BACKGROUND Endoscopic submucosal dissection(ESD)and surgical resection are the standard of care for cT1N0M0 esophageal cancer(EC),whereas definitive chemoradiotherapy(d-CRT)is a treatment option.Nevertheless,the compa...BACKGROUND Endoscopic submucosal dissection(ESD)and surgical resection are the standard of care for cT1N0M0 esophageal cancer(EC),whereas definitive chemoradiotherapy(d-CRT)is a treatment option.Nevertheless,the comparative efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC remain unclear.AIM To compare the efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC.METHODS We retrospectively analyzed the hospitalized data of a total of 472 consecutive patients with cT1N0M0 EC treated at Sun Yat-sen University Cancer center between 2017-2019 and followed up until October 30th,2022.We analyzed demographic,medical recorded,histopathologic characteristics,imaging and endoscopic,and follow-up data.The Kaplan-Meier method and Cox proportional hazards modeling were used to analyze the difference of survival outcome by treatments.Inverse probability of treatment weighting(IPTW)was used to minimize potential confounding factors.RESULTS We retrospectively analyzed patients who underwent ESD(n=99)or surgery(n=220)or d-CRT(n=16)at the Sun Yat-sen University Cancer Center from 2017 to 2019.The median follow-up time for the ESD group,the surgery group,and the d-CRT group was 42.0 mo(95%CI:35.0-60.2),45.0 mo(95%CI:34.0-61.75)and 32.5 mo(95%CI:28.3-40.0),respectively.After adjusting for background factors using IPTW,the highest 3-year overall survival(OS)rate and 3-year recurrence-free survival(RFS)rate were observed in the ESD group(3-year OS:99.7% and 94.7% and 79.1%;and 3-year RFS:98.3%,87.4% and 79.1%,in the ESD,surgical,and d-CRT groups,respectively).There was no difference of severe complications occurring between the three groups(P≥0.05).Multivariate analysis showed that treatment method,histology and depth of infiltration were independently associated with OS and RFS.CONCLUSION For cT1N0M0 EC,ESD had better long-term survival and lower hospitalization costs than those who underwent d-CRT and surgery,with a similar rate of severe complications occurring.展开更多
BACKGROUND:A number of definitions have been used for delayed gastric emptying(DGE) after pancreatoduodenectomy and the reported rates varied widely.The International Study Group of Pancreatic Surgery(ISGPS) definitio...BACKGROUND:A number of definitions have been used for delayed gastric emptying(DGE) after pancreatoduodenectomy and the reported rates varied widely.The International Study Group of Pancreatic Surgery(ISGPS) definition is the current standard but it is not used universally.In this comprehensive review,we aimed to determine the acceptance rate of ISGPS definition of DGE,the incidence of DGE after pancreatoduodenectomy and the effect of various technical modifications on its incidence.DATA SOURCE:We searched PubM ed for studies regarding DGE after pancreatoduodenectomy that were published from 1 January 1980 to 1 July 2015 and extracted data on DGE definition,DGE rates and comparison of DGE rates among different technical modifications from all of the relevant articles.RESULTS:Out of 435 search results,178 were selected for data extraction.The ISGPS definition was used in 80% of the studies published since 2010 and the average rates of DGE and clinically relevant DGE were 27.7%(range:0-100%;median:18.7%) and 14.3%(range:1.8%-58.2%;median:13.6%),respectively.Pylorus preservation or retrocolic reconstruction were not associated with increased DGE rates.Although pyloric dilatation,Braun’s entero-enterostomy and Billroth Ⅱ reconstruction were associated with significantly lower DGE rates,pyloric ring resection appears to be most promising with favorable results in 7 out of 10 studies.CONCLUSIONS:ISGPS definition of DGE has been used in majority of studies published after 2010.Clinically relevant DGE rates remain high at 14.3% despite a number of proposed surgical modifications.Pyloric ring resection seems to offer the most promising solution to reduce the occurrence of DGE.展开更多
In nature, to realize the smooth motion for different speeds, the continuous gait transition is usually required for the quadrupeds. Thus, the gait simulation of quadrupeds is a requisite step to obtain the stable and...In nature, to realize the smooth motion for different speeds, the continuous gait transition is usually required for the quadrupeds. Thus, the gait simulation of quadrupeds is a requisite step to obtain the stable and energy-efficient gait for the walking machines. In this paper, the definitions of the two gait parameters, phasic difference and duty factor are presented, which can determine the gait of the quadrupeds. Then, several typical gaits of the quadrupeds are analyzed such that the seven standard gaits and corresponding parameters are summarized. Additionally, the variance law of the two parameters, which determine the relationship of gait transition, is analyzed. Furthermore, the quadruped gait derivative spectrum (QGDS) is proposed and the gait definition of the quadrupeds is presented. To minimize the power consumption, the choice criterion of gait, the optimal gait in terms of the motion speed, duty factory, and power consumption for the walking machines, is developed. Last, the continuous variance of the gait is implemented by the simulation of the gait transition from walk to trot, which evaluate the choice criterion and transition of gait.展开更多
