Eric Douglass McCollum, M.D.

  • Assistant Professor of Pediatrics

https://www.hopkinsmedicine.org/profiles/results/directory/profile/5368993/eric-mccollum

Patients with this condition should be strongly counselled against pregnancy or offered termination anxiety vs heart attack purchase generic buspar on-line. It is mostly well tolerated in pregnancy anxiety symptoms not going away buy buspar 5mg mastercard, though beta blockers may be used for symptom control anxiety symptoms treatment and prevention buy cheap buspar 10mg line. Hypotension should be avoided as this may increase left ventricular outflow tract obstruction (iv) Peripartum cardiomyopathy this is defined as the development of heart failure in the absence of a known cause anxiety symptoms anxiety attacks buy buspar mastercard, occurring in late pregnancy or up to 5 months post partum. Risk factors include multiple pregnancy, hypertension, increasing maternal age and those of Afro-Caribbean origin. There may be tachycardia and tachypnoea together with signs of cardiac failure and dysrhythmias. Prophylactic anticoagulation should be used as the risk of thromboembolic disease is thought to be as high as 40%. Prognosis depends on normalisation of left ventricular size and function within 6 months of delivery. For those where the disease resolves, the recurrence risk appears to be less than 25%, though high risk care will be advocated. Adequate control of blood pressure cannot be maintained during exercise, and this brings the risk of cerebral haemorrhage or aortic dissection, so exertion needs to be avoided. Normal delivery is possible but in severe disease second stage should be shortened. Ectopic beats are common in both mother and fetus and generally have no adverse effects on either. However, investigations should be performed to exclude, anaemia, thyroid disease, together with an examination of cardiovascular and respiratory symptoms. The physiological stresses of pregnancy and delivery are thought to bring out an underlying potential cardiac arrhythmia. Risk factors include advanced maternal age, smoking, diabetes, obesity, hypertension and a positive family history. Author: J Ablett, A Elkington, L Williams, L MacKillop Date: Job Title: Consultant Obstetrician, Consultant Cardiologist, Consultant Review Anaesthetist, Consultant Obstetric Physician (J Radcliffe Hospital) Date: Policy Group Director Urgent Care Version: V6. They should be referred to the Consultant Anaesthetic Antenatal clinc and offered an appointment. Close co-operation between the anaesthetist, cardiologist and obstetrician is important to ensure optimal management. The anaesthetic management plan will Author: J Ablett, A Elkington, L Williams, L MacKillop Date: Job Title: Consultant Obstetrician, Consultant Cardiologist, Consultant Review Anaesthetist, Consultant Obstetric Physician (J Radcliffe Hospital) Date: Policy Group Director Urgent Care Version: V6. For many of these women an epidural is the ideal labour analgesic and they should be expedited as medically necessary. Ergometrine causes vasoconstriction, Syntocinon vasodilatation and tachycardia while carboprost (haemabate) can cause bronchospasm and pulmonary hypertension. Both Carbetocin and Oxytocin should be diluted and given slowly, observing the effects. Depending on the cardiac condition ergometrine and carboprost may even be contraindicated. This could be provided by regional analgesia/anaesthesia but specific agents such as glycerol nitrate may be required. It may be appropriate for some of these women to be having an elective Caesarean section. The best way to provide a stable anaesthetic will be thought through as a guide in case of the need for emergency delivery. If delivery needs to be expedited within the proscribed period after administration of anticoagulant agents the risks and benefits of performing a block must be evaluated at the time, though this will be discussed at the antenatal assessment. This increases 10 fold if the mother has a cardiac anomaly and may be as high as 10% if both parents are affected. Thus a fetal cardiac scan should be performed at 24 weeks by Dr Suruchi Arora or Miss Surabhi