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Triantafyllidou, C., Effraimidis, P., Schimanke, M., Ignatova, S., Ringman, A., Skoog, S., . . . Cederquist, K. (2021). A Well-Defined Endobronchial Tumor in a 26-Year-Old Man. Chest, 159(5), E313-E317
Open this publication in new window or tab >>A Well-Defined Endobronchial Tumor in a 26-Year-Old Man
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2021 (English)In: Chest, ISSN 0012-3692, E-ISSN 1931-3543, Vol. 159, no 5, p. E313-E317Article in journal (Refereed) Published
Abstract [en]

CASE PRESENTATION: A 26-year-old man presented with a 2-week history of productive cough and a 1-year history of effort-related dyspnea. His medical history was significant for hay fever and exertion-triggered asthma. He was not taking medicines regularly but was using inhaled salbutamol as needed. He was an ex-smoker, with a previous history of 2-pack years.

Place, publisher, year, edition, pages
ELSEVIER, 2021
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:liu:diva-178259 (URN)10.1016/j.chest.2020.11.061 (DOI)000674176100005 ()33965155 (PubMedID)
Available from: 2021-08-18 Created: 2021-08-18 Last updated: 2024-01-10
Boano, G., Åström Aneq, M., Spyrou, G., Enocsson, H., Charitakis, E. & Vánky, F. (2020). Biochemical response to cryothermal and radiofrequency exposure of the human myocardium at surgical ablation of atrial fibrillation: a randomized controlled trial. Translational Medicine Communications, 5, Article ID 11.
Open this publication in new window or tab >>Biochemical response to cryothermal and radiofrequency exposure of the human myocardium at surgical ablation of atrial fibrillation: a randomized controlled trial
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2020 (English)In: Translational Medicine Communications, ISSN 2396-832X, Vol. 5, article id 11Article in journal (Refereed) Published
Abstract [en]

Background: Surgical cryothermia and radiofrequency (RF) ablations for atrial fibrillation (AF) seem to result in similar sinus rhythm restoration, but the biochemical consequences of the two methods are unclear. We aimed to compare the biochemical responses to the two ablative methods in concomitant mitral valve surgery (MVS).

Methods: Sixty mitral valve surgery patients with AF were prospectively included. Forty-one patients planned for ablation were randomized to cryothermia (n = 20) or radiofrequency (n = 21) ablation and 19 served as controls. Markers for myocardial injury, inflammation, cell stress, apoptosis, and heart failure were analyzed pre- and postoperatively at different time points.

Results: Troponin T and creatine kinase isoenzyme MB (CK-MB) peak levels were significantly higher in the cryothermia group compared with the RF group (12,805 [6140–15,700] vs. 2790 [1880–4180] ng/L; P = 0.002 and 271 [217–357] vs. 79 [66–93] μg/L; P < 0.001, respectively). Both groups had significantly higher levels than the no-ablation group. There were no group differences in C-reactive protein (CRP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), but there were correlations between pre- and postoperative levels of both CRP (rs = 0.41, P = 0.001) and NT-proBNP (rs = 0.48, P < 0.001). Protease-activated receptor 1 (PAR-1) and heat shock protein 27 (HSP27) were significantly increased in the cryoablation group.

Conclusions: Cryoablation results in a larger myocardial injury and possibly more elevated apoptotic activity and cell stress compared with the RF technique. The type of ablation device did not have any significant influence on the postoperative inflammatory response nor on the early postoperative levels of NT-proBNP.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2020
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-174088 (URN)10.1186/s41231-020-00064-z (DOI)
Note

Funding agencies: The Swedish Heart-Lung Foundation, grant number 20160391, the ALF founding, County Council of Östergötland, Sweden. Open access funding provided by Linköping University.

