1.Injectable agents for the induction of Peyronie's disease in model rats: a comparative study.
Guang-Jun DU ; Si-Yan XING ; Ning WU ; Tong WANG ; Yue-Hui JIANG ; Tao SONG ; Bai-Bing YANG ; Yu-Tian DAI
Asian Journal of Andrology 2025;27(1):96-100
Peyronie's disease (PD) is a disorder characterized by fibrous plaque formation in the penile tissue that leads to curvature and complications in advanced stages. In this study, we aimed to compare four injectable induction agents for the establishment of a robust rat model of PD: transforming growth factor-β1 (TGF-β1), fibrin, sodium tetradecyl sulfate (STS) combined with TGF-β1, and polidocanol (POL) combined with TGF-β1. The results showed that injection of TGF-β1 or fibrin into the tunica albuginea induced pathological endpoints without causing penile curvature. The STS + TGF-β1 combination resulted in both histological and morphological alterations, but with a high incidence of localized necrosis that led to animal death. The POL + TGF-β1 combination produced pathological changes and curvature comparable to STS + TGF-β1 and led to fewer complications. In conclusion, fibrin, STS + TGF-β1, and POL + TGF-β1 all induced PD with a certain degree of penile curvature and histological fibrosis in rats. The POL + TGF-β1 combination offered comparatively greater safety and clinical relevance and may have the greatest potential for PD research using model rats.
Animals
;
Male
;
Penile Induration/drug therapy*
;
Rats
;
Transforming Growth Factor beta1/metabolism*
;
Disease Models, Animal
;
Fibrin
;
Penis/drug effects*
;
Polidocanol/administration & dosage*
;
Rats, Sprague-Dawley
;
Polyethylene Glycols/administration & dosage*
;
Injections
2.Coagulation profile PT, FBG, FDP, D-D as disease predictors of RA and pSS inflammatory immunity.
Wenwen MIN ; Lei WAN ; Feng LI ; Yu ZHANG ; Ying WANG ; Siyu LIANG
Chinese Journal of Cellular and Molecular Immunology 2025;41(10):895-904
Objective To explore the expression of coagulation indexes in rheumatoid arthritis (RA) and dry syndrome (pSS) and their relationships with inflammation and immune function. Methods A total of 61 patients with RA who were hospitalized in the Department of Rheumatology of Anhui Provincial Hospital of Traditional Chinese Medicine from March 12 to September 9, 2024 were selected as the RA group. And 61 patients with pSS who were hospitalized in the Department of Rheumatology of the same hospital September 4, 2023, to August 17, 2024, were selected as the pSS group. 61 healthy individuals who underwent routine medical checkups at the Physical Examination Center of Anhui Provincial Hospital of Traditional Chinese Medicine during the same period were included as the control group. Baseline clinical indexes before treatment were collected from patients in each group, including prothrombin time(PT), international normalized ratio(INR), thrombia time(TT), fibrinogen(FBG), activated partial thromboplastin time(APTT), fibrin (ogen) degradation products(FDP) and D-Dimer(D-D). Results The expression levels of PT, FBG, TT, FDP, and D-D in the RA group, the pSS group, and the normal group were significantly different. The expression levels of PT, FBG, FDP, and D-D in the RA group were all higher than those in the pSS group and the control group, respectively. And the expression level of TT in the pSS group was lower than that in control group. ROC curve analysis showed that the AUC of PT was 0.638, the AUC of FBG was 0.899, the AUC of FDP was 0.866, and the AUC of D-D was 0.919 in the RA group compared with the normal group. And the AUC of coagulation indexes for joint diagnosis of RA was higher than that of the indexes detected individually. pSS group had an AUC of PT of 0.618 compared with that of the normal group. The AUC of TT was 0.645, and the AUC of coagulation indexes for the joint diagnosis of pSS was higher than the AUC of each index detected separately. Association rule analysis showed that elevated D-D in RA patients had a significant correlation with elevated hs-CRP, CCP and RF, and elevated FBG had a significant correlation with elevated hs-CRP, ESR, RF and CCP. Elevated D-D in pSS patients had a correlation with elevated hs-CRP and anti-SSA, and elevated INR has correlation with elevated hs-CRP, anti-SSA and anti-SSB. Correlation analysis showed that PT, INR, FBG, FDP, and D-D were positively correlated with CRP and ESR, and TT was negatively correlated with CRP and ESR in the RA group. FBG, FDP, and D-D were positively correlated with CRP and ESR in the pSS group. Moreover, coagulation indexes were positively correlated with immune indexes in RA group and pSS group which were all significant. The results of multiple linear regression analysis showed that FBG was a positive correlate of hs-CRP and ESR in RA patients. For PSS patients, FBG and FDP were positive correlates of hs-CRP. APTT and FBG were positive correlates of ESR. Conclusion Compared with pSS, coagulation indexes (especially PT, FBG, FDP and D-D) are more informative for the early diagnosis of RA and the judgment of the degree of the disease, and can be used as an important predictor for the confirmation of the diagnosis of RA.
