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[PMID]:27749290
[Au] Autor:Godet T; Chabanne R; Marin J; Kauffmann S; Futier E; Pereira B; Constantin JM
[Ad] Endereço:From the Department of Perioperative Medicine (T.G., R.C., J.M., S.K., E.F., J.-M.C.) and Biostatistics Unit, DRCI, Gabriel Montpied Hospital (B.P.), University Hospital of Clermont-Ferrand, Clermont-Ferrand, France; and Retinoids, Reproduction and Developmental Disease (R2D2) Unit, EA 7281, University of Clermont-Ferrand 1, Clermont-Ferrand, France (T.G., E.F., J.-M.C.).
[Ti] Título:Extubation Failure in Brain-injured Patients: Risk Factors and Development of a Prediction Score in a Preliminary Prospective Cohort Study.
[So] Source:Anesthesiology;126(1):104-114, 2017 Jan.
[Is] ISSN:1528-1175
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The decision to extubate brain-injured patients with residual impaired consciousness holds a high degree of uncertainty of success. The authors developed a pragmatic clinical score predictive of extubation failure in brain-injured patients. METHODS: One hundred and forty brain-injured patients were prospectively included after the first spontaneous breathing trial success. Assessment of multiparametric hemodynamic, respiratory, and neurologic functions was performed just before extubation. Extubation failure was defined as the need for ventilatory support during intensive care unit stay. Extubation failure within 48 h was also analyzed. Neurologic outcomes were recorded at 6 months. RESULTS: Extubation failure occurred in 43 (31%) patients with 31 (24%) within 48 h. Predictors of extubation failure consisted of upper-airway functions (cough, gag reflex, and deglutition) and neurologic status (Coma Recovery Scale-Revised visual subscale). From the odds ratios, a four-item predictive score was developed (area under the curve, 0.85; 95% CI, 0.77 to 0.92) and internally validated by bootstrap. Cutoff was determined with sensitivity of 92%, specificity of 50%, positive predictive value of 82%, and negative predictive value of 70% for extubation failure. Failure before and beyond 48 h shared similar risk factors. Low consciousness level patients were extubated with 85% probability of success providing the presence of at least two operating airway functions. CONCLUSIONS: A simplified clinical pragmatic score assessing cough, deglutition, gag reflex, and neurologic status was developed in a preliminary prospective cohort of brain-injured patients and was internally validated (bootstrapping). Extubation appears possible, providing functioning upper airways and irrespective of neurologic status. Clinical practice generalizability urgently needs external validation.
[Mh] Termos MeSH primário: Extubação/estatística & dados numéricos
Lesões Encefálicas/complicações
Desmame do Respirador/estatística & dados numéricos
[Mh] Termos MeSH secundário: Extubação/métodos
Lesões Encefálicas/diagnóstico
Lesões Encefálicas/fisiopatologia
Estudos de Coortes
Tosse/diagnóstico
Tosse/fisiopatologia
Deglutição/fisiologia
Feminino
Engasgo/fisiologia
Seres Humanos
Masculino
Meia-Idade
Estudos Prospectivos
Respiração Artificial/estatística & dados numéricos
Fatores de Risco
Sensibilidade e Especificidade
Falha de Tratamento
Desmame do Respirador/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170615
[Lr] Data última revisão:
170615
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161018
[St] Status:MEDLINE


