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1.
Article in English | WPRIM | ID: wpr-915524

ABSTRACT

Background@#In diffuse large B-cell lymphoma (DLBCL), bone marrow involvement (BMI) has an important clinical implication as a component of staging and International Prognostic Index. This study aimed to determine whether molecular analysis of immunoglobulin heavy chain (IgH) genes and positron emission tomography-computed tomography (PET/CT) could overcome the limitation of defining morphologic BMI by trephination biopsy and could increase the diagnostic accuracy or prognostic prediction. @*Methods@#A total of 94 de novo patients with DLBCL underwent PET/CT, polymerase chain reaction (PCR) test for detection of IgH gene rearrangement, and unilateral bone marrow (BM) trephination at diagnosis. @*Results@#A total of 9 patients (9.6%) were confirmed to present morphologic BMI (mBMI) based on trephination biopsy. On the other hand, 21 patients (22.3%) were confirmed to have IgH clonality (IgH BMI), while 16 (17.0%) were classified with BMI based on the assessment of PET/CT (PET BMI). Each IgH rearrangement PCR and PET/CT showed the high negative predictive value of detecting the BMI. However, the combined assessment of IgH rearrangement and PET/CT could increase the diagnostic accuracy and specificity with 87.2% and 97.0%, respectively. The survival outcome of patients with double positive PET BMI and IgH BMI was significantly worse than that with either single positive PET BMI or IgH BMI, and even less than patients with neither PET BMI nor IgH BMI (3-year PFS: 50.0% vs. 75.4% vs. 97.9%, P = 0.007, 3-year OS: 50.0% vs. 75.6% vs. 80.1%, P = 0.035, respectively). @*Conclusion@#This study suggests that the combined evaluation of PET/CT and IgH rearrangement could give additional information for predicting therapeutic outcomes in patients with negative morphologic BMI as an important part of the prognosis.

2.
Article in English | WPRIM | ID: wpr-903570

ABSTRACT

Intrauterine devices (IUDs) are widely used for contraception in South Korea. However, several complications of IUDs have been reported, including inflammation, obstruction, perforation, and fistula. IUD perforation is the rarest of these complications but is also severe. Migrated IUDs can be retrieved through endoscopy, laparoscopy, or laparotomy. Presented below is an atypical case of an IUD perforating the sigmoid colon, which could not be removed endoscopically, and was subsequently incompletely removed through laparoscopic surgery. The present case underlines the importance of appropriate diagnosis and treatment approach in the management of IUD perforation.

3.
Article in English | WPRIM | ID: wpr-900239

ABSTRACT

Purpose@#A hyperextended knee is described as knee pain associated with an impaired knee extensor mechanism. Additionally, a hyperextended knee may involve reduced position sense of the knee joint that decreases the individual’s ability to control end-range knee extension movement. The purpose of this study was to investigate the effects of visual biofeedback information for plantar pressure distribution on knee joint angle and lower extremity muscle activities in participants with hyperextended knees. @*Methods@#Twenty-three participants with hyperextended knees were recruited for the study. Surface electromyography signals were recorded for the biceps femoris, rectus femoris, gastrocnemius, and tibialis anterior muscle activities. The plantar pressure distribution was displayed and measured using a pressure distribution measuring plate. Knee joint angle kinematic parameters were recorded using a motion analysis system. The visual biofeedback condition was the point at which the difference between the forefoot and backfoot plantar foot pressure on the monitor was minimized. The Wilcoxon signed-rank test was used to determine the significance between the visual biofeedback condition and the preferred condition. @*Results@#The knee joint angle was significantly decreased in the visual biofeedback condition compared to that in the preferred condition (p<0.05). The rectus femoris and gastrocnemius muscle activities were significantly different between the visual biofeedback and preferred conditions (p<0.05). @*Conclusion@#The results of this study showed that visual biofeedback of information about plantar pressure distribution is effective for correcting hyperextended knees.

4.
Article in English | WPRIM | ID: wpr-895866

ABSTRACT

Intrauterine devices (IUDs) are widely used for contraception in South Korea. However, several complications of IUDs have been reported, including inflammation, obstruction, perforation, and fistula. IUD perforation is the rarest of these complications but is also severe. Migrated IUDs can be retrieved through endoscopy, laparoscopy, or laparotomy. Presented below is an atypical case of an IUD perforating the sigmoid colon, which could not be removed endoscopically, and was subsequently incompletely removed through laparoscopic surgery. The present case underlines the importance of appropriate diagnosis and treatment approach in the management of IUD perforation.