Humans
;
Female
;
Male
;
Arthritis, Rheumatoid/diagnosis*
;
Middle Aged
;
Fibrin Fibrinogen Degradation Products/analysis*
;
Blood Coagulation
;
Adult
;
Fibrinogen/metabolism*
;
Partial Thromboplastin Time
;
Prothrombin Time
;
Aged
;
Inflammation/immunology*
;
ROC Curve
3.The Predictive Value of Age, D-Dimer, and FIB in Non-Thrombotic Diseases.
Zhao-Bing LUO ; Chao-Zan NONG ; Li-Bing HUANG ; Bai-Hui WEN
Journal of Experimental Hematology 2025;33(3):858-862
OBJECTIVE:
To explore the predictive value of age, D-Dimer and fibrinogen (FIB) for non-thrombotic.
METHODS:
A retrospective analysis was conducted on a total of 1 384 coagulation test cases from January to August 2024 at Nanning No. 8 People's Hospital. Among them, the control group comprised 400 non-thrombotic cases with D-Dimer test results within the reference range. The thrombotic group comprised 57 clinically diagnosed thrombotic patients. The research group comprised 927 non-thrombotic cases with D-Dimer levels exceeding the reference range. The diagnosis treatment records, age information, plasma D-Dimer, and FIB test results of each group were collected. The changes and correlations of age, D-Dimer, and FIB indicators were compared and analyzed among the three groups. A new combination factor was generated by fitting a Logistic binary regression model. ROC curves were used to evaluate the predictive value of each index for non-thrombotic disease in both the research group and the thrombotic group.
RESULTS:
Compared with the control group, the thrombotic group and the research group had significantly higher age, D-Dimer, and FIB levels (P < 0.001). Further comparative analysis showed that the research group had significantly lower age and D-Dimer levels than the thrombotic group, the FIB level was significantly higher than that of the thrombotic group (P < 0.001). Spearman correlation analysis showed that the correlation coefficient between age and D-Dimer in the research group was higher than that in the control group and thrombotic group (P < 0.01), the thrombotic group had the highest negative correlation coefficient between FIB and D-Dimer (P < 0.01). The ROC curve analysis results showed that the AUC values of age, plasma D-dimer, and FIB independently predicted non-thromb diseases were 0.726, 0.735, and 0.611, respectively. A new combined factor was generated by fitting age, D-dimer, and FIB with a logistic binary regression model. The AUC value of the combined prediction of non-thrombotic diseases was the maximum at 0.832, which had high diagnostic value, and its sensitivity and specificity were 0.572 and 0.070.
CONCLUSION
Elevated D-dimer levels were associated with age, increased FIB, and a variety of non-thrombotic diseases, and combination of age, D-dimer, and FIB had a certain predictive value for non-thrombotic diseases, but the combined model had a low specificity, other information needs to be combined in the clinic to improve diagnostic accuracy.
Humans
;
Fibrin Fibrinogen Degradation Products
;
Retrospective Studies
;
Fibrinogen
;
Predictive Value of Tests
;
Thrombosis
;
Age Factors
;
ROC Curve
;
Male
;
Female
;
Middle Aged
;
Adult
4.The Value of Thrombus Biomarkers for Assessing the Progression of Immunoglobulin A Vasculitis in Children.
Fang CHEN ; Han-Jun SHEN ; Cheng WANG ; Liang-Yue CHEN ; Jian XUE ; Jia WEI
Journal of Experimental Hematology 2025;33(4):1113-1119
OBJECTIVE:
To explore the significance of thrombus biomarkers in evaluating the progression of immunoglobulin A vasculitis (IgAV) in children.
