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1.
淮安市食管癌病例—对照研究(I):烟,酒因素的作用   总被引:5,自引:1,他引:4  
沈月平  高玉堂 《肿瘤》1999,19(6):363-367
目的 研究淮安市烟,酒因素对食管癌的作用,方法 用1:1全人群病例-对照研究的方法调查淮安市549对食管癌病例和对照。结果 在调整了年龄,文化程度,腌制品,水果等因素后,发现吸烟是淮安市食管癌的危险因素,与不吸烟人群相比,男性现仍吸烟者OR为2.5(95%CI:1.6-3.8)男性曾经吸烟者OR为1.9(95%CI:0.9~4.0),男性患食管癌的危险随着吸烟量的增多,吸烟年限的延长而增加,且有显  相似文献   

2.
贲门腺癌切除患者预后的多因素COX模型分析:附736例报告   总被引:19,自引:2,他引:17  
通过计算机COX多因素分析模型,利用累积生存率,对736例经手术切除,术后生存≥3个月的贲门腺癌资料进行预后研究。分析结果表明,在选取的30个因素中,对预后影响最大的因素依次为:肿瘤最大直径2(OR=1.90)、手术性质(OR=1.72)、肿瘤浸润深度(OR=1.65)、贲门旁淋巴结转移(OR=1.42)、肿瘤最大直径1(OR=1.42)。性别和术前放射治疗对预后影响不大(P>0.2)。本组资料3、5、10年生存率分别为32.2%、20.2%和12.2%。  相似文献   

3.
我国食管癌高发区营养干预的Meta—analysis   总被引:2,自引:0,他引:2  
本文应用Meta-analysis的随机效应模型,对我国近10年营养干预降低高发食管癌发病率的文献进行统计合并。结果RR=0.81,95%CI=0.42~1.54,齐性检验X^2=13.71,P〉0.05。同时又分别对食管上上细胞重度增生和轻度增生(包括正常人群)营养干预后的效应做了合并分析,结果前者RR=0.96,95%CI=0.32~2.84后者RR=0.91,95%CI=0.47~1.77。  相似文献   

4.
淮安市食管癌病例-对照研究(Ⅰ):烟、酒因素的作用   总被引:5,自引:1,他引:4  
目的 研究淮安市烟、酒因素对食管癌的作用。方法 用1:1全人群病例-对照研究的方法调查淮安市549 对食管癌病例和对照。结果 在调整了年龄、文化程度、腌制品、水果等因素后,发现吸烟是淮安市食管癌的危险因素。与不吸烟人群相比,男性现仍吸烟者OR为2.5(95% CI:1.6~3.8),男性曾经吸烟者OR为1.9(95% CI:0.9~4.0),男性患食管癌的危险随着吸烟量的增多,吸烟年限的延长而增加,且有显著的剂量反应关系,趋势检验P< 0.01,女性也表现出相同的危险趋势,但大部分未达显著水平。采用Bruzzi的方法估计淮安市男性吸烟调整的人群归因危险度百分比(PAR% )为45.7% ,女性为8.3% 。本研究未发现淮安市食管癌与饮酒相联系的证据。结论 吸烟是淮安市食管癌高发的重要原因之一,饮酒因素对淮安市食管癌的作用需进一步研究。  相似文献   

5.
非吸烟女性肺癌患者Apo E的基因多态性   总被引:5,自引:0,他引:5  
为了探讨载脂蛋白E(apoE)的遗传变异体与非吸烟女性肺癌易感性之间的关系,在上海市和哈尔滨市两地分别收集了非吸烟女性肺癌病例100例和82例,以及非吸烟的女性健康人对照95例和89例,应用PCR-内切酶片段长度多态性技术(PCR-RFLP),分析了白细胞DNAapoE等位基因(apo∈)的遗传多态性。结果显示,把突变型等位基因∈4与野生型∈3相比,虽然在上海市病例组中,OR值为0.52(95%CI=0.21~1.29),但无显著性差异,尚待扩大样本做进一步探讨。  相似文献   