AIM To determine the level of consensus on the definition of colorectal anastomotic leakage(CAL) among Dutch and Chinese colorectal surgeons.METHODS Dutch and Chinese colorectal surgeons were asked to partake in an on...AIM To determine the level of consensus on the definition of colorectal anastomotic leakage(CAL) among Dutch and Chinese colorectal surgeons.METHODS Dutch and Chinese colorectal surgeons were asked to partake in an online questionnaire. Consensus in the online questionnaire was defined as > 80% agreement between respondents on various statements regarding a general definition of CAL,and regarding clinical and radiological diagnosis of the complication.RESULTS Fifty-nine Dutch and 202 Chinese dedicated colorectal surgeons participated in the online survey. Consensus was found on only one of the proposed elements of a general definition of CAL in both countries: ‘extravasation of contrast medium after rectal enema on a CT scan'. Another two were found relevant according to Dutch surgeons: ‘necrosis of the anastomosis found during reoperation',and ‘a radiological collection treated with percutaneous drainage'. No consensus was found for all other proposed elements that may be included in a general definition.CONCLUSION There is no universally accepted definition of CAL in the Netherlands and China. Diagnosis of CAL based on clinical manifestations remains a point of discussion in both countries. Dutch surgeons are more likely to report ‘subclinical' leaks as CAL,which partly explains the higher reported Dutch CAL rates.展开更多
In this paper,we review the creation,evolution and application of wetland definitions.Varying wetlands are found from the tundra to the tropics and on every continent except Antarctica in the planet.Wetlands have many...In this paper,we review the creation,evolution and application of wetland definitions.Varying wetlands are found from the tundra to the tropics and on every continent except Antarctica in the planet.Wetlands have many distinguishing features,the most notable of which are water presence,unique soil conditions,and biota that are adapted to or tolerant of saturated soils.Many wetland definitions have been developed by scientists,U.S.federal agencies,and the Ramsar Convention for both scientific and regulatory purposes.Wetlands are not easily defined but a well-conceived,science-based definition of wetlands is important for scientists and resource managers to understand the nature of wetlands and/or to use and protect wetlands.A scientific definition is the basis for wetland classification.Developing an effective wetland classification system requires a well-conceived,science-based definition and clearly explicit guidance on the appropriate use of various wetland indicators to verify the presence of wetlands on the ground.Based on a well-accepted wetland definition,both wetland classification and inventory further provide needed information and a working frame for wise use and management of wetlands.展开更多
A plant-based diet consists of all minimally processedfruits, vegetables, whole grains, legumes, nuts and seeds,herbs, and spices and excludes all animal products, includ-ing red meat, poultry, fish, eggs, and dairy p...A plant-based diet consists of all minimally processedfruits, vegetables, whole grains, legumes, nuts and seeds,herbs, and spices and excludes all animal products, includ-ing red meat, poultry, fish, eggs, and dairy products.展开更多
In this study, a group of indices were defined regarding intensity (P), area (S) and central position (λc, Фc) of the Aleutian low (AL) in the Northern Hemisphere in winter, using seasonal and monthly mean h...In this study, a group of indices were defined regarding intensity (P), area (S) and central position (λc, Фc) of the Aleutian low (AL) in the Northern Hemisphere in winter, using seasonal and monthly mean height field at 1000-hPa. These indices were calculated over 60 winter seasons from 1948/1949 to 2007/2008 using reanalysis data. Climatic and anomalous characteristics of the AL were analyzed based on these indices and relationships between the AL, and general circulations were explored using correlations between indicesP, λc, and Pacific SST, as well as Northern Hemisphere temperature and precipitation. The main