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[PMID]:29466151
[Au] Autor:Comerci G; Katzman J; Duhigg D
[Ad] Endereço:From the Pain Consultation and Treatment Center, Project ECHO Pain and Opioid Management Clinic (G.C., J.K.), the Department of Internal Medicine (G.C.), and the Department of Neurosurgery (J.K.), University of New Mexico, and Department of Addiction Services, Psychiatry and Behavioral Health Clinical Program, Presbyterian Healthcare System (D.D.) - all in Albuquerque, NM.
[Ti] Título:Controlling the Swing of the Opioid Pendulum.
[So] Source:N Engl J Med;378(8):691-693, 2018 Feb 22.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Analgésicos Opioides/uso terapêutico
Buprenorfina/uso terapêutico
Dor Crônica/tratamento farmacológico
Transtornos Relacionados ao Uso de Opioides/prevenção & controle
[Mh] Termos MeSH secundário: Prescrições de Medicamentos
Regulamentação Governamental
Seres Humanos
Legislação de Medicamentos
Tratamento de Substituição de Opiáceos
Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Analgesics, Opioid); 40D3SCR4GZ (Buprenorphine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180222
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMp1713159


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[PMID]:29443676
[Au] Autor:Provenzano AM
[Ad] Endereço:From the MGH Chelsea Health Center, Chelsea, and Harvard Medical School, Boston - both in Massachusetts.
[Ti] Título:Caring for Ms. L. - Overcoming My Fear of Treating Opioid Use Disorder.
[So] Source:N Engl J Med;378(7):600-601, 2018 Feb 15.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Buprenorfina/uso terapêutico
Antagonistas de Entorpecentes/uso terapêutico
Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico
Relações Médico-Paciente
Médicos de Atenção Primária/psicologia
[Mh] Termos MeSH secundário: Medo
Feminino
Redução do Dano
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; PERSONAL NARRATIVES
[Nm] Nome de substância:
0 (Narcotic Antagonists); 40D3SCR4GZ (Buprenorphine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180215
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMp1715093


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[PMID]:27776678
[Au] Autor:Moore BA; Fiellin DA; Cutter CJ; Buono FD; Barry DT; Fiellin LE; O'Connor PG; Schottenfeld RS
[Ad] Endereço:Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA. Electronic address: brent.moore@yale.edu.
[Ti] Título:Cognitive Behavioral Therapy Improves Treatment Outcomes for Prescription Opioid Users in Primary Care Buprenorphine Treatment.
[So] Source:J Subst Abuse Treat;71:54-57, 2016 12.
[Is] ISSN:1873-6483
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:To determine whether treatment outcomes differed for prescription opioid and heroin use disorder patients, we conducted a secondary analysis of a 24-week (N=140) randomized trial of physician management (PM) or PM plus cognitive behavioral therapy (CBT) in primary care buprenorphine/naloxone treatment. Self-reported opioid use and urine toxicology analyses were obtained weekly. We examined baseline demographic differences between primary prescription opioid use patients (n=49) and primary heroin use patients (n=91) and evaluated whether treatment response differed by assigned condition. Compared to primary heroin use patients, primary prescription opioid use patients had marginally fewer years of opioid use, were less likely to have had a previous drug treatment or detoxification, and were less likely to report injection drug use. Although opioid abstinence only, and treatment retention did not differ by opioid use group, opioid category moderated the effect of CBT on urine samples negative for all drugs. Primary prescription opioid use patients assigned to PM-CBT had more than twice the mean number of weeks of abstinence for all drugs (7.6) than those assigned to PM only (3.6; p=.02), while primary heroin use patients did not differ by treatment. Findings suggest that examination of other factors that may predict response to behavioral interventions is warranted.
[Mh] Termos MeSH primário: Analgésicos Opioides/farmacologia
Buprenorfina/farmacologia
Terapia Cognitiva/métodos
Tratamento de Substituição de Opiáceos/métodos
Transtornos Relacionados ao Uso de Opioides/terapia
Avaliação de Resultados (Cuidados de Saúde)
Transtornos Relacionados ao Uso de Substâncias/terapia
[Mh] Termos MeSH secundário: Adulto
Analgésicos Opioides/administração & dosagem
Buprenorfina/administração & dosagem
Terapia Combinada
Feminino
Seres Humanos
Masculino
Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico
Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, N.I.H., EXTRAMURAL
[Nm] Nome de substância:
0 (Analgesics, Opioid); 40D3SCR4GZ (Buprenorphine)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180215
[Lr] Data última revisão:
180215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE


