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Article ; Online: Predictive factors of lymphatic metastasis and evaluation of the Japanese treatment guidelines for endoscopic resection of early gastric cancer in a high-volume center in Perú

Paredes, Oscar / Baca, Carlos / Cruz, Renier / Paredes, Kori / Luque-Vasquez, Carlos / Chavez, Iván / Taxa, Luis / Ruiz, Eloy / Berrospi, Francisco / Payet, Eduardo

Heliyon. 2023 May, v. 9, no. 5 p.e16293-

2023

Abstract: This study aimed to identify the predictive factors of lymph node metastasis (LNM) in patients with early gastric cancer (EGC) and to evaluate the applicability of the Japanese treatment guidelines for endoscopic resection in the western population. Five ...

Abstract	This study aimed to identify the predictive factors of lymph node metastasis (LNM) in patients with early gastric cancer (EGC) and to evaluate the applicability of the Japanese treatment guidelines for endoscopic resection in the western population. Five hundred-one patients with pathological diagnoses of EGC were included. Univariate and multivariate analyses were conducted to identify the predictive factors of LNM. EGC patients were distributed according to the indications for endoscopic resection of the Eastern guidelines. The incidence of LNM was evaluated in each group. From 501 patients with EGC, 96 (19.2%) presented LNM. In 279 patients with tumors with submucosal infiltration (T1b), 83 (30%) patients had LNM. Among 219 patients who presented tumors > 3 cm, 63 (29%) patients had LNM. Thirty-one percent of patients with ulcerated tumors presented LMN (33 out of 105). In 76 patients and 24 patients with lymphovascular and perineural invasion, the percentage of LMN was 84% and 87%, respectively. In the multivariate analysis, a tumor diameter >3 cm, submucosal invasion, lymphovascular, and perineural invasion were independent predictors of LMN in EGC. No patient with differentiated, non-ulcerated mucosal tumors presented LNM regardless of tumor size. Three of 17 patients (18%) with differentiated, ulcerated mucosal tumors and ≤ 3 cm presented LNM. No LNM was evidenced in patients with undifferentiated mucosal tumors and ≤ 2 cm. The presence of LNM in Western EGC patients was independently related to larger tumors (>3 cm), submucosal invasion, lymphovascular and perineural invasion. The Japanese absolute indications for EMR are safe in the Western population. Likewise, Western patients with differentiated, non-ulcerated mucosal tumors, and larger than 2 cm are susceptible to endoscopic resection. Patients with undifferentiated mucosal tumors smaller than 2 cm presented encouraging results and ESD could be recommended only for selected cases.
Keywords	lymph nodes ; metastasis ; multivariate analysis ; patients ; resection ; stomach neoplasms ; Early gastric cancer (EGC) ; Lymph node metastasis (LNM) ; Predictive factors ; Endoscopic mucosal resection (EMR) ; Endoscopic submucosal dissection (ESD)
Language	English
Dates of publication	2023-05
Publishing place	Elsevier Ltd
Document type	Article ; Online
Note	Use and reproduction
ZDB-ID	2835763-2
ISSN	2405-8440
ISSN	2405-8440
DOI	10.1016/j.heliyon.2023.e16293
Database	NAL-Catalogue (AGRICOLA)

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Article: Predictive factors of lymphatic metastasis and evaluation of the Japanese treatment guidelines for endoscopic resection of early gastric cancer in a high-volume center in Perú.

Paredes, Oscar / Baca, Carlos / Cruz, Renier / Paredes, Kori / Luque-Vasquez, Carlos / Chavez, Iván / Taxa, Luis / Ruiz, Eloy / Berrospi, Francisco / Payet, Eduardo

Heliyon

2023 Volume 9, Issue 5, Page(s) e16293

Abstract: Purpose: This study aimed to identify the predictive factors of lymph node metastasis (LNM) in patients with early gastric cancer (EGC) and to evaluate the applicability of the Japanese treatment guidelines for endoscopic resection in the western ... ...

