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Falk Delgado, AlbertoORCID iD iconorcid.org/0000-0001-9107-5814
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Publications (10 of 30) Show all publications
Falk Delgado, A., Zommorodi, S. & Delgado, A. F. (2019). Sentinel Lymph Node Biopsy and Complete Lymph Node Dissection for Melanoma. Current Oncology Reports, 21(6), Article ID 54.
Open this publication in new window or tab >>Sentinel Lymph Node Biopsy and Complete Lymph Node Dissection for Melanoma
2019 (English)In: Current Oncology Reports, ISSN 1523-3790, E-ISSN 1534-6269, Vol. 21, no 6, article id 54Article, review/survey (Refereed) Published
Abstract [en]

Purpose of Review: The main surgical treatment for invasive malignant melanoma consists of wide surgical and examination of the sentinel node and in selected cases complete lymph node dissection. The aim of this review is to present data for the optimal surgical management of patients with malignant melanoma.

Recent Findings: A surgical excision margin of 1-2cm is recommended for invasive melanoma depending on the thickness of the melanoma. Sentinel node biopsy may be considered for patients with at least T1b melanomas thickness 0.8 to 1.0mm or less than 0.8mm Breslow thickness with ulceration, classified as T1b lesion, per recent AJCC guidelines. Two randomized controlled trials have been publishedDeCOG (German Dermatologic Cooperative Oncology Group Selective Lymphadenectomy) and MSLT-2 (Multicenter Selective Lymphadenectomy Trial) comparing the complete lymph node dissection (CLND) with observation after positive sentinel node biopsy. In the MSLT-2 study, the disease control rate was improved in the immediate CLND group compared with observation but there was no difference in 3-year melanoma specific survival (86%1.3% and 86%+/- 1.2%, respectively; p=0.42). Isolated limb perfusion (ILP) or isolated limb infusion (ILI) with melphalan and actinomycin D is recommended for large and multiple in-transit metastases and satellite metastases in the extremities when local excision is considered ineffective or too extensive.

Summary: In light of new adjuvant treatment options and new indications for checkpoint inhibitors, and the lack of survival benefit after CLND, we can expect open surgery to decrease in melanoma disease.

Place, publisher, year, edition, pages
SPRINGER, 2019
Keywords
Melanoma, Sentinel node, Biopsy, Complete, Lymph node, Limb perfusion, Dissection, Survival, Overall survival, Outcome, Surgery, Review, Metastasis, Therapy, Regional, Early, Surgical oncology, Surgical margin
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-383551 (URN)10.1007/s11912-019-0798-y (DOI)000466532800002 ()31028497 (PubMedID)
Available from: 2019-05-20 Created: 2019-05-20 Last updated: 2019-05-20Bibliographically approved
Falk Delgado, A., De Luca, F., van Westen, D. & Delgado, A. F. (2018). Arterial spin labeling MR imaging for differentiation between high- and low-grade glioma: a meta-analysis. Neuro-Oncology, 20(11), 1450-1461
Open this publication in new window or tab >>Arterial spin labeling MR imaging for differentiation between high- and low-grade glioma: a meta-analysis
2018 (English)In: Neuro-Oncology, ISSN 1522-8517, E-ISSN 1523-5866, Vol. 20, no 11, p. 1450-1461Article in journal (Refereed) Published
Abstract [en]

Background. Arterial spin labeling is an MR imaging technique that measures cerebral blood flow (CBF) noninvasively. The aim of the study is to assess the diagnostic performance of arterial spin labeling (ASL) MR imaging for differentiation between high-grade glioma and low-grade glioma.

Methods. Cochrane Library, Embase, Medline, and Web of Science Core Collection were searched. Study selection ended November 2017. This study was prospectively registered in PROSPERO (CRD42017080885). Two authors screened all titles and abstracts for possible inclusion. Data were extracted independently by 2 authors. Bivariate random effects meta-analysis was used to describe summary receiver operating characteristics. Trial sequential analysis (TSA) was performed.

