Revista clinica espanola最新文献

英文中文

Peer-assisted learning enhances non-technical skills in pediatric physical therapy education 同伴辅助学习提高儿童物理治疗教育的非技术技能。

Revista clinica espanola

Pub Date : 2025-08-01 DOI: 10.1016/j.rceng.2025.502328

T.T. Ma , Q. Zhang , H.B. Zhao , H.X. Li

引用次数: 0

The contribution of PET/MRI in benign/malignant nodule separation in thyroid incidentalomas detected in FDG PET/CT imaging PET/MRI对FDG PET/CT检查甲状腺偶发瘤良/恶性结节分离的贡献

Revista clinica espanola

Pub Date : 2025-08-01 DOI: 10.1016/j.rceng.2025.502333

A. Nazari , S. Sager , S. Schenke , L. Uslu Beşli , C. Samancı , T. Öztürk , H.B. Sayman

Introduction and objectives

Incidentalomas of the thyroid gland are frequently observed in oncological patients undergoing FDG PET/CT imaging for staging or treatment response assessment. This study aims to investigate the utility of SUVmax and ADC values measured by PET/MRI in distinguishing between benign and malignant thyroid nodules.

Materials and methods

We selected 108 patients (72 females, 36 males; mean age 54 ± 12 years) who underwent routine oncological FDG PET/CT scans for staging or treatment response assessment, with nodule sizes greater than 1 cm. A one-bed neck PET/MRI scan followed the whole-body PET/CT. SUVmax values were measured, and ADC maps were created using DWI with b factors of 50 and 1000 s/mm². SUVmax and ADC values were correlated with FNAC results.

Results

FNAC results revealed 76 (70.4%) benign and 32 (29.6%) malignant nodules among the 108 patients. The mean SUVmax of malignant nodules was significantly higher than that of benign nodules (10.6 ± 8.3 vs. 5.94 ± 5.2, p < 0.001). Similarly, the mean ADC value was lower in malignant nodules compared to benign ones (1.4 ± 0.6 × 10⁻³ mm²/s vs. 1.8 ± 0.4 × 10⁻³ mm²/s; p < 0.001). A significant but weak correlation was found between FNAC results and mean SUVmax (r = 0.335), as well as a significant weak negative correlation with mean ADC values (r = −0.355). Using a cut-off value of 6 for SUVmax and 1.56 × 10⁻³ mm²/s for ADC, the sensitivity, specificity, and accuracy for SUVmax were 68.7%, 73.6%, and 72.1%, respectively, while for ADC, they were 71.8%, 69.7%, and 70.4%, respectively. The PET/MRI system demonstrated a relative sensitivity, specificity, accuracy, PPV, and NPV of 90.62%, 51.32%, 62.96%, 43.94%, and 92.86%.

Conclusion

This study is one of the first in the literature to explore the use of FDG PET/MRI, a single-stop device, in distinguishing between benign and malignant thyroid nodules with high sensitivity and NPV.

简介和目的：在接受FDG PET/CT成像进行分期或治疗反应评估的肿瘤患者中经常观察到甲状腺偶发瘤。本研究旨在探讨PET/MRI测量的SUVmax和ADC值在区分良性和恶性甲状腺结节中的应用。材料与方法：选取108例患者，其中女性72例，男性36例；平均年龄54±12岁)，接受常规肿瘤FDG PET/CT扫描进行分期或治疗反应评估，结节大小大于1cm。全身PET/CT扫描后进行单床颈部PET/MRI扫描。测量SUVmax值，并使用b因子为50和1000s/mm²的DWI创建ADC图。SUVmax和ADC值与FNAC结果相关。结果：FNAC结果显示，108例患者中良性结节76例（70.4%），恶性结节32例（29.6%）。恶性结节的平均SUVmax明显高于良性结节（10.6±8.3 vs. 5.94±5.2,p）。结论：本研究是文献中首次探索利用FDG PET/MRI这种单次停止装置来区分高灵敏度和NPV的甲状腺结节的良恶性。

