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Jayakrishnan T, Honhar M, Jolly GP, Abraham J, T J. Medical education in India: time to make some changes. THE NATIONAL MEDICAL JOURNAL OF INDIA 2012; 25:164-167. [PMID: 22963298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
India is in need of well-trained doctors. We highlight and analyse some of the problems affecting medical education in India and their possible solutions. The medical education system can be reviewed under four heads: selection of students, medical training, evaluation, and the development and accreditation of faculty. In India, students enter medical colleges without receiving sufficient orientation about the profession. If students were given some exposure to various professions in the final years of school, it would help address this issue. Medical students are selected on the basis of pre-medical tests consisting of multiple-choice questions, the validity of which is being questioned increasingly. There is no coordination between the scheduling of lectures on various diseases and their management and the clinical exposure of the students. Active involvement in treatment is limited to the final year, called internship, which is hampered by preparation for postgraduate entrance examinations. Efforts should be made to provide hands-on experience at an earlier time in the course. A systematic and reliable programme for evaluation is a must. There is a need for a shift in the focus of evaluation, which should assess the application of knowledge rather than the ability to recall facts. The replacement of the traditional long-/short-case examinations with more valid and reliable instruments for the assessment of clinical skills should be considered. 'Vision 2015', a document developed by the Medical Council of India, contains many notable recommendations for the improvement of the current system. If these are implemented effectively, the impact of improvement in Indian medical education will be felt globally.
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Abraham J, Fox P, Koh S. Minocycline Attenuates Microglia Activation and Blocks the Long-Term Epileptogenic Effects of Early-Life Seizures (S28.004). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s28.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Caley A, Hodges E, Barrett-Lee P, Borley A, Abraham J. 250 The Secondary Breast Cancer Multidisciplinary Forum (SBC- MDF): a Novel Strategy to Improve Patient Care and Allow Prospective Data Collection. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)70317-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Damiano JS, Wasserman E, Rendahl K, Jeffry U, Rediske J, Kakar S, Gardner H, Abraham J. P3-17-09: Neutralizing the Prolactin Receptor with Therapeutic Antibody LFA102: A Novel Approach for the Treatment of Breast Cancer. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p3-17-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The prolactin receptor (PRLR) is a class I cytokine receptor required for the normal development of the mammary gland and is frequently found to be overexpressed in breast tumors. The polypeptide hormone prolactin (PRL) has been demonstrated to induce PRLR signaling through the Jak/Stat, PI3-kinase/AKT and MAPK pathways, leading to cell proliferation and survival. Mammary gland-specific overexpression of PRL in transgenic mice leads to a higher incidence of ER+ and ER- mammary tumors. In addition, the PRLR locus is the site of frequent viral integrations in MMTV-induced mammary tumors. Elevated serum PRL levels in humans have been correlated with an increased risk for breast cancer, especially for ER+ cases, implicating a role for this hormone in the development of human breast tumors. An analysis of more than 3000 breast tumor specimens indicates that PRLR is expressed with high prevalence (60-70% of tumors) across all breast cancer subtypes, with a trend towards higher expression in ER+ tumors. All of these lines of evidence support the hypothesis that targeting the PRL/PRLR axis may be a new approach for addressing unmet medical need in breast cancer. LFA102 is a Human Engineered™ anti-PRLR antibody of the IgG1 isotype that neutralizes the function of PRLR through a non-ligand competitive binding interaction. LFA102 blocks PRL-induced signaling and proliferation in T47D and MCF7 ER+ human breast cancer cells in vitro, and abolishes PRL-induced phosphorylation of Stat5 in T47D xenograft tumors in vivo. An examination of disaggregated primary human breast tumors ex vivo has indicated that PRL frequently induces signaling through Stat5 in the cells and that LFA102 is capable of completely antagonizing this signaling. LFA102 also neutralizes rat PRLR and the antibody potently regresses PRL-dependent Nb2-C11 pre-T cell lymphoma tumors in vivo. Preliminary data suggests that LFA102 is also capable of inhibiting the growth of carcinogen-induced rat mammary tumors. In vitro studies have shown that LFA102 can also mediate antibody-dependent cellular cytotoxicity (ADCC) and inhibit the PRL-dependent release of the pro-angiogenic factor VEGF from breast cancer cells. Thus, there are multiple potential mechanisms through which LFA102 could show anti-tumor activity in vivo. Preclinical toxicological studies of LFA102 indicate that this therapeutic is well tolerated and exhibits a normal pharmacokinetic profile in relevant animal species. The safety and pharmacokinetics of LFA102 in humans are currently being evaluated in a phase I healthy volunteer trial. At the three dose levels explored so far, no infusion reactions or severe adverse events related to the drug have been reported. Preliminary results suggest that LFA102 has an adequate pharmacokinetic profile for further clinical development. An assessment of LFA102 in a population of metastatic breast cancer patients predicted to have the highest probability of benefit is imminent.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-17-09.
