-
[show abstract]
[hide abstract]
ABSTRACT: Hexavalent chromium [Cr (VI)] is a well-known human carcinogen associated with the increased risk of lung cancer. However, the mechanism underlying the Cr (VI)-induced carcinogenesis remains unclear due to the lack of suitable experimental models. In this study, we developed an in vitro model by transforming non-tumorigenic human lung epithelial BEAS-2B cells through long-term exposure to Cr (VI). By utilizing this model, we found that miR-143 expression levels were dramatically repressed in Cr (VI)- transformed cells. The repression of miR-143 led to Cr (VI)-induced cell malignant transformation and angiogenesis via up-regulation of IGF-IR and IRS1 expression. Moreover, we found that IL-8 is the major upregulated angiogenesis factor induced by Cr (VI) through activation of IGF-IR/IRS1 axis followed by activation of downstream ERK/HIF/NF-κB signaling pathway. These findings establish a causal role and mechanism of miR-143 in regulating Cr (VI)-induced malignant transformation and tumor angiogenesis.
Toxicological Sciences 06/2013; · 4.65 Impact Factor
-
Xu Qian,
Jing Yu,
Yu Yin,
Jun He,
Lin Wang,
Qi Li,
Lou-Qian Zhang,
Chong-Yong Li,
Zhu-Mei Shi,
Qing Xu,
Wei Li,
Li-Hui Lai,
Ling-Zhi Liu,
Bing-Hua Jiang
[show abstract]
[hide abstract]
ABSTRACT: Colorectal cancer (CRC) is one of the leading cancer-related causes of death in the world. Recently, downregulation of microRNA-143 (miR-143) has been observed in CRC tissues. Here in this study, we found that miR-143 expression was downregulated both in CRC patients' blood samples and tumor specimens. MiR-143 expression levels were strongly correlated with clinical stages and lymph node metastasis. Furthermore, insulin-like growth factor-I receptor (IGF-IR), a known oncogene, was a novel direct target of miR-143, whose expression levels were inversely correlated with miR-143 expression in human CRC specimens. Overexpression of miR-143 inhibited cell proliferation, migration, tumor growth and angiogenesis and increased chemosensitivity to oxaliplatin treatment in an IGF-IR-dependent manner. Taken together, these results revealed that miR-143 levels in human blood and tumor tissues are associated with CRC cancer occurrence, metastasis and drug resistance, and miR-143 levels may be used as a new diagnostic marker and therapeutic target for CRC in the future.
Cell cycle (Georgetown, Tex.) 04/2013; 12(9). · 5.36 Impact Factor
-
Zhu-Mei Shi,
Xie-Feng Wang, Xu Qian,
Tao Tao,
Lin Wang,
Qiu-Dan Chen,
Xi-Rui Wang,
Lei Cao,
Ying-Yi Wang,
Jun-Xia Zhang,
Tao Jiang,
Chun-Sheng Kang,
Bing-Hua Jiang,
Ning Liu,
Yong-Ping You
[show abstract]
[hide abstract]
ABSTRACT: MicroRNAs (miRNAs) are single-stranded, 18- to 23-nt RNA molecules that function as regulators of gene expression. Previous studies have shown that microRNAs play important roles in human cancers, including gliomas. Here, we found that expression levels of miR-181b were decreased in gliomas, and we identified IGF-1R as a novel direct target of miR-181b. MiR-181b overexpression inhibited cell proliferation, migration, invasion, and tumorigenesis by targeting IGF-1R and its downstream signaling pathways, PI3K/AKT and MAPK/ERK1/2. Overexpression of IGF-1R rescued the inhibitory effects of miR-181b. In clinical specimens, IGF-1R was overexpressed, and its protein levels were inversely correlated with miR-181b expression. Taken together, our results indicate that miR-181b functions in gliomas to suppress growth by targeting the IGF-1R oncogene and that miR-181b may serve as a novel therapeutic target for gliomas.
