Investigation of out-of-distribution detection across various models and training methodologies.

Machine learning-based algorithms demonstrate impressive performance across numerous fields; however, they continue to suffer from certain limitations. Even sophisticated and precise algorithms often make erroneous predictions when implemented with datasets having different distributions compared to the training set. Out-of-distribution (OOD) detection, which distinguishes data with different distributions from that of the training set, is a critical research area necessary to overcome these limitations and create more reliable algorithms. The OOD issue, particularly concerning image data, has been extensively studied. However, recently developed OOD methods do not fulfill the expectation that OOD performance will increase as the accuracy of in-distribution classification improves. Our research presents a comprehensive study on OOD detection performance across multiple models and training methodologies to verify this phenomenon. Specifically, we explore various pre-trained models popular in the computer vision field with both old and new OOD detection methods. The experimental results highlight the performance disparity in existing OOD methods. Based on these observations, we introduce Trimmed Rank with Inverse softMax probability (TRIM), a remarkably simple yet effective method for model weights with newly developed training methods. The proposed method could serve as a potential tool for enhancing OOD detection performance owing to its promising results. The OOD performance of TRIM is highly compatible with the in-distribution accuracy model and may bridge the efforts on improving in-distribution accuracy to the ability to distinguish OOD data.

A Retrospective Multicenter Study of Risk Factors, Stratification, and Prognosis of Lymph Node Metastasis in T1 and T2 Colorectal Cancer.

BACKGROUND: The objective of this study was to compare the long-term prognosis of patients with T1 and T2 colorectal cancer (CRC) according to lymph node metastasis (LNM) and to identify risk factors for LNM. METHODS: We retrospectively reviewed patients who underwent curative resection for T1 or T2 CRC at five University-affiliated hospitals between January 2012 and December 2021. The patients were divided into several groups depending on the presence of LNM or the number of risk factors. RESULTS: Of the total 765 patients, 87 (11.3%) patients had LNM. These patients had poorer recurrence-free survival (RFS) than patients without LNM (72.6% vs. 88.6%). The multivariable analysis showed that high-grade tumors (p = 0.003), lymphovascular invasion (p < 0.001), and rectal location (p = 0.049) were independent predictors of LNM. When divided into groups according to the number of the three risk factors, the risk of LNM increased from 5.4% (ultralow-risk group; no risk factor) to 60.0% (high-risk group; all three risk factors) and the 5-year RFS rate decreased from 96.3% in the ultralow-risk group to 60% in the high-risk group (p < 0.001). CONCLUSION: Radical surgery should be considered for T1 and T2 CRC patients with these risk factors.

Oncologic relevance of genetic alterations in sporadic synchronous and solitary colorectal cancer: a retrospective multicenter study.

BACKGROUND: Oncologic impact of genetic alteration across synchronous colorectal cancer (CRC) still remains unclear. This study aimed to compare the oncologic relevance according to genetic alteration between synchronous and solitary CRC with performing systematic review. METHODS: Multicenter retrospective analysis was performed for CRC patients with curative resection. Genetic profiling was consisted of microsatellite instability (MSI) testing, RAS (K-ras, and N-ras), and BRAF (v-Raf murine sarcoma viral oncogene homolog B1) V600E mutation. Multivariate analyses were conducted using logistic regression for synchronicity, and Cox proportional hazard model with stage-adjusting for overall survival (OS) and disease-free survival (DFS). RESULTS: It was identified synchronous (n = 36) and solitary (n = 579) CRC with similar base line characteristics. RAS mutation was associated to synchronous CRC with no relations of MSI and BRAF. During median follow up of 77.8 month, Kaplan-meier curves showed significant differences according to MSI-high for OS, and in RAS, and BRAF mutation for DFS, respectively. In multivariable analyses, RAS and BRAF mutation were independent factors (RAS, HR = 1.808, 95% CI = 1.18-2.77, p = 0.007; BRAF, HR = 2.417, 95% CI = 1.32-4.41, p = 0.004). Old age was independent factor for OS (HR = 3.626, 95% CI = 1.09-12.00, p = 0.035). CONCLUSION: This study showed that oncologic outcomes might differ according to mutation burden characterized by RAS, BRAF, and MSI between synchronous CRC and solitary CRC. In addition, our systematic review highlighted a lack of data and much heterogeneity in genetic characteristics and survival outcomes of synchronous CRC relative to that of solitary CRC.

