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Pesquisa : E03.250 [Categoria DeCS]
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[PMID]:29198818
[Au] Autor:Kim HJ; Park BK; Chung IS
[Ad] Endereço:Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
[Ti] Título:Comparison of General Anesthesia and Conscious Sedation During Computed Tomography-Guided Radiofrequency Ablation of T1a Renal Cell Carcinoma.
[So] Source:Can Assoc Radiol J;69(1):24-29, 2018 Feb.
[Is] ISSN:1488-2361
[Cp] País de publicação:Canada
[La] Idioma:eng
[Ab] Resumo:PURPOSE: Percutaneous radiofrequency ablation is so painful that this treatment requires pain control such as conscious sedation or general anesthesia. It is still unclear which type of anesthesia is better for treatment outcomes of renal cell carcinoma. This study aimed to compare general anesthesia and conscious sedation in treating patients with renal cell carcinoma with radiofrequency ablation. METHODS: Between 2010 and 2015, 51 patients with biopsy-proven renal cell carcinomas (<4 cm) were treated with computed tomography-guided radiofrequency ablation. General anesthesia was performed in 41 and conscious sedation was performed in 10 patients. Tumour size, local tumour progression, metastasis, major complication, effective dose, glomerular filtration rate difference, and recurrence-free survival rate were compared between these groups. RESULTS: The mean tumour size was 2.1 cm in both groups (P = .673). Local tumour progression occurred in 0% (0 of 41) of the general anesthesia group, but in 40% (4 of 10) of the conscious sedation group (P = .001). Metastases in these groups occurred in 2.4% (1 of 41) of the general anesthesia group and 20% (2 of 10) of the conscious sedation group (P = .094). No major complications developed in either group after the first radiofrequency ablation session. The mean effective doses in these groups were 21.7 mSv and 21.2 mSv, respectively (P = .868). The mean glomerular filtration rate differences in the general anesthesia and conscious sedation groups were -13.5 mL/min/1.73 m and -19.1 mL/min/1.73 m , respectively (P = .575). Three-year recurrence-free survival rates in these groups were 97.6% and 60.0%, respectively (P = .001). CONCLUSIONS: General anesthesia may provide better intermediate outcomes than conscious sedation in treating small renal cell carcinomas with radiofrequency ablation.
[Mh] Termos MeSH primário: Anestesia Geral/métodos
Carcinoma de Células Renais/cirurgia
Ablação por Cateter/métodos
Sedação Consciente/métodos
Neoplasias Renais/cirurgia
Manejo da Dor/métodos
Tomografia Computadorizada por Raios X/métodos
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Carcinoma de Células Renais/diagnóstico por imagem
Feminino
Seres Humanos
Neoplasias Renais/diagnóstico por imagem
Masculino
Meia-Idade
Radiografia Intervencionista/métodos
Estudos Retrospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171205
[St] Status:MEDLINE