results are these: (1) AL is the strongest in January, when the center shifts to the south and west of its climatological position, and it is the weakest in December when the center shifts to the north and east. (2) AL intensity (P) is negatively correlated with its longitude (λc): a deeper low occurs toward the east and a shallower low occurs toward the west. On a decadal scale, the AL has been persistently strong and has shifted eastward since the 1970s, but reversal signs have been observed in recent years. (3) The AL is stronger and is located toward the east during strong E1 Nifio winters and vice versa during strong La Nifia years; this tendency is particularly evident after 1975. The AL is also strongly correlated with SST in the North Pacific. It intensifies and moves eastward with negative SST anomalies, and it weakens and moves westward with positive SST anomalies. (4) Maps of significance correlation between AL intensity and Northern Hemisphere temperature and rainfall resemble the PNA teleconnection pattern in mid-latitudes in the North Pacific and across North America. The AL and the Mongolian High are two permanent atmospheric pressure systems adjacent to each other during boreal winter over the middle and high latitudes in the Northern Hemisphere, but their relationships with the E1 Nifio/La Nifia events and with temperature and precipitation in the Northern Hemisphere are significantly different.展开更多
It is known that there exist obivious differences between the two most commonly used definitions of fractional derivatives-Riemann-Liouville (R-L) definition and Caputo definition. The multiple definitions of fracti...It is known that there exist obivious differences between the two most commonly used definitions of fractional derivatives-Riemann-Liouville (R-L) definition and Caputo definition. The multiple definitions of fractional derivatives in fractional calculus have hindered the application of fractional calculus in rheology. In this paper, we clarify that the R-L definition and Caputo definition are both rheologically imperfect with the help of mechanical analogues of the fractional element model (Scott-Blair model). We also clarify that to make them perfect rheologically, the lower terminals of both definitions should be put to ∞. We further prove that the R-L definition with lower terminal a →∞ and the Caputo definition with lower terminal a →∞ are equivalent in the differentiation of functions that are smooth enough and functions that have finite number of singular points. Thus we can define the fractional derivatives in rheology as the R-L derivatives with lower terminal a →∞ (or, equivalently, the Caputo derivatives with lower terminal a →∞) not only for steady-state processes, but also for transient processes. Based on the above definition, the problems of composition rules of fractional operators and the initial conditions for fractional differential equations are discussed, respectively. As an example we study a fractional oscillator with Scott-Blair model and give an exact solution of this equation under given initial conditions.展开更多
BACKGROUND Despite the emerging knowledge about colorectal anastomotic leakage(CAL)through the increasing number of clinical and experimental studies, there is no generally accepted definition of CAL. Because of the w...BACKGROUND Despite the emerging knowledge about colorectal anastomotic leakage(CAL)through the increasing number of clinical and experimental studies, there is no generally accepted definition of CAL. Because of the wide variety of definitions used in literature, comparison of study outcomes and quality of care is complicated.AIM To reach consensus on the definition of CAL using a modified Delphi method.METHODS The RAND/UCLA appropriateness method was used. The expert panel consisted of international colorectal surgeons and researchers who had published three or more articles about CAL. The consensus process consisted of two online distributed questionnaires and a third round with a recommendation. In the questionnaires participants were asked to rate the appropriateness of statements using a 1-9 Likert scale. Consensus was defined as a panel median between 1-3 or 7-9 without disagreement. In the final round a recommendation was formed regarding the definition of CAL and the expert panel was asked if they agreed or disagreed.RESULTSTwenty-three authors participated in the first round and twenty-one finished the second round. After two rounds consensus was reached on 37 items(80%) in nine different categories. The International Study Group of Rectal Cancer definition is the most frequently advised general definition by our panel. Consensus was reached regarding the clinical symptoms of CAL, which serum markers contributes to the suspicion of CAL, which radiological and perioperative findings should be considered as CAL, which grading system is appropriate and if there should be a range of postoperative days in the definition. Eventually, 19 experts completed all three rounds of which 16(84%) agreed with our final recommendations for the definition of CAL.CONCLUSION A consensus-based recommendation for the definition of CAL was formed using our modified Delphi method that can be widely incorporated in the field.展开更多
