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Simple Summary: The combination of atezolizumab plus bevacizumab (Atz/Bev) is now widely used in clinical practice as a first-line treatment for patients with advanced hepatocellular carcinoma (HCC). However, the established regimen for post-treatment after Atz/Bev is unknown. We investigated the efficacy and safety of cabozantinib in patients previously treated with Atz/Bev in real clinical practice, with a focus on whether patients met criteria of Child–Pugh Class A and Eastern Cooperative Oncology Group performance status (ECOG-PS) score 0/1 at baseline. Our results suggest that cabozantinib in patients with advanced HCC previously treated with Atz/Bev can be expected to yield similar outcomes to those seen in the CELESTIAL trial conducted using cabozantinib for post-sorafenib treatment if patients have good liver function and are in good general condition. (1) Background: This study aimed to investigate clinical outcomes for cabozantinib in clinical practice in patients with advanced hepatocellular carcinoma (HCC) previously treated with atezolizumab plus bevacizumab (Atz/Bev), with a focus on whether patients met criteria of Child–Pugh Class A and Eastern Cooperative Oncology Group performance status (ECOG-PS) score 0/1 at baseline. (2) Methods: Eleven patients (57.9%) met the criteria of both Child–Pugh class A and ECOG-PS score 0/1 (CP-A+PS-0/1 group) and eight patients (42.1%) did not (Non-CP-A+PS-0/1 group); efficacy and safety were retrospectively evaluated. (3) Results: Disease control rate was significantly higher in the CP-A+PS-0/1 group (81.1%) than in the non-CP-A+PS-0/1 group (12.5%). Median progression-free survival, overall survival and duration of cabozantinib treatment were significantly longer in the CP-A+PS-0/1 group (3.9 months, 13.4 months, and 8.3 months, respectively) than in the Non-CP-A+PS-0/1 group (1.2 months, 1.7 months, and 0.8 months, respectively). Median daily dose of cabozantinib was significantly higher in the CP-A+PS-0/1 group (22.9 mg/day) than in the non-CP-A+PS-0/1 group (16.9 mg/day). (4) Conclusions: Cabozantinib in patients previously treated with Atz/Bev has potential therapeutic efficacy and safety if patients have good liver function (Child–Pugh A) and are in good general condition (ECOG-PS 0/1). [ABSTRACT FROM AUTHOR]

Pancreatic ductal adenocarcinoma (PDAC) can be treated with surgery, chemotherapy, and radiotherapy. Despite medical progress in each field in recent years, it is still insufficient for managing PDAC, and at present, the only curative treatment is surgery. A typical pancreatic cancer is relatively easy to diagnose with imaging. However, it is often not recommended for surgical treatment at the time of diagnosis due to metastatic spread beyond the pancreas. Even if it is operable, it often recurs during postoperative follow-up. In the case of PDAC with a diameter of 10 mm or less, the 5-year survival rate is as good as 80% or more, and the best index for curative treatment is tumor size. The early detection of pancreatic cancer with a diameter of less than 10 mm or carcinoma in situ is critical. Here, we provide an overview of the current status of diagnostic imaging features and genetic tests for the accurate diagnosis of early-stage PDAC. [ABSTRACT FROM AUTHOR]

Endoscopy is widely applied in the examination of gastric cancer. However, extensive knowledge and experience are required, owing to the need to examine the lesion while manipulating the endoscope. Various diagnostic support techniques have been reported for this examination. In our previous study, segmentation of invasive areas of gastric cancer was performed directly from endoscopic images and the detection sensitivity per case was 0.98. This method has challenges of false positives and computational costs because segmentation was applied to all healthy images that were captured during the examination. In this study, we propose a cascaded deep learning model to perform categorization of endoscopic images and identification of the invasive region to solve the above challenges. Endoscopic images are first classified as normal, showing early gastric cancer and showing advanced gastric cancer using a convolutional neural network. Segmentation on the extent of gastric cancer invasion is performed for the images classified as showing cancer using two separate U-Net models. In an experiment, 1208 endoscopic images collected from healthy subjects, 533 images collected from patients with early stage gastric cancer, and 637 images from patients with advanced gastric cancer were used for evaluation. The sensitivity and specificity of the proposed approach in the detection of gastric cancer via image classification were 97.0% and 99.4%, respectively. Furthermore, both detection sensitivity and specificity reached 100% in a case-based evaluation. The extent of invasion was also identified at an acceptable level, suggesting that the proposed method may be considered useful for the classification of endoscopic images and identification of the extent of cancer invasion. [ABSTRACT FROM AUTHOR]

