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  1. Issn: 1178-7074
    Volume: 12
    Journal: Int J Gen Med
    Date: 2019
    Year: 2019
    Ref: Int J Gen Med. 2019;12:167-171.
    Abstract: High lipid levels in the blood together with high blood pressure and diabetes are among the highest risks for coronary heart disease. In particular, elevated cholesterol levels promote the progression of atherosclerosis. Red yeast rice, also called red fermented rice or red mold rice, is used as a dietary supplement to lower cholesterol levels. It contains varying amounts of natural monacolin K, which is a structural homolog to lovastatin, and shows hypocholesterolemic properties comparable to synthetic statins. Despite being portrayed as a natural alternative, the potential of red yeast rice for side effects and interactions is comparable to statin drugs. Consumers need to be made aware of the varying monacolin K content in red yeast rice products and the insufficient long-term safety data regarding the potential risks of red yeast rice.
    Authors: Farkouh A, Baumgärtel C
    Pages: 167-171
    Pmid: 31118742
    Mesh: (no MeSH)
  2. Issn: 1178-7007
    Volume: 12
    Journal: Diabetes Metab Syndr Obes
    Date: 2019
    Year: 2019
    Ref: Diabetes Metab Syndr Obes. 2019;12:647-653.
    Abstract: Objective: The study aimed to assess the prevalence and correlates of underweight and overweight or obesity among women in India. Subjects and methods: In a population-based cross-sectional 2015-2016 National Family Health Survey, ever married non-pregnant women (18-49 years) were interviewed and assessed with anthropometric, blood pressure and biochemical measures. Results: The total sample included 5,82,320 non-pregnant women 18-49 years, median age 31 years, interquartile range =16 years, from India. Overall, 20.1% of the women were underweight [body mass index (BMI) <18.5 kg/m2] and 36.3% were overweight, or had class I or class II obesity (BMI ≥23.0 kg/m2). In adjusted multinomial logistic regression, younger age, lower education, lower wealth status, not eating daily fruits, vegetables, fried food, belonging to the scheduled tribe and tobacco use were associated with underweight, while older age, higher education, higher wealth, belonging to other backward class or other, urban residence, daily fruit consumption, daily fried food consumption, having hypertension, heart disease and high or very high blood glucose levels were associated with overweight or obesity. Belonging to the scheduled caste and tobacco use were negatively associated with overweight or obesity. Conclusions: A high dual burden of both underweight and overweight or obesity was observed among women in India. Sociodemographic and health variables were identified as risk factors for both underweight and overweight or obesity, which can be utilized in informing intervention strategies.
    Authors: Pengpid S, Peltzer K
    Pages: 647-653
    Pmid: 31118726
    Mesh: (no MeSH)
  3. Issn: 1479-5876
    Volume: 17
    Issue: 1
    Journal: J Transl Med
    Date: 2019 May 22
    Year: 2019
    Ref: J Transl Med. 2019 May 22;17(1):169.
    Abstract: Obesity must be considered a real pathology. In the world wide, obesity represent one of the major public health issue associated with increased morbidity and mortality. Overweight or obesity, in fact, significantly increases the risk of contracting diseases, such as: arterial hypertension, dyslipidemia, type 2 diabetes mellitus, coronary heart disease, cerebral vasculopathy, gallbladder lithiasis, arthropathy, ovarian polycytosis, sleep apnea syndrome, and some neoplasms. Despite numerous informative campaigns, unfortunately, the fight against obesity does not seem to work: in the last years, the prevalence continued to increase. The progressive and rapid increase in the incidence of obesity, which has characterized most of the economically advanced countries in the last decade, has been the main stimulus for the research of the mechanisms underlying this pathology and the related disorders. The aims of this review is to provide a revision of the literature in order to define obesity as diseases, secondly to highlight the limits and the inaccuracy of common tools used for the diagnosis of obesity, and as a third thing to strengthen the concept of the complexity of obesity as a disease among political health care providers. Obesity may be viewed as a multifactorial pathology and chronic low-grade inflammatory disease. In fact, people affected by obesity have greater risk of developing comorbility and morbility, respect to healthy. Hence, the absolute therapeutic benefit is directly proportional to the basic risk. So, internationally interest on early diagnosis of obesity is growing to avoid under- and overdiagnosis consequences. Therefore, the consequences are an aggravation of the disease and an increase in obesity related pathology like diabetes, cardiovascular disease, and cancer. The most widely used parameter for diagnosis, body mass index (BMI) is not suitable for assessing the body fat. In fact, several studies demonstrate that BMI alone cannot define obesity, which consists not so much in weight gain as in excess fat mass. The use of suitable tools for the assessment of fat mass percentage combined with clinical and genetic analysis allowed to identify different phenotypes of obesity, which explain the various paradoxes of obesity. It is essential to adopt all possible strategies to be able to combat obesity, ameliorate the suffering of patients, and reduce the social and treatment costs of obesity.
