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Fehr D, Schmidtlein C, Hwang S, Deasy J, Veeraraghavan H. TH-C-18A-02: Machine Learning and STAPLE Based Simultaneous Longitudinal Segmentation of Bone and Marrow Structures From Dual Energy CT. Med Phys 2014. [DOI: 10.1118/1.4889625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Schmidtlein CR, Hwang S, Veeraraghavan H, Fehr D, Humm J, Deasy J. TU-A-12A-08: Computing Longitudinal Material Changes in Bone Metastases Using Dual Energy Computed Tomography. Med Phys 2014. [DOI: 10.1118/1.4889254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Kang SH, Hwang S, Jung BH, Park YH, Park CS, Namgoong JM, Song GW, Jung DH, Ahn CS, Kim KH, Moon DB, Ha TY, Lee SG. Post-transplant assessment of consciousness in acute-on-chronic liver failure patients undergoing liver transplantation using bispectral index monitoring. Transplant Proc 2014; 45:3069-71. [PMID: 24157038 DOI: 10.1016/j.transproceed.2013.08.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE Deterioration of consciousness is a critical situation for liver transplantation (OLT) recipients. The bispectral (BIS) index based on electroencephalographic parameters, is primarily used to monitor the depth of unconsciousness. The present study sought to assess the usefulness of posttransplant BIS index to monitor acute-on-chronic liver failure patients. METHODS This 1-year retrospective study of 28 adult patients with acute-on-chronic liver failure was performed from July 2011 to June 2012, using post-transplant BIS monitoring. RESULTS The mean patient age was 51 ± 8 years. Their mean pretransplant Child-Turcotte-Pugh score was 12.3 ± 1.4, and the mean Model for End-stage Liver Disease score, 36.4 ± 5.9. After OLT, the mean initial Glasgow Coma Scale (GCS) score and BIS index were 3.4 ± 1.7 and 43.5 ± 9.1, respectively. After 6 hours the mean GCS and BIS values rose to 8.6 ± 4.0 and 52.4 ± 10.3 and after 12 hours to 9.7 ± 3.4 and 61.3 ± 15.7 respectively. Eye opening in response to a voice occurred at a mean of 8.9 ± 6.7 hours after arrival in the intensive care unit regardless of graft function. The mean GCS and BIS values were 10.6 ± 2.8 and 69.1 ± 13.5, respectively. The endotracheal tube was removed after a median of 140 hours; 9 patients required a tracheostomy. Among them 2 died within the first 3 months after OLT. CONCLUSIONS BIS monitoring is a noninvasive, simple, easy-to-interpret method to measure consciousness among patients intubated with an endotracheal tube.
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Namgoong JM, Hwang S, Ahn CS, Kim KH, Moon DB, Ha TY, Song GW, Jung DH, Park GC, Park HW, Park CS, Park YH, Kang SH, Jung BH, Lee SG. A pilot study on the safety and efficacy of generic mycophenolate agent as conversion maintenance therapy in stable liver transplant recipients. Transplant Proc 2014; 45:3035-7. [PMID: 24157030 DOI: 10.1016/j.transproceed.2013.08.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE The patent covering mycophenolate mofetil (MMF) in Korea has expired and, thus, several generic MMF agents are now commercially available. The supply of Cellcept (Roche Korea) was interrupted at the end of 2011, so it was inevitable that a generic MMF would be used instead. During this period, we performed a prospective pilot study to examine the safety and efficacy of a generic mycophenolate agent (Myconol: Hanmi Pharmaceutical, Seoul Korea) for use as conversion maintenance therapy in stable liver transplantation (OLT) recipients. METHODS OLT recipients, who were treated with MMF on an outpatient basis from January 2012 to March 2012, attended follow-up interviews conducted. The patients had undergone OLT ≥ 2 years before the study, had tolerated Cellcept, and showed stable liver function. Fifty-three patients were followed up for more than 3 months after conversion to the same dose of Myconol. RESULTS After conversion to Myconol, 6 patients (11.3%) experienced new side effects, which disappeared when they reverted to Cellcept (n = 5) or stopped taking Myconol medication (n = 1). The side effects associated with Myconol included gastrointestinal symptoms (indigestion and diarrhea; n = 3), skin eruptions (n = 1), pruritus (n = 1), and insomnia (n = 1). The mean mycophenolic acid levels were 1.71 ± 0.88 μg/mL for Cellcept and 1.83 ± 0.91 μg/mL for Myconol, which showed a strong correlation (r(2) = 0.92, P < .001). CONCLUSIONS Myconol showed similar pharmacokinetics to those of Celcept, but a small proportion of patients experienced agent-specific side effects; therefore, patients should be closely monitored when taking Myconol. Also, further studies, with a greater number of patients, are required to identify the full spectrum of drug-associated side effects.
