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Life-Threatening Recurrence of Paroxysmal Cold Hemoglobinuria in a Child During Influenza A Infection. 一名儿童在感染甲型流感期间再次出现危及生命的阵发性冷性血红蛋白尿。
IF 1.3 Q3 PEDIATRICS Pub Date : 2024-07-01 DOI: 10.5152/TurkArchPediatr.2024.24067
İbrahim Cemal Maslak, Muhammed Burak Selver, Ömer Kaşkaya, Merve Bayrak Yıldırım, Ayşe Çiğdem Sivrice, Mahmut Keskin, Ebru Sagay, Ebru Yılmaz Keskin
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引用次数: 0
Revisiting Childhood-Onset Systemic Lupus Erythematosus. 重温童年发病的系统性红斑狼疮
IF 1.3 Q3 PEDIATRICS Pub Date : 2024-07-01 DOI: 10.5152/TurkArchPediatr.2024.24097
Pınar Özge Avar-Aydın, Hı Brunner

Childhood-onset systemic lupus erythematosus (cSLE) is a chronic autoimmune disease with a multisystemic involvement diagnosed during childhood. The disease is marked by the production of autoantibodies targeting self-antigens, often before symptoms emerge. The presentation, clinical course, and outcome vary significantly among patients with cSLE. The onset of cSLE can be at any age during childhood while a diagnosis of cSLE before the age of 5 years is rare and raises a suspicion of monogenic lupus. Childhood-onset systemic lupus erythematosus affects various organs and systems, most frequently presenting with mucocutaneous, musculoskeletal, renal, and neuropsychiatric manifestations. Multiple disease flares can be seen during the disease course. Childhood-onset systemic lupus erythematosus causes significant morbidity and mortality. Children and adolescents with cSLE show higher disease activity and damage, and more aggressive immunosuppressive treatments are needed compared to adultonset SLE. Early diagnosis can be difficult due to the insidious onset with nonspecific symptoms. Disease activity and damage measures aim to ensure an accurate evaluation of disease status. A multidisciplinary approach and individualized disease management are important. Disease management is complex including the control of disease activity, the reduction of flares and damage, and a limitation of drug toxicity while improving the health-related quality of life in patients with cSLE.

儿童期发病的系统性红斑狼疮(cSLE)是一种慢性自身免疫性疾病,可累及多个系统,在儿童期即可确诊。该病的特征是产生针对自身抗原的自身抗体,通常在症状出现之前就已产生。不同的系统性红斑狼疮患者的表现、临床病程和预后有很大差异。系统性红斑狼疮可以在儿童期的任何年龄发病,而在5岁之前确诊为系统性红斑狼疮的情况非常罕见,这就需要怀疑是单基因狼疮。儿童期发病的系统性红斑狼疮会影响多个器官和系统,最常见的表现是皮肤黏膜、肌肉骨骼、肾脏和神经精神症状。病程中会出现多次疾病复发。儿童期发病的系统性红斑狼疮会导致严重的发病率和死亡率。与成人发病的系统性红斑狼疮相比,儿童和青少年系统性红斑狼疮患者的疾病活动度和损害程度更高,需要更积极的免疫抑制治疗。由于起病隐匿,且症状无特异性,早期诊断可能比较困难。疾病活动性和损害测量的目的是确保准确评估疾病状态。多学科方法和个体化疾病管理非常重要。疾病管理是一项复杂的工作,包括控制疾病活动、减少复发和损害、限制药物毒性,同时提高系统性红斑狼疮患者与健康相关的生活质量。
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引用次数: 0
Factors Associated with Post-rewarming Procalcitonin Levels in Newborns with Hypoxic Ischemic Encephalopathy. 缺氧缺血性脑病新生儿退热后降钙素原水平的相关因素
IF 1.3 Q3 PEDIATRICS Pub Date : 2024-07-01 DOI: 10.5152/TurkArchPediatr.2024.24089
Aslı Okbay Güneş, Aydın Bozkaya, Mehmet Emin Avlanmış

