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Adult liver transplant survey: policies towards eligibility criteria in Canada and the United States 2007.

https://arctichealth.org/en/permalink/ahliterature154959
Source
Liver Int. 2008 Nov;28(9):1250-5
Publication Type
Article
Date
Nov-2008
Author
Karen I Kroeker
Vincent G Bain
Thomas Shaw-Stiffel
Tse-Ling Fong
Eric M Yoshida
Author Affiliation
Department of Medicine, University of Alberta, Edmonton, AB, Cananda.
Source
Liver Int. 2008 Nov;28(9):1250-5
Date
Nov-2008
Language
English
Publication Type
Article
Keywords
Canada
Eligibility Determination
Humans
Liver Transplantation - contraindications
Questionnaires
United States
Abstract
To assess the current practice patterns of liver transplant centres in Canada and the USA regarding transplant eligibility.
Liver transplantation is an evolving field and today remains the only life-sustaining treatment for end-stage liver disease. Issues of allocation and transplant eligibility are important factors in the ethical practice of medicine.
Questionnaires were mailed to liver transplant programme directors in Canada and the USA inquiring about current practices regarding recipient eligibility.
This study demonstrates that there is consensus in the use of other eligibility criteria, including non-compliance, social status, abstinence from alcohol and methadone and cocaine use. Interestingly, literature is lacking to support the use of these parameters as eligibility criteria with the exception of alcohol. There is a lack in consensus regarding marijuana use, human immunodeficiency virus status, ability to accept blood transfusions and prisoner status. The literature suggests that liver transplantation in select patients who refuse blood transfusions results in good outcomes.
Important decisions regarding transplant eligibility still have to be made empirically in the absence of scientific literature about various social issues. While consensus among transplant programmes is useful, it is important that we continue to use the evidence in the literature to revise these eligibility criteria, keeping in mind ethical principles applied to the access and allocation of a scarce resource.
Notes
Comment In: Liver Int. 2008 Nov;28(9):1186-918822075
PubMed ID
18822078 View in PubMed
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Canadian national retrospective chart review comparing the long term effect of cyclosporine vs. tacrolimus on clinical outcomes in patients with post-liver transplantation hepatitis C virus infection.

https://arctichealth.org/en/permalink/ahliterature116457
Source
Ann Hepatol. 2013 Mar-Apr;12(2):282-93
Publication Type
Article
Author
Eric M Yoshida
Leslie B Lilly
Paul J Marotta
Andrew L Mason
Marc Bilodeau
Marc Vaillancourt
Author Affiliation
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. eric.yoshida@vch.ca
Source
Ann Hepatol. 2013 Mar-Apr;12(2):282-93
Language
English
Publication Type
Article
Keywords
Adult
Antiviral agents - therapeutic use
Biological Markers - blood
Canada
Carcinoma, Hepatocellular - immunology - virology
Chi-Square Distribution
Cyclosporine - adverse effects - therapeutic use
Diabetes Mellitus - etiology
Female
Graft Rejection - immunology - virology
Hepacivirus - genetics
Hepatitis C - complications - diagnosis - drug therapy - mortality - virology
Humans
Immunosuppressive Agents - adverse effects - therapeutic use
Kaplan-Meier Estimate
Liver Cirrhosis - immunology - virology
Liver Neoplasms - immunology - virology
Liver Transplantation - adverse effects - immunology - mortality
Logistic Models
Male
Middle Aged
Multivariate Analysis
Odds Ratio
RNA, Viral - blood
Recurrence
Retrospective Studies
Risk factors
Tacrolimus - adverse effects - therapeutic use
Time Factors
Treatment Outcome
Viral Load
Abstract
The transition from regular use of cyclosporine to the newer calcineurin-inhibitors, such as tacrolimus, has been suggested as a contributing factor to the "era effect" of worsening outcomes of post-transplant HCV recurrence. This retrospective medical chart review of 458 patients was undertaken to evaluate the role of immunosuppressant choice (cyclosporine vs. tacrolimus) in determining virologic response and clinical outcomes of post-liver transplant HCV infection recurrence. Our results showed that patients undergoing interferon-based treatment taking cyclosporine have significantly better odds (OR: 2.59, P = 0.043) of presenting a sustained viral response (66.7%) compared to tacrolimus (52.8%). This did not result in a significant effect on post-liver transplantation clinical events including HCV-related deaths, graft loss, fibrosing cholestatic hepatitis, hepatocellular carcinoma or graft rejection. Other variables, which showed a significant relationship with the achievement of sustained viral response included donor age (OR 0.96, P = 0.001) and HCV genotype 1 infection (OR 0.05, P
PubMed ID
23396740 View in PubMed
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Characteristics associated with drug-induced liver injury from interferon beta in multiple sclerosis patients.

