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16S rDNA sequencing of valve tissue improves microbiological diagnosis in surgically treated patients with infective endocarditis.

https://arctichealth.org/en/permalink/ahliterature134307
Source
J Infect. 2011 Jun;62(6):472-8
Publication Type
Article
Date
Jun-2011
Author
Martin Vondracek
Ulrik Sartipy
Ewa Aufwerber
Inger Julander
Dan Lindblom
Katarina Westling
Author Affiliation
Department of Clinical Microbiology, Karolinska University Hospital and Department of Clinical Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
Source
J Infect. 2011 Jun;62(6):472-8
Date
Jun-2011
Language
English
Publication Type
Article
Keywords
Adult
Aged
Bacteria - classification - genetics - isolation & purification
Bacteriological Techniques - methods
DNA, Bacterial - chemistry - genetics
DNA, Ribosomal - chemistry - genetics
Endocarditis - diagnosis - microbiology - surgery
Female
Heart Valves - microbiology
Humans
Male
Middle Aged
RNA, Ribosomal, 16S - genetics
Sensitivity and specificity
Sequence Analysis, DNA - methods
Sweden
Abstract
The aim was to evaluate 16S rDNA sequencing in heart valves in patients with infective endocarditis undergoing surgery.
Fifty-seven patients with infective endocarditis were examined in this prospective study by analysing heart valves with 16S rDNA sequencing and culturing methods and comparing the results to blood cultures. As controls, heart valves from 61 patients without any signs of endocarditis were examined.
All together 77% of the endocarditis patients were positive for 16S rDNA, 84% had positive blood cultures and 23% had positive cultures from heart valves, whereas only 16% of the cultures from heart valves were concordant with results from blood cultures or 16S rDNA. Concordant results between 16S rDNA sequencing and blood cultures were found in 75% patients. All controls were negative for 16S rDNA. In 4 out of 9 patients with negative blood cultures, the aetiology was established by 16S rDNA alone, i.e. viridans group streptococci.
In this Swedish study, 16S rDNA sequencing of valve material was shown to be a valuable addition in blood culture-negative cases. The value of heart valve culture was low. Molecular diagnosis using 16S rDNA sequencing should be recommended in patients undergoing valve replacement for infective endocarditis.
PubMed ID
21601285 View in PubMed
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Acute kidney injury after coronary artery bypass grafting and long-term risk of end-stage renal disease.

https://arctichealth.org/en/permalink/ahliterature260955
Source
Circulation. 2014 Dec 2;130(23):2005-11
Publication Type
Article
Date
Dec-2-2014
Author
Linda Rydén
Ulrik Sartipy
Marie Evans
Martin J Holzmann
Source
Circulation. 2014 Dec 2;130(23):2005-11
Date
Dec-2-2014
Language
English
Publication Type
Article
Keywords
Acute Kidney Injury - blood - epidemiology
Aged
Confounding Factors (Epidemiology)
Coronary Artery Bypass - adverse effects - statistics & numerical data
Coronary Artery Disease - epidemiology - surgery
Creatinine - blood
Female
Humans
Incidence
Kidney Failure, Chronic - blood - epidemiology
Male
Middle Aged
Multivariate Analysis
Prognosis
Risk factors
Sweden - epidemiology
Abstract
Acute kidney injury (AKI) is a common complication after coronary artery bypass grafting (CABG) and is associated with adverse outcomes. However, the relationship between AKI after CABG and the long-term risk of end-stage renal disease (ESRD) is unknown.