To determine the factors associated with the procalcitonin levels in newborns with hypoxic-ischemic encephalopathy (HIE) who received therapeutic hypothermia (TH). The neonates, who had moderate/severe HIE and were treated with TH, were included. The neonates were arranged into 2 groups by procalcitonin (PCT) level after rewarming was completed. The neonates who had a procalcitonin level of < 2.5 ng/ml constituted Group 1 and the ones who had a procalcitonin level of ≥ 2.5 ng/ml constituted Group 2. Univariate and multivariate logistic regression was used to assess the factors related with PCT level. The first group included 123 (87.9%) neonates and the second group included 17 (12.1%) neonates. The median gestational age was 38 (36-39) weeks and the mean birth weight was 3081.7 ± 552.8 grams. In group 2, the rates for severe HIE, cesarean section, antibiotic switch, convulsion, inotrope use and mortality were higher, and duration of hospitalization was longer, whereas Apgar scores were lower (P < .05). The risk of a high procalcitonin level was found to be 6-fold (95% CI 1.9-19.1) higher in severe HIE and 5.2-fold higher (95% CI 1.7-16) in cesarean delivery. In neonates with HIE/TH, high post-rewarming procalcitonin levels were related with severe HIE and cesarean delivery. Some other clinical and laboratory findings, which may reflect worse clinical status, were also associated with high procalcitonin levels.

目的:确定与接受治疗性低温疗法(TH)的缺氧缺血性脑病(HIE)新生儿降钙素原水平相关的因素。研究对象包括接受治疗性低温的中度/重度缺氧缺血性脑病新生儿。新生儿在完成复温后按降钙素原(PCT)水平分为两组。采用单变量和多变量逻辑回归评估与 PCT 水平相关的因素。第一组包括 123 名(87.9%)新生儿,第二组包括 17 名(12.1%)新生儿。中位胎龄为 38(36-39)周,平均出生体重为 3081.7 ± 552.8 克。在第二组中,重度 HIE、剖宫产、抗生素转换、惊厥、肌注和死亡率较高,住院时间较长,而 Apgar 评分较低(P < .05)。研究发现,重度 HIE 患儿出现高降钙素原水平的风险比剖宫产患儿高 6 倍(95% CI 1.9-19.1),高 5.2 倍(95% CI 1.7-16)。在患有 HIE/TH 的新生儿中,升温后降钙素原水平高与重度 HIE 和剖宫产有关。其他一些可能反映临床状况恶化的临床和实验室结果也与降钙素原水平高有关。
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引用次数: 0
Comparison of Clinical Presentations and Disease Severity of Children Hospitalized with Influenza A and B. 甲型和乙型流感住院儿童临床表现和疾病严重程度的比较
IF 1.3 Q3 PEDIATRICS Pub Date : 2024-07-01 DOI: 10.5152/TurkArchPediatr.2024.23286
Aykut Ekşi, Gökçen Kartal Öztürk, Candan Çiçek, Figen Gülen, Esen Demir

This study compared the clinical presentations and disease severity between influenza A and B (FLUA and FLUB). The study included children hospitalized with virologically confirmed influenza between 2010 and 2020. The severity of the disease was evaluated based on admission to the pediatric intensive care unit (PICU), mechanical ventilation requirement, length of hospital stay, length of stay in the PICU, and death. Influenza viruses were compared within predefined age groups (0-2, 3-9, and 10-18 years) and in all age groups. Of 343 patients, FLUA and FLUB were detected in 75.8% and 24.2% of children, respectively. FLUB was associated with a higher incidence of headache and abdominal pain (P < .001 and P = .01). Children with FLUB were prescribed antibiotics and antivirals 0.56 and 0.58- fold fewer than those with FLUA. Headache and abdominal pain rates were higher in patients between 3 and 9 years with FLUB. Children between 0 and 2 years with FLUA were more frequently admitted to the PICU than those with FLUB (23.6% vs. 4.0%; P < .004). Eight patients with FLUA died, while only 1 with FLUB died (P = .69). The clinical presentation of FLUA and FLUB appeared similar, except for headache and abdominal pain, which were more prevalent in older patients with FLUB. Our study revealed that children between 0 and 2 years with FLUA were at a significantly higher risk for admission to the PICU. As a result, greater attention and awareness should be paid to children under 2 years old with FLUA.

