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Faraj W, Robson M, Tawil A, Reuter V, Mahfouz R, Cambria R, Saheb N, Ferrer CS, Vemuri S, Yaghi M, Kanso M, Abdullah A, El Nounou G, Jabbour M, Muenkel K, Kaufman K, Wakim JM, Badson S, Wilson R, Houston C, Drobnjak M, Hoballah J, Ziyadeh FN, Zaatari G, Brennan M, O'Reilly EM, Abu-Alfa AK, Abou-Alfa GK. Biospecimen Repositories in Low- and Middle-Income Countries: Insights From an American University of Beirut and Memorial Sloan Kettering Collaboration. JCO Glob Oncol 2023; 9:e2300140. [PMID: 37883726 PMCID: PMC10846789 DOI: 10.1200/go.23.00140] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 07/08/2023] [Accepted: 08/14/2023] [Indexed: 10/28/2023] Open
Abstract
PURPOSE Biobanking helps source tissue and blood for studying cancer genomics. Access to biorepository resources in low- and middle-income countries is lacking. Memorial Sloan Kettering Cancer Center (MSK) and the American University of Beirut (AUB) established a joint tissue biorepository at AUB in Beirut, Lebanon. The undertaking encountered key challenges that were unanticipated. MATERIALS AND METHODS Patients age 18 years or older were eligible for enrollment at AUB. After consent, biospecimens were obtained at the time of routine diagnostic and/or therapeutic interventions. Both normal and abnormal tissue and solid and/or liquid specimens were collected from varied body sites. Early on, declining consent was frequently observed, and this was highlighted for investigation to understand potential participants reasoning. RESULTS Of 850 patients approached, 704 (70.8%) elected to consent and 293 (29.5%) declined participation. The number of declined consents led to an amendment permitting the documentation of reasons for same. Of 100 potential participants who declined to consent and to whom outreach was undertaken, 63% indicated lack of research awareness and 27% deferral to their primary physician or family member. A financial gain for AUB was cited as concern by 5%, cultural boundaries in 4%, and 1% expressed concern about confidentiality. Of the patients who elected to consent, 682 biospecimens were procured. CONCLUSION The AUB-MSK biospecimen repository has provided a unique resource for interrogation. Patient participation rate was high, and analyses of those who elected not to consent (29%) provide important insights into educational need and the local and cultural awareness and norms.
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Affiliation(s)
- Walid Faraj
- American University of Beirut, Beirut, Lebanon
| | - Mark Robson
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Ayman Tawil
- American University of Beirut, Beirut, Lebanon
| | - Victor Reuter
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | - Roy Cambria
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nour Saheb
- American University of Beirut, Beirut, Lebanon
| | | | - Shreya Vemuri
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | - Mark Jabbour
- American University of Beirut, Beirut, Lebanon
- Deceased
| | - Kerri Muenkel
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Sandy Badson
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Roger Wilson
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
- Deceased
| | | | | | | | | | | | - Murray Brennan
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Eileen M. O'Reilly
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | - Ghassan K. Abou-Alfa
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
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Sawma T, Kanso M, Khalife J, Khalife M. Chronic inflammatory demyelinating polyneuropathy caused by hepatocellular carcinoma. BMJ Case Rep 2023; 16:16/2/e251770. [PMID: 36764741 PMCID: PMC9923304 DOI: 10.1136/bcr-2022-251770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
Paraneoplastic syndromes are rare abnormal endocrine or immune responses triggered by neoplasms. Chronic inflammatory demyelinating polyneuropathy (CIDP) is one such example. CIDP is an acquired, immune-mediated neuropathy affecting the peripheral nerves and nerve roots. It is associated with many types of cancers, especially haematological malignancies. We report the case of a man in his 60s who presented to the emergency department with acute symptoms of upper and lower extremity paresis and decreased sensation in the toes and tips of his fingers. Laboratory tests were normal. Electrodiagnostic studies showed diffuse motor and sensory dysfunction in all extremities; a diagnosis of CIDP was consequently made. Imaging studies showed a large left lobe liver mass. Subsequent biopsy revealed histopathological findings characteristic of hepatocellular carcinoma. After failure of medical treatment with intravenous immunoglobulin and corticosteroids, laparoscopic resection of the tumour was planned, performed and resulted in complete resolution of symptoms. At 18 months postoperatively, the patient was asymptomatic.
