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Everything posted by Shiune
Horned Slayers rank 15 + outfit recruiting new members! (Cerulean) 50+ members!
Shiune replied to Qlarity's topic in EuropeI could join with my BD and my SIN. Just have to swap faction on my SIN before though. Since I'm never doing SSP or similar anyway it won't be much of an issue. Ok I will contact one of you guys in around 2-3 hours when i'm at home.
Horned Slayers rank 15 + outfit recruiting new members! (Cerulean) 50+ members!
Shiune replied to Qlarity's topic in EuropeHello, I might be interested in joining your clan. About me: Hardcore PvE and PvP player (more PvP lately but I want to get into PvE again after a longer break). I play BnS on EU since the alpha and played on the TW and RU pserver before. I have 6 Chars on lvl 50 (HM7-HM11). My main was a SIN with Baleful stage 6 but I quit doing PvE like 3 months ago so I didn't bother gearing him up further. Now I am planning to reroll to BD which currently only has 600 AP (and this only due to hepta gems) and some crappy SS but it will have like 750 AP on April 12th (have all the mats to go straight into legendary stage 6+, full MSP SS with flowers on my SIN, etc. etc.). So I will have a quite well geared BD once the patch i out. I also love doing arena PvP. I play 5 different classes (SINx2, BD, BM, FM and SF) with all HM skills unlocked and all of them are at least in gold at the end of the season (SIN and SF are mostly in the top 45). That's it for me so far :) You can contact me ingame on my BD "AnnoyingRat" ( I know nice name hahAA) or on my SIN "Shiunski" if you're interested because I don't browse the forums so often. I'm mostly online in the evening (6pm-11pm or so).
Why Venom Swarm?
Shiune replied to LlamaDude's topic in AssassinThere are many reasons why to use it in pvp. To name a few: -obviously you can block enemys defense skills like BM/KFM block and SIN decoy . -you can also bait an SS/HM block from BM's for example cause a BM really doesn't want to get hit by it . -it's the easiest method to stack poison while someone is webbed since you can use it while he's in the air or you can even use it before using your infiltrate since the dash is faster than venom swarm. -you need it mostly in a combo because without it can happen that you can't restealth with hook kick anymore since spinal tab doesn't give you a poison stack anymore . It has a lot of other uses but to lazy to explain all of them. For the bm and kfm matchup you really want to use it . For the sin matchup it is good but especially for pveing sins poison breath is better in my opinion . Also for the sum matchup you want to use poison breath . Förderung destroyer/BD and WL its a matter of taste . I find myself using poison breath against those more effective because the 2 spin classes have no defense skills to break and for WL I love to use it in their sanctum .
Assasin pov arena 3v3( 2vs3 if u dont count the bot we had)
Shiune replied to azraelkun's topic in AssassinThe amount of missed tech chases, dropped combos, wrong gameplay on both sides and messed up uses of escapes is over 9000!
So you wanna tell me I'm a bad SIN? Is it that? I could bet my azz of i'm doing the PvE rotation faster and better than you without any macros or shit. It's just that PvE is such a lackluster in this game that I choosed to use the lazy way as Nero said already - that's the only reason. But I actually don't even give a damn about your opinion - my stats in 1vs1,3vs3, ToI and 6vs6 speak for itself as a not-so-bad SIN.
Nope. Using macros in PvE as a SIN is the only right way to play BnS and I repeat myself: the best players in Korea/China etc. are all using macros for their PvE rotations to a achieve the highest dps and people which look down at macro users in PvE are clueless all together. Macros in competitive PvP however is a whole different story and those who are using them are indeed scrubs.
An even bettet tip for people with a customable mouse with sidebuttons: Create a macro on your sidebutton which uses T(=RMB)+R(=LMB)+F for Dark Build and T(=RMB)+F+4 for lighting build. Now you only have to press 1 button over and over again (except for poison stacking, cc etc.) for a perfect rotation. Pretty much every SIN uses macros for optimal dps rotations in KR because it is the easiest and best way to do your rotation. Also it is much less harmful for your hands and wrists on the long run.
DPS comparison between Light and Dark build (read text first)
Shiune posted a topic in AssassinHey guys, so I saw that many people want a dps comparison between the two builds and decided to make 2 quick vids on Mushins Tower floor 5. Note that lighting build has a significant advantage on that floor because the boss don't have true sight so I slowed the dps down a bit with running around the boss (which is mandatory with Dark Build). Also i used an anti-CC pot in Dark Build to avoid getting soaked in. Even though I had to dodge 1-2 hits + also failed at the beginning. If the end i want to mention that I personally still prefer Dark build in most bossfights and only switch to lightning when it comes to to specific bosses. Light build: Dark build:
I'm just gonna refer to my second point again: Point of deranking is that you can actually play arena instead of queueing for hours to get an opponent because you are to high and won't get matched since nobody queues on diamond atm. Another point is farming zen beans but I know for a fact that ryuki is deranking because he wants to play and not because he needs zen beans (3vs3 is more effective anyway). And lastly he will stop deranking by the end of the season so he will rank up to the top by the end to get the max rewards. Sounds logical right?
