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His Bundle Pacing: Short Review of Literature and Technical Aspects 他的《捆绑节奏:文学和技术方面的简短回顾》
Pub Date : 2018-10-01 DOI: 10.15744/2394-6504.4.201
M. S
History of pacing has evolved from the primitive state of temporary transvenous pacing by large fixed machine to leadless modern technology. The pacing site has also been changed from traditional right ventricular apex to various other sites. The concept behind such experient was due to several complications in the long term from traditional Right Ventricular Apical Pacing (RVAP). The His Bundle pacing results in conduction and contraction similar to and and more often called physiological pacing. This mini review describes short history of evolution of concept of His Bundle pacing and its technical aspects of successful implantation.
起搏的历史已经从原始的大型固定机器临时经静脉起搏发展到无引线的现代技术。起搏部位也由传统的右心尖向其他部位转移。这种实验背后的概念是由于传统的右心室起搏(RVAP)长期的并发症。他束起搏导致的传导和收缩类似于和,更常被称为生理起搏。这篇简短的综述描述了His束起搏概念的发展历史及其成功植入的技术方面。
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引用次数: 1
Evaluation of the Mandibular Incisive Canal by Panoramic Radiography and Cone-Beam Computed Tomography 全景x线摄影和锥形束计算机断层扫描对下颌切管的评价
Pub Date : 2018-06-01 DOI: 10.15744/2394-6504.4.101
P. Tauber, Virginia Mansilla, P. Brugada, Sara S Sánchez P, S. Honoré, M. Elizari, Sergio Chain Molina, Félix A. Albano, Ricardo R. Corbalán, Federico Figueroa Castellanos, Damian Alzugaray Bioeng
Background: Radiofrequency ablation (RFA) in Brugada syndrome (BrS) has been performed both endocardially and epicardially. The substrate in BrS is thus unclear. Objectives: To investigate the functional endocardial substrate and its correlation with clinical, electrophysiological and ECG findings in order to guide an endocardial ablation. Methods: Thirteen patients (38.7±12.3 years old) with spontaneous type 1 ECG BrS pattern, inducible VF with programmed ventricular stimulation (PVS) and syncope without prodromes were enrolled. Before to endocardial mapping the patients underwent flecainide testing with the purpose of measuring the greatest ST-segment elevation for to be correlated with the size and location of substrate in the electro-anatomic map. Patients underwent endocardial bipolar and electro-anatomic mapping with the purpose of identify areas of abnormal electrograms (EGMs) as target for RFA and determine the location and size of the substrate. Results: When the greatest ST-segment elevation was in the 3rd intercostal space (ICS), the substrate was located upper in the longitudinal plane of the right ventricular outflow tract (RVOT) and a greatest ST-segment elevation in 4th ICS correspond with a location of substrate in lower region of longitudinal plane of RVOT. A QRS complex widening on its initial and final part, with prolonged transmural and regional depolarization time of RVOT corresponded to the substrate locateded in the anterior-lateral region of RVOT. A QRS complex widening rightwards and only prolonged transmural depolarization time corresponded with a substrate located in the anterior, anterior-septal or septal region of RVOT. RFA of endocardial substrate suppressed the inducibility and ECG BrS pattern during 34.7±15.5 months. After RFA, flecainide testing confirmed elimination of the ECG BrS pattern. Endocardial biopsy showed a correlation between functional and ultrastructural alterations in two patients.
