PubMed Health⌕ Search

Biomedical subjects

S K Lo

Publications and source records attributed to S K Lo.

At least 91 records · Page 5Linked to original sources
PubMed1995

CD36 induction on human monocytes upon adhesion to tumor necrosis factor-activated endothelial cells.

Cell adhesion between circulating monocytes and the endothelium is a critical component of vascular thromboregulation and atherogenesis. The biochemical and genetic consequences of adhesion are poorly understood. We have found that monocyte surface expression of CD36, an integral membrane receptor for thrombospondin, collagen, and oxidized low density lipoprotein, increased dramatically upon adhesion to tumor necrosis factor-activated human umbilical vein endothelial cells (HUVEC). Expression was assessed by indirect immunofluorescence microscopy and immunoblotting using monoclonal antibodies to CD36. Steady-state CD36 mRNA levels, detected by RNase protection assay, also showed a similar pattern of up-regulation. To verify the adhesion dependence of the observed phenomenon, monocytes were co-cultured with tumor necrosis factor-activated HUVEC in a transwell apparatus that physically separated monocytes from the endothelial cells. Under these conditions, no increase in CD36 expression was detected, demonstrating that the enhanced monocyte CD36 expression observed is not due to soluble factors released by HUVEC. To characterize the specific adhesion molecules involved in the process, co-culture assays were performed on murine L cells transfected with either human E-selectin or intercellular adhesion molecule-1 cDNAs. A dramatic increase in CD36 mRNA was seen upon monocyte adhesion to E-selectin-transfected L cells compared with adhesion to intercellular adhesion molecule-1 or control transfectants. Furthermore, monoclonal antibodies to E-selectin inhibited the adhesion-dependent up-regulation of CD36 mRNA induced by transfected L cells or cytokine-activated endothelial cells. These findings demonstrate adhesion-dependent gene regulation of monocyte CD36 and suggest the possible involvement of E-selectin in initiating this process.

Adult↗
PubMed1995

Development and validation of the Curtin Back Screening Questionnaire (CBSQ): a discriminative disability measure.

Disability accompanying occupational low back pain (LBP) can include a wide range of incapacitating symptoms which, for the practitioner, can be time-consuming and difficult to identify systematically. A questionnaire designed for case-finding and assessment could assist in both the early recognition of disability and in planning management. A suitable questionnaire for clinical use could not be found in the literature. The Curtin Back Screening Questionnaire (CBSQ) was developed, therefore, as a discriminative screening instrument to serve this purpose. The methods and results of the development and validation of the CBSQ are presented herein. Development of the questionnaire followed the principles of Kirschner and Guyatt (1985) employing data from 74 subjects with at least moderately severe work-related LBP. The research design for the validation was multiple-group repeated-measures with a study population of 150 subjects. The screening function of the questionnaire was developed through selecting 8 questions from the whole questionnaire using regression analysis. The questionnaire includes 79 items based on the subjects' perceived health status. The response structure of the CBSQ has been adapted from that of the General Health Questionnaire (GHQ) and some items in the CBSQ have been developed from items in the Sickness Impact Profile (SIP) and GHQ. The questionnaire discriminates effectively between subjects with different degrees of disability, it correlates quite well with the SIP, test-retest reliability for the whole questionnaire is 0.98, the receiver-operating characteristics are more favourable than those for the SIP, and the CBSQ screening score provides an index of severity which correlates with work incapacity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

The role of pancreatic stenting in obstructive ductal disorders other than pancreas divisum.

Pancreatic ductal strictures may lead to pancreatitis, with associated pain and nausea. Very little literature is available regarding stent placement for this problem; the efficacy of stenting, expected stent viability, and safety of the procedure require further study. In this series, 21 patients with pancreatic ductal strictures underwent a total of 42 ERCPs with pancreatic stent placement. Eighty-six percent of patients experienced significant improvement in their symptom score after at least 1 session; however, relief was usually not evident until day 7. Stent viability averaged 26.9 days, but it was significantly longer for patients with pancreatic cancer. Overall, pancreatic ductal stenting can relieve symptoms of pain and nausea, but relief is usually short-lived. It may be useful only for short-term therapeutic trials and to provide temporary relief in highly selected cases.

Adolescent↗
PubMed1995

Factors influencing reflectance spectrophotometric measurements of gastrointestinal mucosal blood flow.

