Clinical, Prognostic and Possible Therapeutic Relevance of Angiogenesis in Non-Hodgkin’s Lymphoma.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3583-3583
Author(s):  
Leina Y. Etto ◽  
Emilio C.A. Lacerda ◽  
Otavio C.G. Baiocchi ◽  
Vanderleia C. Silva ◽  
Maria Aparecida Dalboni ◽  
...  
Keyword(s):  
Growth Factor ◽  
Serum Level ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
Serum Levels ◽  
Biological Behavior ◽  
Control Group ◽  
Serum Samples ◽  
Tumor Load ◽  
Hodgkin's Lymphomas

Abstract Considering that angiogenesis may have importance in the pathogenesis of non-Hodgkin’s lymphomas (NHL), the aims of this study were to correlate hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF), basic fibroblast growth factor (FGF) serum levels and microvessel density (MVD) with cell origin, biological behavior, tumor load and prognosis in NHL. Materials and methods: Eighty-seven consecutive previously untreated NHL patients had serum samples collected and were included in the study. Thirty-seven (42%) of them also had additional serum follow-up samples. Control group was composed by ten healthy blood donors. HGF, VEGF and FGF serum levels were determined by ELISA. MVD was measured by CD34 staining in patients with available paraffin blocks. Results: HGF mean serum level was significantly higher in both early and advanced NHL Ann Arbor stages when compared to control group. HGF was also significantly higher in both aggressive and indolent NHL when compared to control group. Furthermore, mean serum level of HGF in aggressive NHL was significantly higher than in indolent NHL. Regarding International Prognostic Index (IPI), mean serum levels of HGF at diagnosis was significantly higher for patients with IPI > 2 when compared to IPI <=2. FGF mean serum level was also significantly higher in early and advanced NHL stages when compared to controls. We also observed that FGF mean serum level was significantly higher in indolent NHL when compared to control group. Regarding VEGF, serum levels were significantly higher in aggressive NHL when compared to control group. Sequential analyses of HGF, VEGF and FGF serum levels in NHL showed that serum HGF and VEGF levels decreased significantly after 6 months of treatment completion. When we analyzed MVD, no associations between patient’s groups were found, even when stage, biologic behavior or cell origin were taken into account. We did not find correlation among MVD and serum levels of HGF, VEGF and FGF at diagnosis either. Conclusions: Our findings suggest that HGF seems to play an important role in NHL pathogenesis because: its serum level is associated to tumor load and aggressiveness; it can be correlated to treatment response. In face of these results, we could suggest that HGF is a potential target for therapeutic intervention in NHL.

Pretreatment Serum Level of Osteopontin and Vascular Endothelial Growth Factor Might Have a Prognostic Value in Patients with Diffuse Large B-Cell Lymphoma

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1609-1609
Author(s):  
Antica Duletic Nacinovic ◽  
Tajana Juranovic ◽  
Toni Valkovic ◽  
Duska Petranovic ◽  
Ivan Host ◽  
...  
Keyword(s):  
Serum Level ◽  
B Cell ◽  
Cell Lymphoma ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
B Cell Lymphoma ◽  
Serum Levels ◽  
Large B Cell Lymphoma ◽  
Pretreatment Serum ◽  
Large B Cell

