Education/CredentialsAbdominal Transplant Surgery Fellowship: University of PennsylvaniaGeneral Surgery Residency: University of Cincinnati College of MedicineResearch Fellowship : University of CincinnatiMedical Degree: Baylor College of MedicineBachelor's Degree: University of Texas (Biomedical Engineering) Board Certifications & LicensesAmerican Board of Surgery (Certification Date: 2020-10-20) - (Recertification Date: 2023-10-26) SpecialtiesSurgery-Transplant Contact Information Medical Sciences Building 1461 Office 713-876-6476 Email changax@ucmail.uc.edu Clinical Interests General SurgeryTransplant SurgeryAbdominal HerniaAcute Kidney Injury (AKI)Acute Renal failure (Acute kidney failure)Biliary Tract Liver DiseaseCholangitisCirrhosisGroin HerniasHepatobiliaryKidney DiseaseLiver diseaseLiver FailureNonalcoholic Fatty Liver Disease (NAFLD)Nonalcoholic Steatohepatitis (NASH)Obstructive Biliary Tract Liver DiseaseRenal Artery ObstructionRenal Artery StenosisRenal CancerRenal Cell Carcinoma Peer Reviewed Publications Kim, Young; Xia, Brent T; Jung, Andrew D; Chang, Alex L; Abplanalp, William A; Caldwell, Charles C; Goodman, Michael D; Pritts, Timothy A 2018. Microparticles from stored red blood cells promote a hypercoagulable state in a murine model of transfusion. Surgery, 163 2, 423-429Chang, Alex L; Kim, Young; Ertel, Audrey E; Hoehn, Richard S; Wima, Koffi; Abbott, Daniel E; Shah, Shimul A 2017. Case mix-adjusted cost of colectomy at low-, middle-, and high-volume academic centers. Surgery, 161 5, 1405-1413Chang, Alex L; Kim, Young; Seitz, Aaron P; Schuster, Rebecca M; Lentsch, Alex B; Pritts, Timothy A 2017. Erythrocyte-Derived Microparticles Activate Pulmonary Endothelial Cells in a Murine Model of Transfusion. Shock (Augusta, Ga.), 47 5, 632-637Chang, Alex L; Kim, Young; Seitz, Aaron P; Schuster, Rebecca M; Pritts, Timothy A 2017. pH modulation ameliorates the red blood cell storage lesion in a murine model of transfusion. The Journal of surgical research, 212 , 54-59Chang, Alex L; Pritts, Timothy A 2017. Reply to "Packed Red Blood Cells Accumulate Oxidative Stress With Increased Storage Duration". Shock (Augusta, Ga.), 48 2, 271Chang, Alex; Kim, Young; Hoehn, Richard; Jernigan, Peter; Pritts, Timothy 2017. Cryopreserved packed red blood cells in surgical patients: past, present, and future. Blood transfusion = Trasfusione del sangue, 15 4, 341-347Hoehn, Richard S; Hanseman, Dennis J; Chang, Alex L; Daly, Megan C; Ertel, Audrey E; Abbott, Daniel E; Shah, Shimul A; Paquette, Ian M 2017. Surgeon Characteristics Supersede Hospital Characteristics in Mortality After Urgent Colectomy. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 21 1, 23-32Hoehn, Richard S; Jernigan, Peter L; Japtok, Lukasz; Chang, Alex L; Midura, Emily F; Caldwell, Charles C; Kleuser, Burkhard; Lentsch, Alex B; Edwards, Michael J; Gulbins, Erich; Pritts, Timothy A 2017. Acid Sphingomyelinase Inhibition in Stored Erythrocytes Reduces Transfusion-Associated Lung Inflammation. Annals of surgery, 265 1, 218-226Abbott, Daniel E; Sutton, Jeffrey M; Jernigan, Peter L; Chang, Alex; Frye, Patrick; Shah, Shimul A; Schauer, Daniel P; Eckman, Mark H; Ahmad, Syed A; Sussman, Jeffrey J 2016. Prophylactic pasireotide administration following pancreatic resection reduces cost while improving outcomes. Journal