Xuan Li

Peking University Third Hospital, Peping, Beijing, China

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Publications (18)25.5 Total impact

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    ABSTRACT: Objective: This study investigated the status of isolated superior mesenteric artery (SMA) dissection in the most populous country, China. Methods: The Chinese-language literature published before December 2014 was reviewed. All case reports and series were included. If multiple reports originated from the same hospital and included overlapping time frames, only the most recent report was included. The clinical characteristics, imaging features, and treatment were analyzed. "Symptom relief" was used as the outcome measure. Results: A total of 622 patients (88.5% male) with isolated SMA dissection were found in the Chinese-language literature. Patients were a mean age of 55.4 years. Analysis of the demographic data showed that isolated SMA dissection was most reported from the developed areas of China. The most common symptom (91.1%) was abdominal pain, and 42.7% patients had hypertension as a complication. Contrast-enhanced computed tomography was used to diagnose 95.2% of patients. The mean distance from the SMA ostium to the beginning of the dissection was 20.1 mm (range, 0-65.0 mm). The mean length of dissection was 63.1 mm (range, 10.7-205.9 mm). The percentages of patients who underwent primary conservative, surgical, and endovascular treatments were 63.2%, 3.2% and 33.6%, respectively. As primary management, the symptom relief rate of conservative management, with or without anticoagulation, was 62.6% and 86.5%, respectively. The best result of conservative treatment was achieved in cases of Yun type I and Luan classification type B. The symptom relief rate of surgical and endovascular treatment was 100% and 95.2%, respectively. Conclusions: The incidence of isolated SMA dissection may not be as rare as previously reported. Endovascular treatment of isolated SMA dissection is commonly used in China as a first-line treatment.
    No preview · Article · Nov 2015 · Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter
  • J T Han · H T Qiao · Xuan Li · X G Li · Q Y He · G X Dong · Jun Fu · J Y Luan · C M Wang
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    ABSTRACT: OBJECTIVE:To study the morphology of middle cerebral artery (MCA) M1 segment. We selected the MRA data of 794 MCA (400 of the left side and 394 of the right side) from January 1, 2011 to June 30, 2011 consecutively and analyzed the morphology of the MCA M1 segment in axial, anteroposterior and lateral view, measured the length of the M1 segment, and analyzed the similarity of the left and right side M1 segment morphology. In axial, anteroposterior and lateral view, the MCA M1 segment showed C-shape > L-shape > S-shape. In axial view, it was about 373 (47%) M1 segment performance for the C-shape, of which 340 (42.8%) M1 segments showed bowing to the dorsal side, only 33 (4.2%) M1 segments showed bowing to the ventral side. In anteroposterior view, it was about 322 (40.6%) M1 segments of the performance of the C-shape, of which 262(33.0%) M1 segments showed a bowing to the superior, 60 (7.6%) showed bowing to the inferior. The similarity of the left and right MCA M1 segments was 27.2% (114/419) in axial view and 42.7% (179/419) in anteroposterior view. It was more similar in anteroposterior view than in axial view. Along with the increase of age, in the axial view, L-shape converted to C-shape very obviously, but only mildly elevated in S-shape. In anteroposterior view, the L-shape converted to the C-shape or S-shape along with the increase of age. The different morphology of MCA M1 segment in axial and anteroposterior view may be involved in the development of intracranial atherosclerosis.