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Choi YI, Hwang S, Park GC, Namgoong JM, Jung DH, Song GW, Ha TY, Moon DB, Kim KH, Ahn CS, Lee SG. Clinical outcomes of Pneumocystis carinii pneumonia in adult liver transplant recipients. Transplant Proc 2014; 45:3057-60. [PMID: 24157035 DOI: 10.1016/j.transproceed.2013.08.074] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Pneumocystis carinii pneumonia (PCP) is an opportunistic infection associated with morbidity and mortality in solid-organ transplant recipients. We retrospectively assessed the characteristics and outcomes of liver transplant (OLT) recipients with PCP compared with those of patients with severe non-P carinii pneumonia (non-PCP) who required intensive care with mechanical ventilation. METHODS During the 2-year period between January 2008 and December 2009, 43 adult OLT recipients had severe pneumonia requiring mechanical ventilation; of these, 8 (19%) had PCP. During this period, routine antibiotic prophylaxis was administered for the first 6 months after OLT. RESULTS The median period from OLT to development of PCP was 9.5 months (range, 1-67); the 1-year incidence was 0.9%. The 6 and 6 to 12-month incidences of non-PCP were 4.2% and 0.3%, respectively, and those of PCP were 0.3% and 0.6%, respectively. Four of 8 patients (50%) in the PCP group had a recent history of a rejection episode. PCP was associated with a higher incidence of prior antirejection treatment. There were no significant differences between PCP and non-PCP groups in age, gender, preoperative Model for End-stage Liver Disease score, primary diagnosis, graft type, and total number of rejection episodes. CONCLUSIONS These results indicate that the risk of PCP in OLT recipients is closely related to strong immunosuppressive treatment for acute cellular rejection episodes, suggesting the importance of PCP prophylaxis in these patients. Because most patients developed PCP at around 1 year, it may be advisable to prolong routine post-OLT PCP prophylaxis for 12 months, especially among patients receiving antirejection treatment.
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Park GC, Hwang S, Ahn CS, Kim KH, Moon DB, Ha TY, Song GW, Jung DH, Shin YW, Kim SH, Chang KH, Namgoong JM, Park CS, Park HW, Park YH, Kang SH, Jung BH, Lee SG. Analysis of S gene mutation of the hepatitis B virus in adult liver transplant recipients showing resistance to hepatitis B immunoglobulin therapy. Transplant Proc 2014; 45:3047-51. [PMID: 24157033 DOI: 10.1016/j.transproceed.2013.08.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND A considerable proportion of recipients of liver transplantations who are presented hepatitis B immunoglobulin (HBIG) monotherapy for hepatitis B virus (HBV) prophylaxis develop HBIG resistance. In this study, we investigated the mutation patterns in the major hydrophilic region (MHR) of amino acid sequences 100 to 160. METHODS Using the gene sequence analyzer for amino acid sequences 0 to 226 in the S/pre-S region we analyzed blood samples of 15 patients showing HBIG resistance after high-dose HBIG prophylaxis. RESULTS Various mutations in the MHR were observed in 14/15 samples: Gly145Arg mutation in 8/13 Adr subtype and 1/2 Ayw subtype samples (60%). The next most common mutation was Gly165Trp in 8/13 Adr subtype but neither of 2 Ayw subtype samples (53.3%). Concurrent antiviral resistance was noted in 5 patients: lamivudine (n = 5), or entecavir (n = 3), but not adefovir, suggesting the occurrence of simultaneous, antiviral cross-resistances. Two patients underwent retransplantation due to the progression of HBV infection despite vigorous antiviral therapy. At diagnosis of HBV recurrence, the mean HBV DNA load was 6.5 × 10(6) copies/mL; 4 patients showed paradoxical coexistence of anti-HBs and HBsAg. Currently, 2 subjects show low-level HBV DNA replication in peripheral blood, although the other 12 had no DNA replication after prolonged antiviral therapy. CONCLUSIONS This study suggested that various mutations in the "a" determinant were associated with HBIG resistance. Since treatment failure to rescue antiviral therapy was often associated with delayed detection of HBV recurrence rather than concurrent antiviral resistance, frequent HBV surveillance using more sensitive screening tests, such as HBeAg and HBV DNA polymerase chain reaction assay, seems to be mandatory.
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Park HW, Hwang S, Ahn CS, Kim KH, Moon DB, Ha TY, Song GW, Jung DH, Park GC, Namgoong JM, Park CS, Park YH, Kang SH, Jung BH, Lee SG. Long-term survival outcomes for living donor liver transplant recipients with pathologically nonviable hepatocellular carcinoma. Transplant Proc 2014; 45:3032-4. [PMID: 24157029 DOI: 10.1016/j.transproceed.2013.08.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Complete necrosis of hepatocellular carcinoma (HCC) lesions has occasionally been found by explant pathology after pretransplant neoadjuvant treatment. This study sought to investigate the long-term prognostic effect of loss of tumor viability after HCC treatment in living donor liver transplant (LDLT) recipients. METHODS We reviewed retrospectively the 5-year records of 37 patients who demonstrated nonviable HCC on explant pathology. RESULTS The most common primary disease was hepatitis-B-virus-associated liver cirrhosis (n = 34). Single explant tumors were found in 29 patients; the mean maximal tumor size was 2.1 ± 0.9 cm (range: 0.8-4.0). No patients showed microvascular invasion. The median level of alpha-fetoprotein was 12 ng/mL (range: 1-1160). The 1 patient who showed a recurrence at 20 months remains alive more than 6 years after adrenalectomy and repeated pulmonary metastasectomy. The 5-year HCC recurrence rate was thus 2.1%. There were 2 late mortalities, each due to graft failure and recurrent gastric cancer. The overall patient survival rate was 97.3% at 5 and 92.7% at 10 years. CONCLUSIONS The results of this study revealed that the loss of tumor viability induced by pretransplant neoadjuvant treatment definitely decreased the risk of post-transplant HCC recurrence. Therefore, patients with nonviable HCC can be regarded as members of a superselect group with minimal risk for HCC recurrence, and may be exempted from routine HCC screening.
