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Unlocking the Potential of Three-Dimensional Echocardiography for Diagnosing Pulmonary Valve Diseases. 释放三维超声心动图诊断肺动脉瓣膜疾病的潜力。
IF 1.9 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-02 DOI: 10.4274/balkanmedj.galenos.2024.2024-5-125
Tuğba Kemaloğlu Öz, Luigi P Badano
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引用次数: 0
In response to "Constrictive Pericarditis Associated with COVID-19 or Vaccination". 针对“与COVID-19或疫苗接种相关的缩窄性心包炎”。
IF 1.9 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-02 DOI: 10.4274/balkanmedj.galenos.2024.2024-9-3.response
Çağlar Kaya, Kenan Yalta
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引用次数: 0
Artificial Intelligence in Pediatric Nail Diseases: Limitations and Prospects. 人工智能在小儿指甲疾病中的应用:局限性与前景。
IF 1.9 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-02 DOI: 10.4274/balkanmedj.galenos.2024.2024-8-122
Gianluca Mondillo, Vittoria Frattolillo, Simone Colosimo, Alessandra Perrotta
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引用次数: 0
Association Between Platelet-Albumin-Bilirubin Grade and the 30-Day Mortality in Patients with Acute Respiratory Distress Syndrome: Evidence from the MIMIC-IV Database. 血小板-白蛋白-胆红素等级与急性呼吸窘迫综合征患者30天死亡率之间的关系:来自MIMIC-IV数据库的证据
IF 1.9 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-02 DOI: 10.4274/balkanmedj.galenos.2024.2024-8-7
Dandan Ye, Wei Jiang, Deming Gu

Background: The platelet-albumin-bilirubin (PALBI) grade is a comprehensive assessment index of liver function. Liver dysfunction is a key determinant of the pathogenesis and resolution of acute respiratory distress syndrome (ARDS), which affects the prognosis of patients.

Aims: To evaluate the association of PALBI grade with the risk of 30-day mortality in patients with ARDS.

Study design: Retrospective cohort study.

Methods: Univariate and multivariate Cox proportional hazards models were used to evaluate the association between PALBI grade and the 30-day mortality in patients with ARDS; results were described as hazard ratios (HRs) and 95% confidence intervals (CIs). This association was further assessed by subgroup analyses stratified based on age, sex, and complications.

Results: A total of 2,841 patients with ARDS were included, of whom, 703 (24.74%) died within 30 days. After adjusting all covariates, a higher PALBI grade was associated with higher odds of 30-day mortality (HR: 1.55, 95% CI: 1.05-2.29). High PALBI grade was related to higher odds of 30-day mortality in patients with ARDS aged ≥ 65 years (HR: 2.30, 95% CI: 1.06-5.01), males (HR: 2.10, 95% CI: 1.29-3.44), without sepsis (HR: 1.71, 95% CI: 1.11-2.64), without pneumonia (HR: 1.86, 95% CI: 1.19-2.91), and without any history of chronic obstructive pulmonary disease (HR: 1.93, 95% CI: 1.28-2.91).

Conclusion: The PALBI grade was positively associated with 30-day mortality in patients with ARDS. The present study provides a reference for risk stratification management of patients with ARDS to improve short-term prognosis.

背景:血小板-白蛋白-胆红素(PALBI)分级是肝功能的综合评价指标。肝功能障碍是急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)发病和消退的关键决定因素,影响患者预后。目的:评价PALBI分级与ARDS患者30天死亡风险的关系。研究设计:回顾性队列研究。方法:采用单因素和多因素Cox比例风险模型评价PALBI分级与ARDS患者30天死亡率的关系;结果用风险比(hr)和95%置信区间(ci)来描述。这种关联通过基于年龄、性别和并发症分层的亚组分析进一步评估。结果:共纳入2841例ARDS患者,其中30d内死亡703例(24.74%)。在调整所有协变量后,较高的PALBI分级与较高的30天死亡率相关(HR: 1.55, 95% CI: 1.05-2.29)。高PALBI分级与年龄≥65岁的ARDS患者(HR: 2.30, 95% CI: 1.06-5.01)、男性(HR: 2.10, 95% CI: 1.29-3.44)、无脓毒症(HR: 1.71, 95% CI: 1.11-2.64)、无肺炎(HR: 1.86, 95% CI: 1.19-2.91)、无任何慢性阻塞性肺疾病史(HR: 1.93, 95% CI: 1.28-2.91)的30天死亡率较高相关。结论:PALBI分级与ARDS患者30天死亡率呈正相关。本研究为ARDS患者进行风险分层管理以改善近期预后提供参考。
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引用次数: 0
Transdermal Drug Delivery: An Overview of the Evolving Field. 经皮给药:不断发展的领域综述。
IF 1.9 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-02 DOI: 10.4274/balkanmedj.galenos.2024.2024-111224
Gözde Aktürk, Özgür Gündüz
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引用次数: 0
Trachelectomy After Supracervical Hysterectomy 宫颈上位子宫切除术后的气管切开术:七年单中心经验
IF 1.9 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-02 Epub Date: 2024-09-09 DOI: 10.4274/balkanmedj.galenos.2024.2024-6-30
Tihomir Pankov Totev, Georgi Danielov Prandzhev, Slavcho Tomov Tomov, Nadezhda Hristova Hinkova, Grigor Angelov Gortchev
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引用次数: 0
Autoinflammatory Bone Diseases. 自身炎症性骨病。
IF 1.9 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-02 DOI: 10.4274/balkanmedj.galenos.2024.2024-11-129
Fatih Haşlak, Nergis Akay, Ümit Gül, Aybüke Günalp, Elif Kılıç Könte, Sezgin Şahin, Özgür Kasapçopur