Available from: 2021-03-14 Created: 2021-03-14 Last updated: 2024-02-07Bibliographically approved
Engström, K., Vánky, F., Rehnberg, M., Trinks, C., Jonasson, J., Green, A. & Gunnarsson, C. (2020). Novel SMAD3 p.Arg386Thr genetic variant co-segregating with thoracic aortic aneurysm and dissection. Molecular Genetics & Genomic Medicine, 8(4), Article ID e1089.
Open this publication in new window or tab >>Novel SMAD3 p.Arg386Thr genetic variant co-segregating with thoracic aortic aneurysm and dissection
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2020 (English)In: Molecular Genetics & Genomic Medicine, ISSN 2324-9269, Vol. 8, no 4, article id e1089Article in journal (Refereed) Published
Abstract [en]

Background Pathogenic variants in the SMAD3 gene affecting the TGF-beta/SMAD3 signaling pathway with aortic vessel involvement cause Loeys-Dietz syndrome 3, also known as aneurysms-osteoarthritis syndrome. Methods Description of clinical history of a family in Sweden using clinical data, DNA sequencing, bioinformatics, and pedigree analysis. Results We report a novel SMAD3 variant, initially classified as a genetic variant of uncertain clinical significance (VUS), and later found to be co-segregating with aortic dissection in the family. The index patient presented with a dissecting aneurysm of the aorta including the ascending, descending, and abdominal parts. Genotype analysis revealed a heterozygous missense SMAD3 variant: NM_005902.3(SMAD3): c.11576G amp;gt; C (p.Arg386Thr). The same variant was also identified in a 30 years old formalin-fixed paraffin-embedded block of tissue from a second cousin, who died at 26 years of age from a dissecting aneurysm of the aorta. Conclusion A "variant of uncertain significance" according to the ACMG guidelines has always a scope for reappraisal. Genetic counselling to relatives, and the offering of surveillance service is important to families with aortic aneurysm disease. The report also highlight the potential use of FFPE analysis from deceased relatives to help in the interpretation of variants.

Place, publisher, year, edition, pages
WILEY, 2020
Keywords
aortic aneurysm and dissection; Loeys-Dietz syndrome 3; SMAD3; TAAD
National Category
Medical Genetics
Identifiers
urn:nbn:se:liu:diva-163705 (URN)10.1002/mgg3.1089 (DOI)000511023800001 ()32022471 (PubMedID)
Note

Funding Agencies|ALF Grants; Region Ostergotland; FORSS Medical Research Council of Southeast Sweden

Available from: 2020-02-18 Created: 2020-02-18 Last updated: 2021-05-05
Jiang, H., Holm, J., Vidlund, M., Vánky, F., Friberg, O., Yang, Y. & Svedjeholm, R. (2020). The impact of glutamate infusion on postoperative NT-proBNP in patients undergoing coronary artery bypass surgery: a randomized study. Journal of Translational Medicine, 18(1), Article ID 193.
Open this publication in new window or tab >>The impact of glutamate infusion on postoperative NT-proBNP in patients undergoing coronary artery bypass surgery: a randomized study
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2020 (English)In: Journal of Translational Medicine, ISSN 1479-5876, E-ISSN 1479-5876, JOURNAL OF TRANSLATIONAL MEDICINE, Vol. 18, no 1, article id 193Article in journal (Refereed) Published
Abstract [en]

Background

Glutamate, a key intermediate in myocardial metabolism, may enhance myocardial recovery after ischemia and possibly reduce the incidence and severity of postoperative heart failure in coronary artery bypass surgery (CABG). N-terminal pro-B-type natriuretic peptide (NT-proBNP) can be used to assess postoperative heart failure (PHF) after CABG. Our hypothesis was that glutamate enhances myocardial recovery in post-ischemic heart failure and, therefore, will be accompanied by a mitigated postoperative increase of NT-proBNP.

