Biomedical subjects

S M Zhou

Publications and source records attributed to S M Zhou.

At least 19 recordsLinked to original sources

PubMed2007

Systemic lupus erythematosus: a genetic epidemiology study of 695 patients from China.

Our purpose was to explore potential genetic models for systemic lupus erythematosus (SLE) and analyze genetic epidemiologic characteristics of SLE in a Chinese population. Data for 695 patients with SLE were obtained by using a uniform questionnaire. Patients, clinical characteristics and their family history were analyzed using software. A complex segregation analysis was conducted to propose potential genetic models for SLE. The mean +/- SD age of onset were 30.2 +/- 10.5 years and mean time to progression to SLE was 32.5 +/- 44.4 months. The most frequent initial manifestations were malar rash (61.3%). During the evolution of the disease, the main clinical features were arthritis in 73.6% of our patients, followed by malar rash (68.1%), and renal involvement (56.7%). As the first symptom, the late-onset group (onset of disease beyond the age of 50 years) less often showed malar rash (45% vs. 63.4% in the early-onset group; p = 0.001). There were no significant differences in the other cumulative clinical symptoms between late-onset and early-onset group, except for a lower prevalence of malar rash, photosensitivity and alopecia and a higher prevalence of mucosal ulcers in the late-onset group. A positive family history of SLE was obtained in 50 patients (7.2%). There were no statistical differences in clinical characteristics between familial SLE and sporadic SLE patients. The heritability of SLE was 43.6%, the genetic model of SLE could be polygenetic model and major gene mode is the best fitted one. SLE could be a multifactorial disease with polygenetic model.

Adolescent↗

PubMed2005

The impact of pre-radiotherapy surgery on radiation-induced lung injury.

AIMS: The use of postoperative radiation therapy (PORT) is predicated by an assessment of the potential benefits and risks, including radiation-induced lung injury. In this study, the risk of radiation-induced lung injury is assessed in patients who received PORT, and compared with a group of patients who received radiation without prior surgery, to determine if surgery increases the risk of radiation pneumonitis. MATERIALS AND METHODS: From 1991 to 2003, 251 patients with lung cancer were enrolled into a prospective study to assess radiation-induced lung injury. All patients received three-dimensional-planned, external-beam radiotherapy. One hundred and seventy-seven patients with over 6-months follow-up were eligible. For the current analysis, 49 patients (28%) had surgical intervention before radiotherapy. The rates of Grade 2 symptomatic pneumonitis in subgroups, based on the type of pre-radiation surgery, were computed and compared using Fisher's Exact Test. To consider the confounding factor of irradiated lung volume, patient subgroups were further defined on the basis of the mean lung dose. RESULTS: Surgical procedures included pneumonectomy (n=9), lobectomy (n=16), wedge resection (n=8) and exploration without resection (n=16). Radiation-induced lung injury occurred in 33 out of 177 (19%) patients, including 18% of the surgical group and 19% of the non-surgical group. Additionally, no statistically significant difference was found in the rate of radiation-induced lung injury based on the extent of resection. CONCLUSIONS: The incidence of pneumonitis is similar in the surgical and non-surgical groups. Thus, PORT may be safely given to selected patients after surgical exploration or resection.

Adult↗

PubMed2001

Radiation-induced pulmonary toxicity: a dose-volume histogram analysis in 201 patients with lung cancer.

PURPOSE: To relate lung dose-volume histogram-based factors to symptomatic radiation pneumonitis (RP) in patients with lung cancer undergoing 3-dimensional (3D) radiotherapy planning. METHODS AND MATERIALS: Between 1991 and 1999, 318 patients with lung cancer received external beam radiotherapy (RT) with 3D planning tools at Duke University Medical Center. One hundred seventeen patients were not evaluated for RP because of <6 months of follow-up, development of progressive intrathoracic disease making scoring of pulmonary symptoms difficult, or unretrievable 3D dosimetry data. Thus, 201 patients were analyzed for RP. Univariate and multivariate analyses were performed to test the association between RP and dosimetric factors (i.e., mean lung dose, volume of lung receiving >or=30 Gy, and normal tissue complication probability derived from the Lyman and Kutcher models) and clinical factors, including tobacco use, age, sex, chemotherapy exposure, tumor site, pre-RT forced expiratory volume in 1 s, weight loss, and performance status. RESULTS: Thirty-nine patients (19%) developed RP. In the univariate analysis, all dosimetric factors (i.e., mean lung dose, volume of lung receiving >or=30 Gy, and normal tissue complication probability) were associated with RP (p range 0.006-0.003). Of the clinical factors, ongoing tobacco use at the time of referral for RT was associated with fewer cases of RP (p = 0.05). These factors were also independently associated with RP according to the multivariate analysis (p = 0.001). Models predictive for RP based on dosimetric factors only, or on a combination with the influence of tobacco use, had a concordance of 64% and 68%, respectively. CONCLUSIONS: Dosimetric factors were the best predictors of symptomatic RP after external beam RT for lung cancer. Multivariate models that also include clinical variables were slightly more predictive.