METHODS:
A total of 193 children who were diagnosed as IgAV from September 2021 to June 2023 in the Children's Hospital of Soochow University were enrolled. The levels of plasma thrombomodulin (TM), thrombin-antithrombin complex (TAT), plasmin-α2-plasmin inhibitor complex (PIC), tissue plasminogen activator-plasminogen activator inhibitor-1 complex (t-PAIC) and D-dimer (D-D) were analyzed retrospectively. And, 140 healthy children were selected as controls during the same period. The receiver operating characteristic (ROC) curves were drawn to analyze the role of thrombus parameters in estimating the progression of IgAV in children. Univariate and multivariate logistic regression analysis were used to assess the independent risk factors influencing the progression of pediatric IgAV in acute phase.
RESULTS:
The levels of D-D, TAT, PIC and t-PAIC in plasma of IgAV group were higher than those in control group (all P <0.001). The levels of D-D, TAT and PIC in acute phase children were significantly higher than those in non acute phase children (all P <0.001), while the levels of kidney injury related indicators such as 24h-UTP, urine albumin/creatinine ratio, positive urinary blood on dipstick, serum creatinine and cystatin C were lower (all P <0.05). ROC analysis showed that the area under curve (AUC) of PIC was 0.743 when the cut-off value was 0.93 μg/ml with 71.8% sensitivity and 78.3% specificity, while the AUC of D-D was 0.756 when the cut-off value was 550.0 μg/L with 81.3% sensitivity and 73.4% specificity. Univariate and multivariate logistic regression analysis showed that PIC≥0.93 μg/ml (OR =4.64, P =0.012) and D-D≥550.0 μg/L (OR =3.60, P =0.035) were the independent risk factors for the progression of IgAV in acute phase.
CONCLUSION
The pediatric patients with IgAV have shown hyperfibrinolysis in the acute stage. Furthermore, the levels of PIC and D-D should be of diagnostic value for evaluating the progression of IgAV in the acute phase.
Humans
;
Biomarkers/blood*
;
Child
;
Fibrin Fibrinogen Degradation Products
;
Retrospective Studies
;
Thrombosis
;
Female
;
Male
;
Disease Progression
;
Thrombomodulin/blood*
;
ROC Curve
;
Vasculitis/blood*
;
Antithrombin III
;
Plasminogen Activator Inhibitor 1/blood*
;
IgA Vasculitis/blood*
;
alpha-2-Antiplasmin
;
Adolescent
;
Child, Preschool
;
Fibrinolysin
5.Current situation and exploration of clinical transformation of plasmatrix in oral implantology.
Yulan WANG ; Hao ZENG ; Yufeng ZHANG
Journal of Peking University(Health Sciences) 2025;57(5):836-840
With the rapid development of implant dentistry, increasing attention has been paid to the long-term stability and aesthetic outcomes of dental implants, among which sufficient volume and quality of soft and hard tissues are considered crucial contributing factors for successful treatment outcomes. Among the various available tissue regeneration strategies, plasmatrix, an autologous biomaterial derived from the patient ' s own peripheral blood, has demonstrated unique and significant clinical value in the regeneration and augmentation of both soft and hard tissues associated with dental implant therapy in recent years. This notable potential is primarily attributed to its rich content of multiple growth factors, viable cells, and a supportive fibrin scaffold, along with its excellent biocompatibility, tunable biodegradation profile, and a relatively simple and rapid preparation process that does not require complex laboratory equipment. As a result, its clinical applications have been continuously expanding across a wide range of indications. Based on a comprehensive review of the existing literature and current research evidence, this article provides an in-depth summary of the advancements in both basic science and clinical applications of plasmatrix in the context of implant dentistry. Particular attention is given to its classification from a materials science perspective, underlying molecular mechanisms, biological effects in promoting tissue regeneration, and its implementation under different clinical scenarios. Furthermore, the article discusses unresolved technical challenges and existing controversies, and outlines potential future directions for research and technological innovation, aiming to provide robust evidence-based guidance for clinical practice as well as a theoretical and methodological reference for future scientific investigations.
