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Nongnuang K, Limprasert N, Munjupong S. Can intravenous lidocaine definitely attenuate propofol requirement and improve outcomes among colonoscopic patients under intravenous sedation?: A double-blinded, randomized controlled trial. Medicine (Baltimore) 2022; 101:e30670. [PMID: 36181015 PMCID: PMC9524969 DOI: 10.1097/md.0000000000030670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Propofol-sparing effect of lidocaine has not been fully elucidated because propofol is usually mixed with many medications in anesthetic practice. Therefore, the study aimed to verify the additive effect of intravenous lidocaine to propofol without other sedative medications and control the depth of anesthesia using the bispectral index (BIS) during colonoscopy in a prospective, randomized, double-blinded controlled trial. METHODS Sixty-eight patients scheduled and undergoing colonoscopy were randomly allocated to receive intravenous lidocaine (1.5 mg/kg then 4 mg/kg/h) (Group L) or a similar volume of normal saline (Group C) with propofol administration guided by BIS monitoring. The primary outcome was total propofol requirements between group comparisons. The secondary outcomes included the number of hypoxemic periods, hemodynamic changes, duration in returning of BIS > 85, sedation scores, pain scores, postoperative opioid requirement, and patient satisfaction between group comparisons. RESULTS Intravenous lidocaine showed significantly reduced total propofol use (151.76 ± 50.78 mg vs 242.06 ± 50.86 mg, Group L vs Group C, respectively, P < .001). Duration in returning to BIS > 85, sedation scores, and patient satisfaction scores were significantly superior in Group L (P < .05). The number of hypoxemic episodes, changes of hemodynamic response, pain scores, and postoperative opioid requirement were similar in both groups. No adverse effects were detected in both groups. CONCLUSION Intravenous lidocaine produced a definitely effective reduced propofol requirement without other sedative agents and improved outcomes including patient satisfaction, duration in returning to BIS > 85, and sedation score during colonoscopy without adverse effects.
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Affiliation(s)
- Krisana Nongnuang
- Department of Anesthesiology, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Natirat Limprasert
- Department of Anesthesiology, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Sithapan Munjupong
- Department of Anesthesiology, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
- *Correspondence: Sithapan Munjupong, Department of Anesthesiology, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok 10400, Thailand (e-mail: )
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Endoscopist-directed propofol is more efficient than anesthesiologist-administered propofol in patients at low-intermediate anesthetic risk. Eur J Gastroenterol Hepatol 2020; 32:1440-1446. [PMID: 32925498 DOI: 10.1097/meg.0000000000001820] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Endoscopist-directed propofol (EDP) sedation is becoming more popular, with a reported safety and efficacy similar to anesthesiologist-administered propofol (AAP). The aim of this study is to compare the efficiency of EDP and AAP in patients of low-intermediate anesthetic risk. METHODS A prospective cost-effectiveness comparison study was conducted. The costs of the endoscopic procedures in the EDP and AAP group were calculated using the full cost methodology after breaking down the endoscopic activity into relative value units to allocate costs in an equitable way. To determine the effectiveness, adverse events related to endoscopic sedation and the number of incomplete procedures were registered for the EDP group and compared with those published by anesthesiologists for AAP. RESULTS A total of 1165 and 18 919 endoscopic procedures were, respectively, included in the EDP and AAP groups. The average costs of EDP vs. AAP for gastroscopy, colonoscopy and endoscopic ultrasound were &OV0556; 182.81 vs. &OV0556; 332.93, &OV0556; 297.07 vs. &OV0556; 459.76, and &OV0556; 319.92 vs. &OV0556; 485.12, respectively. No significant differences were detected regarding the rate of overall adverse events (4.43 vs. 4.46%) or serious adverse events (0 vs. 0.17%); the rate of arterial hypotension was significantly lower in the EDP group: 0.34 vs. 1.78% [odds ratio (OR), 0.19; 95% confidence interval (CI), 0.08-0.46] and the desaturation rate was significantly lower in the AAP group: 3.26 vs. 1.29% (OR, 2.58; 95% CI, 1.85-3.60). No significant differences were found in terms of incomplete examinations (0.17 vs. 0.14%). CONCLUSION In patients with low-intermediate anesthetic risk referred for an endoscopic examination, EDP appears to be more efficient than AAP.
