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Hypocalcemia In Neonates Of Diabetic Mother

Calcitonin And Parathyroid Hormone Relation To Early Neonatal Hypocalcemia In Infants Of Diabetic Mothers

Calcitonin And Parathyroid Hormone Relation To Early Neonatal Hypocalcemia In Infants Of Diabetic Mothers

Calcitonin and Parathyroid Hormone Relation to Early Neonatal Hypocalcemia in Infants of Diabetic Mothers I have read the Karger Terms and Conditions and agree. I have read the Karger Terms and Conditions and agree. Buy a Karger Article Bundle (KAB) and profit from a discount! If you would like to redeem your KAB credit, please log in . Save over 20% compared to the individual article price. Buy Cloud Access for unlimited viewing via different devices Access to all articles of the subscribed year(s) guaranteed for 5 years Unlimited re-access via Subscriber Login or MyKarger Unrestricted printing, no saving restrictions for personal use * The final prices may differ from the prices shown due to specifics of VAT rules. For additional information: The levels of total and ultrafiltrable calcium, phosphorus, total protein, calcitonin (CT) and parathyroid hormone (PTH) in plasma were determined together with blood sugar in 11 consecutive cases of infants of diabetic mothers (IDM) and 9 healthy term infants during the first days of life. The decrease of calcium in plasma after birth was significantly greater in IDM than in controls. In both IDM and controls, a marked increase of the CT concentration was observed after birth. The maximum was reached at 24 h of age. No significant differences were seen between the two groups. Only in IDM was a significant correlation between calcium and CT in plasma seen, suggesting a greater sensitivity to CT in these infants. Low values of PTH in comparison with adult standards were found in both groups of infants, despite decreasing calcium levels. A hypothesis is presented to account for early neonatal hypocalcemia (NHC) in IDM. For additional information: Copyright: All rights reserved. No part of this publication may be translated into ot Continue reading >>

Hypocalcemia In Infants Of Diabetic Mothers. Studies In Circulating Calciotropic Hormone Concentrations.

Hypocalcemia In Infants Of Diabetic Mothers. Studies In Circulating Calciotropic Hormone Concentrations.

Hypocalcemia in infants of diabetic mothers. Studies in circulating calciotropic hormone concentrations. Salle B , David L , Glorieux F , Delvin EE , Louis JJ , Troncy G . Twenty-two infants of diabetic mothers (IDM) were studied and were divided into two groups: a first group of 14 IDM did not receive vitamin D3 and was studied at birth and at 2, 24, 48 and 120 hours; a second group was given daily dosage of 60 microgram of vitamin D3 from 3 hours to 120 hours and was studied at 2 hours and 120 hours. In the first group, serum calcium levels decreased markedly during the first 24 hours of life (mean +/- SD: 1.77 +/- 0.3 mmol/l, p less than 0.01) and remained low at 5 days. Serum phosphorus levels remained normal but serum magnesium levels decreased significantly at 24 hours (mean +/- SD: 0.64 +/- 0.108 mmol/l, p less than 0.01) and returned to normal at 5 days. Serum immunoreactive parathormone levels increased consistently to high levels at 24 hours and remained elevated at 120 hours (p less than 0.001). Serum immunoreactive calcitonin levels increased at 24 hours (p less than 0.001) and decreased at 120 hours to low or undetectable values in all infants. In group II, serum 25O-HD levels and 1.25 OH2 D levels increased significantly (p less than 0.001) respectively to 27.2 +/- 2.7 ng/ml and 114 +/- 20 pg/ml at 5 days. The results of this study show hypocalcemia to be a common event in IDM during the first days of life and furthermore hypophosphatemia, hypoparathyroidism, hypomagnesemia or defect of vitamin D metabolism would not seem to be the main etiological factors. Continue reading >>

