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Cizman B, Smith HT, Camejo RR, Casillas L, Dhillon H, Mu F, Wu E, Xie J, Zuckerman P, Coyne D. Clinical and Economic Outcomes of Erythropoiesis-Stimulating Agent Hyporesponsiveness in the Post-Bundling Era. Kidney Med 2020; 2:589-599.e1. [PMID: 33089137 PMCID: PMC7568064 DOI: 10.1016/j.xkme.2020.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Rationale & Objective Since the change in erythropoiesis-stimulating agent (ESA) labeling and bundling of dialysis services in the United States, few studies have addressed the clinical importance of ESA hyporesponsiveness and none have considered health care resource use in this population. We aimed to further explore ESA hyporesponsiveness and its consequences. Study Design Retrospective observational cohort study. Setting & Participants US Renal Data System Medicare participants receiving dialysis with a minimum 6 months of continuous ESA use from 2012 to 2014. Predictors Erythropoietin resistance index (≥2.0 U/kg/wk/g/L) and ESA dose were used to identify ESA hyporesponders and hyporesponsive subgroups: isolated, intermittent, and chronic. Outcomes Associations between ESA responsiveness and mortality, cardiovascular hospitalization rates, and health care resource use were evaluated and compared across subgroups. Analytical Approach Baseline characteristics were compared using Wilcoxon rank sum tests for continuous variables and χ2 tests for categorical variables. Incidence rates of health care resource use were modeled using an unadjusted and adjusted generalized linear model. Results Of 834,115 dialysis patients in the CROWNWeb database, 38,891 ESA hyporesponders and 59,412 normoresponders met all inclusion criteria. Compared with normoresponders, hyporesponders were younger women, weighed less, and had longer durations of dialysis (all P < 0.001). Hyporesponders received 3.8-fold higher ESA doses (mean, 94,831 U/mo) and erythropoietin resistance index was almost 5 times higher than in normoresponders. Hyporesponders had lower hemoglobin levels and parathyroid hormone levels > 800 pg/mL, and iron deficiency was present in 26.5% versus 10.9% in normoresponders. One-year mortality was higher among hypo- compared with normoresponders (25.3% vs 22.6%). Hyporesponders also had significantly higher rates of hospitalization for cardiovascular events, emergency department visits, inpatient stays, home health agency visits, skilled nursing facility, and hospice days. Limitations Only US Medicare patients were included and different hyporesponder definitions may have influenced the results. Conclusions This study explored ESA hyporesponsiveness using new definitions and incorporated clinical and economic outcomes. It established that ESA-hyporesponsive dialysis patients had higher mortality, cardiovascular hospitalization rates, and health care costs as compared with ESA-normoresponsive patients.
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Affiliation(s)
| | | | | | | | | | - Fan Mu
- Analysis Group, Boston, MA
| | | | | | | | - Daniel Coyne
- Washington University School of Medicine, St. Louis, MO
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Okoro T, Sikirica V, Casillas L, Brion T, Devine J, Ong V, Howard K. Elicitation of disease concepts in patients with diabetic foot ulcers: a qualitative study. J Wound Care 2020; 29:S38-S45. [PMID: 32412892 DOI: 10.12968/jowc.2020.29.sup5a.s38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To identify in-depth information directly from patients with diabetic foot ulcers (DFU) on DFU symptoms, impacts on functioning and effects on health-related quality of life (HRQoL). METHOD Semi-structured, qualitative concept elicitation interviews were conducted with patients with DFUs (Wagner grade 1 or 2) until saturation was reached. Qualitative analysis (using MAXQDA, VERBI GmbH, Germany) of interview transcripts was conducted to identify concepts relevant to patients with DFUs, based on the frequency of mentions, and elucidate themes regarding impacts on HRQoL. RESULTS Of the 18 participants, most were male (n=14; 78%) and 10 (56%) presented with a Wagner grade of 1. Frequently reported symptoms were pain/discomfort (n=15; 83%), weeping/discharge (n=10; 56%), bleeding (n=10; 56%) and swelling (n=8; 44%). Overall, patients reported more impacts than symptoms-wound care/treatment burden (n=14; 78%), limitations on exercise/physical activity (n=13; 72%), mobility limitations (n=12; 67%), and offloading (n=12; 67%) were the most frequently mentioned. Based on findings from the patient interviews, a draft conceptual model was developed outlining interrelationships between DFU symptoms, impacts, and HRQoL from the patient perspective. CONCLUSION Qualitative interviews captured the breadth of disease-related concepts of direct importance to patients. The draft conceptual model developed from the analysis can help identify measures or instruments for use in assessing patient-reported symptoms or HRQoL in clinical practice and may have wider research applicability, including evaluation of treatment benefits in patients with DFUs.
