Sixth Edition Research Articles

Book Review: The College Student’s Research Companion: Finding, Evaluating, and Citing the Resources You Need to Succeed, Sixth Edition

Book Review: The College Student’s Research Companion: Finding, Evaluating, and Citing the Resources You Need to Succeed, Sixth Edition

4.L. Skills building seminar: Skills building seminar: Enhancing your elevator pitch: persuading a policymaker in seconds

Abstract Numerous public health researchers aim to influence evidence-based policymaking with their scientific discoveries. However, bridging the gap between research and policy remains a significant challenge. While researchers excel in data analysis and publishing, effectively communicating with policymakers requires additional skills. One crucial skill is the ability to succinctly present research findings, such as in an elevator pitch. In this seminar, top-scoring abstract presenters will have the opportunity to convey their work in just 60 seconds to a panel of policymakers and politicians. Through a hands-on approach, both presenters and attendees will learn, as each pitch receives immediate feedback from the panel. Are they interested? Do they remember the key message? And if all goes well, do you get an invitation to come back and present more of your work? Since several years the European Public Health Association (EUPHA) has been organising skills-building seminars on the elevator pitch. Building forward on those previous five successful and well-attended workshops, the current workshop will follow up on this series and take forward where the previous editions ended. Lessons learned at the previous elevator pitch workshops: - Have a clear ask (keep it simple) and show enthusiasm. - Appeal to the policymaker’s own interests and priorities. - Spell out how action will be beneficial for the policymaker. - Be aware of upcoming elections. - Build a relationship with the assistants of politicians. - Consider the ‘policy window’. - Make the comparison with the policy plan. - Propose an action the politician should undertake. - Identify the relevant stakeholders and groups affected by the problem. For this sixth edition we take the elevator pitch to the next level. Whereas previous editions allowed pitches up to 2 minutes, the current seminar will set the timer at 60 seconds. The previous editions showed that keeping the pitch very short was more successful. The session will be wrapped up by a key note with reflections on the pitches exercise and linking this to what the literature says about influencing healthy policy making. Key messages • The elevator pitch is a useful skill to have for public health researchers to facilitate the outcomes of their research feed into health policies. • There are numerous tools available to effectively communicate public health messages to policymakers and promote evidence-informed policy making. Speakers/Panelists Charlotte Marchandise EUPHA

SEA4DQ 2024 Workshop Summary

Welcome to the sixth edition of the workshop on Machine Learning Techniques for Software Quality Evaluation (SEA4DQ 2024), held in Brazil, July 16th, 2024, co-located with ESEC / FSE 2024 [1]. Three papers from all over the world were submitted, and all of them were accepted based on the overall positive reviews. The program also featured two keynotes by Denys Poshyvanyk on Towards an Interpretable Science of Deep Learning for Software Engineering: A Causal Inference View and Qinghua Lu on Responsible AI Engineering from A Data Perspective.

Navigating the maze of dementia: a qualitative analysis of a peer-assisted help and support programme for informal caregiver

PurposeFollowing several prior editions and the acquisition of quantitative data indicating a 18% reduction in perceived caregiver burden and a 27% improvement in their quality of life regarding pain/mild discomfort, this present study aims to compile and examine the shared experiences of caregivers participating in the peer-to-peer Expert Caregiver Programme. The aim is to gain a deeper understanding of the programme’s inherent value.Design/methodology/approachThis is a qualitative study of the Expert Caregiver Programme, a peer-to-peer support and learning initiative designed for informal caregivers of individuals with dementia. Over a span of two and a half months, this study observed a group of ten informal caregivers who were participants in the sixth edition of the Expert Caregiver Programme at a Sociosanitary Hospital in Catalonia.FindingsThe results have revealed the emergence of two distinct spirals. Firstly, the ongoing challenge of adapting to a degenerative process, coupled with the caregiver's sense of responsibility, leads to an overwhelming situation for the caregiver as far as caregiving and emotional management are concerned. This, in turn, exacerbates their feelings of isolation, fatigue and discouragement. On the other hand, the understanding of the disease and the sense of compassion towards the person with dementia have been identified as pivotal elements in the construction of an upward spiral, creating greater comfort for the caregiver. Consequently, these factors can be effectively addressed within the framework of a programme such as the Expert Caregiver.Originality/valueThe qualitative approach has allowed for a comprehensive and extensive exploration of the caregivers' experiences with individuals suffering from dementia. This has revealed the existence of a positive spiral that can be nurtured through peer support programmes.