    No preview · Article · Feb 2015 · Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences
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    ABSTRACT: Purpose: The authors prospectively compared single dose (0.1 mmol/kg bodyweight) gadobenate dimeglumine with double dose (0.2 mmol/kg bodyweight) gadopentetate dimeglumine for contrast-enhanced magnetic resonance angiography (CE-MRA) in patients with suspected or known steno-occlusive disease of the carotid, renal or peripheral vasculature using an intra-individual crossover study design. Materials and methods: Twenty-eight patients with suspected or known steno-occlusive disease of the carotid (n = 16), renal (n = 5) or peripheral arteries (n = 7) were randomised to receive either 0.1 mmol/kg gadobenate dimeglumine or 0.2 mmol/kg gadopentetate dimeglumine for a first CE-MRA procedure. After 3-5 days all patients underwent a second identical CE-MRA procedure with the other contrast agent. Three blinded readers assessed images for vessel anatomical delineation, disease detection/exclusion, and global preference. Diagnostic performance for detection of ≥51 % stenosis was determined for 20/28 patients who also underwent digital subtraction angiography (DSA). Non-inferiority was assessed using the Wilcoxon signed rank, McNemar and Wald tests. Quantitative (signal-to-noise and contrast-to-noise ratio) enhancement based on 3D maximum intensity projection reconstructions was compared. Results: No differences were noted for any qualitative parameter. Equivalence was reported for all diagnostic preference end-points. Superiority for gadobenate dimeglumine was reported by all readers for sensitivity for disease detection (80.8-86.5 vs. 75.0-82.7 %). Quantitative enhancement was similar for single dose gadobenate dimeglumine and double dose gadopentetate dimeglumine. Conclusions: Under identical examination conditions a single 0.1 mmol/kg body weight dose of gadobenate dimeglumine can fully replace a double 0.2 mmol/kg body weight dose of gadopentetate dimeglumine for routine CE-MRA procedures.
    No preview · Article · Sep 2014 · La radiologia medica
  • J T Han · Xuan Li · Mun Zheng · Jun Fu · C M Wang · G X Dong · Q Y He
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    ABSTRACT: Objective: To assess the safety and effectiveness of middle cerebral artery angioplasty in treatment of subcortical watershed infarcts (S-CWI) with moderate or severe disabilities. Methods: From June 2011 to May 2012, 5 S-CWI patients (six lesions) with moderate or severe disabilities combining severe stenosis in Ipsilateral middle cerebral artery received middle cerebral artery angioplasty in Interventional Radiology and Vascular Surgery Department, Peking University Third Hospital. We observed the neurological score before and after angioplasty and assessed the improvement of neurological functions. Results: The National Institute of Health stroke scale(NIHSS) scores were decreased by 4-6 points and modified Rankin scale(mRs) scores were decreased 1 point in 7 days. In the 3 months' follow-up, 4 patients' mRs scores were 1 point, and 1 patient's was 2 points. In the 1-year follow-up, there were no new strokes and instent restenosis events. Conclusion: Middle cerebral artery angioplasty in treatment of S-CWI with moderate or severe disabilities is beneficial.
    No preview · Article · Aug 2014 · Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences
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    ABSTRACT: Introduction: The M1 segment of the middle cerebral artery (MCA) is of great importance to neurosurgery and interventional radiology. The purpose of this study was to describe the M1 segment in three dimensions based on shape projection using magnetic resonance angiography (MRA). Methods: A three-view method was established and used in the retrospective analysis of 717 M1 segments derived from 3D-TOF MRA images. In this method, the M1 segment was first projected on three orthogonal planes (axial, coronary, and sagittal plane); the courses of the projected vessels were classified as line-shape, C-shape, or S-shape on each orthogonal plane; and then the actual parameters, including internal diameter and so on, were measured on the projected images. The shape classifications and the measured parameters were efficient methods of describing the M1 segment. Twelve geometric models of the vessels were reconstructed and were compared with those from an actual validation method. Results: The 3D shape of the M1 segment in the 3D orthogonal views was not uniform. Only 17.3 % M1 segments were straight, 43.5 % followed plane curves, and nearly 40 % were tortuous in 3D space. The probability distributions of shape classifications changed with age. The proportion of the tortuous vessels increased with age. We also showed that the three-view method is effective with a volume relative error of less than 13 %. Conclusion: The three-view method is convenient for describing the 3D morphology, including the shape information, of the M1 segment. It is a potential method for planning and predicting risk in neurosurgery/neurointervention.
