- [Show abstract] [Hide abstract] ABSTRACT: Approximately 15% of men with hormone naïve metastatic prostate cancer primarily fail to respond to androgen deprivation treatment (ADT). The reason why the response to ADT differs in this subgroup of men with prostate cancer remains unclear. The aim of this study was to describe the characteristics of these men and to thereby define predictors of early ADT failure in prostate cancer patients with bone metastases. The study was based on 915 men from the prospective randomized multicenter trial (no. 5) conducted by the Scandinavian Prostate Cancer Group comparing parenteral estrogen with total androgen blockade. Early ADT failure was defined as death from metastatic prostate cancer within 12 months after the start of ADT. Multivariate logistic regression models were applied to identify clinical predictors of early ADT failure. Ninety-four (10.3%) men were primarily nonresponders to ADT. Independent predictors of early ADT failure were poor Eastern Cooperative Oncology Group performance status (PS), analgesic consumption, low hemoglobin, and high Soloway score (extent of disease observed on the scan), in where patients with poor PS and/or high analgesic consumption had a threefold risk of early ADT failure. Not significantly factors related to early ADT failure were age, treatment, cardiovascular comorbidity, T category, grade of malignancy, serum estrogen level, and SHBG at enrolment. We analyzed characteristics of a subgroup of patients who primarily failed to respond to ADT. Four independent clinical predictors of early ADT failure could be defined, and men exhibiting these features should be considered for an alternative treatment.
- [Show abstract] [Hide abstract] ABSTRACT: Sexual ornaments are used both in intra- and intersexual contexts, and these signals have evolved to function in the particular habitat the animal is adapted to. Habitat characteristics may, however, change rapidly due to anthropogenic effects, sometimes at rates too fast for many organisms to adaptively respond. In aquatic ecosystems, eutrophication is currently changing chemical as well as visual properties of the environment. Algae blooms increase water turbidity, and the reduction of water transparency thus has the potential to alter visual ornaments and their perception. However, results are not congruent. Rather, algae turbidity may decrease, increase, or leave ornaments unaffected. The effect seems to depend on exposure time, condition, population and species. Here, we found that the perception of sexual signals, but not their expression, was hampered by turbidity in the sex-role-reversed pipefish Nerophis ophidion. In a laboratory experiment we found that female sexual ornaments (i.e., blue color markings and a skinfold) and fecundity was unaffected by turbidity. Male adaptive mate choice for larger females with large ornament was, however, hampered under turbid conditions, whereas in clear water males choose larger, more ornamented females. Thus, we show that water turbidity had no effect on signal expression but did hamper ornament perception and consequently randomized mate choice.
- [Show abstract] [Hide abstract] ABSTRACT: Cannibalism provides energetic benefits but is also potentially costly, especially when directed towards kin. Since fitness costs increase with time and energy invested in offspring, cannibalism should be infrequent when parental investment is high. Thus, filial cannibalism in male syngnathids, a group known for the occurrence of male pregnancy, should be rare. Using the pipefish ( Syngnathus abaster) we aimed to investigate whether cannibalism does occur in both sexes and how it is affected by reproductive and nutritional states. Although rare, we witnessed cannibalism both in the wild and in the laboratory. Unlike non-pregnant males and females, pregnant and post-partum males largely refrained from cannibalising juveniles. Reproducing males decreased their feeding activity, thus rendering cannibalism, towards kin or non-kin, less likely to occur. However, if not continuously fed, all pipefish adopted a cannibal strategy, revealing that sex and life history stages influenced the ratio between the benefits and costs of cannibalism.
