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Prolonged ileus with pneumatosis cystoides intestinalis. 长时间肠梗阻伴肠囊性肺肿。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2014-06-01 Epub Date: 2014-04-02 DOI: 10.1179/2295333714Y.0000000021
C-T Chao
A 40-year-old woman with rectal cancer visited our emergency department for abdominal pain and vomiting. She had received operation and chemoradiotherapy 6 months ago with subsequent lymph node recurrence and obstructive uropathy. Ureteral stenting and pecutaneous nephrostomy were performed for relief then. Her abdominal symptoms were attributed to ileus, and consulting surgeon recommended against re-operation owing to poor performance status. Her ileus fluctuated in severity, with recurrent bacteremia. An abdominal film 3 weeks later revealed radiolucent areas surrounding the entire bowel contour (Fig. 1). Abdominal computed tomography demonstrated prominent pneumatosis cystoides intestinalis involving colon and small bowel (Fig. 1). Hypotension and profound metabolic acidosis ensued with consciousness loss, and a family decision was made not to resuscitate her. She passed away 1 day later. Pneumatosis cystoides intestinalis presents as air collection in bowel wall layers, and can be innocent as in idiopathic or post-endoscopic cases. Other causes could be life-threatening. The main aetiologies include mesenteric vascular diseases with bowel ischaemia, followed by inflammatory bowel diseases and intestinal obstruction/infection. Small intestine and right side colon are the most common sites involved. Our patient presumably suffered from Correspondence to: C.-T. Chao, Department of Internal Medicine, National Taiwan University Hospital Jin-Shan Branch, No. 51, Nan-Shih, Jin-Shan District, New Taipei City, Taiwan. Email: b88401084@gmail.com Figure 1 (Left) Abominal plain film disclosed clear contour of the, while colonic segments from right (curved arrow), transverse to left colon (straight arrow) as contrasted from radiolucent bowel wall gas. Small bowel wall pneumatosis was also identified. (Right) Computed tomography demonstrated the extensive bowel gas over small bowel and colon.
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引用次数: 0
Epidemiology of infective endocarditis in a large Belgian non-referral hospital. 比利时一家大型非转诊医院感染性心内膜炎的流行病学研究。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2014-06-01 Epub Date: 2014-04-25 DOI: 10.1179/0001551214Z.00000000046
K Poesen, H Pottel, J Colaert, C De Niel

Objectives: Guidelines for diagnosis of infective endocarditis are largely based upon epidemiological studies in referral hospitals. Referral bias, however, might impair the validity of guidelines in non-referral hospitals. Recent studies in non-referral care centres on infective endocarditis are sparse. We conducted a retrospective epidemiological study on infective endocarditis in a large non-referral hospital in a Belgian city (Kortrijk).

Methods: The medical record system was searched for all cases tagged with a putative diagnosis of infective endocarditis in the period 2003-2010. The cases that fulfilled the modified Duke criteria for probable or definite infective endocarditis were included.

Results: Compared to referral centres, an older population with infective endocarditis, and fewer predisposing cardiac factors and catheter-related infective endocarditis is seen in our population. Our patients have fewer prosthetic valve endocarditis as well as fewer staphylococcal endocarditis. Our patients undergo less surgery, although mortality rate seems to be highly comparable with referral centres, with nosocomial infective endocarditis as an independent predictor of mortality.

Conclusion: The present study suggests that characteristics of infective endocarditis as well as associative factors might differ among non-referral hospitals and referral hospitals.