6.
女性乳腺癌危险因素的Logistic回归分析   总被引:15,自引:0,他引:15       下载免费PDF全文
女性乳腺癌危险因素研究资料采集于广州,韶关,肇庆等八个医院。按1∶2配对设计总共收集了125个病例一对照组作回顾性调查。经条件Logistic回归.分析得:保护因子有喝茶习惯,OR=0.3913;危险因子有精神创伤,OR=3.4338,乳腺炎史,OR=3.4099,被动吸烟,OR=2.0796,平均摄油量,OR=3.1773,流产,OR=1.3544,癌症家族史,OR=5.6797。  相似文献   

7.
目的 系统评价环氧化酶 2(COX 2)在结直肠癌中表达水平及其与临床病理特征的关系。方法 计算机检索CochraneLibrary、PubMed、CNKI等数据库,按照纳入与排除标准选择研究文献,评价质量及提取资料后采用Stata11.0软件对数据库进行系统评价。结果 共纳入14项研究,其中结直肠癌患者1200例,正常对照276例。Meta分析结果显示:(1)COX-2在结直肠癌组及正常对照组中的表达差异有统计学意义(OR=24.49,95%CI=15.95~37.60,P=0.000);(2)COX-2表达水平与结直肠癌临床病理特征的关系为:男性与女性(OR=1.77,95%CI=0.79~3.94,P=0.165),年龄<50岁与≥50岁(OR=0.52,95%CI=0.24~1.11,P=0.089),结肠癌与直肠癌(OR=0.98,95%CI=0.70~1.39,P=0.924),T1+T2与T3+T4(OR=2.37,95%CI=0.96~5.89,P=0.063),肿瘤直径≥5cm与<5cm(OR=3.07,95%CI=1.94~4.86,P=0.000),淋巴结转移与无淋巴结转移(OR=3.08,95%CI=1.73~5.48,P=0.000),Dukes分期中C+D期与A+B期(OR=3.08,95%CI=1.25~7.61,P=0.002),低分化与高、中分化(OR=1.70,95%CI=1.06~2.73,P=0.027)。结论 COX-2在结直肠癌中表达增高,且其高表达增加了结直肠癌恶性行为发生的危险。  相似文献   

8.
应用免疫组织化学的方法,对277例乳腺癌的组织蛋白酶D(Cath-D)、c-erbB-2和表皮生长因子受体(EGFR)癌基因蛋白的表达及其与淋巴结转移的关系进行了研究。结果发现,Cath-D表达阳性者107例(38.62%),阴性者170例(61.38%)。Cath-D阳性的乳腺癌有淋巴结转移的占83.17%,Cath-D阴性的乳腺癌有淋巴结转移的占37.64%,两者的差别极为显著(X ̄2=55.05,P<0.0001)。Cath-D阳性的乳腺癌中,c-erbB-2阳性者56例(52.34%);Cath-D阴性的乳腺癌中,c-erbB-2阳性者27例(15.88%),两者有明显的差别(X ̄2=41.58,P<0.0001)。Cath-D阳性的乳腺癌中,EGFR阳性的有49例(45.79%);Cath-D阴性的乳腺癌中,EGFR阳性的仅24例(14.12%),两者的差别亦极为显著(X ̄2=33.95,P<0.0001)。上述结果提示,Cath-D阳性的乳腺癌恶性程度高,易转移、预后差。临床对上述病人应提供特别的治疗方案并抓紧随访工作。  相似文献   

9.
Modi.  C Alav.  M 《肿瘤》1996,16(4):487-491
目的:调查瑞典养鸟与肺癌危险性的联系。研究设计:肺癌病例与社区对照组的病例对照研究,由两位经过特殊训练的护士进行调查。调查地区:瑞典西南地区三所医院。病例:全部为新近诊断的肺癌病例,年龄最大75岁,居住于Gothenburg,Bohus及Alvsborg三个城市的26个社区。对照组配对条件:从人口登记资料中选出同性别、年龄相近和同一居住地点的居民。养鸟情况:肺癌病例380人(男252,女128),对照组696人(男433,女263)。探讨的主要问题:探讨养鸟与否和养鸟年限与肺癌的OR值。结果:家中曾养鸟和未养鸟的调整OR值男性为0.94(95%CI=0.64~1.39),女性为1.10(95%CI=0.64~1.90)。未见到养鸟年限增加有肺癌危险性增加的倾向。结论:瑞典家中养鸟对男、女肺癌危险性并无影响  相似文献   