Results. In total, 15 studies with 505 patients were included. The diagnostic performance of ASL CBF for glioma grading was 0.90 with summary sensitivity 0.89 (0.79-0.90) and specificity 0.80 (0.72-0.89). The diagnostic performance was similar between pulsed ASL (AUC 0.90) with a sensitivity 0.85 (0.71-0.91) and specificity 0.83 (0.690.92) and pseudocontinuous ASL (AUC 0.88) with a sensitivity 0.86 (0.79-0.91) and specificity 0.80 (0.65-0.87). In astrocytomas, the diagnostic performance was 0.89 with sensitivity 0.86 (0.79 to 0.91) and specificity 0.79 (0.63 to 0.89). Sensitivity analysis confirmed the robustness of the findings. TSA revealed that the meta-analysis was adequately powered.

Conclusion. Arterial spin labeling MR imaging had an excellent diagnostic accuracy for differentiation between high-grade and low-grade glioma. Given its low cost, non-invasiveness, and efficacy, ASL MR imaging should be considered for implementation in the routine workup of patients with glioma.

Keywords
arterial spin labeling, brain tumors, CNS, glioma, imaging
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-369608 (URN)10.1093/neuonc/noy095 (DOI)000448665500005 ()29868920 (PubMedID)
Available from: 2018-12-14 Created: 2018-12-14 Last updated: 2018-12-14Bibliographically approved
Delgado, A. F., De Luca, F., Hanagandi, P., van Westen, D. & Falk Delgado, A. (2018). Arterial Spin-Labeling in Children with Brain Tumor: A Meta-Analysis. American Journal of Neuroradiology, 39(8), 1536-1542
Open this publication in new window or tab >>Arterial Spin-Labeling in Children with Brain Tumor: A Meta-Analysis
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2018 (English)In: American Journal of Neuroradiology, ISSN 0195-6108, E-ISSN 1936-959X, Vol. 39, no 8, p. 1536-1542Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:The value of arterial spin-labeling in a pediatric population has not been assessed in a meta-analysis. PURPOSE:Our aim was to assess the diagnostic accuracy of arterial spin-labeling-derived cerebral blood flow to discriminate low- and high-grade tumors. DATA SOURCES:MEDLINE, EMBASE, the Web of Science Core Collection, and the Cochrane Library were used. STUDY SELECTION:Pediatric patients with arterial spin-labeling MR imaging with verified neuropathologic diagnoses were included. DATA ANALYSIS:Relative CBF and absolute CBF and tumor grade were extracted, including sequence-specific information. Mean differences in CBF between low- and high-grade tumors were calculated. Study quality was assessed. DATA SYNTHESIS:Data were aggregated using the bivariate summary receiver operating characteristic curve model. Heterogeneity was explored with meta-regression and subgroup analyses. The study protocol was published at PROSPERO (CRD42017075055). Eight studies encompassing 286 pediatric patients were included. The mean differences in absolute CBF were 29.62 mL/min/100 g (95% CI, 10.43-48.82 mL/min/100 g), I-2 = 74, P = .002, and 1.34 mL/min/100 g (95% CI, 0.95-1.74 mL/min/100 g), P < .001, I-2 = 38 for relative CBF. Pooled sensitivity for relative CBF ranged from 0.75 to 0.90, and specificity, from 0.77 to 0.92 with an area under curve = 0.92. Meta-regression showed no moderating effect of sequence parameters TE, TR, acquisition time, or ROI method. LIMITATIONS:Included tumor types, analysis method, and original data varied among included studies. CONCLUSIONS:Arterial spin-labeling-derived CBF measures showed high diagnostic accuracy for discriminating low- and high-grade tumors in pediatric patients with brain tumors. The relative CBF showed less variation among studies than the absolute CBF.