Small intestinal tumors (adenoma and adenocarcinoma, SIT) are rare, and their microRNA (miRNA) expression profiles have not been established. Previously, we reported a relationship between miRNA expression profiles and the development, growth, morphology, and anticancer drug resistance of colorectal tumors. Here, we demonstrate that the miRNA expression profile of SIT is significantly different from those of tumors of the colon. We compared the onco-related miRNA expression profiles of SIT and colorectal tumors and found them to be different from each other. The expressions of miR-143 and miR-145 were frequently downregulated in SIT and colorectal tumors but not in sessile serrated adenoma/polyp tumors. The profiles of SIT and colorectal carcinomas of miR-7, miR-21, and miR-34a were considerably different. Upregulation of miR-31 expression was not found in any SIT cases. Our data suggested that miR-143 and miR-145 might act as anti-oncomirs common to adenocarcinoma of the small intestine, similar to those of colorectal adenoma and other cancers. However, the expression profiles of the other miRNAs of SIT were significantly different from those of colorectal tumors. These findings contribute useful insights into the tumor development and diagnosis of SIT. [ABSTRACT FROM AUTHOR]

Upper gastrointestinal endoscopy is widely performed to detect early gastric cancers. As an automated detection method for early gastric cancer from endoscopic images, a method involving an object detection model, which is a deep learning technique, was proposed. However, there were challenges regarding the reduction in false positives in the detected results. In this study, we proposed a novel object detection model, U-Net R-CNN, based on a semantic segmentation technique that extracts target objects by performing a local analysis of the images. U-Net was introduced as a semantic segmentation method to detect early candidates for gastric cancer. These candidates were classified as gastric cancer cases or false positives based on box classification using a convolutional neural network. In the experiments, the detection performance was evaluated via the 5-fold cross-validation method using 1208 images of healthy subjects and 533 images of gastric cancer patients. When DenseNet169 was used as the convolutional neural network for box classification, the detection sensitivity and the number of false positives evaluated on a lesion basis were 98% and 0.01 per image, respectively, which improved the detection performance compared to the previous method. These results indicate that the proposed method will be useful for the automated detection of early gastric cancer from endoscopic images. [ABSTRACT FROM AUTHOR]

Gastrointestinal endoscopy is widely conducted for the early detection of gastric cancer. However, it is often difficult to detect early gastric cancer lesions and accurately evaluate the invasive regions. Our study aimed to develop a detection and segmentation method for early gastric cancer regions from gastrointestinal endoscopic images. In this method, we first collected 1208 healthy and 533 cancer images. The gastric cancer region was detected and segmented from endoscopic images using Mask R-CNN, an instance segmentation method. An endoscopic image was provided to the Mask R-CNN, and a bounding box and a label image of the gastric cancer region were obtained. As a performance evaluation via five-fold cross-validation, sensitivity and false positives (FPs) per image were 96.0% and 0.10 FP/image, respectively. In the evaluation of segmentation of the gastric cancer region, the average Dice index was 71%. These results indicate that our proposed scheme may be useful for the detection of gastric cancer and evaluation of the invasive region in gastrointestinal endoscopy. [ABSTRACT FROM AUTHOR]

Gallbladder (GB) diseases represent various lesions including gallstones, cholesterol polyps, adenomyomatosis, and GB carcinoma. This review aims to summarize the role of endoscopic ultrasound (EUS) in the diagnosis of GB lesions. EUS provides high-resolution images that can improve the diagnosis of GB polypoid lesions, GB wall thickness, and GB carcinoma staging. Contrast-enhancing agents may be useful for the differential diagnosis of GB lesions, but the evidence of their effectiveness is still limited. Thus, further studies are required in this area to establish its usefulness. EUS combined with fine-needle aspiration has played an increasing role in providing a histological diagnosis of GB tumors in addition to GB wall thickness. [ABSTRACT FROM AUTHOR]

