The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Masahiko Watanabe - One of the best experts on this subject based on the ideXlab platform.
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laparoscopically assisted proximal gastrectomy with Esophagogastrostomy using a novel open door technique lapg with novel reconstruction
2017Co-Authors: Kei Hosoda, Keishi Yamashita, Hiromitsu Moriya, Hiroaki Mieno, Akira Ema, Marie Washio, Masahiko WatanabeAbstract:Laparoscopy-assisted proximal gastrectomy (LAPG) with Esophagogastrostomy using a novel “open-door” technique was introduced recently, with the aim of preventing gastroesophageal reflux. However, quantitate assessment of gastroesophageal reflux after this surgery has not been performed till date. The aims of the current study were to investigate the safety and feasibility of this operation and to elucidate the postoperative reflux status. Twenty consecutive patients (18 men) with (y)cStage I gastric cancer in the upper third of the stomach who underwent LAPG at Kitasato University Hospital from May 2015 through September 2016 were retrospectively reviewed. We performed 24-h impedance-pH monitoring 3 months after surgery for the first eight patients and analyzed the postoperative reflux status. Median operation time was 333 min, while median anastomotic time was 81 min. None of the 20 patients experienced anastomotic leakage while two patients experienced anastomotic stricture requiring endoscopic balloon dilatation. No patient experienced heartburn without antacid drugs. During the 24-h impedance-pH monitoring, all but one patient had normal gastroesophageal acid reflux with the acid percent time of <1.1% and reflux percent time of <1.4%. One patient with marginally abnormal postoperative gastroesophageal reflux had a normal DeMeester score of 3.0. Our results showed that Esophagogastrostomy using the “open-door” technique is a safe and feasible procedure for LAPG. The degree of gastroesophageal reflux was acceptable using this technique. Randomized controlled trials with long-term follow-ups are required to confirm that this technique would be superior to the others.
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potential benefits of laparoscopy assisted proximal gastrectomy with Esophagogastrostomy for ct1 upper third gastric cancer
2016Co-Authors: Kei Hosoda, Shinichi Sakuramoto, Keishi Yamashita, Shiro Kikuchi, Natsuya Katada, Hiromitsu Moriya, Hiroaki Mieno, Tomotaka Shibata, Masahiko WatanabeAbstract:Few reports have compared laparoscopy-assisted proximal gastrectomy (LAPG) with laparoscopy-assisted total gastrectomy (LATG) in patients with cT1N0 gastric cancer. This study assessed the safety and feasibility of LAPG with Esophagogastrostomy in these patients and compared postgastrectomy disturbances and nutritional status following LAPG and LATG. This study compared 40 patients who underwent LAPG with Esophagogastrostomy and 59 who underwent LATG with esophagojejunostomy, both with OrVil™. Surgical outcomes, postoperative complications, nutritional status at 1 and 2 years, and relapse-free survival were compared in these two groups. Operation time was significantly shorter in the LAPG group than in the LATG group (280 min vs. 365 min, P < 0.001). Although the rate of surgical complications was similar in the two groups, the rate of anastomotic stricture was significantly higher in the LAPG group than in the LATG group (28 vs. 8.4 %; P = 0.012). Rates of reflux esophagitis graded A or higher in the Los Angeles classification were 10 and 5.1 %, respectively. Hemoglobin levels 2 years after surgery, relative to baseline levels, were significantly higher in the LAPG group than in the LATG group (98.6 vs. 92.9 %, P = 0.020). Body weight, albumin and total protein concentrations, and total lymphocyte count 1 and 2 years after surgery were slightly, but not significantly, higher in the LAPG group. Relapse-free survival rates were similar, as were 5-year overall survival rates (86 vs. 79 %, P = 0.42). LAPG with Esophagogastrostomy using OrVil™ was safe and feasible for patients with cT1N0 gastric cancer. LAPG may have nutritional advantages over LATG, but the rate of anastomotic stricture was significantly higher for LAPG than for LATG.
