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  1. Klionsky DJ, Abdelmohsen K, Abe A, Abedin MJ, Abeliovich H, Acevedo Arozena A, et al.
    Autophagy, 2016;12(1):1-222.
    PMID: 26799652 DOI: 10.1080/15548627.2015.1100356
  2. Piozzi GN, Khobragade K, Aliyev V, Asoglu O, Bianchi PP, Butiurca VO, et al.
    Colorectal Dis, 2023 Sep;25(9):1896-1909.
    PMID: 37563772 DOI: 10.1111/codi.16704
    AIM: Intersphincteric resection (ISR) is an oncologically complex operation for very low-lying rectal cancers. Yet, definition, anatomical description, operative indications and operative approaches to ISR are not standardized. The aim of this study was to standardize the definition of ISR by reaching international consensus from the experts in the field. This standardization will allow meaningful comparison in the literature in the future.

    METHOD: A modified Delphi approach with three rounds of questionnaire was adopted. A total of 29 international experts from 11 countries were recruited for this study. Six domains with a total of 37 statements were examined, including anatomical definition; definition of intersphincteric dissection, intersphincteric resection (ISR) and ultra-low anterior resection (uLAR); indication for ISR; surgical technique of ISR; specimen description of ISR; and functional outcome assessment protocol.

    RESULTS: Three rounds of questionnaire were performed (response rate 100%, 89.6%, 89.6%). Agreement (≥80%) reached standardization on 36 statements.

    CONCLUSION: This study provides an international expert consensus-based definition and standardization of ISR. This is the first study standardizing terminology and definition of deep pelvis/anal canal anatomy from a surgical point of view. Intersphincteric dissection, ISR and uLAR were specifically defined for precise surgical description. Indication for ISR was determined by the rectal tumour's maximal radial infiltration (T stage) below the levator ani. A new surgical definition of T3isp was reached by consensus to define T3 low rectal tumours infiltrating the intersphincteric plane. A practical flowchart for surgical indication for uLAR/ISR/abdominoperineal resection was developed. A standardized ISR surgical technique and functional outcome assessment protocol was defined.

  3. Kok K, Kim JC
    Sci Total Environ, 2019 Apr 01;659:1209-1223.
    PMID: 31096334 DOI: 10.1016/j.scitotenv.2018.12.398
    This study presents a theoretical framework based on power law distribution to identify the vulnerable regions to soil loss in Susu river basin at Cameron Highlands, Malaysia by using the geomorphologic factors from Digital Elevation Model (DEM). Drainage area is used to describe the runoff aggregation structure of the watershed which represents the magnitude of discharge. Stream power is also used to describe the energy expenditure pattern of the watershed. They are fitted to power law distribution by means of the maximum likelihood to estimate the threshold for soil loss. The landscape stability condition is assessed through the mechanism of channel initiation. Two regions in the slope area plot are recognized as the regimes susceptible to soil loss, in that discharge, local slope and energy are sufficient for the initiation of soil movement. The result is further improved by incorporating the Topographic Wetness Index (TWI) aiming to locate vulnerable regions to soil loss under the dynamic saturation process. The final result indicates that the vulnerable regions expand from perennial reaches to ephemeral reaches as saturation process develops. It implies the transition of runoff generation from groundwater in perennial reaches to surface runoff in ephemeral reaches. Identification of soil loss vulnerable regions under the dynamic saturation process helps in planning of the mitigation measures for soil erosion.
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