1
|
Sanchez CE, Barry C, Sabhlok A, Russell K, Majors A, Kollins SH, Fuemmeler BF. Maternal pre-pregnancy obesity and child neurodevelopmental outcomes: a meta-analysis. Obes Rev 2018; 19:464-484. [PMID: 29164765 PMCID: PMC6059608 DOI: 10.1111/obr.12643] [Citation(s) in RCA: 148] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/18/2017] [Accepted: 10/12/2017] [Indexed: 12/29/2022]
Abstract
This review examined evidence of the association between maternal pre-pregnancy overweight/obesity status and child neurodevelopmental outcomes. PubMed and PsycINFO databases were systematically searched for empirical studies published before April 2017 using keywords related to prenatal obesity and children's neurodevelopment. Of 1483 identified papers, 41 were included in the systematic review, and 32 articles representing 36 cohorts were included in the meta-analysis. Findings indicated that compared with children of normal weight mothers, children whose mothers were overweight or obese prior to pregnancy were at increased risk for compromised neurodevelopmental outcomes (overweight: OR = 1.17, 95% CI [1.11, 1.24], I2 = 65.51; obese: OR = 1.51; 95% CI [1.35, 1.69], I2 = 79.63). Pre-pregnancy obesity increased the risk of attention deficit-hyperactivity disorder (OR = 1.62; 95% CI [1.23, 2.14], I2 = 70.15), autism spectrum disorder (OR = 1.36; 95% CI [1.08, 1.70], I2 = 60.52), developmental delay (OR = 1.58; 95% CI [1.39, 1.79], I2 = 75.77) and emotional/behavioural problems (OR = 1.42; 95% CI [1.26, 1.59], I2 = 87.74). Given the current obesity prevalence among young adults and women of childbearing age, this association between maternal obesity during pregnancy and atypical child neurodevelopment represents a potentially high public health burden.
Collapse
Affiliation(s)
- C E Sanchez
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - C Barry
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - A Sabhlok
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - K Russell
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - A Majors
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - S H Kollins
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - B F Fuemmeler
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
2
|
Bykovskaja SN, Buffo MJ, Bunker M, Zhang H, Majors A, Herbert M, Lokshin A, Levitt ML, Jaja A, Scalise D, Kosiban D, Evans C, Marks S, Shogan J. Interleukin-2-induces development of denditric cells from cord blood CD34+ cells. J Leukoc Biol 1998; 63:620-30. [PMID: 9581807 DOI: 10.1002/jlb.63.5.620] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Dendritic cells (DC) have been shown to develop along a myeloid or lymphoid lineage of differentiation propagated from bone marrow or early thymic precursor cells with hematopoietic cytokines. In our study, we have induced growth and differentiation of DC from cord blood CD34+ cells initiated in interleukin-2 (IL-2) alone or in IL-2 + stem cell factor (SCF) + tumor necrosis factor alpha (TNF-alpha)-supplemented medium and cultured with IL-2 or IL-2 + SCF for 28-35 days. Dendritic morphology and antigenic phenotype of DC grown with IL-2 were characteristic for DC cultured in the presence of granulocyte-macrophage colony-stimulating factor (GM-CSF). Growth and differentiation of DC was followed by an increase in expression of MHC II and co-stimulating molecules CD80 and CD86. We have also shown the expression of the IL-2 receptor (IL-2R) gamma-chain in CD34+ cells after 2-3 days of culture with IL-2 alone. The co-expression of the IL-2R alpha, beta, and gamma subunits in both DC cultured with IL-2- or GM-CSF-containing cocktail of cytokines was also shown. The time curve for induction of IL-2R demonstrated low levels of subunit expression at the beginning of culture. The number of CD1a cells co-expressing CD25, CD122, and CDgamma increased to about 24-68 and to 78-95% after 21 and 28-35 days, respectively. Development of natural killer cells was shown along with DC. The proportion of CD56+ cells and cytotoxicity increased in a time-dependent manner.
