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[PMID]: 29236825 [Au] Autor: Heringer LC; Sousa UO; Oliveira MF; Nunes AS; Alves KA; Zancanaro ML; Botelho RV [Ad] Endereço: Instituto de Assistência Médica ao Servidor Público Estadual, Programa de Pós Graduação, São Paulo SP, Brasil. [Ti] Título: The number of burr holes and use of a drain do not interfere with surgical results of chronic subdural hematomas. [So] Source: Arq Neuropsiquiatr;75(11):809-812, 2017 Nov. [Is] ISSN: 1678-4227 [Cp] País de publicação: Brazil [La] Idioma: eng [Ab] Resumo: Burr hole evacuation has been the most frequently-used procedure for the treatment of chronic subdural hematomas (CSDH). OBJECTIVE: To evaluate whether the use of a drain and/or the number of burr holes for treatment of CSDH modifies the rates of recurrence and complications. METHODS: A retrospective review of 142 patients operated on because of CSDH, between 2006 and 2015, analyzing recurrence and complications of the use of one or two burr holes with or without the use of a drain. RESULTS: Thirty-seven patients had bilateral CSDH (26%) and 105 (73.9%) patients had unilateral CSDH. Twenty-two (59.4%) patients were given a drain and 15 (40.6%) were not. A total number of recurrences occurred in 22 (15.5%) patients and the total number of complications was in six (4.2%) patients. Mean follow-up time was 7.67 months. CONCLUSIONS: The number of burr holes and the use of the drain did not alter the rates of recurrence and complications in the treatment of CSDH. [Mh] Termos MeSH primário: Craniotomia/métodos Drenagem Hematoma Subdural Crônico/cirurgia Trepanação/métodos [Mh] Termos MeSH secundário: Idoso Craniotomia/efeitos adversos Feminino Seres Humanos Masculino Meia-Idade Recidiva Estudos Retrospectivos Prevenção Secundária Resultado do Tratamento [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1801 [Cu] Atualização por classe: 180129 [Lr] Data última revisão: 180129 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 171214 [St] Status: MEDLINE

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[PMID]: 28468141 [Au] Autor: Wan Y; Fei X; Jiang D; Chen H; Shi L; Wang Z [Ad] Endereço: *Department of Neurosurgery, Suzhou Kowloon Hospital Affiliated With Shanghai Jiao Tong University School of Medicine †Department of Neurosurgery, The First People's Hospital of Kunshan Affiliated With Jiangsu University, Suzhou, China. [Ti] Título: Clinical Observation of Treatment of Chronic Subdural Hematoma With Novel Double Needle Minimally Invasive Aspiration Technology. [So] Source: J Craniofac Surg;28(3):646-649, 2017 May. [Is] ISSN: 1536-3732 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: OBJECTIVE: The aim of the present study was to explore the clinical effects, including the prevention of complications, of the treatment of chronic subdural hematoma with double needle aspiration. METHODS: The clinical data of 31 patients with chronic subdural hematoma treated by double YL-1 needle double skull drilling and 31 controls treated by traditional drilling and drainage were analyzed retrospectively. RESULTS: In the YL-1 needle group, only 1 patient was with hematoma recurrence, 1 patient was with intracranial pneumocephalus, and the remaining patients who were followed up for 3 months achieved a clinical cure. In the traditional drilling and drainage group, 13 patients were with hematoma recurrence within 3 months after the operation and 7 patients were with postoperative intracranial pneumocephalus. CONCLUSIONS: The method of double YL-1 needle is better than the traditional drilling and drainage method for the treatment of chronic subdural hematoma because it reduces the postoperative recurrence rate and complications. [Mh] Termos MeSH primário: Hematoma Subdural Crônico/cirurgia Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação Agulhas Paracentese/normas Trepanação/instrumentação Trepanação/normas [Mh] Termos MeSH secundário: Idoso Idoso de 80 Anos ou mais Drenagem/métodos Feminino Seguimentos Seres Humanos Masculino Meia-Idade Pneumocefalia/etiologia Complicações Pós-Operatórias/etiologia Recidiva Resultado do Tratamento [Pt] Tipo de publicação: COMPARATIVE STUDY; JOURNAL ARTICLE [Em] Mês de entrada: 1801 [Cu] Atualização por classe: 180126 [Lr] Data última revisão: 180126 [Sb] Subgrupo de revista: D [Da] Data de entrada para processamento: 170505 [St] Status: MEDLINE [do] DOI: 10.1097/SCS.0000000000003462