Place, publisher, year, edition, pages
AMER SOC NEURORADIOLOGY, 2018
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-369527 (URN)10.3174/ajnr.A5727 (DOI)000441271400032 ()30072368 (PubMedID)
Available from: 2018-12-17 Created: 2018-12-17 Last updated: 2018-12-17Bibliographically approved
Delgado, A. F. & Falk Delgado, A. (2018). Discrimination between primary low-grade and high-grade glioma with 11C-methionine PET: a bivariate diagnostic test accuracy meta-analysis. British Journal of Radiology, 91(1082), Article ID 20170426.
Open this publication in new window or tab >>Discrimination between primary low-grade and high-grade glioma with 11C-methionine PET: a bivariate diagnostic test accuracy meta-analysis
2018 (English)In: British Journal of Radiology, ISSN 0007-1285, E-ISSN 1748-880X, Vol. 91, no 1082, article id 20170426Article, review/survey (Refereed) Published
Abstract [en]

Objective: To perform a meta-analysis evaluating the diagnostic accuracy of 11C-methionine (MET) positron emission tomography (PET) to discriminate between primary low-grade glioma (LGG) and high-grade glioma (HGG).

Methods: A systematic database search was performed by a librarian in relevant databases with the latest search on 07 November 2016. Hits were assessed for inclusion independently by two authors. Individual patient data on relative MET uptake was extracted on patients examined pre-operatively with MET PET and subsequent neuropathological diagnosis of astrocytoma or oligodendroglioma. Individual patient data were analysed for diagnostic accuracy using a bivariate diagnostic random-effects meta-analysis model with restricted maximum likelihood estimation method. Bivariate meta-regression and subgroup analyses assessed study heterogeneity and validity. This study is registered with PROSPERO, number CRD42016050747.

Results: Out of 1828 hits, 13 studies comprising of 241 individuals were included in the quantitative and qualitative analysis. MET PET had an area under the bivariate summary receiver operating characteristics curve of 0.78 to discriminate between LGG and HGG and a summary sensitivity of 0.80 with 95% confidence interval (CI) (0.66–0.88) and a summary false positive rate of 0.28, 95% CI (0.19–0.38). Heterogeneity was described by; bias in patient inclusion, study quality, and ratio method. Optimal cutoff for relative MET uptake was 2.21.

Conclusion: MET PET had a moderately high diagnostic accuracy for the discrimination between primary LGG and HGG.

Advances in knowledge: MET PET can be used as a clinical tool for the non-invasive discrimination between LGG and HGG with a moderately high accuracy at cut-off 2.21.

National Category
Surgery Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-350206 (URN)10.1259/bjr.20170426 (DOI)000423547100007 ()
Available from: 2018-05-08 Created: 2018-05-08 Last updated: 2018-05-08Bibliographically approved
Delgado, A. F., Nilsson, M., van Westen, D. & Falk Delgado, A. (2018). Glioma Grade Discrimination with MR Diffusion Kurtosis Imaging: A Meta-Analysis of Diagnostic Accuracy. Radiology, 287(1), 119-127
Open this publication in new window or tab >>Glioma Grade Discrimination with MR Diffusion Kurtosis Imaging: A Meta-Analysis of Diagnostic Accuracy
2018 (English)In: Radiology, ISSN 0033-8419, E-ISSN 1527-1315, Vol. 287, no 1, p. 119-127Article in journal (Refereed) Published
Abstract [en]

Purpose: To assess the diagnostic test accuracy and sources of heterogeneity for the discriminative potential of diffusion kurtosis imaging (DKI) to differentiate low-grade glioma (LGG) (World Health Organization [WHO] grade II) from high-grade glioma (HGG) (WHO grade III or IV).

Materials and Methods: The Cochrane Library, Embase, Medline, and the Web of Science Core Collection were systematically searched by two librarians. Retrieved hits were screened for inclusion and were evaluated with the revised tool for quality assessment for diagnostic accuracy studies (commonly known as QUADAS-2) by two researchers. Statistical analysis comprised a random-effects model with associated heterogeneity analysis for mean differences in mean kurtosis (MK) in patients with LGG or HGG. A bivariate restricted maximum likelihood estimation method was used to describe the summary receiver operating characteristics curve and bivariate meta-regression.

