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Beri N, Narayan O, Mundada V. Gingival hyperplasia in a child with spinal muscular atrophy type 1. Arch Dis Child 2024:archdischild-2024-327148. [PMID: 38816067 DOI: 10.1136/archdischild-2024-327148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2024] [Indexed: 06/01/2024]
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Barker N, Sinha A, Jesson C, Doctor T, Narayan O, Elphick HE. Changes in UK paediatric long-term ventilation practice over 10 years. Arch Dis Child 2023; 108:218-224. [PMID: 36446480 DOI: 10.1136/archdischild-2021-323562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 11/10/2022] [Indexed: 12/02/2022]
Abstract
OBJECTIVES To provide up-to-date information on the use of long-term ventilation (LTV) in the UK paediatric population and to compare the results with data collected 10 and 20 years previously. DESIGN A single timepoint census completed by LTV centres in the UK, carried out via an online survey. SETTING AND PATIENTS All patients attending paediatric LTV services in the UK. RESULTS Data were collected from 25 LTV centres in the UK. The total study population was 2383 children and young people, representing a 2.5-fold increase in the last 10 years. The median age was 9 years (range 0-20 years). Notable changes since 2008 were an increase in the proportion of children with central hypoventilation syndrome using mask ventilation, an increase in overall numbers of children with spinal muscular atrophy (SMA) type 1, chronic lung disease of prematurity and cerebral palsy being ventilated, and a 4.2-fold increase in children using LTV for airway obstruction. The use of 24-hour ventilation, negative pressure ventilation and tracheostomy as an interface had declined. 115 children had received a disease-modifying drug. The use of ataluren and Myozyme did not influence the decision to treat with LTV, but in 35% of the children with SMA type 1 treated with nusinersin, the clinician stated that the use of this drug had or may have influenced their decision to initiate LTV. CONCLUSION The results support the need for national database for children and young people using LTV at home to inform future recommendations and assist in resource allocation planning.
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Fauroux B, Abel F, Amaddeo A, Bignamini E, Chan E, Corel L, Cutrera R, Ersu R, Installe S, Khirani S, Krivec U, Narayan O, MacLean J, Perez De Sa V, Pons-Odena M, Stehling F, Trindade Ferreira R, Verhulst S. ERS Statement on pediatric long term noninvasive respiratory support. Eur Respir J 2021; 59:13993003.01404-2021. [PMID: 34916265 DOI: 10.1183/13993003.01404-2021] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/03/2021] [Indexed: 11/05/2022]
Abstract
Long term noninvasive respiratory support, comprising continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV), in children is expanding worldwide, with increasing complexities of children being considered for this type of ventilator support and expanding indications such as palliative care. There have been improvements in equipment and interfaces. Despite growing experience, there are still gaps in a significant number of areas: there is a lack of validated criteria for CPAP/NIV initiation, optimal follow-up and monitoring; weaning and long term benefits have not been evaluated. Therapeutic education of the caregivers and the patient is of paramount importance, as well as continuous support and assistance, in order to achieve optimal adherence. The preservation or improvement of the quality of life of the patient and caregivers should be a concern for all children treated with long term CPAP/NIV. As NIV is a highly specialised treatment, patients are usually managed by an experienced pediatric multidisciplinary team. This Statement written by experts in the field of pediatric long term CPAP/NIV aims to emphasize on the most recent scientific input and should open up to new perspectives and research areas.
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Bourke M, Sharif N, Narayan O. Association between electronic cigarette use in children and adolescents and coughing a systematic review. Pediatr Pulmonol 2021; 56:3402-3409. [PMID: 34407315 DOI: 10.1002/ppul.25619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/30/2021] [Accepted: 08/04/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND The use of electronic cigarettes (e-cigarettes) among adolescents is increasing worldwide. E-cigarettes are marketed as a safe alternative to other tobacco products. The aim of this systematic review is to evaluate whether e-cigarette use in children and adolescents is associated with coughing. METHOD Studies were identified through systematic searches of Excerpta Medica Database, Medline, Cumulative Index to Nursing and Allied Health Literature, British Nursing Index, OVID Emcare, Health Management Information Consortium, PsycINFO, and Allied and Complementary Medicine. The Grey Literature was also searched. Selected studies either contained only children and adolescents as study participants or if adults were included, the data for adolescents and children must be presented separately. RESULTS Seven studies were selected from 104. Three studies compared e-cigarette users with nonusers; two studies found a significant association between coughing and e-cigarette use in adolescence. Two studies investigated whether adolescents attributed their symptoms to their e-cigarette use. One study reported that coughing was the most likely negative symptom reported by adolescents on initiation of e-cigarette use; the other study found that adolescents, on initiation of e-cigarette use, reported coughing. Two studies looked at the cases of children and adolescents who had presented to the hospital after e-cigarette use and found coughing was a common presenting symptom. CONCLUSION This systematic review shows that adolescent use of e-cigarettes is associated with increased coughing and e-cigarette users are more likely to report coughing compared to non-users.
