scholarly journals Effect of Candesartan Combined with Rosuvastatin on Myocardial Fibrosis in Rats with Alcoholic Cardiomyopathy by Mediating LOX-1 Expression

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Zhanbin Feng ◽  
Yifan Zhang ◽  
Xiaoyan Lv ◽  
Xin Wang ◽  
Bo Yuan
Keyword(s):  
Myocardial Fibrosis ◽  
Volume Fraction ◽  
Statistical Significance ◽  
Intervention Group ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Observation Group ◽  
Alcoholic Cardiomyopathy ◽  
Ventricular Ejection Fraction ◽  
Alcohol Group

Objective: To analyze the effect of candesartan and rosuvastatin on myocardial fibrosis in rats with alcoholic cardiomyopathy by mediating the expression of lectin-like oxidized low-density lipoprotein receptor-1(LOX-1). Methods: The rats were selected as experimental samples, and these rats were randomly divided into observation group and alcohol feeding group (abbreviated as "alcohol group") and desartan combined with rosuvastatin intervention + alcoholic cardiomyopathy group (Referred to as the "intervention group"), the observation group is fed normally, the alcohol group is fed with alcohol, and the intervention group uses two drugs on the basis of the alcohol group to intervene. After 16 weeks of the three groups of experiments, analyze the results of the three groups of experiments. Myocardial structure, myocardial fibrosis and myocardial function. Results: After 16 weeks, the left ventricular short axis shortening rate (FS) and left ventricular ejection fraction in the alcohol group were lower than those in the observation group, while the collagen volume fraction (CVF) and left ventricular end-diastolic diameter (LVEDd) were higher than those in the observation group. The expression of LOX-1 in the intervention group was lower than that in the alcohol group, and the degree of fibrosis was reduced. The expression of LOX-1 in the alcohol group was higher than that in the observation group, and the degree of fiber increased. At the same time, the expression of TN-X and smad-3 protein in the alcohol group (86%± 7%, 83%±9%) were higher than those in the observation group (32%±10%, 30%±7%), while the expression of smad-7 protein (36%±8%) was lower than that in the observation group (78%± 9%), P<0.05 among the three groups of experiments, and there is statistical significance among the groups. Conclusion: Candesartan combined with Rosuvastatin can reduce myocardial fibrosis in rats with alcoholic cardiomyopathy by mediating the expression of LOX-1.

Phenotypic differentiation of patients with chronic heart failure

2021 ◽  
pp. 28-33
Author(s):  
L. P. Voronina ◽  
O. S. Polunina ◽  
O. A. Bashkina ◽  
E. A. Polunina ◽  
T. V. Prokofieva
Keyword(s):  
Heart Failure ◽  
Cluster Analysis ◽  
Chronic Heart Failure ◽  
Functional State ◽  
Vascular Endothelium ◽  
Volume Fraction ◽  
Statistical Significance ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Objective. According to the results of a complex analysis of gender-anamnestic, clinical, biochemical and instrumental parameters using the cluster analysis method to identify phenotypes of chronic heart failure (CHF) in the examined patients.Materials and methods. It was examined 345 patients with CHF with different left ventricular ejection fraction and 60 somatically healthy volunteers. For the study, groups of indicators were formed that most widely characterize the pathogenesis of CHF: gender-anamnestic and clinical, instrumental (echocardiographic study, study of the functional state of the vascular endothelium and skin microcirculation, calculation of the volume fraction of interstitial collagen), biochemical parameters of the functional state of the vascular endothelium, collagen balance, inflammation and oxidative stress.Results. After the cluster analysis by the methods of hierarchical classification and k-means, we identified 4 clusters/phenotypes of CHF: fibrous-rigid, fibrous-inflammatory, inflammatory-destructive and dilatation-maladaptive. According to the results of the analysis of variance were identified 27 of the 48 indicators in which the level of statistical significance of intergroup differences (for the Fisher test) was less than 0.05, that is, indicators that make the greatest contribution to the division of patients with CHF into phenotypic groups.Conclusion. Our analysis with the release of phenotypes indicates that patients with CHF with different phenotypes have clinical and pathogenetic features. The data obtained in the future can be used to determine the prognosis of the disease and the choice of tactics for the management and treatment of patients with CHF depending on the phenotype.

