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Hypokalemia in a young man…think Bartter syndrome type 3 一名年轻人的低钾血症......考虑为巴特综合征 3 型
Pub Date : 2024-03-25 DOI: 10.1097/ms9.0000000000001994
Suaad Hamsho, Abdul Hadi Daher Alhussen, Hadi Alabdullah, Bilal Sleiay, Noor Kasem, Qussai Hassan
Bartter syndrome is an autosomal recessive salt reabsorption disorder that results in decreased extracellular fluid volume with low/normal blood pressure. A 17-year-old boy with polydipsia, polyuria, weakness in the lower limbs, and ataxic gait. His Laboratory test shows Hypokalemia; hypochloremia; hypomagnesemia and metabolic alkalosis. Our patient was managed by fluid and electrolyte replacement which is essential in emergency management. Bartter syndrome is difficult to treat and currently there is no complete cure. The overall prognosis depends on the extent of receptor dysfunction, and despite these facts, most patients can live a normal life if they strictly follow their treatment plan.
巴特综合征是一种常染色体隐性遗传的盐重吸收障碍,会导致细胞外液容量减少,血压低/正常。 一名 17 岁男孩患有多尿、多饮、下肢无力和共济失调步态。他的实验室检查显示低钾血症、低氯血症、低镁血症和代谢性碱中毒。我们对患者进行了液体和电解质补充治疗,这在急诊治疗中至关重要。 巴特综合征很难治疗,目前还没有完全治愈的方法。总体预后取决于受体功能障碍的程度,尽管如此,如果严格遵守治疗计划,大多数患者都能正常生活。
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引用次数: 0
Surgical removal of multiple xanthomas in familial hypercholesterolemia: a case report 家族性高胆固醇血症多发性黄瘤的手术切除:病例报告
Pub Date : 2024-03-25 DOI: 10.1097/ms9.0000000000001997
M. A. Tolba, Anwar Mohamad, Youssef Z. Farhat, Mohammed A. Omar, Ahmed Mohamed Safy
Xanthomas are skin swellings that are caused by the accumulation of cholesterol and lipids in the body. They are associated with lipid disorders, such as familial hypercholesterolemia (FH). FH is a rare genetic disorder which is characterized mainly by high levels of LDL cholesterol. We report a case of an 11-year-old female who had multiple swellings all over the body with the largest measuring 7×4×3 cm in diameter. These lesions were gradually increasing in size since 4 years. She was being bullied by her school colleagues because of swellings appearance. Clinical examination revealed multiple yellowish masses on the patient’s elbows, knees, and buttocks which were painless, firm, and non-tender. Laboratory tests revealed elevated levels of serum cholesterol (512 mg/dL) and LDL cholesterol (469.2 mg/dL). Masses Ultrasound showed similar echogenicity to upper and lower extremities subcutaneous fat. Incisional biopsy microscopic images revealed clusters of foam cells. These findings led to a diagnosis of Homozygous FH (HoFH) and she underwent surgery to remove the xanthomas on her elbows. Xanthomas are small, yellowish skin swellings that form due to the presence of high lipids. As they are typically painless and small, this could lead to a late treatment or misdiagnosis. Drugs, life style changes and surgery represent treatment plan options. Xanthomas can be the first indication of an underlying hypercholesterolemia problem and this case report highlights the importance of early diagnosis of HoFH by providing the suitable management for this case in its early stages which can prevent developing serious complication.
