Hepatobiliary Pancreat Dis Int

	2017 Vol. 16 No. 6
	Published: 2017-12-15


	pages 561-672
	REVIEW ARTICLES ORIGINAL ARTICLES/Transplantation ORIGINAL ARTICLES/Liver ORIGINAL ARTICLES/Biliary ORIGINAL ARTICLES/Pancreas LETTERS TO THE EDITOR THANKS

REVIEW ARTICLES

	570	Bannasch P, Ribback S, Su Q, Mayer D
		Clear cell hepatocellular carcinoma: origin, metabolic traits and fate of glycogenotic clear and ground glass cells ^Hot!
		Clear cell hepatocellular carcinoma (CCHCC) has hitherto been considered an uncommon, highly differentiated variant of hepatocellular carcinoma (HCC) with a relatively favorable prognosis. CCHCC is composed of mixtures of clear and/or acidophilic ground glass hepatocytes with excessive glycogen and/or fat and shares histology, clinical features and etiology with common HCCs. Studies in animal models of chemical, hormonal and viral hepatocarcinogenesis and observations in patients with chronic liver diseases prone to develop HCC have shown that the majority of HCCs are preceded by, or associated with, focal or diffuse excessive storage of glycogen glycogenosis) which later may be replaced by fat (lipidosis/steatosis). In ground glass cells, the glycogenosis is accompanied by proliferation of the smooth endoplasmic reticulum, which is closely related to glycogen particles and frequently harbors the hepatitis B surface antigen (HBsAg). From the findings in animal models a sequence of changes has been establishe, commencing with reneoplastic glycogenotic liver lesions, often containing ground glass cells, and progressing to glycogen-poor neoplasms via various intermediate stages, including glycogenotic/lipidotic clear cell foci, clear cell hepatocellular adenomas (CCHCA) rich in glycogen and/or fat, and CCHCC. A similar process seems to take place in humans, with clear cells frequently persisting in CCHCC and steatohepatitic HCC, which presumably represent intermediate stages in the development rather than particular variants of HCC. During the progression of the preneoplastic lesions, the clear and ground glass cells transform into cells characteristic of common HCC. The sequential cellular changes are associated with metabolic aberrations, which start with an activation of the insulin signaling cascade resulting in preneoplastic hepatic glycogenosis. The molecular and metabolic changes underlying the glycogenosis/lipidosis are apparently responsible for the dramatic metabolic shift from gluconeogenesis to the pentose phosphate pathway and Warburg-type glycolysis, which provide precursors and energy for an ever increasing cell proliferation during progression.
		Hepatobiliary Pancreat Dis Int. 2017; 16(6): 570-594 . [Abstract] ( 200 ) [HTML 1KB] [PDF 1889KB] ( 940 )

	595	Tarantino G, Magistri P, Ballarin R, Assirati G, Di Cataldo A, Di Benedetto F
		Surgery in biliary lithiasis: from the traditional “open” approach to laparoscopy and the “rendezvous” technique
		BACKGROUND: According to the current literature, biliary lithiasis is a worldwide-diffused condition that affects almost 20% of the general population. The rate of common bile duct stones (CBDS) in patients with symptomatic cholelithiasis is estimated to be 10% to 33%, depending on patient’s age. Compared to stones in the gallbladder, the natural history of secondary CBDS is still not completely understood. It is not clear whether an asymptomatic choledocholithiasis requires treatment or not. For many years, open cholecystectomy with choledochotomy and/or surgical sphincterotomy and cleaning of the bile duct were the gold standard to treat both pathologies. Development of both endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic surgery, together with improvements in diagnostic procedures, influenced new approaches to the management of CBDS in association with gallstones. DATA SOURCES: We decided to systematically review the literature in order to identify all the current therapeutic options for CBDS. A systematic literature search was performed independently by two authors using PubMed, EMBASE, Scopus and the Cochrane Library Central. RESULTS: The therapeutic approach nowadays varies greatly according to the availability of experience and expertise in each center, and includes open or laparoscopic common bile duct exploration, various combinations of laparoscopic cholecystectomy and ERCP and combined laparoendoscopic rendezvous. CONCLUSIONS: Although ERCP followed by laparoscopic cholecystectomy is currently preferred in the majority of hospitals worldwide, the optimal treatment for concomitant gallstones and CBDS is still under debate, and greatly varies among different centers.
		Hepatobiliary Pancreat Dis Int. 2017; 16(6): 595-601 . [Abstract] ( 174 ) [HTML 1KB] [PDF 211KB] ( 576 )