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Melenovsky V, Hwang S, Borlaug B. Adverse Effects of Interstitial Pulmonary Edema on Pulmonary Hemodynamics and Right Heart Function in Heart Failure. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.175] [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] Open
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Cho J, Oh S, Kim K, Namgung J, Kim D, Song G, Ha T, Moon D, Ahn C, Kim K, Hwang S, Lee S. Prevalence and Treatment of New-Onset Diabetes Mellitus After Liver Transplantation in Korean Children: A Single-Center Study. Transplant Proc 2014; 46:873-5. [DOI: 10.1016/j.transproceed.2013.11.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 11/22/2013] [Indexed: 11/30/2022]
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Ahn CS, Hwang S, Kim KH, Moon DB, Ha TY, Song GW, Jung DH, Park GC, Kang SH, Jung BH, Kim N, Lee SG. Long-Term Outcome of Living Donor Liver Transplantation for Patients With Alcoholic Liver Disease. Transplant Proc 2014; 46:761-6. [DOI: 10.1016/j.transproceed.2013.12.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 11/30/2013] [Accepted: 12/11/2013] [Indexed: 12/14/2022]
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Moon DB, Lee SG, Hwang S, Kim KH, Ahn CS, Ha TY, Song GW, Jung DH, Park GC, Namkoong JM, Park HW, Park YH, Park CS. Toward more than 400 liver transplantations a year at a single center. Transplant Proc 2014; 45:1937-41. [PMID: 23769078 DOI: 10.1016/j.transproceed.2012.12.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Accepted: 12/04/2012] [Indexed: 12/30/2022]
Abstract
BACKGROUND For the first time at Asan Medical Center (AMC) we performed more than 400 liver transplantations (LTs) per year in 2011, despite same number of living donor liver transplantations (LDLTs). METHODS Our OLT program was started in 1992, but not activated well due to the scarcity of deceased donor organs. Since adult LDLTs using a left lobe and then a right lobe were successfully performed in 1997, we have developed several innovative techniques and approaches for adult LDLT, for example, modified right-lobe graft reconstructing middle hepatic branches in 1998, dual graft LDLT using 2 left lobes in 2000; new criteria for hepatocellular carcinoma (HCC); as well as ABO-incompatible LDLT, the first in the world. As a result, the number of LDLTs has increased rapidly but reached a plateau recently. Nationwide efforts to promote deceased donation increased the number of deceased donor liver transplantation (DDLT). RESULTS We have performed 317 LDLTs per year in 2010 and 2011, respectively. The number of LTs reached 403 in 2011. This large number was possible due to a remarkable increase of DDLTs from 50 in 2010 to 86 in 2011. Seventy-nine patients (68.1%) among 116 patients (28.8%) required an urgent LT receiving a DDLT. LT for HCC or ABO-mismatch comprised 50.3% (n = 150) or 8.7% (n = 35), respectively. In-hospital mortality rate in 2011 was 4.7%. CONCLUSIONS The increased LTs number at AMC was aided by the nationwide campaign.
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Celebi ME, Hwang S, Wen Q. Colour quantisation using the adaptive distributing units algorithm. THE IMAGING SCIENCE JOURNAL 2014. [DOI: 10.1179/1743131x13y.0000000059] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Mortensen E, Hellinger W, Keller C, Cowan LS, Shaw T, Hwang S, Pegues D, Ahmedov S, Salfinger M, Bower WA. Three cases of donor-derived pulmonary tuberculosis in lung transplant recipients and review of 12 previously reported cases: opportunities for early diagnosis and prevention. Transpl Infect Dis 2014; 16:67-75. [PMID: 24383414 DOI: 10.1111/tid.12171] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 03/05/2013] [Accepted: 05/29/2013] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Solid organ transplant recipients have a higher frequency of tuberculosis (TB) than the general population, with mortality rates of approximately 30%. Although donor-derived TB is reported to account for <5% of TB in solid organ transplants, the source of Mycobacterium tuberculosis infection is infrequently determined. METHODS We report 3 new cases of pulmonary TB in lung transplant recipients attributed to donor infection, and review the 12 previously reported cases to assess whether cases could have been prevented and whether any cases that might occur in the future could be detected and investigated more quickly. Specifically, we evaluate whether opportunities existed to determine TB risk on the basis of routine donor history, to expedite diagnosis through routine mycobacterial smears and cultures of respiratory specimens early post transplant, and to utilize molecular tools to investigate infection sources epidemiologically. FINDINGS On review, donor TB risk was present among 7 cases. Routine smears and cultures diagnosed 4 asymptomatic cases. Genotyping was used to support epidemiologic findings in 6 cases. CONCLUSION Validated screening protocols, including microbiological testing and newer technologies (e.g., interferon-gamma release assays) to identify unrecognized M. tuberculosis infection in deceased donors, are warranted.
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Warrier SK, Hwang S, Koh C, Shepherd H, Mak C, Carmalt H, Solomon M. Abstract P2-18-06: Preservation or division of the intercostobrachial nerve in axillary dissection for breast cancer: Meta-analysis of randomised controlled trials. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p2-18-06] [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
Purpose: Management of the ICBN during axillary dissection is controversial and the division of ICBN is often trivialised.The effect of dividing the ICBN, and its association with sensory disturbance, is unclear. A systemic review and meta-analysis was performed to evaluate the effect of preserving the ICBN during axillary dissection.