Abstract Abstract 1609 Background: Angiogenesis is gaining importance in hematological malignancies; it is regulated by a balance of various enhancing and inhibiting angiogenic factors. However, studies related to the prognostic value of angiogenic factors and aggressive Non-Hodgkin lymphomas are limited compared to solid tumors. The aim of this study was to determine pretreatment serum level of vascular endothelial growth factor (VEGF) and osteopontin (OPN) in patients with diffuse large B cell lymphoma (DLBCL) and to investigate whether these factors provide prognostic information. METHODS: We measured pretreatment serum levels of VEGF and OPN by Enzyme-Linked Immunosorbent Assay (ELISA) in 67 patients newly diagnosed as diffuse large B-cell lymphoma and in 30 healthy controls. All patients were treated with rituximab-CHOP chemotherapy. RESULTS: The serum OPN levels were found elevated in untreated DLBCL patients compared to controls: in newly diagnosed patients it ranged from 25 to 238 pg/ml; median 94.2 pg/ml while in the healthy controls it ranged from 13 to 46.5 pg/ml; median 30.0 pg/ml (P=0.00008). There were significant differences in the serum VEGF levels between DLBCL patients and controls (median 480.96 pg/ml vs. 163.8 pg/ml, P=0.001). Serum OPN levels higher than the median level were related to advanced Ann Arbor stage (P=0.026), International Prognostic Index of 2 or higher (P=0.005), ECOG III-V (P=0.004). The complete remission rate after treatment was higher in patients with low OPN serum levels than in those with high OPN serum levels (67.5% versus 32.4%, P=0.002). Elevated serum levels of OPN were strongly associated with shorter overall survival (P=0.007) and event-free survival (P=0.04). In multivariate analysis with International Prognostic Index criteria, OPN remained a significant predictor for overall survival (P=0.033). VEGF level was significantly correlated with age (P=0.01) and serum lactate dehydrogenase level (P=0.02), but not strongly correlated with other potential prognostic factors, and it failed to show prognostic significance. CONCLUSION: Our results showed that pretreatment serum level of OPN is significantly related to outcome in DLBCL patients. Ongoing extension study and additional follow-up will provide more information moving forward. Disclosures: No relevant conflicts of interest to declare.

Elevated Serum Level of Vascular Endothelial Growth Factor and Basic Fibroblast Growth Factor Correlates with Stage of Chronic Lymphocytic Leukemia and Resistance to Treatment

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4172-4172
Author(s):  
Bulat Bakirov ◽  
Anastasiya Sgibneva ◽  
Akhat Bakirov
Keyword(s):  
Growth Factor ◽  
High Risk ◽  
Serum Level ◽  
Serum Levels ◽  
Lymphocytic Leukemia ◽  
Control Group ◽  
Vascular Endothelial ◽  
Fibroblast Growth ◽  
High Risk Disease ◽  
Endothelial Growth Factor

Abstract Background: B-cell chronic lymphocytic leukemia (B-CLL) is the most common leukemia in western world with an incidence of 3,36/100,000 in European males. It is characterized by a clonal growth of long lived, slowly proliferating mature B lymphoid cells in the bone marrow (BM), peripheral blood (PB), and lymphoid tissues. Basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) is a pleiotropic cytokine that plays a role in hematopoiesis and apoptosis. Angiogenesis may have a role in a pathophysiology of leukemias and antiangiogenesis therapy could have an anticancer effect. Aim: analyze the clinical significance of serum levels of angiogenic factors and how it’s correlate with clinical stage and survival in patients with B-CLL Methods: the enzyme-linked immunosorbent assays (ELISAs) for VEGF and bFGF were performed in 78 CLL patients and 29 healthy person as a control group. The patients was divided on low-risk disease (44 patients) and high-risk disease (34 patients). Results: VEGF and bFGF serum levels were significantly increased in patient with high-risk disease, the median serum VEGF level was 185.66 pg/ml, compared with 72.67 pg/ml in patient with a low-risk and in control, it was 48.62 pg/ml. The difference in the VEGF levels was significant for the comparison between low- and high-risk disease (p&lt;0.001). VEGF levels correlate with high white blood cell/lymphocyte counts, short period of time to begin treatment, disease progression, lymphocyte doubling time and worse answer to chemotherapy. No significant increase was found in bFGF serum level between low- and high-risk disease (34.06 pg/ml and 35.84 pg/ml, respectevely), but between patient and control group it was differences in serum level of bFGF (34.85 pg/ml and 7.77 pg/ml, respectively) (p&lt;0.001). Conclusion: as we found, serum levels of bFGF and VEGF were significantly higher in the patients with B-CLL than in controls. High serum level of VEGF and bFGF associated with poor prognosis and worse answer on treatment. In summary, our data suggest that angiogenic factors play a significant role in the leukemic process and may suggest novel therapeutic approaches in B-CLL.

scholarly journals Investigating the Relationship between Serum Level of s-Met (Soluble Hepatic Growth Factor Receptor) and Preeclampsia in the First and Second Trimesters of Pregnancy