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引用次数: 0

Predictors of the appearance of radiological alterations at 12 months after COVID-19 pneumonia COVID-19肺炎后12个月影像学改变的预测因素

Revista clinica espanola

Pub Date : 2025-08-01 DOI: 10.1016/j.rceng.2025.502325

C. Roig-Martí , I. Pérez-Catalán , S. Folgado-Escudero , M. Varea-Villanueva , Antonio Navarro-Ballester , M.P. Fernández-García , A. Segura-Fábrega , M.-L. Mateu-Campos , J. Usó-Blasco , J.-M. Ramos-Rincón

Background and objective

The radiological evolution after COVID-19 pneumonia is unknown. We propose to analyze the main radiological findings one year after COVID-19 pneumonia, as well as identify possible factors that may influence it.

Material and methods

Cohort study of patients with COVID-19 pneumonia undergoing high-resolution computed tomography (HRCT) 12 months after hospital discharge. A descriptive study of the radiological findings and a multivariate analysis are carried out to identify the factors of the appearance of radiological anomalies.

Results

n = 139 patients, with a mean age of 63 years and 66.2% male. The most frequent radiological findings were ground-glass opacities (59%), followed by bronchiectasis (42.4%), subpleural parenchymal bands (32.4%), atelectasis (13.7%), septal thickening (12.9%) and fibrotic tracts (9.4%). Male sex was associated with the presence of bronchiectasis (ORa = 3.55; p = 0.026), peak admission IL-6 levels > 133 ng/L with the detection of subpleural parenchymal bands (ORa = 3.58; p = 0.048) and obesity with the occurrence of atelectasis (ORa = 3.70; p = 0.014). Systemic corticotherapy during admission decreased the risk of fibrotic tracts (ORa = 0.02; p = 0.003).

Conclusions

Lung damage persists with high frequency one year after COVID-19 pneumonia. Male sex, high peak admission IL-6 levels and obesity were risk factors for radiological abnormalities while systemic corticosteroid therapy decreased the occurrence of fibrotic tracts 12 months after hospital admission.

背景与目的：COVID-19肺炎后的影像学演变尚不清楚。我们建议分析COVID-19肺炎一年后的主要影像学表现，并确定可能影响其的因素。材料与方法：对COVID-19肺炎患者出院后12个月行高分辨率计算机断层扫描（HRCT）的队列研究。对放射学结果进行描述性研究，并进行多变量分析，以确定放射学异常出现的因素。结果：139例患者，平均年龄63岁，66.2%为男性。最常见的影像学表现为毛玻璃混浊（59%），其次是支气管扩张（42.4%）、胸膜下实质带（32.4%）、肺不张（13.7%）、间隔增厚（12.9%）和纤维化束（9.4%）。男性与支气管扩张相关(ORa = 3.55；p = 0.026)，胸膜下实质带检测的峰值IL-6水平> 133 ng/L (ORa = 3.58；p = 0.048)，肥胖与肺不张的发生相关(ORa = 3.70；p = 0.014)。入院时全身皮质治疗可降低纤维化束的风险(ORa = 0.02；p = 0.003)。结论：新型冠状病毒肺炎后1年仍存在高频率肺损伤。男性、入院时峰值IL-6水平和肥胖是放射学异常的危险因素，而全身皮质类固醇治疗可减少住院后12个月纤维化束的发生。

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引用次数: 0

Expert consensus on interstitial lung disease associated with systemic autoimmune diseases. Executive summary 专家共识：间质性肺疾病与系统性自身免疫性疾病相关。执行概要。

Revista clinica espanola

Pub Date : 2025-08-01 DOI: 10.1016/j.rceng.2025.502326

A. González-García , M. Akasbi , M.P. Brito-Zerón , J.L. Callejas , I. Cusacovich , F. Jiménez Segovia , M. Martín Cascón , S. Prieto-González , L. Sáez Comet , C.P. Simeón , R. Solans Laque , J.S. García Morillo , on behalf of Systemic Autoimmune Disease Group (GEAS) of the Spanish Society of Internal Medicine (SEMI)