Adult↗

PubMed2001

Acute urinary toxicity following transperineal prostate brachytherapy using a modified Quimby loading method.

PURPOSE: To examine the acute urinary toxicity following transperineal prostate implant using a modified Quimby loading method with regard to time course, severity, and factors that may be associated with a higher incidence of morbidity. METHODS AND MATERIALS: One hundred thirty-nine patients with prostate adenocarcinoma treated with brachytherapy from 1997 through 1999 had follow-up records available for review. Patients considered for definitive brachytherapy alone included those with prostate specific antigen (PSA) < or = 6, Gleason score (GS) < or = 6, clinical stage < T2b, and prostate volumes generally less than 40 cc. Patients with larger prostate volumes were given neoadjuvant antiandrogen therapy. Those with GS > 6, PSA > 6, or Stage > T2a were treated with external beam radiation therapy followed by brachytherapy boost. Sources were loaded according to a modified Quimby method. At each follow-up, toxicity was graded based on a modified RTOG urinary toxicity scale. RESULTS: Acute urinary toxicity occurred in 88%. Grade I toxicity was reported in 23%, grade II in 45%, and grade III in 20%, with 14% requiring prolonged (greater than 1 week) intermittent or indwelling catheterization. Overall median duration of symptoms was 12 months. There was no difference in duration of symptoms between patients treated with I-125 or Pd-103 sources (p = 0.71). After adjusting for GS and PSA, multivariate logistic regression analysis showed higher incidence of grade 3 toxicity in patients with larger prostate volumes (p = 0.002), and those with more seeds implanted (p < 0.001). Higher incidence of prolonged catheterization was found in patients receiving brachytherapy alone (p = 0.01), with larger prostate volumes (p = 0.01), and those with more seeds implanted (p < 0.001). CONCLUSION: Interstitial brachytherapy for prostate cancer leads to a high incidence of acute urinary toxicity, most of which is mild to moderate in severity. A prolonged need for catheterization can occur in some patients. Patients receiving brachytherapy alone, those with prostate volumes greater than 30 cc, and those implanted with a greater number of seeds have the highest incidence of significant toxicity.

Acute Disease↗

PubMed2000

Asymmetry in elementary events of magnetization reversal in a ferromagnetic/antiferromagnetic bilayer.

Real-time magneto-optical indicator film images reveal distinct asymmetry in the motion of a single domain wall in a wedged-NiFe/uniform-FeMn bilayer due to the nucleation and behavior of an exchange spring in the antiferromagnetic layer. Magnetization reversal from the ground state begins at the thick end of the wedge where the exchange anisotropy field (HE) is minimal and the magnetostatic field (HMS) is maximal, whereas reversal into the ground state begins from the thin end where HE is maximal and HMS is minimal.

Journal Article↗

PubMed2000

A new three-dimensional dose distribution reduction scheme for tubular organs.

In tubular structures, spatial aspects of the dose distribution may be important in determining the normal tissue response. Conventional dose-volume-histograms (DVHs) and dose-surface-histograms (DSHs) lack spatial information and may not be adequate to represent the three-dimensional (3D) dose data. A new 3D dose distribution data reduction scheme which preserves its longitudinal and circumferential character is presented. Dose distributions were generated at each axial level for esophagus or rectum in 123 patients with lung cancer or prostate cancer. Dose distribution histograms at each axial level were independently analyzed along the esophageal or rectal circumference to generate dose-circumference-histogram (DCH) sheets. Two types of plots were then generated from the DCH sheet. The first considered the percentage of the circumference at each axial level receiving various doses. The second considered the minimum dose delivered to any percentage of the circumference at each axial level. The DCH as a treatment planning tool can be easily implemented in a 3D planing system and is potentially useful for the study of the relationship between the complication risk and the longitudinal and circumferential dose distributions.