Bisht. March 2008 Author: J Ablett, A Elkington, L Williams, L MacKillop Date: Job Title: Consultant Obstetrician, Consultant Cardiologist, Consultant Review Anaesthetist, Consultant Obstetric Physician (J Radcliffe Hospital) Date: Policy Group Director Urgent Care Version: V6. Jill Ablett, Consultant Obstetrician and Medical Lead Andrew Elkington, Consultant Cardiologist Lucy MacKillop, Consultant Obstetric Physician, John Radcliffe hospital, Oxford 26. Anaesthetic Referral All pregnant women with cardiac conditions need referral to the Anaesthetic Department. Fetal Medicine Referral Any woman with a congenital cardiac abnormality needs referral for a fetal cardiac scan at 24 weeks (Refer to Miss S Bisht or Dr Arora) back to top of page Author: J Ablett, A Elkington, L Williams, L MacKillop Date: Job Title: Consultant Obstetrician, Consultant Cardiologist, Consultant Review Anaesthetist, Consultant Obstetric Physician (J Radcliffe Hospital) Date: Policy Group Director Urgent Care Version: V6. In some cases it is appropriate to give Oxytocin in a lower dose, diluted in smaller volumes and / or infused slowly. Carbetocin is a long acting Oxytocin analogue which appears to cause relatively little cardiovascular disturbance. Ergometrine causes an increase in systemic vascular resistance and should be avoided in some cases of congenital heart disease (ischaemic heart disease, coarctation and pulmonary hypertension). Carboprost (haemabate) and misoprostol are contraindicated in patients with myocardial ischaemia. Carboprost may also cause bronchoconstriction Intravenous fluids General principles: Maintain normovolaemia Monitor input and output closely to avoid fluid overload Use volumetric fluid pump Author: J Ablett, A Elkington, L Williams, L MacKillop Date: July 2018 Job Title: Consultant Obstetrician, Consultant Cardiologist, Consultant Anaesthetist, Review July 2020 Consultant Obstetric Physician (J Radcliffe Hospital) Date: Policy Group Director Urgent Care Version: V6. Introduction and Who Guideline applies to this guideline is intended to assist staff in the management of the common cardiac conditions likely to be encountered in an acute hospital setting. In this latest edition there have been new contributions from Dr Elved Roberts in structural interventions. Dr Loke and Professor Squire reviewed the heart failure guidelines, Dr Stanley hypertension management. Guideline is the important word, as this booklet is not intended to be the definitive text of the management of cardiac patients. It is simply meant to guide medical and nursing staff in the management of acute cardiac problems presenting to the cardiology wards or medical admissions units. The guidelines should also assist more widely across the trust in other disciplines. If anyone using this guideline has any suggestions for additions, improvements or have identified errors, then please let me know. No part of this publication may be reproduced, stored in any retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the author. The author has, as far as it is possible, taken care to ensure that the information given in this text is accurate and up to date. However, readers are strongly advised to confirm that the information, especially with regard to drug usage, complies with current legislation and standards of practice. Patients may be admitted directly via paramedic crews, the Emergency Department or other wards. It is appropriate for most patients to be discharged to the wards within 24 to 48 hours. Forward planning is important as only in exceptional circumstances should patients be transferred after 22:00hrs. The yellow clerking sheets should be filled in even when patients are transferred from other wards as the design allows quicker assessment of pertinent issues such as risk factor profile and previous cardiac events. The yellow sheets are multidisciplinary and so nursing and medical staff document relevant issues in them for improved communication. Ward rounds take place first thing each morning and generally again later in the day. It is essential that a full hand-over is performed every day to the next doctor on duty for the unit.