Methods: A systemic literature review and meta-analysis was performed according to the PRISMA and Cochrane Collaboration guidelines. Two authors (SW and SH) independently searched Medline, Pubmed, Embase, Cochrane Database of Systemic Reviews and the Cochrane Controlled Trials Register from 1950 to December 2012 for studies comparing preservation or division of the ICBN in axillary dissection for breast cancer. The primary outcome of this meta-analysis was sensory disturbance, defined as objectively assessed change in sensation in the distribution of the ICBN after axillary dissection. The nature of sensory disturbance was assessed as a secondary outcome, categorised into two types: “hypersensitivity” and “hyposensitivity”.
Results: Three RCTs and four non-RCTs were reviewed. A meta-analysis demonstrated that the incidence of sensory disturbance was significantly lower with preservation of ICBN compared to division of the ICBN with Mantel-Haenzel combined odds ratio 0.31 (0.17-0.57, 95% CI). There was relatively low level of heterogeneity (I2 = 19%, c2 = 2.48, df = 2).
The sensory disturbance was more likely to be hyposensitivity when compared to hypersensitivity (p <0.0001). No difference on number of lymph nodes dissected or operating time was noted.
Conclusion: This meta-analysis demonstrates that division of the ICBN is associated with higher risk of sensory disturbance, and that the nature of this sensory disturbance is more likely to be hyposensitivity, attributable to reduced nerve function.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-18-06.
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Acerbi I, Hwang S, Munson J, Au A, Zheng S, Yu H, Mouw J, Lakins J, Swartz M, Shi Q, Liphardt J, Ruffell B, Coussen LM, Yunn-Yi C, Weaver VM. Abstract S2-06: Extracellular matrix stiffness modulates tissue inflammation to promote breast tumor aggression. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-s2-06] [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
Tumor progression is influenced by the dynamic interplay between the genetically-modified epithelium and the associated microenvironment. We previously showed that the extra-cellular matrix (ECM) progressively stiffens as mammary tumors evolve, and that stiffening the ECM promotes malignant transformation while inhibiting ECM stiffening reduces tumor progression (Levental et al., 2009; reviewed in Butcher et al., 2009). Yet breast cancers also exhibit elevated influx of inflammatory cells and tissue inflammation promotes tumor progression by fostering angiogenesis and enhancing tumor cell growth and motility (Ruffell et al., 2011). Tumor-associated macrophages additionally stimulate stromal fibroblasts, implying that tissue inflammation could promote malignancy by stiffening the ECM. To address this possibility, we explored the relationship between ECM tension and macrophages in human breast cancer and during mammary tumor development in transgenic mice. Using fresh and archived tissue samples, we quantified a progressive increase in ECM remodeling and stiffening as human breast tumors and mouse mammary cancers developed. We found that the ECM associated with triple negative breast cancers was almost twice as stiff as the ECM adjacent to ER+/PR+ tumors and that ECM stiffness correlated significantly with increased numbers of infiltrating activated macrophages. Consistently, we established a positive correlation between tumor progression, elevated mechanosignaling, ECM stiffness and tissue inflammation in both human and mouse tissue. However surprisingly, when macrophages were depleted from the mammary glands of MMTV-PyMT tumors, ECM tension did not change. Instead we found that inhibiting lysyl oxidase activity to decrease collagen cross-linking and ECM stiffness reduced the activation state of the macrophages within the mammary glands of 14-week old mice. Consistently, in vitro studies showed that ECM tension potentiates the expression of pro-inflammatory chemokines and increases levels of phosphoStat3 and that ECM tension directly modifies macrophage polarity. These findings suggest that ECM tension may promote malignancy either by directly regulating macrophage activity or indirectly through enhancing expression of pro-inflammatory chemokines. Further studies are now underway to explore these findings and to clarify their impact on tumor progression and response to therapy.
Acknowledgements: supported by W81XWH-05-1-0330 and R01 CA138818-01A1 to VMW, 1U01 ES019458-01 to VMW and ZW, and P50 CA 58207 to JG, VW, SH and LC, U54CA143836-01 to JL and VW, and Susan G. Komen for the Cure PSF12230246 to IA.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr S2-06.
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McGuire KP, De Los Santos JF, Cantor A, Forero A, Golshan M, Meric-Bernstam F, Horton JK, Amos KD, Hudis CA, Hylton NM, Meszoely IM, Nanda R, Hwang S. Abstract P1-01-04: Nodal patterns of care in patients with invasive breast cancer treated with neoadjuvant systemic therapy: Results of a secondary analysis of TBCRC 017. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p1-01-04] [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: Neoadjuvant chemotherapy (NCT) to downstage locally advanced tumors and potentially allow breast conservation has increased. In parallel, the use of sentinel lymph node biopsy (SNB) and axillary node dissection has evolved. This analysis reports patterns of care for axillary evaluation at 8 NCI Comprehensive Cancer Centers in women receiving NCT.
