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Traction-assisted endoscopic submucosal dissection reduces procedure time and risk of serious adverse events: a systematic review and meta-analysis.

Surg Endosc 2021 Apr 6. Epub 2021 Apr 6.

Division of Gastroenterology and Hepatology, Johns Hopkins University, 733 N Broadway, Baltimore, MD, USA.

Background And Aims: Conventional endoscopic submucosal dissection (C-ESD) is a technically demanding procedure with prolonged procedure times and higher risk of adverse events. To overcome the procedural difficulty of ESD, several traction-assisted techniques (T-ESD) have been developed to improve visualization of the submucosa in hopes to facilitate safe and effective dissection. The aim of this study was to conduct a meta-analysis that compares short-term outcomes (30-day) of T-ESD to C-ESD. Read More

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Cost-effectiveness of a stepwise cardiometabolic disease prevention program: results of a randomized controlled trial in primary care.

BMC Med 2021 Mar 11;19(1):57. Epub 2021 Mar 11.

Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.

Background: Cardiometabolic diseases (CMD) are the major cause of death worldwide and are associated with a lower quality of life and high healthcare costs. To prevent a further rise in CMD and related healthcare costs, early detection and adequate management of individuals at risk could be an effective preventive strategy. The objective of this study was to determine long-term cost-effectiveness of stepwise CMD risk assessment followed by individualized treatment if indicated compared to care as usual. Read More

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Azithromycin in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial.

Authors:

Lancet 2021 Feb 2;397(10274):605-612. Epub 2021 Feb 2.

Background: Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatory actions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.

Methods: In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospital with COVID-19 in the UK. Read More

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February 2021

Pansomatostatin Agonist Pasireotide Long-Acting Release for Patients with Autosomal Dominant Polycystic Kidney or Liver Disease with Severe Liver Involvement: A Randomized Clinical Trial.

Clin J Am Soc Nephrol 2020 09 25;15(9):1267-1278. Epub 2020 Aug 25.

Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota.

Background And Objectives: We assessed safety and efficacy of another somatostatin receptor analog, pasireotide long-acting release, in severe polycystic liver disease and autosomal dominant polycystic kidney disease. Pasireotide long-acting release, with its broader binding profile and higher affinity to known somatostatin receptors, has potential for greater efficacy.

Design, Setting, Participants, & Measurements: Individuals with severe polycystic liver disease were assigned in a 2:1 ratio in a 1-year, double-blind, randomized trial to receive pasireotide long-acting release or placebo. Read More

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September 2020

Mildly Elevated Cardiac Troponin below the 99th-Percentile Upper Reference Limit after Noncardiac Surgery.

Korean Circ J 2020 Oct 24;50(10):925-937. Epub 2020 Jul 24.

Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Background And Objectives: In patients with perioperative cardiac troponin (cTn) I below the 99th-percentile upper range of limit (URL), mortality according to cTn I level has not been fully evaluated. This study evaluated the association between postoperative cTn I level above the lowest limit of detection but within the 99th-percentile URL and 30-day mortality after noncardiac surgery.

Methods: Patients with cTn I values below the 99th-percentile URL during the perioperative period were divided into a no-elevation group with cTn I at the lowest limit of detection (6 ng/L) and a minor elevation group with cTn I elevation below the 99th percentile URL (6 ng/L < cTn I < 40 ng/L). Read More

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October 2020

Identification of novel activators of the metal responsive transcription factor (MTF-1) using a gene expression biomarker in a microarray compendium.

Metallomics 2020 09;12(9):1400-1415

Center for Computational Toxicology and Exposure, US Environmental Protection Agency, 109 T.W. Alexander Dr. MD-B105-3, Research Triangle Park, NC 27711, USA.

Environmental exposure to metals is known to cause a number of human toxicities including cancer. Metal-responsive transcription factor 1 (MTF-1) is an important component of metal regulation systems in mammalian cells. Here, we describe a novel method to identify chemicals that activate MTF-1 based on microarray profiling data. Read More

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September 2020

Management and outcomes of newborns at risk for inherited antithrombin deficiency.