这项研究比较了甲型流感和乙型流感(FLUA 和 FLUB)的临床表现和疾病严重程度。研究对象包括2010年至2020年期间因病毒学确诊流感而住院的儿童。根据儿童重症监护室(PICU)的入院情况、机械通气需求、住院时间、在重症监护室的住院时间和死亡情况来评估疾病的严重程度。对预定年龄组(0-2 岁、3-9 岁和 10-18 岁)和所有年龄组的流感病毒进行了比较。在 343 名患者中,分别有 75.8% 和 24.2% 的儿童检测到 FLUA 和 FLUB。FLUB与较高的头痛和腹痛发病率有关(P < .001 和 P = .01)。FLUB患儿的抗生素和抗病毒药物处方量分别是FLUA患儿的0.56倍和0.58倍。3至9岁的FLUB患者头痛和腹痛的发生率更高。与FLUB患者相比,0至2岁的FLUA患儿更常入住PICU(23.6%对4.0%;P < .004)。8名FLUA患者死亡,而只有1名FLUB患者死亡(P = .69)。FLUA和FLUB的临床表现相似,但头痛和腹痛在年龄较大的FLUB患者中更为常见。我们的研究表明,0 到 2 岁的 FLUA 患儿入住 PICU 的风险明显更高。因此,应更加关注和认识两岁以下的 FLUA 儿童。
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引用次数: 0
Through the Glass Ceiling: The Quest for Gender Equality in Academia. 穿越玻璃天花板:学术界对性别平等的追求》。
IF 1.3 Q3 PEDIATRICS Pub Date : 2024-07-01 DOI: 10.5152/TurkArchPediatr.2024.28624
Tanyel Zubarioğlu
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引用次数: 0
The Correlation of Fluid Creep with Fluid and Electrolyte Imbalance In Pediatric Intensive Care Unit Dr. Cipto Mangunkusumo National Central Public Hospital. 儿科重症监护室液体蠕变与体液和电解质失衡的相关性 Cipto Mangunkusumo 博士,国立中央公立医院。
IF 1.3 Q3 PEDIATRICS Pub Date : 2024-07-01 DOI: 10.5152/TurkArchPediatr.2024.23309
Irene Yuniar, Jojor Sihotang, Regina Suriadi, Devina June

Fluid creep, used as a drug diluent can contribute to fluid and electrolyte balance. Fluid creep brings substantial volume and electrolyte load to patients, especially in critically ill children. This study is conducted to evaluate the correlation of fluid creep with fluid and electrolyte balance in critically ill children. This cross-sectional study was conducted in a single tertiary center. We include children aged 1 month- 18 years in the pediatric intensive care unit (PICU). Exclusion criteria were patients receiving renal replacement therapy and plasmapheresis. Fluids and electrolyte intake were recorded at admission and the first 24 hours in the PICU. A total of 64 patients were observed. The sources of fluid intake are 61% from parenteral, 25% from enteral nutrition, and 12% from fluid creep. There were significant correlations between the volume (r = 0.304, P = .015) and electrolyte intake (r = 0.742, P = .035) of fluid creep with daily fluid balance. There is no correlation between fluid creep and electrolyte changes in 24 hours. Fifty-two patients used WFI (81.2%) as a drug diluent. Our study showed that fluid creep constitutes 12% of daily fluid intake. There is a correlation between the volume and electrolyte intake from fluid creep to daily fluid balance, so it is important to include the volume of fluid creep in calculating the fluid balance. Thus, it is recommended to use hypotonic fluid like WFI compared to NaCl 0.9% for drug diluent.

