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[Indocyanine green angiography in assessment of parathyroid remnant perfusion after subtotal parathyroidectomy: a case report]. [吲哚青绿血管造影术在甲状旁腺次全切除术后甲状旁腺残余灌注评估中的应用:一份病例报告]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia202402261
V V Polkin, P A Isaev, N V Severskaya, S A Ivanov, A D Kaprin

A 72-year-old female patient with chronic kidney disease stage presented with multiple parathyroid adenomas and tertiary hyperparathyroidism. SPECT/CT with 99mTc-MIBI revealed accumulation of radiopharmaceuticals in 2 out of 4 parathyroid glands. Ultrasound established localization of all parathyroid glands. Subtotal parathyroidectomy with excision of 3 glands and resection of half of the fourth gland was performed. Intraoperative indocyanine green angiography was performed to identify all parathyroid glands and remnant perfusion. There was normal parathyroid function after 6 months.

一名72岁的慢性肾病期女性患者患有多发性甲状旁腺腺瘤和三级甲状旁腺功能亢进症。使用99m锝-MIBI的SPECT/CT显示,放射性药物在4个甲状旁腺中的2个聚集。超声波确定了所有甲状旁腺的位置。患者接受了甲状旁腺次全切除术,切除了3个腺体,并切除了第4个腺体的一半。术中进行了吲哚菁绿血管造影,以确定所有甲状旁腺和残余灌注。6个月后,患者的甲状旁腺功能恢复正常。
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引用次数: 0
[Choice of hybrid interventions for iliac-femoral arterial lesions]. [髂股动脉病变的混合干预选择]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia202403121
G B Fataliev, V S Arakelyan, A A Shubin

Objective: To compare the short-term and long-term outcomes of hybrid interventions after various infrainguinal reconstructions (restoration of blood flow through superficial femoral artery and pulsatile blood flow through deep femoral artery) in patients with iliac-femoral arterial disease.

Material and methods: A retrospective analysis included patients after hybrid iliac-femoral interventions between 2014 and 2018. These interventions included stenting of iliac arteries and various open infrainguinal reconstructions. The first group (n=41) consisted of patients who underwent reconstruction of superficial femoral artery, the second group (n=88) - restoration of pulsatile blood flow in deep femoral artery. We analyzed the Rutherford score, perioperative complications, primary patency rates and limb salvage rates after 12 months in both groups.

Results: Significant improvement (Rutherford score +3) was achieved in 28 (70%) and 14 (15.9%) patients, respectively (p<0.05). There were no significant between-group differences in the number of postoperative complications. Surgery time was longer in the first group (median 160 and 130 min, respectively, p<0.05). However, intraoperative blood loss was similar. Primary patency rates after 12 months were 82.4% and 95.1%, respectively (p=0.054). Limb salvage rates after 12 months were 94.7% and 100%, respectively (p<0.05).

Conclusion: This study highlights the potential advantages of restoring pulsatile blood flow through the deep femoral artery in hybrid interventions. Higher primary patency and limb salvage rates in the second group indicate better long-term outcomes after restoration of blood flow through the deep femoral artery. Further prospective studies are needed to confirm these results and determine the underlying mechanisms of differences.

目的比较髂股动脉疾病患者接受各种腹股沟下重建(通过股浅动脉恢复血流和通过股深动脉恢复搏动性血流)后进行混合介入治疗的短期和长期疗效:回顾性分析纳入了2014年至2018年间接受髂股混合动脉介入治疗的患者。这些介入治疗包括髂动脉支架植入术和各种开放性腹股沟下动脉重建术。第一组(人数=41)包括接受股浅动脉重建的患者,第二组(人数=88)--恢复股深动脉的搏动性血流。我们分析了两组患者的卢瑟福评分、围术期并发症、初次通畅率和12个月后的肢体挽救率:结果:28 名患者(70%)和 14 名患者(15.9%)的治疗效果明显改善(卢瑟福评分+3)(ppp=0.054)。12个月后的肢体挽救率分别为94.7%和100%(p结论:这项研究强调了在混合介入治疗中通过股深动脉恢复搏动性血流的潜在优势。第二组患者的初次通畅率和肢体挽救率更高,这表明股深动脉血流恢复后的长期疗效更好。需要进一步的前瞻性研究来证实这些结果,并确定差异的内在机制。
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引用次数: 0
[Bilateral stenting for malignant tracheal and bronchial stenosis]. [恶性气管和支气管狭窄的双侧支架植入术]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia202402184
Yu S Teterin, M A Gasanov, S S Petrikov, P A Yartsev, E S Eletskaya, I U Ibavov, A N Musaev

Malignant lesions of tracheal bifurcation usually lead to respiratory failure and risk of mortality. Airway stenting is the only minimally invasive method for these patients. The authors present a patient with T4N3M0 left-sided lung cancer (inoperable stage IIIc) complicated by respiratory failure due to tracheal bifurcation obstruction. Bilateral stenting by self-expanding stents with perforated coatings was effective for airway recanalization and provided subsequent chemotherapy.