https://arctichealth.org/en/permalink/ahliterature266928
Source
Expert Opin Drug Saf. 2014 Oct;13(10):1305-17
Publication Type
Article
Date
Oct-2014
Author
Kaarina Kowalec
Elaine Kingwell
Eric M Yoshida
Ruth Ann Marrie
Marcelo Kremenchutzky
Trudy L Campbell
Mia Wadelius
Bruce Carleton
Helen Tremlett
Source
Expert Opin Drug Saf. 2014 Oct;13(10):1305-17
Date
Oct-2014
Language
English
Publication Type
Article
Keywords
Adult
British Columbia - epidemiology
Canada - epidemiology
Drug-Induced Liver Injury - epidemiology - etiology
Female
Follow-Up Studies
Humans
Immunologic Factors - adverse effects - therapeutic use
Interferon-beta - adverse effects - therapeutic use
Male
Middle Aged
Multiple Sclerosis - drug therapy
Proportional Hazards Models
Retrospective Studies
Risk factors
Sex Factors
Sweden - epidemiology
Time Factors
United States - epidemiology
Abstract
To identify and characterize drug-induced liver injury (DILI) associated with IFN-Ã? in multiple sclerosis (MS) using recommended criteria.
This retrospective, mixed methods design included a cohort of IFN-Ã? exposed MS patients from British Columbia (BC), Canada and a series of DILI cases from other Canadian provinces and two adverse drug reaction (ADR) networks (USA and Sweden). Associations between sex, age and IFN-Ã? product, and DILI were explored in BC cohort using Cox proportional hazard analyses. Characteristics, including the time to DILI, were compared between sites.
In BC, 18/942 (1.9%) of IFN-Ã? exposed MS patients met criteria for DILI, with a trend toward an increased risk for women and those exposed to IFN-Ã?-1a SC (44 mcg 3 Ã? weekly) (adjusted Hazard Ratios: 3.15;95% CI:0.72 - 13.72, p = 0.13 and 6.26;95%CI:0.78 - 50.39, p = 0.08, respectively). Twenty-four additional cases were identified from other sites; the median time to DILI was comparable between BC and other Canadian cases (105 and 90 days, respectively), but longer for the ADR network cases (590 days, p = 0.006).
Approximately 1 in 50 IFN-Ã? exposed patients developed DILI in BC, Canada. Identification of DILI cases from diverse sources highlighted that this reaction occurs even after years of exposure.
PubMed ID
25134421 View in PubMed
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Cross-sectional study of hepatitis B awareness among Chinese and Southeast Asian Canadians in the Vancouver-Richmond community.

https://arctichealth.org/en/permalink/ahliterature175031
Source
Can J Gastroenterol. 2005 Apr;19(4):245-9
Publication Type
Article
Date
Apr-2005
Author
Justin Cheung
Tim K Lee
Chong-Ze Teh
Caroline Y M Wang
W C Peter Kwan
Eric M Yoshida
Author Affiliation
Department of Medicine, University of British Columbia, Vancouver.