A Retrospective Multicenter Study of the Clinicopathological Characteristics and Prognosis of Young Adult Patients with Colorectal Cancer: Effects of Chemotherapy on Prognosis.

BACKGROUND: The objective of this study was to evaluate clinicopathologic features of young patients with colorectal cancer (CRC) and to compare their prognosis with those of older patients Methods: We retrospectively reviewed the medical records of patients who underwent surgery for stage 0-III CRC at four university-affiliated hospitals between January 2011 and December 2020. The patients were divided into two groups, the young adult group (≤45 years) and the older group (>45 years). RESULTS: Of 1992 patients, 93 (4.6%) were young adults and 1899 (95.3%) were older patients. Young patients showed more symptoms (p = 0.014) and more poorly or undifferentiated adenocarcinoma (p = 0.047) than older patients. The young adult patients were more likely to receive adjuvant chemotherapy (p < 0.001) and multidrug agents (p = 0.029), and less likely to cease chemotherapy (p = 0.037). The five-year RFS (recurrence-free survival) rate was better in the young adults than in the older patients (p = 0.009). In the multivariable analysis, young age was a significant prognostic factor for better RFS (p = 0.015). CONCLUSIONS: Young patients with CRC had more symptoms, aggressive histological features than older patients. They received more multidrug agents and discontinued chemotherapy less often, resulting in better prognosis.

Self-expandable metallic stents as a bridge to surgery in obstructive right- and left-sided colorectal cancer: a multicenter cohort study.

The insertion of a self-expandable metal stent (SEMS) has been proposed as an alternative to emergent surgery (ES) for obstructive colorectal cancer (CRC). We aimed to evaluate the perioperative and oncologic outcomes of SEMS as a bridge to surgery in obstructive CRC, as compared with ES. We retrospectively reviewed the medical records of patients who underwent curative resection of obstructive CRC at four Hallym University-affiliated hospitals between January 2010 and December 2019. All patients were analyzed overall colon, then according to the side of obstruction (overall, right or left). Of 167 patients, 52 patients underwent ES and 115 underwent SEMS insertion and surgery (SEMS group). The postoperative hospital stay and time to soft diet were shorter in the SEMS group than in the ES group for overall and both sided cancer. The SEMS group had lower rates of stoma formation and severe complications for overall and for left-sided cancer. The 5-year overall survival (P = 0.682) and disease-free survival (P = 0.233) rates were similar in both groups. SEMS insertion as a bridge to surgery was associated with faster recovery, a lower rate of stoma formation with similar oncologic outcomes to those of ES.

Recurrence-Free Survival Outcomes Based on Novel Classification Combining Lymphovascular Invasion, Perineural Invasion, and T4 Status in Stage II-III Colon Cancer.

Background: T4 tumor, lymphovascular invasion (LVI) and perineural invasion (PNI) are regarded as one of risk factors and associated with poor outcomes in colorectal cancer. The relationship between these three combined risk factors and the prognosis for colon cancer is not yet clear. The purpose of this study was to evaluate the prognostic value of combining the risk factors T4 tumor, LVI, and PNI in stage II-III colon cancer. Methods: Between January 2011 and December 2019, we retrospectively reviewed the medical records of patients who underwent curative resection for stage II-III colon cancer at four Hallym University-affiliated hospitals. These patients are categorized into three groups based on T4, LVI and PNI: no-risk group (no risk factors), low-risk group (one risk factor), and high-risk group (two or more risk factors). Results: Of 1684 patients, the incidence of no-, low-, and high-risk group were 49.3%, 32.6%, 18.0%, respectively. The median follow-up period was 48.9 months, and the 5-year recurrence-free survival (RFS) rate decreased from 78.5% to 58.7% as the number of risk factors increased (P < 0.001). Cox's proportional hazard regression models showed that T4 (P < 0.001), LVI (P = 0.043), and PNI (P = 0.018) were independent prognostic factors for poor RFS. In subgroup analysis in stage II colon cancer, patients with one or more risk factors showed the better 5-year RFS rate when they received adjuvant chemotherapy than in those who did not (P < 0.001). Poor/mucinous differentiation, obstruction, and lymph-node positivity were independent predictors in the high risk group. Conclusion: The present study showed the histological combination of LVI, PNI, and T4 indicates a poor prognosis for RFS in patients with stage II-III colon cancer. Therefore, patients with one of these risk factors should be considered for chemotherapy and have close follow-up.