scholarly journals Evaluation of arterial stiffness in systolic heart failure

2021 ◽  
Vol 67 (2) ◽  
pp. 86-89
Author(s):  
Lajos Fehérvári ◽  
István Adorján Szabó ◽  
Lóránd Kocsis ◽  
Attila Frigy
Keyword(s):  
Heart Failure ◽  
Arterial Stiffness ◽  
Statistical Significance ◽  
Systolic Heart Failure ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Chi Square ◽  
Ventricular Ejection Fraction

Abstract Objective: Micro- and macrovascular changes can occur in heart failure, and could influence its prognosis and management. In a prospective study, we proposed the evaluation of arterial stiffness (macrovascular function) and its correlations in patients with systolic heart failure. Methods: 40 patients (32 men, 8 women, mean age 63±2.9 years), with hemodynamically stable systolic heart failure (left ventricular ejection fraction, EF<40%) were enrolled in the study. In every patient, beyond routine explorations (ECG, cardiac and carotid ultrasound, laboratory measurements), arterial stiffness was assessed by measuring pulse wave velocity (PWV). The correlations of PWV with clinical and echo-cardiographic characteristics were studied using t-test and chi-square test (p<0.05 being considered for statistical significance). Results: The average PWV was 8.55±2.2 m/s, and 16 patients had increased PWV (>10 m/s). We found significantly higher PWV values in patients older than 65 years (p<0.001), in patients with eGFR <60 ml/min/1.73 m2 (p<0.001), hypertension (p=0.006), and increased (>1 mm) carotid intima-media thickness (p=0.016). PWV was found to be significantly lower when EF was <30% (p=0.049). Furthermore, the presence of an increased PWV was correlated significantly with age (p<0.001), and (with borderline significance) with eGFR <60 ml/min/1.73 m2 and, inversely, with EF<30%. Conclusions: Increased arterial stiffness reflected by high PWV is frequently present in patients with systolic heart failure, and is mainly correlated with general risk factors of arterial involvement. Low EF, due to low stroke volume and decreased systolic arterial wall tension can influence the values and the interpretation of PWV.

scholarly journals Serum autotaxin level predicts future cardiac events in patients with dilated cardiomyopathy

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
T Araki ◽  
T Okumura ◽  
T Mizutani ◽  
Y Kimura ◽  
S Kazama ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Dilated Cardiomyopathy ◽  
Volume Fraction ◽  
Left Ventricular ◽  
Cox Proportional Hazards ◽  
Left Ventricular Ejection ◽  
Myocardial Inflammation ◽  
Prognostic Impact ◽  
Cardiac Events ◽  
Ventricular Ejection Fraction

Abstract Background Autotaxin (ATX) has been reported to promote myocardial inflammation and subsequent cardiac remodeling through lysophosphatidic acid (LPA) production. However, the prognostic impact of ATX has not been clarified in dilated cardiomyopathy (DCM). Purpose We aimed to investigate the prognostic impact of ATX in patients with DCM. Methods We enrolled 104 DCM patients (49.8 years, 76 males). The subjects underwent blood sampling, echocardiography, cardiac catheterization, and endomyocardial biopsy. Gender differences in serum ATX levels have been reported, thus we divided the subjects into two groups using median serum ATX levels for men and women: High-ATX group and Low-ATX group. All patients were followed up by expert cardiologists. The cardiac event was defined as a composite of cardiac death and hospitalization for worsening heart failure. Results Eighty-nine percent of the subjects were classified as New York Heart Association functional class I or II. Female patients had higher serum ATX levels than male patients, with median values of 257.0 ng/mL and 203.5 ng/mL, respectively (Figure A). The average left ventricular ejection fraction and brain natriuretic peptide levels were 30.6% and 122.5 pg/mL. In survival analysis, cumulative event-free probability was significantly lower in High ATX group (p=0.007, Figure B). In Cox proportional hazards analysis, High-ATX was one of the independent predictors of composite cardiac events (Hazards Ratio, 2.575; p=0.043). On the other hand, high sensitive C-reactive protein and collagen volume fraction in myocardial samples were not significant predictors. Conclusion High serum ATX level was associated with poor prognosis in patients with DCM. FUNDunding Acknowledgement Type of funding sources: None. Gender difference in autotaxin levels Survival analysis of cardiac events

scholarly journals The Diagnostic and Prognostic Utility of Contemporary Cardiac Magnetic Resonance in Suspected Acute Myocarditis