背景:Brugada综合征(BrS)的射频消融(RFA)已在心内膜和心外膜进行。因此,BrS中的底物尚不清楚。目的:探讨心内膜底物的功能及其与临床、电生理和心电图表现的关系,以指导心内膜消融。方法:选取自发性1型心电图BrS型、诱发性室颤伴程序性心室刺激(PVS)、无前驱症状的晕厥患者13例(38.7±12.3岁)。在心内膜测图之前,患者进行了氟氯胺测试,目的是测量与电解剖图中底物的大小和位置相关的最大st段抬高。患者接受心内膜双极和电解剖定位,目的是确定异常电图(EGMs)区域作为RFA的目标,并确定底物的位置和大小。结果:第3肋间隙(ICS) st段抬高最大时,底物位于右心室流出道(RVOT)纵面上方,第4肋间隙st段抬高最大时底物位于RVOT纵面下方。RVOT的基底位于前外侧区,QRS复合物在RVOT的始端和终端加宽,RVOT的跨壁和区域退极化时间延长。QRS复合体向右加宽且仅延长跨壁去极化时间,与RVOT前区、前间隔区或间隔区有底物相对应。心内膜底物RFA在34.7±15.5个月内抑制了诱导性和ECG BrS模式。RFA后,氟氯胺试验证实心电图BrS模式消除。心内膜活检显示两例患者的功能和超微结构改变之间存在相关性。
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引用次数: 0
Bernoulli Equation in the Mitral Valve of Heart 心脏二尖瓣的伯努利方程
Pub Date : 2018-06-01 DOI: 10.15744/2394-6504.4.102
Karvandi M, Ranjbar S
Background: The mechanics of the mitral valve leaflet as a nonlinear, inelastic and anisotropic soft tissue results from an integrated response of many mathematical/physical indexes’ that illustrate the tissue. Objectives: The objective of this paper is to study and give an algorithm for the mechanisms of mitral valve of the heart based on mathematical techniques and Bernoulli’s equation. Methods and Results: Utilizing mathematical techniques and Bernoulli’s equation, we can make a geometrical modeling of the mitral valve leaflets and give available and valuable clinical benefit information of the Mitral valve behaviors for physician. Echocardiography was performed on healthy volunteers. Data evaluated included: velocity (radial, longitudinal, rotational and vector point), displacement (longitudinal and rotational), strain rate (longitudinal and circumferential) and strain (radial, longitudinal and circumferential) of all leaflet segments. Using these data, force vectors of myocardial samples and a new formula that was provided by Bernoulli equation, we were able to see what’s happening around the mitral valve of heart. All data were estimated/run by MATLAB software.
背景:二尖瓣小叶作为一种非线性、非弹性和各向异性软组织的力学是由许多描述该组织的数学/物理指标的综合响应引起的。目的:研究并给出一种基于数学技术和伯努利方程的心脏二尖瓣机制的算法。方法与结果:利用数学方法和伯努利方程,建立二尖瓣小叶的几何模型,为医生提供可获得的、有价值的二尖瓣行为的临床获益信息。对健康志愿者进行超声心动图检查。评估的数据包括:所有小叶段的速度(径向、纵向、旋转和矢量点)、位移(纵向和旋转)、应变率(纵向和周向)和应变(径向、纵向和周向)。利用这些数据,心肌样本的力矢量和伯努利方程提供的新公式,我们能够看到心脏二尖瓣周围发生了什么。所有数据均通过MATLAB软件估算/运行。
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引用次数: 0
Impact of Myocardial Revascularization on the Range of Joint Motion of the Superior and Inferior Members 心肌血运重建术对上下关节活动范围的影响
Pub Date : 2018-06-01 DOI: 10.15744/2394-6504.4.105
Li Al, De Lima Asf, Silva Rds, Borges Dl, G. G, Guimaraes Ar, Esquivel Ms, Mascarenhas Hdc
Introduction: The surgical procedure for myocardial revascularization (MRI) may compromise chest stability, compliance and range of motion (ROM) of the shoulder joint due to sternotomy and knee joint due to saphenectomy. Objective: To evaluate the impact of myocardial revascularization surgery on upper and lower limb ROM Methodology: This is a prospective cohort study, performed with a group of patients submitted to cardiac surgery. In the preoperative period the ROM was evaluated through a goniometer, for flexion, horizontal abduction and vertical abduction of the right and left shoulder, as well as evaluation of the flexo-extension movement of the right knee. On the day of discharge from the Intensive Care Unit, the patients were reassessed. Results:Twenty patients were evaluated during the time of the study. The majority were men 14 (70%), with a mean age of 60 ± 10 years. Regarding ROM, it was verified that all the movements presented a significant reduction in the postoperative period. The right shoulder flexion (75 ± 11ºvs66 ± 8º, p = 0, p <0.01), right shoulder abduction (155 ± 17º vs127 ± 22º, p < (P = 0.02), right vertical abduction (142 ± 24º vs117 ± 22º, p <0.01), left vertical abduction (142 ± 24º vs121 ± 22º, p = 0), left horizontal abduction (79 ± 9º vs70 ± 5º, p=0,02), Knee flexion (100 ± 14º vs75 ± 19º, p <0.01) and knee extension (94 ± 13º vs79 ± 15º, p <0.01). Conclusion: It can be concluded that the surgery promote reduction of the range of joint motion in this sample of patients submitted to myocardial revascularization.