气管分叉处的恶性病变通常会导致呼吸衰竭和死亡风险。气道支架是治疗这类患者的唯一微创方法。作者介绍了一名 T4N3M0 左侧肺癌患者(无法手术的 IIIc 期),患者因气管分叉阻塞而并发呼吸衰竭。使用带孔涂层的自膨胀支架进行双侧支架置入术有效地重新疏通了气道,并提供了后续化疗。
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引用次数: 0
[In searching for perfect blood substitute. Creation and application of perftorane]. [寻找完美的血液替代品。perftorane的创造与应用]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia2024021111
N N Krylov, A Yu Kazhlaev, I V Karpenko, S D Batoev

The article is devoted to historiography of perfluorocarbons, as well as discoverers of perftorane and their discoveries. There would be no national priority in transfusiology without these discoveries. Perftorane is the only one of the world series of perfluorocarbon emulsion drugs that has passed all phases of clinical trials. Perftorane has been used in clinical medicine for 30 years.

文章专门介绍了全氟化碳的历史,以及全氟芴的发现者和他们的发现。没有这些发现,就不会有输血学的国家优先权。全氟托烷是世界上唯一一种通过了所有阶段临床试验的全氟化合物乳剂药物。Perftorane 已在临床医学中应用了 30 年。
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引用次数: 0
[Combined surgeries for secondary chest wall lesions]. [继发性胸壁病变的联合手术]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia2024051103
M S Rudenko, S Yu Pushkin, R O Kamenev, A P Eliseeva

The authors present treatment of rhabdomyosarcoma of the gluteal region with secondary lesion of the lung and chest wall. Features of chest wall defect closure are analyzed.

作者介绍了臀部横纹肌肉瘤继发肺和胸壁病变的治疗方法。分析了胸壁缺损闭合的特点。
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引用次数: 0
[Synchronous primary multiple cancer: distal cholangiocarcinoma of the intrapancreatic common bile duct and intraductal papillary mucinous tumor associated with ductal adenocarcinoma of the pancreatic tail]. [同步原发性多发性癌症:胰总胆管内远端胆管癌和导管内乳头状粘液瘤伴胰尾导管腺癌]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia202408157
G R Setdikova, E A Stepanova, A N Verbovsky, A V Semenkov

We present a combination of distal cholangiocarcinoma of the intrapancreatic common bile duct and intraductal papillary mucinous tumor associated with ductal adenocarcinoma of the pancreatic tail. This clinical case is unique. When analyzing the literature, we found no any case of similar primary multiple malignant tumor. Importantly, final diagnosis of simultaneous malignant pancreatobiliary neoplasia is possible only via intraoperative biopsy after adequate morphological dissection and research of resected organ complex including molecular genetic analysis due to identical histological and immunohistochemical picture of ductal neoplasia.

我们介绍了一例胰内总胆管远端胆管癌和导管内乳头状粘液瘤合并胰尾导管腺癌的病例。这个临床病例非常独特。在分析文献时,我们没有发现任何类似的原发性多发性恶性肿瘤病例。重要的是,由于导管肿瘤的组织学和免疫组化表现相同,只有通过术中活检,经过充分的形态学解剖和对切除器官复合物的研究,包括分子遗传学分析,才能最终确诊胰胆管同时恶性肿瘤。
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引用次数: 0
[Endovascular technologies in the treatment of patients with blunt abdominal trauma]. [治疗腹部钝挫伤患者的血管内技术]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia2024081108
V A Tsurkan, A V Shabunin, D N Grekov, V V Bedin, A V Arablinskiy, L A Yakimov, D V Shikov, A A Ageeva