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[PMID]:29390531
[Au] Autor:Tu Y; Gao F
[Ad] Endereço:Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China.
[Ti] Título:Dexmedetomidine-based monitored conscious sedation combined local anesthesia for levator resection in a 10-year-old child with Marcus Gunn jaw-winking synkinesis: A case report.
[So] Source:Medicine (Baltimore);96(51):e9369, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Levator resection has become a routine procedure for patients with severe Marcus Gunn jaw-winking synkinesis (MGJWS). To optimize the surgical outcome, adult patients need to be kept awake, or easily aroused and responsive to verbal commands during the operation. However, levator resection is commonly performed under general anesthesia in pediatric patients. In the present case, we described a successful anesthetic protocol of conscious sedation with local anesthesia for levator resection in a child. PATIENT CONCERNS: A 10-year-old boy with MGJWS was admitted to our hospital and scheduled for levator resection. The patient was born through a normal delivery and had no previous history of allergy, no comorbidity, and no history of receiving anesthesia or operation. The laboratory tests of the patient were unremarkable. DIAGNOSES: The diagnosis of MGJWS was made by two experienced ophthalmologists. INTERVENTIONS: A 10-year-old boy with MGJWS was admitted to our hospital and scheduled for levator resection. The levator resection was performed under monitored conscious sedation with dexmedetomidine and local anesthesia. OUTCOMES: Patient with spontaneous breathing responded normally to verbal commands throughout the operation, and no adverse events occurred. The patient and ophthalmologist reported high satisfaction with anesthesia management. LESSONS: Dexmedetomidine-based monitored conscious sedation with local anesthesia is a feasible alternative to general anesthesia for levator resection in collaborative patients.
[Mh] Termos MeSH primário: Blefaroptose/diagnóstico
Blefaroptose/terapia
Dexmedetomidina/administração & dosagem
Cardiopatias Congênitas/diagnóstico
Cardiopatias Congênitas/terapia
Anormalidades Maxilomandibulares/diagnóstico
Anormalidades Maxilomandibulares/terapia
Monitorização Fisiológica/métodos
Doenças do Sistema Nervoso/diagnóstico
Doenças do Sistema Nervoso/terapia
Músculos Oculomotores/cirurgia
[Mh] Termos MeSH secundário: Anestesia Local
Criança
Sedação Consciente/métodos
Seguimentos
Seres Humanos
Masculino
Doenças Raras
Reflexo Anormal
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
67VB76HONO (Dexmedetomidine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180219
[Lr] Data última revisão:
180219
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009369


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[PMID]:29202258
[Au] Autor:Shehabi Y; Forbes AB; Arabi Y; Bass F; Bellomo R; Kadiman S; Howe BD; McArthur C; Reade MC; Seppelt I; Takala J; Webb S; Wise MP; The SPICE III study investigators ; The Australian and New Zealand Intensive Care Society Clinical Trials Group ; The Australian and New Zealand Intensive Care Research Centre
[Ad] Endereço:Monash University, Melbourne, VIC, Australia. yahya.shehabi@monashhealth.org.
[Ti] Título:The SPICE III study protocol and analysis plan: a randomised trial of early goaldirected sedation compared with standard care in mechanically ventilated patients.
[So] Source:Crit Care Resusc;19(4):318-326, 2017 Dec.
[Is] ISSN:1441-2772
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Sedation strategy in critically ill patients who are mechanically ventilated is influenced by patient-related factors, choice of sedative agent and the intensity or depth of sedation prescribed. The impact of sedation strategy on outcome, in particular when delivered early after initiation of mechanical ventilation, is uncertain. OBJECTIVES: To present the protocol and analysis plan of a large randomised clinical trial investigating the effect of a sedation strategy, in critically ill patients who are mechanically ventilated, based on a protocol targeting light sedation using dexmedetomidine as the primary sedative, termed "early goal-directed sedation", compared with usual practice. METHODS: This is a multinational randomised clinical trial in adult intensive care patients expected to require mechanical ventilation for longer than 24 hours. The main exclusion criteria include suspected or proven primary brain pathology or having already been intubated or sedated in an intensive care unit for longer than 12 hours. Randomisation occurs via a secured website with baseline stratification by site and suspected or proven sepsis. The primary outcome is 90-day all-cause mortality. Secondary outcomes include death, institutional dependency, cognitive function and health-related quality of life 180 days after randomisation, as well as deliriumfree, coma-free and ventilation-free days at 28 days after randomisation. A predefined subgroup analysis will also be conducted. Analyses will be on an intention-to-treat basis and in accordance with this pre-specified analysis plan. CONCLUSION: SPICE III is an ongoing large scale clinical trial. Once completed, it will inform sedation practice in critically ill patients who are ventilated.
[Mh] Termos MeSH primário: Sedação Consciente/métodos
Estado Terminal
Dexmedetomidina/administração & dosagem
Hipnóticos e Sedativos/administração & dosagem
Respiração Artificial
[Mh] Termos MeSH secundário: Protocolos Clínicos
Seres Humanos
Unidades de Terapia Intensiva
Estudos Prospectivos
Projetos de Pesquisa
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Hypnotics and Sedatives); 67VB76HONO (Dexmedetomidine)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180104
[Lr] Data última revisão:
180104
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171205
[St] Status:MEDLINE