ORIGINAL ARTICLES/Transplantation

	602	Cen C, Fang HX, Yu SF, Liu JM, Liu YX, Zhou L, Yu J, Zheng SS
		Association between ADIPOQ gene polymorphisms and the risk of new-onset diabetes mellitus after liver transplantation ^Hot!
		BACKGROUND: New-onset diabetes after transplantation (NODAT) has become one of the major factors that affect the overall survival and long-term life quality in liver transplantation (LT) recipients. Previous studies found that the serum adiponectin concentration of diabetic patients is significantly lower than that of healthy subjects. Adiponectin regulates the blood glucose level by increasing body sensitivity to insulin through various mechanisms. In this study, we aimed to investigate the impact of diabetes related gene polymorphisms on the development of NODAT in liver recipients. METHODS: A total of 256 LT patients in a single-center were selected retrospectively for the study. Genomic DNA was extracted from explanted liver tissues, and tested for twelve diabetes mellitus associated single nucleotide polymorphisms by Sequenom MassARRAY. Modified clinical models in predicting NODAT were established and evaluated. RESULTS: The GG genotype of ADIPOQ rs1501299 gene polymorphism was significantly more frequent in NODAT than non-NODAT LT patients (56% vs 39%, P=0.014). Dominant model (GG vs GT+TT, P=0.030) and recessive model (GT+GG vs TT, P=0.005) also confirmed the genotype distribution difference between NODAT and non-NODAT groups. Age (OR=1.048, P=0.004), BMI (OR=1.107, P=0.041), and blood tacrolimus level at 1-month LT (OR=1.170, P=0.003) were clinical independent risk factors of NODAT. Furthermore, rs1501299 could improve the ability of clinical model in predicting NODAT (AUROC=0.743, P<0.001). CONCLUSION: ADIPOQ rs1501299 gene polymorphism is associated with an increased risk of NODAT, which should be added to the clinical models in predicting the occurrence of NODAT in LT recipients.
		Hepatobiliary Pancreat Dis Int. 2017; 16(6): 602-609 . [Abstract] ( 189 ) [HTML 1KB] [PDF 520KB] ( 391 )

	610	Yang J, Wang HQ, Yang JY, Wen TF, Li B, Wang WT, Yan LN
		Role of the postoperative cholesterol in early allograft dysfunction and survival after living donor liver transplantation
		BACKGROUND: Many studies have confirmed that serum total cholesterol (sTC) concentrations were associated with underlying liver damage and the synthesis capacity of liver. However, the role of postoperative sTC level on evaluating graft function and predicting survival of recipients who underwent liver transplantation has not been discussed. METHODS: Clinical data of 231 living donor liver transplantation recipients from May 2003 to January 2015 were retrospectively collected. Patients were stratified into the low sTC group (sTC <1.42 mmol/L, 57 recipients) and high sTC group (sTC ≥1.42 mmol/L, 174 recipients) according the sTC level on postoperative day 3 based on receiver-operating characteristic curve analysis. The clinical characteristics and postoperative short- and long-term outcomes were compared between the two groups. RESULTS: Recipients with sTC <1.42 mmol/L experienced more severe preoperative disease conditions, a higher incidence of postoperative early allograft dysfunction (38.6% vs 10.3%, P<0.001), 90-day mortality (28.1% vs 10.9%, P=0.002) and severe complications (29.8% vs 17.2%, P=0.041) compared to recipients with sTC ≥1.42 mmol/L. The multivariate analysis demonstrated that sTC <1.42 mmol/L had a 4.08-fold (95% CI: 1.83-9.11, P=0.001) and 2.72-fold (95% CI: 1.23-6.00, P=0.013) greater risk of developing allograft dysfunction and 90-day mortality, and patients with sTC <1.42 mmol/L had poorer overall recipient and graft survival rates at 1-, 3-, and 5-year than those with sTC ≥1.42 mmol/L (67%, 61% and 61% vs 83%, 71% and 69%, P=0.025; 65%, 59% and 59% vs 81%, 68% and 66%, P=0.026, respectively). Cox multivariate analysis showed that sTC <1.42 mmol/L was an independent predicting factor for total recipient survival (HR=2.043; 95% CI: 1.173-3.560; P=0.012) and graft survival (HR=1.905; 95% CI: 1.115-3.255; P=0.018). CONCLUSIONS: sTC <1.42 mmol/L on postoperative day 3 was an independent risk factor of postoperative early allograft dysfunction, 90-day mortality, recipient and graft survival, which can be used as a marker for predicting postoperative short- and long-term outcomes.
		Hepatobiliary Pancreat Dis Int. 2017; 16(6): 610-616 . [Abstract] ( 180 ) [HTML 1KB] [PDF 480KB] ( 416 )