AIM: To study the accuracy of using high definition(HD) scope with narrow band imaging(NBI) vs standard white light colonoscope without NBI(ST), to predict the histology of the colon polyps, particularly those < 1 ...AIM: To study the accuracy of using high definition(HD) scope with narrow band imaging(NBI) vs standard white light colonoscope without NBI(ST), to predict the histology of the colon polyps, particularly those < 1 cm.METHODS: A total of 147 African Americans patients who were referred to Howard University Hospital for screening or, diagnostic or follow up colonoscopy, during a 12-mo period in 2012 were prospectively recruited. Some patients had multiple polyps and total number of polyps was 179. Their colonoscopies were performed by 3 experienced endoscopists who determined the size and stated whether the polyps being removed were hyperplastic or adenomatous polyps using standard colonoscopes or high definition colonoscopes with NBI. The histopathologic diagnosis was reported by pathologists as part of routine care. RESULTS: Of participants in the study, 55(37%) were male and median(interquartile range) of age was 56(19-80). Demographic, clinical characteristics, past medical history of patients, and the data obtained by two instruments were not significantly different and two methods detected similar number of polyps. In ST scope 89% of polyps were < 1 cm vs 87% in HD scope(P = 0.7). The ST scope had a positive predictive value(PPV) and positive likelihood ratio(PLR) of 86% and 4.0 for adenoma compared to 74% and 2.6 for HD scope. There was a trend of higher sensitivity for HD scope(68%) compare to ST scope(53%) with almost the same specificity. The ST scope had a PPV and PLR of 38% and 1.8 for hyperplastic polyp(HPP) compared to 42% and 2.2 for HD scope. The sensitivity and specificity of two instruments for HPP diagnosis were similar.CONCLUSION: Our results indicated that HD scope was more sensitive in diagnosis of adenoma than ST scope. Clinical diagnosis of HPP with either scope is less accurate compared to adenoma. Colonoscopy diagnosis is not yet fully matched with pathologic diagnosis of colon polyp. However with the advancement of both imaging and training, it may be possible to increase the sensitivity and specificity of the scopes and hence save money for eliminating time and the cost of Immunohistochemistry/pathology.展开更多
基金Supported by the Guangdong Esophageal Cancer Institute Science and Technology Program,No.M202013Guangdong Medical Research Foundation,No.A2021369.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)and surgical resection are the standard of care for cT1N0M0 esophageal cancer(EC),whereas definitive chemoradiotherapy(d-CRT)is a treatment option.Nevertheless,the comparative efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC remain unclear.AIM To compare the efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC.METHODS We retrospectively analyzed the hospitalized data of a total of 472 consecutive patients with cT1N0M0 EC treated at Sun Yat-sen University Cancer center between 2017-2019 and followed up until October 30th,2022.We analyzed demographic,medical recorded,histopathologic characteristics,imaging and endoscopic,and follow-up data.The Kaplan-Meier method and Cox proportional hazards modeling were used to analyze the difference of survival outcome by treatments.Inverse probability of treatment weighting(IPTW)was used to minimize potential confounding factors.RESULTS We retrospectively analyzed patients who underwent ESD(n=99)or surgery(n=220)or d-CRT(n=16)at the Sun Yat-sen University Cancer Center from 2017 to 2019.The median follow-up time for the ESD group,the surgery group,and the d-CRT group was 42.0 mo(95%CI:35.0-60.2),45.0 mo(95%CI:34.0-61.75)and 32.5 mo(95%CI:28.3-40.0),respectively.After adjusting for background factors using IPTW,the highest 3-year overall survival(OS)rate and 3-year recurrence-free survival(RFS)rate were observed in the ESD group(3-year OS:99.7% and 94.7% and 79.1%;and 3-year RFS:98.3%,87.4% and 79.1%,in the ESD,surgical,and d-CRT groups,respectively).There was no difference of severe complications occurring between the three groups(P≥0.05).Multivariate analysis showed that treatment method,histology and depth of infiltration were independently associated with OS and RFS.CONCLUSION For cT1N0M0 EC,ESD had better long-term survival and lower hospitalization costs than those who underwent d-CRT and surgery,with a similar rate of severe complications occurring.