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[PMID]: 28591391 [Au] Autor: André C [Ad] Endereço: Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Departamento de Neurologia, Rio de Janeiro RJ, Brasil. [Ti] Título: Evolving story: trepanation and self-trepanation to enhance brain function. [So] Source: Arq Neuropsiquiatr;75(5):307-313, 2017 May. [Is] ISSN: 1678-4227 [Cp] País de publicação: Brazil [La] Idioma: eng [Ab] Resumo: Trepanation has been performed by people interested in enhancing mental power and well-being since the early 1960s. The pioneers and main proponents of the procedure are described here. The phenomenon appeared in Europe after a Dutch former medical student published a psychoactive drug-friendly scroll suggesting trepanation as a form of permanently increasing cerebral blood volume and function. He trepanned himself in 1965. Three of his friends became enthusiasts. They also submitted themselves to the procedure and published films and books describing their experiences. Two of them coauthored papers, in collaboration with Russian researchers, and created institutions to promote discussion on trepanation. One of these institutions organized trips to Central and South America to get the operation done. Dozens of people nowadays look for trepanation as a method of spiritualization and increasing well-being and mental power. The phenomenon has an uncertain future, however, as the main proponents and supporters are aging. [Mh] Termos MeSH primário: Encéfalo/fisiologia Circulação Cerebrovascular Trepanação/história [Mh] Termos MeSH secundário: História do Século XIX História do Século XX Seres Humanos Trepanação/métodos [Pt] Tipo de publicação: BIOGRAPHY; HISTORICAL ARTICLE; JOURNAL ARTICLE [Ps] Nome de pessoa como assunto: Huges HB; Mellen J; Feilding A; Halvorson P [Em] Mês de entrada: 1706 [Cu] Atualização por classe: 170630 [Lr] Data última revisão: 170630 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170608 [St] Status: MEDLINE

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[PMID]: 28583456 [Au] Autor: Eaton J; Hanif AB; Mulima G; Kajombo C; Charles A [Ad] Endereço: UNC-Project Malawi, Lilongwe, Malawi. [Ti] Título: Outcomes Following Exploratory Burr Holes for Traumatic Brain Injury in a Resource Poor Setting. [So] Source: World Neurosurg;105:257-264, 2017 Sep. [Is] ISSN: 1878-8769 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. The incidence of TBI in low- and middle-income countries (LMICs) is disproportionately high, with an associated increased risk of mortality from TBI relative to high-income countries. Although computed tomography is the diagnostic method of choice, this is often unavailable in LMICs. Exploratory burr holes may provide a suitable choice for diagnosis and treatment of TBI. METHODS: We performed a retrospective review of prospectively collected data at KCH, a tertiary care center in Lilongwe, Malawi. All trauma patients presenting between June 2012 and July 2015 with a deteriorating level of consciousness and localizing signs and who underwent exploratory burr holes were included. Additionally, we included all patients admitted with TBI, requiring higher-level care during 2011. No patients underwent exploratory burr hole during this time. We performed logistic regression to identify predictors of mortality in the total population of TBI patients. RESULTS: Among the 241 patients who presented to KCH with TBI requiring higher-level care, the total mortality was 16.4%. More than half (163, or 68%) underwent exploratory burr hole with a mortality of 6.8%. Mortality in patients who did not undergo exploratory burr hole was 43.9%. Upon adjusted logistic regression, not undergoing exploratory burr hole significantly increased the odds of mortality (odds ratio = 12.0, P = 0.000, 95% confidence interval = 4.48-31.9). CONCLUSION: Exploratory burr holes remain an important diagnostic and therapeutic procedure for TBI in LMICs. Exploratory burr hole