Methods: Between 2002 and 2010, 770 women were retrospectively identified as having received NCT, 758 of who had nodal imaging either before or after NCT. Clinical, pathologic, and treatment data were collected. Univariate and multivariate analyses of covariates associated with axillary management were performed using logistic regression (SAS 9.2, Proc Logistic).
Results: Between 2002 and 2010, the odds of receiving a post-NCT SNB increased by 8% per year (p<0.001). Rates of post-NCT SNB were significantly different in only one of eight institutions (p<0.001), where pre-NCT nodal evaluation was made by SNB. The remainder of institutions used SNB following NCT. Of those who underwent post-NCT SNB, regardless of nodal status pre-NCT, 55% (171/314) had axillary lymph node dissection (ALND). Prior to NCT, 74% (564/758) of patients exhibited at least one abnormal lymph node on pretreatment imaging.
Imaging modalities used pretreatment to assess axillary lymph nodes Suspicious Nodes N (%)Ultrasound24 (4.3)Ultrasound+MRI218 (38.7)Ultrasound +MRI+CT103 (18.3)Ultrasound+MRI+CT+PET39 (6.9)Ultrasound+MRI+PET9 (1.6)Ultrasound+CT12 (2.1)Ultrasound+CT+PET8 (1.4)Ultrasound+PET3 (0.5)MRI36 (6.4)MRI+CT58 (10.3)MRI+CT+PET21 (3.7)MRI+PET9 (1.6)CT18 (3.2)CT+PET3 (0.5)CT+PET3 (0.5)TOTAL564 (100)
Of those, 52% (291/564) of the lymph nodes were sampled using fine needle aspiration (FNA) and 27% (149/564) were sampled with CNB. Odds of undergoing a core needle biopsy (CNB) at presentation for radiographically or clinically suspicious lymph nodes increased by 27% per year (p<0.001). 57% (322/564) of all sampled lymph nodes were positive for malignant cells by either FNA or CNB. Of those with confirmed positive nodes at diagnosis, 26% (83/322) had nodal sampling with SNB after NCT. Of the 462 patients with pretreatment MRI suggesting an abnormal lymph node, 155 (33.5%) had a complete imaging response in the lymph nodes by MRI. Of those patients 32% (49/155) had SNB as their initial axillary evaluation after NCT, of which 45% (22/49) of those exhibited persistently positive nodes and underwent completion axillary node dissection.
Conclusions: Among a contemporary cohort of women receiving NCT, a significant trend was observed towards increased use of needle biopsy for patients with abnormal pretreatment nodal imaging at presentation and sentinel lymph node biopsy after NCT nodal evaluation. A trend was also observed over time towards greater use of post-NCT SNB in patients with confirmed pathologic positive nodes at presentation. These data demonstrate a trend towards less invasive assessment of suspicious lymph nodes both before and after NCT.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-01-04.
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Lorizio W, Luttgen M, Marks J, Wilderman E, Bethel K, Kuhn P, Hwang S. Abstract P4-03-05: Characterization of circulating tumor cells identified by high definition assay in patients with benign and malignant breast disease. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p4-03-05] [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: Identification of circulating tumor cells (CTC) has the potential for minimally invasive diagnosis and assessment of therapy response. Current CTC assay techniques rely on immunomagnetic bead isolation for CTC enrichment. However, these methods result in low cell yield, limiting the potential use in early stage where CTCs are thought to be less abundant. The high definition (HD)-CTC assay is a novel non-enrichment assay providing unique opportunities to identify single circulating epithelial cells (CepiCs) in patients before or at diagnosis. This study's goal is to determine feasibility and performance of the HD-CTC method for isolating CepiCs in women presenting for diagnostic breast biopsy. Methods: Women undergoing image-guided biopsy for BIRADS 4 and 5 mammographic abnormalities were selected from April 2012 onward at the Duke Breast Clinic. After obtaining informed consent, sample collection and shipping procedures were performed following specific standard operating procedures. Diagnosis was kept blinded during assay analysis. Quantitative measurements were used at the single-cell level to identify and enumerate CepiCs. We morphologically characterized specific high content screening variables including cytokeratin (CK) intensity and epithelial cell adhesion molecule (EpCAM) staining. Measurements included cellular size, shape, and staining pattern. For each draw, 4 monochrome images per frame from 4 stained slides were used for CK/EpCAM evaluation. Results: To date 34 women have been enrolled. Fourteen samples (41%) were drawn before biopsy and 20 (59%) after. Out of the 20, 2 (10%) were non-evaluable and a total of 18 (90%) have HD-CTC assay derived data available. The average diagnosis age was 54; 70% were Caucasian. Six (33%) out of 18 had benign disease (fibrocystic, fibroadenoma and apocrine), 10 (55%) had invasive (ductal or lobular), and 2 (12%) had atypical ductal hyperplasia and ductal carcinoma in situ. Five (83%) benign cases and 4 (40%) invasive had detectable CepiCs (Fisher exact test = 0.43). We found a borderline significant trend between the number of CepiCs and the nodes involved (P for trend = 0.06). No association found with ER, PR or ERBB2 status. The mean number of CepiCs/mL in invasive cases was 45.25 +/-96.65 (range 0 to 270.6) compared to 17.47 CepiCs/mL +/-27.8 (range 0 to 72.3) in benign. Additionally, all the CK(+) morphologically distinct cells were EpCAM(-). There is no significant difference between benign and malignant cases when analyzing draws after biopsy. Conclusion: HD-CTC technology is feasible for detection of CepiCs in early stage breast cancer, and in some cases, results in retrieval of a large number of them. Additional technology refinements including determination of appropriate thresholds are needed to improve discrimination of cancer patients from non-cancer, and follow up will help determine whether HD-CTC assay derived enumeration and characterization of CepiCs are associated with prognosis. These early results are promising and ongoing studies at Duke with TSRI will further evaluate the role of CepiCs in early stage breast cancer along with the isolation and analysis of DNA from single-CepiCs. New data will be available by time of presentation.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-03-05.