5.
Article in English | WPRIM | ID: wpr-892535

ABSTRACT

Purpose@#A hyperextended knee is described as knee pain associated with an impaired knee extensor mechanism. Additionally, a hyperextended knee may involve reduced position sense of the knee joint that decreases the individual’s ability to control end-range knee extension movement. The purpose of this study was to investigate the effects of visual biofeedback information for plantar pressure distribution on knee joint angle and lower extremity muscle activities in participants with hyperextended knees. @*Methods@#Twenty-three participants with hyperextended knees were recruited for the study. Surface electromyography signals were recorded for the biceps femoris, rectus femoris, gastrocnemius, and tibialis anterior muscle activities. The plantar pressure distribution was displayed and measured using a pressure distribution measuring plate. Knee joint angle kinematic parameters were recorded using a motion analysis system. The visual biofeedback condition was the point at which the difference between the forefoot and backfoot plantar foot pressure on the monitor was minimized. The Wilcoxon signed-rank test was used to determine the significance between the visual biofeedback condition and the preferred condition. @*Results@#The knee joint angle was significantly decreased in the visual biofeedback condition compared to that in the preferred condition (p<0.05). The rectus femoris and gastrocnemius muscle activities were significantly different between the visual biofeedback and preferred conditions (p<0.05). @*Conclusion@#The results of this study showed that visual biofeedback of information about plantar pressure distribution is effective for correcting hyperextended knees.

6.
Article in English | WPRIM | ID: wpr-919168

ABSTRACT

Background/Aims@#The objective of this study was to evaluate the efficacy and feasibility of the pediatric-inspired regimen of the adult acute lymphoblastic leukemia (ALL) Working Party, the Korean Society of Hematology. @*Methods@#Data of 99 patients with newly diagnosed ALL, who were treated with the KALLA 1406/1407 protocol, were retrospectively analyzed. All patients equally received age-adjusted daunorubicin, vincristine, and prednisolone. L-asparaginase was additionally administered to Philadelphia (Ph)-negative patients according to age, whereas Ph-positive patients received 600 mg/day of imatinib. @*Results@#A total of 99 patients were enrolled in this study, of whom 62 (62.6%) were diagnosed with Ph-negative ALL and 37 (37.3%) were diagnosed with Ph-positive ALL. The median age of patients in the Ph-negative ALL group was 46 years, and that of patients in the Ph-positive ALL group was 49 years. In patients with Ph-negative ALL, 57 (92%) patients achieved complete remission (CR) and CR with incomplete hematologic recovery (CRi). Disease-free survival (DFS) and overall survival (OS) rates at 2 years were estimated to be 42% and 63%, respectively. In patients with Ph-positive ALL, 32 (86%) patients achieved CR/CRi, and 2-year DFS and OS were 31.2% and 49.1%, respectively. Patients who were able to proceed to the allogeneic hematopoietic cell transplantation and younger patients showed significantly superior survival in both Ph-negative ALL and Ph-positive ALL. Neutropenic fever and bacterial infection were the most common and severe adverse events. @*Conclusions@#The KALLA 1406/1407 protocol showed tolerable toxicities in adult ALL patients. Especially, younger patients had more survival benefits with KALLA 1406/1407 protocol.

7.
Article in English | WPRIM | ID: wpr-915463

ABSTRACT

We used serial rectal swabs to investigate the amount and duration of virus secretion through the gastrointestinal tract and assessed the association between fecal shedding and gastrointestinal symptoms and to clarify the clinical usefulness testing rectal swabs.We enrolled ten adult patients hospitalized with symptomatic coronavirus disease 2019 (COVID-19). Respiratory and stool specimens were collected by physicians. The presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed using real-time reverse-transcription polymerase chain reaction. All ten patients had respiratory symptoms, six had diarrhea, and seven were positive for SARS-CoV-2 on rectal swabs. The viral loads in the respiratory specimens was higher than those in the rectal specimens, and no rectal specimens were positive after the respiratory specimens became negative. There was no association between gastrointestinal symptoms, pneumonia, severity, and rectal viral load. Rectal swabs may play a role in detecting SARS-CoV-2 in individuals with suspected COVID-19, regardless of gastrointestinal symptoms.