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Jiménez Sánchez J, Serrano Díaz L, Gallego Pérez B, Marín Bernabé CM, García Belmonte D, Gómez Lozano M, Gajownik Ú, Martínez Crespo JJ. Percutaneous hepatic biopsy under propofol sedation. A safe and effective procedure. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 112:903-908. [PMID: 33118358 DOI: 10.17235/reed.2020.6942/2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION the percutaneous hepatic biopsy is a necessary procedure for the diagnosis of liver diseases which can cause complications and psychological discomfort for the patient. AIMS to determine the safety profile of propofol in percutaneous hepatic biopsy, the complications of the technique per se and patients satisfaction once completed. METHODS a retrospective observational study was performed via the acquisition of data of tolerance and perceived quality by the patients using a transversal survey. RESULTS ninety-seven patients were included with an average propofol dose of 170.46 mg. Of the complications resulting from the sedation, there were six slight desaturations (6.2 %) resolved with a forehead maneuver (50 %) or cessation of the propofol infusion pump (50 %) and eleven hypotension episodes (11.3 %) resolved without intervention (82.82 %) or with fluid replacement (18.18 %). Of the complications resulting from the technique, there were three cases of early-onset pain (3.1 %) and one delayed (1.03 %); all were resolved with 1 g of intravenous paracetamol. All patients were discharged with oral tolerance and without the need for analgesia 24 hours after the procedure. General satisfaction, as well as psychological discomfort, were evaluated as "very good/excellent" in 100 % of the patients. DISCUSSION propofol demonstrated a favorable safety profile in hepatic biopsy, aiding in the ultimate success of the procedure and tolerance for the patient. We propose the expansion of the use of sedation with propofol to this procedure.
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Affiliation(s)
| | | | | | | | | | | | - Úrszula Gajownik
- Aparato Digestivo , Hospital Clínico Universitario Virgen de la Arrixaca, España
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Elsamragy S, Vats T, Osborn I. Airway Management in out of the Operating Room Environments. CURRENT ANESTHESIOLOGY REPORTS 2020. [DOI: 10.1007/s40140-020-00410-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yang SM, Yi DY, Choi GJ, Lim IS, Chae SA, Yun SW, Lee NM, Kim SY, Choi ES. Effects of Sedation Performed by an Anesthesiologist on Pediatric Endoscopy: a Single-Center Retrospective Study in Korea. J Korean Med Sci 2020; 35:e183. [PMID: 32476304 PMCID: PMC7261697 DOI: 10.3346/jkms.2020.35.e183] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/24/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Endoscopy is used for diagnosing and treating various digestive diseases in children as well as in adults. However, in pediatric patients, it is recommended that sufficient sedation should be ensured before conducting endoscopy, since insufficient sedation may cause serious complications. However, in Korea, no studies have yet described the types of sedation drugs, effects of sedation, and efficiency of endoscopy with respect to the sedation instructor. Thus, we investigated the effectiveness of sedative procedures performed by anesthesiologists. METHODS We retrospectively reviewed the medical records of patients aged < 18 years who underwent endoscopy during March 2014-July 2019. Data of sedation instructors, sedation drugs and their doses, complications, and the recovery after sedation were evaluated. RESULTS Of 257 patients, 217 underwent esophagogastroduodenoscopy (EGD) and 40 underwent colonoscopies. Before EGD, 29 patients (13.4%) underwent sedation by the pediatric endoscopist and 188 (86.6%) were sedated by the anesthesiologist. The anesthesiologist performed the sedation for all 40 patients who underwent colonoscopy. Endoscopic examinations performed by the anesthesiologist were relatively more time-consuming (401.0 ± 135.1 seconds vs. 274.9 ± 106.1 seconds, P < 0.001). We observed that in patients who underwent EGD, there was a difference in the dose of midazolam administered (P = 0.000). When comparing EGD and colonoscopy in patients undergoing sedation by the anesthesiologist, there were no significant differences in the doses of midazolam and ketamine, but the dose of propofol increased for colonoscopy (2.50 ± 0.95 mg/kg vs. 4.71 ± 1.66 mg/kg, P = 0.000). The cognitive recovery time according to drug dose was associated with propofol only in EGD with a shorter endoscopy time. The longer cognitive recovery time in colonoscopy and the discharge time of EGD and colonoscopies were not associated with propofol use. CONCLUSION When sedation is performed by an anesthesiologist, various drugs are used with sufficient doses and complications are reduced, but the discharge time does not change. For performing pediatric endoscopy in Korea, anesthesiologists should be considered for inducing anesthesia.