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Virani S, Lagos R, Hobbs G, Marano G, Nagaiah G, Abraham J. P4-12-14: Pilot Study Utilizing Fluorine-18 Fluorodeoxyglucose (F-18 FDG) Positron Emission Tomography–Computed Tomography Scan (PET-CT Scan) To Investigate Brain Metabolic Changes during Treatment in Women with Breast Cancer. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p4-12-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: Approximately 25% of the patients undergoing chemotherapy develop cognitive changes. Similarly, significant neurocognitive changes in verbal memory and executive functioning have been reported in patients undergoing endocrine therapy. Though extensively studied, specific changes in the brain associated with cognitive dysfunction are still not clear. We performed an IRB-approved retrospective pilot study utilizing brain images from standard PET-CT scans in patients being treated for breast cancer. Comparison was made between patients initial and follow-up scans to look for metabolic changes.
MATERIALS AND METHODS: Thirty nine patients with a diagnosis of breast cancer were identified from radiology database of West Virginia University Hospitals, who underwent at least two PET-CT scans during their treatment for breast cancer from 2004–2009. Patients with brain metastasis were excluded. NeuroMIM® software analysis program was used to compare a comprehensive database of physiologic brain anatomy and metabolism with F-18 FDG perfusion brain images from the patients. Comparison was made in sixty-three defined brain regions. For each patient, two scans at approximately twelve month intervals were analyzed. The data sets from initial scans were compared with the follow up.
RESULTS: A total of 37 patients received cytotoxic chemotherapy, 2 patients received only endocrine therapy. Data analysis using the signed-rank test shows that the collective Z-score values change between the initial and follow up scans. When data analysis is applied to the individual brain regions, the Lingual Gyrus (p=0.012) and the Angular Gyrus (p=0.056)show statistically significant and near significant decreases in brain metabolism respectively. These regions are attributed with language, mathematics and cognition. Several additional regions such as the fusiform gyrus and the primary visual cortex show p-values between 0.05 and 0.10, which indicate “trending”. These regions may demonstrate statistically significant decrease in metabolism if the sample size is increased.
DISCUSSION: The Lingual and the Angular Gyrus show a statistically significant and near significant decrease in glucose metabolism respectively, in patients receiving treatment for breast cancer. Limitations of this study include lack of baseline brain imaging and its clinical correlation with cognitive function. Based upon these preliminary findings prospective studies are being planned.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-12-14.
