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Monitoring surgical wounds post-operatively is necessary to prevent infection, dehiscence and other complications. However, the monitoring of deep surgical sites is typically limited to indirect observations or to costly radiological investigations that often fail to detect complications before they become severe. Bioelectronic sensors could provide accurate and continuous monitoring from within the body, but the form factors of existing devices are not amenable to integration with sensitive wound tissues and to wireless data transmission. Here we show that multifilament surgical sutures functionalized with a conductive polymer and incorporating pledgets with capacitive sensors operated via radiofrequency identification can be used to monitor physicochemical states of deep surgical sites. We show in live pigs that the sutures can monitor wound integrity, gastric leakage and tissue micromotions, and in rodents that the healing outcomes are equivalent to those of medical-grade sutures. Battery-free wirelessly operated bioelectronic sutures may facilitate post-surgical monitoring in a wide range of interventions. Multifilament surgical sutures functionalized with a conductive polymer and incorporating pledgets with capacitive sensors operated via radiofrequency identification can be used to monitor physicochemical states of deep surgical sites.

3′UTR shortening in cancer has been shown to activate oncogenes, partly through the loss of microRNA-mediated repression. This suggests that many reported microRNA-oncogene target interactions may not be present in cancer cells. One of the most well-studied oncogenes is the transcription factor MYC, which is overexpressed in more than half of all cancers. MYC overexpression is not always accompanied by underlying genetic aberrations. In this study, we demonstrate that the MYC 3′UTR is shortened in colorectal cancer (CRC). Using unbiased computational and experimental approaches, we identify and validate microRNAs that target the MYC coding region. In particular, we show that miR-138 inhibits MYC expression and suppresses tumor growth of CRC and hepatocellular carcinoma (HCC) cell lines. Critically, the intravenous administration of miR-138 significantly impedes MYC-driven tumor growth in vivo. Taken together, our results highlight the previously uncharacterized shortening of the MYC 3′UTR in cancer, and identify miR-138 as a potent regulator of the heterogenous MYC transcript population.

Introduction Management of sigmoid volvulus is often challenging because of its prevalence in high-risk patients and the associated perioperative morbidity and mortality rates. This study was designed to review the management and outcome of all patients admitted with sigmoid volvulus. Methods A retrospective review of all patients who were admitted for sigmoid volvulus from October 2001 to June 2009 was performed. Diagnosis was confirmed on clinical evaluation, radiological studies, and/or intraoperative findings. Results Seventy-one patients, median age 73 (range, 17–96) years, were admitted a total of 134 times for acute sigmoid volvulus during the study period. The majority ( n  = 51, 71.8%) were older than aged 60 years, and 41 (57.7%) had at least one premorbid condition. Seven (9.9%) patients underwent emergency surgery on presentation. The remaining 64 (90.1%) patients were initially managed conservatively using a flatus tube and/or sigmoidoscopic decompression. One patient had an endoscopic-related perforation and required emergency surgery. Another ten patients failed conservative management for which nine underwent operative intervention. The last patient refused surgery and died subsequently. Fifty-three (74.6%) patients had successful conservative management; seven of them underwent elective surgery subsequently. Of the remaining 46 patients, 28 (60.9%) were admitted for recurrent sigmoid volvulus. Of these 28 patients, 12 eventually had elective surgery after successful decompression, whereas the remaining 16 were not operated. In our series, three patients died after emergency surgery and there was no mortality after elective surgery. Another six patients died from medical conditions that were unrelated to sigmoid volvulus. Conclusions Acute sigmoid volvulus is a surgical emergency, although the majority (75%) can be successfully decompressed nonoperatively. Emergency surgery in these patients is associated with a mortality of 17.6% in our series. Elective definitive surgery is suggested in view of the high recurrence rate (>60%) and the considerable risks of emergency surgery.