technique should be integrated into general surgery education to attenuate TBI-related mortality. [Mh] Termos MeSH primário: Lesões Encefálicas Traumáticas/cirurgia Trepanação/métodos [Mh] Termos MeSH secundário: Adolescente Adulto Lesões Encefálicas Traumáticas/diagnóstico por imagem Criança Feminino Escala de Coma de Glasgow Seres Humanos Modelos Logísticos Masculino Meia-Idade Razão de Chances Estudos Retrospectivos Tomografia Computadorizada por Raios X Adulto Jovem [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1709 [Cu] Atualização por classe: 170929 [Lr] Data última revisão: 170929 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170607 [St] Status: MEDLINE

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[PMID]: 28479520 [Au] Autor: Riccomi G; Fornaciari G; Vitiello A; Bini A; Caramella D; Giuffra V [Ad] Endereço: Division of Paleopathology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy. Electronic address: giulia.riccomi@med.unipi.it. [Ti] Título: Trepanation to Treat a Head Wound: A Case of Neurosurgery from 13th-Century Tuscany. [So] Source: World Neurosurg;104:9-13, 2017 Aug. [Is] ISSN: 1878-8769 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: During the archaeological excavations conducted in the 13th century cemetery of the Church of Sant'Agostino in Poggibonsi (Tuscany, Italy), a skull with evidence of neurosurgical intervention was brought to light. The skull, belonging to an adult male, shows two traumatic lesions produced by bladed instruments. The first lesion, located on the anterior part of the parietal bones, involved only the outer cranial table; bone remodeling indicates that the individual survived the injury for a long time. The second lesion, located on the frontal bone, involved all the thickness of the bone; the absence of reparative processes allows a diagnosis of peri mortem lesion. To treat this wound, the patient underwent surgical intervention. In fact, in correspondence to the lesion, an oval bone loss, with clean and well-defined cutting edges, can be interpreted as the result of a trepanation, probably performed to clean the wound and to remove any bone splinters. Half of the bone "rondella" was found in situ; it can be hypothesized that the surgeon decided to replace the bony piece to protect the brain. However, the surgical intervention failed, and the patient died soon afterwards. Trepanation for the treatment of cranial traumas is described by several medical classical and medieval authors, whose texts were available in the 13th century. This case represents rare Middle Ages evidence of neurosurgery used to treat a bone injury. [Mh] Termos MeSH primário: Traumatismos Craniocerebrais/história Traumatismos Craniocerebrais/cirurgia Neurocirurgia/história Fraturas Cranianas/história Fraturas Cranianas/cirurgia Trepanação/história [Mh] Termos MeSH secundário: História Medieval Seres Humanos Itália [Pt] Tipo de publicação: HISTORICAL ARTICLE; JOURNAL ARTICLE; REVIEW [Em] Mês de entrada: 1709 [Cu] Atualização por classe: 170925 [Lr] Data última revisão: 170925 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170509 [St] Status: MEDLINE

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[PMID]: 28419880 [Au] Autor: Tsoucalas G; Kousoulis AA; Mariolis-Sapsakos T; Sgantzos M [Ad] Endereço: History of Medicine Department, Faculty of Medicine, University of Thessaly, Larissa, Greece. Electronic address: gregorytsoucalas@yahoo.gr. [Ti] Título: Trepanation Practices in Asclepieia: Systematizing a Neurosurgical Innovation. [So] Source: World Neurosurg;103:501-503, 2017 Jul. [Is] ISSN: 1878-8769 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: As ancient Greeks started looking for deities that could fulfill the pragmatic needs of common people, local heroes started being mythologized and worshipped through cults. METHODS: The most widespread such example was Asclepius, possibly a skilled war surgeon who followed military expeditions to Colchis and Troy. Our study investigates the possibility of the early neurosurgery to have been started inside Asclepieia by Asclepius and his followers. RESULTS: Asclepius was worshipped at religious temples called Asclepieia where certain