文摘BACKGROUND:A number of definitions have been used for delayed gastric emptying(DGE) after pancreatoduodenectomy and the reported rates varied widely.The International Study Group of Pancreatic Surgery(ISGPS) definition is the current standard but it is not used universally.In this comprehensive review,we aimed to determine the acceptance rate of ISGPS definition of DGE,the incidence of DGE after pancreatoduodenectomy and the effect of various technical modifications on its incidence.DATA SOURCE:We searched PubM ed for studies regarding DGE after pancreatoduodenectomy that were published from 1 January 1980 to 1 July 2015 and extracted data on DGE definition,DGE rates and comparison of DGE rates among different technical modifications from all of the relevant articles.RESULTS:Out of 435 search results,178 were selected for data extraction.The ISGPS definition was used in 80% of the studies published since 2010 and the average rates of DGE and clinically relevant DGE were 27.7%(range:0-100%;median:18.7%) and 14.3%(range:1.8%-58.2%;median:13.6%),respectively.Pylorus preservation or retrocolic reconstruction were not associated with increased DGE rates.Although pyloric dilatation,Braun’s entero-enterostomy and Billroth Ⅱ reconstruction were associated with significantly lower DGE rates,pyloric ring resection appears to be most promising with favorable results in 7 out of 10 studies.CONCLUSIONS:ISGPS definition of DGE has been used in majority of studies published after 2010.Clinically relevant DGE rates remain high at 14.3% despite a number of proposed surgical modifications.Pyloric ring resection seems to offer the most promising solution to reduce the occurrence of DGE.
文摘In nature, to realize the smooth motion for different speeds, the continuous gait transition is usually required for the quadrupeds. Thus, the gait simulation of quadrupeds is a requisite step to obtain the stable and energy-efficient gait for the walking machines. In this paper, the definitions of the two gait parameters, phasic difference and duty factor are presented, which can determine the gait of the quadrupeds. Then, several typical gaits of the quadrupeds are analyzed such that the seven standard gaits and corresponding parameters are summarized. Additionally, the variance law of the two parameters, which determine the relationship of gait transition, is analyzed. Furthermore, the quadruped gait derivative spectrum (QGDS) is proposed and the gait definition of the quadrupeds is presented. To minimize the power consumption, the choice criterion of gait, the optimal gait in terms of the motion speed, duty factory, and power consumption for the walking machines, is developed. Last, the continuous variance of the gait is implemented by the simulation of the gait transition from walk to trot, which evaluate the choice criterion and transition of gait.
文摘AIM To determine the level of consensus on the definition of colorectal anastomotic leakage(CAL) among Dutch and Chinese colorectal surgeons.METHODS Dutch and Chinese colorectal surgeons were asked to partake in an online questionnaire. Consensus in the online questionnaire was defined as > 80% agreement between respondents on various statements regarding a general definition of CAL,and regarding clinical and radiological diagnosis of the complication.RESULTS Fifty-nine Dutch and 202 Chinese dedicated colorectal surgeons participated in the online survey. Consensus was found on only one of the proposed elements of a general definition of CAL in both countries: ‘extravasation of contrast medium after rectal enema on a CT scan'. Another two were found relevant according to Dutch surgeons: ‘necrosis of the anastomosis found during reoperation',and ‘a radiological collection treated with percutaneous drainage'. No consensus was found for all other proposed elements that may be included in a general definition.CONCLUSION There is no universally accepted definition of CAL in the Netherlands and China. Diagnosis of CAL based on clinical manifestations remains a point of discussion in both countries. Dutch surgeons are more likely to report ‘subclinical' leaks as CAL,which partly explains the higher reported Dutch CAL rates.
