right temporal lobe (0.81 ± 0.12 and 3.28 ± 2.27 mm), left temporal lobe (0.82 ± 0.09 and 3.73 ± 2.08 mm), right temporomandibular joint (0.70 ± 0.13 and 1.79 ± 0.79 mm), left temporomandibular joint (0.70 ± 0.16 and 1.98 ± 1.48 mm), mandible (0.89 ± 0.02 and 1.66 ± 0.51 mm), right parotid (0.77 ± 0.07 and 7.30 ± 4.19 mm) and left parotid (0.71 ± 0.12 and 8.41 ± 4.84 mm). The total segmentation time was 40.13 s. The 3D encoder–decoder network facilitated by the slice classification model demonstrated superior performance in accuracy and efficiency in segmenting OARs in H&N CT images. This may significantly reduce the workload for radiation oncologists.

The retention of a capsule endoscope (CE) in the stomach and the duodenal bulb during the examination is a troublesome problem, which can make the medical staff spend several hours observing whether the CE enters the descending segment of the duodenum (DSD). This paper investigated and evaluated the Convolution Neural Network (CNN) for automatic retention-monitoring of the CE in the stomach or the duodenal bulb. A trained CNN system based on 180,000 CE images of the DSD, stomach, and duodenal bulb was used to assess its recognition of the accuracy by calculating the area under the receiver operating characteristic curve (ROC-AUC), sensitivity and specificity. The AUC for distinguishing the DSD was 0.984. The sensitivity, specificity, positive predictive value, and negative predictive value of the CNN were 97.8%, 96.0%, 96.1% and 97.8%, respectively, at a cut-off value of 0.42 for the probability score. The deviated rate of the time into the DSD marked by the CNN at less than ±8 min was 95.7% (P < 0.01). These results indicate that the CNN for automatic retention-monitoring of the CE in the stomach or the duodenal bulb can be used as an efficient auxiliary measure in the clinical practice.

Objective To investigate the feasibility and clinical efficacy of transcatheter arterial embolization using hemostatic clips as the guidance in the patients with peptic ulcer bleeding after endoscopic treatment failure. Methods From February 2009 to October 2018, 33 patients with peptic ulcer bleeding who were treated with transcatheter arterial embolization after endoscopic treatment failure were included in the study. Clinical success rate, 30-d mortality rate and complication rate were observed. Results According to Forrest grading of ulcer bleeding on endoscopy, 8 patients (24.2%) were defined as Ⅰa, 14 patients (42.5%) Ⅰb, 4 patients (12.1%) Ⅱa, and 7 patients (21.2%) Ⅱb. There were 8 patients not given endoscopic treatment due to poor vision. In 25 patients who received endoscopic treatment, 7 patients did not achieve primary endoscopic hemostasis and 18 patients had re-bleeding despite successful primary hemostasis. The mean interval time from endoscopic treatment failure to transcatheter arterial embolization was (35.42±67.54) h. All patients underwent arterial angiography, and 18 patients with positive angiographic findings were treated with embolization. Among the 15 patients with negative angiographic findings, hemostatic clip could be observed fluoroscopically in 8 patients and used as guidance for embolization. Prophylactic embolization was performed in 4 out of 7 patients without visualization of clip fluoroscopically. The clinical success rates in negative angiographic findings patients with and without clip guidance were 75.0% and 28.6% respectively. The clinical success rate with positive angiographic findings was 66.7%. The overall clinical success rate and 30-d mortality rate were 60.0% and 20.0% respectively. No complication related to embolization was observed. Conclusion The preliminary clinical study demonstrates that transcatheter arterial embolization with the guidance of clips is effective and safe for patients with peptic ulcer bleeding after endoscopic treatment failure.

was the worst.Pooled RR while comparing glue and TIPS for encephalopathy was 0.20 (0.05, 0.84), in favor of glue.Conclusions BRTO was found to be the best treatment modality for management of bleeding GV in terms of mortality and rebleeding, followed by glue injection.TIPS was ranked third, with a higher risk of encephalopathy, and banding was worst.Newer endoscopic modalities that draw from interventional radiology experience such as coil embolization and gel foam, which were not assessed in this analysis, may yield similar results as BRTO in the near future.