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Ali AMG, Provenzano E, Abraham J, Bartlett JM, Poole CJ, Hiller L, Dunn J, Twelves C, Earl HM, Caldas C, Pharoah P. Prognosis by breast cancer subtypes in patients treated with adjuvant chemotherapy in a clinical trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.27_suppl.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12 Background: Breast cancer can be classified into molecular subtypes that have distinct survival patterns. The purpose of this study was i) to evaluate the prognostic significance of breast cancer subtypes in a cohort of women taking part in the NEAT and BR9601 clinical trials comparing CMF with ECMF, and ii) to evaluate whether the subtypes were predictive of the added benefit of epirubicin in these trials. Methods: Tumor tissue microarrays were stained and scored for ER, PR, HER2, EGFR and CK5/6. These were used to classify the tumors into six intrinsic subtypes (1). We used Cox regression to compare overall survival (OS), breast cancer specific survival (BSS) and relapse free survival (RFS) in the different subgroups. We also compared the effect of ECMF with CMF by subgroup. Results: IHC data were available for 1725 cases of whom 805 were Luminal 1-basal negative, 153 were Luminal 1-basal positive, 174 were Luminal 2, 192 were HER2-like, 230 were core basal phenotype and 171 were 5-negative phenotype. Median follow-up time was 7 years. The prognostic effects of the subtypes were similar to those reported for unselected breast cancer cases irrespective of adjuvant therapy (Blows FM, et al. PLoS Med 2010;75:e1000279.). In particular, the luminal 1-basal negative tumors were associated with the best prognosis in five years after surgery and the HER2-like tumors were associated with the poorest prognosis. ECMF has previously shown to be associated with a 33% relative risk reduction for OS compared to CMF (Poole CJ et al. N Engl J Med 2006;35518:1851-62.). There was little evidence for significant heterogeneity of effect by tumor subtype for any end point (OS P= 0.40, BSS P=0.53 RFS P=0.50). However, there was an observed trend towards the largest additional benefit from ECMF being in women with tumors of the 5-negative phenotype (OS HR=0.39 95% CI 0.21-0.73) and the smallest being in Luminal 1-basal negative tumors (OS HR=0.86 95% CI 0.64-1.16). Conclusions: In a clinical trial in which all patients received chemotherapy, we confirmed that breast cancer subtypes show distinct behaviour with differences in short and long term survival. The benefit of ECMF over CMF was statistically similar in all disease subtypes.
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Penot A, Abraham J, Debarri H, Desport E, Aguilar C, Lavergne D, Auroy F, Leleu X, Goldstein A, Kolb B, Bridoux F, Fermand JP, Leblond V, Jaccard A. Effectiveness of second-line treatment in AL amyloidosis patient's refractory to M-Dex. Amyloid 2011; 18 Suppl 1:145-7. [PMID: 21838466 DOI: 10.3109/13506129.2011.574354054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gourin MP, Gachard N, Trimoreau F, Abraham J, Moreau S, Mallissein E, Touati M, Feuillard J, Bordessoule D. 148 Myelodysplastic syndrome in very elderly patients: practice in the real life. Preliminary results on a monocentric cohort. Leuk Res 2011. [DOI: 10.1016/s0145-2126(11)70150-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Courtier N, Gambling T, Barrett-Lee P, Abraham J, Mason M. Hepatic Irradiation during Modern Radiotherapy Protocols after Breast Conservation. Clin Oncol (R Coll Radiol) 2011. [DOI: 10.1016/j.clon.2011.01.363] [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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Awan FT, Osman S, Kochuparambil ST, Gibson L, Remick SC, Abraham J, Craig M, Jillella A, Hamadani M. Impact of response to thalidomide-, lenalidomide- or bortezomib- containing induction therapy on the outcomes of multiple myeloma patients undergoing autologous transplantation. Bone Marrow Transplant 2011; 47:146-8. [DOI: 10.1038/bmt.2011.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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86
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Kanate A, Chaudhary L, Cumpston A, Leadmon S, Bunner P, Bulian D, Gibson L, Tse W, Abraham J, Remick S, Craig M, Hamadani M. High Rates of Non-Relapse Mortality and Graft-Versus-Host Disease in Patient Undergoing Allogeneic Stem Cell Transplantation (ASCT) Following Non-Myeloablative (NMA) Conditioning With TLI/ATG. Biol Blood Marrow Transplant 2011. [DOI: 10.1016/j.bbmt.2010.12.476] [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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Osman S, Kanate A, Bunner P, Leadmon S, Hart K, Goff L, Tse W, Cumpston A, Remick S, Abraham J, Craig M, Hamadani M. Cyclophosphamide (CY)/G-CSF Cannot Completely Overcome Imid-Induced Impairment of Peripheral Blood Stem Cell (PBSC) Mobilization (Mob) in Patients With Multiple Myeloma (MM). Biol Blood Marrow Transplant 2011. [DOI: 10.1016/j.bbmt.2010.12.