目的:感染性心内膜炎的诊断指南主要基于转诊医院的流行病学研究。然而,转诊偏倚可能会损害指南在非转诊医院的有效性。最近在非转诊护理中心对感染性心内膜炎的研究很少。我们在比利时城市(Kortrijk)的一家大型非转诊医院对感染性心内膜炎进行了回顾性流行病学研究。方法:检索2003-2010年期间所有诊断为感染性心内膜炎的病例。符合修改的杜克标准的病例可能或明确的感染性心内膜炎包括在内。结果:与转诊中心相比,我们的人群中有老年感染性心内膜炎,易感心脏因素和导管相关的感染性心内膜炎较少。我们的病人有较少的人工瓣膜心内膜炎以及较少的葡萄球菌性心内膜炎。我们的患者较少接受手术,尽管死亡率似乎与转诊中心高度相似,医院感染性心内膜炎是死亡率的独立预测因子。结论:非转诊医院与转诊医院感染性心内膜炎的特点及相关因素可能存在差异。
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引用次数: 12
Pyroglutamic acid-induced metabolic acidosis: a case report. 热谷氨酸致代谢性酸中毒1例。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2014-06-01 Epub Date: 2014-04-02 DOI: 10.1179/2295333714Y.0000000022
S Luyasu, M M C Wamelink, L Galanti, A Dive

High anion gap metabolic acidosis due to pyroglutamic acid (5-oxoproline) is a rare complication of acetaminophen treatment (which depletes glutathione stores) and is often associated with clinically moderate to severe encephalopathy. Acquired 5-oxoprolinase deficiency (penicillins) or the presence of other risk factors of glutathione depletion such as malnutrition or sepsis seems to be necessary for symptoms development. We report the case of a 55-year-old women who developed a symptomatic overproduction of 5-oxoproline during flucloxacillin treatment for severe sepsis while receiving acetaminophen for fever control. Hemodialysis accelerated the clearance of the accumulated organic acid, and was followed by a sustained clinical improvement.

焦谷氨酸(5-氧脯氨酸)引起的高阴离子间隙代谢性酸中毒是对乙酰氨基酚治疗(消耗谷胱甘肽储存)的罕见并发症,通常与临床上中度至重度脑病有关。获得性5-羟脯氨酸酶缺乏(青霉素类)或其他谷胱甘肽耗竭的危险因素,如营养不良或败血症,似乎是症状发展的必要条件。我们报告的情况下,55岁的妇女谁在氟氯西林治疗严重败血症期间,同时接受对乙酰氨基酚发热控制的症状性过量生产5-氧脯氨酸。血液透析加速了积累的有机酸的清除,随后是持续的临床改善。
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引用次数: 17
Effectiveness and tolerability of second-line therapy with vildagliptin versus other oral agents in type 2 diabetes (EDGE): post-hoc subanalysis of the Belgian data. 维格列汀二线治疗与其他口服药物治疗2型糖尿病(EDGE)的有效性和耐受性:比利时数据的事后亚分析
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2014-06-01 Epub Date: 2014-03-20 DOI: 10.1179/2295333714Y.0000000018
J Hoste, E Daci, C Mathieu

Aim: To assess the efficacy and safety of vildagliptin versus other oral glucose-lowering drugs added to antidiabetic monotherapy in Belgian patients with type 2 diabetes mellitus, in comparison to the global EDGE study results.

Methods: This is a pre-specified post-hoc subanalysis of the Belgian patient cohort from a worldwide 1-year observational study that compared the effectiveness and tolerability of vildagliptin to other oral antidiabetic agents in type 2 diabetes patients failing monotherapy with oral glucose-lowering agents (EDGE). A total of 1793 Belgian patients were enrolled. Physicians could add any oral antidiabetic drug and patients entered either into the vildagliptin or the comparator cohort. The primary effectiveness and tolerability endpoint was defined as the proportion of patients having a treatment response (HbA1c reduction from baseline to month 12 endpoint >0·3%) without hypoglycemia, weight gain, peripheral oedema, or gastrointestinal side-effects.

Results: In the Belgian population, 37·8% of patients in the vildagliptin group and 32·8% in the comparator group had a decrease in HbA1c of >0·3% without the predefined tolerability issues of hypoglycemia, weight gain, oedema or, gastrointestinal complaints (primary endpoint), resulting in an unadjusted odds ratio of 1·24 (95% CI: 0·96-1·61). Mean HbA1c change from baseline was -0·81% in the vildagliptin cohort and -0·75% in the comparator cohort. Overall, vildagliptin was well tolerated with similarly low incidences of total adverse events (14·9% versus 14·5% in the compactor group) and serious adverse events (2·7% versus 2·5% in the comparator group).