The effect of epidermal growth factor receptor mutation on adjuvant chemotherapy with tegafur/uracil for patients with completely resected, non-lymph node metastatic non-small cell lung cancer (> 2cm): a multicenter, retrospective, observational study as exploratory analysis of the CSPOR-LC03 study.

The use of adjuvant osimertinib for epidermal growth factor receptor (EGFR) mutants is expected to expand to earlier stage I in the future, potentially competing with the current standard of care, oral tegafur/uracil (UFT), in Japan. However, the effect of EGFR mutation status on the therapeutic effect of UFT remains unclear. This study was conducted as an exploratory analysis of a retrospective observational study that investigated the real-world data of postoperative adjuvant chemotherapy in Japan (CSPOR-LC03). Between 2008 and 2013, 1812 patients with completely resected adenocarcinoma diagnosed as pathologic stage I (T1>2cm, TNM classification, sixth edition) who have maintained organ function, and no history of other cancers were included. The primary endpoint was the 5-year disease-free survival (DFS) rate, and we compared this rate between four groups classified based on the administration of adjuvant UFT and EGFR mutation status. Of the 933 (51%) patients with EGFR mutations, 394 underwent adjuvant UFT therapy. Of the 879 (49%) patients without EGFR mutations, 393 underwent adjuvant UFT therapy. The 5-year DFS of UFT+/EGFR+ and UFT-/EGFR+ patients were 82.0 and 87.1%, respectively, and those of UFT+/EGFR- and UFT-/EGFR- patients were 80.0 and 86.9%, respectively. DFS was significantly worse in the UFT+ group than in the UFT- group (P=0.015). Adjuvant UFT therapy was not an independent prognostic factor for DFS, regardless of the EGFR mutation status. In pathologic stage I (>2cm) lung adenocarcinomas with EGFR mutation, the survival benefit of adjuvant UFT was not observed.

GERENCIAMENTO DE RISCOS NO PLANEJAMENTO DAS LICITAÇÕES E CONTRATOS PÚBLICOS

Recent legislative changes in the area of public bidding and contracts, especially the guidelines implemented by Normative Instruction SEGES/MPDG Nº. 05/2017, established a new regime for contracting outsourced services in the Brazilian legal system. This new instrument aims to expand the dispute, in compliance with the principle of competitiveness, resulting in the expansion of the supplier market. IN Nº. 05/2017 establishes the rules and guidelines for the procedure for contracting services under the indirect execution regime within the scope of the Direct, autarchic and foundational Federal Public Administration. The regulation establishes innovative phases: Contracting Planning; Supplier Selection; and Contract Management. The Planning phase consists, according to the IN, of 3 stages: Preliminary Studies; Risk Management; and Terms of Reference or Basic Design. This paper aims to present a Risk Management Plan, developed in the planning phase of contracting a bidding process in the Electronic Auction for Price Registration modality. According to the PMBOK® Guide Sixth Edition p. 395, project risk management includes the processes of conducting planning, identification, analysis, response planning, implementation of responses and monitoring of risks in a project. The objective is to maximize exposure to positive events and minimize exposure to negative events. In this context, through causes, consequences, categories and SWOT analysis, 75 risks were identified. Risk management processes were used in accordance with the PMBOK® doctrine and the Pareto Principle to prioritize 25 risks.

A real-world survey on expensive drugs used as first-line chemotherapy in patients with HER2-negative unresectable advanced/recurrent gastric cancer in the stomach cancer study group of the Japan clinical oncology group.