Background and Objectives: It remains unclear which domains of preoperative health-related quality of life (HRQOL) and mental health are predictive of postoperative clinical and patient-reported outcomes in colorectal cancer (CRC) patients. Materials and Methods: A prospective cohort of 78 CRC patients undergoing elective curative surgery was recruited. The EORTC QLQ-C30 and HADS questionnaires were administered preoperatively and one month after surgery. Results: Preoperative cognitive functioning scores (95% CI 0.131–1.158, p = 0.015) and low anterior resection (95% CI 14.861–63.260, p = 0.002) independently predicted poorer 1-month postoperative global QOL. When postoperative complications were represented using the comprehensive complication index (CCI), poorer preoperative physical function scores were associated with higher CCI scores (B = −0.277, p = 0.014). Preoperative social function score (OR = 0.925, 95% CI 0.87 to 0.99; p = 0.019) was an independent predictor for 30-day readmission, while physical functioning score (OR = −0.620, 95% CI −1.073–−0.167, p = 0.008) was inversely related to the length of hospitalization. The overall regressions for 1-month postoperative global QOL (R2: 0.546, F: 1.961, p = 0.023) and 30-day readmission (R2: 0.322, χ2: 13.129, p < 0.001) were statistically significant. Conclusions: Various QLQ-C30 domains were found to be predictive of postoperative outcomes, including complications, readmission, and length of hospitalization. Preoperative cognitive dysfunction and low AR were independent predictors of poorer postoperative global QOL. Future research should seek to examine the efficacy of targeting specific baseline QOL domains in improving clinical as well as patient-reported outcomes after CRC surgery.

This study was conducted to better understand the pervasive gender barriers obstructing the progression of women in surgery by synthesising the perspectives of both female surgical trainees and surgeons. Five electronic databases, including Medline, Embase, PsycINFO, CINAHL and Web of Science Core Collection, were searched for relevant articles. Following a full-text review by three authors, qualitative data was synthesized thematically according to the Thomas and Harden methodology and quality assessment was conducted by two authors reaching a consensus. Fourteen articles were included, with unfavorable work environments, male-dominated culture and societal pressures being major themes. Females in surgery lacked support, faced harassment, and had unequal opportunities, which were often exacerbated by sex-blindness by their male counterparts. Mothers were especially affected, struggling to achieve a work-life balance while facing strong criticism. However, with increasing recognition of the unique professional traits of female surgeons, there is progress towards gender quality which requires continued and sustained efforts. This systematic review sheds light on the numerous gender barriers that continue to stand in the way of female surgeons despite progress towards gender equality over the years. As the global agenda towards equality progresses, this review serves as a call-to-action to increase collective effort towards gender inclusivity which will significantly improve future health outcomes.

To understand racial bias in clinical settings from the perspectives of minority patients and healthcare providers to inspire changes in the way healthcare providers interact with their patients. Articles on racial bias were searched on Medline, CINAHL, PsycINFO, Web of Science. Full text review and quality appraisal was conducted, before data was synthesized and analytically themed using the Thomas and Harden methodology. 23 articles were included, involving 1,006 participants. From minority patients' perspectives, two themes were generated: 1) alienation of minorities due to racial supremacism and lack of empathy, resulting in inadequate medical treatment; 2) labelling of minority patients who were stereotyped as belonging to a lower socio-economic class and having negative behaviors. From providers' perspectives, one theme recurred: the perpetuation of racial fault lines by providers. However, some patients and providers denied racism in the healthcare setting. Implicit racial bias is pervasive and manifests in patient-provider interactions, exacerbating health disparities in minorities. Beyond targeted anti-racism measures in healthcare settings, wider national measures to reduce housing, education and income inequality may mitigate racism in healthcare and improve minority patient care.

Colonoscopy requires the intubation of the cecum for screening of colorectal diseases. The conventional position used for colonoscopy is the left lateral position (LLP). However, alternative positions have also been utilized to enhance the success of intubation. Thus, the aim of this study was to perform a meta-analysis of the different positions to determine the effectiveness of the individual positions for successful colonoscopy. Medline, Embase and Cochrane trials electronic databases were searched for studies on colonoscopy positions. The primary outcome was defined as the cecal intubation rate. Pooled risk ratios (RR) and 95% confidence intervals (CI) for the rates of cecal intubation were estimated. Secondary outcomes such as the cecal intubation time and adenoma detection rate were further analyzed qualitatively. After reviewing 644 identified records, 7 randomized control trials (RCT) studies were included. No significant difference was observed in either comparisons, between the LLP vs. supine position (SP) (RR = 1.01, 95% CI, 0.98 to 1.04, P = 0.55) or the LLP vs. prone position (PP) (RR = 1.02, 95% CI, 0.98 to 1.06, P = 0.27). Amidst available literature, the use of other positions can be considered when performing colonoscopy. These further highlights that the existential practice is based predominantly on familiarity instead of evidence-based-research.