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Farshad Naghshvar ◽  
Zhila Torabizadeh ◽  
Narges Moslemi Zadeh ◽  
Hooman Mirbaha ◽  
Parand Gheshlaghi
Keyword(s):  
Growth Factor ◽  
Serum Level ◽  
Growth Factor Receptor ◽  
Serum Levels ◽  
Severe Preeclampsia ◽  
Soluble Form ◽  
Control Group ◽  
Case Group ◽  
Mortality And Morbidity ◽  
Hepatic Growth Factor

Introduction. Preeclampsia (PE) is an important cause of mortality and morbidity for mothers, fetuses, and the newborns. Placenta plays a pivotal role in pathogenesis of PE. Hepatic growth factor (HGF) is a cytokine expressed by the mesenchymal stalk of placental villi during pregnancy and assumes a paracrine role in trophoblasts which express its receptor (c-MET). In the present study, we investigate the diagnostic value of s-Met (the soluble form of the receptor) in the first and second trimesters of pregnancy for early diagnosis of preeclampsia. Method and Materials. This is a case-control study conducted on 95 pregnant women. The serum level of s-Met was measured in the first and second trimesters, and the participants were followed until delivery. 44 individuals with preeclampsia (the case group) and 51 individuals without preeclampsia (the control group) were evaluated. Results. Serum level of s-Met in preeclamptic participants was lower than that of the control group in both the first and the second trimesters (P<0.0001). In addition, serum levels of s-Met were significantly lower during the first and second trimesters in patients with early, severe preeclampsia compared to those with late, mild preeclampsia (P<0.0001). The sensitivity and specificity of s-Met in the first and second trimesters were, respectively, (83%, 94%) and (77%, 94%) for early preeclampsia and (88%, 92%) and (86%, 98%) for severe preeclampsia. Conclusion. Considering our findings, serum level of s-Met may be used as a predictive factor for early detection of preeclampsia. Further research is required to corroborate the functional and therapeutic value of s-Met in preeclampsia.

Prognostic Value of Angiogenic Factors (Vacular Endothelial Growth Factor [VEGF] and Basic Fibroblast Growth Factor [bFGF]) and Endostatin in Patients with Non-Hodgkin Lymphoma.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1768-1768
Author(s):  
Jean Abou Yared ◽  
Theodore Girinsky ◽  
Serge Koscielny ◽  
Vincent Ribrag ◽  
Patrice Carde ◽  
...  
Keyword(s):  
Serum Level ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
Serum Levels ◽  
Angiogenic Factors ◽  
Angiogenic Factor ◽  
Prognostic Impact ◽  
Lymphoproliferative Diseases ◽  
Prognostic Group ◽  
Pretreatment Serum

