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Training in endoscopic submucosal dissection

World Journal of Gastrointestinal Endoscopy 2013年第8期5卷 369-378页

作者： roxana M Coman Takuji Gotoda peter V Draganov Division of Gastro-enterology Hepatology and Nutrition University of Florida Department of Gastroenterology and Hepatology Tokyo Medical University

Endoscopic submucosal dissection (ESD) represents an important advancement in the therapy of early neoplastic gastrointestinal lesions by providing higher en-bloc curative resection rate with lower recurrence compared to endoscopic mucosal resection (EMR) and by sparing the involved organ and protecting patient' s quality of life. Despite these advantages ESD is associated with long procedure times and a higher rate of complications, making ESD a challenging procedure which requires advanced endoscopic skills. Thus, there has been a recognized need for structured training system for ESD to enhance trainee experience and, to reduce the risks of complications and inadequate treatment. ESD has a very flat learning curve. However, we do not have uniformly accepted benchmarks for competency. Nevertheless, it appears that, in Japan, more than 30 supervised gastric ESD procedures are required to achieve technical proficiency and minimize complications. A number of training algorithms have been pro-posed in Japan with the aim to standardize ESD training. These algorithms cannot be directly applied in the West due to substantial differences including the availability of highly qualified mentors, the type of pathology seen, choice of devices, and trainee's background. We propose a training algorithm for Western physicians which integrates both hands-on training courses, animal model work as well as visits to expert centers. No specific preceptor training programs have been yet developed but there is a consensus that these programs are important for permeation of ESD worldwide.

关键词： Endoscopic submucosal dissection Training Learning curve Early gastrointestinal cancer En-doscopic mucosal resection

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Co-contaminants of microplastics in two seabird species from the Canadian Arctic

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Environmental Science and ecotechnology 2022年第4期12卷 87-96页

作者： roxana Sühring Julia E.Baak Robert J.Letcher Birgit M.Braune Amila de Silva Cody Dey Kim Fernie Zhe Lu Mark L.Mallory Stephanie Avery-Gomm Jennifer F.provencher Department of Chemistry and Biology Toronto Metropolitan University(formerly known as Ryerson University)350 Victoria StTorontoONM5B 2K3Canada Department of Natural Resource Science McGill UniversitySainte Anne de BellevueQuebecH9X 3V9Canada Environment and Climate Change Canada National Wildlife Research CentreCarleton UniversityRaven RoadOttawaOntarioK1A 0H3Canada Aquatic Contaminants Research Division Environment and Climate Change CanadaBurlingtonOntarioL7S 1A1Canada ecotoxicology&Wildlife Health Division Environment and Climate Change CanadaBurlingtonOntarioL7S 1A1Canada Institut des Sciences de la Mer de Rimouski Université du Québec à RimouskiRimouskiQuébecG5L 3A1Canada Department of Biology Acadia UniversityWolfvilleNova ScotiaB4P 2R6Canada

Through ingestion and subsequent egestion,Arctic seabirds can bioaccumulate microplastics at and around their colony breeding *** microplastics in Arctic seabirds have been well documented,it is not yet understood to what extent these particles can act as transport vehicles for plastic-associated contaminants,including legacy persistent organic pollutants(pOps),trace metals,and organic *** investigated the occurrence and pattern of organic and inorganic co-contaminants of microplastics in two seabird species from the Canadian Arctic-northern fulmar(Fulmarus glacialis)and black-legged kittiwake(Rissa tridactyla).We found that fulmars had higher levels of plastic contamination and emerging organic compounds(known to be plastic additives)than kittiwakes,whereas higher concentrations of legacy pOps were found in kittiwakes than the ***,fulmars,the species with the much larger foraging range(~200 km),had higher plastic pollution and overall contaminant burdens,indicating that birds may be acting as long-range transport vectors for plasticassociated *** results suggest a potential connection between plastic additive contamination and plastic pollution burdens in the bird stomachs,highlighting the importance of treating plastic particles and plastic-associated organic additives as co-contaminants rather than separate pollution issues.