Does the morphology of the umbilicus influence the incidence of surgical site infections in transumbilical single-incision laparoscopic appendectomy?

Background: Transumbilical laparoscopic appendectomy (TULA) may be a feasible alternative to conventional laparoscopic appendectomy. However, a transumbilical incision may increase incisional surgical site infections (SSIs) compared to conventional laparoscopic appendectomy. This study aimed to investigate the relationship between the morphology of the umbilicus and the incidence of SSIs in patients who underwent TULA. Patients and Methods: This retrospective study analysed the medical records of consecutive patients who underwent surgery for acute appendicitis at our institution from June 2016 to October 2020. The patients were assigned to the SSI group (those with an SSI) or the non-SSI group. The morphology of the umbilicus was calculated by measuring its width and depth on preoperative computed tomography images and was compared between the SSI and non-SSI groups. Results: The SSI group included 23 patients, while the non-SSI group included 252 patients. The width of the umbilicus was significantly shorter in the SSI group than in the non-SSI group (29 ± 10 mm vs. 34 ± 9 mm, P = 0.027). The umbilicus was slightly deeper in the SSI group than in the non-SSI group; however, the difference was not significant (16 mm vs. 15 mm, P = 0.384). Conclusions: This was the first study investigating the correlation between the morphology of the umbilicus and SSI development in TULA. SSIs tended to occur more commonly in a narrow and deep umbilicus. An extension of the umbilical incision may help prevent SSI in patients with this umbilical morphology.

Clinical and oncologic outcomes of laparoscopic versus open surgery in elderly patients with colorectal cancer: a retrospective multicenter study.

BACKGROUND: Laparoscopic surgery is commonly used in elderly patients over 80 years old. The purpose of this study was to compare the perioperative and oncologic outcomes between laparoscopic surgery and open surgery in elderly patients with colorectal cancer. METHODS: We retrospectively analyzed the medical records of patients aged ≥ 80 years who underwent curative resection of colorectal cancer at six Hallym University-affiliated hospitals. The perioperative outcomes and oncologic outcomes were compared between laparoscopic and open surgery RESULTS: Of 294 elderly patients, 104 (35.3%) underwent open surgery and 190 (64.7%) underwent laparoscopic surgery. The postoperative hospital stay (P = 0.019) and time to soft diet (P = 0.009) were shorter in the laparoscopic group than in the open group. Postoperative complications were less frequent in the laparoscopic group than in the open group (P < 0.001), including wound infection (P = 0.005), ileus (P = 0.005), and pneumonia (P = 0.001). The 3-year overall survival (OS) (P = 0.982) and recurrence-free survival rates (RFS) (P = 0.532) were similar in both groups. In multivariable analyses, positive lymph node status was the only independent factor associated with OS (P = 0.019) and RFS (P = 0.012). Laparoscopic surgery was not associated with OS (P = 0.874) and RFS (P = 0.772). CONCLUSION: Laparoscopic surgery offers several perioperative advantages over open surgery and similar long-term oncological outcomes for elderly patients with colorectal cancer. Therefore, we suggest that laparoscopic surgery can be safely performed for the treatment of elderly patients (≥ 80 years old) with colorectal cancer.

Oral Administration of Live and Dead Cells of Lactobacillus sakei proBio65 Alleviated Atopic Dermatitis in Children and Adolescents: a Randomized, Double-Blind, and Placebo-Controlled Study.