作为药物稀释剂使用的液体蠕变可促进体液和电解质平衡。液体蠕变会给患者带来巨大的容量和电解质负荷,尤其是重症儿童。本研究旨在评估液体蠕变与重症儿童体液和电解质平衡的相关性。这项横断面研究在一家三级医疗中心进行。研究对象包括儿科重症监护室(PICU)中 1 个月至 18 岁的儿童。排除标准是正在接受肾脏替代疗法和血浆置换术的患者。记录了入院时和在 PICU 的头 24 小时的液体和电解质摄入量。共观察了 64 名患者。液体摄入量的61%来自肠外营养,25%来自肠内营养,12%来自液体蠕动。液体爬行的体积(r = 0.304,P = .015)和电解质摄入量(r = 0.742,P = .035)与每日液体平衡之间存在明显的相关性。液体爬行与 24 小时内的电解质变化之间没有相关性。52 名患者使用 WFI(81.2%)作为药物稀释剂。我们的研究表明,液体蠕变占每日液体摄入量的 12%。液体蠕变的体积和电解质摄入量与每日液体平衡之间存在相关性,因此在计算液体平衡时必须包括液体蠕变的体积。因此,与 0.9% 氯化钠相比,建议使用 WFI 等低渗液体作为药物稀释剂。
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引用次数: 0
Comparison of Real-time Polymerase Chain Reaction and Culture for Targeting Pathogens in Pediatric Severe Community-Acquired Pneumonia. 比较实时聚合酶链式反应和培养法,以确定小儿严重社区获得性肺炎的病原体。
IF 1.3 Q3 PEDIATRICS Pub Date : 2024-07-01 DOI: 10.5152/TurkArchPediatr.2024.24005
Khai Quang Tran, Van Hung Pham, Chau Minh Vo, Quan Minh Pham, Phuong Minh Nguyen

Objective: This study aims to determine the frequency of pathogen detection by real-time polymerase chain reaction (PCR), the frequency of pathogen isolation by culture; and compare the value of real-time PCR and culture of nasopharyngeal aspiration samples in patients with severe community-acquired pneumonia (sCAP).

Materials and methods: It was a prospective and descriptive study. All pediatric patients diagnosed with sCAP were performed real-time PCR and culture of nasopharyngeal aspiration samples.

Results: A total of 336 patient samples were obtained from children with sCAP. Real-time PCR detected pathogens in 312 patients (92.9%), while culture isolated bacteria in 228 patients (67.9%). Coinfections were reported in 279 cases (83.0%) through real-time PCR. The frequency of agreement between culture and real-time PCR was quite high (P < .001).

Conclusion: Real-time PCR demonstrated more ability for detecting microorganisms than culture. This finding highlighted the value of real-time PCR for targeting pathogens in children with sCAP, particularly in cases involving complex pathogens or those requiring timely identification.

研究目的本研究旨在确定通过实时聚合酶链反应(PCR)检测病原体的频率、通过培养分离病原体的频率;并比较重症社区获得性肺炎(sCAP)患者鼻咽吸痰样本的实时PCR和培养的价值:这是一项前瞻性和描述性研究。对所有确诊为社区获得性肺炎(sCAP)的儿科患者的鼻咽抽吸样本进行实时 PCR 检测和培养:结果:共获得 336 份患儿样本。实时 PCR 检测出 312 名患者(92.9%)的病原体,而培养分离出 228 名患者(67.9%)的细菌。通过实时 PCR 检测,有 279 例(83.0%)患者合并感染。培养与实时 PCR 的一致率相当高(P < .001):结论:与培养相比,实时 PCR 显示出更强的微生物检测能力。这一发现凸显了实时 PCR 在确定 sCAP 患儿病原体方面的价值,尤其是在涉及复杂病原体或需要及时鉴定的病例中。
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引用次数: 0
Serious Medical and Psychosocial Complications in Pregnant and Postpartum Adolescents at a Pediatric Emergency Department. 儿科急诊室中怀孕和产后青少年的严重医疗和心理并发症。
IF 1.3 Q3 PEDIATRICS Pub Date : 2024-07-01 DOI: 10.5152/TurkArchPediatr.2024.24072
Leman Akcan Yıldız, Halise Akça, Funda Kurt, Ayla Akça Çağlar