Source
Can J Gastroenterol. 2005 Apr;19(4):245-9
Date
Apr-2005
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Asia, Southeastern - ethnology
Attitude to Health - ethnology
British Columbia
Carcinoma, Hepatocellular - virology
China - ethnology
Cross-Sectional Studies
Educational Status
Ethnic Groups
Female
Health Education - methods
Health Knowledge, Attitudes, Practice
Hepatitis B - ethnology
Humans
Liver Cirrhosis - virology
Liver Neoplasms - virology
Male
Mass Media
Middle Aged
Physicians
Residence Characteristics
Abstract
Hepatitis B (HBV) is endemic and a leading cause of morbidity and mortality in Asia. British Columbia has the highest proportion of Chinese and Southeast Asians among all Canadian provinces. The present study was designed to evaluate the degree of concern for and knowledge of HBV in this high-risk community.
Unselected patrons of two large Asian commercial centres in Richmond, British Columbia were surveyed. The variables studied were population demographics, concern for HBV, level of HBV knowledge and awareness of HBV-related cirrhosis or hepatocellular carcinoma (HCC). Associations were assessed using c2 testing and multiple logistic regression analysis.
A total of 1008 individuals participated in the survey. Fifteen incomplete surveys were excluded. Only 7.7% felt that HBV was not a concern for the community. Only 13% of respondents felt that HBV education was adequate in the community. The main sources of community health education were their doctor's office (56.3%) and media (49.1%). A high number stated they were "aware" of HBV (68%) but over 60% were unaware that HBV could cause HCC or cirrhosis and only 61.3% scored a 'reasonable' level of HBV knowledge. Higher HBV knowledge was significantly associated with increasing age (P
PubMed ID
15861267 View in PubMed
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Does cirrhosis affect quality of life in hepatitis C virus-infected patients?

https://arctichealth.org/en/permalink/ahliterature152194
Source
Liver Int. 2009 Mar;29(3):449-58
Publication Type
Article
Date
Mar-2009
Author
Priscilla C Hsu
Mel Krajden
Eric M Yoshida
Frank H Anderson
George A Tomlinson
Murray D Krahn
Author Affiliation
British Columbia Centre for Disease Control, Vancouver, BC, Canada.
Source
Liver Int. 2009 Mar;29(3):449-58
Date
Mar-2009
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
British Columbia
Health Status Indicators
Hepatitis C - complications
Humans
Linear Models
Liver Cirrhosis - etiology - physiopathology
Middle Aged
Quality of Life
Socioeconomic Factors
Abstract
Hepatitis C virus (HCV) infection is a major cause of chronic liver disease and is associated with impairments in health-related quality of life.
To evaluate quality of life (QOL) in cirrhotic (compensated and decompensated) and non-cirrhotic patients with chronic HCV infection, using preference-based (utilities) and non-preference-based methods of evaluating QOL.
In a tertiary care setting, 271 patients completed a self-administered time trade-off utility instrument, the Health Utility Index Mark 2 and Mark 3, and the Hepatitis Quality of Life Questionnaire Version 2. Mean QOL scores were compared across HCV disease stages and sociodemographical categories. We examined the association between QOL and disease stage using linear regression adjusting for age, education, marital status, log income and Charlson comorbidity scores. Mean utility scores were compared across disease stages using a propensity score method.
Mean utilities were lower than general population norms (0.81-0.92) and ranged from 0.62 to 0.82 in non-cirrhotic patients (n=197), 0.56-0.84 in compensated cirrhotic patients (n=17) and 0.55-0.76 for decompensated cirrhotic patients (n=57). No significant association found was between disease stage and utility for current health status. Higher income, fewer comorbidities and living in a married or common-law relationship were significantly associated with higher utilities and better QOL. No significant difference in utilities was found between disease stages using propensity score matching.
Our study confirms that changes in HCV disease stage explain only small changes in QOL and suggests that factors such as underlying comorbidities, income and marital status have a greater effect on QOL than disease stage.
PubMed ID
19267865 View in PubMed
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Efficacy of maintenance subcutaneous hepatitis B immune globulin (HBIG) post-transplant for prophylaxis against hepatitis B recurrence.

https://arctichealth.org/en/permalink/ahliterature143053
Source
Ann Hepatol. 2010 Apr-Jun;9(2):166-71
Publication Type
Article
Author
Janakie Singham
Erica D Greanya
Kirby Lau
Siegfried R Erb
Nilu Partovi
Eric M Yoshida
Author Affiliation
University of British Columbia, Vancouver BC, Canada.
