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| 1 | Training in endoscopic submucosal dissection显示文摘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. | Roxana M Coman Takuji Gotoda Peter V Draganov | 2013 | World Journal of Gastrointestinal Endoscopy2013，5，8： | 8 |
| 2 | Role of observation of live cases done by Japanese experts in the acquisition of ESD skills by a western endoscopist显示文摘AIM:To evaluate the role of observation of experts performing endoscopic submucosal dissection(ESD)in the acquisition of ESD skills.METHODS:This prospective study is documenting the learning curve of one Western endoscopist.The study consisted of three periods.In the first period(preobservation),the trainee performed ESDs in animal models in his home institution in the United States.The second period(observation)consisted of visit to Japan and observation of live ESD cases done by experts.The observation of cases occurred over a 5-wk period.During the third period(post-observation),the trainee performed ESD in animal models in a similar fashion as in the first period.Three animal models were used:live40-50 kg Yorkshire pig,explanted pig stomach model,and explanted pig rectum model.The outcomes from the ESDs done in the animal models before and after observation of live human cases(main study intervention)were compared.Statistical analysis of the data included:Fisher’s exact test to compare distributions of a categorical variable,Wilcoxon rank sum test to compare distributions of a continuous variable between the two groups(pre-observation and post-observation),and Kruskal-Wallis test to evaluate the impact of lesion location and type of model(ex-vivo vs live pig)on lesion removal time.RESULTS:The trainee performed 38 ESDs in animal model(29 pre-observation/9 post-observation).The removal times post-observation were significantly shorter than those pre-observation(32.7±15.0 min vs 63.5±9.8 min,P<0.001).To minimize the impact of improving physician skill,the 9 lesions post-observation were compared to the last 9 lesions pre-observation and the removal times remained significantly shorter(32.7±15.0 min vs 61.0±7.4 min,P=0.0011).Regression analysis showed that ESD observation significantly reduced removal time when controlling for the sequence of lesion removal(P=0.025).Furthermore,it was also noted a trend towards decrease in failure to remove lesions and decrease in complications after the period of observation.This study did not find a significant difference in the time needed to remove lesions in different animal models.This finding could have important implications in designing training programs due to the substantial difference in cost between live animal and explanted organ models.The main limitation of this study is that it reflects the experience of a single endoscopist.CONCLUSION:Observation of experts performing ESD over short period of time can significantly contribute to the acquisition of ESD skills. | Peter V Draganov Myron Chang Roxana M Coman Mihir S Wagh Qi An Takuji Gotoda | 2014 | World Journal of Gastroenterology2014，20，16： | 3 |
| 3 | Value of acoustic radiation force impulse elastography for the assessment of ascites syndrome显示文摘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 ascites.METHODS:Our study included 153 patients with ascites,mean age 58.8 ± 13.1 years.One 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 ascites.We 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 abscess.In 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 metastases.RESULTS: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 < 0.001).For a cut-off value of 1.8 m/s for 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 ascites.For 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. | Simona Bota Ioan Sporea Roxana Sirli Alina Popescu Mirela Dǎnilǎ Mǎdǎlina Sendroiu | 2011 | World Journal of Radiology2011，3，8： | 2 |
| 4 | Impact of major bleeding on 30-day mortality and clinical outcomes in patients with acute coronary syndromes显示文摘 | Steven VM Frederick F Roxana M | 2007 | J Am Coll Cardiol2007，49，： | 1 |
| 5 | Hydrothermal synthesis of ceramic nanomaterials for functional applications 显示文摘 | Piticescu Roxana M Piticescu R R Taloi D | 2003 | Nanotechnol2003，14，2： | 1 |
| 6 | Differential impact on sur- vival of electrocardiographic q - wave versus enzymatic myocardial in- farction after percutaneous intervention a device - specific analysis of 7147 patients显示文摘 | Gregg WW Roxana M George D | 2001 | Circulation2001，104，： | 1 |
| 7 | Diagnostic Yield of Primary Circulating Tumor Ceils in Women Suspected of Breast Cancer: the BEST (Breast Early Screening Test ) Study 显示文摘 | Murray NP Roxana M Amparo R | 2015 | Asian Pac J Cancer Prey2015，16，5： | 1 |
| 8 | One-year clinical outcome after minimally invasive direct coronary artery bypass显示文摘 | ROXANA M GEORGE D SOTIRIS C S | 2000 | Circulation2000，102，： | 1 |
| 9 | Nine Ways to Reduce Cognitive Load in Multimedia Learning显示文摘 | Richard E M Roxana M | 2003 | Educational Psychologist2003，38，1： | 1 |
| 10 | Medium -density particleboards from modified rice husks and soybean protein concentrate - based adhesives 显示文摘 | Emiliano M C Pablo M S Roxana A R | 2010 | Bioresource Technology2010，101，： | 1 |
| 11 | Intragraft TGF-β1 Mrna:A correlate of interstitial fibrosis and chronic allograft nephropathy显示文摘 | Vijay K Sharma A Roxana M | 1996 | Kindney Int1996，48，49： | 1 |
| 12 | Pericentric inversion of chronome 18 in parents leading to a phenotypically norn child with segnntal uni- parental disomy 18显示文摘 | Ariana KJ Roxana KJ Azadeh M el al | 2011 | Eur J of Hum Genet2011，19，5： | 1 |
| 13 | Studying current-potential curves using a bipotentiometric iodometric back-titration for the determination of ascorbic acid in fruits and vegetables显示文摘 | Roxana A V Claudia M L | 2004 | Journal of Chemical Education2004，81，10： | 1 |
| 14 | Impact of major bleeding on 30-day mortality and clinical outcomes in patients with acute coronary syndromes 显示文摘 | Steven V M Frederick F Roxana M | 2007 | J Am Coll Cardiol2007，49，： | 1 |
| 15 | Screening promoters for Anthurium transformation using transient expression显示文摘 | Tracie K M Lisa M K Roxana Y M C | 2013 | Plant Cell Rep2013，32，： | 1 |
| 16 | Medium-density particleboards from modified rice husks and soybean protein concentrate-based adhesives显示文摘 | Ciannamea Emiliano M Stefani Pablo M Ruseekaite Roxana A | 2010 | Bioresource Technology2010，101，： | 1 |
| 17 | 3-D Elbow Kinematics during Cricket Bowling显示文摘 | ROXANA M ALIAH S | 2008 | J Bio2008，41，1： | 1 |
| 18 | Interactive Multimodal Learning Environments-Special Issue on Interactive Learning Environments: Contemporary Issues and Trends显示文摘 | Roxana M | 2007 | Educ Psychol Rev2007，，19： | 1 |
| 19 | Prognostic value of cardiac troponin-I levels following catheter-based coronary interventions显示文摘 | Shmuel Fuchs Ran Kornowski Roxana Mehran Alexandra J Lansky Lowell F Satler Augusto D Pichard Kenneth M Kent Chester E Clark Gregg W Stone Martin B Leon | 2000 | The American Journal of Cardiology2000，，9： | 1 |
| 20 | Autographic assay for the rapid detection of antioxidant capacity of liquid and semi-solid pharmaceutical formulations using ABTS^++ immobilized by gel entrapment 显示文摘 | Iris C Z Roxana M O Maria I I | 2011 | AAPS Pharm Sci Tech2011，11，3： | 1 |
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