关键词： plastic contaminants Contaminants of emerging arctic concern Arctic Seabirds pFAS OpEs pBDEs Trace metals

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(Tb1-xMny)MnO3-δ的合成、结构和磁性

(Tb1-xMny)MnO3-δ的合成、结构和磁性

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第十三届固态化学与无机合成学术会议

作者：张昊 F.roxana 孙俊良李国宝廖复辉林建华北京大学化学与分子工程学院

我们利用高温固相法合成了(Tb1-xMny)MnO3-δ固溶体1中的两个化合物W1(x=0.089,y=0.063)和W2(x=0.122,y=0.102)。磁性测量表明W1和W2在低温下都是变磁体,各有两个不同的Neel温度(W1:TN1=37K,TN2=22K;W2:TN1=42K,TN2=30K)。不同温度下的中子衍射数据显示W1和W2具有不同的磁结构,且这些磁结构与著名的多铁化合物TbMnO3被报道的磁结构2有一定的差异。如图1所示,在3.5K时,W1只含有一种q=(.283,0,0)的非公度磁有序,W2则呈现公度倾斜反铁磁有序和q=(.280,0,0)的非公度磁有序共存,TbMnO3是两种非公度磁有序共存,其q=(.283,0,0)和(.415,0,0)。在3.5K的低温下,TbMnO3、W1及W2的核结构都可以用pna21空间群来描述。

关键词：多铁 TbMnO3 (Tb1-xMny)MnO3 磁结构

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pathological response to neoadjuvant therapy with chemotherapy vs chemoradiotherapy in stage III NSCLC-contribution of IASLC recommendations

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World Journal of Clinical Oncology 2021年第11期12卷 1047-1063页

作者： Diego Muñoz-Guglielmetti David Sanchez-Lorente roxana Reyes Daniel Martinez Carmen Lucena Marc Boada pilar paredes Marta parera-Roig Ivan Vollmer Joel Mases Roberto Martin-Deleon Sergi Castillo Mariana Benegas Silvia Muñoz Maria Mayoral Carla Cases Meritxell Mollà Francesc Casas Radiation Oncology Department Hospital Clínic de BarcelonaBarcelona 08036CataluñaSpain Thoracic Surgery Department Thoracic UnitHospital Clínic de BarcelonaBarcelona 08036CataluñaSpain Medical Oncology Department Thoracic UnitHospital Clínic de BarcelonaBarcelona 08036CataluñaSpain pathology Department Thoracic UnitHospital Clínic de BarcelonaBarcelona 08036CataluñaSpain pneumology Department Thoracic UnitHospital Clínic de BarcelonaBarcelona 08036CataluñaSpain Nuclear Medicine Department Faculty of Medicine of University of BarcelonaInstitut d'Investigacions Biomèdiques August Pi i Sunyer(IDIBAPS)Barcelona 08036CataluñaSpain Medical Oncology Department Hospital Comarcal de VicVic 08500CataluñaSpain Radiology Department Thoracic UnitHospital Clínic de BarcelonaBarcelona 08036CataluñaSpain pneumology Department Hospital Universitario Reina SofiaCórdoba 14004AndalucíaSpain Medical Oncology Department Hospital de MolletMollet 08100CataluñaSpain Medical Oncology Department Hospital General de GranollersGranollers 08402CataluñaSpain Nuclear Medicine Department Thoracic UnitHospital Clínic de BarcelonaBarcelona 08036CataluñaSpain Radiation Oncology Department Thoracic UnitHospital Clínic de BarcelonaBarcelona 08036CataluñaSpain

BACKGROUND Neoadjuvant treatment(NT)with chemotherapy(Ch)is a standard option for resectable stage III(N2)*** studies have suggested benefits with the addition of radiotherapy(RT)to NT *** International Association for the Study of Lung Cancer(IASLC)published recommendations for the pathological response(pHR)of NSCLC resection specimens after *** To contribute to the IASLC recommendations showing our results of pHR to NT Ch vs NT chemoradiotherapy(ChRT).METHODS We analyzed 67 consecutive patients with resectable stage III NSCLC with positive mediastinal nodes treated with surgery after NT Ch or NT ChRT between 2013 and *** NT,all patients were evaluated for radiological response(RR)according to Response Evaluation Criteria in Solid Tumours criteria and evaluated for surgery by a specialized group of thoracic *** histological samples were examined by the same two *** was evaluated by the percentage of viable cells in the tumor and the resected lymph *** Forty patients underwent NT ChRT and 27 NT ***-six(83.6%)patients underwent surgery(35 ChRT and 21 Ch).The median time from ChRT to surgery was 6 wk(3-19)and 8 wk(3-21)for Ch *** observed significant differences in RR,with disease progression in 2.5%and 14.8%of patients with ChRT and Ch,respectively,and partial response in 62.5%ChRT vs 29.6%Ch(p=0.025).In pHR we observed≤10%viable cells in the tumor in 19(54.4%)and 2 cases(9.5%),and in the resected lymph nodes(RLN)30(85.7%)and 7(33.3%)in ChRT and Ch,respectively(p=0.001).Downstaging was greater in the ChRT compared to the Ch group(80%vs 33.3%;p=0.002).In the univariate analysis,NT ChRT had a significant impact on partial RR[odds ratio(OR)12.5;95%confidence interval(CI):1.21-128.61;p=0.034],a decreased risk of persistence of cancer cells in the tumor and RLN and an 87.5%increased probability for achieving downstaging(OR 8;95%CI:2.34-27.32;p=0.001).CONCLUSION We found significant benefits in RR and pHR