Although the technique of endoscopic reflectance spectrophotometry has been applied in clinical studies, factors that modify the reproducibility of measurements have not been assessed systematically. To determine the limitations of the technique, measurements were made while endoscopic light intensity, systemic oxygen saturation, and orientation of the measuring probe were varied. The effects of hemorrhagic hypotension and exposure of the mucosa to 10% dextrose were also studied. When a large number (n = 480) of measurements in the human colon were considered, endoscopic light significantly decreased the index of oxygen saturation (ISO2) and increased the index of hemoglobin concentration (IHB). The decrease in ISO2, however, was small and unlikely to be of clinical importance despite being statistically significant. In one subject with chronic lung disease and baseline hypoxemia, administration of supplemental oxygen significantly increased oxygen saturation at the finger tip as measured by an oximeter and ISO2 of the buccal mucosa as measured by reflectance spectrophotometry. Varying the angle between the measuring probe and the gastric mucosa in rats from 90 degrees to 60 degrees did not affect ISO2 or IHB measurements. At 45 degrees, however, IHB but not ISO2 was significantly increased. Ischemia subsequent to induction of hemorrhagic hypotension and hyperemia induced by administration of 10% dextrose could be demonstrated reproducibly. We conclude that by lowering the intensity of endoscopic light and providing supplemental oxygen, errors in the measurement of IHB and ISO2, respectively, can be minimized. Minor deviations from the perpendicular orientation do not significantly affect ISO2 and IHB measurements. Attention to these details enhances the accuracy of endoscopic reflectance spectrophotometric recordings of ISO2 and IHB in clinical studies.

Animals↗
PubMed1995

Metabolic effect of parenteral nutrition in dogs with obstructive jaundice.

OBJECTIVE: To assess the effect of total parenteral nutrition (TPN) on macronutrient metabolism in obstructive jaundice. METHODS: Forty adult mongrel dogs were equally divided into four groups: group I (PO-control) received sham ligation of common bile duct (CBDL) and was fed dog chow and water ad libitum; group II (PO-CBDL) underwent CBDL and was fed dog chow; group III (TPN-control) received sham CBDL and TPN; and group IV (TPN-CBDL) underwent CBDL and received TPN. Blood chemistries, plasma amino acids and liver histologies were studied before (Day 1) and at the end (Day 14) of the experiment. RESULTS: A significant elevation of bilirubin and alkaline phosphatase was observed in dogs with CBDL. Blood glucose was not changed significantly in any group. Significant increases in triglyceride and cholesterol were present in CBDL dogs. Significant differences in the concentrations of a few plasma amino acids, including an elevation of phenylalanine, were found in TPN dogs. A significant increase in aromatic amino acids (AAA) and a noticeable depression of the molar ratio of branched-chain amino acids (BCAA) to AAA was present in TPN-CBDL dogs, as was a significant increase in blood ammonia. CONCLUSION: In the presence of obstructive jaundice, TPN does not significantly affect carbohydrate or lipid metabolism. However, a derangement in protein metabolism with the standard TPN solution in current use suggests that either a modification of amino acid composition or an increase in total energy to protein energy ratio in TPN solution may be necessary to obviate such a consequence.

Alkaline Phosphatase↗
PubMed1995

Monitoring of leukocyte cytomegalovirus DNA in bone marrow transplant recipients by nested PCR.

A nested PCR assay for the detection of human cytomegalovirus (CMV) DNA was evaluated by weekly monitoring of blood samples taken from 101 bone marrow transplant (BMT) recipients. When peripheral blood leukocytes were used as the source of CMV DNA, even a modified assay with stringent temperature-cycling conditions was as sensitive as the standard assay. The sensitivity, specificity, and positive predictive value of two consecutively positive leukocytic PCR results with this modified assay in predicting CMV disease of 101 patients submitting 1,441 peripheral blood leukocyte samples were found to be 92.1, 63.5, and 60.3%, respectively. The positive predictive value of patients' seropositivity for CMV was 40%, while that of viremia was 72%. However, viremia followed CMV disease by a median of 1.5 days, while the first leukocytic positive PCR assay preceded disease by a median of 14 days. By use of the criteria of two consecutively positive PCR results instead of recipient CMV seropositivity for starting preemptive ganciclovir treatment, 38 of the 43 recipients with isolated single positive or negative assays (groups I and II) would be spared unnecessary ganciclovir treatment. Moreover, two other findings support the use of antiviral prophylaxis before engraftment in high-risk cases and subsequent preemptive treatment of patients with two consecutively positive PCR assays. First, for 7.9% of 76 patients with positive assays (groups II and III), the first positive PCR assay occurred before engraftment, which implied the presence of viral DNA in the blood (DNAemia) soon after transplantation. Second, isolated single positive assays which were clustered around the second to sixth weeks after transplantation were found for 18 patients (group II) and could represent abortive episodes of CMV infection.

