Leveraging machine learning for early recurrence prediction in hepatocellular carcinoma:A step towards precision medicine

The high rate of early recurrence in hepatocellular carcinoma(HCC)post curative surgical intervention poses a substantial clinical hurdle,impacting patient outcomes and complicating postoperative management.The advent of machine learning provides a unique opportunity to harness vast datasets,identifying subtle patterns and factors that elude conventional prognostic methods.Machine learning models,equipped with the ability to analyse intricate relationships within datasets,have shown promise in predicting outcomes in various medical disciplines.In the context of HCC,the application of machine learning to predict early recurrence holds potential for personalized postoperative care strategies.This editorial comments on the study carried out exploring the merits and efficacy of random survival forests(RSF)in identifying significant risk factors for recurrence,stratifying patients at low and high risk of HCC recurrence and comparing this to traditional COX proportional hazard models(CPH).In doing so,the study demonstrated that the RSF models are superior to traditional CPH models in predicting recurrence of HCC and represent a giant leap towards precision medicine.

Risk Factors Recurrence of Spontaneous Ascitic Fluid Infection (Slai) in Cirrhotic Patients

Introduction: After an episode of spontaneous infection of ascitic fluid (ISLA). The recurrence of ISLA at one year is greater than 70%. We studied the risk factors associated with the occurrence of recurrence. Patients and methods: this was a retrospective, descriptive and analytical study of patient files, hospitalized in the department for 12 months, the choice of the sample was of convenience. Results: We have 1347 patient files collected including 389 cases of cirrhosis. We had 37 files of cirrhotic patients with ISLA including 28 cures without recurrence of ISLA, 08 files of patients with recurrence of ISLA and 03 excluded, i.e. a hospital prevalence of recurrence of 0.6% and a prevalence in cirrhotic patients of 23.5%. The most common antecedents were: hospital contact recent (35.3%), the concept of iterative ascites punctures (32.3%), the presence of HCC (29.4%), hepatic encephalopathy (20.6%) and digestive hemorrhage (14.7%). In univariate analysis, recent digestive bleeding was associated with an increased risk of recurrence (OR 7.2, 95% CI 0.96 - 67.1). HBV (62.5%) is the main etiology of cirrhosis. The PNN rate at 250 - 499 mm3 (62.5%), the protein level 3 (75%). Patients on secondary prophylaxis with NORFLOXACIN were 25%. Recurrence of ISLA was treated with CEFTRIAXONE 2 g/24 hours. Conclusion: Recurrence of ISLA is serious, the predictive factors for recurrence are, hospital contact recent, the concept of iterative ascites punctures, the presence of HCC, the presence of hepatic encephalopathy and digestive bleeding.

Development and validation of a nomogram model for predicting the risk of gallstone recurrence after gallbladder-preserving surgery

Background:The high incidence of gallstone recurrence was a major concern for laparoscopic gallbladderpreserving surgery.This study aimed to investigate the risk factors for gallstone recurrence after gallbladder-preserving surgery and to establish an individualized nomogram model to predict the risk of gallstone recurrence.Methods:The clinicopathological and follow-up data of 183 patients who were initially diagnosed with gallstones and treated with gallbladder-preserving surgery at our hospital from January 2012 to January 2019 were retrospectively collected.The independent predictive factors for gallstone recurrence following gallbladder-preserving surgery were identified by multivariate logistic regression analysis.A nomogram model for the prediction of gallstone recurrence was constructed based on the selected variables.The C-index,receiver operating characteristic(ROC)curve and calibration curve were used to evaluate the predictive power of the nomogram model for gallstone recurrence.Results:During the follow-up period,a total of 65 patients experienced gallstone recurrence,and the recurrence rate was 35.5%.Multivariate logistic regression analysis revealed that the course of gallstones>2 years[odds ratio(OR)=2.567,95%confidence interval(CI):1.270-5.187,P=0.009],symptomatic gallstones(OR=2.589,95%CI:1.059-6.329,P=0.037),multiple gallstones(OR=2.436,95%CI:1.133-5.237,P=0.023),history of acute cholecystitis(OR=2.778,95%CI:1.178-6.549,P=0.020)and a greasy diet(OR=2.319,95%CI:1.186-4.535,P=0.014)were independent risk factors for gallstone recurrence after gallbladder-preserving surgery.A nomogram model for predicting the recurrence of gallstones was established based on the above five variables.The results showed that the C-index of the nomogram model was 0.692,suggesting it was valuable to predict gallstone recurrence.Moreover,the calibration curve showed good consistency between the predicted probability and actual probability.Conclusions:The nomogram model for the prediction of gallstone recurrence might help clinicians develop a proper treatment strategy for patients with gallstones.Gallbladder-preserving surgery should be cautiously considered for patients with high recurrence risks.

