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Microrna-96 Promotes Schistosomiasis Hepatic Fibrosis In Mice By Suppressing Smad7, Xufeng Luo, Dongmei Zhang, Jun Xie, Qin Su, Xing He, Ruipu Bai, Guangping Gao, Weiqing Pan 2018 Second Military Medical University

Microrna-96 Promotes Schistosomiasis Hepatic Fibrosis In Mice By Suppressing Smad7, Xufeng Luo, Dongmei Zhang, Jun Xie, Qin Su, Xing He, Ruipu Bai, Guangping Gao, Weiqing Pan

UMass Center for Clinical and Translational Science Supported Publications

Infection with Schistosoma causes aberrant expression of host microRNAs (miRNAs), and normalizing the levels of dysregulated miRNAs can attenuate pathology. Here, we show that the host miRNA, miR-96, is markedly upregulated during the progression of hepatic schistosomiasis. We demonstrate that elevation of miR-96 induces hepatic fibrosis in infected mice by suppressing the expression of its target gene, Smad7. We show that infection with Schistosoma induces the expression of transforming growth factor beta1 (TGF-beta1), which in turn upregulates the expression of miR-96 through SMAD2/3-DROSHA-mediated post-transcriptional regulation. Furthermore, inhibition of miR-96 with recombinant adeno-associated virus 8 (rAAV8)-mediated delivery of Tough ...


Association Between Sarcopenia And Functional Status In Liver Transplant Patients, Natasha H. Dolgin, Andrew J. Smith, Samantha G. Harrington, Babak Movahedi, Paulo N.A. Martins, Adel Bozorgzadeh 2018 University of Massachusetts Medical School

Association Between Sarcopenia And Functional Status In Liver Transplant Patients, Natasha H. Dolgin, Andrew J. Smith, Samantha G. Harrington, Babak Movahedi, Paulo N.A. Martins, Adel Bozorgzadeh

Open Access Articles

OBJECTIVES: A growing body of evidence shows that frailty and functional performance predict liver transplant outcomes. The Organ Procurement and Transplant Network uses the Karnofsky Performance Status scale to adjust for transplant center case mix in assessing quality measures. This study explores the strength of the relationship between Karnofsky Performance Status scores and objective measures of frailty.

MATERIALS AND METHODS: This observational study includes 136 adult, first-time liver transplant recipients at UMass Memorial (2006-2015) who had 2 abdominal computed tomography scans available (at < /= 90 days pretransplant and > /= 7 days before that). We analyzed the relationship between Karnofsky Performance Status and muscle wasting using absolute ...


The Continuing Epidemic Of Hepatitis C In The United States: The Case Of West Virginia, David P. Paul III, Neha Botre, Maggie Phillips, Jumana Abboud, Alberto Coustasse 2018 Marshall University

The Continuing Epidemic Of Hepatitis C In The United States: The Case Of West Virginia, David P. Paul Iii, Neha Botre, Maggie Phillips, Jumana Abboud, Alberto Coustasse

Management Faculty Research

Hepatitis C virus (HCV) is one of the most significant public health problems currently facing the U.S. If it is left untreated, the likelihood of sustaining a treatment response decreases. While early identification has been identified as a critical focus in trying to obtain better health outcomes, new drug treatments appear quite promising.


Reduced Incidence And Better Liver Disease Outcomes Among Chronic Hcv Infected Patients Who Consume Cannabis, Adeyinka Adejumo, Oluwole Muyiwa Adegbala, Kelechi Lauretta Adejumo, Terence N. Bukong 2018 University of Massachusetts Medical School

Reduced Incidence And Better Liver Disease Outcomes Among Chronic Hcv Infected Patients Who Consume Cannabis, Adeyinka Adejumo, Oluwole Muyiwa Adegbala, Kelechi Lauretta Adejumo, Terence N. Bukong

Open Access Articles

Background and Aim: The effect of cannabis use on chronic liver disease (CLD) from Hepatitis C Virus (HCV) infection, the most common cause of CLD, has been controversial. Here, we investigated the impact of cannabis use on the prevalence of CLD among HCV infected individuals.

Methods: We analyzed hospital discharge records of adults (age > /= 18 years) with a positive HCV diagnosis. We evaluated records from 2007 to 2014 of the Nationwide Inpatient Sample (NIS). We excluded records with other causes of chronic liver diseases (alcohol, hemochromatosis, NAFLD, PBC, HBV, etc.). Of the 188,333 records, we matched cannabis users to ...