Abstract	Purpose: This study aimed to identify the predictive factors of lymph node metastasis (LNM) in patients with early gastric cancer (EGC) and to evaluate the applicability of the Japanese treatment guidelines for endoscopic resection in the western population. Methods: Five hundred-one patients with pathological diagnoses of EGC were included. Univariate and multivariate analyses were conducted to identify the predictive factors of LNM. EGC patients were distributed according to the indications for endoscopic resection of the Eastern guidelines. The incidence of LNM was evaluated in each group. Results: From 501 patients with EGC, 96 (19.2%) presented LNM. In 279 patients with tumors with submucosal infiltration (T1b), 83 (30%) patients had LNM. Among 219 patients who presented tumors > 3 cm, 63 (29%) patients had LNM. Thirty-one percent of patients with ulcerated tumors presented LMN (33 out of 105). In 76 patients and 24 patients with lymphovascular and perineural invasion, the percentage of LMN was 84% and 87%, respectively. In the multivariate analysis, a tumor diameter >3 cm, submucosal invasion, lymphovascular, and perineural invasion were independent predictors of LMN in EGC. No patient with differentiated, non-ulcerated mucosal tumors presented LNM regardless of tumor size. Three of 17 patients (18%) with differentiated, ulcerated mucosal tumors and ≤ 3 cm presented LNM. No LNM was evidenced in patients with undifferentiated mucosal tumors and ≤ 2 cm. Conclusions: The presence of LNM in Western EGC patients was independently related to larger tumors (>3 cm), submucosal invasion, lymphovascular and perineural invasion. The Japanese absolute indications for EMR are safe in the Western population. Likewise, Western patients with differentiated, non-ulcerated mucosal tumors, and larger than 2 cm are susceptible to endoscopic resection. Patients with undifferentiated mucosal tumors smaller than 2 cm presented encouraging results and ESD could be recommended only for selected cases.
Language	English
Publishing date	2023-05-15
Publishing country	England
Document type	Journal Article
ZDB-ID	2835763-2
ISSN	2405-8440
ISSN	2405-8440
DOI	10.1016/j.heliyon.2023.e16293
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Article: Adjuvant chemotherapy after curative D2 gastrectomy in Latin American patients with gastric cancer.

Serrano, Mariana / Araujo, Jhajaira M / Pacheco, Cristian / Macetas, Jackeline / Blum, Mariella A / Carrato, Alfredo / Ruiz, Eloy / Berrospi, Francisco / Luque, Carlos / Chavez, Ivan / Payet, Eduardo / Taxa, Luis / Montenegro, Paola

Ecancermedicalscience

2022 Volume 16, Page(s) 1387

Abstract: Background: Gastric cancer (GC) is the fourth most common cause of cancer deaths around the world and the first cause of cancer deaths in Peru; however, there are no prospective trials for adjuvant chemotherapy in GC after curative gastrectomy in this ... ...

Abstract	Background: Gastric cancer (GC) is the fourth most common cause of cancer deaths around the world and the first cause of cancer deaths in Peru; however, there are no prospective trials for adjuvant chemotherapy in GC after curative gastrectomy in this country. The objective of this study was to evaluate the effectiveness of adjuvant chemotherapy in stage II-III gastric cancer patients who underwent D2 gastrectomy. Methods: We included patients with stage II-III gastric cancer who underwent radical gastrectomy and D2 dissection between 2014 and 2016 at our institution. Patients received 3-week cycles of capecitabine (1,000 mg/m Results: In total, 173 patients were included: 100 (57.8%) patients received adjuvant chemotherapy and surgery (AChS) and 73 (42.2%) surgery alone (SA). Three-year disease-free survival (DFS) was higher in the AChS groups (69%) than in the SA group (52.6%) ( Conclusion: These data suggest that adjuvant capecitabine and oxaliplatin reduce the recurrence and mortality in patients with stage II-III gastric cancer who underwent D2 gastrectomy. PS IIIA and IIIB and LNR > 13.1 benefited more from receiving adjuvant chemotherapy and poorly cohesive gastric carcinoma did not significantly reduce the rates of survival.
Language	English
Publishing date	2022-05-12
Publishing country	England
Document type	Journal Article
ISSN	1754-6605
ISSN	1754-6605
DOI	10.3332/ecancer.2022.1387
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Article ; Online: Metallomic profile in non-cirrhotic hepatocellular carcinoma supports a phenomenon of metal metabolism adaptation in tumor cells.