of surgical oncology, 113 7, 784-8Abbott, Daniel E; Sutton, Jeffrey M; Jernigan, Peter L; Chang, Alex; Frye, Patrick; Shah, Shimul A; Schauer, Daniel P; Eckman, Mark H; Ahmad, Syed A; Sussman, Jeffrey J 2016. How Much Should We Pay to Minimize Pancreatic Leak? The Cost-effectiveness of Pasireotide in Pancreatic Resection: RETRACTED. Annals of surgery, , Chang, Alex L; Cortez, Alexander R; Bondoc, Alexander; Schauer, Daniel P; Fitch, Angela; Shah, Shimul A; Woodle, Steve E; Diwan, Tayyab 2016. Metabolic syndrome in liver transplantation: A preoperative and postoperative concern. Surgery, 160 4, 1111-1117Chang, Alex L; Hoehn, Richard S; Jernigan, Peter; Cox, Daniel; Schreiber, Martin; Pritts, Timothy A 2016. Previous Cryopreservation Alters the Natural History of the Red Blood Cell Storage Lesion. Shock (Augusta, Ga.), , Ertel, Audrey E; Chang, Alex L; Kim, Young; Shah, Shimul A 2016. Management of gastrointestinal bleeding in patients with cirrhosis. Current problems in surgery, 53 8, 366-95Ertel, Audrey E; Wima, Koffi; Chang, Alex L; Hoehn, Richard S; Hohmann, Samual F; Edwards, Michael J; Abbott, Daniel E; Shah, Shimul A 2016. Risk of Reoperation Within 90 Days of Liver Transplantation: A Necessary Evil? Journal of the American College of Surgeons, , Ertel, Audrey E; Wima, Koffi; Hoehn, Richard S; Chang, Alex L; Hohmann, Samuel F; Ahmad, Syed A; Sussman, Jeffrey J; Shah, Shimul A; Abbott, Daniel E 2016. Variability in postoperative resource utilization after pancreaticoduodenectomy: Who is responsible. Surgery, 160 6, 1477-1484Go, Derek E; Abbott, Daniel E; Wima, Koffi; Hanseman, Dennis J; Ertel, Audrey E; Chang, Alex L; Shah, Shimul A; Hoehn, Richard S 2016. Addressing the High Costs of Pancreaticoduodenectomy at Safety-Net Hospitals. JAMA surgery, 151 10, 908-914Hoehn, Richard S; Hanseman, Dennis J; Go, Derek; Wima, Koffi; Chang, Alex; Ertel, Audrey E; Shah, Shimul A; Abbott, Daniel E 2016. Hospital resources are associated with value-based surgical performance. The Journal of surgical research, 204 1, 15-21Hoehn, Richard S; Jernigan, Peter L; Chang, Alex L; Edwards, Michael J; Caldwell, Charles C; Gulbins, Erich; Pritts, Timothy A 2016. Acid Sphingomyelinase Inhibition Prevents Hemolysis During Erythrocyte Storage. Cellular physiology and biochemistry : international journal of experimental cellular physiology, biochemistry, and pharmacology, 39 1, 331-40Hoehn, Richard S; Jernigan, Peter L; Japtok, Lukasz; Chang, Alex L; Midura, Emily F; Caldwell, Charles C; Kleuser, Burkhard; Lentsch, Alex B; Edwards, Michael J; Gulbins, Erich; Pritts, Timothy A 2016. Acid Sphingomyelinase Inhibition in Stored Erythrocytes Reduces Transfusion-Associated Lung Inflammation. Annals of surgery, , Kim, Young; Chang, Alex L; Wima, Koffi; Ertel, Audrey E; Diwan, Tayyab S; Abbott, Daniel E; Shah, Shimul A 2016. The impact of morbid obesity on resource utilization after renal transplantation. Surgery, 160 6, 1544-1550Kim, Young; Xia, Brent T; Chang, Alex L; Pritts, Timothy A 2016. Role of Leukoreduction of Packed Red Blood Cell Units in Trauma Patients: A Review. International journal of hematology research, 2 2, 124-129Hoehn, Richard S; Jernigan, Peter L; Chang, Alex L; Edwards, Michael J; Pritts, Timothy A 2015. Molecular mechanisms of erythrocyte aging. Biological chemistry, 396 6-7, 