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[PMID]:27770695
[Au] Autor:Carrieri P; Vilotitch A; Nordmann S; Lions C; Michel L; Mora M; Morel A; Maradan G; Spire B; Roux P; Methaville Study Group
[Ad] Endereço:INSERM U912 (SESSTIM), Marseille, France; Université Aix Marseille, IRD, UMR-S912, Marseille, France; ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France.
[Ti] Título:Decrease in self-reported offences and incarceration rates during methadone treatment: A comparison between patients switching from buprenorphine to methadone and maintenance treatment incident users (ANRS-Methaville trial).
[So] Source:Int J Drug Policy;39:86-91, 2017 01.
[Is] ISSN:1873-4758
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Patients receiving buprenorphine who are poor responders can continue to commit drug-related offences. Switching them from buprenorphine to methadone may result in reduced criminal behaviour. We compared self-reported offences and incarceration before and after starting methadone treatment of patients switching from buprenorphine (PSB) and maintenance treatment incident users (MIU). METHODS: Data on offences, incarceration and other information, were obtained via a telephone interview. Mixed models were used to assess the impact of methadone initiation and being PSB or MIU on (1) the number of days when offences were committed (drug sale, drug purchase, other offences) and (2) experiencing incarceration during the previous 6 months. RESULTS: Among the 176 patients with at least one assessment for self-reported offences, 51.7% were PSB. Receiving methadone was significantly associated with a reduction in the number of days when drug sale or drug purchase offences were committed, but not other offences. PSB and MIU groups were different only for drug purchase, as PSB were more likely to have a higher number of days of drug purchase from month 3 onwards. A reduction of 77% in the likelihood of experiencing incarceration was observed and this was comparable in PSB and MIU. CONCLUSION: Switching non-responding buprenorphine patients to methadone can result in a major reduction in offences and incarceration rates. Increasing access to methadone, using more flexible models of care is urgent for clinical and public health reasons.
[Mh] Termos MeSH primário: Buprenorfina/efeitos adversos
Crime/estatística & dados numéricos
Metadona/efeitos adversos
[Mh] Termos MeSH secundário: Adulto
Tráfico de Drogas/estatística & dados numéricos
Feminino
França
Seres Humanos
Masculino
Tratamento de Substituição de Opiáceos/estatística & dados numéricos
Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos
Autorrelato
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
40D3SCR4GZ (Buprenorphine); UC6VBE7V1Z (Methadone)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180207
[Lr] Data última revisão:
180207
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161023
[St] Status:MEDLINE


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[PMID]:28457152
[Au] Autor:Woody GE
[Ad] Endereço:From the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
[Ti] Título:Current Progress in Opioid Treatment.
[So] Source:Am J Psychiatry;174(5):414-416, 2017 05 01.
[Is] ISSN:1535-7228
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Naltrexona
Antagonistas de Entorpecentes
[Mh] Termos MeSH secundário: Buprenorfina
Seres Humanos
Transtornos Relacionados ao Uso de Opioides
Síndrome de Abstinência a Substâncias
[Pt] Tipo de publicação:EDITORIAL; COMMENT
[Nm] Nome de substância:
0 (Narcotic Antagonists); 40D3SCR4GZ (Buprenorphine); 5S6W795CQM (Naltrexone)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180123
[Lr] Data última revisão:
180123
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.1176/appi.ajp.2016.16121398