J Thromb Haemost 2020 10 21;18(10):2582-2589. Epub 2020 Jul 21.

Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.

Background: As levels of antithrombin (AT) are low at birth, diagnosing inherited AT deficiency in newborns is challenging. In Stockholm, Sweden, pregnant women with known AT deficiency are referred to the Karolinska University Hospital, where local guidelines for management of newborns at risk of inherited AT deficiency have been established. Data on pregnancy, obstetric, and neonatal outcomes are recorded in a registry. Read More

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October 2020

Large-scale mortality gap between SLE and control population is associated with increased infection-related mortality in lupus.

Rheumatology (Oxford) 2020 11;59(11):3443-3451

Department of Rheumatology, 3rd Department of Internal Medicine, Semmelweis University, Budapest.

Objective: The aim of the present study was to analyse the incidence, prevalence, mortality and cause of death data of adult SLE patients and matched controls in a full-populational, nationwide, retrospective study.

Methods: This non-interventional study was based on database research of the National Health Insurance Fund of Hungary. A total of 7888 patients were included in the analyses, within which two subgroups of incident patients were created: the 'All incident SLE patients' group consisted of all incident SLE patients (4503 patients), while the 'Treated SLE patients' group contained those who received relevant therapy in the first 6 months after diagnosis (2582 patients). Read More

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November 2020

Implementation of a Prehospital Stroke Triage System Using Symptom Severity and Teleconsultation in the Stockholm Stroke Triage Study.

JAMA Neurol 2020 06;77(6):691-699

Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.

Importance: To our knowledge, it is unknown whether a prehospital stroke triage system combining symptom severity and teleconsultation could accurately select patients for primary stroke center bypass and hasten delivery of endovascular thrombectomy (EVT) without delaying intravenous thrombolysis (IVT).

Objective: To evaluate the predictive performance of the newly implemented Stockholm Stroke Triage System (SSTS) for large-artery occlusion (LAO) stroke and EVT initiation. Secondary objectives included evaluating whether the Stockholm Stroke Triage System shortened onset-to-puncture time for EVT and onset-to-needle time (ONT) for IVT. Read More

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Persistent Low Level of Hepatitis B Virus Promotes Fibrosis Progression During Therapy.

Clin Gastroenterol Hepatol 2020 10 6;18(11):2582-2591.e6. Epub 2020 Mar 6.

Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis, National Clinical Research Center of Digestive Diseases, Beijing, China. Electronic address:

Background & Aims: Progression of liver fibrosis still occurs in some patients with chronic hepatitis B virus (HBV) infection despite antiviral therapy. We aimed to identify risk factors for fibrosis progression in patients who received antiviral therapy.

Methods: We conducted a longitudinal study of patients with chronic HBV infection and liver biopsies collected before and after 78 weeks of anti-HBV therapy. Read More

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October 2020

Factors associated with self-medication in users of drugstores and pharmacies in Peru: an analysis of the National Survey on User Satisfaction of Health Services, ENSUSALUD 2015.

F1000Res 2019 7;8:23. Epub 2019 Jan 7.

Epi-Gnosis Solutions, Piura, Peru.

Irresponsible self-medication is a problem for health systems in developing countries. We aimed to estimate the frequency of self-medication and associated factors in users of drugstores and pharmacies in Peru. We performed a secondary data analysis of the 2015 National Survey on User Satisfaction of Health Services (ENSUSALUD), a two-stage probabilistic sample of all regions of Peru. Read More

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Cigarette Smoking in Men and Women and Electronic Cigarette Smoking in Men are Associated with Higher Risk of Elevated Cadmium Level in the Blood.

J Korean Med Sci 2020 Jan 13;35:e15. Epub 2020 Jan 13.

Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea.

Background: We investigated the association between blood concentration of cadmium and smoking status including use of electronic cigarettes (E-cigars).

Methods: We used data from the Korea National Health and Nutritional Survey 2013 and 2016. A total of 4,744 participants (2,162 men and 2,582 women) were included and were categorized into five groups (Non-smokers, E-cigar non-users in past-smokers, E-cigar users in past-smokers, E-cigar non-users in cigarette-smokers and E-cigar users in cigarette-smokers). Read More

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January 2020

Comparison of different human papillomavirus (HPV) vaccine types and dose schedules for prevention of HPV-related disease in females and males.

