中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R

Research advances in traditional Chinese medicine for the treatment of hepatocellular carcinoma by regulating immune cells

DOI: 10.12449/JCH250223
Research funding:

National Natural Science Foundation of China (81860889);

Joint Project on Regional High-Incidence Diseases Research of Guangxi Natural Science Foundation (2024GXNSFAA010131);

Joint Project on Regional High-Incidence Diseases Research of Guangxi Natural Science Foundation (2024GXNSFBA010182);

Guangxi Zhuang Autonomous Region Snake Resources Anti Tumor Medicinal Research and Application Engineering Research Center Project (Gui Development and Reform High Technology Letter[2023]No.2727)

More Information
  • Corresponding author: QIU Hua, qiuhua8899@163.com (ORCID: 0000-0001-7297-7214)
  • Received Date: 2024-05-30
  • Accepted Date: 2024-07-17
  • Published Date: 2025-02-25
  • Hepatocellular carcinoma (HCC) is a common malignant tumor with a high mortality rate, an insidious onset, and complex pathological mechanisms. In the tumor microenvironment, tumor-promoting immune cells protect tumor cells from immune attacks, while dysfunction of anti-tumor immune cells causes the inhibition of immune response, thereby leading to the continuous deterioration of cancer. In recent years, traditional Chinese medicine has shown good efficacy in the treatment of HCC, and it can inhibit the proliferation and metastasis of cancer cells by regulating immune cells. By analyzing related articles in China and globally, this article summarizes how immune cells affect the progression of HCC through the immunosuppressive pathway and how traditional Chinese medicine exerts an anti-HCC effect by regulating immune cells, in order to provide theoretical basis and reference for optimizing the treatment of HCC.

     

  • [1]
    SUNG H, FERLAY J, SIEGEL RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71( 3): 209- 249. DOI: 10.3322/caac.21660.
    [2]
    VOGEL A, MEYER T, SAPISOCHIN G, et al. Hepatocellular carcinoma[J]. The Lancet, 2022, 400( 10360): 1345- 1362. DOI: 10.1016/S0140-6736(22)01200-4.
    [3]
    ANWANWAN D, SINGH SK, SINGH S, et al. Challenges in liver cancer and possible treatment approaches[J]. Biochim Biophys Acta Rev Cancer, 2020, 1873( 1): 188314. DOI: 10.1016/j.bbcan.2019.188314.
    [4]
    QUAN H, SHI L, CHEN J, et al. Research progress of tumor microenvironment in hepatocelluar carcinoma[J]. Anti Tumor Pharm, 2023, 13( 2): 150- 154. DOI: 10.3969/j.issn.2095-1264.2023.02.03.

    权虎, 石磊, 陈杰, 等. 肿瘤微环境在肝细胞癌中的研究进展[J]. 肿瘤药学, 2023, 13( 2): 150- 154. DOI: 10.3969/j.issn.2095-1264.2023.02.03.
    [5]
    WANG WQ, GAO ZH, YIN CJ. A methodological study of traditional Chinese medicine treatment of primary liver cancer[J]. J Clin Hepatol, 2021, 37( 9): 2009- 2015. DOI: 10.3969/j.issn.1001-5256.2021.09.003.

    王伟芹, 高占华, 尹常健. 中医药治疗原发性肝癌的方法学研究[J]. 临床肝胆病杂志, 2021, 37( 9): 2009- 2015. DOI: 10.3969/j.issn.1001-5256.2021.09.003.
    [6]
    WANG ZY, GAO L, HU SP, et al. Discussion on tumor immune microenvironment and the application of traditional Chinese medicine based on the theory of“healthy and evil Qi”[J]. Mod Chin Clin Med, 2023, 30( 6): 71- 75. DOI: 10.3969/j.issn.2095-6606.2023.06.016.

    王郅宜, 高磊, 胡少朴, 等. 从正邪理论探讨肿瘤免疫微环境及中医辨治思路[J]. 现代中医临床, 2023, 30( 6): 71- 75. DOI: 10.3969/j.issn.2095-6606.2023.06.016.
    [7]
    CAI X, YU LH, LIU XL, et al. Standard for diagnosis and treatment of primary liver cancer(2022 edition)[J]. Chin J Integr Tradit West Med Liver Dis, 2024, 34( 4): 351- 354. DOI: 10.3969/j.issn.1005-0264.2024.004.015.