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clinical experience of laparoscopy assisted proximal gastrectomy with toupet like partial fundoplication in early gastric cancer for preventing reflux esophagitis
2009Co-Authors: Shinichi Sakuramoto, Keishi Yamashita, Shiro Kikuchi, Nobue Futawatari, Natsuya Katada, Hiromitsu Moriya, Kazuya Hirai, Masahiko WatanabeAbstract:Background Laparoscopy-assisted proximal gastrectomy (LAPG) has become prevalent for early gastric cancer in the upper stomach, but standard Esophagogastrostomy is sometimes complicated with reflux esophagitis. Clinical outcomes are described here in patients with reconstruction by Esophagogastrostomy with Toupet-like partial fundoplication (TPF) in LAPG. Study Design From November 2005 through December 2008, LAPG was performed in 36 patients with early gastric cancer, 26 (72.2%) of whom could have reconstruction with the TPF because the remnant stomach was sufficiently large. Results In LAPG with TPF, mean operation time was 293 minutes, mean blood loss was 119 g, and the mean number of dissected lymph nodes was 25.1. Regarding postoperative complications, anastomotic leakage occurred in two patients. More than 1 year after operation, 3 (15.0%) of the 20 patients had heartburn and 6 (30.0%) had reflux esophagitis (Los Angeles classification grade A, n=2; grade B, n=4); proton pump inhibitors were effective in these patients. Conclusions Esophagogastrostomy with TPF could be a simple, safe, and useful technique for reconstruction after LAPG in patients with early gastric cancer, and its clinical usefulness is worthwhile for the prospective validation.
Longqi Chen - One of the best experts on this subject based on the ideXlab platform.
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a prospective randomized controlled trial of semi mechanical versus hand sewn or circular stapled Esophagogastrostomy for prevention of anastomotic stricture
2013Co-Authors: Wenping Wang, Kangning Wang, Longqi ChenAbstract:Background Successful anastomosis is essential in esophagogastrectomy, and the application of the circular stapler effectively reduces the anastomotic leakage, although stricture formation has become more frequent. The present study, a randomized controlled trial, compared the recently developed semi-mechanical anastomosis with a hand-sewn or circular stapled Esophagogastrostomy in prevention of anastomotic stricture.
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linear stapled Esophagogastrostomy is more effective than hand sewn or circular stapler in prevention of anastomotic stricture a comparative clinical study
2011Co-Authors: Kangning Wang, Wenping Wang, Kun Zhang, Longqi ChenAbstract:Objective The aim of this study was to retrospectively compare the operative effects of linear stapled intrathoracic Esophagogastrostomy with hand-sewn or circular stapled anastomosis in prevention of anastomotic stricture.
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linear stapled Esophagogastrostomy is more effective than hand sewn or circular stapler in prevention of anastomotic stricture a comparative clinical study
2011Co-Authors: Kangning Wang, Wenping Wang, Kun Zhang, Longqi ChenAbstract:The aim of this study was to retrospectively compare the operative effects of linear stapled intrathoracic Esophagogastrostomy with hand-sewn or circular stapled anastomosis in prevention of anastomotic stricture. Between October 2007 and October 2009, 293 patients with esophageal or gastric cardia cancer underwent a curative intent resection. Patients received either a linear stapled (LS group, n = 166), conventional hand-sewn (HS group, n = 59), or circular stapled intrathoracic esophagogastric anastomosis (CS group, n = 68). The patients were followed-up and compared at 3 months after the operation. Three groups of patients were comparable on clinical baseline characteristics. There was one operative death in the HS group. The operative complications were documented in 15 patients (5.1%), with no difference among three groups (χ 2 = 2.215, P = 0.330). The follow-up rate was 96.9%. The anastomotic diameter was 1.6 ± 0.4 cm in the LS group, 1.2 ± 0.3 cm in the HS group, and 1.0 ± 0.4 cm in the CS group, respectively (F = 58.110, P < 0.001). The anastomotic stricture rates were 1.9% (3/162) in the LS group, 9.3% (5/54) in the HS group, and 20.9% (14/67) in the CS group, respectively (χ 2 = 24.095, P < 0.001). The reflux score in LS group was lower than other two groups (H = 6.995, P = 0.030). The linear stapled Esophagogastrostomy could decrease anastomotic stricture without increasing gastroesophageal reflux.