Autoinflammatory bone diseases (AIBDs) constitute a recently identified subset of autoinflammatory diseases. These conditions are characterized by an exaggerated inflammatory response in the bones without any apparent etiology. Inflammatory bone lesions associated with AIBDs exhibit chronic inflammation, are typically culture-negative, and do not exhibit discernible microorganisms on histopathological examination. The most common and representative AIBD is chronic non-bacterial osteomyelitis (CNO), which is also known as chronic recurrent multifocal osteomyelitis. Another variant of CNO, which is typically observed in older teenagers or adults, is known as synovitis, acne, hyperostosis, pustulosis, osteitis syndrome. This condition is distinguished by its notable skin manifestations. Advancements in genetic research have led to the identification of three novel monogenic subtypes within the category of AIBDs. These include Majeed syndrome, pyogenic arthritis, pyoderma gangrenosum, and acne syndrome, and interleukin-1 receptor antagonist deficiency syndrome. Another monogenic AIBD, called cherubism, affects only the maxilla and mandible. Data on the diagnosis and treatment of these rare diseases are extremely limited. However, if not diagnosed and treated promptly, it can result in significant complications, including severe disability and mortality. Thus, it is imperative to maintain a high level of clinical awareness of these diseases. These rare diagnoses should be considered in patients with musculoskeletal complaints in whom no specific etiology can be identified or in patients with systemic manifestations such as cutaneous and gastrointestinal symptoms or fever. In such patients, the diagnostic process, which encompasses imaging and genetic studies, should be initiated promptly.

自身炎症性骨病(aibd)是最近发现的一种自身炎症性疾病。这些疾病的特点是骨骼的炎症反应过度,没有任何明显的病因。与aibd相关的炎性骨病变表现为慢性炎症,典型的培养阴性,在组织病理学检查中不表现出可识别的微生物。最常见和最具代表性的AIBD是慢性非细菌性骨髓炎(CNO),也称为慢性复发性多灶性骨髓炎。CNO的另一种变体,通常在年龄较大的青少年或成年人中观察到,被称为滑膜炎,痤疮,骨质增生,脓疱病,骨炎综合征。这种病的特点是其明显的皮肤表现。遗传研究的进步已经导致aibd类别中三个新的单基因亚型的鉴定。这些包括马吉德综合征、化脓性关节炎、坏疽性脓皮病和痤疮综合征,以及白细胞介素-1受体拮抗剂缺乏综合征。另一种单基因AIBD称为小天使病,只影响上颌骨和下颌骨。关于这些罕见疾病的诊断和治疗的数据极为有限。然而,如果不及时诊断和治疗,它可能导致严重的并发症,包括严重残疾和死亡。因此,必须保持对这些疾病的高度临床认识。这些罕见的诊断应在没有明确病因的肌肉骨骼疾病患者或有全身表现(如皮肤和胃肠道症状或发烧)的患者中予以考虑。对于这类患者,应立即开始包括影像学和遗传学研究在内的诊断过程。
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引用次数: 0
Constrictive Pericarditis Associated with COVID-19 or Vaccination. 与COVID-19或疫苗接种相关的缩窄性心包炎。
IF 1.9 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-02 DOI: 10.4274/balkanmedj.galenos.2024.2024-9-3
Vitorino Modesto Dos Santos, Andressa Plaça Tedeschi, Laura Campos Modesto, Julia Campos Modesto
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引用次数: 0
How Uremic Toxins Alter Atorvastatin Disposition: Molecular Mechanisms of Inhibition of the Enzyme CYP3A4. 尿毒症毒素如何改变阿托伐他汀处置:抑制CYP3A4酶的分子机制。
IF 1.9 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-02 DOI: 10.4274/balkanmedj.galenos.2024.2024-9-12
Ashna Asim, Fen Wang, Dong Pu, Sisi Wang, Dian Wang, Wenwen Li, Feng Yu, Li Ji