    No preview · Article · Aug 2014 · Neuroradiology
  • Q C Feng · Xuan Li · G X Dong · Jun Fu · C M Wang
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    ABSTRACT: Objective: To study the influence of r-tPA and urokinase in curative effect and thrombolysis time on patients with acute and severe pulmonary embolism after interventional thrombectomy. Methods: After reviewing and analyzing the clinical data of 19 acute and severe pulmonary embolism patients, we classified them into two groups in accordance with the application of r-tPA and urokinase to compare the changes of their heart rate, blood pressure, pulmonary arterial pressure, arterial partial pressure of oxygen and hemachrome before and after thrombolysis, as well as the thrombolysis effect time the two groups took. Results: The heart rate, blood pressure, pulmonary arterial pressure, arterial partial pressure of oxygen of the patients in both groups gained remarkable improvement after operation (P<0.05); the pulmonary arterial pressure of the r-tPA patient group dropped but not significantly compared with that before operation (P>0.05); the pulmonary arterial pressure of the urokinase patient group dropped significantly compared with that study before operation (P<0.05); the hemachrome of both patient groups did not significantly drop after operation (P>0.05); the thrombolysis effect time by adopting r-tPA was remarkably shorter than that caused in thrombolysis by adopting urokinase (P<0.05). Conclusion: Both r-tPA and urokinase are effective in interventional thrombolysis for acute and severe pulmonary embolism. However, r-tPA could significantly shorten the time caused in thrombolysis without increasing any bleeding risk.
    No preview · Article · Jun 2014 · Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences
  • C M Wang · Xuan Li · Jun Fu · J Y Luan · T R Li · Jun Zhao · G X Dong
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    ABSTRACT: To introduce the technological modification of stents placement with combined naked self-expanding stent and stent-graft for the construction of portosystemic shunt during transjugular intrahepatic portosystemic shunt (TIPS). In the study, 17 patients who suffered from upper digestive tract hemorrhage due to portal hypertension post liver cirrhosis underwent modified TIPS. The shunts were constructed with stepwise placement of naked self-expanding stent and a stent-graft other than stent-graft only for the purpose of precisely covering the parenchymal segment of the shunt and the active control of portosystemic gradient (PSG). The feasibility, safety, and clinical application results of the new technique were analyzed. Technically, the success rate of operation was 100%. The mean PSG before and after TIPS was (28.2±7.6) mmHg, (12.1±3.5) mmHg, respectively (1 mmHg=0.133 kPa, P<0.001). One patient died 6 days after operation. The median follow-up period was 181 days (ranging from 32 days to 563 days) for all the other 16 cases, during which period 3 patients died because of encephalopathy, liver failure and septicemia, respectively, and 2 cases of encephalopathy occurred and were relieved with medical treatment. The shunts patency rate was 100% and no chance of digestive re-bleeding occurred. The mean Child-Pugh score before TIPS and at the end of the follow-up was (7.8±2.0) points and (7.5±1.7) points, respectively (P=0.584). The technological modification of TIPS with combined naked self-expanding stent and stent-graft for the precise covering of the parenchymal segment of the shunts was relatively simple to apply, and was helpful for the adjustment of PSG. The preliminary clinical application indicated that it had satisfying results in the matter of shunts patency, incidence of encephalopathy, and the relapse of digestive bleeding during the short-term follow-up.
    No preview · Article · Feb 2014 · Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences

  • No preview · Article · Nov 2013 · Journal of vascular and interventional radiology: JVIR
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    ABSTRACT: To summarize the significance of lumbar punctures in remedy for aneurysmal subarachnoid hemorrhage (aSAH) after embolization. From December 2002 to September 2011, 43 cases of aSAH underwent aneurysm embolization at department of interventional radiology and vascular surgery, Peking University Third Hospital. After the embolization,consecutive lumbar punctures were undertaken everyday, by which we measured proper cerebrospinal fluid pressure and slow drainage of cerebrospinal fluid. In accordance with the lumbar puncture results we determined the control of blood pressure, dehydration and rehydration therapy procedures. Two patients died. Only one patient in the 41 cases of the survived patients developed cerebral vasospasm, cerebral infarction and obstructive hydrocephalus, but by ventriculo-peritoneal shunt, obstructive hydrocephalus was relieved. The remaining 39 patients recovered well. After the mean follow-up of (26.0±5.8) months, no new neurological symptoms were found. Early consecutive lumbar puncture treatment in ASH after embolization is significant.