Currently, there are no set standards or quantitative guidelines available in the U.S. for arsenic levels in rice cereal, one of the most common first solid foods for infants. The objective of this study was to evaluate whether the detected levels of inorganic arsenic (As(i)) in rice cereal in the U.S. market are safe for consumption by infants and toddlers. A risk assessment was conducted based on literature reviews of the reported As(i) in rice cereal from the U.S. Food and Drug Administration's (FDA) survey and the recommended daily intake of rice cereal by body weight, for infants and toddlers between four and 24 months old. As a part of risk management, a maximum contaminant level (MCL) for Asi in rice cereal was computed considering overall exposure sources including drinking water, infant formula, and other infant solid foods. Hazard quotients (HQs) for acute and chronic exposures were calculated based on the U.S. Agency for Toxic Substances and Disease Registry's (ATSDR) Minimal Risk Level (MRL)(acute) (5.0 × 10(-3) mg/kg/day) and MRL(chronic) (3.0 × 10(-4) mg/kg/day). A cancer slope or potency factor of 1.5 mg/kg/day was used to predict an incremental lifetime cancer risk (ILCR). Exposure assessment showed that the largest source of As(i) for infants and toddlers between four and 24 months old was rice cereal (55%), followed by other infant solid food (19%), and drinking water (18%). Infant formula was the smallest source of As(i) for babies (9%) at the 50th percentile based on Monte Carlo simulations. While HQ(acute) were consistently below 1.0, HQ(chronic) at the 50 and 75th percentiles exceeded 1.0 for both rice cereal and total sources. ILCR ranged from 10(-6) (50th) to 10(-5) (75th percentile). MCLs for As(i) in rice cereal ranged from 0.0 (chronic) to 0.4 mg/kg (acute exposures).

Accumulating data indicates that certain microRNAs (miRNAs or miRs) are differently expressed in samples of tumors and paired non-tumorous samples taken from the same patients with colorectal tumors. We examined the expression of onco-related miRNAs in 131 sporadic exophytic adenomas or early cancers and in 52 sporadic flat elevated adenomas or early cancers to clarify the relationship between the expression of the miRNAs and the endoscopic morphological appearance of the colorectal tumors. The expression levels of miR-143, -145, and -34a were significantly reduced in most of the exophytic tumors compared with those in the flat elevated ones. In type 2 cancers, the miRNA expression profile was very similar to that of the exophytic tumors. The expression levels of miR-7 and -21 were significantly up-regulated in some flat elevated adenomas compared with those in exophytic adenomas. In contrast, in most of the miR-143 and -145 down-regulated cases of the adenoma-carcinoma sequence and in some of the de novo types of carcinoma, the up-regulation of oncogenic miR-7 and/or -21 contributed to the triggering mechanism leading to the carcinogenetic process. These findings indicated that the expression of onco-related miRNA was associated with the morphological appearance of colorectal tumors.

This pilot study evaluated the potential effect of household environmental factors such as income, maternal characteristics, and indoor air pollution on children's respiratory status in an Eastern Indonesian community. Household data were collected from cross-sectional (n = 461 participants) and preliminary childhood case-control surveys (pneumonia cases = 31 diagnosed within three months at a local health clinic; controls = 30). Particulate matter (PM2.5 and PM10) was measured in living rooms, kitchens, children's bedrooms, and outside areas in close proximity once during the case-control household interviews (55 homes) and once per hour from 6 a.m. to midnight in 11 homes. The household survey showed that children were 1.98 times (p = 0.02) more likely to have coughing symptoms indicating respiratory infection, if mothers were not the primary caregivers. More children exhibited coughing if they were not exclusively breastfed (OR = 2.18; p = 0.06) or there was a possibility that their mothers were exposed to environmental tobacco smoke during pregnancy (OR = 2.05; p = 0.08). This study suggests that household incomes and mother's education have an indirect effect on childhood pneumonia and respiratory illness. The concentrations of PM2.5 and PM10 ranged from 0.5 to 35.7 µg/m3 and 7.7 to 575.7 µg/m3, respectively, based on grab samples. PM was significantly different between the case and control groups (p < 0.01). The study also suggests that ambient air may dilute indoor pollution, but also introduces pollution into the home from the community environment. Effective intervention programs need to be developed that consider multiple direct and indirect risk factors to protect children.