- [Show abstract] [Hide abstract] ABSTRACT: Background: Maintenance treatment (mt) with bevacizumab (bev) +/- erlotinib (erlo) has modest effect after induction chemotherapy in metastatic colorectal cancer (mCRC). We hypothesized the efficacy of erlo to be dependent on KRAS mutational status, and investigated this by exploring mt strategies with bev +/- erlo and low-dose capecitabine (cap). Patients and methods: Included patients had mCRC scheduled for first line therapy, ECOG 0-1 and no major comorbidities. Treatment with XELOX/ FOLFOX or XELIRI/FOLFIRI+bev was given for 18 weeks. After induction patients without progression were eligible for randomization to mt; KRAS wild type (wt) patients were randomized to bev +/- erlo (arms wt-BE, N=36 vs. wt-B, N=35), KRAS mutated (mut) patients to bev or metronomic cap (arms mut-B, N=34 vs. mut-C, N= 33). Primary endpoint was PFS rate at three months (PFSr) after start of mt. A pooled analysis of KRASwt patients from the previous ACT study was performed. Results: We included 233 patients. Median age was 64 years, 62% male, 68% ECOG 0, 52% with primary tumor in situ. 138 patients started mt after randomization. PFSr was 64.7% vs. 63.6% in wt-B vs. wt-BE, P= 1.000; and 75% vs. 66.7% in mut-B vs. mut-C, P= 0.579, with no significant difference in median PFS and OS. In the pooled cohort, median PFS was 3.7 months in wt-B (N=64) and 5.7 months in wt-BE (N=62), (HR 1.03, 95% CI:0.70-1.50, P=0.867). The frequency of any grade 3/4 toxicities during mt were: 28%/58%/18%/15% (wt-B/wt-BE/mut-B/mut-C). Conclusions: Addition of erlo to bev as mt in KRAS wt mCRC did not significantly improve PFS or OS, but it did increase toxicity. KRAS status does not seem to influence the outcome of treatment with erlotinib. Metronomic cap warrants further investigation in mt strategies, given our explorative results.
- [Show abstract] [Hide abstract] ABSTRACT: Epidermal growth factor receptor (EGFR) analysis is the first molecular test introduced in the routine care of patients with non-small cell lung cancer (NSCLC). In the present study, we describe the prevalence of EGFR mutations and the adherence to testing and treatment guidelines in a population-based Swedish NSCLC cohort. Patients with NSCLC analyzed for EGFR mutations were identified and their characteristics and survival data were retrieved. We compared the study cohort to a matched lung cancer population. The EGFR mutation frequency was 10%. Mutations were enriched in women and in adenocarcinoma cases. Out of patients with advanced-stage NSCLC with non-squamous histology, only 49% were referred for EGFR analysis. Out of the patients with EGFR mutation and advanced disease, only 38% received EGFR-tyrosine kinase inhibitor (TKI) in first-line therapy. The EGFR-mutated NSCLC population studied is similar to other Western populations. Surprisingly, a large proportion of patients were not referred for EGFR analysis. Out of the patients with EGFR mutation, fewer than 40% received EGFR-TKI as first-line treatment. Our results highlight the need for follow-up of treatment and diagnostic algorithms in routine healthcare. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.
Article: [In Process Citation][Show abstract] [Hide abstract] ABSTRACT: The work-up process for lung cancer patients consists of several steps from suspicion of malignant disease to start of treatment. Delays between these steps should be minimized. Data in the Swedish National Lung Cancer Register show that the work-up times for lung cancer patients vary greatly between different counties in central Sweden. In order to reduce delays, a trial of implementing patient guides (Sw: patientlotsar) for patients referred to the hospital was conducted. When comparing the work-up times before and after implementation of patient guides the median waiting time from suspicion of lung cancer to start of treatment in the region was reduced from 71 to 45 days. Furthermore, the duration of most of the steps in the work-up process were shortened despite more complex investigation procedures, e.g. increased use of PET/CT in the guided patient group.
- [Show abstract] [Hide abstract] ABSTRACT: Objective To describe characteristics and quality-of-life (QOL) and to define factors associated with long-term survival in a subgroup of prostate cancer patients with M1b disease.Methods and patientsThe study was based on 915 patients from a prospective randomised multicentre trial (no.5) by the Scandinavian Prostate Cancer Group, comparing parenteral oestrogen with total androgen blockade (TAB). Long-term survival was defined as patients having an overall survival >10 year, and logistic regression models were constructed to identity clinical predictors of survival. QOL during follow-up was assessed using EROTC-30 ratings. .ResultsForty (4.4%) of the 915 men survived longer than 10 years. Factors significantly associated with increased likelihood of surviving more than ten years in the univariate analyses were: absence of cancer-related pain; performance status < 2; negligible analgesic consumption; T-category 1-2; PSA <231 μg/L; and a Soloway score 1. In the multivariate analyses, performance status < 2, PSA < 231 μg/L, and Soloway score 1, were all independent predictors of long-term survival. All subscales of EORTC-C30 were higher in this group than for patients with short survival, but slowly declined over the decade.ConclusionA subgroup of prostate cancer patients with M1b disease and certain characteristics showed a positive long-term response to ADT with an acceptable QOL over a decade or more. Independent predictors of long-term survival were identified as performance status < 2, limited extent of bone metastases (Soloway score 1), and a PSA level < 231 μg/L at the time of enrolment.This article is protected by copyright. All rights reserved.