This study included 29 330 patients who underwent primary isolated CABG in Sweden between 2000 and 2008. AKI was classified according to the Acute Kidney Injury Network (AKIN) classification: stage 1, >0.3 mg/dL (>26 µmol/L) or 50% to 100% increase; stage 2, 100% to 200% increase; and stage 3, >200% increase from the preoperative to postoperative serum creatinine level. Cox proportional hazards regression analysis was used to calculate hazard ratios with 95% confidence intervals for ESRD in AKIN stage 1 and stage 2 to 3. Postoperative AKI occurred in 13% of patients. During a mean follow-up of 4.3±2.4 years, 123 patients (0.4%) developed ESRD, including 50 (1.6%) in AKIN stage 1, 29 (5.2%) in AKIN stage 2 to 3, and 44 (0.2%) without AKI after CABG. After multivariable adjustment, the hazard ratio for ESRD was 2.92 (95% confidence interval, 1.87-4.55) for AKIN stage 1 and 3.81 (95% confidence interval, 2.14-6.79) for AKIN stage 2 to 3.
This nationwide study of patients who underwent CABG found that a small increase in the postoperative serum creatinine level was associated with an almost 3-fold increase in the long-term risk of ESRD after adjustment for a number of confounders, including preoperative renal function.
PubMed ID
25239439 View in PubMed
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Acute kidney injury after coronary artery bypass grafting and long-term risk of myocardial infarction and death.

https://arctichealth.org/en/permalink/ahliterature258575
Source
Int J Cardiol. 2014 Mar 1;172(1):190-5
Publication Type
Article
Date
Mar-1-2014
Author
Linda Rydén
Staffan Ahnve
Max Bell
Niklas Hammar
Torbjörn Ivert
Ulrik Sartipy
Martin J Holzmann
Source
Int J Cardiol. 2014 Mar 1;172(1):190-5
Date
Mar-1-2014
Language
English
Publication Type
Article
Keywords
Acute Kidney Injury - mortality
Aged
Aged, 80 and over
Coronary Artery Bypass - adverse effects - mortality
Creatinine - blood
Female
Follow-Up Studies
Glomerular Filtration Rate
Humans
Incidence
Male
Middle Aged
Myocardial Infarction - metabolism - mortality - surgery
Prognosis
Proportional Hazards Models
Registries - statistics & numerical data
Risk factors
Sweden - epidemiology
Abstract
Acute kidney injury (AKI) after coronary artery bypass grafting (CABG) is associated with early mortality. Its impact on the risk of myocardial infarction (MI) over time and long-term mortality has not been well described.
We performed a nationwide population-based cohort study in 27,929 patients who underwent a first isolated CABG between 2000 and 2008 in Sweden. Acute kidney injury was divided into three categories based on the absolute increase in postoperative serum creatinine (sCr) concentration compared with the preoperative baseline: stage 1, sCr increase of 0.3 to 0.5mg/dL; stage 2, sCr increase of >0.5 to 1.0mg/dL and stage 3, sCr increase of = 1.0mg/dL.
The overall incidence of postoperative AKI was 13%, 6.3% met the criterion for stage 1, 4.3% for stage 2 and 2.3% for stage 3. During a mean follow-up of 5.0 years, there were 2119 (7.6%) MIs and 4679 (17%) deaths. Multivariable adjusted hazard ratios with 95% confidence intervals for MI were 1.35 (1.15 to 1.57), 1.80 (1.53 to 2.13) and 1.63 (1.29 to 2.07), in AKI stages 1, 2 and 3, respectively. The corresponding hazard ratios for all-cause mortality were 1.30 (1.17 to 1.44), 1.65 (1.48 to 1.83) and 2.68 (2.37 to 3.03), respectively.
Our results show that AKI after CABG is associated with an increased long-term risk of MI and death.
PubMed ID
24502882 View in PubMed
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Acute kidney injury and long-term risk of stroke after coronary artery bypass surgery.

https://arctichealth.org/en/permalink/ahliterature107407
Source
Int J Cardiol. 2013 Oct 15;168(6):5405-10
Publication Type
Article
Date
Oct-15-2013
Author
Martin J Holzmann
Linda Rydén
Ulrik Sartipy
Author Affiliation
Department of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Internal Medicine, Karolinska Institutet, Stockholm, Sweden. Electronic address: martin.holzmann@karolinska.se.