    Authors: De Lorenzo A, Gratteri S, Gualtieri P [show all 6]
    Pages: 169
    Pmid: 31118060
    Mesh: (no MeSH)
  4. Issn: 1178-1998
    Volume: 14
    Journal: Clin Interv Aging
    Date: 2019
    Year: 2019
    Ref: Clin Interv Aging. 2019;14:735-742.
    Abstract: Frailty and atherosclerotic diseases are prevalent among the older people and usually present the same pathogenesis and risk factors. Therefore, the aim of this study was to determine the association between frailty and atherosclerosis.
    Authors: Xue Q, Qin MZ, Jia J [show all 5]
    Pages: 735-742
    Pmid: 31114178
    Mesh: (no MeSH)
  5. Issn: 1873-5169
    Journal: Peptides
    Date: 2019 May 18
    Year: 2019
    Ref: Peptides. 2019 May 18 [Epub ahead of print].
    Abstract: Cardiovascular disease (CVD) remains the leading cause of death worldwide, despite multiple treatment options. In addition to elevated lipid levels, oxidative stress and inflammation are key factors driving atherogenesis and CVD. New strategies are required to mitigate risk and most urgently for statin-intolerant patients. The neuropeptide hormone oxytocin, synthesized in the brain hypothalamus, is worthy of consideration as a CVD ancillary treatment because it moderates factors directly linked to atherosclerotic CVD such as inflammation, weight gain, food intake and insulin resistance. Though initially studied for its contribution to parturition and lactation, oxytocin participates in social attachment and bonding, associative learning, memory and stress responses. Oxytocin has shown promise in animal models of atherosclerosis and in some human studies as well. A number of properties of oxytocin make it a candidate CVD treatment. Oxytocin not only lowers fat mass and cytokine levels, it improves glucose tolerance, lowers blood pressure and relieves anxiety. Further, it has an important role in communication in the gut-brain axis that makes it a promising treatment for obesity and type 2 diabetes. Oxytocin acts through its receptor which is a class I G-protein-coupled receptor present in cells of the vascular system including the heart and arteries. While oxytocin is not used for heart disease at present, residual CVD risk remains in a substantial portion of patients despite multidrug regimens, leaving open the possibility of using the endogenous nonapeptide as an adjunct therapy. This review discusses the possible role for oxytocin in human CVD prevention and treatment.
    Authors: Reiss AB, Glass DS, Lam E [show all 6]
    Pmid: 31112739
    Mesh: (no MeSH)
  6. Issn: 1522-726X
    Journal: Catheterization and Cardiovascular Interventions
    Date: 2019 May 21
    Year: 2019
    Ref: Catheterization and Cardiovascular Interventions. 2019 May 21 [Epub ahead of print].
    Abstract: Dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) prevents ischemic events while increasing bleeding risk. Real-world-based metrics to accurately predict postdischarge bleeding (PDB) occurrence and its potential impact on postdischarge major cardiovascular event (MACE) remain undefined. This study sought to evaluate the impact of PDB on MACE occurrence, and to develop a score to predict PDB risk among Chinese acute coronary syndrome (ACS) patients after PCI.
    Authors: Chen Y, Yin T, Xi S [show all 32]
    Pmid: 31112635
    Mesh: (no MeSH)
  7. Issn: 2332-8363
    Issue: 124
    Journal: Natl Health Stat Report
    Date: 2019 Apr
    Year: 2019
    Ref: Natl Health Stat Report. 2019 Apr(124):1-9.