Infant Of Diabetic Mother

Infant Of Diabetic Mother

Author: Charles F Potter, MD; Chief Editor: Ted Rosenkrantz, MD more... Infants of diabetic mothers (IDMs) have experienced a nearly 30-fold decrease in morbidity and mortality rates since the development of specialized maternal, fetal, and neonatal care for women with diabetes and their offspring. Before then, fetal and neonatal mortality rates were as high as 65%. Today, 3-10% of pregnancies are affected by abnormal glucose regulation and control. Of these cases, 80-88% are related to abnormal glucose control of pregnancy or gestational diabetes mellitus. Of mothers with preexisting diabetes, 35% have been found to have type 1 diabetes mellitus, and 65% have been found to have type 2 diabetes mellitus. Infants born to mothers with glucose intolerance are at an increased risk of morbidity and mortality related to the following: Growth abnormalities (large for gestational age [LGA], small for gestational age [SGA]) Hypocalcemia , hypomagnesemia, and iron abnormalities These infants are likely to be born by cesarean delivery for many reasons, among which are such complications as shoulder dystocia with potential brachial plexus injury related to the infant's large size. These mothers must be closely monitored throughout pregnancy. If optimal care is provided, the perinatal mortality rate, excluding congenital malformations, is nearly equivalent to that observed in normal pregnancies. Communication between members of the perinatal team is of crucial importance to identify infants who are at the highest risk for complications from maternal diabetes. Fetal congenital malformations are most common when maternal glucose control has been poor during the first trimester of pregnancy. As such, the need for preconceptional glycemic control in women with diabetes cannot be overst Continue reading >>

Neonatal Hypocalcemia

Neonatal Hypocalcemia

Early-onset hypocalcemia ordinarily resolves in a few days, and asymptomatic neonates with serum calcium levels > 7 mg/dL or ionized calcium > 3.5 mg/dL rarely require treatment. Those term infants with levels < 7 mg/dL and preterm infants with calcium < 6 mg/dL (< 1.5 mmol/L) should be treated with 2 mL/kg of 10% calcium gluconate (200 mg/kg) by slow IV infusion over 30 min. Too-rapid infusion can cause bradycardia, so heart rate should be monitored during the infusion. The IV site should also be watched closely because tissue infiltration by a calcium solution is irritating and may cause local tissue damage or necrosis. Manifestations of calcium infiltration include skin redness, calcification, and necrosis or slough; there can be radial nerve damage at the wrist. After acute correction of hypocalcemia, calcium gluconate may be mixed in the maintenance IV infusion and given continuously. Starting with 400 mg/kg/day of calcium gluconate, the dose may be increased gradually to 800 mg/kg/day, if needed, to prevent a recurrence. When oral feedings are begun, the formula may be supplemented with the same daily dose of calcium gluconate, if needed, by adding the 10% calcium gluconate solution into the days formula. Supplementation is usually required for only a few days. Late-onset hypocalcemia treatment is addition of calcitriol or additional calcium to infant formula to provide a 4:1 molar ratio of calcium:phosphate until normal calcium levels are maintained. Oral calcium preparations have a high sucrose content, which may lead to diarrhea in preterm infants. Neonatal hypocalcemia usually occurs within the first 2 days of life and is most often caused by prematurity, being small for gestational age, maternal diabetes or hyperparathyroidism, and perinatal asphyxia. Neonat Continue reading >>

Hypocalcemic Seizures In Neonates

Hypocalcemic Seizures In Neonates

A case of a 2-week-old infant who presented to the emergency department (ED) with rapid eye blinking and jerking in the absence of physical abnormalities is presented. Hypocalcemia and hypomagnesemia were detected. This case represents the common presentation, therapy, and outcome of neonatal hypocalcemia. It is of particular interest to ED physicians because most of the time the etiology of neonatal seizures can be diagnosed in the ED and appropriate therapy can be immediately instituted. Neonatal seizures occur within the first 2 weeks of life. Even though the threshold for seizure is high in the neonatal period, neonatal seizures are quite common. The overall incidence is 1 in 200 live births. Neonatal seizures tend to be brief, because immature neurons are unable to sustain repetitive activity for long periods of time and to be focal or multifocal. Parents invariably rush their child with seizure to the emergency department (ED) for immediate treatment. Specific cause can be determined only in about 70% of cases. Infants commonly present with subtle symptoms, more often than with clonic or tonic convulsion. Recognization of these symptoms is important for making the diagnosis and initiation of appropriate treatment in the ED. A 2-week-old infant was brought to the ED by her mother, who stated that the child had been well until 2 days earlier, when she began having episodes of rapid eye blinking, trembling, and jerking occurring several times a day, each episode lasting approximately 1 minute. All four extremities were involved symmetrically; each episode was followed by a brief period of sleep. There was no associated skin color change or respiratory difficulty, and there was no history of trauma, fever, vomiting, or diarrhea. The child had continued to feed well o Continue reading >>

