Gastric cancer is a major cause of global cancer mortality. We surveyed the spectrum of somatic alterations in gastric cancer by sequencing the exomes of 15 gastric adenocarcinomas and their matched normal DNAs. Frequently mutated genes in the adenocarcinomas included TP53 (11/15 tumors), PIK3CA (3/15) and ARID1A (3/15). Cell adhesion was the most enriched biological pathway among the frequently mutated genes. A prevalence screening confirmed mutations in FAT4, a cadherin family gene, in 5% of gastric cancers (6/110) and FAT4 genomic deletions in 4% (3/83) of gastric tumors. Frequent mutations in chromatin remodeling genes (ARID1A, MLL3 and MLL) also occurred in 47% of the gastric cancers. We detected ARID1A mutations in 8% of tumors (9/110), which were associated with concurrent PIK3CA mutations and microsatellite instability. In functional assays, we observed both FAT4 and ARID1A to exert tumor-suppressor activity. Somatic inactivation of FAT4 and ARID1A may thus be key tumorigenic events in a subset of gastric cancers.

Background: In recent years, the flipped classroom method of teaching has received much attention in health sciences education. However, the application of flipped classrooms in ophthalmology education has not been well investigated. Objective: The goal of this study was to investigate the effectiveness and acceptability of the flipped classroom approach to teaching ophthalmology at the clerkship level. Design: Ninety-five fourth year medical students in an ophthalmology clerkship were randomly divided into two groups. An ocular trauma module was chosen for the content of this study. One group (FG (flipped group), n = 48) participated in flipped classroom instruction and was asked to watch a recorded lecture video and to read study materials before a face-to-face class meeting. They used the in-class time for discussion. The other group (TG (traditional group), n = 47) was assigned to traditional lecture-based instruction. These students attended a didactic lecture and completed assigned homework after the lecture. Feedback questionnaires were collected to compare students’ perspectives on the teaching approach they experienced and to evaluate students’ self-perceived competence and interest in ocular trauma. Pre- and post-tests were performed to assess student learning of the course materials. Results: More students in the FG agreed that the classroom helped to promote their learning motivation, improve their understanding of the course materials, and enhance their communication skill and clinical thinking. However, students in the FG did not show a preference for this method of teaching, and also reported more burden and pressure than those from the TG. Students from the FG performed better on the post test over the ocular trauma-related questions when compared to those from the TG. Conclusions: The flipped classroom approach shows promise in ophthalmology clerkship teaching. However, it has some drawbacks. Further evaluation and modifications are required before it can be widely accepted and implemented. Abbreviations FG: Flipped classroom group; TG: Traditional lecture-based classroom group; TBL: Team-based learning; PBL: Problem-based learning; ZOC: Zhongshan Ophthalmic Center

Background CC-Cruiser is an artificial intelligence (AI) platform developed for diagnosing childhood cataracts and providing risk stratification and treatment recommendations. The high accuracy of CC-Cruiser was previously validated using specific datasets. The objective of this study was to compare the diagnostic efficacy and treatment decision-making capacity between CC-Cruiser and ophthalmologists in real-world clinical settings. Methods This multicentre randomized controlled trial was performed in five ophthalmic clinics in different areas across China. Pediatric patients (aged ≤ 14 years) without a definitive diagnosis of cataracts or history of previous eye surgery were randomized (1:1) to receive a diagnosis and treatment recommendation from either CC-Cruiser or senior consultants (with over 5 years of clinical experience in pediatric ophthalmology). The experts who provided a gold standard diagnosis, and the investigators who performed slit-lamp photography and data analysis were blinded to the group assignments. The primary outcome was the diagnostic performance for childhood cataracts with reference to cataract experts' standards. The secondary outcomes included the evaluation of disease severity and treatment determination, the time required for the diagnosis, and patient satisfaction, which was determined by the mean rating. This trial is registered with ClinicalTrials.gov ( NCT03240848 ). Findings Between August 9, 2017 and May 25, 2018, 350 participants (700 eyes) were randomly assigned for diagnosis by CC-Cruiser (350 eyes) or senior consultants (350 eyes). The accuracies of cataract diagnosis and treatment determination were 87.4% and 70.8%, respectively, for CC-Cruiser, which were significantly lower than 99.1% and 96.7%, respectively, for senior consultants ( p < 0.001, OR = 0.06 [95% CI 0.02 to 0.19]; and p < 0.001, OR = 0.08 [95% CI 0.03 to 0.25], respectively). The mean time for receiving a diagnosis from CC-Cruiser was 2.79 min, which was significantly less than 8.53 min for senior consultants ( p < 0.001, mean difference 5.74 [95% CI 5.43 to 6.05]). The patients were satisfied with the overall medical service quality provided by CC-Cruiser, typically with its time-saving feature in cataract diagnosis. Interpretation CC-Cruiser exhibited less accurate performance comparing to senior consultants in diagnosing childhood cataracts and making treatment decisions. However, the medical service provided by CC-Cruiser was less time-consuming and achieved a high level of patient satisfaction. CC-Cruiser has the capacity to assist human doctors in clinical practice in its current state. Funding National Key R&D Program of China (2018YFC0116500) and the Key Research Plan for the National Natural Science Foundation of China in Cultivation P...