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Registro de Ensaios Clínicos
Registro de Ensaios Clínicos
Texto completo
[PMID]:28468518
[Au] Autor:Kraft WK; Adeniyi-Jones SC; Chervoneva I; Greenspan JS; Abatemarco D; Kaltenbach K; Ehrlich ME
[Ad] Endereço:From Sidney Kimmel Medical College, Thomas Jefferson University (W.K.K., S.C.A.-J., I.C., J.S.G., D.A., K.K.), and Nemours duPont Pediatrics, Thomas Jefferson University Hospital (S.C.A.-J., J.S.G.) - both in Philadelphia; and the Departments of Neurology, Pediatrics, and Genetics and Genomic Scienc
[Ti] Título:Buprenorphine for the Treatment of the Neonatal Abstinence Syndrome.
[So] Source:N Engl J Med;376(24):2341-2348, 2017 06 15.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Current pharmacologic treatment of the neonatal abstinence syndrome with morphine is associated with a lengthy duration of therapy and hospitalization. Buprenorphine may be more effective than morphine for this indication. METHODS: In this single-site, double-blind, double-dummy clinical trial, we randomly assigned 63 term infants (≥37 weeks of gestation) who had been exposed to opioids in utero and who had signs of the neonatal abstinence syndrome to receive either sublingual buprenorphine or oral morphine. Infants with symptoms that were not controlled with the maximum dose of opioid were treated with adjunctive phenobarbital. The primary end point was the duration of treatment for symptoms of neonatal opioid withdrawal. Secondary clinical end points were the length of hospital stay, the percentage of infants who required supplemental treatment with phenobarbital, and safety. RESULTS: The median duration of treatment was significantly shorter with buprenorphine than with morphine (15 days vs. 28 days), as was the median length of hospital stay (21 days vs. 33 days) (P<0.001 for both comparisons). Adjunctive phenobarbital was administered in 5 of 33 infants (15%) in the buprenorphine group and in 7 of 30 infants (23%) in the morphine group (P=0.36). Rates of adverse events were similar in the two groups. CONCLUSIONS: Among infants with the neonatal abstinence syndrome, treatment with sublingual buprenorphine resulted in a shorter duration of treatment and shorter length of hospital stay than treatment with oral morphine, with similar rates of adverse events. (Funded by the National Institute on Drug Abuse; BBORN ClinicalTrials.gov number, NCT01452789 .).
[Mh] Termos MeSH primário: Analgésicos Opioides/efeitos adversos
Analgésicos Opioides/uso terapêutico
Buprenorfina/uso terapêutico
Síndrome de Abstinência Neonatal/tratamento farmacológico
Tratamento de Substituição de Opiáceos
[Mh] Termos MeSH secundário: Administração Oral
Administração Sublingual
Buprenorfina/efeitos adversos
Método Duplo-Cego
Quimioterapia Combinada
Feminino
Seres Humanos
Hipnóticos e Sedativos/uso terapêutico
Recém-Nascido
Tempo de Internação
Masculino
Morfina/efeitos adversos
Morfina/uso terapêutico
Fenobarbital/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Analgesics, Opioid); 0 (Hypnotics and Sedatives); 40D3SCR4GZ (Buprenorphine); 76I7G6D29C (Morphine); YQE403BP4D (Phenobarbital)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:180121
[Lr] Data última revisão:
180121
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170505
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMoa1614835