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Kline JA, Watts J, Courtney D, Lee YY, Hwang S. Severe pulmonary embolism decreases plasma L-arginine. Eur Respir J 2013; 43:906-9. [DOI: 10.1183/09031936.00171913] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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NEURO/MEDICAL ONCOLOGY. Neuro Oncol 2013; 15:iii98-iii135. [PMCID: PMC3823897 DOI: 10.1093/neuonc/not182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/14/2023] Open
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S, Shin M, Saito N, Ozawa T, Riester M, Cheng YK, Huse J, Helmy K, Charles N, Squatrito M, Michor F, Holland E, Perrech M, Dreher L, Rohn G, Goldbrunner R, Timmer M, Pollo B, Palumbo V, Calatozzolo C, Patane M, Nunziata R, Farinotti M, Silvani A, Lodrini S, Finocchiaro G, Lopez E, Rioscovian A, Ruiz R, Siordia G, de Leon AP, Rostomily C, Rostomily R, Silbergeld D, Kolstoe D, Chamberlain M, Silber J, Roth P, Keller A, Hoheisel J, Codo P, Bauer A, Backes C, Leidinger P, Meese E, Thiel E, Korfel A, Weller M, Saito K, Mukasa A, Nagae G, Nagane M, Aihara K, Takayanagi S, Tanaka S, Aburatani H, Saito N, Salama S, Sanborn JZ, Grifford M, Brennan C, Mikkelsen T, Jhanwar S, Chin L, Haussler D, Sasayama T, Tanaka K, Nakamizo S, Nishihara M, Tanaka H, Mizukawa K, Kohmura E, Schliesser M, Grimm C, Weiss E, Claus R, Weichenhan D, Weiler M, Hielscher T, Sahm F, Wiestler B, Klein AC, Blaes J, Weller M, Plass C, Wick W, Stragliotto G, Rahbar A, Soderberg-Naucler C, Sulman E, Won M, Ezhilarasan R, Sun P, Blumenthal D, Vogelbaum M, Colman H, Jenkins R, Chakravarti A, Jeraj R, Brown P, Jaeckle K, Schiff D, Dignam J, Atkins J, Brachman D, Werner-Wasik M, Gilbert M, Mehta M, Aldape K, Terashima K, Shen J, Luan J, Yu A, Suzuki T, Nishikawa R, Matsutani M, Liang Y, Man TK, Lau C, Trister A, Tokita M, Mikheeva S, Mikheev A, Friend S, Rostomily R, van den Bent M, Erdem L, Gorlia T, Taphoorn M, Kros J, Wesseling P, Dubbink H, Ibdaih A, Sanson M, French P, van Thuijl H, Mazor T, Johnson B, Fouse S, Heimans J, Wesseling P, Ylstra B, Reijneveld J, Taylor B, Berger M, Chang S, Costello J, Prabowo A, van Thuijl H, Scheinin I, van Essen H, Spliet W, Ferrier C, van Rijen P, Veersema T, Thom M, Meeteren ASV, Reijneveld J, Ylstra B, Wesseling P, Aronica E, Kim H, Zheng S, Mikkelsen T, Brat DJ, Virk S, Amini S, Sougnez C, Chin L, Barnholtz-Sloan J, Verhaak RGW, Watts C, Sottoriva A, Spiteri I, Piccirillo S, Touloumis A, Collins P, Marioni J, Curtis C, Tavare S, Weiss E, Grimm C, Schliesser M, Hielscher T, Claus R, Sahm F, Wiestler B, Klein AC, Blaes J, Tews B, Weiler M, Weichenhan D, Hartmann C, Weller M, Plass C, Wick W, Yeung TPC, Al-Khazraji B, Morrison L, Hoffman L, Jackson D, Lee TY, Yartsev S, Bauman G, Zheng S, Fu J, Vegesna R, Mao Y, Heathcock LE, Torres-Garcia W, Ezhilarasan R, Wang S, McKenna A, Chin L, Brennan CW, Yung WKA, Weinstein JN, Aldape KD, Sulman EP, Chen K, Koul D, Verhaak RGW. OMICS AND PROGNSTIC MARKERS. Neuro Oncol 2013; 15:iii136-iii155. [PMCID: PMC3823898 DOI: 10.1093/neuonc/not183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
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Arakawa Y, Fujimoto KI, Murata D, Nakamoto Y, Okada T, Miyamoto S, Bahr O, Harter PN, Weise L, You SJ, Ronellenfitsch MW, Rieger J, Steinbach JP, Hattingen E, Bahr O, Jurcoane A, Daneshvar K, Pilatus U, Mittelbronn M, Steinbach JP, Hattingen E, Carrillo J, Bota D, Handwerker J, Su LMY, Chen T, Stathopoulos A, Yu H, Chang JH, Kim EH, Kim SH, Mi, Yun J, Pytel P, Collins J, Choi Y, Lukas R, Nicholas M, Colen R, Jafrani R, Zinn P, Colen R, Ashour O, Zinn P, Colen R, Vangel M, Gutman D, Hwang S, Wintermark M, Jain R, Jilwan-Nicolas M, Chen J, Raghavan P, Holder C, Rubin D, Huang E, Kirby J, Freymann J, Jaffe C, Flanders A, Zinn P, Colen R, Ashour O, Zinn P, Colen R, Zinn P, Dahiya S, Statsevych V, Elson P, Xie H, Chao S, Peereboom D, Stevens G, Barnett G, Ahluwalia M, Daras M, Karimi S, Abrey L, Sanchez J, Beal K, Gutin P, Kaley T, Grommes C, Correa D, Reiner A, Briggs S, Omuro A, Verburg N, Hoefnagels F, Pouwels