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Chenbhanich J, Wu A, Phupitakphol T, Atsawarungruangkit A, Treadwell T. Hospitalisation of adults with Down syndrome: lesson from a 10-year experience from a community hospital. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:266-276. [PMID: 30484927 DOI: 10.1111/jir.12572] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 08/16/2018] [Accepted: 11/07/2018] [Indexed: 05/26/2023]
Abstract
BACKGROUND Life expectancy of individuals with Down syndrome (DS) has improved significantly over the past decades. However, there are sparse data documenting the co-morbidities and hospitalisation of adult patients with DS in the literature. The aim of this study was to characterise the co-morbidities and pattern of hospitalisation in adult patients with DS during a 10-year period at the community hospital as well as to compare hospitalisation parameters with the general adult population during the same years. METHOD We reviewed the medical records of 81 hospitalisations from 37 patients with DS aged 21 to 68 years at Metrowest Medical Center during a 10-year period and compared with those of the general adult population during the same time. Co-morbidities were also described. RESULTS Adults with DS had a mean age at admission of 48.6 ± 8.8 years with the median length of stay of 3 days (interquartile range 4 days). Male patients were hospitalised longer than female patients (mean 5.0 vs. 2.8 days; P < 0.05), and patients who lived at home were admitted at earlier ages than those who came from residential healthcare facility (mean 41.5 vs. 52.2 years; P < 0.001). The most common cause of hospitalisation was pneumonia/aspiration syndrome (29.6%), and the most common co-morbidity was gastroesophageal reflux disease (GERD)/dysphagia (70.3%). Presence of GERD/dysphagia or seizure disorder was significantly associated with multiple admission and readmission within 1 month (P < 0.05). The mortality rate was 4.9%, and the rate of intensive care unit admission was 8.6%. CONCLUSIONS Our cohort did not show statistically significant different hospitalisation parameters such as inpatient mortality and average length of stay when compared with general adult population hospitalised at the same years. The care of adult patients with DS presents challenges in internal medicine due to its unique co-morbid profile and signifies the importance of multidisciplinary approach. In order to improve the care of this patient population, their co-morbidities, particularly GERD/dysphagia and seizure disorder, should be optimally managed and comprehensively addressed when patients are hospitalised.
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Morin O, Chen W, Villanueva-Meyer J, Gennatas E, Wu A, Cha S, Magill S, Perry A, Sneed P, McDermott M, Solberg T, Valdes G, Braunstein S, Raleigh D. Point-of-Care Local Failure and Overall Survival Prediction Models for Meningioma. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Maxwell R, Luksik A, Garzon-Muvdi T, Hung A, Kim E, Wu A, Xia Y, Belcaid Z, Gorelick N, Theodros D, Jackson C, Ye X, Tran P, Redmond K, Brem H, Pardoll D, Kleinberg L, Lim M. Impact of Corticosteroids on the Efficacy of Anti-PD-1 Therapy for Tumors Located Within or Outside the Central Nervous System. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Shaverdian N, Chang E, Morasso E, Pfeffer M, Cheng E, Wu A, McCloskey S, Raldow A, Steinberg M. Impact of Electronic Access to Physician Notes on Oncology Patients: A Prospective Evaluation. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Chen W, Hara J, Magill S, Wu A, Aghi M, Theodosopoulos P, Perry A, McDermott M, Sneed P, Braunstein S, Raleigh D. Clinical Outcomes and Safety Profile of Salvage External Beam Radiation Therapy and Re-Irradiation for Recurrent Atypical Meningioma. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Song M, Cai Y, Wang W, Li Y, Wang L, Zhu X, Li X, Geng J, Zhang Y, Mi L, Wu A, Liu M. The Effect of Omitting the Ischiorectal Fossa from the Clinical Target Volume for Neoadjuvant Chemoradiotherapy in Resectable Advanced Lower Rectal Cancer. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gennatas E, Wu A, Braunstein S, Morin O, Chen W, Magill S, Villanueva-Meyer J, Perry A, McDermott M, Solberg T, Valdes G, Raleigh D. Pre- and Postoperative Prediction of Long-Term Meningioma Outcomes. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fish A, Vachani A, Beggs M, Carbonell L, Haddad Z, Juang A, Kamer S, Patel B, Yu H, Wu A, Massion P, Arjomandi M, Brown J, Trivedi N, Rubenstein T. MA23.03 Risk Assessment for Indeterminate Pulmonary Nodules Using a Novel, Plasma-Protein Based Biomarker Assay. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wang C, Sidiqi B, Yorke E, Mcknight D, Dick-Godfrey R, Torres D, Gelblum D, Rimner A, Wu A. MA01.10 Toxicity and Local Control in “Ultra-Central” Lung Tumors Treated With SBRT or High-Dose Hypofractionated RT. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Shepherd A, Gelblum D, Wu A, Rimner A. P1.17-14 Outcomes of Hypofractionated Radiation Therapy (HFRT) with Concurrent Chemotherapy in Patients with Stage III Non Small Cell Lung Cancer (NSCLC). J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Maxwell R, Luksik AS, Garzon-Muvdi T, Hung AL, Kim ES, Wu A, Xia Y, Belcaid Z, Gorelick N, Choi J, Theodros D, Jackson CM, Mathios D, Ye X, Tran PT, Redmond KJ, Brem H, Pardoll DM, Kleinberg LR, Lim M. Contrasting impact of corticosteroids on anti-PD-1 immunotherapy efficacy for tumor histologies located within or outside the central nervous system. Oncoimmunology 2018; 7:e1500108. [PMID: 30524891 PMCID: PMC6279341 DOI: 10.1080/2162402x.2018.1500108] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/02/2018] [Accepted: 07/07/2018] [Indexed: 12/21/2022] Open
Abstract
Immune checkpoint blockade targeting programmed cell death protein 1 (PD-1) is emerging as an important treatment strategy in a growing list of cancers, yet its clinical benefits are limited to a subset of patients. Further investigation of tumor-intrinsic predictors of response and how extrinsic factors, such as iatrogenic immunosuppression caused by conventional therapies, impact the efficacy of anti-PD-1 therapy are paramount. Given the widespread use of corticosteroids in cancer management and their immunosuppressive nature, this study sought to determine how corticosteroids influence anti-PD-1 responses and whether their effects were dependent on tumor location within the periphery versus central nervous system (CNS), which may have a more limiting immune environment. In well-established anti-PD-1-responsive murine tumor models, corticosteroid therapy resulted in systemic immune effects, including severe and persistent reductions in peripheral CD4+ and CD8 + T cells. Corticosteroid treatment was found to diminish the efficacy of anti-PD-1 therapy in mice bearing peripheral tumors with responses correlating with peripheral CD8/Treg ratio changes. In contrast, in mice bearing intracranial tumors, corticosteroids did not abrogate the benefits conferred by anti-PD-1 therapy. Despite systemic immune changes, anti-PD-1-mediated antitumor immune responses remained intact during corticosteroid treatment in mice bearing intracranial tumors. These findings suggest that anti-PD-1 responses may be differentially impacted by concomitant corticosteroid use depending on tumor location within or outside the CNS. As an immune-specialized site, the CNS may potentially play a protective role against the immunosuppressive effects of corticosteroids, thus sustaining antitumor immune responses mediated by PD-1 blockade.
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Wu A, Cardarelli P, Oyasu M, Menezes D, Ponath P, Cogswell J, Maxwell R, Luksik A, Hung A, Kim E, Belcaid Z, Brem H, Pardoll D, Lim M. Abstract 1736: The combination of CXCR4 and checkpoint receptor inhibition improves survival in an orthotopic murine glioma model. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-1736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Angiogenesis plays an important role in the malignancy of glioblastoma (GBM) as well as in cancer immunotherapy. In addition, PD-1 checkpoint receptors are upregulated in GBM. We investigate the treatment effects of combination immunotherapy with checkpoint inhibitor anti-PD-1 and anti-CXCR4, an antagonist of a chemokine receptor involved in immune cell homing as well as vasculature development, in a murine glioma model.
Methods: C57Bl/6 mice were implanted with GL261-Luc+ glioma cells and randomized into 4 treatment arms: 1) control, 2) anti-PD-1 monotherapy, 3) anti-CXCR4 monotherapy, and 4) combination anti-PD-1 and anti-CXCR4 therapy. Overall survival and median survival were assessed. Brain samples from untreated mice were stained for CXCR4 expression on plasma membrane, and immunohistochemistry studies were conducted on human glioblastoma specimens as well. Immune cell activation and cell population changes were assessed through flow cytometry analysis.
