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A System For Estimating Drug Delivery From A Dry Powder Inhaler By Analysis Of Acoustic Recordings Of Time-Stamped Inhaler Events, Jansen N. Seheult 2016 Royal College of Surgeons in Ireland

A System For Estimating Drug Delivery From A Dry Powder Inhaler By Analysis Of Acoustic Recordings Of Time-Stamped Inhaler Events, Jansen N. Seheult

MD theses

Inhaled medications are the mainstay of therapy in the treatment of chronic respiratory diseases like asthma and COPD because they allow delivery of the active ingredient directly to the site of action. Poor adherence to inhaled controller medications has been estimated to account for up to 60% of asthma-related hospitalizations and increased rates of 30- and 60- day hospital readmissions in patients with COPD. Numerous electronic monitoring devices have been developed over the last four decades to monitor temporal non-adherence; however, many of these devices do not monitor all or most aspects of inhaler technique. Currently used methods for monitoring ...


High Levels Of Anti-Tuberculin (Igg) Antibodies Correlate With The Blocking Of T-Cell Proliferation In Individuals With High Exposure To Mycobacterium Tuberculosis, E. J. Feris, L. Encinales, C. Awad, J. N. Stern, I. Tabansky, L. Jimenez-Alvarez, G. Ramirez-Martinez, A. Cruz-Lagunas, K. Bobadilla, E. Marquez 2016 Hofstra Northwell School of Medicine

High Levels Of Anti-Tuberculin (Igg) Antibodies Correlate With The Blocking Of T-Cell Proliferation In Individuals With High Exposure To Mycobacterium Tuberculosis, E. J. Feris, L. Encinales, C. Awad, J. N. Stern, I. Tabansky, L. Jimenez-Alvarez, G. Ramirez-Martinez, A. Cruz-Lagunas, K. Bobadilla, E. Marquez

Joel Stern

OBJECTIVES: To determine the effect of anti-tuberculin antibodies in the T-cell proliferation in response to tuberculin and Candida antigens in individuals with different levels of tuberculosis (TB) risk. METHODS: Sixteen high-risk TB individuals, 30 with an intermediate TB risk (group A), and 45 with a low TB risk (group B), as well as 49 control individuals, were studied. Tuberculin skin test (TST) results were analyzed and serum levels of antibodies (IgG and IgM) against purified protein derivative (PPD) were measured by ELISA. Tuberculin and Candida antigens were used to stimulate T-cell proliferation in the presence of human AB serum or ...


Respiratory Rate Variability In Sleeping Adults Without Obstructive Sleep Apnea, Guillermo Gutierrez, Jeffrey Williams, Ghadah Alrehaili, Anna McLean, Ramin Pirouz, Richard L. Amdur, Vivek Jain, Jalil Ahari, Amandeep Bawa, Shawn Kimbro 2016 George Washington University

Respiratory Rate Variability In Sleeping Adults Without Obstructive Sleep Apnea, Guillermo Gutierrez, Jeffrey Williams, Ghadah Alrehaili, Anna Mclean, Ramin Pirouz, Richard L. Amdur, Vivek Jain, Jalil Ahari, Amandeep Bawa, Shawn Kimbro

Surgery Faculty Publications

Characterizing respiratory rate variability (RRV) in humans during sleep is challenging, since it requires the analysis of respiratory signals over a period of several hours. These signals are easily distorted by movement and volitional inputs. We applied the method of spectral analysis to the nasal pressure transducer signal in 38 adults with no obstructive sleep apnea, defined by an apnea‐hypopnea index <5, who underwent all‐night polysomnography (PSG). Our aim was to detect and quantitate RRV during the various sleep stages, including wakefulness. The nasal pressure transducer signal was acquired at 100 Hz and consecutive frequency spectra were generated for the length of the PSG with the Fast Fourier Transform. For each spectrum, we computed the amplitude ratio of the first harmonic peak to the zero frequency peak (H1/DC), and defined as RRV as (100 − H1/DC) %. RRV was greater during wakefulness compared to any sleep stage, including rapid‐eye‐movement. Furthermore, RRV correlated with the depth of sleep, being lowest during N3. Patients spent most their sleep time supine, but we found no correlation between RRV and body position. There was a correlation between respiratory rate and sleep stage, being greater in wakefulness than in any sleep stage. We conclude that RRV varies according to sleep stage. Moreover, spectral analysis of nasal pressure signal appears to provide a valid measure of RRV during sleep. It remains to be seen if the method can differentiate normal from pathological sleep patterns.