specific medical and surgical techniques were followed. The most advanced technique was skull trepanation, which was most likely done as an acute operation to release intracranial pressure. The contemporary Hippocratic corpus provided extensive descriptions of the technique, and archaeologic evidence has shown that many patients survived the operation. CONCLUSIONS: Decompressive craniectomy techniques have been practiced for millennia but it is possible that they were first systematized as a neurosurgical innovation through the Ancient Greek religious cult followed in Asclepieia. [Mh] Termos MeSH primário: Craniectomia Descompressiva/história Medicina Militar/história Neurocirurgia/história Trepanação/história [Mh] Termos MeSH secundário: Grécia Antiga História Antiga Seres Humanos [Pt] Tipo de publicação: HISTORICAL ARTICLE; JOURNAL ARTICLE; REVIEW [Em] Mês de entrada: 1709 [Cu] Atualização por classe: 171116 [Lr] Data última revisão: 171116 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170419 [St] Status: MEDLINE

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[PMID]: 28349381 [Au] Autor: Guilfoyle MR; Hutchinson PJ; Santarius T [Ad] Endereço: Division of Neurosurgery, Addenbrooke's Hospital, Box 167, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK. mathew.guilfoyle@addenbrookes.nhs.uk. [Ti] Título: Improved long-term survival with subdural drains following evacuation of chronic subdural haematoma. [So] Source: Acta Neurochir (Wien);159(5):903-905, 2017 May. [Is] ISSN: 0942-0940 [Cp] País de publicação: Austria [La] Idioma: eng [Ab] Resumo: BACKGROUND: Chronic subdural haematoma (CSDH) is a common condition that is effectively managed by burrhole drainage but requires repeat surgery in a significant minority of patients. The Cambridge Chronic Subdural Haematoma Trial (CCSHT) was a randomised controlled study that showed placement of subdural drains for 48 h following burrhole evacuation significantly reduces the incidence of reoperation and improves survival at 6 months. The present study examined the long-term survival of the patients in the trial. METHODS: In the original trial patients at a single neurosurgical centre from 2004-2007 were randomly assigned to receive a drain (n = 108) or no drain (n = 107) following burrhole drainage of CSDH. We ascertained whether the trial patients were alive in February 2016-a minimum of 8 years following enrollment-via the UK NHS tracing service. Survival was compared between the trial groups and against expected survival for the UK general population matched for age and sex. RESULTS: At 5 years following surgery the drain group continued to have significantly better survival than the no drain patients (p = 0.027), but this was no longer apparent at 10 years. Survival of patients in the drain group did not differ significantly from that of the general population whereas patients who did not receive a drain had significantly lower survival than expected (p = 0.0006). CONCLUSION: Subdural drains following CSDH evacuation are associated with improved long-term survival, which appears similar to that expected for the general population of the same age and sex. All patients having burrhole CSDH evacuation should receive a drain as standard practice unless specifically contraindicated. [Mh] Termos MeSH primário: Drenagem/métodos Hematoma Subdural Crônico/cirurgia Complicações Pós-Operatórias Trepanação/métodos [Mh] Termos MeSH secundário: Adulto Idoso Idoso de 80 Anos ou mais Drenagem/efeitos adversos Feminino Seres Humanos Masculino Meia-Idade Reoperação/estatística & dados numéricos Espaço Subdural/cirurgia Análise de Sobrevida Trepanação/efeitos adversos [Pt] Tipo de publicação: JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL [Em] Mês de entrada: 1709 [Cu] Atualização por classe: 170911 [Lr] Data última revisão: 170911 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170329 [St] Status: MEDLINE [do] DOI: 10.1007/s00701-017-3095-2