Recurrence scoring system predicting early recurrence for patients with pancreatic ductal adenocarcinoma undergoing pancreatectomy and portomesenteric vein resection

BACKGROUND Pancreatectomy with concomitant portomesenteric vein resection(PVR)enables patients with portomesenteric vein(PV)involvement to achieve radical resection of pancreatic ductal adenocarcinoma,however,early recurrence(ER)is frequently observed.AIM To predict ER and identify patients at high risk of ER for individualized therapy.METHODS Totally 238 patients undergoing pancreatectomy and PVR were retrospectively enrolled and were allocated to the training or validating cohort.Univariate Cox and LASSO regression analyses were performed to construct serum recurrence score(SRS)based on 26 serum-derived parameters.Uni-and multivariate Cox regression analyses of SRS and 18 clinicopathological variables were performed to establish a Nomogram.Receiver operating characteristic curve analysis was used to evaluate the predictive accuracy.Survival analysis was performed using Kaplan-Meier method and log-rank test.RESULTS Independent serum-derived recurrence-relevant factors of LASSO regression model,including postoperative carbohydrate antigen 19-9,postoperative carcinoembryonic antigen,postoperative carbohydrate antigen 125,preoperative albumin(ALB),preoperative platelet to ALB ratio,and postoperative platelets to lymphocytes ratio,were used to construct SRS[area under the curve(AUC):0.855,95%CI:0.786–0.924].Independent risk factors of recurrence,including SRS[hazard ratio(HR):1.688,95%CI:1.075-2.652],pain(HR:1.653,95%CI:1.052-2.598),perineural invasion(HR:2.070,95%CI:0.827-5.182),and PV invasion(HR:1.603,95%CI:1.063-2.417),were used to establish the recurrence nomogram(AUC:0.869,95%CI:0.803-0.934).Patients with either SRS>0.53 or recurrence nomogram score>4.23 were considered at high risk for ER,and had poor long-term outcomes.CONCLUSION The recurrence scoring system unique for pancreatectomy and PVR,will help clinicians in predicting recurrence efficiently and identifying patients at high risk of ER for individualized therapy.

Cholera Recurrence within Benin Littoral County: Analysis of Epidemics from 2008, 2016 to 2023

Introduction: Cholera is an acute diarrheal infection caused by the bacillus Vibrio cholerae, which can be fatal in a few hours if left untreated. It rages in endemic-epidemic mode in several countries, including Benin. Despite being the economic capital, the largest city in Benin and the most urbanized municipality in the country, the Littoral County, confounded with the city of Cotonou, is subject to recurrent epidemics. This paper aims to analyze successive cholera epidemics with a view of highlighting the factors contributing to this recurrence. Methods: A secondary analysis was done of the cholera-related databases of the County health office from 2016 to 2023, and its Situation Report No. 79 of December 7th, 2016, to describe the 2016 epidemic. Database data were analyzed in Excel. Results: Similarly to 2008, the 2016 cholera epidemic in Cotonou, which recorded 519 cases and 07 deaths, i.e. a case-fatality rate of 1.35%, spread to the town and six neighboring municipalities. The municipality of So-Ava, home to the index case, had the highest overall attack rate. The two epidemics share the same period of severity. Both epidemic and endemic cases are concentrated in the first seven boroughs of Cotonou, located on the lagoon shore, with low levels of hygiene and sanitation and a poor supply of drinking water. Conclusion: Low levels of hygiene, sanitation and drinking water supply all play a part in the recurrence of cholera epidemics. Sanitation work. Undertaken by the Beninese government is a ray of hope for improving this situation. Meanwhile, public awareness of hygiene measures must continue.