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Affiliation(s)
- Sung Min Yang
- Department of Pediatrics, Chung-Ang University Hospital, Seoul, Korea
| | - Dae Yong Yi
- Department of Pediatrics, Chung-Ang University Hospital, Seoul, Korea
- Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea.
| | - Geun Joo Choi
- Department of Anesthesiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - In Seok Lim
- Department of Pediatrics, Chung-Ang University Hospital, Seoul, Korea
- Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea
| | - Soo Ahn Chae
- Department of Pediatrics, Chung-Ang University Hospital, Seoul, Korea
- Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sin Weon Yun
- Department of Pediatrics, Chung-Ang University Hospital, Seoul, Korea
- Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea
| | - Na Mi Lee
- Department of Pediatrics, Chung-Ang University Hospital, Seoul, Korea
- Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea
| | - Su Yeong Kim
- Department of Pediatrics, Chung-Ang University Hospital, Seoul, Korea
| | - Eung Sang Choi
- Department of Pediatrics, Hanil General Hospital, Seoul, Korea
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Hsieh YH, Tseng CW, Koo M, Leung FW. Feasibility of sedation on demand in Taiwan using water exchange and air insufflation: A randomized controlled trial. J Gastroenterol Hepatol 2020; 35:256-262. [PMID: 31420895 DOI: 10.1111/jgh.14839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/08/2019] [Accepted: 08/12/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Completion of colonoscopy without sedation eliminates sedation cost and complications. Reported in the United States and Europe, on-demand sedation is not routine practice in Taiwan. Water exchange (WE), characterized by infusion and nearly complete removal of infused water during insertion, reduces insertion pain compared to air insufflation (AI) during colonoscopy. We evaluated the feasibility of on-demand sedation in Taiwan. In a randomized controlled trial of WE vs AI colonoscopy, we also aimed to determine if WE augmented the implementation by reducing insertion pain and decreasing sedation requirement. METHODS This prospective patient-blinded study randomized patients to AI or WE (75 patients/group) to aid insertion. The primary outcome was the proportion of patients completing without sedation. RESULTS In the AI and WE groups, 76.0% and 93.3% (P = 0.006) completed without need for sedation, respectively. The WE group had lower insertion pain score (mean [SD]) (4.0 [2.9] vs 2.1 [2.6], P < 0.001), lower doses of propofol (25.7 [52.7] mg vs 9.1 [35.6] mg, P = 0.012), and less time in the recovery room (3.4 [7.4] vs 1.5 [5.5], P = 0.027) than the AI group. Patient satisfaction scores and willingness to repeat if needed in the future were similar. CONCLUSION On-demand sedation was feasible in Taiwan. The completion rate without sedation was high in patients (76.0% with standard AI) open to the option (no prior intent to receive the standard of full or minimal sedation). WE augmented the implementation by reducing insertion pain and decreasing sedation requirement without adversely affecting patient satisfaction or willingness to repeat.
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Affiliation(s)
- Yu-Hsi Hsieh
- Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Chih-Wei Tseng
- Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Malcolm Koo
- Graduate Institute of Long-term Care, Tzu Chi University of Science and Technology, Hualien, Taiwan.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Felix W Leung
- Veterans Affairs Greater Los Angeles Healthcare System, Sepulveda Ambulatory Care Center, North Hill, California, USA.,David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Pace D, Borgaonkar M. Deep sedation for colonoscopy is unnecessary and wasteful. CMAJ 2019; 190:E153-E154. [PMID: 29440334 DOI: 10.1503/cmaj.170953] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- David Pace
- Departments of Surgery (Pace) and of Medicine (Borgaonkar), Memorial University, St. Johns, NL
| | - Mark Borgaonkar
- Departments of Surgery (Pace) and of Medicine (Borgaonkar), Memorial University, St. Johns, NL
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Ruiz-Curiel RE, Bonilla H Y, Baptista A, Bronstein M. Sedation with propofol in digestive endoscopy administered by gastroenterologists. Experience in a Venezuelan hospital. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018. [PMID: 29542326 DOI: 10.17235/reed.2018.5185/2017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES propofol is a rapid acting hypnotic that is becoming the drug of choice for sedation in digestive endoscopy worldwide. There is some controversy with regard to the use of propofol by physicians who are not anesthesiologists. We present our experience of the administration of propofol by endoscopist and nursing personnel. METHODS this was a retrospective study of sedation in endoscopy. Propofol was exclusively used and administered by the endoscopist who performed the procedure and the nursing staff. All patients included were of a low and moderate surgical risk (ASA I, II and III). No complementary medication was used such as benzodiazepines or opiates. RESULTS a total of 70,696 digestive endoscopy procedures performed between 2002 and 2017 were included in the study. Propofol was administered in an induction bolus of 10 to 50 mg, continuing with intermittent boluses of 10 to 20 mg, according to the patients' response. The incidence of complications was very low, assisted ventilation with a mask was required on 78 (0.11%) occasions. Only one case required endotracheal intubation and two patients had significant hypotension that required the administration of ephedrine. The average recovery time of all neuropsychomotor functions after the procedure was 15 minutes; 98% of patients reported a good or excellent level of tolerance and clearly remembered the details of the interview one hour after the procedure. CONCLUSIONS the use of propofol as a sedative in digestive endoscopy is a safe and effective technique, provided that it is administered and controlled by the endoscopist and nursing staff in properly selected patients. This allows gastroenterologists to achieve adequate sedation.