Cochrane Database Syst Rev 2019 11 22;2019(11). Epub 2019 Nov 22.

Cochrane, Cochrane Response, St Albans House, 57-59 Haymarket, London, UK, SW1Y 4QX.

Background: Uptake of human papillomavirus (HPV) vaccine remains low in many countries, although the bivalent and quadrivalent HPV vaccines given as a three-dose schedule are effective in the prevention of precancerous lesions of the cervix in women. Simpler immunisation schedules, such as those with fewer doses, might reduce barriers to vaccination, as may programmes that include males.

Objectives: To evaluate the efficacy, immunogenicity, and harms of different dose schedules and different types of HPV vaccines in females and males. Read More

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November 2019

Evaluation of emergency department derived delirium prediction models using a hospital-wide cohort.

J Psychosom Res 2019 12 13;127:109850. Epub 2019 Oct 13.

University of Iowa College of Public Health, United States of America.

Objective: Delirium is acute disorder of attention and cognition. We conducted an observational study using a hospital-wide database to validate three delirium prediction models that were developed to predict prevalent delirium within the first day of hospitalization after ED visit.

Methods: This was a retrospective cohort study at the academic medical center to evaluate the predictive ability of three previously developed prediction models for delirium from 2014 to 2017. Read More

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December 2019

Comparison of Multiparametric Magnetic Resonance Imaging and Targeted Biopsy With Systematic Biopsy Alone for the Diagnosis of Prostate Cancer: A Systematic Review and Meta-analysis.

JAMA Netw Open 2019 08 2;2(8):e198427. Epub 2019 Aug 2.

National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol National Health Service Foundation Trust, Bristol, United Kingdom.

Importance: The current diagnostic pathway for patients with suspected prostate cancer (PCa) includes prostate biopsy. A large proportion of individuals who undergo biopsy have either no PCa or low-risk disease that does not require treatment. Unnecessary biopsies may potentially be avoided with prebiopsy imaging. Read More

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Identification of Inflammatory Mediators in Tendinopathy Using a Murine Subacromial Impingement Model.

J Orthop Res 2019 12 13;37(12):2575-2582. Epub 2019 Aug 13.

Department of Orthopaedic Surgery, Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, The Hospital for Special Surgery, New York, New York, 10021.

Subacromial impingement is associated with a spectrum of disorders-including rotator cuff disease-but their relationship is complex. We have established a novel murine model of subacromial impingement to study supraspinatus tendinopathy. The purpose of this study was to evaluate changes in gene expression in this murine shoulder impingement model to further elucidate the mechanisms underlying the development of tendinopathy. Read More

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December 2019

Thyroid nodules as a risk factor for thyroid cancer in patients with Graves' disease: A systematic review and meta-analysis of observational studies in surgically treated patients.

Clin Endocrinol (Oxf) 2019 10 13;91(4):571-577. Epub 2019 Aug 13.

3rd Department of Surgery, "AHEPA" University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.

Objective: Graves' disease (GD) is an autoimmune thyroid disorder characterized by hyperthyroidism. The incidence of thyroid cancer in patients with GD varies from 0.15% to 15%. Read More

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October 2019

Tumor necrosis factor-α-308 polymorphism is not associated with Kawasaki disease: A meta-analysis of case-control studies.

Medicine (Baltimore) 2019 Jun;98(26):e15963

Department of Pediatrics, the First Hospital of Jilin University, Changchun, Jilin, China.

Background: Genetic factors in the pathogenesis of Kawasaki disease (KD) have received a lot of attention during the past decade. Some studies have reported that tumor necrosis factor (TNF)-α-308 polymorphism has been associated with KD. However, there have been inconsonant results among different studies. Read More

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What is the Diagnostic Accuracy of MRI for Component Loosening in THA?

Clin Orthop Relat Res 2019 Sep;477(9):2085-2094

A.J. Burge, G.P. Konin, J.L. Berkowitz, B. Lin, M.F. Koff, H.G. Potter, Departments of Radiology and Imaging, Biostatistics, and MRI Laboratory, Hospital for Special Surgery, New York, NY, USA.