	617	Andert A, Ulmer TF, Schoning W, Kroy D, Hein M, Alizai PH, Heidenhain C, Neumann U, Schmeding M
		Grade of donor liver microvesicular steatosis does not affect the postoperative outcome after liver transplantation
		BACKGROUND: The potential effect of graft steatosis on the postoperative liver function is discussed controversially. The present study aimed to evaluate the effect of the donor liver microvesicular steatosis on the postoperative outcome after liver transplantation. METHODS: Ninety-four patients undergoing liver transplantation at the University Hospital Aachen were included in this study. The patient cohort was divided into three groups according to the grade of microvesicular steatosis (MiS): MiS <30% (n=27), MiS 30%-60% (n=41) and MiS >60% (n=26). The outcomes after liver transplantation were evaluated, including the 30-day and 1-year patient and graft survival rates and the incidences of early allograft dysfunction (EAD) and primary nonfunction (PNF). RESULTS: The incidences of EAD and PNF did not differ significantly between the groups. We observed 5 cases of PNF, one occurred in the MiS <30% group and 4 in the MiS 30%-60% group. The 30-day and 1-year graft survivals did not differ significantly between groups. The 30-day patient survival rates were 100% in all groups. The 1-year patient survival rates were 94.4% in the MiS <30% group, 87.9% in the MiS 30%-60% group and 90.9% in the MiS >60% group. CONCLUSION: Microvesicular steatosis of donor livers has no negative effect on the postoperative outcome after liver transplantation.
		Hepatobiliary Pancreat Dis Int. 2017; 16(6): 617-623 . [Abstract] ( 164 ) [HTML 1KB] [PDF 574KB] ( 482 )

ORIGINAL ARTICLES/Liver

	624	Mumtaz K, Patel N, Modi RM, Patel V, Hinton A, Hanje J, Black SM, Krishna S
		Trends and outcomes of transarterial chemoembolization in hepatocellular carcinoma: a national survey ^Hot!
		BACKGROUND: Transarterial chemoembolization (TACE) is a palliative procedure frequently used in patients with advanced hepatocellular carcinoma (HCC). We examined the national inpatient trends of TACE and related outcomes in the United States over the last decade. METHODS: We utilized the National Inpatient Sample (2002 to 2012) and performed trend analyses of TACE for HCC in all adult patients (age >18 years). Multivariate analyses for the outcomes of in-hospital “procedure-related complications” (PRCs) and “post-procedure complications” (PPCs) were performed. We also compared early (2002 to 2006) and late (2007 to 2012) eras by multivariate analyses to identify predictors of complications, healthcare resource utilization and mortality. RESULTS: Overall, 19058 patients underwent TACE for HCC where PRCs and PPCs were seen in 24.2% and 17.6% of patients, respectively. The overall trends in the use of TACE (P<0.001) and associated PRCs (P=0.006) were observed to be increasing. There was less mortality [adjusted Odds ratio (aOR): 0.58; 95% CI: 0.41, 0.82], reduced length of hospital stay (-1.87 days; 95% CI: -2.77, -0.97) and increased hospital charges ($19232; 95% CI: 11013, 27451) in the late era. Additionally, there was increased mortality (aOR: 4.07; 95% CI: 2.96, 5.59), PRCs (aOR: 3.21; 95% CI: 2.56, 4.02), and PPCs (aOR: 2.70; 95% CI: 2.11, 3.46) among patients with coagulopathy. CONCLUSIONS: There is an increasing trend of TACE utilization in HCC. However, the outcomes are worse in patients with coagulopathy. Although PRCs have increased, mortality has decreased in recent years. These findings should be considered during TACE evaluation in patients with HCC.
		Hepatobiliary Pancreat Dis Int. 2017; 16(6): 624-630 . [Abstract] ( 204 ) [HTML 1KB] [PDF 537KB] ( 394 )