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[PMID]:27973941
[Au] Autor:De Veaux CK; Montagnese TA; Heima M; Aminoshariae A; Mickel A
[Ad] Endereço:Resident, Postgraduate Endodontic Program, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio.
[Ti] Título:The Effect of Various Concentrations of Nitrous Oxide and Oxygen on the Hypersensitive Gag Reflex.
[So] Source:Anesth Prog;63(4):181-184, 2016.
[Is] ISSN:0003-3006
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The purpose of this study was to compare the effectiveness of various concentrations of N O/O on obtunding a hypersensitive gag reflex. We hypothesized that the administration of nitrous oxide and oxygen would obtund a hypersensitive gag reflex enough to allow a patient to tolerate the placement and holding of a digital x-ray sensor long enough to obtain a dental radiograph. Volunteers claiming to have a hypersensitive gag reflex were first screened to validate their claim and then tested by placing a size 2 digital x-ray sensor in the position for a periapical radiograph of the right mandibular molar area and holding it in place for 10 seconds. Subjects were first tested using room air only, then 30%, 50%, or 70% nitrous oxide until they were able to tolerate the sensor without gagging or discomfort. A visual analog scale was used for subjective responses, and other statistical tests were used to analyze the results. We found that for some subjects, 30% nitrous oxide was sufficient; for others, 50% was needed; and for the remainder of the subjects, 70% was sufficient to tolerate the test. Using a combination of 70% nitrous oxide and 30% oxygen allowed all patients claiming to have a hypersensitive gag reflex to tolerate the placement and holding of a digital x-ray sensor long enough to take a periapical radiograph.
[Mh] Termos MeSH primário: Engasgo/fisiologia
Hipersensibilidade/fisiopatologia
Óxido Nitroso/administração & dosagem
Oxigênio/administração & dosagem
[Mh] Termos MeSH secundário: Adulto
Idoso
Feminino
Seres Humanos
Masculino
Meia-Idade
Estudos Prospectivos
Escala Visual Analógica
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
K50XQU1029 (Nitrous Oxide); S88TT14065 (Oxygen)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170619
[Lr] Data última revisão:
170619
[Sb] Subgrupo de revista:D
[Da] Data de entrada para processamento:161216
[St] Status:MEDLINE


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[PMID]:27647715
[Au] Autor:Fangupo LJ; Heath AM; Williams SM; Erickson Williams LW; Morison BJ; Fleming EA; Taylor BJ; Wheeler BJ; Taylor RW
[Ad] Endereço:Departments of Human Nutrition.
[Ti] Título:A Baby-Led Approach to Eating Solids and Risk of Choking.
[So] Source:Pediatrics;138(4), 2016 Oct.
[Is] ISSN:1098-4275
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To determine the impact of a baby-led approach to complementary feeding on infant choking and gagging. METHODS: Randomized controlled trial in 206 healthy infants allocated to control (usual care) or Baby-Led Introduction to SolidS (BLISS; 8 contacts from antenatal to 9 months providing resources and support). BLISS is a form of baby-led weaning (ie, infants feed themselves all their food from the beginning of complementary feeding) modified to address concerns about choking risk. Frequencies of choking and gagging were collected by questionnaire (at 6, 7, 8, 9, 12 months) and daily calendar (at 6 and 8 months); 3-day weighed diet records measured exposure to foods posing a choking risk (at 7 and 12 months). RESULTS: A total of 35% of infants choked at least once between 6 and 8 months of age, and there were no significant group differences in the number of choking events at any time (all Ps > .20). BLISS infants gagged more frequently at 6 months (relative risk [RR] 1.56; 95% confidence interval [CI], 1.13-2.17), but less frequently at 8 months (RR 0.60; 95% CI, 0.42-0.87), than control infants. At 7 and 12 months, 52% and 94% of infants were offered food posing a choking risk during the 3-day record, with no significant differences between groups (7 months: RR 1.12; 95% CI, 0.79-1.59; 12 months: RR 0.94; 95% CI, 0.83-1.07). CONCLUSIONS: Infants following a baby-led approach to feeding that includes advice on minimizing choking risk do not appear more likely to choke than infants following more traditional feeding practices. However, the large number of children in both groups offered foods that pose a choking risk is concerning.
[Mh] Termos MeSH primário: Obstrução das Vias Respiratórias/epidemiologia
Ingestão de Alimentos
Desmame
[Mh] Termos MeSH secundário: Registros de Dieta
Feminino
Engasgo
Seres Humanos
Lactente
Masculino
Nova Zelândia/epidemiologia
Risco
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170622
[Lr] Data última revisão:
170622
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:160921
[St] Status:MEDLINE