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clinical application of layered anastomosis during Esophagogastrostomy
2008Co-Authors: Zijiang Zhu, Longqi Chen, Yun Wang, Yongfan Zhao, Lunxu Liu, Yingli KouAbstract:The aim of this study was to compare the operative results in regard to reducing anastomotic leakage and stricture formation using a newly designed layered manual esophagogastric anastomosis versus a stapler Esophagogastrostomy versus the conventional hand-sewn whole-layer anastomosis after resection for esophageal or gastric cardiac carcinoma. From January 2004 to September 2006, a total of 1024 patients with esophageal or gastric cardia carcinoma underwent a layered esophagogastric anastomosis with the assistance of a three-leaf clipper in a single university medical center. The mucosal layers of the esophagus and stomach were sutured continuously with 4/0 Vicryl plus antibacterial suture (polyglyconate). From May 2002 to December 2003, there were also 170 patients and 69 patients who underwent stapler and conventional whole-layer anastomosis, respectively; they served as control groups. The results were analyzed retrospectively. The operative mortality rate was 0.7% in the layered group compared to 5.9% and 7.2% for the stapler group and the whole-layer group (p < 0.01), The anastomotic leakage rates were 0%, 3.5%, and 5.8% for the layered group, stapler group, and whole-layer group, respectively (p < 0.01). All patients were followed postoperatively. Six patients in the layered group (0.6%) developed mild stricture formation compared to 16 patients in stapled group (9.9%) and 5 patients in the conventional whole-layer group (7.8%) (p < 0.01). The application of layered esophagogastric anastomosis could reduce the incidence of anastomotic leakage and stricture after esophagectomy compared with the stapler and whole-layer manual anastomoses. It is easy to apply and could be used as an alternative for esophagogastric anastomosis after resection for esophageal or cardiac carcinoma.
Masayuki Watanabe - One of the best experts on this subject based on the ideXlab platform.
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influence of damaged stomach on anastomotic leakage following cervical Esophagogastrostomy in patients with esophageal cancer
2021Co-Authors: Suguru Maruyama, Akihiko Okamura, Yasukazu Kanie, Kei Sakamoto, Daisuke Fujiwara, Jun Kanamori, Yu Imamura, Masayuki WatanabeAbstract:Anastomotic leakage (AL) is one of the most common complications after esophagectomy. Although some patients have a history of peptic ulcers or other prior stomach diseases, the influence of a damaged stomach (DS) on AL incidence remains unclear. Therefore, we investigated the association between DS and incidence of AL in patients who underwent esophagectomy. Between 2015 and 2019, a total of 447 consecutive patients who underwent cervical Esophagogastrostomy using gastric tube following esophagectomy were enrolled. DS was defined on the basis of endoscopic findings of ulcers or scars due to medical history or prior treatment. We compared the incidence of AL between patients with DS and those with a healthy stomach (HS). Univariate and multivariate logistic regression analyses were used to identify factors that could predict AL incidence. Fifty-one patients (11.4%) had DS. Causes of DS included peptic ulcer (n = 36), endoscopic resection for early gastric cancer (n = 9), percutaneous endoscopic gastrostomies (n = 5), and post-chemotherapy scar for gastric malignant lymphoma (n = 1). Overall, AL occurred in 35 patients (7.8%). The incidence of AL in the DS group was significantly higher than in the HS group (15.7 vs. 6.8%, p = 0.03). DS was one of the independent predictive factors for AL (odds ratio, 2.75; 95% confidence interval, 1.10–6.92; p = 0.03) on multivariate analysis. Further, the diseases in the lower third of the conduit were associated with AL. Presence of DS can predict AL in patients who underwent cervical Esophagogastrostomy after esophagectomy.