Interstitial lung disease (ILD) is a frequent and potentially fatal manifestation of systemic autoimmune diseases (SAD). Early screening, diagnosis, and treatment with immunomodulators, and in some cases, antifibrotics, as well as appropriate follow-up, are essential to improving patients’ quality of life and survival. The complexity of these diseases and the limited robust evidence to guide clinical decision-making lead to significant variability in management guidelines. In this article, a group of experts in SAD has developed recommendations for the screening, diagnosis, treatment, and follow-up of ILD, considering the latest evidence, their clinical experience, and the results of a survey conducted among specialists. The diseases included are systemic sclerosis, Sjögren’s disease, idiopathic inflammatory myopathy, ANCA-associated vasculitis, sarcoidosis and systemic lupus erythematosus.

间质性肺疾病（ILD）是系统性自身免疫性疾病（SAD）的一种常见且可能致命的表现。早期筛查、诊断和免疫调节剂治疗，在某些情况下使用抗纤维化药物，以及适当的随访，对于改善患者的生活质量和生存率至关重要。这些疾病的复杂性和指导临床决策的有限有力证据导致管理指南的显著差异。在这篇文章中，一组SAD的专家考虑到最新的证据、他们的临床经验和一项专家调查的结果，对ILD的筛查、诊断、治疗和随访提出了建议。这些疾病包括系统性硬化症、Sjögren病、特发性炎性肌病、anca相关血管炎、结节病和系统性红斑狼疮。

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引用次数: 0

Conscientious objection to medical aid in dying: Knowledge, attitudes, and practices in primary care 对死亡医疗援助的良心反对：初级保健的知识、态度和实践。

Revista clinica espanola

Pub Date : 2025-08-01 DOI: 10.1016/j.rceng.2025.502329

R. Triviño-Caballero , J. Franco , L. Sordo

Background/objective

The Euthanasia Regulation Law includes the right to conscientious objection (CO). However, there is hardly any information available on its exercise or the grounds for objection. The objective of this study was to identify knowledge, attitudes, and practices (KAP) regarding CO to the provision of medical aid in dying (MAID) in primary care, which is the level of care where most provisions occur.

Materials and methods

Cross-sectional KAP model study. A total of 434 active General Practitioners (GPs) working in health centres across Spain were surveyed through self-administered questionnaires on knowledge, attitudes, and practices related to CO. A descriptive analysis of the responses in each domain was performed, followed by multivariate analyses to determine the factors related to having objected or considering doing so.

Results

Of the GPs surveyed, 46.3% practised in Madrid. 75.2% were women, with an average age of 47. 84.8% had received training in bioethics. 54.9% reported knowing the law, only 29% correctly answered questions about CO in end-of-life practices. 35% had objected or considered objecting. Higher rates of objection were observed among those practising in Madrid (aOR = 2.98; 95% CI 1.16–5.34), those with religious beliefs (aOR = 5.23; 95% CI 2.78–9.80), and those opposed to MAID (aOR = 12.63; 95% CI 5.80−27.50).

Conclusions

The main reasons for objecting are moral and emotional, although other contextual factors also emerge. Given the high level of ignorance of the practices to which one can object, improvements in training and institutional involvement are needed for responsible practice and to guarantee the MAID.

背景/目的：《安乐死管理法》规定了良心拒服兵役的权利。但是，几乎没有任何关于行使这种权利或反对理由的资料。本研究的目的是确定关于初级保健中死亡医疗援助（MAID）提供的CO的知识、态度和实践（KAP），这是大多数提供服务的护理水平。材料与方法：横断面KAP模型研究。通过自我填写的问卷调查，对在西班牙各地保健中心工作的434名在职全科医生（gp）进行了调查，内容涉及与同性婚姻有关的知识、态度和做法。对每个领域的回答进行了描述性分析，然后进行了多变量分析，以确定与反对或考虑这样做有关的因素。结果：在接受调查的全科医生中，46.3%在马德里执业，75.2%为女性，平均年龄为47岁。84.8%接受过生命伦理学培训。54.9%的人表示了解法律，只有29%的人正确回答了有关临终实践中CO的问题。35%的人反对或考虑反对。马德里执业者的反对率较高(aOR = 2.98；95% CI 1.16-5.34)，有宗教信仰的人(aOR = 5.23；95% CI 2.78-9.80)，反对MAID的患者(aOR = 12.63；95% ci 5.80-27.50)。结论：反对的主要原因是道德和情感，尽管其他背景因素也会出现。鉴于对人们可以反对的做法的高度无知，需要改进培训和机构参与，以便负责任的做法和保证MAID。