Diagnostics ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 156
Author(s):  
Jakub Lagan ◽  
Christien Fortune ◽  
David Hutchings ◽  
Joshua Bradley ◽  
Josephine H. Naish ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Volume Fraction ◽  
Acute Myocarditis ◽  
Multivariable Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Parametric Mapping ◽  
The Impact

Cardiovascular magnetic resonance (CMR) is used to investigate suspected acute myocarditis, however most supporting data is retrospective and few studies have included parametric mapping. We aimed to investigate the utility of contemporary multiparametric CMR in a large prospective cohort of patients with suspected acute myocarditis, the impact of real-world variations in practice, the relationship between clinical characteristics and CMR findings and factors predicting outcome. 540 consecutive patients we recruited. The 113 patients diagnosed with myocarditis on CMR performed within 40 days of presentation were followed-up for 674 (504–915) days. 39 patients underwent follow-up CMR at 189 (166–209) days. CMR provided a positive diagnosis in 72% of patients, including myocarditis (40%) and myocardial infarction (11%). In multivariable analysis, male sex and shorter presentation-to-scan interval were associated with a diagnosis of myocarditis. Presentation with heart failure (HF) was associated with lower left ventricular ejection fraction (LVEF), higher LGE burden and higher extracellular volume fraction. Lower baseline LVEF predicted follow-up LV dysfunction. Multiparametric CMR has a high diagnostic yield in suspected acute myocarditis. CMR should be performed early and include parametric mapping. Patients presenting with HF and reduced LVEF require closer follow-up while those with normal CMR may not require it.

scholarly journals A model based on clinical parameters to identify myocardial late gadolinium enhancement by magnetic resonance in patients with aortic stenosis: An observational study

2020 ◽  
Vol 9 ◽  
pp. 204800402092240
Author(s):  
Mariya Kuk ◽  
Simon Newsome ◽  
Francisco Alpendurada ◽  
Marc Dweck ◽  
Dudley J Pennell ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Aortic Stenosis ◽  
Risk Stratification ◽  
Myocardial Fibrosis ◽  
Surgical Intervention ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Study Patient ◽  
Ventricular Ejection Fraction

Objective With increasing age, the prevalence of aortic stenosis grows exponentially, increasing left heart pressures and potentially leading to myocardial hypertrophy, myocardial fibrosis and adverse outcomes. To identify patients who are at greatest risk, an outpatient model for risk stratification would be of value to better direct patient imaging, frequency of monitoring and expeditious management of aortic stenosis with possible earlier surgical intervention. In this study, a relatively simple model is proposed to identify myocardial fibrosis in patients with a diagnosis of moderate or severe aortic stenosis. Design Patients with moderate to severe aortic stenosis were enrolled into the study; patient characteristics, blood work, medications as well as transthoracic echocardiography and cardiovascular magnetic resonance were used to determine potential identifiers of myocardial fibrosis. Setting The Royal Brompton Hospital, London, UK Participants One hundred and thirteen patients in derivation cohort and 26 patients in validation cohort. Main outcome measures Identification of myocardial fibrosis. Results Three blood biomarkers (serum platelets, serum urea, N-terminal pro-B-type natriuretic peptide) and left ventricular ejection fraction were shown to be capable of identifying myocardial fibrosis. The model was validated in a separate cohort of 26 patients. Conclusions Although further external validation of the model is necessary prior to its use in clinical practice, the proposed clinical model may direct patient care with respect to earlier magnetic resonance imagining, frequency of monitoring and may help in risk stratification for surgical intervention for myocardial fibrosis in patients with aortic stenosis.

