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  1. Article: SEVTAR-A multicenter randomized controlled trial to investigate the impact of prophylactic endoluminal placed vacuum sponge for prevention of anastomotic leakage after low rectal resections.

    Schiffmann, Leif / Becker, Matthias / Develing, Leendert / Varga-Szabo, David / Scheidereiter-Krüger, Caroline / Zirngibl, Hubert / Seifert, Michael / Biermann, Lothar / Schlüter, Claudia / Tumczak, Felicitas / Weimann, Arved / Jansen-Winkeln, Boris / Wallstabe, Ingo / Schwandner, Frank / Denecke, Sandra / Schafmayer, Clemens / Kamaleddine, Imad / Stier, Albrecht / Haegele, Katharina /
    Kindler, Michael / Michling, Sabine / Horling, Ernst-Wilhelm / Denzer, Ulrike

    Frontiers in surgery

    2023  Volume 9, Page(s) 1099549

    Abstract: Background: Low anterior resection for rectal cancer is commonly associated with a diverting stoma. In general, the stoma is closed 3 months after the initial operation. The diverting stoma reduces the rate of anastomotic leakage as well as the ... ...

    Abstract Background: Low anterior resection for rectal cancer is commonly associated with a diverting stoma. In general, the stoma is closed 3 months after the initial operation. The diverting stoma reduces the rate of anastomotic leakage as well as the severeness of a potential leakage itself. Nevertheless, anastomotic leakage is still a life-threatening complication and might reduce the quality of life in the short and long term. In case of leakage, the construction can be converted into a Hartmann situation or it could be treated by endoscopic vacuum therapy or by leaving the drains. In recent years, endoscopic vacuum therapy has become the treatment of choice in many institutions. In this study, the hypothesis is to be evaluated, if a prophylactic endoscopic vacuum therapy reduces the rate of anastomotic leakage after rectal resections.
    Methods: A multicenter parallel group randomized controlled trial is planned in as many as possible centers in Europe. The study aims to recruit 362 analyzable patients with a resection of the rectum combined with a diverting ileostoma. The anastomosis has to be between 2 and 8 cm off the anal verge. Half of these patients receive a sponge for 5 days, and the control group is treated as usual in the participating hospitals. There will be a check for anastomotic leakage after 30 days. Primary end point is the rate of anastomotic leakages. The study will have 60% power to detect a difference of 10%, at a one-sided alpha significance level of 5%, assuming an anastomosis leakage rate of 10%-15%.
    Discussion: If the hypothesis proves to be true, anastomosis leakage could be reduced significantly by placing a vacuum sponge over the anastomosis for 5 days.
    Trial registration: The trial is registered at DRKS: DRKS00023436. It has been accredited by Onkocert of the German Society of Cancer: ST-D483. The leading Ethics Committee is the Ethics Committee of Rostock University with the registration ID A 2019-0203.
    Language English
    Publishing date 2023-02-13
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2773823-1
    ISSN 2296-875X
    ISSN 2296-875X
    DOI 10.3389/fsurg.2022.1099549
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: STIM and Orai in platelet function

    Varga-Szabo, David / Braun, Attila / Nieswandt, Bernhard

    Cell calcium. 2011 Sept., v. 50, no. 3

    2011  

    Abstract: Physiological platelet activation and thrombus formation are essential to stop bleeding in case of vascular injury, whereas inadequate triggering of the same process in diseased vessels can lead to fatal thromboembolism and tissue ischemia of vital ... ...

