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Should varicocele screening be conducted in men diagnosed with chronic venous insufficiency? A prospective study. 是否应对被诊断为慢性静脉功能不全的男性进行精索静脉曲张筛查?一项前瞻性研究。
IF 0.7 Q4 SURGERY Pub Date : 2024-03-01 Epub Date: 2024-03-30 DOI: 10.5114/kitp.2024.138486
Ferit Çetinkaya, Kamil Doğan, Ayşe Taş

Introduction: It has been previously proposed in numerous studies that chronic venous insufficiency (CVI) has similar pathogenesis to varicocele in males. Varicocele has been identified as the most common cause of infertility in men, accounting for 40% of cases.

Aim: This study investigates whether varicocele screening should be conducted in patients with CVI and, if so, which patients should undergo such screening.

Material and methods: The study included 102 adult male patients with venous insufficiency complaints who presented to the cardiovascular surgery clinic between January 2023 and June 2023. Data were prospectively collected through medical history interviews and Doppler ultrasound measurements performed by a single radiologist. The relationship between non-normally distributed measurement data of the two groups was evaluated using the Mann-Whitney U test, while the association between categorical variables was assessed using the χ2 test. ROC analysis was employed for determining predictive value. A type 1 error level of α = 0.05 was adopted.

Results: The mean left great saphenous vein (GSV) diameter of those with varicocele (6.6 ±2.3) was significantly larger compared to the mean left GSV diameter of those without varicocele (5.3 ±2.6) (p = 0.004). The area under the ROC curve for left GSV diameter was 67% (p = 0.005). When varicocele screening is performed in patients with a left GSV diameter of 5.35 cm and above, sensitivity is 71.4% and specificity is 61.2%.

Conclusions: There is a significant association between left GSV diameter and varicocele (p = 0.004). Varicocele screening can be carried out with 71.4% sensitivity in adult male patients with a left GSV diameter of 5.35 cm and above. Both cardiovascular surgeons and radiologists can conduct varicocele screening by measuring pampiniform veins in patients with a left GSV diameter of 5.35 cm and above. This approach has the potential to reduce the incidence of varicocele and associated infertility.

导言:以前有许多研究提出,慢性静脉功能不全(CVI)与男性精索静脉曲张的发病机制相似。精索静脉曲张已被确定为导致男性不育的最常见原因,占不育病例的 40%。目的:本研究探讨是否应对 CVI 患者进行精索静脉曲张筛查,如果是,哪些患者应接受此类筛查:研究对象包括2023年1月至2023年6月期间到心血管外科门诊就诊的102名静脉功能不全的成年男性患者。数据通过病史访谈和由一名放射科医生进行的多普勒超声测量进行前瞻性收集。两组非正态分布测量数据之间的关系采用 Mann-Whitney U 检验进行评估,分类变量之间的关联采用 χ2 检验进行评估。采用 ROC 分析法确定预测值。采用的 1 型误差水平为 α = 0.05:结果:患有精索静脉曲张者的平均左大隐静脉(GSV)直径(6.6 ± 2.3)明显大于无精索静脉曲张者的平均左大隐静脉直径(5.3 ± 2.6)(P = 0.004)。左侧 GSV 直径的 ROC 曲线下面积为 67% (p = 0.005)。如果对左侧 GSV 直径为 5.35 厘米及以上的患者进行精索静脉曲张筛查,敏感性为 71.4%,特异性为 61.2%:结论:左侧 GSV 直径与精索静脉曲张之间存在明显关联(p = 0.004)。对于左侧 GSV 直径在 5.35 厘米及以上的成年男性患者,精索静脉曲张筛查的灵敏度为 71.4%。心血管外科医生和放射科医生都可以通过测量左侧GSV直径在5.35厘米及以上的患者的瓣膜静脉来进行精索静脉曲张筛查。这种方法有可能降低精索静脉曲张和相关不育症的发病率。
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引用次数: 0
The importance of the development of extracorporeal life support simulation centres for improving skills and knowledge during the COVID-19 pandemic. 发展体外生命支持模拟中心对于在 COVID-19 大流行期间提高技能和知识的重要性。
IF 0.7 Q4 SURGERY Pub Date : 2024-03-01 Epub Date: 2024-03-30 DOI: 10.5114/kitp.2024.138522
Piotr Ziemak, Marek Dąbrowski, Mateusz Puślecki, Agata Dąbrowska, Marcin Ligowski, Sebastian Stefaniak, Marek Jemielity, Bartłomiej Perek, Ryszard Marciniak