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[PMID]:29190831
[Au] Autor:Lugoboni F; Zamboni L; Federico A; Tamburin S; Gruppo InterSERT di Collaborazione Scientifica (GICS)
[Ad] Endereço:Department of Medicine, Addiction Medicine Unit, Verona University Hospital, Verona, Italy.
[Ti] Título:Erectile dysfunction and quality of life in men receiving methadone or buprenorphine maintenance treatment. A cross-sectional multicentre study.
[So] Source:PLoS One;12(11):e0188994, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Erectile dysfunction (ED) is common among men on opioid replacement therapy (ORT), but most previous studies exploring its prevalence and determinants yielded contrasting findings. Moreover, the impact of ED on patients' quality of life (QoL) has been seldom explored. OBJECTIVE: To explore the prevalence and determinants of ED in men on ORT, and the impact on QoL. METHODS: In a multicentre cross-sectional study, we recruited 797 consecutive male patients on methadone and buprenorphine treatment, collected data on demographic, clinical, and psychopathological factors, and explored their role as predictors of ED and QoL through univariate and multivariate analysis. ED severity was assessed with a self-assessment questionnaire. RESULTS: Nearly half of patients in our sample were sexually inactive or reported some degree of ED. Some demographic, clinical and psychopathological variables significantly differed according to the presence or absence of ED. Multivariate regression analysis indicated that age, employment, smoke, psychoactive drugs, opioid maintenance dosage, and severity of psychopathological factors significantly influenced the risk and severity of ED. QoL was worse in patients with ED and significantly correlated with ED severity. Age, education, employment, opioid maintenance dosage, ED score, and severity of psychopathology significantly influenced QoL in the multivariate analysis. CONCLUSIONS: ED complaints can be explored in male opioid users on ORT through a simple and quick self-assessment tool. ED may have important effects on emotional and social well-being, and may affect outcome.
[Mh] Termos MeSH primário: Buprenorfina/administração & dosagem
Disfunção Erétil
Metadona/administração & dosagem
Tratamento de Substituição de Opiáceos/efeitos adversos
Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico
Qualidade de Vida
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Estudos Transversais
Seres Humanos
Masculino
Meia-Idade
Transtornos Relacionados ao Uso de Opioides/fisiopatologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Nm] Nome de substância:
40D3SCR4GZ (Buprenorphine); UC6VBE7V1Z (Methadone)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180101
[Lr] Data última revisão:
180101
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0188994


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[PMID]:29040331
[Au] Autor:Lagisetty P; Klasa K; Bush C; Heisler M; Chopra V; Bohnert A
[Ad] Endereço:Division of General Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, United States of America.
[Ti] Título:Primary care models for treating opioid use disorders: What actually works? A systematic review.
[So] Source:PLoS One;12(10):e0186315, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Primary care-based models for Medication-Assisted Treatment (MAT) have been shown to reduce mortality for Opioid Use Disorder (OUD) and have equivalent efficacy to MAT in specialty substance treatment facilities. OBJECTIVE: The objective of this study is to systematically analyze current evidence-based, primary care OUD MAT interventions and identify program structures and processes associated with improved patient outcomes in order to guide future policy and implementation in primary care settings. DATA SOURCES: PubMed, EMBASE, CINAHL, and PsychInfo. METHODS: We included randomized controlled or quasi experimental trials and observational studies evaluating OUD treatment in primary care settings treating adult patient populations and assessed structural domains using an established systems engineering framework. RESULTS: We included 35 interventions (10 RCTs and 25 quasi-experimental interventions) that all tested MAT, buprenorphine or methadone, in primary care settings across 8 countries. Most included interventions used joint multi-disciplinary (specialty addiction services combined with primary care) and coordinated care by physician and non-physician provider delivery models to provide MAT. Despite large variability in reported patient outcomes, processes, and tasks/tools used, similar key design factors arose among successful programs including integrated clinical teams with support staff who were often advanced practice clinicians (nurses and pharmacists) as clinical care managers, incorporating patient "agreements," and using home inductions to make treatment more convenient for patients and providers. CONCLUSIONS: The findings suggest that multidisciplinary and coordinated care delivery models are an effective strategy to implement OUD treatment and increase MAT access in primary care, but research directly comparing specific structures and processes of care models is still needed.
[Mh] Termos MeSH primário: Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico
Atenção Primária à Saúde
[Mh] Termos MeSH secundário: Adulto
Buprenorfina/uso terapêutico
Assistência à Saúde
Seres Humanos
Metadona/uso terapêutico
Transtornos Relacionados ao Uso de Opioides/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
40D3SCR4GZ (Buprenorphine); UC6VBE7V1Z (Methadone)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171031
[Lr] Data última revisão:
171031
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171018
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0186315