Airway Secretory Micrornaome Changes During Rhinovirus Infection In Early Childhood., M. Gutierrez, J. Gomez, Geovanny Perez, Krishna Pancham, Dinesh K. Pillai, M. Giri, S. Ferrante, Robert J. Freishtat, Mary C. Rose, Diego A. Preciado, Gustavo Nino 2016 George Washington University

Airway Secretory Micrornaome Changes During Rhinovirus Infection In Early Childhood., M. Gutierrez, J. Gomez, Geovanny Perez, Krishna Pancham, Dinesh K. Pillai, M. Giri, S. Ferrante, Robert J. Freishtat, Mary C. Rose, Diego A. Preciado, Gustavo Nino

Pediatrics Faculty Publications

BACKGROUND:

Innate immune responses are fine-tuned by small noncoding RNA molecules termed microRNAs (miRs) that modify gene expression in response to the environment. During acute infections, miRs can be secreted in extracellular vesicles (EV) to facilitate cell-to-cell genetic communication. The purpose of this study was to characterize the baseline population of miRs secreted in EVs in the airways of young children (airway secretory microRNAome) and examine the changes during rhinovirus (RV) infection, the most common cause of asthma exacerbations and the most important early risk factor for the development of asthma beyond childhood.

METHODS:

Nasal airway secretions were obtained from ...


Effects Of Prenatal Exposure To Bisphenol A On Fetal Lung Development, Ayten Hijazi 2016 The University of Western Ontario

Effects Of Prenatal Exposure To Bisphenol A On Fetal Lung Development, Ayten Hijazi

Electronic Thesis and Dissertation Repository

Prenatal exposure to bisphenol A (BPA), one of the most prevalent endocrine disrupting chemicals, is associated with lung dysfunction and diseases in later life. However, it is unknown if this association has a fetal origin. In this thesis, a series of in vivo and in vitro experiments were conducted to determine the effects of prenatal exposure to BPA on fetal lung development, and define the underlying molecular mechanisms. Environmentally relevant doses of BPA were administered to pregnant mice via diet from embryonic day (E) 7.5 to 18.5. Fetal lungs were analyzed at E18.5 for changes in structure ...


Sustained Expression With Partial Correction Of Neutrophil Defects 5 Years After Intramuscular Raav1 Gene Therapy For Alpha-1 Antitrypsin Deficiency, Terence R. Flotte, Christian Mueller, Gwladys Gernoux, Alisha Gruntman, Jeffrey D. Chulay, David R. Knop, Noel G. McElvaney, Martha Campbell-Thompson, James M. Wilson 2016 University of Massachusetts Medical School

Sustained Expression With Partial Correction Of Neutrophil Defects 5 Years After Intramuscular Raav1 Gene Therapy For Alpha-1 Antitrypsin Deficiency, Terence R. Flotte, Christian Mueller, Gwladys Gernoux, Alisha Gruntman, Jeffrey D. Chulay, David R. Knop, Noel G. Mcelvaney, Martha Campbell-Thompson, James M. Wilson

UMass Center for Clinical and Translational Science Research Retreat

Alpha-1 antitrypsin (AAT) deficiency is a common monogenic disorder resulting in emphysema, which is currently treated with weekly infusions of protein replacement. We previously reported achieving plasma wild-type (M) AAT concentrations at 2.5-3.8% of the therapeutic level at 1 year after intramuscular (IM) administration of 6×1012vg/kg of a recombinant adeno-associated virus serotype 1 (rAAV1)-AAT vector in AAT-deficient patients, with an associated regulatory T cell (Treg) response to AAV1 capsid epitopes in the absence of any exogenous immune suppression. Here, we report sustained expression at greater than 2% of the therapeutic level for 5 years after ...


