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  1. Article ; Online: STOP: an open label crossover trial to study ICS withdrawal in patients with a combination of obesity and low-inflammatory asthma and evaluate its effect on asthma control and quality of life.

    Witte, Jan A / Braunstahl, Gert-Jan / Blox, Wouter J B / van 't Westeinde, Susan C / In 't Veen, Johannes C C M / Kappen, Jasper H / van Rossum, Elisabeth F C

    BMC pulmonary medicine

    2022  Volume 22, Issue 1, Page(s) 53

    Abstract: Background: Asthma patients with obesity often have a high disease burden, despite the use of high-dose inhaled corticosteroids (ICS). In contrast to asthmatics with normal weight, the efficacy of ICS in patients with obesity and asthma is often ... ...

    Abstract Background: Asthma patients with obesity often have a high disease burden, despite the use of high-dose inhaled corticosteroids (ICS). In contrast to asthmatics with normal weight, the efficacy of ICS in patients with obesity and asthma is often relatively low. Meanwhile, patients do suffer from side effects, such as weight gain, development of diabetes, cataract, or high blood pressure. The relatively poor response to ICS might be explained by the low prevalence of type 2 inflammatory patterns (T2-low) in patients with asthma and obesity. T2-low inflammation is characterized by low eosinophilic count, low Fractional exhaled NO (FeNO), no clinically allergy-driven asthma, and no need for maintenance oral corticosteroids (OCS). We aim to study whether ICS can be safely withdrawn in patients with T2-low asthma and obesity while maintaining an equal level of asthma control. Secondary outcomes focus on the prevalence of 'false-negative' T2-low phenotypes (i.e. T2-hidden) and the effect of ICS withdrawal on parameters of the metabolic syndrome. This study will lead to a better understanding of this poorly understood subgroup and might find new treatable traits.
    Methods: The STOP trial is an investigator-initiated, multicenter, non-inferiority, open-label, crossover study aiming to assess whether ICS can be safely withdrawn in adults aged 17-75 years with T2-low asthma and obesity (body mass index (BMI) ≥ 30 kg/m
    Discussion: This study yields valuable data on ICS tapering in patients with T2-low asthma and obesity. It informs future guidelines and committees on corticosteroid-sparing algorithms in these patients. Trial registration Netherlands Trial Register, NL8759, registered 2020-07-06, https://www.trialregister.nl/trial/8759 . Protocol version and date: version 2.1, 20 November 2020.
    MeSH term(s) Administration, Inhalation ; Adolescent ; Adrenal Cortex Hormones/therapeutic use ; Adult ; Aged ; Anti-Asthmatic Agents/therapeutic use ; Asthma/complications ; Asthma/drug therapy ; Asthma/psychology ; Cross-Over Studies ; Drug Therapy, Combination ; Female ; Health Status Indicators ; Humans ; Male ; Middle Aged ; Netherlands ; Obesity/complications ; Program Development ; Quality of Life ; Randomized Controlled Trials as Topic/methods ; Withholding Treatment ; Young Adult
    Chemical Substances Adrenal Cortex Hormones ; Anti-Asthmatic Agents
    Language English
    Publishing date 2022-02-05
    Publishing country England
    Document type Journal Article
    ZDB-ID 2059871-3
    ISSN 1471-2466 ; 1471-2466
    ISSN (online) 1471-2466
    ISSN 1471-2466
    DOI 10.1186/s12890-022-01843-0
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Liquid biopsy-based decision support algorithms for diagnosis and subtyping of lung cancer.

    Visser, Esther / Genet, Sylvia A A M / de Kock, Remco P P A / van den Borne, Ben E E M / Youssef-El Soud, Maggy / Belderbos, Huub N A / Stege, Gerben / de Saegher, Marleen E A / van 't Westeinde, Susan C / Brunsveld, Luc / Broeren, Maarten A C / van de Kerkhof, Daan / Deiman, Birgit A L M / Eduati, Federica / Scharnhorst, Volkher

    Lung cancer (Amsterdam, Netherlands)

    2023  Volume 178, Page(s) 28–36

    Abstract: Objectives: Pathologic subtyping of tissue biopsies is the gold standard for the diagnosis of lung cancer (LC), which could be complicated in cases of e.g. inconclusive tissue biopsies or unreachable tumors. The diagnosis of LC could be supported in a ... ...