Conclusion: In this EDGE subgroup of Belgian patients with type 2 diabetes who do not achieve the glycemic targets with monotherapy, a similar trend as in the global EDGE study was observed. Adding vildagliptin as a second oral glucose-lowering agent resulted in lowering HbA1c to <7% without weight gain, hypoglycemia or peripheral oedema in a higher proportion of patients than comparator oral antidiabetic drugs, with no differences in the reported number of adverse events.

目的:评估维格列汀与其他口服降糖药物联合抗糖尿病单药治疗比利时2型糖尿病患者的疗效和安全性,并与全球EDGE研究结果进行比较。方法:这是一项针对比利时患者队列的预先指定的回顾性分析,该队列来自一项为期1年的全球观察性研究,该研究比较了维格列汀与其他口服降糖药在单药口服降糖药(EDGE)治疗失败的2型糖尿病患者中的有效性和耐受性。共有1793名比利时患者入组。医生可以添加任何口服降糖药,患者可以进入维格列汀组或比较组。主要有效性和耐受性终点被定义为无低血糖、体重增加、外周水肿或胃肠道副作用的治疗反应患者的比例(从基线到12个月终点HbA1c降低> 0.3%)。结果:在比利时人群中,维格列汀组中37.8%的患者和比较组中32.8%的患者HbA1c下降> 0.3%,没有预先定义的低血糖、体重增加、水肿或胃肠道不适等耐受性问题(主要终点),导致未经调整的优势比为1.24 (95% CI: 0.96 - 1.61)。维格列汀组平均HbA1c较基线变化为- 0.81%,比较组为- 0.75%。总体而言,维格列汀耐受性良好,总不良事件发生率(14.9%,压实剂组为14.5%)和严重不良事件发生率(2.7%,比较剂组为2.5%)相似。结论:在比利时2型糖尿病患者的EDGE亚组中,单药治疗未达到血糖目标,与全球EDGE研究中观察到的趋势相似。加入维格列汀作为第二种口服降糖药,将HbA1c降至
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引用次数: 3
Validation of the Flemish version of the Quality of Life in Short Stature Youth (QoLISSY) questionnaire. 佛兰德语版矮小青年生活质量(QoLISSY)问卷的验证。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2014-06-01 Epub Date: 2014-04-02 DOI: 10.1179/2295333714Y.0000000024
A C Rohenkohl, J De Schepper, J Vanderfaeillie, K Fricke, S Hendrickx, K Lagrou, M Bullinger, J Quitmann

Objectives: The Quality of Life in Short Stature Youth (QoLISSY) questionnaire was recently developed in five European countries to assess health-related quality of life in children and adolescents with idiopathic short stature or growth hormone deficiency from child and parent perspectives. In addition to the existing French version, a Flemish version is needed for use of QoLISSY in the Flemish speaking part of Belgium.

Methods: Children (8-18 years) and their parents recruited from two Belgian paediatric endocrinology clinics completed the QoLISSY in a cross-sectional study. Cronbach's Alpha and test-retest reliability was assessed. Validity was examined by correlation with the generic KIDSCREEN questionnaire as well as by group comparisons according to diagnostic and treatment status.

Results: The QoLISSY scales had an acceptable internal consistency with Cronbach's Alpha ranging from 0·80 to 0·94 (child version) and from 0·77 to 0·92 (parent version). Test-retest reliability correlation coefficients ranged from r = 0·75 to 0·89 in the child version and from r = 0·58 to 0·85 in the parent version. Moderate correlations with the generic KIDSCREEN questionnaire suggested construct validity. Differences between child groups according to child age, underlying diagnosis, and degree of height deficit were found. Correlations with the European QoLISSY were significant for all scales.

Discussion: The Flemish QoLISSY instrument is a psychometrically sound, reliable, and valid short stature specific questionnaire measuring health-related quality of life. It is expected to be of great use in upcoming clinical research on growth disorders and growth hormone treatment in Belgium and Europe.