10.
目的:验证基于影像学特征的风险评估模型在胸外科肺结节手术患者中筛选肺恶性肿瘤的有效性。方 法:采用回顾性研究,以 2018年 1月至 2019年 12月四川省肿瘤医院胸外科行手术治疗的 351例患者为样本,包括 278例肺恶性肿瘤患者和 73例肺良性疾病患者。采集患者的影像学特征,并通过 Logistic二分类回归分析,绘制受 试者工作特征曲线,计算曲线下面积(areaundercurve,AUC),以 Youden指数最大的分界点作为最佳诊断分界点。 结果:结节直径每增加 1cm(OR=3.166,95%CI:1.983~5.055,P<0.001)、结节边缘有毛刺(OR=4.721,95%CI: 2.487~8.962,P<0.001)、非实性结节(OR=6.392,95%CI:2.915~14.018,P<0.001)为肺恶性肿瘤的独立危险因 素,差异具有统计学意义;基于影像学特征的风险评估模型 Y=-1.618+1.153×X1 +1.552×X2 +1.855×X3,AUC 为 0.81(P<0.001),模型在 Cut off值为 8.95时,对应的 Youden指数为 0.518,敏感度为 0.669,特异度为 0.849。结 论:随着结节最大径的增加,恶性结节的概率增加;边缘有毛刺的结节较边缘无毛刺的结节恶性概率大;非实性结节 较实性结节恶性概率大。基于影像学特征的风险评估模型可以提高术前判断肺结节良恶性的准确性。由此构建的 模型具有一定的实用性,或可用于帮助临床医生判断肺结节的良恶性。  相似文献   

11.
中国女性乳腺癌危险因素的Meta分析   总被引:2,自引:1,他引:1  
[目的]评价中国女性乳腺癌部分危险因素的作用,探讨乳腺癌的病因。[方法]运用Meta分析方法对我国1996~2006年间公开发表的有关乳腺癌危险因素病例对照研究的12篇文献资料进行定量综合分析。[结果]各因素合并OR值分别为:初潮年龄OR=1.5401(95%CI:1.3437~1.7654);哺乳OR=0.6837(95%CI:0.4779—0.9782);口服避孕药OR=1.3278(95%CI:1.0627—1.6589);良性乳腺疾病史OR=2.6180(95%CI:2.0275—3.3804);吸烟OR=1.8576(95%CI:1.5394—2.2415);饮酒OR=0.8137(95%CI:0.6196~1.0686);饮茶OR=0.8625(95%CI:0.7646~0.9728)。[结论]初潮年龄、口服避孕药、良性乳腺疾病史及吸烟是乳腺癌发生的危险因素,哺乳及饮茶则是乳腺癌的保护因素。  相似文献   

12.
Together with thyroid cancer, cancer of the gallbladder is the only non-sex hormone-related cancer displaying a female preponderance, with incidence being 3-4 times more common among women. We carried out this study to evaluate the role of menstrual, reproductive and lifestyle factors in gallbladder carcinogenesis. A case-control study involving 64 newly diagnosed cases of gallbladder cancer and 101 cases of cholelithiasis was carried out. A detailed menstrual and reproductive history was illustrated beside detailed lifestyle history, in particular consumption of betel nut, tobacco and alcohol and smoking, odds ratio was calculated. Mean age of the patients with cancer was 51+/-1.2 years while it was 40.9+/-1.2 years for gallstones; 69% of cancer patients and 90% of gallstones patients were females. More than half of the cancer patients (53%) and 43% of the gallstone patients were illiterate. A past history of typhoid was present in 22% of cancer patients and 13% of gallstone patients, while 35% of cancer and 25% of gallstone patients were chewers, 18.1 and 9.9% were smokers, and 10% of cancer and 2% of gallstone patients consumed alcohol. Mean age of menarche was 13.4+/-1.2 years among female patients with cancer while it was 14.0+/-1.4 years for gallstone patients. Higher age at menarche (>13 years, OR 2.48, 95% confidence interval (CI) 1.16-5.3), higher number of childbirths(>3 births, OR 3.92; 95% CI 1.4-10.3), higher number of pregnancies (>3 pregnancies, OR 6.66, 95% CI 1.8-23.4), and higher age at last childbirth (>25 years, OR 2.97, 95% CI 1.04-8.5) were found to have significantly higher risk of developing gallbladder cancer. In conclusion, tobacco chewing and smoking are associated with increased odds of gallbladder cancer. Similarly early menarche, late menopause, multiple pregnancies and childbirth increased the risk of gallbladder cancer.  相似文献   