Trauma is one of the leading causes of disability and mortality in working-age population. Abdominal injuries comprise 20-30% of traumas. Uncontrolled bleeding is the main cause of death in 30-40% of patients. Among abdominal organs, spleen is most often damaged due to fragile structure and subcostal localization. In the last two decades, therapeutic management has become preferable in patients with abdominal trauma and stable hemodynamic parameters. In addition to clinical examination, standard laboratory tests and ultrasound, as well as contrast-enhanced CT of the abdomen should be included in diagnostic algorithm to identify all traumatic injuries and assess severity of abdominal damage. Development of interventional radiological technologies improved preservation of damaged organs. Endovascular embolization can be performed selectively according to indications (leakage, false aneurysm, arteriovenous anastomosis) and considered for severe damage to the liver and spleen, hemoperitoneum or severe polytrauma. Embolization is essential in complex treatment of traumatic vascular injuries of parenchymal abdominal organs. We reviewed modern principles and methods of intra-arterial embolization for the treatment of patients with traumatic injuries of the liver and spleen.

外伤是导致劳动适龄人口残疾和死亡的主要原因之一。腹部损伤占创伤的 20-30%。无法控制的出血是 30-40% 患者死亡的主要原因。在腹部器官中,脾脏因结构脆弱和位于肋下而最常受损。近二十年来,对于腹部创伤且血流动力学参数稳定的患者,治疗方法已成为首选。除临床检查外,标准实验室检查和超声检查以及腹部对比增强 CT 也应纳入诊断算法,以识别所有创伤并评估腹部损伤的严重程度。介入放射学技术的发展改善了受损器官的保存。血管内栓塞术可根据适应症(渗漏、假性动脉瘤、动静脉吻合术)有选择地进行,肝脏和脾脏严重受损、腹腔积血或严重多发性创伤时可考虑进行血管内栓塞术。栓塞是腹部实质器官外伤性血管损伤的复杂治疗中必不可少的手段。我们回顾了治疗肝脾外伤患者的现代动脉内栓塞原理和方法。
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引用次数: 0
[Ankle replacement for severe post-traumatic deformation of the distal tibia: a case report]. [胫骨远端严重创伤后变形的踝关节置换术:病例报告]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia2024011110
G P Kotelnikov, A V Kolsanov, A N Nikolaenko, V V Ivanov, D A Dolgushkin, A S Pankratov, D O Ogurtsov, S O Doroganov, A D Stroikova

Objective: To evaluate the immediate results of ankle replacement with original prosthesis in a patient with severe post-traumatic deformation of the distal tibia.

Material and methods: When developing the original design of ankle prosthesis, we considered foreign analogues of classical and revision models of ankle prostheses taking into account their shortcomings. In this case, an integrated approach was used. Extensive work has been carried out to select materials for prosthetic components. Experimental work with mesenchymal stromal cells of bone marrow was aimed at testing cytotoxicity and biological compatibility. The staff of the department of designing biomechanical structures of the Research Institute of Bionics and Personalized Medicine of the Samara State Medical University carefully studied the proposed design of endoprosthesis using the Ansys software. After cadaver tests on full-scale models, we performed surgical intervention in a patient with severe post-traumatic deformity of the lower third of the left tibia.

Results: Our studies revealed convenience and certain advantages of intraoperative installation of original ankle prosthesis. Along with this, this clinical example indicated come features that must be taken into account in revision ankle replacement to avoid possible postoperative consequences.

Conclusion: Original ankle prosthesis makes it possible to replace the distal tibia and preserve limb function.