Adolescent↗
PubMed1995

Activation of cultured vascular endothelial cells by antiphospholipid antibodies.

Circulating antiphospholipid antibodies (aPL) are associated with a syndrome of thrombosis, recurrent fetal loss, and thrombocytopenia. We have demonstrated the activation of cultured human umbilical vein endothelial cells (HUVEC) by IgG from patients with anticardiolipin antibodies (aCL). Incubation of HUVEC for 4 h with purified IgG (100 micrograms/ml) from patients with high-titer aCL induced a 2.3-fold increase in monocyte adhesion over that seen in HUVEC incubated with IgG's from normal subjects. The effect of aCL was not attributable to LPS contamination, Fc receptors, or immune complexes. Monocyte adhesion was not induced when the aCL were added in serum-free media but was restored by the addition of purified beta 2GP1, previously described as a necessary cofactor for aCL reactivity. Purified rabbit polyclonal IgG raised against beta 2GP1 also induced monocyte adhesion when incubated with HUVEC. Preadsorption of patient serum with cardiolipin reduced monocyte adhesion by 60%. Immunofluorescent microscopy demonstrated that endothelial cells incubated with patient IgG expressed cell adhesion molecules, including E-selectin, vascular cell adhesion molecule-1, and intracellular adhesion molecule-1. These data support the hypothesis that aPL activate vascular endothelial cells, thereby leading to a pro-thrombotic state.

Antibodies, Antiphospholipid↗
PubMed1995

[Non-significant in univariate but significant in multivariate analysis: a discussion with examples].

Perhaps as a result of higher research standard and advancement in computer technology, the amount and level of statistical analysis required by medical journals become more and more demanding. It is now realized by researchers that univariate analysis alone may not be sufficient, especially for complex data sets. Additional, and sometimes even contradictory, results may be found using multivariate analysis. During the course of data analysis, a common practice is to include in multivariate analysis only those variables that are statistically significant in univariate analysis. Such a habit is risky as some variables not significant in univariate analysis may become significant in multivariate analysis. In this study, we identify, with examples, four possible scenarios in which the above situation could occur: (1) the effect of unbalanced sample size; (2) the influence of missing data; (3) an extremely large within group variation, relative to between group variation; and (4) the presence of interaction. In addition to detailed analysis steps, raw data sets are also available for readers to verify all the results presented. Although we only used the log-rank test and Cox regression for illustration purposes, the underlying concepts can be applied to other multivariate procedures such as the logistic regression and multiple linear regression.

Analysis of Variance↗
PubMed1995

Outcome of Graves' thyrotoxicosis after antithyroid drug treatment.