8.
Article in English | WPRIM | ID: wpr-915425

ABSTRACT

In 2020, the novel coronavirus disease 2019 (COVID-19) began to spread worldwide and remains an ongoing medical challenge. This case series reports on the clinical features and characteristics of patients with inflammatory bowel disease (IBD) and confirmed COVID-19 infection. From February 2020 to March 2021, nine patients with IBD had confirmed COVID-19 across four hospitals in Korea. The median age at COVID-19 diagnosis was 42 years. Six patients were male, and seven patients had ulcerative colitis (UC). No patients required oxygen therapy, intensive care unit hospitalizations, or died. The most common symptom was fever, and gastrointestinal (GI) symptoms developed as diarrhea in five patients with UC. Oral steroids were used to combat UC aggravation in two patients. In this case series of nine IBD patients diagnosed with COVID-19 in Korea, the clinical presentation was predominately a mild respiratory tract infection. Most patients with UC developed new GI symptoms including diarrhea.

9.
Article in English | WPRIM | ID: wpr-914227

ABSTRACT

Combination treatment with hypomethylating agents (HMAs) and venetoclax is being used increasingly in elderly patients with acute myeloid leukemia (AML).Venetoclax with HMAs has been reported to be associated with tumor lysis syndrome (TLS) in AML patients with high leukemic burden. We present a case of an elderly AML patient with low leukemic burden who developed TLS while receiving venetoclax and azacitidine (AZA). A 74-year-old man with newly diagnosed AML with NPM1 mutation received combination therapy with venetoclax and AZA in an outpatient clinic. Within 12 hours after starting venetoclax and AZA, the patient was admitted to the emergency room with fever, general weakness, and laboratory findings consistent with TLS. Based on our results, we recommend monitoring at the start of the treatment with venetoclax and HMAs to prevent and control TLS regardless of the leukemic burden and favorable genetic ris

10.
Article | WPRIM | ID: wpr-837279

ABSTRACT

Coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 has become a global pandemic and is now the most threatening public health issue. Patients with the infection present with high fever and pneumonia with respiratory symptoms, but some patients also develop digestive symptoms such as diarrhea, vomiting, and abdominal pain. This may be the basis for the transmission route of the new virus, not only for respiratory infection through droplets but also for fecal-to-oral transmission. In addition, the high expression level of angiotensin-converting enzyme 2 on the surface cells in the gastrointestinal tract may support the occurrence of digestive symptoms and the possibility of fecal-to-oral transmission. Recent studies have shown positive fecal polymerase chain reaction (PCR) test results in patients with the infection who showed digestive symptoms. Therefore, we reviewed the related literature on the occurrence of digestive symptoms in patients with COVID-19 and present the usefulness and clinical application of the fecal PCR test for identifying the potential infection route and criteria for isolation.

11.
Yonsei Medical Journal ; : 452-459, 2020.
Article | WPRIM | ID: wpr-833364

ABSTRACT

Purpose@#Allogeneic hematopoietic stem cell transplantation (HSCT) with optimal conditioning has helped better long-term survival in acute lymphoblastic leukemia (ALL). This study investigated the efficacy and safety of reduced-intensity conditioning (RIC) with busulfan and fludarabine in adult ALL patients unfit for myeloablation. @*Materials and Methods@#Records of 78 patients who underwent HSCT with RIC consisting of 3.2 mg/kg/day of busulfan for 2 or 3 days and 30 mg/m2/day of fludarabine for 5 or 6 days were analyzed. @*Results@#The median age at diagnosis was 49 years. Over a median follow-up of 22 months, 2-year estimates of relapse-free survival (RFS) and overall survival were 57.4% and 68.7%, respectively. Multivariate analysis showed a trend of improved RFS in patients with chronic graft-versus-host disease (GVHD) (hazard ratio, 0.53; 95% confidence interval, 0.26–1.08; p=0.080). The cumulative incidences of relapse and non-relapse mortality were 42.9% and 19.6%, respectively and one case of central nervous system relapse was noted. No hepatic veno-occlusive disease was reported. Grade II–IV acute GVHD and any grade chronic GVHD occurred in 21.1% and 41.7%, respectively. @*Conclusion@#RIC with busulfan and fludarabine is an effective and safe conditioning regimen for adult ALL patients unfit for myeloablation.