    No preview · Article · Aug 2013 · Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences
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    ABSTRACT: Nonalcoholic steatohepatitis (NASH) is a prevalent disease in countries around the world. The branched-chain amino acids (BCAAs) leucine, isoleucine, and valine cannot be synthesized by the body and have been shown to promote muscle buildup; thus, it is logical to suggest that BCAAs can reduce fat deposition in the body. We used gonadectomized rats fed a high-fat diet to investigate the effects of BCAAs on lipid metabolism over an 8-week experimental period. Body composition, tissue histology, plasma lipid indices, and hormone levels were examined. We demonstrated that the body weights of rats were not significantly decreased but the mesenteric fat was significantly decreased (p < 0.05) in BCAA-treated rats. In addition, BCAAs decreased plasma lipid levels and fat deposition in the liver. At week 4, when the untreated rats displayed macrovesicular steatosis, BCAA-treated rats had only macrovesicular droplets in their hepatocytes. At week 8, when the untreated rat livers displayed profound inflammation and cirrhosis, BCAA-treated rat livers remained in the macrovesicular stage of steatosis. BCAAs induced higher blood glucose and plasma insulin levels (p < 0.05). BCAAs also improved liver blood flow by increasing mean arterial blood pressure and decreasing portal pressure, which helped delay the change in blood flow pattern to that of cirrhosis. BCAAs also induced the skeletal muscle to express higher levels of branched-chain α-keto acid dehydrogenase E1α, which indicates an enhanced metabolic capacity of BCAAs in muscle tissue. This study clearly demonstrates the effects of BCAAs on the amelioration of fat deposition in rats fed a high-fat diet.
    No preview · Article · Aug 2013 · Applied Physiology Nutrition and Metabolism
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    ABSTRACT: Objective: We report our experience in the treatment of isolated superior mesenteric artery dissection and review the clinical and imaging features reported in the literature. Methods: A retrospective study was conducted of 18 consecutive patients with isolated superior mesenteric artery dissection who presented at the Peking University Third Hospital between September 2008 and May 2012. Their clinical characteristics, including age, sex, medical history, risk factors, symptoms, diagnostic imaging modality, and treatment, were analyzed. Also reviewed were 278 patients with isolated superior mesenteric artery dissection reported in the English language literature. The epidemiology, mechanism, clinical presentation, imaging features, and treatment were discussed. Results: There were 14 men and four women with a mean age of 55.6 years (range, 41-84 years). Four patients were asymptomatic, and 14 presented with acute-onset abdominal pain. The diagnosis was established by contrast-enhanced computed tomography in 17 patients and ultrasound imaging in one patient. All dissections were located at the anterior wall and around the convex curvature of the superior mesenteric artery. The decision to intervene was based on symptoms. Three asymptomatic patients underwent successful conservative management, and one asymptomatic patient with an aneurysmal dilated false lumen underwent endovascular stent placement. For the 14 symptomatic patients, definitive treatment included catheter-directed infusion of a vasodilator in four and stent placement combined with catheter-directed infusion of a vasodilator in 10, of whom one patient underwent hybrid stent placement. No complications or deaths occurred. During the mean 14.9-month (range, 1-40 month) follow-up period, all patients were asymptomatic, and patency of the superior mesenteric artery was demonstrated by contrast-enhanced computed tomography scan. Conclusions: Conservative management can be applied to asymptomatic patients with isolated superior mesenteric artery dissection. For symptomatic patients, stent placement is the definitive treatment if there is no arterial rupture or intestinal necrosis. Self-expanding bare stents that completely cover the curvature of the superior mesenteric artery are recommended. Catheter-directed infusion of a vasodilator can be an effective accessional process after stent placement.
    No preview · Article · Mar 2013 · Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter
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    ABSTRACT: To investigate the characteristics of intimal hyperplasia and lovastatin's effects on canine jugular venous prosthesis bypass grafting. In the study, 12 adult mistus dogs were randomly divided into 2 groups: lovastatin group and control group. All the dogs were performed with jugular venous prosthesis bypass grafting (ePTFE, 6 mm in diameter, and 5 cm in length). Four weeks later, all the 12 specimens were harvested. The patency and mural thrombus of grafts were evaluated. The characteristics of intimal hyperplasia were described and measured by HE staining and endothelial nitric oxide synthase (eNOs) immunohistochemical method. The differences between the two groups were compared. Four weeks later, 3 grafts with complete occlusion were found in the two groups separately. Apparent intimal hyperplasia was observed in all the grafts. The neointima of proximal and distal part in lovastatin group were thinner than in control group respectively (proximal P=0.045, distal P=0.040). The endothelial cells were found in the surface of neointima. Newly born vessels could be found in the neointima and the new vessels were more in lovastatin group than in control group (proximal P=0.041, distal P=0.031). At the end of 4 weeks, the intimal hyperplasia with neovascularization was obviously near the anastomosis. Lovastatin showed the ability to inhibit the intimal hyperplasia and promote the neovascularization.