Cano, Luis / Bertani, Stéphane / Island, Marie-Laure / Cerapio, Juan Pablo / Ruiz, Eloy / Pineau, Pascal / Monbet, Valérie / Boudjema, Karim / Taxa, Luis / Casavilca-Zambrano, Sandro / Ropert, Martine / Turlin, Bruno / Loréal, Olivier

Scientific reports

2021 Volume 11, Issue 1, Page(s) 14195

Abstract: We have previously described a form of hepatocellular carcinoma (HCC) in non-cirrhotic liver (HCC-NC) developed by Peruvian patients. We analyzed the metallomic profile in hepatic tissues from two independent cohorts exhibiting HCC-NC. Clinical, ... ...

Abstract	We have previously described a form of hepatocellular carcinoma (HCC) in non-cirrhotic liver (HCC-NC) developed by Peruvian patients. We analyzed the metallomic profile in hepatic tissues from two independent cohorts exhibiting HCC-NC. Clinical, histopathological data, and HCC and non-tumoral liver (NTL) samples of 38 Peruvian and 38 French HCC-NC patients, were studied. Twelve metals were quantified using ICP/MS: Mn, Fe, Cu, Co, Zn, As, Se, Rb, Mo, Cd, Pb, and Sn. Associations between metals and survival were assessed. Our data showed significant differences between cohorts. Mean ages were 40.6 ± 20, 67.5 ± 9 years old for Peruvians and French, respectively. Fifty percent of the Peruvian patients were positive for the HBsAg, versus 3% in French patients. Mn, Cu, Zn, As, Se, Rb, Mo, Cd, Sn metal concentrations were higher in NTL of Peruvians. Importantly, metal concentrations were lower in HCC areas compared to NTL tissues in both cohorts, except for Cu for which mean concentration was higher in HCC (p < 0.05). Se concentration in HCC was associated with extended survival only in Peruvians. Our data, obtained in Peruvian and French HCC-NC cohorts, highlights similarity in the metallomic profile of HCC compared to NTL during the hepatic tumorigenesis in these specific groups of patients.
MeSH term(s)	Adult ; Aged ; Carcinoma, Hepatocellular/metabolism ; Carcinoma, Hepatocellular/pathology ; Female ; Humans ; Liver/metabolism ; Liver/pathology ; Liver Neoplasms/metabolism ; Liver Neoplasms/pathology ; Male ; Metals/metabolism ; Middle Aged ; Retrospective Studies ; Young Adult
Chemical Substances	Metals
Language	English
Publishing date	2021-07-09
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-021-93369-4
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: The relationship between tumour infiltrating lymphocytes, Epstein-Barr virus and

Castañeda, Carlos / Castillo, Miluska / Bernabe, Luis / Suarez, Nancy / Fassan, Matteo / Sanchez, Joselyn / Tello, Katherine / Alatrista, Raul / Chavez, Ivan / Ruiz, Eloy / Bazan, Yaqueline / Barreda, Fernando / Valdivia, Daniel / Meng, Wei / Chakravarti, Arnab / Sanchez, Juvenal / Taxa, Luis / Montenegro, Paola

Ecancermedicalscience

2022 Volume 16, Page(s) 1362

Abstract: Objective: Epstein-Barr virus (EBV) and : Methods: TIL evaluation in haematoxylin-eosin was performed by a pathologist and density of CD3, CD8 and CD163 positive (immunohistochemistry staining) immune cells was calculated with the use of digital ... ...

Abstract	Objective: Epstein-Barr virus (EBV) and Methods: TIL evaluation in haematoxylin-eosin was performed by a pathologist and density of CD3, CD8 and CD163 positive (immunohistochemistry staining) immune cells was calculated with the use of digital pathology software. EBV infection was detected by Results: We included 98 resected GC Peruvian cases in our evaluation. Median TIL percentage was 30. The proportion of EBV+ detected by ISH was 24.1%, of EBV+ detected by qPCR was 41.8%, while 70% showed methylation of EBV-related genes, and 58.21% of cases were HP+. Younger age ( Conclusion: Lower CD8 density and HP+ predict longer OS. High TIL level is associated with EBV+ and methylation of EBV-related genes, while lower CD8 density is associated with HP+ GC.
Language	English
Publishing date	2022-03-01
Publishing country	England
Document type	Journal Article
ISSN	1754-6605
ISSN	1754-6605
DOI	10.3332/ecancer.2022.1362
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Article ; Online: Cáncer colorrectal en los jóvenes: factores pronósticos y características clínico patológicas en un instituto del cáncer de Perú.