12.
Article | WPRIM | ID: wpr-831909

ABSTRACT

Background/Aims@#It is difficult to reach a social agreement on the appropriatelevel of compensation for professionals. This study was performed to examine thephysician fee embedded in the relative value unit (RVU) system in comparisonwith the Korean hourly minimum wage. @*Methods@#The Health Insurance Service Price and the Korean Classification ofProcedural Terminology were used to obtain the hourly wages of physicians fordesignated health care services. In addition, the physician fee schedule at theUnited States Centers for Medicare and Medicaid Services and the Organisationfor Economic Co-operation and Development (OECD) report on minimal wagewere used. Health care service fees were selected based on laboratory, pathology,imaging, and procedure codes as well as examination fees. For calculation of physicianlabor costs per hour, physician workload × conversion factor was divided bythe time involved. To calculate the proportion of physician labor fee in the totalfee, the physician workload RVU for each service fee was divided by the total RVU. @*Results@#A total of 27 physician fee codes were selected. Compared to the Koreanhourly minimum wage in 2015, the average physician wages were greater by 2.80-fold for primary care and by 3.05-fold for tertiary care. The mean proportion ofphysician labor cost in the total cost was 0.19, which was significantly lower thanthat of corresponding procedures in the United States RVU (mean, 0.48). @*Conclusions@#The average Korean physician wages compared to the hourly minimumwage were disproportionately low compared to the USA and other referenceOECD countries.

13.
Blood Research ; : S37-S42, 2020.
Article | WPRIM | ID: wpr-830982

ABSTRACT

Since the introduction of an alkylator to the treatment of multiple myeloma (MM), new effective agents have been developed, such as immunomodulatory drugs including thalidomide, lenalidomide, and pomalidomide; proteasome inhibitors including bortezomib, carfilzomib, and ixazomib; monoclonal antibodies including daratumumab and elotuzumab; and deacetylase inhibitors including panobinostat. Numerous regimens with these new agents have been developed and they have contributed in improving survival outcomes in MM patients. In addition, the recommended therapies for newly diagnosed MM change every year based on the results of clinical trials. This review will discusses the appropriate induction therapies based on recent clinical trials for patients with newly diagnosed MM.

14.
Article in English | WPRIM | ID: wpr-919157

ABSTRACT

In multiple myeloma (MM), the impaired function of several types of immune cells favors the tumor’s escape from immune surveillance and, therefore, its growth and survival. Tremendous improvements have been made in the treatment of MM over the past decade but cellular immunotherapy using dendritic cells, natural killer cells, and genetically engineered T-cells represent a new therapeutic era. The application of these treatments is growing rapidly, based on their capacity to eradicate MM. In this review, we summarize recent progress in cellular immunotherapy for MM and its future prospects.

15.
Article in English | WPRIM | ID: wpr-119537

ABSTRACT

BACKGROUND/AIMS: In recent years, the incidence of acute pancreatitis (AP) has been increasing. A better understanding of the etiology is directly linked to more favorable outcomes. Unfortunately, there have been reports suggesting the variation of etiologies of AP across countries. The objective of this study was to determine the etiology of AP in a general hospital of Seoul-Gyeonggi province in Korea during the past decade. METHODS: We retrospectively reviewed the medical records of consecutive patients with AP who were admitted to St. Paul's Hospital (Seoul, Korea) with an affiliation to the Catholic University of Korea between January 2003 and January 2013. RESULTS: A total of 1,110 patients were enrolled, totaling 1,833 attacks, and the most frequent cause of AP was alcohol consumption. The recurrence rate of AP was 24.5% (272/1,110), and habitual recurrence rate (more than three times) was 12.6% (140/1,110). The rate of severe AP was 4.9% (90/1,833 attacks). The mortality rate of AP was 2.6% (29/1,110 patients). The frequency of an idiopathic cause of AP was 13.3%. The recurrence rate and mortality rate of idiopathic AP were 16.2% and 5.4%, respectively. In 41.7% (10/24) of cases of idiopathic AP, microlithiasis was suspected. CONCLUSIONS: Between 2003 and 2013 in Korea, alcohol was the most frequent cause of AP in the general hospital of Seoul-Gyeonggi province of Korea. It appears that alcohol abstinence program may be necessary. Further nationwide studies would be needed to evaluate the etiologies of AP.