Source
Ann Hepatol. 2010 Apr-Jun;9(2):166-71
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antiviral agents - therapeutic use
British Columbia
Drug Administration Schedule
Drug Therapy, Combination
Female
Hepatitis B Antibodies - blood
Hepatitis B vaccines - administration & dosage
Hepatitis B, Chronic - complications - prevention & control - surgery
Humans
Immunoglobulins - administration & dosage
Injections, Intramuscular
Injections, Subcutaneous
Liver Transplantation - adverse effects
Male
Middle Aged
Patient Preference
Pilot Projects
Prospective Studies
Questionnaires
Recurrence - prevention & control
Time Factors
Treatment Outcome
Abstract
Patients who receive liver transplantation for chronic hepatitis B infection require long-term combination therapy with hepatitis B immunoglobulin (HBIG) and oral antiviral medication to prophylax against graft re-infection. This study examines the efficacy and patient preference of subcutaneous (SC) administration of HBIG in maintaining anti HBs titres > 100 IU/L.
12 patients who were stable while receiving our standard IM HBIG protocol received an alternate formulation by SC injection, consisting of 10 mL (3120 IU) HBIG as 4 x 2.5 mL SC injections. SC injection were repeated as soon as titres reached 100-150 IU/mL during the 3 month study period. A questionnaire was administered upon study entry and exit to subjectively assess patient preference.
Anti- HBs Cmax after first injection was 441.6 IU/L +/- 81.5, and Tmax was 7.1 +/- 3.2 days. SC injections were required every 56 days, which compared well to the frequency of required IM injections prior to study enrollment of 45 days. The patients mean ratings of pain on a 0-10 scale were 5 for the IM route and 1.6 for the SC route. All patients preferred the SC injections to the IM.
SC administration of HBIG can effectively maintain anti HBs levels above the requisite 100 IU/L while substantially decreasing patient discomfort and improving patient satisfaction, and therefore becomes a very attractive alternative to IM HBIG injections. Further studies and wider use of SC HBIG based on this study may alter the standard practice of transplantation centers
PubMed ID
20526010 View in PubMed
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In a 'real-world', clinic-based community setting, sorafenib dose of 400 mg/day is as effective as standard dose of 800 mg/day in patients with advanced hepatocellular carcimona, with better tolerance and similar survival.

https://arctichealth.org/en/permalink/ahliterature108663
Source
Can J Gastroenterol. 2013 Jul;27(7):393-6
Publication Type
Article
Date
Jul-2013
Author
Alexandra Shingina
Al Moutaz Hashim
Mazhar Haque
Michael Suen
Eric M Yoshida
Sharlene Gill
Fergal Donnellan
Alan A Weiss
Author Affiliation
Department of Medicine, Division of Gastroenterology, Department of Obstetrics and Gynecology, University of British Columbia, Canada.
Source
Can J Gastroenterol. 2013 Jul;27(7):393-6
Date
Jul-2013
Language
English
Publication Type
Article
Keywords
Aged
Antineoplastic Agents - administration & dosage - adverse effects - therapeutic use
British Columbia
Carcinoma, Hepatocellular - drug therapy - pathology
Disease Progression
Dose-Response Relationship, Drug
Female
Humans
Insurance Coverage
Liver Neoplasms - drug therapy - pathology
Male
Middle Aged
Niacinamide - administration & dosage - adverse effects - analogs & derivatives - therapeutic use
Phenylurea Compounds - administration & dosage - adverse effects - therapeutic use
Protein Kinase Inhibitors - administration & dosage - adverse effects - therapeutic use
Retrospective Studies
Survival Rate
Treatment Outcome
alpha-Fetoproteins - metabolism
Abstract
Sorafenib, an oral multityrosine kinase inhibitor, has been approved for treatment of unresectable hepatocellular carcinoma (HCC). British Columbia (BC) was the first province in Canada to provide drug coverage for sorafenib.
To review the BC experience with sorafenib to assess its effectiveness and tolerance in a 'real-world' clinical setting.