  4 / 446 MEDLINE  
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[PMID]:27512858
[Au] Autor:Heng L; Wang MY; Sun HL; Zhu SS
[Ad] Endereço:aDepartment of Anesthesiology, Xuzhou Tumor Hospital bDepartment of Anesthesiology, Xuzhou Maternity & Child Hospital, Xuzhou, Jiangsu, RR China.
[Ti] Título:Awake nasotracheal fiberoptic intubation and self-positioning followed by anesthesia induction in prone patients: A pilot observational study.
[So] Source:Medicine (Baltimore);95(32):e4440, 2016 Aug.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Anesthesia followed by placement in the prone position takes time and may result in complications. This study aimed to evaluate the feasibility of awake nasotracheal fiberoptic intubation and self-positioning followed by anesthesia induction in prone-positioned patients under general anesthesia.Sixty-two patients (ASA physical status I-II) scheduled for awake nasotracheal fiberoptic intubation and prone self-positioning before surgery under general anesthesia were selected. Patient preparation began with detailed preoperative counseling regarding the procedure. Premedication with sedative and antisialagogue was followed by airway anesthesia with topical lidocaine; then, awake nasotracheal fiberoptic intubation was carried out. The patients then positioned themselves comfortably before induction of general anesthesia. The changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), incidence of coughing or gagging, and rate pressure product (RPP) were assessed. Statistical analysis was performed with repeated-measures one-way analysis of variance.Fifty-eight of the 62 patients completed prone self-positioning smoothly. Compared with values before intubation, SBP, DBP, HR, and RPP were slightly increased after intubation, although the difference was not statistically significant (P > 0.05). One patient had moderate coughing and 1 patient had gagging during prone self-positioning, which were tolerable.These findings indicated that awake nasotracheal fiberoptic intubation and self-positioning followed by induction of anesthesia is safe and feasible alternative to routine prone positioning after induction of general anesthesia.
[Mh] Termos MeSH primário: Anestesia Geral/métodos
Intubação Gastrointestinal/métodos
Posicionamento do Paciente
[Mh] Termos MeSH secundário: Idoso
Pressão Sanguínea
Estado de Consciência
Tosse/etiologia
Estudos de Viabilidade
Feminino
Engasgo
Frequência Cardíaca
Seres Humanos
Masculino
Fibras Ópticas
Projetos Piloto
Decúbito Ventral
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1702
[Cu] Atualização por classe:170220
[Lr] Data última revisão:
170220
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:160812
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000004440


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[PMID]:27477832
[Au] Autor:Almoznino G; Zini A; Sharav Y; Yanko R; Lvovsky A; Aframian DJ
[Ad] Endereço:Department of Oral Medicine, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel; Department of Oral Medicine, Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces, Tel-Hashomer, Israel. Electronic address: galit@almoznino.com.
[Ti] Título:Overlap between dental anxiety, gagging and Blood-Injection-Injury related fears - A spectrum of one multidimensional phenomenon.
[So] Source:Physiol Behav;165:231-8, 2016 Oct 15.
[Is] ISSN:1873-507X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND OBJECTIVES: Dental anxiety (DA) and gagging (GAG) are prevalent problems that severely impact social behavior and quality of life. Furthermore, because dental phobia is considered a Blood-Injection-Injury (B-I-I) phobia, the present study contrasted DA, GAG and control subjects regarding the severity of dental anxiety and investigated the comorbidity of GAG, DA and B-I-I fears. METHODS: Demographics, Verbal Pain Scale (VPS), Oral Health Impact Profile-14 (OHIP-14), Decay, Missing and Filled Teeth (DMFT), Dental Anxiety Scale (DAS) and response to phobic stimuli were collected from 53 GAG, 68 DA and 80 control subjects. RESULTS: GAGs exhibited results between DA and controls regarding the likelihood to have high-anxiety/phobia (DA group: OR=55.56; GAG group: OR=17.24), self-assessed dental anxiety (OR=29.14; OR=17.48), fear of dental injections (OR=8.51; OR=2.91) and dental drills (OR=12.02; OR=5.82). DA and GAG had similar results regarding: DAS score (p=0.13), fear of blood tests (OR=4.68; OR=4.09) and blood donations (OR=3.13; OR=3.10). Overlap between GAG, DA and a B-I-I fear was observed. GAG and DA patients and worse maximal VPS and OHIP-14 scores retained their significant positive association with the DAS score in the multivariate analysis. CONCLUSIONS: The co-occurrence of DA, GAG and B-I-I-related fears suggests these entities are linked. However, different anxiety levels, symptoms and triggers, reflect the broad spectrum of fear of medical/dental situations.
[Mh] Termos MeSH primário: Atitude Frente à Saúde
Ansiedade ao Tratamento Odontológico/epidemiologia
Medo/psicologia
Engasgo/fisiologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Análise de Variância
Comorbidade
Feminino
Seres Humanos
Modelos Logísticos
Masculino
Meia-Idade
Medição da Dor
Inquéritos e Questionários
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170713
[Lr] Data última revisão:
170713
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160802
[St] Status:MEDLINE