Prothrombin Complex Concentrates Or Recombinant Factor Viia Are More Effective Than Fresh-Frozen Plasma At Lowering Inr In Patients With Liver Disease, Abel J. Ignatius 2018 Wayne State University

Prothrombin Complex Concentrates Or Recombinant Factor Viia Are More Effective Than Fresh-Frozen Plasma At Lowering Inr In Patients With Liver Disease, Abel J. Ignatius

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Kwon JO, MacLaren R. Comparison of fresh-frozen plasma, four-factor prothrombin complex concentrates, and recombinant factor VIIa to facilitate procedures in critically ill patients with coagulopathy from liver disease: a retrospective cohort study. Pharmacotherapy. 2016;36(10):1047-1054. doi: 10.1002/phar.1827


Cellular Senescence And Their Role In Liver Metabolism In Health And Disease: Overview And Future Directions, Matthew Schade, Jacqueline A. Sanabria, Rodrigo Aguilar, Milad Modarresi, Brad Gillon, Zach Hunter, Jacqueline Fannin, Amrita Mallick, Henri Brunengraber, Juan Sanabria 2018 Marshall University

Cellular Senescence And Their Role In Liver Metabolism In Health And Disease: Overview And Future Directions, Matthew Schade, Jacqueline A. Sanabria, Rodrigo Aguilar, Milad Modarresi, Brad Gillon, Zach Hunter, Jacqueline Fannin, Amrita Mallick, Henri Brunengraber, Juan Sanabria

Surgery

Chronic liver disease has globally risen mainly due to a prevalent Hepatitis C Virus (HCV) infection rate and an epidemic of obesity. It is estimated by the year 2030, 2.2 billion people around the world will be overweight and 1.1 billion people will be obese. Diabetes and obesity are the main risk factors for the development of the metabolic syndrome and in the liver of Non-Alcoholic Fatty Liver Disease (NAFLD) which could progress to NASH related cirrhosis and liver malignancy. At present there is not effective therapy for NASH besides loss of weight and exercise. Furthermore, optimal management ...


Placement Of Lumen-Apposing Metal Stents To Drain Pseudocysts And Walled-Off Pancreatic Necrosis Can Be Safely Performed On An Outpatient Basis: A Multicenter Study, Douglas G. Adler, Janak Shah, Jose Nieto, Kenneth Binmoeller, Yasser Bhat, Linda Jo Taylor, Ali A. Siddiqui 2018 University of Utah Hospital

Placement Of Lumen-Apposing Metal Stents To Drain Pseudocysts And Walled-Off Pancreatic Necrosis Can Be Safely Performed On An Outpatient Basis: A Multicenter Study, Douglas G. Adler, Janak Shah, Jose Nieto, Kenneth Binmoeller, Yasser Bhat, Linda Jo Taylor, Ali A. Siddiqui

Division of Gastroenterology and Hepatology Faculty Papers

Backgrounds and Objectives: No study on the use of lumen-apposing fully covered self-expanding metal stent (LAMS) to drain pancreatic fluid collections (PFCs) has evaluated outcomes of patients in the outpatient setting. The objective of this multicenter study was to evaluate the clinical outcomes, success rate, and adverse events of the LAMS for endoscopic ultrasound (EUS)-guided transmural drainage of patients with symptomatic PFCs on an inpatient versus an outpatient basis.

Methods: This was a multicenter, retrospective study conducted at 4 tertiary care centers. Results: We identified eighty patients with PFCs in whom EUS-guided transmural drainage using the LAMS was performed ...


Metastatic Breast Cancer Presenting As Painless Jaundice, Daniel S. Wilen DO, Donald J. McMahon DO, Brian J. Blair DO, Joanne Kaiser-Smith DO, Darshan B. Roy MD 2018 Rowan University SOM

Metastatic Breast Cancer Presenting As Painless Jaundice, Daniel S. Wilen Do, Donald J. Mcmahon Do, Brian J. Blair Do, Joanne Kaiser-Smith Do, Darshan B. Roy Md

Stratford Campus Research Day

Breast cancer is the most commonly diagnosed cancer in women in the United States. Treatment options are wide-­‐ ranging based on a multitude of factors, including extent of disease and receptor positivity. Following treatment, a relapse-­‐free interval ≥ 2 years carries a more favorable prognosis.