Background: In uremic patients, the accumulation of gut-derived protein-bound uremic toxins (PBUTs) induces changes in the microenvironment of the patients, leading to changes in the elimination pattern of drugs.

Aims: To assess ways in which PBUTs alter the CYP450 enzymes in hepatocytes as well as the possible effects of specific PBUTs on the metabolism and excretion of atorvastatin (ATV).

Study design: An experimental study.

Methods: The experimental group was treated with long-term MHD for > 3 months, estimated-glomerular filtration rate (e-GFR) < 15 ml/min, normal Alb level (35.0-55.0 g/l), and no urine; the control group was not treated with hemodialysis, e-GFR < 60 ml/min, normal Alb level, and normal urinary excretion function. A suitable UPLC-MS/MS method was developed for detecting the concentration of 4-hydroxy ATV. Fresh primary hepatocytes were isolated from rats, and the uptake of ATV was tested in the uremic serum (US) group, IS group, and HA group and compared with that in the normal serum group. The metabolic status of ATV in the US group, IS group, and HA group was compared with that in the ATV group. RLM were extracted, and the metabolic experiment of ATV was performed in a human CYP3A4 model. The influence of UTs on pregnane X receptor (PXR)/nuclear factor kappa B (NF-κB) mRNA and the protein expression was also detected.

Results: IS and HA inhibited the ATV metabolism to varying degrees, wherein IS was the most potent inhibitor, producing > 50% inhibition. Meanwhile, the protein expression of CYP3A4 was downregulated after incubation with US, IS, and HA (p < 0.01). The excretion of ATV was also inhibited by 59.24% and 71.95% after incubation with IS and HA, respectively. The effects of uremic toxins on PXR/NF-κB mRNA and protein expression elucidated that PBUTs can inhibit ATV uptake and metabolism by exerting inhibitory effects on CYP3A4 through the PXR/NF-κB signaling pathway.

Conclusion: ATV metabolism could be significantly altered in the presence of uremic toxins, suggesting a downregulated effect on the ATV uptake, possibly through Oatp1b1, and also on the activity of CYP3A4 through the PXR/NF-κB signaling pathway.