Source
Int J Cardiol. 2013 Oct 15;168(6):5405-10
Date
Oct-15-2013
Language
English
Publication Type
Article
Keywords
Acute Kidney Injury - epidemiology - mortality
Age Distribution
Aged
Cerebral Hemorrhage - epidemiology - mortality
Coronary Artery Bypass - adverse effects - mortality
Coronary Artery Disease - epidemiology - mortality - surgery
Female
Follow-Up Studies
Glomerular Filtration Rate
Heart Failure - epidemiology - mortality
Humans
Incidence
Male
Middle Aged
Prognosis
Proportional Hazards Models
Registries - statistics & numerical data
Risk factors
Sex Distribution
Stroke - epidemiology - mortality
Sweden - epidemiology
Abstract
Acute kidney injury (AKI) is associated with death, end-stage renal disease, and heart failure in patients with coronary heart disease. This study investigated the association between AKI and long-term risk of stroke.
50,244 patients who underwent coronary artery bypass grafting (CABG) in Sweden between 2000 and 2008 were identified from the SWEDEHEART registry. After exclusions 23,584 patients without prior stroke who underwent elective, primary, isolated, CABG were included. AKI was categorized according to absolute increases in postoperative creatinine values compared with preoperative values: stage 1, 0.3-0.5 mg/dL (26-44 µmol/L); stage 2, 0.5-1.0mg/dL (44-88 µmol/L); and stage 3, >1.0 mg/dL (=88 µmol/L). Cox proportional hazards regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for stroke. There were 1156 (4.9%) strokes during a mean follow-up of 4.1 years. After adjustment for confounders, HRs (95% CIs) for stroke in AKI stages 1, 2 and 3 were 1.12 (0.89-1.39), 1.31 (1.04-1.66) and 1.31 (0.92-1.87), respectively, compared with no AKI. This association disappeared after taking death into account in competing risk analysis. There was a significant association between AKI and stroke in men (HR: 1.26 [1.05-1.50]) but not in women (HR: 1.07 [0.75-1.53]), and in younger (
PubMed ID
24012170 View in PubMed
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Acute kidney injury following coronary artery bypass surgery and long-term risk of heart failure.

https://arctichealth.org/en/permalink/ahliterature118220
Source
Circ Heart Fail. 2013 Jan;6(1):83-90
Publication Type
Article
Date
Jan-2013
Author
Daniel Olsson
Ulrik Sartipy
Frieder Braunschweig
Martin J Holzmann
Author Affiliation
Department of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden.
Source
Circ Heart Fail. 2013 Jan;6(1):83-90
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Acute Kidney Injury - blood - complications - epidemiology
Aged
Confidence Intervals
Coronary Artery Bypass - adverse effects
Coronary Artery Disease - surgery
Creatinine - blood
Female
Follow-Up Studies
Heart Failure - epidemiology - etiology
Humans
Incidence
Male
Postoperative Complications
Prognosis
Retrospective Studies
Risk factors
Sweden - epidemiology
Time Factors
Abstract
Acute kidney injury (AKI) after coronary artery bypass grafting (CABG) is common and increases the risk of postoperative complications and mortality. There is little information on the association between AKI after CABG and long-term risk of incident heart failure (HF).
All patients (n=24 018) undergoing primary, isolated CABG in Sweden between 2000 and 2008 with complete information on pre- and postoperative serum creatinine values, and no prior hospitalization for HF were included. The postoperative increase in serum creatinine was used to define different stages of AKI: stage 1, 0.3 to 0.5 mg/dL; stage 2, 0.5 to 1 mg/dL; stage 3, >1 mg/dL. Hazard ratios with 95% confidence intervals were calculated for first hospitalization for HF for each stage of AKI using Cox proportional hazards regression. Twelve percent of the study population developed AKI. During a mean follow-up of 4.1 years, there were 1325 cases (5.5%) of incident HF. Hazard ratios with 95% confidence interval for HF in AKI stage 1, 2, and 3 were 1.60 (1.34-1.92), 1.87 (1.54-2.27), and 1.98 (1.53-2.57), respectively, after multivariable adjustment for age, sex, diabetes mellitus, estimated glomerular filtration rate, left ventricular ejection fraction, and myocardial infarction before surgery or during follow-up.