Dual-wavelength pumped latticed Fermi-Pasta-Ulam recurrences in nonlinear Schrödinger equation

We show that the nonlinear stage of the dual-wavelength pumped modulation instability(MI)in nonlinear Schrödinger equation(NLSE)can be effectively analyzed by mode truncation methods.The resulting complicated heteroclinic structure of instability unveils all possible dynamic trajectories of nonlinear waves.Significantly,the latticed-Fermi-Pasta-Ulam recurrences on the modulated-wave background in NLSE are also investigated and their dynamic trajectories run along the Hamiltonian contours of the heteroclinic structure.It is demonstrated that there has much richer dynamic behavior,in contrast to the nonlinear waves reported before.This novel nonlinear wave promises to inject new vitality into the study of MI.

Fear of Cancer Recurrence in Women with Gynecological Cancer:A Systematic Review

Although some types of gynecological cancer have a poor prognosis and high recurrence rate,less is known about the fear of cancer recurrence(FCR)in gynecological cancer patients than in other cancer populations.Psychosocial problems may be experienced more in gender-specific cancers.In order to prevent future health problems related to FCR,it is critical to identify the factors affecting FCR in different subgroups and to develop various interventions.The aim of this study was to review the literature on the factors affecting the FCR in women diagnosed with gynecological cancer and interventions to reduce the FCR.The protocol of this review was registered with PROSPERO(Registration number:CRD42023452570).A total of 18 studies from 10 different countries were included in the systematic review by searching on the PubMed,ScienceDirect,Ovid,Sage,Scopus,Taylor&Francis,Web of Science,CINAHL Complete,and Cochrane databases were searched in English between July-August 2023 without year limitation to identify studies on FCR in women with gynecological cancer.Data from eligible articles were extracted and appraised for quality by two independent reviewers.In addition,bibliometric analysis method was used to visually map the studies on FCR in women with gynecological cancer according to the most frequently repeated keyword,number of citations,most cited author and publication year.Thefindings of the study are categorized and interpreted under two headings,“Interventions affecting FCR”and“Factors influencing FCR”.Sociodemographic characteristics such as age,economic status,social support,family history of cancer,psychological characteristics,quality of life and symptoms affect FCR.Deterioration in mental health and emotional weakness predict higher FCR,increase in positive emotional expression reduces FCR.The negative effects of cancer on sexuality and relationships,concerns about future treatments and emotional problems,and anxiety about not being able to fulfill their roles at home/work are the underlying reasons for the FCR.Therefore,professional psychosocial support should be provided to cancer survivors.Further studies are needed to identify the factors that trigger FCR and to plan interventions accordingly.This study is expected to encourage health professionals to plan interventions and research for gynecological cancer survivors.

Research Status of Fear of Cancer Recurrence in Breast Cancer Patients

Fear of disease progression is one of the most common psychological problems in the treatment of cancer patients. Early recognition and intervention can effectively control the level of fear of disease progression and improve the quality of life of patients. The present situation and influencing factors of FoP in breast cancer patients were reviewed in this paper, in order to provide reference for clinical research of breast cancer patients.

Research Progress of Breast Cancer Stem Cell Stemness and Breast Cancer Recurrence

Currently, breast cancer is the most common malignant tumour in Chinese women with a high incidence rate, and recurrence and metastasis are the main reasons affecting survival. Breast Cancer Stem Cells (BCSCs) are stem cells capable of continuous regeneration in vivo with strong self-renewal ability and multidirectional differentiation potential, which are highly tumourigenic and insensitive to radiotherapy and chemotherapy, and are highly susceptible to breast cancer recurrence. Therefore, exploring the stemness of BCSCs and their mechanism associated with recurrence is important for developing new therapeutic strategies, improving therapeutic efficacy, and improving patient prognosis.

Early gastric cancer recurrence after endoscopic submucosal dissection:Not to be ignored!

This editorial comments on the article“Efficacy of multi-slice spiral computed tomography in evaluating gastric cancer recurrence after endoscopic submucosal dissection”.We focus on the importance of paying more attention to postendoscopic submucosal dissection(ESD)gastric cancer recurrence in patients with early gastric cancer(EGC)and how to manage it effectively.ESD has been a wellknown treatment and the mainstay for EGC,with the advantages of less invasion and fewer complications when compared with traditional surgical procedures.Despite a lower local recurrence rate after ESD,the problem of postoperative recurrence in patients with EGC has become increasingly non-ignorable with the global popularization of ESD technology and the increasing number of post-ESD patients.