Characterization Of Respiratory Phenotype In Very Long-Chain Acyl-Coa Dehydrogenase Deficient Mice., Allison M. Keeler, Kaitlyn Desrochers, Mai K. Elmallah 2016 University of Massachusetts Medical School

Characterization Of Respiratory Phenotype In Very Long-Chain Acyl-Coa Dehydrogenase Deficient Mice., Allison M. Keeler, Kaitlyn Desrochers, Mai K. Elmallah

UMass Center for Clinical and Translational Science Research Retreat

Rationale: Very Long-chain Acyl-CoA dehydrogenase (VLCAD) deficiency the most common inherited long-chain fatty acid disorder. The VLCAD enzyme catalyzes the first step of mitochondrial fatty acid oxidation and loss of the enzyme results in energy deficiency as well as accumulation of long chain fatty acids. Recently, a related enzyme, Long-chain Acyl-CoA dehydrogensase (LCAD), which unlike VLCAD is not highly expressed in metabolic tissues like liver, heart and skeletal muscle, was found to be expressed in the lung and surfactant and lung dysfunction were observed in LCAD deficient mice. Respiratory distress syndrome has been described in other fatty acid oxidation disorders ...


Immune Features That Afford Protection From Clinical Disease Versus Sterilizing Immunity To Bordetella Pertussis Infection In A Nonhuman Primate Model Of Whooping Cough, Keith A. Reimann, Aaron J. Belli, Sarah Fulco, Jason M. Warfel, Rijian Wang, Lisa Cavacini, James F. Papin, Steven F. Merkel, Tod J. Merkel, Mark S. Klempner 2016 University of Massachusetts Medical School

Immune Features That Afford Protection From Clinical Disease Versus Sterilizing Immunity To Bordetella Pertussis Infection In A Nonhuman Primate Model Of Whooping Cough, Keith A. Reimann, Aaron J. Belli, Sarah Fulco, Jason M. Warfel, Rijian Wang, Lisa Cavacini, James F. Papin, Steven F. Merkel, Tod J. Merkel, Mark S. Klempner

UMass Center for Clinical and Translational Science Research Retreat

The respiratory bacterial infection caused by Bordetella pertussis (whooping cough) is the only vaccine-preventable disease whose incidence has been increasing over the last 3 decades. To better understand the resurgence of this infection, a baboon animal model of pertussis infection has been developed. Naïve baboons that recover from experimental pertussis infection are resistant both to clinical disease and to airway colonization when re-challenged. In contrast, animals vaccinated with acellular pertussis vaccine and experimentally challenged do not develop disease, but airways remain colonized for 4-6 weeks. We explored the possibility that the IgG antibody response to pertussis infection is qualitatively different ...


The Effect Of Mobile Self-Monitoring On Self-Care Behaviors In Heart Failure And Copd Patients: A Feasibility Study, Elizabeth Chin, Kristen Sethares, Paul Fortier, Benjamin Viall 2016 University of Massachusetts Dartmouth

The Effect Of Mobile Self-Monitoring On Self-Care Behaviors In Heart Failure And Copd Patients: A Feasibility Study, Elizabeth Chin, Kristen Sethares, Paul Fortier, Benjamin Viall

UMass Center for Clinical and Translational Science Research Retreat

Exacerbations of heart failure (HF) and chronic obstructive lung disease (COPD) are among the most costly illnesses. Patient recognition of changes in symptoms cueing imminent exacerbation is poor. Innovative strategies to improve patient symptom recognition, self-care behaviors and treatment seeking are necessary to improve overall health outcomes.

The aim of this pilot study was to test the feasibility of a wireless health monitoring device and cell phone app in 10 patients (5 with COPD and 5 with HF). This collaborative multidisciplinary study is innovative in its inclusion of the patient as an active partner in the use of technology to ...


Patterns Of Growth And Decline In Lung Function In Persistent Childhood Asthma, Michael J. McGeachie, Gaurav Jain, Amartya Sanyal, Ye Zhan, Bryan R. Lajoie, Job Dekker, Scott T. Weiss, CAMP Research Group 2016 Brigham and Women’s Hospital

Patterns Of Growth And Decline In Lung Function In Persistent Childhood Asthma, Michael J. Mcgeachie, Gaurav Jain, Amartya Sanyal, Ye Zhan, Bryan R. Lajoie, Job Dekker, Scott T. Weiss, Camp Research Group

Program in Systems Biology Publications and Presentations

BACKGROUND: Tracking longitudinal measurements of growth and decline in lung function in patients with persistent childhood asthma may reveal links between asthma and subsequent chronic airflow obstruction.