Subject(s)
Alcohol Abstinence , Alcohol Drinking , Alcohols , Gallstones , Hospitals, General , Humans , Incidence , Korea , Medical Records , Mortality , Pancreatitis , Recurrence , Retrospective Studies
16.
Blood Research ; : 293-299, 2017.
Article in English | WPRIM | ID: wpr-21828

ABSTRACT

BACKGROUND: Signal transducer and activator of transcription 3 (STAT3) is not only a key signaling molecule in the regulation of growth but is also involved in malignant transformation. We investigated the prognostic significance of STAT3 expression in 94 non-elderly adult patients (aged 38 to 65 yr) with newly diagnosed multiple myeloma (MM). METHODS: Tumor cell-specific phosphotyrosine-STAT3 (PY-STAT3) expression at the time of diagnosis was evaluated with dual immunohistochemical (IHC) staining for PY-STAT3 and CD138. RESULTS: PY-STAT3 positivity was detected in 10 patients (10.6%), including three who showed strong expression. PY-STAT3-positive patients had higher serum C-reactive protein and calcium levels at diagnosis than did PY-STAT3-negative patients. PY-STAT3 positivity had predictive value for poor progression-free survival (PFS; P=0.001) and overall survival (OS; P=0.003). Among the 60 patients who received frontline autologous stem cell transplantation, PY-STAT3-positive patients had poorer PFS than did PY-STAT3-negative patients (4.2 vs. 19.2 mo, respectively; P=0.013). Multivariate analysis identified PY-STAT3 expression as an independent prognostic factor for PFS (relative risk [RR]=2.706, P=0.014) and OS (RR=3.091, P=0.044). CONCLUSION: These data show that PY-STAT3 positivity, as determined using dual IHC, is a marker of poor prognosis in non-elderly adult patients with MM.


Subject(s)
Adult , C-Reactive Protein , Calcium , Diagnosis , Disease-Free Survival , Humans , Multiple Myeloma , Multivariate Analysis , Prognosis , STAT3 Transcription Factor , Stem Cell Transplantation
17.
Article in Korean | WPRIM | ID: wpr-7504

ABSTRACT

Primary intestinal lymphoma is a rare disease. It accounts for approximately 1~4% of gastrointestinal malignancy. Extranodal lymphoma of the intestine mainly arises from B cells. Diffuse large B-cell lymphoma is the most common type of the disease. Approximately 40% of intestinal lymphoma can be cured, while 60% have varied disease progression. Ki-67 proliferation has been recently used as an index of cell growth to predict the progression of the disease. Reported herein is a case of a rapidly progressive small bowel diffuse large B-cell lymphoma in a 51-year-old man with a high Ki-67 expression level. He visited the emergency department because of hematochezia. Abdominal computed tomography revealed distal small bowel segmental wall thickening. He underwent operation due to spontaneous small bowel perforation. The result of the pathological examination of the resected specimen was compatible with diffuse large B-cell lymphoma. The Ki-67 index within 5 months was 90%.


Subject(s)
B-Lymphocytes , Disease Progression , Emergency Service, Hospital , Gastrointestinal Hemorrhage , Humans , Intestine, Small , Intestines , Lymphoma , Lymphoma, B-Cell , Lymphoma, Large B-Cell, Diffuse , Middle Aged , Rare Diseases
18.
Article in English | WPRIM | ID: wpr-130337

ABSTRACT

Acute cholecystitis after colonoscopy is very rare, and has not been extensively studied. A 51-year-old male with history of acute cholecystitis caused by common bile duct stones 1 year ago underwent screening colonoscopy. Colonoscopy was performed without difficulty and showed normal findings. Two days after colonoscopy, right upper quadrant abdominal pain and fever were developed. Abdominal computed tomography showed an enlargement of gallbladder with diffuse wall thickening and gallstones in the neck of gallbladder. The findings were consistent with that of acute cholecystitis as post-colonoscopy complication. Although its pathophysiology is uncertain, possible causes including dehydration of patient, concentration of bile and bacterial translocation were suggested in previous reports. Due to its rarity, it is hard to suspect an acute cholecystitis as primary complication of colonoscopy. Thus acute cholecystitis should be considered in differential diagnosis of patients with abdominal pain and fever after colonoscopy, particularly those who with history of gallstones.


