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1.
Sci Rep ; 10(1): 145, 2020 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-31924802

RESUMO

This study provide an insight that the panel genes methylation status in different clinical stage tended to reflect a different prognosis even in matched normal tissues, to clinical recommendation. We enrolled 153 colorectal cancer patients from a medical center in Taiwan and used the candidate gene approach to select five genes involved in carcinogenesis pathways. We analyzed the relationship between DNA methylation with different cancer stages and the prognostic outcome. There were significant trends of increasing risk of 5-year time to progression and event-free survival of subjects with raising number of hypermethylation genes both in normal tissue and tumor tissue. The group with two or more genes with aberrant methylation in the advanced cancer stages (Me/advanced) had lower 5-year event-free survival among patients with colorectal cancer in either normal or tumor tissue. The adjusted hazard ratios in the group with two or more genes with aberrant methylation with advanced cancer stages (Me/advanced) were 8.04 (95% CI, 2.80-23.1; P for trend <0.01) and 8.01 (95% CI, 1.92-33.4; P for trend <0.01) in normal and tumor tissue, respectively. DNA methylation status was significantly associated with poor prognosis outcome. This finding in the matched normal tissues of colorectal cancer patients could be an alternative source of prognostic markers to assist clinical decision making.

2.
World J Gastroenterol ; 26(2): 154-167, 2020 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-31988582

RESUMO

BACKGROUND: It is evident that current clinical criteria are suboptimal to accurately estimate patient prognosis. Studies have identified epigenetic aberrant changes as novel prognostic factors for colorectal cancer (CRC). AIM: To estimate whether a methylation gene panel in different clinical stages can reflect a different prognosis. METHODS: We enrolled 120 CRC patients from Tri-Service General Hospital in Taiwan and used the candidate gene approach to select six genes involved in carcinogenesis pathways. Patients were divided into two groups based on the methylation status of the six evaluated genes, namely, the < 3 aberrancy group and ≥ 3 aberrancy group. Various tumor stages were divided into two subgroups (local and advanced stages) on the basis of the pathological type of the following tissues: Tumor and adjacent normal tissues (matched normal). We assessed DNA methylation in tumors and adjacent normal tissues from CRC patients and analyzed the association between DNA methylation with different cancer stages and the prognostic outcome including time to progression (TTP) and overall survival. RESULTS: We observed a significantly increasing trend of hazard ratio as the number of hypermethylated genes increased both in normal tissue and tumor tissue. The 5-year TTP survival curves showed a significant difference between the ≥ 3 aberrancy group and the < 3 aberrancy group. Compared with the < 3 aberrancy group, a significantly shorter TTP was observed in the ≥ 3 aberrancy group. We further analyzed the interaction between CRC prognosis and different cancer stages (local and advanced) according to the methylation status of the selected genes in both types of tissues. There was a significantly shorter 5-year TTP for tumors at advanced stages with the promoter methylation status of selected genes than for those with local stages. We found an interaction between cancer stages and the promoter methylation status of selected genes in both types of tissues. CONCLUSION: Our data provide a significant association between the methylation markers in normal tissues with advanced stage and prognosis of CRC. We recommend using these novel markers to assist in clinical decision-making.

3.
Medicine (Baltimore) ; 99(1): e18530, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895788

RESUMO

The role of atopic dermatitis (AD) in the development of colorectal cancer (CRC) has been a matter of scientific debate with mixed results. We conducted a nationwide cohort study to assess the association between AD and risk of CRC. Drawing on Taiwan's National Health Insurance Research Database, 46,703 patients with AD (the AD cohort) and 186,812 sex, age, and index year-matched patients without AD (the non-AD cohort) were identified in the period between 2000 and 2008. Follow-up time was calculated from the date of entry in the cohort until the occurrence of a first CRC diagnosis, death, or the end of the observation period (December 31, 2013), whichever occurred first. Hazards ratios (HRs) and accompanying 95% confidence intervals (CIs) derived from the Fine-Gray competing risk model were used to estimate the association between AD and CRC risk. After multivariable adjustment, AD was associated with an increased risk of CRC (adjusted HR, 1.26; 95% CI, 1.14-1.40). Of note, a significant positive association between AD and CRC risk was evident in both men and women and in all age groups. In summary, this population-based cohort study revealed that AD was associated with an increased risk of CRC in an Asian population. It will be of interest for cohort studies with prediagnostic specimens to evaluate the potential relationship between AD and CRC using biomarkers for allergy status.