Hypocalcemia In Infants Of Diabetic Mothers

Hypocalcemia In Infants Of Diabetic Mothers

Abstract Since infants of diabetic mothers are often delivered prematurely, it has been uncertain whether the hypocalcemia reported in them is related to maternal diabetes or to prematurity. In this study of 28 infants of diabetic mothers and 28 prospectively matched infants born to nondiabetic mothers, the incidence of hypocalcemia was significantly increased in the infants of diabetic mothers, even when gestational age and perinatal complications were taken into consideration. Renal studies demonstrated no differences in excretion of calcium, magnesium, and phosphorus between infants of diabetic mothers and control infants. Serum calcium levels were higher in diabetic mothers than in nondiabetic control subjects. Lower serum calcium levels and higher serum phosphate levels were present in infants of diabetic mothers postnatally. End organ responsiveness was shown by a calcemic and phosphaturic response to exogenous parathormone. It is speculated that relative maternal hyperparathyroidism leading to fetal hypoparathyroidism may be a factor in the pathogenesis of neonatal hypocalcemia in infants of diabetic mothers. Continue reading >>

Magnesium Deficiency - Neonatal Hypocalcemia In Diabetic Mothers'infants Mimouni, Francis University Of Cincinnati, Cincinnati, Oh, United States

Magnesium Deficiency - Neonatal Hypocalcemia In Diabetic Mothers'infants Mimouni, Francis University Of Cincinnati, Cincinnati, Oh, United States

Magnesium Deficiency - Neonatal Hypocalcemia in Diabetic Mothers'Infants The proposal builds upon our long-term studies of calcium and magnesium homeostasis in the perinatal period and the diabetic pregnancy. It is designed to examine calcium-magnesium metabolism in infants in insulin dependent diabetic mothers. Infants studied are derived from the Core Clinical Trial of diabetic women randomized into Group I, strict control versus Group II, customary control; and Group III, late entry subjects. In the present proposal, infants of diabetic mothers are further randomized at the time of delivery into-two groups, one given intramuscular magnesium sulfate and one untreated. The hypothesis to be studied is that magnesium deficiency is the major mechanism for hypocalcemia in infants of diabetic mothers, and therefore prophylactic magnesium administration in a clinical trial will prevent neonatal hypercalcemia in such infants. We hypothesize that infants randomized to magnesium sulfate at birth will have higher serum magnesium, calcium, parathyroid hormone, and similar 1,25-dihydroxyvitamin D concentrations at 12, 24 and 72 hours of age when compared with infants randomized to receive no magnesium sulfate. Since hypomagnesemia and hypocalcemia in the neonatal period may be associated with electroencephalographic abnormalities, tetany, convulsions, and cardiac disturbances, and since traditional treatment of neonatal hypocalcemia (i.e. calcium salts) is responsible for many potential complications, magnesium administration at birth could prove to be a safe, simple alternative to calcium therapy. The present study also will take into account major confounding variables of neonatal asphyxia and prematurity, and allow the determination of the contribution of magnesium deficiency Continue reading >>

Hypocalcemia In Infants Of Diabetic Mothers: Studies In Calcium, Phosphorus, And Magnesium Metabolism And Parathormone Responsiveness - Sciencedirect

Hypocalcemia In Infants Of Diabetic Mothers: Studies In Calcium, Phosphorus, And Magnesium Metabolism And Parathormone Responsiveness - Sciencedirect

Volume 80, Issue 3 , March 1972, Pages 384-395 Get rights and content Since infants of diabetic mothers are often delivered prematurely, it has been uncertain whether the hypocalcemia reported in them is related to maternal diabetes or to prematurity. In this study of 28 infants of diabetic mothers and 28 prospectively matched infants born to nondiabetic mothers, the incidence of hypocalcemia was significantly increased in the infants of diabetic mothers, even when gestational age and perinatal complications were taken into consideration. Renal studies demonstrated no differences in excretion of calcium, magnesium, and phosphorus between infants of diabetic mothers and control infants. Serum calcium levels were higher in diabetic mothers than in nondiabetic control subjects. Lower serum calcium levels and higher serum phosphate levels were present in infants of diabetic mothers postnatally. End organ responsiveness was shown by a calcemic and phosphaturic response to exogenous parathormone. It is speculated that relative maternal hyperparathyroidism leading to fetal hypoparathyroidism may be a factor in the pathogenesis of neonatal hypocalcemia in infants of diabetic mothers. Continue reading >>