黄瘤是由体内胆固醇和脂质堆积引起的皮肤肿胀。它们与血脂紊乱有关,如家族性高胆固醇血症(FH)。家族性高胆固醇血症是一种罕见的遗传性疾病,其主要特征是高水平的低密度脂蛋白胆固醇。 我们报告了一例 11 岁女性的病例,她全身多处肿胀,最大的直径达 7×4×3 厘米。这些病变从 4 年前开始逐渐增大。由于肿物的出现,她受到了学校同事的欺负。临床检查发现,患者的肘部、膝盖和臀部有多个淡黄色肿块,这些肿块无痛、坚实、无触痛。实验室检查显示血清胆固醇(512 毫克/分升)和低密度脂蛋白胆固醇(469.2 毫克/分升)水平升高。肿块 超声波显示上肢和下肢皮下脂肪的回声相似。切口活检显微镜图像显示有成群的泡沫细胞。这些结果使她被确诊为同型高脂血症(HoFH),并接受了切除肘部黄瘤的手术。 黄瘤是由于高血脂而形成的微小、淡黄色皮肤肿物。由于黄瘤通常无痛且体积小,因此可能导致治疗不及时或误诊。药物、改变生活方式和手术是治疗方案的选择。 黄瘤可能是潜在高胆固醇血症问题的最初征兆,本病例报告强调了早期诊断高胆固醇血症的重要性,在早期阶段为该病例提供合适的治疗方案,可防止发展成严重的并发症。
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引用次数: 0
Anti coauglants induced intracranial hemorrhage managed with decompressive craniectomy: A case report of lesson learned 抗鸦片剂诱发的颅内出血通过减压开颅术得到了控制:一例经验教训报告
Pub Date : 2024-03-25 DOI: 10.1097/ms9.0000000000001996
Sagun Ghimire, Shikher Shrestha, Dinuj Shrestha, Ananta maharjan, Bibek Jaiswal, Prabin chaudhary, Sharon Sherpa
Intracerebral hemorrhage (ICH)secondary to use of anti-coagulants is one of the fearsome complications. Hemorrhage within the intracranial space due to such anti-coagulants results in expansion of the intracranial bleeding despite the reversal of anti-coagulants. Hence timely surgical intervention can be lifesaving. An elderly female who was undergoing management for her deranged coagulation parameters was found to be in a state of features suggestive of stroke. Patient was on regular anti-coagulants medication for her cardiology issues. CT scan showed intracranial hemorrhage which underwent expansion in same day hence decompressive craniectomy was done. In further stay in the ICU patient GCS was fluctuating but symptomatic improvement was noted. Anti-coagulants adjustment was done from cardiologist and further there was no expansion of intracranial bleeding with within normal coagulation parameters. Anti-coagulants are rampantly used in several cases . Despite the several complications there is desperate need of such medications for the betterment of the patient condition. Pharmacological management is major modality in reversal of OAC induced ICH but in rare cases in the background of OACs induced ICH there occurs expansion of hemorrhage. Hence the need for neurosurgical intervention whether be it minimal invasive surgery or decompressive craniectomy . In the background of less prevalence of OACs induced ICH, there is absence of robust guiding treatment protocol. Furthermore there exist minimal reported cases which underwent surgical intervention and resulted good prognosis.
因使用抗凝剂而继发的脑出血(ICH)是可怕的并发症之一。使用抗凝血剂引起的颅内出血会导致颅内出血扩大,尽管抗凝血剂已被逆转。因此,及时的手术干预可以挽救生命。 一名老年女性患者因凝血参数紊乱而接受治疗,发现其特征提示中风。患者因心脏病定期服用抗凝药物。CT 扫描显示患者有颅内出血,并在当天进行了扩容,因此对患者进行了颅骨减压切除术。在重症监护室继续住院期间,患者的 GCS 出现波动,但症状有所改善。心脏科医生对抗凝剂进行了调整,颅内出血没有扩大,凝血指标正常。 抗凝剂在一些病例中被大量使用。尽管存在多种并发症,但为了改善患者的病情,仍迫切需要使用此类药物。药物治疗是逆转 OAC 引起的 ICH 的主要方式,但在极少数情况下,OAC 引起的 ICH 会导致出血扩大。因此,无论是微创手术还是减压开颅手术,都需要神经外科介入治疗。 在 OACs 引起的 ICH 发病率较低的背景下,缺乏强有力的指导性治疗方案。此外,接受手术干预并获得良好预后的病例报道极少。
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引用次数: 0
Individualized prediction of conditional survival for colorectal signet ring cell carcinoma patients 结直肠标志环细胞癌患者条件生存期的个性化预测
Pub Date : 2024-03-25 DOI: 10.1097/ms9.0000000000001982
Jiani Gu, Lijun Zhang, Yanjin Zhang, Xia Chen, Ting Gu, Jidong Cai, Lifeng Yao, Lihua Yan