Assuntos
Neoplasias Colorretais/epidemiologia , Dermatite Atópica/complicações , Adulto , Neoplasias Colorretais/etiologia , Bases de Dados Factuais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia , Adulto Jovem
4.
Asian J Surg ; 43(1): 330-338, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31320234

RESUMO

BACKGROUND: Laparoscopy-assisted robotic transanal total mesorectal excision is a novel surgical technique for rectal cancer resection. Compared to prior DaVinci Si system case series, this case series is the first to report robotic taTME assisted by laparoscopy (r-taTME) in which the "transanal team" operates via the DaVinci Xi system. As a result, we aim to delineate and discuss preliminary findings from our robotic taTME experiences. METHODS: A total of twenty patients (twelve males) who underwent robotic taTME assisted by laparoscopy (r-taTME) between January 2016 and November 2016 at a single institution were documented. Surgical outcomes, including complications, pathological outcomes, and short-term results, were then retrospectively analyzed. RESULTS: All patients underwent r-taTME via a two-team approach. The "abdominal team" operated via a single port method (ileostomy site), while the "transanal team" operated via the DaVinci Xi system. The mean patient age was 56.7 ± 14.3 years (range 31-79), and the mean distance from tumor to anal verge was 6.0 ± 2.7 cm (range 2-10). The mean estimated intraoperative blood loss was 88 ± 107 ml (range 30-500), and circular stapling was utilized to restore continuity in 80% of study patients. The overall postoperative complication rate was 35%, and the mean distal margin length was 3.1 ± 1.3 cm. There were three patients who had a circumferential margin (CRM) involved by cancer cells (≤1 mm). CONCLUSION: Our preliminary series report demonstrates that utilization of r-taTME assisted by laparoscopy is safe and feasible. Development of a novel transanal approach that allows single-port access alongside a multi-arm robotic system may increase the convenience and efficiency of future operation.

5.
Sleep Med ; 66: 15-20, 2019 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-31785565

RESUMO

BACKGROUND: Epidemiological studies on the obstructive sleep apnea (OSA) and cancer relationship in humans are inconsistent. Furthermore, there are limited prospective studies on the association between OSA and the risk of colorectal cancer (CRC). This retrospective cohort study examined the longitudinal relationship between OSA and CRC in a nationwide population-based cohort. METHODS: We identified 4180 individuals newly diagnosed with OSA (the exposed cohort) and randomly selected 16,720 age- and sex-matched subjects without OSA (the nonexposed cohort) between 2000 and 2008 from Taiwan's National Health Insurance Research Database (NHIRD). The Kaplan-Meier method was used for calculating the cumulative incidence of CRC in each cohort. Cox proportional hazard regression models were used to estimate hazard ratios (HRs) and the accompanying 95% confidence intervals (CIs) for the association between OSA and CRC. RESULTS: After adjusting for potential confounders, patients with OSA were associated with a significantly higher risk of CRC than those without OSA (adjusted HR, 1.80; 95% CI, 1.28-2.52). The cumulative incidence of CRC was significantly higher in the OSA cohort than in the comparison cohort (log-rank test, p < 0.001). Furthermore, the association between OSA and CRC appeared to be enhanced with increasing frequency of OSA medical visits (adjusted HR [95% CI] was 1.61 [0.97-2.66] and 1.86 [1.26-2.75] for one visit and two or more visits, respectively). CONCLUSION: This population-based cohort study demonstrated that OSA was associated with an increased risk of CRC. Further large-scale prospective studies are needed to confirm our results.

