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COST-UTILITY ANALYSIS OF PERSONALIZED ANTIPLATELET THERAPY 个体化抗血小板治疗的成本-效用分析
Pub Date : 2023-05-16 DOI: 10.29039/2712-8164-2023-1-17-26
M. Abdullaev, B. Kantemirova, E. Chernysheva, A. Romanova
The article contains the results of a comparison pharmacoeconomical cost-utility analysis of several options for dual antiplatelet therapy in patients with acute coronary syndrome after stent implanting. The costs for treatment alternatives with and without prior pharmacogenetic testing for CYP2C19 were calculated. According to the results of the analysis the most cost-effective treatment option for patients with acute coronary syndrome is prior pharmacogenetic testing and the choice of the antiplatelet drug prasugrel in slow and intermediate metabolizers (CUA: 289,111.00 rubles per QALY).
这篇文章包含了对急性冠脉综合征患者支架植入术后几种双重抗血小板治疗方案的比较药物经济成本-效用分析的结果。计算有和没有事先进行CYP2C19药物遗传学检测的治疗方案的费用。根据分析结果,对急性冠状动脉综合征患者来说,最具成本效益的治疗方案是事先进行药物遗传学检查,并选择抗血小板药物普拉格雷治疗慢代谢和中度代谢(按质量计算,平均平均损失为289,111.00卢布)。
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引用次数: 0
CHALLENGES IN EARLY DIAGNOSIS OF JUVENILE DERMATOMYOSITIS: A BRIEF REVIEW OF THE LITERATURE AND A CASE STUDY 青少年皮肌炎早期诊断的挑战:简要回顾文献和个案研究
Pub Date : 2023-05-04 DOI: 10.29039/1992-6499-2023-1-106-115
S. Mamedova, N. Surkhay
Juvenile dermatomyositis (JDM) is an autoimmune, relatively rare multisystem disease of unknown etiology, of which late diagnosis and late initiation of therapy can lead to a child's disability and even lethal outcome. The disease begins in most cases at the age of 5–12 years though can manifest itself both in earlier, and at more advanced age. This disease has a pronounced clinical polymorphism, which complicates early diagnosis and therapy. The article provides a brief overview of research car-ried out in recent years. A rare case of development of juvenile dermatomyositis in a teenager is con-sidered. Attention is drawn to the complexity of staging this disease during the initial treatment for medical care. A positive dynamics of the course of the disease was shown against the background of correctly selected therapy. The importance of adherence to the prescribed treatment is indicated, the refusal of which can lead to adverse outcomes
青少年皮肌炎(JDM)是一种病因不明的自身免疫性、相对罕见的多系统疾病,其晚诊断和晚开始治疗可导致儿童残疾甚至死亡。这种疾病在大多数情况下开始于5-12岁,但可以在更早和更大的年龄表现出来。这种疾病具有明显的临床多态性,使早期诊断和治疗复杂化。本文对近年来的研究进行了简要概述。一个罕见的情况下发展的青少年皮肌炎被认为是一个青少年。需要注意的是,在医疗护理的初始治疗阶段,这种疾病的分期是复杂的。在正确选择治疗的背景下,显示了疾病病程的积极动态。指出了坚持规定治疗的重要性,拒绝治疗可能导致不良后果
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引用次数: 0
CLINICAL «MASKS» OF PYELONEPHRITIS IN CHILDREN (CASE STUDIES) 儿童肾盂肾炎的临床“面具”(个案研究)
Pub Date : 2023-05-04 DOI: 10.29039/1992-6499-2023-1-116-120
G. R. Sagitova, A.A. Antonova, V. Sereda, Marina Gerner
Various variants of the clinical manifestation of the development of acute pyelonephritis in children are presented. Attention is drawn to the need for a detailed survey and examination of a sick child with suspected acute pyelonephritis. It is shown that laboratory diagnostics helps in making the speci-fied diagnosis and prescribing the necessary therapy. In differential diagnosis, it is important to under-stand the causes of the development of clinical manifestations of various diseases.