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Hyperdense middle cerebral artery represents the blood clot formed in a major intracranial arterial trunk that will be seen as hyperdensity within the artery as a result of clot retraction resulting to very high concentration of protein or globin component of blood (Fig anxiety medication 05 mg buspar 10mg on line. Likewise anxiety 5 steps best 5mg buspar, if the There are also different etiologic causes of stroke such as cardiogenic or embolic anxiety symptoms webmd order buspar in united states online, hyperdensity is noted in both middle cerebral arteries anxiety journal template discount buspar 5 mg amex, its value as an early sign of stroke is no atherosclerotic, lacunar and watershed type of infarcts, among others. As the contrast agent passes through the brain patient exhibiting a completed infarct parenchyma, there will be transient hyperattenuation of the tissues that is directly proportional after two days (white arrow head) at the right insular cortical and subcortical to the amount of contrast material in the vessels and blood. The right lentiform nucleus is obscured, an early sign of hyperacute infarct (double black arrows) with normal left lentiform nucleus. One difficulty in thrombolysis is the assessment of the volume of the infarct core, whether its size is still within one-third the volume of the middle cerebral artery distribution. Parts of the brain are assigned points with the normal brain being a perfect 10 points. By deducting the equivalent point/s for each area of the brain that is infarcted from the total perfect score of 10 points assigned to the normal brain, the volume of infarct core is estimated. It can also demonstrate the resulting from restricted diffusion of presence of arterial dissection and at the same time determine the degree of collateral blood water. This is a fast that is at risk of infarction or the penumbra, that may eventually become infracted if blood and accurate method in stroke diagnosis and considered straight forward although it will require supply is not restored in time. This will provide a tool that can allow stroke recognition and diagnosis within a short interval of thirty minutes from the onset of the ischemic lesion. High field gradients that is typically found in magnets that A very important consideration in prognosticating the outcome of intracerebral hemorrhage is is at least 1. The basis for demonstration of hematomas is the degradation of hemoglobin in the brain tissue from its intravascular state. Normal bone, physiologic calcification of the pineal gland, choroid plexus, basal ganglia and falx cerebri b. Written Care Protocols: the availability of written protocols is key in reducing time to treatment and treatment complications. Laboratory Services: Standard laboratory services should be available round-the 1. Outcomes/Quality Improvement: Primary Stroke Centers should have a database on the very acute care for a selected group of acute stroke patients and have little or registry for tracking the type and number of stroke patients seen, their or no focus on rehabilitation. The units usually do not have intensive care facilities, but usually education, the Stroke Center should plan and implement at least two annual have facilities for non-invasive monitoring of vital signs. In general, length of stay not longer than seven days Analysis on Cochrane Data Base involving 23 trials showed significant reduction of death C. Indications for Admission to the Stroke Unit when patients were treated in a stroke unit compared with those treated in general wards. Awake, somnolent patient Two trials evaluated the long-term effects of stroke unit care. Stupor and coma benefit is the combined acute/rehabilitation stroke-unit model, and to some extent the 2 b. Admission within the unstable phase (in general, <24 hours) and expertise in the assessment and rehabilitation of disabling illness, but do 2. Very old patients or those with multiple comorbidities the stroke unit benefits stroke patients of both sexes, all ages, and those with mild, moderate or severe strokes. Patients with the following should be admitted to the intensive care unit instead of the acute stroke unit: Comparing the different stroke unit models, the unit with the strongest evidence of a. Have undergone stroke fellowship or preceptorship training on stroke based on the a. Aboderin I, Venables G; for the Pan European Consensus Meeting on Stroke Management prevention of stroke. Stroke identifying clients developing stroke on the established management of 1997;28:1861-1866. Stroke unit treatment improves long term quality (Screening) for stroke and shall utilize a risk assessment nursing of life: a randomized controlled trial. Five year follow-up of a randomized controlled clients identified high-risk will be implemented trial of a stroke rehabilitation unit. A focus group discussion and consensus building was conducted with the modification. Diaz Stroke Scale intensive care unit thereafter as necessary and neurological technique c. Provision of needs in collaboration condition, needs neurologic vital signs with windows/murals for every with other members and priorities proper documentation and room of the health team a. Nursing Care on Continued Stabilization of the Stroke Patient the Comprehensive Overview of Nursing and Interdisciplinary Care of the Acute Ischemic Stroke Patient: A Scientific Statement from the American Heart Association (Summers et al Class I 2009), Stroke, Journal of the American Heart Association. Class I 1) Emergency personnel should be highly trained in stroke care (Class I, Level of B. Emergency Nursing Interventions in the Emergency/Hyperacute Phase of Stroke should begin immediately (Class I, Level of Evidence B). Class I 3) Supplement oxygen should be given to patients with an oxygen saturation of 92% All nurses should be familiar with the basic neuroimaging testing for stroke patients so that and a decreased level of consciousness (Class I, Level of Evidence C). Further studies of dysphagia in the Speakership Experienced in internal Experienced in external Experienced in setting of acute stroke should be performed. Describe the methods of assessment and diagnosis used for stroke and management of the disease from a nursing perspective. Key issues with regards to out of the way to make room for a wheelchair or for walking with a walker rehabilitation of stroke patients were identified. It provides basic standard care for stroke patients although approach and management should be individualized as dictated 2. This guideline was developed through the formation of a consensus panel composed of a A.