Chapter 48. Infant Of A Diabetic Mother

Chapter 48. Infant Of A Diabetic Mother

Heather Morein French; Rebecca A. Simmons French H, Simmons RA. French H, Simmons R.A. French, Heather Morein, and Rebecca A. Simmons.Chapter 48. Infant of a Diabetic Mother. In: Rudolph CD, Rudolph AM, Lister GE, First LR, Gershon AA. Rudolph C.D., Rudolph A.M., Lister G.E., First L.R., Gershon A.A. Eds. Colin D. Rudolph, et al.eds. Rudolph's Pediatrics, 22e New York, NY: McGraw-Hill; 2011. Accessed April 24, 2018. French H, Simmons RA. French H, Simmons R.A. French, Heather Morein, and Rebecca A. Simmons.. "Chapter 48. Infant of a Diabetic Mother." Rudolph's Pediatrics, 22e Rudolph CD, Rudolph AM, Lister GE, First LR, Gershon AA. Rudolph C.D., Rudolph A.M., Lister G.E., First L.R., Gershon A.A. Eds. Colin D. Rudolph, et al. New York, NY: McGraw-Hill, 2011, Abnormal maternal glucose metabolism occurs in 3% to 10% of pregnancies in the United States. 1 While 90% of cases encountered during pregnancy are caused by gestational diabetes mellitus, the incidence of pregestational diabetes mellitus is rapidly increasing, in large part because of the increased incidence of obesity-related type 2 diabetes. 2 The infant of the diabetic mother (IDM) is at increased risk for periconceptional, fetal, neonatal, and long-term morbidities. All of the complications faced by this fragile group of infants are the direct result of maternal glycemic control both before and during pregnancy. Before the availability of insulin to the pregnant mother, perinatal mortality rates were as high as 75%. With the addition of insulin therapy and good prenatal care, perinatal mortality rates now approach those seen in the nondiabetic population. 3 Even with strict glycemic control, fetal and infant complications persist. Congenital anomalies are more frequent in the diabetic versus nondiabetic pregna Continue reading >>

Hypocalcemia And Neonates

Hypocalcemia And Neonates

Kelly A1, Levine MA. Hypocalcemia in the critically ill patient. J Intensive Care Med. 2013 May-Jun;28(3):166-77. PMID: 21841146 . [PubMed] [Read by QxMD] Hypocalcemia is common in the critically ill patient. In this population, however, the diagnosis of hypocalcemia is complicated by limitations in the interpretation of the total plasma calcium concentration. These limitations are principally the result of the effects of hypoalbuminemia and disorders of acid-base balance on the total calcium concentration. Thus, measurement of ionized calcium can be critical in determining an individuals true ser [] Thornton MD1, Chen L, Langhan ML. Neonatal seizures: soothing a burning topic. Pediatr Emerg Care. 2013 Oct;29(10):1107-10. PMID: 24084610 . [PubMed] [Read by QxMD] Neonatal seizures are a potentially life-threatening pediatric problem with a variety of causes, such as birth trauma, asphyxia, congenital anomalies, metabolic disturbances, infections, and drug withdrawal or intoxication. Thorough and timely evaluations of such patients are necessary to identify and treat the underlying etiology, therefore reducing potential morbidity and mortality. We review neonatal seizures and hypocalcemia and present the c [] Walton DM1, Thomas DC, Aly HZ, Short BL. Morbid hypocalcemia associated with phosphate enema in a six-week-old infant. Pediatrics. 2000 Sep;106(3):E37. PMID: 10969121 . [PubMed] [Read by QxMD] A 6-week-old premature infant who was born at 29 weeks of gestation presented to the emergency department with a several-hour history of stiffness and increased alarms on his apnea monitor at home. On arrival he was noted to have generalized seizures, apnea, and bradycardia. He was intubated and required cardiopulmonary resuscitation including chest compressions and medication Continue reading >>