小儿急性肾盂肾炎的临床表现各不相同。注意到需要详细的调查和检查一个生病的孩子怀疑急性肾盂肾炎。结果表明,实验室诊断有助于作出明确的诊断和规定必要的治疗。在鉴别诊断中,了解各种疾病临床表现发展的原因是很重要的。
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引用次数: 0
PREVENTION OF DAMAGES OF THE GASTRIC AND DUODENAL MUCOSA DURING CHEMOTHERAPY 化疗期间胃和十二指肠黏膜损伤的预防
Pub Date : 2023-05-03 DOI: 10.29039/1992-6499-2023-1-97-105
Yaroslav Yakimenko, V. Kutukov, V. Antonyan, Svetlana Gavrilova, E. Gasanova, D. Bogomolov, M. Gaziev, E. Andreeva
Abstract. The main goal of the study was to prevent the development of gastric and duodenal ulcers in patients with colorectal cancer receiving adjuvant therapy with 5-fluorouracil. Materials and methods. The study included 60 patients with a verified diagnosis of localized or locally advanced colon and rectosigmoid cancer after radical surgical treatment. The patients are divided into two groups. The first group included 28 people who were found to have Helicobacter pylori during fibro-gastroduodenoscopy and 13C-respiratory urease test. Patients underwent anti-Helicobacter and gastro-protective therapy before adjuvant chemotherapy with 5-fluorouracil according to the developed scheme. The second group included 32 people. Tests for infection with Helicobacter pylori in these patients were negative, they did not receive gastroprotective therapy. Research results. The study showed the effectiveness of prophylactic therapy administered to patients from the first group before the start of the adjuvant chemotherapy program, since ulcerative lesions of the mucous membranes of the stomach and duodenum in patients were detected less frequently, responded better to conservative therapy, and also did not cause a delay in the next course of drug treatment. including 5-fluorouracil. When preventive antiulcer treatment was administered, the chance of developing ulcer complications in patients decreased by 5.08 times. The most vulnerable in terms of mucosal damage were female pa-tients of elderly and senile age, complications developed even against the background of antiulcer treatment.
摘要该研究的主要目的是预防接受5-氟尿嘧啶辅助治疗的结直肠癌患者胃和十二指肠溃疡的发展。材料和方法。该研究包括60例经根治性手术治疗后确诊为局部或局部晚期结肠癌和直肠乙状结肠癌的患者。病人被分为两组。第一组包括28名在纤维-胃十二指肠镜检查和13c -呼吸脲酶测试中发现幽门螺杆菌的人。根据制定的方案,患者在5-氟尿嘧啶辅助化疗前接受抗幽门螺杆菌和胃保护治疗。第二组有32人。这些患者的幽门螺杆菌感染试验均为阴性,未接受胃保护治疗。研究的结果。该研究表明,在开始辅助化疗计划之前,对第一组患者进行预防性治疗是有效的,因为患者胃和十二指肠粘膜溃疡病变的检测频率较低,对保守治疗的反应更好,并且也没有造成下一个疗程药物治疗的延迟。包括5 -氟尿嘧啶。给予预防性抗溃疡治疗后,患者发生溃疡并发症的几率降低5.08倍。最易发生粘膜损伤的是老年女性患者,即使在抗溃疡治疗的背景下也会出现并发症。
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引用次数: 0
PREVALENCE OF DIABETIC RETINOPATHY IN THE POPULATION OF PEOPLE WITH DIABETES IN ASTRAKHAN 阿斯特拉罕地区糖尿病人群中糖尿病视网膜病变的患病率
Pub Date : 2023-05-02 DOI: 10.29039/1992-6499-2023-1-81-87
Mekher Skandrani, L. Ramazanova, Khazem Alui, R. Shamratov, Mariya Ploskonos
The purpose of the study: analysis of examination and treatment data of patients with diabetic reti-nopathy in the adult population of the city of Astrakhan. Materials and methods. The medical records of 1111 patients with type 1 and type 2 diabetes mellitus who were treated in the ophthalmological and endocrinological departments of the Aleksandro-Mariinsky Regional Clinical Hospital from January to August 2022 were studied. All patients were examined using standard clinical, laboratory, and instru-mental examination methods. Research results. According to our data, in recent years, the incidence of diabetes mellitus among the adult population of Astrakhan has more than doubled. Of the 1111 ex-amined patients, 185 were diagnosed with type 1 diabetes mellitus (16,7 %), and the