Improvement in the Severity of Mitral Regurgitation after Direct Intramyocardial Injection of Angiogenic Cell Precursor

2009 ◽  
Vol 4 (5) ◽  
pp. 291-293
Author(s):  
Kitipan V. Arom ◽  
Permyos Ruengsakulrach ◽  
Lertlak Chaothawee
Keyword(s):  
Mitral Regurgitation ◽  
Dilated Cardiomyopathy ◽  
Myocardial Fibrosis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Severe Mitral Regurgitation ◽  
Class Iii ◽  
Intramyocardial Injection ◽  
Ventricular Ejection Fraction ◽  
Cell Implantation

We reported a case of dilated cardiomyopathy and moderate-severe mitral regurgitation (MR) who we treated by surgical direct intramyocardial angiogenic cell precursors injection. The patient was a New York Heart Association functional class III-IV, 56 year old man, who presented with end-stage congestive heart failure, moderate/severe mitral regurgitation, and myocardial fibrosis with the left ventricular ejection fraction of 13%. After he underwent direct surgical intramyocardial cell implantation, the myocardial fibrosis was resolved at 3 months follow-up. The severity of MR reduced to moderate and mild at 3 and 9 months, respectively. The left ventricular function gradually improved up to 53% at 19 months. To our knowledge, this is one of the only reports of successful direct surgical intramyocardial peripheral blood stem cell implantation to treat MR in dilated cardiomyopathy patient.

scholarly journals Effects of Vitamin D on Left Ventricular Ejection Fraction in Patients with Systolic Heart Failure: A Double-Blind Randomized Clinical Trial

2020 ◽  
Vol 18 (3) ◽  
Author(s):  
Reza Hassanzadeh-Makoui ◽  
Maziar Jamei ◽  
Masoud Hassanzadeh-Makoui ◽  
Hamid Khederlou
Keyword(s):  
Heart Failure ◽  
Vitamin D ◽  
Placebo Group ◽  
Ejection Fraction ◽  
Vitamin D Deficiency ◽  
Intervention Group ◽  
Systolic Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Background: Heart failure is a pathophysiologic state in which the cardiac output is not able to supply the body with enough oxygen and nutrients. The prevalence of heart failure has increased dramatically over the last decades. Vitamin D levels in patients with chronic heart failure are lower than healthy controls, and vitamin D deficiency has a direct relationship with mortality. Objectives: This study aimed to evaluate the effect of vitamin D on the improvement of left ventricular ejection fraction in patients with systolic heart failure. Methods: In this case-control clinical trial, 142 patients with chronic systolic heart failure were identified. Based on the inclusion and exclusion criteria, 114 patients were enrolled in the study and randomly divided into two groups. One group (n = 58) received 50,000 units of vitamin D capsules weekly for eight weeks, and the patients in the other group (n = 56) received a placebo. After excluding 15 patients from the placebo group and 17 patients from the intervention group during the study, according to the exclusion criteria, 41 patients were evaluated in both groups for ejection fraction changes after two months. Results: According to the results of this research, there were no statistically significant differences in the baseline parameters between the two studied groups. The intervention group consisted of 18 female and 23 male patients with a mean age of 61.68 ± 19.8 years. Moreover, the placebo group included 21 female and 20 male patients with a mean age of 62.12 ± 18.2 years. After a 2-month follow-up, the intervention group showed statistically significant changes in ejection fraction, end-diastolic volume, and heart failure class compared to the placebo group. Also, the serum level of albumin and vitamin D in the intervention group was significantly higher than the placebo group. Conclusions: The results of this study show that vitamin D treatment can improve the ejection fraction and functional ability of patients with vitamin D deficiency. If more comprehensive studies support this hypothesis, vitamin D deficiency assessment and correction in patients with chronic heart failure may be recommended.