621-31Fan, Yihui; Yu, Yang; Shi, Yi; Sun, Wenjing; Xie, Min; Ge, Ningling; Mao, Renfang; Chang, Alex; Xu, Gufeng; Schneider, Michael D; Zhang, Hong; Fu, Songbin; Qin, Jun; Yang, Jianhua 2010. Lysine 63-linked polyubiquitination of TAK1 at lysine 158 is required for tumor necrosis factor alpha- and interleukin-1beta-induced IKK/NF-kappaB and JNK/AP-1 activation. The Journal of biological chemistry, 285 8, 5347-60Chang, Alex; Abbott, Daniel E . Cost-Effectiveness Analysis in Cancer Care. Cancer treatment and research, 168 , 377-91
Clinical Interests General SurgeryTransplant SurgeryAbdominal HerniaAcute Kidney Injury (AKI)Acute Renal failure (Acute kidney failure)Biliary Tract Liver DiseaseCholangitisCirrhosisGroin HerniasHepatobiliaryKidney DiseaseLiver diseaseLiver FailureNonalcoholic Fatty Liver Disease (NAFLD)Nonalcoholic Steatohepatitis (NASH)Obstructive Biliary Tract Liver DiseaseRenal Artery ObstructionRenal Artery StenosisRenal CancerRenal Cell Carcinoma
Peer Reviewed Publications Kim, Young; Xia, Brent T; Jung, Andrew D; Chang, Alex L; Abplanalp, William A; Caldwell, Charles C; Goodman, Michael D; Pritts, Timothy A 2018. Microparticles from stored red blood cells promote a hypercoagulable state in a murine model of transfusion. Surgery, 163 2, 423-429Chang, Alex L; Kim, Young; Ertel, Audrey E; Hoehn, Richard S; Wima, Koffi; Abbott, Daniel E; Shah, Shimul A 2017. Case mix-adjusted cost of colectomy at low-, middle-, and high-volume academic centers. Surgery, 161 5, 1405-1413Chang, Alex L; Kim, Young; Seitz, Aaron P; Schuster, Rebecca M; Lentsch, Alex B; Pritts, Timothy A 2017. Erythrocyte-Derived Microparticles Activate Pulmonary Endothelial Cells in a Murine Model of Transfusion. Shock (Augusta, Ga.), 47 5, 632-637Chang, Alex L; Kim, Young; Seitz, Aaron P; Schuster, Rebecca M; Pritts, Timothy A 2017. pH modulation ameliorates the red blood cell storage lesion in a murine model of transfusion. The Journal of surgical research, 212 , 54-59Chang, Alex L; Pritts, Timothy A 2017. Reply to "Packed Red Blood Cells Accumulate Oxidative Stress With Increased Storage Duration". Shock (Augusta, Ga.), 48 2, 271Chang, Alex; Kim, Young; Hoehn, Richard; Jernigan, Peter; Pritts, Timothy 2017. Cryopreserved packed red blood cells in surgical patients: past, present, and future. Blood transfusion = Trasfusione del sangue, 15 4, 341-347Hoehn, Richard S; Hanseman, Dennis J; Chang, Alex L; Daly, Megan C; Ertel, Audrey E; Abbott, Daniel E; Shah, Shimul A; Paquette, Ian M 2017. Surgeon Characteristics Supersede Hospital Characteristics in Mortality After Urgent Colectomy. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 21 1, 23-32Hoehn, Richard S; Jernigan, Peter L; Japtok, Lukasz; Chang, Alex L; Midura, Emily F; Caldwell, Charles C; Kleuser, Burkhard; Lentsch, Alex B; Edwards, Michael J; Gulbins, Erich; Pritts, Timothy A 2017. Acid Sphingomyelinase Inhibition in Stored Erythrocytes Reduces Transfusion-Associated Lung Inflammation. Annals of surgery, 265 1, 218-226Abbott, Daniel E; Sutton, Jeffrey M; Jernigan, Peter L; Chang, Alex; Frye, Patrick; Shah, Shimul A; Schauer, Daniel P; Eckman, Mark H; Ahmad, Syed A; Sussman, Jeffrey J 2016. Prophylactic pasireotide administration following pancreatic resection reduces cost while improving outcomes. Journal of surgical oncology, 113 7, 