Results: Ten studies involving 430 patients were included. The mean difference in MK between LGG and HGG was 0.17 (95% confidence interval [CI]: 0.11, 0.22) with a z score equal to 5.86 (P<.001). The statistical heterogeneity was explained by glioma subtype, echo time, and the proportion of recurrent glioma versus primary glioma. The pooled area under the curve was 0.94 for discrimination of HGG from LGG, with 0.85 (95% CI: 0.74, 0.92) sensitivity and 0.92 (95% CI: 0.81, 0.96) specificity. Heterogeneity was driven by neuropathologic subtype and DKI technique.

Conclusion: MK shows high diagnostic accuracy in the discrimination of LGG from HGG.

Place, publisher, year, edition, pages
RADIOLOGICAL SOC NORTH AMERICA, 2018
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-351571 (URN)10.1148/radiol.2017171315 (DOI)000427992600016 ()29206593 (PubMedID)
Available from: 2018-05-29 Created: 2018-05-29 Last updated: 2018-05-29Bibliographically approved
Falk Delgado, A. & Falk Delgado, A. (2018). Home institution bias in the New England Journal of Medicine?: A noninferiority study on citation rates. Scientometrics, 115(1), 607-611
Open this publication in new window or tab >>Home institution bias in the New England Journal of Medicine?: A noninferiority study on citation rates
2018 (English)In: Scientometrics, ISSN 0138-9130, E-ISSN 1588-2861, Vol. 115, no 1, p. 607-611Article in journal (Refereed) Published
Abstract [en]

Recently, in the four top journals of humanities, an institutional bias towards publication of authors from Harvard and Yale was shown. The New England Journal of Medicine (NEJM) is today the highest ranked general medical journal. It is unknown if there exists institutional bias favoring publication of articles originating from Harvard University, since the NEJM is produced by the Massachusetts Medical Society with close connections to the Harvard University. We examined if studies originating from the Harvard University published in the NEJM were noninferior in terms of citation rates compared to articles with an origin outside Harvard University. We evaluated original research articles published in the NEJM in 2000 up until June 2001. A two-sample noninferiority test based on the primary endpoint of citations was performed. Twenty-two studies were affiliated to the Harvard University and 280 studies were not affiliated to the Harvard University. The mean number of citations for Harvard affiliated studies was 625 (95% CI 358-952, median 354) and for non-Harvard affiliated studies 493 (95% CI 421-569, median 303). The mean difference was not statistically different between affiliations, but fulfilled the requirements for noninferiority [132 (95% CI - 138-402, P = 0.343), Delta 200]. In summary, citation rates were comparable between studies origination from the Harvard University compared to non-Harvard Institutions. Based on these results there appears to be low risk of institutional bias in the publishing process of original studies in the NEJM.

Place, publisher, year, edition, pages
SPRINGER, 2018
Keywords
Citations rates, Institutional bias, Academic publishing, Impact of articles
National Category
Information Studies
Identifiers
urn:nbn:se:uu:diva-350743 (URN)10.1007/s11192-017-2584-7 (DOI)000426807700031 ()29527075 (PubMedID)
Available from: 2018-05-16 Created: 2018-05-16 Last updated: 2018-05-16Bibliographically approved
Svee, A., Mani, M., Sandquist, K., Audolfsson, T., Folkvaljon, Y., Isern, A. E., . . . Wärnberg, F. (2018). Survival and risk of breast cancer recurrence after breast reconstruction with deep inferior epigastric perforator flap. British Journal of Surgery, 105(11), 1446-1453
Open this publication in new window or tab >>Survival and risk of breast cancer recurrence after breast reconstruction with deep inferior epigastric perforator flap
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2018 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 105, no 11, p. 1446-1453Article in journal (Refereed) Published
Abstract [en]

Background: Women who undergo autologous breast reconstruction have been reported to have an increased risk of breast cancer recurrence compared with those who have mastectomy alone. It has been suggested that more extensive surgery possibly activates dormant micrometastases. The aim of this study was to evaluate whether delayed unilateral deep inferior epigastric perforator (DIEP) flap reconstruction after mastectomy increases the risk of breast cancer recurrence or affects mortality among women previously treated for breast cancer.