Conditional survival (CS) considers the time already survived after surgery and may provide additional survival information. We sought to construct and validate novel conditional survival nomograms for the prediction of conditional overall survival (OS) and cancer specific survival (CSS) of colorectal signet ring cell carcinoma (SRCC) patients. Patients diagnosed with stage I-III SRCC between 2010 and 2019 were identified from the Surveillance, Epidemiology, and End Results database. The formula calculating CS was: CS(x|y) = S(x+y)/S(x), where S(x) represents the survival at x years. CS nomograms were then constructed to predict the 5-year conditional OS and CSS, followed by internal validation. A total of 944 colorectal SRCC patients were finally identified in this study. The 5-year OS and CSS improved gradually with additional survival time. Univariate and multivariate Cox regression analysis conducted in training set revealed that age, race, T stage, LNR, and perineural invasion were independent risk factors for both OS and CSS. Two nomograms with considerable predictive ability were successfully constructed (AUC for OS: 0.788; AUC for CSS: 0.847) and validated (AUC for OS: 0.773; AUC for CSS: 0.799) for the prediction of 5-year OS and CSS, based on the duration of1-4 years post-surgery survival. The probability of achieving 5-year OS and 5-year CSS in colorectal SRCC patients improved gradually with additional time. Conditional nomograms considering survival time will be more reliable and informative for risk stratification and postoperative follow-up.
条件生存期(CS)考虑的是手术后已存活的时间,可提供额外的生存信息。我们试图构建并验证新型条件生存提名图,用于预测结直肠标志环细胞癌(SRCC)患者的条件总生存期(OS)和癌症特异性生存期(CSS)。 2010年至2019年期间诊断为I-III期SRCC的患者均来自监测、流行病学和最终结果数据库。CS的计算公式为CS(x|y) = S(x+y)/S(x),其中 S(x) 代表 x 年的生存率。然后构建CS提名图来预测5年条件OS和CSS,并进行内部验证。 本研究最终确定了 944 例结直肠 SRCC 患者。随着生存时间的延长,5年OS和CSS逐渐改善。在训练集中进行的单变量和多变量 Cox 回归分析显示,年龄、种族、T 期、LNR 和神经周围侵犯是 OS 和 CSS 的独立危险因素。根据术后1-4年的生存期,成功构建了两个具有相当预测能力的提名图(OS的AUC:0.788;CSS的AUC:0.847),并对其进行了验证(OS的AUC:0.773;CSS的AUC:0.799),用于预测5年OS和CSS。 结直肠 SRCC 患者获得 5 年 OS 和 5 年 CSS 的概率随着时间的延长而逐渐提高。考虑生存时间的条件提名图在风险分层和术后随访方面更可靠、更有参考价值。
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引用次数: 0
Can we improve therapeutic compliance in cancer patients? report of a cross-sectional case series study in Morocco 我们能否提高癌症患者的治疗依从性? 摩洛哥横断面病例系列研究报告
Pub Date : 2024-03-21 DOI: 10.1097/ms9.0000000000001869
Khadija Mokhtari, B. Hajji, Hanane El oualy, Hamid Madani
Therapeutic compliance (TC) refers to the compliance of a patient to the prescriptions and recommendations of a doctor. Patients with cancer often exhibit unsatisfactory TC. The objective of our study was to assess TC levels in cancer patients and identify predictors of poor compliance. We conducted a cross-sectional study in March 2023 at the oncology center, where the vast majority of medical activity is performed in the day hospital. TC was measured using a questionnaire or survey. Various parameters were analyzed to identify predictive factors of poor therapeutic compliance. Our study included 175 cancer patients with a mean age of 55 years. The study revealed that 85% exhibited good compliance (GC) as indicated by the confidence interval [8.500 ± 0.075], signifying patients who consistently adhered to their medication schedule. Conversely, 15% demonstrated poor compliance (PC), as indicated by the confidence interval [0.825 ± 0.750]. Compliance status was assessed by considering patients who adhered to the prescribed medication timing as good compliance (GC) and those who did not adhere as poor compliance (PC). The analysis of our study results indicated that poor therapeutic compliance was associated with low socioeconomic and educational levels. Therefore, it is important to utilize all available resources to improve therapeutic compliance. The majority of factors contributing to poor compliance can be mitigated through effective coordination between the patient and their support network.