关键词： Non-small cell lung cancer Chemotherapy Chemoradiotherapy Neoadjuvant treatment Resectable stage III pathological response

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Implementation of a Telechemotherapy Module in the peruvian Jungle with Adequate Quality of Life:Breaking the Access Gaps to Health with Teleoncology

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Journal of Cancer Therapy 2019年第8期10卷 677-691页

作者： Tatiana Vidaurre Jule Vásquez Fernando Valencia Cindy Alcarraz Luis Más Nataly poma Litol Becerra Gino Rodriguez Socorro Saldana pepe Diaz Silvia Neciosup Karina Aliaga roxana Regalado Miriam Salazar Kavita Sarwal Simon Sutcliffe Julio Abugattas Carlos Castaneda Mónica Calderón Hugo Fuentes Henry Gómez Medical Oncologist Instituto Nacional de Enfermedades Neoplasicas(INEN)LimaPeru Hospital II-E Lamas San MartinPeru Instituto Nacional de Enfermedades Neoplasicas(INEN) LimaPeru International Cancer Control Congress Association(ICCCA) VancouverCanada

Background: Cancer is a leading cause of death worldwide as well as in peru. The national cancer plan includes decentralization, but one of the greatest barriers is our complicated geography. San Martin is a department located in the peruvian jungle where there are no public services for cancer care. Our aim was to implement a “distance telemedicine-enabled” outpatient chemotherapy module, monitored by oncologists. Methods: The implementation was conducted in 3 stages: 1) planning and Organization: working teams were formed, a chemotherapy room was developed and people were trained. 2) Execution: patients from San Martín region, aged >18 years with pathological confirmation of cancer, requiring systemic chemotherapy, ecOG py received at INEN without adverse reaction were selected. 3) Evaluation: adverse events, cost-user evaluation and quality of life (QoL) were assessed. Results: By November 2015, a module with a chemotherapy room with 18 chairs, a pharmacy, a hospitalization room, 1 medical office, a training room, a nutrition area, and a nursing station was implemented. 3 physicians, 3 nurses and 1 pharmacist were trained. Through March 2018, 501 sessions of teleoncology were completed to deliver 232 cycles of chemotherapy for 56 patients aged 19 - 78 years with different solid tumors, with no serious adverse event, without negatively affecting their QoL, and with an average out-of-pocket expense saving of 500 pEN. Conclusions: Using information and communication technology, a telechemotherapy module was successfully implemented in the peruvian jungle, without adversely affecting the QoL of patients. Neither patients nor family members needed to travel to Lima to receive chemotherapy. This first program can be replicated in other rural and remote regions through non-specialized personnel and facilities, providing chemotherapy services equivalent to a tertiary center through trained health care professionals, supported through tel

关键词： Telechemotherapy Module Cancer Treatment Urban Tertiary Center Teleoncology

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Value of acoustic radiation force impulse elastography for the assessment of ascites syndrome

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World Journal of Radiology 2011年第8期3卷 205-209页

作者： Simona Bota Ioan Sporea roxana Sirli Alina popescu Mirela Dǎnilǎ Mǎdǎlina Sendroiu Department of Gastroen-terology and Hepatology University of Medicine and Pharmacy

