Early onset colorectal cancer (EOCRC), defined as colorectal cancers in patients aged less than 50 years, is becoming an increasingly common issue, globally. Since 1994, the incidence of this condition has been rising by 2% annually. Approximately one in five patients under 50 years of age diagnosed with colorectal cancer have an underlying genetic predisposition syndrome. The detection of cancer among the other 80% of patients poses a considerable task, as there is no family history to advocate for commencing early screening in this group. Patients with EOCRC have distinct social, spiritual, fertility, and financial needs from their older counterparts that need to be addressed. This review discusses the risk factors associated with the development of EOCRC and current best practice for the management of this disease.

Studies investigating the histopathologic response of gastric carcinoma to neoadjuvant treatment have used a variety of different tumor regression grading systems. The aim of this Delphi survey was to review the available systems and reach consensus on a potential international standard. An international e-mail-based Delphi survey involving 6 expert pathologists was undertaken between January and October 2017. A questionnaire consisting of 72 items was formed after reviewing the 5 available systems. Rating of the items was done on a symmetric 4-point Likert-type scale, and feedback was provided between rounds. A total of 4 rounds were required to reach consensus on 97% of the items covering the topics: (1) specimen processing, (2) gross examination, (3) cross sectioning/method of sampling, (4) staining, (5) immunohistochemistry, (6) assessment of tumor regression in response to neoadjuvant therapy, (7) tumor regression grading, (8) assessment of regression of nodal metastases, and (9) role of histologic tumor type. Through the outcome of this comprehensive Delphi study, a group of experts is proposing a 4-tiered system for the grading of regression of the primary tumor, combined with a 3-tiered system for lymph node metastases. Grade 1 represents complete response, grade 2 contains less than 10% residual tumor (subtotal regression), grade 3 contains 10% to 50% residual tumor (partial regression), and grade 4 contains greater than 50% residual tumor (minimal/no regression). The addition of "a", "b", or "c" indicates complete, partial, or no response of lymph node metastases. It is recommended to use this grading system irrespective of histologic subtype.

The care of patients with venous thromboembolism (VTE) is delivered via a multidisciplinary team. The primary treatment for VTE is anticoagulation; however, placement of filter devices in the inferior vena cava (IVC) to prevent embolisation of deep venous thrombosis (DVT) is a well-established secondary treatment option. Many controversies remain regarding utilisation and management of filters.

Tumor budding is a histopathological biomarker associated with metastases and adverse survival outcomes in colorectal carcinoma (CRC) patients. It is characterized by the presence of single tumor cells or small clusters of cells within the tumor or at the tumor-invasion front. In order to obtain a tumor budding score for a patient, the region with the highest tumor bud density must first be visually identified by a pathologist, after which buds will be counted in the chosen hotspot field. The automation of this process will expectedly increase efficiency and reproducibility. Here, we present a deep learning convolutional neural network model that automates the above procedure. For model training, we used a semi-supervised learning method, to maximize the detection performance despite the limited amount of labeled training data. The model was tested on an independent dataset in which human- and machine-selected hotspots were mapped in relation to each other and manual and machine detected tumor bud numbers in the manually selected fields were compared. We report the results of the proposed method in comparison with visual assessment by pathologists. We show that the automated tumor bud count achieves a prognostic value comparable with visual estimation, while based on an objective and reproducible quantification. We also explore novel metrics to quantify buds such as density and dispersion and report their prognostic value. We have made the model available for research use on the grand-challenge platform.

Isolated cuboid dislocations are rare injuries Jacobson (1990). It is clinically significant and important in surgical education, as it is an injury and a source of lateral foot pain that can be misdiagnosed at the time of initial presentation and may be difficult to identify clinically or with imaging Drummond and Hastings (1969). We present a case report in a 33year old rugby player, who was injured during a match after a tackle. The patient had ongoing concerns that he was not recovering following initial discharge, as he was unable to weight bear since his initial presentation to the Emergency Department (E.D.), and he had ongoing lateral foot pain. Important clinical findings include lateral foot pain, a palpable gap at the cuboid level and difficulty weight-bearing. Closed reduction is usually difficult as it can be blocked mechanically by the extensor digitorum brevis muscle or peroneus longus tendon Dobbs et al. (1969). Initial X-Rays may be inconclusive with this presentation. CT scanning is indicated if suspicion for pathology is high. Open reduction and internal fixation with Kirschner wires are usually necessary for isolated cuboid dislocations. Our take home message from this case report is that cuboid dislocations are rare injuries and are important to be aware of in reviewing X-rays in the E.D. Particularly in patients with inversion and plantar flexion type injuries to their foot and ankle joint, with an inability to weight bear and lateral midfoot pain following their injury.