Introduction: Despite increasing implementation of sophisticated and logistically challenging techniques to support patients in life-threatening conditions in the last years, there were no devoted education centres, especially in coronavirus pandemic.

Aim: To assess the value of gaining evidence-based knowledge and improving the skills of physicians by means of simulation techniques in the safe use of extracorporeal technologies to support patients in the life-threatening conditions.

Material and methods: In 2019, the National Education Centre for Artificial Life Support and Patient Safety and the frame program of the course of "Artificial Life Support with ECMO". was created. In years 2019-2023, we managed to organise 34 such courses for 405 physicians, which were additionally endorsed by ELSO (Extracorporeal Life Support Organisation). The physicians' cognitive, behavioural, and technical skills were evaluated before and after the courses.

Results: The participants' gender was well balanced (54% men and 46% women). Most of them (mainly at the age between 31-40 years) presented more than 5 years of clinical experience, predominantly in anaesthesiology and intensive care (63%). Of note, 54% of them had no experience with ECMO application. In all detailed aspects of cognitive, behavioural, and technical assessment and knowledge scores, significant improvement was observed after the course.

Conclusions: The development of a simulation-based education centre was found to be an invaluable achievement that enabled not only successful standardised training and testing of novel or previously accepted procedures, but also the upgrading of technical skills, even in the challenging COVID-19 pandemic period.

导言:目的:评估在安全使用体外循环技术为生命垂危的患者提供支持方面,通过模拟技术获得循证知识和提高医生技能的价值:2019年,国家人工生命支持与患者安全教育中心和 "ECMO人工生命支持 "课程框架计划成立。2019-2023 年,我们为 405 名医生组织了 34 次此类课程,这些课程还得到了 ELSO(体外生命支持组织)的认可。课程前后对医生的认知、行为和技术技能进行了评估:参与者的性别非常均衡(54% 为男性,46% 为女性)。他们中的大多数人(主要在 31-40 岁之间)都有 5 年以上的临床经验,主要集中在麻醉学和重症监护领域(63%)。值得注意的是,其中 54% 的人没有使用过 ECMO。课程结束后,在认知、行为、技术评估和知识评分等所有细节方面都有明显改善:模拟教育中心的发展是一项宝贵的成就,它不仅成功地实现了标准化培训,测试了新程序或以前接受的程序,还提高了技术技能,即使是在具有挑战性的 COVID-19 大流行期间也是如此。
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引用次数: 0
Image-guided techniques for localization of pulmonary nodules during video-assisted thoracoscopic surgery lobectomy. 视频辅助胸腔镜手术肺叶切除术中肺结节定位的图像引导技术。
IF 0.6 Q4 SURGERY Pub Date : 2023-12-01 Epub Date: 2024-01-11 DOI: 10.5114/kitp.2023.134162
Danilo Coco, Silvana Leanza, Sebastiano Angelo Bastone, Massimo Giuseppe Viola, Vincenzo Ambrogi