Molecular-targeted drugs and immune checkpoint inhibitors have been developed for various malignant diseases, thereby improving clinical outcomes. However, these drugs are expensive, and few studies have assessed their actual use and costs in Japan. This study aimed to survey the use and costs of first-line chemotherapy for advanced/recurrent gastric cancer (AGC) in real-world settings. The survey included patients with human epidermal growth factor receptor type2 (HER2)-negative AGC who initiated first-line chemotherapy from January 2022 to December 2022 at the participating 92 institutions in the Japan Clinical Oncology Group. Data on the regimens were collected using Google Forms. A regimen that costs >500 000 Japanese yen (JPY) per month was defined as expensive. Data on chemotherapy regimens were collected from 2173 patients at all 92 institutions between March 2023 and May 2023. We analyzed 2113 patients who underwent the chemotherapy with recommended regimens and conditionally recommended regimens according to the Japanese Gastric Cancer Treatment Guidelines sixth edition. The expensive regimens were triplet chemotherapy with fluoropyrimidine (S-1 or capecitabine or 5-fluorouracil/levofolinate), oxaliplatin, and nivolumab. Their monthly costs ranged from 767 648 to 771 046 JPY. Nivolumab-containing regimens cost more than 20 times the price of conventional chemotherapy with fluoropyrimidine and oxaliplatin. These regimens were used in 1416 (67%) of 2113 patients: in 71% of patients aged ≤74years and in 59% of patients aged ≥75years. The regimens with >20-fold cost of conventional chemotherapy were used as first-line chemotherapy in two-thirds of patients and more than half even in the elderly population with HER2-negative AGC. This finding is important for future health economic studies on drug cost-efficacy.

Editors' Letter

Almost a year ago, in the summer of 2023, the managing editors of the Emerging Library and Information Perspectives (ELIP) journal called upon LIS graduate students and recent alumni to submit their papers for the sixth edition of the journal. This marked the beginning of a significant transformation for ELIP, transitioning it from a structured process managed by a hired editor and faculty advisory board to a fully student-run, volunteer-driven journal. The relaunch involved revamping the editorial process, expanding the author pool, and enhancing outreach efforts, all aimed at creating a more inclusive and independent platform. The new issue exemplifies these changes, featuring diverse contributions across multiple categories, from research articles on TikTok's algorithms and information science ontologies to insightful discussions on podcasts and Wikipedia for information literacy. The managing editors, reflecting on the journey, now pass the baton to future editors, eager to see the continued growth and impact of ELIP within the LIS community.

Comparative Analysis of Upper Limb Impairment Rating Processes in the AMA Guides Sixth Edition 2024 vs 2008: Impact on Stakeholders.

To evaluate how upper limb impairment ratings are affected by updates to the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) Sixth Edition 2024 compared with the AMA Guides Sixth Edition 2008, and to investigate potential correlations with judicial, legislative, and economic factors. Two expert evaluators reviewed 31 upper limb clinical vignettes from the 2008 and 2024 versions. The impairment ratings for each version were compared. After following the impairment ratings steps in each version, the results for 2024 showed no significant differences when compared with the impairment ratings generated using 2008 methods (Cohen's Kappa = 1.00). The updated AMA Guides Sixth Edition 2024 with improved, transparent processes and enhanced diagnosis-based impairment tables provides efficiency while retaining the accuracy, validity, and reliability of past versions of the AMA Guides.