    Abstract Physiological platelet activation and thrombus formation are essential to stop bleeding in case of vascular injury, whereas inadequate triggering of the same process in diseased vessels can lead to fatal thromboembolism and tissue ischemia of vital organs. A central step in platelet activation is agonist-induced elevation of the intracellular Ca²⁺ concentration. This happens on the one hand through the release of Ca²⁺ from intracellular stores and on the other hand through Ca²⁺ influx from the extracellular space. In platelets, the major Ca²⁺ influx pathway is the so-called store operated Ca²⁺ entry (SOCE), induced by store depletion. Studies in the last five years discovered the molecular background of platelet SOCE. Stromal interaction molecule 1 (STIM1) and Orai1, two so far unknown molecules, got in the focus of research. STIM1 was found to be the Ca²⁺ sensor in the endoplasmic reticulum (ER) membrane, whereas Orai1 was identified as the major store operated Ca²⁺ (SOC) channel in the plasma membrane. These two molecules and their role in platelet function and thrombus formation are the topic of the present review with a special focus on apoptosis and apoptosis-like processes in platelet physiology.
    Keywords apoptosis ; calcium ; endoplasmic reticulum ; extracellular space ; hemorrhage ; ischemia ; plasma membrane ; platelet activation
    Language English
    Dates of publication 2011-09
    Size p. 270-278.
    Publishing place Elsevier India Pvt Ltd.
    Document type Article
    ZDB-ID 757687-0
    ISSN 1532-1991 ; 0143-4160
    ISSN (online) 1532-1991
    ISSN 0143-4160
    DOI 10.1016/j.ceca.2011.04.002
    Database NAL-Catalogue (AGRICOLA)

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  3. Article ; Online: STIM and Orai in platelet function.

    Varga-Szabo, David / Braun, Attila / Nieswandt, Bernhard

    Cell calcium

    2011  Volume 50, Issue 3, Page(s) 270–278

    Abstract: Physiological platelet activation and thrombus formation are essential to stop bleeding in case of vascular injury, whereas inadequate triggering of the same process in diseased vessels can lead to fatal thromboembolism and tissue ischemia of vital ... ...

    Abstract Physiological platelet activation and thrombus formation are essential to stop bleeding in case of vascular injury, whereas inadequate triggering of the same process in diseased vessels can lead to fatal thromboembolism and tissue ischemia of vital organs. A central step in platelet activation is agonist-induced elevation of the intracellular Ca(2+) concentration. This happens on the one hand through the release of Ca(2+) from intracellular stores and on the other hand through Ca(2+) influx from the extracellular space. In platelets, the major Ca(2+) influx pathway is the so-called store operated Ca(2+) entry (SOCE), induced by store depletion. Studies in the last five years discovered the molecular background of platelet SOCE. Stromal interaction molecule 1 (STIM1) and Orai1, two so far unknown molecules, got in the focus of research. STIM1 was found to be the Ca(2+) sensor in the endoplasmic reticulum (ER) membrane, whereas Orai1 was identified as the major store operated Ca(2+) (SOC) channel in the plasma membrane. These two molecules and their role in platelet function and thrombus formation are the topic of the present review with a special focus on apoptosis and apoptosis-like processes in platelet physiology.
    MeSH term(s) Animals ; Apoptosis ; Blood Platelets/physiology ; Calcium/metabolism ; Calcium Channels/metabolism ; Calcium Signaling ; Cell Membrane/metabolism ; Endoplasmic Reticulum/metabolism ; Homeostasis ; Humans ; Membrane Proteins/metabolism ; Neoplasm Proteins/metabolism ; ORAI1 Protein ; Stromal Interaction Molecule 1 ; Thrombosis/metabolism
    Chemical Substances Calcium Channels ; Membrane Proteins ; Neoplasm Proteins ; ORAI1 Protein ; ORAI1 protein, human ; STIM1 protein, human ; Stromal Interaction Molecule 1 ; Calcium (SY7Q814VUP)
    Language English
    Publishing date 2011-09
    Publishing country Netherlands
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 757687-0
    ISSN 1532-1991 ; 0143-4160
    ISSN (online) 1532-1991
    ISSN 0143-4160
    DOI 10.1016/j.ceca.2011.04.002
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Conference proceedings: Anastomoseninsuffizienz nach tiefer anteriorer Rektumresektion: Einfluss der präoperativen Radio-Chemotherapie

    Varga-Szabo, David / Genova, Radostina / Zirngibl, Hubert

    2013  , Page(s) 13dgch507

    Event/congress 130. Kongress der Deutschen Gesellschaft für Chirurgie; München; Deutsche Gesellschaft für Chirurgie; 2013
    Keywords Medizin, Gesundheit
    Publishing date 2013-04-26
    Publisher German Medical Science GMS Publishing House; Düsseldorf
    Document type Conference proceedings
    DOI 10.3205/13dgch507
    Database German Medical Science

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  5. Article ; Online: STIM and Orai in hemostasis and thrombosis.