Methods: This was a matched retrospective cohort study including women with a previous unilateral invasive breast cancer who received a delayed DIEP flap breast reconstruction and a control cohort of individually matched women with unilateral breast cancer who underwent mastectomy but no autologous breast reconstruction. Matching criteria comprised: year of diagnosis (+/-3years), age at diagnosis (+/-5years), type of cancer and demographic region. The primary endpoints were local recurrence or distant metastasis, and overall mortality was a secondary endpoint. Absolute risk of recurrent disease and mortality was analysed, and relative risks were estimated using Cox proportional hazards analysis.

Results: There were 225 women in the DIEP cohort and 450 in the no-DIEP cohort. The median follow-up time was 125months. There was no difference in absolute risk of recurrence between the cohorts. The hazard ratio for breast cancer recurrence in DIEP versus no-DIEP cohorts was 0·76 (95 per cent c.i. 0·47 to 1·21).

Conclusion: There is no increased risk in breast cancer recurrence after delayed DIEP flap reconstruction compared with mastectomy alone. As above

National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-366957 (URN)10.1002/bjs.10888 (DOI)000444672600009 ()29999520 (PubMedID)
Funder
The Breast Cancer Foundation
Available from: 2018-11-27 Created: 2018-11-27 Last updated: 2018-11-27Bibliographically approved
Falk Delgado, A., Lang, A., Hakelius, M., Skoog, V. & Nowinski, D. (2018). The Skoog Lip Repair for Unilateral Cleft Lip Deformity: The Uppsala Experience. Plastic and reconstructive surgery (1963), 141(5), 1226-1233
Open this publication in new window or tab >>The Skoog Lip Repair for Unilateral Cleft Lip Deformity: The Uppsala Experience
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2018 (English)In: Plastic and reconstructive surgery (1963), ISSN 0032-1052, E-ISSN 1529-4242, Vol. 141, no 5, p. 1226-1233Article in journal (Refereed) Published
Abstract [en]

Background: The Uppsala Craniofacial Center has been treating patients with unilateral cleft lip deformity using the lip repair technique described by Tord Skoog. The aim of this study was to determine complications after lip surgery and the incidence and indications for lip revisions in all patients born with unilateral cleft lip from 1960 to 2004.

Methods: All patients who were born from 1960 to 2004 with unilateral cleft lip, cleft lip and alveolus, or cleft lip and palate and underwent lip repair were studied retrospectively. The timing, indication, complications of the primary procedure, and type of secondary surgery were recorded. Kruskal-Wallis and Fisher’s exact tests were used, with Bonferroni correction.

Results: The study included 443 patients. The total rate of early surgical complications was 6 percent (n = 26). Secondary surgery for short upper lip was performed in 3.8 percent (n = 17), 8.4 percent (n = 37) underwent reduction of excess vermillion, 8.6 percent (n = 38) underwent scar revision, 11 percent (n = 51) underwent revision for incongruent vermillion-cutaneous border, and 10 percent (n = 45) underwent revision for other indications. Altogether, 45 percent had no secondary revisions.

Conclusion: In conclusion, the Skoog lip repair is associated with a low total revision rate, and a short-lip deformity is rare.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-357583 (URN)10.1097/PRS.0000000000004321 (DOI)000433322900058 ()29697619 (PubMedID)
Available from: 2018-08-17 Created: 2018-08-17 Last updated: 2018-08-17Bibliographically approved
Falk Delgado, A., Andersson, T. & Delgado, A. F. (2017). Clinical outcome after surgical clipping or endovascular coiling for cerebral aneurysms: a pragmatic meta- analysis of randomized and non- randomized trials with short- and long- term follow- up. JOURNAL OF NEUROINTERVENTIONAL SURGERY, 9(3), 264-+
Open this publication in new window or tab >>Clinical outcome after surgical clipping or endovascular coiling for cerebral aneurysms: a pragmatic meta- analysis of randomized and non- randomized trials with short- and long- term follow- up
2017 (English)In: JOURNAL OF NEUROINTERVENTIONAL SURGERY, ISSN 1759-8478, Vol. 9, no 3, p. 264-+Article in journal (Refereed) Published
Abstract [en]