Several studies suggest that probiotics might be useful in the management of atopic dermatitis (AD). However, the efficacy and comparison between both the administration of viable and non-viable probiotics on alleviation of AD is not well studied. Therefore, the purpose of this study was to evaluate the effect of L. sakei proBio65 live and dead cells when administered (1 × 1010 cells/day) for 12 weeks to children and adolescents (aged 3 to 18) with atopic dermatitis. In this randomized double-blind, placebo-controlled study, ninety patients were recruited and randomly allocated to either the L. sakei proBio65 live cells, L. sakei proBio65 dead cells, or placebo groups. Assessment of efficacy was based on the change in SCORing Atopic Dermatitis (SCORAD) score, Investigators Global Assessment (IGA) score, serum inflammatory markers such as the serum eosinophil (count), IgE, eosinophil cationic protein (ECP), CCL17 (thymus and activation-regulated chemokine [TARC]), and CCL27 (cutaneous T cell-attracting chemokine [CTACK]), and changes in skin condition (moisture and sebum) at baseline, week 6 and week 12. The SCORAD total score decreased in the live cells (p = 0.0015) and dead cell group (p = 0.0017) from the baseline after 12 weeks, whereas there were no significant changes in the placebo group when compared with baseline. The skin sebum content increased in both the live cell (p < 0.0001) and the dead cell group (p < 0.0001), suggesting potential improvements in skin barrier functions. Current data suggested a positive improvement in alleviation of AD symptoms upon oral administration of L. sakei proBio65 in both viable and non-viable forms.

Clinical outcomes of sigmoid volvulus and risk factors for its recurrence: a multicenter study in Korea.

PURPOSE: Sigmoid volvulus is one of the leading causes of colonic obstruction. The aims of this study were to review the treatment characteristics and clinical outcomes of patients diagnosed with sigmoid volvulus over 10 years at five university-affiliated hospitals in Korea, and to identify possible risk factors for its recurrence. METHODS: Retrospective review was performed for medical records of patients who were diagnosed with sigmoid volvulus and managed surgically or conservatively at the five Hallym University-affiliated hospitals between January 2005 and July 2018. RESULTS: A total of 69 patients were diagnosed, of whom 11 patients underwent emergency surgery and 58 patients were conservatively managed. Non-operative management was successful in 53 of 58 patients (91.4%) at initial admission. Of the non-operative managed patients, six patients required emergency surgery due to unsuccessful decompression or recurrence whereas 23 patients underwent regular surgery for definitive treatment. And overall recurrence rate and mortality rate were 25.8% (15/58) and 1.7% (1/58), respectively. A total of 40 patients underwent surgery; 23 underwent regular surgery and 17 underwent emergency surgery. Restoration of bowel continuity was more frequently performed in the regular surgery group than in the emergency surgery group (87.0% vs 52.9%, P = 0.03). In multivariable analysis, only non-operative management at the initial admission (P = 0.029) was independently associated with recurrence. CONCLUSION: Although non-operative treatment can be initially attempted, surgery is required for preventing recurrence. Regular surgery should be considered to restore continuity of the bowel.

Early versus late surgical management for complicated appendicitis in adults: a multicenter propensity score matching study.

PURPOSE: Surgeons may be uncertain about the optimal timing of appendectomy to decrease complications, especially for complicated appendicitis. The aim of the study was to compare clinical outcomes between early and late surgery for complicated appendicitis. METHODS: A prospectively maintained database of complicated appendicitis was queried. Elective interval surgery (EIS) group and early surgery (ES) were matched with propensity score and marked with a prefix 'p.' Patient characteristics and surgical outcomes were compared. RESULTS: The propensity score-matched EIS group had a lower chance to underwent ileo-cecectomy or right hemicolectomy (1.5% vs. 6.9%, P = 0.031), a tendency of lower rate of postoperative complication (6.9% vs. 13.7%, P = 0.067), a lower rate of wound infection (1.5% vs. 8.4%, P = 0.010), and shorter postoperative hospital stay (3.72 days vs. 5.82 days, P < 0.001) than the propensity score-matched ES group. Multivariate analysis showed that delayed surgery for more than 48 hours or urgent surgery due to failure of EIS and open conversion were independent risk factors for postoperative complications (P = 0.001 and P = 0.025, respectively). In subgroup analysis, high American Society of Anesthesiologists physical status classification and distant abscess or generalized ascites in initial CT increased the risk of failure of EIS. CONCLUSION: EIS can be a useful option for selected adult patients with complicated appendicitis.