A retrospective clinic chart review identified 99 patients referred to the BC Cancer Agency from 2008 to 2010 with a diagnosis of HCC who qualified for treatment with sorafenib.
Therapy with sorafenib was initiated and continued at a reduced dosage of 400 mg/day in 66 of 99 patients, with 22 patients requiring further dose reduction. Full- and reduced-dose group patients had similar baseline characteristics, except for a higher proportion of female patients (P=0.02) and individuals with alcoholic liver disease (P=0.04) in the full-dose group. The incidence of any grade of adverse effects was higher in the full-dose group (94% versus 77% in the reduced-dose group; P=0.04). Dose reduction rates were significantly higher in the full-dose group, occurring in 66% versus 24% of reduced-dose group patients (P=0.001). The overall survival rates were similar between the two groups: 7.8 months versus 7.1 months in full- versus reduced-dose groups (P=0.14), as were radiological progression rates and alpha-fetoprotein levels.
In a review of 99 patients in a 'real-world' community setting, a sorafenib dose of 400 mg/day was better tolerated and had similar efficacy compared with a sorafenib dose of 800 mg/day with respect to survival and outcomes.
Notes
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PubMed ID
23862169 View in PubMed
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Liver injury associated with the beta-interferons for MS: a comparison between the three products.

https://arctichealth.org/en/permalink/ahliterature181406
Source
Neurology. 2004 Feb 24;62(4):628-31
Publication Type
Article
Date
Feb-24-2004
Author
Helen L Tremlett
Eric M Yoshida
Joel Oger
Author Affiliation
Department of Medicine, Division of Neurology, Vancouver Hospital & Health Sciences Center, University of British Columbia, Vancouver, BC, Canada. tremlett@interchange.ubc.ca
Source
Neurology. 2004 Feb 24;62(4):628-31
Date
Feb-24-2004
Language
English
Publication Type
Article
Keywords
Adult
Alanine Transaminase - blood
Aspartate Aminotransferases - blood
Biological Markers
British Columbia - epidemiology
Drug Monitoring
Drug-Induced Liver Injury, Chronic - epidemiology - etiology
Female
Follow-Up Studies
Humans
Injections, Intramuscular
Injections, Subcutaneous
Interferon-beta - administration & dosage - adverse effects - therapeutic use
Male
Middle Aged
Multiple Sclerosis - drug therapy
Retrospective Studies
Risk factors
Abstract
A population-based retrospective chart review of the biochemical liver tests of 844 patients with multiple sclerosis prescribed a beta-interferon (IFNbeta) product in British Columbia, Canada was performed between 1995 and 2001. Overall, 36.9% (243/659) of patients developed new elevations of alanine aminotransferase. All the IFNbetas caused elevated aminotransferase levels compared with pretreatment levels (p IFNbeta-1a(IM).
Notes
Comment In: Neurology. 2004 Sep 28;63(6):1142-3; author reply 1142-315452330
Comment In: Neurology. 2004 Sep 28;63(6):1142-3; author reply 1142-315457586
SummaryForPatientsIn: Neurology. 2004 Feb 24;62(4):E8-914981207
PubMed ID
14981183 View in PubMed
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Liver transplantation for alcoholic liver disease among Canadian transplant centres: a national study.

https://arctichealth.org/en/permalink/ahliterature107226
Source
Can J Gastroenterol. 2013 Nov;27(11):643-6
Publication Type
Article
Date
Nov-2013
Author
Natasha Chandok
Mohammed Aljawad
Angela White
Roberto Hernandez-Alejandro
Paul Marotta
Eric M Yoshida
Source
Can J Gastroenterol. 2013 Nov;27(11):643-6
Date
Nov-2013
Language
English
Publication Type
Article
Keywords
Acute Disease
Alcohol Drinking - adverse effects - epidemiology
Alcoholism - complications - rehabilitation
Canada
Health Care Surveys
Hepatitis, Alcoholic - physiopathology - surgery
Humans
Liver Diseases, Alcoholic - physiopathology - surgery
Liver Transplantation - statistics & numerical data
Patient Selection
Severity of Illness Index
Social Support
Temperance
Time Factors
Waiting Lists
Abstract
BACKGROUND/
Alcoholic liver disease (ALD) is a controversial yet established indication for liver transplantation (LT), and there is emerging evidence supporting a survival benefit in selected patients with severe acute alcoholic hepatitis. The aim of the present survey was to describe policies among Canadian transplant centres for patients with ALD.