治疗依从性(TC)是指患者对医生处方和建议的依从性。癌症患者的治疗依从性往往不尽人意。我们的研究旨在评估癌症患者的治疗依从性水平,并确定不良依从性的预测因素。我们于 2023 年 3 月在肿瘤中心进行了一项横断面研究,该中心的绝大多数医疗活动都是在日间医院进行的。采用问卷或调查的方式测量了依从性。对各种参数进行了分析,以确定治疗依从性差的预测因素。我们的研究包括 175 名癌症患者,平均年龄 55 岁。研究显示,85%的患者表现出良好的依从性(GC),置信区间为[8.500 ± 0.075],这表明患者始终坚持按时服药。相反,15% 的患者依从性较差 (PC),可信区间为 [0.825 ± 0.750]。评估依从性状况时,将遵守规定用药时间的患者视为依从性良好(GC),不遵守规定用药时间的患者视为依从性差(PC)。我们的研究结果分析表明,治疗依从性差与社会经济和教育水平低有关。因此,利用所有可用资源提高治疗依从性非常重要。导致依从性差的大多数因素都可以通过患者及其支持网络之间的有效协调来缓解。
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引用次数: 0
Ethics in scientific research: a lens into its importance, history, and future 科学研究伦理:透视其重要性、历史和未来
Pub Date : 2024-03-21 DOI: 10.1097/ms9.0000000000001959
G. D. Miteu
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引用次数: 0
Evaluation of the relationship between restless legs syndrome, mental status and sleep disorders among moroccan women during their third trimester of pregnancy 评估摩洛哥妊娠三个月妇女的不安腿综合征、精神状态和睡眠障碍之间的关系
Pub Date : 2024-03-21 DOI: 10.1097/ms9.0000000000001987
M. Guerroumi, A. Aquil, Ouassil El kherchi, Salma Ait bouighoulidne, Meryam Belhaj Haddou, A. Elgot
Restless legs syndrome (RLS) is a motor disorder encountered during pregnancy and leading to psychological and sleep impairments. The latter seems to be non-restorative and its occurrence alters the quality of life of pregnant woman. The objective of this study was to evaluate the prevalence of RLS and its relationship with both anxio-depressive symptoms and sleep disorders among a population of Moroccan pregnant women during their third trimester of pregnancy. A cross-sectional study was conducted in a population of pregnant women in their third trimester (n=178) admitted to two health facilities in the city of Marrakech: Youssef Ibn Tachafine and Oasis. The face-to-face questionnaire was used to collect data including, demographic and clinical characteristics, the four diagnostic criteria of RLS, the Pittsburgh Sleep Quality Index (PSQI) and the Hospital Anxiety and Depression Scale (HADS). Patients were divided into two groups RLS+ (women with restless legs syndrome) and RLS- (women without restless legs syndrome). The prevalence of RLS was 59.5%, this syndrome was more common in the ninth month (74.15%) compared with the seventh and eighth months. Sleep impairment including sleep efficiency was significantly higher in RLS+ more than RLS- (P-value 0.05). Anxiety but not depression is significantly increased in RLS+ compared to RLS- (48.11% versus 38.8%, P = 0.000). No significant differences between RLS+ and RLS- in terms of socio-demographic and other clinical characteristics. RLS is encountered during the prenatal period, with a higher prevalence in the last trimester. During this stage of pregnancy, women suffering from RLS were vulnerable to anxiety and sleep disorders. Prevention and early diagnosis of RLS syndrome could be a proactive healthcare management leading to ensure better health outcomes and better conditions of pregnancy which precedes childbirth.