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引用次数: 0

On the difficulty of clinical diagnosis of acute heart failure in the emergency department 浅谈急诊科急性心力衰竭临床诊断的难点。

Revista clinica espanola

Pub Date : 2025-06-01 DOI: 10.1016/j.rceng.2025.502301

Ò. Miró , N. Ivars , P. Llorens

引用次数: 0

Comparison of real and standardized patients in Degree in Medicine: a randomized controlled intervention study 医学学位真实患者与标准化患者的比较：一项随机对照干预研究。

Revista clinica espanola

Pub Date : 2025-06-01 DOI: 10.1016/j.rceng.2025.502306

N. Díez , B. Franchez , M.C. Rodríguez-Díez , M. Vidaurreta , M.T. Betés , S. Fernández , P. Palacio , F.J. Pueyo , N. Martín-Calvo

Introduction

Simulated clinical scenarios allow students to learn in a safe environment. Although it is recommended that standardized patients (SP) participate in these scenarios, few studies compare the impact of SP and real patients (RP) on medical education.

Methods

Forty medical students per course (4th, 5th, and 6th) were selected and randomly assigned (1:1) to two groups: a scenario with RP or SP. The students and the external observer were unaware of the type of patient participating in the scenario. The students completed questionnaires on perceptions and knowledge, and the responsible professors and external observer completed questionnaires on perceptions. Qualitative information was collected through focus groups with the students.

Results

No significant differences were found between both groups in perceptions and acquired knowledge, but there was a significant difference in the probability of correctly identifying the type of patient (p < 0.001): most students in the scenario with SP identified it as RP. No differences were found between groups in the professor and external observer questionnaires. Students were more prepared and involved if they believed they were facing a RP and considered the patient's feedback enriching, regardless of the type of patient.

Conclusions

Medical students do not differentiate SP from RP in scenarios and evaluate them similarly. Given the difficulty of having PR with diverse pathologies and severity levels, SP is a good alternative for training medical students.

简介：模拟临床场景，让学生在一个安全的环境中学习。虽然推荐标准化患者（SP）参与这些场景，但很少有研究比较SP和真实患者（RP）对医学教育的影响。方法：每门课程（四、五、六）选取40名医学生，按1:1的比例随机分为两组：RP或SP情景。学生和外部观察者不知道参与情景的患者类型。学生完成感知和知识问卷，负责的教授和外部观察者完成感知问卷。定性信息是通过与学生的焦点小组收集的。结果：两组在认知和获得性知识上无显著差异，但在正确识别患者类型的概率上有显著差异(p)。结论：医学生在情景中没有区分SP和RP，并且对它们的评价相似。鉴于具有不同病理和严重程度的PR的困难，SP是培养医学生的一个很好的选择。