目的:最近在五个欧洲国家开发了矮小青少年生活质量(QoLISSY)问卷,从儿童和父母的角度评估特发性矮小或生长激素缺乏症儿童和青少年的健康相关生活质量。除了现有的法语版本外,在比利时讲佛兰德语的地区使用QoLISSY还需要一个佛兰德语版本。方法:从比利时两家儿科内分泌科诊所招募儿童(8-18岁)及其父母完成QoLISSY横断面研究。评估Cronbach's Alpha信度和重测信度。通过与通用KIDSCREEN问卷的相关性以及根据诊断和治疗状况的组比较来检验有效性。结果:QoLISSY量表与Cronbach's Alpha量表的内部一致性在0.80 ~ 0.94(儿童版)和0.77 ~ 0.92(家长版)之间,具有可接受的一致性。子版本的重测信度相关系数r = 0.75 ~ 0.89,父版本的重测信度相关系数r = 0.58 ~ 0.85。与一般KIDSCREEN问卷有中度相关,提示建构效度。根据儿童年龄、基础诊断和身高缺陷程度,发现儿童群体之间存在差异。所有量表与欧洲QoLISSY的相关性均显著。讨论:佛兰德QoLISSY是一种心理测量学上健全、可靠、有效的矮小身材特定问卷,用于测量与健康相关的生活质量。预计在比利时和欧洲即将进行的生长障碍和生长激素治疗的临床研究中有很大的用处。
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引用次数: 7
Friable coronary arteries are link between pathogenesis and treatment of spontaneous coronary artery dissection. 冠状动脉脆弱是自发性冠状动脉夹层发病和治疗的重要环节。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2014-06-01 Epub Date: 2014-04-08 DOI: 10.1179/2295333714Y.0000000020
M Vanhaverbeke, T Sarens, L Van Driessche
Abstract Spontaneous coronary artery dissection (SCAD) is increasingly being diagnosed as the cause of an acute coronary syndrome, especially in young patients. We report the case of a 32-year-old woman with postpartum SCAD of the left main and left anterior descending coronary artery which required the implantation of two drug-eluting stents. We present a literature study that correlates the pathogenesis of SCAD to the treatment options. Non-atherosclerotic SCAD is clearly associated with connective tissue disorders, vasculitis, and the peripartum period with its hormonal and haemodynamic changes. The coronary arteries of these SCAD patients are friable and should be approached with caution. Percutaneous coronary intervention has a reported success rate of only 65% and may cause propagation of the dissection. Lately, more and more authors suggest the possibility of a conservative approach in the absence of remaining cardiac ischaemia, even in this era of percutaneous stent implantation.
自发性冠状动脉剥离(SCAD)越来越多地被诊断为急性冠状动脉综合征的原因,特别是在年轻患者中。我们报告的情况下,32岁的妇女产后SCAD左主干和左前降支需要植入两个药物洗脱支架。我们提出了一项文献研究,将SCAD的发病机制与治疗方案联系起来。非动脉粥样硬化性SCAD与结缔组织疾病、血管炎和围产期激素和血流动力学变化明显相关。这些SCAD患者的冠状动脉是脆弱的,应谨慎处理。据报道,经皮冠状动脉介入治疗的成功率仅为65%,并可能导致夹层扩大。最近,越来越多的作者提出,即使在这个经皮支架植入的时代,在没有剩余心脏缺血的情况下,保守方法的可能性。
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引用次数: 1
Reversible splenial lesion in auto-immune thyroid disease: a case report. 自身免疫性甲状腺疾病的可逆性脾损害1例
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2014-06-01 Epub Date: 2014-03-13 DOI: 10.1179/2295333713Y.0000000002
J De Greef, C Jaumotte, B Quivron, G Derue

Reversible lesions of the splenium of the corpus callosum constitute a clinicoradiological syndrome that has been associated to various medical conditions. We report the case of a 47-year-old man who presented with encephalopathy associated to auto-immune thyroid disease in which a reversible splenial lesion was isolated. Although encephalopathy associated to auto-immune thyroid disease is characterized by variable radiological findings, it has only been once associated with a reversible splenial lesion.