Humans
;
Biocompatible Materials/therapeutic use*
;
Dental Implants
;
Tissue Scaffolds
;
Fibrin/therapeutic use*
;
Tissue Engineering/methods*
;
Dental Implantation/methods*
;
Dental Implantation, Endosseous/methods*
6.Changes in inflammatory composite markers and D<b>-b>dimer levels in young and middle<b>-b>aged/elderly patients with hypertriglyceridemic acute pancreatitis and their predictive value for disease progression.
Jing LI ; Jinrong HU ; Yuanyuan GOU ; Long YAO ; Jie CAO
Journal of Central South University(Medical Sciences) 2025;50(2):215-226
OBJECTIVES:
Hypertriglyceridemic acute pancreatitis (HTG-AP) has a rapid onset and is associated with a high risk of progression and recurrence. Early identification of patients at risk of severe disease can help reduce the likelihood of multiple organ failure and mortality. This study aims to investigate the changes in inflammatory composite markers and D-dimer (D-D) levels in young and middle-aged/elderly patients with HTG-AP and to evaluate their predictive value for disease progression.
METHODS:
A total of 230 patients with HTG-AP admitted to Chongqing University Jiangjin Hospital (Jiangjin Central Hospital) between 2017 and 2023 were retrospectively enrolled. Patients were first divided into a young group (≤45 years) and a middle-aged/elderly group (>45 years), and then stratified into mild and severe groups based on disease severity. Inflammatory composite markers, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), C-reactive protein-to-lymphocyte ratio (CLR), systemic inflammation response index (SIRI), systemic immune inflammation index (SII), as well as D-D levels, were compared among groups. Least absolute shrinkage and selection operator (LASSO) regression and Logistic regression were used to identify independent risk factors for disease progression in each age group. Receiver operating characteristic (ROC) curves and the DeLong test were used to assess and compare the predictive performance (area under the curve, AUC) of risk factors. Internal validation was performed using the bootstrap method (n=1 000).
RESULTS:
No significant differences in NLR, PLR, MLR, SIRI, SII, CLR, or D-D levels were observed between the young (n=127) and middle-aged/elderly (n=103) groups (all P>0.05). Among young patients, the severe group (n=59) had significantly higher NLR, SIRI, SII, CLR, and D-D levels compared to the mild group (n=68) (all P<0.05). Among middle-aged/elderly patients, CLR and D-D levels were significantly higher in the severe group (n=49) than in the mild group (n=54) (P<0.05). LASSO and Logistic regression analyses identified elevated D-D as an independent risk factor for disease progression in young patients (P=0.007, OR=1.458, 95% CI 1.107 to 1.920), while both D-D (P=0.001, OR=2.267, 95% CI 1.413 to 3.637) and CLR (P=0.003, OR=1.007, 95% CI 1.003 to 1.012) were independent risk factors in middle-aged/elderly patients. ROC analysis showed that D-D predicted disease progression in young and middle-aged/elderly patients with AUCs of 0.653 and 0.741, sensitivities of 67.8% and 57.1%, and specificities of 72.1% and 88.9%, respectively. CLR predicted progression in middle-aged/elderly patients with an AUC of 0.687, sensitivity of 63.3%, and specificity of 70.4%. DeLong test showed no significant difference in AUC between D-D and CLR for middle-aged/elderly patients (Z=0.993, P=0.321). Internal validation via bootstrap analysis yielded a D-D AUC of 0.732, with sensitivity and specificity of 68.1% and 91.0%, respectively.
CONCLUSIONS
Differences in inflammatory response and coagulation function exist across age groups and disease severities in HTG-AP patients. Elevated D-D is an independent predictor of disease progression in both young and middle-aged/elderly patients, while CLR also predicts progression in the latter group. D-D, in particular, demonstrates strong predictive value for severe disease in middle-aged/elderly patients with HTG-AP.
Humans
;
Fibrin Fibrinogen Degradation Products/metabolism*
;
Disease Progression
;
Middle Aged
;
Pancreatitis/etiology*
;
Male
;
Female
;
Retrospective Studies
;
Adult
;
Biomarkers/blood*
;
Hypertriglyceridemia/blood*
;
Acute Disease
;
Predictive Value of Tests
;
Aged
;
Inflammation
;
C-Reactive Protein/analysis*
;
Neutrophils
;
Age Factors
7.Progress in application of medical absorbable haemostatic materials for haemostasis in orthopaedic surgery.