13.
A hospital-based case-control study was carried out among 504 women with breast cancer and 610 controls to analyse the risk factors for breast cancer in Turkey. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for each risk factor were obtained from logistic regression analysis. Risk factors for breast cancer were found to be long-term lactation (> or = 5 years versus never OR 0.31, 95% CI 0.12-0.79), young age at menarche (< 15 years versus > or = 15 OR 1.72, 95% CI 1.30-2.28), late age at first full-term pregnancy (> or = 30 versus < 20 OR 2.86, 95% CI 1.32-6.21), oral contraceptive use (ever versus never OR 1.51, 95% CI 1.10-2.08), positive family history (positive versus negative OR 2.81, 95% CI 1.35-5.82), and menstrual irregularity (yes versus no OR 1.61, 95% CI 1.05-2.49). The results of the present study will lead to a better understanding of the risk factors for breast cancer in a developing country.  相似文献   

14.
We examined effects of obesity and lifetime exercise patterns on postmenopausal breast cancer risk according to family history in a large population-based case control study conducted in Los Angeles County, California, because we hypothesized that both factors would affect risk through similar mechanistic pathways, and that their effects would be stronger among women with a family history. We studied 1883 postmenopausal breast cancer case subjects and 1628 postmenopausal control subjects ranging in age from 55-72 years. Cases were diagnosed with incident breast cancer in the late 1980s and 1990s. Controls were individually matched to case subjects on age, ethnic origin and neighborhood. In-person interviews determined known breast cancer risk factors including: height, weight, lifetime exercise, and family history of breast and other cancers. Breast cancer risk was raised among women who had at least 1 first-degree relative with breast cancer (odds ratio [OR] = 1.68; 95% confidence interval [CI] = 1.36-2.08). Risk increased with increasing levels of body-mass index (wt-kg/ht-m(2)) (p-trend = 0.005). Breast cancer risk was reduced among women who maintained, on average, 17.6 metabolic equivalent of energy expenditure (MET)-hr of activity/week from menarche onward (OR = 0.66; 95% CI = 0.48-0.90). Body-mass index, adjusted for lifetime exercise, was strongly associated with breast cancer risk among women with a positive family history of breast cancer (p-trend < 0.0001), but only weakly associated among women with no family history (p-trend = 0.08; homogeneity of trends p = 0.0005). In contrast, the risk reduction associated with exercise activity, adjusting for body-mass index, was limited to women without a family history of breast cancer (p-trend = 0.001; homogeneity of trends p = 0.005). Body-mass index and exercise activity, both modifiable risk factors for breast cancer, seem to have differential effects depending on a woman's family history of breast cancer, and may impact risk through different biological mechanisms.  相似文献   

15.
BACKGROUND: Polymorphisms in the N-acetyltransferase 2 (NAT2) gene influence the rate of metabolism of aromatic and heterocyclic amines present in tobacco smoke. Because the physicochemical composition of mainstream and sidestream smoke differ, we conducted a case-control study to assess a possible differential effect of NAT2 genotype on the relationship between active/passive smoke exposure and breast cancer risk. METHODS: Breast cancer patients diagnosed by 50 years of age and population-sampled controls were interviewed to obtain detailed lifetime active and passive smoking history. NAT2 genotype was determined in 422 breast cancer patients and 887 controls. Multivariate logistic regression analysis was performed to estimate breast cancer risk in relation to smoking history by acetylator status and interaction effects. RESULTS: Compared with women never regularly exposed to tobacco smoke, odds ratios (ORs) for current smoking and ex-smoking were 1.7 [95% confidence interval (CI): 1.0-2.9] and 1.2 (95% CI, 0.7-2.0) in slow acetylators, and not increased in rapid acetylators. Active smoking variables, such as pack-years, duration of smoking, and time since cessation, showed significant dose-response relationships with breast cancer risk among slow acetylators but not rapid acetylators. In contrast, passive smoking was associated with higher risk in rapid than in slow acetylators, with ORs of 2.0 (95% CI, 1.0-4.1) and 1.2 (95% CI, 0.7-2.0), respectively. CONCLUSIONS: Our results suggest that the NAT2 status has a differential effect on the association of active and passive smoking with breast cancer and demonstrate the need to consider possible different mechanisms associated with exposure to main- and sidestream tobacco smoke.  相似文献   