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[PMID]:27461807
[Au] Autor:Roy S; Bhayya DP; Gupta S; Upadhyay K; Tiwari S; Rao A
[Ad] Endereço:Department of Pedodontics and Preventive Dentistry, Hitkarini Dental College and Hospital, Jabalpur, Madhya Pradesh, India.
[Ti] Título:Awareness and prevention of patient gag reflex among pedodontists in India: A web-based survey.
[So] Source:J Indian Soc Pedod Prev Dent;34(3):238-43, 2016 Jul-Sep.
[Is] ISSN:1998-3905
[Cp] País de publicação:India
[La] Idioma:eng
[Ab] Resumo:AIM: The aim of this study is to devise a reliable and valid web-based survey to predict the awareness level and prevention of patient's gag reflex among Indian pedodontists. MATERIALS AND METHODS: An 11-question predictive gagging survey was created, refined, and tested on 377 pedodontists. The questions focused on age group, common procedure associated with gag reflex and the most common technique adapted by dentists in their clinics to prevent gag. RESULTS: There was no statistically significant difference in gagging reflex among age groups with 53.5% of patients reported anxiety and fear as a main cause of gag; behavioral modification technique was considered as the most reliable method for gagging prevention in 68.5% of patients and there was no statistically significant difference in gagging severity index among patients irrespective of age, causes, and methods used to prevent it. CONCLUSION: The web-based gagging survey established that level of awareness regarding management of patient's gag is significantly low among pedodontists in India and hence is a major hindrance in the clinical practice.
[Mh] Termos MeSH primário: Engasgo
Odontopediatria/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adolescente
Fatores Etários
Terapia Comportamental/métodos
Criança
Pré-Escolar
Feminino
Engasgo/prevenção & controle
Conhecimentos, Atitudes e Prática em Saúde
Seres Humanos
Índia
Masculino
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171106
[Lr] Data última revisão:
171106
[Sb] Subgrupo de revista:D
[Da] Data de entrada para processamento:160728
[St] Status:MEDLINE
[do] DOI:10.4103/0970-4388.186742


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[PMID]:27344999
[Au] Autor:Takeyama K; Suzuki T
[Ad] Endereço:Department of Anesthesiology, Tokai University School of Medicine, Tokyo Hospital, 1-2-5 Yoyogi, Shibuya-ku, Tokyo 151-0053, Japan. takeyama@is.icc.u-tokai.ac.jp.
[Ti] Título:A Case of Mediastimal Emphysema Possibly Caused by the Insertion of a Laryngoscope.
[So] Source:Tokai J Exp Clin Med;41(2):88-91, 2016 Jun 20.
[Is] ISSN:2185-2243
[Cp] País de publicação:Japan
[La] Idioma:eng
[Ab] Resumo:Insertion of a laryngoscope to a patient with a strong pharyngeal reflex resulted in pharyngeal injury and subsequent development of mediastinal emphysema. An increase in airway pressure accompanying a strong pharyngeal reflex, as well as pharyngeal injury were thought to be factors associated with the development of mediastinal emphysema.
[Mh] Termos MeSH primário: Engasgo/fisiologia
Laringoscópios/efeitos adversos
Enfisema Mediastínico/etiologia
Faringe/lesões
[Mh] Termos MeSH secundário: Adulto
Contraindicações
Feminino
Granuloma/fisiopatologia
Granuloma/cirurgia
Seres Humanos
Doença Iatrogênica
Doenças da Laringe/fisiopatologia
Doenças da Laringe/cirurgia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1703
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160628
[St] Status:MEDLINE


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[PMID]:27245000
[Au] Autor:Flores JR
[Ti] Título:Seven Protective Reflexes Every Dentist Should Know.
[So] Source:Dent Today;35(4):126-7, 2016 Apr.
[Is] ISSN:8750-2186
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Assistência Odontológica
Reflexo/fisiologia
[Mh] Termos MeSH secundário: Aclimatação
Aerossóis
Anestesia Dentária/métodos
Anestésicos Locais/administração & dosagem
Asma/prevenção & controle
Controle Comportamental
Espasmo Brônquico/fisiopatologia
Espasmo Brônquico/prevenção & controle
Tosse/fisiopatologia
Tosse/prevenção & controle
Engasgo/fisiologia
Seres Humanos
Laringismo/fisiopatologia
Laringismo/prevenção & controle
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Aerosols); 0 (Anesthetics, Local)
[Em] Mês de entrada:1606
[Cu] Atualização por classe:160601
[Lr] Data última revisão:
160601
[Sb] Subgrupo de revista:D
[Da] Data de entrada para processamento:160602
[St] Status:MEDLINE


