Background
Conventional anorectal manometric parameters based on linear waves cannot properly predict balloon expulsion (BE) time. We aimed to determine the correlation between integrated pressurized ...volume (IPV) parameters during simulated evacuation (SE) and BE time in healthy individuals and constipated patients and to assess the correlation between each parameter and symptoms.
Methods
A total of 230 male participants (including 26 healthy volunteers and 204 chronically constipated patients) underwent high‐resolution anorectal manometry (HRAM) and BE tests. The IPV was calculated by multiplying the amplitude, distance, and time from the HRAM profile. Receiver operating characteristic curve (ROC) analysis and partial least square regression (PLSR) were performed.
Key Results
ROC analysis indicated that the IPV ratio between the upper 1 cm and lower 4 cm of the anal canal was more effective for predicting BE time (area under the curve AUC: 0.74, 95% confidence interval CI: 0.67‐0.80, P < .01) than the conventional anorectal parameters, including defecation index and rectoanal gradient (AUC: 0.60, 95% CI: 0.52‐0.67, P = .01). PLSR analysis of a linear combination of IPV parameters yielded an AUC of 0.79. Moreover, the IPV ratio showed a greater clinical correlation with patient symptoms than conventional parameters.
Conclusions and Inferences
The IPV parameters and the combination of IPV parameters via PLSR were more significantly correlated with BE time than the conventional parameters. Thus, this study presents a useful diagnostic tool for the evaluation of pathophysiologic abnormalities in dyssynergic defecation using IPV and BE time.
The novel integrated pressurized volume (IPV) parameters and the combination of IPV parameters via partial least square regression were more significantly correlated with balloon expulsion (BE) time than the conventional parameters. IPV parameters can be useful diagnostic tools for the evaluation of pathophysiologic abnormalities in dyssynergic defecation using high‐resolution anorectal manometry and BE tests.
Background
The beneficial effect of biofeedback therapy (BFT) over a period of more than 2 years has not been studied in a large group of patients. The aim of this study was to evaluate the long‐term ...efficacy of BFT for dyssynergic defecation (DD).
Methods
We evaluated the results for 347 consecutive constipated patients with DD who underwent BFT for a median of five sessions between 2004 and 2009. Initial responses were assessed immediately after the completion of BFT. A responder was defined as a subject with at least a three‐point improvement from before to after BFT on an 11‐point global bowel satisfaction (GBS) scale, or a two‐point improvement if the baseline GBS was more than six points. The probability of remaining a responder was estimated by non‐parametric maximum likelihood estimation.
Key Results
The initial response rate to BFT was 72.3% (n = 251), Parkinson's disease and higher baseline GBS scores were associated with initial non‐response. The long‐term efficacy of BFT was analyzed in 103 patients who were followed up for more than 6 months; the initial effects of BFT were maintained in 85 of the patients (82.5%) during a median of 44 months of follow‐up (IQR = 12–68). The probability of remaining a responder was 60% at 2 years, and 58% at 5 years.
Conclusions & Inferences
The efficacy of BFT is maintained for more than 2 years after BFT in a considerable proportion of constipated patients with DD. BFT is effective and durable treatment for managing DD.
The estimated probability of remaining a responder during long‐term follow‐up among initial responders to biofeedback therapy. Dashed lines indicate 95% confidence intervals.
Intestinal tuberculosis and Crohn's disease are chronic inflammatory bowel disorders that are difficult to differentiate from one another. This study aimed to evaluate the diagnostic value of various ...colonoscopic findings in the differential diagnosis between intestinal tuberculosis and Crohn's disease.
Colonoscopic findings on initial work-up were prospectively recorded in patients with an initial diagnosis of either intestinal tuberculosis or Crohn's disease. These findings were analyzed after a final diagnosis of intestinal tuberculosis (n = 44) or Crohn's disease (n = 44) had been made after follow-up.
Four parameters (anorectal lesions, longitudinal ulcers, aphthous ulcers, and cobblestone appearance) were significantly more common in patients with Crohn's disease than in patients with intestinal tuberculosis. Four other parameters (involvement of fewer than four segments, a patulous ileocecal valve, transverse ulcers, and scars or pseudopolyps) were observed more frequently in patients with intestinal tuberculosis than in patients with Crohn's disease. We hypothesized that a diagnosis of Crohn's disease could be made when the number of parameters characteristic of Crohn's disease was higher than the number of parameters characteristic of intestinal tuberculosis, and vice versa. Making these assumptions, we calculated that the diagnosis of either intestinal tuberculosis or Crohn's disease would have been made made correctly in 77 of our 88 patients (87.5 %), incorrectly in seven patients (8.0 %), and would not have been made in four patients (4.5 %).
A systematic analysis of colonoscopic findings is very useful in the differential diagnosis between intestinal tuberculosis and Crohn's disease.