16.
Previous studies suggested that smoking and passive smoking could increase the risk of breast cancer, but the results were inconsistent, especial y for Chinese females. Thus, we systematical y searched cohort and case-control studies investigating the associations of active and passive smoking with breast cancer risk among Chinese females in four English databases (PubMed, Embase, ScienceDirect, and Wiley) and three Chinese databases (CNKI, WanFang, and VIP). Fifty-one articles (3 cohort studies and 48 case-control studies) covering 17 provinces of China were finally included in this systematic review. Among Chinese females, there was significant association between passive smoking and this risk of breast cancer [odds ratio (OR): 1.62; 95% confidence interval (CI): 1.39-1.85; I2 = 75.8%, P 〈 0.001; n = 26] but no significant association between active smoking and the risk of breast cancer (OR:1.04;95%CI:0.89-1.20;I2=13.9%, P=0.248;n=31). The OR of exposure to husband’s smoking and to smoke in the workplace was 1.27 (95% CI: 1.07-1.50) and 1.66 (95% CI: 1.07-2.59), respectively. The OR of light and heavy passive smoking was 1.11 and 1.41, respectively, for women exposed to their husband’s smoke (〈20 and≥20 cigarettes per day), and 1.07 and 1.87, respectively, for those exposed to smoke in the workplace (〈300 and≥300 min of exposure per day). These results imply that passive smoking is associated with an increased risk of breast cancer, and the risk seems to increase as the level of passive exposure to smoke increases among Chinese females. Women with passive exposure to smoke in the workplace have a higher risk of breast cancer than those exposed to their husband’s smoking.  相似文献   

17.
BACKGROUND: Risk factors associated with invasive breast cancer are well documented, but those associated with breast carcinoma in situ are not well defined. METHODS: We conducted a population-based, case-control study among female residents of Connecticut to identify risk factors for breast carcinoma in situ. Case patients, diagnosed with ductal carcinoma in situ (DCIS) (n = 875) or lobular carcinoma in situ (LCIS) (n = 123), were matched by 5-year age groups with control subjects (n = 999). Case patients were diagnosed between September 15, 1994, through March 14, 1998, and all subjects were between the ages of 20 and 79 years. Information on risk factors and cancer-screening history was collected by telephone interviews. Conditional logistic regression was used to determine odds ratios (ORs) for the association of these factors with the risk of DCIS and LCIS. RESULTS: Case patients with DCIS were more likely than control subjects to report a family history of breast cancer (OR = 1.48; 95% confidence interval [CI] = 1.19 to 1.85) or previous breast biopsy (OR = 3.56; 95% CI = 2.86 to 4.43). They also had fewer full-term pregnancies (OR = 0.86; 95% CI = 0.80 to 0.93) and were older at first full-term pregnancy (OR for being 20-29 years old relative to being <20 years old = 1.68; 95% CI = 1.17 to 2.43) and at menopause (OR for being > or =55 years old relative to being <45 years old = 1.71; 95% CI = 1.05 to 2.77). DCIS case patients were more likely than control subjects to have had a mammographic examination (OR = 2.46; 95% CI = 1.78 to 3.40) or an annual clinical breast examination (OR = 1.83; 95% CI = 1.48 to 2.26). DCIS patients and control subjects did not differ with respect to oral contraceptive use, hormone replacement therapy, alcohol consumption or smoking history, or breast self-examination. Associations for LCIS were similar. CONCLUSIONS: The risk factors associated with DCIS and LCIS are similar to those associated with invasive breast cancer. Diagnosis of DCIS is associated with increased mammography screening.  相似文献   