目的评估对一名胫骨远端严重创伤后变形的患者进行踝关节原型假体置换术的即时效果:在开发踝关节假体的原始设计时,我们考虑到了国外经典踝关节假体和翻修型踝关节假体的缺点。在这种情况下,我们采用了综合方法。为选择假体部件的材料,我们开展了大量工作。骨髓间充质基质细胞的实验工作旨在测试细胞毒性和生物兼容性。萨马拉国立医科大学仿生学和个性化医学研究所生物力学结构设计部的工作人员使用 Ansys 软件仔细研究了假体的设计方案。在对全尺寸模型进行尸体测试后,我们对一名左胫骨下三分之一严重创伤后畸形的患者进行了手术干预:我们的研究表明,术中安装原装踝关节假体既方便又有一定优势。结果:我们的研究显示了原装踝关节假体术中安装的便利性和某些优势,同时,该临床病例还显示了翻修踝关节置换术中必须考虑的一些特点,以避免术后可能出现的后果:结论:原装踝关节假体可以置换胫骨远端并保留肢体功能。
{"title":"[Ankle replacement for severe post-traumatic deformation of the distal tibia: a case report].","authors":"G P Kotelnikov, A V Kolsanov, A N Nikolaenko, V V Ivanov, D A Dolgushkin, A S Pankratov, D O Ogurtsov, S O Doroganov, A D Stroikova","doi":"10.17116/hirurgia2024011110","DOIUrl":"10.17116/hirurgia2024011110","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the immediate results of ankle replacement with original prosthesis in a patient with severe post-traumatic deformation of the distal tibia.</p><p><strong>Material and methods: </strong>When developing the original design of ankle prosthesis, we considered foreign analogues of classical and revision models of ankle prostheses taking into account their shortcomings. In this case, an integrated approach was used. Extensive work has been carried out to select materials for prosthetic components. Experimental work with mesenchymal stromal cells of bone marrow was aimed at testing cytotoxicity and biological compatibility. The staff of the department of designing biomechanical structures of the Research Institute of Bionics and Personalized Medicine of the Samara State Medical University carefully studied the proposed design of endoprosthesis using the Ansys software. After cadaver tests on full-scale models, we performed surgical intervention in a patient with severe post-traumatic deformity of the lower third of the left tibia.</p><p><strong>Results: </strong>Our studies revealed convenience and certain advantages of intraoperative installation of original ankle prosthesis. Along with this, this clinical example indicated come features that must be taken into account in revision ankle replacement to avoid possible postoperative consequences.</p><p><strong>Conclusion: </strong>Original ankle prosthesis makes it possible to replace the distal tibia and preserve limb function.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 1","pages":"110-118"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139521871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Right upper lobe pulmonary sequestration as a rare cause of recurrent spontaneous pneumothorax]. [右上叶肺动脉栓塞是复发性自发性气胸的罕见病因]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia2024011102
G M Agafonov, A S Petrov, M A Atyukov, O V Novikova, I Yu Zemtsova, I V Dvorakovskaya, P K Yablonsky

A 19-year-old patient after previous wedge resection of the right upper pulmonary lobe a year ago urgently admitted with recurrent right-sided spontaneous pneumothorax. According to standard management of spontaneous pneumothorax, we performed diagnostic thoracoscopy and drainage of the right pleural cavity with regular X-ray examinations. However, these measures were ineffective. The patient was scheduled for surgery, and we intraoperatively observed an unusual cause of pneumothorax. Thus, we present spontaneous pneumothorax following right upper lobe pulmonary sequestration. The uniqueness of this case is associated with unusual manifestation and non-standard localization of rare lesion. A few cases of pneumothorax in similar patients are described in the world literature. The key limiting factor in diagnosis of such defects (identification of aberrant vessel supplying abnormal lung parenchyma) is the lack of routine CT angiography in patients diagnosed with pneumothorax. That is why CT changes were interpreted as postoperative ones, and the true cause was established only during redo surgery. A thorough inspection of the pleural cavity and alertness regarding unusual appearance of the right upper pulmonary lobe made it possible to suggest a non-standard diagnosis, avoid complications (bleeding from afferent vessel) and perform adequate lung resection.

一名 19 岁的患者一年前曾接受过右上肺叶楔形切除术,后因反复出现右侧自发性气胸而急诊入院。根据自发性气胸的标准治疗方法,我们进行了诊断性胸腔镜检查和右侧胸膜腔引流术,并定期进行 X 光检查。然而,这些措施都没有效果。患者被安排接受手术治疗,我们在术中观察到了气胸的异常原因。因此,我们介绍了右上叶肺栓塞后的自发性气胸。本病例的独特性与罕见病变的不寻常表现和非标准定位有关。世界文献中描述了几例类似患者的气胸病例。诊断此类缺陷(识别供应异常肺实质的异常血管)的关键限制因素是缺乏对气胸患者进行常规 CT 血管造影检查。这就是为什么 CT 变化被解释为术后变化,而真正的原因只有在重新手术时才能确定。对胸膜腔的彻底检查以及对右上肺叶异常外观的警觉使我们有可能提出非标准诊断,避免并发症(传入血管出血)并进行适当的肺部切除。
{"title":"[Right upper lobe pulmonary sequestration as a rare cause of recurrent spontaneous pneumothorax].","authors":"G M Agafonov, A S Petrov, M A Atyukov, O V Novikova, I Yu Zemtsova, I V Dvorakovskaya, P K Yablonsky","doi":"10.17116/hirurgia2024011102","DOIUrl":"10.17116/hirurgia2024011102","url":null,"abstract":"<p><p>A 19-year-old patient after previous wedge resection of the right upper pulmonary lobe a year ago urgently admitted with recurrent right-sided spontaneous pneumothorax. According to standard management of spontaneous pneumothorax, we performed diagnostic thoracoscopy and drainage of the right pleural cavity with regular X-ray examinations. However, these measures were ineffective. The patient was scheduled for surgery, and we intraoperatively observed an unusual cause of pneumothorax. Thus, we present spontaneous pneumothorax following right upper lobe pulmonary sequestration. The uniqueness of this case is associated with unusual manifestation and non-standard localization of rare lesion. A few cases of pneumothorax in similar patients are described in the world literature. The key limiting factor in diagnosis of such defects (identification of aberrant vessel supplying abnormal lung parenchyma) is the lack of routine CT angiography in patients diagnosed with pneumothorax. That is why CT changes were interpreted as postoperative ones, and the true cause was established only during redo surgery. A thorough inspection of the pleural cavity and alertness regarding unusual appearance of the right upper pulmonary lobe made it possible to suggest a non-standard diagnosis, avoid complications (bleeding from afferent vessel) and perform adequate lung resection.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 1","pages":"102-109"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139521957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Serum ghrelin changes after bariatric surgery]. [减肥手术后血清胃泌素的变化]。
Q4 Medicine Pub Date : 2024-01-01 DOI: 10.17116/hirurgia202404149
O V Galimov, V O Khanov, K V Nasyrova, D O Galimov