Methods

Substudy of the GLUTAmate for Metabolic Intervention in Coronary Surgery (GLUTAMICS) trial (ClinicalTrials.gov Identifier: NCT00489827) a prospective triple-center double-blind randomized clinical trial on 399 patients undergoing CABG with or without concomitant procedure for acute coronary syndrome at three Swedish Cardiac Surgery centres (Linköping, Örebro, and Karlskrona) from May 30, 2007 to November 12, 2009. Patients were randomly assigned to intravenous infusion of 0.125 M L-glutamic acid or saline (1.65 mL/kg of body weight per hour) intraoperatively and postoperatively. Plasma NT-proBNP was measured preoperatively, the first (POD1) and third postoperative morning (POD3). A Clinical Endpoints Committee, blinded to both intervention and NT-proBNP used prespecified criteria to diagnose PHF. The primary endpoints were the absolute levels of postoperative NT-proBNP and the difference between preoperative and postoperative levels of NT-proBNP.

Results

Overall no significant difference was detected in postoperative NT-proBNP levels between groups. However, in high-risk patients (upper quartile of EuroSCORE II ≥ 4.15; glutamate group n = 56; control group n = 45) glutamate was associated with significantly lower postoperative increase of NT-proBNP (POD3-Pre: 3900 [2995–6260] vs. 6745 [3455–12,687] ng•L−1, p = 0.012) and lower NT-proBNP POD3 (POD3: 4845 [3426–7423] vs. 8430 [5370–14,100] ng•L−1, p = 0.001). After adjusting for significant differences in preoperative demographics, NT-proBNP POD3 in the glutamate group was 0.62 times of that in the control group (p = 0.002). Patients in the glutamate group also had shorter ICU stay (21 [19–26] vs. 25 [22–46] h, p = 0.025) and less signs of myocardial injury (Troponin T POD3 (300 [170–500] vs. 560 [210–910] ng•L−1, p = 0.025).

Conclusions

Post hoc analysis of postoperative NT-proBNP suggests that intravenous infusion of glutamate may prevent or mitigate myocardial dysfunction in high-risk patients undergoing CABG. Further studies are necessary to confirm these findings.

Trial registration Swedish Medical Products Agency 151:2003/70403 (prospectively registered with amendment about this substudy filed March 17, 2007). ClinicalTrials.gov Identifier: NCT00489827 (retrospectively registered) https://clinicaltrials.gov/ct2/show/NCT00489827?term=glutamics&draw=1&rank=1

Place, publisher, year, edition, pages
BioMed Central, 2020
Keywords
Glutamic acid; Natriuretic peptide; Heart failure; Coronary artery bypass surgery; Postoperative care
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-166100 (URN)10.1186/s12967-020-02351-7 (DOI)000534291800002 ()32393387 (PubMedID)2-s2.0-85084541718 (Scopus ID)
Note

Funding Agencies|Linkoping University; Swedish Heart-Lung FoundationSwedish Heart-Lung Foundation [20030595, 20140633]; Region Ostergotland [LIO-443891, LIO-693091]

Available from: 2020-06-08 Created: 2020-06-08 Last updated: 2024-01-10Bibliographically approved
Jiang, H., Vánky, F., Hultkvist, H., Holm, J., Yang, Y. & Svedjeholm, R. (2019). NT-proBNP and postoperative heart failure in surgery for aortic stenosis. Open heart, 6(1), Article ID UNSP e001063.
Open this publication in new window or tab >>NT-proBNP and postoperative heart failure in surgery for aortic stenosis
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2019 (English)In: Open heart, E-ISSN 2053-3624, Vol. 6, no 1, article id UNSP e001063Article in journal (Refereed) Published
Abstract [en]

Objective Postoperative heart failure (PHF) after aortic valve replacement (AVR) for aortic stenosis (AS) may initially appear mild and transient but has serious long-term consequences. Methods to assess PHF are not well documented. We studied the association between N-terminal pro-B-type natriuretic peptide (NT-proBNP) and PHF after AVR for AS.

Methods This is a prospective, observational, longitudinal study of 203 patients undergoing elective first-time AVR for AS. Plasma NT-proBNP was assessed at preoperative evaluation, the day before surgery, and the first (POD1) and third postoperative morning. A clinical endpoints committee, blinded to NT-proBNP results, used prespecified haemodynamic criteria to diagnose PHF. The mean follow-up was 8.6±1.1 years.