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Affiliation(s)
| | | | | | - Triza Brion
- ICON Clinical Research, South San Francisco, CA, US
| | - Jacob Devine
- ICON Clinical Research, South San Francisco, CA, US
| | - Vivien Ong
- ICON Clinical Research, South San Francisco, CA, US
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Haffner CD, Charnley AK, Aquino CJ, Casillas L, Convery MA, Cox JA, Elban MA, Goodwin NC, Gough PJ, Haile PA, Hughes TV, Knapp-Reed B, Kreatsoulas C, Lakdawala AS, Li H, Lian Y, Lipshutz D, Mehlmann JF, Ouellette M, Romano J, Shewchuk L, Shu A, Votta BJ, Zhou H, Bertin J, Marquis RW. Discovery of Pyrazolocarboxamides as Potent and Selective Receptor Interacting Protein 2 (RIP2) Kinase Inhibitors. ACS Med Chem Lett 2019; 10:1518-1523. [PMID: 31749904 DOI: 10.1021/acsmedchemlett.9b00141] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 09/26/2019] [Indexed: 12/30/2022] Open
Abstract
Herein we report the discovery of pyrazolocarboxamides as novel, potent, and kinase selective inhibitors of receptor interacting protein 2 kinase (RIP2). Fragment based screening and design principles led to the identification of the inhibitor series, and X-ray crystallography was used to inform key structural changes. Through key substitutions about the N1 and C5 N positions on the pyrazole ring significant kinase selectivity and potency were achieved. Bridged bicyclic pyrazolocarboxamide 11 represents a selective and potent inhibitor of RIP2 and will allow for a more detailed investigation of RIP2 inhibition as a therapeutic target for autoinflammatory disorders.
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Affiliation(s)
- Curt D. Haffner
- GlaxoSmithKline, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
| | - Adam K. Charnley
- GlaxoSmithKline, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
| | | | - Linda Casillas
- GlaxoSmithKline, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
| | - Máire A. Convery
- GlaxoSmithKline, Medicines Research Centre, Gunnels Wood Road, Stevenage, SG1 2NY, U.K
| | - Julie A. Cox
- GlaxoSmithKline, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
| | - Mark A. Elban
- GlaxoSmithKline, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
| | - Nicole C. Goodwin
- GlaxoSmithKline, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
| | - Peter J. Gough
- GlaxoSmithKline, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
| | - Pamela A. Haile
- GlaxoSmithKline, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
| | | | - Beth Knapp-Reed
- GlaxoSmithKline, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
| | - Constantine Kreatsoulas
- GlaxoSmithKline, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
| | - Ami S. Lakdawala
- GlaxoSmithKline, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
| | - Huijie Li
- GlaxoSmithKline, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
| | - Yiqian Lian
- GlaxoSmithKline, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
| | - David Lipshutz
- GlaxoSmithKline, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
| | - John F. Mehlmann
- GlaxoSmithKline, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
| | - Michael Ouellette
- GlaxoSmithKline, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
| | - Joseph Romano
- GlaxoSmithKline, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
| | - Lisa Shewchuk
- GlaxoSmithKline, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
| | - Arthur Shu
- GlaxoSmithKline, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
| | - Bartholomew J. Votta
- GlaxoSmithKline, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
| | - Huiqiang Zhou
- GlaxoSmithKline, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
| | - John Bertin
- GlaxoSmithKline, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
| | - Robert W. Marquis
- GlaxoSmithKline, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
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Goyal N, Mohamed K, Rolfe K, Sahota S, Ernest T, Duparc S, Taylor M, Casillas L, Koh GCKW. Application of the Stable Isotope Label Approach in Clinical Development-Supporting Dissolution Specifications for a Commercial Tablet Product with Tafenoquine, a Long Half-life Compound. AAPS J 2018; 20:74. [PMID: 29869298 DOI: 10.1208/s12248-018-0234-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 05/16/2018] [Indexed: 12/16/2022]
Abstract