784-8Abbott, Daniel E; Sutton, Jeffrey M; Jernigan, Peter L; Chang, Alex; Frye, Patrick; Shah, Shimul A; Schauer, Daniel P; Eckman, Mark H; Ahmad, Syed A; Sussman, Jeffrey J 2016. How Much Should We Pay to Minimize Pancreatic Leak? The Cost-effectiveness of Pasireotide in Pancreatic Resection: RETRACTED. Annals of surgery, , Chang, Alex L; Cortez, Alexander R; Bondoc, Alexander; Schauer, Daniel P; Fitch, Angela; Shah, Shimul A; Woodle, Steve E; Diwan, Tayyab 2016. Metabolic syndrome in liver transplantation: A preoperative and postoperative concern. Surgery, 160 4, 1111-1117Chang, Alex L; Hoehn, Richard S; Jernigan, Peter; Cox, Daniel; Schreiber, Martin; Pritts, Timothy A 2016. Previous Cryopreservation Alters the Natural History of the Red Blood Cell Storage Lesion. Shock (Augusta, Ga.), , Ertel, Audrey E; Chang, Alex L; Kim, Young; Shah, Shimul A 2016. Management of gastrointestinal bleeding in patients with cirrhosis. Current problems in surgery, 53 8, 366-95Ertel, Audrey E; Wima, Koffi; Chang, Alex L; Hoehn, Richard S; Hohmann, Samual F; Edwards, Michael J; Abbott, Daniel E; Shah, Shimul A 2016. Risk of Reoperation Within 90 Days of Liver Transplantation: A Necessary Evil? Journal of the American College of Surgeons, , Ertel, Audrey E; Wima, Koffi; Hoehn, Richard S; Chang, Alex L; Hohmann, Samuel F; Ahmad, Syed A; Sussman, Jeffrey J; Shah, Shimul A; Abbott, Daniel E 2016. Variability in postoperative resource utilization after pancreaticoduodenectomy: Who is responsible. Surgery, 160 6, 1477-1484Go, Derek E; Abbott, Daniel E; Wima, Koffi; Hanseman, Dennis J; Ertel, Audrey E; Chang, Alex L; Shah, Shimul A; Hoehn, Richard S 2016. Addressing the High Costs of Pancreaticoduodenectomy at Safety-Net Hospitals. JAMA surgery, 151 10, 908-914Hoehn, Richard S; Hanseman, Dennis J; Go, Derek; Wima, Koffi; Chang, Alex; Ertel, Audrey E; Shah, Shimul A; Abbott, Daniel E 2016. Hospital resources are associated with value-based surgical performance. The Journal of surgical research, 204 1, 15-21Hoehn, Richard S; Jernigan, Peter L; Chang, Alex L; Edwards, Michael J; Caldwell, Charles C; Gulbins, Erich; Pritts, Timothy A 2016. Acid Sphingomyelinase Inhibition Prevents Hemolysis During Erythrocyte Storage. Cellular physiology and biochemistry : international journal of experimental cellular physiology, biochemistry, and pharmacology, 39 1, 331-40Hoehn, Richard S; Jernigan, Peter L; Japtok, Lukasz; Chang, Alex L; Midura, Emily F; Caldwell, Charles C; Kleuser, Burkhard; Lentsch, Alex B; Edwards, Michael J; Gulbins, Erich; Pritts, Timothy A 2016. Acid Sphingomyelinase Inhibition in Stored Erythrocytes Reduces Transfusion-Associated Lung Inflammation. Annals of surgery, , Kim, Young; Chang, Alex L; Wima, Koffi; Ertel, Audrey E; Diwan, Tayyab S; Abbott, Daniel E; Shah, Shimul A 2016. The impact of morbid obesity on resource utilization after renal transplantation. Surgery, 160 6, 1544-1550Kim, Young; Xia, Brent T; Chang, Alex L; Pritts, Timothy A 2016. Role of Leukoreduction of Packed Red Blood Cell Units in Trauma Patients: A Review. International journal of hematology research, 2 2, 124-129Hoehn, Richard S; Jernigan, Peter L; Chang, Alex L; Edwards, Michael J; Pritts, Timothy A 2015. Molecular mechanisms of erythrocyte aging. Biological chemistry, 396 6-7, 