- [Show abstract] [Hide abstract] ABSTRACT: Courtship is an important part of the reproductive process, ensuring reproductive compatibility and conveying individual quality. One factor in aquatic environments that has the potential to influence courtship behaviours and mating propensity is the level of dissolved oxygen. Furthermore, hypoxic areas are currently spreading due to anthropogenic disturbance, such as eutrophication. In marine environments, hypoxia often occurs in shallow coastal regions that are particularly important areas for reproduction. Here, we investigated how types of reproductive behaviour were affected by mild hypoxia using the well-studied broad-nosed pipefish, Syngnathus typhle. More precisely, we investigated the impact of acute hypoxia on the reproductive behaviour preceding mating, and on the probability of mating, as well as on the latency until these occurred. We found that the latency period to courting and copulation occurring was prolonged in the low-oxygen environment. However, the total time spent courting as well as the probability of mating was unaffected by hypoxia. Other types of reproductive behaviour found in this species, such as dancing, and the unique male pouch-flap behaviour, were also unaffected by the low-oxygen treatment. We conclude that although latency to courting and copulating was prolonged in the hypoxic environment, most reproductive behaviour investigated was unaffected by hypoxia. Thus, hypoxia commonly occurring in shallow coastal regions has the potential to delay certain components of reproduction, but overall the broad- nosed pipefish shows robustness to hypoxic conditions.
- [Show abstract] [Hide abstract] ABSTRACT: The work-up process for lung cancer patients consists of several steps from suspicion of malignant disease to start of treatment. Delays between these steps should be minimized. Data in the Swedish National Lung Cancer Register show that the work-up times for lung cancer patients vary greatly between different counties in central Sweden. In order to reduce delays, a trial of implementing patient guides (Sw: patientlotsar) for patients referred to the hospital was conducted. When comparing the work-up times before and after implementation of patient guides the median waiting timefrom suspicion of lung cancer to start of treatment in the region was reduced from 71 to 45 days. Furthermore, the duration of most of the steps in the work-up process were shortened despite more complex investigation procedures, e.g. increased use of PET/CT in the guided patient group.
- [Show abstract] [Hide abstract] ABSTRACT: The discussion on the role of adjuvant chemotherapy for rectal cancer patients treated according to current guidelines is still ongoing. A multicentre, randomised phase III trial, PROCTOR-SCRIPT, was conducted to compare adjuvant chemotherapy with observation for rectal cancer patients treated with preoperative (chemo)radiotherapy and total mesorectal excision. The PROCTOR-SCRIPT trial recruited patients from 52 hospitals. Patients with histologically proven stage II or III rectal adenocarcinoma were randomly assigned (1:1) to observation or adjuvant chemotherapy after preoperative (chemo)radiotherapy and total mesorectal excision. Radiotherapy consisted of 5x5 Gy. Chemoradiotherapy consisted of 25x1.8-2 Gy combined with 5-FU based chemotherapy. Adjuvant chemotherapy consisted of 5-FU/LV (PROCTOR), or eight courses capecitabine (SCRIPT). Randomisation was based on permuted blocks of six, stratified according to centre, residual tumour, time between last irradiation and surgery, and preoperative treatment. The primary end-point was overall survival. Of 470 enrolled patients, 437 were eligible. The trial closed prematurely because of slow patient accrual. Patients were randomly assigned to observation (n=221) or adjuvant chemotherapy (n=216). After a median follow-up of 5.0 years, five-year overall survival was 79.2% in the observation group and 80.4% in the chemotherapy group (HR 0.93, 95% CI 0.62-1.39; p=0.73). The hazard ratio for disease-free survival was 0.80 (95% CI 0.60-1.07; p=0.13). Five-year cumulative incidence for locoregional recurrences was 7.8% in both groups. Five-year cumulative incidence for distant recurrences was 38.5% and 34.7%, respectively (p=0.39). The PROCTOR-SCRIPT trial could not demonstrate a significant benefit of adjuvant chemotherapy with fluoropyrimidine monotherapy after preoperative (chemo)radiotherapy and total mesorectal excision on overall survival, disease-free survival, and recurrence rate. However, this trial did not complete planned accrual. © The Author 2014. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: email@example.com.