Results No patient with PHF (n=18) died within 30 days after surgery, but PHF was associated with poor long-term survival (HR 3.01, 95% CI 1.45 to 6.21, p=0.003). NT-proBNP was significantly higher in patients with PHF only on POD1 (6415 (3145–11 220) vs 2445 (1540–3855) ng/L, p<0.0001). NT-proBNP POD1 provided good discrimination of PHF (area under the curve=0.82, 95% CI 0.72 to 0.91, p<0.0001; best cut-off 5290 ng/L: sensitivity 63%, specificity 85%). NT-proBNP POD1 ≥5290 ng/L identified which patients with PHF carried a risk of poor long-term survival, and PHF with NT-proBNP POD1 ≥ 5290 ng/L emerged as a risk factor for long-term mortality in the multivariable Cox regression (HR 6.20, 95% CI 2.72 to 14.1, p<0.0001).

Conclusions The serious long-term consequences associated with PHF after AVR for AS were confirmed. NT-proBNP level on POD1 aids in the assessment of PHF and identifies patients at particular risk of poor long-term survival.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-159019 (URN)10.1136/openhrt-2019-001063 (DOI)000471922200086 ()31218010 (PubMedID)2-s2.0-85066069325 (Scopus ID)
Note

Funding Agencies|Medical Research Council of Southeast Sweden FORSS [12657, 23891, 159851, 311341]; County Council of Ostergotland, Sweden [LIO-610951, LIO 693091, LIO-796412]

Available from: 2019-07-19 Created: 2019-07-19 Last updated: 2024-01-10Bibliographically approved
Nilsson, L., Appel, C.-F., Hultkvist, H. & Vánky, F. (2015). Evaluation of the Valve Academic Research Consortium-2 Criteria for Myocardial Infarction in Transcatheter Aortic Valve Implantation: A Prospective Observational Study. PLOS ONE, 10(6), e0130423
Open this publication in new window or tab >>Evaluation of the Valve Academic Research Consortium-2 Criteria for Myocardial Infarction in Transcatheter Aortic Valve Implantation: A Prospective Observational Study
2015 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 10, no 6, p. e0130423-Article in journal (Refereed) Published
Abstract [en]

Objective To evaluate the relevance of the individual components of the Valve Academic Research Consortium (VARC)-2 criteria for periprocedural myocardial infarction (MI) in transcatheter aortic valve implantation (TAVI). The association between biomarkers and adverse procedural outcome has been established. However, the additive prognostic importance of signs and symptoms are more uncertain. Methods A total of 125 consecutive TAVI patients were prospectively included in this study. Biomarkers for MI were analyzed and signs and symptoms according to VARC-2 criteria were collected from clinical records. Results The criteria of elevated biomarkers and of signs or symptoms were found in 27 (22%) and 32 (26%) of the patients, respectively. According to VARC-2 definition, 12 (10%) had MI. VARC-2 definition of MI, Troponin T (TnT) greater than 600 ng/L, and presence of signs or symptoms correlated with 6 months mortality, prolonged ICU stay, elevation of N-terminal prohormone brain natriuretic peptide, and renal impairment. No signs or symptoms were found in 7 (44%) of the patients who fulfilled the criterion of elevated TnT greater than 600 ng/L. In the group with positive TnT criterion, there were no significant differences between those with and without signs or symptoms in respect to levels of TnT (1014 [585-1720] ng/L versus 704 [515-905] ng/L, p = 0.17) or creatine kinase-MB (36 [25-52] mu g/L versus 29 [25-39] mu g/L, p = 0.32). In the multivariate Cox regression analysis, TnT greater than 600 ng/L was the only significant independent variable associated with 6-months postprocedural mortality. Conclusions Myocardial injury in TAVI, measured with biomarkers, correlates well with adverse procedural outcome. In this study it is also the strongest predictor for early postprocedural mortality. The additional requirement of signs or symptoms for the diagnosis of MI results in omission of a considerable number of clinically significant MI.