胼胝体脾的可逆性病变构成一种与各种医疗条件相关的临床放射学综合征。我们报告的情况下,47岁的男子谁提出脑病相关的自身免疫性甲状腺疾病,其中可逆的脾脏病变是孤立的。虽然与自身免疫性甲状腺疾病相关的脑病具有不同的影像学表现,但它只与一次可逆性脾病变相关。
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引用次数: 8
Gas-forming liver abscess in a patient with multi-organ failure: role of imaging and management. 多器官功能衰竭患者的气性肝脓肿:影像学和治疗的作用。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2014-06-01 DOI: 10.1179/2295333714Y.0000000025
M B Kachare, N S Desai, V K Patki, V K Patki, J A Ricci, Y-H Juan, S S Saboo

We present an unusual case of air-containing liver abscess demonstrated on plain film and ultrasonography with successful treatment utilizing ultrasound-guided drainage in a patient in septic shock. Although surgical drainage is often indicated, ultrasound-guided catheter drainage along with supportive antibiotic therapy can be a safe treatment alternative in critical patients.

我们报告一个不寻常的病例含气肝脓肿平片和超声显示成功的治疗利用超声引导引流病人脓毒性休克。虽然手术引流经常指征,超声引导下的导管引流与支持抗生素治疗可以是一个安全的治疗方案,在危重患者。
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引用次数: 3
Importance of preoperative anaesthetic consultation in perioperative medicine. 术前麻醉会诊在围手术期医学中的重要性。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2014-06-01 Epub Date: 2014-04-25 DOI: 10.1179/0001551214Z.00000000058
M Raes, J Poelaert

This report describes two patients for whom the preoperative, anaesthetic consultation led to postponing planned surgery because of important, undiagnosed health problems. In one of the two cases, this consultation was even life-saving. However, actual literature cannot prove any advantage on the outcome of the individual patient. The only proven advantages in favour of pre-operative consultation are a reduced length of stay in the hospital and a reduction in the cost of preoperative testing.

本报告描述了两例患者,他们的术前麻醉咨询导致推迟计划手术,因为重要的,未确诊的健康问题。在其中一个案例中,这种咨询甚至挽救了生命。然而,实际的文献不能证明对个体患者的结果有任何好处。唯一证明有利于术前咨询的优势是缩短住院时间和减少术前检查费用。
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引用次数: 2
Cost of 1-year left ventricular assist device destination therapy in chronic heart failure: a comparison with heart transplantation. 慢性心力衰竭1年左心室辅助装置终点治疗的费用:与心脏移植的比较。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2014-06-01 Epub Date: 2014-03-20 DOI: 10.1179/2295333714Y.0000000017
W Droogne, S Jacobs, K Van den Bossche, J Verhoeven, R R Bostic, J Vanhaecke, J Van Cleemput, F Rega, B Meyns

Objective: To analyse overall cost involved with destination therapy (DT) in comparison to transplantation (HTX) and bridging to transplantation.

Methods: Three groups of patients at one hospital were considered for this cost analysis: (1) patients included in the BENEMACS study starting May 2009 (n = 6); (2) all patients from May 2009 till May 2010 undergoing heart transplantation (n = 19); or (iii) undergoing Heartmate II implantation as a bridge to transplant (n = 13). Patients undergoing bridging were more sick (lower Intermacs class). DT patients were older (64±8 years). Cost was derived from actual hospital invoices, device, organ procurement and medical cost, and follow-up care during 1 year from implantation. Costs are presented in euro, by their mean values and standard deviation.

Results: One-year survivals were 83, 84, and 77%, respectively, for DT, HTX, and bridging. Costs for initial and re-hospitalizations were not different between groups. Costs for medical follow-up and medication were significantly higher for transplanted patients. The 1-year total cost was €85 531±19 823 for HTX, €125 108±32 399 for bridging, and €137 068±29 007 for DT. As 42% of the transplanted patients were bridged, the cost of the medical pathway HTX was €138 076±19 823. Assuming a 5-year survival and a similar yearly follow-up cost, the average cost per year is €42 153 for HTX, €53 637 for transplantation including the bridging cost, and €47 487 for DT.