So first of all SIN is really not an easy class to play at max potential in PvP. 2nd: Ryuki, the top assassin on EU, is always deranking if he's too high so the current number 1 SIN on EU is not the best SIN on EU. Also he's not playing very active lately afaik. 3rd: The latest patch buffed Summoners and BMs extremely good which makes those classes a bigger pain in the azz as they were before anyway (though SIN got buffed aswell). The class assassin itself is still a top PvP class but there are only a very few people which can actually play the class close to perfect and therefore there aren't so many high SINs in the leader board.
I'll easily answer you this. Because SIN (and Destroyers) benefits the most of the legendary soul badges (amulets). This is only the beginning though. Legendary soulshields and legendary soul will give us a huge dps + chi regen bonus. Ofc other classes get the same but right now SIN is one if the only classes which still struggles which chi management and therefore it happens once in a while that we are out of chi and need to cancel our rotation. In the end our version is still to much behind and we're missing essential gear upgrades to take out the biggest potential of the classes but if we refer to KR we can clearly see what which class is capable to do. Having the most updated skill patch won't change the fact above. P.S. I can't link them because i'm writings from my phone and this forum is cancer for smartphones. Maybe I'll do so when i'm at home.
Let me get 4 things clear: Are SINs a top tier dps class on EU/NA? They definitely are together with BM, FM, WL and SF (difference between all those classes are 5% at max). Are SINs the best dps class? Arguably no because BMs took that spot for EU/NA. Are SINs top tier in KR? Again they definitely are. Are SINs the best dps class on KR? According to the dps meter they are together with FMs and SFs (no BM isn't top in KR). Period.
Dark Build rotation after the latest patch
Shiune posted a topic in AssassinYo here's a small footage of my Dark Build rotation on a dummy after the latest patch:
Wow even after 2 explanations you still don't understand it. Really now I'm out.
I'll explain it to you again: Basic combo is RB+LMB+F which even you should know. Now before with HM mist slash you could crit with RMB if you crit with LMB before which allows you cast F after. Now if you did the basic rotation with RB+LMB+F and didn't crit the first RB but crit with LMB you had to cast RMB again to pull out F. In a clear sentence: If you didn't crit with RMB before your rotation would look like this: RMB+LMB+RMB+F. Now that a LMB crit allows us to pull out F instantly without casting RMB again you have 2 chances to proc F in 1 rotation. Means if your first RB didn't crit but your LMB crit you could cast F anyway instead of going for another RMB before. If you you still didn't understand this you can't be helped.
Ok you just proved me that you're a bad sin. Thanks and i'm out of the discussion.
1. Mist Slash got BUFFED and any sin which says smth different is a bad sin to begin with 2. Poison stacking methods got buffed - 100% uptime on the dark build rotation is easier than ever 3. we get a lot of of damage buffs like poison breath (instacast), lighting stride (tons of damage + poison reset), fighting spirit 300% dmg of AP instead of 100% 4. our focus management improved a lot because of lower cd on 4 lighting rend. We got buffed by a ton and you actually have no clue about what you're writing (your guildmates obviously aren't any better). Change summoner with SIN and you'll list might wouldn't even be so wrong.
With summoner you just dig your own grave because they are AT MAX mid tier after the latest patch. SF, WL, SIN - any of those classes are stronger than summoners currently.
Not my fault that your guildmates are shitty sins. And if SIN is mid tier what is high tier?
Beside the fact that BM's hit like trucks now I do 24k on 670 AP without a WL or grab class. SIN dps not so good hurr durr.
First of all thank you for taking my vid as reference (i'm the sin in there) but now i'm gonna give you some facts: Back then I did not have HM RMB, HM V, legendary weapon for resets and much worse gear as i have now. Oh and btw back then I had like 620 AP so who outgears who again? By now i do like double the dps I did back then when I made this video and I can guarantee you that your destroyer won't even come close to the dps I am doing now. Just for your clarification. Topic: DPS on EU/NA: FM > SIN > WL (all very close together) > rest DPS on KR: SF/FM/SIN/WL are all pretty much the top dps with their amulets etc. according to the dps meter. Kthxbye
Do you think you'll quit this game in the next year?
Shiune replied to Ruziro's topic in General DiscussionHonestly I guess I won't ever quit the game per se but I will definitely stop playing the PvE content and just do arena in the future (even i have 690 AP etc.). My reason is that i'm done with the PvE grind. I always knew BnS was a grindy game and everything but I came to a point where I just "fck it i'm done with it". Also the PvE content is simply just not challenging enough and everytime I think the next patch will have challenging dungeons I get fcked up by NCsoft because they nerf it before we get it (Ebondrake citadel). Ofc we are also much to good geared and have much stronger skills as the Koreans back then but that doesn't change the fact that all current dungeons are easy af. So BnS will be my 1vs1 PvP game while Revelation Online will be my main MMORPG for PvE and mass PvP content in the future.
More or less it's unfortunately the case yes. Except that summoners are much easier to deal with since they don't have 2 escapes, Frost sheat, frost prison and chill stacks/frost orbs. Comboing a FM is even more difficult than comboing a summoner or destroyer in my opinion and those 2 are already cancer enough to combo.