Results of Laparotomy and Laparoscopy for Perforated Colonic Diverticulitis.

BACKGROUND AND OBJECTIVES: The applications of laparoscopic surgery are expanding, but there is still controversy about its application in patients with peritonitis resulting from diverticulitis perforation. This study aimed to investigate the factors affecting the postoperative mortality rate in patients undergoing surgery for perforated diverticulitis. Further, we compared the recovery courses of patients between open and laparoscopic surgeries. METHODS: We analyzed the medical records of adult patients with peritonitis caused by perforated diverticulitis from six hospitals of Hallym University Medical Center from January 2006 to December 2016. RESULTS: A total of 166 patients were identified. In the univariate analysis, the statistically significant factors associated with postoperative mortality were age ≥ 60 years, body mass index ≥ 23 kg/m2, American Society of Anesthesiologists score ≥ 3, hypertension, serum blood urea nitrogen ≥ 23 mg/dL, creatinine ≥ 1.2 mg/dL, albumin < 3.0 g/dL, modified Hinchey score ≥ grade III, formation of stoma, and laparoscopic surgery. In multivariate analysis, serum albumin < 3.0 g/dL was the only factor associated with mortality. After case-control matching, we compared postoperative hospital course and prognosis between open and laparoscopic surgery groups. There was no significant difference in the clinical course between the groups. No significant difference was observed in the complication rate, reoperation rate, readmission rate, and mortality. CONCLUSION: Low preoperative serum albumin level (<3.0 g/dL) affects the mortality rate of patients after surgery. The hospital course and prognosis after laparoscopic surgery and conventional open surgery are comparable in patients with peritonitis caused by diverticulitis perforation.

Transumbilical Single-Incision Laparoscopic-Assisted Appendectomy (TULAA) Is Useful in Adults and Young Adolescents: Comparison with Multi-Port Laparoscopic Appendectomy.

Background and objectives: Single-port laparoscopic appendectomy (SLA) in most previous studies has used intracorporeal excision of the appendix and needed a longer operative time than multi-port laparoscopic appendectomy (MLA), although SLA does have the potential benefit of an almost invisible scar within the umbilicus. Some studies have reported that extracorporeal transumbilical single-incision laparoscopic-assisted appendectomy (TULAA) in children took a considerably reduced operative time compared to MLA. We adopted TULAA in adults, adding routine dissection of the peritoneal attachment of the appendix. The aim was to compare the operative outcomes between TULAA and MLA. Materials and Methods: Between March 2013 and January 2016, 770 patients with acute uncomplicated and complicated appendicitis from 15 to 75 years of age were enrolled retrospectively. The operation was performed as early (EA) and interval appendectomy (IA). Results: Operative time was shorter in the TULAA group than in the MLA group, except for IA. No open conversion occurred in the TULAA group, except one case of ileocecal resection for IA. No intra-abdominal fluid collection was found in the TULAA group. Extended resection (especially partial cecectomy) was performed less frequently in the TULAA group than in the MLA group for IA. Mean postoperative hospital stay was shorter in the TULAA group for uncomplicated appendicitis. When the data of the EA group and the IA group were compared, operative time was significantly shorter in the IA group for both MLA and TULAA. The open conversion rate and the complication rate tended to be lower in the IA group. Confined to IA, the TULAA group tended to have shorter mean initial, postoperative, and total hospital stays. Conclusions: TULAA can be a useful surgical alternative to MLA in adults and young adolescents, because it lacks open conversion and provides both a shorter operative time and a shorter postoperative hospital stay. TULAA is feasible for IA in that it showed a lower rate of extended resection and complications.

Safety and feasibility of laparoscopic surgery for appendiceal mucocele: a multicenter study.