    Braun, Attila / Vogtle, Timo / Varga-Szabo, David / Nieswandt, Bernhard

    Frontiers in bioscience (Landmark edition)

    2011  Volume 16, Issue 6, Page(s) 2144–2160

    Abstract: At sites of vascular injury, platelets rapidly adhere to the exposed subendothelial extracellular matrix, become activated and, together with the coagulation system, form a plug that seals the lesion. This process is essential to prevent blood loss, ... ...

    Abstract At sites of vascular injury, platelets rapidly adhere to the exposed subendothelial extracellular matrix, become activated and, together with the coagulation system, form a plug that seals the lesion. This process is essential to prevent blood loss, however, under pathological conditions it may lead to vessel occlusion. Agonist-induced elevation of intracellular Ca(2+) levels is essential for platelet activation. It occurs through two different mechanisms: Ca(2+) release from internal stores, involving phospholipase C (PLC)-dependent generation of inositol-1,4,5-trisphosphate (IP3) and activation of IP3 sensitive channels in the store membrane, and Ca(2+) influx across the plasma membrane. Store operated Ca(2+) entry (SOCE), triggered by store depletion, is the main influx pathway for extracellular Ca(2+) in platelets, but the molecular mechanism underlying this pathway has long remained elusive. In the last years, however, the Ca(2+) sensor stromal interaction molecule 1 (STIM1) and the channel protein Orai1 emerged as the key players in platelet SOCE. This review summarizes the current knowledge about the role of these proteins in platelet physiology and thrombus formation and discusses their suitability as antithrombotic targets.
    MeSH term(s) Animals ; Blood Platelets/physiology ; Calcium Channels/blood ; Calcium Channels/deficiency ; Calcium Channels/genetics ; Calcium Signaling ; Fibrinolytic Agents/pharmacology ; Hemostasis/physiology ; Humans ; Mice ; Mice, Knockout ; Models, Biological ; Platelet Activation ; Platelet Membrane Glycoproteins/deficiency ; Platelet Membrane Glycoproteins/genetics ; Platelet Membrane Glycoproteins/physiology ; Stroke/blood ; Stroke/drug therapy ; Thrombosis/blood ; Thrombosis/drug therapy ; Thrombosis/etiology
    Chemical Substances Calcium Channels ; Fibrinolytic Agents ; Platelet Membrane Glycoproteins
    Language English
    Publishing date 2011-06-01
    Publishing country Singapore
    Document type Journal Article ; Review
    ZDB-ID 2704569-9
    ISSN 2768-6698 ; 1093-9946
    ISSN (online) 2768-6698
    ISSN 1093-9946
    DOI 10.2741/3844
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Cell adhesion mechanisms in platelets.

    Varga-Szabo, David / Pleines, Irina / Nieswandt, Bernhard

    Arteriosclerosis, thrombosis, and vascular biology

    2008  Volume 28, Issue 3, Page(s) 403–412

    Abstract: At sites of vascular injury, platelets come into contact with the subendothelial extracellular matrix which triggers their activation and the formation of a hemostatic plug. This process is crucial for normal hemostasis, but may also lead to pathological ...