First of all Yuketsu was NEVER a top tier sin. NEVER. He is not to bad but nowhere near a top tier sin. 2nd I eat summoners and BMs for breakfast as a sin. 3rd FM matchup is hard but doable - if you know how to avoid chill stacks. Ice bomb build vs them is a very good wa to get your cooldowns back and get rid of chillstacks for example. It's a very lame technique but against a class with 2 escapes and so much utility it's nearly a must to play for timeouts/cooldowns.
What am I doing wrong?
Shiune replied to Crimson73's topic in Arena and BattlegroundsI lol'ed.


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current happenings!
"K" - 3rd Grade
Dinner & Service
Friday, March 15, 2019
All members of our community are invited to a potluck dinner and Shabbat service with our Kindergarten-Third grade students.
Dinner is at 5:30, the service will begin at 6:15.
To sign up to bring food for the potluck, click the button below
We look forward to seeing you!
Sinai Readers
We meet next on Wednesday, March. 27, 7 p.m. to discuss Waking Lions, by contemporary Israeli novelist Ayelet Gundar-Goshen, which begins with a accidental moment that leads to layers of moral complexity and suspense. The story unfolds in a uniquely Israeli setting but deals with universal moral dilemmas of social and personal justice, refugees and giving refuge.
A copy is in our library.
For March & April selections--
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Snyder Award Dinner
Please note the change of date!
Carol Tivoli will be honored at the Snyder Award dinner and service will be on May 10.
Sinai's Alternative Income Group
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You can help us find innovative, creative, and fun ideas to raise money for our congregation.
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Caring Community
The Caring Community Committee would like you to know that we are here! Several members of Sinai Temple are here to help other congregants with the following:
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Sinai Temple QQQis a welcoming and inclusive Reform Congregation where our members pursue a continuing journey of Jewish growth. We are guided by the history and tradition of the Jewish people as we encounter the challenges of the modern world. We encourage participation in prayer, life-long Jewish learning, and social justice within a joyful, creative, and compassionate community.

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1 day tour
About Taroko
About Kayaking: Along Qingshui Cliff
The magnificent area around Qingshui Cliff has been known as one of the Eight Wonders of Taiwan, offering a splendid view of the Pacific Ocean. Not everyone gets to enjoy such a picturesque view, let alone literally being in the view itself.
Hulien TRA / Hotel in city-Taroko Archway -Swallow Grotto (Taroko Gorge)-Eternal Spring Shrine-Kayaking(Along Qingshui Cliff)-Qixingtan
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Kayaking(Along Qingshui Cliff)
Appreciate the iconic Taroko Gorge by strolling Swallow Grotto
Enjoy the cascading falls at Eternal Spring Shrine


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Donald Burton Bonkemeyer
1933 - 2019
Funeral Service
Final Resting Place
Obituary of Donald Burton Bonkemeyer
Donald Burton Bonkemeyer, 86, was called home to his heavenly father on Tuesday, July 2, 2019 with his loved ones gathered around him, at Hospice House of Randolph County in Asheboro, N.C. Donald was born in Asheboro on February 5, 1933 to the late Lucian and Corda Underwood Bonkemeyer. He was taught from a young age to help the family in whatever way that he could. As a boy, he cared for his family's farm animals and would later learn the family business of dry cleaning from his father. The business thrived from its grand opening on 8/2/48 until 6/29/2013. Donald also served his country proudly in the US Army for 2 years. He enjoyed old machinery, like gasoline engines and how they operated, and loved visiting the Thresher's Reunion in Denton. Donald will greatly be missed by all who knew and loved him, but none more than his dear friend of 32 years, Miss Thyra Nance. He will leave priceless memories for all to cherish. Donald was preceded in death by his sister, Loretta B. Williams and her husband, Marvin, and brothers, Edward and Bobby Bonkemeyer. Donald is survived by his brother, Charles Bonkemeyer and wife, Linda, and sisters, Lois Rumbley and husband Ray, Shelba Laughlin and husband, Malcom, sister in-law, Gretna Bonkemeyer, wife of deceased brother, Bobby; numerous nieces and nephews, and great nieces and nephews.
The family will receive friends on Friday, July 5, from 12:45-1:45 at Pugh Funeral Home, 437 Sunset Avenue, Asheboro. Funeral services will follow on Friday at 2 p.m. at the Pugh Funeral Home Chapel with Pastor Tim Isley officiating.
Interment will follow at The Randolph Memorial Park in Asheboro, NC.
Memorials may be made to The National Kidney Foundation of North Carolina, 5950 Fairview Rd., Suite 708, Charlotte, NC 28210 or Hospice House, P.O. Box 9, Asheboro, NC 27204.
The family would like to extend a special thank you to Cynthia Cole and her staff for the loving care and friendship given to Donald, and the great staff at Hospice House of Randolph County, for the professional care which they extended to Donald.