基金funded by the National Nat-ural Science Foundation of China(No.40830535andNo.40871089)
文摘In this paper,we review the creation,evolution and application of wetland definitions.Varying wetlands are found from the tundra to the tropics and on every continent except Antarctica in the planet.Wetlands have many distinguishing features,the most notable of which are water presence,unique soil conditions,and biota that are adapted to or tolerant of saturated soils.Many wetland definitions have been developed by scientists,U.S.federal agencies,and the Ramsar Convention for both scientific and regulatory purposes.Wetlands are not easily defined but a well-conceived,science-based definition of wetlands is important for scientists and resource managers to understand the nature of wetlands and/or to use and protect wetlands.A scientific definition is the basis for wetland classification.Developing an effective wetland classification system requires a well-conceived,science-based definition and clearly explicit guidance on the appropriate use of various wetland indicators to verify the presence of wetlands on the ground.Based on a well-accepted wetland definition,both wetland classification and inventory further provide needed information and a working frame for wise use and management of wetlands.
文摘A plant-based diet consists of all minimally processedfruits, vegetables, whole grains, legumes, nuts and seeds,herbs, and spices and excludes all animal products, includ-ing red meat, poultry, fish, eggs, and dairy products.
基金supported by National Key Technology Research and Development Program (Grant No. 2007BAC29B02)the National Basic Research Program of China’s 973 Program (Grant Nos.2010CB950502 and 2010CB428904)the project funded by the Priority Academic Program Development of Jiangsu Higher Education Institutions (PAPD)
文摘In this study, a group of indices were defined regarding intensity (P), area (S) and central position (λc, Фc) of the Aleutian low (AL) in the Northern Hemisphere in winter, using seasonal and monthly mean height field at 1000-hPa. These indices were calculated over 60 winter seasons from 1948/1949 to 2007/2008 using reanalysis data. Climatic and anomalous characteristics of the AL were analyzed based on these indices and relationships between the AL, and general circulations were explored using correlations between indicesP, λc, and Pacific SST, as well as Northern Hemisphere temperature and precipitation. The main results are these: (1) AL is the strongest in January, when the center shifts to the south and west of its climatological position, and it is the weakest in December when the center shifts to the north and east. (2) AL intensity (P) is negatively correlated with its longitude (λc): a deeper low occurs toward the east and a shallower low occurs toward the west. On a decadal scale, the AL has been persistently strong and has shifted eastward since the 1970s, but reversal signs have been observed in recent years. (3) The AL is stronger and is located toward the east during strong E1 Nifio winters and vice versa during strong La Nifia years; this tendency is particularly evident after 1975. The AL is also strongly correlated with SST in the North Pacific. It intensifies and moves eastward with negative SST anomalies, and it weakens and moves westward with positive SST anomalies. (4) Maps of significance correlation between AL intensity and Northern Hemisphere temperature and rainfall resemble the PNA teleconnection pattern in mid-latitudes in the North Pacific and across North America. The AL and the Mongolian High are two permanent atmospheric pressure systems adjacent to each other during boreal winter over the middle and high latitudes in the Northern Hemisphere, but their relationships with the E1 Nifio/La Nifia events and with temperature and precipitation in the Northern Hemisphere are significantly different.
基金supported by the National Natural Science Foundation of China (10972117)
文摘It is known that there exist obivious differences between the two most commonly used definitions of fractional derivatives-Riemann-Liouville (R-L) definition and Caputo definition. The multiple definitions of fractional derivatives in fractional calculus have hindered the application of fractional calculus in rheology. In this paper, we clarify that the R-L definition and Caputo definition are both rheologically imperfect with the help of mechanical analogues of the fractional element model (Scott-Blair model). We also clarify that to make them perfect rheologically, the lower terminals of both definitions should be put to ∞. We further prove that the R-L definition with lower terminal a →∞ and the Caputo definition with lower terminal a →∞ are equivalent in the differentiation of functions that are smooth enough and functions that have finite number of singular points. Thus we can define the fractional derivatives in rheology as the R-L derivatives with lower terminal a →∞ (or, equivalently, the Caputo derivatives with lower terminal a →∞) not only for steady-state processes, but also for transient processes. Based on the above definition, the problems of composition rules of fractional operators and the initial conditions for fractional differential equations are discussed, respectively. As an example we study a fractional oscillator with Scott-Blair model and give an exact solution of this equation under given initial conditions.