	631	Sheng RF, Zhai CW, Ji Y, Chen CZ, Yang L, Zeng MS
		Role of MR in the differentiation of IgG4-related from non-IgG4-related hepatic inflammatory pseudotumor
		BACKGROUND: Hepatic inflammatory pseudotumor (IPT) is classified into 2 types based on IgG4 stain: IgG4-related and non-IgG4-related; the two types differ not only in their pathological characteristics, but also in the clinical features. This study aimed to investigate the MR character of hepatic IPT, and differentiate the IgG4-related IPT from the non-IgG4-related IPT. METHODS: Twenty-five patients with 27 histologically proven hepatic IPTs were retrospectively analyzed. Ten lesions were diagnosed as IgG4-related IPT, and the other 17 as non-IgG4-related IPT. The MR signal features on T1, T2-weighted, dynamic-enhanced, and diffusion-weighted imaging were evaluated and compared. RESULTS: The dominant lesions were subcapsularly distributed (n=17, 63.0%) with clear boundary (n=20, 74.1%), and showed progressive enhancement pattern (n=21, 77.8%) with diffuse homogeneous (n=12, 44.4%) or heterogeneous (n=8, 29.6%) hyperintensity, accompanied by delayed capsule-like enhancement (n=17, 63.0%) and central nonenhanced areas (n=18, 66.7%). Morphological features (P>0.05) were not sufficient to differentiate IgG4-related IPT from non-IgG4-related IPT; the wash-out pattern was only found in 2 IgG4-related IPT, while the progressive enhancement pattern was more common in the non-IgG4-related lesions (n=16) (P=0.022). During portal and delayed phases, iso-/hypoenhanced lesions were only seen in 3 IgG4-related IPT, and circular-enhanced lesions (n=5) existed exceptionally in the non-IgG4-related group with significant differences (P=0.029 and 0.027). Most IgG4-related IPTs had lower apparent diffusion coefficient compared with the liver parenchyma (n=6), while most non-IgG4-related IPTs had higher apparent diffusion coefficient value (n=13) (P=0.046). CONCLUSIONS: Although MR images of hepatic IPT have certain characteristics, they are not enough to differentiate IgG4-related IPT from non-IgG4-related IPT. The enhancement pattern, signal features on portal and delayed phases, and the apparent diffusion coefficient value of the lesion may be helpful for the diagnosis.
		Hepatobiliary Pancreat Dis Int. 2017; 16(6): 631-637 . [Abstract] ( 159 ) [HTML 1KB] [PDF 927KB] ( 352 )

ORIGINAL ARTICLES/Biliary

	638	Cao XY, Ji HJ, Zhou YJ, Lu XF, Shen JY, Wu ZR, Bu H, Shi YJ
		Elevated expression of G_sα in intrahepatic cholangiocarcinoma associates with poor prognosis ^Hot!
		BACKGROUND: The stimulatory G protein α subunit (Gsα) plays important roles in diverse cell processes including tumorigenesis. Activating mutations in Gsα gene (GNAS) have been reported to be associated with poor prognosis in various human carcinomas. Furthermore, Gsα signaling is crucial in promoting liver regeneration by interacting with growth factor signaling, indicating that Gsα might play a promoting role in cancer development. However, little is known about the correlation between Gsα levels and clinicopathological parameters in intrahepatic cholangiocarcinoma (ICC). METHODS: We performed immunoblotting to examine the expression levels of Gsα and Ki67 proteins in tumor tissues and the corresponding adjacent tissues. A total of 74 pair of specimens resected from 74 ICC patients were examined. The association between Gsα levels and clinicopathological findings and prognosis of the patients was evaluated. RESULTS: Western blotting demonstrated that the expression of Gsα was significantly higher in ICC tissues compared with that in their corresponding adjacent tissues. Gsα protein was highly expressed in about half of ICC tissues (48.6%, 36/74) while only 28.4% (21/74) of tumor adjacent tissues showed Gsα high expression (P=0.011). High Gsα expression in ICC was significantly associated with the numbers of tumor nodules (P=0.037) and lymph node metastases (P=0.010). Moreover, the level of Gsα was significantly and positively correlated with Ki67 expression (P<0.001). In addition, the recurrence-free survival rate and overall survival rate in the Gsα high group were significantly lower than those in the Gsα low group (P=0.004 and P=0.005, respectively). CONCLUSIONS: High Gsα expression is correlated with poor prognosis in ICC patients. Gsα might serve as a potential prognostic indicator of ICC.
		Hepatobiliary Pancreat Dis Int. 2017; 16(6): 638-644 . [Abstract] ( 235 ) [HTML 1KB] [PDF 784KB] ( 382 )