Ruiz, Rossana / Taxa, Luis / Ruiz, Eloy F / Mantilla, Raúl / Casanova, Luis / Montenegro, Paola

Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru

2016 Volume 36, Issue 1, Page(s) 35–42

Abstract: Objective: To determine clinicopathological features and prognostic factors among young colorectal cancer (CRC) patients in a Peruvian Cancer Institute.: Methods: Data of patients 40 years or younger, admitted between January 2005 and December 2010, ... ...

Title translation	Colorectal cancer in the young: clinicopathologic features and prognostic factors from a cancer institute in Peru.
Abstract	Objective: To determine clinicopathological features and prognostic factors among young colorectal cancer (CRC) patients in a Peruvian Cancer Institute. Methods: Data of patients 40 years or younger, admitted between January 2005 and December 2010, were analyzed. Results: During the study period, 196 young patients with CRC were admitted. The tumor was located in the rectum, left colon and right colon in 45.9%, 28.6% and 25.5% of cases. Family history of CRC was found in 13.2% and an autosomal pattern of inheritance, in 8.6% of the cases. The most common symptoms were pain (67.9%) and bleeding (67.3%). The majority (63.1%) of colon cancer cases and more than a third (34.4%) of rectal cancer cases were diagnosed in stage III or IV. The histologic type was tubular, mucinous and signet ring cell adenocarcinoma in 73.5%, 14.8% and 8.6%, respectively. The depth of invasion was T3 in 21.4% and T4 in 53%. Nodal involvement was detected in 44.5%. Five-year overall survival (OS) was 44.3%. In the multivariate analysis, only the stage resulted an independent prognostic factor for survival. Conclusions: CRC in Peruvian young patients is mostly sporadic. It presents more often in the distal colon or rectum and at advanced stages of the disease. Mucinous and signet ring cell carcinoma were requent histological types. Five-year OS stage by stage is similar to that reported in the literature for older patients. Stage was the only independent prognostic factor for survival.
MeSH term(s)	Adenocarcinoma/diagnosis ; Adenocarcinoma/mortality ; Adenocarcinoma/pathology ; Adenocarcinoma/therapy ; Adolescent ; Adult ; Child ; Colorectal Neoplasms/diagnosis ; Colorectal Neoplasms/mortality ; Colorectal Neoplasms/pathology ; Colorectal Neoplasms/therapy ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Humans ; Lymphatic Metastasis ; Male ; Neoplasm Staging ; Peru ; Prognosis ; Retrospective Studies ; Survival Analysis ; Young Adult
Language	English
Publishing date	2016-01
Publishing country	Peru
Document type	Journal Article
ZDB-ID	2058591-3
ISSN	1609-722X ; 1022-5129
ISSN (online)	1609-722X
ISSN	1022-5129
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Article ; Online: Tuberculosis que imita cáncer: casos derivados al Instituto Nacional de Enfermedades Neoplásicas, Lima-Perú.

Villena-Suarez, Juliana R / Vicente, William / Taxa, Luis / Cuéllar, Luis / Nuñez-Butrón, Maria T / Villegas, Valeria / Castillo, Miluska / Castañeda, Carlos A

Revista peruana de medicina experimental y salud publica

2018 Volume 35, Issue 1, Page(s) 77–83

Abstract: Tuberculosis (TB) is a major public health problem that, due to the clinical variability of its presentation, can be confused with cancer. The aim of this study was to identify the clinical-radiological characteristics and to describe the methodology ... ...