    Abstract Objectives: Pathologic subtyping of tissue biopsies is the gold standard for the diagnosis of lung cancer (LC), which could be complicated in cases of e.g. inconclusive tissue biopsies or unreachable tumors. The diagnosis of LC could be supported in a minimally invasive manner using protein tumor markers (TMs) and circulating tumor DNA (ctDNA) measured in liquid biopsies (LBx). This study evaluates the performance of LBx-based decision-support algorithms for the diagnosis of LC and subtyping into small- and non-small-cell lung cancer (SCLC and NSCLC) aiming to directly impact clinical practice.
    Materials and methods: In this multicenter prospective study (NL9146), eight protein TMs (CA125, CA15.3, CEA, CYFRA 21-1, HE4, NSE, proGRP and SCCA) and ctDNA mutations in EGFR, KRAS and BRAF were analyzed in blood of 1096 patients suspected of LC. The performance of individual and combined TMs to identify LC, NSCLC or SCLC was established by evaluating logistic regression models at pre-specified positive predictive values (PPV) of ≥95% or ≥98%. The most informative protein TMs included in the multi-parametric models were selected by recursive feature elimination.
    Results: Single TMs could identify LC, NSCLC and SCLC patients with 46%, 25% and 40% sensitivity, respectively, at pre-specified PPVs. Multi-parametric models combining TMs and ctDNA significantly improved sensitivities to 65%, 67% and 50%, respectively.
    Conclusion: In patients suspected of LC, the LBx-based decision-support algorithms allowed identification of about two-thirds of all LC and NSCLC patients and half of SCLC patients. These models therefore show clinical value and may support LC diagnostics, especially in patients for whom pathologic subtyping is impossible or incomplete.
    MeSH term(s) Humans ; Lung Neoplasms/diagnosis ; Lung Neoplasms/genetics ; Carcinoma, Non-Small-Cell Lung/diagnosis ; Carcinoma, Non-Small-Cell Lung/genetics ; Carcinoma, Non-Small-Cell Lung/pathology ; Prospective Studies ; Biomarkers, Tumor ; Phosphopyruvate Hydratase ; Liquid Biopsy
    Chemical Substances antigen CYFRA21.1 ; Biomarkers, Tumor ; Phosphopyruvate Hydratase (EC 4.2.1.11)
    Language English
    Publishing date 2023-02-01
    Publishing country Ireland
    Document type Multicenter Study ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 632771-0
    ISSN 1872-8332 ; 0169-5002
    ISSN (online) 1872-8332
    ISSN 0169-5002
    DOI 10.1016/j.lungcan.2023.01.014
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Screening and early detection of lung cancer.

    Van't Westeinde, Susan C / van Klaveren, Rob J

    Cancer journal (Sudbury, Mass.)

    2011  Volume 17, Issue 1, Page(s) 3–10

    Abstract: Lung cancer with an estimated 342,000 deaths in 2008 (20% of total) is the most common cause of death from cancer, followed by colorectal cancer (12%), breast cancer (8%), and stomach cancer (7%) in Europe. In former smokers, the absolute lung cancer ... ...