In the modern era when screening and early surveillance of pulmonary nodules are increasing in importance, the management of the pulmonary nodule represents a different challenge to thoracic surgeons. The difficulty lies in the merging of sound surgical and oncological principles with more minimally invasive and appropriate lung-sparing surgery. The success rates of video-assisted thoracoscopic surgery (VATS) resection for smaller as well as subsolid nodules have increased as a result of radiologists' preoperative localization tools. Fast tracking in thoracic surgery is promoted by proper postoperative care for patients having lobectomies in combination with the VATS technique. Image-guided surgery refers to the application of a real-time correlation of the surgical field to preoperative imaging data collection that reflects the precise placement of a chosen surgical instrument in the adjacent anatomic structures. Among the cross-sectional digital imaging techniques the most widely utilized imaging modalities for image-guided therapy are computed tomography and magnetic resonance imaging. Additionally, surgical navigation devices, tracking tools, integration software, ultrasound, and angiography are used to support these procedures. For people who are thinking about implementing or optimizing a nodule localization program in view of workflow patterns, surgeon preferences, and institutional resources in a certain facility, this review provides in-depth, unbiased evaluation and offers useful information.

在肺结节筛查和早期监测日益重要的现代,肺结节的治疗对胸外科医生来说是一个不同的挑战。困难在于如何将合理的外科和肿瘤学原则与更微创、更适当的保肺手术相结合。由于放射科医生的术前定位工具,视频辅助胸腔镜手术(VATS)切除较小结节和实性下结节的成功率有所提高。通过对结合 VATS 技术进行肺叶切除术的患者进行适当的术后护理,促进了胸腔镜手术的快速跟踪。图像引导手术指的是将手术区域与术前成像数据收集进行实时关联,以反映所选手术器械在邻近解剖结构中的精确位置。在横断面数字成像技术中,用于图像引导治疗最广泛的成像模式是计算机断层扫描和磁共振成像。此外,手术导航设备、跟踪工具、集成软件、超声波和血管造影术也用于支持这些手术。对于那些考虑根据工作流程模式、外科医生偏好和某个机构的机构资源来实施或优化结节定位计划的人来说,这篇综述提供了深入、公正的评估,并提供了有用的信息。
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引用次数: 0
Successful conservative management of iatrogenic coronary artery dissection proceeding into the ascending aorta. 成功保守治疗进入升主动脉的先天性冠状动脉夹层。
IF 0.6 Q4 SURGERY Pub Date : 2023-12-01 Epub Date: 2024-01-11 DOI: 10.5114/kitp.2023.134133
Anna Maria Witkowska, Bart Omiej Perek, Anna Olasiñska-Wiœniewska, Sebastian Stefaniak, Marek Jemielity
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引用次数: 0
The effect of different regional analgesia methods on chronic pain after thoracic surgery. 不同区域镇痛方法对胸外科手术后慢性疼痛的影响。
IF 0.6 Q4 SURGERY Pub Date : 2023-12-01 Epub Date: 2024-01-11 DOI: 10.5114/kitp.2023.134175
Korgün Ökmen, Şule Balk, Gamze Gözen Güvenç

Introduction: Chronic postsurgical pain (CPSP) is defined as pain persisting for ≥ 3 months after surgery, severely impairing patients' long-term daily activities and quality of life.

Aim: To evaluate the effects of various regional analgesia methods, including thoracic epidural (TE), serratus anterior plane (SAP) block, rhomboid intercostal block (RIB) and paravertebral block (PVB), on the incidence of chronic post-thoracic surgery pain.

Material and methods: A total of 489 patients (240 thoracotomy, 249 VATS) were included in the analysis. The primary outcome measure was the VAS score (postoperative 6th month), while the secondary outcome measures were the LANSS score (postoperative 6th month), the use of analgesic medication and descriptive information.

Results: In thoracotomy patients, VAS scores were statistically significantly lower in patients who underwent RIB and SAP block compared to those who underwent TE and patient-controlled anesthesia (PCA). LANSS scores did not differ between the RIB, SAP and TE groups, while higher scores were found in the PCA group. After VATS, VAS scores were statistically significantly lower in patients who underwent RIB, SAP and PVB block compared to the PCA group. LANSS scores were statistically significantly lower in the RIB and SAP block groups than in the PVB and PCA groups.