    Abstract: Introduction-This report presents the most recent nationally representative percentages of adult day services centers (ADSCs) with hospitalizations and chronic conditions by service provision. Service provision may further one or two of the primary goals of adult day services: to reduce the risk of hospitalizations and readmissions, and manage chronic conditions among their participants. Methods-Estimates are from the 2016 Adult Day Services Center survey in the biennial National Study of Long-Term Care Providers conducted by the National Center for Health Statistics. Service provision was measured using scales that included five types of services: mental health, social work, therapeutic (physical, speech, or occupational), dietary and nutritional, and skilled nursing. Provision methods included by employees only or a mix of employees, arrangement, or referrals; by arrangement or referrals; and not provided. The percentage of ADSCs with hospitalizations was measured by having at least one participant discharged from an overnight hospital stay in the past 90 days. The number of chronic conditions included the four most prevalent types of chronic conditions reported by ADSCs (Alzheimer disease and other dementias, diabetes, depression, and heart disease). Analyses included univariate and bivariate statistics showing the percentages of ADSCs with hospitalizations and chronic conditions by service provision. Results-Although a little more than one-half of ADSCs (52.6%) provided all five services, approximately one-tenth of ADSCs provided none of the five services. About 64.0% of ADSCs had hospitalizations among participants. Almost 7 in 10 ADSCs (69.2%) reported the prevalence of all 4 conditions in their center. Approximately three-fourths (74.3%) of ADSCs that provided all five services had hospitalizations among participants compared with almost one-third of ADSCs (31.5%) that provided none of the services. Almost 83.0% of ADSCs that provided all five services had all four conditions in their center, compared with approximately one-third (31.5%) of ADSCs that provided none of the five services.
    Authors: Caffrey C, Lendon JP
    Pages: 1-9
    Pmid: 31112122
    Mesh: (no MeSH)
  8. Issn: 1857-9655
    Volume: 7
    Issue: 8
    Journal: Open Access Maced J Med Sci
    Date: 2019 Apr 30
    Year: 2019
    Ref: Open Access Maced J Med Sci. 2019 Apr 30;7(8):1309-1313.
    Abstract: Obesity is a multifactorial disease that is dangerous and is a factor in the emergence of serious diseases such as dyslipidemia, stroke, coronary heart disease and others. In Type 2 Diabetes Mellitus (T2DM) patients there is a disorder of lipid metabolism, namely dyslipidemia. Changes in lipid profile that occurred were an increase in total cholesterol levels, Low-Density Lipoprotein (LDL), and triglycerides, and decreased levels of high-density lipoprotein (HDL). The phenomenon of an increase in T2DM patients in Indonesia caused double mortality in recent decades.
    Authors: Silitonga HA, Siahaan JM, Anto EJ
    Pages: 1309-1313
    Pmid: 31110575
    Mesh: (no MeSH)
  9. Issn: 1444-2892
    Journal: Heart Lung Circ
    Date: 2019 Apr 23
    Year: 2019
    Ref: Heart Lung Circ. 2019 Apr 23 [Epub ahead of print].
    Abstract: Sudden cardiac death (SCD) still accounts for the majority of deaths from the four major cardiovascular events (myocardial infarction (MI), heart failure (HF), atrial fibrillation (AF), and stroke) despite substantial progress on prevention.
    Authors: Feng JL
    Pmid: 31109887
    Mesh: (no MeSH)
  10. Issn: 1880-3865
    Journal: J Oral Biosci
    Date: 2019 May 14
    Year: 2019
    Ref: J Oral Biosci. 2019 May 14 [Epub ahead of print].
    Abstract: Overweight and obesity are defined as excessive or abnormal fat accumulation in adipose tissues, and increase the risk of morbidity in many diseases, including hypertension, dyslipidemia, type 2 diabetes, coronary heart disease, and stroke, through pathophysiological mechanisms. There is strong evidence that weight loss reduces the risk of metabolic syndrome by limiting blood pressure and improving the levels of serum triglycerides, total cholesterol, low-density lipoprotein-cholesterol, and high-density lipoprotein-cholesterol. To date, several attempts have been made to develop effective anti-obesity medication or weight-loss drugs; however, satisfactory drugs for clinical use have not yet been developed. Therefore, elucidation of the molecular mechanisms driving fat metabolism (adipogenesis and lipolysis) represents the first step in developing clinically useful drugs and/or therapeutic treatments to control obesity.