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[PMID]:27188131
[Au] Autor:Laverty DP; Damien Walmsley A
[Ti] Título:Training Plates: A Solution for Patients Unable to Tolerate a Removable Prosthesis.
[So] Source:Dent Update;43(2):159-60, 163-6, 2016 Mar.
[Is] ISSN:0305-5000
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Dealing with patients who are unable to tolerate dentures can present a challenge to the general dental practitioner (GDP). Careful assessment of patients and their dentures will identify any causes of the intolerance to dentures. Training plates are a useful technique that can be used to allow patients to become accustomed to removable prosthesis but will inevitably lengthen the treatment process. CPD/Clinical Relevance: Training plates offer a possible solution to general dental practitioners who treat patients who are struggling to tolerate dentures.
[Mh] Termos MeSH primário: Adaptação Fisiológica/fisiologia
Bases de Dentadura
Planejamento de Dentadura
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Prótese Total Imediata
Prótese Total Superior
Prótese Parcial Removível
Prótese Parcial Temporária
Dessensibilização Psicológica/métodos
Feminino
Engasgo/prevenção & controle
Seres Humanos
Masculino
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1606
[Cu] Atualização por classe:160518
[Lr] Data última revisão:
160518
[Sb] Subgrupo de revista:D
[Da] Data de entrada para processamento:160519
[St] Status:MEDLINE


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[PMID]:26754182
[Au] Autor:Elbay M; Tak Ö; Sermet Elbay Ü; Kaya C; Eryilmaz K
[Ad] Endereço:Department of Pediatric Dentistry, Faculty of Dentistry, Kocaeli University, Izmit, Kocaeli, Turkey. elbaymesut@hotmail.com.
[Ti] Título:The use of low-level laser therapy for controlling the gag reflex in children during intraoral radiography.
[So] Source:Lasers Med Sci;31(2):355-61, 2016 Feb.
[Is] ISSN:1435-604X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:The current literature suggests that low-level laser stimulation of the PC 6 acupuncture points may prevent gagging. This study aimed to determine if low-level laser therapy (LLLT) can reduce the gag reflex in children undergoing intraoral maxillary radiography. This randomized, controlled, double-blind clinical trial was conducted with 25 children with moderate-to-very severe gag reflexes who required bilateral periapical radiographic examination of the maxillary molar region. Children's anxiety levels were initially evaluated using Corah's Dental Anxiety Scale (DAS) to identify any possible relationship between gagging and anxiety. A control radiograph was taken of one randomly selected side in each patient after simulated laser application so that the patient was blinded to the experimental conditions (control group). Laser stimulation was then performed for the experimental side. A laser probe was placed on the Pericardium 6 (PC 6) acupuncture point on each wrist, and laser energy was delivered for 14 s (300 mW, energy density 4 J/cm(2)) at a distance of 1 cm from the target tissue. Following laser stimulation, the experimental radiograph was taken (experimental group). Gagging responses were measured using the Gagging Severity Criteria for each group. Data were analyzed using Spearman's rho correlations and Mann-Whitney U tests. Both mean and median gagging scores were higher in the control group than in the experimental group. Patients who were unable to tolerate the intraoral control radiography were able to tolerate the procedure after LLLT. Differences between gagging scores of the control and experimental groups were statistically significant (P = .000). There was no significant correlation between gagging severity and anxiety score (P > .05). A negative correlation was found between age and gagging score in the control group (P Ë‚ .05). Within the limitations of this study, LLLT of the PC 6 acupuncture points appears to be a useful technique for controlling the gag reflex in children during maxillary radiography.
[Mh] Termos MeSH primário: Engasgo/efeitos da radiação
Terapia com Luz de Baixa Intensidade
Dente Molar/diagnóstico por imagem
Radiografia/efeitos adversos
Reflexo/efeitos da radiação
[Mh] Termos MeSH secundário: Pontos de Acupuntura
Criança
Método Duplo-Cego
Feminino
Engasgo/prevenção & controle
Seres Humanos
Masculino
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1610
[Cu] Atualização por classe:171013
[Lr] Data última revisão:
171013
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160113
[St] Status:MEDLINE
[do] DOI:10.1007/s10103-016-1869-z



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