Low skeletal muscle mass and high visceral adiposity are associated with recurrence of acute cholecystitis after conservative management:A propensity score-matched cohort study

Background:Recurrent acute cholecystitis(RAC)can occur after non-surgical treatment for acute cholecystitis(AC),and can be more severe in comparison to the first episode of AC.Low skeletal muscle mass or adiposity have various effects in several diseases.We aimed to clarify the relationship between RAC and body parameters.Methods:Patients with AC who were treated at our hospital between January 2011 and March 2022 were enrolled.The psoas muscle mass and adipose tissue area at the third lumbar level were measured using computed tomography at the first episode of AC.The areas were divided by height to obtain the psoas muscle mass index(PMI)and subcutaneous/visceral adipose tissue index(SATI/VATI).According to median VATI,SATI and PMI values by sex,patients were divided into the high and low PMI groups.We performed propensity score matching to eliminate the baseline differences between the high PMI and low PMI groups and analyzed the cumulative incidence and predictors of RAC.Results:The entire cohort was divided into the high PMI(n=81)and low PMI(n=80)groups.In the propensity score-matched cohort there were 57 patients in each group.In Kaplan-Meier analysis,the low PMI group and the high VATI group had a significantly higher cumulative incidence of RAC than their counterparts(log-rank P=0.001 and 0.015,respectively).In a multivariate Cox regression analysis,the hazard ratios of low PMI and low VATI for RAC were 5.250(95%confidence interval 1.083-25.450,P=0.039)and 0.158(95%confidence interval:0.026-0.937,P=0.042),respectively.Conclusions:Low skeletal muscle mass and high visceral adiposity were independent risk factors for RAC.

Prognostic factors of early recurrence after complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

BACKGROUND Although cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)offer the potential for long-term survival in peritoneal carcinomatosis,outcomes following CRS/HIPEC vary significantly.AIM To identify the clinical factors associated with progression-free survival(PFS)after complete CRS/HIPEC in patients with colorectal/high-grade appendiceal,ovarian,and gastric cancers.METHODS We retrospectively evaluated the risk of recurrence within 1 year after CRS/HIPEC and its impact on overall survival(OS)in patients recruited between 2015 and 2020.Logistic regression models were used to assess the prognostic factors for the risk of recurrence within 1 year.Kaplan–Meier survival curves and Cox proportional hazards models were used to evaluate the association between recurrence and OS.RESULTS Of the 80 enrolled patients,39 had an unfavorable PFS(<1 year)and 41 had a favorable PFS(≥1 year).Simple logistic models revealed that the patients with a completeness of cytoreduction score of 0(CC-0)or length of CRS≤6 h had a favorable PFS[odds ratio(OR)=0.141,P=0.004;and OR=0.361,P=0.027,respectively].In multiple logistic regression,achieving CC-0 was the strongest prognostic factor for a favorable PFS(OR=0.131,P=0.005).A peritoneal cancer index score>12 was associated with a lower rate of achieving CC-0(P=0.027).The favorable PFS group had a significantly longer OS(median 81.7 mo vs 17.0 mo,P<0.001).CONCLUSION Achieving CC-0 was associated with a lower early recurrence rate and improved long-term survival.This study underscores the importance of selecting appropriate candidates for CRS/HIPEC to manage peritoneal carcinomatosis.

In situ engineered magnesium alloy implant for preventing postsurgical tumor recurrence

Invasive tumors are difficult to be completely resected in clinical surgery due to the lack of clear resection margins,which greatly increases the risk of postoperative recurrence.However,chemotherapy and radiotherapy as the traditional means of postoperative adjuvant therapy,are limited in postoperative applications,such as multi-drug resistance and low sensitivity,etc.Therefore,an engineered magnesium alloy rod is designed as a postoperative implant to completely remove postoperative residual tumor tissue and inhibit tumor recurrence by gas and mild magnetic hyperthermia therapy(MMHT).As a reactive metal,magnesium alloy responds to the acidic tumor microenvironment by continuously generating hydrogen.The in-situ generation of hydrogen not only protects the surrounding normal tissue,but also enables the magnesium alloy to achieve MMHT under lowintensity alternating magnetic field(AMF).Furthermore,the numerous reactive oxygen species(ROS)produced by heat stress will combine with nitric oxide(NO)generated in situ,to produce more toxic reactive nitrogen species(RNS)storm.In summary,engineered magnesium alloy can completely remove residual tumor tissue and inhibit tumor recurrence by MMHT and RNS storm under low-intensity AMF,and the biodegradability of magnesium alloy makes great potential for clinical application.