Dose-Response Relationship, Radiation↗

PubMed2000

Routine 3D treatment planning: opportunities, challenges, and hazards.

Three-dimensional (3D) treatment planning refers to the use of software and hardware tools to design and implement more accurate and conformal radiation therapy. This is a major advance in oncology that should lead to the reduction of treatment-associated morbidity and facilitate safe dose escalation for many tumor sites. This technology affords the incorporation of physiologic and anatomic information into the treatment planning process, further enhancing our ability to improve the therapeutic ratio. However, as with any new technology, care must be taken when applying it in the clinic. The introduction of 3D planning presents new challenges to existing quality assurance systems. These need to be addressed to maintain patient safety. Based on our experience with over 1,500 patients treated at Duke University, the benefits, challenges, and hazards of routine 3D treatment planning are discussed.

Dose Fractionation, Radiation↗

PubMed2000

[The enlarged translabyrinthine removal of large acoustic neuromas: 18 cases report].

OBJECTIVE: To investigate the surgical methods and results of enlarged translabyrinthine approach in the removal of large acoustic neuromas. METHOD: A large mastoidectomy involved complete exposure of sigmoid sinus, the dura behind the sinus for at least 1 cm, the superior petrosal sinus and the middle fossa dura. The jugular bulb was exposed and pressed downwards if necessary. The internal auditory meatus was skeletonized and uncovered for at least 270 degrees. The debulking of the tumor began inside the anterior and inferior poles in order to find the brainstem and the facial nerve root as early as possible, then the dissection of the nerve was performed medially to laterally. Intraoperative facial nerve monitoring and postoperative CT and MRI were performed in all cases. RESULT: Total removal was achieved in all 18 patients with tumors larger than 3 cm (mean size: 4.2 cm). There were no death as well as other complications such as intracranial infection and persistent cerebrospinal fluid leakage. There were no obvious cerebral sequela. The facial nerve was preserved both anatomically and functionally in 14 cases, with Grade I or II in 8 cases, Grade III or IV in 6 cases. Nerve interruption occurred in 4 cases who all had severe facial paralysis or nerve interruption before operation. 16 patients returned to work within 1-3 months. CONCLUSION: Total removal of large acoustic neuroma could be accomplished via the translabyrinthine approach, with good result of facial nerve function and minimum incidence of morbidity.

Adult↗

PubMed2000

[The semiconductor diode laser application in tympanoplasty].

OBJECTIVE: To investigate the method, indications and initial results of semiconductor diode laser application in tympanoplasty. METHOD: The diode laser was used in 14 tympanoplasty procedures. The laser manipulation was mainly used in cases of malleus and incus bony fixation with the tympanum, the fibrous scar tissue around the ossicular chain and the malleus head resection. RESULT: There was no postoperative vertigo and facial paralysis. The average hearing improvement was 24 dB. Seven cases (50%) reached an air-bone gap within 20 dB. CONCLUSION: The application of diode laser in tympanoplasty could effectively reduce the manipulation trauma of ossicular chain and control the bleeding of operative field, especially in managing the bony adhesion of the ossicular chain.

Adolescent↗

PubMed1999

Clinical and dosimetric predictors of radiation-induced esophageal toxicity.