AIM:To assess the feasibility of performing acoustic radiation force impulse(ARFI) elastography in patients with ascites and its predictive value for the cirrhotic or non-cirrhotic etiology of ***:Our study included 153 patients with ascites,mean age 58.8 ± 13.1 *** hundred and fifteen(75.2%) patients had ascites in the context of cirrhosis,29(18.9%) had non-cirrhotic ascites(diagnosed by clinical,ultrasound,endoscopic and/or laparoscopic criteria) and in 9(5.9%) cases we could not establish the etiology of *** performed 10 ARFI measurements and the median value was calculated and expressed in meters/second(m/s).Among the 29 patients with non-cirrhotic ascites were included:20 laparoscopically demonstrated peritoneal carcinomatosis with histological confirmation,7 acute pancreatitis with ascites which later resolved,and one case each of lymphatic ascites and ascites in the context of a liver *** 11 of the 20 patients with peritoneal carcinomatosis,the liver structure was homogenous in the ultrasound examination and in 9 patients the ultrasound exam revealed liver ***:We could not obtain valid ARFI measurements in 5 patients(3.2%).The mean liver stiffness measurements by means of ARFI were statistically significantly higher in patients with cirrhotic ascites than in those with non-cirrhotic ascites:3.04 ± 0.70 vs 1.45 ± 0.59 m/s(p predicting cirrhosis(and ascites in the context of cirrhosis),as obtained in a previous study,ARFI had 98.1% sensitivity,86.2% specificity,96.4% positive predictive value,92.5% negative predictive value and 95.6% accuracy for predicting cirrhotic *** a cut-off value of 1.9 m/s the accuracy was 94.9% and for a 2 m/s cut-off value it was 92.8%.CONCLUSION:ARFI elastography is feasible in most patients with ascites and has a very good predictive value for the cirrhotic or non-cirrhotic etiology of ascites.

关键词： Ascites Liver stiffness Liver cirrhosis Acoustic radiation force impulse Elastography

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HORIZONS-AMI研究:比伐卢定在行血管成形术的急性心肌梗死患者中的应用

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中国处方药 2009年第11期8卷 46-46页

作者： roxana Mehran Alexandra J Lansky Bernhard Witzenbichler

背景及目的：HORIZONS-AMI研究已经发现，行pCI的急性ST段抬高的心肌梗死（STEMI）患者给予凝血酶抑制剂比伐卢定治疗，与肝素加糖蛋白Ⅱb／Ⅲa抑制剂（GpI）治疗相比，30天时的大出血并发症以及实际不良反应事件显著降低。本研究又对用... 详细信息

背景及目的：HORIZONS-AMI研究已经发现，行pCI的急性ST段抬高的心肌梗死（STEMI）患者给予凝血酶抑制剂比伐卢定治疗，与肝素加糖蛋白Ⅱb／Ⅲa抑制剂（GpI）治疗相比，30天时的大出血并发症以及实际不良反应事件显著降低。本研究又对用药1年后的疗效进行了评价。

关键词：急性ST段抬高心肌梗死患者比伐卢定血管成形术糖蛋白Ⅱb/Ⅲa抑制剂 AMI 凝血酶抑制剂不良反应事件

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Is ARFI elastography reliable for predicting fibrosis severity in chronic HCV hepatitis?

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World Journal of Radiology 2011年第7期3卷 188-193页

作者： Ioan Sporea roxana Sirli Simona Bota Carmen Fierbinteanu-Braticevici Alina popescu Radu Badea Monica Lupsor Ana petrisor Mirela Dnil Department of Gastroenterology and Hepatology University of Medicine and Pharmacy Timi oara10 Iosif Bulbuca Bv.300736 TimisoaraRomania IInd Medical Clinic and Gastroenterology University Hospital169 Independen ei AvenueSector 5050098 BucharestRomania Department of Medical Imaging 3rd Medical ClinicUniversity of Medicine and PharmacyClujNapoca21-23 Croitorilor Str.400162Cluj-NapocaRomania

AIM:To determine whether acoustic radiation force impulse(ARFI) elastography is a reliable method for predicting fibrosis severity in patients with chronic hepatitis C virus(HCV) ***:We performed a multicenter study including 274 subjects with HCV chronic hepatitis in which we compared ARFI with liver biopsy(LB).In each patient we performed LB(evaluated according to the Metavir score) and ARFI measurements(using a Siemens Acuson S2000TM ultrasound system:10 valid measurements were performed and median values were calculated and expressed in meters/second(m/s).RESULTS:A direct,strong,correlation(Spearman r = 0.707) was found between ARFI measurements and fibrosis(p predicting the presence of fibrosis(F ≥ 1 Metavir),significant fibrosis(F ≥ 2),severe fibrosis(F ≥ 3) and cirrhosis(F = 4),the cutoff values of 1.19,1.21,1.58 and 1.82 m/s were determined,respectively,liver stiffness measurements had 73%,84%,84% and 91% Se respectively;93%,91%,94%,90% Sp,respectively;with AUROCs of 0.880,0.893,0.908 and 0.937,***:ARFI measurement is a reliable method for predicting the severity of fibrosis in HCV