Neonatal Hypocalcemia In Infants Of Diabetic Mothers-hormonal Effects

Neonatal Hypocalcemia In Infants Of Diabetic Mothers-hormonal Effects

NEONATAL HYPOCALCEMIA IN INFANTS OF DIABETIC MOTHERS-HORMONAL EFFECTS Pediatric Research volume 8, page 140 (1974) | Download Citation Infants of diabetic mothers (IDM) are prone to develop neonatal hypocalcemia (NHC) more frequently than control infants. To evaluate the possible role of thyrocalcitonin (TCT) as a cause of NHC a group of 12 IDM was studied and compared with 11 control infants. The IDM had a significantly lower Ca level in serum (both total and ultrafiltrable) than the controls at 24 hrs, despite equal values at birth. Both groups had a significant increase of the TCT level at 24 hrs compared with 0 and 48 hrs. No significant difference between the 2 groups was, however, observed. The Ca level in serum at 24 hrs was significantly correlated to the TCT value in IDM but not in controls. In 2 controls and 3 IDM the concentration of parathyroid hormone in blood was measured at 0, 24 and 48 hrs. All infants had markedly reduced levels, compared to adult standards. One IDM, who developed NHC, increased the concentration of parathyroid hormone 3 times without affecting the serum Ca but with an increased phosphaturia.-It is suggested that NHC is related to the high concentrations of TCT which inhibit the mobilizing effect on Ca from the skeleton by parathyroid hormone. The high incidence of NHC in IDM is ascribed to a more rapid turn-over of Ca in the skeleton of these infants--enhancing the effect of TCT. Pediatric Clinic, Children's Hospital, Gteborg, Sweden. Continue reading >>

Shiraz E-medical Journal

Shiraz E-medical Journal

1 Neonatal Division, Aliasghar Hospital, Iran University of Medical Sciences, Tehran, IR Iran 2 Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, IR Iran * Corresponding Author: Zahra Farahani, Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-9121764503, Fax: +98-2166591315, E-mail: [email protected] Shiraz E-Medical Journal: June 01, 2015, 16 (6) ; e28080 Published Online: June 23, 2015 To Cite: Khalesi N, Namiranian P, Samavati S, Farahani Z. The Frequency of Early and Late Hypocalcemia Among Hospitalized Newborns in An Iranian Hospital, Shiraz E-Med J. 2015 ;16(6):e28080. doi: 10.17795/semj28080 . Background: Hypocalcemia is a common neonatal abnormality particularly in high-risk neonates. Hypocalcaemic neonates with early diagnosis recover after a period of treatment with calcium. Objectives: In this study we aimed to determine the frequency of early and late hypocalcemia, as well as the influence of some relating factors. Patients and Methods: One hundred neonates with early or late hypocalcemia (hospitalized in Aliasghar Hospital of Tehran, Iran, during 2011) were enrolled. The required information was extracted from medical records. The frequency of each hypocalcemia type and relating factors were assessed. Results: Amongst all subjects, 63% had early and 37% had late hypocalcemia. We found significant associations between early or late hypocalcemia with Apgar score of < 5 and prematurity (P < 0.05). Conclusions: Calcium supplemented food could prevent hypocalcemia complications in high-risk neonates. Keywords: Hypocalcemia; Newborns; Apgar Score; Premature Copyright 2015, Shiraz University of Medical Sciences. This is an open-access article distributed Continue reading >>

Metabolic Problems In Infants Of Diabetic Mothers (idm's)

Metabolic Problems In Infants Of Diabetic Mothers (idm's)