P-013 A potential therapeutic approach of intermittent fasting on sperm viscosity

Abstract Study question Does intermittent fasting affect sperm viscosity and motility? Summary answer The obtained results demonstrate that intermittent fasting significantly improves sperm viscosity and motility, and might be considered as a potential therapeutic approach for sperm hyperviscosity. What is known already Numerous factors influence sperm quality, functionality, and, consequently, male fertility. In the last decade, nutritional deficiency and lifestyle, have been grouped as popular factors that affect human sperm function and fertilization processes. Semen hyperviscosity which occurs in 12-29% of ejaculates is another condition that can contribute to male subfertility, as it is associated with changes in the chemical and physical characteristics of semen. Additionally, semen hyperviscosity contributes as well to poor sperm motility. Based on the aforementioned facts, focusing on identifying factors to enhance sperm viscosity and motility is crucial for improving IVF outcomes. Study design, size, duration The present study was based on semen analyses of 60 samples from 30 IVF patients. Following the purpose of the study and inclusion criteria, all 30 patients were diagnosed with abnormal sperm viscosity. Out of this number, 13 patients had asthenozoospermia, 4 patients were diagnosed with asthenoteratozoospermia, 7 patients were diagnosed with teratozoospermia and 6 patients had normozoospermia. All patients followed 4 days of sexual abstinence. All specimens were analyzed within 1 hour of collection. Participants/materials, setting, methods Sperm analysis including sperm viscosity was processed according to the WHO laboratory manual sperm criteria (Sixth edition 2021). For the study purpose, all the participants followed an intermittent fasting period of 14-16 hours for 30 days. Samples were analyzed twice, the first time before fasting and the second time after 30 days of fasting. Most of the patients did not consume food from 6 pm until 8 or 10 am. Main results and the role of chance The average age of the patients included in the study was 37.53 ± 4.6 years, while the BMI ranged from 21.26 to 32.28 kg/m2. Abnormal viscosity (hyperviscosity) was diagnosed when the drop formed a thread more than 2 cm long, while normal liquefied ejaculate fell as small discrete drops. The obtained results indicated that sperm parameters were improved after intermittent fasting. The most significant difference was observed in semen viscosity where out of the 30 patients who were diagnosed with abnormal semen viscosity after 30 days of intermittent fasting only 9 patients still had viscose semen (p<0.0001). Additionally, a significant difference was revealed in sperm motility before and after the fasting period as well(33.73±12.15 vs 44.10 ±11.54; respectively p < 0.001). Among the 17 subjects initially diagnosed with abnormal motility, following the implementation of intermittent fasting, 11 demonstrated a sperm improvement and were diagnosed with normal motility. The difference in sperm viability (52.8± 7.71 vs 61.3±8.37; respectively p < 0.01) and Ph values before and after fasting as well were statistically significant. On the other side, although sperm concentration (Mil/ml) was increased after fasting, the difference was not statistically significant (39.03±19.52 vs 41.53±19.19; respectively p = 0.92). Additionally, intermittent fasting did not affect sperm morphology either. Limitations, reasons for caution The limitation of the presented study was a relatively small patient cohort. Further research should link intermittent fasting with IVF outcomes. Wider implications of the findings Until today there are no clear dietary guidelines created for infertile males. As far as we know this is the first research, that includes a comparison of sperm parameters, based on intermittent fasting, and the obtained results confirm that intermittent fasting can be used as a potential therapeutic approach. Trial registration number not applicable

Evaluating predictors of kinase activity of STK11 variants identified in primary human non-small cell lung cancers.

Critical evaluation of computational tools for predicting variant effects is important considering their increased use in disease diagnosis and driving molecular discoveries. In the sixth edition of the Critical Assessment of Genome Interpretation (CAGI) challenge, a dataset of 28 STK11 rare variants (27 missense, 1 single amino acid deletion), identified in primary non-small cell lung cancer biopsies, was experimentally assayed to characterize computational methods from four participating teams and five publicly available tools. Predictors demonstrated a high level of performance on key evaluation metrics, measuring correlation with the assay outputs and separating loss-of-function (LoF) variants from wildtype-like (WT-like) variants. The best participant model, 3Cnet, performed competitively with well-known tools. Unique to this challenge was that the functional data was generated with both biological and technical replicates, thus allowing the assessors to realistically establish maximum predictive performance based on experimental variability. Three out of the five publicly available tools and 3Cnet approached the performance of the assay replicates in separating LoF variants from WT-like variants. Surprisingly, REVEL, an often-used model, achieved a comparable correlation with the real-valued assay output as that seen for the experimental replicates. Performing variant interpretation by combining the new functional evidence with computational and population data evidence led to 16 new variants receiving a clinically actionable classification of likely pathogenic (LP) or likely benign (LB). Overall, the STK11 challenge highlights the utility of variant effect predictors in biomedical sciences and provides encouraging results for driving research in the field of computational genome interpretation.