BACKGROUND: Although laparoscopic appendectomy has been widely performed since 1987, concerns over potential spillage of mucus into the peritoneal cavity during laparoscopic manipulation have prevented the use of laparoscopic surgery (LS) for appendiceal mucocele. The purpose of the present study was to evaluate the safety, feasibility, and short-term perioperative outcomes of LS for appendiceal mucocele. METHODS: A retrospective review was performed to identify patients diagnosed with appendiceal mucocele based on their imaging studies and who underwent surgery at one of six Hallym-University-affiliated hospitals between January 2007 and June 2016. Patient demographics, surgical outcomes, and postoperative outcomes were retrospectively analyzed. RESULTS: A total of 96 patients were evaluated, of whom 58 underwent LS (LS group) and 38 underwent open surgery (OS; OS group). There were no significant differences in patient characteristics between groups. The operation time was similar in both groups (P = 0.399). Intraoperative rupture occurred in two patients in each group (no significant difference, P = 0.647). Time to flatus, time to soft food intake, and length of hospital stay were shorter in the LS group than in the OS group (2.4 vs. 3.2 days, P = 0.003; 3.6 vs. 4.5 days, P = 0.024; 6.5 vs. 8.8 days, P = 0.011, respectively). The rate of postoperative complications was similar between the groups (P = 0.786). Univariate analysis revealed that rupture of appendiceal mucocele was associated with white blood cell count > 10,000/µL (P = 0.032) but not with LS (P = 0.647). CONCLUSIONS: The results showed that LS is safe and feasible for the surgical treatment of appendiceal mucocele. An elevated WBC count was associated with a risk of appendiceal mucocele rupture.

The intertwine of nanotechnology with the food industry.

The past decade has proven the competence of nanotechnology in almost all known fields. The evolution of nanotechnology today in the area of the food industry has been largely and has had a lot of contribution in the food processing, food package, and food preservation. The increasing global human population has come with growing population to be fed, and food production is not adjusted to at par with the growing population. This mismatch has shown the real essence of food preservation so that food products can reach to people on a global scale. The introduction of nanotechnology in the food industry has made it easy to transport foods to different parts of the world by extending the shelf-life of most food products. Even with this beneficial aspect of nanotechnology, it has not been proven an entire full-proof measure, and the field is still open to changing technology. It suffices to note that nanotechnology has to a big extent succeed in curbing the extent of food wastage due to food spoilage by the microbial infestation. Nanotechnology has focused on fresh foods, ensuring a healthier food by employing nano-delivery systems in the process. The delivery systems are the ones, which carries the food supplements. However, these are certain sets of regulations that must be followed to tame or control the health related risks of nanotechnology in food industries. This paper outlines the role of nanotechnology at different levels of the food industry including, packaging of food, processing of food and the various preservation techniques all aiming to increase the shelf life of the food products.

Factors predicting malignancy in adult intussusception: An experience in university-affiliated hospitals.

BACKGROUND: Intussusception is one of the common causes of intestinal obstruction in children but is uncommon in adults. Unlike pediatric intussusception, most adult cases have a demonstrable etiology. The purpose of this study was to review our experience of adult intussusception and to identify the predictive factors for malignancy in this disease. METHODS: We retrospectively reviewed the medical records of patients who were diagnosed with intussusception and admitted to the six Hallym University-affiliated hospitals between January 2005 and July 2016. RESULTS: The 77 patients had a mean age of 50.5 years (range, 18-91 years). Enteric intussusception is the most common type of adult intussusception (33.7%), and 11 patients (14.2%) had no definite lesion at operation. The most common symptom was abdominal pain (90.9%), and 18 (23.3%) presented with chronic symptoms. Computed tomography was the most common diagnostic modality used, with a diagnostic accuracy of 96.9%. The leading point was identified in 62 (80.5%) patients. Malignancy was more frequently present in the colonic type than in the other two types (61.5% vs. 10%, 37.9%). In a multivariate analysis, chronic symptom >14 days (p = 0.031) and colonic intussusception (p = 0.026) were independent predictors for malignancy. CONCLUSIONS: Enteric intussusception is the most common type of adult intussusception, and the most common test is computed tomography. Because chronic symptoms and colonic-type intussusception were predictive factors for malignancy, en bloc resection should be considered in patients with chronic or colonic intussusception.