A survey was distributed to the medical directors of all seven liver transplant centres in Canada.
All seven liver transplant programs in Canada participated in the survey. Every centre requires patients to have a minimum of six months of abstinence from alcohol before listing for LT. Completion of a rehabilitation program is only mandatory in one program; the remaining programs do not mandate this if patients have demonstrated prolonged abstinence, and sufficient insight and social supports. No program considers LT for patients with severe acute alcoholic hepatitis, although six of the seven programs are interested in exploring a national policy. Random alcohol checks for waitlisted patients are performed routinely on patients listed for ALD at only one centre; the remaining centres only perform checks if there is clinical suspicion. In the past five years, the mean (± SD) number of patients per centre with graft dysfunction from recidivism was 10±4.36; a mean of 2.5±4.36 patients per centre developed graft failure.
With minor exceptions, LT policies for subjects with ALD are uniform across Canadian transplant programs. Presently, no centres perform LT for acute alcoholic hepatitis, although there is broad interest in exploring a national policy. Recidivism resulting in graft loss is a rare phenomenon.
Notes
Comment In: Can J Gastroenterol. 2013 Nov;27(11):625-624199208
PubMed ID
24040631 View in PubMed
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Liver transplantation for hepatic epithelioid hemangioendothelioma: the Canadian multicentre experience.

https://arctichealth.org/en/permalink/ahliterature154685
Source
Can J Gastroenterol. 2008 Oct;22(10):821-4
Publication Type
Article
Date
Oct-2008
Author
Carmine G Nudo
Eric M Yoshida
Vincent G Bain
Denis Marleau
Phil Wong
Paul J Marotta
Eberhard Renner
Kymberly D Watt
Marc Deschênes
Author Affiliation
McGill University, Montréal, Québec. carmine.nudo@mail.mcgill.edu
Source
Can J Gastroenterol. 2008 Oct;22(10):821-4
Date
Oct-2008
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Canada - epidemiology
Female
Follow-Up Studies
Hemangioendothelioma, Epithelioid - mortality - pathology - surgery
Humans
Liver Neoplasms - mortality - pathology - surgery
Liver Transplantation
Lymphatic Metastasis
Male
Middle Aged
Neoplasm Recurrence, Local
Splenic Neoplasms - secondary
Survival Rate
Treatment Outcome
Young Adult
Abstract
Hepatic epithelioid hemangioendothelioma (HEHE) is a rare entity. At the present time, there is no standardized effective therapy. Liver transplantation (LT) has emerged as a treatment for this rare tumour.
To evaluate the outcome of liver transplantation for HEHE at eight centres across Canada.
The charts of patients who were transplanted for HEHE at eight centres across Canada were reviewed.
A total of 11 individuals (eight women and three men) received a LT for HEHE. All LTs were performed between 1991 and 2005. The mean (+/- SD) age at LT was 38.7+/-13 years. One patient had one large liver lesion (17 cm x 14 cm x 13 cm), one had three lesions, one had four lesions and eight had extensive (five or more) liver lesions. One patient had spleen involvement and two had involved lymph nodes at the time of transplantation. The mean duration of follow-up was 78+/-63 months (median 81 months). Four patients (36.4%) developed recurrence of HEHE with a mean time to recurrence of 25+/-25 months (median 15.6 months) following LT. The calculated survival rate following LT for HEHE was 82% at five years.
The results of LT for HEHE are encouraging, with a recurrence rate of 36.4% and a five-year survival rate of 82%. Further studies are needed to help identify patients who would benefit most from LT for this rare tumour.
Notes
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PubMed ID
18925305 View in PubMed
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20 records – page 1 of 2.