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Interendoscopist variability in proximal colon polyp detection is twice higher for serrated polyps than adenomas

World Journal of Gastroenterology 2016年第38期22卷 8549-8557页

作者： Jean-François Bretagne Stéphanie Hamonic Christine Piette Jean-François Viel Guillaume Bouguen service des maladies de l'appareil digestif hopital PontchaillouCentre hospitalo-universitaire de Rennes35033 RennesFrance service d'épidémiologie et de santé publique Centre hospitalo-universitaire de Rennes35033 Rennes France Association pour le dépistage des cancers en Ille et Vilaine 35033 RennesFrance

AIM To assess the interendoscopist variability in the detection of colorectal polyps according to their location and histological *** This study was a retrospective analysis of prospectively collected data from a regional colorectal cancer(CRC) screening program; 2979 complete colonoscopies from 18 endoscopists were included. Variability in performance between endoscopists for detection of at least one adenoma(A), one proximal adenoma(PA), one distal adenoma(dA), and one proximal serrated polyp(PSP) was assessed by using multilevel logistic regression *** The observed detection rates among the 18 endoscopists ranged from 24.6% to 47.6%(mean = 35.7%) for A, from 19.1% to 39.0%(mean = 29.4%) for dA, from 6.0% to 22.9%(mean = 12.4%) for PA, and from 1.3% to 19.3%(mean = 6.9%) for *** adjusting for patient-level variables(sex, age), the interendoscopist detection rates variability achieved a significant level for A, PA, and PSP but not for dA(P = 0.03, P = 0.02, P = 0.02 and P = 0.08, respectively). This heterogeneity, as measured by the variance partition coefficient, was approximately threefold higher for PA(6.6%) compared with A(2.1%), and twofold higher for PSP(12.3%) compared with *** These results demonstrate significant interendoscopist variability for proximal polyp particularly for serrated p o l y p s, b u t n o t f o r d i s t a l a d e n o m a d e t e c t i o n. These findings contribute to explain the decreased effectiveness of complete colonoscopies at preventing proximal CRCs and the need to carefully assess the proximal colon during scope procedure.

关键词： Colonoscopy Colorectal cancer Adenoma Serrated polyp Proximal polyp detection rate Quality performance

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Psychological distress in Moroccan Patients with Hematological Malignancies and Its Impact on Their Quality of Life

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Psycho-Oncologie 2023年第4期17卷 235-244页

作者： Maha Ouazzani Zineb El Khammar Nawal Oubelkacem Youssef Aboussaleh Hajar Masrour Moncef Maiouak Rhizlane Berrady Laboratoire de Nutrition Santéet EnvironnementDépartement de BiologieFacultédes SciencesUniversitéIbn TofailKenitra14000Maroc service de Médecine Interne et d’oncohématologie CHU Hassan IIFès30050Maroc Laboratoire d’épidémiologie Facultéde Médecine et de Médecine DentaireFès30050Maroc

Introduction:la qualitéde vie des patients suivis pour une hémopathie maligne dépend non seulement du type de la maladie,de ses caractéristiques cliniques,biologiques et thérapeutiques,mais aussi de la santémentale du patient.L’objectif de notreétude est d’évaluer l’état psychologique des patients au diagnostic,de rechercher les facteurs associésàson altération et de préciser son impact sur la qualitéde vie des patients.Méthode:nous avons menéuneétude monocentrique transversale quiévalue la dépression,l’anxiétéet la qualitéde vie d’une population de patients atteints de syndromes lymphoprolifératifs sur une période de *** questionnaires ontétéutilisés au moment du diagnostic:le HAdS pour rechercher la dépression et l’anxiétéet le SF12échelle pourévaluer la qualitéde vie liéeàla santé.Résultat:Les cent patients ont acceptéde répondre aux *** patients sont suivis pour un lymphome malin non hodgkinien,une maladie de Hodgkin,et une leucémie lymphoïde *** sex-ratio(H/F)est de 1,*** prévalence des symptômes anxieux est de 70%avec 95%CI(61,01%;78,99%)et des symptômes dépressifs de 76%avec 95%CI(49,4%;82,6%)des *** analyse univariée,le caractère féminin est associéaux symptômes anxieux(p=0,008),etàl’altération de qualitéde vie mentale(p=0,02).Alors qu’en analyse multivariée,Les symptômes anxio-dépressifs sont significativement associésàun score de qualitéde vie faible aussi bien mentale que *** plus les symptômes anxieux sont corrélés au sexe féminin(ORA=20,50;95%CI[1,58–264,48]);et la douleur(ORA=12,33;95%CI[1,07–141,77]).Conclusion:la recherche de comorbidités psychologiques doit faire partie du diagnostic initial de cette population vulnérable pour une meilleure qualitéde vie.