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[PMID]: 28300712 [Au] Autor: Kolcun JPG; Gernsback JE; Richardson AM; Jagid JR [Ad] Endereço: Department of Neurosurgery, University of Miami, Jackson Memorial Hospital, Miami, Florida, USA. [Ti] Título: Flow, Liver, Flow: A Retrospective Analysis of the Interplay of Liver Disease and Coagulopathy in Chronic Subdural Hematoma. [So] Source: World Neurosurg;102:246-252, 2017 Jun. [Is] ISSN: 1878-8769 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: Chronic subdural hematoma (cSDH) is a common neurosurgical ailment, particularly in elderly patients. A recent study uncovered an association between liver disease and recurrence in patients with cSDH. Here, we explored that relationship to identify recurrence predictors in at-risk patients. OBJECTIVE: We hypothesized that the association between liver disease and recurrence was attributable to coagulopathy secondary to liver disease. METHODS: We retrospectively reviewed all patients with cSDH treated with burr-hole drainage by 2 surgeons between 2007 and 2015. Comorbidities and laboratory findings for each patient were examined by Pearson χ analysis or Mann-Whitney U tests. RESULTS: We identified 261 cSDH in 215 patients. Patients were a mean age of 65.6 years, and 72% were male. Sixteen patients with cSDH required repeat surgery (6.1%). There were 123 coagulopathic patients (47.1%), and 14 with liver disease (5.4%), all of whom were coagulopathic (P < 0.001). Coagulopathic patients with liver disease were more likely to experience recurrence than patients with coagulopathy alone (relative risk = 4.09, P = 0.019). Patients with liver disease had significantly elevated prothrombin time (P = 0.013) and reduced platelet counts (P < 0.001). Platelets also were reduced in coagulopathic patients with liver disease, as compared with those with coagulopathy alone (P = 0.002). Thrombocytopenia remained significant in a multivariate analysis (P < 0.001). CONCLUSIONS: Liver disease is significantly associated with the recurrence of cSDH. Although coagulopathy alone does not predict recurrence, patients with coagulopathy and liver disease are at greater risk for recurrence than those with coagulopathy alone. Liver disease effects are reflected in certain hematologic laboratory values. [Mh] Termos MeSH primário: Transtornos da Coagulação Sanguínea/epidemiologia Transtornos da Coagulação Sanguínea/etiologia Hematoma Subdural Crônico/complicações Hepatopatias/epidemiologia [Mh] Termos MeSH secundário: Adulto Idoso Idoso de 80 Anos ou mais Drenagem/efeitos adversos Feminino Hematoma Subdural Crônico/cirurgia Seres Humanos Masculino Meia-Idade Procedimentos Neurocirúrgicos/efeitos adversos Recidiva Estudos Retrospectivos Estatísticas não Paramétricas Trepanação [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1709 [Cu] Atualização por classe: 170925 [Lr] Data última revisão: 170925 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170317 [St] Status: MEDLINE

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[PMID]: 28224817 [Au] Autor: Kale A; Öz II; Gün EG; Kalayci M; Gül S [Ad] Endereço: a Faculty of Medicine, Department of Neurosurgery , Bülent Ecevit University , Zonguldak , Turkey. [Ti] Título: Is the recurrence rate of chronic subdural hematomas dependent on the duration of drainage? [So] Source: Neurol Res;39(5):399-402, 2017 May. [Is] ISSN: 1743-1328 [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo: OBJECTIVES: Chronic subdural hematoma (CSDH) is the most frequent type of intracranial hemorrhage which especially affects the elderly. Various surgical techniques have been reported for CSDH treatment; optimal treatment methods are still controversial. In this study, the effects of long drainage durations on results and recurrences were investigated in patients on whom closed system drainage with burr hole craniotomy was applied due to CSDH. METHODS: 90 patients with 105 CSDH were operated between 2008 and 2016. Patients were divided into two groups based on the duration of drainage. Group A (n = 40) was determined as 2-4 days of closed-system drainage, while Group B (n = 50) was recorded as 5-7 days of closed-system drainage. Recurrence was defined as accumulation of blood in the operation area and recurrence of symptoms within the monitoring period of six months. RESULTS: Recurrence was observed in 7 (15.6) of the Group A patients and 2 (3.3%) of the Group B