A Review of Semen Analysis: Updates From the WHO Sixth Edition Manual and Advances in Male Fertility Assessment.

Semen analysis is essentially used to check the fertility of a man, especially when couples are having difficulties conceiving. Studies concerning male fertility, testicular factors, and seminal characteristics have been under investigation for the last few decades. In 1980, the World Health Organization (WHO) started reaching out to scientists in order to set standards for high-quality semen and develop a semen manual. From this point to the present, six editions of this manual have been produced, delineating the characteristics of semen and reporting protocols for semen analysis. Sperm morphology is analyzed as per WHO norms to measure the biological capacity of a male for reproduction. Both national and international manuals have been developed, with the latest, the sixth edition, produced in July 2021. This review paper conveys the current WHO publication's updates and identifies the clinical recommendations for proper evaluations. The publication considers the characteristics of semen in order to discuss the content of the previous editions of the WHO. It is also utilized to assess the method applied to determine the DNA presence of sperm fragmentation.

Early access programs for medicines: a reform proposal for the Italian National Health Service

The present paper illustrates a reform proposal on early access for medicines. In this proposal early access stands for patient’s access, outside of clinical trials and covered by the Italian National Health Service (Servizio Sanitario Nazionale, SSN), to a new medicine or an indication of an already approved medicine before the approval o in between the approval and the decision on price and reimbursement status. The proposal emerged from a multi-stakeholder working group within the Sixth Edition of the “Seminari di Mogliano Veneto”. The reform proposal is aimed at converting the current early access programs (mainly, the programs introduced with Laws 648/96 and 326/03) into a single program inspired by the one introduced in France in 2021. The proposal provides indications on eligibility criteria for drugs and patients, application procedure, evaluation process, economic safeguard clauses, data collection, issues derived from the circumstance that the drug/indication included into the early access program is not reimbursed afterwards and the actions to implement this program.

Critical assessment of missense variant effect predictors on disease-relevant variant data.

Regular, systematic, and independent assessment of computational tools used to predict the pathogenicity of missense variants is necessary to evaluate their clinical and research utility and suggest directions for future improvement. Here, as part of the sixth edition of the Critical Assessment of Genome Interpretation (CAGI) challenge, we assess missense variant effect predictors (or variant impact predictors) on an evaluation dataset of rare missense variants from disease-relevant databases. Our assessment evaluates predictors submitted to the CAGI6 Annotate-All-Missense challenge, predictors commonly used by the clinical genetics community, and recently developed deep learning methods for variant effect prediction. To explore a variety of settings that are relevant for different clinical and research applications, we assess performance within different subsets of the evaluation data and within high-specificity and high-sensitivity regimes. We find strong performance of many predictors across multiple settings. Meta-predictors tend to outperform their constituent individual predictors; however, several individual predictors have performance similar to that of commonly used meta-predictors. The relative performance of predictors differs in high-specificity and high-sensitivity regimes, suggesting that different methods may be best suited to different use cases. We also characterize two potential sources of bias. Predictors that incorporate allele frequency as a predictive feature tend to have reduced performance when distinguishing pathogenic variants from very rare benign variants, and predictors supervised on pathogenicity labels from curated variant databases often learn label imbalances within genes. Overall, we find notable advances over the oldest and most cited missense variant effect predictors and continued improvements among the most recently developed tools, and the CAGI Annotate-All-Missense challenge (also termed the Missense Marathon) will continue to assess state-of-the-art methods as the field progresses. Together, our results help illuminate the current clinical and research utility of missense variant effect predictors and identify potential areas for future development.