Is Robot-Assisted Surgery Really Scarless Surgery? Immediate Reconstruction with a Jejunal Free Flap for Esophageal Rupture after Robot-Assisted Thyroidectomy.

Esophageal perforation is a rare but potentially fatal complication of robot-assisted thyroidectomy (RAT). Herein, we report the long-term outcome of an esophageal reconstruction with a jejunal free flap for esophageal rupture after RAT. A 33-year-old woman developed subcutaneous emphysema and hoarseness on postoperative day1 following RAT. Esophageal rupture was diagnosed by computed tomography and endoscopy, and immediate surgical exploration confirmed esophageal rupture, as well as recurrent laryngeal nerve injury. We performed a jejunal free flap repair of the 8-cm defect in the esophagus. End-to-side microvascular anastomoses were created between the right external carotid artery and the jejunal branches of the superior mesenteric artery, and end-to-end anastomosis was performed between the external jugular vein and the jejunal vein. The right recurrent laryngeal nerve injury was repaired with a 4-cm nerve graft from the right ansa cervicalis. Esophagography at 1 year after surgery confirmed that there were no leaks or structures, endoscopy at 1 year confirmed the resolution of vocal cord paralysis, and there were no residual problems with swallowing or speech at a 5-year follow-up examination. RAT requires experienced surgeons with a thorough knowledge of anatomy, as well as adequate resources to quickly and competently address potentially severe complications such as esophageal rupture.

Poorly Differentiated Clusters in Colorectal Adenocarcinomas Share Biological Similarities with Micropapillary Patterns as well as Tumor Buds.

In colorectal carcinoma, poorly differentiated clusters (PDCs) are a poor prognostic indicator and show morphological continuity and behavioral similarities to micropapillary patterns (MPPs) as well as tumor buds (TBs). Epithelial-mesenchymal transition (EMT) and inhibition of cancer-stromal interactions may contribute to the development of PDCs. To clarify the biological nature of PDCs, we examined immunohistochemical stainings for ß-catenin, Ki-67, E-cadherin, epithelial cell adhesion molecule (EpCAM), MUC1, and epithelial membrane antigen (EMA), which are associated with EMT and cancer-stromal interactions. The expression frequencies and patterns of PDCs, TBs, and differentiated neoplastic glands from the tumor center (TC) were compared. In the study group (117 cases), the nuclear ß-catenin staining index was higher in PDCs (37.3%) and TBs (43.3%) than in neoplastic glands from TC (8.9%, P < 0.001). The mean Ki-67 labeling index in TC was 71.5%, whereas it was decreased in PDCs (31.2%) and TBs (10.2%, P < 0.001). E-cadherin and EpCAM displayed a tendency to be found along the cell membrane in TC samples (91.5% and 92.3%, respectively), whereas they showed loss of membranous staining in PDC (44.4% and 36.8%, respectively) and TB samples (60.7% and 68.4%, respectively). An inside-out pattern for MUC1 and EMA was frequently observed in PDC (48.7% and 45.3%, respectively) and TB samples (46.2% and 45.3%, respectively), but not in TC samples. Our data demonstrate that there is a pathogenetic overlap among PDCs, TBs, and MPPs and suggest that they might represent sequential growth patterns that branch from common biological processes such as dedifferentiation and alteration in cancer-stromal interactions.

Self-medication and antibiotic resistance: Crisis, current challenges, and prevention.

The present study aims to explore the crisis of antibiotic resistance and discover more about the current challenges related to self-medication. The current challenges related to antibiotic resistance are unique and differ from the challenges of the past since new bacterial pathogens are involved and continue to evolve. Strains with resistance to multiple antibiotic classes have emerged which the discovery of new antibiotics has failed to match. The consequences of antibiotic resistance are grave with mortality and morbidity continually on the rise. This paper also highlights the possible interventions that can be effective at the micro or individual level in the prevention of development of antibiotic resistance.