Laparoscopic colectomy for colon cancer is a well-established procedure supported by several well-conducted large-scale randomised controlled trials. Patients could now be conferred the benefits of the minimally invasive approach while retaining comparable oncologic outcomes to the open approach. However, the benefits of laparoscopic proctectomy for rectal cancer remained controversial. While the laparoscopic approach is more technically demanding, results from randomised controlled trials regarding long term oncologic outcomes are only beginning to be reported. The impacts of bladder and sexual functions following proctectomy are considerable and are important contributing factors to the patients’ quality of life in the long-term. These issues present a delicate dilemma to the surgeon in his choice of operative approach in tackling rectal cancer. This is compounded further by the rapid proliferation of various laparoscopic techniques including the hand assisted, robotic assisted, and single port laparoscopy. This review article aims to draw on the significant studies which have been conducted to highlight the short- and long-term outcomes and evidence for laparoscopic resection for rectal cancer.

Notch1 plays various roles in cancer development, and Notch1-induced transactivation is controlled by phosphorylation of its cleaved intracellular domain. However, it is unclear whether there are phosphatases capable of dephosphorylating the cleaved Notch1 transmembrane/intracellular region (NTM) to regulate its function. Here, we show that DUSP6 can function as a phosphatase for Notch1, thereby regulating NTM stability and transcriptional activity, thus influencing colorectal cancer (CRC) development. In human CRC cells, elevated DUSP6 expression correlates with increased NTM levels, leading to enhanced CRC cell proliferation both in vitro and in vivo. High tumoral DUSP6 protein expression is associated with poorer overall CRC patient survival. In mice, DUSP6 deficiency results in reduced CRC development. Mechanistically, DUSP6 dephosphorylates phospho-Y2116, which in turn reduces NTM ubiquitination, leading to increased NTM stability and transcriptional activity. As a result, the expression of Notch1-targeted proliferation genes is increased to promote tumour cell growth. Notch1 activation in cancer is regulated through phosphorylation of Notch1 intracellular domain. Here, the authors find that DUSP6 functions as a phosphatase for Notch1 transmembrane/intracellular domain (NTM) to increase NTM protein stability and promote colorectal cancer progression.