Collapse
Affiliation(s)
- S N Bykovskaja
- Department of Laboratory Medicine, Cardiovascular Research, and Radiation Oncology of the Allegheny-Singer Research Institute, Allegheny University of the Health Sciences, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Majors A, Ehrhart LA, Pezacka EH. Homocysteine as a risk factor for vascular disease. Enhanced collagen production and accumulation by smooth muscle cells. Arterioscler Thromb Vasc Biol 1997; 17:2074-81. [PMID: 9351374 DOI: 10.1161/01.atv.17.10.2074] [Citation(s) in RCA: 182] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
An increased plasma homocysteine level is an independent risk factor for vascular disease. However, the pathological mechanisms by which homocysteine promotes atherosclerosis are not yet clearly defined. Arterial smooth muscle cells cultured in the presence of homocysteine grew to a higher density and produced and accumulated collagen at levels significantly above control values. Homocysteine concentrations as low as 50 mumol/L significantly increased both cell density and collagen production. Cell density increased by as much as 43% in homocysteine-treated cultures. Homocysteine increased collagen production in a dose-dependent manner. Smooth muscle cells treated with homocysteine at concentrations observed in patients with hyperhomocysteinemia had collagen synthesis rates as high as 214% of control values. Likewise, collagen accumulation in the cell layer was nearly doubled in homocysteine-treated cultures. Addition of aquacobalamin to homocysteine-treated cultures controlled the increase in smooth muscle cell proliferation and collagen production. These results indicate a cellular mechanism for the atherogenicity of homocysteine and provide insight into a potential preventive treatment.
Collapse
Affiliation(s)
- A Majors
- Department of Cell Biology, Cleveland Clinic Foundation, Ohio.
| | | | | |
Collapse
|
4
|
Abstract
Precise localization of the epileptogenic zone in patients suffering from mesial temporal lobe epilepsies is a prerequisite for surgery. For this purpose, a scheme for selecting the volume of interest in an oblique plane covering the head, body, and tail of the hippocampal formation (HF) was implemented in a water-suppressed proton chemical shift imaging (CSI) acquisition. This approach, evaluated by consecutively acquired CSI spectra of both temporal lobes, demonstrates that it can potentially be a routine technique for clinical diagnosis. Since the method produces localized spectral detail of the HF, it facilitates a convenient comparison of CSI lateralization to that assessed by HF atrophy (due to sclerosis) using the MRI-volumetry technique.
Collapse
Affiliation(s)
- M Xue
- MR Research Center, Cleveland Clinic Foundation, OH 44195, USA
| | | | | | | | | |
Collapse
|
5
|
Wang Y, Majors A, Najm I, Xue M, Comair Y, Modic M, Ng TC. Postictal alteration of sodium content and apparent diffusion coefficient in epileptic rat brain induced by kainic acid. Epilepsia 1996; 37:1000-6. [PMID: 8822700 DOI: 10.1111/j.1528-1157.1996.tb00539.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE We studied temporal changes of brain sodium and apparent diffusion coefficient (ADC) in a temporal lobe epilepsy (TLE) rat model using kainic acid (KA). METHODS In situ three-dimensional 23Na magnetic resonance imaging (MRI) and proton diffusion-weighted imaging (DWI) were used. KA at a dose of 10 mg/kg body weight and 12 adult Sprague Dawley rats weighing 228-318 g (268 +/- 25 g) were used. RESULTS Twenty-four hours after KA injection, magnetic resonance (MR) visible sodium levels increased in both the pyriform cortex (+90%) and amygdala (+68%) and increased insignificantly in the hippocampus (+18%) and caudate-putamen (12%). The ADC in the pyriform cortex showed a -9% decrease at 5 h postictally, reaching -30% at 24 h, whereas in the amygdala decreases were -8 and -26% respectively. A significant decrease in ADC (-7%) in the hippocampus was also observed 24 h postically. Seven days later, sodium increases persisted, whereas ADC returned to normal level. CONCLUSIONS The increase in MR visible sodium, associated with the decrease in ADC is consistent with the hypothesis that sequential seizures caused an increase in sodium influx and perturbation of membrane ion homeostasis, which eventually evolved into an irreversible phase of cellular edema, with increased MR visible intracellular sodium and decreased ADC. Return of ADC to near-control level and persistent high sodium level at 7 days may be explained by the increase in extracellular space and tissue necrosis.