Subject(s)
Abdominal Pain , Bacterial Translocation , Bile , Cholecystectomy , Cholecystitis , Cholecystitis, Acute , Colonoscopy , Common Bile Duct , Dehydration , Diagnosis, Differential , Fever , Gallbladder , Gallstones , Humans , Male , Mass Screening , Middle Aged , Neck
19.
Article in English | WPRIM | ID: wpr-130324

ABSTRACT

Acute cholecystitis after colonoscopy is very rare, and has not been extensively studied. A 51-year-old male with history of acute cholecystitis caused by common bile duct stones 1 year ago underwent screening colonoscopy. Colonoscopy was performed without difficulty and showed normal findings. Two days after colonoscopy, right upper quadrant abdominal pain and fever were developed. Abdominal computed tomography showed an enlargement of gallbladder with diffuse wall thickening and gallstones in the neck of gallbladder. The findings were consistent with that of acute cholecystitis as post-colonoscopy complication. Although its pathophysiology is uncertain, possible causes including dehydration of patient, concentration of bile and bacterial translocation were suggested in previous reports. Due to its rarity, it is hard to suspect an acute cholecystitis as primary complication of colonoscopy. Thus acute cholecystitis should be considered in differential diagnosis of patients with abdominal pain and fever after colonoscopy, particularly those who with history of gallstones.


Subject(s)
Abdominal Pain , Bacterial Translocation , Bile , Cholecystectomy , Cholecystitis , Cholecystitis, Acute , Colonoscopy , Common Bile Duct , Dehydration , Diagnosis, Differential , Fever , Gallbladder , Gallstones , Humans , Male , Mass Screening , Middle Aged , Neck
20.
Article in English | WPRIM | ID: wpr-78633

ABSTRACT

The migration of dendritic cells (DCs) to secondary lymphoid organs depends on chemoattraction through the interaction of the chemokine receptors with chemokines. However, the mechanism of how lymphoid chemokines attract DCs to lymphoid organs remains unclear. Here, we demonstrate the mechanism of DC migration in response to the lymphoid chemokine CCL21. CCL21-mediated DC migration is controlled by the regulation of sarcoplasmic reticulum Ca²⁺ ATPase 2 (SERCA2) expression rather than through the activation of mitogen-activated protein kinases CCL21-exposed mature DCs (mDCs) exhibited decreased SERCA2 expression but not decreased phospholamban (PLB) or Hax-1 expression, which are known to be SERCA2-interacting proteins. In addition, CCL21 did not affect the mRNA levels of SERCA2 or its interacting protein Hax-1. Interestingly, SERCA2 expression was inversely related to DC migration in response to chemokine stimulation. The migratory capacity of CCL21-treated mDCs was decreased by the phospholipase C inhibitor U73122 and by the protein kinase C inhibitor BAPTA-AM. The migratory capacities of mDCs were increased in response to SERCA2 siRNA expression but were decreased by SERCA2 overexpression. In addition, DCs treated with a SERCA2-specific inhibitor (cyclopiazonic acid) had significantly increased migratory capacities as mDCs regardless of SERCA2 expression. Moreover, SERCA2 expression was dependent on DC maturation induced by cytokines or Toll-like receptor agonists. Therefore, the migratory capacities differed in differentially matured DCs. Taken together, these results suggest that SERCA2 contributes to the migration of CCL21-activated DCs as an important feature of the adaptive immune response and provide novel insights regarding the role of SERCA2 in DC functions.


Subject(s)
Adaptive Immunity , Adenosine Triphosphatases , Chemokine CCL21 , Chemokines , Cytokines , Dendritic Cells , Mitogen-Activated Protein Kinases , Protein Kinase C , Receptors, Chemokine , RNA, Messenger , RNA, Small Interfering , Sarcoplasmic Reticulum , Toll-Like Receptors , Type C Phospholipases
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