Chinese Journal of Reparative and Reconstructive Surgery 2024;38(11):1421-1426
OBJECTIVE:
The application progress of medical absorbable haemostatic material (MAHM) in hemostasis during orthoapedic surgery was reviewed, in order to provide reference for clinical hemostasis program.
METHODS:
The domestic and foreign literature on the application of MAHM for hemostasis in orthopedic surgery was extensively reviewed and summarized.
RESULTS:
According to biocompatibility, MAHM can be divided into oxidized cellulose/oxidized regenerated cellulose materials, chitosan and its derivatives materials, starch materials, collagen and gelatin materials, and fibrin glue materials, etc., which can effectively reduce blood loss when used in orthopedic surgery for hemostasis. Each hemostatic material has different coagulation mechanism and suitable population. Oxidized cellulose/oxidized regenerated cellulose, chitosan and its derivatives, starch hemostatic material mainly stops bleeding by stimulating blood vessel contraction and gathering blood cells, which is suitable for people with abnormal coagulation function. Collagen, gelatin and fibrin glue hemostatic materials mainly affect the physiological coagulation mechanism of the human body to stop bleeding, suitable for people with normal coagulation function.
CONCLUSION
Reasonable selection of MAHM can effectively reduce perioperative blood loss and reduce the risk of postoperative complications, but at present, single hemostatic material can not meet clinical needs, and a new composite hemostatic material with higher hemostatic efficiency needs to be developed.
Humans
;
Hemostatics
;
Orthopedic Procedures/methods*
;
Hemostasis, Surgical/methods*
;
Biocompatible Materials
;
Cellulose, Oxidized
;
Chitosan
;
Fibrin Tissue Adhesive
;
Gelatin
;
Blood Loss, Surgical/prevention & control*
;
Hemostasis/drug effects*
8.Progress in Application of Concentrated Growth Factor in Oral Tissue Regeneration.
Ying LU ; Si-Jun WANG ; Duo-Hong ZOU
Acta Academiae Medicinae Sinicae 2023;45(3):500-505
Tissue regeneration is an important engineering method for the treatment of oral soft and hard tissue defects.Growth factors,as one of the three elements of tissue regeneration,are a necessary condition for tissue regeneration.Concentrated growth factor(CGF)is a new generation of blood extract prepared by changing the centrifugal speed on the basis of the preparation of platelet-rich plasma(PRP)and platelet-rich fibrin(PRF).It contains abundant growth factors and a fibrin matrix with a three-dimensional network structure,being capable of activating angiogenesis and promoting tissue regeneration and healing.CGF has been widely used in the repair and regeneration of oral soft and hard tissues.This paper introduces the preparation and composition of CGF and reviews the application of CGF in oral implantation and the regeneration of oral bone tissue,periodontal tissue,and dental pulp tissue.
Platelet-Rich Plasma/metabolism*
;
Platelet-Rich Fibrin
;
Cell Proliferation
;
Bone and Bones
;
Intercellular Signaling Peptides and Proteins/metabolism*
;
Bone Regeneration
9.Clinicopathological features of fibrin-associated diffuse large B-cell lymphoma: a report of six cases.