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Reader's Guide to Lesbian and Gay Studies
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As an academic discipline, lesbian and gay studies is still in its infancy. A distinct body of scholarly literature on lesbian/gay/ queer-related topics has emerged, however, especially in the last 20 ... Read full review
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Standing Committee on Aboriginal Affairs and Northern Development (AANO)
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Pelicans' Jahlil Okafor: Good to go Friday
Okafor (knee) will be available for Friday's preseason game against the Jazz, Eric Walden of The Salt Lake Tribune reports.
Okafor was added to the injury report Thursday due to a bruised right knee, but it looks like it wasn't anything too serious. Okafor played 18 minutes in his last time out against Chicago, and he'll have his workload limited again Friday, per Andrew Lopez of The New Orleans Times-Picayune.
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text: Your preview to Bright is about to begin. Over the next week, we will begin sending your login information. You should expect to get yours between now and early next week. Once you do, you will enter the Calibrate phase of your transition – meaning you can log in to Brightmls.com. We made logging into Bright easy. Use your existing TREND Login and a NEW temporary password that we'll send you. This is not your conversion. During this "preview" phase, you will be able to log in, learn to navigate around the new system, perform searches, update your information, register for training, check your listings and prepare your clients for the conversion. You will receive two emails: one with your login (which is the same as your login to TREND) and the second with a NEW temporary password for Bright. Please be sure to use the information from these emails to log in. They may not come at the same exact time, so look for both emails in your inbox prior to attempting to log in. Training is available starting next week. Training opportunities are now available at www.trendmls.com. Click here to register for training. Additional training dates and locations, including online options will be available after you receive your login information for Bright. For a reminder of the entire conversion process, what to expect, and what to do at each stage, please click here. Don't forget to check your email this week for your login and password information. Thank you, and we look forward to working with you! Bright MLS Staff On November 28, 2018 / Weekly News


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Diagnostic and prognostic value of preoperative 18F-fluorodeoxyglucose positron emission tomography/computed tomography for colorectal cancer: comparison with conventional computed tomography
Article information
18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) has been used for preoperative staging of colorectal cancer (CRC). However, the diagnostic accuracy of FDG-PET/CT for detection of lymph node or distant metastasis and its prognostic role have not been well established. We therefore evaluated the diagnostic and prognostic value of FDG-PET/CT in comparison with conventional CT for CRC.
We investigated 220 patients who underwent preoperative FDG-PET/CT and CT, followed by curative surgery for CRC. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of FDG-PET/CT and CT for detection of lymph node metastasis and distant metastasis were evaluated. In addition, we assessed the findings of FDG-PET/CT and CT according to outcomes, including cancer recurrence and cancer-related death, for evaluation of prognostic value.
For detection of lymph node metastasis, FDG-PET/CT had a sensitivity of 44%, a specificity of 84%, and an accuracy of 67%, compared with 59%, 65%, and 62%, respectively, for CT (P=0.029, P=0.000, and P=0.022). For distant metastasis, FDG-PET/CT had a sensitivity of 79%, a specificity of 94%, and an accuracy of 93%, compared with 79%, 87%, and 86%, respectively, for CT (P=1.000, P=0.004, and P=0.037). In addition, positive findings of lymph node metastasis and distant metastasis on FDG-PET/CT were associated significantly with cancer recurrence or cancer-related death (P=0.009, P=0.001, respectively).
Preoperative FDG-PET/CT had a higher specificity and accuracy compared to CT for detection of lymph node metastasis and distant metastasis of CRC. In addition, FDG-PET/CT could be a valuable prognostic tool for CRC.
Colorectal cancer (CRC) is the third most commonly diagnosed cancer in males and the second most diagnosed cancer in females, accounting for over one million cases per year worldwide.1 The overall survival or disease-free survival of CRC has improved because of more accurate preoperative staging using advanced imaging technology and better treatment options, including refinements in surgical techniques and more options for chemotherapy and radiation therapy.2
Choosing and planning the appropriate therapies depend on the use of non-invasive imaging that accurately identifies the extent of disease involvement.3 Fluorine-18 (18F) fluorodeoxyglucose (FDG)-PET/CT is one of the developments of imaging technology. The primary indications for FDG-PET/CT in CRC are for staging, restaging, and detection of recurrence. The value of FDG-PET/CT for detecting recurrence and/or metastasis of CRC is well established.456 In addition, the effectiveness of FDG-PET/CT for predicting chemotherapy response has been studied.37
However, the diagnostic accuracy of FDG-PET/CT for detection of lymph node or distant metastasis has not been fully assessed, and the prognostic role of preoperative FDG-PET/CT for CRC is not well established. We therefore evaluated the diagnostic accuracy of preoperative FDG-PET/CT compared with conventional CT for CRC, and also investigated the prognostic role of FDG-PET/CT.
1. Patients
Between January 2009 and June 2012, 220 patients who underwent curative surgery for CRC in Chungbuk National University Hospital were included in this retrospective study. Preoperative whole body FDG-PET/CT, and chest and abdominopelvic contrast-enhanced CT scans were performed in each case. For all patients, pathologic staging was obtained after surgery. Patients who underwent palliative surgery or preoperative chemotherapy and/or radiation therapy, and patients who did not undergo preoperative FDG-PET/CT were excluded (Fig. 1). Data were obtained by review of medical records. This study was conducted with the approval of the Institutional Review Board of Chungbuk National University Hospital.