We present a case involving a female with history of breast cancer and relapse-­free interval of 15 years who unfortunately presented with metastatic disease involving the liver, bone, and lymph nodes.


The Effect Of Hepatitis C On Maternal Bile Acid Level And The Fetal Left Ventricular Tei Index, Kelly Cummings, Jesse Cottrell, Songthip Ounpraseuth, Ryan Stone, David G. Chaffin, Everett Magann 2018 Marshall University

The Effect Of Hepatitis C On Maternal Bile Acid Level And The Fetal Left Ventricular Tei Index, Kelly Cummings, Jesse Cottrell, Songthip Ounpraseuth, Ryan Stone, David G. Chaffin, Everett Magann

Marshall Journal of Medicine

Hepatitis C (HCV) is a common form of liver disease encountered in pregnancy. The purpose of this study is to evaluate if hepatitis C is associated with elevated maternal serum bile acids and abnormal fetal cardiac function measured by the left ventricular Tei index in the absence of intrahepatic cholestasis of pregnancy. This is a prospective cohort study on pregnant women with hepatitis C seen through Marshall University’s high-risk obstetrics clinic from 2013 to 2014. Women with hepatitis C had a laboratory evaluation and an ultrasound on the fetus to calculate the left ventricular Tei index. Demographic information and ...


Periostin And Mesothelin: Potential Predictors Of Malignant Progression In Intrahepatic Cholangiocarcinoma, Pranoti Mandrekar, Vincenzo Cardinale 2018 University of Massachusetts Medical School

Periostin And Mesothelin: Potential Predictors Of Malignant Progression In Intrahepatic Cholangiocarcinoma, Pranoti Mandrekar, Vincenzo Cardinale

Open Access Articles

Cholangiocarcinoma (CCA), a heterogeneous group of malignancy arising at any level of the biliary tree based on their anatomical location, is classified into intrahepatic (iCCA), perihilar, and distal subtypes. iCCA, which arises distally to the second‐order bile ducts, is a highly heterogeneous and aggressive malignancy with overall poor prognosis. The rate of iCCA is increasing rapidly, particularly in Western countries; however, its precise etiology and pathogenesis remain elusive.1 While surgical resection is the first line of treatment, liver transplantation is the potential curative treatment for unresectable tumors in patients with iCCA, and posttransplantation 5‐year survival rates are ...


Acute-On-Chronic Liver Failure: Getting Ready For Prime-Time, Jasmohan S. Bajaj, Richard Moreau, Patrick S. Kamath, Hugo E. Vargas, Vicente Arroyo, K. Rajender Reddy, Gyongyi Szabo, Puneeta Tandon, Jody Olson, Constantine Karvellas, Thierry Gustot, Jennifer C. Lai, Florence Wong 2018 Virginia Commonwealth University

Acute-On-Chronic Liver Failure: Getting Ready For Prime-Time, Jasmohan S. Bajaj, Richard Moreau, Patrick S. Kamath, Hugo E. Vargas, Vicente Arroyo, K. Rajender Reddy, Gyongyi Szabo, Puneeta Tandon, Jody Olson, Constantine Karvellas, Thierry Gustot, Jennifer C. Lai, Florence Wong

University of Massachusetts Medical School Faculty Publications

Acute on chronic liver failure (ACLF) is a culmination of chronic liver disease and extra-hepatic organ failures, which is associated with a high short-term mortality and immense healthcare expenditure. There are varying definitions for organ failures and ACLF in Europe, North America and Asia. These differing definitions need to be reconciled to enhance progress in the field. The pathogenesis of ACLF is multi-factorial and related to interactions between the immuno-inflammatory system, microbiota and the precipitating factors. Individual organ failures related to the kidney, brain, lungs and circulation have cumulative adverse effects on mortality and are often complicated or precipitated by ...