Collapse
Affiliation(s)
- Y Wang
- Department of Radiology, Cleveland Clinic Foundation, OH 44195, USA
| | | | | | | | | | | | | |
Collapse
|
6
|
Abstract
PURPOSE Anastomotic intimal hyperplasia is characterized by smooth muscle cell (SMC) proliferation, but its final form is predominantly extracellular matrix. The purpose of this study was to compare collagen synthesis from graft SMC to that from adjacent native arterial SMC. METHODS Thoracoabdominal bypass grafts were excised 20 weeks after implantation into canine models. SMC harvested from six anastomotic graft segments and adjacent native aorta were passaged twice, grown to near-confluence, and then assayed for collagen synthesis and total protein synthesis. In four of these sites type I alpha-1 procollagen mRNA levels were measured and normalized to glyceraldehyde-3-phosphate dehydrogenase. To control for increases in collagen synthesis associated with proliferation, SMC were plated at equal densities and tritium-thymidine incorporation and DNA concentration were determined. Data (mean +/- SE) were analyzed with two-factor ANOVA for repeated measures and paired Student t test and were considered significant if p < 0.05. RESULTS There was no difference in thymidine incorporation and total protein synthesis between groups, but collagen synthesis (graft: 52.9 +/- 1.6 disintegrations per minute/ng DNA versus native: 42.6 +/- 1.9 dpm/ng DNA; p = 0.03) and collagen synthesis as a percentage of total protein synthesis (graft: 7.16% +/- 0.11% versus native: 5.8% +/- 0.14%; p = 0.001) increased significantly in graft SMC as compared to native SMC. Type I alpha-1 procollagen mRNA levels were higher in graft SMC, but this difference was not significant. CONCLUSIONS Graft SMC specifically produce more collagen than SMC from adjacent native artery. This change does not simply reflect increases in either total protein synthesis or proliferation and may, in part, be due to increased collagen gene expression.
Collapse
Affiliation(s)
- C L Mesh
- Division of Vascular Surgery, Case Western Reserve University, Cleveland, OH, USA
| | | | | | | | | |
Collapse
|
7
|
Abstract
PURPOSE To assess two-dimensional phase-encoded proton chemical shift imaging for potential clinical application in presurgical localization of temporal lobe epilepsy (TLE). MATERIALS AND METHODS Interictal chemical shift imaging studies were performed in 25 patients (17 unilateral, eight bilateral epileptogenic abnormalities) and 12 healthy volunteers. Results were compared with those of electroencephalography. For each temporal lobe, the volume of interest (VOI) included mesial, lateral, anterior, and posterior areas. RESULTS The epileptogenic zone was characterized by an abnormal pattern of decreased signal intensity in the N-acetylaspartate (NAA) peak, either increased or unchanged choline (Cho) level relative to creatine (Cr) signal intensity, and, occasionally, elevated lactate level. NAA/Cho was the most sensitive and reliable quantitative marker for abnormality. The sensitivity and specificity of this technique compared with EEG were 90% and 85%, respectively. The difference in NAA/Cho between epileptogenic and normal temporal lobes was highly significant (P < .001). No statistically significant difference was found between normal temporal lobes and patients' uninvolved temporal lobes. CONCLUSION NAA/Cho is an excellent marker for localizing the epileptogenic zone in TLE.
Collapse
Affiliation(s)
- T C Ng
- MR Research Center, Cleveland Clinic, OH 44195
| | | | | | | | | | | | | | | |
Collapse
|
8
|
Czerski L, Majors A, Ng TC, Vijayakumar S, Weichselbaum R. Growth and magnetic resonance characteristics of human squamous cell carcinoma xenografts implanted with cells suspended in Matrigel. NMR Biomed 1993; 6:297-301. [PMID: 8268061 DOI: 10.1002/nbm.1940060503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Growth and magnetic resonance characteristics of a human squamous cell carcinoma SQ20B were studied in vivo as xenografts in nu/nu nude mice. Tumor cells injected subcutaneously in the flank using either Matrigel (MTG, an extract of basement membrane proteins) or growth medium (GM) as a vehicle were compared. Much higher tumor growth rates and cell density were observed with Matrigel than with GM implantation. Histology also showed that MTG implanted cells grew as vascularized solid tumors compared to GM tumors which formed cysts. As a result of increased cell density with the improved method, tumors as small as 0.3 cm3 provide high S/N magnetic resonance spectra which yield smaller standard deviations with fewer experiments.