2. Materials
Patient clinical features, including age and gender, factors that could affect the accuracy of the FDG-PET/CT such as blood sugar level, and mean CEA level were collected. Operation and pathologic features such as cancer size, location, cell type, differentiation, stage, and microsatellite instability (MSI) status were also collected. Data for maximum standardized uptake value (SUVmax), lymph node metastasis, and distant metastasis in FDG-PET/CT and CT were collected.
CT was performed with a 64-slice scanner (Brilliance CT; Philips Healthcare, Cleveland, OH, USA) and nonionic intravenous contrast material was administered at a dose of 2 mL/kg up to a maximum of 180 mL. FDG-PET/CT studies were performed on a hybrid PET/CT scanner (Discovery STE; GE Healthcare, Milwaukee, WI, USA). Patients fasted for at least 6 hours before the scan. Blood glucose levels were recorded prior to 18F-FDG administration. If the serum glucose level was greater than 200 mg/dL, the study was rescheduled. Patients were injected with 296 to 370 MBq of 18F-FDG. Imaging was performed 60 minutes later in accordance with the institutional PET protocol, including two-dimensional mode acquisition with a field of view of 15 cm. All images were reconstructed using post-emission transmission attenuation-corrected data sets.
The CT scan was reviewed by experienced radiologists in our institute; regional lymph nodes of 1 cm or larger were regarded as lymph node metastasis, and other site abnormalities interpreted as probable metastatic disease were regarded as distant metastasis. FDG-PET/CT images were interpreted using visualization and semiquantitative analysis by an experienced nuclear medicine physician, and the criterion for malignancy was accepted as 18F-FDG hypermetabolism at the site of pathological changes noted on CT, or via marked focal hypermetabolism at the physiological uptake sites. Distant metastasis in FDG-PET/CT were defined as positive or indicative of malignancy in organs other than the primary CRC site. SUVmax was calculated for all pathological lesions.
Cancer recurrence and cancer-related death were investigated by reviewing medical records or making phone calls to patients or patient's families for the assessment of prognosis.
3. Statistical Analysis
Descriptive numerical values were reported as mean±SD and percentage. For comparison of sensitivity, specificity, and the accuracy of detection of lymph node metastasis and distant metastasis by CT and FDG-PET/CT, the chi-square test and McNemar test were used. Kaplan-Meier and log-rank methods were used to analyze the prognosis for CRC. All P-values were two-sided, with P<0.05 considered statistically significant. All statistical analyses were carried out using SPSS for Windows version 18.0 (SPSS Inc., Chicago, IL, USA).
1. Baseline Characteristics of the Study Population
Among the 220 patients with CRC, the mean age was 63.8 years and the mean cancer size was 25.2 cm3. Left-sided colon cancer accounted for 73.2%, while right-sided cancer accounted for 26.8%. Adenocarcinoma cell type was found in 94.5% of patients, and 87.7% of these patients showed moderate differentiation. Stages II and III accounted for 81.8% of all patients. Cancer recurrence and cancer-related death occurred in 32 (14.5%) and eight (3.6%) of the patients, respectively (Table 1).
2. Diagnostic Yield of FDG-PET/CT and CT for CRC
CT had significantly higher sensitivity compared to FDG-PET/CT for detection of lymph node metastasis (59% vs. 44%, P=0.029). On the other hand, FDG-PET/CT had significantly higher specificity and accuracy than CT for detection of lymph node metastasis (84% vs. 65%, P=0.000; 67% vs. 62%, P=0.022) (Table 2). In addition, FDG-PET/CT had significantly higher specificity and accuracy than CT for detection of distant metastasis (94% vs. 87%, P=0.004; 93% vs. 86%, P=0.037); however, there was no difference in sensitivity between FDG-PET/CT and CT for detection of distant metastasis (79% vs. 79%, P=1.000) (Table 3). Tumor SUVmax of FDG-PET/CT was significantly correlated with tumor size alone (P=0.001). Metastatic sites on FDG-PET/CT were liver (n=8), lung (n=8), bone (n=4), peritoneum (n=2), and other organs including spleen and kidney (n=1). However, the numbers of among organs were too small to be meaningful in statistical analysis.
3. Prognostic Yield of FDG-PEG/CT and CT for CRC
Age, gender, blood glucose level, location, cell type, cancer size, CEA level, SUVmax, and MSI had no significant relationship with prognosis. Factors influencing prognosis of CRC were cell differentiation and cancer stage (P=0.020, P<0.001, respectively). In addition, positive findings for lymph node metastasis and distant metastasis on FDG-PET/CT were associated significantly with cancer recurrence or cancer-related death (P=0.009, P=0.001, respectively), whereas positive findings for lymph node metastasis and distant metastasis on CT were not associated with cancer recurrence or cancer-related death (P=0.116, P=0.120, respectively) (Figs. 2 and 3).