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Affiliation(s)
- Tedy Sawma
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Kanso
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jawad Khalife
- Department of Neurosurgery, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Mohammad Khalife
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Yaghi M, Jaafar R, Kanso M, Khalife M, Faraj W. Choledochal anomalies in adults: A 20-year single-center retrospective cohort experience in the Middle East. Arab J Gastroenterol 2022; 23:235-240. [PMID: 36371373 DOI: 10.1016/j.ajg.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/04/2021] [Revised: 03/31/2022] [Accepted: 10/14/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND STUDY AIMS Choledochal cysts are rare congenital cystic dilatations of the bile ducts that occur in fewer than 1% of individuals. The disease is common in East Asia, and most of the literature concerns those populations, but some data about Western populations have been published recently. Long-term reports about the disease in Middle Eastern populations, however, are currently lacking. We report a single-center 20-year experience in diagnosing and managing choledochal anomalies. PATIENTS AND METHODS Participants were adult patients in whom choledochal cysts were diagnosed over a 20-year (2000-2019) period at a single tertiary academic care center. Clinical data, including radiologic imaging findings, were retrieved from the patients' medical records. To describe the baseline characteristics of the population, we calculated descriptive statistics. RESULTS Choledochal anomalies were diagnosed in 19 adult patients, whose median age was 30 years (interquartile range [IQR], 23-67 years). Of the choledochal cysts 13 (68.4%) were classified as Todani type I, 4 (21.1%) as Todani type IV, and 3 (15.8%) as Todani type V (Caroli's disease). No patient had underlying chronic liver disease, and liver synthetic function was preserved in all. Eighteen patients (94.7%) underwent surgery: cyst excision with Roux-en-Y hepaticojejunostomy in 17 and liver transplantation in 1. All 18 survived surgery, and the median postoperative hospital stay was 11 days (IQR, 5-34 days). All 18 were alive 90 days after surgery, and the median follow-up period was 40 months (IQR, 12-140 months). Seven patients (36.8%) developed postoperative surgical complications; 2 patients required rehospitalization, and 1 required reoperation. CONCLUSION This description of adults with choledochal cysts is the latest long-term report about this disease in the Middle East. In our 20-year experience, the disease characteristics in our patients were moderately consistent with those described previously.
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Affiliation(s)
- Marita Yaghi
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut, Lebanon
| | - Rola Jaafar
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut, Lebanon
| | - Mariam Kanso
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut, Lebanon
| | - Mohamed Khalife
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut, Lebanon
| | - Walid Faraj
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut, Lebanon.
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Monzer A, Wakimian K, Ballout F, Al Bitar S, Yehya A, Kanso M, Saheb N, Tawil A, Doughan S, Hussein M, Mukherji D, Faraj W, Gali-Muhtasib H, Abou-Kheir W. Novel therapeutic diiminoquinone exhibits anticancer effects on human colorectal cancer cells in two-dimensional and three-dimensional in vitro models. World J Gastroenterol 2022; 28:4787-4811. [PMID: 36156922 PMCID: PMC9476858 DOI: 10.3748/wjg.v28.i33.4787] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/24/2022] [Accepted: 08/05/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is the second leading cause of cancer-related mortality. Cancer stem cells (CSCs) in CRC, which are spared by many chemotherapeutics, have tumorigenic capacity and are believed to be the reason behind cancer relapse. So far, there have been no effective drugs to target colon CSCs. Diiminoquinone (DIQ) has shown promising effects on targeting colon cancer. However, there is limited research on the effects of DIQ on eradicating CSCs in CRC.
AIM To investigate the anticancer potential of DIQ on colon CSCs in two-dimensional (2D) and three-dimensional (3D) models using colonospheres and patient-derived organoids.
METHODS Various 2D methods have been used to assess the effect and the mechanism of DIQ on HCT116 and HT29 cell lines including cell proliferation and viability assays, migration and invasion assays, immunofluorescence staining, and flow cytometry. The potency of DIQ was also assessed in 3D culture using the sphere formation assay and colon cancer patient-derived organoid model.