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kanate A, Osman S, Cumpston A, Hobbs G, Leadmon S, Bunner P, Gibson L, Tse W, Abraham J, Remick S, Craig M, Hamadani M. In Vivo T-Cell Depletion (TCD) Does Not Improve Rates of Graft-Versus-Host Disease (GVHD) and Transplantation Outcomes in Patients Undergoing Peripheral Blood Allogeneic Hematopoietic Cell Transplant (AHCT). Biol Blood Marrow Transplant 2011. [DOI: 10.1016/j.bbmt.2010.12.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abdella K, Bartolomeos K, Tsegaye F, Bhalla K, Abraham J. Estimates of the burden of injuries in Ethiopia derived from all existing data sources. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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90
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Bhalla K, Abraham J, Harrison J, Bartolomeos K, Mtonga R, Abdella K. Using mortuary data for estimating urban injury mortality incidence in Africa. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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91
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Wandera B, Bhalla K, Abraham J, Lipnick M, Mabweijano J, Nakitto M, Bahcani A, Kobusingye O, Hyder AA. Estimating the burden of injuries in Uganda from all available data sources. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bartels D, Bhalla K, Shahraz S, Abraham J, Lozano R, Murray CJ. Incidence of road injuries in Mexico: country report. Int J Inj Contr Saf Promot 2010; 17:169-76. [DOI: 10.1080/17457300903564553] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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93
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Webster R, Palaniappan N, Abraham J, Bertelli G, Jasani B, Barrett-Lee P. HER2 testing, adjuvant trastuzumab use and results. Our experience in South Wales. Clin Oncol (R Coll Radiol) 2010; 22:894. [PMID: 20708911 DOI: 10.1016/j.clon.2010.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 07/09/2010] [Indexed: 01/08/2023]
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94
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Nanda S, Sahu S, Abraham J. Studies on the biodegradation of natural and synthetic polyethylene by Pseudomonas spp. ACTA ACUST UNITED AC 2010. [DOI: 10.4314/jasem.v14i2.57839] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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95
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Rahman RN, Hossain AM, Abraham J. Colon cancer disparities: A SEER-based analysis of epidemiologic data on Asian and Pakistani immigrants in the United States. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.1603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Gourin M, Turlure P, Gachard N, Girault S, Touati M, Abraham J, Philippon C, Feuillard J, Bordessoule D. Increased of overall survival (OS) and malignancies (K) during tyrosine kinase inhibitors (TKI) in a real life cohort of patients (pts) with a chronic myeloid leukemia (CML). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.6602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Barrett-Lee PJ, Murray N, Abraham J, Casbard A, Clements H, Maughan TS, Griffiths G. Interim safety data on the ZICE trial: A randomized phase III, open-label, multicener, parallel group clinical trial to evaluate and compare the efficacy, safety profile, and tolerability of oral ibandronate versus intravenous zoledronate in the treatment of patients with breast cancer with bone metastases. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.1085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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98
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Touati M, Gourin M, Abraham J, Weinbreck N, Gachard N, Olivrie-Gamaury A, Feuillard J, Jaccard A, Bordessoule D. Epidemiological review of lymphoma diagnosis in a French rural area between 2003 and 2008. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e18551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Mirza MA, Newton MD, Sager R, Kurian S, Abraham J. Decline in the use of erythropoiesis-stimulating agents: Long-term effects of regulation, reimbursement, and unfavorable data. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e13158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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100
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Gadiyaram VK, Kurian S, Abraham J, Ducatman B, Hazard H, Hobbs G, Vona-Davis L. Recurrence and survival after pulmonary metastasis in triple-negative breast cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.1131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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