Abstract Introduction: Tumor angiogenesis is gaining importance in hematological malignancies; it is balanced by many known and unknown positive and negative angiogenic factors. However, studies related to the prognostic significance of angiogenic factors and lymphoproliferative diseases are limited compared to solid tumors. This is a single institution study evaluating the prognostic impact of serum Endostatin, VEGF, and bFGF in non-Hodgkin’s lymphoma (NHL). Patients and methods: Pretreatment serum level of Endostatin (S-Endostatin), VEGF (S-VEGF), and bFGF (S-bFGF) were measured by Enzyme-Linked Immunoabsorbant Assay (ELISA) on 136 NHL patients: 82 patients (60%) had aggressive NHL (diffuse large B cell lymphoma [DLBCL] or other aggressive non-DLBCL) and 54 patients (40%) had indolent lymphomas (follicular lymphoma [FL] or other indolent non-FL). For each angiogenic factor, univariate progression-free survival (PFS) and overall survival (OS) analyses were performed according to the quartiles of the distribution of serum level values. Each of the analyses was aimed to detect a trend between prognosis and the serum level of the angiogenic factor. Eight prognostic groups were defined according to the type of NHL and the prognostic indexes (International Prognostic Index [IPI] for DLBCL and aggressive non-DLBCL, and Follicular International Prognostic Index [FLIPI] for FL). Survival analyses stratified on the prognostic group were used to test the independent prognostic value of each angiogenic factor. Survival curves were compared with logrank tests. Distributions of serum level values were compared with Kruskal-Wallis tests. The median follow-up was 78 months. Results: Pretreatment angiogenic serum levels were not significantly different between all categories of NHL, except for VEGF level, which was slightly higher in the aggressive group compared to the indolent group (666 pg/ml vs. 465 pg/ml; p=0.03). Low S-Endostatin and high S-VEGF at diagnosis were associated with poor PFS (p=0.002 and p=10−4 respectively) and poor OS (p=0.04 and p=10−6 respectively). Patients with S-Endostatin within the lowest quartile had only 29% PFS and 49% OS in contrast to a 67% PFS and 82% OS among patients with Endostatin within the highest quartile. Similarly, patients with S-VEGF within the highest quartile had only 20% PFS and 26% OS in contrast to a 70% PFS and 85% OS among patients with VEGF within the lowest quartile. The VEGF/Endostatin ratio was used to combine the results from S-VEGF and S-Endostatin. The 4 groups corresponding to the quartiles of the distribution of VEGF/Endostatin ratio had different OS and PFS (p&lt;10−6 for both); PFS and OS were respectively 15% and 16% for patients from the highest quartile VEGF/Endostatin ratio and 79% and 84% for those from the lowest quartile Figure 1. The independent prognostic impact of S-Endostatin, S-VEGF and VEGF/Endostatin ratio remained significant on PFS (p=0.0003, p=0.001 and p&lt;10−6 respectively) and OS (p=0.01, p=10−4 and p&lt;10−6 respectively) after stratification on the prognostic group. We did not find any relation between pretreatment S-bFGF and prognosis in our patients. Conclusion: Our results showed that pretreatment serum levels of VEGF and Endostatin are significantly related to outcome in NHL patients; the higher the VEGF/Endostatin ratio is, the poorer the prognosis. A better understanding of angiogenesis in lymphoproliferative diseases is mandatory in order to develop new anti-angiogenic targeted therapeutic agents that can change the outcome of these patients. Figure Figure

scholarly journals VEGFandbFGFGene Polymorphisms in Patients with Non-Hodgkin's Lymphoma

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Tomasz Wróbel ◽  
Grzegorz Mazur ◽  
Justyna Dzietczenia ◽  
Katarzyna Gębura ◽  
Kazimierz Kuliczkowski ◽  
...  
Keyword(s):  
Growth Factor ◽  
Gene Polymorphisms ◽  
International Prognostic Index ◽  
Prognostic Significance ◽  
Prognostic Index ◽  
Vascular Endothelial ◽  
Healthy Individuals ◽  
Pcr Rflp ◽  
Hodgkin's Lymphomas ◽  
Endothelial Growth Factor

Angiogenesis and lymphangiogenesis are important in the proliferation and survival of the malignant hematopoietic neoplasms, including non-Hodgkin’s lymphomas (NHLs). Vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) play an important role in the initiation of angiogenesis. Both VEGF and bFGF have been reported to have prognostic significance in NHL. The present study aimed to determine an association between theVEGFandbFGFgene polymorphisms and disease susceptibility and progression.VEGF(rs3025039; 936 C>T) andbFGF(rs308395, −921 G>C) variants were determined in 78 NHL patients and 122 healthy individuals by PCR-RFLP technique. The presence of theVEGF 936Tallele was found to significantly associate with worse prognosis of the disease (expressed by the highest International Prognostic Index (IPI)) (0.41 versus 0.20, for IPI 4 among patients having and lacking theTallele). TheVEGF 936Tvariant was also more frequent among patients with IPI 4 than in controls (OR = 3.37, ). ThebFGF −921Gvariant was more frequently detected among patients with aggressive as compared to those with indolent histological subtype (0.37 versus 0.18, ) and healthy individuals (0.37 versus 0.19, OR = 2.51, ). These results imply that VEGF and bFGF gene polymorphisms have prognostic significance in patients with NHL.