    Authors: Kanematsu T, Oue K, Okumura T [show all 9]
    Pmid: 31109860
    Mesh: (no MeSH)
  11. Issn: 1873-4294
    Journal: Curr Top Med Chem
    Date: 2019 May 20
    Year: 2019
    Ref: Curr Top Med Chem. 2019 May 20 [Epub ahead of print].
    Abstract: Cardiovascular disease is the leading cause of death worldwide. Despite extensive socioeconomic interests and mounting clinical needs, our understanding of the underlying pathophysiology remains incomplete. Multiple forms of the cardiovascular disease involve acute or chronic disturbance in cardiac myocytes, which may lead to potent activation of the unfolded protein response (UPR), a cellular adaptive reaction to accommodate protein-folding stress. Accumulation of unfolded and misfolded proteins in the endoplasmic reticulum (ER) causes activation of the three signaling branches of the UPR, which otherwise remain quiescent. This ER stress response then transiently lowers global protein translation, augments production of protein chaperones, and enhances ER associated protein degradation with an aim to restore cellular homeostasis. Ample evidence has firmly established that the UPR is strongly induced in heart disease. Recently, the mechanism of action and multiple pharmacological means to favorably modulate the UPR are emerging to curb the initiation and progression of cardiovascular disease. Here, we review the current understanding of the UPR in cardiovascular disease and discuss existing therapeutic explorations and future treatment perspectives.
    Authors: Zhang G, Wang X, Gillette TG [show all 5]
    Pmid: 31109279
    Mesh: (no MeSH)
  12. Issn: 1550-5057
    Volume: 42
    Issue: 3
    Journal: Family and Community Health
    Date: 2019 Jul/Sep
    Year: 2019
    Ref: Family and Community Health. 2019 Jul/Sep;42(3):221-226.
    Abstract: African American men report lower levels of depressive symptoms that their white peers in national data. However, the value of these studies is often undermined by data that confound race, socioeconomic status, and segregation. We sought to determine whether race differences in depressive symptoms were present after minimizing the effects of socioeconomic status and segregation within a cohort of southwest Baltimore (SWB) men using the data from the Exploring Health Disparities in Integrated Communities (EHDIC), a novel study of racial disparities within communities where African American and non-Hispanic white males live together and have similar median incomes. Using the Patient Health Questionnaire, a standard instrument for assessing mental disorders, we categorized participants as experiencing depressive symptoms (including depressive syndrome and major depression) or not experiencing depressive symptoms. Logistic regression was performed to examine the association between depressive symptoms and race in EHDIC-SWB, adjusting for age, marital status, income, education, insurance, physical inactivity, current smoking or drinking status, poor/fair health, hypertension, heart disease, diabetes, stroke, and obesity. Of the 628 study participants, 12.6% of white men and 8.6% of African American men reported depressive symptoms. African American males had similar odds of reporting depressive symptoms (odds ratio = 0.61, 95% confidence interval = 0.34-1.11) as compared with white men. Within this low-income urban racially integrated community, race differences in depressive symptoms among men were not observed. This finding suggests that social and environmental conditions may impact the race differences in depressive symptoms.
    Authors: Hale D, Smith G, Bowie J [show all 5]
    Pages: 221-226
    Pmid: 31107733
    Mesh: (no MeSH)
  13. Issn: 1743-6109
    Journal: J Sex Med
    Date: 2019 May 16
    Year: 2019
    Ref: J Sex Med. 2019 May 16 [Epub ahead of print].
    Abstract: Previous studies demonstrating that erectile dysfunction (ED) predicts the risk of further cardiovascular events (CV) events are insufficient to make recommendations for cardiologists, diabetologists, urologists, and more, and the association between CV events and ED degree is unclear.
    Authors: Zhao B, Hong Z, Wei Y [show all 6]
    Pmid: 31104857
    Mesh: (no MeSH)
  14. Issn: 2047-4881
    Journal: Eur J Prev Cardiol
    Date: 2019 May 19
    Year: 2019
    Ref: Eur J Prev Cardiol. 2019 May 19:2047487319851298. [Epub ahead of print].
    Abstract: Body mass index †Deceased. (BMI) is a risk factor for heart failure with preserved ejection fraction (HFpEF).