Lan SUN ; Peng LI ; Xiao Ge ZHOU ; Xiao Jing TENG ; Yuan Yuan ZHENG ; Yan Lin ZHANG ; Jian Lan XIE
Chinese Journal of Pathology 2023;52(6):592-598
Objective:b> To investigate the clinical, pathological and immunophenotypic features, molecular biology and prognosis of fibrin-associated large B-cell lymphoma (LBCL-FA) in various sites. Methods:b> Six cases of LBCL-FA diagnosed from April 2016 to November 2021 at the Beijing Friendship Hospital, Capital Medical University, Beijing, China and the First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China were collected. The cases were divided into atrial myxoma and cyst-related groups. Clinical characteristics, pathological morphology, immunophenotype, Epstein Barr virus infection status, B-cell gene rearrangement and fluorescence in situ hybridization of MYC, bcl-2, bcl-6 were summarized. Results:b> The patients' mean age was 60 years. All of them were male. Three cases occurred in atrial myxoma background, while the others were in cyst-related background, including adrenal gland, abdominal cavity and subdura. All cases showed tumor cells located in pink fibrin clot. However, three cyst-related cases showed the cyst wall with obviously fibrosis and inflammatory cells. All cases tested were non germinal center B cell origin, positive for PD-L1, EBER and EBNA2, and were negative for MYC, bcl-2 and bcl-6 rearrangements, except one case with MYC, bcl-2 and bcl-6 amplification. All of the 5 cases showed monoclonal rearrangement of the Ig gene using PCR based analysis. The patients had detailed follow-ups of 9-120 months, were treated surgically without radiotherapy or chemotherapy, and had long-term disease-free survivals. Conclusions:b> LBCL-FA is a group of rare diseases occurring in various sites, with predilection in the context of atrial myxoma and cyst-related lesions. Cyst-related lesions with obvious chronic inflammatory background show more scarcity of lymphoid cells and obvious degeneration, which are easy to be missed or misdiagnosed. LBCL-FA overall has a good prognosis with the potential for cure by surgery alone and postoperative chemotherapy may not be necessary.
Humans
;
Male
;
Middle Aged
;
Atrial Fibrillation
;
Epstein-Barr Virus Infections
;
Fibrin/genetics*
;
Herpesvirus 4, Human/genetics*
;
In Situ Hybridization, Fluorescence
;
Lymphoma, Large B-Cell, Diffuse/pathology*
;
Myxoma
;
Proto-Oncogene Proteins c-bcl-2/genetics*
;
Proto-Oncogene Proteins c-bcl-6/genetics*
10.Comparison of pingyangmycin fibrin glue composite and pingyangmycin dexamethasone composite in the treatment of pharyngolaryngeal venous malformation.
Bo WANG ; Yu LIN ; Hui Jun YUE ; Wen Bin GUO ; Lin CHEN ; Ke Xing LYU ; Dai Ying HUANG ; Wen Bin LEI
Chinese Journal of Otorhinolaryngology Head and Neck Surgery 2023;58(6):552-557
Objective:b> To analyze and compare the efficacy and safety of pingyangmycin fibrin glue composite (PFG) and pingyangmycin dexamethasone composite (PD) in the treatment of pharyngolaryngeal venous malformation (VM). Methods:b> The clinical data of 98 patients with pharyngolaryngeal VM who underwent sclerotherapy with pingyangmycin composite in the First Affiliated Hospital of Sun Yat-sen University from June 2013 to November 2022 were retrospectively analyzed. According to their treatment, patients were divided into PFG group (n=34) and PD group (n=64), among those patients there were 54 males and 44 females, aged 1-77(37.06±18.86)years. The lesion size, total treatment times and adverse events were recorded before and after treatment. And the efficacy was divided into three grades: recovery, effective and invalid. According to the length of VM, all patients were divided into three subgroups, to compare the differences in efficacy and treatment times between each two groups.And finally the adverse events and their treatments were analyzed. SPSS 25.0 software was used for statistical analysis. Results:b> The efficacy of PFG group was 94.11%(32/34), the recovery rate was 85.29%(29/34).And the efficacy of PD group was 93.75%(60/64), the recovery rate was 64.06%(41/64). No serious adverse eventst occurred in subgroup comparison, there was no statistical difference between the two groups in efficacy and the times of treatments when the length was≤3 cm (Zefficacy=1.04, ttreatment times=2.18, P>0.05); when the length was 3-5 cm, there was no significant efficacy difference between the two groups(Zefficacy=1.17, P>0.05), but the treatment times of PFG were less (ttreatment times=4.87, P<0.01); when the length≥5 cm, efficacy of PFG was significantly better than PD (Zefficacy=2.94, P<0.01), and had fewer treatments times (ttreatment times=2.16, P<0.01). There were no serious adverse events in either group during treatment and follow-up. Conclusion:b> Both PFG and PD are safe and effective composite sclerotherapy agent for the treatment of laryngeal VM, but PFG has a higher cure rate and fewer treatment times for massive lesions.
Male
;
Female
;
Humans
;
Fibrin Tissue Adhesive/therapeutic use*
;
Retrospective Studies
;
Bleomycin/adverse effects*
;
Vascular Malformations/therapy*
;
Dexamethasone/therapeutic use*
;
Treatment Outcome

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