Serum levels of growth factors in patients with urinary bladder cancer

2017 ◽  
Vol 42 (5) ◽  
Author(s):  
Şölen Himmetoğlu ◽  
Mustafa Bilal Tuna ◽  
Eylem Efe Koç ◽  
Süleyman Ataus ◽  
Yildiz Dincer
Keyword(s):  
Bladder Cancer ◽  
Growth Factor ◽  
Epidermal Growth Factor ◽  
Serum Level ◽  
Urinary Bladder ◽  
Urinary Bladder Cancer ◽  
Serum Levels ◽  
Control Group ◽  
Her 2 ◽  
Epidermal Growth

AbstractBackground:Altered signalling of human epidermal growth factor receptor-2 (HER-2/neu), insulin-like growth factor 1 (IGF-1) and epidermal growth factor (EGF) have been shown to play important role in tumor development and progression in various cancers. Their serum levels may be reliable indicator for diagnosis and progression of cancer.Objective:To examine the serum levels of soluble HER-2/neu (sHER-2/neu), IGF1 and EGF in patients with urinary bladder cancer (UBC).Material and methods:Serum levels of sHER-2/neu, IGF1 and EGF were measured by enzyme-linked immune assay in newly diagnosed, untreated patients with UBC.Results:In the patient group, sHER-2/neu level was found to be increased, IGF1 level was found to be decreased in comparison to those in the control group. Although serum level of sHER-2/neu was lower in the patients with Ta stage than that in the patients with T1 and T2 stages, this difference was not at a statistically significant level.Conclusion:Serum level of sHER-2/neu is increased in patients with UBC. Despite the lack of a significant association between sHER-2/neu level and pathological pT stage, sHER-2/neu may be a promising marker for UBC but IGF-1 and EGF have not such a potential.

scholarly journals Comparative study between serum level of hepatocyte growth factor and CA-125 in patients with suspicious malignant adnexal masses

2016 ◽  
Vol 6 (1) ◽  
pp. 38
Author(s):  
Ziad Mansour Ahmed ◽  
Helmy Helmy Abdel Satar ◽  
Moyassar Ahmed Zaki ◽  
Hassan Mansour Hassan
Keyword(s):  
Ovarian Cancer ◽  
Growth Factor ◽  
Serum Level ◽  
Hepatocyte Growth Factor ◽  
Serum Levels ◽  
Ca 125 ◽  
Control Group ◽  
Ovarian Carcinomas ◽  
Adnexal Masses ◽  
Hepatocyte Growth

Background: Hepatocyte growth factor has been described to be increased in different cancers. The aim of the present study is to evaluate as a screening marker the‏ serum level of Hepatocyte growth factor among suspicious adnexal masses as compared to serum levels of CA125.Methods: The present study included 80 female patients who are admitted to the Gynecology unit in Elshatby Maternity University Hospital divided into two groups. Forty patients with benign gynecological conditions (control group) and 40 patients with suspicious malignant adnexal masses (cases group). Preoperative blood samples were withdrawn from all patients of both cases and control group to assess the level of serum hepatocyte growth factor (HGF) and serum cancer antigen 125 (CA 125). Both were quantified using ELISA technique.Results: Out of the 40 cases with suspicious malignant adnexal masses, 35 had ovarian cancer while five only were borderline. Patients with ovarian carcinomas had significantly higher preoperative HGF and CA 125 serum levels than patients with borderline pathology. Patients with borderline tumors had a significantly higher serum HGF and CA 125 levels than patients with benign gynecological conditions in control group.Conclusions: HGF in serum was elevated in 71% of patients with suspicious malignant adnexal masses proved to be ovarian cancer by histopathology using a quantitative ELISA. HGF can be used as a screening tool for ovarian cancer.

scholarly journals New biomarkers of bone remodelling regulation in patients with acromegaly and endogenous hypercortisolism

2018 ◽  
Vol 15 (3) ◽  
pp. 33-41 ◽  
Author(s):  
Timur T. Tsoriev ◽  
Zhanna E. Belaya ◽  
Lyudmila Y. Rozhinskaya ◽  
Galina A. Mel’nichenko ◽  
Aleksandr V. Ilyin ◽  
...  
Keyword(s):  
Growth Factor ◽  
Bone Tissue ◽  
Bone Remodelling ◽  
Fibroblast Growth Factor 23 ◽  
Serum Levels ◽  
Enzyme Linked Immunosorbent Assay ◽  
Control Group ◽  
Serum Samples ◽  
Late Night ◽  
Fgf 23