    No preview · Article · Oct 2012 · Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences
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    ABSTRACT: In recent years, the incidence of unexplained sudden death has risen significantly across the world. However, it occurred suddenly, often in young apparently healthy individuals and almost 50% of the patients did not have any warning signals or symptoms. Therefore, the prodromal symptoms before the incident are extremely important for early prediction of sudden death. In this article, we aimed to explore the value of prodromal symptoms for unexplained sudden death and whether the prodromal symptoms have a predictive function to unexplained sudden death (USD) without underlying diseases. A total of 208 sudden death cases were selected for the survey in the Emergency Department of Peking University Third Hospital from January 2006 to December 2009 and their medical records were reviewed. The patients were divided into two groups, 65 patients had underlying diseases while 143 had not underlying diseases. In the meantime, their prodromal symptoms were collected and compared, prodromal symptoms including chest distress, dyspnea, syncope, fever, headache, vomiting, etc. Patients with underlying diseases were compared to those without underlying diseases associated with sudden death; there was no significant difference in gender and age distribution. Among the 208 cases, 39 cases (18.75%) had prodromal symptoms, patients with underlying diseases had prodromal symptoms in 12 cases (18.46%), while patients without underlying diseases had prodromal symptoms in 27 cases (18.88%). The difference between the two groups with prodromal symptoms was not statistically significant (P > 0.05). Prodromal symptoms are extremely important warning signals in the occurrence of USD. It has equally important predictive value for patients both with and without underlying diseases, especially in predicting sudden death caused by cardiopulmonary and neurological diseases.
    Full-text · Article · Oct 2012 · Chinese medical journal
  • Jing Yuan Luan · Xuan Li
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    ABSTRACT: Study Design. Case report.Objective. To describe a unique case of iliac pseudoaneurysm complicated lumbar disc surgery 13 years ago.Summary of Background Data. Major vascular injury is an unusual but life-threatening complication of lumbar disc surgery. If a major vascular injury is unnoticed, the late complications, pseudoaneurysm, may be diagnosed years after primary lumbar disc surgery. Pseudoaneurysm can lead to compression of adjacent neurovascular structures, however, erosion into the adjacent vertebras and presentation with symptoms of nerve root irritation are rare.Methods. The patient was a 54-year-old man presented with pain and numbness in right hip and leg. Examination was normal. Plain X-ray film showed destruction of the fourth and fifth lumbar vertebras. Magnetic resonance scanning showed a retroperitoneal mass eroding into the adjacent vertebras. The mass was primarily misdiagnosed as a neoplasm and a percutaneous needle biopsy was recommended. Before puncture, the CT angiogram confirmed it to be a pseudoaneurysm of left common iliac artery. Then, implantation of a covered stent was undergone.Results. After implantation of a covered stent, the symptoms were relieved immediately. At the 12-month follow-up, the patient remained asymptomatic, and computed tomography angiogram revealed progressive shrinkage of the mass and significant healing of the eroded vertebras.Conclusion. As an unusual complication of lumbar disc surgery, iliac pseudoaneurysm can present with radiating pain even 13-year later, and erode into the adjacent vertebras producing appearances mimicking a tumor. For mass located anterior to vertebras, the percutaneous biopsy must be cautiously, and a contrast-enhanced CT scan is necessary.