    Authors: Campbell DJ, Gong FF, Jelinek MV [show all 14]
    Pages: 2047487319851298
    Pmid: 31104485
    Mesh: (no MeSH)
  15. Issn: 1476-5527
    Journal: Journal of Human Hypertension
    Date: 2019 May 17
    Year: 2019
    Ref: Journal of Human Hypertension. 2019 May 17 [Epub ahead of print].
    Abstract: A tremendous increase in the coexistence of diabetes and hypertension has been observed recently in India. Apart from lifestyle and genetic factors, socioeconomic status, age, gender, occupation and lack of awareness are also contributing to the tremendous increases in the prevalence of both the diseases. Hypertension has been long recognised as one of the major risk factors for chronic disease burden, morbidity and mortality in India, attributable to 10.8% of all deaths in the country. Even though microvascular complications are frequently linked to hyperglycaemia, studies have also proven the critical involvement of hypertension in the development of these co-morbidities. The co-occurrence of hypertension in diabetic patients considerably escalates the risks of coronary heart disease, stroke, nephropathy and retinopathy. The annual expenditure for diabetes for the Indian population was estimated to be 1541.4 billion INR ($31.9 billion) in 2010. The expense of diabetes care further escalates in the presence of complications or co-morbidities. Generally, a diabetic patient with hypertension spent an average of 1.4 times extra than a diabetic patient without hypertension. Even though diabetes and hypertension are considered as important risk factors for cardiovascular and chronic kidney diseases, the awareness about the prevention, treatment and control of these diseases remains alarmingly low in the developing countries like India. The healthcare system in India should focus on better hypertension screening and control, especially in diabetic patients, to minimise the burden of the dual epidemic.
    Authors: Viswanathan V, Smina TP
    Pmid: 31101888
    Mesh: (no MeSH)
  16. Issn: 1522-1539
    Journal: Am J Physiol Heart Circ Physiol
    Date: 2019 May 17
    Year: 2019
    Ref: Am J Physiol Heart Circ Physiol. 2019 May 17 [Epub ahead of print].
    Abstract: Diabetes is a metabolic disorder characterized by hyperglycemia, resulting in low-grade systemic inflammation. Diabetic cardiomyopathy (DCM) is a common complication among diabetes patients, and the mechanism underlying its induction of cardiac remodeling and dysfunction remains unclear. Numerous experimental and clinical studies suggested that adaptive immunity, especially T lymphocyte-mediated immunity, plays a potentially important role in in the pathogenesis of diabetes and DCM. Metallothioneins (MTs), cysteine-rich metal-binding proteins, have antioxidant properties. Some potential mechanisms underlying the cardioprotective effects of MTs include the role of MTs in calcium regulation, zinc homeostasis, insulin sensitization, and antioxidant activity. Moreover, metal homeostasis, especially MT-regulated zinc homeostasis, is essential for immune function. This review discusses aberrant immune regulation in diabetic heart disease with respect to endothelial insulin resistance and the effects of hyperglycemia and hyperlipidemia on tissues and the different effects of intracellular and extracellular MTs on adaptive immunity. This review shows that intracellular MTs are involved in naïve T cell activation and reduce Treg polarization, while extracellular MTs promote proliferation and survival in naïve T cells and Treg polarization but inhibit their activation, thus revealing potential therapeutic strategies targeting the regulation of immune cell function by MTs.
    Authors: Ge T, Yu Y, Cai L [show all 4]
    Pmid: 31100011
    Mesh: (no MeSH)
  17. Issn: 2574-3805
    Volume: 2
    Issue: 5
    Journal: JAMA Netw Open
    Date: 2019 May 03
    Year: 2019
    Ref: JAMA Netw Open. 2019 May 03;2(5):e193121.
    Abstract: Research has linked sugar-sweetened beverage (SSB) consumption to coronary heart disease (CHD) risk, but the role of nutritionally similar fruit juice and the association of these beverages with mortality risk is unknown.
    Authors: Collin LJ, Judd S, Safford M [show all 5]
    Pages: e193121
    Pmid: 31099861
    Mesh: (no MeSH)
  18. Issn: 1557-8674
    Journal: Surg Infect (Larchmt)
    Date: 2019 May 23
    Year: 2019
    Ref: Surg Infect (Larchmt). 2019 May 23 [Epub ahead of print].