导言:心肌血运重建术(MRI)的外科手术可能会损害胸骨切开术和隐骨切除术导致的肩关节的胸部稳定性、顺应性和活动范围(ROM)。目的:评估心肌血运重建术对上肢和下肢ROM的影响方法学:这是一项前瞻性队列研究,对一组接受心脏手术的患者进行了研究。术前通过测角仪评估左、右肩关节屈曲、水平外展和垂直外展的活动度,并评估右膝屈伸活动。出院当天,对患者进行重新评估。结果:在研究期间对20例患者进行了评估。以男性14岁(70%)居多,平均年龄60±10岁。关于ROM,我们证实术后所有的运动都有明显的减少。右肩弯曲(75±11ºvs66±8º,p = 0, p < 0.01),右肩绑架(155±17ºvs127±22º,p < (p = 0.02),对垂直绑架(142±24ºvs117±22º,p < 0.01),左侧垂直绑架(142±24ºvs121±22º,p = 0),左水平绑架(79±9ºvs70±5º,p = 0, 02),膝盖弯曲(100±14ºvs75±19º,p < 0.01)和膝盖扩展(94±13ºvs79±15º,p < 0.01)。结论:在心肌血运重建术患者中,手术可促进关节活动范围的缩小。
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引用次数: 0
Health-Related Quality of life of Complete versus Infarct artery-only Percutaneous Coronary Revascularization in Multi-vessel Disease with ST-Segment Elevation Myocardial Infarction st段抬高型心肌梗死多血管疾病中完全与仅梗死动脉经皮冠状动脉重建术的健康相关生活质量
Pub Date : 2018-06-01 DOI: 10.15744/2394-6504.4.104
Jayaraj Jc
Objective: The aim of this study was to evaluate the health-related quality of life (HRQoL) as measured by the EQ-5D (European quality of life-5 dimensions) self-report questionnaire in patients treated with complete revascularization versus infarct artery-only revascularization at index admission. Background: The revascularization strategies for multivessel disease while undergoing primary percutaneous coronary intervention (P-PCI) on HRQoL is uncertain. Methods and Results: STEMI patients with multivessel disease underwent either complete or between April 1, 2012, and March 31, 2014, were subdivided into those who underwent complete revascularization (n = 133) or infarct-related artery (IRA)-only revascularization (n = 139) at index admission. The EQ-5D assessed mobility, self-care, usual activity, pain or discomfort, and anxiety or depression. Patient groups were differed at baseline by gender and prevalence of heart failure. At 2-year follow-up, both mean (±SD) EQ-VAS and EQ-5D utility scores were lower for patients who underwent complete revascularization versus infarct artery-only revascularization (60.00 (±18.8) vs. 59.03 (±16.9), P < 0.03, and 0.68 (±0.02) vs. 0.54 (±0.02), P<0.004, respectively). Conclusion: The clinically significant improvement in QoL was seen in the complete revascularization group compared with treating only the IRA at 24 months.