A number of imaging modalities are used in the preoperative staging of CRC, including CT, MRI, ultrasound imaging, and FDG-PET/CT. CT is an established method for staging CRC, and a cross-sectional imaging technique that uses X-rays provides detailed anatomical information.8 FDG-PET/CT scan is not routinely indicated and should be used to evaluate an equivocal finding on a contrast-enhanced CT scan or in patients with contraindications to intravenous contrast.9 However, according to several studies, FDG-PET/CT can be a valuable tool in accurate staging; FDG-PET/CT can aid in the management of patients with primary CRC, and can be useful for ambiguous or equivocal lesions on CT.101112 In addition, a major drawback of CT is that it does not provide functional information and hence cannot reliably discriminate between enlarged cancerous nodes and enlarged benign reactive nodes. On the other hand, FDG-PET/CT, which provides both anatomic and functional information, has been shown to be accurate in diagnosing primary colorectal tumor extension and metastasis.13 FDG-PET/CT has also been used for diagnostic staging in recurrent CRC.14 Furthermore, it has been reported to influence surgical decision-making in up to 40% of patients with documented recurrence by other imaging methods.15161718
In this study, we found that preoperative FDG-PET/CT had a higher specificity and accuracy compared to CT for detection of lymph node metastasis and distant metastasis in patients with CRC. The higher specificity of FDG-PET/CT for lymph node metastasis is related to nonspecific lymph node enlargement or reactive changes.19 Frequently, CT shows inflammatory or nonspecific lymph node enlargement as a positive finding. However, these findings do not always mean true malignant lymph node metastasis. Additionally, the higher specificity of FDG-PET/CT for distant metastasis is related to liver metastasis, because the most frequent site of CRC metastasis is the liver, and FDG-PET/CT accurately identifies hepatic metastasis.202122 Thus, FDG-PET/CT can be used for accurate staging of patients with primary CRC, with higher specificity than CT. However, despite its high specificity in characterizing lymph node involvement, FDG-PET/CT had lower sensitivity than CT for regional lymph node metastasis. The higher false-negative rate for FDG-PET/CT is due to its limited spatial resolution, which makes it difficult to detect proximal lymph node metastasis from the primary tumor.23 This means that preoperative FDG-PET/CT may have low value for detecting regional lymph node metastasis surrounding a primary lesion. Additionally, FDG-PET/CT is limited by minimum detectable lesion size.24 SUV, especially in smaller lesions, is generally proportional to lesion size.25 That is why this study showed that SUVmax was significantly related to tumor size. Therefore, small lymph node metastasis can be hard to detect with FDG-PET/CT, resulting in low sensitivity of the examination. However, if the SUVmax is 2 or 3, pathological metastatic lymph nodes can frequently be seen.26 In addition, FDG-PET/CT with high specificity can help to clarify the nature of uncertain lymph nodes detected by other imaging modalities such as CT.
In our study, we evaluated the factors influencing the prognosis of CRC. Age, gender, blood glucose level, location, cell type, cancer size, CEA level, SUVmax, and MSI did not affect CRC prognosis. Factors influencing the prognosis were cell differentiation and cancer stage. Additionally, positive findings of lymph node metastasis and distant metastasis on FDG-PET/CT were valuable as prognostic factors for CRC. The high prognostic impact of lymph node metastasis in CRC is well established.27 In this study, CRC staging for event-free survival was based on the imaging finding, not on final pathologic stage. CT uses size as the main criterion in the assessment of nodal involvement, although lymph node size is not an ideal indicator of metastasis and lacks accuracy.28 The accuracy of CT for detection of lymph node metastasis was 62.3% in this study, and this is why CT was not associated with event-free survival in CRC. Several studies have shown that FDG-PET/CT can be predictive of prognosis for postoperative recurrent CRC. Imdahl et al.29 showed that FDG-PET/CT has greater accuracy for staging of recurrent CRC than CT. Fernandez et al.30 showed that screening with FDG-PET/CT was associated with post-resection five-year overall survival for patients who underwent resection of hepatic metastasis from CRC. Additionally, Flanagan et al.31 reported that FDG-PET/CT was a valuable imaging tool in patients who had a rising CEA level after colorectal surgery. Because FDG-PET/CT has higher accuracy for detection of lymph node metastasis and distant metastasis, it can be valuable for predicting prognosis. It is notable that FDG-PET/CT, as an accurate preoperative staging method, can determine appropriate management decisions and precise prognosis in patients with CRC.
This study had several limitations, including its retrospective single-center study design and relatively short-term follow-up. Only patients who underwent preoperative FDG-PET/CT were included, and patients who underwent preoperative chemotherapy and/or radiation therapy were excluded. However, accurate pathologic staging was accomplished because all patients in our study underwent surgery, and a relatively large number of patients were enrolled and followed up.
In conclusion, this study showed that preoperative FDG-PET/CT had a higher specificity and accuracy compared to CT scan for detection of lymph node metastasis and distant metastasis of CRC. In addition, positive findings of lymph node metastasis and distant metastasis on FDG-PET/CT were significantly associated with poor outcome; thus, FDG-PET/CT could be useful as a prognostic tool for CRC. Additional well-powered and prospective studies are needed to validate our findings.