This study aimed to describe the clinical characteristics and serious medical and psychosocial complications of pregnant and postpartum adolescent patients at a pediatric emergency department (PED). Demographic and clinical data of all pregnant and postpartum adolescents who presented to the PED of a single tertiary referral hospital between January 2020 and January 2023 were collected and documented retrospectively. Twenty-seven patients with a mean age of 16.7 ± 0.8 years were included in the study. The main presenting complaints were abdominal pain (n = 9), suspicion of pregnancy (n = 5), cough, seizure, and vomiting (3 patients each). Potentially life-threatening medical complications included stroke (n = 3), placental abruption (n = 1), and carbon monoxide intoxication (n = 1). Sexual assault (n = 4), physical assault (n = 2), recurrent pregnancies (n = 5), and suicide attempts (n = 4) were serious psychological and social complications in our patient group. Pregnant and post-partum adolescents may present to PED with serious lifethreatening complications, and permanent sequelae may occur. In addition to sexual and physical violence, various psychological problems are comorbid conditions. These patients should be managed with a multidisciplinary biopsychosocial approach, and these issues considered in their acute treatment and follow-up at emergency departments.

本研究旨在描述一家儿科急诊科(PED)的怀孕和产后青少年患者的临床特征以及严重的医疗和心理并发症。研究收集并回顾性记录了2020年1月至2023年1月期间在一家三级转诊医院儿科急诊科就诊的所有怀孕和产后青少年的人口统计学和临床数据。研究共纳入 27 名患者,平均年龄(16.7±0.8)岁。主要主诉为腹痛(9 例)、怀疑怀孕(5 例)、咳嗽、抽搐和呕吐(各 3 例)。可能危及生命的医疗并发症包括中风(3 例)、胎盘早剥(1 例)和一氧化碳中毒(1 例)。性侵犯(4 例)、人身攻击(2 例)、反复妊娠(5 例)和自杀未遂(4 例)是本组患者严重的心理和社会并发症。怀孕和产后的青少年到 PED 就诊时可能会出现严重的危及生命的并发症,并可能出现永久性后遗症。除了性暴力和身体暴力,各种心理问题也是并发症。这些患者应采用多学科生物-心理-社会方法进行管理,并在急诊科的急性治疗和随访中考虑这些问题。
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引用次数: 0
Extracorporeal Membrane Oxygenation after Pediatric Cardiac Surgery: A Single-Center Experience. 小儿心脏手术后的体外膜氧合:单中心经验
IF 1.3 Q3 PEDIATRICS Pub Date : 2024-07-01 DOI: 10.5152/TurkArchPediatr.2024.23291
Edin Botan, Ayşe Durak Aslan, Emrah Gün, Merve Havan, Nur Dikmen, Anar Gurbanov, Burak Balaban, Fevzi Kahveci, Hasan Özen, Hacer Uçmak, Özlem Selvi Can, Selen Karagözlü, Mehmet Cahit Sarıcaoğlu, Zeynep Eyileten, Tayfun Uçar, Ercan Tutar, Ahmet Rüçhan Akar, Mustafa Adnan Uysalel, Tanıl Kendirli

Extracorporeal membrane oxygenation (ECMO) is a life-saving treatment option providing cardiopulmonary support when standard therapies prove insufficient for reversible diseases. The mean objective of this study was to evaluate our center's experience with ECMO following pediatric cardiac surgery. This retrospective study was conducted in our pediatric intensive care unit (PICU) between November 2014 and March 2021 and included patients who received ECMO following cardiac surgery. Over the 7-year period, 324 patients underwent cardiac surgery, of which 24 (7.4%) required ECMO support. Among them, 13 (54.2%) were female, with a median age of 16.0 (2.0- 208) months and a median weight of 7.0 (3.5-70) kg. The mean vasoactive inotrope score (VIS) was 53.9 ± 44.5. Atrioventricular septal defect repair was the most common surgical procedure (n = 8/24, 41.6%). The primary indication for ECMO was low cardiac output syndrome (LCOS) in 14 (58.3%) patients. The median duration of ECMO support was 6.0 (1.0-46.0) days. Nonsurvivors had significantly higher Pediatric Risk Score of Mortality (PRISM) III scores (P = .014) and VIS scores during the pre-ECMO period (P = .004). Early or late neurological complications developed in 12 (50%) patients, with significant differences in lactate levels and pH levels preECMO between those with and without neurological complications (P = .01, P = .02, respectively). We successfully decannulated 16 (66.6%) patients, with a final survival rate of 12 (50%). ECMO plays a crucial role in providing pre- and post-cardiac surgery support for children. LCOS remains the main indication, and high PRISM III and VIS scores are valuable predictors of outcomes.