PURPOSE: To evaluate the incidence, severity, and clinical/dosimetric predictors of acute and chronic esophageal toxicities in patients with non-small cell lung cancer (NSCLC) treated with high-dose conformal thoracic radiation. METHODS AND MATERIALS: Ninety-one patients with localized NSCLC treated definitively with high-dose conformal radiation therapy (RT) at Duke University Medical Center (DUMC) were reviewed. Patient characteristics were as follows: 53 males and 38 females; median age 64 yr (range 46-82); stage I--16, II--3, IIIa--40, IIIb--30, X--2; dysphagia pre-RT--6 (7%). Treatment parameters included: median corrected dose-78.8 Gy (range 64.2-85.6); BID fractionation-58 (64%); chemotherapy-43 (47%). Acute and late esophageal toxicities were graded by RTOG criteria. Using 3D treatment planning tools, the esophagus was contoured in a uniform fashion, the 3D dose distribution calculated (with lung density correction), and the dose-volume (DVH) and dose-surface histograms (DSH) generated. At each axial level, the percentage of the esophageal circumference at each dose level was calculated. The length of circumferential esophagus and the maximum circumference treated to doses >50 Gy were assessed. Patient and treatment factors were correlated with acute and chronic esophageal dysfunction using univariate and multivariate logistic regression analyses. RESULTS: There were no acute or late grade 4 or 5 esophageal toxicities. Ten of 91 patients (11%) developed grade 3 acute toxicity. On univariate analysis of clinical parameters, both dysphagia pre-RT (p = 0.10) and BID fractionation (p = 0.11) tended toward significantly predicting grade 3 acute esophagitis. None of the dosimetric parameters analyzed significantly predicted for grade 3 acute esophagitis. Twelve of 66 assessable patients (18%) developed late esophageal toxicity. Of the clinical parameters analyzed, only dysphagia pre-RT (p = 0.06) tended toward significantly predicting late esophageal toxicity. On univariate analyses, the effects of percent organ volume treated >50 Gy (p = 0.05), percent surface area treated >50 Gy (p = 0.05), length of 100% circumference treated >50 Gy (p = 0.04), and maximum percent of circumference treated >80 Gy (p = 0.01) significantly predicted for late toxicity of all grades. On multivariate analysis, percent organ volume treated >50 Gy (p = 0.02) and maximum percent of circumference treated >80 Gy (p = 0.02) predicted for late toxicity. CONCLUSIONS: Late esophageal toxicity following aggressive, high-dose conformal radiotherapy is common but rarely severe. Dosimetric variables addressing the longitudinal and circumferential character of the esophagus have biologic rationale and are predictive of late toxicity. Further studies are needed to assess whether these parameters are better predictors than those derived from traditional DVHs.

Acute Disease↗

PubMed1999

The effect of lanthanide chloride on abscisic acid and electron-transport activity of some crops.

The abscisic acid (ABA) content of the root tips of four crops grown in lanthanide chloride solution and their root lengths had been determined. At lanthanide concentrations of 5 and 10 ppm, these crops all grew well and the ABA decreased. At higher lanthanide concentrations (100-500 ppm), the ABA is increased again. At these concentrations of lanthanum chloride, the photosystems I and II (PSI and PSII) and whole electron chain transport activities were inhibited. PSII was more sensitive than PSI, and it is concluded that La3+ acts on the diphenylcarbazide (DPC) action place of PSII oxidizing site.

Abscisic Acid↗

PubMed1999

Conformal radiation therapy treatment planning reduces the dose to the optic structures for patients with tumors of the paranasal sinuses.

PURPOSE: Compare dose distributions of traditional versus conformal beam orientations in paranasal sinus malignancies. MATERIALS AND METHODS: Maximum normal tissue doses, dose volume histograms (DVH), normal tissue complication probabilities (NTCP), and the percentage of each normal tissue receiving >80% of the average target dose (V80) were calculated. RESULTS/CONCLUSIONS: Conformal planning reduced the V80 to the optic nerves and chiasm as well as the normal tissue maximum doses to the ipsilateral and contralateral optic nerves and chiasm, and mean NTCPs.

Ethmoid Sinus↗

PubMed1999

[Repair of recurrent laryngeal nerve injuries after thyroidectomy].

OBJECTIVE: In order to investigate the opportunity of repair and prognosis of recurrent laryngeal nerve injuries after thyroidectomy. METHODS: Twelve cases with recurrent laryngeal nerve injuries after thyroidectomy were immediately and delayed operated on nerve repair and reinnervation. In immediate operation, 5 cases were repaired by direct recurrent laryngeal nerve suture, and 1 case was treated by transposition of the phrenic nerve to the recurrent laryngeal nerve and sutured the adductor branch to the branch of ansa cervicalis. In delayed operation, 3 cases were treated by anastomosis the main trunk of ansa cervicalis to the adductor branch of recurrent laryngeal nerve, and 3 cases were operated on neuromuscular pedicle to reinnervate posterior cricoarytenoid muscle. RESULTS: Followed up 6 months, the effect was excellent in 1 case who was immediately operated by selective reinnervation of the abductor and adductor muscles of the larynx, better in 9 cases, and poor in 2 cases who were delayed operated over 12 months. CONCLUSION: It can be concluded that the earlier reinnervation is performed, the better prognosis is.