Bioavailability/bioequivalence studies supporting clinical drug development or commercial supply of drug formulations are often time, cost, and resource intensive. The drug's pharmacokinetic (PK) variability, systemic half-life, and safety issues may pose additional challenges. The stable isotope label (SIL) approach provides a useful tool to significantly reduce the study size in clinical PK studies. Tafenoquine (TQ) is an 8-aminoquinoline under development for preventing Plasmodium vivax malaria relapse. This SIL study assessed the impact of differences in the in vitro dissolution profiles on in vivo exposure of TQ tablets. Fourteen healthy volunteers received a single dose of 300 mg TQ Intermediate Aged or 300 mg TQ Control formulations in this single-center, two-arm, randomized, open-label, parallel-group study. Endpoints included the geometric means ratio of the area under the concentration-time curve (AUC(0-t) and AUC(0-∞); primary endpoint) and maximum plasma concentration (Cmax) for Intermediate Aged versus Control TQ; correlation of PK parameters for venous versus peripheral (via microsample) blood samples; and safety and tolerability endpoints. Geometric mean ratios for PK parameters (AUC and Cmax) and their 90% confidence intervals fell well within standard bioequivalence limits (0.80-1.25). Only one mild adverse event (skin abrasion) was reported. In summary, this SIL methodology-based study demonstrates that the observed differences in the in vitro dissolution profiles between the Control and Intermediate Aged TQ tablets have no clinically relevant effect on systemic TQ exposure. The SIL approach was successfully implemented to enable the setting of a clinically relevant dissolution specification. CLINICAL TRIAL This study (GSK study number 201780) is registered at clinicaltrials.gov with identifier NCT02751294.
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Affiliation(s)
- Navin Goyal
- Clinical Pharmacology, GlaxoSmithKline US, Swedeland Road, King of Prussia, Pennsylvania, 19406, USA.
| | - Khadeeja Mohamed
- Statistics, Programming and Data Strategy, GlaxoSmithKline, Uxbridge, Middlesex, UK
| | - Katie Rolfe
- Statistics, Programming and Data Strategy, GlaxoSmithKline, Uxbridge, Middlesex, UK
| | - Satty Sahota
- Product Development, GlaxoSmithKline, Ware, Hertfordshire, UK
| | - Terry Ernest
- Product Development, GlaxoSmithKline, Ware, Hertfordshire, UK
| | | | - Maxine Taylor
- Mechanistic Safety and Disposition, GlaxoSmithKline, Ware, Hertfordshire, UK
| | - Linda Casillas
- Clinical Pharmacology, GlaxoSmithKline US, Swedeland Road, King of Prussia, Pennsylvania, 19406, USA
| | - Gavin C K W Koh
- Diseases of the Developing World, GlaxoSmithKline, Uxbridge, Middlesex, UK
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Charnley AK, Convery MA, Lakdawala Shah A, Jones E, Hardwicke P, Bridges A, Ouellette M, Totoritis R, Schwartz B, King BW, Wisnoski DD, Kang J, Eidam PM, Votta BJ, Gough PJ, Marquis RW, Bertin J, Casillas L. Crystal structures of human RIP2 kinase catalytic domain complexed with ATP-competitive inhibitors: Foundations for understanding inhibitor selectivity. Bioorg Med Chem 2015; 23:7000-6. [PMID: 26455654 DOI: 10.1016/j.bmc.2015.09.038] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 09/09/2015] [Accepted: 09/22/2015] [Indexed: 01/01/2023]
Abstract
Receptor interacting protein 2 (RIP2) is an intracellular kinase and key signaling partner for the pattern recognition receptors NOD1 and NOD2 (nucleotide-binding oligomerization domain-containing proteins 1 and 2). As such, RIP2 represents an attractive target to probe the role of these pathways in disease. In an effort to design potent and selective inhibitors of RIP2 we established a crystallographic system and determined the structure of the RIP2 kinase domain in an apo form and also in complex with multiple inhibitors including AMP-PCP (β,γ-Methyleneadenosine 5'-triphosphate, a non-hydrolysable adenosine triphosphate mimic) and structurally diverse ATP competitive chemotypes identified via a high-throughput screening campaign. These structures represent the first set of diverse RIP2-inhibitor co-crystal structures and demonstrate that the protein possesses the ability to adopt multiple DFG-in as well as DFG-out and C-helix out conformations. These structures reveal key protein-inhibitor structural insights and serve as the foundation for establishing a robust structure-based drug design effort to identify both potent and highly selective inhibitors of RIP2 kinase.