目的:本研究的目的是通过EQ-5D(欧洲生活质量5维度)自我报告问卷来评估入院时接受完全血运重建术与仅接受梗死动脉血运重建术的患者的健康相关生活质量(HRQoL)。背景:多血管疾病患者行经皮冠状动脉介入治疗(P-PCI)时HRQoL的血运重建策略尚不确定。方法和结果:2012年4月1日至2014年3月31日期间,STEMI多血管疾病患者接受了完全血运重建术(n = 133)和仅梗死相关动脉(IRA)血运重建术(n = 139)。EQ-5D评估活动能力、自我护理、日常活动、疼痛或不适以及焦虑或抑郁。患者组在基线时根据性别和心力衰竭的患病率进行区分。在2年的随访中,接受完全血运重建术的患者与只接受梗死动脉血运重建术的患者相比,EQ-VAS和EQ-5D的平均(±SD)评分均较低(60.00(±18.8)比59.03(±16.9),P< 0.03, 0.68(±0.02)比0.54(±0.02),P<0.004)。结论:在24个月时,完全血运重建术组患者的生活质量明显优于单纯血运重建术组。
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引用次数: 0
The Use of Cardiac Resynchronization Therapy in Cancer Patients with Heart Failure. 心脏再同步化治疗在癌症合并心力衰竭患者中的应用。
Pub Date : 2017-04-01 Epub Date: 2017-04-27 DOI: 10.15744/2394-6504.3.105
Anecita P Fadol, Elie Mouhayar, Cielito C Reyes-Gibby

Objectives: Investigate the use of cardiac resynchronization therapy (CRT) in cancer patients with heart failure (HF); assess factors associated with ischemic and non-ischemic HF.

Background: Many newer cancer therapies are cardiotoxic; thus, the incidence of HF has been increasing in this high-risk patient population. CRT has beneficial effects on morbidity, mortality, and left ventricular function in patients with non-ischemic cardiomyopathy, yet cancer patients and survivors who develop severe HF and are eligible for CRT often do not receive it.

Methods: Review of 2 years of echocardiography and electrocardiography data from cancer patients.

Results: Of 272 patients meeting inclusion criteria for CRT placement (LVEF ≤35%, QRS duration ≥120 ms), 131 (48.2%) had HF with ischemic etiology and 141 (51.8%) had HF with non-ischemic etiology. Most patients had solid tumors, including breast, lung, sarcoma, and lymphoma (73.2%, n=199). Only 21.3% (58/272; 27 ischemic; 31 non-ischemic) underwent CRT placement, who were mostly women and those with solid tumors. Non-ischemic HF was significantly associated with younger age (<65 years) (OR=0.91; 95% CI=0.87-0.95) and female sex (OR=2.5; 95% CI=1.1-6.0). As expected, ischemic HF was significantly associated with history of myocardial infarction, diabetes, and cardiovascular disease.

Conclusions: CRT is underutilized in cancer patients with HF. Most of the cancer patients who did not receive CRT had non-ischemic HF secondary to chemotherapy. CRT may be less utilized in those patients due to shortened life expectancy, yet evidence suggests that CRT has beneficial effects on morbidity, mortality, and left ventricular function. Its use may improve patient quality of life and allow oncologists to continue cancer treatments that could prolong survival.