AKI is associated with increased long-term risk of HF after CABG. Patients with AKI after CABG should be followed closely to detect early changes in cardiac function.
PubMed ID
23230310 View in PubMed
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An Adjusted Calculation Model Allows for Reduced Protamine Doses without Increasing Blood Loss in Cardiac Surgery.

https://arctichealth.org/en/permalink/ahliterature284260
Source
Thorac Cardiovasc Surg. 2016 Sep;64(6):487-93
Publication Type
Article
Date
Sep-2016
Author
Gunilla Kjellberg
Ulrik Sartipy
Jan van der Linden
Emelie Nissborg
Gabriella Lindvall
Source
Thorac Cardiovasc Surg. 2016 Sep;64(6):487-93
Date
Sep-2016
Language
English
Publication Type
Article
Keywords
Aged
Anticoagulants - administration & dosage - adverse effects
Blood Coagulation - drug effects
Blood Coagulation Tests
Blood Loss, Surgical - prevention & control
Body Height
Body Weight
Cardiac Surgical Procedures - adverse effects
Cardiopulmonary Bypass - adverse effects
Computer simulation
Drug Dosage Calculations
Female
Heparin - administration & dosage - adverse effects
Heparin Antagonists - administration & dosage - adverse effects
Humans
Male
Middle Aged
Models, Biological
Postoperative Hemorrhage - etiology - prevention & control
Protamines - administration & dosage - adverse effects
Sweden
Time Factors
Treatment Outcome
Abstract
Background Heparin dosage for anticoagulation during cardiopulmonary bypass (CPB) is commonly calculated based on the patient's body weight. The protamine-heparin ratio used for heparin reversal varies widely among institutions (0.7-1.3?mg protamine/100 IU heparin). Excess protamine may impair coagulation. With an empirically developed algorithm, the HeProCalc program, heparin, and protamine doses are calculated during the procedure. The primary aim was to investigate whether HeProCalc-based dosage of heparin could reduce protamine use compared with traditional dosages. The secondary aim was to investigate whether HeProCalc-based dosage of protamine affected postoperative bleeding. Patients and Methods We consecutively randomized 40 patients into two groups. In the control group, traditional heparin and protamine doses, based on body weight alone, were given. In the treatment group, the HeProCalc program was used, which calculated the initial heparin bolus dose from weight, height, and baseline activated clotting time and the protamine dose at termination of CPB. Results We analyzed the results from 37 patients, after exclusion of three patients. Equal doses of heparin were given in both groups, whereas significantly lower mean doses of protamine were given in the treatment group versus control group (211?±?56 vs. 330?±?61?mg, p?
PubMed ID
26270199 View in PubMed
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Antidepressant use before coronary artery bypass surgery is associated with long-term mortality.

https://arctichealth.org/en/permalink/ahliterature120881
Source
Int J Cardiol. 2013 Sep 10;167(6):2958-62
Publication Type
Article
Date
Sep-10-2013
Author
Malin Stenman
Martin J Holzmann
Ulrik Sartipy
Author Affiliation
Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden.
Source
Int J Cardiol. 2013 Sep 10;167(6):2958-62
Date
Sep-10-2013
Language
English
Publication Type
Article
Keywords
Aged
Antidepressive Agents - administration & dosage - adverse effects
Cohort Studies
Coronary Artery Bypass - mortality - trends
Female
Humans
Male
Middle Aged
Population Surveillance - methods
Preoperative Period
Survival Rate - trends
Sweden - epidemiology
Time Factors
Treatment Outcome
Abstract
Depression is common in patients with coronary artery disease and is associated with increased cardiovascular morbidity and mortality. Previous reports on the relationship between antidepressant use before coronary artery bypass grafting (CABG) and survival are conflicting. Our aim was to study the association between preoperative antidepressant use and survival following CABG.