    Abstract Lung cancer with an estimated 342,000 deaths in 2008 (20% of total) is the most common cause of death from cancer, followed by colorectal cancer (12%), breast cancer (8%), and stomach cancer (7%) in Europe. In former smokers, the absolute lung cancer risk remains higher than in never-smokers; these data therefore call for effective secondary preventive measures for lung cancer in addition to smoking cessation programs. This review presents and discusses the most recent advances in the early detection and screening of lung cancer.An overview of randomized controlled computerized tomography-screening trials is given, and the role of bronchoscopy and new techniques is discussed. Finally, the approach of (noninvasive) biomarker testing in the blood, exhaled breath, sputum, and bronchoscopic specimen is reviewed.
    MeSH term(s) Biomarkers, Tumor/analysis ; Bronchoscopy/methods ; Early Detection of Cancer/methods ; Early Diagnosis ; Humans ; Lung Neoplasms/diagnosis ; Randomized Controlled Trials as Topic
    Chemical Substances Biomarkers, Tumor
    Language English
    Publishing date 2011-01
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2018400-1
    ISSN 1540-336X ; 1528-9117 ; 1081-4442
    ISSN (online) 1540-336X
    ISSN 1528-9117 ; 1081-4442
    DOI 10.1097/PPO.0b013e3182099319
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: Stem cells and the natural history of lung cancer: implications for lung cancer screening.

    van Klaveren, Rob J / van't Westeinde, Susan C / de Hoop, Bart-Jan / Hoogsteden, Henk C

    Clinical cancer research : an official journal of the American Association for Cancer Research

    2009  Volume 15, Issue 7, Page(s) 2215–2218

    Abstract: Lung cancer is not simply a single disease, but a collection of several phenotypically very diverse and regionally distinct neoplasias. Its natural history is complex and not yet fully understood. Stem cells and the complex interaction with the ... ...

    Abstract Lung cancer is not simply a single disease, but a collection of several phenotypically very diverse and regionally distinct neoplasias. Its natural history is complex and not yet fully understood. Stem cells and the complex interaction with the microenvironment of the tumor and the immune system play an important role in tumor progression and metastasizing capacity. This finding explains why lung cancer does not always follow the multistep carcinogenetic and exponential growth model and why small lesions do not always equate to early-stage disease. Despite the fact that volume doubling times are increasingly used as surrogate markers for the natural history of lung cancer and as estimates for the proportion of overdiagnosed cases, it is only a momentary impression. At baseline screening especially, screen-detected lung cancer cases are preferably detected when they are in the indolent phase of their growth curve (length-biased sampling), from which it can by no means be concluded that they may not progress or metastasize at a later stage. Because the natural history of lung cancer is only partly elucidated, conclusions on the impact of overdiagnosis in lung cancer screening are premature.
    MeSH term(s) Humans ; Lung Neoplasms/diagnostic imaging ; Lung Neoplasms/etiology ; Male ; Mass Screening ; Middle Aged ; Neoplastic Stem Cells/physiology ; Tomography, X-Ray Computed
    Language English
    Publishing date 2009-04-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1225457-5
    ISSN 1557-3265 ; 1078-0432
    ISSN (online) 1557-3265
    ISSN 1078-0432
    DOI 10.1158/1078-0432.CCR-08-1920
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: How to deal with incidentally detected pulmonary nodules less than 10mm in size on CT in a healthy person.

    van't Westeinde, Susan C / de Koning, Harry J / Xu, Dong-Ming / Hoogsteden, Henk C / van Klaveren, Rob J

    Lung cancer (Amsterdam, Netherlands)

    2008  Volume 60, Issue 2, Page(s) 151–159

    Abstract: The high frequency of non-calcified pulmonary nodules (NCN) <10mm incidentally detected on a multi-detector CT (MDCT) of the chest raises the question of how clinicians and radiologists should deal with these nodules. Management algorithms for solitary ... ...