RESULTS Our results showed that DIQ significantly inhibited cell proliferation, migration, and invasion in HCT116 and HT29 cell lines. DIQ treatment induced apoptosis along with an accumulation of HCT116 and HT29 cancer cells in the sub-G1 region and an increase in reactive oxygen species in both CRC cell lines. DIQ reduced sphere-forming and self-renewal ability of colon cancer HCT116 and HT29 stem/progenitor cells at sub-toxic doses of 1 μmol/L. Mechanistically, DIQ targets CSCs by downregulating the main components of stem cell-related -catenin, AKT, and ERK oncogenic signaling pathways. Potently, DIQ displayed a highly significant decrease in both the count and the size of the organoids derived from colon cancer patients as compared to control and 5-fluorouracil conditions.
CONCLUSION This study is the first documentation of the molecular mechanism of the novel anticancer therapeutic DIQ via targeting CSC, a promising compound that needs further investigation.
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Affiliation(s)
- Alissar Monzer
- Department of Biology, American University of Beirut, Beirut 1107-2020, Lebanon
| | - Kevork Wakimian
- Department of Anatomy, Cell Biology and Physiological Sciences, American University of Beirut, Beirut 1107-2020, Lebanon
| | - Farah Ballout
- Department of Biology, American University of Beirut, Beirut 1107-2020, Lebanon
| | - Samar Al Bitar
- Department of Biology, American University of Beirut, Beirut 1107-2020, Lebanon
| | - Amani Yehya
- Department of Anatomy, Cell Biology and Physiological Sciences, American University of Beirut, Beirut 1107-2020, Lebanon
| | - Mariam Kanso
- Department of Surgery, American University of Beirut Medical Center, Beirut 1107-2020, Lebanon
| | - Nour Saheb
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut 1107-2020, Lebanon
| | - Ayman Tawil
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut 1107-2020, Lebanon
| | - Samer Doughan
- Department of Surgery, American University of Beirut Medical Center, Beirut 1107-2020, Lebanon
| | - Maher Hussein
- Department of Surgery, American University of Beirut Medical Center, Beirut 1107-2020, Lebanon
| | - Deborah Mukherji
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut 1107-2020, Lebanon
| | - Walid Faraj
- Department of Surgery, American University of Beirut Medical Center, Beirut 1107-2020, Lebanon
| | - Hala Gali-Muhtasib
- Department of Biology and Center for Drug Discovery, American University of Beirut, Beirut 1107-2020, Lebanon
| | - Wassim Abou-Kheir
- Department of Anatomy, Cell Biology and Physiological Sciences, American University of Beirut, Beirut 1107-2020, Lebanon
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Faraj W, Abi Faraj C, Kanso M, Nassar H, Hoteit L, Farsakoury R, Zaghal A, Yaghi M, Jaafar RF, Khalife M. Hydatid Disease of the Liver in the Middle East: A Single Center Experience. Surg Infect (Larchmt) 2021; 23:29-34. [PMID: 34559001 DOI: 10.1089/sur.2021.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Background: Human cystic echinococcosis (CE), most commonly caused by echinococcosis granulosis, is the most common presentation of hydatid disease of the liver and is considered endemic in the Middle East region. Patients and Methods: This study is a retrospective single-center analysis of all patients with hepatic hydatid disease presenting for surgical management from 2001 to 2019. Results: From 2001 to 2019, 100 patients (54 males, 46 females) were diagnosed with hydatid disease of the liver with a mean age of 45 years (range, 19-82). The most common presenting symptom was right upper quadrant abdominal pain followed by incidental finding of cyst on imaging. Thirteen patients (13%) presented with signs and symptoms of obstructive jaundice. Of the 100 patients, 39 underwent laparoscopic surgery and 61 underwent open surgery. The most common complications were as follows: 16 bile leaks (16%), 14 intra-abdominal fluid collections (14%), 8 wound infections (8%), and 3 patients had biliary strictures (3%). Of the 100, 8 patients(8%) had recurrence of their hepatic hydatid disease. Conclusions: Hydatid disease of the liver is not a common disease, and its management can include medical, surgical, and interventional radiology. The decision depends on the size and complexity of the cyst and its location. Bile leak is a common complication and should be managed conservatively or through intervention by radiology or endoscopic retrograde cholangiopancreatography (ERCP).