Conclusion: Direct transplantation without bridging is the most cost-efficient treatment. The cost per patient per year for DT is similar to HTX considering its bridging activity.

目的:分析目的治疗(DT)与移植(HTX)和移植桥接治疗的总成本。方法:对同一家医院的三组患者进行成本分析:(1)2009年5月开始纳入BENEMACS研究的患者(n = 6);(2) 2009年5月至2010年5月接受心脏移植的患者(n = 19);或(iii)接受心脏伴侣II型植入作为移植的桥梁(n = 13)。接受桥接治疗的患者病情加重(Intermacs分级较低)。DT患者年龄较大(64±8岁)。费用来源于医院实际发票、器械、器官采购和医疗费用以及植入后1年内的随访护理。成本按其平均值和标准差以欧元表示。结果:DT、HTX和桥接的1年生存率分别为83,84和77%。初次住院和再次住院的费用在两组之间没有差异。移植患者的医疗随访和药物费用明显较高。HTX的1年总成本为€85 531±19 823,桥接为€125 108±32 399,DT为€137 068±29 007。42%的移植患者进行了桥接,HTX医疗路径的费用为€138 076±19 823。假设5年生存期和相似的年度随访成本,HTX每年的平均成本为42 153欧元,移植(包括桥接费用)为53 637欧元,DT为47 487欧元。结论:无桥接直接移植是最经济有效的治疗方法。考虑到其桥接活性,DT每年每位患者的费用与HTX相似。
{"title":"Cost of 1-year left ventricular assist device destination therapy in chronic heart failure: a comparison with heart transplantation.","authors":"W Droogne,&nbsp;S Jacobs,&nbsp;K Van den Bossche,&nbsp;J Verhoeven,&nbsp;R R Bostic,&nbsp;J Vanhaecke,&nbsp;J Van Cleemput,&nbsp;F Rega,&nbsp;B Meyns","doi":"10.1179/2295333714Y.0000000017","DOIUrl":"https://doi.org/10.1179/2295333714Y.0000000017","url":null,"abstract":"<p><strong>Objective: </strong>To analyse overall cost involved with destination therapy (DT) in comparison to transplantation (HTX) and bridging to transplantation.</p><p><strong>Methods: </strong>Three groups of patients at one hospital were considered for this cost analysis: (1) patients included in the BENEMACS study starting May 2009 (n = 6); (2) all patients from May 2009 till May 2010 undergoing heart transplantation (n = 19); or (iii) undergoing Heartmate II implantation as a bridge to transplant (n = 13). Patients undergoing bridging were more sick (lower Intermacs class). DT patients were older (64±8 years). Cost was derived from actual hospital invoices, device, organ procurement and medical cost, and follow-up care during 1 year from implantation. Costs are presented in euro, by their mean values and standard deviation.</p><p><strong>Results: </strong>One-year survivals were 83, 84, and 77%, respectively, for DT, HTX, and bridging. Costs for initial and re-hospitalizations were not different between groups. Costs for medical follow-up and medication were significantly higher for transplanted patients. The 1-year total cost was €85 531±19 823 for HTX, €125 108±32 399 for bridging, and €137 068±29 007 for DT. As 42% of the transplanted patients were bridged, the cost of the medical pathway HTX was €138 076±19 823. Assuming a 5-year survival and a similar yearly follow-up cost, the average cost per year is €42 153 for HTX, €53 637 for transplantation including the bridging cost, and €47 487 for DT.</p><p><strong>Conclusion: </strong>Direct transplantation without bridging is the most cost-efficient treatment. The cost per patient per year for DT is similar to HTX considering its bridging activity.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/2295333714Y.0000000017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32337366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 11
期刊
Acta Clinica Belgica
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