{"title":"Comparison of real and standardized patients in Degree in Medicine: a randomized controlled intervention study","authors":"N. Díez , B. Franchez , M.C. Rodríguez-Díez , M. Vidaurreta , M.T. Betés , S. Fernández , P. Palacio , F.J. Pueyo , N. Martín-Calvo","doi":"10.1016/j.rceng.2025.502306","DOIUrl":"10.1016/j.rceng.2025.502306","url":null,"abstract":"<div><h3>Introduction</h3><div>Simulated clinical scenarios allow students to learn in a safe environment. Although it is recommended that standardized patients (SP) participate in these scenarios, few studies compare the impact of SP and real patients (RP) on medical education.</div></div><div><h3>Methods</h3><div>Forty medical students per course (4th, 5th, and 6th) were selected and randomly assigned (1:1) to two groups: a scenario with RP or SP. The students and the external observer were unaware of the type of patient participating in the scenario. The students completed questionnaires on perceptions and knowledge, and the responsible professors and external observer completed questionnaires on perceptions. Qualitative information was collected through focus groups with the students.</div></div><div><h3>Results</h3><div>No significant differences were found between both groups in perceptions and acquired knowledge, but there was a significant difference in the probability of correctly identifying the type of patient (p < 0.001): most students in the scenario with SP identified it as RP. No differences were found between groups in the professor and external observer questionnaires. Students were more prepared and involved if they believed they were facing a RP and considered the patient's feedback enriching, regardless of the type of patient.</div></div><div><h3>Conclusions</h3><div>Medical students do not differentiate SP from RP in scenarios and evaluate them similarly. Given the difficulty of having PR with diverse pathologies and severity levels, SP is a good alternative for training medical students.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 6","pages":"Article 502306"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056537","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: 0

In reply to the article of Ivars N, et al. “Clinical features, management in the emergency department and mortality of acute heart failure episodes in patients with chronic obstructive pulmonary disease” 回复Ivars N等人的文章。慢性阻塞性肺疾病患者急性心力衰竭发作的临床特点、急诊处理和死亡率

Revista clinica espanola

Pub Date : 2025-06-01 DOI: 10.1016/j.rceng.2025.502298

A. Gil-Rodrigo , M.-J. Luque-Hernández , L. Cuesta-García , C. Martínez-Buendía

引用次数: 0

Aging with HIV: a cross-sectional look at comorbidities 衰老与HIV：合并症的横断面观察。

Revista clinica espanola

Pub Date : 2025-06-01 DOI: 10.1016/j.rceng.2025.502310

M.C. Montes , J.A. Rueda-Camino , N. Rallón , S. Nistal-Juncos , R. Barba Martín

Background

People living with HIV (PLHIV) are at increased risk of multimorbidity compared to the general population. The goal of this study is to evaluate the prevalence of non-infectious comorbidities and geriatric syndromes in PLHIV ≥ 50 years old.

Methods

A cross-sectional analysis was conducted on a cohort of PLHIV regularly followed at an outpatient clinic in a University Hospital in Spain, focusing on PLHIV aged 50 and above. Participants were categorized by age into ten-year intervals. Crude and standardized prevalence of each comorbidity and its trend across age groups were estimated. The prevalence of multimorbidity (≥2 diseases) was also evaluated. All prevalence were estimated with the exact method.

Results

We evaluated 122 PLHIV, of which 25.4% were women and 13% resided in nursing homes. The median time between HIV diagnosis and the last documented visit was 19 (9–29) years. Overall prevalence of multimorbidity was 37% (95% CI 28.4 %–45.6 %), being the most prevalent comorbidities cardiovascular risk factors dyslipidemia (37.7%; 95% CI 29.6 %–46.6 %), hypertension (26.2%; 95% CI: 19.2 %–34.7 %), diabetes mellitus (14.8%; 95% CI: 9.5 %–22.1 %) and non-AIDS defining cancers (15.6%; 95% CI: 10.2 %–23.0 %). The most common geriatric syndromes were fractures/osteoporosis (9.8%; 95% CI: 5.7 %–16.4 %), dementia (8.2%; 95% CI: 4.5–14.4 %) and frailty (8.2%; 95% CI: 4.5–14.4 %). The prevalence of most comorbidities and multimorbidity showed a significantly increasing trend across age groups.

Conclusions

PLHIV who are over 50 years of age have a high prevalence of non-infectious comorbidities and geriatric syndromes. Multimorbidity increases with age in this population group.