    蔡雪, 于莉华, 刘晓利, 等. 基于免疫微环境探讨养阴扶正解毒法治疗原发性肝癌[J]. 中西医结合肝病杂志, 2024, 34( 4): 351- 354. DOI: 10.3969/j.issn.1005-0264.2024.004.015.
    [8]
    DUNN GP, BRUCE AT, IKEDA H, et al. Cancer immunoediting: From immunosurveillance to tumor escape[J]. Nat Immunol, 2002, 3( 11): 991- 998. DOI: 10.1038/ni1102-991.
    [9]
    WANG P, QIU JN, WANG ZX, et al. Research advances in tumor-associated macrophages in hepatocellular carcinoma microenvironment[J]. J Clin Hepatol, 2023, 39( 5): 1212- 1218. DOI: 10.3969/j.issn.1001-5256.2023.05.033.

    汪鹏, 仇建南, 王忠夏, 等. 肝癌微环境中肿瘤相关巨噬细胞的研究进展[J]. 临床肝胆病杂志, 2023, 39( 5): 1212- 1218. DOI: 10.3969/j.issn.1001-5256.2023.05.033.
    [10]
    MIRLEKAR B. Tumor promoting roles of IL-10, TGF-β, IL-4, and IL-35: Its implications in cancer immunotherapy[J]. SAGE Open Med, 2022, 10: 20503121211069012. DOI: 10.1177/20503121211069012.
    [11]
    WANG D, YANG L, YUE DL, et al. Macrophage-derived CCL22 promotes an immunosuppressive tumor microenvironment via IL-8 in malignant pleural effusion[J]. Cancer Lett, 2019, 452: 244- 253. DOI: 10.1016/j.canlet.2019.03.040.
    [12]
    ZHANG H, LIU L, LIU JB, et al. Roles of tumor-associated macrophages in anti-PD-1/PD-L1 immunotherapy for solid cancers[J]. Mol Cancer, 2023, 22( 1): 58. DOI: 10.1186/s12943-023-01725-x.
    [13]
    ZHANG QW, LIU L, GONG CY, et al. Prognostic significance of tumor-associated macrophages in solid tumor: A meta-analysis of the literature[J]. PLoS One, 2012, 7( 12): e50946. DOI: 10.1371/journal.pone.0050946.
    [14]
    LAN YT, FAN XP, FAN YC, et al. Change in the Treg/Th17 cell imbalance in hepatocellular carcinoma patients and its clinical value[J]. Medicine, 2017, 96( 32): e7704. DOI: 10.1097/MD.0000000000007704.
    [15]
    YU SZ, WANG Y, HOU J, et al. Tumor-infiltrating immune cells in hepatocellular carcinoma: Tregs is correlated with poor overall survival[J]. PLoS One, 2020, 15( 4): e0231003. DOI: 10.1371/journal.pone.0231003.
    [16]
    AJITH A, MERIMI M, ARKI MK, et al. Immune regulation and therapeutic application of T regulatory cells in liver diseases[J]. Front Immunol, 2024, 15: 1371089. DOI: 10.3389/fimmu.2024.1371089.
    [17]
    CHEN X, DU Y, HU QQ, et al. Tumor-derived CD4+CD25+regulatory T cells inhibit dendritic cells function by CTLA-4[J]. Pathol Res Pract, 2017, 213( 3): 245- 249. DOI: 10.1016/j.prp.2016.12.008.
    [18]
    HOECHST B, ORMANDY LA, BALLMAIER M, et al. A new population of myeloid-derived suppressor cells in hepatocellular carcinoma patients induces CD4+CD25+Foxp3(+) T cells[J]. Gastroenterology, 2008, 135( 1): 234- 243. DOI: 10.1053/j.gastro.2008.03.020.
    [19]
    ZHANG XY, FU X, LI TY, et al. The prognostic value of myeloid derived suppressor cell level in hepatocellular carcinoma: A systematic review and meta-analysis[J]. PLoS One, 2019, 14( 12): e0225327. DOI: 10.1371/journal.pone.0225327.
    [20]
    LU LC, CHANG CJ, HSU CH. Targeting myeloid-derived suppressor cells in the treatment of hepatocellular carcinoma: Current state and future perspectives[J]. J Hepatocell Carcinoma, 2019, 6: 71- 84. DOI: 10.2147/JHC.S159693.
    [21]