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a novel technique of anti reflux Esophagogastrostomy following left thoracoabdominal esophagectomy for carcinoma of the esophagogastric junction
2015Co-Authors: Shinji Mine, Souya Nunobe, Masayuki WatanabeAbstract:We developed an anti-reflux technique of intrathoracic Esophagogastrostomy, based on the “Kamikawa procedure” or “Double flap technique”, which is sometimes used in Japan after open proximal gastrectomy for early upper gastric cancer. We applied this technique to four patients with tumors of the esophagogastric junction. All four patients underwent lower esophagectomy and proximal gastrectomy via a left thoraco-abdominal approach. This procedure includes four steps. Firstly, “double door” seromuscular flaps were created at the anterior wall of the gastric tube. Secondly, the inferior end of the mucosal “window” was opened. Thirdly, suturing was performed between the esophagus and the gastric mucosal “window”. Finally, the anastomosis was covered by the seromuscular flaps. No patient experienced post-operative morbidity, or suffered from reflux, even in the Trendelenburg position, dysphagia, or belching. Although this procedure has only been applied to a limited number of patients, we consider that this anastomosis surgical technique is a promising approach to the prevention of reflux after Esophagogastrostomy.
Hiromitsu Moriya - One of the best experts on this subject based on the ideXlab platform.
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laparoscopically assisted proximal gastrectomy with Esophagogastrostomy using a novel open door technique lapg with novel reconstruction
2017Co-Authors: Kei Hosoda, Keishi Yamashita, Hiromitsu Moriya, Hiroaki Mieno, Akira Ema, Marie Washio, Masahiko WatanabeAbstract:Laparoscopy-assisted proximal gastrectomy (LAPG) with Esophagogastrostomy using a novel “open-door” technique was introduced recently, with the aim of preventing gastroesophageal reflux. However, quantitate assessment of gastroesophageal reflux after this surgery has not been performed till date. The aims of the current study were to investigate the safety and feasibility of this operation and to elucidate the postoperative reflux status. Twenty consecutive patients (18 men) with (y)cStage I gastric cancer in the upper third of the stomach who underwent LAPG at Kitasato University Hospital from May 2015 through September 2016 were retrospectively reviewed. We performed 24-h impedance-pH monitoring 3 months after surgery for the first eight patients and analyzed the postoperative reflux status. Median operation time was 333 min, while median anastomotic time was 81 min. None of the 20 patients experienced anastomotic leakage while two patients experienced anastomotic stricture requiring endoscopic balloon dilatation. No patient experienced heartburn without antacid drugs. During the 24-h impedance-pH monitoring, all but one patient had normal gastroesophageal acid reflux with the acid percent time of <1.1% and reflux percent time of <1.4%. One patient with marginally abnormal postoperative gastroesophageal reflux had a normal DeMeester score of 3.0. Our results showed that Esophagogastrostomy using the “open-door” technique is a safe and feasible procedure for LAPG. The degree of gastroesophageal reflux was acceptable using this technique. Randomized controlled trials with long-term follow-ups are required to confirm that this technique would be superior to the others.
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potential benefits of laparoscopy assisted proximal gastrectomy with Esophagogastrostomy for ct1 upper third gastric cancer
2016Co-Authors: Kei Hosoda, Shinichi Sakuramoto, Keishi Yamashita, Shiro Kikuchi, Natsuya Katada, Hiromitsu Moriya, Hiroaki Mieno, Tomotaka Shibata, Masahiko WatanabeAbstract:Few reports have compared laparoscopy-assisted proximal gastrectomy (LAPG) with laparoscopy-assisted total gastrectomy (LATG) in patients with cT1N0 gastric cancer. This study assessed the safety and feasibility of LAPG with Esophagogastrostomy in these patients and compared postgastrectomy disturbances and nutritional status following LAPG and LATG. This study compared 40 patients who underwent LAPG with Esophagogastrostomy and 59 who underwent LATG with esophagojejunostomy, both with OrVil™. Surgical outcomes, postoperative complications, nutritional status at 1 and 2 years, and relapse-free survival were compared in these two groups. Operation time was significantly shorter in the LAPG group than in the LATG group (280 min vs. 365 min, P < 0.001). Although the rate of surgical complications was similar in the two groups, the rate of anastomotic stricture was significantly higher in the LAPG group than in the LATG group (28 vs. 8.4 %; P = 0.012). Rates of reflux esophagitis graded A or higher in the Los Angeles classification were 10 and 5.1 %, respectively. Hemoglobin levels 2 years after surgery, relative to baseline levels, were significantly higher in the LAPG group than in the LATG group (98.6 vs. 92.9 %, P = 0.020). Body weight, albumin and total protein concentrations, and total lymphocyte count 1 and 2 years after surgery were slightly, but not significantly, higher in the LAPG group. Relapse-free survival rates were similar, as were 5-year overall survival rates (86 vs. 79 %, P = 0.42). LAPG with Esophagogastrostomy using OrVil™ was safe and feasible for patients with cT1N0 gastric cancer. LAPG may have nutritional advantages over LATG, but the rate of anastomotic stricture was significantly higher for LAPG than for LATG.
