Endoscopic Submucosal Dissection (ESD)was introduced in the West later than in the East. Our aim was to assess how Western endoscopists performing ESD have been trained and how they value animal models for training.
An online survey regarding training in ESD was sent to Western endoscopists who published articles on advanced resection techniques.
From 279 endoscopists, 58 (21%) completed the questionnaire, of which 50 confirmed performance of clinical ESD. Endoscopists had a median of 15 years of endoscopic experience (IQR 9.75-20.25) and all of them were performing conventional EMR, before starting ESD. Prior to clinical ESD, 74% (
= 37) underwent training with
models, 84% (
= 42) with live animal models and 92% (
= 46) with at least, one of the two models. After starting clinical ESD, as trainers, 52% (
= 26) were involved with
and 60% (
= 30) with live animal models. Personal usefulness of
and live animal models was rated with a median of 9 (IQR 8-10) and 10 (IQR 8-10), out of 10, respectively. Courses with
and live animal models were considered a prerequisite before clinical practice by 84% (
= 42) and 78% (
= 39), respectively.
Western endoscopists have extensive endoscopic experience before starting ESD. The majority had pre-clinical training with
and live animal models and more than half are acting as trainers of other endoscopists with these models. Animal models are considered very useful and deemed a prerequisite before clinical practice by the majority of the endoscopists.
Western endoscopists have extensive endoscopic experience before starting ESD. The majority had pre-clinical training with ex vivo and live animal models and more than half are acting as trainers of other endoscopists with these models. AS101 purchase Animal models are considered very useful and deemed a prerequisite before clinical practice by the majority of the endoscopists.
There are no currently available biomarkers that can accurately indicate the presence of non-alcoholic steatohepatitis (NASH). We investigated the association between endotrophin, a cleavage product of collagen type 6α3, and disease severity in patients with non-alcoholic fatty liver disease (NAFLD).
We measured serum endotrophin levels in 211 patients with NAFLD and nine healthy controls. Liver biopsy data was available for 141 (67%) of the patients. Associations between endotrophin and the presence of NASH and advanced fibrosis were investigated alone and in combination with standard clinical parameters using logistic regression.
A total of 211 patients were enrolled in this study, consisting of 108 (51%) men and 103 (49%) women with a mean age of 55.6years. 58 (27%) of the patients had advanced fibrosis. Of those with biopsy data, 87 (62%) had NASH. Serum levels of endotrophin were significantly higher in patients with NAFLD than those in healthy controls (37[±12] vs. 17[±7] ng/mL,
<.001). Serum levels of endotrophin were also significantly higher in patients with NASH than in those without NASH (40[±12] vs. 32[±13] ng/mL,
<.001). A model using age, sex, body mass index and levels of alanine aminotransferase (ALT), glucose and endotrophin effectively predicted the presence of NASH in a derivation (AUROC 0.83, 95%CI = 0.74-0.92) and validation cohort (AUROC 0.71, 95%CI = 0.54-0.88). There was no significant association between serum levels of endotrophin and advanced fibrosis.
These data suggest that serum endotrophin could be a valuable biomarker for diagnosing NASH, but not for detecting advanced fibrosis in NAFLD.
These data suggest that serum endotrophin could be a valuable biomarker for diagnosing NASH, but not for detecting advanced fibrosis in NAFLD.
To systematically determine the miss rate and risk factors for polyps, adenomas and advanced adenomas in the same population, and to further analyze the impact of colonoscopy with anesthesia on miss rate.
We retrospectively analyzed the information of the patients undergoing the second colonoscopy within 1 year after their first. The patient and lesion miss rate were calculated. The patient and lesion features of missed lesion were compared with non-missed lesion. Finally, the patients were divided into anesthesia group and without anesthesia group, and the impact of colonoscopy with anesthesia on missed lesions was further analyzed.
The patient miss rate of polyps, adenomas and advanced adenomas was 32.8, 25.6 and 10.4%, and the lesions miss rate was 19.6, 15.8 and 7.2%. In multivariable logistic regression analysis, lesion-related factors (large number of lesions, small lesion size, flat shape and location at the right colon) and patient-related factors (male, elder, abdominal symptoms, surgical history, diverticulum, colonoscopy without anesthesia and suboptimal bowel preparation) were found to be independently associated with missed polyps and adenomas (
< .05). Large number of lesions, flat shape and suboptimal bowel preparation were associated with missed advanced adenoma (
< .05). Colonoscopy with anesthesia can reduce the polyp miss rate (PMR) and male and elderly patients are more likely to be missed during colonoscopy without anesthesia.
Many factors of patients and lesions can affect the lesions miss rate. Colonoscopy with anesthesia can reduce the PMR and male and elderly patients are more likely to be missed during colonoscopy without anesthesia.
Many factors of patients and lesions can affect the lesions miss rate. Colonoscopy with anesthesia can reduce the PMR and male and elderly patients are more likely to be missed during colonoscopy without anesthesia.This study investigated the stability of Wechsler Intelligence Scale for Children-Fifth Edition (WISC-V) scores for 225 children and adolescents from an outpatient neuropsychological clinic across, on average, a 2.6 year test-retest interval. WISC-V mean scores were relatively constant but subtest stability score coefficients were all below 0.80 (M = 0.66) and only the Verbal Comprehension Index (VCI), Visual Spatial Index (VSI), and omnibus Full Scale IQ (FSIQ) stability coefficients exceeded 0.80. Neither intraindividual subtest difference scores nor intraindividual composite difference scores were stable across time (M = 0.26 and 0.36, respectively). Rare and unusual subtest and composite score differences as well as subtest and index scatter at initial testing were unlikely to be repeated at retest (kappa = 0.03 to 0.49). It was concluded that VCI, VSI, and FSIQ scores might be sufficiently stable to support normative comparisons but that none of the intraindividual (i.e. idiographic, ipsative, or person-relative) measures were stable enough for confident clinical decision making.AS101 purchase
Top comments (0)