    HOECHST B, VOIGTLAENDER T, ORMANDY L, et al. Myeloid derived suppressor cells inhibit natural killer cells in patients with hepatocellular carcinoma via the NKp30 receptor[J]. Hepatology, 2009, 50( 3): 799- 807. DOI: 10.1002/hep.23054.
    [22]
    WU Y, KUANG DM, PAN WD, et al. Monocyte/macrophage-elicited natural killer cell dysfunction in hepatocellular carcinoma is mediated by CD48/2B4 interactions[J]. Hepatology, 2013, 57( 3): 1107- 1116. DOI: 10.1002/hep.26192.
    [23]
    EASOM NJW, STEGMANN KA, SWADLING L, et al. IL-15 overcomes hepatocellular carcinoma-induced NK cell dysfunction[J]. Front Immunol, 2018, 9: 1009. DOI: 10.3389/fimmu.2018.01009.
    [24]
    YU LH, LIU XL, WANG XH, et al. TIGIT+ TIM-3+ NK cells are correlated with NK cell exhaustion and disease progression in patients with hepatitis B virus-related hepatocellular carcinoma[J]. Oncoimmunology, 2021, 10( 1): 1942673. DOI: 10.1080/2162402X.2021.1942673.
    [25]
    LUO QZ, LUO WG, ZHU Q, et al. Tumor-derived soluble MICA obstructs the NKG2D pathway to restrain NK cytotoxicity[J]. Aging Dis, 2020, 11( 1): 118- 128. DOI: 10.14336/AD.2019.1017.
    [26]
    XU XZ, TAN YL, QIAN Y, et al. Clinicopathologic and prognostic significance of tumor-infiltrating CD8+ T cells in patients with hepatocellular carcinoma: A meta-analysis[J]. Medicine, 2019, 98( 2): e13923. DOI: 10.1097/MD.0000000000013923.
    [27]
    JIANG WQ, HE YJ, HE WG, et al. Exhausted CD8+T cells in the tumor immune microenvironment: New pathways to therapy[J]. Front Immunol, 2020, 11: 622509. DOI: 10.3389/fimmu.2020.622509.
    [28]
    ZHENG CH, ZHENG LT, YOO JK, et al. Landscape of infiltrating T cells in liver cancer revealed by single-cell sequencing[J]. Cell, 2017, 169( 7): 1342- 1356. e 16. DOI: 10.1016/j.cell.2017.05.035.
    [29]
    WANG S, WANG R, XU N, et al. SULT2B1-CS-DOCK2 axis regulates effector T-cell exhaustion in HCC microenvironment[J]. Hepatology, 2023, 78( 4): 1064- 1078. DOI: 10.1097/HEP.0000000000000025.
    [30]
    PU J, XU ZM, NIAN JH, et al. M2 macrophage-derived extracellular vesicles facilitate CD8+T cell exhaustion in hepatocellular carcinoma via the miR-21-5p/YOD1/YAP/β-catenin pathway[J]. Cell Death Discov, 2021, 7( 1): 182. DOI: 10.1038/s41420-021-00556-3.
    [31]
    ROBERTS EW, BROZ ML, BINNEWIES M, et al. Critical role for CD103+/CD141+ dendritic cells bearing CCR7 for tumor antigen trafficking and priming of T cell immunity in melanoma[J]. Cancer Cell, 2016, 30( 2): 324- 336. DOI: 10.1016/j.ccell.2016.06.003.
    [32]
    DU Y, CHEN X, LIN XQ, et al. Tumor-derived CD4+CD25+ Tregs inhibit the maturation and antigen-presenting function of dendritic cells[J]. Asian Pac J Cancer Prev, 2015, 16( 7): 2665- 2669. DOI: 10.7314/apjcp.2015.16.7.2665.
    [33]
    ZHOU GY, SPRENGERS D, BOOR PPC, et al. Antibodies against immune checkpoint molecules restore functions of tumor-infiltrating T cells in hepatocellular carcinomas[J]. Gastroenterology, 2017, 153( 4): 1107- 1119. e 10. DOI: 10.1053/j.gastro.2017.06.017.
    [34]
    LIU XY, CAO MD, LAN Y, et al. Effects of sinomenine on α7nAChR-involved M2 polarization of macrophages and TAM polarization in hepatoma ascitic tumor mouse model[J]. Tradit Chin Drug Res Clin Pharmacol, 2022, 33( 12): 1645- 1653. DOI: 10.19378/j.issn.1003-9783.2022.12.008.