    Abstract: Background: Fungal isolates from peritoneal fluid sampling in patients with perforated peptic ulcer (PPU) is not uncommon and its management unclear. This study aims to evaluate whether the presence of fungus in peritoneal fluid cultures is a predictor of morbidity and mortality after laparotomy for PPU. Method: This is a single-center retrospective study including adult patients with perforated gastric and duodenal ulcers over a 10-year period (January 2004 to January 2014). Evaluation of predictors contributing to fungal growth was conducted using multiple logistic regression analysis. Operative factors and 30-day mortality and morbidity outcomes were compared against fungal growth using a multivariable generalized linear mixed model analysis. Results: The median age was 58 (interquartile range [IQR] 44-70) years with 110 (20.3%) females. In addition to hypertension and hyperlipidemia, diabetes mellitus (13.5%), ischemic heart disease (2.6%), and heart failure (2.4%) were common. Fungus was cultured from peritoneal fluid in 209 (38.6%) patients. Median American Society of Anesthesiology (ASA) score was 2 (IQR 2-3) and median Mannheim peritonitis index (MPI) score was 15 (IQR 10-20). Free air was detected in 323 (59.6%) patients and 52 (9.6%) patients had gastrectomy. Median length of stay was 7 (IQR 6-11) days. All-cause complications were seen in 53 (9.8%) patients, of whom 37 patients (6.8%) developed intra-abdominal collection, 20 patients (3.7%) had anastomotic leakage, and 12 patients (2.2%) required repeat operation. Thirty-day mortality was seen in 47 (8.7%) patients. Multivariable analysis showed age (median age, 64; IQR 53-74) as a predictor of fungal growth (p < 0.001) but fungal growth not a predictor of adverse peri-operative outcomes. Conclusion: Fungal isolates in peritoneal fluid cultures are more likely to occur in older patients who have PPU. Presence of fungal isolates does not impact peri-operative outcomes.
    Authors: Kwan JR, Lim M, Ng F [show all 4]
    Pmid: 31099700
    Mesh: (no MeSH)
  19. Issn: 1548-8756
    Volume: 39
    Journal: Am Soc Clin Oncol Educ Book
    Date: 2019 Jan
    Year: 2019
    Ref: Am Soc Clin Oncol Educ Book. 2019 Jan;39:e22-e33.
    Abstract: Observational evidence has consistently linked excess adiposity and inactivity to increased breast cancer risk and to poor outcomes in individuals diagnosed with early-stage, potentially curable breast cancer. There is less information from clinical trials testing the effect of weight management or physical activity interventions on breast cancer risk or outcomes, but a number of ongoing trials will test the impact of weight loss and other lifestyle changes after cancer diagnosis on the risk of breast cancer recurrence. Lifestyle changes have additional benefits beyond their potential to decrease primary or secondary breast cancer risk, including improvements in metabolic parameters, reduction in the risk of comorbidities such as diabetes and heart disease, improvement of physical functioning, and mitigation of side effects of cancer therapy. Despite these myriad benefits, implementation of lifestyle interventions in at-risk and survivor populations has been limited to date. This article reviews the evidence linking lifestyle factors to breast cancer risk and outcomes, discusses completed and ongoing randomized trials testing the impact of lifestyle change in primary and secondary breast cancer prevention, and reviews efforts to implement and disseminate lifestyle interventions in at-risk and breast cancer survivor populations.
    Authors: Ligibel JA, Basen-Engquist K, Bea JW
    Pages: e22-e33
    Pmid: 31099634
    Mesh: (no MeSH)
  20. Issn: 1747-0803
    Journal: Congenit Heart Dis
    Date: 2019 May 17
    Year: 2019
    Ref: Congenit Heart Dis. 2019 May 17 [Epub ahead of print].
    Abstract: The aging patient with adult congenital heart disease (ACHD) faces the risk of developing atherosclerotic disease. Patients with coarctation of the aorta (CoA) are especially vulnerable because of an inherent high risk of developing hypertension. However, data on the prevalence of other cardiovascular risk factors are scarce. Therefore, this study aimed to describe the prevalence of traditional cardiovascular risk factors (diabetes, hypertension, hyperlipidemia, smoking, obesity, and sedentary lifestyle) in adult patients with CoA.
    Authors: Fedchenko M, Mandalenakis Z, Dellborg H [show all 7]
    Pmid: 31099471
    Mesh: (no MeSH)
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