6.
BMC Cancer ; 19(1): 1120, 2019 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-31733644

RESUMO

BACKGROUND: Kidney transplantation (KT) correlates with an increased risk of developing several malignancies; however, the risk of colorectal cancer (CRC) after KT remains debatable and has been marginally explored. Hence, in this nationwide, retrospective, population-based cohort study, we aimed to examine the correlation between KT and CRC in a large-scale population-based Chinese cohort. METHODS: We identified a total of 3739 regular hemodialysis patients undergoing KT (exposed cohort) and 42,324 hemodialysis patients not undergoing KT (non-exposed cohort) between 2000 and 2008 from Taiwan's National Health Insurance Research Database (NHIRD). Both cohorts were followed up from January 1, 2000, to the date of CRC diagnosis, death, or the end of 2013. Using Kaplan-Meier method, we measured the cumulative incidence of CRC in each cohort. Furthermore, Cox proportional hazards models were used to compute hazards ratios (HRs) and 95% confidence intervals (CIs) to estimate the correlation between KT and CRC in hemodialysis patients. RESULTS: The Kaplan-Meier analysis revealed that the cumulative incidence of CRC was significantly higher in the exposed cohort than in the non-exposed cohort (log-rank test, P < 0.001). After adjusting for potential confounders, the exposed cohort exhibited a significantly increased risk of CRC compared with the non-exposed cohort (adjusted HR, 1.34; 95% CI, 1.11-1.62). CONCLUSIONS: Hemodialysis patients undergoing KT have a significantly higher risk of CRC than those not undergoing KT. Cancer should continue to be a primary focus of prevention during KT.

7.
Int J Mol Sci ; 20(19)2019 09 20.
Artigo em Inglês | MEDLINE | ID: mdl-31547144

RESUMO

Colorectal cancer (CRC) is one of the most common cancers and the second leading cause of cancer-related deaths. Discrepancies in clinical outcomes are observed even among patients with same-stage CRC due to molecular heterogeneity. Thus, biomarkers for predicting prognosis in CRC patients are urgently needed. We previously demonstrated that stage II CRC patients with NKX6.1 methylation had poor 5-year overall survival. However, the methylation frequency of NKX6.1 was only 23% in 151 pairs of CRC tissues. Thus, we aimed to develop a more robust prognostic panel for CRC using NKX6.1 in combination with three genes: LIM homeobox transcription factor 1α (LMX1A), sex-determining region Y-box 1 (SOX1), and zinc finger protein 177 (ZNF177). Through quantitative methylation analysis, we found that LMX1A, SOX1, and ZNF177 were hypermethylated in CRC tissues. LMX1A methylation was significantly associated with poor 5-year overall, and disease-free survivals in stage I and II CRC patients. Sensitivity and specificity analyses of the four-gene combination revealed the best sensitivity and optimal specificity. Moreover, patients with the four-gene methylation profile exhibited poorer disease-free survival than those without methylation. A significant effect of the four-gene methylation status on overall survival and disease-free survival was observed in early stage I and II CRC patients (p = 0.0016 and p = 0.0230, respectively). Taken together, these results demonstrate that the combination of the methylation statuses of NKX6.1, LMX1A, SOX1, and ZNF177 creates a novel prognostic panel that could be considered a molecular marker for outcomes in CRC patients.