    Abstract At sites of vascular injury, platelets come into contact with the subendothelial extracellular matrix which triggers their activation and the formation of a hemostatic plug. This process is crucial for normal hemostasis, but may also lead to pathological thrombus formation causing diseases such as myocardial infarction or stroke. The initial capture of flowing platelets is mediated by the interaction of the glycoprotein (GP) Ib-V-IX complex with von Willebrand factor (vWF) immobilized on exposed collagens. This interaction allows the binding of the collagen receptor GPVI to its ligand and to initiate cellular activation, a process that is reinforced by locally produced thrombin and soluble mediators released from platelets. These events lead to the shift of beta1 and beta3 integrins on the platelet surface from a low to a high affinity state, thereby enabling them to bind their ligands and to mediate firm adhesion, spreading, coagulant activity, and aggregation. This review summarizes the most important structural and functional properties of these adhesion receptors and briefly discusses their potential as targets for antithrombotic therapy.
    MeSH term(s) Animals ; Blood Platelets/cytology ; Blood Platelets/physiology ; Cell Adhesion/physiology ; Extracellular Matrix/genetics ; Extracellular Matrix/metabolism ; Humans ; Mice ; Molecular Biology/methods ; Platelet Adhesiveness/genetics ; Platelet Adhesiveness/physiology ; Platelet Aggregation/genetics ; Platelet Aggregation/physiology ; Platelet Membrane Glycoproteins/genetics ; Platelet Membrane Glycoproteins/metabolism ; Sensitivity and Specificity ; Signal Transduction/genetics ; Signal Transduction/physiology
    Chemical Substances Platelet Membrane Glycoproteins ; platelet membrane glycoprotein VI
    Language English
    Publishing date 2008-03
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 1221433-4
    ISSN 1524-4636 ; 1079-5642
    ISSN (online) 1524-4636
    ISSN 1079-5642
    DOI 10.1161/ATVBAHA.107.150474
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Conference proceedings: Intracellular calcium is essential for stable thrombus formation – the role of STIM1

    Varga-Szabo, David / Zirngibl, Hubert / Nieswandt, Bernhard

    2011  , Page(s) 11dgch817

    Event/congress 128. Kongress der Deutschen Gesellschaft für Chirurgie; München; Deutsche Gesellschaft für Chirurgie; 2011
    Keywords Medizin, Gesundheit
    Publishing date 2011-05-20
    Publisher German Medical Science GMS Publishing House; Düsseldorf
    Document type Conference proceedings
    DOI 10.3205/11dgch817
    Database German Medical Science

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  8. Article: Laparoszkópos cholecystectomia kapcsán fel nem ismert pancreasrák, mutéti tanulságok.

    Molnár, Béla Akos / Varga-Szabó, Dávid / Kaliszky, Péter

    Orvosi hetilap

    2005  Volume 146, Issue 50, Page(s) 2541–2545

    Abstract: Introduction: In Hungary surgeons perform approximately 24000 cholecystectomies per year. Nowadays the choice of treatment of uncomplicated cholelithiasis is laparoscopic cholecystectomy. The advantages and popularity of the procedure are well known; ... ...