Background
High‐resolution manometry (HRM) based on spatiotemporal plots is increasingly being used. The aim this study was to evaluate, for the first time, the influence of gender, with adjustment ...for age, body mass index (BMI), and vaginal delivery, on anorectal functions in asymptomatic adults.
Methods
Fifty‐four asymptomatic healthy subjects (M : F = 27 : 27; age = 20–67 years) who were matched by age and gender were enrolled prospectively. We evaluated anorectal pressures, rectal sensation using a HRM probe, and balloon expulsion time. Multivariate linear regression analysis was performed to identify the independent effects of each factor.
Key Results
Anal resting pressure (median IQR; 32 18 vs 46 17 mmHg, p < 0.001), anal squeeze pressure (75 28 vs 178 72 mmHg, p < 0.001), rectal pressure (33 16 vs 53 46 mmHg, p = 0.009) and anal pressure (16 17 vs 30 36 mmHg, p = 0.019) during simulated evacuation with rectal distention, and the threshold for the desire to defecate (60 20 vs 80 60 mL, p = 0.020) were significantly lower in women than in men. BMI was positively correlated with anal resting pressure (95% CI: 0.598–2.947) and negatively correlated with the threshold for first sensation (95% CI: −0.099 to −0.015). Vaginal delivery did not affect any of the anorectal HRM parameters.
Conclusions & Inferences
HRM parameters may be associated with gender and BMI. Therefore, gender and BMI should be taken into consideration when interpreting HRM results.
This study investigated, for the first time, the influences of gender and body mass index (BMI) on high‐resolution anorectal manometry (HRM) parameters in asymptomatic normal Korean men and women populations. HRM parameters may be associated with gender and BMI. Therefore, gender and BMI should be taken into consideration when interpreting HRM results.
•IG-W and CR-W differed in their grain structures and surface morphologies.•ΦD and DD in IG-W and CR-W were affected by grain structures and lattice defects.•Our results were compared with those ...reported in earlier studies.
The transport behavior of hydrogen isotopes in ITER grade tungsten (IG-W) and commercial rolled polycrystalline tungsten (CR-W) was investigated using deuterium gas. Analyses using field-emission scanning electron microscopy revealed that both IG-W and CR-W had a polycrystalline structure, but their surface grain structures were apparently different. The permeability and diffusivity of deuterium in IG-W and CR-W were obtained using a time-dependent gas-phase technique in the temperature range of 650–850 °C, being observed to be affected by surface morphology and grain boundaries. Our results in this study were also compared with previous results for polycrystalline W reported by other authors.
Aim
This study aimed to evaluate an association between colorectal neoplasm (CRN) and skeletal muscle mass using three widely accepted skeletal muscle mass indices (SMIs) in a large population at ...average risk.
Method
We performed a cross‐sectional study using a screening colonoscopy database of 33 958 asymptomatic subjects aged 40–75 years. Appendicular skeletal muscle mass (ASM) was measured using a bioelectrical impedance analyser. ASM adjusted for height squared (ASM/ht2), weight (ASM/wt) and body mass index (ASM/BMI) were used as indices for muscle mass. Logistic regression models were used to evaluate the association between SMIs and CRN.
Results
In a multivariable‐adjusted model, the risk of an advanced CRN increased linearly with decreasing quartiles for all three SMIs. The adjusted odds ratios (ORs) for advanced CRN in quartiles 1, 2 and 3 of ASM/wt compared with that in quartile 4 were 1.279, 1.196 and 1.179, respectively (Ptrend = 0.017); for ASM/BMI, ORs were 1.307, 1.144 and 1.091, respectively (Ptrend = 0.002); and for ASM/ht2, ORs were 1.342, 1.169 and 1.062, respectively (Ptrend = 0.002). The risk of distally located advanced CRN was higher in quartile 1 than in quartile 4 for all three SMIs (ASM/wt, OR = 1.356; ASM/BMI, OR = 1.383; ASM/ht2, OR = 1.430).
Conclusion
Our study demonstrated that low skeletal muscle mass was consistently associated with the presence of advanced CRN in a population at average risk regardless of the operational definition of the SMI, and it was particularly associated with distal advanced CRN.
Aim
The main aim of this study was to compare the long‐term outcome of a conventional colorectal endoscopic submucosal dissection (ESD) in which submucosal dissection was continued throughout until ...the completion of resection (ESD‐T) to hybrid endoscopic submucosal dissection (ESD‐H) in the colorectum.
Method
Medical records of 836 colorectal neoplasia patients treated by ESD‐T or ESD‐H were reviewed. ESD‐H was defined as colorectal ESD with additional snaring in the final stage of the procedure. Primary outcomes were the overall and metastatic recurrence rates. Secondary outcomes were short‐term outcomes such as the en bloc resection rate, procedure time and adverse events.