- [Show abstract] [Hide abstract] ABSTRACT: Background and purpose: To evaluate the long-term effects of dietary intervention on gastrointestinal symptoms after highly dose-escalated radiotherapy for localized prostate cancer, using boost with protons or high-dose-rate brachytherapy. Materials and methods: Patients were randomized to an intervention group (n=64) advised to reduce insoluble dietary fiber and lactose intake, or to a standard care group (n=66) advised to continue their usual diet. Gastrointestinal symptoms, other domains of health-related quality of life (HRQOL), and dietary intake were evaluated for ⩽24months post-radiotherapy with the European Organization for Research and Treatment of Cancer quality-of-life questionnaires QLQ-C30 and QLQ-PR25, Gastrointestinal Side Effects Questionnaire, and Food Frequency Questionnaire. The effect of the intervention on gastrointestinal symptoms was evaluated using generalized estimating equations. Results: Dietary intervention had no obvious effect on long-term gastrointestinal symptoms or HRQOL. The intervention group markedly reduced their dietary fiber and lactose intake during radiotherapy, but adherence tended to decline over time. The vast majority of long-term gastrointestinal symptoms were reported as 'a little', with a noticeable difference from pre-treatment only for unintentional stool leakage, limitations on daily activities, and mucus discharge. Conclusion: Long-term gastrointestinal symptoms were predominantly mild, and dietary intervention was not superior to a usual diet in preventing these symptoms.
- [Show abstract] [Hide abstract] ABSTRACT: Claudins (CLDNs) are central components of tight junctions that regulate epithelial-cell barrier function and polarity. Altered CLDN expression patterns have been demonstrated in numerous cancer types and lineage-specific CLDNs have been proposed as therapy targets. The objective of this study was to assess which fraction of patients with non-small-cell-lung cancer (NSCLC) express CLDN6 and CLDN18 isoform 2 (CLDN18.2). Protein expression of CLDN6 and CLDN18.2 was examined by immunohistochemistry on a tissue microarray (n = 355) and transcript levels were supportively determined based on gene expression microarray data from fresh-frozen NSCLC tissues (n = 196). Both were analyzed with regard to frequency, distribution, and association with clinical parameters. Immunohistochemical analysis of tissue sections revealed distinct membranous positivity of CLDN6 (6.5%) and CLDN18.2 (3.7%) proteins in virtually non-overlapping subgroups of adenocarcinomas and large-cell carcinomas. Pneumocytes and bronchial epithelial cells were consistently negative. Corresponding to the protein expression, in subsets of non-squamous lung carcinoma high mRNA levels of CLDN6 (7-16%) and total CLDN18 (5-12%) were observed. Protein expression correlated well with total mRNA expression of the corresponding gene (rho = 0.4-0.8).CLDN18.2 positive tumors were enriched among slowly proliferating, thyroid transcription factor 1 (TTF-1)-negative adenocarcinomas, suggesting that isoform-specific CLDN expression may delineate a specific subtype. Noteworthy, high CLDN6 protein expression was associated with worse prognosis in lung adenocarcinoma in the univariate (HR: 1.8; p = 0.03) and multivariate COX regression model (HR: 1.9; p = 0.02). These findings encourage further clinical exploration of targeting ectopically activated CLDN expression as a valuable treatment concept in NSCLC. © 2014 Wiley Periodicals, Inc.
- [Show abstract] [Hide abstract] ABSTRACT: Purpose: To compare sickness absence and disability pension in a population-based cohort of women with breast cancer (n = 463) from 1 year pre-diagnosis until 3 years post-diagnosis with a matched control group (n = 2310), and to investigate predictors of sickness absence during the 2nd and 3rd year post-diagnosis. Results: Following breast cancer, the proportion of disease-free women with sickness absence decreased post-diagnosis (1st-3rd year; 78%-31%-19%), but did not reach the pre-diagnostic level (14%; P < 0.05). Post-diagnosis, patients were more likely than controls to be sickness absent (1st-3rd year; P < 0.001). No between-group differences were observed for disability pension post-diagnosis (P > 0.05). Among patients, chemotherapy, baseline fatigue and pre-diagnosis sick days predicted sickness absence during the 2nd, 3rd, and 2nd and 3rd year post-diagnosis, respectively (P < 0.05). Conclusions: Breast cancer is associated with increased sickness absence 3 years post-diagnosis. In a clinical setting, prevention and treatment of side effects are important in reducing long-term consequences.