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Affiliation(s)
- Adam K Charnley
- Pattern Recognition Receptor Discovery Performance Unit, Immuno-Inflammation Therapy Area, GlaxoSmithKline, 1250 S. Collegeville Road, Collegeville, PA 19426, USA.
| | - Máire A Convery
- Platform Technology & Science, GlaxoSmithKline, Medicines Research Centre, Gunnels Wood Road, Stevenage SG1 2NY, UK.
| | - Ami Lakdawala Shah
- Platform Technology & Science, GlaxoSmithKline, 1250 S. Collegeville Road, Collegeville, PA 19426, USA
| | - Emma Jones
- Platform Technology & Science, GlaxoSmithKline, Medicines Research Centre, Gunnels Wood Road, Stevenage SG1 2NY, UK
| | - Philip Hardwicke
- Platform Technology & Science, GlaxoSmithKline, Medicines Research Centre, Gunnels Wood Road, Stevenage SG1 2NY, UK
| | - Angela Bridges
- Platform Technology & Science, GlaxoSmithKline, Medicines Research Centre, Gunnels Wood Road, Stevenage SG1 2NY, UK
| | - Michael Ouellette
- Platform Technology & Science, GlaxoSmithKline, 1250 S. Collegeville Road, Collegeville, PA 19426, USA
| | - Rachel Totoritis
- Platform Technology & Science, GlaxoSmithKline, 1250 S. Collegeville Road, Collegeville, PA 19426, USA
| | - Benjamin Schwartz
- Platform Technology & Science, GlaxoSmithKline, 1250 S. Collegeville Road, Collegeville, PA 19426, USA
| | - Bryan W King
- Platform Technology & Science, GlaxoSmithKline, 1250 S. Collegeville Road, Collegeville, PA 19426, USA
| | - David D Wisnoski
- Platform Technology & Science, GlaxoSmithKline, 1250 S. Collegeville Road, Collegeville, PA 19426, USA
| | - James Kang
- Pattern Recognition Receptor Discovery Performance Unit, Immuno-Inflammation Therapy Area, GlaxoSmithKline, 1250 S. Collegeville Road, Collegeville, PA 19426, USA
| | - Patrick M Eidam
- Pattern Recognition Receptor Discovery Performance Unit, Immuno-Inflammation Therapy Area, GlaxoSmithKline, 1250 S. Collegeville Road, Collegeville, PA 19426, USA
| | - Bartholomew J Votta
- Pattern Recognition Receptor Discovery Performance Unit, Immuno-Inflammation Therapy Area, GlaxoSmithKline, 1250 S. Collegeville Road, Collegeville, PA 19426, USA
| | - Peter J Gough
- Pattern Recognition Receptor Discovery Performance Unit, Immuno-Inflammation Therapy Area, GlaxoSmithKline, 1250 S. Collegeville Road, Collegeville, PA 19426, USA
| | - Robert W Marquis
- Pattern Recognition Receptor Discovery Performance Unit, Immuno-Inflammation Therapy Area, GlaxoSmithKline, 1250 S. Collegeville Road, Collegeville, PA 19426, USA
| | - John Bertin
- Pattern Recognition Receptor Discovery Performance Unit, Immuno-Inflammation Therapy Area, GlaxoSmithKline, 1250 S. Collegeville Road, Collegeville, PA 19426, USA
| | - Linda Casillas
- Pattern Recognition Receptor Discovery Performance Unit, Immuno-Inflammation Therapy Area, GlaxoSmithKline, 1250 S. Collegeville Road, Collegeville, PA 19426, USA
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Desai B, Haile P, Casillas L, Gough P, Bertin J, Votta B. Use of novel small molecule inhibitors to investigate the role of endogenous RIP2 kinase activity in modulating NOD2/RIP2-dependent cytokine signaling (172.4). The Journal of Immunology 2012. [DOI: 10.4049/jimmunol.188.supp.172.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