不宁腿综合征(RLS)是一种在怀孕期间出现的运动障碍,会导致心理和睡眠障碍。后者似乎不能使人恢复精神,其发生会改变孕妇的生活质量。本研究的目的是评估摩洛哥孕妇在怀孕三个月期间的 RLS 患病率及其与焦虑抑郁症状和睡眠障碍的关系。 这项横断面研究的对象是马拉喀什市两家医疗机构收治的怀孕三个月的孕妇(178 人):Youssef Ibn Tachafine 和 Oasis。采用面对面问卷调查的方式收集数据,包括人口统计学和临床特征、RLS 的四项诊断标准、匹兹堡睡眠质量指数 (PSQI) 和医院焦虑抑郁量表 (HADS)。患者被分为 RLS+(患有不安腿综合征的女性)和 RLS-(没有不安腿综合征的女性)两组。 RLS的发病率为59.5%,与第7个月和第8个月相比,第9个月更常见(74.15%)。RLS+患者的睡眠障碍(包括睡眠效率)明显高于RLS-患者(P值为0.05)。与 RLS- 相比,RLS+ 患者的焦虑程度明显增加(48.11% 对 38.8%,P = 0.000),但抑郁程度并未增加。RLS+和RLS-在社会人口学和其他临床特征方面无明显差异。 RLS 在产前就会出现,在妊娠的最后三个月发病率较高。在这一怀孕阶段,患有 RLS 的妇女很容易出现焦虑和睡眠障碍。预防和早期诊断 RLS 综合征可作为一种积极的保健管理方法,从而确保更好的健康结果和分娩前更好的妊娠条件。
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引用次数: 0
A rare case of retained metallic foreign body in liver - case report and review of literature 肝内金属异物残留的罕见病例--病例报告和文献综述
Pub Date : 2024-03-21 DOI: 10.1097/ms9.0000000000001992
Santosh Dev, Manish Yadav, Newton Ashish Shah, Barsha Dev, Shishir Devkota, Laxman Khadka, Dhiraj Kumar Das, Samridhi Yadav, J. Sah, B. Ghimire
Foreign bodies in the liver are uncommon but can lead to severe conditions like liver abscess and sepsis. They typically enter through direct penetration, migration from the gastrointestinal tract, or through the blood. Common foreign objects include metal pins or sewing needles swallowed accidentally. A 25-year-old male presented to our OPD with pain over the right abdomen with a prior history of projectile injury causing laceration over the right anterior abdomen with primary suturing. On radiological investigation, a retained foreign body was revealed. The metallic foreign body was embedded in the liver for 5 months. Removal of the foreign body was performed without any complications. Intrahepatic foreign bodies (FBs) in the liver can result from penetrating injuries, iatrogenic causes, or ingestion, particularly in children. Clinical presentations vary, and complications such as abscess formation may occur. Diagnosis involves imaging modalities like X-rays, ultrasonography, and CT scans. The presented case highlights the importance of meticulous follow-up, as chronic pain manifested despite conservative management. The management of intrahepatic FBs depends on factors like size, location, and symptoms, with conservative approaches for stable patients. Surgical removal remains the mainstay of the treatment. Long-term monitoring is crucial to detect potential complications, and imaging studies play a key role in regular follow-up. Hepatic foreign bodies are rare, and symptoms vary based on size, type, and location, ranging from asymptomatic to complications such as abscess formation. Surgical removal is the main treatment, but in cases of noncomplicated hepatic foreign bodies, close follow up is necessary.