8.
Int J Clin Pract ; 72(7): e13212, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29920876

RESUMO

AIMS: This cohort study aimed to investigate the association between irritable bowel syndrome (IBS) and the risk of developing psychiatric disorders. METHODS: Utilizing the National Health Insurance Research Database (NHIRD) of Taiwan, IBS patients were identified and compared with age, sex, and index year-matched controls (1:3). RESULTS: Of the IBS subjects, 3934 in 22 356 (17.60%, or 1533.68 per 100 000 person-years) developed psychiatric disorders when compared with 6127 in 67 068 (9.14%, or 802 per 100 000 person-years) in the non-IBS control group. Fine and Gray's survival analysis revealed that the study subjects were more likely to develop psychiatric disorders. The crude hazard ratio (HR) is 3.767 (95% CI: 3.614-3.925, P < .001), and the adjusted HR is 3.598 (95% CI: 3.452-3.752, P < .001) in the risk of developing psychiatric disorders after being adjusted for age, sex, comorbidities, geographical area of residence, urbanisation level of residence, and monthly insurance premiums. The cohort study revealed that IBS subjects were associated with an increased risk of anxiety, depression, bipolar, and sleep disorders. CONCLUSIONS: This cohort study, using NHIRD, shows evidence support that patients with IBS have a 3.6-fold risk of developing psychiatric disorders. Other large or national datasets should be done to explore to underlying mechanisms.


Assuntos
Transtornos de Ansiedade/epidemiologia , Transtornos Bipolares e Relacionados/epidemiologia , Transtorno Depressivo/epidemiologia , Síndrome do Intestino Irritável/epidemiologia , Adulto , Idoso , Transtornos de Ansiedade/psicologia , Transtornos Bipolares e Relacionados/psicologia , Estudos de Coortes , Comorbidade , Bases de Dados Factuais , Transtorno Depressivo/psicologia , Feminino , Humanos , Incidência , Síndrome do Intestino Irritável/psicologia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Projetos de Pesquisa , Transtornos do Sono-Vigília/epidemiologia , Taiwan , Adulto Jovem
9.
Int J Colorectal Dis ; 33(3): 349-352, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29397431

RESUMO

BACKGROUND: Periodontal disease (PD) and colorectal cancer (CRC) were associated with chronic inflammation. This retrospective cohort study examined the association between PD severity and CRC in a large-scale, population-based Chinese cohort. METHODS: A total of approximately 106,487 individuals with newly diagnosed PD and 106,487 age-matched and sex-matched patients without PD from 2000 to 2002 were identified from Taiwan's National Health Insurance Research Database (NHIRD). RESULTS: The Kaplan-Meier analysis revealed that the cumulative incidence of CRC was significantly higher in patients with PD than in those without PD (log-rank test, P < 0.001). After adjustment for age, sex, and comorbidities, patients with PD were associated with a significantly higher risk of CRC compared with those without PD (adjusted HR = 1.64, 95% CI = 1.50-1.80). Further, the risk of CRC appeared to increase with increasing frequency of PD medical visits [adjusted HR (95% CI) was 1.78 (1.58-2.02) and 1.53 (1.35-1.74) for annual visits > 10 and < 4, respectively]. CONCLUSION: Based on our study, PD severity was associated with an increase in the risk of CRC. Further mechanistic research is needed.


Assuntos
Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/etiologia , Doenças Periodontais/complicações , Doenças Periodontais/patologia , Índice de Gravidade de Doença , Adulto , Estudos de Coortes , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Fatores de Risco
10.
Genes Chromosomes Cancer ; 57(5): 268-277, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29363224