Results: Both murine and human glioma specimens demonstrated robust positive expression of CXCR4 on tumor-infiltrating immune cells and endothelial cells of vasculature specific to the tumor bed. Combination therapy with anti-PD-1 and anti-CXCR4 conferred survival benefit compared to control and both monotherapy arms. Long-term survivors that had received combination therapy demonstrate immune memory and decreased populations of immunosuppressive, tumor-promoting immune cells. For instance, the monocytic myeloid-derived suppressor cell population was decreased in the brain in mice treated with combination therapy. The pattern of change in microglia was similar in the brain compartment for the combination treatment group as well.
Conclusion: Anti-CXCR4 and anti-PD-1 synergistic immunotherapy not only modulates the immune cell make-up of the glioma microenvironment but also affects vasculature within the tumor region. Dual therapy targeting both checkpoint and chemokine receptors results in improved survival rates.
Citation Format: Adela Wu, Pina Cardarelli, Miho Oyasu, Daniel Menezes, Paul Ponath, John Cogswell, Russell Maxwell, Andrew Luksik, Alice Hung, Eileen Kim, Zineb Belcaid, Henry Brem, Drew Pardoll, Michael Lim. The combination of CXCR4 and checkpoint receptor inhibition improves survival in an orthotopic murine glioma model [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 1736.
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Hung AL, Maxwell R, Theodros D, Belcaid Z, Mathios D, Luksik AS, Kim E, Wu A, Xia Y, Garzon-Muvdi T, Jackson C, Ye X, Tyler B, Selby M, Korman A, Barnhart B, Park SM, Youn JI, Chowdhury T, Park CK, Brem H, Pardoll DM, Lim M. TIGIT and PD-1 dual checkpoint blockade enhances antitumor immunity and survival in GBM. Oncoimmunology 2018; 7:e1466769. [PMID: 30221069 PMCID: PMC6136875 DOI: 10.1080/2162402x.2018.1466769] [Citation(s) in RCA: 192] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/11/2018] [Accepted: 04/13/2018] [Indexed: 12/12/2022] Open
Abstract
The use of inhibitory checkpoint blockade in the management of glioblastoma has been studied in both preclinical and clinical settings. TIGIT is a novel checkpoint inhibitor recently discovered to play a role in cancer immunity. In this study, we sought to determine the effect of anti-PD-1 and anti-TIGIT combination therapy on survival in a murine glioblastoma (GBM) model, and to elucidate the underlying immune mechanisms. Using mice with intracranial GL261-luc+ tumors, we found that TIGIT expression was upregulated on CD8+ and regulatory T cells (Tregs) in the brain compared to draining cervical lymph nodes (CLN) and spleen. We then demonstrated that treatment using anti-PD-1 and anti-TIGIT dual therapy significantly improved survival compared to control and monotherapy groups. The therapeutic effect was correlated with both increased effector T cell function and downregulation of suppressive Tregs and tumor-infiltrating dendritic cells (TIDCs). Clinically, TIGIT expression on tumor-infiltrating lymphocytes was shown to be elevated in patient GBM samples, suggesting that the TIGIT pathway may be a valuable therapeutic target. Expression of the TIGIT ligand, PVR, further portended a poor survival outcome in patients with low-grade glioma. We conclude that anti-TIGIT is an effective treatment strategy against murine GBM when used in combination with anti-PD-1, improving overall survival via modifications of both the T cell and myeloid compartments. Given evidence of PVR expression on human GBM cells, TIGIT presents as a promising immune therapeutic target in the management of these patients.