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clinical experience of laparoscopy assisted proximal gastrectomy with toupet like partial fundoplication in early gastric cancer for preventing reflux esophagitis
2009Co-Authors: Shinichi Sakuramoto, Keishi Yamashita, Shiro Kikuchi, Nobue Futawatari, Natsuya Katada, Hiromitsu Moriya, Kazuya Hirai, Masahiko WatanabeAbstract:Background Laparoscopy-assisted proximal gastrectomy (LAPG) has become prevalent for early gastric cancer in the upper stomach, but standard Esophagogastrostomy is sometimes complicated with reflux esophagitis. Clinical outcomes are described here in patients with reconstruction by Esophagogastrostomy with Toupet-like partial fundoplication (TPF) in LAPG. Study Design From November 2005 through December 2008, LAPG was performed in 36 patients with early gastric cancer, 26 (72.2%) of whom could have reconstruction with the TPF because the remnant stomach was sufficiently large. Results In LAPG with TPF, mean operation time was 293 minutes, mean blood loss was 119 g, and the mean number of dissected lymph nodes was 25.1. Regarding postoperative complications, anastomotic leakage occurred in two patients. More than 1 year after operation, 3 (15.0%) of the 20 patients had heartburn and 6 (30.0%) had reflux esophagitis (Los Angeles classification grade A, n=2; grade B, n=4); proton pump inhibitors were effective in these patients. Conclusions Esophagogastrostomy with TPF could be a simple, safe, and useful technique for reconstruction after LAPG in patients with early gastric cancer, and its clinical usefulness is worthwhile for the prospective validation.
Keishi Yamashita - One of the best experts on this subject based on the ideXlab platform.
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laparoscopically assisted proximal gastrectomy with Esophagogastrostomy using a novel open door technique lapg with novel reconstruction
2017Co-Authors: Kei Hosoda, Keishi Yamashita, Hiromitsu Moriya, Hiroaki Mieno, Akira Ema, Marie Washio, Masahiko WatanabeAbstract:Laparoscopy-assisted proximal gastrectomy (LAPG) with Esophagogastrostomy using a novel “open-door” technique was introduced recently, with the aim of preventing gastroesophageal reflux. However, quantitate assessment of gastroesophageal reflux after this surgery has not been performed till date. The aims of the current study were to investigate the safety and feasibility of this operation and to elucidate the postoperative reflux status. Twenty consecutive patients (18 men) with (y)cStage I gastric cancer in the upper third of the stomach who underwent LAPG at Kitasato University Hospital from May 2015 through September 2016 were retrospectively reviewed. We performed 24-h impedance-pH monitoring 3 months after surgery for the first eight patients and analyzed the postoperative reflux status. Median operation time was 333 min, while median anastomotic time was 81 min. None of the 20 patients experienced anastomotic leakage while two patients experienced anastomotic stricture requiring endoscopic balloon dilatation. No patient experienced heartburn without antacid drugs. During the 24-h impedance-pH monitoring, all but one patient had normal gastroesophageal acid reflux with the acid percent time of <1.1% and reflux percent time of <1.4%. One patient with marginally abnormal postoperative gastroesophageal reflux had a normal DeMeester score of 3.0. Our results showed that Esophagogastrostomy using the “open-door” technique is a safe and feasible procedure for LAPG. The degree of gastroesophageal reflux was acceptable using this technique. Randomized controlled trials with long-term follow-ups are required to confirm that this technique would be superior to the others.