Conclusions: This study found that patients who received regional anesthesia had lower LANSS scores and VAS values, indicative of neuropathic pain reduction, following thoracotomy and VATS procedures.

简介:慢性手术后疼痛(CPSP)是指手术后疼痛持续≥3 个月,严重影响患者的长期日常活动和生活质量:目的:评估包括胸硬膜外(TE)、前锯肌平面(SAP)阻滞、斜方肌肋间阻滞(RIB)和椎旁阻滞(PVB)在内的各种区域镇痛方法对胸外科术后慢性疼痛发生率的影响:共有 489 例患者(240 例开胸术,249 例 VATS)被纳入分析。主要结果指标为VAS评分(术后第6个月),次要结果指标为LANSS评分(术后第6个月)、镇痛药物使用情况和描述性信息:在胸廓切开术患者中,与接受 TE 和患者控制麻醉 (PCA) 的患者相比,接受 RIB 和 SAP 阻滞的患者的 VAS 评分在统计学上明显较低。RIB、SAP和TE组的LANSS评分没有差异,而PCA组的评分较高。VATS 后,与 PCA 组相比,接受 RIB、SAP 和 PVB 阻滞的患者的 VAS 评分在统计学上明显较低。RIB和SAP阻滞组的LANSS评分在统计学上明显低于PVB和PCA组:本研究发现,接受区域麻醉的患者在胸廓切开术和 VATS 手术后的 LANSS 评分和 VAS 值较低,表明神经性疼痛减轻。
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引用次数: 0
An unusual combination of aspergillosis in multiple hydatid cysts in an immuno-competent patient. 一名免疫功能正常的患者在多发性包虫囊肿中罕见地合并了曲霉菌病。
IF 0.6 Q4 SURGERY Pub Date : 2023-12-01 Epub Date: 2024-01-11 DOI: 10.5114/kitp.2023.134137
Anshuman Darbari, Sawan Dalal, Abisho S Russel, B Bhartendu
{"title":"An unusual combination of aspergillosis in multiple hydatid cysts in an immuno-competent patient.","authors":"Anshuman Darbari, Sawan Dalal, Abisho S Russel, B Bhartendu","doi":"10.5114/kitp.2023.134137","DOIUrl":"10.5114/kitp.2023.134137","url":null,"abstract":"","PeriodicalId":49945,"journal":{"name":"Kardiochirurgia I Torakochirurgia Polska","volume":"20 4","pages":"277-279"},"PeriodicalIF":0.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10809812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139570357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Evaluation of perioperative risk factors in pediatric patients with left ventricle outflow tract obstruction. 评估左心室流出道梗阻儿科患者围手术期的风险因素。
IF 0.6 Q4 SURGERY Pub Date : 2023-12-01 Epub Date: 2024-01-11 DOI: 10.5114/kitp.2023.134161
Canan Salman Önemli, Kübra Evren Şahin, Mustafa Karaçelik, Çagatay Bilen

Introduction: Left ventricular outflow tract obstructions (LVOTO) presents as complex cardiac diseases accompanied by other cardiac anomalies in the pediatric age group. Postoperative complications, especially cardiac, pulmonary, and renal complications, that may develop after pediatric cardiac surgery can become life-threatening. If the perioperative risk factors for these complications are known in pediatric patients with LVOTO, anesthesiologists and surgeons may take precautions to eliminate undesirable outcomes.

Aim: To evaluate the perioperative risk factors that may contribute to the development of postoperative complications in pediatric patients operated on for LVOTO in a pediatric cardiac surgery clinic.

Material and methods: The study retrospectively investigated 58 patients who were operated on for LVOTO in a pediatric cardiac surgery clinic. The patients were divided into two groups, those with and without postoperative complications. Preoperative laboratory test results, anesthesia time, operation time, aortic cross-clamp time, cardiopulmonary bypass (CPB) time, postoperative inotropes, first postoperative laboratory tests, intraoperative and postoperative complications, mechanical ventilation time, intensive care unit stay, and hospital stay were recorded.