Adult↗

PubMed1998

Differences in gross target volumes on contrast vs. noncontrast CT scans utilized for conformal radiation therapy treatment planning for prostate carcinoma.

PURPOSE: To compare the gross target volumes (GTVs) (prostate and seminal vesicles) defined on noncontrast and contrast-enhanced computed tomography (CT) images used for three-dimensional conformal treatment planning (3DCRT). METHODS AND MATERIALS: From 1993 to 1996, 39 patients referred for radiation therapy for adenocarcinoma of the prostate underwent pretreatment pelvic CT scanning with and without intravenous (i.v.) contrast for treatment planning purposes. Seven patients were excluded because of incomplete data sets. The prostate and seminal vesicles were outlined by the same physician on all images of 32 patients. On 18 CT exams, the prostate and seminal vesicles were blindly outlined a second time by the same physician to evaluate intraphysician consistency. Discrepancies between the GTVs outlined with and without contrast and between the first and second outline on the same study were assessed by calculating the projected area in the anterior-to-posterior (AP) and right lateral (RLAT) beam's-eye view (BEV). To assess the magnitude, frequency, and direction of discrepancies between the two GTVs, the extension of the GTVs in six directions (right, left, anterior, posterior, cephalad, and caudal) was determined. RESULTS: The GTV outlined with contrast was larger in all directions, except caudal, in the majority of patients. The change in the GTV with contrast was significant in the cephalad (p=0.0003) and right (p=0.0007) directions, but not in the other directions. Although the increase with contrast in any direction was usually small (average < or =5 mm), these changes resulted in a significant increase in GTV area in both the AP and RLAT BEV (9.0%, p=0.0017 and 8.2%, p=0.023, respectively). The intraphysician variability in outlining the prostate/ seminal vesicles was minimal. CONCLUSIONS: The addition of i.v. contrast does appear to make a significant difference in how the prostate and seminal vesicles are outlined by an experienced observer. The increase in area of the target, found when contrast is used, should be taken into consideration when designing the treatment fields for patients with carcinoma of the prostate.

Contrast Media↗

PubMed1997

Physical and biological predictors of changes in whole-lung function following thoracic irradiation.

PURPOSE: To develop methods of predicting the pulmonary consequences of thoracic irradiation (RT) by prospectively studying changes in pulmonary function following RT. METHODS AND MATERIALS: 100 patients receiving incidental partial-lung irradiation during treatment of tumors in or adjacent to the thorax had whole-lung function assessed via symptoms and pulmonary function tests (PFTs: FEV1-forced expiratory volume 1 s; DLCO-diffusion capacity) before and repeatedly 6-48 months following RT. All had computed tomography-based three-dimensional (3D) dose calculations with lung density heterogeneity corrections for dose-volume histogram (DVH) and normal tissue complication probability (NTCP) calculations. Functional DVHs (DVfH) based on SPECT (single photon emission computed tomography) lung perfusion scans, and serial transforming growth factor-beta (TGF-beta1) levels were available in 50 and 48 patients, respectively. The incidence and severity of changes in whole-lung function were correlated with clinical, physical, and biological factors. Exploratory statistical analyses were performed using chi-square, Pearson correlations, logistic regression, and multiple linear regression. RESULTS: RT-induced symptoms developed in 21 patients. In the overall group, the single best predictor for the development of symptoms was the NTCP (p < 0.05). Pre-RT PFTs alone were less predictive (p = 0.1 for FEV1, p = 0.08 for DLCO). A multivariate model based on pre-RT DLCO and CT-based NTCP was strongly predictive for the development of symptoms (p < 0.001). NTCPs based on SPECT-derived DVf Hs and TGF-beta1 levels did not appear to provide additional predictive value. The presence or absence of pulmonary symptoms was correlated with the decline in PFT 6 months following RT (p < 0.05). In the overall group, the degree of decline in PFTs was not well correlated with any of the dose-volume variables considered. In patients with "good" pre-RT PFTs, there was a relationship between the percent reduction in PFT and dose-volume parameters such as the percent of lung volume receiving > 30 Gy (p < 0.05). CONCLUSION: The extent of alteration in whole-lung function (symptoms or PFT changes) appears to be related to both dose-volume and pre-RT PFT parameters. The data suggest that no one variable is likely to be an adequate predictor and that multivariate predictive models will be needed. Additional studies are underway to develop better predictive models that consider physical factors such as the DVH and regional perfusion, as well as biological/clinical factors such as pre-RT PFTs and TGF-beta1.