    刘新迎, 曹敏蝶, 蓝燕, 等. 青藤碱对α7nAChR参与的巨噬细胞M2极化和小鼠肝癌TAM极化的干预作用[J]. 中药新药与临床药理, 2022, 33( 12): 1645- 1653. DOI: 10.19378/j.issn.1003-9783.2022.12.008.
    [35]
    SU Q, CHEN HR, LU J, et al. Experimental study of Corydalis saxicola total alkaloids inhibiting M2-type macrophages against mice liver cancer[J]. J Chin Med Mater, 2023, 46( 7): 1760- 1765. DOI: 10.13863/j.issn1001-4454.2023.07.031.

    苏倩, 陈好然, 陆洁, 等. 岩黄连总生物碱抑制M2型巨噬细胞抗小鼠肝癌实验研究[J]. 中药材, 2023, 46( 7): 1760- 1765. DOI: 10.13863/j.issn1001-4454.2023.07.031.
    [36]
    HAN Z, LIU S, LIN HS, et al. Inhibition of murine hepatoma tumor growth by cryptotanshinone involves TLR7-dependent activation of macrophages and induction of adaptive antitumor immune defenses[J]. Cancer Immunol Immunother, 2019, 68( 7): 1073- 1085. DOI: 10.1007/s00262-019-02338-4.
    [37]
    ZHANG Y, DONG J, GUO B, et al. Effect of Sanjie tablet on macrophage polarization and MAPK/JNK signaling pathway in rats with liver cancer[J]. Chin J Anat, 2023, 46( 5): 406- 410, 439. DOI: 10.3969/j.issn.1001-1633.2023.05.008.

    张远, 董晶, 国滨, 等. 散结片对肝癌大鼠巨噬细胞极化及MAPK/JNK信号通路的作用机制[J]. 解剖学杂志, 2023, 46( 5): 406- 410, 439. DOI: 10.3969/j.issn.1001-1633.2023.05.008.
    [38]
    PENG L, ZHANG X, ZUO AX, et al. Polysaccharides from aconiturn brachypodum Diels ameliorate liver metastasis via regulating Treg cells[J]. J Yunnan Univ Chin Med, 2023, 46( 4): 75- 80. DOI: 10.19288/j.cnki.issn.1000-2723.2023.04.015.

    彭磊, 张霞, 左爱学, 等. 雪上一枝蒿多糖调控调节性T细胞抑制肝癌肺转移机制的研究[J]. 云南中医药大学学报, 2023, 46( 4): 75- 80. DOI: 10.19288/j.cnki.issn.1000-2723.2023.04.015.
    [39]
    GAO JW, XU K, RAN R, et al. Impacts of solanine on tumor immune escape mediated by Treg cells in hepatocellular carcinoma[J]. China Mod Dr, 2021, 59( 18): 35- 38, 42, 193.

    高聚伟, 徐凯, 冉冉, 等. 龙葵碱对肝癌Treg细胞介导的肿瘤免疫逃逸的影响[J]. 中国现代医生, 2021, 59( 18): 35- 38, 42, 193.
    [40]
    WU L, YANG FR, XING ML, et al. Multi-material basis and multi-mechanisms of the Dahuang Zhechong pill for regulating Treg/Th1 balance in hepatocellular carcinoma[J]. Phytomedicine, 2022, 100: 154055. DOI: 10.1016/j.phymed.2022.154055.
    [41]
    ZHANG LJ. Basic research on QHF compound's application in resisting immune escape of liver cancer by chemotactic Tregs cells[D]. Yichang: China Three Gorges University, 2021.