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Temsah MH, Al-Eyadhy A, Alsohime F, Nassar SM, AlHoshan TN, Alebdi HA, Almojel F, AlBattah MA, Narayan O, Alhaboob A, Hasan GM, Abujamea A. Unintentional exposure and incidental findings during conventional chest radiography in the pediatric intensive care unit. Medicine (Baltimore) 2021; 100:e24760. [PMID: 33655939 PMCID: PMC7939184 DOI: 10.1097/md.0000000000024760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/25/2021] [Indexed: 01/04/2023] Open
Abstract
Radiation overexposure is common in chest X-ray (CXRs) of pediatric patients. However, overexposure may reveal incidental findings that can help to guide patient management or warrant quality improvement.To assess the prevalence of overexposure in CXRs in pediatric intensive care unit (PICU); and identify the incidental findings within overexposed areas, we conducted a retrospective cohort study of children who were admitted to PICU. Two independent evaluators reviewed patient's charts and digital CXRs according to the American College of Radiology standards; to evaluate overexposure of the anatomical parameters and incidental findings.A total of 400 CXRs of 85 patients were reviewed. The mean number of CXRs per patient was 4.7. Almost all (99.75%) CXRs met the criteria for overexposure, with the most common being upper abdomen (99.2%), upper limbs (97%) and neck (95.7%). In addition, 43% of these X-rays were cropped by the radiology technician to appear within the requested perimeter. There was a significant association between field cropping and overexposure (t-test: t = 9.8, P < .001). Incidental findings were seen in 41.5% of the radiographs; with the most common being gaseous abdominal distension (73.1%), low-positioned nasogastric tube (24.6%), and constipation (10.3%).Anatomical overexposure in routine CXRs remains high and raises a concern in PICU practice. Appropriate collimation of the X-ray beam, rather than electronically cropping the image, is highly recommended to minimize hiding incidental findings in the cropped-out areas. Redefining the anatomic boundaries of CXR in critically ill infants and children may need further studies and consideration. Quality improvement initiatives to minimize radiation overexposure in PICU are recommended, especially in younger children and those with more severe illness upon PICU admission.
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Sutherland N, Dayawansa N, Filipopoulos B, Vasanthakumar S, Narayan O, Ponnuthurai F, van Gaal W. Reduced Presentations and Increased Ischaemic Times for Patients With Acute Coronary Syndromes During the COVID-19 Pandemic. Heart Lung Circ 2021. [PMCID: PMC8324092 DOI: 10.1016/j.hlc.2021.06.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Narayan O, Bentley A, Mowbray K, Hermansson M, Pivonka D, Kemadjou EN, Belsey J. Updated cost-effectiveness analysis of palivizumab (Synagis) for the prophylaxis of respiratory syncytial virus in infant populations in the UK. J Med Econ 2020; 23:1640-1652. [PMID: 33107769 DOI: 10.1080/13696998.2020.1836923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIMS Respiratory syncytial virus (RSV) is a common cause of respiratory infection in infants and severe infection can result in hospitalization. The passive immunization, palivizumab, is used as prophylaxis against RSV, however, use in the UK is restricted to populations at high risk of hospitalization. This study assesses the cost-effectiveness (CE) of palivizumab in premature infants with and without risk factors for hospitalization (congenital heart disease [CHD], bronchopulmonary dysplasia [BPD]). METHODS A decision tree model, based on earlier CE analyses, was updated using data derived from targeted literature reviews and advice gained from a Round Table meeting. All costs were updated to 2019 prices. One-way and probabilistic sensitivity analyses were performed to assess the degree of uncertainty surrounding the results. RESULTS Palivizumab is dominant (i.e. clinically superior and cost saving) when used in premature infants born ≤35 weeks gestational age (wGA) without CHD or BPD and aged <6 months at the start of the RSV season, infants aged <24 months with CHD and infants aged <24 months requiring treatment for BPD within the last 6 months. LIMITATIONS One-way sensitivity analysis suggests that these results are highly sensitive to the efficacy of prophylaxis, number of doses, impact of long-term respiratory sequalae, rate of hospitalization and mortality due to RSV. A conservative approach has been taken toward long-term respiratory sequalae due to uncertainty around epidemiology and etiology and a lack of recent cost and utility data. CONCLUSIONS Palivizumab prophylaxis is cost-effective in preventing severe RSV infection requiring hospital admission in a wider population than currently recommended in UK guidelines. Prophylaxis in premature infants born <29 wGA, 29-32 wGA and 33-35 wGA without CHD or BPD aged <6 months at the start of the RSV season is not funded under current guidance, however, prophylaxis has been demonstrated to be cost-effective in this analysis.