Adult↗

PubMed1997

Epstein-Barr virus BHRF1 prohibits the cells of nasopharyngeal carcinoma from apoptosis.

Epstein-Barr virus (EBV) is associated with nasopharyngeal carcinoma (NPC). The BHRF1 EBV protein is expressed at high levels in productively infected cells and certain latently infected cells. In order to investigate the effect of expression of BHRF1 on the biological behaviour of NPC cells, we constructed the BHRF1 high expression vector and transfected it into the NPC cell line, CNE2. Then, the alteration of proliferation and apoptotic rates in the cells were tested before and after camptothecin treatment. After treatment by camptothecin, BHRF1-CNE2 cells could constantly and slowly proliferate and its apoptotic rate was less than in control groups, and the number of cells in the G phase decreased and in the S phase increased. So, it suggests that BHRF1 expression can enhance the resistibility of CNE2 cells to DNA-damaging agents that cause apoptosis.

Antineoplastic Agents, Phytogenic↗

PubMed1996

A multicentre study to investigate the prevalence of abnormal carbohydrate metabolism in Chinese pregnant women.

OBJECTIVES: To determine the prevalence of abnormal carbohydrate metabolism in Chinese pregnant women. To study the inter-relationship between maternal body habitus, maternal serum glucose and birth weight of the baby. METHODS: Multicentre observational study involving 713 pregnant Chinese women, attending antenatal clinics in Beijing, Shanghai, Guangzhou and Hong Kong. RESULTS AND CONCLUSION: The overall prevalence of abnormal glucose tolerance was 6.9%. The prevalence was 6.8%, 5.5%, 7.2% and 8.1% in Beijing, Shanghai, Guangzhou and Hong Kong, respectively. The differences among the centres did not reach statistical significance (p = 0.9). The mean ponderal index of women with abnormal glucose tolerance was significantly higher than that of women with normal glucose tolerance (15.2 vs 14.3, p < 0.01). The birth weight ratio of the babies was positively correlated with the maternal height (correlation coefficient 0.23, 95% C.I. 0.15-0.30), weight (0.32, 95% C.I. 0.25-0.39) and to a lesser extent, the fasting level of serum glucose (0.10, 95% C.I. 0.02-0.28) but not with the 2 hour level of serum glucose.

Birth Weight↗

PubMed1995

Gastric atrophy and regional variation in upper gastrointestinal disease.

OBJECTIVE: To compare the upper gastrointestinal disease profiles of Helicobacter pylori-infected patients drawn from two distinct regions of China, one with a low incidence of gastric cancer (Guangzhou) and the other with a high incidence of gastric cancer (Lanzhou). The age-standardized prevalence of H. pylori within the populations of these two cities was similar (approximately 56%). In these patient groups, the prevalence of different gastrointestinal disease states and the occurrence and severity of gastritis, gastric atrophy, and intestinal metaplasia were compared. METHODS: This study was based on consecutive patients: 265 from Guangzhou and 275 from Lanzhou. The grading of gastritis and the detection of H. pylori was determined by histology using the "Sydney System". RESULTS: The ratio of cases of duodenal to gastric ulceration for the two cities was: Guangzhou 14:1 and Lanzhou 3:1. Gastric cancer was more prevalent in the patients from Lanzhou (9.8%) than from Guangzhou (3%). In nonulcer dyspepsia patients from Guangzhou, gastritis was predominantly antral, whereas, in Lanzhou, gastritis was predominantly uniform. The amount and severity of atrophy was significantly greater in Lanzhou compared with Guangzhou. CONCLUSIONS: The prevalence of atrophy, rather than age of acquisition and prevalence of H. pylori infection, appears to be a marker of the major upper gastrointestinal disease profiles of a region. Development of atrophy, although apparently related to H. pylori infection, may be a multifactorial condition. Differences in diet, as seen between Guangzhou and Lanzhou, may be important in this regard. Understanding the factors leading to the development of atrophy may enhance our understanding of processes leading to gastric malignancy.

Atrophy↗