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[PMID]:29182126
[Au] Autor:Jordan RW; Aquilina A; Westacott DJ; Cooke S
[Ti] Título:A comparison of ketamine sedation and general anaesthesia for manipulation of paediatric forearm fractures.
[So] Source:Acta Orthop Belg;82(4):836-842, 2016 Dec.
[Is] ISSN:0001-6462
[Cp] País de publicação:Belgium
[La] Idioma:eng
[Ab] Resumo:The purpose of the study was to compare the use of ketamine sedation and general anaesthesia for manipulation of paediatric wrist and forearm fractures. A retrospective analysis was performed of patients under 16 years treated at our centre between October 2014 and October 2015. Exclusion criteria were open fractures and fractures with complete displacement. Outcomes measured were fracture reduction, the quality of the cast, fracture redisplacement, further surgical intervention and use of theatre time. 66 children were manipulated over the study period; 31 received ketamine sedation and 35 general anaesthesia. No statistically significant difference was found in the rate of re-intervention (p=0.48), quality of reduction (p=0.39), quality of cast (p=0.14 and p=0.21), or redisplacement (p=0.87). Those undergoing general anaesthesia used on average 50 minutes of theatre time and one third required an overnight admission. We conclude that ketamine sedation achieves comparable treatment outcomes to general anaesthesia whilst using fewer resources.
[Mh] Termos MeSH primário: Anestesia Geral/métodos
Anestésicos Dissociativos/uso terapêutico
Redução Fechada/métodos
Sedação Consciente/métodos
Traumatismos do Antebraço/cirurgia
Ketamina/uso terapêutico
[Mh] Termos MeSH secundário: Criança
Feminino
Seres Humanos
Masculino
Fraturas do Rádio/cirurgia
Estudos Retrospectivos
Fraturas da Ulna/cirurgia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anesthetics, Dissociative); 690G0D6V8H (Ketamine)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171228
[Lr] Data última revisão:
171228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE


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[PMID]:28466100
[Au] Autor:Karube N; Ito S; Sako S; Hirokawa J; Yokoyama T
[Ad] Endereço:Department of Dental Anesthesiology, Faculty of Dental Science, Kyushu University, Fukuoka, 812-8582, Japan.
[Ti] Título:Sedative effects of oral pregabalin premedication on intravenous sedation using propofol target-controlled infusion.
[So] Source:J Anesth;31(4):586-592, 2017 Aug.
[Is] ISSN:1438-8359
[Cp] País de publicação:Japan
[La] Idioma:eng
[Ab] Resumo:PURPOSE: The sedative effects of pregabalin during perioperative period have not been sufficiently characterized. The aim of this study was to verify the sedative effects of premedication with pregabalin on intravenous sedation (IVS) using propofol and also to assess the influences of this agent on circulation, respiration, and postanesthetic complications. METHODS: Ten healthy young volunteers underwent 1 h of IVS using propofol, three times per subject, on separate days (first time, no pregabalin; second time, pregabalin 100 mg; third time, pregabalin 200 mg). The target blood concentration (C ) of propofol was increased in a stepwise fashion based on the bispectral index (BIS) value. Ramsay's sedation score (RSS) was determined at each propofol C . Propofol C was analyzed at each sedation level. Circulation and respiration during IVS and complications were also verified. RESULTS: Propofol C was reduced at BIS values of 60 and 70 in both premedicated groups (100 mg: p = 0.043 and 0.041; 200 mg: p = 0.004 and 0.016, respectively) and at a BIS value of 80 in the pregabalin 200 mg group (p < 0.001). Propofol C was decreased at RSS 4-6 in the pregabalin 100 mg group (RSS 4: p = 0.047; RSS 5: p = 0.007; RSS 6: p = 0.014), and at RSS 3-6 in the pregabalin 200 mg group (RSS 3-5: p < 0.001; RSS 6: p = 0.002). CONCLUSION: We conclude that oral premedication with pregabalin reduces the amount of propofol required to obtain an acceptable and adequate sedation level.
[Mh] Termos MeSH primário: Hipnóticos e Sedativos/administração & dosagem
Pregabalina/administração & dosagem
Pré-Medicação/métodos
Propofol/administração & dosagem
[Mh] Termos MeSH secundário: Adulto
Anestesia/métodos
Sedação Consciente/métodos
Eletroencefalografia
Feminino
Seres Humanos
Masculino
Adulto Jovem
[Pt] Tipo de publicação:CLINICAL TRIAL; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Hypnotics and Sedatives); 55JG375S6M (Pregabalin); YI7VU623SF (Propofol)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171207
[Lr] Data última revisão:
171207
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE
[do] DOI:10.1007/s00540-017-2366-7