RESUMO

Colorectal cancer (CRC) is a common malignancy worldwide. CRC patients in the same stage often present with dramatically different clinical scenarios. Thus, robust prognostic biomarkers are urgently needed to guide therapies and improve treatment outcomes. The NKX6.1 gene has been identified as a hypermethylation marker in cervical cancer, functioning as a metastasis suppressor by regulating epithelial-mesenchymal transition. Here, we investigated whether hypermethylation of NKX6.1 might be a prognostic biomarker for CRC. By analyzing the methylation and expression of NKX6.1 in CRC tissues and CRC cell lines. We quantitatively examined the NKX6.1 methylation levels in 151 pairs of CRC tissues by using methylation-specific polymerase chain reaction analysis and found that NKX6.1 was hypermethylated in 35 of 151 CRC tissues (23%). NKX6.1 gene expression was inversely correlated with the DNA methylation level in CRC cell lines in vitro. Then, we analyzed the association of NKX6.1 methylation with clinical characteristics of these CRC patients. Our data demonstrated that patients with NKX6.1 methylation presented poorer 5-year overall survival (P = 0.0167) and disease-free survival (P = 0.0083) than patients without NKX6.1 methylation after receiving adjuvant chemotherapy. Most importantly, these data revealed that stage II CRC patients with NKX6.1 methylation had poorer 5-year disease-free survival (P = 0.0322) than patients without NKX6.1 methylation after adjuvant chemotherapy. Our results demonstrate that methylation of NKX6.1 is a novel prognostic biomarker in CRC and that it may be used as a predictor of the response to chemotherapy.


Assuntos
Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/genética , Metilação de DNA , Proteínas de Homeodomínio/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/genética , Biomarcadores Tumorais/metabolismo , Quimioterapia Adjuvante , Neoplasias Colorretais/metabolismo , Neoplasias Colorretais/patologia , Intervalo Livre de Doença , Feminino , Proteínas de Homeodomínio/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Prognóstico , Regiões Promotoras Genéticas , Resultado do Tratamento , Adulto Jovem
11.
Pediatr Allergy Immunol ; 29(3): 260-266, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29314287

RESUMO

BACKGROUND: Atopic dermatitis (AD) is associated with systemic inflammation and may have a similar pathogenesis as obstructive sleep apnea (OSA). However, to date, studies on the association between AD and OSA are limited. OBJECTIVES: This study evaluated the association between OSA and AD in children in a large-scale, population-based cohort. METHODS: A total of approximately 120 736 children (<18 years) with newly diagnosed AD and 120 736 age- and sex-matched patients without AD from 2000 to 2007 were identified from Taiwan's National Health Insurance Research Database from 2000 to 2007. The Kaplan-Meier test was used for measuring the cumulative incidence of OSA in each cohort. Cox proportional hazard regression models were used for evaluating the risk of OSA in patients with or without AD between the two cohorts. RESULTS: The Kaplan-Meier analysis revealed that the cumulative incidence curves of OSA were significantly higher in patients with AD than in those without AD (log-rank test, P < .001). After adjusting for age, sex, urbanization level, and comorbidities, patients with AD had a higher risk of OSA than those without AD (adjusted hazard ratio = 1.86, 95% confidence interval = 1.43-2.42). Compared with patients without AD, patients with AD exhibited a higher risk of developing OSA, irrespective of underlying comorbidities. CONCLUSION: This nationwide, population-based cohort study revealed an increased risk of OSA in children with AD. Therefore, comprehensive evaluation and aggressive risk reduction for OSA are recommended in these patients.


Assuntos
Dermatite Atópica/complicações , Apneia Obstrutiva do Sono/epidemiologia , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Incidência , Masculino , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Apneia Obstrutiva do Sono/complicações , Análise de Sobrevida , Taiwan/epidemiologia
12.
J Chin Med Assoc ; 79(9): 477-88, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27329402