We identified all patients who underwent primary isolated non-emergent CABG in Sweden between 2006 and 2008. We used the SWEDEHEART registry and the Swedish National Patient Register to acquire information about baseline characteristics, and the national Prescribed Drug Register to obtain data regarding exposure, defined as at least one antidepressant prescription dispensed before surgery.
Of the 10,884 patients identified, 1171 (11%) were treated with antidepressants before surgery. Unadjusted 4-year survival was 89% in the antidepressant group compared with 92% in the group without antidepressant use (p=0.002). After multivariable adjustment, antidepressant use was associated with increased mortality (hazard ratio [HR] 1.45; 95% confidence interval [CI] 1.18-1.77), compared with non-use of antidepressants. Antidepressant use was also associated with an increased risk of rehospitalization (HR 1.40; 95% CI 1.19-1.65) and the composite endpoint rehospitalization or death (HR 1.44; 95% CI 1.26-1.65).
Among patients who underwent contemporary primary isolated CABG on a nonemergency basis in Sweden, there was a strong and statistically significant association between antidepressant use prior to surgery and long-term survival.
PubMed ID
22959870 View in PubMed
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Association of Donor Age and Sex With Survival of Patients Receiving Transfusions.

https://arctichealth.org/en/permalink/ahliterature285053
Source
JAMA Intern Med. 2017 Jun 01;177(6):854-860
Publication Type
Article
Date
Jun-01-2017
Author
Gustaf Edgren
Henrik Ullum
Klaus Rostgaard
Christian Erikstrup
Ulrik Sartipy
Martin J Holzmann
Olof Nyrén
Henrik Hjalgrim
Source
JAMA Intern Med. 2017 Jun 01;177(6):854-860
Date
Jun-01-2017
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Aged, 80 and over
Blood Donors - statistics & numerical data
Blood Transfusion - mortality
Cohort Studies
Denmark - epidemiology
Humans
Middle Aged
Proportional Hazards Models
Retrospective Studies
Risk factors
Survival Analysis
Survivors - statistics & numerical data
Sweden - epidemiology
Abstract
Following animal model data indicating the possible rejuvenating effects of blood from young donors, there have been at least 2 observational studies conducted with humans that have investigated whether donor age affects patient outcomes. Results, however, have been conflicting.
To study the association of donor age and sex with survival of patients receiving transfusions.
A retrospective cohort study based on the Scandinavian Donations and Transfusions database, with nationwide data, was conducted for all patients from Sweden and Denmark who received at least 1 red blood cell transfusion of autologous blood or blood from unknown donors between January 1, 2003, and December 31, 2012. Patients were followed up from the first transfusion until death, emigration, or end of follow-up. Data analysis was performed from September 15 to November 15, 2016.
The number of transfusions from blood donors of different age and sex. Exposure was treated time dependently throughout follow-up.
Hazard ratios (HRs) for death and adjusted cumulative mortality differences, both estimated using Cox proportional hazards regression.
Results of a crude analysis including 968?264 transfusion recipients (550?257 women and 418?007 men; median age at first transfusion, 73.0 years [interquartile range, 59.8-82.4 years]) showed a U-shaped association between age of the blood donor and recipient mortality, with a nadir in recipients for the most common donor age group (40-49 years) and significant and increasing HRs among recipients of blood from donors of successively more extreme age groups (
Notes
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PubMed ID
28437543 View in PubMed
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Bilateral versus single internal mammary coronary artery bypass grafting in Sweden from 1997-2008.