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Affiliation(s)
- Walid Faraj
- Liver Transplantation and Hepatopancreaticobiliary Unit, Department of General Surgery, American University of Beirut Medical Center Beirut, Lebanon
| | - Christina Abi Faraj
- Liver Transplantation and Hepatopancreaticobiliary Unit, Department of General Surgery, American University of Beirut Medical Center Beirut, Lebanon
| | - Mariam Kanso
- Liver Transplantation and Hepatopancreaticobiliary Unit, Department of General Surgery, American University of Beirut Medical Center Beirut, Lebanon
| | - Hussein Nassar
- Liver Transplantation and Hepatopancreaticobiliary Unit, Department of General Surgery, American University of Beirut Medical Center Beirut, Lebanon
| | - Lara Hoteit
- Liver Transplantation and Hepatopancreaticobiliary Unit, Department of General Surgery, American University of Beirut Medical Center Beirut, Lebanon
| | - Rana Farsakoury
- Liver Transplantation and Hepatopancreaticobiliary Unit, Department of General Surgery, American University of Beirut Medical Center Beirut, Lebanon
| | - Ahmad Zaghal
- Liver Transplantation and Hepatopancreaticobiliary Unit, Department of General Surgery, American University of Beirut Medical Center Beirut, Lebanon
| | - Marita Yaghi
- Liver Transplantation and Hepatopancreaticobiliary Unit, Department of General Surgery, American University of Beirut Medical Center Beirut, Lebanon
| | - Rola F Jaafar
- Liver Transplantation and Hepatopancreaticobiliary Unit, Department of General Surgery, American University of Beirut Medical Center Beirut, Lebanon
| | - Mohamad Khalife
- Liver Transplantation and Hepatopancreaticobiliary Unit, Department of General Surgery, American University of Beirut Medical Center Beirut, Lebanon
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Abstract
Robotic-assisted surgery for the management of hepatic echinococcosis was introduced in 2016. The advantage it offers over laparoscopy is less rigidity with the use of the 360° rotation of the Endo-Wrist technology, thus allowing the preservation of the integrity of the liver tissue. Herein, we report the first successful robotic resection of the left lobe of the liver for hydatid disease in the Middle East. Our patient is a 71-year-old man found to have a large left hepatic lobe hydatid disease on CT scan. The hydatid liver disease was resected completely with an operation time of 130 min and minimal intraoperative blood loss. Patient did well postoperatively and was discharged home on day 2. Our experience shows that robotic surgery for hydatid disease of the liver can be safely performed, with an excellent outcome to the patient. It also provides unique technical advantages in the field of minimal-invasive surgery.
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Affiliation(s)
- Marita Yaghi
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maya Zorkot
- Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Kanso
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Walid Faraj
- Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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7
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Sawaf B, Ali AH, Jaafar RF, Kanso M, Mukherji D, Khalife MJ, Faraj W. Spectrum of liver diseases in patients referred for Fibroscan: A single center experience in the Middle East. Ann Med Surg (Lond) 2020; 57:166-170. [PMID: 32774848 PMCID: PMC7394832 DOI: 10.1016/j.amsu.2020.07.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/17/2020] [Accepted: 07/17/2020] [Indexed: 12/16/2022] Open
Abstract
Background Liver diseases is a worldwide etiology causing high morbidity and mortality. Fibroscan is a quick, painless examination performed in clinic or at the patient's bedside. It is used to evaluate liver status for patients with suspected liver disease prognosis. This study aims at describing the spectrum of liver diseases among patients performing Fibroscan at a tertiary care center in Lebanon. Methods This is a retrospective data collection study on patients who underwent Fibroscan at the American University of Beirut hepatobiliary unit between 2015 and 2018. Medical charts of all patients were reviewed. Data were collected and analyzed using SPSS 25 software. Results A total of 620 patients presented to the hepatobiliary unit for Fibroscan, of which 419 (67.5%) were males. The mean age was 47.8 ± 13.4 (range 18-84). 362(58.3%) had NAFLD, 89 (14.3%) had Hepatitis-B, 69 (11.1%) had Hepatitis-C, 48 (7.7%) had ALD, 20 (3.3%) had DILI, and 13 (2.9%) had autoimmune hepatitis. 190 (30.6%) were overweight (BMI over 25), 128 (20.6%) had diabetes. Liver stiffness corresponding to the diagnosis of F4 liver fibrosis stage on Fibroscan was mostly reported in 6 (46.5%) autoimmune hepatitis, 101 (27.9%) NAFLD, and 18 (26.1%) HCV patients. 141 (45.5%) patients who had one or more metabolic risk factors suffered from severe stage steatosis compared with 78 (28.9%) who had not any risk factors with P-value 0.04. Conclusions Based on our sample, NAFLD is emerging as a predominant etiology of CLD, followed by, HBV, and HCV. This is the first study that reports CLD status in Lebanon, further studies that describe the prevalence and incidence of the disease at a larger scale are needed.