ORIGINAL ARTICLES/Pancreas

	645	Ikeura T, Kato K, Takaoka M, Shimatani M, Kishimoto M, Nishi K, Kariya S, Okazaki K
		A body mass index ≥25 kg/m² is associated with a poor prognosis in patients with acute pancreatitis: a study of Japanese patients
		BACKGROUND: In Asian population, there is limited information on the relevance between obesity and poor outcomes in acute pancreatitis (AP). The objective of this study was to examine the clinical impact of obesity based on body mass index (BMI) on prognosis of AP in Japanese patients. METHODS: A total of 116 patients with AP were enrolled in this study. Univariate and multivariate logistic regression analyses were performed to examine relations between BMI and patients’ outcomes. Additionally, to investigate whether including obesity as a prognostic factor improved the predictive accuracy of a Japanese prognostic factor score (PF score), a receiver-operating characteristic (ROC) curve analysis of mortality was conducted. RESULTS: Multiple logistic regression analyses revealed that BMI ≥25 kg/m2 was associated with a significant higher mortality [odds ratio (OR)=15.8; 95% confidence interval (CI): 1.1-227; P=0.043]. The area under the ROC curve (AUC) for the combination of PF score and BMI ≥25 kg/m2 (AUC=0.881; 95% CI: 0.809-0.952) was higher than that for the PF score alone (AUC=0.820; 95% CI: 0.713-0.927) (P=0.034). CONCLUSIONS: The negative impact of a high BMI on the prognosis of AP was confirmed in a Japanese population. Including BMI ≥25 kg/m2 as an additional parameter to PF score enhanced the predictive value of the PF score for AP-related mortality.
		Hepatobiliary Pancreat Dis Int. 2017; 16(6): 645-651 . [Abstract] ( 178 ) [HTML 1KB] [PDF 541KB] ( 383 )

	652	Vicente E, Quijano Y, Ielpo B, Duran H, Diaz E, Fabra I, Malave L, Caruso R
		Role of robotic-assisted pancreatic surgery: lessons learned from our initial experience
		BACKGROUND: Minimally invasive surgery has achieved worldwide acceptance in various fields, however, pancreatic surgery remains one of the most challenging abdominal procedures. In fact, the indication for robotic surgery in pancreatic disease has been controversial. The present study aimed to assess the safety and feasibility of robotic pancreatic resection. METHODS: We retrospectively reviewed our experience of robotic pancreatic resection done in Sanchinarro University Hospital. Clinicopathologic characteristics, and perioperative and postoperative outcomes were recorded and analyzed. RESULTS: From October 2010 to April 2016, 50 patients underwent robotic-assisted surgery for different pancreatic pathologies. All procedures were performed using the da Vinci robotic system. Of the 50 patients, 26 were male and 24 female. The average age of all patients was 62 years. Operative time was 370 minutes. Among the procedures performed were 16 pancreaticoduodenectomies (PD), 23 distal pancreatectomies (DP), 11 tumor enucleations (TE). The mean hospital stay was 17.6 days in PD group, 9.0 days in DP group and 8.4 days in TE group. Pancreatic fistula occurred in 10 cases (20%), 2 after PD, 3 after DP, and 5 after TE. Four patients had postoperative transfusion in PD group and one in DP group. Conversion to open laparotomy occurred in four patients (8%). No serious intraoperative complications were observed. CONCLUSIONS: From our early experience, robotic pancreatic surgery is a safe and feasible procedure. Further experience and follow-up are required to confirm the role of robotic approach in pancreatic surgery.
		Hepatobiliary Pancreat Dis Int. 2017; 16(6): 652-658 . [Abstract] ( 169 ) [HTML 1KB] [PDF 389KB] ( 387 )