John A. Widness, MD Peer Review Status: Internally Peer Reviewed Maternal Factors The degree of illness in the IDM has been associated with the duration, severity and control of the mother's diabetes. Hence, essential points in the maternal history are: White's Class of diabetes (increasing from "Classes" A->R), Therapy (diet, insulin, oral hypoglycemic drugs, etc.), Time of the last insulin injection prior to delivery since this affects maternal glucose, Amount and type of IV fluids given during labor and delivery, Estimated gestational age , and Degree of chronic glucose control during pregnancy by HgbA1c and/or by maternal outpatient glucose "home" monitoring. Congenital Anomalies Because the incidence of congenital anomalies is increased in IDM's, a thorough physical examination is essential. In particular, the incidence of congenital heart disease and anomalies of the nervous system, e.g., anencephaly, spina bifida, microcephaly, caudal regression syndrome, are higher in IDM's. (This knowledge also has important implications in counseling diabetics who have delivered and adolescent girls who have diabetes.) RDS The IDM is at greater risk for RDS than most non-IDM infants of comparable gestational age. During the first hours of life, all IDMs should be observed carefully for this morbidity and treated promptly. Hypoglycemia The incidence of hypoglycemia in IDM’s has been reported as high as 50% in some studies. Optimally, cord blood obtained at delivery should be sent to STAT for a true plasma glucose level. The higher the cord plasma glucose value, the greater the likelihood the infant will develop hypoglycemia within the first hours of life. The incidence of hypoglycemia is highest at 1-4 hours of age after the fall in plasma glucose following the cessation of m Continue reading >>

Polycythemia, Hypomagnesemia, And Hypocalcemia In Infants Of Diabetic Mothers

Polycythemia, Hypomagnesemia, And Hypocalcemia In Infants Of Diabetic Mothers

Polycythemia, Hypomagnesemia, and Hypocalcemia in Infants of Diabetic Mothers Hypomagnesemia (serum megnesium concentration, <1.5 mg/dL [0.62 mmol/L]) and hypocalcemia (serum calcium concentration, <8 mg/dL [2.00 mmol/L]) have been reported in polycythemic infants, as well as in infants of diabetic mothers (IDMs). These latter infants are at risk for neonatal polycythemia (venous hematocrit, 65% [0.65]). We tested the hypothesis that neonatal polycythemia in IDMs is associated with increased serum calcitonin concentration, hypomagnesemia, and hypocalcemia. Serum magnesium and calcium concentrations were measured at 24 and 72 hours of age in 76 IDMs; serum calcitonin concentration was measured at 24 hours of age. Peripheral venous spun hematocrit was measured between 2 and 4 hours of age. The rates of hypomagnesemia and hypocalcemia were similar in polycythemic and nonpolycythemic IDMs (0% vs 9% and 56% vs 49%, respectively). The serum calcitonin concentration was similar in both groups. There was no correlation between hematocrit and the serum magnesium or calcium concentration; a significant association existed between hypocalcemia and hypomagnesemia. Continue reading >>

Hypocalcemia In The Newborn

Hypocalcemia In The Newborn

, Volume 68, Issue10 , pp 973976 | Cite as Healthy term babies undergo a physiological nadir in serum calcium levels by 2448 hours of age. This nadir may be related to the delayed response of parathyroid and calcitonin hormones in a newborn. This nadir may drop to hypocalcemic levels in high-risk neonates including infants of diabetic mothers, preterm infants and infants with perinatal asphyxia. This early onset hypocalcemia which presents within 72 hours, requires treatment with calcium supplementation for at least 72 hours. In contrast late onset hypocalcemia usually presents after 7 days and requires long term therapy. Ionized calcium is crucial for many biochemical processes and total serum calcium is a poor substitute for the diagnosis of hypocalcemia. This is a preview of subscription content, log in to check access. Unable to display preview. Download preview PDF. Oden J, Bourgeois M. Neonatal endocrinology.Indian J Pediatr 2000; 67: 217223. PubMed Google Scholar Schwartz R, Teramo KA. Effects of diabetic pregnancy on the fetus and newborn.Semin Perinatol 2000; 24: 120135. PubMed CrossRef Google Scholar Salle BL, Delvin EE, Lapillonne A, Bishop NJ, Glorieux FH. Perinatal metabolism of vitamin D.Am J Clin Nutr 2000; 71 (Suppl 5): 1317S-1324S. PubMed Google Scholar Marx SJ. Hyperparathyroid and hypoparathyroid disorders.N Engl J Med 2000; 343: 18631875. PubMed CrossRef Google Scholar Mimouni F, Tsang RC. Neonatal hypocalcemia: to treat or not to treat?J Am Coll Nutr 1994; 13: 408415. PubMed Google Scholar Salle BL, Delvin E, Glorieux F, David L. Human neonatal hypocalcemia.Biol Neonate 1990; 58 (Suppl 1): 2231. PubMed Google Scholar Continue reading >>

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