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Shetty T, Nguyen J, Sasaki M, Wu A, Bogner E, Burge A, Cogsil T, Dalal A, Halvorsen K, Cummings K, Su E, Lyman S. Risk factors for nerve injury after total knee arthroplasty: a case control study. Neuromuscul Disord 2018. [DOI: 10.1016/s0960-8966(18)30360-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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90
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Shetty T, Nguyen J, Wu A, Cogsil T, Sasaki M, Bogner E, Burge A, Su E, Lyman S. Risk factors for nerve injury after total hip arthroplasty: a case control study. Neuromuscul Disord 2018. [DOI: 10.1016/s0960-8966(18)30359-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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91
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Tay JC, Sule AA, Chew EK, Tey JS, Lau T, Lee S, Lee SH, Leong CK, Lim ST, Low LP, Oh VM, Phoon KY, Tan KW, Wu A, Yeo LS. Ministry of Health Clinical Practice Guidelines: Hypertension. Singapore Med J 2018; 59:17-27. [DOI: 10.11622/smedj.2018007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Iyer RR, Wu A, Macmillan A, Musavi L, Cho R, Lopez J, Jallo GI, Dorafshar AH, Ahn ES. Use of computer-assisted design and manufacturing to localize dural venous sinuses during reconstructive surgery for craniosynostosis. Childs Nerv Syst 2018; 34:137-142. [PMID: 28921242 DOI: 10.1007/s00381-017-3601-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 09/10/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Cranial vault remodeling surgery for craniosynostosis carries the potential risk of dural venous sinus injury given the extensive bony exposure. Identification of the dural venous sinuses can be challenging in patients with craniosynostosis given the lack of accurate surface-localizing landmarks. Computer-aided design and manufacturing (CAD/CAM) has allowed surgeons to pre-operatively plan these complex procedures in an effort to increase reconstructive efficiency. An added benefit of this technology is the ability to intraoperatively map the dural venous sinuses based on pre-operative imaging. We utilized CAD/CAM technology to intraoperatively map the dural venous sinuses for patients undergoing reconstructive surgery for craniosynostosis in an effort to prevent sinus injury, increase operative efficiency, and enhance patient safety. Here, we describe our experience utilizing this intraoperative technology in pediatric patients with craniosynostosis. METHODS We retrospectively reviewed the charts of children undergoing reconstructive surgery for craniosynostosis using CAD/CAM surgical planning guides at our institution between 2012 and 2016. Data collected included the following: age, gender, type of craniosynostosis, estimated blood loss, sagittal sinus deviation from the sagittal suture, peri-operative outcomes, and hospital length of stay. RESULTS Thirty-two patients underwent reconstructive cranial surgery for craniosynostosis, with a median age of 11 months (range, 7-160). Types of synostosis included metopic (6), unicoronal (6), sagittal (15), lambdoid (1), and multiple suture (4). Sagittal sinus deviation from the sagittal suture was maximal in unicoronal synostosis patients (10.2 ± 0.9 mm). All patients tolerated surgery well, and there were no occurrences of sagittal sinus, transverse sinus, or torcular injury. CONCLUSIONS The use of CAD/CAM technology allows for accurate intraoperative dural venous sinus localization during reconstructive surgery for craniosynostosis and enhances operative efficiency and surgeon confidence while minimizing the risk of patient morbidity.
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Imber B, Rimner A, Isbell J, Wu A. P3.15-011 Contemporary Treatment and Prognosis of Non-Metastatic Atypical Bronchopulmonary Carcinoid Tumors. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Vasudevan H, Braunstein S, Wu A, Reis G, Magill S, Phillips J, Chang S, Sneed P, McDermott M, Perry A, Raleigh D. Molecular Profiling of Meningioma Identifies Genomic Signatures That Predict Clinical Outcomes Independent of Tumor Grade. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hatami S, Qi X, White C, Burhani M, Aboelnazer N, Himmat S, Wu A, Matsumura N, Nagendran J, Freed D. ENDOPLASMIC RETICULUM STRESS IN EX VIVO HEART PERFUSION: A COMPARISON BETWEEN WORKING VERSUS NON-WORKING MODES. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Boreta L, Xu M, Wu S, Wu A, Nguyen H, Chang A, Roach M, Spratt D, Feng F, Carroll P, Hope T. Location of Recurrence by Gallium-68 PSMA PET Scan in Prostate Cancer Patients Eligible for Salvage Radiation Therapy. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Taggar A, Cohen G, Brady P, Cuaron J, Wu A. EP-1255: Early clinical results for esophageal brachytherapy using a novel multi-balloon HDR applicator. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31690-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Nguyen J, Su E, Lyman S, Manning E, Cummings K, Wu A, Sasaki M, Dalal A, Ching C, Shetty T. Incidence and risk factors for neuropathy following primary total knee arthroplasty. Neuromuscul Disord 2017. [DOI: 10.1016/s0960-8966(17)30299-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nguyen J, Su E, Lyman S, Manning E, Cummings K, Wu A, Sasaki M, Dalal A, Ching C, Shetty T. Incidence and risk factors for neuropathy following primary total hip arthroplasty. Neuromuscul Disord 2017. [DOI: 10.1016/s0960-8966(17)30298-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Li H, Wu A, Reed-Maldonado A, Ning H, Banie L, Wang L, Lee Y, Xin Z, Guo Y, Lin G, Lue T. 144 Therapeutic Mechanism of Low Intensity Extracorporeal Shock Wave in Ameliorating Neurogenic Erectile Dysfunction in Bilateral Cavernous Nerve Injury Rat Model. J Sex Med 2017. [DOI: 10.1016/j.jsxm.2016.11.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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