Prognosis of incidental left bundle branch block

EP Europace ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. 956-963
Author(s):  
Abbasin Zegard ◽  
Osita Okafor ◽  
Joseph de Bono ◽  
Richard Steeds ◽  
Lucy Hudsmith ◽  
...  
Keyword(s):  
Myocardial Fibrosis ◽  
Left Bundle Branch Block ◽  
Total Mortality ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cardiac Events ◽  
Bundle Branch Block ◽  
Ventricular Ejection Fraction ◽  
Clinical Events ◽  
Cardiac Symptoms

Abstract Aims Incidental left bundle branch block (iLBBB) is a frequent cause for cardiology referrals. In such instances, there is uncertainty as to its prognosis. We sought to determine the utility of cardiovascular magnetic resonance (CMR) in the risk stratification of patients with iLBBB. Methods and results Clinical events were collected in patients with iLBBB who had CMR. Controls had no cardiac symptoms or cardiac disease, a normal CMR scan and electrocardiogram. Amongst patients with iLBBB [n = 193, aged 62.7 ± 12.6 years (mean ± SD)], 110/193 (56.9%) had an abnormal phenotype (iLBBBCMR+) and 83/110 (43.0%) had a normal phenotype (iLBBBCMR−). Over 3.75 years (median; inter-quartile range: 2.7–5.5), iLBBBCMR+ had a higher total mortality [adjusted hazard ratio (aHR) 6.49, 95% confidence interval (CI) 1.91–22.0] and total mortality or major adverse cardiac events (MACEs; aHR 9.15, 95% CI 2.56–32.6) than controls (n = 107). In contrast, iLBBBCMR− had a similar risk of total mortality compared with controls, but total mortality or MACEs was higher (aHR 4.24, 95% CI 1.17–15.4; P = 0.028). Amongst iLBBB patients, both myocardial fibrosis (aHR 5.15, 95% CI 1.53–17.4) and left ventricular ejection fraction (LVEF)  ≤ 50% (aHR 3.88, 95% CI 1.67–9.06) predicted total mortality. Myocardial fibrosis plus LVEF ≤50% was associated with the highest risk of total mortality (aHR: 9.87, 95% CI 2.99–32.6) and total mortality or MACEs (aHR 3.98, 95% CI 1.73–9.11). Conclusions Outcomes in iLBBBCMR+ were poor whereas survival in iLBBBCMR− was comparable with controls. Myocardial fibrosis and LVEF &lt;50% had an additive effect on the risk of clinical outcomes. A CMR scan is pivotal in risk-stratifying patients with iLBBB.

scholarly journals miR-19a-3p containing exosomes improve function of ischaemic myocardium upon shock wave therapy

2019 ◽  
Vol 116 (6) ◽  
pp. 1226-1236 ◽  
Author(s):  
Can Gollmann-Tepeköylü ◽  
Leo Pölzl ◽  
Michael Graber ◽  
Jakob Hirsch ◽  
Felix Nägele ◽  
...  
Keyword(s):  
Shock Wave ◽  
Myocardial Fibrosis ◽  
Myocardial Ischaemia ◽  
Heart Function ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Shock Wave Therapy ◽  
Ventricular Ejection Fraction ◽  
Ischaemic Myocardium