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Affiliation(s)
- Bisher Sawaf
- Department of Surgery, Faculty of Medicine, American University of Beirut Medical Center Beirut, Lebanon
| | - Adel Hajj Ali
- Department of Internal Medicine, Faculty of Medicine, American University of Beirut Medical Center Beirut, Lebanon
| | - Rola F Jaafar
- Department of Surgery, Faculty of Medicine, American University of Beirut Medical Center Beirut, Lebanon
| | - Mariam Kanso
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center Beirut, Lebanon
| | - Deborah Mukherji
- Department of Internal Medicine, Faculty of Medicine, American University of Beirut Medical Center Beirut, Lebanon
| | - Mohamad J Khalife
- Department of Surgery, Faculty of Medicine, American University of Beirut Medical Center Beirut, Lebanon.,Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center Beirut, Lebanon
| | - Walid Faraj
- Department of Surgery, Faculty of Medicine, American University of Beirut Medical Center Beirut, Lebanon.,Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center Beirut, Lebanon
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8
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Abou-Kheir W, Mukherji D, Hadadeh O, Saleh E, Bahmad HF, Kanso M, Khalifeh M, Shamseddine A, Tamraz S, Jaafar R, Dagher C, Khalifeh I, Faraj W. CYR61/CCN1 expression in resected pancreatic ductal adenocarcinoma: A retrospective pilot study of the interaction between the tumors and their surrounding microenvironment. Heliyon 2020; 6:e03842. [PMID: 32395647 PMCID: PMC7205742 DOI: 10.1016/j.heliyon.2020.e03842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/10/2020] [Accepted: 04/20/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND CCN1 is an extracellular matrix-associated protein thought to be implicated in tumor-stromal interaction in several solid tumors. The aim of our pilot study was to evaluate the correlation between CCN1 expression in stromal cells, pancreatic intraepithelial neoplasia (PanIN) and pancreatic ductal adenocarcinoma cells in resected pancreatic ductal adenocarcinoma (PDAC) specimens, and correlate that clinically. METHODS A total of 42 paraffin-embedded PDAC tumor specimens were stained for CCN1 and evaluated via immunohistochemical (IHC) analysis. Statistical analysis was performed to correlate between CCN1 expression profiles in tumor tissues and clinicopathological parameters of patients. RESULTS Our results showed CCN1 (CYR61) gene was highly expressed in PDAC tissues relative to other organ specific tumor tissues. Also, moderate and overexpression of CCN1 in PanIN was associated with PanIN grade 3 tissues. A statistically significant association was found between PanIN CCN1 scores on one hand and cancer stage, cancer grade, and CCN1 expression among ductal tumor cells and adjacent stromal cells on the other hand. DISCUSSION The associations demonstrated suggest that CCN1 might be contributing to a substantial role in the interaction between the pancreatic tumors on one hand and their surrounding microenvironment and their precursors on the other hand; hence, it might serve as a potential therapeutic target for PDAC.