METHODS: We classified children with asthma according to four characteristic patterns of lung-function growth and decline on the basis of graphs showing forced expiratory volume in 1 second (FEV1), representing spirometric measurements performed from childhood into adulthood. Risk factors associated with abnormal patterns were also examined. To define normal values, we used FEV1 values from participants in the National Health and Nutrition Examination Survey who did not have asthma.

RESULTS: Of the 684 ...


Clinical Approach To Nonresponsive Pneumonia In Adults Diagnosed By A Primary Care Clinician: A Retrospective Study, Kiley B. Vander Wyst, Jessica J. F. Kram, Dennis J. Baumgardner 2016 Center for Urban Population Health; Aurora Health Care

Clinical Approach To Nonresponsive Pneumonia In Adults Diagnosed By A Primary Care Clinician: A Retrospective Study, Kiley B. Vander Wyst, Jessica J. F. Kram, Dennis J. Baumgardner

Dennis J. Baumgardner. MD

Purpose

Community-acquired pneumonia (CAP) is commonly diagnosed in the primary care setting. Management of nonresponsive pneumonia (NRP), i.e. failure to respond to CAP treatment, is not clearly understood. The purpose of this study was to describe the initial work-up and treatment of CAP in the ambulatory primary care setting and to determine relative proportion of, diagnostic approach to and treatment of NRP.

Methods

We retrospectively studied adult patients diagnosed with CAP within our large, integrated health care system from October 2006 through July 2013. Cases were defined as patients with CAP who worsened after 4 days, or did not ...


Clinical Approach To Nonresponsive Pneumonia In Adults Diagnosed By A Primary Care Clinician: A Retrospective Study, Kiley B. Vander Wyst, Jessica J. F. Kram, Dennis J. Baumgardner 2016 Center for Urban Population Health; Aurora Health Care

Clinical Approach To Nonresponsive Pneumonia In Adults Diagnosed By A Primary Care Clinician: A Retrospective Study, Kiley B. Vander Wyst, Jessica J. F. Kram, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

Purpose

Community-acquired pneumonia (CAP) is commonly diagnosed in the primary care setting. Management of nonresponsive pneumonia (NRP), i.e. failure to respond to CAP treatment, is not clearly understood. The purpose of this study was to describe the initial work-up and treatment of CAP in the ambulatory primary care setting and to determine relative proportion of, diagnostic approach to and treatment of NRP.

Methods

We retrospectively studied adult patients diagnosed with CAP within our large, integrated health care system from October 2006 through July 2013. Cases were defined as patients with CAP who worsened after 4 days, or did not ...


Is 13-Valent Pneumococcal Conjugate Vaccine (Pcv13) Combined With 23-Valent Pneumococcal Polysaccharide Vaccine (Ppsv23) Superior To Ppsv23 Alone For Reducing Incidence Or Severity Of Pneumonia In Older Adults? A Clin-Iq, Starla Hayward, Lou Ann Thompson, Andrea McEachern 2016 OSU Medical Center

Is 13-Valent Pneumococcal Conjugate Vaccine (Pcv13) Combined With 23-Valent Pneumococcal Polysaccharide Vaccine (Ppsv23) Superior To Ppsv23 Alone For Reducing Incidence Or Severity Of Pneumonia In Older Adults? A Clin-Iq, Starla Hayward, Lou Ann Thompson, Andrea Mceachern

Journal of Patient-Centered Research and Reviews

Pneumonia infection is a significant cause of morbidity and mortality worldwide. In addition to the public health concerns, pneumonia also accounts for a significant cost to the health care system. Currently there are two leading vaccines targeted against Streptococcus pneumoniae: 23-valent pneumococcal polysaccharide vaccine (PPSV23) and 13-valent pneumococcal conjugate vaccine (PCV13). Until recently, the recommendation for adult pneumonia vaccination has been a single dose of PPSV23 for all adults aged 65 years or older. However, concerns were raised regarding the vaccine’s efficacy due to the persistent burden of pneumococcal disease in the elderly population. This paper focuses on two ...