Place, publisher, year, edition, pages
Public Library of Science, 2015
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-120231 (URN)10.1371/journal.pone.0130423 (DOI)000356327000157 ()26069958 (PubMedID)
Note

Funding Agencies|Medical Research Council of Southeast Sweden [FORSS-12657, FORSS-23891, FORSS-159851, FORSS-311341]; ALF founding, County Council of Ostergotland, Sweden

Available from: 2015-07-21 Created: 2015-07-20 Last updated: 2021-06-14
Vánky, F., Hultkvist, H., Svedjeholm, R. & Nilsson, L. (2015). Is the present definition of mycardial infarction in transcatheter aortic valve implantation relevant for the postprocedulal outcome?. In: : . Paper presented at 7th joint Scandinavian Conference in Cardiothoracic Surgery,Bergen, Norway, 3-5 September 2015 (pp. 30-30).
Open this publication in new window or tab >>Is the present definition of mycardial infarction in transcatheter aortic valve implantation relevant for the postprocedulal outcome?
2015 (English)Conference paper, Oral presentation with published abstract (Other academic)
Abstract [en]

Background: The association between biomarkers and adverse procedural outcome has been established. However, the additive prognostic importance of signs and symptoms according to the Valve Academic Research Consortium (VARC)-2 criteria for periprocedural myocardial infarction (MI) are more uncertain.

Aim: To evaluate the relevance of the individual components of the VARC-2 criteria for periprocedural myocardial infarction (MI) in transcatheter aortic valve implantation (TAVI).Methods: A total of 125 consecutive TAVI patients were prospectively included in this study. Biomarkers for MI were analyzed and signs and symptoms according to VARC-2 criteria were collected from clinical records.

Results: The criteria of elevated biomarkers and of signs or symptoms were found in 27 ( 22%) and 32 ( 26%) of the patients, respectively. According to VARC-2 definition, 12 (10%) had MI. VARC-2 definition of MI, Troponin T (TnT) >600 ng/L, and presence of signs or symptoms correlated with 6 month mortality, prolonged ICU stay, elevation of N-terminal prohormone brain natriuretic peptide, and renal impairment. No signs or symptoms were found in 7 (4 4%) of the patients who fulfilled the criterion of elevated TnT>600 ng/L. In the group with positive TnT criterion, there were no significant differences between those with and without signs or symptoms in respect to levels of TnT (1014 [585-1720] ng/L versus 704 [515-905] ng/L, p=0.17) or creatine kinase-MB ( 36 [25-52] μg/L versus 29 [25-39] μg/L, p=0.32). In the multiple logistic regression model, TnT>600 ng/L turned out as the only independent variable associated with 6-month mortality, OR 7.89 (95% CI 2.21-28.1, p = 0.001).

Conclusion: Myocardial injury in TAVI, measured with TnT, correlates well with adverse procedural outcome. The additional requirement of signs or symptoms for the diagnosis of MI results in omission of a considerable number of clinically significant MI.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-124325 (URN)
Conference
7th joint Scandinavian Conference in Cardiothoracic Surgery,Bergen, Norway, 3-5 September 2015
Available from: 2016-01-26 Created: 2016-01-26 Last updated: 2021-03-14Bibliographically approved
Holm, J., Vidlund, M., Vánky, F., Friberg, O., Håkanson, E., Walther, S. & Svedjeholm, R. (2014). EuroSCORE II and N-terminal pro-B-type natriuretic peptide for risk evaluation: an observational longitudinal study in patients undergoing coronary artery bypass graft surgery. British Journal of Anaesthesia, 113(1), 75-82
Open this publication in new window or tab >>EuroSCORE II and N-terminal pro-B-type natriuretic peptide for risk evaluation: an observational longitudinal study in patients undergoing coronary artery bypass graft surgery
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2014 (English)In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 113, no 1, p. 75-82Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Postoperative heart failure remains the major cause of death after cardiac surgery. As N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a predictor for postoperative heart failure, the aim was to evaluate if preoperative NT-proBNP could provide additional prognostic information to the recently launched EuroSCORE II.