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Trummel JM, Chandrasekhara V, Kochman ML. Anesthesia for Colonoscopy and Lower Endoscopic Procedures. Anesthesiol Clin 2018; 35:679-686. [PMID: 29101957 DOI: 10.1016/j.anclin.2017.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Demand for anesthesiologist-assisted sedation is expanding for gastrointestinal lower endoscopic procedures and may add to the cost of these procedures. Most lower endoscopy can be accomplished with either no, moderate, or deep sedation; general anesthesia and active airway management are rarely needed. Propofol-based sedation has advantages in terms of satisfaction and recovery over other modalities, but moderate sedation using benzodiazepines and opiates work well for low-risk patients and procedures. No sedation for routine colonoscopy works well for selected patients and eliminates sedation-related risks. There is no difference in outcome measures based on sedation received.
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Affiliation(s)
- John Michael Trummel
- Anesthesiology, Dartmouth Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA.
| | - Vinay Chandrasekhara
- Gastroenterology Division, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Michael L Kochman
- Gastroenterology Division, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
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DuVal DB. Anesthesiologists provide excellent value in colonoscopy. CMAJ 2018; 190:E749-E750. [PMID: 29914914 DOI: 10.1503/cmaj.69318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Douglas B DuVal
- Clinical professor, Department of Anesthesiology, Faculty of Medicine, University of Alberta, Edmonton, Alta.; president, Canadian Anesthesiologists' Society, Toronto, Ont
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Zhang H, Fang B, Zhou W. The efficacy of dexmedetomidine-remifentanil versus dexmedetomidine-propofol in children undergoing flexible bronchoscopy: A retrospective trial. Medicine (Baltimore) 2017; 96:e5815. [PMID: 28072737 PMCID: PMC5228697 DOI: 10.1097/md.0000000000005815] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Flexible bronchoscopy has been more and more used for diagnosis and management diseases of respiratory system in pediatrics. Previous studies have reported that remifentanil (RF) and propofol are safe and effective for flexible bronchoscopy in adults, however, there have no trials evaluate the efficacy of DEX-RF versus dexmedetomidine-propofol in children undergoing flexible bronchoscopy.We divided 123 children undergoing flexible bronchoscopy with DEX-RF or dexmedetomidine-propofol into 2 groups: Group DR (n = 63, DEX infusion at 1.0 μg kg for 10 minutes, then adjusted to 0.5-0.7 μg kg h; RF infusion at 1.0 μg kg for 5 minutes, then adjusted to 0.05-0.2 μg kg min), Group DP (n = 60, DEX infusion at 1.0 μg kg for 10 minutes, then adjusted to 0.5-0.7 μg kg h; propofol infusion at 10 μg kg for 5 minutes, then adjusted to 0.05-0.1 μg kg min). Ramsay sedation scale of the 2 groups was maintained at 3. Anesthesia onset time; total number of intraoperative patient movements; hemodynamics; total cumulative dose of DEX; amount of and time to first-dose rescue midazolam and lidocaine; postoperative recovery time; adverse events; and bronchoscopist satisfaction score were recorded.Anesthesia onset time was significantly shorter in DP (8.22 ± 2.48 vs 12.25 ± 6.43 minutes, respectively, for DP, DR, P = 0.015). The perioperative hemodynamic profile was more stable in DR than DP group. More children moved during flexible bronchoscopy in DP group (P = 0.009). Total dose of rescue midazolam and lidocaine was significantly higher in DR than in DP (P < 0.001). Similarly, the time to first dose of rescue midazolam and lidocaine was significantly longer in DP than in DR (P < 0.001). Total cumulative dose of DEX was more in DR than DP group (P < 0.001). The time to recovery for discharge from the postanesthesia care unit (PACU) was significantly shorter in DP than in DR group (P < 0.001). The bronchoscopist-satisfaction scores were higher for DR than DP (P = 0.036). There were significant differences between the 2 groups in terms of the overall incidence of hypertension, tachycardia, and hypoxemia (P < 0.05).Although underwent longer recovery time and more incidence of rescue scheme, DEX-RF resulted in more stable hemodynamic profiles and bronchoscopist-satisfaction scores, lesser patient movements, and can hence be more effectively used in children undergoing flexible bronchoscopy than dexmedetomidine-propofol.
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Affiliation(s)
- Hongquan Zhang
- Department of Anesthesiology, Liaocheng People's Hospital
| | | | - Wenjing Zhou
- Department of General ward, women and children health of Dongchangfu District, Liaocheng, Shandong, China
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