关键词： dépression anxiété qualitéde vie liéàla santé lymphome

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Testing for hepatitis B virus alone does not increase vaccine coverage in non-immunized persons

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World Journal of Gastroenterology 2017年第38期23卷 7037-7046页

作者： Anders Boyd Julie Bottero Fabrice Carrat Joel Gozlan Hayette Rougier Pierre-Marie Girard Karine Lacombe Institute Pierre Louis d’épidémiologie et de SantéPublique(IPLESP UMRS 1136) INSERMSorbonne Universités service de maladies infectieuses Hopital Saint-AntoineAP-HP département de santépublique Hopital Saint-AntoineAP-HP Laboratoire de Virologie Hopital Saint-AntoineAP-HP INSERM UMR_S1135 CIMI

AIM To determine whether hepatitis B virus(HBV)-testing could serve as a gateway to vaccinate non-immunized individuals in a low-prevalent *** Non-immunized subjects participating in a multi-center, HBV-testing campaign in Paris, France were identified and contacted via telephone 3-9 mo after testing in order to determine vaccination status. Vaccination coverage was evaluated in per-protocol(for all respondents) and intent-to-treat analysis(assuming all non-responders did not vaccinate).RESULTS In total, 1215/4924(24.7%) enrolled subjects with complete HBV serology were identified as nonimmunized and eligible for analysis. There were 99/902 successfully contacted subjects who had initiated HBV vaccination after screening: per-protocol, 11.0%(95%CI: 9.0-13.2); intent-to-treat, 8.2%(95%CI: 6.7-9.8). In multivariable analysis, vaccination was more likely to be initiated in individuals originating from moderate or high HBV-endemic countries(P d healthcare coverage(P = 0.01) and men who have sex with men(P = 0.02). When asked about the reasons for not initiating HBV vaccination, the most frequent response was "will be vaccinated later"(33.4%), followed by "did not want to vaccinate"(29.8%), and "vaccination was not proposed by the physician"(21.5%). Sub-group analysis indicated a stark contrast in vaccination coverage across centers, ranging from 0%-56%.CONCLUSION HBV-vaccination after HBV screening was very low in this study, which appeared largely attributed to physician-patient motivation towards vaccination. Increased vaccination coverage might be achieved by emphasizing its need at the organizational level.

关键词： Health service organization Hepatitis B virus vaccination Public health Testing intervention Vaccine coverage

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Validity of the French version of Catquest-9SF and use of an electronic notepad for entering patient-reported outcome measures

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Eye and Vision 2021年第1期8卷 92-100页

作者： Gregory Katz Alexandra Rouquette François Lignereux Thierry Mourgues Michel Weber Mats Lundström Chair of Innovation&Value in Health University of Paris School of MedicineParisFrance Value-Based Health Care Consortium ParisFrance Prom-Time ParisFrance service de SantéPublique et d’Épidémiologie AP-HP Paris-SaclayLe Kremlin-BicêtreFrance Centre de recherche enÉpidémiologie et Santédes Populations InsermUniversitéParis-SaclayVillejuifFrance Ophtalmologie Chénieux Polyclinique de LimogesLimogesFrance Institut Ophtalmologique Sourdille-Atlantique Elsan SantéAtlantiqueNantesFrance Ophthalmology department Centre Hospitalier-Universitaire de NantesNantesFrance department of Clinical Sciences OphthalmologyFaculty of MedicineLund UniversityLundSweden