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[PMID]:28966276
[Au] Autor:Ishikawa K; Karaki F; Tayama K; Higashi E; Hirayama S; Itoh K; Fujii H
[Ad] Endereço:Laboratory of Medicinal Chemistry, School of Pharmacy, Kitasato University.
[Ti] Título:C-Homomorphinan Derivatives as Lead Compounds to Obtain Safer and More Clinically Useful Analgesics.
[So] Source:Chem Pharm Bull (Tokyo);65(10):920-929, 2017.
[Is] ISSN:1347-5223
[Cp] País de publicação:Japan
[La] Idioma:eng
[Ab] Resumo:Buprenorphine shows strong analgesic effects on moderate to severe pain. Although buprenorphine can be used more safely than other opioid analgesics, it has room for improvement in clinical utility. Investigation of compounds structurally related to buprenorphine should be an approach to obtain novel analgesics with safer and improved profiles compared to buprenorphine. In the course of our previous studies, we observed that derivatives obtained by cyclizing C-homomorphinans were structurally related to buprenorphine. Hence, we synthesized cyclized C-homomorphinan derivatives with various oxygen functionalities on the side chains and evaluated their in vitro pharmacological profiles for the opioid receptors. Among the tested compounds, methyl ketone 2a with an N-methyl group showed full agonistic activities for the µ and the δ receptors and partial agonistic activity for the κ receptor. These properties were similar to those of norbuprenorphine, a major metabolite of buprenorphine, which reportedly contributes to the antinociceptive effect of buprenorphine. From these results, we concluded that cyclized C-homomorphinan would be a possible lead compound to obtain novel analgesics with buprenorphine-like properties.
[Mh] Termos MeSH primário: Analgésicos Opioides/química
Morfinanos/química
[Mh] Termos MeSH secundário: Analgésicos Opioides/síntese química
Animais
Buprenorfina/análogos & derivados
Buprenorfina/química
Células CHO
Cricetinae
Cricetulus
Ciclização
Seres Humanos
Cinética
Conformação Molecular
Morfinanos/síntese química
Ligação Proteica
Receptores Opioides/química
Receptores Opioides/genética
Receptores Opioides/metabolismo
Proteínas Recombinantes/biossíntese
Proteínas Recombinantes/química
Proteínas Recombinantes/isolamento & purificação
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Analgesics, Opioid); 0 (Morphinans); 0 (Receptors, Opioid); 0 (Recombinant Proteins); 40D3SCR4GZ (Buprenorphine); 7E53B4O073 (norbuprenorphine)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171003
[St] Status:MEDLINE
[do] DOI:10.1248/cpb.c17-00385


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[PMID]:28880503
[Au] Autor:Grossman MR; Berkwitt AK; Osborn RR
[Ad] Endereço:Yale School of Medicine, New Haven, CT
[Ti] Título:Buprenorphine for the Neonatal Abstinence Syndrome.
[So] Source:N Engl J Med;377(10):996-7, 2017 09 07.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Buprenorfina
Síndrome de Abstinência Neonatal
[Mh] Termos MeSH secundário: Seres Humanos
Recém-Nascido
Metadona
Tratamento de Substituição de Opiáceos
Transtornos Relacionados ao Uso de Opioides
Complicações na Gravidez
[Pt] Tipo de publicação:LETTER; COMMENT
[Nm] Nome de substância:
40D3SCR4GZ (Buprenorphine); UC6VBE7V1Z (Methadone)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171031
[Lr] Data última revisão:
171031
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170908
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMc1709121



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