Research on the Association between Fear of Cancer Recurrence in Young Breast Cancer Patients and Adult Attachment and Self-Disclosure

Background:Although fear of cancer recurrence(FCR)is the most important factor affecting the life quality of young breast cancer patients,and it may be affected by the patient’s personality,marital relationship and communication,there is a lack of research on the relationship between adult attachment,self-disclosure and FCR in patients.This study investigated the current situation of FCR in young breast cancer patients,its correlation with adult attachment and self-disclosure and its influencing factors,in order to predict the impact of adult attachment and self-disclosure of patients to spouse on FCR.Methods:A survey was conducted on 126 breast cancer patients at our hospital using the General Information Questionnaire(GIQ),Fear of Progression Questionnaire-Short Form(FoP-Q-SF),Experiences in Close Relationships inventory(ECR),and Distress Disclosure Index(DDI).The study analyzed the status of FCR among young breast cancer patients and its correlation with adult attachment and self-disclosure,along with its influencing factors.Results:Among the 126 young breast cancer patients,50 had a FoP-Q-SF score<34(normal group),while 76 had a FoP-Q-SF score≥34(FCR positive group),with an FCR incidence rate of 60.32%.Univariate analysis showed statistically significant differences between the two groups in terms of FoP-Q-SF score,ECR score,attachment anxiety score,attachment avoidance score,DDI score,age,educational level,employment status,per capita monthly income,and treatment method(p<0.05).Correlation analysis revealed that FoP-Q-SF scores were positively correlated with attachment anxiety score,attachment avoidance score,ECR scores and negatively correlated with DDI scores(p<0.05).Linear regression analysis indicated that age,per capita monthly income,treatment method,attachment anxiety,attachment avoidance and self-disclosure level were negative predictors of FoP-Q-SF scores in young breast cancer patients(p<0.05).Conclusion:The incidence rate of FCR among young breast cancer patients is high.There is a positive correlation between adult attachment and the level of FCR,and a negative correlation between the level of self-disclosure and FCR.Patients with lower per capita monthly income,more complex treatment methods,higher level of attachment anxiety,higher level of attachment avoidance and lower DDI scores had higher FoP-Q-SF scores.

Identifying timing and risk factors for early recurrence of resectable rectal cancer: A single center retrospective study

BACKGROUND Colorectal cancer is a common malignancy and various methods have been introduced to decrease the possibility of recurrence.Early recurrence(ER)is related to worse prognosis.To date,few observational studies have reported on the analysis of rectal cancer.Hence,we reported on the timing and risk factors for the ER of resectable rectal cancer at our institute.AIM To analyze a cohort of patients with local and/or distant recurrence following the radical resection of the primary tumor.METHODS Data were retrospectively collected from the institutional database from March 2011 to January 2021.Clinicopathological data at diagnosis,perioperative and postoperative data,and first recurrence were collected and analyzed.ER was defined via receiver operating characteristic curve.Prognostic factors were evaluated using the Kaplan–Meier method and Cox proportional hazards modeling.RESULTS We included 131 patients.The optimal cut off value of recurrence-free survival(RFS)to differentiate between ER(n=55,41.9%)and late recurrence(LR)(n=76,58.1%)was 8 mo.The median post-recurrence survival(PRS)of ER and LR was 1.4 mo and 2.9 mo,respectively(P=0.008)but PRS was not strongly associated with RFS(R^(2)=0.04).Risk factors included age≥70 years[hazard ratio(HR)=1.752,P=0.047],preoperative concurrent chemoradiotherapy(HR=3.683,P<0.001),colostomy creation(HR=2.221,P=0.036),and length of stay>9 d(HR=0.441,P=0.006).CONCLUSION RFS of 8 mo was the optimal cut-off value.Although ER was not associated with PRS,it was still related to prognosis;thus,intense surveillance is recommended.