RNA 02/2013; · 5.09 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: MicroRNAs (miRNAs) have been shown to be involved in different aspects of cancer biology including tumor angiogenesis. In this study, we identified that two miRNAs, miR-199a and miR-125b were downregulated in ovarian cancer tissues and cell lines. Overexpression of miR-199a and miR-125b inhibited tumor-induced angiogenesis associated with the decrease of HIF-1α and VEGF expression in ovarian cancer cells. Moreover, the levels of miR-199a and miR-125b were negatively correlated with VEGF mRNA levels in ovarian tissues. We further showed that direct targets of miR-199a and miR-125b HER2 and HER3 were functionally relevant. Forced expression of HER2 and HER3 rescued miR-199a- and miR-125b-inhibiting angiogenesis responses and Akt/p70S6K1/HIF-1α pathway. This study provides a rationale for new therapeutic approach to suppress tumor angiogenesis using miR-199a, miR-125b, or their mimics for ovarian cancer treatment in the future.
PLoS ONE 01/2013; 8(2):e56647. · 4.09 Impact Factor
-
Wei Li,
Jing Wang,
Qiu-Dan Chen, Xu Qian,
Qi Li,
Yu Yin,
Zhu-Mei Shi,
Lin Wang,
Jie Lin,
Ling-Zhi Liu,
Bing-Hua Jiang
[show abstract]
[hide abstract]
ABSTRACT: Insulin is known to regulate multiple cellular functions and is used for the treatment of diabetes. MicroRNAs have been demonstrated to be involved in many human diseases, including Type 2 diabetes. In this study, we showed that insulin decreased miR-99a expression levels, but induced glucose consumption and lactate production, and increased the expression of mTOR, HIF-1α and PKM2 in HepG2 and HL7702 cells. Forced expression of miR-99a or rapamycin treatment blocked insulin-induced PKM2 and HIF-1α expression, and glucose consumption and lactate production. Meanwhile, knockdown of HIF-1α inhibited PKM2 expression and insulin-induced glucose consumption. Taken together, these findings will reveal the role and mechanism ofinsulin in regulating glycolytic activities via miR-99a/mTOR.
PLoS ONE 01/2013; 8(6):e64924. · 4.09 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: MicroRNA-145 (miR-145) is downregulated in various tumor types. However, its mechanism in inhibiting tumor growth and angiogenesis remains to be elucidated. In this study, we found that miR-145 was significantly downregulated in the plasma and cancer tumor tissues of colorectal cancer (CRC) patients, and overexpression of miR-145 inhibited cell proliferation, migration and invasion. To understand the potential mechanism of miR-145 in inhibiting tumor growth, we showed that miR-145 blocked the activation of AKT and ERK1/2 pathways, and the expression of HIF-1 and VEGF via directly targeting N-RAS and IRS1, and VEGF is an important effector for tumor growth. Forced expression of N-RAS and IRS1 restored VEGF expression via transcriptional activation. MiR-145 also inhibited N-RAS and IRS1 expression to suppress AKT and ERK1/2 activation, and VEGF expression in mouse xenograft tumors. To test the clinical relevance of these results, we used 60 pairs of colorectal cancer tissues and adjacent normal tissues, analyzed the levels of miR-145, N-RAS and IRS1 expression in these tissues, and found that miR-145 levels were significantly inversely correlated with N-RAS and IRS1 levels in these colorectal cancer tissues, suggesting the important implication of our findings in translational application for colorectal cancer diagnostics and treatment in the future.
Biochimica et Biophysica Acta 11/2012; · 4.66 Impact Factor
-
Jun He,
Qing Xu,
Yi Jing,
Faton Agani, Xu Qian,
Richard Carpenter,
Qi Li,
Xin-Ru Wang,
Stephen S Peiper,
Zhimin Lu,
Ling-Zhi Liu,
Bing-Hua Jiang
[show abstract]
[hide abstract]
ABSTRACT: Overexpression of ERBB2 or ERBB3 is associated with cancer development and poor prognosis. In this study, we show that reactive oxygen species (ROS) induce both ERBB2 and ERBB3 expression in vitro and in vivo. We also identify that miR-199a and miR-125b target ERBB2 and/or ERBB3 in ovarian cancer cells, and demonstrate that ROS inhibit miR-199a and miR-125b expression through increasing the promoter methylation of the miR-199a and miR-125b genes by DNA methyltransferase 1. These findings reveal that ERBB2 and ERBB3 expression is regulated by ROS via miR-199a and miR-125b downregulation and DNA hypermethylation.