Gut-Liver Axis Beyond The Microbiome: How The Fungal Mycobiome Contributes To Alcoholic Liver Disease., Gyongyi Szabo 2018 University of Massachusetts Medical School

Gut-Liver Axis Beyond The Microbiome: How The Fungal Mycobiome Contributes To Alcoholic Liver Disease., Gyongyi Szabo

University of Massachusetts Medical School Faculty Publications

Beginning of article: The importance of the “gut‐liver axis” has been long established in alcoholic liver disease (ALD). The direct effects of alcohol, its metabolites, and reactive oxygen species produced during alcohol metabolism result in cellular stress in hepatocytes, release of damage‐associated molecules (DAMPs), and increased hepatocyte vulnerability to inflammation‐related cellular injury. Excessive alcohol use also results in gut “leakiness,” resulting in increased delivery of pathogen‐derived molecular patterns (PAMPs) to the liver through the portal system. All of these gut‐derived PAMPs and hepatocyte‐derived DAMPs contribute to Kupffer cell (KC) and innate immune cell activation ...


Inhibition Of Insulin‐Like Growth Factor 1 Receptor Enhances The Efficacy Of Sorafenib In Inhibiting Hepatocellular Carcinoma Cell Growth And Survival, Fang Wang, Thomas Bank, George Malnassy, Maribel Arteaga, Na Shang, Annika Dalheim, Xianzhong Ding, Scott J. Cotler, Mitchell F. Denning, Michael I. Nishimura, Peter Breslin, Wei Qiu 2018 Loyola University Chicago

Inhibition Of Insulin‐Like Growth Factor 1 Receptor Enhances The Efficacy Of Sorafenib In Inhibiting Hepatocellular Carcinoma Cell Growth And Survival, Fang Wang, Thomas Bank, George Malnassy, Maribel Arteaga, Na Shang, Annika Dalheim, Xianzhong Ding, Scott J. Cotler, Mitchell F. Denning, Michael I. Nishimura, Peter Breslin, Wei Qiu

Biology: Faculty Publications and Other Works

Hepatocellular carcinoma (HCC) is the fifth most common primary cancer and second largest cause of cancer‐related death worldwide. The first‐line oral chemotherapeutic agent sorafenib only increases survival in patients with advanced HCC by less than 3 months. Most patients with advanced HCC have shown limited response rates and survival benefits with sorafenib. Although sorafenib is an inhibitor of multiple kinases, including serine/threonine‐protein kinase c‐Raf, serine/threonine‐protein kinase B‐Raf, vascular endothelial growth factor receptor (VEGFR)‐1, VEGFR‐2, VEGFR‐3, and platelet‐derived growth factor receptor β, HCC cells are able to escape from ...


An Expert Consensus For The Management Of Chronic Hepatitis B In Asian Americans., M. J. Tong, C. Q. Pan, S.-H. B. Han, D. S.-K. Lu, S. Raman, K.-Q. Hu, J. K. Lim, H.W. Hann, A. D. Min 2018 UCLA; Huntington Medical Research Institutes

An Expert Consensus For The Management Of Chronic Hepatitis B In Asian Americans., M. J. Tong, C. Q. Pan, S.-H. B. Han, D. S.-K. Lu, S. Raman, K.-Q. Hu, J. K. Lim, H.W. Hann, A. D. Min

Division of Gastroenterology and Hepatology Faculty Papers

BACKGROUND: Hepatitis B virus (HBV) infection is common with major clinical consequences. In Asian Americans, the HBsAg carrier rate ranges from 2% to 16% which approximates the rates from their countries of origin. Similarly, HBV is the most important cause of cirrhosis, hepatocellular carcinoma (HCC) and liver related deaths in HBsAg positive Asians worldwide.

AIM: To generate recommendations for the management of Asian Americans infected with HBV.

METHODS: These guidelines are based on relevant data derived from medical reports on HBV from Asian countries as well as from studies in the HBsAg positive Asian Americans. The guidelines herein differ from ...


Will Aiming For Quantity Affect Quality? Establishing Open Access At A Fellow-Run Gastroenterology Clinic., Matthew Sullivan DO, Patrick Hickey DO, Eric Nellis MD, Abdul Aleem MBBS, Rajesh Essrani MD, Hiral N. Shah MD 2018 Lehigh Valley Health Network

Will Aiming For Quantity Affect Quality? Establishing Open Access At A Fellow-Run Gastroenterology Clinic., Matthew Sullivan Do, Patrick Hickey Do, Eric Nellis Md, Abdul Aleem Mbbs, Rajesh Essrani Md, Hiral N. Shah Md

Department of Medicine

No abstract provided.