Abstract Aims As many current approaches for heart regeneration exert unfavourable side effects, the induction of endogenous repair mechanisms in ischaemic heart disease is of particular interest. Recently, exosomes carrying angiogenic miRNAs have been described to improve heart function. However, it remains challenging to stimulate specific release of reparative exosomes in ischaemic myocardium. In the present study, we sought to test the hypothesis that the physical stimulus of shock wave therapy (SWT) causes the release of exosomes. We aimed to substantiate the pro-angiogenic impact of the released factors, to identify the nature of their cargo, and to test their efficacy in vivo supporting regeneration and recovery after myocardial ischaemia. Methods and results Mechanical stimulation of ischaemic muscle via SWT caused extracellular vesicle (EV) release from endothelial cells both in vitro and in vivo. Characterization of EVs via electron microscopy, nanoparticle tracking analysis and flow cytometry revealed specific exosome morphology and size with the presence of exosome markers CD9, CD81, and CD63. Exosomes exhibited angiogenic properties activating protein kinase b (Akt) and extracellular-signal regulated kinase (ERK) resulting in enhanced endothelial tube formation and proliferation. A miRNA array and transcriptome analysis via next-generation sequencing were performed to specify exosome content. miR-19a-3p was identified as responsible cargo, antimir-19a-3p antagonized angiogenic exosome effects. Exosomes and target miRNA were injected intramyocardially in mice after left anterior descending artery ligation. Exosomes resulted in improved vascularization, decreased myocardial fibrosis, and increased left ventricular ejection fraction as shown by transthoracic echocardiography. Conclusion The mechanical stimulus of SWT causes release of angiogenic exosomes. miR-19a-3p is the vesicular cargo responsible for the observed effects. Released exosomes induce angiogenesis, decrease myocardial fibrosis, and improve left ventricular function after myocardial ischaemia. Exosome release via SWT could develop an innovative approach for the regeneration of ischaemic myocardium.

scholarly journals Continuous hemodiafiltration as a rescue therapy for patients with cardiopulmonary failure caused by enterovirus-71: a retrospective observational study in a PICU

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Chunxia Wang ◽  
Yun Cui ◽  
Yan Zhu ◽  
Fei Wang ◽  
Qunfang Rong ◽  
...  
Keyword(s):  
Observational Study ◽  
Statistical Significance ◽  
Enterovirus 71 ◽  
Left Ventricular ◽  
Retrospective Observational Study ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Continuous Hemodiafiltration ◽  
Ventricular Ejection Fraction ◽  
Cardiopulmonary Failure

Abstract Background Hand, foot and mouth disease (HFMD) remains a burdensome health issue in mainland China. Enterovirus71 (EV-A71) is the main pathogen of severe HFMD. Continuous hemofiltration improves fluid overload, restores kidney function and alleviates inflammatory reactions. The aim of the present study was to evaluate the effects of continuous veno-venous hemodiafiltration (CVVHDF) on severe HFMD caused by EV-A71(EV-A71-HFMD) in a pediatric intensive care unit (PICU). Methods A retrospective observational study was performed in a tertiary university PICU from January 2012 to December 2016. Children with severe EV-A71-HFMD complicated by cardiopulmonary failure were included. The patients were divided into a CVVHDF group and a conventional therapy (control) group (non-CVVHDF). The demographics, characteristics, and outcomes between the groups were collected and analyzed. Results Twenty-nine patients with severe EV-A71-HFMD were enrolled. The 28-day mortality was 17.6% (3/17) in the CVVHDF group and 33.3% (4/12) in the non-CVVHDF group, with no statistical significance between the two groups (P = 0.403). The median interval between CVVHDF initiation and PICU admission was 6 (4,8.5) hrs, and the median duration of CVVHDF was 48 (36, 64) hrs. The left ventricular ejection fraction (LVEF) and cardiac index (CI) in the CVVHDF group were improved after treatment. The plasma levels of catecholamines and renin-angiotensin-aldosterone system (RAAS) substances in the CVVHDF group were significantly decreased after treatment. The decreased catecholamines and RAAS substances included adrenalin (169.8 [145.5, 244.6] vs. 148.0 [109.0, 208.1] ng/L, P = 0.033), dopamine (152.7 [97.0, 191.1] vs. 96.0 [68.0, 160.9] ng/L, P = 0.026), angiotensin II (185.9 [125.2, 800.0] vs. 106.0 [90.8, 232.5] ng/L, P = 0.047), aldosterone (165.7 [94.0, 353.3] vs. 103.3 [84.3, 144.3] ng/L, P = 0.033), and renin (1.12 [0.74, 3.45] vs. 0.79 [0.52, 1.25] μg/L/h, P = 0.029), Conclusions CVVHDF reduced the levels of catecholamines and RAAS substances and improved cardiovascular function. Continuous hemodiafiltration may represent a potential therapy in patients with severe EV-A71-HFMD complicated with cardiopulmonary failure.

Sign in / Sign up

Export Citation Format

Share Document