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Affiliation(s)
- Wassim Abou-Kheir
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Deborah Mukherji
- Department of Internal Medicine, Division of Hematology/Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ola Hadadeh
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Eman Saleh
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Hisham F. Bahmad
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Mariam Kanso
- Department of Surgery, Division of General Surgery, Liver Transplantation and Hepatopancreaticobiliary (HPB) Unit, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohamad Khalifeh
- Department of Surgery, Division of General Surgery, Liver Transplantation and Hepatopancreaticobiliary (HPB) Unit, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Shamseddine
- Department of Internal Medicine, Division of Hematology/Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sally Tamraz
- Department of Internal Medicine, Division of Hematology/Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rola Jaafar
- Department of Surgery, Division of General Surgery, Liver Transplantation and Hepatopancreaticobiliary (HPB) Unit, American University of Beirut Medical Center, Beirut, Lebanon
| | - Christelle Dagher
- Department of Internal Medicine, Division of Hematology/Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ibrahim Khalifeh
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Walid Faraj
- Department of Surgery, Division of General Surgery, Liver Transplantation and Hepatopancreaticobiliary (HPB) Unit, American University of Beirut Medical Center, Beirut, Lebanon
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9
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Faraj W, Nassar H, Zaghal A, Mukherji D, Shamseddine A, Kanso M, Jaafar RF, Khalife M. Pancreaticoduodenectomy in the Middle East: Achieving optimal results through specialization and standardization. Hepatobiliary Pancreat Dis Int 2019; 18:478-483. [PMID: 30846244 DOI: 10.1016/j.hbpd.2019.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 02/13/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Pancreaticoduodenectomy is a challenging surgical intervention that remains the cornerstone in the treatment of localized peri‑ampullary pathologies. The concept of treatment standardization has been well-established in many high-volume centers in the world. Here, we present our experience in pancreaticoduodenectomy from 1994 to 2015. METHODS We performed a retrospective review of the medical charts of patients who underwent pancreaticoduodenectomy at our institution. Data was entered to SPSS statistical software and analyzed. The Mann-Whitney U and Fisher's exact tests were used to report statistical differences between groups. RESULTS Of the 370 patients who underwent pacreaticoduodenectomy, 300 were analyzed. The 1-, 3-, 5- and 10-year survival rates were 85%, 35%, 15%, and 7%, respectively with a 30-day mortality rate of 5.0% (15 patients). The median age of the patients was 61 (13-84) years, with 193 (64.3%) males and 107 (35.7%) females. The median operative time was 300 (130-570) min. The median postoperative length of hospital stay was 12 (5-76) days. Thirty-two patients required re-laparotomies; 10 for pancreatic leak, 7 for biliary leak and 15 for control of bleeding. Seventy-five (25.0%) patients developed pancreatic fistulae. Delayed gastric emptying was present in 31 (10.3%) patients. A significant improvement in surgical outcome was observed in cases done after 2008 which indicates the important role of specialized team in surgical management. CONCLUSIONS The number of patients undergoing pancreaticoduodenectomy has been increasing annually over the past twenty-two years in our institution with results comparable to published series from high-volume centers. Through standardization of surgical techniques and perioperative management carried out by a specialist team, our results continue to improve despite the increasing complexity of cases referred to our unit.
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Affiliation(s)
- Walid Faraj
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Hussein Nassar
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ahmad Zaghal
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Deborah Mukherji
- Department of Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Shamseddine
- Department of Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Kanso
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rola F Jaafar
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohamad Khalife
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Faraj W, Mukherji D, Zaghal AM, Nassar H, Mokadem FH, Jabbour S, Ayoub C, Rizk MS, Kanso M, Jaafar RF, Heaton N, Khalife M. Perioperative Management of Pancreaticoduodenectomy: Avoiding Admission to the Intensive Care Unit. Gastrointest Tumors 2019; 6:108-115. [PMID: 31768354 DOI: 10.1159/000502887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 06/13/2019] [Accepted: 08/23/2019] [Indexed: 01/23/2023] Open
Abstract
Introduction With the advancement in surgical expertise at high-volume centers and advances in perioperative management, pancreaticoduodenectomy is becoming safer and remains the gold standard for treating periampullary pathologies. We describe our experience in optimizing perioperative management in order to avoid admission to the intensive care unit and improve outcomes. Method Retrospective data were collected on 370 surgical patients who underwent a pancreaticoduodenectomy between the years 1994 and 2016. Results Of the 370 patients, 200 operated between 2009 and 2016 did not require intensive care admission, blood transfusion, or central line insertion. The results were compared between different time intervals: before the year 1998, between the years 1998 and 2008, and between the years 2009 and 2016. The median blood loss dropped from 800 to 400 to 300 mL, respectively. The median operative time also dropped from 360 to 335 to 215 min, respectively. In addition, the median length of hospital stay decreased from 25 to 16 to 7 days, respectively. Conclusion With the centralization of pancreaticoduodenectomy in high-volume centers and with specialized surgeons performing the surgery, there is a significant decrease in the onset of postoperative complications with a lesser need for blood transfusions and, subsequently, better recovery of patients without the need for intensive care unit admission.