背景:在尿毒症患者中,肠道源性蛋白结合尿毒症毒素(PBUTs)的积累会引起患者微环境的变化,从而导致药物消除模式的改变。目的:评估PBUTs改变肝细胞CYP450酶的途径,以及特异性PBUTs对阿托伐他汀(ATV)代谢和排泄的可能影响。研究设计:实验研究。方法:实验组患者长期MHD治疗> ~ 3个月,估计肾小球滤过率(e-GFR) < 15 ml/min,白蛋白水平正常(35.0 ~ 55.0 g/l),无尿;对照组不进行血液透析,e-GFR < 60 ml/min,白蛋白水平正常,尿排泄功能正常。建立了一种适用于4-羟基ATV浓度检测的UPLC-MS/MS方法。从大鼠身上分离新鲜原代肝细胞,检测尿毒症血清(US)组、IS组和HA组对ATV的摄取,并与正常血清组进行比较。比较US组、IS组和HA组与ATV组的ATV代谢状况。提取RLM,在人CYP3A4模型中进行ATV代谢实验。检测UTs对妊娠X受体(PXR)/核因子κB (NF-κB) mRNA及蛋白表达的影响。结果:IS和HA对ATV代谢均有不同程度的抑制作用,其中IS的抑制作用最强,抑制bbb50 %。与US、IS和HA孵育后,CYP3A4蛋白表达下调(p < 0.01)。与IS和HA孵育后,ATV的排泄也分别受到59.24%和71.95%的抑制。尿毒症毒素对PXR/NF-κB mRNA和蛋白表达的影响说明PBUTs通过PXR/NF-κB信号通路对CYP3A4产生抑制作用,从而抑制ATV的摄取和代谢。结论:尿毒症毒素存在可显著改变ATV代谢,提示ATV摄取可能通过Oatp1b1下调,同时通过PXR/NF-κB信号通路下调CYP3A4活性。
{"title":"How Uremic Toxins Alter Atorvastatin Disposition: Molecular Mechanisms of Inhibition of the Enzyme CYP3A4.","authors":"Ashna Asim, Fen Wang, Dong Pu, Sisi Wang, Dian Wang, Wenwen Li, Feng Yu, Li Ji","doi":"10.4274/balkanmedj.galenos.2024.2024-9-12","DOIUrl":"10.4274/balkanmedj.galenos.2024.2024-9-12","url":null,"abstract":"<p><strong>Background: </strong>In uremic patients, the accumulation of gut-derived protein-bound uremic toxins (PBUTs) induces changes in the microenvironment of the patients, leading to changes in the elimination pattern of drugs.</p><p><strong>Aims: </strong>To assess ways in which PBUTs alter the CYP450 enzymes in hepatocytes as well as the possible effects of specific PBUTs on the metabolism and excretion of atorvastatin (ATV).</p><p><strong>Study design: </strong>An experimental study.</p><p><strong>Methods: </strong>The experimental group was treated with long-term MHD for > 3 months, estimated-glomerular filtration rate (e-GFR) < 15 ml/min, normal Alb level (35.0-55.0 g/l), and no urine; the control group was not treated with hemodialysis, e-GFR < 60 ml/min, normal Alb level, and normal urinary excretion function. A suitable UPLC-MS/MS method was developed for detecting the concentration of 4-hydroxy ATV. Fresh primary hepatocytes were isolated from rats, and the uptake of ATV was tested in the uremic serum (US) group, IS group, and HA group and compared with that in the normal serum group. The metabolic status of ATV in the US group, IS group, and HA group was compared with that in the ATV group. RLM were extracted, and the metabolic experiment of ATV was performed in a human CYP3A4 model. The influence of UTs on pregnane X receptor (PXR)/nuclear factor kappa B (NF-κB) mRNA and the protein expression was also detected.</p><p><strong>Results: </strong>IS and HA inhibited the ATV metabolism to varying degrees, wherein IS was the most potent inhibitor, producing > 50% inhibition. Meanwhile, the protein expression of CYP3A4 was downregulated after incubation with US, IS, and HA (<i>p</i> < 0.01). The excretion of ATV was also inhibited by 59.24% and 71.95% after incubation with IS and HA, respectively. The effects of uremic toxins on PXR/NF-κB mRNA and protein expression elucidated that PBUTs can inhibit ATV uptake and metabolism by exerting inhibitory effects on CYP3A4 through the PXR/NF-κB signaling pathway.</p><p><strong>Conclusion: </strong>ATV metabolism could be significantly altered in the presence of uremic toxins, suggesting a downregulated effect on the ATV uptake, possibly through Oatp1b1, and also on the activity of CYP3A4 through the PXR/NF-κB signaling pathway.</p>","PeriodicalId":8690,"journal":{"name":"Balkan Medical Journal","volume":"42 1","pages":"37-44"},"PeriodicalIF":1.9,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11725675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Efficacy and Safety of a Combination of Enteral and Parenteral Nutrition Support in the Postoperative Period for Patients with Gastrointestinal Cancer: A Systematic Review and Meta-Analysis. 胃肠道肿瘤患者术后联合肠内和肠外营养支持的有效性和安全性:一项系统综述和荟萃分析
IF 1.9 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-02 DOI: 10.4274/balkanmedj.galenos.2024.2024-10-65
Meixiang Cai, Bo Yang, Yaping Zheng, Lei Ding

Background: Postoperative nutritional support in gastrointestinal cancer, including enteral nutrition (EN), parenteral nutrition (PN), and combined nutrition strategies, is vital for enhancing recovery and patient outcomes.

Aims: We aimed to comprehensively evaluate the impact of postoperative EN, PN, and EN + PN in patients with gastrointestinal cancer.

Methods: PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wan Fang, and VIP were searched from conception until January 2, 2024. Randomized controlled trials (RCTs) that compared different postoperative nutritional support (EN, PN, or EN + PN) in patients with gastrointestinal cancer were included. The Cochrane Risk of Bias Assessment tool was used to assess the quality of the RCTs. Fixed- and random-effects models were chosen according to the heterogeneity of variables for the synthesis of results. Continuous and categorical variables were analyzed using the weighted mean difference or relative risk (RR) and 95% confidence interval (CI).