BackgroundEmerging data suggest that the incidence of young-onset cancers, defined as cancer diagnosed in adults < 50 years, is increasing, but has not been systematically assessed. We aimed to evaluate temporal changes in the incidence of young-onset cancers in a large, nationwide cohort study.MethodsWe analyzed data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results 17 registry from 2000 to 2019. Age-standardised incidence rates (ASIR) per 100,000 from 2010 to 2019 were extracted for young-onset cancers based on ICD-O-3 definitions, with rates age-adjusted to the United States standard population. The annual percentage change (APC) of the ASIRs were estimated via the SEER*Stat program.ResultsBetween 2010 and 2019, a total of 562,145 cases of early-onset cancer (62.5% female) were recorded (IDDF2023-ABS-0012 Table 1). A total of 425,718 cases (75.7%) were White, 62,780 (11.2%) were Black, 55,976 (10.0%) were Asian or Pacific Islander individuals, 5120 (0.9%) were American Indian/Alaska Native and 12,551 (2.2%) were of unknown race. From 2010 to 2019, the annual percentage change of early-onset cancer was +0.276%, 95% CI 0.085 to 0.467%, p = 0.01(IDDF2023-ABS-0012 Table 2). There was lower APC in males vs females, -0.366 vs +0.667, p < 0.001. The APC in Whites, Blacks, Asians or Pacific Islanders, American Indian/Alaska Natives, and unknown races were +0.173, -0.637, +0.990, +1.170 and undefined, respectively. Gastrointestinal cancers were the fastest-growing cause of young-onset cancer (APC 2.161%, 95% CI: 1.660 - 2.665%), followed by urinary tract cancers (APC 1.336%, 95% CI: 0.607 – 2.070%), and breast cancers (APC 0.906%, 95% CI: 0.554 - 1.259%). Among gastrointestinal cancers, miscellaneous digestive organ cancers had the highest APC from 2010 to 2019 (APC 12.19%, 95% CI 9.99-14.43%), followed by cancers of the small intestine (APC 2.107%), stomach (APC 1.595%), and transverse colon (APC 1.689%).Abstract IDDF2023-ABS-0012 Table 1Baseline Characteristics of Early-Onset Cancers from 2010 to 2019* Age Group, No of Patient (%) 0-19y 20-29y 30-39y 40-49y Total Gender Male 22 615 (10.7) 27 175 (12.9) 47 521 (22.5) 113 714 (53.9) 211 025 Female 19 768 (5.6) 31 970 (9.1) 88 958 (25.3) 210 424 (60.0) 351 120 Race White 32 838 (7.7) 46 417 (10.9) 103 186 (24.2) 243 277 (57.1) 425 718 Black 4470 (7.1) 5410 (8.6) 14 308 (22.8) 38 592 (61.5) 62 780 Asian/Pacific Islander 3750 (6.7) 4971 (8.9) 14 012 (25.0) 33 243 (59.4) 55 976 American Indian/Alaska Native 444 (8.7) 602 (11.8) 1388 (27.1) 2686 (52.5) 5120 Unknown 881 (7.0) 1745 (13.9) 3585 (28.6) 6340 (50.5) 12 551 *Data extracted from the Surveillance, Epidemiology and End Results Database 17 Registry, November 2021 (2000-2019), Linked by countyAbstract IDDF2023-ABS-0012 Table 2Incidence of early-onset cancers from 2010 to 2019, stratified by cancer site 2010 Incidence (A SIR per 100.000) 2019 Incidence (A SIR per 100,000) APC (95% CI ) p* All cancers 56 051 (100.0) 56 468 (103.0) 0.28 (0.1 to 0.5) 0.01 By system Bones, soft tissue, and joints 1400 (2.46) 1426 (2.52) 0.12 (-0.7 to 0.9) 0.73 Brain and nervous system 2097 (3.69) 1821 (3.23) -0.99 (-1.7 to -0.3) 0.01 Breast 11 745 (21.25) 12 649 (23.74) 0.91 (0.6 to 1.3) <0.01 Endocrine 5659 (10.15) 6151 (10.95) 0.54 (-0.3 to 1.4) 0.18 Female reproductive 4636 (8.36) 4906 (8.99) 0.93 (0.3 to 1.6) 0.01 Male reproductive 3701 (6.40) 3233 (5.59) -0.75 (-2.4 to -1.1) <0.01 Gastrointestinal 6431 (11.49) 7383 (13.65) 2.16 (1.7 to 2.7) <0.01 Head and neck 1531 (2.72) 1400 (2.57) -0.60 (-1.3 to 0.2) 0.1 Hematological 7266 (12.82) 6960 (12.36) -0.32 (-0.7 to 0.0) 0.05 Respiratory 2277 (3.99) 1474 (2.74) -4.57 (-5.3 to -3.8) <0.01 Skin 4451 (7.97) 4161 (7.58) -0.34 (-1.0 to 0.3) 0.25 Urinary 2720 (4.87) 2938 (5.47) 1.34 (0.6 to 2.1) <0.01 Others 2137 (3.79) 1966 (3.59) -0.76 (-1.4 to -0.1) 0.03 AbbreviationsASIR – age-standardized incidence rate; APC – annual percentage change*p-value of APC from 2010 to 2019ConclusionsThe incidence of young-onset cancers is increasing in the United States. In particular, the incidence of the young-onset appendix, intrahepatic bile duct, and miscellaneous digestive organ cancers are rapidly rising. These data have important implications for surveillance strategies.