Objective: To study the effect of bariatric surgery on serum ghrelin in patients with morbid obesity.

Material and methods: We experimentally analyzed serum ghrelin in 96 rats. Of these, 84 rats underwent sleeve gastrectomy, and 12 rats comprised the control group (no surgery). We measured body weight and serum ghrelin using ELISA method after 1, 3, 7, 14, 21 and 30 days after surgery. Serum ghrelin was studied before and after bariatric surgery in 23 patients with morbid obesity.

Results: Baseline serum ghrelin was lower in larger rats and obese patients compared to normal body weight. We found no decrease in serum ghrelin after resection of fundal ghrelin-releasing part of the stomach.

Conclusion: Stomach volume changes after restrictive bariatric surgery (sleeve resection or gastroplication) are accompanied by mild increase in serum ghrelin. This increment is greater after more significant body weight loss after surgery. Similar researches will help to find new treatment strategies for pathological obesity.

目的:研究减肥手术对病态肥胖患者血清胃泌素的影响:研究减肥手术对病态肥胖症患者血清胃泌素的影响:我们对 96 只大鼠的血清胃泌素进行了实验分析。其中,84 只大鼠接受了袖状胃切除术,12 只大鼠为对照组(未接受手术)。我们在手术后 1、3、7、14、21 和 30 天后使用 ELISA 方法测量体重和血清胃泌素。对 23 名病态肥胖症患者在减肥手术前后的血清胃泌素进行了研究:结果:与正常体重相比,体型较大的大鼠和肥胖患者的血清胃泌素基线较低。我们发现切除胃底释放胃泌素的部分后,血清胃泌素没有下降:结论:限制性减肥手术(胃袖状切除术或胃切除术)后胃容量的变化伴随着血清胃泌素的轻度增加。在手术后体重明显减轻的情况下,这种增加幅度更大。类似的研究将有助于找到治疗病理性肥胖的新策略。
{"title":"[Serum ghrelin changes after bariatric surgery].","authors":"O V Galimov, V O Khanov, K V Nasyrova, D O Galimov","doi":"10.17116/hirurgia202404149","DOIUrl":"https://doi.org/10.17116/hirurgia202404149","url":null,"abstract":"<p><strong>Objective: </strong>To study the effect of bariatric surgery on serum ghrelin in patients with morbid obesity.</p><p><strong>Material and methods: </strong>We experimentally analyzed serum ghrelin in 96 rats. Of these, 84 rats underwent sleeve gastrectomy, and 12 rats comprised the control group (no surgery). We measured body weight and serum ghrelin using ELISA method after 1, 3, 7, 14, 21 and 30 days after surgery. Serum ghrelin was studied before and after bariatric surgery in 23 patients with morbid obesity.</p><p><strong>Results: </strong>Baseline serum ghrelin was lower in larger rats and obese patients compared to normal body weight. We found no decrease in serum ghrelin after resection of fundal ghrelin-releasing part of the stomach.</p><p><strong>Conclusion: </strong>Stomach volume changes after restrictive bariatric surgery (sleeve resection or gastroplication) are accompanied by mild increase in serum ghrelin. This increment is greater after more significant body weight loss after surgery. Similar researches will help to find new treatment strategies for pathological obesity.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 4","pages":"49-54"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140853940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Khirurgiya
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