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potential benefits of laparoscopy assisted proximal gastrectomy with Esophagogastrostomy for ct1 upper third gastric cancer
2016Co-Authors: Kei Hosoda, Shinichi Sakuramoto, Keishi Yamashita, Shiro Kikuchi, Natsuya Katada, Hiromitsu Moriya, Hiroaki Mieno, Tomotaka Shibata, Masahiko WatanabeAbstract:Few reports have compared laparoscopy-assisted proximal gastrectomy (LAPG) with laparoscopy-assisted total gastrectomy (LATG) in patients with cT1N0 gastric cancer. This study assessed the safety and feasibility of LAPG with Esophagogastrostomy in these patients and compared postgastrectomy disturbances and nutritional status following LAPG and LATG. This study compared 40 patients who underwent LAPG with Esophagogastrostomy and 59 who underwent LATG with esophagojejunostomy, both with OrVil™. Surgical outcomes, postoperative complications, nutritional status at 1 and 2 years, and relapse-free survival were compared in these two groups. Operation time was significantly shorter in the LAPG group than in the LATG group (280 min vs. 365 min, P < 0.001). Although the rate of surgical complications was similar in the two groups, the rate of anastomotic stricture was significantly higher in the LAPG group than in the LATG group (28 vs. 8.4 %; P = 0.012). Rates of reflux esophagitis graded A or higher in the Los Angeles classification were 10 and 5.1 %, respectively. Hemoglobin levels 2 years after surgery, relative to baseline levels, were significantly higher in the LAPG group than in the LATG group (98.6 vs. 92.9 %, P = 0.020). Body weight, albumin and total protein concentrations, and total lymphocyte count 1 and 2 years after surgery were slightly, but not significantly, higher in the LAPG group. Relapse-free survival rates were similar, as were 5-year overall survival rates (86 vs. 79 %, P = 0.42). LAPG with Esophagogastrostomy using OrVil™ was safe and feasible for patients with cT1N0 gastric cancer. LAPG may have nutritional advantages over LATG, but the rate of anastomotic stricture was significantly higher for LAPG than for LATG.
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clinical experience of laparoscopy assisted proximal gastrectomy with toupet like partial fundoplication in early gastric cancer for preventing reflux esophagitis
2009Co-Authors: Shinichi Sakuramoto, Keishi Yamashita, Shiro Kikuchi, Nobue Futawatari, Natsuya Katada, Hiromitsu Moriya, Kazuya Hirai, Masahiko WatanabeAbstract:Background Laparoscopy-assisted proximal gastrectomy (LAPG) has become prevalent for early gastric cancer in the upper stomach, but standard Esophagogastrostomy is sometimes complicated with reflux esophagitis. Clinical outcomes are described here in patients with reconstruction by Esophagogastrostomy with Toupet-like partial fundoplication (TPF) in LAPG. Study Design From November 2005 through December 2008, LAPG was performed in 36 patients with early gastric cancer, 26 (72.2%) of whom could have reconstruction with the TPF because the remnant stomach was sufficiently large. Results In LAPG with TPF, mean operation time was 293 minutes, mean blood loss was 119 g, and the mean number of dissected lymph nodes was 25.1. Regarding postoperative complications, anastomotic leakage occurred in two patients. More than 1 year after operation, 3 (15.0%) of the 20 patients had heartburn and 6 (30.0%) had reflux esophagitis (Los Angeles classification grade A, n=2; grade B, n=4); proton pump inhibitors were effective in these patients. Conclusions Esophagogastrostomy with TPF could be a simple, safe, and useful technique for reconstruction after LAPG in patients with early gastric cancer, and its clinical usefulness is worthwhile for the prospective validation.