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[PMID]:28920646
[Ti] Título:Statement on the use of general anesthetics and sedation drugs in children and pregnant women.
[So] Source:Bull Am Coll Surg;102(4):39, 2017 04.
[Is] ISSN:0002-8045
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Anestesia Geral
Anestésicos Gerais/administração & dosagem
Sedação Consciente
Hipnóticos e Sedativos/administração & dosagem
[Mh] Termos MeSH secundário: Adulto
Comitês Consultivos
Anestesia Geral/efeitos adversos
Anestésicos Gerais/efeitos adversos
Pré-Escolar
Sedação Consciente/efeitos adversos
Feminino
Seres Humanos
Hipnóticos e Sedativos/efeitos adversos
Lactente
Recém-Nascido
Masculino
Gravidez
Sociedades Médicas
Estados Unidos
United States Food and Drug Administration
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anesthetics, General); 0 (Hypnotics and Sedatives)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171010
[Lr] Data última revisão:
171010
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:170919
[St] Status:MEDLINE


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[PMID]:28880899
[Au] Autor:Kang H; Nakae A; Ito H; Vitayaburananont P; Minamoto T; Ikeda T; Osaka M; Mashimo T; Fujino Y; Hagihira S
[Ad] Endereço:Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
[Ti] Título:Effects of sedation on subjective perception of pain intensity and autonomic nervous responses to pain: A preliminary study.
[So] Source:PLoS One;12(9):e0183635, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Rather than relying solely on subjective pain evaluation using means such as the visual analogue scale (VAS), in clinical situations it is possible to observe evoked responses of the autonomic nervous system (ANS) as objective indicators. Few studies, however, have reported these relationships under finely controlled sedation. 16 healthy male participants were administrated in intravenous sedation with either propofol or midazolam randomly. We initially determined, using pharmacokinetic simulation, the effect-site concentration (Ce) of anaesthetic at loss of response to verbal command and eyelash reflex (Ce-LOR). Then subsequently adjusted Ce to 75%, 50%, and 25% of Ce-LOR to achieve deep, moderate, and light sedation. At awake control state and each sedation level, a noxious electrical stimulation was applied three times at the right forearm, an average pain intensity of the three stimuli was rated on a VAS (0-10). Changes in the peripheral perfusion index measured by oximetry were used as an indicator of ANS response. We analyzed the influence of sedation level on VAS and ANS responses compared to the awake control state. While ANS responses were similar in all conditions, VAS was statistically significantly lower in moderate (5.6±0.6, p <0.005) or deep (5.3±0.6, p <0.001) sedation than in the awake state (7.2±0.4). This study revealed that even when the ANS responds similarly to the same stimulation, subjective pain perception is attenuated by sedation. A cerebral mechanism other than that of the brainstem might determine subjective pain intensity.
[Mh] Termos MeSH primário: Sistema Nervoso Autônomo/efeitos dos fármacos
Hipnóticos e Sedativos/uso terapêutico
Midazolam/uso terapêutico
Dor/tratamento farmacológico
Propofol/uso terapêutico
[Mh] Termos MeSH secundário: Adulto
Anestésicos Intravenosos
Sedação Consciente
Seres Humanos
Hipnóticos e Sedativos/administração & dosagem
Masculino
Midazolam/administração & dosagem
Medição da Dor
Propofol/administração & dosagem
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Anesthetics, Intravenous); 0 (Hypnotics and Sedatives); R60L0SM5BC (Midazolam); YI7VU623SF (Propofol)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170908
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0183635