EMBO Reports 11/2012; · 7.36 Impact Factor
-
Zhu-mei Shi,
Jing Wang,
Zhiping Yan,
Yong-ping You,
Chong-yong Li, Xu Qian,
Yu Yin,
Peng Zhao,
Ying-ying Wang,
Xie-feng Wang,
Ming-na Li,
Ling-Zhi Liu,
Ning Liu,
Bing-Hua Jiang
[show abstract]
[hide abstract]
ABSTRACT: MicroRNAs are a class of small noncoding RNAs that function as critical gene regulators through targeting mRNAs for translational repression or degradation. In this study, we showed that miR-128 expression levels were decreased in glioma, and identified p70S6K1 as a novel direct target of miR-128. Overexpression of miR-128 suppressed p70S6K1 and its downstream signaling molecules such as HIF-1 and VEGF expression, and attenuated cell proliferation, tumor growth and angiogenesis. Forced expression of p70S6K1 can partly rescue the inhibitory effect of miR-128 in the cells. Taken together, these findings will shed light to the role and mechanism of miR-128 in regulating glioma tumor angiogenesis via miR-128/p70S6K1 axis, and miR-128 may serve as a potential therapeutic target in glioma in the future.
PLoS ONE 01/2012; 7(3):e32709. · 4.09 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Apigenin, a flavonoid commonly present in the daily diet, is known for its potential anti-tumor properties. However, the effect of apigenin via oral administration on tumor growth and metastasis remains unknown. In this study we developed an orthotopic ovarian tumor model in nude mice to test the effect of apigenin oral administration, and showed that apigenin inhibited the micrometastasis of cancer cells in the animal tumor model. To understand the mechanism of apigenin in inhibiting metastasis, we found that apigenin greatly inhibited MMP-9 expression and p-AKT and p-p70S6K1 levels in the tumor tissues compared to the control group. We further demonstrated that the downregulation of MMP-9 by apigenin was mediated by the AKT/p70S6K1 pathway. These findings help to address the question with common interests to the public of whether oral uptake of flavonoids is effective in preventing cancer. Our results demonstrate for the first time that oral uptake of apigenin can inhibit tumor metastasis through MMP-9 expression using the orthotopic ovarian tumor model.
International Journal of Molecular Sciences 01/2012; 13(6):7271-82. · 2.60 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: MiR-145 can regulate cell apoptosis, proliferation, neural development and stem cell differentiation. Previous studies indicate that miR-145 is downregulated in human colon cancer cells. However, the molecular mechanisms of miR-145 used to regulate colon carcinogenesis and angiogenesis remain to be clarified. Here, we show that the expression of miR-145 is downregulated in colon and ovarian cancer tissues and cell lines. MiR-145 inhibits p70S6K1 post-transcriptional expression by binding to its 3'-UTR. The angiogenic factors hypoxia-inducible factor 1 (HIF-1) and vascular endothelial growth factor (VEGF), which are downstream molecules of p70S6K1, are decreased by miR-145 overexpression. P70S6K1 rescues miR-145-suppressed HIF-1 and VEGF levels, tumorigenesis and tumor angiogenesis. Furthermore, the miR-145 level is inversely correlated with the amount of p70S6K1 protein in colon cancer tissues. Taken together, these studies suggest that miR-145 serves as a tumor suppressor which downregulates HIF-1 and VEGF expression by targeting p70S6K1, leading to the inhibition of tumor growth and angiogenesis. The miR-145 rescue could be a rationale for therapeutic applications in colon cancer in the future.
