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These EVs are taken up by adjacent colonic epithelial cells (CECs), where the mitochondrial genome drives metabolic reprogramming, mitochondrial respiration, and reactive oxygen species (ROS) production, thereby promoting TGF1-mediated tumor progression (Guan et al., 2024)

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Results: Among 33 participants (median 12.5 years experience), COSMOS had substantial inter-rater reliability (Congers Kappa 0.77, 95%CI:0.72-0.84) and almost-perfect intra-rater availability (Kappa 0.85, 0.82-0.88)