    Title translation Failure of diagnosing pancreatic tumors in the course of laparoscopic cholecystectomy: surgical lessons.
    Abstract Introduction: In Hungary surgeons perform approximately 24000 cholecystectomies per year. Nowadays the choice of treatment of uncomplicated cholelithiasis is laparoscopic cholecystectomy. The advantages and popularity of the procedure are well known; otherwise the exploration of the abdominal cavity is not so complete than during open surgery. In the course of laparoscopic surgery the surgeon has minimal chance to find the preoperatively not diagnosed tumour.
    Aims: In our retrospective study we analysed those complains and clinical signs, when we suspect the presence of a pancreas tumour.
    Patients and methods: We analysed the clinical data of patients who were operated on with pancreatic tumor and before the surgery, laparoscopic cholecystectomy had been performed in the previous 24 month.
    Results: In the period of 1996-2003 we operated 1515 patients with pancreatic tumor, at our clinic. 21 patients (1.39%) had laparoscopic cholecystectomy in the last 24 month, before the surgery. The age of the patients was between 50-78 (average age 65), the rate of the female and male patients was 15/6. Most of the patients had weight loss (in 11 cases it was considerable, 5.4 kg in one month) and the uncertain abdominal pain, feeling of discomfort, meteorism was also characteristic of these patients. In 16 cases (76%) the blood glucose level had been elevated. The ultrasound examination before the cholecystectomy in these cases was focused to the gall bladder. After the cholecystectomy, complains did not disappear definitely and further diagnostic steps verified the pancreatic tumour. The average time between the laparoscopic cholecystectomy and the open surgery was 10 month. In 4 cases we were able to remove the tumor, but in 17 cases only palliative operation was performed.
    Conclusions: If the patient is over the age of 50, especially if he is male, has weight loss and if the symptoms are not characteristic of gallbladder disease, further diagnostic steps are necessary before cholecystectomy. Complains remaining after laparoscopic cholecystectomy must be indication for urgent diagnostic steps. The life expectancy of patients with advanced pancreatic tumor is very poor.
    MeSH term(s) Aged ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy, Laparoscopic ; Diagnostic Errors ; Female ; Humans ; Male ; Middle Aged ; Palliative Care ; Pancreatectomy/methods ; Pancreatic Neoplasms/diagnosis ; Pancreatic Neoplasms/diagnostic imaging ; Pancreatic Neoplasms/surgery ; Retrospective Studies ; Risk Factors ; Time Factors ; Tomography, X-Ray Computed
    Language Hungarian
    Publishing date 2005-12-11
    Publishing country Hungary
    Document type Case Reports ; Journal Article
    ZDB-ID 123879-6
    ISSN 1788-6120 ; 0030-6002
    ISSN (online) 1788-6120
    ISSN 0030-6002
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Two-phase antithrombotic protection after anti-glycoprotein VI treatment in mice.

    Schulte, Valerie / Reusch, H Peter / Pozgajová, Miroslava / Varga-Szabó, David / Gachet, Christian / Nieswandt, Bernhard

    Arteriosclerosis, thrombosis, and vascular biology

    2006  Volume 26, Issue 7, Page(s) 1640–1647

    Abstract: Objective: Collagen and thrombin are the strongest physiological platelet agonists, acting through different receptors, among which glycoprotein VI (GPVI) and protease-activated receptors, respectively, are the essential ones. In mice, targeting of GPVI ...

    Abstract Objective: Collagen and thrombin are the strongest physiological platelet agonists, acting through different receptors, among which glycoprotein VI (GPVI) and protease-activated receptors, respectively, are the essential ones. In mice, targeting of GPVI with the monoclonal antibody JAQ1 induces depletion of the receptor from circulating platelets, resulting in abolished collagen responses and long-lasting antithrombotic protection.
    Methods and results: Mice were treated with JAQ1, and the early effects of this treatment were analyzed. In addition to the known abolition of the collagen reactivity, this treatment also affected platelet response to thrombin but not other agonists. In platelets from JAQ1-treated mice, thrombin-induced activation of integrin alphaIIbbeta3, the surface expression of P-selectin, and the procoagulant activity were decreased on days 1 and 2, then progressively recovered and returned to normal on day 5. In parallel, the mice were transiently protected from lethal tissue factor-induced pulmonary thromboembolism (100% survivors versus 40% in control group), which appeared to be based on a decreased generation and activity of intravascular thrombin.
    Conclusions: Anti-GPVI treatment induces 2-phase antithrombotic protection in mice consisting of a partial and transient inhibition of thrombin responses in platelets and a prolonged and complete loss of the collagen response.
    MeSH term(s) Animals ; Antibodies, Monoclonal/therapeutic use ; Blood Platelets/drug effects ; Blood Platelets/metabolism ; Male ; Mice ; Mice, Inbred Strains ; P-Selectin/drug effects ; P-Selectin/metabolism ; Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors ; Platelet Membrane Glycoproteins/immunology ; Pulmonary Embolism/chemically induced ; Pulmonary Embolism/prevention & control ; Thrombin/antagonists & inhibitors ; Thromboembolism/chemically induced ; Thromboembolism/prevention & control ; Thromboplastin ; Thrombosis/prevention & control
    Chemical Substances Antibodies, Monoclonal ; P-Selectin ; Platelet Glycoprotein GPIIb-IIIa Complex ; Platelet Membrane Glycoproteins ; platelet membrane glycoprotein VI ; Thromboplastin (9035-58-9) ; Thrombin (EC 3.4.21.5)
    Language English
    Publishing date 2006-07
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1221433-4
    ISSN 1524-4636 ; 1079-5642
    ISSN (online) 1524-4636
    ISSN 1079-5642
    DOI 10.1161/01.ATV.0000225697.98093.ed
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: STIM1-independent T cell development and effector function in vivo.