Collapse
Affiliation(s)
- L Czerski
- MR Research Center, Cleveland Clinic Foundation, OH 44195-5129
| | | | | | | | | |
Collapse
|
9
|
Majors A, Ehrhart LA. Basic fibroblast growth factor in the extracellular matrix suppresses collagen synthesis and type III procollagen mRNA levels in arterial smooth muscle cell cultures. Arterioscler Thromb 1993; 13:680-6. [PMID: 8485119 DOI: 10.1161/01.atv.13.5.680] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
To determine the effects of an intact extracellular matrix on collagen synthesis, arterial smooth muscle cells (SMCs) were plated sparsely on a cell-free, SMC-derived matrix and examined the following day. Collagen synthesis during a 5-hour incubation by cells on the matrix was reduced to 67% of the control values obtained from cultures on plastic. Total protein synthesis was unaffected. Treatment of the matrix with heparitinase to remove basic fibroblast growth factor (bFGF) before seeding the SMCs abolished the inhibitory effect of the matrix on collagen synthesis. The inhibitory effect was also eliminated by treating the matrix with a neutralizing polyclonal antibody directed against bFGF. Collagen synthesis by SMC cultures grown in wells coated with purified bFGF was only 61% that of control cultures, whereas total protein synthesis remained unchanged. Slot-blot analysis revealed that the relative message level for alpha 1(III) procollagen was reduced in cultures grown on the preexisting matrix or on plastic precoated with bFGF, whereas the alpha 1(I) procollagen message was unaffected. These results demonstrate the ability of the extracellular matrix to modulate the synthesis of collagen by arterial SMCs and indicate that bFGF in the matrix is responsible for these effects.
Collapse
Affiliation(s)
- A Majors
- Research Institute, Cleveland Clinic Foundation, OH 44195
| | | |
Collapse
|
10
|
Vijayakumar S, Czerski L, Majors A, Valenzuela R, Beckett M, Weichselbaum R, Ng T. Phosphorous metabolite and cell cycle kinetic response of two human squamous cell carcinomas to radiation. Cancer Res 1992; 52:5299-306. [PMID: 1394134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Phosphorous metabolism and cell cycle phase kinetics in response to radiation of two perfused human squamous cell carcinoma cell lines, SQ20B (radioresistant) and SQ38 (relatively radiosensitive), embedded in both basement membrane (Matrigel) and agarose gel threads were studied. The findings for these human cancer cells in response to 2- and 50-Gy irradiation are as follows. (a) Well perfused pure cancer cells (both SQ20B and SQ38) in both proliferative (cells embedded in Matrigel) and static (cells embedded in agarose threads) states did not show significant alteration in either phosphorous bioenergetics or membrane metabolites at 24 and 48 h after irradiation, although a large fraction of the population was clonogenically impaired. Previously reported, sensitively detected, metabolite alterations in response to radiation in rodent and human tumors in situ were not seen in these homogeneous cancer cell populations. (b) The radiosensitive squamous cell carcinoma cell lines SQ38 exhibited G1 block (from 54.38 +/- 1.40% in control to 73.93 +/- 1.01% after irradiation; mean +/ SD) in response to low-dose 2-Gy irradiation and G2 block (from 12.98 +/- 2.15% in control to 25.6 +/- 3.15% after irradiation) in response to high-dose 50-Gy irradiation, while the radioresistant cell line SQ20B showed only conventional G2 block in response to both doses. The differential cell cycle phase response may indicate the difference in radioresistance. (c) The membrane metabolites (including phosphomonoesters and phosphodiesters) and phosphocreatine gradually increased from the early passages to late passages, suggesting that cell proliferation rates were increasing as the cells adapted to tissue culture. The results suggest that the radiation-induced metabolite changes observed in solid tumors in situ may not be a direct response to interim changes within the cancer cells but, rather, a consequence of radiation damage either to the vasculature or to other host-mediated factors.
Collapse
Affiliation(s)
- S Vijayakumar
- MR Research Center, Cleveland Clinic Foundation, Ohio 44195-5129
| | | | | | | | | | | | | |
Collapse
|
11
|
Abstract
Short echo time, single voxel localized proton spectroscopy was accomplished using a stimulated echo (STEAM) sequence running on a Siemens 1.5-T system with a head coil incorporating the Z and Y gradients. Spectra from the temporal lobe, the cerebellum and mid brain were acquired from a group of normal volunteers using the following parameters: voxel size = 8 ml, TE = 22 msec, 512 signal averages and TR = 1.7 sec. STEAM spectra acquired with the small diameter gradients showed significantly fewer artifacts at short TE, allowing the observation of glutamate/glutamine, GABA, taurine, and inositol in addition to the prominent resonance of choline, creatine/phosphocreatine and N-acetylaspartate (NAA). The levels of chlorine, creatine and NAA were found to be significantly different in the three regions of the brain examined.