https://arctichealth.org/en/permalink/ahliterature105157
Source
PLoS One. 2014;9(1):e86929
Publication Type
Article
Date
2014
Author
Magnus Dalén
Torbjörn Ivert
Martin J Holzmann
Ulrik Sartipy
Author Affiliation
Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden ; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Source
PLoS One. 2014;9(1):e86929
Date
2014
Language
English
Publication Type
Article
Keywords
Aged
Coronary Artery Bypass - methods
Coronary Artery Disease - mortality - pathology - therapy
Female
Hospital Mortality
Humans
Mammary Arteries - pathology
Middle Aged
Sweden
Treatment Outcome
Abstract
Prior observational studies have suggested better outcomes in patients who receive bilateral internal mammary arteries (BIMA) during coronary artery bypass grafting (CABG) compared with patients who receive a single internal mammary artery (SIMA). The aim of this study was to analyze the association between BIMA use and long-term survival in patients who underwent primary isolated CABG.
Patients who underwent primary isolated non-emergent CABG in Sweden between 1997 and 2008 were identified. The SWEDEHEART registry and other national Swedish registers were used to acquire information about patient characteristics and outcomes. Unadjusted and multivariable adjusted regression models were used to estimate the association between BIMA use and early mortality, long-term survival, and a composite of death from any cause or rehospitalization for myocardial infarction, heart failure, or stroke in the overall cohort and in a propensity score-matched cohort. The study population consisted of 49702 patients who underwent CABG with at least one internal mammary artery, and 559 (1%) of those had BIMA grafting. In the adjusted analyses, BIMA use was not associated with better survival compared with SIMA use in the overall cohort (hazard ratio (HR) for death: 1.16, 95% confidence interval (CI): 0.97 to 1.37) or in the matched cohort (HR: 1.04, 95% CI: 0.78 to 1.40). The results were similar for early mortality and the composite endpoint. Reoperation for sternal wound complications was more common among BIMA patients (odds ratio: 1.71, 95% CI: 1.01 to 2.88).
BIMA grafting was performed infrequently and was not associated with better outcomes compared with SIMA grafting in patients undergoing non-emergent primary isolated CABG in Sweden during 1997-2008.
Notes
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PubMed ID
24466293 View in PubMed
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Cardiovascular medication in relation to renal function after coronary artery bypass surgery.

https://arctichealth.org/en/permalink/ahliterature260160
Source
Int J Cardiol. 2013 Oct 9;168(4):4033-8
Publication Type
Article
Date
Oct-9-2013
Author
Ulrik Sartipy
Erik Rampell
Axel C Carlsson
Per Wändell
Martin J Holzmann
Source
Int J Cardiol. 2013 Oct 9;168(4):4033-8
Date
Oct-9-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Cardiovascular Agents - pharmacology - therapeutic use
Cohort Studies
Coronary Artery Bypass - adverse effects - trends
Coronary Artery Disease - drug therapy - epidemiology - surgery
Female
Glomerular Filtration Rate - physiology
Humans
Kidney - drug effects - physiology
Male
Middle Aged
Population Surveillance - methods
Retrospective Studies
Sweden - epidemiology
Treatment Outcome
Abstract
Guidelines for recommended medication use for the secondary prevention of coronary heart disease are exceedingly important in patients with chronic kidney disease. Despite a high risk for recurrent cardiovascular events, these patients are less likely to use evidence-based recommended medications. The objective of the current study was to analyze the association between renal function and guideline-recommended drug therapy in patients with coronary heart disease.
In this nationwide population-based cohort study, we included 12,332 patients with established coronary heart disease who underwent primary isolated coronary artery bypass grafting in Sweden between 2005 and 2008. Medication use was retrieved from the national Prescribed Drug Register.
During the first year after coronary surgery, 94% of patients had at least two dispensed prescriptions for an antiplatelet agent, 68% for an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker, 92% for a beta-blocker, and 93% for a statin. Only 57% of all patients had prescriptions for all four medication classes. Reduced renal function (estimated glomerular filtration rate (eGFR) of 30 to 45 mL/min per 1.73 m(2) and 60 mL/min per 1.73 m(2)).
In patients with established coronary heart disease, moderate to severe renal dysfunction was associated with significantly lower use of guideline-recommend medications as compared to normal renal function.
PubMed ID
23880581 View in PubMed
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40 records – page 1 of 4.