Background:The Catquest-9SF questionnaire is a patient reported outcome measure that quantifies the visual benefits from cataract *** purpose of this study was to translate and adapt the Catquest-9SF questionnaire for France,to assess its psychometric properties via Rasch analysis,and to assess its validity when completed using an electronic ***:The Catquest-9SF questionnaire was translated following the guidelines of the International Society for Pharmacoeconomics and Outcomes ***-9SF and clinical data were collected from patients before and after routine cataract *** questionnaire data were collected via an electronic *** analysis was performed to assess psychometric properties,and sensitivity to change was analysed for patients with complete paired pre-and post-operative ***:A complete filled-in preoperative questionnaire was obtained for 848 *** analysis showed good precision(person separation:2.32,person reliability:0.84),ordered category probability curves,no item misfit,and *** respondents were slightly more able than the level of item difficulty(targeting:−1.12 logits).Sensitivity was analysed on 211 paired questionnaires,and the postoperative questionnaires showed a clear ceiling *** effect size was *** use of an electronic notepad for completing the questionnaire worked out very well after some ***:The French version of Catquest-9SF has good psychometric properties and is suitable for use in French-speaking *** use of the Catquest-9SF questionnaire in an electronic format showed good validity.

关键词： Cataracts Patient-related outcome measures Quality of life Questionnaire Value-based health care Catquest-9SF

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Predicting factors for the need of extracorporeal membrane oxygenation for suicide attempts by cardiac medication:a single-center cohort study

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World Journal of Emergency Medicine 2022年第4期13卷 283-289页

作者： david Vandroux Thomas Aujoulat Bernard-Alex Gaüzère Bérénice Puech Bertrand Guihard Olivier Martinet Intensive Care Unit Félix Guyon HospitalUniversity Teaching Hospital of La Réunion97400 Saint DenisReunion IslandFrance Cardiosurgical Intensive Care Unit Dupuytren II HospitalUniversity Teaching Hospital of Limoges87042 LimogesFrance UMR 1094 Neuro-épidémiologie Tropicale University of Limoges87042 LimogesFrance Cardiovascular Anesthesia department Félix Guyon HospitalUniversity Teaching Hospital of La Réunion97400 Saint DenisReunion IslandFrance service d’Aide Médicale d’Urgence Félix Guyon HospitalUniversity Teaching Hospital of La Réunion97400 Saint DenisReunion IslandFrance

BACKGROUNd:Severe poisoning due to the overdosing of cardiac drugs can lead to cardiovascular *** order to decrease the mortality rate,the most severe patients should be transferred as quickly as possible to an extracorporeal membrane oxygenation(ECMO)***,the predictive factors showing the need for venous-arterial ECMO(VA-ECMO)had never been ***:A retrospective,descriptive,and single-center cohort *** consecutive patients admitted in the largest ICU of Reunion Island(Indian Ocean)between January 2013 and September 2018 for beta-blockers(BB),calcium channel blockers(CCB),renin-angiotensin-aldosterone system blockers,digoxin or anti-arrythmic intentional poisonings were *** implementation was the primary ***:A total of 49 consecutive admissions were *** patients had ECMO,39 patients did not have *** patients in ECMO group died,while no patients in the conventional group *** most relevant ECMO-associated factors were pulse pressure and heart rate at first medical contact and pulse pressure,heart rate,arterial lactate concentration,liver enzymes and left ventricular ejection fraction(LVEF)at *** pulse pressure at first medical contact and LVEF were significant after logistic ***:A transfer to an ECMO center should be considered for a pulse pressuredical contact or LVEFdmission to ICU.

关键词： Extracorporeal membrane oxygenation Implementation Cardiac medication Overdose Predicting factor

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Inflammatory status in chronic renal failure: The role of homocysteinemia and pro-inflammatory cytokines

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World Journal of Nephrology 2013年第2期2卷 31-37页

作者： Hadja Fatima Tbahriti djamel Meknassi Rachid Moussaoui Amar Messaoudi Lakhdar Zemour Abbou Kaddous Malika Bouchenak Khedidja Mekki Laboratoire de Nutrition Clinique et Métabolique Faculté des Sciences de la Nature et de la Vie Université d’Oran Oran 31100 Algérie service de Néphrologie Etablissement Hospitalier Universitaire (EHU) d’Oran Oran 31037 Algérie service de Biochimie Etablissement Hospitalier Universitaire (EHU) d’Oran Oran 31037 Algérie service d’épidémiologie Etablissement Hospitalier Universitaire (EHU) d’Oran 31037 Oran 31037 Algérie