肝脏异物并不常见,但可导致肝脓肿和败血症等严重病症。异物通常通过直接穿透、从胃肠道移入或通过血液进入肝脏。常见的异物包括误吞的金属针或缝衣针。 一名 25 岁的男性因右腹部疼痛到我院手术室就诊,既往病史为弹射伤导致右前腹部撕裂并进行了初步缝合。放射检查发现异物残留。金属异物嵌入肝脏 5 个月。异物取出后未出现任何并发症。 肝内异物(FBs)可由穿透性损伤、先天性原因或摄入引起,尤其是在儿童中。临床表现各不相同,可能会出现脓肿形成等并发症。诊断需要借助 X 光、超声波和 CT 扫描等影像学手段。本病例强调了精心随访的重要性,因为尽管进行了保守治疗,但仍会出现慢性疼痛。肝内 FB 的治疗取决于其大小、位置和症状等因素,对于病情稳定的患者可采取保守治疗。手术切除仍是治疗的主要方法。长期监测对发现潜在并发症至关重要,影像学检查在定期随访中发挥着关键作用。 肝异物非常罕见,其症状因大小、类型和位置而异,从无症状到脓肿形成等并发症不等。手术切除是主要的治疗方法,但对于非并发症的肝异物,则需要密切随访。
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引用次数: 0
Empowering access: the US’ first over-the-counter birth control pill revolutionizes contraception 增强获得避孕药具的能力:美国首款非处方避孕药彻底改变了避孕方式
Pub Date : 2024-03-21 DOI: 10.1097/ms9.0000000000001986
Fatima Bint Sajid, Z. Mughal, Nabiha Syed, Abdul Maalik, Abdullah Mussarat, B. Rangwala, Syeda Mahrukh Fatima Zaidi, Hussain Sohail Rangwala, Mirha Ali, Asma Ahmed Farah
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引用次数: 0
Effect of needles distance of arteriovenous fistula cannulation on hemodialysis adequacy based on KT/V: a randomized controlled trial 基于 KT/V 的动静脉内瘘插管针距对血液透析充分性的影响:随机对照试验
Pub Date : 2024-03-21 DOI: 10.1097/ms9.0000000000001966
Samad Karkhah, Majid Pourshaikhian, Saman Maroufizadeh, Pooyan Ghorbani Vajargah, P. Aghajanzadeh, Joseph Osuji, M. Moghadamnia
This study aims to assess the effect of needle distance of arteriovenous fistula (AVF) cannulation on hemodialysis adequacy based on KT/V. This study was a parallel-group, randomized controlled trial. Patients who met the inclusion criteria were divided into two groups with 3 and 6 cm needle distances using block randomization. Data acquisition transpired through a comprehensive checklist encompassing demographic variables such as age and gender, alongside clinical metrics comprising actual weight, dry weight, average dialysis duration, fistula longevity, and KT/V rate. A total of 42 hemodialysis patients were enrolled in this investigation, with 21 allocated to the 3 cm needle distance group and another 21 to the 6 cm needle distance group. The mean post-hemodialysis KT/V values for the 3 cm and 6 cm needle distance groups were 1.25 (SD=0.25) and 1.42 (SD=0.24), respectively, demonstrating a statistically significant difference (P<0.001). While there was no significant difference in the average pre- and post-hemodialysis KT/V values within the 3 cm needle distance group (t=1.93, P=0.068), the corresponding values for the 6 cm needle distance group exhibited a notable discrepancy (t=9.66, P<0.001). In general, a needle distance of 6 cm between arteriovenous points yielded superior enhancements in dialysis adequacy compared to a 3 cm needle distance following hemodialysis. Consequently, health administrators and policymakers may consider instituting efficacious interventions to scrutinize the care and therapeutic protocols for hemodialysis patients, involving the development of policies and applications.
本研究旨在根据 KT/V 评估动静脉内瘘插管针距对血液透析充分性的影响。 本研究是一项平行分组随机对照试验。符合纳入标准的患者被随机分为两组,针距分别为 3 厘米和 6 厘米。数据采集采用全面的核对表,包括年龄和性别等人口统计学变量,以及实际体重、干重、平均透析时间、瘘管寿命和 KT/V 率等临床指标。 共有 42 名血液透析患者参与了此次调查,其中 21 人被分配到针距为 3 厘米组,另外 21 人被分配到针距为 6 厘米组。3 厘米针距组和 6 厘米针距组血液透析后的 KT/V 平均值分别为 1.25(SD=0.25)和 1.42(SD=0.24),差异具有统计学意义(P<0.001)。虽然 3 厘米针距组的血液透析前和透析后 KT/V 平均值没有明显差异(t=1.93,P=0.068),但 6 厘米针距组的相应值却有明显差异(t=9.66,P<0.001)。 总体而言,与血液透析后 3 厘米的针距相比,动静脉点之间 6 厘米的针距能更好地提高透析充分性。因此,卫生管理者和政策制定者可以考虑采取有效的干预措施,对血液透析患者的护理和治疗方案进行仔细检查,包括制定政策和应用程序。
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引用次数: 0
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Annals of Medicine &amp; Surgery
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