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[PMID]:28872988
[Au] Autor:Blumer S; Peretz B; Zisman G; Ratson T
[Ti] Título:Effect of Sedation with Midazolam and Time to Discharge among Pediatric Dental Patients.
[So] Source:J Clin Pediatr Dent;41(5):384-387, 2017.
[Is] ISSN:1053-4628
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The aim of this study was to examine the recovery time of children who underwent conscious sedation with oral or rectal midazolam. STUDY DESIGN: The medical files in the Department of Pediatric Dentistry of all the children who underwent conscious sedation with midazolam between 3/2013-4/2016 were examined. The total duration of sedation and time to discharge were calculated. Descriptions of the children's behavior before and during sedation were compared. RESULTS: The files of 120 children were retrieved. They included 64 girls, mean (± standard deviation) age 5.7 ± 2.67 years and 56 boys, mean age 4.9 ±1.06 years. The mean weight for the entire cohort was 18.7 ± 5.2 kg. Eighty-one children (67.5%) received oral sedation and 39 (32.5%) received rectal sedation. The mean total duration of sedation was 105 ± 26 min, and the mean time to discharge after treatment was 55:17 ± 22:30 min. A hundred and seven children exhibited positive behavior before undergoing sedation, but the behavior deteriorated during sedation in 36 cases. CONCLUSION: The time to discharge post-midazolam sedation correlated to the child's age and weight and total amount of administered midazolam. Sedation negatively affected behavior in 43.6% of the cases.
[Mh] Termos MeSH primário: Comportamento Infantil
Sedação Consciente
Hipnóticos e Sedativos/administração & dosagem
Midazolam/administração & dosagem
Alta do Paciente
[Mh] Termos MeSH secundário: Criança
Pré-Escolar
Feminino
Seres Humanos
Masculino
Odontopediatria
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Hypnotics and Sedatives); R60L0SM5BC (Midazolam)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:D
[Da] Data de entrada para processamento:170906
[St] Status:MEDLINE
[do] DOI:10.17796/1053-4628-41.5.384


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[PMID]:28870308
[Au] Autor:Coleman AC
[Ad] Endereço:Andrews Institute for Orthopaedics & Sports Medicine, 1040 Gulf Breeze Pky, #200, Gulf Breeze, FL 32561, USA. Electronic address: colemanac@gmail.com.
[Ti] Título:Perioperative Pain Management for Upper Extremity Surgery.
[So] Source:Orthop Clin North Am;48(4):487-494, 2017 Oct.
[Is] ISSN:1558-1373
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Upper extremity surgeons are currently faced with a daunting array of anesthesia techniques, ranging from traditional general anesthesia to wide-awake surgery, during which patients can watch their surgeons operate in the morning and return to work as soon as that afternoon. This range of options means that surgeons must consider patient-related factors such as disease process and relevant comorbidities, as well as surgery-related factors such as anatomic location, complexity, length of procedure, and postoperative pain expectations. In general, the least invasive technique is favored, but each patient must be considered individually to ensure the best anesthesia choice.
[Mh] Termos MeSH primário: Anestesia Geral/métodos
Sedação Consciente/métodos
Bloqueio Nervoso/métodos
Procedimentos Ortopédicos
Manejo da Dor/métodos
Dor Pós-Operatória/terapia
Extremidade Superior/cirurgia
[Mh] Termos MeSH secundário: Seres Humanos
Dor Pós-Operatória/diagnóstico
Período Perioperatório
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170919
[Lr] Data última revisão:
170919
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170906
[St] Status:MEDLINE


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[PMID]:28829870
[Au] Autor:Leung FW
[Ad] Endereço:Veterans Affairs Greater Los Angeles Healthcare System, David Geffen School of Medicine, Los Angeles, California.
[Ti] Título:Water Exchange to Facilitate Unsedated Colonoscopy-Reply.
[So] Source:JAMA;318(8):754-755, 2017 08 22.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Colonoscopia
Água
[Mh] Termos MeSH secundário: Sedação Consciente
Seres Humanos
[Pt] Tipo de publicação:LETTER; COMMENT
[Nm] Nome de substância:
059QF0KO0R (Water)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170921
[Lr] Data última revisão:
170921
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170823
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.9994



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