P, Boellaard R, Barkhof F, Hoekstra O, Wesseling P, Reijneveld J, Heimans J, Vandertop P, Zwinderman K, Hamer HDW, Elinzano H, Kadivar F, Yadav PO, Breese VL, Jackson CL, Donahue JE, Boxerman JL, Ellingson B, Pope W, Lai A, Nghiemphu P, Cloughesy T, Ellingson B, Pope W, Chen W, Czernin J, Phelps M, Lai A, Nghiemphu P, Liau L, Cloughesy T, Ellingson B, Leu K, Tran A, Pope W, Lai A, Nghiemphu P, Harris R, Woodworth D, Cloughesy T, Ellingson B, Pope W, Leu K, Chen W, Czernin J, Phelps M, Lai A, Nghiemphu P, Liau L, Cloughesy T, Ellingson B, Enzmann D, Pope W, Lai A, Nghiemphu P, Liau L, Cloughesy T, Eoli M, Di Stefano AL, Aquino D, Scotti A, Anghileri E, Cuppini L, Prodi E, Finocchiaro G, Bruzzone MG, Fujimoto K, Arakawa Y, Murata D, Nakamoto Y, Okada T, Miyamoto S, Galldiks N, Stoffels G, Filss C, Dunkl V, Rapp M, Sabel M, Ruge MI, Goldbrunner R, Shah NJ, Fink GR, Coenen HH, Langen KJ, Guha-Thakurta N, Langford L, Collet S, Valable S, Constans JM, Lechapt-Zalcman E, Roussel S, Delcroix N, Bernaudin M, Abbas A, Ibazizene E, Barre L, Derlon JM, Guillamo JS, Harris R, Bookheimer S, Cloughesy T, Kim H, Pope W, Yang K, Lai A, Nghiemphu P, Ellingson B, Huang R, Rahman R, Hamdan A, Kane C, Chen C, Norden A, Reardon D, Mukundan S, Wen P, Jafrani R, Zinn P, Colen R, Jafrani R, Zinn P, Colen R, Jancalek R, Bulik M, Kazda T, Jensen R, Salzman K, Kamson D, Lee T, Varadarajan K, Robinette N, Muzik O, Chakraborty P, Barger G, Mittal S, Juhasz C, Kamson D, Barger G, Robinette N, Muzik O, Chakraborty P, Kupsky W, Mittal S, Juhasz C, Kinoshita M, Sasayama T, Narita Y, Kawaguchi A, Yamashita F, Chiba Y, Kagawa N, Tanaka K, Kohmura E, Arita H, Okita Y, Ohno M, Miyakita Y, Shibui S, Hashimoto N, Yoshimine T, Ronan LK, Eskey C, Hampton T, Fadul C, LaMontagne P, Milchenko M, Sylvester P, Benzinger T, Marcus D, Fouke SJ, Lupo J, Bian W, Anwar M, Banerjee S, Hess C, Chang S, Nelson S, Mabray M, Sanchez L, Valles F, Barajas R, Rubenstein J, Cha S, Miyake K, Ogawa D, Hatakeyama T, Kawai N, Tamiya T, Mori K, Ishikura R, Tomogane Y, Ando K, Izumoto S, Nelson S, Lieberman F, Lupo J, Viziri S, Nabors LB, Crane J, Wen P, Cote A, Peereboom D, Wen Q, Cloughesy T, Robins HI, Fisher J, Desideri S, Grossman S, Ye X, Blakeley J, Nonaka M, Nakajima S, Shofuda T, Kanemura Y, Nowosielski M, Wiestler B, Gobel G, Hutterer M, Schlemmer H, Stockhammer G, Wick W, Bendszus M, Radbruch A, Perreault S, Yeom K, Ramaswamy V, Shih D, Remke M, Luu B, Schubert S, Fisher P, Partap S, Vogel H, Poussaint TY, Taylor M, Cho YJ, Piludu F, Pace A, Fabi A, Anelli V, Villani V, Carapella C, Marzi S, Vidiri A, Pungavkar S, Tanawde P, Epari S, Patkar D, Lawande M, Moiyadi A, Gupta T, Jalali R, Rahman R, Akgoz A, You H, Hamdan A, Seethamraju R, Wen P, Young G, Rao A, Rao G, Flanders A, Ghosh P, Rao G, Martinez J, Rao A, Roh TH, Kim EH, Chang JH, Kushnirsky M, Katz J, Knisely J, Schulder M, Steinklein J, Rosen L, Warshall C, Nguyen V, Tiwari P, Rogers L, Wolansky L, Sloan A, Barnholtz-Sloan J, Tatsauka C, Cohen M, Madabhushi A, Rachinger W, Thon N, Haug A, Schuller U, Schichor C, Tonn JC, Tran A, Lai A, Li S, Pope W, Teixeira S, Harris R, Woodworth D, Nghiemphu P, Cloughesy T, Ellingson B, Villanueva-Meyer J, Barajas R, Mabray M, Barani I, Chen W, Shankaranarayanan A, Koon P, Cha S, Wen Q, Elkhaled A, Essock-Burns E, Molinaro A, Phillips J, Chang S, Cha S, Nelson S, Wolf D, Ye X, Lim M, Zhu H, Wang M, Quinones-Hinojosa A, Weingart J, Olivi A, van Zijl P, Laterra J, Zhou J, Blakeley J, Zakaria R, Das K, Sluming V, Bhojak M, Walker C, Jenkinson MD, (Tiger) Yuan S, Tao R, Yang G, Chen Z, Mu D, Zhao S, Fu Z, Li W, Yu J. RADIOLOGY. Neuro Oncol 2013; 15:iii191-iii205. [PMCID: PMC3823904 DOI: 10.1093/neuonc/not189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/14/2023] Open