AIM： To evaluate determinants of infammatory mark-ers in chronic renal failure patients according to the level of glomerular fltration rate. METHOdS： One hundred ffty four patients （Age： 44 ± 06 years; male/female： 66/88） with chronic renal fail-ure （CRF） were divided into 6 groups according to the National Kidney Foundation （NKF） classification. They included 28 primary stage renal failure patients （CRF 1）, 28 moderate stage renal failure patients （CRF 2）,28 severe stage renal failure patients （CRF 3）, 18 end-stage renal failure patients （CRF 4）, 40 hemodialysis （Hd） patients, and 12 peritoneal dialysis （Pd） patients. Tumor necrosis factor-α （TNF-α）, interleukin-1β （IL-1β）, interleukin-6 （IL-6） and C-reactive protein （CRP） were analyzed by immunosorbent assay kit （ELISA）（Cayman Chemical’s ACETM EIA kit）. Immunoassay methods were used for total homocysteine （tHcy）（fuorescence polarization immunoanalysis HPLC, PerkinEmer 200 series）, transferrin （MININEPHTM human transferin kit： ZK070.R）, ferritin （AdVIA Centaur ） and fbrinogen analysis （ACL 200）. differences between groups were performed using SPSS 20.0 and data are expressed as the mean ± ***： Results showed that in comparison with CRF 1 group and other groups, TNF-α and IL-6 levels were respectively more elevated in Hd （16.38 ± 5.52 pg/mL vs 0.39 ± 0.03 pg/mL, 11.05 ± 3.59 pg/mL vs 8.20 ± 0.22 pg/mL, P 〈 0.001） and Pd （14.04 ± 3.40 pg/mL vs 0.39 ± 0.03 pg/mL, 10.15 ± 1.66 pg/mL vs 8.20 ± 0.22 pg/mL, P 〈 0.001）. IL-1β levels were increased in Hd （9.63 ± 3.50 pg/mL vs 3.24 ± 0.10 pg/mL, P 〈 0.001） and CRF 4 （7.76 ± 0.66 pg/mL vs 3.24 ± 0.10 pg/mL, P 〈 0.001） patients than in CRF 1 and in the other groups. Plasma tHcy levels were higher in Hd （32.27 ± 12.08 μmol/L） and Pd （28.37 ± 4.98 μmol/L） patients compared to the other groups of CRF （P 〈 0.001）. The serum CRP level was signifcantly increased in Hd （18.17 ± 6.38 mg/L） and Pd （17.97 ± 4.85 mg/L） patients compared to the other groups of CRF patients

关键词： Chronic renal failure Infammation Pro-infammatory cytokines Total homocysteine Glomerular fltration rate

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FOLFIRI regimen in metastatic pancreatic adenocarcinoma resistant to gemcitabine and platinum-salts

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World Journal of Gastroenterology 2012年第33期18卷 4533-4541页

作者： Cindy Neuzillet Olivia Hentic Benot Rousseau Vinciane Rebours Léla Bengrine-Lefèvre Franck Bonnetain Philippe Lévy Eric Raymond Philippe Ruszniewski Christophe Louvet Pascal Hammel service de Gastroentérologie-Pancréatologie Hpital Beaujon 100 Boul-evard du Général Leclerc 92110 Clichy La Garenne AP-HP France service d'Oncologie Médicale Hpital Saint Antoine 184 Rue du Faubourg Saint-Antoine 75012 Paris AP-HP France Unité de Biostatistique et d'Epidémiologie EA 4184 Centre Georges Franois Leclerc 1 Rue du Pr Marion 21079 Dijon France service d'Oncologie Médicale Hpital Beau-jon 100 Boulevard du Général Leclerc 92110 Clichy La Garenne AP-HP France département d'Oncologie Médicale Institut Mutualiste Montsouris 42 Boulevard Jourdan 75014 Paris France