基金Supported by the Dutch Research Council(NWO)research programme Vidi project,No.91719343。
文摘BACKGROUND Despite the emerging knowledge about colorectal anastomotic leakage(CAL)through the increasing number of clinical and experimental studies, there is no generally accepted definition of CAL. Because of the wide variety of definitions used in literature, comparison of study outcomes and quality of care is complicated.AIM To reach consensus on the definition of CAL using a modified Delphi method.METHODS The RAND/UCLA appropriateness method was used. The expert panel consisted of international colorectal surgeons and researchers who had published three or more articles about CAL. The consensus process consisted of two online distributed questionnaires and a third round with a recommendation. In the questionnaires participants were asked to rate the appropriateness of statements using a 1-9 Likert scale. Consensus was defined as a panel median between 1-3 or 7-9 without disagreement. In the final round a recommendation was formed regarding the definition of CAL and the expert panel was asked if they agreed or disagreed.RESULTSTwenty-three authors participated in the first round and twenty-one finished the second round. After two rounds consensus was reached on 37 items(80%) in nine different categories. The International Study Group of Rectal Cancer definition is the most frequently advised general definition by our panel. Consensus was reached regarding the clinical symptoms of CAL, which serum markers contributes to the suspicion of CAL, which radiological and perioperative findings should be considered as CAL, which grading system is appropriate and if there should be a range of postoperative days in the definition. Eventually, 19 experts completed all three rounds of which 16(84%) agreed with our final recommendations for the definition of CAL.CONCLUSION A consensus-based recommendation for the definition of CAL was formed using our modified Delphi method that can be widely incorporated in the field.
基金Supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health(in part)Award No.G12MD007597
文摘AIM: To study the accuracy of using high definition(HD) scope with narrow band imaging(NBI) vs standard white light colonoscope without NBI(ST), to predict the histology of the colon polyps, particularly those < 1 cm.METHODS: A total of 147 African Americans patients who were referred to Howard University Hospital for screening or, diagnostic or follow up colonoscopy, during a 12-mo period in 2012 were prospectively recruited. Some patients had multiple polyps and total number of polyps was 179. Their colonoscopies were performed by 3 experienced endoscopists who determined the size and stated whether the polyps being removed were hyperplastic or adenomatous polyps using standard colonoscopes or high definition colonoscopes with NBI. The histopathologic diagnosis was reported by pathologists as part of routine care. RESULTS: Of participants in the study, 55(37%) were male and median(interquartile range) of age was 56(19-80). Demographic, clinical characteristics, past medical history of patients, and the data obtained by two instruments were not significantly different and two methods detected similar number of polyps. In ST scope 89% of polyps were < 1 cm vs 87% in HD scope(P = 0.7). The ST scope had a positive predictive value(PPV) and positive likelihood ratio(PLR) of 86% and 4.0 for adenoma compared to 74% and 2.6 for HD scope. There was a trend of higher sensitivity for HD scope(68%) compare to ST scope(53%) with almost the same specificity. The ST scope had a PPV and PLR of 38% and 1.8 for hyperplastic polyp(HPP) compared to 42% and 2.2 for HD scope. The sensitivity and specificity of two instruments for HPP diagnosis were similar.CONCLUSION: Our results indicated that HD scope was more sensitive in diagnosis of adenoma than ST scope. Clinical diagnosis of HPP with either scope is less accurate compared to adenoma. Colonoscopy diagnosis is not yet fully matched with pathologic diagnosis of colon polyp. However with the advancement of both imaging and training, it may be possible to increase the sensitivity and specificity of the scopes and hence save money for eliminating time and the cost of Immunohistochemistry/pathology.