    Beyersdorf, Niklas / Braun, Attila / Vögtle, Timo / Varga-Szabo, David / Galdos, Ronmy Rivera / Kissler, Stephan / Kerkau, Thomas / Nieswandt, Bernhard

    Journal of immunology (Baltimore, Md. : 1950)

    2009  Volume 182, Issue 6, Page(s) 3390–3397

    Abstract: Store-operated Ca(2+) entry (SOCE) is believed to be of pivotal importance in T cell physiology. To test this hypothesis, we generated mice constitutively lacking the SOCE-regulating Ca(2+) sensor stromal interaction molecule 1 (STIM1). In vitro analyses ...

    Abstract Store-operated Ca(2+) entry (SOCE) is believed to be of pivotal importance in T cell physiology. To test this hypothesis, we generated mice constitutively lacking the SOCE-regulating Ca(2+) sensor stromal interaction molecule 1 (STIM1). In vitro analyses showed that SOCE and Ag receptor complex-triggered Ca(2+) flux into STIM1-deficient T cells is virtually abolished. In vivo, STIM1-deficient mice developed a lymphoproliferative disease despite normal thymic T cell maturation and normal frequencies of CD4(+)Foxp3(+) regulatory T cells. Unexpectedly, STIM1-deficient bone marrow chimeric mice mounted humoral immune responses after vaccination and STIM1-deficient T cells were capable of inducing acute graft-versus-host disease following adoptive transfer into allogeneic hosts. These results demonstrate that STIM1-dependent SOCE is crucial for homeostatic T cell proliferation, but of much lesser importance for thymic T cell differentiation or T cell effector functions.
    MeSH term(s) Animals ; Biological Transport/genetics ; Biological Transport/immunology ; Calcium Channels/metabolism ; Cell Differentiation/genetics ; Cell Differentiation/immunology ; Cell Proliferation ; Cells, Cultured ; Coculture Techniques ; Disease Models, Animal ; Female ; Graft vs Host Disease/genetics ; Graft vs Host Disease/immunology ; Graft vs Host Disease/metabolism ; Homeostasis/genetics ; Homeostasis/immunology ; Membrane Glycoproteins/deficiency ; Membrane Glycoproteins/genetics ; Membrane Glycoproteins/physiology ; Mice ; Mice, Inbred BALB C ; Mice, Inbred C57BL ; Mice, Knockout ; Mice, Mutant Strains ; Stromal Interaction Molecule 1 ; T-Lymphocyte Subsets/immunology ; T-Lymphocyte Subsets/metabolism ; T-Lymphocyte Subsets/transplantation ; Thymus Gland/cytology ; Thymus Gland/immunology ; Thymus Gland/metabolism
    Chemical Substances Calcium Channels ; Membrane Glycoproteins ; Stim1 protein, mouse ; Stromal Interaction Molecule 1
    Language English
    Publishing date 2009-03-15
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 3056-9
    ISSN 1550-6606 ; 0022-1767 ; 1048-3233 ; 1047-7381
    ISSN (online) 1550-6606
    ISSN 0022-1767 ; 1048-3233 ; 1047-7381
    DOI 10.4049/jimmunol.0802888
    Database MEDical Literature Analysis and Retrieval System OnLINE

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