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Affiliation(s)
- Walid Faraj
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Deborah Mukherji
- Department of Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ahmad M Zaghal
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hussein Nassar
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Farah H Mokadem
- Department of Anesthesia, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samar Jabbour
- Department of Anesthesia, American University of Beirut Medical Center, Beirut, Lebanon
| | - Chakib Ayoub
- Department of Anesthesia, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwan S Rizk
- Department of Anesthesia, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Kanso
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rola F Jaafar
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nigel Heaton
- Institute of Liver Studies, Kings College Hospital, London, United Kingdom
| | - Mohamad Khalife
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Mukherji D, Massih SA, Tfayli A, Kanso M, Faraj W. Three different polymorphisms of the DPYD gene associated with severe toxicity following administration of 5-FU: a case report. J Med Case Rep 2019; 13:76. [PMID: 30898145 PMCID: PMC6429833 DOI: 10.1186/s13256-019-2013-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 02/07/2019] [Indexed: 12/27/2022] Open
Abstract
Background Dihydropyrimidine dehydrogenase deficiency secondary to polymorphisms in the DPYD gene can lead to significant toxicity associated with the administration of fluoropyrimidine chemotherapy. Case presentation We report a case of a 59-year-old Lebanese woman with metastatic pancreatic cancer who received FOLFIRINOX therapy and developed severe 5-fluorouracil toxicity after a single cycle. The entire DPYD gene was sequenced, and the patient was found to be heterozygous for three different polymorphisms that have reportedly been associated with dihydropyrimidine dehydrogenase deficiency. Conclusion Because data regarding the prevalence and clinical significance of several heterozygous polymorphisms in a single DPYD gene are very limited, we suggest that full gene sequencing should be carried out, at least in populations in which the allele frequencies are unknown.
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Affiliation(s)
- Deborah Mukherji
- Division of Hematology-Oncology, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Sarah Abdel Massih
- Division of Hematology-Oncology, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Arafat Tfayli
- Division of Hematology-Oncology, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Mariam Kanso
- Department of Surgery, HPB and Liver Transplant Unit, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon
| | - Walid Faraj
- Department of Surgery, HPB and Liver Transplant Unit, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon.
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Nassar H, Zaghal A, Taher A, Mahfouz R, Safadi B, Kanso M, Khalife M, Faraj W. Erratum: Triple thrombophilic simultaneous mutations in patients after bariatric surgery: is there a role for screening in the Eastern Mediterranean? J Surg Case Rep 2018; 2018:rjy179. [PMID: 30002807 PMCID: PMC6037088 DOI: 10.1093/jscr/rjy179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Indexed: 11/12/2022] Open
Abstract
[This corrects the article DOI: 10.1093/jscr/rjy135.][This corrects the article DOI: 10.1093/jscr/rjy135.].