    No preview · Article · Sep 2012 · Spine
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    ABSTRACT: Isolated iliac aneurysm is rare and difficult for surgery repair because it locates in the deep pelvis. Endovascular repair is preferred currently, and internal iliac artery is generally embolized in order to avoid the endoleak. Embolization of the internal iliac artery can lead to the complications such as buttock claudication, colon ischaemia and erectile dysfunction. Therefore, the antegrade flow of internal iliac artery should be reserved. One seventy-seven-year-old male patient with isolated left common iliac aneurysm, 30 mm in diameter, was successful endovascular repaired using fenestrated covered stent. At 1-month follow up, the patient was asymptomatic. Computed tomography scan shows the iliac aneurysm was completely excluded, and the antegrade flow of the left common, internal and external iliac arteries were normal.
    No preview · Article · Jun 2012 · Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences
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    ABSTRACT: Hepatocellular carcinoma (HCC) is the leading cause of cancer mortality in many countries. Evaluation of new susceptibility risk factors is therefore warranted in order to explore means to improve the survival rate. Here, we report on a novel HCC-related gene known as lysosomal protein transmembrane 4 beta (LAPTM4B) that has two alleles designated LAPTM4B*1 and LAPTM4B*2. Allele *1 differs from allele *2 in that it contains one copy of a 19-bp sequence, whereas this sequence is duplicated in allele *2 in exon 1 of LAPTM4B. In this study, we aimed to investigate the relationship between LAPTM4B allelic variation and HCC susceptibility. The LAPTM4B genotype was analyzed in the blood samples from 102 HCC patients and 135 healthy individuals by PCR. The genotypic distribution of LAPTM4B was analyzed using the chi-squared test. The frequencies of allele *2 were 38.24 and 24.07% in the HCC group and control group, respectively, representing a significant difference between these two groups (P < 0.001). Thus, allele *2 of LAPTM4B appears to be associated with genetic susceptibility of HCC and may therefore be considered as a risk factor.
    No preview · Article · Dec 2011 · Medical Oncology
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    ABSTRACT: This study was designed to introduce our novel technique of percutaneous single catheter placement into the hilar bile ducts strictures while fulfilling the purpose of bilateral biliary drainage and stenting. We investigated the efficacy and safety of the technique for the treatment of hilar nonanastomotic biliary strictures. Ten patients who were post-orthotopic liver transplantation between July 2000 and July 2010 were enrolled in this study. Percutaneous Y-configured single-catheter stenting for bilateral bile ducts combined with balloon dilation was designed as the main treatment approach. Technical success rate, clinical indicators, complications, and recurrent rate were analyzed. Technical success rate was 100%. Nine of the ten patients had biochemical normalization, cholangiographic improvement, and clinical symptoms relief. None of them experienced recurrence in a median follow-up of 26 months after completion of therapy and removal of all catheters. Complications were minor and limited to two patients. The one treatment failure underwent a second liver transplantation but died of multiple system organ failure. Percutaneous transhepatic Y-configured single-catheter stenting into the hilar bile ducts is technically feasible. The preliminary trial of this technique combined with traditional PTCD or choledochoscopy for the treatment of hilar biliary strictures after orthotopic liver transplantation appeared to be effective and safe. Yet, further investigation is needed.
    No preview · Article · Jun 2011 · CardioVascular and Interventional Radiology
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    ABSTRACT: Arteriosclerosis obliterans (ASO) is a kind of peripheral arterial disease. Most patients with ASO have no apparent clinical symptoms early on, but a diagnosis at the early stage is essential to prevent progression. Unfortunately, the specific and sensitive markers for ASO are still lacking currently. In this study, using both tissue samples and blood samples obtained from ASO patients, we aim to find a cluster of miRNAs that can be used as new risk-markers for the diagnosis of ASO in the earlier stages. We enrolled 104 patients diagnosed with ASO and 105 age-matched controls. We examined the expression levels of a series of miRNAs in both intima samples and serum samples from these patients. Levels of miR-21, miR-130a, miR-27b, let-7f and miR-210 significantly increased, while levels of miR-221 and miR-222 significantly decreased in the sclerotic samples compared with normal samples. Significant increase of miR-130a, miR-27b and miR-210 expression was observed in the serum samples of ASO patients. Moreover, the expression of miR-130a and miR-27b in sera of ASO patients was positively correlated with Fontaine stages. The serum levels of miR-130a, miR-27b and miR-210 may serve as potential biomarkers for early stage ASO.
    Full-text · Article · Sep 2010 · Clinica chimica acta; international journal of clinical chemistry