    张丽瑾. QHF复方通过趋化Tregs细胞抗肝癌免疫逃逸的应用基础研究[D]. 宜昌: 三峡大学, 2021.
    [42]
    TIAN S, LIAO L, ZHOU Q, et al. Curcumin inhibits the growth of liver cancer by impairing myeloid-derived suppressor cells in murine tumor tissues[J]. Oncol Lett, 2021, 21( 4): 286. DOI: 10.3892/ol.2021.12547.
    [43]
    NIE SC. Effect and mechanism of Jinmao Jiedu recipe on recruitment and differentiation of marrow-derived inhibitory cells induced by hepatic stellate cells[D]. Shanghai: Naval Medical University, 2023.

    聂姝常. 金猫解毒方对肝星状细胞诱导的髓源性抑制细胞募集和分化的影响及机制探究[D]. 上海: 中国人民解放军海军军医大学, 2023.
    [44]
    XIE YJ, ZHANG Y, WEI XH, et al. Jianpi Huayu Decoction attenuates the immunosuppressive status of H22 hepatocellular carcinoma-bearing mice: By targeting myeloid-derived suppressor cells[J]. Front Pharmacol, 2020, 11: 16. DOI: 10.3389/fphar.2020.00016.
    [45]
    FENG XY, CHEN BC, LI JC, et al. Gansui-Banxia Decoction extraction inhibits MDSCs accumulation via AKT/STAT3/ERK signaling pathways to regulate antitumor immunity in C57bl/6 mice[J]. Phytomedicine, 2021, 93: 153779. DOI: 10.1016/j.phymed.2021.153779.
    [46]
    XIE X, SHEN W, ZHOU YR, et al. Characterization of a polysaccharide from Eupolyphaga sinensis walker and its effective antitumor activity via lymphocyte activation[J]. Int J Biol Macromol, 2020, 162: 31- 42. DOI: 10.1016/j.ijbiomac.2020.06.120.
    [47]
    SONG AP, DING TT, WEI N, et al. Schisandrin B induces HepG2 cells pyroptosis by activating NK cells mediated anti-tumor immunity[J]. Toxicol Appl Pharmacol, 2023, 472: 116574. DOI: 10.1016/j.taap.2023.116574.
    [48]
    FU R, YU FJ, WU WQ, et al. Bufalin enhances the killing efficacy of NK cells against hepatocellular carcinoma by inhibiting MICA shedding[J]. Int Immunopharmacol, 2021, 101( Pt B): 108195. DOI: 10.1016/j.intimp.2021.108195.
    [49]
    WANG H, QI XZ, JIA WT, et al. The immunoregulatory effect of aconite treatment on H22 tumor-bearing mice via modulating adaptive immunity and natural killer-related immunity[J]. Evid Based Complement Alternat Med, 2023, 2023: 1481114. DOI: 10.1155/2023/1481114.
    [50]
    YUAN Q, YAO F, LIU M, et al. Study of the mechanism of improving NK cell activity in the immunosuppressive microenvironment of hepatocellular carcinoma by Yupingfeng powder through STAT3[J]. J Nantong Univ Med Sci, 2023, 43( 3): 211- 215. DOI: 10.16424/j.cnki.cn32-1807/r.2023.03.003.

    袁琴, 姚霏, 刘敏, 等. 玉屏风散通过STAT3改善肝细胞肝癌免疫抑制微环境中NK细胞活性的机制研究[J]. 南通大学学报(医学版), 2023, 43( 3): 211- 215. DOI: 10.16424/j.cnki.cn32-1807/r.2023.03.003.
    [51]
    LI M, JIANG CZ, CHEN JT, et al. Formononetin enhances the antitumor effect of H22 hepatoma transplanted mice[J]. Chin J Cell Mol Immunol, 2023, 39(‍ 12): 1063- 1068. DOI: 10.13423/j.cnki.cjcmi.009768.

    李汨, 蒋承志, 陈建婷, 等. 芒柄花黄素对小鼠H22肝癌移植瘤的抗肿瘤作用[J]. 细胞与分子免疫学杂志, 2023, 39(‍ 12): 1063- 1068. DOI: 10.13423/j.cnki.cjcmi.009768.
    [52]
    GUO DF, ZHANG M, ZHANG XD, et al. Experimental observation of pectolinarigenin in promoting CD8+ T cell infiltration in mice bearing hepatocellular carcinoma[J/CD]. Pract J Organ Transplant Electron Version, 2022, 10( 4): 347- 352. DOI: 10.3969/j.issn.2095-5332.2022.04.011.