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Farquhar M, Urquhart DS, Russo K, Abel F, Elphick HE, Gibson N, Gringras P, Hill C, Joseph D, Kingshott RN, Orgill J, Narayan O, Samuels M, Tan HL. Response to 'How to interpret polysomnography' by Leong et al. Arch Dis Child Educ Pract Ed 2020; 105:136. [PMID: 32024670 DOI: 10.1136/archdischild-2019-318613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 01/17/2020] [Indexed: 11/03/2022]
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Al-Najjar H, Breen R, Santis G, Narayan O. The utility and safety of linear endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the paediatric population. Eur Respir J 2020; 55:13993003.02277-2019. [DOI: 10.1183/13993003.02277-2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/07/2020] [Indexed: 01/06/2023]
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Kenna DTD, Coward A, Perry C, Pike R, Schaefer U, Turton J, Green H, Jones AM, Bright-Thomas RJ, Burns P, Narayan O, Wilkinson S, Turton JF. Investigation of a Pandoraea apista cluster common to adult and paediatric cystic fibrosis patients attending two hospitals in the same city. J Med Microbiol 2019; 68:1081-1095. [DOI: 10.1099/jmm.0.001010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Shaltoni D, Narayan O. P046 Relationship between the first isolation of Pseudomonas Aeruginosa and the preceding viral infection in children with cystic fibrosis. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30343-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kenna DTD, Fuller A, Martin K, Perry C, Pike R, Burns PJ, Narayan O, Wilkinson S, Hill R, Woodford N, Logan JMJ, Turton JF. rpoB gene sequencing highlights the prevalence of an E. miricola cluster over other Elizabethkingia species among UK cystic fibrosis patients. Diagn Microbiol Infect Dis 2017; 90:109-114. [PMID: 29174734 DOI: 10.1016/j.diagmicrobio.2017.10.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 10/20/2017] [Accepted: 10/23/2017] [Indexed: 11/26/2022]
Abstract
Difficulties in distinguishing species of the Elizabethkingia genus by MALDI-TOF prompted use of rpoB sequencing to investigate species distribution among 44 isolates from cystic fibrosis (CF) patients. Forty-three isolates from 38 patients formed a cluster comprising E. miricola and proposed novel species E. bruuniana sp. nov., the exception clustering with proposed species E. ursingii sp. nov., also part of this wider cluster. All 44 isolates were PCR-positive for urease gene ureG, whereas only one of 23 E. anophelis isolates from non-CF patients was positive, suggesting that this gene is largely associated with the E. miricola cluster. Antibiotic susceptibilities of 12 CF isolates revealed all were resistant to beta-lactams with the exception of piperacillin-tazobactam, and were only susceptible to minocycline and co-trimoxazole. Pulsed-field gel electrophoresis analysis revealed 4 shared strains among 17 CF patients in one pediatric clinic, but epidemiological investigations did not support patient-to-patient transmission except between one sibling pair.