LETTERS TO THE EDITOR

	659	Maruyama H, Tominaga K, Kato K, Sugimori S, Shiba M, Watanabe T, Fujiwara Y
		Safety and efficacy of transpapillary bridged bilateral side-by-side stenting for unresectable malignant hilar biliary obstruction
		To the Editor: Biliary drainage is most frequently performed among endoscopic procedures using pancreatobiliary endoscopy. A large-diameter metallic stent can significantly extend the patency period rather than a plastic stent for extrahepatic biliary stricture.[1] However, the optimal drainage for the hilar biliary obstruction is still controversial. Various techniques have been attempted for unresectable malignant hilar biliary obstruction.[2] There are also some controversies regarding unilateral versus bilateral liver drainage.[3, 4] Recent studies have reported that at least 50% drainage of liver volume achieves sufficient efficacy or longer survival in patients with malignant hilar obstruction.[3, 5] Therefore, multiple kinds of endoscopic placements of self-expandable metallic stents (SEMSs) may be required. However, despite recent innovations in endoscopic technology, bilateral SEMS placement may be difficult and challenging. As the reasons, insert a second stent through tight stricture, adjustment of the lower end of the SEMSs, and re-intervention under fluoroscopy are difficult associated with bilateral side-by-side stenting.
		Hepatobiliary Pancreat Dis Int. 2017; 16(6): 659-661 . [Abstract] ( 182 ) [HTML 1KB] [PDF 330KB] ( 395 )

	662	Kim SH, Song GW, Hwang S, Ahn CS, Moon DB, Ha TY, Lee SG
		Feasibility of ABO-incompatible adult living donor liver transplantation for acute-on-chronic liver failure
		To the Editor: In Korea, the annual number of deceased donors for organ transplantation per million people is still less than 10. Thus, approximately 40% of patients with acute liver failure or acute-on-chronic liver failure undergo living donor liver transplantation (LDLT).[1] Although the use of ABO-incompatible (ABOi) living donors is an attractive option, ABOi LDLT has very restricted applications for expanding the donor pool.[2] The main reason for its limited application is the considerable time required for desensitization using the anti-CD20 monoclonal antibody, rituximab (RIT), and total plasma exchange (TPE). For the effective suppression of B-cell activity, most protocols usually require the administration of RIT for 2-3 weeks prior to LDLT.[2] Although the impact of TPE on the pharmacokinetics of RIT is not well known in the LDLT setting, very early initiation of TPE immediately after RIT infusion significantly reduces the plasma concentration of RIT. Therefore, a certain waiting interval between RIT administration and TPE might be a more rational approach for preventing the post-LDLT rebound rise in the B-cell count and isoagglutinin titer, which may render ABOi LDLT unsuitable for patients requiring urgent LDLT.
		Hepatobiliary Pancreat Dis Int. 2017; 16(6): 662-664 . [Abstract] ( 204 ) [HTML 1KB] [PDF 225KB] ( 437 )

	665	Zhuang Q, Liu H, Cheng K, Niu Y, She XG, Ming YZ
		Severe and delayed immune-mediated hemolysis post-liver transplantation
		To the Editor: Hemolysis, which is caused by a variety of immune and non-immune mechanisms, is a well-recognized complication of solid organ transplantation.[1] Hemolysis post-liver transplantation can be induced by drug, infection, autoimmune disorders, blood-group incompatible transplantation or passenger lymphocyte syndrome (PLS), which mostly is a quick and non-fatal complication and usually recovered easily. However, immune-mediated hemolysis post-liver transplantation is rare. The antibodies can be of donor and/or recipient origin.[2] Recently, we encountered a case of severe and delayed hemolysis post-liver transplantation caused by anti-e autoantibody. It did not response by all the regular treatments. In addition to ABO and Rh blood systems, there are also some other blood systems in human beings, such as Lewis, MNSs or Kell blood groups.[3] Although those irregular blood phenotypes are not regularly tested, we still need understand comprehensively.
		Hepatobiliary Pancreat Dis Int. 2017; 16(6): 665-668 . [Abstract] ( 179 ) [HTML 1KB] [PDF 250KB] ( 354 )

THANKS

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		Hepatobiliary Pancreat Dis Int. 2017; 16(6): 671-672 . [Abstract] ( 167 ) [HTML 1KB] [PDF 134KB] ( 867 )

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