To investigate the outcome of Graves' thyrotoxicosis after antithyroid drug management, data from 81 patients, treated in Chang Gung Memorial Hospital at Taipei and Linkou from October 1981 to March 1990, were analyzed. The gender ratio of female to male was 59:22. The mean age of onset was 33.1 +/- 10.5(15-60) year-old. All the patients were treated with antithyroid drug (Thionamide group) for a duration of 11 to 63 months (mean +/- SD = 28.1 +/- 9.8 months). Forty of 81 patients (49.4%) were remained remission after up to 2 years of follow-up. Those patients relapse usually occurred within 2 years after discontinuation of treatment (34/41), and only one exceptional case relapsed after 3 years. Three conditions affected the relapse rate. Patients with larger goiter (grade II-III) and shorter duration of treatment (< 23 months) had a higher relapse rate than those-with smaller goiter (grade O-I) [29/46 vs. 12/35; chi 2 = 6.576, p = 0.010; p = 0.015 in stepwise logistic regression (LR)] and longer duration of treatment (> or = 23 months) (15/20 vs. 26/61; chi 2 = 6.316, p = 0.012; p = 0.020 in LR). Patients with higher pre-treated serum triiodothyronine (T3) level (T3 > or = 300 ng/dl) had a higher relapse rate than those with lower T3 level (T3 < 300 ng/dl) in univariate analysis (30/50 vs. 11/31, chi 2 = 4.601, p = 0.032), but no significant difference by LR (P = 0.094). Other clinical parameters including age, sex, past history, family history, thyroxine (T4) level, T3/T4 ratio, thyroid autoantibodies, staging of ophthalmopathy, responsiveness to thyrotropin-releasing hormone stimulation test at the end of treatment, and whether combined treatment with thyroxine had no significant difference between the relapse and remission groups. These data suggest: (a) patients with larger goiter (grade II-III had higher relapse rate; (b) most of the recurrent thyrotoxicosis patients relapsed within two years after drug withdrawal; (c) continuing treatment for more than twenty-three months produces better outcome; (d) patients with Graves' thyrotoxicosis should be followed up for at least three years after withdrawal of antithyroid drug.

Adolescent↗
PubMed1995

Comparison of the outcome between the calculated dosimetry and the estimated dosimetry of 131I in the treatment of hyperthyroidism.

To compare the outcomes of different methods in prescribing the optimal dose of radioactive iodine (131I) for the treatment of hyperthyroidism, we retrospectively analyzed 52 patients with toxic diffuse goiter. They received single dose of 131I for the treatment of hyperthyroidism. In addition, all of them met the following criteria: 1) symptoms and signs of hyperthyroidism; 2) elevated blood triiodothyronine (T3) and thyroxin (T4) by radioimmunoassay (RIA) method; 3) diffuse goiter with increase of uptake proved by thyroid scintiscan; 4) only one dose of 131I was given during the follow-up period; 5) well-documented thyroid function test in the medical chart during the follow-up period (6 months, 1 year, 2 years and 5 years after 131I therapy). The enrolled patients were divided into estimated and calculated group. The dose of 131I in the calculated group was obtained from the measurement of size and 131I uptake of thyroid gland. The dose of 131I in the estimated group was prescribed according to the size of thyroid gland by physical examination, and the association with cardiac arrhythmia, congestive heart failure, or ischemic heart disease. The mean doses of 131I were 4.8 +/- 1.4 mCi and 7.0 +/- 1.1 mCi in the calculated and estimated group respectively. In this study, there were no significant difference in the incidence of euthyroidism, hyperthyroidism, and hypothyroidism between these two groups in thefollow-up period after 131I therapy. In view of simplicity and time-saving, it is a practical choice to prescribe the dose of 131I therapy for toxic diffuse goiter according to the size of thyroid gland and the associated cardiac condition.

Adult↗
PubMed1994

Sequence variation of the amino-terminal antigenic domains of glycoprotein B of human cytomegalovirus strains isolated from Chinese patients.

To study the genetic variation of human cytomegalovirus (HCMV) in Asian populations, the amino-terminal antigenic domains of glycoprotein B of HCMVs isolated from ethnic Chinese transplant patients were cloned and sequenced. The nucleotide and encoded amino acid sequences were compared with published sequences of AD169 and Towne laboratory strains. Within the region sequenced, 9 out of 15 clinical isolates (60%) possessed a peptide configuration similar to that of strain AD169 while 6 isolates (40%) displayed a peptide configuration similar to that of strain Towne. The nucleotide and amino acid identities of AD169-like clinical isolates exhibited variations of 95.4%-99.6% and 95.4%-100% respectively, whereas the identities of Towne-like clinical isolates were within the range of 97.3%-100% and 96.6%-100% at the nucleotide and amino acid levels. The previously defined neutralizing epitope was conserved among the clinical isolates sequenced while unique non-conservative amino acid substitutions were detected in the non-neutralizing epitope within the amino-terminal antigenic domain of glycoprotein B of all AD169-like isolates (Y- > S) and one of the Towne-like isolates (R- > Q).

Amino Acid Sequence↗
PubMed1994

A 2-year follow-up study of anti-neutrophil antibody in primary sclerosing cholangitis: relationship to clinical activity, liver biochemistry and ursodeoxycholic acid treatment.