Delayed Hepatic Rupture Post Ultrasound-Guided Percutaneous Liver Biopsy: A Case Report., Jia-Yan Huang, Qiang Lu, Ji-Bin Liu 2018 West China Hospital of Sichuan University

Delayed Hepatic Rupture Post Ultrasound-Guided Percutaneous Liver Biopsy: A Case Report., Jia-Yan Huang, Qiang Lu, Ji-Bin Liu

Department of Radiology Faculty Papers

RATIONALE: Hemorrhage, one of complications after liver biopsy, is often identified immediately after the procedure while delayed liver rupture is relatively rare.

PATIENT CONCERNS: A 45-year-old woman was diagnosed with undetermined liver cirrhosis and abnormal liver function. To determine the etiology and severity of liver cirrhosis, ultrasound-guided liver biopsy was arranged. The patients did not complain any pain during the procedure. Ultrasound examination on postoperative day1 (POD 1) and MRI on POD 3 showed no evidence of hematoma and ascites. On POD 7, however, the patient was taken to the hospital with a sudden onset of pain in the right ...


A Research Agenda For Curing Chronic Hepatitis B Virus Infection., Harvey Alter, Timothy Block, Nathaniel Brown, Alan Brownstein, Carol Brosgart, Kyong-Mi Chang, Pei-Jer Chen, Francis V Chisari, Chari Cohen, Hashem El-Serag, Jordan Feld, Robert Gish, Jeffrey Glenn, Tim Greten, Haitao Guo, Ju-Tao Guo, Yujin Hoshida, Jianming Hu, Kris V Kowdley, Wenhui Li, Jake Liang, Stephan Locarnini, Anna S Lok, William Mason, Brian McMahon, Anand Mehta, Robert Perrillo, Peter Revill, Charles M Rice, JoAnn Rinaudo, Raymond Schinazi, Christoph Seeger, Kirty Shetty, John Tavis, Fabien Zoulim 2018 Swedish Medical Center, Seattle, WA

A Research Agenda For Curing Chronic Hepatitis B Virus Infection., Harvey Alter, Timothy Block, Nathaniel Brown, Alan Brownstein, Carol Brosgart, Kyong-Mi Chang, Pei-Jer Chen, Francis V Chisari, Chari Cohen, Hashem El-Serag, Jordan Feld, Robert Gish, Jeffrey Glenn, Tim Greten, Haitao Guo, Ju-Tao Guo, Yujin Hoshida, Jianming Hu, Kris V Kowdley, Wenhui Li, Jake Liang, Stephan Locarnini, Anna S Lok, William Mason, Brian Mcmahon, Anand Mehta, Robert Perrillo, Peter Revill, Charles M Rice, Joann Rinaudo, Raymond Schinazi, Christoph Seeger, Kirty Shetty, John Tavis, Fabien Zoulim

Articles, Abstracts, and Reports

No abstract provided.


Extracorporeal Cellular Therapy (Elad) In Severe Alcoholic Hepatitis: A Multinational, Prospective, Controlled, Randomized Trial., Julie Thompson, Natasha Jones, Ali Al-Khafaji, Shahid Malik, David Reich, Santiago Munoz, Ross MacNicholas, Tarek Hassanein, Lewis Teperman, Lance Stein, Andrés Duarte-Rojo, Raza Malik, Talal Adhami, Sumeet Asrani, Nikunj Shah, Paul Gaglio, Anupama Duddempudi, Brian Borg, Rajiv Jalan, Robert Brown, Heather Patton, Rohit Satoskar, Simona Rossi, Amay Parikh, Ahmed ElSharkawy, Parvez Mantry, Linda Sher, David Wolf, Marquis Hart, Charles Landis, Alan Wigg, Shahid Habib, Geoffrey McCaughan, Steven Colquhoun, Alyssa Henry, Patricia Bedard, Lee Landeen, Michael Millis, Robert Ashley, William Frank, Andrew Henry, Jan Stange, Ram Subramanian 2018 Swedish Medical Center, Seattle, WA