Results: In this meta-analysis, 11 RCTs were included. The PN + EN group exhibited significantly improved postoperative recovery, nutritional function, and immune indicators than the PN and EN groups (p < 0.05). Additionally, a higher incidence of postoperative complications such as abdominal distension (RR: 2.53; 95% CI: 1.17-5.49), nausea/vomiting (RR: 2.01; 95% CI: 1.09-3.71), and diarrhea (RR: 3.17; 95% CI: 1.41-7.10) was observed in the EN group than in the PN + EN group.

Conclusion: Combining supplemental PN with enteral support improves energy intake and prognosis in gastrointestinal cancer, though limited studies restrict publication bias evaluation.

背景:胃肠道肿瘤术后的营养支持,包括肠内营养(EN)、肠外营养(PN)和联合营养策略,对促进恢复和患者预后至关重要。目的:我们旨在综合评估胃肠道肿瘤患者术后EN、PN和EN + PN的影响。方法:检索PubMed、Embase、Cochrane Library、Web of Science、中国知网(CNKI)、万方网(wanfang)、维普网(VIP)从受孕至2024年1月2日。纳入了比较胃肠道癌患者术后不同营养支持(EN、PN或EN + PN)的随机对照试验(rct)。采用Cochrane偏倚风险评估工具评估随机对照试验的质量。根据变量的异质性选择固定效应和随机效应模型进行结果综合。使用加权平均差或相对危险度(RR)和95%置信区间(CI)分析连续变量和分类变量。结果:本荟萃分析共纳入11项随机对照试验。与PN组和EN组相比,PN + EN组术后恢复、营养功能和免疫指标均显著改善(p < 0.05)。此外,术后并发症如腹胀的发生率较高(RR: 2.53;95% CI: 1.17-5.49),恶心/呕吐(RR: 2.01;95% CI: 1.09-3.71)和腹泻(RR: 3.17;95% CI: 1.41-7.10), EN组较PN + EN组差异显著。结论:尽管有限的研究限制了发表偏倚评价,但联合补充PN和肠内支持可改善胃肠道肿瘤患者的能量摄入和预后。
{"title":"Efficacy and Safety of a Combination of Enteral and Parenteral Nutrition Support in the Postoperative Period for Patients with Gastrointestinal Cancer: A Systematic Review and Meta-Analysis.","authors":"Meixiang Cai, Bo Yang, Yaping Zheng, Lei Ding","doi":"10.4274/balkanmedj.galenos.2024.2024-10-65","DOIUrl":"10.4274/balkanmedj.galenos.2024.2024-10-65","url":null,"abstract":"<p><strong>Background: </strong>Postoperative nutritional support in gastrointestinal cancer, including enteral nutrition (EN), parenteral nutrition (PN), and combined nutrition strategies, is vital for enhancing recovery and patient outcomes.</p><p><strong>Aims: </strong>We aimed to comprehensively evaluate the impact of postoperative EN, PN, and EN + PN in patients with gastrointestinal cancer.</p><p><strong>Methods: </strong>PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wan Fang, and VIP were searched from conception until January 2, 2024. Randomized controlled trials (RCTs) that compared different postoperative nutritional support (EN, PN, or EN + PN) in patients with gastrointestinal cancer were included. The Cochrane Risk of Bias Assessment tool was used to assess the quality of the RCTs. Fixed- and random-effects models were chosen according to the heterogeneity of variables for the synthesis of results. Continuous and categorical variables were analyzed using the weighted mean difference or relative risk (RR) and 95% confidence interval (CI).</p><p><strong>Results: </strong>In this meta-analysis, 11 RCTs were included. The PN + EN group exhibited significantly improved postoperative recovery, nutritional function, and immune indicators than the PN and EN groups (<i>p</i> < 0.05). Additionally, a higher incidence of postoperative complications such as abdominal distension (RR: 2.53; 95% CI: 1.17-5.49), nausea/vomiting (RR: 2.01; 95% CI: 1.09-3.71), and diarrhea (RR: 3.17; 95% CI: 1.41-7.10) was observed in the EN group than in the PN + EN group.</p><p><strong>Conclusion: </strong>Combining supplemental PN with enteral support improves energy intake and prognosis in gastrointestinal cancer, though limited studies restrict publication bias evaluation.</p>","PeriodicalId":8690,"journal":{"name":"Balkan Medical Journal","volume":"42 1","pages":"14-26"},"PeriodicalIF":1.9,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11725663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","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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Balkan Medical Journal
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