- [Show abstract] [Hide abstract] ABSTRACT: Selection processes are influenced by both biotic and abiotic variables, most of which seasonally fluctuate. Therefore, selection may also vary temporally. Specifically, sexual selection, an integral component of natural selection, will inevitably exhibit temporal varia- tion but the scale at which these changes occur are still not well understood. In this study, performed on a wild population of the sex-role reversed black striped pipe- fish Syngnathus abaster (Risso, 1827), we contrast var- iables such as male reproductive success, mating suc- cess, female investment, mate choice and operational sex ratio between two periods, either near the onset or end of the breeding season. Sexual selection is stronger early in the breeding season. Male reproductive and mating success are significantly affected by male size during the onset of the breeding season but not during the end. Moreover, we found that larger females repro- duce mainly during the onset while smaller females had increased chances of reproducing towards the end. As our sampling was performed in two consecutive years, it could be argued that our results stem primarily from between-year variation. Nevertheless, variation in de- mographic parameters from the onset to the end of the breeding season is similar to that observed in past sam- pling events. Hence, we suggest that the change in mating patterns within the breeding season derives from seasonal fluctuations in several abiotic (e.g., temperature) and biotic variables (e.g., operational sex ratio), ren- dering the expression of selective forces, such as sexual selection, inherently dynamic.
- [Show abstract] [Hide abstract] ABSTRACT: Aims: To study whether there is an association between dyadic consensus, depressive symptoms, and parental stress during early parenthood and marital separation 6-8 years after childbirth, among couples in Sweden. Methods: At baseline, 393 couples were included. The couples answered three questionnaires, including: Dyadic consensus at 1 week post-partum, depressive symptoms at 3 months post-partum and parental stress at 18 months post-partum. The parents' addresses were followed up after 6-8 years, to study the marital separation rate. Results: We found, 6-8 years after childbirth, that 20% of study couples were separated. Separation was associated with less dyadic consensus (mothers p < 0.001; fathers p < 0.001), depressive symptoms (mothers p = 0.022; fathers p = 0.041) and parental stress (mothers p = 0.002; fathers p = 0.040). The hazard ratio (HR) for marital separation was related to dyadic consensus for fathers (HR 0.51; 95% CI 0.28-0.92), depressive symptoms for mothers (HR 1.69; 95% CI 1.01-2.84) and fathers (HR 1.92; 95% CI 1.12-3.28), and the mother's parental stress (HR 2.16; 95% CI 1.14-4.07). Conclusions: Understanding how dyadic consensus, depressive symptoms and parental stress are associated with marital separation is important for health professionals it could be useful in developing interventions to provide parents with adequate support during pregnancy and early parenthood this knowledge is also important for the public parents should get support in pregnancy and while bringing up children, which may help prevent marital separation and optimize conditions for the children.
- [Show abstract] [Hide abstract] ABSTRACT: Background. Capture rate and representativity of quality registers need to be assessed in order to ensure that register data are generalizable. Material and methods. In 1998–2009, 103 047 men had been diagnosed with prostate cancer and registered in the Swedish Cancer Register to which registration is mandated by law and of these men, 100 849 men (98%) had also been registered in The National Prostate Cancer Register (NPCR) of Sweden. We compared demographics, cancer treatment, comorbidity, and mortality in men in NPCR, with those who had only been registered in the Cancer Register, by use of data from the Cause of Death Register, the In-Patient Register and the Prescribed Drug Register. In addition, we identified 1929 men who had prostate cancer as underlying cause of death in the Cause of Death Register who had neither been registered in the Cancer Register nor in NPCR. Results. Compared to men in NPCR, men only registered in the Cancer Register were slightly older, median age 72 versus 71 years, and a lower proportion underwent radical prostatectomy, 15% versus 27%. Ten year prostate cancer mortality was 23% (95% CI 20–25) for men in the Cancer Register only and 24% (95% CI 24–25) in NPCR, while mortality from competing causes was 28% (95% CI 26–31) and 30% (95% CI 30–30), respectively. Men identified with prostate cancer by a death certificate were old and had high comorbidity. Conclusion. The capture rate of NPCR is very high and there are only modest differences in demographics, cancer treatment, comorbidity, and mortality between the small proportion of men only registered in the Cancer Register and men registered in NPCR, indicating that information in NPCR can be generalized to all men with prostate cancer in Sweden.