Extracorporeal Cellular Therapy (Elad) In Severe Alcoholic Hepatitis: A Multinational, Prospective, Controlled, Randomized Trial., Julie Thompson, Natasha Jones, Ali Al-Khafaji, Shahid Malik, David Reich, Santiago Munoz, Ross Macnicholas, Tarek Hassanein, Lewis Teperman, Lance Stein, Andrés Duarte-Rojo, Raza Malik, Talal Adhami, Sumeet Asrani, Nikunj Shah, Paul Gaglio, Anupama Duddempudi, Brian Borg, Rajiv Jalan, Robert Brown, Heather Patton, Rohit Satoskar, Simona Rossi, Amay Parikh, Ahmed Elsharkawy, Parvez Mantry, Linda Sher, David Wolf, Marquis Hart, Charles Landis, Alan Wigg, Shahid Habib, Geoffrey Mccaughan, Steven Colquhoun, Alyssa Henry, Patricia Bedard, Lee Landeen, Michael Millis, Robert Ashley, William Frank, Andrew Henry, Jan Stange, Ram Subramanian

Articles, Abstracts, and Reports

Severe alcoholic hepatitis (sAH) is associated with a poor prognosis. There is no proven effective treatment for sAH, which is why early transplantation has been increasingly discussed. Hepatoblastoma-derived C3A cells express anti-inflammatory proteins and growth factors and were tested in an extracorporeal cellular therapy (ELAD) study to establish their effect on survival for subjects with sAH. Adults with sAH, bilirubin ≥8 mg/dL, Maddrey's discriminant function ≥ 32, and Model for End-Stage Liver Disease (MELD) score ≤ 35 were randomized to receive standard of care (SOC) only or 3-5 days of continuous ELAD treatment plus SOC. After a minimum follow-up of ...


Patient Perspectives On Adherence To The New Hepatitis C Antiviral Medications: ‘A New Lease On Life’, Nicole M. Giordano, Anthony J. Brinn, Guadalupe Garcia-Tsao, Steve Martino 2018 VA Connecticut Healthcare System

Patient Perspectives On Adherence To The New Hepatitis C Antiviral Medications: ‘A New Lease On Life’, Nicole M. Giordano, Anthony J. Brinn, Guadalupe Garcia-Tsao, Steve Martino

The Qualitative Report

This study explored patients’ perspectives about taking the new direct-acting antivirals (DAAs) for the treatment of Hepatitis C (i.e., sofosbuvir, simeprevir, ledipasvir/sofosbuvir, ombitasvir/paritraprevir/ritonavir and dasabuvir) to identify facilitators of medication adherence. The project was conducted using semi-structured interviews with 12 Veterans who successfully completed a treatment course on the new DAAs. The Veterans were recruited using purposive sampling. The data collected from the semi-structured interviews was analyzed using an adapted open coding method outlined by Auerbach and Silverstein (2003), with identification of relevant text sub-grouped into repeating ideas, and then creation of overarching themes and constructs ...


Bleeding In Locally Invasive Pelvic Malignancies: Is Hypofractionated Radiation Therapy A Safe And Effective Non-Invasive Option For Securing Hemostasis? A Single Institution Perspective, Muhammad Shuja, Saadiya Nazli, Muhammad Atif Mansha, Asif Iqbal, Reham Mohamed, Mutahir A. Tunio, Eyad F. Alsaeed, Mushabbab Asiri, Yasser Bayoumi 2018 Mayo Clinic, Rochester, MN, USA

Bleeding In Locally Invasive Pelvic Malignancies: Is Hypofractionated Radiation Therapy A Safe And Effective Non-Invasive Option For Securing Hemostasis? A Single Institution Perspective, Muhammad Shuja, Saadiya Nazli, Muhammad Atif Mansha, Asif Iqbal, Reham Mohamed, Mutahir A. Tunio, Eyad F. Alsaeed, Mushabbab Asiri, Yasser Bayoumi

Department of Anaesthesia

Introduction: Control of bleeding due to locally invasive disease is of paramount importance in the management of cancer patients. This study was undertaken to explore the outcomes of palliative intent hypofractionated radiation therapy (HRT) in advanced stage pelvic malignancies that presented with bleeding. Methods: This study enrolled patients treated with palliative intent hypofractionated radiation therapy from July 2015 to November 2017. In the inclusion criteria, all these patients had the common presenting complaint of bleeding from the tumor. These patients were not treated with radiation therapy before for the same indication. Patients with known bleeding disorders and those undergoing parallel ...


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