    郭丹风, 张铭, 张笑丹, 等. 柳穿鱼黄素促进肝癌小鼠肿瘤中CD8+ T细胞浸润的实验性观察[J/CD]. 实用器官移植电子杂志, 2022, 10( 4): 347- 352. DOI: 10.3969/j.issn.2095-5332.2022.04.011.
    [53]
    GAO M, ZHANG DJ, JIANG CH, et al. Paeoniflorin inhibits hepatocellular carcinoma growth by reducing PD-L1 expression[J]. Biomed Pharmacother, 2023, 166: 115317. DOI: 10.1016/j.biopha.2023.115317.
    [54]
    MA XJ, LIU B, WANG L, et al. Modified Danggui Beimu Kushen pills inhibit tumor growth and regulates T cell subsets in H22 hepatocellular carcinoma-bearing mice[J]. Chin J Exp Tradit Med Formulae, 2024, 30( 12): 87- 96. DOI: 10.13422/j.cnki.syfjx.20232224.

    马晓洁, 刘犇, 王磊, 等. 加味当归贝母苦参丸对H22肝癌荷瘤小鼠抑瘤及T细胞免疫调节作用[J]. 中国实验方剂学杂志, 2024, 30( 12): 87- 96. DOI: 10.13422/j.cnki.syfjx.20232224.
    [55]
    YAN FN, WANG XH, XIE YQ, et al. Yangyin Fuzheng Jiedu Prescription exerts anti-tumor immunity in hepatocellular carcinoma by alleviating exhausted T cells[J]. Phytomedicine, 2021, 91: 153722. DOI: 10.1016/j.phymed.2021.153722.
    [56]
    YU YT, NADIREMU XKLT, LU YQ, et al. Immunotherapeutic effect of dendritic cell vaccine assisted by Glycyrrhiza in flata polysaccharides in H22 hepatoma-bearing mice[J]. Chin J Hosp Pharm, 2024, 44( 1): 35- 41. DOI: 10.13286/j.1001-5213.2024.01.06.

    俞永婷, 娜迪热木·肖克拉提, 卢泳强, 等. 胀果甘草多糖佐助的树突状细胞疫苗对H22肝癌荷瘤小鼠的免疫治疗作用[J]. 中国医院药学杂志, 2024, 44( 1): 35- 41. DOI: 10.13286/j.1001-5213.2024.01.06.
    [57]
    ZHANG ML, CHEN YP, WANG Q, et al. Lycium barbarum L. polysaccharide LBP3 exerts the anti-tumor effect through enhancing the function of tumor-associated dendritic cells via inhibiting IRE1α-XBP1 pathway of ER stress[J]. J Funct Foods, 2024, 112: 105950. DOI: 10.1016/j.jff.2023.105950.
    [58]
    WU YN, LI X, ZHANG D, et al. Influence of beilong Ruangan Decoction on perliferation of peripheral blood dendritic cells from HBV related hepatocellular carcinoma patients[J]. Liaoning J Tradit Chin Med, 2019, 46( 3): 646- 649, 673. DOI: 10.13192/j.issn.1000-1719.2019.03.060.

    伍玉南, 李秀, 张冬, 等. 鳖龙软肝汤含药血浆对HBV相关性肝癌患者外周血树突状细胞增殖的影响[J]. 辽宁中医杂志, 2019, 46( 3): 646- 649, 673. DOI: 10.13192/j.issn.1000-1719.2019.03.060.
    [59]
    YAO F, YUAN Q, SONG XD, et al. Yupingfeng granule improves Th2-biased immune state in microenvironment of hepatocellular carcinoma through TSLP-DC-OX40L pathway[J]. Evid Based Complement Alternat Med, 2020, 2020: 1263053. DOI: 10.1155/2020/1263053.
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(2)  / Tables(2)

    Article Metrics

    Article views (101) PDF downloads(19) Cited by()
    Proportional views
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return