目的:探讨心脏再同步化治疗(CRT)在癌症合并心力衰竭(HF)患者中的应用;评估缺血性和非缺血性心衰相关因素。背景:许多较新的癌症治疗方法具有心脏毒性;因此,在这一高危患者人群中,心衰的发病率一直在增加。CRT对非缺血性心肌病患者的发病率、死亡率和左心室功能都有有益的影响,但患有严重心衰的癌症患者和幸存者通常不接受CRT。方法:回顾2年来癌症患者的超声心动图和心电图资料。结果:272例符合CRT放置标准(LVEF≤35%,QRS持续时间≥120 ms)的患者中,缺血性病因HF 131例(48.2%),非缺血性病因HF 141例(51.8%)。大多数患者为实体肿瘤,包括乳腺、肺、肉瘤和淋巴瘤(73.2%,n=199)。只有21.3% (58/272;27缺血;31例非缺血性患者接受了CRT放置,其中大部分为女性和实体瘤患者。非缺血性心衰与低龄显著相关(结论:CRT在合并心衰的癌症患者中应用不足)。大多数未接受CRT的癌症患者有继发于化疗的非缺血性心衰。由于预期寿命缩短,CRT可能较少用于这些患者,但有证据表明CRT对发病率,死亡率和左心室功能有有益的影响。它的使用可以提高病人的生活质量,并允许肿瘤学家继续癌症治疗,延长生存期。
{"title":"The Use of Cardiac Resynchronization Therapy in Cancer Patients with Heart Failure.","authors":"Anecita P Fadol,&nbsp;Elie Mouhayar,&nbsp;Cielito C Reyes-Gibby","doi":"10.15744/2394-6504.3.105","DOIUrl":"https://doi.org/10.15744/2394-6504.3.105","url":null,"abstract":"<p><strong>Objectives: </strong>Investigate the use of cardiac resynchronization therapy (CRT) in cancer patients with heart failure (HF); assess factors associated with ischemic and non-ischemic HF.</p><p><strong>Background: </strong>Many newer cancer therapies are cardiotoxic; thus, the incidence of HF has been increasing in this high-risk patient population. CRT has beneficial effects on morbidity, mortality, and left ventricular function in patients with non-ischemic cardiomyopathy, yet cancer patients and survivors who develop severe HF and are eligible for CRT often do not receive it.</p><p><strong>Methods: </strong>Review of 2 years of echocardiography and electrocardiography data from cancer patients.</p><p><strong>Results: </strong>Of 272 patients meeting inclusion criteria for CRT placement (LVEF ≤35%, QRS duration ≥120 ms), 131 (48.2%) had HF with ischemic etiology and 141 (51.8%) had HF with non-ischemic etiology. Most patients had solid tumors, including breast, lung, sarcoma, and lymphoma (73.2%, n=199). Only 21.3% (58/272; 27 ischemic; 31 non-ischemic) underwent CRT placement, who were mostly women and those with solid tumors. Non-ischemic HF was significantly associated with younger age (<65 years) (OR=0.91; 95% CI=0.87-0.95) and female sex (OR=2.5; 95% CI=1.1-6.0). As expected, ischemic HF was significantly associated with history of myocardial infarction, diabetes, and cardiovascular disease.</p><p><strong>Conclusions: </strong>CRT is underutilized in cancer patients with HF. Most of the cancer patients who did not receive CRT had non-ischemic HF secondary to chemotherapy. CRT may be less utilized in those patients due to shortened life expectancy, yet evidence suggests that CRT has beneficial effects on morbidity, mortality, and left ventricular function. Its use may improve patient quality of life and allow oncologists to continue cancer treatments that could prolong survival.</p>","PeriodicalId":90582,"journal":{"name":"Journal of clinical and experimental research in cardiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6022845/pdf/nihms938415.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36274980","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: 5
Acculturation and Subclinical Atherosclerosis among U.S. South Asians: Findings from the MASALA study. 美国南亚人的文化适应和亚临床动脉粥样硬化:来自MASALA研究的发现。
Pub Date : 2014-06-23 DOI: 10.15744/2394-6504.1.102
Kanaya Am, Ewing Sk, Vittinghoff E, Herrington D, Tegeler C, Mills C, Kandula Nr
OBJECTIVELonger duration of residence among immigrants to the United States, a proxy measure of acculturation, has been associated with higher subclinical atherosclerosis. South Asian immigrants are the second fastest growing immigrant group in the U.S. but little is known about the effects of acculturation with atherosclerosis in this high cardiovascular risk population.METHODSWe conducted a cross-sectional analysis using data from a community-based cohort called the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. Participants (n=900) were between ages of 40-84 years and had no existing cardiovascular disease. We developed a multi-dimensional measure of acculturation in South Asians, called traditional cultural beliefs, and measured other proxy measures of acculturation to determine whether they were associated with higher levels of subclinical atherosclerosis after controlling for socioeconomic, behavior/lifestyle, and cardiovascular risk factors.RESULTSMean duration of residence in the U.S. was 27±11 years and tertiles of strength of traditional cultural beliefs were examined. Longer duration of U.S. residence was associated with higher levels of coronary artery calcium even after adjustment for covariates and lifestyle mediators. The novel measure of strength of traditional cultural beliefs was associated with lower common carotid intima media thickness among those with moderate traditional beliefs only.CONCLUSIONSThese findings support the need for better conceptualization and measurement of how migration influences cultural beliefs and practices, and their subsequent influence on health behaviors and cardiovascular disease risk.
