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5 mm [OR 1.080 (95% CI 1.021-1.142), P=0.007] and flat/depressed shape [OR 0.206 (95% CI 0.076-0.564), P=0.002] were significantly associated with histopathologic discrepancies in EFB. Conclusions EFB was of limited clinical value in identifying the preoperative diagnosis of rectal lesions. N-Methyl-D-aspartic acid in vitro Lesions thickness and flat/depressed shape at EFB were independent risk factors for pathologic discrepancies. TRUS-guided CNB may serve as a safe and effective supplement to routine EFB. 2019 Annals of Translational Medicine. All rights reserved.Background Follistatin-like protein 1 (FSTL1) has been demonstrated to play a controversial role in cancer. In this study, we aimed to investigate the expression of FSTL1 and its characteristics in patients with colorectal cancer (CRC). Methods Gene expression microarray assays in 30 CRC patients and a real-time quantitative polymerase chain reaction (RT-qPCR) of 22 patients were performed to compare the mRNA level of FSTL1 in tumor lesions and paired normal tissues. Also, 332 consecutive patients with pathologically confirmed CRC were selected to detect FSTL1 expression by using immunohistochemistry (IHC). Enzyme-linked immunosorbent assay (ELISA) was also applied to determine the serum level of FSTL1 in 60 CRC patients, as well as 34 healthy donors. Results Gene expression microarray assays and RT-qPCR in CRC tissues, as well as ELISA in the serum all, revealed that the expression level of FSTL1 was higher in cancer tissue of CRC patients compared with paired normal tissue or healthy donors. The IHC results suggested that FSTL1 was also higher in tumor tissues than in its normal counterparts, however interestingly, a narrow scan focusing on the stromal region indicated that FSTL1 was significantly higher in normal tissues than in cancerous tissues. Besides, higher FSTL1 expression in cancer tissue, as well as lower FSTL1 expression in cancer stroma, both correlated with a worse prognosis, and the latter was an independent prognostic factor. Conclusions Our results provide novel insight into the role of FSTL1 in CRC, and it might be an essential factor in CRC development. 2019 Annals of Translational Medicine. All rights reserved.Background To evaluate the effect of biofeedback on intestinal function among patients with middle and low rectal cancer. Methods Using a randomized controlled trial design, 109 patients with middle and low rectal cancer indicated to have preoperative radiochemotherapy, anterior resection of the rectum, and preventive stoma were randomly divided into three groups the blank control group, the pelvic floor muscle exercise group, and the biofeedback training group. A 16-month intervention and longitudinal follow-up study was conducted, and a questionnaire on intestinal function by the Memorial Sloan-Kettering Cancer Center (MSKCC) was adopted into a Chinese version to evaluate patients' intestinal function situation. Results The intestinal function of the biofeedback training group was better than the blank control group and pelvic floor muscle exercise group. The total score of intestinal function and the scores of each dimension were statistically significant (P less then 0.05). Conclusions Biofeedback training could significantly improve the intestinal function of patients with middle and low rectal cancer, promote its recovery, and is thus worthy of clinical application. 2019 Annals of Translational Medicine. All rights reserved.Background We launched a screening program for colorectal cancer (CRC) in Yuexiu District, Guangzhou, China, in 2014. Here we aimed to report the early results of the program and evaluate the benefits of a screening questionnaire. Methods Residents aged between 50 and 74 were eligible for the screening. A questionnaire and two consecutive fecal immunological tests (FITs) were used as primary screening methods. Subjects who were positive for any of the two tests were referred for further examination with colonoscopy. Neoplasms were removed either colonoscopically or by colectomy. Atypical adenoma and CRC were defined as advanced neoplasms. Results A total of 6,971 residents in Dadong Street, Yuexiu District were screened with a questionnaire, and among them, 5,343 underwent at least one FIT. Four thousand and two hundred eleven (60.4%) were female, and 2,760 (39.6%) were male, with a median age of 62.0 years. Questionnaire and FITs identified 1,219 candidates for further examination with colonoscopy, among whom only 647 (53.1%) comply. As of this writing, 623 colonoscopy results were obtained, among which 270 (43.3%) had positive findings. The adenoma detection rate (ADR) was 43.3% (270/623). The ADR was 43.3% (270/623). Of the 270 patients, 10 (3.07%) had CRC, 81 (30.0%) had advanced adenoma, 178 had low-grade adenoma or other benign polyps, one had carcinoid. Except for three advanced CRC, all neoplasms detected were benign or in an early stage. Conclusions Our screening program help identified patients with colonic neoplasms at an early stage, precluding them from developing into the malignant disease. The addition of the questionnaire significantly increased the sensitivity of primary screening, while also decreasing the specificity. Long-term results should evaluate the social and economic benefits of this program. 2019 Annals of Translational Medicine. All rights reserved.Edwardsiella species are one of the top causative pathogens of mortality in various fisheries worldwide. Their role in zoonotic infections and increase in antibiotic-resistance has raised concerns and interests in many research fields. Similar to the studies investigating human clinical cases, there has been an increase in research examining the potential pathogenic role of the bacterium in aquaculture. Within the Edwardsiella family, Edwardsiella anguillarum was lastest group to be differentiated from the Edwardsiella tarda group, and many studies focusing on the virulence of this species have since ensued. In Korea, only E. tarda infections have been reported in aquaculture industries, and there have been no reports on economic losses incurred owing to E. anguillarum infection. There has been a recent report investigating the pathogenicity and pathological changes caused by E. anguillarum infection in a tilapia farm located in the Costa Rica. To the best of our knowledge, as ours is the first report of E. anguillarum infection in a Nile tilapia (Oreochromis niloticus) farm located in an Asian country, the pathogenicity of the bacterial strain was histopathologically compared to that of the past studies.