背景：与一般人群相比，艾滋病毒感染者（PLHIV）多重发病的风险增加。本研究的目的是评估PLHIV感染者中非感染性合并症和老年综合征的患病率。方法：对西班牙某大学医院门诊定期随访的一组PLHIV患者进行横断面分析，研究对象为年龄在50岁及以上的PLHIV患者。参与者按年龄分为10年一组。估计了每种合并症的粗患病率和标准化患病率及其在各年龄组的趋势。多病（>2疾病）的患病率也进行了评估。所有的患病率都是用精确的方法估计的。结果：我们评估了122例PLHIV，其中25.4%为女性，13%居住在养老院。从HIV诊断到最后一次记录访问的中位时间为19（9-29）年。多病的总体患病率为37% (95% CI 28.4%-45.6%)，最普遍的合并症是心血管危险因素血脂异常(37.7%；95% CI 29.6%-46.6%)，高血压(26.2%；95% CI: 19.2%- 34.7%)，糖尿病(14.8%；95% CI: 9.5%-22.1%)和非艾滋病定义的癌症(15.6%；95% ci: 10.2%-23.0%)。最常见的老年综合征是骨折/骨质疏松症(9.8%；95% CI: 5.7%-16.4%)，痴呆(8.2%；95% CI: 4.5-14.4%)和虚弱(8.2%；95% ci: 4.5-14.4%)。大多数合并症和多病的患病率在各年龄组中呈显著增加趋势。结论：50岁以上的PLHIV患者非传染性合并症和老年综合征的患病率较高。在这一人群中，多发病随年龄增长而增加。

{"title":"Aging with HIV: a cross-sectional look at comorbidities","authors":"M.C. Montes , J.A. Rueda-Camino , N. Rallón , S. Nistal-Juncos , R. Barba Martín","doi":"10.1016/j.rceng.2025.502310","DOIUrl":"10.1016/j.rceng.2025.502310","url":null,"abstract":"<div><h3>Background</h3><div>People living with HIV (PLHIV) are at increased risk of multimorbidity compared to the general population. The goal of this study is to evaluate the prevalence of non-infectious comorbidities and geriatric syndromes in PLHIV ≥ 50 years old.</div></div><div><h3>Methods</h3><div>A cross-sectional analysis was conducted on a cohort of PLHIV regularly followed at an outpatient clinic in a University Hospital in Spain, focusing on PLHIV aged 50 and above. Participants were categorized by age into ten-year intervals. Crude and standardized prevalence of each comorbidity and its trend across age groups were estimated. The prevalence of multimorbidity (≥2 diseases) was also evaluated. All prevalence were estimated with the exact method.</div></div><div><h3>Results</h3><div>We evaluated 122 PLHIV, of which 25.4% were women and 13% resided in nursing homes. The median time between HIV diagnosis and the last documented visit was 19 (9–29) years. Overall prevalence of multimorbidity was 37% (95% CI 28.4 %–45.6 %), being the most prevalent comorbidities cardiovascular risk factors dyslipidemia (37.7%; 95% CI 29.6 %–46.6 %), hypertension (26.2%; 95% CI: 19.2 %–34.7 %), diabetes mellitus (14.8%; 95% CI: 9.5 %–22.1 %) and non-AIDS defining cancers (15.6%; 95% CI: 10.2 %–23.0 %). The most common geriatric syndromes were fractures/osteoporosis (9.8%; 95% CI: 5.7 %–16.4 %), dementia (8.2%; 95% CI: 4.5–14.4 %) and frailty (8.2%; 95% CI: 4.5–14.4 %). The prevalence of most comorbidities and multimorbidity showed a significantly increasing trend across age groups.</div></div><div><h3>Conclusions</h3><div>PLHIV who are over 50 years of age have a high prevalence of non-infectious comorbidities and geriatric syndromes. Multimorbidity increases with age in this population group.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 6","pages":"Article 502310"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055685","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: 0

SGLT2 inhibitors after acute heart failure: great benefit, low prescription rates 急性心力衰竭后的SGLT2抑制剂：疗效显著，处方率低。

Revista clinica espanola

Pub Date : 2025-06-01 DOI: 10.1016/j.rceng.2025.502299

R. Quirós-López

引用次数: 0

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