Financial support: This work was supported by the overseas dispatch program of Chungbuk National University in 2014.
Conflict of interest: None.


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I graduated from The University of North Florida with a bachelor's degree in communications in 1990. I then went on to receive a master's degree in media technology, and a teacher's certification in grades 4-8 middle schools. I am certified to teach language arts, literature, social studies, elementary education, and to be a media specialists as well. Currently, I am seeking a specialist's degree in curriculum and instruction.
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For a brief period of time in 1987, U.S. Rep. Patricia Schroeder made headlines by attempting to win the Democratic Party nomination to run for president.
This is the kind of thing that leads to press conferences, especially in Denver.
Schroeder was, to say the least a freethinker on a host of cultural and political leaders, including gay rights. At one press conference, I asked the congresswoman a question that went something like this (I am paraphrasing): You have said that you believe people are born gay. Do you believe that, at some point, there will be genetic evidence to back this stance and strengthen your case?
She said "yes," but didn't elaborate. However, she did allow me to ask a follow-up question. I asked: If that is the case, and this genetic information could be shown in prenatal tests, would you support a ban on parents choosing to abort gay fetuses?
The press aide in charge was not amused and shut that down immediately. However, I was not accosted by other journalists in the room. A few Rocky Mountain News (RIP) colleagues used to refer to this as "that Mattingly question." They may not have approved, but some thought it was logical and, thus, fair game.
This anecdote popped into my mind when I read a re-posted 2015 think piece by Mollie "GetReligionista emerita" Hemingway at The Federalist. The headline: "Why Do The Media Keep Helping Nancy Pelosi Avoid Abortion Questions?" While, obviously, she offers commentary about abortion, Hemingway is primarily asking a journalism question about bias linked to mainstream news coverage of an issue that always involves religion, morality and culture.
This media-bias question remains relevant, after all of these years — as readers could see in the comments attached to this recent Bobby Ross post: "Looking for God — and a bit of fairness — in coverage of Alabama's abortion ban vote." Thus, let's look at this older Hemingway work.
Here's my take: Yes, I have seen some improvement in abortion coverage, if your goal is balanced, accurate reporting that shows respect for people on both sides of the debates. Some religion-beat reporters have worked hard to talk to both sides. However, in my opinion, political-desk coverage of abortion issues has been as bad as ever — or worse.
This brings us back to that Hemingway piece. The setting is a press conference and a tough, but totally logical, question from a journalist with press credentials. Press reporters noted this was a "conservative" journalist (true, but not that relevant) or even a "protester" (totally inaccurate). Here's the Hemingway thesis:
Asking Rep. Nancy Pelosi, a hardline defender of the practice of killing unborn children even in the latest stages of development in the womb (she calls late-term abortion "sacred ground"), what constitutes a baby being alive is a question any journalist should ask, and not just conservative ones.
Journalists love asking tough questions about abortion … so long as the recipient of those questions is pro-life. When the politician is pro-choice, they just can't imagine even the first question you might ask. That's because, it seems more than safe to say given the last two months of deferential coverage of Planned Parenthood, they are pretty big fans of abortion themselves.
There was, in this case, some celebration that ended up in print. Check out the link to The Hill at the top of this post and listen to the laughter and affirmation from reporters, as Pelosi ducks the question.
Mollie also saved this shot of a Washington Post headline.
Yes, note the word "protester."
I screencapped it so that if they develop any shame and change it, like they did this piece of pro-Planned Parenthood puffery … we'll have a record. Oh look at that! The URL tells the story of the original headline, but they did, in fact, change the headline, however many hours later. Now it says "Nancy Pelosi shut down a reporter's abortion question in a press conference."
This piece, by Kelsey Snell, seems to view asking reasonable questions of pro-choice politicians as something that journalists should not do.
Snell doesn't know enough to tell us the name of the journalist asking the question, but she does, somehow, know that he or she is an "abortion protester." Except, as the correction to her piece now admits, she didn't know the reporter was an abortion protester. He wasn't. She just assumed, I guess, since all the journalists in the mainstream outlets are so supportive of abortion and wouldn't dare ask a question that casts even a moment of skepticism on the practice, that he must be a "protester."
Pelosi refused to answer the question, saying — along with the motherhood comment — that there were no "public policy" questions involved in a question about government funds being used to back Planned Parenthood.
It appears that many political reporters involved in that press conference agreed.
Thus, here is Hemingway's main point, once again:
The question is, though, why do reporters think they need to be so supportive of Pelosi avoiding answering these questions?
I would like to note that the reporters, in this case, were probably helping Republicans, in the long run. That would still be true, today, in similar pressers.
Why? Because there are quite a few pro-life Democrats in America (Marist Poll), believe it or not. Many of them are in crucial swing states. Political reporters who keep defending what millions of Democrats — including many who back Roe — believe are extreme positions on abortion only help, well, efforts by someone like Donald Trump to woo heartland Democrats. Why is it radical to seek compromises similar to laws found in Europe?