- [Show abstract] [Hide abstract] ABSTRACT: Background: Patient safety is of the utmost importance in health care. The patient safety culture in an institution has great impact on patient safety. To enhance patient safety and to design strategies to reduce medical injuries, there is a current focus on measuring the patient safety culture. The aim of the present study was to describe the patient safety culture in an ED at two different hospitals before and after a Quality improvement (QI) project that was aimed to enhance patient safety. Methods: A repeated cross-sectional design, using the Hospital Survey On Patient Safety Culture questionnaire before and after a quality improvement project in two emergency departments at a county hospital and a university hospital. The questionnaire was developed to obtain a better understanding of the patient safety culture of an entire hospital or of specific departments. The Swedish version has 51 questions and 15 dimensions. Results: At the county hospital, a difference between baseline and follow-up was observed in three dimensions. For two of these dimensions, Team-work within hospital and Communication openness, a higher score was measured at the follow-up. At the university hospital, a higher score was measured at follow-up for the two dimensions Team-work across hospital units and Team-work within hospital. Conclusion: The result showed changes in the self-estimated patient safety culture, mainly regarding team-work and communication openness. Most of the improvements at follow-up were seen by physicians, and mainly at the county hospital.
- [Show abstract] [Hide abstract] ABSTRACT: Background Commonly used inhalational hypnotics, such as sevoflurane, are pro-inflammatory, whereas the intravenously administered hypnotic agent propofol is anti-inflammatory and anti-oxidative. A few clinical studies have indicated similar effects in patients. We examined the possible association between patient survival after radical cancer surgery and the use of sevoflurane or propofol anaesthesia. Patients and methods Demographic, anaesthetic, and surgical data from 2,838 patients registered for surgery for breast, colon, or rectal cancers were included in a database. This was record-linked to regional clinical quality registers. Cumulative 1- and 5-year overall survival rates were assessed using the Kaplan–Meier method, and estimates were compared between patients given propofol (n = 903) or sevoflurane (n = 1,935). In a second step, Cox proportional hazard models were calculated to assess the risk of death adjusted for potential effect modifiers and confounders. Results Differences in overall 1- and 5-year survival rates for all three sites combined were 4.7% (p = 0.004) and 5.6% (p < 0.001), respectively, in favour of propofol. The 1-year survival for patients operated for colon cancer was almost 10% higher after propofol anaesthesia. However, after adjustment for several confounders, the observed differences were not statistically significant. Conclusion Propofol anaesthesia might be better in surgery for some cancer types, but the retrospective design of this study, with uneven distributions of several confounders, distorted the picture. These uncertainties emphasize the need for a randomized controlled trial.
- [Show abstract] [Hide abstract] ABSTRACT: Mate choice for compatible genes is often based on genes of the major histocompatibility complex (MHC). Although MHC-based mate choice is commonly observed in female choice, male mate choice remains elusive. In particular, if males have intense paternal care and are thus the choosing sex, male choice for females with dissimilar MHC can be expected. Here, we investigated whether male mate choice relies on MHC class I genes in the sex-role reversed pipefish Syngnathus typhle. In a mate choice experiment, we determined the relative importance of visual and olfactory cues by manipulating visibility and olfaction. We found that pipefish males chose females that maximize sequence-based amino acid distance between MHC class I genotypes in the offspring when olfactory cues were present. Under visual cues, large females were chosen, but in the absence of visual cues, the choice pattern was reversed. The use of sex-role reversed species thus revealed that sexual selection can lead to the evolution of male mate choice for MHC class I genes.
Uppsala, Uppsala, Sweden
- • Department of Surgical Sciences
- • Department of Ecology and Genetics
Michigan State University
Ист-Лансинг, Michigan, United States
- Department of Zoology