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Treatment for the premenstrual syndrome with treatment of generalized anxiety disorder: a placebo agnus castus fruit extract: prospective anxiety symptoms 5 yr old buspar 5 mg overnight delivery, randomized anxiety ulcer discount buspar uk, placebo controlled comparison of imipramine anxiety breathing problems cheap 10 mg buspar free shipping, trazodone and controlled study anxiety 2 days after drinking order buspar amex. Paroxetine treatment of hydroxytryptophan administration inhibits carbon-dioxide generalized anxiety disorder: a double-blind, placebo induced panic in panic disorder patients. Phenomenology of obsessive-compulsive temporal lobe and thought disorder in schizophrenia: a neurosis. Prophylactic lithium in postpartum affective for obsessive-compulsive disorder: evidence for susceptibility psychosis. The switch process in manic pathology in schizophrenia: a quantitative magnetic depressive illness: circadian variation in time of switch and resonance imaging study. Paroxetine treatment of controlled comparison of clonazepam and alprazolam for generalized social phobia (social anxiety disorder). Compr Psychiatry 1990; social phobia (social anxiety disorder): a double-blind, 51(suppl. The effect of citalopram receptor binding and distribution in generalized anxiety in panic disorders. Suicide in schizophrenics, manics, depressives, and adrenal axis function in patients with bipolar disorder. A group of benign psychoses: prolonged manic with psychiatrically symptom-free surgical controls. Psychosis in bipolar and unipolar affective illness with distinction between unipolar and bipolar disorders Cortisol and catecholamines in randomized, double-blind, placebo-controlled crossover trial. Regardless of the degree of intoxication, most patients recover within Of the many stimulants that are used for intoxication, hours to a day or so. These drugs may be taken orally intoxication, and in some of these cases, such symptoms or, after being crushed and dissolved, intravenously. In some cases there may be bizarre increased self-confidence, and talkativeness; the pupils are delusions, including Schneiderian first rank symptoms dilated, the blood pressure, both systolic and diastolic, is (Janowsky and Risch 1979). This amphetamine-induced psy With more severe intoxication there may be agitation and chosis generally clears within a matter of days or weeks, but some bizarre behavior: often patients take a particular it may occasionally last many months. Fleeting delu With chronic use of stimulants, both tolerance and sions of persecution and auditory hallucinations may withdrawal may occur. In severe intoxication a delirium may ensue, with patients require ever larger doses to achieve euphoria, in confusion, incoherence, and disorientation. A withdrawal syn movements, such as bruxism, chorea (Lundh and Tunving drome (Kramer et al. Arrhythmias a week or more; however, mild symptomatology may may appear, and with severe elevations of blood pressure linger for weeks or months. Recreational use of stimulants is not uncommon, and such Pharmacologic treatment is generally not indicated. The overall treatment of stimulant addiction has as its Some patients may develop an abusive pattern of use, how goal abstinence. Hospitalization is often required to break ever, and continue to seek intoxication despite suffering the pattern of use, and long-term involvement with groups social or legal consequences. Addiction is said to occur when such as Cocaine Anonymous or Narcotics Anonymous a craving develops for the stimulant, accompanied by the may be helpful. Cocaine hydrochloride is a white powder that may be withdrawal syndrome before going on yet another binge. Both the free base and crack prepara atology is mediated by enhanced noradrenergic tone tions evaporate with heating and thus may be smoked. During intoxication denial seen in many cases), the elation and talkativeness of (Kleber and Gawin 1984), patients become euphoric, the intoxication may suggest mania, and the irritability, hyperalert, talkative, and grandiose. Hyperactivity is com fatigue, and sleep disturbance of withdrawal may suggest mon, and with higher doses agitation may occur depression. Some patients may experience vation in a controlled environment will also tell the tale, as visual hallucinations, and these are typically of insects, the symptoms resolve over the expected time period. In severe intoxica Treatment tion, especially after intravenous