621-31Fan, Yihui; Yu, Yang; Shi, Yi; Sun, Wenjing; Xie, Min; Ge, Ningling; Mao, Renfang; Chang, Alex; Xu, Gufeng; Schneider, Michael D; Zhang, Hong; Fu, Songbin; Qin, Jun; Yang, Jianhua 2010. Lysine 63-linked polyubiquitination of TAK1 at lysine 158 is required for tumor necrosis factor alpha- and interleukin-1beta-induced IKK/NF-kappaB and JNK/AP-1 activation. The Journal of biological chemistry, 285 8, 5347-60Chang, Alex; Abbott, Daniel E . Cost-Effectiveness Analysis in Cancer Care. Cancer treatment and research, 168 , 377-91
Kim, Young; Xia, Brent T; Jung, Andrew D; Chang, Alex L; Abplanalp, William A; Caldwell, Charles C; Goodman, Michael D; Pritts, Timothy A 2018. Microparticles from stored red blood cells promote a hypercoagulable state in a murine model of transfusion. Surgery, 163 2, 423-429Chang, Alex L; Kim, Young; Ertel, Audrey E; Hoehn, Richard S; Wima, Koffi; Abbott, Daniel E; Shah, Shimul A 2017. Case mix-adjusted cost of colectomy at low-, middle-, and high-volume academic centers. Surgery, 161 5, 1405-1413Chang, Alex L; Kim, Young; Seitz, Aaron P; Schuster, Rebecca M; Lentsch, Alex B; Pritts, Timothy A 2017. Erythrocyte-Derived Microparticles Activate Pulmonary Endothelial Cells in a Murine Model of Transfusion. Shock (Augusta, Ga.), 47 5, 632-637Chang, Alex L; Kim, Young; Seitz, Aaron P; Schuster, Rebecca M; Pritts, Timothy A 2017. pH modulation ameliorates the red blood cell storage lesion in a murine model of transfusion. The Journal of surgical research, 212 , 54-59Chang, Alex L; Pritts, Timothy A 2017. Reply to "Packed Red Blood Cells Accumulate Oxidative Stress With Increased Storage Duration". Shock (Augusta, Ga.), 48 2, 271Chang, Alex; Kim, Young; Hoehn, Richard; Jernigan, Peter; Pritts, Timothy 2017. Cryopreserved packed red blood cells in surgical patients: past, present, and future. Blood transfusion = Trasfusione del sangue, 15 4, 341-347Hoehn, Richard S; Hanseman, Dennis J; Chang, Alex L; Daly, Megan C; Ertel, Audrey E; Abbott, Daniel E; Shah, Shimul A; Paquette, Ian M 2017. Surgeon Characteristics Supersede Hospital Characteristics in Mortality After Urgent Colectomy. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 21 1, 23-32Hoehn, Richard S; Jernigan, Peter L; Japtok, Lukasz; Chang, Alex L; Midura, Emily F; Caldwell, Charles C; Kleuser, Burkhard; Lentsch, Alex B; Edwards, Michael J; Gulbins, Erich; Pritts, Timothy A 2017. Acid Sphingomyelinase Inhibition in Stored Erythrocytes Reduces Transfusion-Associated Lung Inflammation. Annals of surgery, 265 1, 218-226Abbott, Daniel E; Sutton, Jeffrey M; Jernigan, Peter L; Chang, Alex; Frye, Patrick; Shah, Shimul A; Schauer, Daniel P; Eckman, Mark H; Ahmad, Syed A; Sussman, Jeffrey J 2016. Prophylactic pasireotide administration following pancreatic resection reduces cost while improving outcomes. Journal of surgical oncology, 113 7, 784-8Abbott, Daniel E; Sutton, Jeffrey M; Jernigan, Peter L; Chang, Alex; Frye, Patrick; Shah, Shimul A; Schauer, Daniel P; Eckman, Mark H; Ahmad, Syed A; Sussman, Jeffrey J 2016. How Much Should We Pay to Minimize Pancreatic Leak? The Cost-effectiveness of Pasireotide in Pancreatic Resection: RETRACTED. Annals of surgery, , Chang, Alex L; Cortez, Alexander R; Bondoc, Alexander; Schauer, Daniel P; Fitch, Angela; Shah, Shimul A; Woodle, Steve E; Diwan, Tayyab 2016. Metabolic syndrome in liver