METHODS:

A total of 365 patients with acute coronary syndrome (ACS) undergoing isolated coronary artery bypass graft (CABG) surgery were studied prospectively. Preoperative NT-proBNP and EuroSCORE II were evaluated with regard to severe circulatory failure after operation according to prespecified criteria. To assess what clinical outcomes are indicated by NT-proBNP levels in different risk categories, the patients were stratified according to EuroSCORE II. Based on receiver operating characteristics analysis, these cohorts were assessed with regard to preoperative NT-proBNP below or above 1028 ng litre(-1). The follow-up time averaged 4.4 (0.7) yr.

RESULTS:

Preoperative NT-proBNP≥1028 ng litre(-1) [odds ratio (OR) 9.9, 95% confidence interval (CI) 1.01-98.9; P=0.049] and EuroSCORE II (OR 1.24, 95% CI 1.06-1.46; P=0.008) independently predicted severe circulatory failure after operation. In intermediate-risk patients (EuroSCORE II 2.0-10.0), NT-proBNP≥1028 ng litre(-1) was associated with a higher incidence of severe circulatory failure (6.6% vs 0%; P=0.007), renal failure (14.8% vs 5.4%; P=0.03), stroke (6.6% vs 0.7%; P=0.03), longer intensive care unit stay [37 (35) vs 27 (38) h; P=0.002], and worse long-term survival.

CONCLUSIONS:

Combining EuroSCORE II and preoperative NT-proBNP appears to improve risk prediction with regard to severe circulatory failure after isolated CABG for ACS. NT-proBNP may be particularly useful in patients at intermediate risk according to EuroSCORE II.

Place, publisher, year, edition, pages
Oxford University Press, 2014
Keywords
acute coronary syndrome; coronary artery bypass surgery; natriuretic peptides; risk assessment
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-109246 (URN)10.1093/bja/aeu088 (DOI)000338598700011 ()24727704 (PubMedID)
Available from: 2014-08-12 Created: 2014-08-11 Last updated: 2024-01-10Bibliographically approved
Svedjeholm, R., Tajik, B., Vidlund, M., Friberg, Ö., Holm, J., Vanky, F. & Håkansson, E. (2014). Intravenous glutamatereduces the need for inotropes in patients with heart failure after CABG foracute coronary syndrome?. In: : . Paper presented at 6th Joint Scandinavian conference in Cardiothoracic Surgery, Gothenburg, Sweden.
Open this publication in new window or tab >>Intravenous glutamatereduces the need for inotropes in patients with heart failure after CABG foracute coronary syndrome?
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2014 (English)Conference paper, Poster (with or without abstract) (Other academic)
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-114365 (URN)
Conference
6th Joint Scandinavian conference in Cardiothoracic Surgery, Gothenburg, Sweden
Available from: 2015-02-19 Created: 2015-02-19 Last updated: 2024-01-10
Tajik, B., Vidlund, M., Sundbom, P., Friberg, Ö., Holm, J., Vanky, F. & Svedjeholm, R. (2014). Intravenous glutamatereduces the need for inotropes in patients with heart failure after CABG foracute coronary syndrome?. In: : . Paper presented at 29th Annual meeting of the European Association of Cardiothoracic Anesthesiologists, Florence, Italy.
Open this publication in new window or tab >>Intravenous glutamatereduces the need for inotropes in patients with heart failure after CABG foracute coronary syndrome?
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2014 (English)Conference paper, Poster (with or without abstract) (Other academic)
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-114367 (URN)
Conference
29th Annual meeting of the European Association of Cardiothoracic Anesthesiologists, Florence, Italy
Available from: 2015-02-19 Created: 2015-02-19 Last updated: 2024-01-10
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-1005-091x

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