Aligning Asthma Education Across The Continuum Of Physician Education: Impact On Clinical Metrics, Lisa Sullivan Vedder, Deborah Simpson, Jacob L. Bidwell, John R. Brill, Theresa Frederick 2016 Department of Family Medicine, Aurora UW Medical Group

Aligning Asthma Education Across The Continuum Of Physician Education: Impact On Clinical Metrics, Lisa Sullivan Vedder, Deborah Simpson, Jacob L. Bidwell, John R. Brill, Theresa Frederick

Lisa Sullivan Vedder, MD

Background: All trainees entering family medicine residency training programs after June 1, 2012, must complete the same American Board of Family Medicine (ABFM) Maintenance of Certification (MOC) requirements as practicing physicians. These shared requirements provide an opportunity to align physician education initiatives across the continuum focused around a clinical care topic to improve health care system metrics.

Purpose: To assess the initial effectiveness of an ABFM Asthma Part IV approved MOC module, aligned to meet residency and medical student program accreditation requirements, on health care system metrics.

Methods: An ABFM Asthma Part IV MOC module was implemented for family medicine ...


"Mi Niño Con Asma": Hispanic/Latina Mothers, Environmental Justice, And Photovoice At The Front Lines Of The Asthma Epidemic, Robin A. Evans-Agnew RN, PhD, Julie Postma RN, PhD, Lee Sledd M. Ed 2016 University of Washington Tacoma

"Mi Niño Con Asma": Hispanic/Latina Mothers, Environmental Justice, And Photovoice At The Front Lines Of The Asthma Epidemic, Robin A. Evans-Agnew Rn, Phd, Julie Postma Rn, Phd, Lee Sledd M. Ed

Journal of Health Disparities Research and Practice

Asthma is an important environmental justice concern for first generation Mexican-Americans. Families experience disparities in housing conditions, access to care, and legal marginalization. Little is known about how Hispanic/Latina mothers of children with asthma navigate these oppressions.

Problem: The purpose of this paper is to describe the discourses of environmental justice of a group Hispanic/Latina caregivers of children with asthma.

Method: A photovoice design was used with Hispanic/Latina mothers (n=11) in Tacoma, Washington, to take, discuss, select and display phototexts to policymakers that communicated their experiences and opinions in managing asthma for their child. Using critical ...


Aligning Asthma Education Across The Continuum Of Physician Education: Impact On Clinical Metrics, Lisa Sullivan Vedder, Deborah Simpson, Jacob L. Bidwell, John R. Brill, Theresa Frederick 2016 Department of Family Medicine, Aurora UW Medical Group

Aligning Asthma Education Across The Continuum Of Physician Education: Impact On Clinical Metrics, Lisa Sullivan Vedder, Deborah Simpson, Jacob L. Bidwell, John R. Brill, Theresa Frederick

Deborah Simpson, PhD

Background: All trainees entering family medicine residency training programs after June 1, 2012, must complete the same American Board of Family Medicine (ABFM) Maintenance of Certification (MOC) requirements as practicing physicians. These shared requirements provide an opportunity to align physician education initiatives across the continuum focused around a clinical care topic to improve health care system metrics.

Purpose: To assess the initial effectiveness of an ABFM Asthma Part IV approved MOC module, aligned to meet residency and medical student program accreditation requirements, on health care system metrics.

Methods: An ABFM Asthma Part IV MOC module was implemented for family medicine ...


High Levels Of Anti-Tuberculin (Igg) Antibodies Correlate With The Blocking Of T-Cell Proliferation In Individuals With High Exposure To Mycobacterium Tuberculosis, E. J. Feris, L. Encinales, C. Awad, J. N. Stern, I. Tabansky, L. Jimenez-Alvarez, G. Ramirez-Martinez, A. Cruz-Lagunas, K. Bobadilla, E. Marquez, +6 additional authors 2016 Hofstra Northwell School of Medicine

High Levels Of Anti-Tuberculin (Igg) Antibodies Correlate With The Blocking Of T-Cell Proliferation In Individuals With High Exposure To Mycobacterium Tuberculosis, E. J. Feris, L. Encinales, C. Awad, J. N. Stern, I. Tabansky, L. Jimenez-Alvarez, G. Ramirez-Martinez, A. Cruz-Lagunas, K. Bobadilla, E. Marquez, +6 Additional Authors

Journal Articles

OBJECTIVES: To determine the effect of anti-tuberculin antibodies in the T-cell proliferation in response to tuberculin and Candida antigens in individuals with different levels of tuberculosis (TB) risk. METHODS: Sixteen high-risk TB individuals, 30 with an intermediate TB risk (group A), and 45 with a low TB risk (group B), as well as 49 control individuals, were studied. Tuberculin skin test (TST) results were analyzed and serum levels of antibodies (IgG and IgM) against purified protein derivative (PPD) were measured by ELISA. Tuberculin and Candida antigens were used to stimulate T-cell proliferation in the presence of human AB serum or ...