Nucleic Acids Research 09/2011; 40(2):761-74. · 8.03 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: microRNA-199a (miR-199a) is a highly conserved miRNA, always deregulated in numerous human tumors. The results of microarray analysis indicated that miR-199a was frequently downregulated in hepatocellular carcinoma (HCC). The expression levels of miR-199a in 11 pairs of matched HCC neoplastic and adjacent non-neoplastic tissues, 5 HCC cell lines and liver cell line L02 were examined by quantitative real-time PCR analysis. We found miR-199a was significantly down-regulated in HCC tissues when compared with pair-matched adjacent non-tumor tissues. We also found the expression level of miR-199a was also substantially decreased in several human HCC cell lines including SMMC-7721, BEL-7402, BEL-7701, MHCC97H, and HepG2. To investigate the role of miR-199a in tumorigenesis, we developed a lentiviral vector for the expression of pre-miR-199a (Lenti-miR-199a). Lenti-miR-199a inhibited HCC cell proliferation in vitro and in vivo. Compared to parental cells or cells transfected with a control vector, the overexpression of microRNA-199a in the HCC cell lines HepG2 stably was showed to reduce cell proliferation in vitro and in vivo. Luciferase reporter assay revealed the regulation of miR-199a on 3'-UTR of HIF-1α. Further investigation confirmed that miR-199a significantly reduced the endogenous protein level of HIF-1α in hypoxia. MiR-199a inhibits cell proliferation in vitro and in vivo partly through down-regulation of HIF-1α in human HCC. Thus, these studies provide an important new insight into the pathogenesis of human HCC and it may open a new perspective for the development of effective gene therapy for human HCC.
Cell biochemistry and biophysics 08/2011; 62(1):237-44. · 3.34 Impact Factor
-
Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi 08/2010; 31(8):945-947.
-
[show abstract]
[hide abstract]
ABSTRACT: To provide data for decision-making and community nutrition intervention for middle and aged women, the dietary patterns and nutritional status were investigated in Shanghai.
A stratified cluster random sampling dietary survey was performed for a sample (n = 596) of women aged 45 to 65 years old from 2 streets in Shanghai. Factor analysis was applied to define major dietary patterns by using dietary information collected from food-frequency questionnaires (FFQs), and to further examine associations between dietary patterns and main nutrients and demographic characteristics.
Four major dietary patterns were identified. The first pattern was characterized by higher intake of eggs, legumes and products, second pattern was characterized by higher of oil, sugar and condiments, the third pattern was characterized by a higher intake of dairy, vegetables and rice, while the fourth pattern was characterized by higher intake of fruits, beef and fish. Oil, sugar and condiments pattern associated with higher total energy and fat percentage of energy (P < 0.001), lower educated (P = 0.009) and lower household income (P = 0.008). A positively correlation was found between rice, vegetables, dairy pattern with calcium, protein and carbohydrates percentage of energy, and inversely correlated with BMI (P = 0.019), as well as energy and total fat. Fruit, meat and fish pattern was higher for the protein, vitamins B2, vitamin B6 and vitamin C. But no positive correlation was found between eggs and legumes and products pattern with nutrients intake or other sample characteristics.
Rice, vegetables and milk dietary pattern was associated with reduced risk of overweight and obesity.
Wei sheng yan jiu = Journal of hygiene research 07/2010; 39(4):472-7.
-
[show abstract]
[hide abstract]
ABSTRACT: To study the association of vertical facial skeletal types and sagittal facial skeletal types with anterior alveolar bone thickness.
Among 168 cases with malocclusion in early permanent dentition stage, 93 patients were male and 75 patients were female. All patients (aged 10-14 years) were divided into 9 groups by different facial skeletal types, mandibular anterior alveolar bone thickness in patients' lateral cephalometric films were measured. ANOVA were performed to measurement results with the SPSS 13.0 statistical software.
Though sagittal facial skeletal types were the same, there were significant differences between different vertical facial types groups. The order was low-angle group, average-angle group and high-angle group according to the size. A high-angle individual often had a thin anterior alveolar bone while a low-angle individual often had the opposite morphology character. There was no statistical significance between skeletal type I, II and III. But group of skeletal type III also had a thin alveolar bone thickness which had no significant difference with high-angle group. Low-angle group III had no significant difference with average-angle group I and II in alveolar bone thickness.
Sagittal facial skeletal types have little influence on anterior alveolar morphology, but the vertical facial skeletal types have strong connection with anterior alveolar bone thickness.
Hua xi kou qiang yi xue za zhi = Huaxi kouqiang yixue zazhi = West China journal of stomatology 09/2008; 26(4):399-401.