Collapse
Affiliation(s)
- A Majors
- MR Research Center, Cleveland Clinic Foundation, OH 44195
| | | | | | | |
Collapse
|
12
|
Ng TC, Vijayakumr S, Czerski L, Majors A, Valenzuela R, Weichselhaun R. In vivo 31P MRS and DNA flow cytometry studies of perfused human squamous cell carcinom SQ38 in response to X-radiation. Int J Radiat Oncol Biol Phys 1991. [DOI: 10.1016/0360-3016(91)90661-m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
13
|
Abstract
The editing pulse sequence DEPT (D.T. Pegg, D.M. Doddrell, and M.R. Bendall, J. Chem. Phys. 77, 2745 (1982)) was modified using a scheme of various composite pulses and a 16-step phase cycling to obtain proton-decoupled natural-abundance 13C edited subspectra of solid tumors. A solenoidal probe including a Faraday shield and an orthogonal saddle decoupling coil was built for this purpose.
Collapse
Affiliation(s)
- M Xue
- MR Research Center, Division of Radiology, Cleveland Clinic Foundation, Ohio 44106
| | | | | |
Collapse
|
14
|
Bretan PN, Baldwin N, Novick AC, Majors A, Easley K, Ng T, Stowe N, Rehm P, Streem SB, Steinmuller DR. Pretransplant assessment of renal viability by phosphorus-31 magnetic resonance spectroscopy. Clinical experience in 40 recipient patients. Transplantation 1989; 48:48-53. [PMID: 2665235 DOI: 10.1097/00007890-198907000-00011] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A group of 40 cadaveric kidneys was studied just prior to planned transplantation to further assess the applicability of 31P-MRS in the analysis of clinical renal transplant viability. Renal intracellular high-energy phosphorus metabolites (ATP [or NADP], phosphomonoester [PME] and inorganic phosphate [Pi]) and pH were measured noninvasively with MRS surface coils external to cold storage containers. Pretransplant MRS parameters were correlated with subsequent renal function in recipient patients (measured one week postoperatively by the need of dialysis, drop in serum creatinine, urine output, and 123I or 131I Hippuran assessed renal tubular function). ATP and NADP was detected in eleven kidneys and was significantly (P less than 0.001) associated with the best renal function posttransplantation. These kidneys also had the highest PME/Pi ratios (1.66-0.54), while lower ratios (0.36-0.10) were associated with prolonged acute tubular necrosis. The PME/Pi ratios significantly (P less than 0.0001) correlated with subsequent clinical renal function, whereas cold storage times (37 +/- 10 hr) or intracellular renal pH (6.53-7.91) did not. These preliminary data suggest that MRS is a noninvasive, nondestructive and sterile method for assessing clinical viability during hypothermic storage of human cadaver kidneys and the subsequent recovery of renal function postrenal transplantation.
Collapse
Affiliation(s)
- P N Bretan
- Department of Urology, Cleveland Clinic Foundation, Ohio 44106
| | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Bretan PN, Baldwin N, Novick AC, Majors A, Easley K, Ng TC, Stowe N, Streem S, Steinmuller D, Rehm P. Clinical experience with pretransplant assessment of renal viability by phosphorus-31 magnetic resonance spectroscopy (31P-MRS) in 40 recipient patients. Transplant Proc 1989; 21:1266-7. [PMID: 2652418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- P N Bretan
- Department of Urology, Cleveland Clinic Foundation, OH 44106
| | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Bretan PN, Baldwin N, Novick AC, Ng TC, Majors A, Stowe N, Streem S, Steinmuller D, Go R, Meaney T. Preliminary clinical experience with pretransplant assessment of renal viability by phosphorus-31 magnetic resonance spectroscopy (31P-MRS). Transplant Proc 1988; 20:852-3. [PMID: 3055516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- P N Bretan
- Department of Urology, Cleveland Clinic Foundation, OH 44106
| | | | | | | | | | | | | | | | | | | |
Collapse
|