关键词： Acoustic radiation force impulse elastography Chronic HCV hepatitis Cirrhosis Liver fibrosis Liver stiffness

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Intravascular ultrasound assessment of the incidence and predictors of edge dissections and intramural hematomas after drug-eluting stent implantation

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上海医学 2007年第S1期30卷 32-32页

作者： Gary S.Mintz Stéphane G.Carlier Jose de Ribamar Costa Jr Koichi Sano Joanna Lui Giora Weisz Issam Moussa George D.Dangas roxana Mehran Edward M.Kreps Michael Collins Gregg W.Stone Jeffrey W.Moses GE Junbo Martin B.Leon Department of Cardiology Zhongshan HospitalFudan UniversityShanghai 200032China Columbia University Medical Center and Cardiovascular Research Foundation New York USA.

Objective We used intravascular ultrasound (IVUS) to assess incidence, predictors, morphology, and angiographic findings of edge dissections and intramural hematomas after drug-eluting stent (DES) implantation. Methods We studied 887 patients with 1 045 non-in-stent restenosis lesions in 977 native arteries undergoing DES implantation with IVUS imaging, and compared the dissected stent end to the non-dissected stent end. Results Eighty-two dissections were detected; 51.2% (42/82) involved the proximal and 48.8% (40/82) the distal stent edge. When compared to the non-dissected stent end, residual plaque area [(8.0±4.3) mm2 vs (5.2±3.0) mm2, pplaque burden [(52±12)% vs (36±15)%, pplaque eccentricity (8.4±5.5 vs 4.0±3.4, pp=0.02) were larger; plaque burden≥50% was more frequent (62% vs 17%, pposits (52.5% vs 35.6%, p=0.03) more common; and the lumen/stent area (0.86±0.16 vs 1.02±0.18, pected end. Independent predictors of stent edge dissection were residual plaque eccentricity (OR=1.3, pplaque burden≥50% (OR=7.3, ppredictors of intramural hematomas were plaque eccentricity (OR=1.4, p=0.005), plaque burden≥50% (OR=7.1, p=0.02), and mean lumen diameter to stent diameter ratio (OR=0.37, p=0.04).Concluslon IVUS identified edge dissections after 9.4% of DES implantations. Residual plaque eccentricity and significant plaque burden predicted coronary stent edge dissections. Dissections in less diseased reference segments with an arc of normal vessel wall (greater plaque eccentricity) more often evolved into an intramural hematoma.

关键词： stent eluting plaque implantation burden restenosis intravascular incidence lumen dissection

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Assessment of inconclusive left main coronary lesions: lessons from an intravascular ultrasound study

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上海医学 2007年第S1期30卷 109-109页

作者： Gary S.Mintz Stéphane G.Carlier Jose de Ribamar Costa Jr Koichi Sano Joanna Lui Giora Weisz Issam Moussa George D.Dangas roxana Mehran Edward M.Kreps Michael Collins Gregg W.Stone Jeffrey W.Moses Junbo Ge Martin B.Leon Department of Cardiology Zhongshan HospitalFudan UniversityShanghai 200032China Columbia University Medical Center and Cardiovascular Research Foundation New YorkUSA

Objective Angiographic assessment of a left main coronary artery (LMCA) stenosis is often difficult and unreliable. Intravascular ultrasound (IVUS) assessment of absolute lumen dimensions has been shown to correlate with fractional flow reserve (FFR) and to predict clinical outcome in patients with a LMCA stenosis. Methods During 21 months period (October, 2004 to July, 2006), 153 patients (Ostial lesions, n=47; Non-ostial lesion, n=106) underwent IVUS evaluation specifically to assess the severity of an angiographically inconclusive LMCA narrowing. IVUS analysis included plaque morphology; external elastic membrane (EEM), lumen, plaque cross-sectional areas (CSA), plaque burden (plaque CSA/ EEM) and remodeling index (lesion EEM CSA/reference EEM CSA). Results Overall, minimum lumen area (MLA) and diameter (MLD) and plaque burden measured 8.2 mm2, 2.6 mm, and 59.3 %, respectively. An MLAparticular, ostial LMCA lesions had a larger MLA and a smaller plaque burden than non-ostial lesions (Table). Conclusions patients referred for LMCA evaluation commonly have insignificant narrowing. Negative remodeling was prominent at the LMCA ostium. These patients deserve IVUS assessment before revascularization.

关键词： intravascular plaque remodeling stenosis burden severity lumen absolute dimensions correlate

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