Special Issue on IberSPEECH 2022: Speech and Language Technologies for Iberian Languages

ThisSpecial Issue presents the latest advances in research and novel applications of speech and language technologies based on the works presented at the sixth edition of the IberSPEECH conference held in Granada in 2022, paying special attention to those focused on Iberian languages. IberSPEECH is the international conference of the Special Interest Group on Iberian Languages (SIG-IL) of the International Speech Communication Association (ISCA) and the Spanish Thematic Network on Speech Technologies (Red Temática en Tecnologías del Habla, or RTTH for short). Several researchers were invited to extend the contributions presented at IberSPEECH2022 due to their interest and quality. As a result, the Special Issue is composed of 11 papers that cover different research topics related to speech perception, speech analysis and enhancement, speaker verification and identification, speech production and synthesis, natural language processing, together with several applications and evaluation challenges.

Advancements in AMA Guides Musculoskeletal Impairment Evaluations: Improved Reliability and Ease of Use.

Describe and evaluate methodological improvements in AMA Guides to the Evaluation of Permanent Impairment ( Guides ) Sixth Edition 2024, including an updated sequential method and enhanced diagnosis-based impairment tables, compared to the Guides Sixth 2008. Three physician experts and 3 premedical students, respectively, completed 2 rounds of impairment ratings using the AMA Guides Sixth 2008 versus 2024 methods. Impairment values and completion times using each method were compared for both groups. Time to complete an impairment rating by experts averaged 3.5 minutes using Guides 2024 compared with 13.9 minutes using Guides 2008, with 100% accuracy and reliability for both. Students' time averaged 5.3 and 15.9 minutes, respectively, with increased accuracy and reliability with Guides 2024. The Guides Sixth 2024 allowed more efficient impairment ratings while retaining accuracy, consistency, reliability, and reproducibility.

Advanced airway management in the prehospital setting during traumatic out-of-hospital cardiac arrest following traffic collision in Japan, 2013-2019

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Okinaka Memorial Institute for Medical Research; Toranomon Hospital. Background The European guideline on management of major bleeding and coagulopathy following trauma (sixth edition) recommend that endotracheal intubation or alternative airway management be performed without delay to facilitate adequate ventilation and oxygenation during trauma resuscitation. However, controversy remains as to whether advanced airway management should be provided for out-of-hospital cardiac arrest (OHCA) in the prehospital setting. Purpose This study aimed to examine the association of prehospital advanced airway management with outcomes after traumatic OHCA. Methods This observational study analyzed the Japanese government-led nationwide population-based registry data of OHCA patients. Patients with traumatic OHCA following traffic collision who received advanced life support in the prehospital setting from 2013 to 2019 were included. Propensity score matching was used to examine the association of advanced airway management with outcomes after traumatic OHCA following traffic collision. The primary outcome was one-month survival. Results A total of 5,617 patients (mean [SD] age, 60.1 [21.6] years; 68.6% male) were included. 3,822 (68.0%) received advanced airway management, and 1,795 (32.0%) did not. After adjusting for potential confounders using propensity score matching, advanced airway management was associated with decreased chance of one-month survival (23/1452 [1.6%] vs 43/1452 [3.0%]; RR, 0.53; 95%CI, 0.32-0.88; P=0.0128). Similar association was observed for prehospital return of spontaneous circulation (88/1452 [6.1%] vs 139/1452 [9.6%]; RR, 0.63; 95%CI, 0.49-0.82; P=0.0004). Conclusion Among patients with traumatic OHCA following traffic collision, advanced airway management was associated with decreased chance of one-month survival and prehospital return of spontaneous circulation.

Head and Neck Cancer: United Kingdom National Multidisciplinary Guidelines, Sixth Edition - ERRATUM.

Head and Neck Cancer: United Kingdom National Multidisciplinary Guidelines, Sixth Edition - ERRATUM.

Clinicopathological Characteristics, Survival and Prognostic Factors in Gastrointestinal Large Cell Neuroendocrine Carcinoma: A Retrospective Cohort Study.