Background: Bone tissue is a non-classical endocrine organ, which produces at least two hormones: fibroblast growth factor 23 (FGF-23) and decarboxylated osteocalcin (OC). In addition to this, recent studies demonstrate that specific proteins involved in the paracrine regulation of bone remodelling can be measured in peripheral serum samples and may serve as additional biomarkers of bone metabolism. Aims: to evaluate the serum levels of biomarkers related to endocrine and paracrine function of bone tissue in patients with Cushings disease (CD) and acromegaly. Materials and methods: The study was conducted according to the cross-sectional case-control type. Fasting serum samples were taken between 810 a.m. from patients with CD, acromegaly and age-, sex- and BMI-matched healthy volunteers and stored at -40 C. Commercially available kits for enzyme-linked immunosorbent assay (ELISA) were used to determine the serum levels of FGF-23, co-factor (co-receptor) Klotho, cathepsin K, sclerostin, P1NP. Insulin-like growth factor-1 (IGF-1) was measured by the immunochemiluminescence assay, late-night (11 p.m.) salivary cortisol (LNSC) was evaluated using the electrochemiluminescence method. Non-parametric tests (the Kruskal-Wallis test and the Mann-Whitney test) were used to assess the differences between the groups of patients. Results: The study includes 78 patients, (37.6 years old, 95% CI 34.7540.46): 29 patients with CD (group 1), 22 with acromegaly (group 2), and 27 healthy individuals (group 3), matched by sex, age and BMI (p = 0.432, 0.373 and 0.725 between groups, respectively). LNSC in patients with CD and IGF-1 in patients with acromegaly were significantly higher compared to the control group (p = 0.004 and p 0.001, respectively). In patients with acromegaly, a statistically significant increase in FGF-23 (1.13 (0.78;1.49) vs 0.78 (0.54;1.09)) and phosphorus (1.38 (1.24;1.52) vs 1.16 (1.12;1.29)) (p = 0.01 and p 0.001, respectively) was observed along with increased levels of bone remodelling markers. In patients with CD, bone formation markers were suppressed, but differences in the levels of other biomarkers could not be identified. Conclusions: Acromegaly leads to hyperphosphatemia and increase in FGF-23, which is most likely due to the development of resistance to FGF-23, and the intensification of bone remodelling. With CD, another bone hormone, osteocalcin, is suppressed along with the suppression of P1NP.

Serum otolin-1 as a biomarker for benign paroxysmal positional vertigo: a case-control study

2021 ◽  
pp. 1-4
Author(s):  
D V K Irugu ◽  
A Singh ◽  
H Yadav ◽  
H Verma ◽  
R Kumar ◽  
...  
Keyword(s):  
Serum Level ◽  
Benign Paroxysmal Positional Vertigo ◽  
Case Control Study ◽  
Serum Levels ◽  
Case Control ◽  
Control Group ◽  
Positional Vertigo ◽  
The Difference ◽  
Control Study ◽  
Paroxysmal Positional Vertigo

Abstract Objectives This study aimed to evaluate serum otolin-1 levels in patients with benign paroxysmal positional vertigo and to compare these levels with healthy individuals. Method This was a case-control study. After obtaining institutional ethical committee clearance, the serum level of otolin-1 was calculated in adult individuals (18–75 years old) who were divided into group 1 (patients presenting with benign paroxysmal positional vertigo) and group 2 (healthy patients without benign paroxysmal positional vertigo as the control group). Data analysis was carried out to compare the serum levels in the cases and controls. A p-value less than 0.05 was considered significant. Results A total of 70 age-matched individuals (cases, n = 40; controls, n = 30) were included in the study. The mean serum level of otolin-1 was 636.8 pg/ml (range, 259–981 pg/ml) in the group of patients with benign paroxysmal positional vertigo and 236.2 pg/ml (range, 189–370 pg/ml) in the control group. The difference was statistically significant (p = 0.0000). Conclusion The serum levels of otolin-1 in patients with benign paroxysmal positional vertigo are significantly higher compared with individuals without benign paroxysmal positional vertigo.

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