Results: The most common postoperative complications were endocrine complications, followed by hepatic complications. The preoperative lymphocyte count was significantly higher (p < 0.05), and the neutrophil-to-lymphocyte ratio (NLR) was significantly lower (p < 0.05) in the group with postoperative complications. The postoperative pH, glucose, creatinine, and aspartate aminotransferase (AST) levels were significantly lower (p < 0.05), and the postoperative calcium level was significantly higher (p < 0.05) in the group without postoperative complications. Intraoperative platelet transfusion rate was found to be significantly lower (p < 0.05) in the group with postoperative complications.

Conclusions: It is critical to identify predictive factors to prevent postoperative complications in pediatric patients undergoing surgery for LVOTO. Preoperative NLR, intraoperative platelet transfusion, and postoperative calcium, glucose, pH and AST levels may help in the prediction of complications.

导言:左心室流出道梗阻(LVOTO)是小儿时期伴有其他心脏畸形的复杂心脏疾病。小儿心脏手术后可能出现术后并发症,尤其是心脏、肺部和肾脏并发症,可危及生命。目的:评估在小儿心脏外科诊所接受左心室瓣膜置换手术的小儿患者术后出现并发症的围手术期风险因素:研究回顾性调查了58名在小儿心脏外科诊所接受左心室开放手术的患者。患者分为两组,即有术后并发症和无术后并发症。记录了术前实验室检查结果、麻醉时间、手术时间、主动脉交叉钳夹时间、心肺旁路(CPB)时间、术后肌力药物、术后首次实验室检查、术中和术后并发症、机械通气时间、重症监护室住院时间和住院时间:最常见的术后并发症是内分泌并发症,其次是肝脏并发症。术前淋巴细胞计数明显高于术后并发症组(P<0.05),中性粒细胞与淋巴细胞比值(NLR)明显低于术后并发症组(P<0.05)。无术后并发症组的术后pH值、血糖、肌酐和天冬氨酸氨基转移酶(AST)水平明显降低(P<0.05),术后血钙水平明显升高(P<0.05)。术后出现并发症组的术中血小板输注率明显降低(P < 0.05):结论:对于接受左心室视网膜缺损手术的儿童患者来说,确定预防术后并发症的预测因素至关重要。术前NLR、术中血小板输注以及术后钙、葡萄糖、pH值和谷草转氨酶水平可能有助于预测并发症。
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引用次数: 0
A decade later: long-term results of the first percutaneous epicardial closure of the left atrial appendage using the LARIAT device. 十年之后:首次使用 LARIAT 设备经皮心外膜关闭左心房阑尾的长期效果。
IF 0.6 Q4 SURGERY Pub Date : 2023-12-01 Epub Date: 2024-01-11 DOI: 10.5114/kitp.2023.134176
Marian Burysz, Michalina Malec-Litwinowicz, Jakub Batko, Radoslaw Litwinowicz, Mariusz Kowalewski, Bogus Aw Kapelak, Krzysztof Bartus

Introduction: Over the past decade, left atrial appendage occlusion (LAAO) has emerged as an established alternative to oral anticoagulation for patients diagnosed with atrial fibrillation (AF). The LARIAT device stands as the sole available epicardial system for complete percutaneous left atrial appendage (LAA) closure.

Aim: To present the extended outcomes (spanning over 9 years of observation) in patients with AF who underwent epicardial LAAO. The presented results constitute the longest observation in world literature.

Material and methods: A prospective, single-center study was conducted on 121 patients undergoing LAAO with the LARIAT system. Incidence of thromboembolic events and severe bleeding and mortality rates were documented. The reduction in the risk of thromboembolism and bleeding after LAAO was quantified.