-
[show abstract]
[hide abstract]
ABSTRACT: To understand the situation of institutional delivery of rural pregnant women in Guangxi Autonomous Region in the period of 1998 - 2003 and to identify the determinants on institutional delivery utilization.
Using Andersen's behavioral model as analytical framework and Guangxi databank of the 3rd National Health Service Survey as data source, we described the status of institutional delivery with the rural women having had live birth history in the period of 1998 - 2003 as subjects, while and the univariate analysis and multivariate logistic analysis were done to identify determinants of institutional delivery utilization.
Among a total number of 407 women with live birth history, 39.80 percent of them delivered at the health-care facilities. The rate of institutional delivery increased annually in 1998 - 2003 (P< 0.0001). The proportion of delivery in township health centers increased and the proportion of home delivery decreased by year (P< 0.0001). Results from both univariate and multivariate analysis showed that parity, education background of women, type of drinking water, time needed to get to the nearest healthcare facilities by the most convenient traffic,frequency of prenatal checkup, together with whether or not being advocated on institutional delivery etc. were determinants of delivery utilization. The OR value were 1.749 for multipara, 1.995 for those going to the nearest healthcare facilities by the most convenient traffic in less than 10 minutes, 3.011 for those drinking tap water, 5.435 for those with the education of high school, 29.149 for those with over 5 times in terms of frequency of prenatal checkup and 37.822 for those being advocated on institutional delivery.
Socio-economic situation, status of maternal health care and parity made main contribution to institutional delivery and skilled birth attendance for women in rural Guangxi.
Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi 04/2008; 29(3):224-9.
-
[show abstract]
[hide abstract]
ABSTRACT: To measure the economic burden of Down syndrome (DS) in China is to facilitate strategic planning development for managing and preventing DS.
The economic burden of DS was calculated from direct healthcare costs, direct non-health-care costs, and indirect costs. The incidence approach was employed to measure the lifetime economic burden of a new DS birth in China in 2003. Most parameters came from a household health services survey, which was given to caregivers of people with DS. This survey was conducted in Hebei, Shaanxi, and Shanghai in 2004.
Caregivers of 222 people with DS were interviewed in six cities and neighboring rural areas. Average expenses and utilization rate of different services by age groups from this sample were obtained to estimate the economic burden of DS. The average lifetime economic burden of a new DS case from the family perspective and the societal perspective amounted to US$47,000 and US$55,000, respectively. Indirect (productivity) costs were responsible for most of the total economic loss. Sensitivity analysis showed that the incidence rate, survival rate, value of productivity such as GDP per capita or salary, productivity of people with DS, and utilization rate of related services were influencing factors to the economic burden of DS.
The economic burden of DS is substantial for the family of a person with DS, as well as to society. Appropriate management and prevention of DS is needed to reduce the heavy burden for people with DS and their families. Birth Defects Research (Part A) 2008.
Birth Defects Research Part A Clinical and Molecular Teratology 02/2008; 82(1):25-33. · 2.27 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The digitalization-production shop is a very complex and dynamic production environment. It a task-oriented production organization, so its production scale and machining ability should be dynamic too. This paper presents a two-hierarchical strategy to analyze the machine load balance and machinability so as to obtain a feasible schedule with minimum total tardiness and maximum machines utilizations. In the first hierarchy, using fuzzy judgment, the substitution of equipment or combination of equipment can be found, which has similar functions with the bottleneck equipment. The tasks in the bottleneck equipment can be dispatched to the substitutable equipment in order to achieve load balance. The second hierarchy is an optimization part. A new scheduling algorithm, which integrates genetic algorithm and particle swarm optimization algorithm, is adapted to solve scheduling problem. It is more effective than genetic algorithm. The validity and feasibility of the strategy is verified by the final experiment.
Industrial Engineering and Engineering Management, 2007 IEEE International Conference on; 01/2008
-
[show abstract]
[hide abstract]
ABSTRACT: The cost-effectiveness of prenatal diagnosis intervention for Down's syndrome (DS) in China was assessed and evidence-based information for policy makers and providers is presented.
Based on field surveys in four selected cities in China and a literature review, the economic evaluation of prenatal diagnosis for DS from a societal perspective is conducted by cost-effectiveness analysis.