Background Two randomized trials have evaluated clipping and coiling in patients with ruptured aneurysms. Aggregated evidence for management of ruptured and unruptured aneurysms is missing. Objective To conduct a meta- analysis evaluating clinical outcome after aneurysm treatment. Methods PubMed, Cochrane Central Register of Controlled Trials, and Clinicaltrials. gov were searched for studies evaluating aneurysm treatment. The primary outcome measure was an independent clinical outcome ( modified Rankin scale 0- 2, Glasgow Outcome Scale 4- 5, or equivalent). Secondary outcomes were poor outcome and mortality. ORs were calculated on an intention- to- treat basis with 95% Cls. Outcome heterogeneity was evaluated with Cochrane's Q test ( significance level cut- off value at < 0.10) and l(2) ( significance cut- off value > 50%) with the Mantel-Haenszel method for dichotomous outcomes. A p value < 0.05 was regarded as statistically significant. Results Searches yielded 18 802 articles. All titles were assessed, 403 abstracts were evaluated, and 183 full-text articles were read. One- hundred and fifty articles were qualitatively assessed and 85 articles were included in the meta- analysis. Patients treated with coiling ( randomized controlled trials ( RCTs)) had higher independent outcome at short- term follow- up ( OR= 0.67, 95% Cl 0.57 to 0.79). Independent outcome was favored for coiling at intermediate and long- term follow-up ( RCTs and observational studies combined-OR= 0.80, 0.68 to 0.94 and OR= 0.81, 0.71 to 0.93, respectively). Independent outcome and lower mortality was favored after coiling in unruptured aneurysms ( database registry studies) at short- term follow- up ( OR= 0.34, 0.29 to 0.41 and OR= 1.74, 1.52 to 1.98, respectively). Conclusions This meta- analysis evaluating clinical outcome after coiling or clipping for intracranial aneurysms, indicates a higher independent outcome and lower mortality after coiling.

Place, publisher, year, edition, pages
BMJ PUBLISHING GROUP, 2017
National Category
Surgery Neurology
Identifiers
urn:nbn:se:uu:diva-320860 (URN)10.1136/neurintsurg-2016-012292 (DOI)000394618300011 ()27053705 (PubMedID)
Available from: 2017-04-26 Created: 2017-04-26 Last updated: 2017-04-26Bibliographically approved
Falk Delgado, A. & Falk Delgado, A. (2017). Complete Lymph Node Dissection in Melanoma: A Systematic Review and Meta-Analysis. Anticancer Research, 37(12), 6825-6829
Open this publication in new window or tab >>Complete Lymph Node Dissection in Melanoma: A Systematic Review and Meta-Analysis
2017 (English)In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 37, no 12, p. 6825-6829Article, review/survey (Refereed) Published
Abstract [en]

Background: The aim of this meta-analysis was to estimate the survival after immediate complete lymph node dissection (CLND) compared to observation only (OO) or delayed CLND in patients with melanoma and lymph node metastasis.

Materials and Methods: A systematic search was performed in: PubMed, Web of Science, Cochrane Library, CINAHL, Clinical trials and Embase. Eligible studies were randomized controlled trials (RCTs) comparing: CLND with OO, or immediate CLND with delayed CLND.

Results: Four RCTs were included. There was no difference in melanoma-specific survival (MSS) (HR=0.91, 95% CI=0.77-1.08, p=0.29). In a sensitivity analysis, MSS was higher after immediate CLND compared to delayed CLND in patients with nodal metastasis (HR=0.63, 95% CI=0.35-0.74, p=0.0004) without evidence of heterogeneity.

Conclusion: CLND appears to have no additional survival benefit after SNB compared to OO. However, subgroup analysis suggests a time-dependent benefit for early surgical lymph node removal compared to delayed or none.

Keywords
Complete lymph node dissection, melanoma, review
National Category
Cancer and Oncology Surgery
Identifiers
urn:nbn:se:uu:diva-345600 (URN)10.21873/anticanres.12143 (DOI)000417022100038 ()29187461 (PubMedID)
Available from: 2018-03-12 Created: 2018-03-12 Last updated: 2018-03-12Bibliographically approved
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