patients. There was a statistically significant difference between groups in terms of recurrence rate (p = 0.04). Postoperative thickness of hematoma was measured in the first month follow-up computerized tomography. There was a statistically significant difference between groups in terms of postoperative thickness of residual hematoma (p = 0.05). CONCLUSION: 2-4 days of closed system drainage following burr hole craniotomy is an effective and reliable choice of treatment in CSDH. Nevertheless, increasing the duration of drainage to 5-7 days provided better results without increasing the risk of complication. [Mh] Termos MeSH primário: Craniotomia/efeitos adversos Drenagem/efeitos adversos Hematoma Subdural Crônico/epidemiologia Hematoma Subdural Crônico/etiologia Trepanação/efeitos adversos [Mh] Termos MeSH secundário: Adolescente Adulto Idoso Idoso de 80 Anos ou mais Feminino Hematoma Subdural Crônico/diagnóstico por imagem Seres Humanos Masculino Meia-Idade Complicações Pós-Operatórias/epidemiologia Complicações Pós-Operatórias/etiologia Recidiva Estudos Retrospectivos Estatísticas não Paramétricas Adulto Jovem [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1704 [Cu] Atualização por classe: 170424 [Lr] Data última revisão: 170424 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170223 [St] Status: MEDLINE [do] DOI: 10.1080/01616412.2017.1296655

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[PMID]: 28223259 [Au] Autor: Chen F; Duan Y; Li Y; Han W; Shi W; Zhang W; Huang Y [Ad] Endereço: Department of Neurology, General Hospital of Beijing Military Command, Beijing, China; Department of Neurology, Haidian Hospital, Beijing, China. [Ti] Título: Use of an antiepileptic drug to control epileptic seizures associated with cranioplasty: A randomized controlled trial. [So] Source: Int J Surg;40:113-116, 2017 Apr. [Is] ISSN: 1743-9159 [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo: BACKGROUND: Epilepsy is a common complication of cranioplasty. The present study was designed to explore the clinical effect of prophylactic anti-epilepsy drugs (AED) to control epileptic seizures associated with cranioplasty. METHODS: and design: This trial was a prospective, randomized, open-label, single-centre, active controlled study designed to investigate the use of antiepileptic drug to control epileptic seizures associated with cranioplasty. We tested the necessity and methods of drug use. Three hundred twenty epilepsy patients who underwent cranioplasty were included in this study. The patients were randomly divided into the control group (160 cases) and the experimental group (160 cases). AED were administered to experimental group from 4 days before the surgery until 1 month after the surgery. The incidence of early and late epileptic seizures after cranioplasty was analyzed. The liver function, abnormal blood test 1 month after surgery were compared between these two groups. RESULTS: The incidence of seizures in the Control group was 28.6% (43 cases in 149 cases) while in the experimental group was only 5.9% (9 cases in 151 cases), which had statistical significance. The incidence of epileptic seizure was significantly higher in patients who received no AED treatment than in those who received AED treatment. Besides, the abnormal liver function and blood routine examination in both control and experimental group had no significant differences. CONCLUSION: The incidence of epilepsy associated with the cranioplasty is high and early use of anti-epileptic drugs can effectively reduce the occurrence of seizures. [Mh] Termos MeSH primário: Anticonvulsivantes/uso terapêutico Epilepsia/tratamento farmacológico Trepanação/efeitos adversos [Mh] Termos MeSH secundário: Adulto Epilepsia/epidemiologia Epilepsia/etiologia Feminino Seres Humanos Incidência Masculino Meia-Idade Estudos Prospectivos [Pt] Tipo de publicação: JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL [Nm] Nome de substância: 0 (Anticonvulsants) [Em] Mês de entrada: 1705 [Cu] Atualização por classe: 170523 [Lr] Data última revisão: 170523 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170223 [St] Status: MEDLINE

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