AIM: To evaluate the efficacy and safety of the FOLFIRI regimen in patients with metastatic pancreatic adenocarcinoma (PAC) after the failure of gemcitabine and platinum salts. METHOdS: All consecutive patients with histologically confirmed, metastatic PAC and World Health Organiza-tion performance status (PS) ≤ 2 received FOLFIRI-1 [irinotecan 180 mg/m2 on day 1 and leucovorin 400 mg/m2 followed by 5-fluorouracil (5-FU) 400 mg/m2 bolus, then 5-FU 2400 mg/m2 as a 46-h infusion, biweekly] or FOLFIRI-3 (irinotecan 100 mg/m2 on day 1 and leucovorin 400 mg/m2, then 5-FU 2400 mg/m2 as a 46-h infusion and irinotecan 100 mg/m2 repeated on day 3, biweekly) after failure of gemcitabine and platinum-based chemotherapies as a systematic policy in two institutions between January 2005 and May 2010. Tumor response, time to progression (TTP), overall survival rate (OS) and grade 3-4 toxicities were retrospectively studied. Subgroup analyses were performed to search for prognostic factors. RESULTS: Sixty-three patients (52.4% male, median age 59 years) were analyzed. Among them, 42.9% were PS 0, 38.1% were PS 1 and 19.0% were PS 2. Fifty one patients (81.0%) had liver metastases. Before the FOLFIRI regimen, patients had received 1 line (n = 19), 2 lines (n = 39) or 3 lines (n = 5) of chemotherapy. Median TTP obtained with the line before FOLFIRI was 3.9 mo (95% CI: 3.4-5.3 mo). A total of 480 cycles was completed (median: 6 cycles, range: 1-51 cycles). The main reason for discontinuing FOLFIRI was tumor progression (90.3%). Tumor control was achieved in 25 patients (39.7%) (partial response: n = 5, stable disease: n = 20) with FOLFIRI. Median TTP was 3.0 mo (95% CI: 2.1-3.9 mo) and median OS was 6.6 mo (95% CI: 5.3-8.1 mo). dose adaptation was required in 36 patients (57.1%). Fifteen patients (23.8%) had grade 3-4 toxicities, mainly hematological (n = 11) or digestive (n = 4). Febrile neutropenia occurred in 3 patients. There was no toxic death. PS 2 was significantly associated w

关键词： Pancreatic cancer Pancreatic adenocarcinoma Metastases Chemotherapy 5-fluorouracil Irinotecan Camptothecin FOLFIRI regimen

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Oral care offerings in populations of Ferlo (Senegal): The contribution of traditional dentistry

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Open Journal of Epidemiology 2013年第2期3卷 89-92页

作者： Massamba diouf Gilles Boetsch Anta Tal-dia Jean Jacques Bonfil CNRS—UMI 3189 “Environnement Santé Sociétés” Faculté de Médecine Secteur Nord Marseille France service d’Epidémiologie Faculté d’Odontologie Marseille France service de Santé Publique et Médecine Préventive Faculté de Médecine Université Cheikh Anta Diop Dakar Sénégal

The aim of this study was to examine whether the offering of traditional treatments can constitute a positive contribution to integrate in an oral public health care settings. Method: This was a cross-sectional study involving 300 people living in the area of Ferlo in East Central Senegal. Selected individuals must be residents of the area over the age of 15 years. Cluster sampling was used as a recruitment method. data collected concerned the type of oral health care used whether modern or traditional, the periodontal condition (plaque, gingival and bleeding index, attachment loss, pocket depth and CPITN). dental status was evaluated by dMFT. The data were analyzed with R software and the Student’s t test was used to compare the averages of indices in both groups at the threshold of 5%. A co-variance analysis was allowed in order to determine associations between some indices and therapy type in multivariate approach. Results: Averages of dental and periodontal indices were globally higher in people using modern therapies. dMFT, CPITN and gingival index increased significantly when the type of therapy was modern after adjustment on the plaque index and age. Conclusion: The traditional dentistry could constitute a positive contribution to a public health care, especially in a context of developing country. However, this practice should be guided and validated by a research-based evidence to allow better use of the therapeutic processes, and promote the health of populations.

关键词： Oral Care Supply Senegal Traditional dentistry

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Predictors of Nonunion in Humerus Shaft Fractures in Adults in Lomé(Togo)

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Open Journal of Orthopedics 2015年第11期5卷 361-368页

作者： Atchi Walla Gamal Ayouba dadja Essoya Landoh Batarabadja Bakriga Tchaa Towoezim Anani Abalo Assang Michel dossim service de Chirurgie Orthopédique et Traumatologique CHU Sylvanus Olympio Lomé Togo service de Chirurgie Générale du Centre Hospitalier de Kpalimé Kpalimé Togo division de l’Epidémiologie Ministère de la Santé Lomé Togo