A specific anti-neutrophil antibody was recently described in primary sclerosing cholangitis and was detected using an indirect immunoalkaline phosphatase method. The present study examined the relationship of this antibody with respect to time, clinical activity, liver biochemistry, histology and ursodeoxycholic acid treatment. Fourteen patients with primary sclerosing cholangitis were followed up at regular intervals for 2 years. Clinical activity, liver biochemistry, histology and anti-neutrophil antibody titre were determined during the study period. A fluctuating course of the anti-neutrophil antibody was noted in both untreated patients and in those who were on ursodeoxycholic acid. This finding will have clinical implications if anti-neutrophil antibody is used to screen for potential primary sclerosing cholangitis in the future. The results suggest that several determinations of the antibody would need to be carried out over a period of time. No correlation was found between the antibody titre, clinical activity, liver biochemistry or histology. Anti-neutrophil antibody in primary sclerosing cholangitis probably has no pathogenic significance and is an epiphenomenon.

Adult↗
PubMed1994

Epidemiology of fireworks injuries: the National Electronic Injury Surveillance System, 1980-1989.

STUDY OBJECTIVES: To estimate the annual fireworks injury rates in the United States over the past decade (1980 through 1989) and to describe the epidemiology of fireworks-related trauma. DESIGN: Retrospective analysis of fireworks-related injuries reported from the National Electronic Injury Surveillance System of the Consumer Product Safety Commission. RESULTS: During the study period, nearly 10,000 Americans were injured annually by fireworks. The rates were highest in the young, with a peak of 22.3 per 100,000 persons per year for males age 10 to 14. Males outnumbered females by 2.5:1. Half of the fireworks injuries occurred around the week of July 4. The hand was the most frequently injured body part, followed by the eyes and the face. Active participants consistently were the major victims in all "personal-use" fireworks and had more severe injuries than bystanders. Rockets were the most dangerous device among class C fireworks. CONCLUSION: Fireworks injuries are a health hazard to the public. Young persons are at the highest risk to suffer injuries, mainly due to personal-use fireworks. A majority of victims are injured during the week of July 4. Class B fireworks and rockets appear to be very dangerous.

Blast Injuries↗
PubMed1994

Increased frequency of apolipoprotein B signal peptide sp24/24 in patients with coronary artery disease. General allele survey in the population of Taiwan and comparison with Caucasians.

Apolipoprotein B (apoB) signal peptide (sp) polymorphism was characterized by polymerase chain reaction in blood samples of 58 coronary artery disease (CAD) patients and 319 control individuals of Chinese Han ethnic origin in Taiwan. In the CAD group, 77% of the observed alleles were sp27 (sp with 27 amino acids), and the remaining 23% sp24 (sp with 24 amino acids). The frequency distributions of the apoB sp allele in the control group were 0.81 for sp27 and 0.19 for sp24. The genotype distributions were 0.64 sp27/27, 0.26 sp27/24 and 0.10 sp24/24 in the CAD group; 0.64 sp27/27, 0.33 sp27/24 and 0.03 sp24/24 in the control group. The frequency of sp24/24 was significantly higher (p = 0.012) in the CAD group than in the control group. Several studies have shown that the frequency of sp24/24 is higher in hyperlipidemic than in normolipidemic groups. This marker is probably in linkage disequilibrium with some other atherogenic genes. Our study shows that the differences in both apoB signal peptide alleles and sp27/27 and sp27/24 genotype distributions are statistically significant between the Taiwanese and Caucasians.

Adult↗
PubMed1994

Immunohistochemical analysis of dermal mononuclear cell infiltrates in cutaneous lupus erythematosus, polymorphous light eruption, lymphocytic infiltration of Jessner, and cutaneous lymphoid hyperplasia: a comparative differential study.