Gastrointestinal large cell neuroendocrine carcinoma (GILCNEC) has a low incidence but high malignancy and poor prognosis. The main purpose of this study was to thoroughly investigate its clinicopathological features, survival and prognostic factors. Information on patients with GILCNEC was extracted from the Surveillance, Epidemiology, and End Result program, and prognostic factors were analyzed by analyzing clinicopathological data and survival functions. Finally, multivariate analysis was applied to identify independent risk factors associated with survival. A total of 531 individuals were screened in our study from the Surveillance, Epidemiology, and End Result database. The primary sites are mainly from the following: esophagus in 39 (7.3%) patients, stomach in 72 (13.6%) patients, hepatobiliary in 51 (9.6%) patients, pancreas in 97 (18.3%) patients, small intestines in 27 (5.1%), and colorectum in 245 (46.1%) patients. Esophagus, stomach, pancreas, and colorectum large cell neuroendocrine carcinoma (LCNEC) were more common in males ( P = 0.001). Esophagus LCNEC had inferior overall survival (OS), whereas small intestine LCNEC was associated with better OS. The results of multivariate analysis showed that the American Joint Committee on Cancer Sixth Edition stage, surgery, and radiotherapy were independent prognostic indicators of OS in patients with GILCNEC ( P < 0.05). The prognosis of patients with GILCNEC varies depending on the primary tumor site. American Joint Committee on Cancer Sixth Edition stage, surgery, and radiotherapy are independent prognostic factors of patients with GILCNEC. Although surgery and radiotherapy can prolong the survival of patients with GILCNEC, their prognosis remains poor, and further prospectively designed multicenter clinical studies are needed to indicate the decision for clinicians.

Characteristics of early gastric tumors with different differentiation and predictors of long-term outcomes after endoscopic submucosal dissection

BACKGROUND Gastric cancer is a common malignant tumor of the digestive tract, and endoscopic submucosal dissection (ESD) is the preferred treatment for early-stage gastric cancer. The analysis of the epidemiological characteristics of gastric mucosal tumors with different differentiation degrees and the influencing factors of long-term ESD efficacy may have certain significance for revealing the development of gastric cancer and ESD. AIM To analyze the features of gastric mucosal tumors at different differentiation levels, and to explore the prognostic factors of ESD. METHODS We retrospectively studied 301 lesions in 285 patients at The Second Affiliated Hospital of Xi'an Jiaotong University from 2014 to 2021, according to the latest Japanese guidelines (sixth edition), and divided them into low-grade intraepithelial neoplasia (LGIN), high-grade intraepithelial neoplasia (HGIN), and differentiated and undifferentiated early carcinoma. They are followed up by endoscopy, chest and abdominal computed tomography at 3, 6 and 12 months after ESD. We compared clinicopathologic characteristics, ESD efficacy, and complications with different degrees of differentiation, and analyzed the related factors associated with ESD. RESULTS HGIN and differentiated carcinoma patients were significantly older compared with LGIN patients (P &lt; 0.001) and accounted for more 0-IIc (P &lt; 0.001), atrophic gastritis was common (P &lt; 0.001), and irregular microvascular patterns (IMVPs) and demarcation lines (DLs) were more obvious (P &lt; 0.001). There was more infiltration in the undifferentiated carcinoma tissue (P &lt; 0.001), more abnormal folds and poorer mucosal peristalsis (P &lt; 0.001), and more obvious IMVPs, irregular microsurface patterns and DLs (P &lt; 0.05) than in the LGIN and HGIN tissues. The disease-free survival rates at 2, 5, and 8 years after ESD were 95.0%, 90.1%, and 86.9%, respectively. Undifferentiated lesions (HR 5.066), white moss (HR 7.187), incomplete resection (HR 3.658), and multiple primary cancers (HR 2.462) were significantly associated with poor prognosis. CONCLUSION Differentiations of gastric mucosal tumors have different epidemiological and endoscopic characteristics, which are closely related to the safety and efficacy of ESD.