remaining 926 patients were diagnosed with type 2 diabetes (83,3 %). The diagnosis of diabetic retinopathy of vary-ing severity during the examination of patients with diabetes mellitus was established in 77 out of 185 examined patients with diabetes mellitus type 1 (41,6 %) and in 665 out of 926 with diabetes mellitus type 2 (71,8 %). Thus, against the background of an increase in the incidence of diabetes, there is a tendency to reduce the incidence of diabetic retinopathy among the adult population of Astrakhan, which can be explained not only by the widespread use of transretinal laser photocoagulation and vitrectomy, but also by new methods for monitoring blood glucose, hypertension and serum lipids. Conclusion. Diabetic retinopathy is a highly specific vascular complication of both type 1 and type 2 diabetes mellitus. The prevalence of retinopathy is closely related to the duration of diabetes. After 20 years of diabetes, almost all patients with type 1 diabetes and more than 60 % of patients with type 2 diabetes have some degree of retinopathy. The best screening method for diabetic retinopathy is an extended eye examination performed by an ophthalmologist. Modern ophthalmic diagnostic and treatment methods can prevent or delay the onset of diabetic retinopathy, as well as prevent vision loss in a significant proportion of diabetic patients.
本研究的目的:分析阿斯特拉罕市成人糖尿病视网膜病变患者的检查和治疗资料。材料和方法。对2022年1 - 8月在亚历山大-马林斯基地区临床医院眼科和内分泌科就诊的1111例1型和2型糖尿病患者的病历进行分析。所有患者均采用标准的临床、实验室和器械检查方法进行检查。研究的结果。根据我们的数据,近年来,糖尿病在阿斯特拉罕成年人口中的发病率增加了一倍多。1111例患者中,185例诊断为1型糖尿病(16.7%),其余926例诊断为2型糖尿病(83.3%)。185例1型糖尿病患者中有77例(41.6%)确诊为糖尿病视网膜病变,926例2型糖尿病患者中有665例(71.8%)确诊为不同程度的糖尿病视网膜病变。因此,在糖尿病发病率增加的背景下,阿斯特拉罕成年人群中糖尿病视网膜病变的发病率有降低的趋势,这不仅可以解释为经视网膜激光光凝和玻璃体切除术的广泛使用,还可以解释为监测血糖、高血压和血脂的新方法。结论。糖尿病视网膜病变是1型和2型糖尿病的高度特异性血管并发症。视网膜病变的患病率与糖尿病病程密切相关。糖尿病20年后,几乎所有的1型糖尿病患者和超过60%的2型糖尿病患者都有一定程度的视网膜病变。糖尿病视网膜病变的最佳筛查方法是由眼科医生进行扩展眼科检查。现代眼科诊断和治疗方法可以预防或延缓糖尿病视网膜病变的发病,并预防相当一部分糖尿病患者的视力丧失。
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引用次数: 0
COMPARATIVE DYNAMICS OF SPIROMETRY INDICATORS IN PATIENTS WITH DIFFERENT OCCUPATIONAL PATHOLOGIES OF THE BRONCHOPULMONARY SYSTEM 不同支气管肺系统职业病理患者肺量测定指标的比较动态
Pub Date : 2023-05-02 DOI: 10.29039/1992-6499-2023-1-88-96
V. Fedotov
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引用次数: 0
IRON INDICATORS IN THE UMBILICAL BLOOD OF PREMATURE CHILDREN BORN USING IVF TECHNOLOGY 体外受精技术早产儿脐血铁指标的研究
Pub Date : 2023-04-28 DOI: 10.29039/1992-6499-2023-1-66-71
N.P. Provatar, E. Kashirskaya, A. A. Nikolaev, A. Kashirskiy
The paper presents the results of a study of iron metabolism in full-term infants conceived naturally and using in vitro fertilization (IVF) technology. The data obtained allowed us to conclude that there were no statistically significant differences in the studied indicators in the groups and did not reveal the effect of IVF technology on the iron metabolism of full-term newborns. The purpose of the study. To study and compare the data of iron metabolism - hemoglobin, serum iron, serum transferrin recep-tor (sTfR), ferritin, ferritin index (sTfR/logFer), transferrin saturation, zinc protoporphyrin/ heme ratio in full-term infants conceived using IVF technology and children born by natural conception. Materi-als and methods. Clinical, biochemical and statistical methods were used in the work. The indicators of hemogram and ferrokinetics were determined in 20 full-term children conceived by observation, and in 18 children born using the technology of in vitro fertilization. Research results. In