体外膜肺氧合(ECMO)是一种挽救生命的治疗方法,可在标准疗法不足以治疗可逆性疾病时提供心肺支持。本研究的主要目的是评估本中心在小儿心脏手术后使用 ECMO 的经验。这项回顾性研究于 2014 年 11 月至 2021 年 3 月期间在我们的儿科重症监护病房(PICU)进行,包括心脏手术后接受 ECMO 的患者。在这 7 年间,共有 324 名患者接受了心脏手术,其中 24 人(7.4%)需要 ECMO 支持。其中 13 人(54.2%)为女性,中位年龄为 16.0(2.0- 208)个月,中位体重为 7.0(3.5-70)公斤。血管活性肌力素评分(VIS)的平均值为(53.9 ± 44.5)分。房室间隔缺损修补术是最常见的手术方法(n = 8/24,41.6%)。14 名患者(58.3%)的 ECMO 主要适应症是低心排量综合征(LCOS)。ECMO 支持的中位持续时间为 6.0 (1.0-46.0) 天。非存活患者的儿科死亡率风险评分(PRISM)III 评分(P = .014)和 ECMO 前的 VIS 评分(P = .004)明显更高。12名患者(50%)出现了早期或晚期神经系统并发症,出现和未出现神经系统并发症的患者在ECMO前的乳酸水平和pH水平存在显著差异(分别为P = .01和P = .02)。我们成功为 16 例(66.6%)患者解除了封管,最终存活率为 12 例(50%)。ECMO 在为儿童提供心脏手术前后支持方面发挥着至关重要的作用。LCOS 仍是主要适应症,PRISM III 和 VIS 高分是预测预后的重要指标。
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引用次数: 0
Associated Congenital Abnormalities and Physical Phenotype in Patients with Diamond-Blackfan Anemia May Be Overlooked. 菱形-黑范氏贫血症患者的相关先天畸形和身体表型可能会被忽视。
IF 1.3 Q3 PEDIATRICS Pub Date : 2024-06-17 DOI: 10.5152/TurkArchPediatr.2024.23193
Gulare Soltanova, Niham Avcu Oral, Fatma Gümrük, Pelin Özlem Şimşek Kiper, Şule Ünal

Diamond-Blackfan anemia (DBA) is a rare and inherited form of erythroid aplasia, characterized by severe macrocytic anemia, congenital malformations, and predisposition to cancer. The purpose of this study is to determine the congenital abnormalities and dysmorphological features of DBA patients in a cross-sectional manner. The study group included patients who had diagnosis of DBA between 1983 and 2017. Dysmorphological examinations of the patients were performed by an experienced dysmorphologist and also echocardiography and abdominal ultrasonography were performed in order to figure out cardiac and urogenital abnormalities. A total of 45 patients were examined in this study. Dysmorphological examination, echocardiography, and abdominal ultrasonography revealed the rate of congenital abnormalities as high as 88.7%. In consideration of the congenital abnormalities, the most common findings were craniofacial, followed by skeletal abnormalities. The rate of anomalies was found higher in our series of patients than that have been previously reported, most probably due to the evaluations being performed by a dysmorphologist in our cohort and not only depending on patient records or hematologists' physical examination.

菱形-贝克范贫血症(DBA)是一种罕见的遗传性红细胞再生障碍,以严重的巨幼红细胞性贫血、先天畸形和易患癌症为特征。本研究的目的是以横断面方式确定 DBA 患者的先天性异常和畸形特征。研究对象包括1983年至2017年间确诊为DBA的患者。由经验丰富的畸形学家对患者进行畸形检查,同时进行超声心动图和腹部超声波检查,以确定心脏和泌尿生殖系统的异常。本研究共对 45 名患者进行了检查。畸形检查、超声心动图和腹部超声波检查显示,先天性畸形率高达 88.7%。在先天性畸形中,最常见的是颅面畸形,其次是骨骼畸形。在我们的系列患者中,畸形率高于之前的报道,这很可能是因为在我们的队列中,由畸形学家进行评估,而不仅仅依赖于患者记录或血液学专家的体格检查。
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引用次数: 0
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Turkish archives of pediatrics
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