Title translation	Tuberculosis That Mimics Cancer: Cases Referred to the National Institute of Neoplastic Diseases, Lima-Peru.
Abstract	Tuberculosis (TB) is a major public health problem that, due to the clinical variability of its presentation, can be confused with cancer. The aim of this study was to identify the clinical-radiological characteristics and to describe the methodology that allowed to achieve a TB diagnosis in patients referred to the National Institute of Neoplastic Diseases (INEN) with a presumed diagnosis of cancer between 2014 and 2016. The study included 170 patients (52.4% men) with an average age of 41.1 years; 18% presented a history of contact with TB, and 5.9% had had the disease previously. The TB was pulmonary in 22.4% and extrapulmonary in 77.7% of patients. The most frequent symptoms were respiratory, tumor, weight loss, and neurological. The cancer diagnoses most frequently discarded were lymphoma, lung cancer, and brain cancer. The lesions that suggested a neoplasm indicated an advanced clinical stage in 63.5%. Therefore, it follows that the symptoms and images associated with TB can be confused with malignant neoplasms.
MeSH term(s)	Academies and Institutes ; Adult ; Diagnosis, Differential ; Female ; Humans ; Male ; Neoplasms/diagnosis ; Peru ; Referral and Consultation ; Retrospective Studies ; Tuberculosis/diagnosis
Language	Spanish
Publishing date	2018-06-18
Publishing country	Peru
Document type	Journal Article
ZDB-ID	2120092-0
ISSN	1726-4642 ; 1726-4634
ISSN (online)	1726-4642
ISSN	1726-4634
DOI	10.17843/rpmesp.2018.351.3602
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Article: Survival after curative pancreaticoduodenectomy for ampullary adenocarcinoma in a South American population: A retrospective cohort study.

Fernandez-Placencia, Ramiro Manuel / Montenegro, Paola / Guerrero, Melvy / Serrano, Mariana / Ortega, Emperatriz / Bravo, Mercedes / Huanca, Lourdes / Bertani, Stéphane / Trejo, Juan Manuel / Webb, Patricia / Malca-Vasquez, Jenny / Taxa, Luis / Lachos-Davila, Alberto / Celis-Zapata, Juan / Luque-Vasquez, Carlos / Payet, Eduardo / Ruiz, Eloy / Berrospi, Francisco

World journal of gastrointestinal surgery

2022 Volume 14, Issue 1, Page(s) 24–35

Abstract: Background: Ampullary adenocarcinoma (AAC) is a rare neoplasm that accounts for only 0.2% of all gastrointestinal cancers. Its incidence rate is lower than 6 cases per million people. Different prognostic factors have been described for AAC and are ... ...

Abstract	Background: Ampullary adenocarcinoma (AAC) is a rare neoplasm that accounts for only 0.2% of all gastrointestinal cancers. Its incidence rate is lower than 6 cases per million people. Different prognostic factors have been described for AAC and are associated with a wide range of survival rates. However, these studies have been exclusively conducted in patients originating from Asian, European, and North American countries. Aim: To evaluate the histopathologic predictors of overall survival (OS) in South American patients with AAC treated with curative pancreaticoduodenectomy (PD). Methods: We analyzed retrospective data from 83 AAC patients who underwent curative (R0) PD at the National Cancer Institute of Peru between January 2010 and October 2020 to identify histopathologic predictors of OS. Results: Sixty-nine percent of patients had developed intestinal-type AAC (69%), 23% had pancreatobiliary-type AAC, and 8% had other subtypes. Forty-one percent of patients were classified as Stage I, according to the AJCC 8 Conclusion: Extended tumour stage (T3), pancreatobiliary type, and positive lymph node metastasis represent independent predictors of a lower OS rate in South American AAC patients who underwent curative PD.
Language	English
Publishing date	2022-01-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	2573700-4
ISSN	1948-9366
ISSN	1948-9366
DOI	10.4240/wjgs.v14.i1.24
Database	MEDical Literature Analysis and Retrieval System OnLINE

2022 Volume 82, Issue 20, Page(s) 3763–3773

Abstract: Peripheral T-cell lymphomas (PTCL) are agressive lymphomas that develop from mature T cells. The most common PTCLs are genetically, molecularly, and clinically diverse and are generally associated with dismal outcomes. While Notch signaling plays a ... ...