目的移民在美国居住的时间越长(一种衡量文化适应程度的替代指标),其亚临床动脉粥样硬化的发生率越高。南亚移民是美国增长速度第二快的移民群体,但人们对文化适应对动脉粥样硬化的影响知之甚少。方法:我们使用来自社区队列的数据进行横断面分析,该队列称为生活在美国的南亚人动脉粥样硬化介质(MASALA)研究。参与者(n=900)年龄在40-84岁之间,没有心血管疾病。我们开发了南亚人文化适应的多维测量方法,称为传统文化信仰,并测量了文化适应的其他替代测量方法,以确定在控制了社会经济、行为/生活方式和心血管危险因素后,它们是否与较高水平的亚临床动脉粥样硬化相关。结果研究对象在美平均居住时间为27±11年,传统文化信仰强度分位数。即使在调整协变量和生活方式调节因子后,在美国居住的时间越长,冠状动脉钙水平也越高。传统文化信仰强度的新测量仅与中等传统信仰的人颈总动脉内膜中膜厚度较低有关。结论这些发现支持了更好地概念化和测量移民如何影响文化信仰和习俗,以及它们对健康行为和心血管疾病风险的后续影响的必要性。
{"title":"Acculturation and Subclinical Atherosclerosis among U.S. South Asians: Findings from the MASALA study.","authors":"Kanaya Am, Ewing Sk, Vittinghoff E, Herrington D, Tegeler C, Mills C, Kandula Nr","doi":"10.15744/2394-6504.1.102","DOIUrl":"https://doi.org/10.15744/2394-6504.1.102","url":null,"abstract":"OBJECTIVE\u0000Longer duration of residence among immigrants to the United States, a proxy measure of acculturation, has been associated with higher subclinical atherosclerosis. South Asian immigrants are the second fastest growing immigrant group in the U.S. but little is known about the effects of acculturation with atherosclerosis in this high cardiovascular risk population.\u0000\u0000\u0000METHODS\u0000We conducted a cross-sectional analysis using data from a community-based cohort called the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. Participants (n=900) were between ages of 40-84 years and had no existing cardiovascular disease. We developed a multi-dimensional measure of acculturation in South Asians, called traditional cultural beliefs, and measured other proxy measures of acculturation to determine whether they were associated with higher levels of subclinical atherosclerosis after controlling for socioeconomic, behavior/lifestyle, and cardiovascular risk factors.\u0000\u0000\u0000RESULTS\u0000Mean duration of residence in the U.S. was 27±11 years and tertiles of strength of traditional cultural beliefs were examined. Longer duration of U.S. residence was associated with higher levels of coronary artery calcium even after adjustment for covariates and lifestyle mediators. The novel measure of strength of traditional cultural beliefs was associated with lower common carotid intima media thickness among those with moderate traditional beliefs only.\u0000\u0000\u0000CONCLUSIONS\u0000These findings support the need for better conceptualization and measurement of how migration influences cultural beliefs and practices, and their subsequent influence on health behaviors and cardiovascular disease risk.","PeriodicalId":90582,"journal":{"name":"Journal of clinical and experimental research in cardiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78578084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 30
期刊
Journal of clinical and experimental research in cardiology
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