    Abstract The high frequency of non-calcified pulmonary nodules (NCN) <10mm incidentally detected on a multi-detector CT (MDCT) of the chest raises the question of how clinicians and radiologists should deal with these nodules. Management algorithms for solitary pulmonary nodules >10mm do not carry across to sub-centimeter lesions. Purpose of this review is to provide a 10-step approach for routinely detected sub-centimeter NCN on a MDCT in healthy persons in order to be able to make an optimal discrimination between benign and malignant NCNs. Recommendations are primarily based on individual cancer risk, the presence or absence of calcifications and nodule size. In nodules >4-5mm nodule consistency, margin and shape should be taken into account. Next steps in the nodule evaluation are the assessment of localization, nodule number, presence or absence of growth and volume doubling time. Growth is defined as a volume doubling time of 400 days or less, based on volumetry. For nodules <4mm, a follow-up CT at 12 months is recommended in high risk persons, whilst for low-risk persons no follow-up is needed. If no growth is observed at 12 months, no further follow-up is required. For solid, smooth or attached indeterminate NCN between 5 and 10mm we recommend an annual repeat scan, whilst for purely intra-parenchymal nodules a 3-month repeat scan should be made to assess growth. Growing lesions with a volume doubling time <400 days require further work-up and diagnosis, otherwise an annual repeat scan to assess growth is recommended.
    MeSH term(s) Humans ; Incidental Findings ; Risk Factors ; Solitary Pulmonary Nodule/pathology ; Tomography, X-Ray Computed
    Language English
    Publishing date 2008-05
    Publishing country Ireland
    Document type Journal Article ; Review
    ZDB-ID 632771-0
    ISSN 0169-5002
    ISSN 0169-5002
    DOI 10.1016/j.lungcan.2008.01.020
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Complications following lung surgery in the Dutch-Belgian randomized lung cancer screening trial.

    Van't Westeinde, Susan C / Horeweg, Nanda / De Leyn, Paul / Groen, Harry J M / Lammers, Jan-Willem J / Weenink, Carla / Nackaerts, Kristiaan / van Klaveren, Rob J

    European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery

    2012  Volume 42, Issue 3, Page(s) 420–429

    Abstract: Objectives: To assess the complication rate in participants of the screen arm of the NELSON lung cancer screening trial who underwent surgical resection and to investigate, based on a literature review, whether the complication rate, length of hospital ... ...

    Abstract Objectives: To assess the complication rate in participants of the screen arm of the NELSON lung cancer screening trial who underwent surgical resection and to investigate, based on a literature review, whether the complication rate, length of hospital stay, re-thoracotomy and mortality rates after a surgical procedure were different from those of the non-screening series, taking co-morbidity into account.
    Methods: Between April 2004 and December 2008, 198 subjects underwent thoracic surgery. Co-morbid conditions were retrieved from the medical records. Postoperative complications were classified as minor and major.
    Results: In total, 182 thoracotomies, 5 thoracotomies after video-assisted thoracoscopic surgery (VATS) and 11 VATS procedures were performed. In these patients, 36% had chronic obstructive lung disease, 16% coronary artery disease, 14% diabetes mellitus and 11% peripheral vascular disease. Following thoracotomy, 47% (88/187) had ≥1 minor (7-57% in literature) and 10% (18/187) ≥1 major complication (2-26% in literature); following VATS, 38% (6/16) had ≥1 minor complication, but no major complications. Seventeen per cent (3/18) of major complications and 21% (20/96) of minor complications were seen in subjects operated for benign disease. The re-thoracotomy rate was 3% and there was no 30-day mortality after thoracotomy or VATS (0-8.3% in literature). The mortality rate of 0% after surgical procedures is low when compared with the non-screening series (0-8.3%); the rate of complications (53%) is within range when compared with the non-screening series (8.5-58%).
    Conclusions: In conclusion, mortality rates after surgical procedures are lower in the NELSON lung cancer screening trial than those in the non-screening series. The rate of complications is within the same range as in the non-screening series.
    Trial registration number: ISR CTN 63545820.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Cause of Death ; Chi-Square Distribution ; Confidence Intervals ; Disease-Free Survival ; Early Detection of Cancer/methods ; Female ; Humans ; Linear Models ; Lung Neoplasms/diagnosis ; Lung Neoplasms/epidemiology ; Lung Neoplasms/surgery ; Male ; Middle Aged ; Multidetector Computed Tomography/methods ; Neoplasm Invasiveness/pathology ; Neoplasm Staging ; Netherlands ; Pneumonectomy/methods ; Pneumonectomy/mortality ; Positron-Emission Tomography/methods ; Postoperative Complications/mortality ; Postoperative Complications/physiopathology ; Postoperative Complications/surgery ; Prognosis ; Reoperation/methods ; Reoperation/mortality ; Risk Assessment ; Survival Analysis ; Thoracic Surgery, Video-Assisted/adverse effects ; Thoracic Surgery, Video-Assisted/methods ; Thoracotomy/adverse effects ; Thoracotomy/methods ; Treatment Outcome
    Language English
    Publishing date 2012-09
    Publishing country Germany
    Document type Comparative Study ; Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 639293-3
    ISSN 1873-734X ; 1010-7940 ; 1567-4258
    ISSN (online) 1873-734X
    ISSN 1010-7940 ; 1567-4258
    DOI 10.1093/ejcts/ezs081
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: The role of the ¹⁸f-fluorodeoxyglucose-positron emission tomography scan in the Nederlands Leuvens Longkanker screenings Onderzoek lung cancer screening trial.