In current clinical practice, for a cohort of 10,000 pregnant women, the strategy that delivers karyotyping by chorionic villus sampling (CVS) or amniocentesis (AC) only to those pregnant women 35 years of age and older (maternal age screening strategy) can detect .67 DS births. The strategy that offers the diagnostic test after maternal serum screening with alpha-fetoprotein and human chorionic gonadotrophin (maternal serum screening strategy) can detect 1.41 DS births. The cost per prevented DS birth by the maternal age screening strategy and maternal serum screening strategy is US$ 13,091 and US$ 56,048, respectively. Sensitivity analysis shows that the maternal serum screening strategy can be cost-effective if uptake rate of CVS or AC for patients with positive serum tests increase while the cost of serum screening decreases.
Although, in general, serum screening has been found to be more cost-effective than maternal age screening, this appears not to be the case in China. The reasons appear to be low uptake rate of the maternal serum strategy, low uptake rate of CVS or AC, and the high price of serum screening. Our findings are that health system factors concerning technology utilization are important determinants of the technology's efficiency.
International Journal of Technology Assessment in Health Care 02/2007; 23(1):138-45. · 1.37 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In urban China, more single women are becoming pregnant and resorting to induced abortion, despite the wide availability of temporary methods of contraception. We developed and piloted a workplace-based intervention to promote contraceptive use in unmarried female migrants working in privately owned factories.
Quasi-experimental design. In consultation with clients, we developed a workplace based intervention to promote contraception use in unmarried female migrants in a privately owned factory. We then implemented this in one factory, using a controlled before-and-after design. The intervention included lectures, bespoke information leaflets, and support to the factory doctors in providing a contraceptive service.
598 women participated: most were under 25, migrants to the city, with high school education. Twenty percent were lost when staff were made redundant, and implementation was logistically complicated. All women attended the initial lecture, and just over half the second lecture. Most reported reading the educational material provided (73%), but very few women reported using the free family planning services offered at the factory clinic (5%) or the Family Planning Institute (3%). At baseline, 90% (N = 539) stated that contraceptives were required if having sex before marriage; of those reporting sex in the last three months, the majority reporting using contraceptives (78%, 62/79) but condom use was low (44%, 35/79). Qualitative data showed that the reading material seemed to be popular and young women expressed a need for more specific reproductive health information, particularly on HIV/AIDS. Women wanted services with some privacy and anonymity, and views on the factory service were mixed.
Implementing a complex intervention with a hard to reach population through a factory in China, using a quasi-experimental design, is not easy. Further research should focus on the specific needs and service preferences of this population and these should be considered in any policy reform so that contraceptive use may be encouraged among young urban migrant workers.
BMC Health Services Research 02/2007; 7:77. · 1.66 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A variety of international organizations, professional groups and individuals are promoting evidence-informed obstetric care in China. We measured change in obstetric practice during vaginal delivery that could be attributed to the diffusion of evidence-based messages, and explored influences on practice change.
Sample surveys of women at postnatal discharge in three government hospitals in Shanghai and one in neighbouring Jiangsu province carried out in 1999, repeated in 2003, and compared. Main outcome measures were changes in obstetric practice and influences on provider behaviour. "Routine practice" was defined as more than 65% of vaginal births. Semi-structured interviews with doctors explored influences on practice.
In 1999, episiotomy was routine at all four hospitals; pubic shaving, rectal examination (to monitor labour) and electronic fetal heart monitoring were routine at three hospitals; and enema on admission was common at one hospital. In 2003, episiotomy rates remained high at all hospitals, and actually significantly increased at one; pubic shaving was less common at one hospital; one hospital stopped rectal examination for monitoring labour, and the one hospital where enemas were common stopped this practice. Mobility during labour increased in three hospitals. Continuous support was variable between hospitals at baseline and showed no change with the 2003 survey. Provider behaviour was mainly influenced by international best practice standards promoted by hospital directors, and national legislation about clinical practice.
Obstetric practice became more evidence-informed in this selected group of hospitals in China. Change was not directly related to the promotion of evidence-based practice in the region. Hospital directors and national legislation seem to be particularly important influences on provider behaviour at the hospital level.
BMC Health Services Research 02/2006; 6:29. · 1.66 Impact Factor