full-term children born as a result of IVF procedure, the level of Hb it was 17,03 ± 0,82 g/dl. The level of serum iron was comparable in the study groups (in full–term children conceived naturally, it is 26,09 ± 0,68 μmol/l, in children conceived by IVF – 25,24 ± 0,5 μmol/l). Studies of the ferritin level in full–term children conceived in the traditional way showed values of 175,73 ± 11,63 μg/l, in children after IVF procedure – 177,04 ± 11,21 μg/l. When calculating the ferritin index (sTfR / log10 Ferritin), data were obtained - in full-term children, the ferritin index is 3,72 ± 0,28 and 4,03 ± 0,36 mg/l depending on the method of conception, the differences are not statistically significant. In full-term children conceived naturally, the TS level was determined to be 61,18 ± 4,11 %, and in full-term children born as a result of traditional conception – 61,77 ± 5,3 %. Conclusion. The study allowed us to conclude that there is no statistically significant effect of the IVF method on iron metabolism and ferrokinetic factors in full-term newborns conceived by this method.
本文介绍了利用体外受精(IVF)技术自然受孕的足月婴儿铁代谢的研究结果。根据所获得的数据,我们得出的结论是,所研究的指标在两组之间没有统计学上的显著差异,也没有揭示体外受精技术对足月新生儿铁代谢的影响。研究的目的。研究比较体外受精和自然受孕足月婴儿的铁代谢指标——血红蛋白、血清铁、血清转铁蛋白受体(sTfR)、铁蛋白、铁蛋白指数(sTfR/logFer)、转铁蛋白饱和度、锌原卟啉/血红素比值。材料和方法。采用临床、生化、统计学等方法。对20例观察妊娠足月患儿和18例体外受精患儿的血象和铁动力学指标进行了测定。研究的结果。在IVF手术后出生的足月儿童中,Hb水平为17.03±0.82 g/dl。各研究组血清铁水平具有可比性(自然妊娠足月患儿为26、09±0.68 μmol/l,体外受精妊娠患儿为- 25、24±0.5 μmol/l)。传统方法妊娠足月儿铁蛋白水平分别为175、73±11、63 μg/l,体外受精后足月儿铁蛋白水平分别为- 177、04±11、21 μg/l。在计算铁蛋白指数(sTfR / log10铁蛋白)时,获得数据-足月儿铁蛋白指数分别为3,72±0,28和4,03±0,36 mg/l,根据受孕方法不同,差异无统计学意义。在自然受孕的足月儿童中,TS水平为61,18±4.11%,而在传统受孕的足月儿童中,TS水平为61,77±5.3%。结论。该研究使我们得出结论,IVF方法对通过该方法受孕的足月新生儿的铁代谢和铁动力学因子没有统计学意义的影响。
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引用次数: 0
CLUSTER ANALYSIS AS AN INTEGRATOR OF DIFFERENT TECHNIQUES FOR ASSESSING THE PHYSICAL DEVELOPMENT OF HEALTHY ADOLESCENTS 聚类分析作为评估健康青少年身体发育的不同技术的整合者
Pub Date : 2023-04-28 DOI: 10.29039/1992-6499-2023-1-72-80
A. Semenov, I. Gayvoronskiy, V. Krishtop
The influence of external factors can significantly deviate the distribution of somatotypes from the indicators of the general population, which makes researchers select the most suitable scheme of so-matotyping from the already known ones or construct their own. Applicants of military universities are a particular case of such samples, formed as a result of a complex of factors, including the work of military medical commissions. The aim was to use cluster analysis to develop an integrative classifica-tion for assessing the physical development of practically healthy adolescents. Materials and meth-ods. The object of the study was 280 applicants (234 boys and 46 girls), who were examined by spe-cialists in the medical commissions of military commissariats and were considered to be practically healthy. Anthropometric data were analyzed: body length, body weight, length of the torso, limbs, girth dimensions of the torso and limbs, as well as body component composition. Hierarchical cluster analysis by the Ward method and Kendall's correlation coefficient were used in the study. Results. By means of cluster analysis of the physical development indicators of the virtually healthy individuals, we identified a significant contribution of body mass index, weight, body length in the formation of three major groups, which we characterized as: the male macrosomatic phenotype, the male mesoso-matic phenotype, and the female phenotype. Based on the proportion of muscle and fat