Results: The mean follow-up duration was 74.18 months. The average CHADS2 score was 1.9 ±1.0, CHA2DS2-VAS score was 2.8 ±1.5, and HAS-BLED score was 2.7 ±1.0. The mean annual thromboembolic event rate was 0.7%, resulting in a 75% reduction in estimated thromboembolic risk. The annual occurrence of major bleeding complications was 0.8%, leading to a 67.9% reduction in estimated bleeding risk. The overall annual mortality rate was 1.2%.

Conclusions: Epicardial LAAO employing the LARIAT device yields commendable long-term outcomes by reducing stroke and bleeding risk.

简介:在过去十年中,左心房阑尾封堵术(LAAO)已成为心房颤动(AF)患者口服抗凝药的一种成熟替代方案。LARIAT 装置是目前唯一可用于经皮左心房阑尾(LAA)完全闭合的心外膜系统。目的:介绍对接受心外膜 LAAO 治疗的房颤患者的长期疗效(超过 9 年的观察期)。材料与方法:一项前瞻性单中心研究:对121名接受LARIAT系统LAAO手术的患者进行了前瞻性单中心研究。研究记录了血栓栓塞事件、严重出血和死亡率的发生率。对 LAAO 术后血栓栓塞和出血风险的降低进行了量化:平均随访时间为 74.18 个月。平均 CHADS2 评分为 1.9 ± 1.0,CHA2DS2-VAS 评分为 2.8 ± 1.5,HAS-BLED 评分为 2.7 ± 1.0。年平均血栓栓塞事件发生率为 0.7%,估计血栓栓塞风险降低了 75%。大出血并发症的年发生率为 0.8%,估计出血风险降低了 67.9%。年总死亡率为1.2%:结论:采用 LARIAT 装置的心外膜 LAAO 可降低中风和出血风险,从而获得值得称道的长期疗效。
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引用次数: 0
A huge thymoma accidentally discovered during minimally invasive aortic valve surgery. 在主动脉瓣微创手术中意外发现巨大胸腺瘤。
IF 0.6 Q4 SURGERY Pub Date : 2023-12-01 Epub Date: 2024-01-11 DOI: 10.5114/kitp.2023.134160
Zoran Saša Tabakoviæ, Milan Æirkoviæ, Petar Milačiæ, Marko Anđelkoviæ, Igor Živkoviæ
{"title":"A huge thymoma accidentally discovered during minimally invasive aortic valve surgery.","authors":"Zoran Saša Tabakoviæ, Milan Æirkoviæ, Petar Milačiæ, Marko Anđelkoviæ, Igor Živkoviæ","doi":"10.5114/kitp.2023.134160","DOIUrl":"10.5114/kitp.2023.134160","url":null,"abstract":"","PeriodicalId":49945,"journal":{"name":"Kardiochirurgia I Torakochirurgia Polska","volume":"20 4","pages":"268-269"},"PeriodicalIF":0.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10809808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139570165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Various uses of the thermal camera in some thoracic surgical procedures. 热像仪在某些胸外科手术中的各种用途。
IF 0.6 Q4 SURGERY Pub Date : 2023-12-01 Epub Date: 2024-01-11 DOI: 10.5114/kitp.2023.134135
Muhammet Sayan, Aykut Kankoc, Elgun Valiyev, Ali Celik
{"title":"Various uses of the thermal camera in some thoracic surgical procedures.","authors":"Muhammet Sayan, Aykut Kankoc, Elgun Valiyev, Ali Celik","doi":"10.5114/kitp.2023.134135","DOIUrl":"10.5114/kitp.2023.134135","url":null,"abstract":"","PeriodicalId":49945,"journal":{"name":"Kardiochirurgia I Torakochirurgia Polska","volume":"20 4","pages":"270-273"},"PeriodicalIF":0.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10809810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139571367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Kardiochirurgia I Torakochirurgia Polska
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