Age-Related Effect Of Viral-Induced Wheezing In Severe Prematurity, Geovanny F. Perez, Amisha Jain, Bassem Kurdi, Rosemary Megalaa, Krishna Pancham, Shehlanoor Huseni, Natalia Isaza, Carlos E. Rodriguez-Martinez, Mary C. Rose, Dinesh Pillai, Gustavo Nino 2016 George Washington University

Age-Related Effect Of Viral-Induced Wheezing In Severe Prematurity, Geovanny F. Perez, Amisha Jain, Bassem Kurdi, Rosemary Megalaa, Krishna Pancham, Shehlanoor Huseni, Natalia Isaza, Carlos E. Rodriguez-Martinez, Mary C. Rose, Dinesh Pillai, Gustavo Nino

Pediatrics Faculty Publications

Premature children are prone to severe viral respiratory infections in early life, but the age at which susceptibility peaks and disappears for each pathogen is unclear.

Methods: A retrospective analysis was performed of the age distribution and clinical features of acute viral respiratory infections in full-term and premature children, aged zero to seven years.

Results: The study comprised of a total of 630 hospitalizations (n = 580 children). Sixty-seven percent of these hospitalizations occurred in children born full-term (>37 weeks), 12% in preterm (32–37 weeks) and 21% in severely premature children (<32 weeks). The most common viruses identified were rhinovirus (RV; 60%) and respiratory syncytial virus (RSV; 17%). Age-distribution analysis of each virus identified that severely premature children had a higher relative frequency of RV and RSV in their first three years, relative to preterm or full-term children. Additionally, the probability of RV- or RSV-induced wheezing was higher overall in severely premature children less than three years old.

Conclusions: Our results indicate that the vulnerability to viral ...


Obesity And Asthma: Adiponectin Receptor 1 (Adipo R1) And Adiponectin Receptor 2 (Adipo R2) Are Expressed By Normal Human Bronchial Epithelial (Nhbe) Cells At Air-Liquid Interface (Ali) And Expression Changes With Il-13 Stimulation, Jennifer L. Bradley 2016 Virginia Commonwealth University

Obesity And Asthma: Adiponectin Receptor 1 (Adipo R1) And Adiponectin Receptor 2 (Adipo R2) Are Expressed By Normal Human Bronchial Epithelial (Nhbe) Cells At Air-Liquid Interface (Ali) And Expression Changes With Il-13 Stimulation, Jennifer L. Bradley

Theses and Dissertations

Obesity is recognized as an important risk factor for the development of many chronic diseases such as hypertension, Type 2 diabetes mellitus (T2DM) cardiovascular disease, cancer, renal disease, neurologic dysfunction, metabolic syndrome and asthma (3, 4). Circulating serum adiponectin levels in obese asthmatics have been reported to be low. Therefore, we aimed to investigate the role of adiponectin in a mucus hypersecretion model and hypothesized that adiponectin would decrease IL-13 induced MUC5AC expression from differentiated NHBE cells and that increasing concentrations of IL-13 would cause a decrease in Adipo R1 and Adipo R2 expression. MUC5AC expression with exposure to adiponectin ...


Lung Cancer And Mesothelioma, Jeffrey A. Gordon, Elizabeth Kurian, Arash Bedayat, Ali Akalin, Karl Uy, Richard S. Pieters 2015 UMass Memorial Health Care

Lung Cancer And Mesothelioma, Jeffrey A. Gordon, Elizabeth Kurian, Arash Bedayat, Ali Akalin, Karl Uy, Richard S. Pieters

Cancer Concepts: A Guidebook for the Non-Oncologist

This chapter in Cancer Concepts: A Guidebook for the Non-Oncologist presents an overview of lung cancer and mesothelioma, including epidemiology, etiology, screening, pathology, staging, and treatment.


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