Background: Implant loosening is a common cause of reoperation after THA. Plain radiographs have been the default modality to evaluate loosening, although radiographs provide a relatively insensitive assessment of integration; cross-sectional modalities may provide a more detailed evaluation but traditionally have suffered from metal-related artifacts. We sought to determine whether MRI is capable of reliably detecting operatively confirmed component loosening in patients after hip arthroplasty. Read More

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September 2019

Using latent class analysis to identify treatment-use subgroups among parents of children with autism spectrum disorder.

Autism Res 2019 05 16;12(5):843-854. Epub 2019 Apr 16.

Department of Pediatrics, Baylor College of Medicine, Houston, Texas.

Among parents of 2,582 children (ages 4-17 years old) with autism spectrum disorder (ASD), we used latent class analysis to identify subgroups and profiles of treatment users and included annual household income in the specification of the models, then described characteristics of each subgroup. Based on three indicators of fit (Akaike's Information Criterion, Bayesian Information Criterion, and Lo-Mendell-Rubin), six latent classes of treatment users emerged. Subgroups included users of: (a) mostly private and school speech and occupational therapies; (b) nearly all treatment types; (c) mostly speech and occupational therapies, plus intensive behavioral and "other" treatments, but little medication use; (d) private therapies almost exclusively; (e) primarily psychotropic medications; and (f) mostly school-based therapies. Read More

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Transrectal and transvaginal catheter drainages and aspirations for management of pelvic fluid collections: technique, technical success rates, and outcomes in 150 patients.

Abdom Radiol (NY) 2019 07;44(7):2582-2593

Department of Radiology, Louisiana State University Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71130, USA.

Purpose: To evaluate outcomes of image-guided transrectal/transvaginal (TR/TV) drainage for symptomatic pelvic fluid collections (SPFCs).

Materials And Methods: Single-center retrospective study of 150 consecutive patients (36 males, 114 females, average age 41 years) who underwent attempted TR/TV drainages of SPFCs during an 11-year, 5-month period. All patients presented with pain and had SPFCs with rectal or vaginal contact on preceding diagnostic CT. Read More

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The effect of combining coronary bypass with carotid endarterectomy in patients with unrevascularized severe coronary disease.

J Vasc Surg 2019 Sep 6;70(3):815-823. Epub 2019 Mar 6.

Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass. Electronic address:

Objective: Management of significant carotid stenosis in those with symptomatic coronary disease remains controversial. Staged and combined carotid endarterectomy (CEA) with coronary artery bypass grafting has been described. Yet, an understanding of the additive risks of these approaches is poor. Read More

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September 2019

Continuity of genetic and environmental influences on clinically assessed major depression from ages 18 to 45.

Psychol Med 2019 11 28;49(15):2582-2590. Epub 2018 Nov 28.

Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA.

Background: Studies on the stability of genetic risk for depression have relied on self-reported symptoms rather than diagnoses and/or short follow-up time. Our aim is to determine to what degree genetic and environmental influences on clinically assessed major depressive disorder (MDD) are stable between age 18 and 45.

Methods: A population-based sample of 11 727 twins (6875 women) born between 1967 and 1991 was followed from 2006 to 2015 in health registry data from primary care that included diagnoses provided by treating physicians. Read More

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November 2019

Trends in Patch Testing With the Mayo Clinic Standard Series, 2011-2015.

Dermatitis 2018 Nov/Dec;29(6):310-315

Department of Dermatology and.

Background: Patch testing to a standard (baseline) series of allergens is the screening tool used to identify culprit allergens in patients with contact dermatitis. The allergens and concentrations used in a standard series are constantly evolving to be most relevant to the patients being patch tested.

Objective: The aim of this study was to analyze the 2011-2015 patch test results of the Mayo Clinic standard series. Read More

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External validation and clinical usefulness of first-trimester prediction models for small- and large-for-gestational-age infants: a prospective cohort study.

BJOG 2019 Mar 17;126(4):472-484. Epub 2019 Jan 17.