    van't Westeinde, Susan C / de Koning, Harry J / Thunnissen, Frederik B / Oudkerk, Matthijs / Groen, Harry J M / Lammers, Jan-Willem J / Weenink, Carla / Vernhout, Rene / Nackaerts, Kristiaan / Mali, Willem / van Klaveren, Rob J

    Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer

    2011  Volume 6, Issue 10, Page(s) 1704–1712

    Abstract: Background: In computed tomography lung cancer screening programs, up to 30% of all resections are futile.: Objective: To investigate whether a preoperative positron emission tomography (PET) after a conclusive or inconclusive nonsurgical workup will ...

    Abstract Background: In computed tomography lung cancer screening programs, up to 30% of all resections are futile.
    Objective: To investigate whether a preoperative positron emission tomography (PET) after a conclusive or inconclusive nonsurgical workup will reduce the resection rate for benign disease in test-positive participants of a lung cancer screening program.
    Methods: ¹⁸F-Fluorodeoxyglucose-PET scans were made in 220 test positives. Nodules were classified as positive, indeterminate, or negative based on visual comparison with background activity. Gold standard for a positive PET was the presence of cancer in the resection specimen or the detection of cancer during more than 2 years follow-up. Sensitivity, specificity, positive predictive value, and negative predictive value (NPV) were calculated at participant level and 95% confidence intervals (CIs) constructed.
    Results: The sensitivity of PET to detect cancer was 84.2% (95% CI: 77.6-90.7%), the specificity 75.2% (95% CI: 67.1-83.3), the positive predictive value 78.9% (95% CI: 71.8-86.0), and the NPV 81.2% (95% CI: 73.6-88.8). The resection rate for benign disease was 23%, but 26% of them had a diagnosis with clinical consequences. A preoperative PET after an inconclusive nonsurgical workup reduced the resection rate for benign lesions by 11 to 15%, at the expense of missing 12 to 18% lung cancer cases. A preoperative PET after a conclusive nonsurgical workup reduced the resection rate by 78% at the expense of missing 3% lung cancer cases.
    Conclusion: A preoperative PET scan in participants with an inconclusive nonsurgical workup is not recommended because of the very low NPV, but after a conclusive nonsurgical workup, the resection rate for benign disease can be decreased by 72%.
    MeSH term(s) Adenocarcinoma/diagnostic imaging ; Adenocarcinoma/pathology ; Adenocarcinoma/surgery ; Aged ; Carcinoma, Large Cell/diagnostic imaging ; Carcinoma, Large Cell/pathology ; Carcinoma, Large Cell/surgery ; Carcinoma, Non-Small-Cell Lung/diagnostic imaging ; Carcinoma, Non-Small-Cell Lung/pathology ; Carcinoma, Non-Small-Cell Lung/surgery ; Carcinoma, Squamous Cell/diagnostic imaging ; Carcinoma, Squamous Cell/pathology ; Carcinoma, Squamous Cell/surgery ; Female ; Fluorodeoxyglucose F18 ; Follow-Up Studies ; Humans ; Lung Neoplasms/diagnostic imaging ; Lung Neoplasms/pathology ; Lung Neoplasms/surgery ; Male ; Mass Screening ; Middle Aged ; Neoplasm Staging ; Positron-Emission Tomography ; Preoperative Care ; Prognosis ; Prospective Studies ; Radiopharmaceuticals ; Sensitivity and Specificity ; Small Cell Lung Carcinoma/diagnostic imaging ; Small Cell Lung Carcinoma/pathology ; Small Cell Lung Carcinoma/surgery ; Survival Rate
    Chemical Substances Radiopharmaceuticals ; Fluorodeoxyglucose F18 (0Z5B2CJX4D)
    Language English
    Publishing date 2011-10
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2432037-7
    ISSN 1556-1380 ; 1556-0864
    ISSN (online) 1556-1380
    ISSN 1556-0864
    DOI 10.1097/JTO.0b013e3182286d0b
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: The role of conventional bronchoscopy in the workup of suspicious CT scan screen-detected pulmonary nodules.