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Al-Najjar H, Bailey S, Woodhead M, Rana D, Narine N, Child F, Narayan O, Shelton D. The utility of EBUS-TBNA in the investigation of suspected mediastinal and hilar tuberculosis in children. Tuberculosis (Edinb) 2017. [DOI: 10.1183/1393003.congress-2017.pa2757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Edgar J, Narayan O, Tetlow L, Hird B. WS11.2.1 Review of cystic fibrosis infants referred with 2 raised immunoreactive trypsinogen (IRT) and no common mutations. J Cyst Fibros 2016. [DOI: 10.1016/s1569-1993(16)30122-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Narayan O, Ho SA, Lenney W, Wells D, Gilchrist F. Complications of a totally implantable venous access device. Arch Dis Child Educ Pract Ed 2016; 101:95, 112. [PMID: 25920317 DOI: 10.1136/archdischild-2014-307605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 03/21/2015] [Indexed: 11/03/2022]
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Narayan O, Davies S, Tibbins C, Rees JM, Lenney W, Gilchrist FJ. Developing a handheld record for patients with cystic fibrosis. PATIENT-RELATED OUTCOME MEASURES 2015; 6:225-8. [PMID: 26316833 PMCID: PMC4540166 DOI: 10.2147/prom.s86298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Patient handheld records (PHHRs) promote self-management and empower the holder to take a more active role in the management of their disease. They have been used successfully in improving preventative care for children and have contributed to improved adherence in a number of chronic illnesses. Despite the potential advantages, there are no standard PHHRs for patients with cystic fibrosis (CF). We report the consultation process that led to the development of a CF PHHR, describe the final document, and analyze the feedback from their use at our center. We have made the CF PHHR freely available online.
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Jheeta JS, Narayan O, Krasemann T. Republished: Accuracy in interpreting the paediatric ECG: a UK-wide study and the need for improvement. Postgrad Med J 2015; 91:436-8. [DOI: 10.1136/postgradmedj-2013-305788rep] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Narayan O, Davies J, Hughes A, Parker K, Hope S, Meredith I, Cameron J. An increase in peak excess pressure accounts for the rise in systolic blood pressure along the aorta. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Narayan O, Leung M, Wong D, Malaiapan Y, Meredith I, Cameron J. Effects of dobutamine and glyceryl trinitrate therapy on coronary blood flow, the coronary wave intensity profile and central aortic pressure waveform. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Jheeta JS, Narayan O, Krasemann T. Accuracy in interpreting the paediatric ECG: a UK-wide study and the need for improvement. Arch Dis Child 2014; 99:646-8. [PMID: 24625668 DOI: 10.1136/archdischild-2013-305788] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Paediatric ECG interpretation is significant for informed treatment of several conditions. Formal training in paediatric ECG is rarely undertaken. METHODS A prospective survey based study module of UK-wide paediatricians registered with the UK Royal College of Paediatricians and Child Health (RCPCH) was conducted. 10 common clinical conditions seen in paediatrics for which there are recognisable ECGs had to be interpreted. After provision of an educational page, 10 further ECGs were presented. FINDINGS 8450 RCPCH members were emailed a link to the online survey–study module, of whom 764 participated. Of these, 493 interpreted the first 10 ECGs, and 385 interpreted both sets of ECGs. The accuracy for the first ECGs was 61.5% (63.5% for those who participated in the whole survey), and after use of the educational page increased to 73.3%. This was independent from previous ECG training. CONCLUSIONS The use of an easily accessible online educational page improved the accuracy of paediatric ECG interpretation significantly. Internet based education can improve the accuracy of paediatric ECG interpretation and should be developed further.
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Narayan O, Davies S, Bakewell K, Lenney W, Gilchrist F. 229 Review of personal hand held record for cystic fibrosis children. J Cyst Fibros 2014. [DOI: 10.1016/s1569-1993(14)60364-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wong D, Narayan O, Ko B, Leong D, Seneviratne S, Cameron J, Soh S, Meredith I, Malaiapan Y. Area of Myocardium at Risk and Lesion Length are Predictors of Functionally Significant Coronary Artery Stenoses Assessed by Fractional Flow Reserve. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.04.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Wong D, Ko B, Narayan O, Leong D, Seneviratne S, Cameron J, Meredith I, Malaiapan Y. Area of Myocardium at Risk and Lesion Length are Predictors of Functionally Significant Coronary Artery Stenoses Assessed by Fractional Flow Reserve. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Narayan O, Li Q, Curry G, Coombs P, Mottram P, Meredith I, Cameron J. Timing of the Aortic Pulse Wave Inflection Point is Associated with Mitral Annular Systolic Motion. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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