Abstract	Peripheral T-cell lymphomas (PTCL) are agressive lymphomas that develop from mature T cells. The most common PTCLs are genetically, molecularly, and clinically diverse and are generally associated with dismal outcomes. While Notch signaling plays a critically important role in both the development of immature T cells and their malignant transformation, its role in PTCL is poorly understood, despite the increasingly appreciated function of Notch in regulating the proliferation and differentiation of mature T cells. Here, we demonstrate that Notch receptors and their Delta-like family ligands (DLL1/DLL4) play a pathogenic role in PTCL. Notch1 activation was observed in common PTCL subtypes, including PTCL-not otherwise specified (NOS). In a large cohort of PTCL-NOS biopsies, Notch1 activation was significantly associated with surrogate markers of proliferation. Complementary genetically engineered mouse models and spontaneous PTCL models were used to functionally examine the role of Notch signaling, and Notch1/Notch2 blockade and pan-Notch blockade using dominant-negative MAML significantly impaired the proliferation of malignant T cells and PTCL progression in these models. Treatment with DLL1/DLL4 blocking antibodies established that Notch signaling is ligand-dependent. Together, these findings reveal a role for ligand-dependent Notch signaling in driving peripheral T-cell lymphomagenesis. Significance: This work demonstrates that ligand-dependent Notch activation promotes the growth and proliferation of mature T-cell lymphomas, providing new therapeutic strategies for this group of aggressive lymphomas.
MeSH term(s)	Animals ; Antibodies, Blocking ; Ligands ; Mice ; Receptor, Notch1 ; Receptors, Notch/genetics ; Signal Transduction ; T-Lymphocytes
Chemical Substances	Antibodies, Blocking ; Ligands ; Receptor, Notch1 ; Receptors, Notch
Language	English
Publishing date	2022-08-25
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1432-1
ISSN	1538-7445 ; 0008-5472
ISSN (online)	1538-7445
ISSN	0008-5472
DOI	10.1158/0008-5472.CAN-22-1215
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Article ; Online: Depth of Cervical Intraepithelial Neoplasia Grade 3 in Peruvian Women: Implications for Therapeutic Depth of Necrosis.

Taxa, Luis / Jeronimo, Jose / Alonzo, Todd A / Gage, Julia / Castle, Philip E / Cremer, Miriam L / Felix, Juan C

Journal of lower genital tract disease

2017 Volume 22, Issue 1, Page(s) 27–30

Abstract: Objective: To determine the involvement of cervical intraepithelial neoplasia grade 3 (CIN3) in a population of women in a lower-resource setting.: Methods: One hundred twelve consecutive cone excision specimens with histological diagnosis of CIN3 ... ...

Abstract	Objective: To determine the involvement of cervical intraepithelial neoplasia grade 3 (CIN3) in a population of women in a lower-resource setting. Methods: One hundred twelve consecutive cone excision specimens with histological diagnosis of CIN3 were retrieved from the National Institute of Neoplastic Diseases in Lima Peru. Two pathologists independently evaluated each specimen microscopically and confirmed 107 cases that could be measured by optical micrometry. Depth and breadth of the lesions were measured microscopically. Results: The mean maximal depth of cervical involvement by CIN3 was 2 ± 0.13 mm; depth was less than 3.5 mm in 89.7% of cases and less than 5 mm in 93.5%. Mean breadth of CIN3 was 7.3 ± 4.4 mm; breadth was less than 15.9 mm in 95% of cases and less than 20.5 mm in 99.7%. The correlation coefficient between breadth and depth of CIN3 was 0.61. No significant correlation was found between age and depth. Conclusions: Depth of CIN3 involvement in a developing country is significantly deeper than that reported in the United States. Treatment selection for women with CIN3 and risk of treatment failure may vary between developing and developed countries because of the difference in the depth of lesions. Countries with underscreened populations need to consider the increased disease severity in devising treatment strategies.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Biometry ; Developing Countries ; Female ; Humans ; Microscopy ; Middle Aged ; Necrosis/pathology ; Peru ; Retrospective Studies ; Squamous Intraepithelial Lesions of the Cervix/pathology ; Young Adult
Language	English
Publishing date	2017-12-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	2041332-4
ISSN	1526-0976 ; 1089-2591
ISSN (online)	1526-0976
ISSN	1089-2591
DOI	10.1097/LGT.0000000000000355
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