use or smoking, a delirium may occur, with confusion, incoherence, lability, Intoxication, if mild, may be managed with simple obser and delusions and hallucinations. In severe cases one may utilize an antipsychotic signs include mydriasis, hypertension, headache, nausea such as haloperidol, in a dose of approximately 5 mg, either and vomiting, tachycardia, and arrhythmias or cardiac as the concentrate or parenterally, with repeat doses every arrest (Hsue et al. Leone and Dhuna 1990), myocardial infarction (Virmani Stimulant psychosis may be treated with an antipsy et al. Clear-cut withdrawal, however, does occur with epinephrine are involved, it appears that the euphoriant chronic use and indeed may appear after only a few days of effects of cocaine are related to the increased concentration heavy use. This withdrawal reaches a maximum of severity within a few days and then gradually A clinical differentiation of cocaine intoxication from remits over days or weeks. Rarely, dystonia may appear dur stimulant intoxication may not be possible, and the differ ing withdrawal (Choy-Kwong and Lipton 1989). Unfortunately, this tolerance applies on observation in a controlled environment, which will only to the euphoriant effects of cocaine and not to its reveal the fairly rapid resolution of symptoms. The diagnosis of a persistent cocaine psychosis is gener After approximately two or more years of frequent cocaine ally straightforward as it is difficult to hide the history of use, intoxications may become characterized by delusions chronic cocaine addiction. If, however, this history is not of persecution and of reference, and by auditory hallucina available, then the differential for psychosis, as discussed in tions (Brady et al. Although initially these symptoms tend to resolve shortly after the intoxication resolves (Brady et al. Abusive use, with legal, social, and medical conse addiction to effect a period of abstinence, during which quences, may also occur with snorting but is more common other measures may be initiated. Cocaine is the overall goal of treatment of cocaine abuse or addic one of the most, perhaps the most, addictive substances in tion is abstinence from cocaine and other substances, such the world, and craving may develop rapidly, leading to as alcohol, benzodiazepines, and opioids.

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The 2016 recipient of the Pascal Rol Award participants must: was Zhuolin Liu and her colleagues from Indiana Univ. Then, two abstracts will be selected for oral pre Best Student Paper Award sentation. Authors must choose which We are pleased to announce that a cash prize will be awarded to the best award they would like their paper to be considered for. Qualifying papers and presentations will be evaluated by the awards committee and the winner will be notifed at Submitted proceedings manuscripts may be resubmitted to the Journal the end of or after the meeting. Participants should also register their names (4 to 12 pages) by no later than midnight, Saturday, 11 February 2017. Authors may be considered for either the JenLab Young than 1 June 2017 and ofcially presented at the opening ceremony of Investigator Award or the Student Poster Session Competition Award. Submitted Photons Plus Ultrasound: Imaging and Sensing 2016 proceeding manuscripts are allowed for resubmission to the Journal of Best Paper Award Winner Biomedical Optics (please visit spie. Seno Medical Instruments is pleased to announce the winner of the Best Prize donated by the Conference Sponsors. The criteria for this award includes the technical profciency and excellence demonstrated by the presentation and proceedings paper as evaluated by the Organizing Committee, and the applicability of the research toward future commercialization as evaluated by the expert committee of peers and management at Seno Medical Instruments. Participants must be both the primary author and We are pleased to announce that PiPhotonics and Hitachi High-Tech will presenter of an accepted abstract to be eligible. This award is sponsored by PicoQuant two Hitachi High-Tech Best Paper Awards ($500 each). Evaluation Criteria Ocean Optics Young A panel of experts will evaluate all papers submitted for consideration for both quality and content. The First Prize will consist of a $1,000 cash prize for the Young Investigator and $2,000 Ocean Optics equipment credit for the laboratory where the work was performed. The Second Prize will consist of a $500 cash prize for the Young