RIP2 is a Ser/Thr protein kinase, which undergoes autophosphorylation and activates NF-κB and MAPKs following stimulation of the upstream NOD1/NOD2 receptors resulting in proinflammatory cytokine production. Previous studies using transient overexpression systems have suggested that RIP2 kinase activity mediates NOD1/2-dependent signaling by regulating cellular RIP2 protein levels. To interrogate whether this is also the case for endogenous RIP2 kinase, we used novel, potent and highly-selective small-molecule RIP2 kinase inhibitors to study MDP-stimulated signaling in both primary human monocytes and human colonic epithelial (HCT116) cells. We demonstrated that inhibition of RIP2 kinase activity blocks proinflammatory cytokine production in monocytes in the absence of detectable changes in total RIP2 protein levels. Using TNFα-primed HCT116 cells, we confirmed these observations and demonstrated a direct correlation between the inhibition of endogenous RIP2 kinase activity (measured as a decrease in pS176-RIPK2 levels) and a reduction in proinflammatory cytokine signaling in response to MDP-stimulation. Our data confirm the importance of endogenous RIP2 kinase activity in modulating proinflammatory cytokine release from both human monocytes and intestinal epithelial cells in response to bacterial ligands. Furthermore, our results suggest that RIP2 kinase inhibition may represent a novel therapeutic strategy for the treatment of intestinal inflammation.
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Affiliation(s)
- Biva Desai
- 1Pattern Recognition Receptor DPU, Immuno-Inflammation Therapeutic Area, GlaxoSmithKline, Collegeville, PA
| | - Pamela Haile
- 1Pattern Recognition Receptor DPU, Immuno-Inflammation Therapeutic Area, GlaxoSmithKline, Collegeville, PA
| | - Linda Casillas
- 1Pattern Recognition Receptor DPU, Immuno-Inflammation Therapeutic Area, GlaxoSmithKline, Collegeville, PA
| | - Peter Gough
- 1Pattern Recognition Receptor DPU, Immuno-Inflammation Therapeutic Area, GlaxoSmithKline, Collegeville, PA
| | - John Bertin
- 1Pattern Recognition Receptor DPU, Immuno-Inflammation Therapeutic Area, GlaxoSmithKline, Collegeville, PA
| | - Bart Votta
- 1Pattern Recognition Receptor DPU, Immuno-Inflammation Therapeutic Area, GlaxoSmithKline, Collegeville, PA
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Casillas L, Vargas LA. Height and weight charts for Mexican adults. Arch Invest Med (Mex) 1980; 11:157-174. [PMID: 7396632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The relation between height and weight is one of the criteria most widely used by doctors to evaluate nutritional condition. The simplest way to establish this relationship is to consult a chart that indicates what a person's weight should be in relation to his height. The charts for adults used in Mexico are deficient, since their design was based on popluations from other countries. In this study the advantages and limitations of this method for evaluating nutritional condition are pointed out and charts designed with data on Mexican university students are presented and compared with the charts that are most frequently being used in Mexico now.
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Vázquez-Santaella J, Benítez H, Azuara Martínez C, de la Rosa Lazos O, Killner S, Casillas L. [Incidence of anemia in 1,545 students at the time of admission at the National University of Mexico]. Salud Publica Mex 1978; 20:485-91. [PMID: 754309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Serrano Muñoz F, Alix Trueba A, Toledo J, García Las F, Casillas L. [Surgical treatment of pulmonary emphysema]. Rev Clin Esp 1966; 103:324-8. [PMID: 5999587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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