Results
The overall recurrence rate was higher in the ESD‐H than in the ESD‐T group (5.7% vs 0.7%, P = 0.001). The metastatic recurrence rate showed no significant difference between these groups (1.4% vs 1.4%, P = 1.000). Multivariate analysis revealed that a failed en bloc resection (hazard ratio 24.097; 95% CI 5.446–106.237; P < 0.001) and larger tumour size (hazard ratio 1.042; 95% CI 1.014–1.070; P = 0.003) were independently associated with overall recurrence. The ESD‐H group showed a lower en bloc resection rate (56.8% vs 96.5%, P < 0.001), shorter procedure time (45.6 vs 54.3 min, P < 0.001) and higher perforation rate (10.3% vs 6.0%, P = 0.029).
Conclusion
Although long‐term outcomes in terms of overall recurrence are inferior following ESD‐H, a failed en bloc resection and large tumour size are the only independent risk factors for recurrence. Further investigations are warranted to improve the long‐term outcomes of ESD‐H.
Cu2ZnSnS4 thin films were deposited on soda lime glass substrates by pulsed laser deposition at various deposition temperatures. Without experiencing the sulfurization process, the single phase ...Cu2ZnSnS4 thin film was deposited with no secondary phases. The grain size increased with increasing deposition temperature. The grain size at the highest temperature was approximately double than that at the lowest temperature. All Cu2ZnSnS4 thin films had a Cu-rich and S-poor state and there was a compositional change at high deposition temperature. Secondary ion mass spectrometry showed that Na ions from soda lime glass diffuse into the Cu2ZnSnS4 thin film. These Cu2ZnSnS4 thin films deposited at 300°C exhibited good crystallinity, large particle size and ideal energy band gap (Eg=1.52eV), which meets the critical requirements for the thin film solar cell performance.
•Cu2ZnSnS4 thin films were deposited by pulsed laser deposition.•Cu2ZnSnS4 thin films have single structure without sulfurization process.•Cu2ZnSnS4 thin films deposited at 300°C exhibited energy band gap (Eg=1.52eV)
Colorectal cancer (CRC) is rapidly increasing in Asia, but screening guidelines are lacking. Through reviewing the literature and regional data, and using the modified Delphi process, the Asia ...Pacific Working Group on Colorectal Cancer and international experts launch consensus recommendations aiming to improve the awareness of healthcare providers of the changing epidemiology and screening tests available. The incidence, anatomical distribution and mortality of CRC among Asian populations are not different compared with Western countries. There is a trend of proximal migration of colonic polyps. Flat or depressed lesions are not uncommon. Screening for CRC should be started at the age of 50 years. Male gender, smoking, obesity and family history are risk factors for colorectal neoplasia. Faecal occult blood test (FOBT, guaiac-based and immunochemical tests), flexible sigmoidoscopy and colonoscopy are recommended for CRC screening. Double-contrast barium enema and CT colonography are not preferred. In resource-limited countries, FOBT is the first choice for CRC screening. Polyps 5-9 mm in diameter should be removed endoscopically and, following a negative colonoscopy, a repeat examination should be performed in 10 years. Screening for CRC should be a national health priority in most Asian countries. Studies on barriers to CRC screening, education for the public and engagement of primary care physicians should be undertaken. There is no consensus on whether nurses should be trained to perform endoscopic procedures for screening of colorectal neoplasia.
Abstract Background De novo malignancy is not uncommon after liver transplantation (LT). Gastric cancer is one of the most common malignancies in both the Korean general population and LT recipients, ...and colorectal cancer prevalence is gradually increasing. Methods Among 3690 adult recipients who underwent LT from January 1999 and December 2013, the screening patterns and prognosis of 26 cases of gastric cancer and 22 cases of colorectal cancer were analyzed. Results For gastric cancer, the mean patient age was 54.6 ± 6.2 years at LT and 59.5 ± 6.7 years at cancer diagnosis, with a post-transplant interval of 60.2 ± 29.8 months. Patients were divided into regular (n = 18) and non-regular (n = 8) screening groups, with early cancer found in 14 and 0 patients; their 2-year survival rates after cancer diagnosis were 93.1% and 33.3% ( P = .006), respectively. Endoscopic resection was successfully performed in 8 patients, all in the regular screening group. For colorectal cancer, the mean patient age was 53.3 ± 6.1 years at LT and 58.1 ± 6.7 years at cancer diagnosis, with a post-transplant interval of 54.3 ± 38.0 months. Patients were divided into regular (n = 19) and non-regular (n = 3) screening groups, with early cancer found in 12 and 0 patients; their 2-year survival rates after cancer diagnosis of 92.3% and 33.3% ( P = .003), respectively. Endoscopic resection was successfully performed in 6 patients, all in the regular screening group. Conclusions LT recipients are strongly advised to undergo regular screening studies for various de novo malignancies, especially cancers common in the general population. Regular endoscopic screening contributes to the timely detection of gastric and colorectal cancers, improving post-treatment survival outcomes.
PDF