Investigator and $1,000 Ocean Optics equipment credit for the laboratory where the work was performed. To be eligible, manuscripts of self-nominating authors must be received by the due date. Cordova, Kivanc Kose, William Phillips, Anthony Rossi, Dell Medical School, the Univ. In vivo multiphoton-microscopy of laser-induced optical breakdown (Russian Federation); Alexander A. Kozlov, Samara State in human skin, Mihaela Balu, Griffn Lentsch, Beckman Laser Institute and Medical Univ. Hospital (Taiwan); Chi-Kuang Sun, Institute of Photonics and Hypericin-mediated selective photomodifcation of connective tissues, Optoelectronics, National Taiwan Univ. Hovhannisyan, European Regional Education Academy (Armenia); Vladimir Ghukasyan, Neuroscience Ctr. Durkin, Imaging cold-induced vasodynamic behaviour in skin using optical Beckman Laser Institute and Medical Clinic, Univ. College London (United Kingdom); Harald Kittler, Wolfgang Drexler, Medizinische Univ. Ramella-Roman, Light emitting fabric for photodynamic treatment of actinic keratosis, Florida International Univ. Fabrication of double-layered optical skin phantom with artifcial blood vessels embedded for port wine stain laser treatment, Hyejin Kim, Hanna Kim, Van Phuc Nguyen, Hyun Wook Kang, Pukyong National Univ. Assessment of cylindrical diffusing applicator for 1470 nm Laser lipolysis, Jieun Hwang, Han Jae Pyo, Pukyung National Univ. Munchen (Germany) Session Chair: Hyun Wook Kang, Marine-derived optical skin patch for wound healing and tissue Pukyong National Univ. In vivo fuorescence imaging of an orthotopic rat bladder tumor model (Korea, Republic of); Yun-Hee Rhee, Dankook Univ. Slaton, treatment of female stress urinary incontinence, Chun-Hung Chang, the Univ. Pham, Seul Lee Lee, Eisel, Thomas Pongratz, Keerthanan Ulaganathan, Laser-Forschungslabor Yong Wook Lee, Hyun Wook Kang, Pukyong National Univ. Descartes (France); Chongqing Yang, Beijing Hospital of Health Ministry (China); Fried, the Univ. Ulm (Germany); (Korea, Republic of); Zhongping Chen, Beckman Laser Institute and Medical Werner Hiereth, Dornier MedTech Laser GmbH (Germany); Raimund Hibst, Clinic, Univ. Ulm One to one correlation of needle based optical coherence tomography with (Germany). Authors of poster papers will be present to Spectroscopy I answer questions concerning their papers. Optical monitoring of kidney oxygenation and hemodynamics using a Session Chair: Hyun Wook Kang, miniaturized near-infrared sensor, Babak Shadgan, Christopher Nguan, Pukyong National Univ. Hospital (Korea, Republic of) dynamic upper airway imaging, Santosh Balakrishnan, Ruofei Bu, Hillel B. Micro-optical coherence tomography imaging of cochlear cells and nerve Price, Carlton J. Chu, vocalization, speech and expiration, Krzysztof Izdebski, Pacifc Voice and Hui Min Leung, Wellman Ctr. Sterenborg, Academisch Medisch Centrum (Netherlands) and the Netherlands Cancer Institute (Netherlands); Theo J. Mainz (Germany); Francois Lacombe, Mauna Kea Technologies (France); Stephen Lam M. Hauser, Deutsches Nucleaire et de Physique des Particules (France); Marc Zanello, Ctr. Hospitalier Rheuma-Forschungszentrum (Germany) and Charite Berlin (Germany); Sainte-Anne (France); Remi Habert, Lab. Niesner, Deutsches Rheuma-Forschungszentrum Molecules (France); Pascale Varlet, Bertrand Devaux, Ctr. Sun 11:50 am to 1:20 pm for Innovative Optical Imaging and its Translation to Medicine, Medizinische (Austria); Daniel J. Tearney, Kunze, Sven Flaemig, Grintech GmbH (Germany); Severin Filser, Ludwig Wellman Ctr. Munchen (Germany); Herbert Gross, Esophagus screening, Rohith Reddy, Jing Dong, Michalina J. Ford, Daryl Chulho Hyun, Characterization of neutrophil migration using high resolution Hui Min Leung, Biwei Yin, Wellman Ctr. Birks, Visualization of ex vivo human ciliated epithelium and induced fow using Univ. Jena (Germany); Sebastian Dochow, Leibniz-Institut fur Photonische Technologien. Jena Using molecular imaging to assess the delivery and infection of protease (Germany); Bernhard R. Bodensee (Switzerland); activated virus in animal model of myocardial infarction, Banghe Zhu, the Jurgen Popp, Leibniz-Institut fur Photonische Technologien. Sterenborg, Het Nederlands Kanker Instituut Antoni van Leeuwenhoek Session Chair: Melissa C. Campbell, strip-mosaicking microscopy, Sanjeewa Abeytunge, Memorial Sloan-Kettering Kevin W. Holness, Florida Breast cancer margin delineation with fuorescence lifetime imaging, International Univ.

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