18.
This case-control study was carried out in a university-affiliated teaching hospital, Tehran city, Iran. A total of312 newly diagnosed cases aged less than 40 years old participated and were matched for age and ethnicity with312 controls. The results showed that in women who never married (OR=2.42 95%CI=1.51-3.88) (P<0.001), hada family history of breast cancer (OR=7.07 95%CI=2.95-16.99) (P<0.001), a low age of menarche (OR=0.1 95%CI=0.04-0.23) (P<0.001)), lower parity (OR=13.3 95% CI=3.89-45.66) (P<0.001) and took oral contraceptive pills(OR= 2.83 95% CI=1.87-4.24) (P<0.000) were at increased risk. A direct association with age at first birth wasalso evident(P=0.041), with a significantly inverse association between duration of lactation and breast cancer risk(p=0.016). On multivariate logistic regression, parity, family history of breast cancer, use of oral contraceptivepills, and age at first birth remained significant. In women lower than 40 years of age, breast cancer risk wassignificantly higher in women with parity ≥4 compared with nulliparity but no association emerged with historyof breast-feeding. Other risk factors were similar to those described in breast cancer epidemiology at any age.  相似文献   

19.
Passive and active smoking and breast cancer risk in Canada, 1994–97   总被引:1,自引:0,他引:1  
Background: Studies comparing ever smokers with never smokers have found little increase in breast cancer risk. However, the five published studies examining passive smoking and breast cancer have all suggested associations with both passive and active smoking, particularly premenopausal risk. Methods: We analyzed data collected through the Canadian National Enhanced Cancer Surveillance System, from 805 premenopausal and 1512 postmenopausal women with newly diagnosed (incident), histologically confirmed, primary breast cancer and 2438 population controls. The mailed questionnaire included questions on breast cancer risk factors and a lifetime residential and occupational history of exposure to passive smoking. Results: Among premenopausal women who were never active smokers, regular exposure to passive smoke was associated with an adjusted breast cancer odds ratio (OR) of 2.3 (95% confidence interval [CI] 1.2–4.6). Passive exposure showed a strong dose–response trend (test for trend p=0.0007) with an OR of 2.9 (95% CI 1.3–6.6) for more than 35 years of passive residential and/or occupational exposure. When premenopausal women who had ever actively smoked were compared with women never regularly exposed to passive or active smoke, the adjusted OR for breast cancer was also 2.3 (95% CI 1.2–4.5). Among postmenopausal women who were never-active smokers, regular exposure to passive smoke was associated with an adjusted breast cancer OR of 1.2 (95% CI 0.8–1.8) and an OR of 1.4 (95% CI 0.9–2.3) for the most highly exposed quartile of women. The adjusted OR for postmenopausal breast cancer risk for ever-active smokers compared with women never regularly exposed to passive or active smoke was 1.5 (95% CI 1.0–2.3). Statistically significant dose–response relationships were observed with increasing years of smoking, increasing pack-years and decreasing years since quitting. Women with 35 or more years of smoking had an adjusted OR of 1.7 (95% CI 1.1–2.7). Conclusions: Active and passive smoking may be associated with increased breast cancer risk, particularly premenopausal risk.  相似文献   

20.
Polymorphisms in phase I and phase II enzymes may enhance the occurrence of mutations at critical tumor suppressor genes, such as p53, and increase breast cancer risk by either increasing the activation or detoxification of carcinogens and/or endogenous estrogens. We analyzed polymorphisms in CYP1B1, GSTM1, GSTT1, and GSTP1 and p53 mutations in 323 breast tumor samples. Approximately 11% of patients exhibited mutations in p53. Women with mutations had a significantly younger age of diagnosis (P = 0.01) and a greater incidence of tumors classified as stage II or higher (P = 0.002). More women with mutations had a history of smoking (55%) compared to women without mutations (39%). Although none of the genotypes alone were associated with p53 mutations, positive smoking history was associated with p53 mutations in women with the GSTM1 null allele [OR = 3.54; 95% CI = 0.97-12.90 P = 0.06] compared to women with the wild-type genotype and smoking history [OR = 0.62, 95% CI = 0.19-2.07], although this association did not reach statistical significance. To test for gene-gene interactions, our exploratory analysis in the Caucasian cases suggested that individuals with the combined GSTP1 105 VV, CYP1B1 432 LV/VV, and GSTM1 positive genotype were more likely to harbor mutations in p53 [OR = 4.94; 95% CI = 1.11-22.06]. Our results suggest that gene-smoking and gene-gene interactions may impact the prevalence of p53 mutations in breast tumors. Elucidating the etiology of breast cancer as a consequence of common genetic polymorphisms and the genotoxic effects of smoking will enable us to improve the design of prevention strategies, such as lifestyle modifications, in genetically susceptible subpopulations.  相似文献   

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