RESUMO

BACKGROUND: It is uncertain whether adjuvant chemotherapy (CMT) improves survival in patients with low-risk Stage II colon cancer. We aimed to determine the disease-free survival (DFS) and 5-year overall survival (OS) of low-risk Stage II colon cancer patients treated with adjuvant tegafur/uracil (UFUR). METHODS: From January 2004 to December 2011, the follow-up status of 278 low-risk Stage II colon cancer patients who underwent surgery in a single medical center was retrospectively analyzed. These patients were divided into three groups based on whether they received adjuvant CMT with UFUR, adjuvant CMT with 5-fluorouracil, or surgery alone. DFS and 5-year OS curves were calculated using Kaplan-Meier survival analysis and Cox proportional hazards regression. RESULTS: In the study population, including 278 low-risk Stage II colon cancer patients with a mean age of 68.28 ± 13.01 years, 132 (47.5%) received adjuvant CMT with UFUR, 49 (17.6%) received adjuvant CMT with 5-fluorouracil, and 97 (34.9%) underwent radical surgery alone. At 5 years, the adjusted DFS and OS of low-risk Stage II colon cancer patients were 85.5% and 81.8%, respectively, in the surgery alone group and 97.9% and 96.2%, respectively, in the surgery plus UFUR > 12 months group (p = 0.004 and p = 0.098, respectively). In multivariate analysis, CMT with UFUR for more than 12 months increased DFS over surgery alone. There was no statistical difference in the 5-year OS. CONCLUSION: Adjuvant CMT treatment of low-risk Stage II colon cancer patients with UFUR for more than 12 months following surgery improves DFS over surgery alone.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias do Colo/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Adjuvante , Neoplasias do Colo/mortalidade , Neoplasias do Colo/patologia , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Tegafur/administração & dosagem , Uracila/administração & dosagem
13.
Taiwan J Obstet Gynecol ; 55(2): 198-201, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27125402

RESUMO

OBJECTIVE: We investigated the necessity of preoperative bowel preparation for gynecological oncology surgery. MATERIALS AND METHODS: We retrospectively reviewed the medical records of patients who underwent gynecological oncology surgery with simultaneous colon or rectal resection between April 2005 and September 2014 at the Tri-Service General Hospital, Taipei, Taiwan. Patients were divided into two groups based on whether preoperative mechanical bowel preparation (MBP) was performed. Patient characteristics, including duration of antibiotic treatment, surgical procedures, and occurrence of surgical and nonsurgical complications, were compared. RESULTS: We enrolled 124 patients who underwent gynecological oncology surgery with simultaneous colon or rectal resection, of whom 76 received MBP and 48 did not receive mechanical bowel preparation. On comparison between the two groups, no significant differences were noted in the assessed patient characteristics, including mean age (p = 0.61), Federation of Gynecology and Obstetrics stage (p = 0.9), American Society of Anesthesiologists grade (p = 0.9), body mass index (p = 0.8), and residual tumor size (p = 0.86). Furthermore, duration of antibiotic treatment (p = 0.97), surgical procedures (p = 0.99), and total hospital days (p = 0.75), were not different between groups. The risk of surgical (p = 0.78) or nonsurgical (p = 1.0) complications was not significantly higher in the non-MBP group than in the MBP group. CONCLUSION: MBP provides no significant benefit during gynecological oncology surgery. Thus, preoperative MBP is not essential before gynecological oncology surgery and can be omitted.


Assuntos
Antibacterianos/administração & dosagem , Antibioticoprofilaxia , Colectomia , Neoplasias dos Genitais Femininos/cirurgia , Laxantes/administração & dosagem , Reto/cirurgia , Abscesso Abdominal/etiologia , Idoso , Fístula Anastomótica/etiologia , Colectomia/efeitos adversos , Enema , Feminino , Humanos , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/etiologia
14.
Asian Pac J Trop Biomed ; 3(3): 229-31, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23620844

RESUMO

A case of furuncular myiasis was reported for the first time in a 29-year-old young Taiwanese traveler returning from an ecotourism in Peru. Furuncle-like lesions were observed on the top of his head and he complained of crawling sensations within his scalp. The invasive larva of botfly, Dermatobia hominis, was extruded from the furuncular lesion of the patient. Awareness of cutaneous myiasis for clinicians should be considered for a patient who has a furuncular lesion and has recently returned from a botfly-endemic area.


Assuntos
Dípteros/fisiologia , Miíase/diagnóstico , Adulto , Animais , Dípteros/crescimento & desenvolvimento , Humanos , Larva/fisiologia , Masculino , Miíase/parasitologia , Taiwan , Resultado do Tratamento
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