Department of Obstetrics and Gynaecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Centre, Maastricht, the Netherlands.

Objective: To assess the external validity of all published first-trimester prediction models based on routinely collected maternal predictors for the risk of small- and large-for-gestational-age (SGA and LGA) infants. Furthermore, the clinical potential of the best-performing models was evaluated.

Design: Multicentre prospective cohort. Read More

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Endometrial hyperplasia and the risk of coexistent cancer: WHO versus EIN criteria.

Histopathology 2019 Apr 10;74(5):676-687. Epub 2019 Feb 10.

Gynaecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.

Endometrial hyperplasia (EH) is classified into benign and precancerous according to two different histomorphological systems: the World Health Organisation (WHO) system (based on the subjective evaluation of cytological atypia) and the endometrial intraepithelial neoplasia (EIN) system (based on a combination of several parameters that are assessable subjectively, or objectively through computerised analysis). The American College of Obstetricians and Gynecologists recommends use of the EIN system. Nonetheless, a higher prognostic value for EIN criteria was demonstrated only with the objective assessment, which is not routinely applicable. Read More

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Intravenous morphine titration vs. oral hydrocodone/acetaminophen for adults with lower extremity displaced fracture in an emergency department setting: A randomized controlled trial.

Exp Ther Med 2018 Oct 14;16(4):3674-3679. Epub 2018 Aug 14.

Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China.

The objective of the present study was to test the hypothesis that intravenous morphine titration provides superior analgesia to oral hydrocodone/acetaminophen for patients with lower extremity displaced fracture in an emergency department (ED) setting. A prospective, randomized clinical trial of ED patients suffering acute lower extremity displaced fracture pain was performed with a total of 206 participants included. After application of exclusion criteria, the cohort comprised 166 patients, 85 of which were randomly allocated to the oral hydrocodone/acetaminophen (5 mg/500 mg) group and 81 to the intravenous morphine titration (every 5 min by 3-mg increments) group. Read More

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October 2018

Screening for gestational diabetes mellitus: one step versus two step approach. A meta-analysis of randomized trials.

J Matern Fetal Neonatal Med 2020 May 25;33(9):1616-1624. Epub 2018 Sep 25.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Phila, PA, USA.

Worldwide controversy exists regarding the best approach and criteria for gestational diabetes mellitus (GDM) screening and diagnosis. The aim of this systematic review and meta-analysis of randomized trials was to assess the incidence of maternal and neonatal outcomes comparing the one step with the two step approach for the diagnosis of GDM. Electronic databases were searched from their inception until June 2018. Read More

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Congenital Loss of Permanent Teeth in a Patient With Congenital Insensitivity to Pain With Anhidrosis due to 2 Novel Mutations in the NTRK1 Gene.

J Oral Maxillofac Surg 2018 12 7;76(12):2582.e1-2582.e9. Epub 2018 Jul 7.

Professor, Department Head, and Vice Dean, Department of Oromaxillofacial-Head and Neck Surgery and Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, China. Electronic address:

Congenital insensitivity to pain with anhidrosis (CIPA), also known as hereditary sensory and autonomic neuropathy type IV, is an extremely rare autosomal recessive disorder. This study investigated the oral and craniofacial manifestations of a 7-year-old Chinese boy affected by CIPA and identified 2 novel mutations in the NTRK1 gene, and a new feature of the disorder was identified. The patient had typical features, including insensitivity to pain, anhidrosis, and mental retardation; recurrent fractures and osteoporosis also were noted. Read More

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December 2018

Direct-acting antivirals and hepatocellular carcinoma in chronic hepatitis C: A few lights and many shadows.

World J Gastroenterol 2018 Jun;24(24):2582-2595

Filomena Morisco, Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy.

With the introduction of direct-acting antiviral agents (DAA), the rate of sustained virological response (SVR) in the treatment of hepatitis C virus (HCV) has radically improved to over 95%. Robust scientific evidence supports a beneficial role of SVR after interferon therapy in the progression of cirrhosis, resulting in a decreased incidence of hepatocellular carcinoma (HCC). However, a debate on the impact of DAAs on the development of HCC is ongoing. Read More

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