Background: To identify predictors of humerus shaft fractures nonunion in adults whatever the type of treatment performed. Patients and Methods: We conducted a retrospective study among patients who had a fracture of the humeral shaft moving towards healing or nonunion. Patients were treated in the orthopedic trauma unit of Sylvanus Olympio Teaching Hospital and two other private clinics in Lomé between January 2008 and June 2012. On the X-ray of each patient, we measured the angulation, the diastasis, and inter fragmentary contact. For each included patient, we looked for: age, sex, medical history, body mass index (BMI), according to the third location of the shaft fracture, the type of fracture according to AO classification and the type of opening according Tscherne classification. Results: during the study period, 184 patients with humeral shaft fracture were identified. Of these 108 were men. The mean age of patients was 37.3 years. The fractures were treated conservatively in 100 patients (54.3%), 78 treated surgically and six (3.3%) have discharged from hospital against medical advice for traditional treatment. The factors that were associated with nonunion of humerus shaft fractures in these patients were: the opening of the fracture (RR = 4.5;95% CI = [2.9;7.1]), the presence of immediately radial paralysis (RR = 5.6;95% CI = [3.7;8.5]), the existence of other associated lesions or fracture (RR = 1.8;95% CI = [1.1;3.1]), energy of the trauma (RR = 2.3;95% CI = [1.3;4.4]) and type III classification of Tscherne (RR = 0.3;95% CI = [0.2;0.6]). After multivariate analysis, factors that remained significantly associated with the failure of consolidation were: the existence of diastasis > 2 mm (OR = 7.6;95% CI = [2.2;25.6)), the Body Mass Index (BMI) > 25 (OR = 1.3;95% CI = [1.1 - 1.6]) and the existence of other bone lesion (OR = 4.3;95% CI = [1.4 - 18.9]). Conclusion: BMI greater than 25, the existence of an interfragmentary gap of more than 2 mm and existence

关键词： Humerus Shaft Fracture Nonunion Predisposing Factors

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Hypofractionated Radiation Therapy for the Treatment of Breast Cancer: Experience of National Institute of Oncology, Rabat, Morocco

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Journal of Cancer Therapy 2016年第10期7卷 773-783页

作者： A. S. Koné A. diakité S. Ahid I. M. diarra K. diabaté R. Abouqal Y. Cherrah N. Benjaafar service de Radiothérapie Institut National d’Oncologie de Rabat Rabat Morocco Laboratoire de Pharmacologie & Toxicologie Faculté de Médecine et de pharmacie de Rabat Rabat Morocco Laboratoire de Biostatistique de Recherche Clinique et d’Epidémiologie Faculté de Médecine et de pharmacie de Rabat Rabat Morocco

Hypofractionated radiation therapy has proven effective on locoregional control and tolerance in the adjuvant treatment of breast cancer. The aim of this study is to compare the results of hypofractionated radiation therapy versus conventional radiation therapy in terms of local control and tolerance. It was a retrospective study of patients observations collected from January 2007 to december 2008 in department of Radiation Therapy in Institut National d’Oncologie de Rabat. The treatment results were evaluated by the rate of locoregional recurrence, distant recurrence and research of late toxicities. Radiotherapy was delivered using the same technique in both groups, by gamma photons of cobalt 60 with an energy of 1.25 MeV. They were 2 groups: the first group treated with standard dose rate and the second group treated by hypofractionated radiation therapy. The mean age of the patients was 42.8 ± 6.9 years old in the standard group and 43.22 ± 7.2 years old in the hypofractionation group. We noted a predominance of infiltrating ductal carcinoma. The majority of patients were pT2, pN0 and pN1. The majority of patients had radical surgery and chemotherapy with anthracyclines in both groups. We noted a statistically significant difference in the irradiation of chest wall between the standard (89.2%) and hypofractionated group (70.3%), with p = 0.043. The median duration of radiation therapy was statistically different in both groups: 39 days in the standard and 23 days in the hypofractionated group (p 0.001). The local recurrences were statistically identical to 12 and 24 months (p = 0.999). Concerning toxicities, the frequency of adverse event was similar in both groups. Hypofractionated radiation therapy with a total dose of 42 Gy at 2.8 Gy per fraction in 5 fractions weekly is comparable to standard radiotherapy in terms of local control and tolerance and is therefore a very good alternative to standard treatment.

关键词： Hypofractionated Radiation Therapy Breast Cancer Local Control Tolerance

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