Pre-operative enhanced magnetic resonance imaging combined with clinical features predict early recurrence of hepatocellular carcinoma after radical resection

BACKGROUND Indentifying predictive factors for postoperative recurrence of hepatocellular carcinoma(HCC)has great significance for patient prognosis.AIM To explore the value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)enhanced magnetic resonance imaging(MRI)combined with clinical features in predicting early recurrence of HCC after resection.METHODS A total of 161 patients with pathologically confirmed HCC were enrolled.The patients were divided into early recurrence and non-early recurrence group based on the follow-up results.The clinical,laboratory,pathological results and Gd-EOB-DTPA enhanced MRI imaging features were analyzed.RESULTS Of 161 patients,73 had early recurrence and 88 were had non-early recurrence.Univariate analysis showed that patient age,gender,serum alpha-fetoprotein level,the Barcelona Clinic Liver Cancer stage,China liver cancer(CNLC)stage,microvascular invasion(MVI),pathological satellite focus,tumor size,tumor number,tumor boundary,tumor capsule,intratumoral necrosis,portal vein tumor thrombus,large vessel invasion,nonperipheral washout,peritumoral enhancement,hepatobiliary phase(HBP)/tumor signal intensity(SI)/peritumoral SI,HBP peritumoral low signal and peritumoral delay enhancement were significantly associated with early recurrence of HCC after operation.Multivariate logistic regression analysis showed that patient age,MVI,CNLC stage,tumor boundary and large vessel invasion were independent predictive factors.External data validation indicated that the area under the curve of the combined predictors was 0.861,suggesting that multivariate logistic regression was a reasonable predictive model for early recurrence of HCC.CONCLUSION Gd-EOB-DTPA enhanced MRI combined with clinical features would help predicting the early recurrence of HCC after operation.

Establishment and evaluation of prediction model of recurrence after laparoscopic choledocholithotomy

BACKGROUND Choledocholithiasis is a common clinical bile duct disease,laparoscopic choledocholithotomy is the main clinical treatment method for choledocho-lithiasis.However,the recurrence of postoperative stones is a big challenge for patients and doctors.AIM To explore the related risk factors of gallstone recurrence after laparoscopic choledocholithotomy,establish and evaluate a clinical prediction model.METHODS A total of 254 patients who underwent laparoscopic choledocholithotomy in the First Affiliated Hospital of Ningbo University from December 2017 to December 2020 were selected as the research subjects.Clinical data of the patients were collected,and the recurrence of gallstones was recorded based on the postope-rative follow-up.The results were analyzed and a clinical prediction model was established.RESULTS Postoperative stone recurrence rate was 10.23%(26 patients).Multivariate Logistic regression analysis showed that cholangitis,the diameter of the common bile duct,the diameter of the stone,number of stones,lithotripsy,preoperative total bilirubin,and T tube were risk factors associated with postoperative recurrence(P<0.05).The clinical prediction model was ln(p/1-p)=-6.853+1.347×cholangitis+1.535×choledochal diameter+2.176×stone diameter+1.784×stone number+2.242×lithotripsy+0.021×preoperative total bilirubin+2.185×T tube.CONCLUSION Cholangitis,the diameter of the common bile duct,the diameter of the stone,number of stones,lithotripsy,preoperative total bilirubin,and T tube are the associated risk factors for postoperative recurrence of gallstone.The prediction model in this study has a good prediction effect,which has a certain reference value for recurrence of gallstone after laparoscopic choledocholi-thotomy.

Impact of different anastomosis methods on post-recurrence after intestinal resection for Crohn's disease:A meta-analysis