Cutaneous lupus erythematosus (LE), polymorphous light-eruption (PMLE), lymphocytic infiltration of Jessner (LIJ), and cutaneous lymphoid hyperplasia (CLH) are often difficult to differentiate from one another by light microscopic examination. We conducted an immunohistochemical analysis of the mononuclear cell infiltrates in 13 LE, 12 PMLE, 10 LIJ, and 13 CLH with various antibodies. Antibodies L26, UCHL1, and S100 achieved statistically significant differences among the four diseases, but because of the overlaps in the number of UCHL1(+) T cells and S100 protein (+) cells in individual cases, these two antibodies were not useful. Only CLH could be distinguished from LE, PMLE, and LIJ by a greater number of CD20(+) B cells. The latter three conditions could not be differentiated. Contrary to previous reports, plasmacytoid-monocytes were not found to be increased in LIJ for the differentiation of the latter from LE and PMLE. Our results support the conclusion that CLH is a reactive lymphoid hyperplastic process with proliferation of both B and T cells, whereas the T cell was the predominant cell type in the infiltrates of LE, PMLE, and LIJ, indicating that they were related to T cell disorders. The histiocyte was only a minor component cell. The plasmacytoid monocyte in general was not significantly present in all four conditions, but relatively more plasmacytoid monocytes were present in CLH.

Analysis of Variance↗
PubMed1994

E-selectin ligands mediate tumor necrosis factor-induced neutrophil sequestration and pulmonary edema in guinea pig lungs.

We have previously shown in perfused guinea pig lungs that tumor necrosis factor-alpha (TNF-alpha) pretreatment of lungs enhanced neutrophil sequestration as reflected by a 2.4-fold increase in lung myeloperoxidase (MPO) activity. Subsequent perfusion of phorbol 12-myristate 13-acetate (PMA) to activate the sequestered neutrophils produced an approximately threefold increase in the pulmonary capillary hydrostatic pressure and fulminant pulmonary edema. Using this ex vivo model of lung injury, we studied the role of three putative E-selectin ligands, sialyl-Lewis X, Lewis X, and dimeric sialyl-Lewis X, in mediating neutrophil sequestration and pulmonary edema. We pretreated neutrophils with monoclonal antibodies (mAbs) directed against these E-selectin ligands. Pretreatment of neutrophils with mAbs to sialyl-Lewis X and Lewis X reduced the neutrophil sequestration, as evidenced by 45% and 27% reductions in MPO activity from control levels, respectively. This occurred in parallel with inhibition of neutrophil adhesion to the TNF-alpha-activated endothelial cells in vitro. The mAbs to dimeric sialyl-Lewis X and an isotype-matched control mAb against lactosamines present on neutrophils had no effect on lung MPO activity and neutrophil adhesion. All mAbs to sialyl-Lewis X, Lewis X, and dimeric sialyl-Lewis X reduced the increases in the pulmonary capillary hydrostatic pressure after challenge of the sequestered neutrophils with PMA and also reduced lung weight gain by 71%, 45% and 38%, respectively. The control mAb to the lactosamines had no effect on the pulmonary capillary hydrostatic pressure and lung weight gain.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

Noninvasive predictors of systemic embolism in mitral stenosis. An echocardiographic and clinical study of 500 patients.

Few predictors of systemic embolism in patients with mitral stenosis have been identified by noninvasive methods. This study used the most powerful noninvasive diagnostic tool, transthoracic echocardiography, as well as other noninvasive clinical information to look for predictors. Five hundred consecutive patients with a mitral valve area of 2 cm2 or less were studied. They were divided into two groups: group 1 consisted of 143 patients with a history of systemic embolism and group 2 consisted of 357 patients with no history of systemic embolism. Using a stepwise logistic regression on a random subsample of 400 patients, 4 independent predictors were found: the presence of atrial fibrillation (p = 0.003, relative risk [RR] = 2.3, 95% CI = 1.3, 4.2), the absence of significant tricuspid regurgitation (p = 0.008, RR = 2.5, 95% CI = 1.3, 4.9), the absence of aortic regurgitation (p = 0.022, RR = 2.2, 95% CI = 1.1, 4.2), and the presence of left atrial smoky echoes (p = 0.039, RR = 1.7, 95% CI = 1.1, 3.0). When the above model, together with significant interaction terms, was applied to the remaining 100 patients, both the Hosmer-Lemeshow and Brown goodness-of-fit statistics were not significant (p = 0.888 and p = 0.248, respectively), indicating that the fit was adequate and the model was validated. Thus, important noninvasive predictors of systemic embolism in patients with mitral stenosis can easily be obtained. Subgroups of patients with high risk of systemic embolism can be identified. This may refine our therapeutic strategies to prevent the catastrophe of systemic embolism.

Adolescent↗