tissue, visceral fat, distal diameter of the forearm as an indicator of bone development, body mass index and thick-ness of the skin-fat fold of the anterior abdominal wall, the following subgroups were identified: male macrosomatic phenotype, with hyperstenic features, male macrosomatic phenotype, with normosthen-ic features, male mesosomatic phenotype with digestive features, male mesosomatic phenotype with mesotonic features, male mesosomatic muscle phenotype, female megalosomic athletic and subathletic phenotype, female stenoplastic phenotype. Conclusion. The used statistical approach allows to change the classical paradigm of searching for a universal methodology of somatotyping, to the creation of algorithms of compilation of well-known schemes of physical development evaluation in the selected population groups.
外部因素的影响会使个体的体型分布明显偏离一般人群的指标,这就要求研究者从已知的体型分型方案中选择最合适的体型分型方案,或者自行构建体型分型方案。军事大学的申请者是这类样本中的一个特例,是军事医学委员会工作等复杂因素的结果。目的是使用聚类分析来制定一个综合分类,以评估实际健康的青少年的身体发育。材料和方法。这项研究的对象是280名申请者(234名男孩和46名女孩),他们由军事军需处医疗委员会的专家进行了检查,被认为实际上健康。分析人体测量数据:体长、体重、躯干和四肢的长度、躯干和四肢的周长尺寸以及身体成分组成。采用Ward方法进行层次聚类分析,采用Kendall相关系数进行分析。结果。通过对虚拟健康个体身体发育指标的聚类分析,我们发现体重指数、体重、体长在形成3个主要群体中有显著贡献,我们将其描述为:男性大体细胞表型、男性中体细胞表型和女性表型。根据肌肉和脂肪组织比例、内脏脂肪、作为骨骼发育指标的前臂远端直径、体重指数和前腹壁皮肤脂肪褶厚度,确定了以下亚组:男性大体细胞表型,具有肥大特征,男性大体细胞表型,具有正常特征,男性中体细胞表型,具有消化特征,男性中体细胞表型,具有中紧张性特征,男性中体细胞肌肉表型,女性巨大体运动和亚运动表型,女性狭窄表型。结论。所使用的统计方法允许改变寻找身体分型的通用方法的经典范式,以创建在选定的人口群体中编写众所周知的身体发育评估方案的算法。
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引用次数: 1
CLINICAL AND ANAMNESTIC FACTORS OF PREGNANT WOMEN WITH DIFFER-ENT COURSE OF A NEW CORONAVIRUS INFECTION 新型冠状病毒感染不同病程孕妇的临床及遗忘因素分析
Pub Date : 2023-04-27 DOI: 10.29039/1992-6499-2023-1-59-65
Nasri Onsi, Mariya Marina V. Kuzmina Kuzmina Marina V. Kuzmina, S. Sinchihin, O. Nagaeva, Georgiy Gviniashvili, Anakhanum Muratova
Pregnant women infected with SARS-CoV-2 are considered as a risk group for the development of severe complications and an unfavorable outcome of a new coronavirus infection. At the same time, various non-gestational factors may be an additional unfavorable background that determines the course of this disease in pregnant women. The purpose of the study was to evaluate the clinical and anamnestic data of pregnant women with different course of a new coronavirus infection. Material and research methods. A retrospective analysis of the history and comorbidity data of 360 pregnant women infected with SARS-CoV-2 was carried out. The features of the reproductive history and ex-tragenital pathology of pregnant women with different course of Coronavirus Disease 2019 (COVID-19) were revealed. The standard collection of anamnesis and clinical examination was carried out, which is required to fill in the medical records of an outpatient and inpatient patient. Statistical pro-cessing of the obtained results was carried out using Microsoft Excel 2010 and Statistica (version 6.0). Research results. It has been established that among pregnant women with a severe course of this dis-ease, patients who use nicotine-containing products and have such concomitant somatic pathologies as diabetes mellitus, obesity, hypothyroidism, iron deficiency anemia, chronic arterial hypertension and varicose veins are significantly more common. Unfavorable factors of the reproductive history in-clude: abortion, non-developing pregnancy, preeclampsia. Conclusion. To predict the course of a new coronavirus disease in the gestational period, it is necessary to take into account the listed clinical and anamnestic data of the patient.