transplantation: A preoperative and postoperative concern. Surgery, 160 4, 1111-1117Chang, Alex L; Hoehn, Richard S; Jernigan, Peter; Cox, Daniel; Schreiber, Martin; Pritts, Timothy A 2016. Previous Cryopreservation Alters the Natural History of the Red Blood Cell Storage Lesion. Shock (Augusta, Ga.), , Ertel, Audrey E; Chang, Alex L; Kim, Young; Shah, Shimul A 2016. Management of gastrointestinal bleeding in patients with cirrhosis. Current problems in surgery, 53 8, 366-95Ertel, Audrey E; Wima, Koffi; Chang, Alex L; Hoehn, Richard S; Hohmann, Samual F; Edwards, Michael J; Abbott, Daniel E; Shah, Shimul A 2016. Risk of Reoperation Within 90 Days of Liver Transplantation: A Necessary Evil? Journal of the American College of Surgeons, , Ertel, Audrey E; Wima, Koffi; Hoehn, Richard S; Chang, Alex L; Hohmann, Samuel F; Ahmad, Syed A; Sussman, Jeffrey J; Shah, Shimul A; Abbott, Daniel E 2016. Variability in postoperative resource utilization after pancreaticoduodenectomy: Who is responsible. Surgery, 160 6, 1477-1484Go, Derek E; Abbott, Daniel E; Wima, Koffi; Hanseman, Dennis J; Ertel, Audrey E; Chang, Alex L; Shah, Shimul A; Hoehn, Richard S 2016. Addressing the High Costs of Pancreaticoduodenectomy at Safety-Net Hospitals. JAMA surgery, 151 10, 908-914Hoehn, Richard S; Hanseman, Dennis J; Go, Derek; Wima, Koffi; Chang, Alex; Ertel, Audrey E; Shah, Shimul A; Abbott, Daniel E 2016. Hospital resources are associated with value-based surgical performance. The Journal of surgical research, 204 1, 15-21Hoehn, Richard S; Jernigan, Peter L; Chang, Alex L; Edwards, Michael J; Caldwell, Charles C; Gulbins, Erich; Pritts, Timothy A 2016. Acid Sphingomyelinase Inhibition Prevents Hemolysis During Erythrocyte Storage. Cellular physiology and biochemistry : international journal of experimental cellular physiology, biochemistry, and pharmacology, 39 1, 331-40Hoehn, Richard S; Jernigan, Peter L; Japtok, Lukasz; Chang, Alex L; Midura, Emily F; Caldwell, Charles C; Kleuser, Burkhard; Lentsch, Alex B; Edwards, Michael J; Gulbins, Erich; Pritts, Timothy A 2016. Acid Sphingomyelinase Inhibition in Stored Erythrocytes Reduces Transfusion-Associated Lung Inflammation. Annals of surgery, , Kim, Young; Chang, Alex L; Wima, Koffi; Ertel, Audrey E; Diwan, Tayyab S; Abbott, Daniel E; Shah, Shimul A 2016. The impact of morbid obesity on resource utilization after renal transplantation. Surgery, 160 6, 1544-1550Kim, Young; Xia, Brent T; Chang, Alex L; Pritts, Timothy A 2016. Role of Leukoreduction of Packed Red Blood Cell Units in Trauma Patients: A Review. International journal of hematology research, 2 2, 124-129Hoehn, Richard S; Jernigan, Peter L; Chang, Alex L; Edwards, Michael J; Pritts, Timothy A 2015. Molecular mechanisms of erythrocyte aging. Biological chemistry, 396 6-7, 621-31Fan, Yihui; Yu, Yang; Shi, Yi; Sun, Wenjing; Xie, Min; Ge, Ningling; Mao, Renfang; Chang, Alex; Xu, Gufeng; Schneider, Michael D; Zhang, Hong; Fu, Songbin; Qin, Jun; Yang, Jianhua 2010. Lysine 63-linked polyubiquitination of TAK1 at lysine 158 is required for tumor necrosis factor alpha- and interleukin-1beta-induced IKK/NF-kappaB and JNK/AP-1 activation. The Journal of biological chemistry, 285 8, 5347-60Chang, Alex; Abbott, Daniel E . Cost-Effectiveness Analysis in Cancer Care. Cancer treatment and research, 168 , 377-91