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Affiliation(s)
- Hussein Nassar
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ahmad Zaghal
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Taher
- Department of Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rami Mahfouz
- Department of Pathology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Bassem Safadi
- Department of General Surgery, Bariatric Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Kanso
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohammad Khalife
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Walid Faraj
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Nassar H, Zaghal A, Taher A, Mafouz R, Safadi B, Kanso M, Khalife M, Faraj W. Triple thrombophilic simultaneous mutations in patients after bariatric surgery: is there a role for screening in the Eastern Mediterranean? J Surg Case Rep 2018; 2018:rjy135. [PMID: 29942483 PMCID: PMC6007279 DOI: 10.1093/jscr/rjy135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 06/06/2018] [Indexed: 11/16/2022] Open
Abstract
Background and purpose: Thrombophilia is a hypercoagulable state that predisposes to thrombosis. Several genetic risk factors have been shown to predispose to thromboembolic events. Homozygosity to a thrombophilic mutation certainly predisposes the affected patient to more serious symptoms. Materials and methods: Here we present a case of a 56-year-old male patient who underwent sleeve gastrectomy for morbid obesity, presenting to our institution with abdominal pain. Investigations revealed thrombosis of the splenic, axillary vein as well as the right pulmonary artery. The patient was found to have triple thrombophilic mutations. Results: To our knowledge, this is the first reported case of three specific simultaneous thrombophilic mutations in a patient from the Eastern Middle East. Conclusion: We suggest a role for screening for thrombophilic mutations in the Eastern Mediterranean patients undergoing bariatric surgeries for morbid obesity due to the increased risk of thrombosis in this group of patients
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Affiliation(s)
- Hussein Nassar
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ahmad Zaghal
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Taher
- Department of Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rami Mafouz
- Department of Pathology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Bassem Safadi
- Department of General Surgery, Bariatric Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Kanso
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohamad Khalife
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Walid Faraj
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Ezzeddine H, Husari A, Nassar H, Kanso M, Nounou GE, Khalife M, Faraj W. Life Threatening Complications Post-Liposuction. Aesthetic Plast Surg 2018; 42:384-387. [PMID: 29387943 DOI: 10.1007/s00266-017-1058-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 12/06/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Liposuction is one of the most commonly performed aesthetic procedures. It is performed worldwide as an outpatient procedure. However, the complications are underestimated and underreported by caregivers. We present a case of delayed diagnosis of bilothorax secondary to liver and gallbladder injury after tumescent liposuction. METHODS A 26-year-old female patient was transferred to our emergency department from an aesthetic clinic with worsening dyspnea, tachypnea and fatigue. She had undergone extensive liposuction of the thighs, buttocks, back and abdomen 5 days prior to presentation. RESULTS A chest X-ray showed significant right-sided pleural effusion. Thoracentesis was performed and drained bilious fluid. CT scan of the abdomen revealed pleural, liver and gall bladder injury. An exploratory laparoscopy confirmed the findings, the collections were drained; cholecystectomy and intraoperative cholangiogram were performed. The patient did very well postoperatively and was discharged home in 2 days. CONCLUSION Even though liposuction is considered a simple office-based procedure, its complications can be fatal. The lack of strict laws that exclusively place this procedure in the hands of medical professionals allow these procedures to still be done by less experienced hands and in outpatient-based settings. Our case serves to highlight yet another unique but potentially fatal complication of liposuction. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Hiba Ezzeddine
- Department of General Surgery, Liver Transplantation and Hepatopancreaticobiliary Unit, American University of Beirut Medical center, Beirut, Lebanon
| | - Ahmad Husari
- Department of Internal Medicine, Respiratory Diseases and Sleep Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hussein Nassar
- Department of General Surgery, Liver Transplantation and Hepatopancreaticobiliary Unit, American University of Beirut Medical center, Beirut, Lebanon
| | - Mariam Kanso
- Department of General Surgery, Liver Transplantation and Hepatopancreaticobiliary Unit, American University of Beirut Medical center, Beirut, Lebanon
| | - Ghina El Nounou
- Department of General Surgery, Liver Transplantation and Hepatopancreaticobiliary Unit, American University of Beirut Medical center, Beirut, Lebanon
| | - Mohamad Khalife
- Department of General Surgery, Liver Transplantation and Hepatopancreaticobiliary Unit, American University of Beirut Medical center, Beirut, Lebanon
| | - Walid Faraj
- Department of General Surgery, Liver Transplantation and Hepatopancreaticobiliary Unit, American University of Beirut Medical center, Beirut, Lebanon.
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Faraj W, Nassar H, Kanso M, Shamseddine A, Mukherji D, Khalifeh M. Pancreaticoduodenectomy in the Middle East: A single center experience. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx261.224] [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: 11/12/2022] Open
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Faraj W, Wehbe Mohamad R, Kanso M, Shamseddine A, Mukherji D, Haydar A, Khalifeh M. Two hundred pancreaticoduodenectomies with no intensive care unit admission at a single center in the Middle East: Case for sub-specialization. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx261.223] [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: 11/14/2022] Open
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Kanso M, Cuenot S, Louarn G. Roughness effect on the SPR measurements for an optical fibre configuration: experimental and numerical approaches. ACTA ACUST UNITED AC 2007. [DOI: 10.1088/1464-4258/9/7/008] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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