感染SARS-CoV-2的孕妇被认为是发生严重并发症的危险人群,也是新冠病毒感染的不利结果。与此同时,各种非妊娠因素可能是一个额外的不利背景,决定了这种疾病在孕妇中的病程。本研究的目的是评估不同病程的新型冠状病毒感染孕妇的临床和记忆资料。材料和研究方法。回顾性分析360例孕妇感染SARS-CoV-2的病史及合并症资料。分析不同病程的新冠肺炎(COVID-19)孕妇的生殖史和外阴病理学特点。进行标准的记忆收集和临床检查,门诊和住院患者需要填写病历。使用Microsoft Excel 2010和Statistica(6.0版)软件对所得结果进行统计处理。研究的结果。已经确定,在病程严重的孕妇中,使用含尼古丁产品并伴有糖尿病、肥胖、甲状腺功能减退、缺铁性贫血、慢性动脉高血压和静脉曲张等躯体病变的患者更为常见。生育史的不利因素包括:流产、未发育性妊娠、先兆子痫。结论。要预测新型冠状病毒病在妊娠期的病程,有必要考虑患者列出的临床和记忆资料。
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引用次数: 0
PATHOLOGY OF THE URINARY SYSTEM AND ITS FREQUENCY IN CHILDREN WITH COVID-19 COVID-19患儿泌尿系统病理及发病频率
Pub Date : 2023-04-27 DOI: 10.29039/1992-6499-2023-1-39-49
D. Yarovaya, O. Bashkina, Elena V. Krasilova, M. Samotrueva, E. Kasymova
This review presents data on endothelial dysfunction and the mechanisms of its development in coro-navirus disease. The possible pathology of the urinary system and its frequency in children against the background of COVID-19, which is mainly due to endothelial dysfunction, is described. Displayed studies on the frequency of urinary tract infections in children and adolescents during a pandemic, which depended on the level of quarantine measures, which in turn affect the neuro-psychological causes of bladder dysfunction, limited timely access to medical care, etc. A systematic review of stud-ies published in English from 2000 to 2019 was performed (with predominant inclusion (84,6 %) of data for the last 2 years) using PubMed, ScienceDirect, ProQuest, GoogleScholar, Cochrane, Medline, AMED databases., EMBASE, CINHAL, SportDiscus, Scopus and PEDro. The review included review articles, meta-analyses, qualitative studies, retrospective and prospective studies.
本文综述了冠状病毒病中内皮功能障碍及其发生机制的研究进展。本文描述了在COVID-19背景下,儿童泌尿系统可能的病理及其频率,主要是由于内皮功能障碍。展示关于大流行期间儿童和青少年尿路感染频率的研究,这取决于隔离措施的水平,这反过来影响膀胱功能障碍的神经心理原因,及时获得医疗服务的机会有限等。使用PubMed、ScienceDirect、ProQuest、GoogleScholar、Cochrane、Medline、AMED数据库对2000年至2019年发表的英文研究进行了系统回顾(过去两年的主要数据(84.6%))。, EMBASE, CINHAL, SportDiscus, Scopus和PEDro。本综述包括综述文章、荟萃分析、定性研究、回顾性和前瞻性研究。
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引用次数: 0
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ASTRAKHAN MEDICAL JOURNAL
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