    van 't Westeinde, Susan C / Horeweg, Nanda / Vernhout, René M / Groen, Harry J M / Lammers, Jan-Willem J / Weenink, Carla / Nackaerts, Kristiaan / Oudkerk, Matthijs / Mali, Willem / Thunnissen, Frederik B / de Koning, Harry J / van Klaveren, Rob J

    Chest

    2012  Volume 142, Issue 2, Page(s) 377–384

    Abstract: Background: Up to 50% of the participants in CT scan lung cancer screening trials have at least one pulmonary nodule. To date, the role of conventional bronchoscopy in the workup of suspicious screen-detected pulmonary nodules is unknown. If a ... ...

    Abstract Background: Up to 50% of the participants in CT scan lung cancer screening trials have at least one pulmonary nodule. To date, the role of conventional bronchoscopy in the workup of suspicious screen-detected pulmonary nodules is unknown. If a bronchoscopic evaluation could be eliminated, the cost-effectiveness of a screening program could be enhanced and the potential harms of bronchoscopy avoided.
    Methods: All consecutive participants with a positive result on a CT scan lung cancer screening between April 2004 and December 2008 were enrolled. The diagnostic sensitivity and negative predictive value were calculated at the level of the suspicious nodules. In 95% of the nodules, the gold standard for the outcome of the bronchoscopy was based on surgical resection specimens.
    Results: A total of 318 suspicious lesions were evaluated by bronchoscopy in 308 participants. The mean ± SD diameter of the nodules was 14.6 ± 8.7 mm, whereas only 2.8% of nodules were > 30 mm in diameter. The sensitivity of bronchoscopy was 13.5% (95% CI, 9.0%-19.6%); the specificity, 100%; the positive predictive value, 100%; and the negative predictive value, 47.6% (95% CI, 41.8%-53.5%). Of all cancers detected, 1% were detected by bronchoscopy only and were retrospectively invisible on both low-dose CT scan and CT scan with IV contrast.
    Conclusion: Conventional white-light bronchoscopy should not be routinely recommended for patients with positive test results in a lung cancer screening program.
    MeSH term(s) Aged ; Bronchoscopy ; Cohort Studies ; Early Detection of Cancer ; Female ; Humans ; Lung Neoplasms/diagnostic imaging ; Lung Neoplasms/pathology ; Male ; Middle Aged ; Predictive Value of Tests ; Solitary Pulmonary Nodule/diagnostic imaging ; Solitary Pulmonary Nodule/pathology ; Time Factors ; Tomography, X-Ray Computed
    Language English
    Publishing date 2012-08
    Publishing country United States
    Document type Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 1032552-9
    ISSN 1931-3543 ; 0012-3692
    ISSN (online) 1931-3543
    ISSN 0012-3692
    DOI 10.1378/chest.11-2030
    Database MEDical Literature Analysis and Retrieval System OnLINE

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