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Kim N, Park PJ, Jung MK, Song GW, Jung DH, Lee SG, Ahn CS, Hwang S. Differential function of natural killer cells in the liver graft perfusate of Korean population. Transplant Proc 2013; 45:2886-91. [PMID: 24156998 DOI: 10.1016/j.transproceed.2013.08.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Liver perfusate (LP) lymphocytes show unique subsets compared with peripheral blood (PB) lymphocytes. LP natural killer (NK) and NKT cells may display unique cytotoxicity and cytokine production, thus leading to distinct roles in liver transplantation. In this study, we sought to evaluate the functions of graft perfusate NK and NKT cells in clinical liver transplantation. METHODS The living donor right lobe graft was initially washed with 1 L of histidine-tryptophan-ketoglutarate solution to collect the perfusate. We also collected donor PB. Lymphocytes separated by the Ficoll-Hypaque density gradient method underwent immunophenotyping using multicolor flow cytometry. To assess cytokine secretion, we performed the enzyme-linked immunosorbent assay. RESULTS There were more NK and NKT cells in LP confirming previous reports. In particular, CD56(bright)CD16(low) NK cells accounted for approximately 50% of total NK cells compared with 5% to 10% among PB NK cells. In response to cytokine stimulation LP NK cells produce tumor necrosis factor-α at different levels and less interleukin-10 compared with PB NK cells. The major source of interferon-γ production upon stimulation with liver caner cells were CD56(dim) NK cells and CD56(-)CD3(-) cells rather than NKT or T cells. Unlike PB NK cells, LP CD56(bright)CD16(low) NK cells along with CD56(dim)CD16(high) NK cells and NKT cells were efficient killers against Korean liver cancer cells. CONCLUSION LP NK and NKT cells showed unique functions in cytotoxicity and cytokine production.
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Kang SH, Hwang S, Jung DH, Ahn CS, Moon DB, Ha TY, Song GW, Kim KH, Park GC, Namgoong JM, Park YH, Park HW, Jung BH, Lee SG. Unification venoplasty to cope with recipient portal vein anomaly during living donor liver transplantation. Transplant Proc 2013; 45:3000-4. [PMID: 24157023 DOI: 10.1016/j.transproceed.2013.08.073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To cope with recipient portal vein (PV) anomalies, such as early branching of the right posterior section (RPS), during living donor liver transplantation (LDLT) surgery, we performed a simulation study to standardize the surgical technique for unification portal venoplasty. METHODS This study included an observational analysis of conventional methods utilizing RPS PV, simulation-based design of a new surgical technique, and clinical application of this new technique. RESULTS In a case encountering RPS PV, a mild anastomotic PV stenosis was persistent over 6 months postsurgery, indicating the need for technical refinement. After computational simulation analysis, we found that simple suturing of the PV branch patch automatically resulted in a funnel-shaped elongation. A prospective recipient study (n = 30) indicated that usual PV reconstruction via the PV bifurcation method is feasible in the absence of unusual donor or recipient PV anomaly. Retrospective living donor PV anatomy analysis (n = 20) revealed that 20-mm-long limbs of the first-order PV branches are necessary to make a 10- to l5-mm-long funneled PV stump. This technique of unification venoplasty for an anomalous recipient PV was applied to an adult patient undergoing LDLT with a right liver graft, for which it was shown to be technically feasible and effective. CONCLUSIONS A simplified unification venoplasty technique was developed to cope with a recipient PV anomaly in adult LDLT.
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Hwang S, Sarna LK, Siow YL, K O. High Fat Diet Disrupts Homocysteine Metabolism. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Hwang S, Moon DB, Ahn CS, Kim KH, Ha TY, Song GW, Jung DH, Park GC, Lee H, Lee Y, Chung YH, Abdulkarim B, Lee SG. Risk-Based Long-Term Screening for Hepatocellular Carcinoma Recurrence After Living Donor Liver Transplantation. Transplant Proc 2013; 45:3076-84. [DOI: 10.1016/j.transproceed.2013.08.068] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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