So here's another question: Do many, even most, political-desk news reporters (not editorial-page writers) consider anathema all compromises on abortion issues, even those linked to safety issues and late-term procedures?
Check out Hemingway's old post and focus on the journalism issues.


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Ranked in these QuestionsQuestion Ranking
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SINDH'S first sugar factory was established in Tando Mohammad Khan — then part of Hyderabad district — some time in the early sixties. It was situated on the left bank of the Indus.
Cotton cultivation was allowed on the left bank while rice cultivation has been banned in this area, at least on paper. The right bank areas, however, were to produce rice as a matter of policy. And all this land was fed by the colonial era Sukkur barrage, built in 1932.
The crop-mapping or zoning strategy for Sindh's agriculture sector was based on parameters established long ago. Sadly, things are different today. A major shift is seen in crop cultivation as the government, both provincial and federal, has turned a blind eye to it.
Crop zoning regulates the farm sector. It determines how and where a particular crop or is to be cultivated so as to achieve the greatest yield. Such zones are defined in view of weather conditions, available water flows, drainage system and soil fertility etc of that area. This method helps ensure efficient utilisation of resources.
Sindh and Punjab are both bearing the brunt of adverse implications of this change. Punjab's southern parts are home to sugar cane cultivation thanks to the unusual growth of the sugar industry in water deficient areas that do not suit the crop. Sugar cane is considered Pakistan's political crop commanding patronage of all bigwigs.
The crop-mapping or zoning strategy for Sindh's agriculture sector was based on parameters established long ago. Sadly, things are different today. A major shift is seen in crop cultivation as the government, both provincial and federal, has turned a blind eye to it
Pakistan's National Food Security Policy was approved for the first time in 72 years by the outgoing PML-N government. Punjab and Sindh — Pakistan's two main grain producing provinces — have also framed their own agriculture policies.
Besides these two provinces, Balochistan contributes towards the paddy crop while Khyber Pakhtunkhwa focuses on tobacco, although it also has a lot of potential for maize production.
The national food security policy, coupled with the two provincial agriculture policies, cover all policy areas for sustainable agriculture growth. However, to ensure sustainability, what appears to be missing is synchronisation at federal and provincial levels.
"The government needs to share information-based knowledge to convince growers about which crop should be sown in a given season. This culture needs to be developed if we aim to achieve sustainability in our farm sector which has a huge potential for growth," contended Dr Yusuf Zafar, former chairman Pakistan Agricultural Research Council.
Water, a precious commodity, is becoming scarce. The government often uses the public's purse to provide subsidies to first produce a certain crop, such as sugarcane, and then export the sweetener with rebate, without benefitting either genuine farmers or consumers. Farmers don't get the desired price for their produce while consumers get expensive sugar thanks to institutional lacunas at the implementation stage.
It is owing to a missing zoning system that Pakistan often has a bumper sugarcane crop coupled with sugar surpluses, all at the cost of declining cotton acreage and looming water scarcity. The country has a huge potential for cotton production and a large textile industry.
To borrow from a Punjab-based agriculture analyst, Ibrahim Mughal, Pakistan is spending Rs600-700 billion on import of various agro-commodities especially cotton, edible oil and pulses.
"We can easily produce [these commodities] by ensuring proper zoning to protect our ecosystem. But we have to protect the natural habitat of our crops and we must stop tinkering with the natural ecosystem or be ready to face the consequences," he observed.
If the country earns foreign exchange on rice exports, it also spends a huge amount to import edible oil and pulses. And both crops can be grown domestically, as evident from the experience gained in the 2010 super floods when sunflower cultivation boomed.
The West Pakistan Rice (Restriction on Cultivation) Ordinance 1959 is often invoked in command (left bank) areas of Ghotki Feeder canal (Guddu barrage), Nara and Rohri canals (Sukkur barrage) to ban sowing of paddy. This mirrors the zoning system. But due to weak governmental writ these rules are not strictly enforced, thus paddy surpluses are seen in banned areas.
Pakistan exports a freshwater resource when rice is exported, says former chairman Pakistan Council of Research in Water Resources Dr Mohammad Ashraf. Out of 8.6 million tonnes of rice produced in 2015-16, 4.2m tonnes (worth Rs194bn) were exported. These exports required 6.8MAF of freshwater amounting to Rs8.4bn (at Rs1,233 per acre foot of water)
Due to nonexistent zoning, high delta crops are grown in areas where surface water is insufficient and groundwater is deep or saline. Edible oil crops should be introduced which require less water and don't affect foreign exchange.
Dr Ashraf underscored the need for crop zoning given depleting water resources. The focus should be on water conservation and maximization of per acre productivity to lessen the usage of surface freshwater resources. Abstraction of groundwater, another important resource, is going unchecked and is another burden on the ecosystem.
Over the years Pakistan has become largely dependent on cotton import thanks to declining domestic production of cotton bales. The textile industry needs around 15m cotton bales while domestic production hovers around 10m, resulting in imports.
The area under cultivation for cotton faces massive encroachment in Sindh and Punjab by the sugar cane crop which continues to be politically patronised regardless of which party is in power. This has lead to an unnatural growth of the sugar industry.