BACKGROUND Crohn's disease(CD)is a chronic inflammatory disease of the gastrointestinal tract,often requiring intestinal resection as a common treatment.However,recurrence after surgery is common.The anastomotic configuration after bowel resection appears to be associated with the recurrence of CD.Previous studies have suggested that the Kono-S anastomosis may help to reduce the recurrence rate.However,the results remain controversial.Therefore,evidence-based evidence is needed to prove the advantages of Kono-S anastomosis.AIM To measure the influence of anastomosis techniques on the long-term relapse rate of CD by conducting a meta-analysis.METHODS PubMed,Scopus,and Cochrane Library were searched until October 8,2023.Patients who underwent intestinal resection due to CD were included.The intervention measures included Kono-S anastomosis,whereas the control group received traditional anastomosis such as end-to-end,end-to-side,and side-to-side anastomosis.Only randomized clinical trials and observational studies were included.The primary outcome measures were hospital stay post-surgery,overall postoperative complication incidence,the proportion of Clavien-Dindo grade IIIa or higher,overall postoperative recurrence rate,and Rutgeerts score.RESULTS From 2011 to 2023,six articles met the inclusion and exclusion criteria.The results indicated that Kono-S anastomosis can reduce the hospital stay post-surgery of patients with CD[MD=-0.26,95%CI:-0.42 to-0.10,P=0.002]than other traditional anastomosis methods.Compared to other traditional anastomosis methods,Kono-S anastomosis can significantly reduce the total recurrence rate[MD=0.40,95%CI:0.17 to 0.98,P=0.05]and postoperative Rutgeerts score[MD=-0.81,95%CI:-0.96 to-0.66,P<0.001]in patients with CD.However,there is no significant disparity in the overall occurrence of postoperative complications and the proportion of Clavien-Dindo≥IIIa.CONCLUSION Kono-S anastomosis has the potential to expedite the recuperation of CD and diminish relapse hazards;however,additional larger trials are necessary to authenticate its effectiveness.

Medical imaging for the diagnosis,recurrence and metastasis evaluation of clear cell sarcoma

Clear cell sarcoma(CCS)of soft tissue is extremely rare,accounting for approximately 1%of all soft tissue tumours.It is very difficult to diagnose CCS based on clinical manifestations.Magnetic resonance imaging(MRI)provides highresolution images of soft tissues and pathological features such as mucus,necrosis,bleeding,and fat through high and low signals on T1 weighted image(T1WI)and T2 weighted image(T2WI).On the other hand,the paramagnetism of melanin in CCS shortens the relaxation time of T1 and T2,and high signal intensity on T1WI and low signal intensity on T2WI can be found.This is different from most other soft tissue sarcomas.At present,the treatment method for CCS is surgical resection.MRI can effectively display the tumour edge,extent of surrounding oedema,and extent of fat involvement,which is highly important for guiding surgical resection and predicting postoperative recurrence.As an invasive sarcoma,CCS has a high risk of metastasis.Regardless of the pathological condition of the resected tumour,MRI or computed tomography(CT)should be performed every 1-2 years to assess recurrence at the primary site and to screen for metastasis in the lungs,liver,and bones.If necessary,PET-CT can be performed to evaluate the overall condition of the patient.

Development and validation of a circulating tumor DNA-based optimization-prediction model for short-term postoperative recurrence of endometrial cancer

BACKGROUND Endometrial cancer(EC)is a common gynecological malignancy that typically requires prompt surgical intervention;however,the advantage of surgical management is limited by the high postoperative recurrence rates and adverse outcomes.Previous studies have highlighted the prognostic potential of circulating tumor DNA(ctDNA)monitoring for minimal residual disease in patients with EC.AIM To develop and validate an optimized ctDNA-based model for predicting shortterm postoperative EC recurrence.METHODS We retrospectively analyzed 294 EC patients treated surgically from 2015-2019 to devise a short-term recurrence prediction model,which was validated on 143 EC patients operated between 2020 and 2021.Prognostic factors were identified using univariate Cox,Lasso,and multivariate Cox regressions.A nomogram was created to predict the 1,1.5,and 2-year recurrence-free survival(RFS).Model performance was assessed via receiver operating characteristic(ROC),calibration,and decision curve analyses(DCA),leading to a recurrence risk stratification system.RESULTS Based on the regression analysis and the nomogram created,patients with postoperative ctDNA-negativity,postoperative carcinoembryonic antigen 125(CA125)levels of<19 U/mL,and grade G1 tumors had improved RFS after surgery.The nomogram’s efficacy for recurrence prediction was confirmed through ROC analysis,calibration curves,and DCA methods,highlighting its high accuracy and clinical utility.Furthermore,using the nomogram,the patients were successfully classified into three risk subgroups.CONCLUSION The nomogram accurately predicted RFS after EC surgery at 1,1.5,and 2 years.This model will help clinicians personalize treatments,stratify risks,and enhance clinical outcomes for patients with EC.