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Darville-Beneby R, Lomanowska AM, Yu HC, Jobin P, Rosenbloom BN, Gabriel G, Daudt H, Negraeff M, Di Renna T, Hudspith M, Clarke H. The Impact of Preoperative Patient Education on Postoperative Pain, Opioid Use, and Psychological Outcomes: A Narrative Review. Can J Pain 2023; 7:2266751. [PMID: 38126044 PMCID: PMC10732618 DOI: 10.1080/24740527.2023.2266751] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/30/2023] [Indexed: 12/23/2023]
Abstract
Background Recent studies have shown that preoperative education can positively impact postoperative recovery, improving postoperative pain management and patient satisfaction. Gaps in preoperative education regarding postoperative pain and opioid use may lead to increased patient anxiety and persistent postoperative opioid use. Objectives The objective of this narrative review was to identify, examine, and summarize the available evidence on the use and effectiveness of preoperative educational interventions with respect to postoperative outcomes. Method The current narrative review focused on studies that assessed the impact of preoperative educational interventions on postoperative pain, opioid use, and psychological outcomes. The search strategy used concept blocks including "preoperative" AND "patient education" AND "elective surgery," limited to the English language, humans, and adults, using the MEDLINE ALL database. Studies reporting on preoperative educational interventions that included postoperative outcomes were included. Studies reporting on enhanced recovery after surgery protocols were excluded. Results From a total of 761 retrieved articles, 721 were screened in full and 34 met criteria for inclusion. Of 12 studies that assessed the impact of preoperative educational interventions on postoperative pain, 5 reported a benefit for pain reduction. Eight studies examined postoperative opioid use, and all found a significant reduction in opioid consumption after preoperative education. Twenty-four studies reported on postoperative psychological outcomes, and 20 of these showed benefits of preoperative education, especially on postoperative anxiety. Conclusion Preoperative patient education interventions demonstrate promise for improving postoperative outcomes. Preoperative education programs should become a prerequisite and an available resource for all patients undergoing elective surgery.
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Affiliation(s)
- Rasheeda Darville-Beneby
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management Pain Research Unit, Toronto General Hospital, Toronto, Ontario, Canada
- Transitional Pain Service, Toronto General Hospital, Toronto, Ontario, Canada
| | - Anna M. Lomanowska
- Department of Anesthesia and Pain Management Pain Research Unit, Toronto General Hospital, Toronto, Ontario, Canada
- Transitional Pain Service, Toronto General Hospital, Toronto, Ontario, Canada
| | - Hai Chuan Yu
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Parker Jobin
- Department of Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Brittany N. Rosenbloom
- Transitional Pain Service, Toronto General Hospital, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gretchen Gabriel
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management Pain Research Unit, Toronto General Hospital, Toronto, Ontario, Canada
- Transitional Pain Service, Toronto General Hospital, Toronto, Ontario, Canada
| | - Helena Daudt
- Pain BC/Pain Canada, Vancouver, British Columbia, Canada
| | - Michael Negraeff
- Pain BC/Pain Canada, Vancouver, British Columbia, Canada
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Tania Di Renna
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto Academic Pain Medicine Institute, Toronto, Ontario, Canada
| | - Maria Hudspith
- Pain BC/Pain Canada, Vancouver, British Columbia, Canada
| | - Hance Clarke
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management Pain Research Unit, Toronto General Hospital, Toronto, Ontario, Canada
- Transitional Pain Service, Toronto General Hospital, Toronto, Ontario, Canada
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2
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Morley-Senkler V, Jobin P, Wright JM. Blood pressure lowering effect of hydrochlorothiazide compared to other diuretics for hypertension. Cochrane Database of Systematic Reviews 2022; 2022:CD015250. [PMCID: PMC9678436 DOI: 10.1002/14651858.cd015250] [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: 11/23/2022]
Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: This review aims to assess the short‐term (3 to 12 weeks) blood pressure lowering efficacy of hydrochlorothiazide in comparison with other diuretics for primary hypertension in adults, and will build upon the other Cochrane Reviews studying the blood pressure lowering effect of diuretics (Chen 2009; Musini 2009; Musini 2014). The main outcomes of this review will be change in blood pressure, heart rate, and withdrawals due to adverse effects three to 12 weeks after starting the medication.
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Affiliation(s)
| | | | - Parker Jobin
- Faculty of MedicineUniversity of British ColumbiaVancouverCanada
| | - James M Wright
- Department of Anesthesiology, Pharmacology and TherapeuticsUniversity of British ColumbiaVancouverCanada
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3
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Dufour A, Bellac CL, Eckhard U, Solis N, Klein T, Kappelhoff R, Fortelny N, Jobin P, Rozmus J, Mark J, Pavlidis P, Dive V, Barbour SJ, Overall CM. C-terminal truncation of IFN-γ inhibits proinflammatory macrophage responses and is deficient in autoimmune disease. Nat Commun 2018; 9:2416. [PMID: 29925830 PMCID: PMC6010466 DOI: 10.1038/s41467-018-04717-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 05/18/2018] [Indexed: 01/02/2023] Open
Abstract
Controlled macrophage differentiation and activation in the initiation and resolution of inflammation is crucial for averting progression to chronic inflammatory and autoimmune diseases. Here we show a negative feedback mechanism for proinflammatory IFN-γ activation of macrophages driven by macrophage-associated matrix metalloproteinase 12 (MMP12). Through C-terminal truncation of IFN-γ at 135Glu↓Leu136 the IFN-γ receptor-binding site was efficiently removed thereby reducing JAK-STAT1 signaling and IFN-γ activation of proinflammatory macrophages. In acute peritonitis this signature was absent in Mmp12–/– mice and recapitulated in Mmp12+/+ mice treated with a MMP12-specific inhibitor. Similarly, loss-of-MMP12 increases IFN-γ–dependent proinflammatory markers and iNOS+/MHC class II+ macrophage accumulation with worse lymphadenopathy, arthritic synovitis and lupus glomerulonephritis. In active human systemic lupus erythematosus, MMP12 levels were lower and IFN-γ higher compared to treated patients or healthy individuals. Hence, macrophage proteolytic truncation of IFN-γ attenuates classical activation of macrophages as a prelude for resolving inflammation. IFN-γ is central in inflammatory pathogenesis, response to infection and autoimmune diseases. Here the authors show that MMP12 expression is reduced in patients with SLE and that MMP12 post-translationally truncates IFN-y, inhibiting its function and affecting pathogenesis of mouse models of peritonitis, SLE and rheumatoid arthritis.
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Affiliation(s)
- Antoine Dufour
- Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, 4.401-2350 Health Sciences Mall, Vancouver, V6T 1Z3, BC, Canada.,Centre for Blood Research, 4.401-2350 Health Sciences Mall, Vancouver, V6T 1Z3, BC, Canada.,Department of Physiology and Pharmacology McCaig Institute for Bone and Joint Health, Cumming School of Medicine, HRIC 3C64 3330 Hospital, Dr NW Calgary, T2N 4N1, AB, Canada
| | - Caroline L Bellac
- Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, 4.401-2350 Health Sciences Mall, Vancouver, V6T 1Z3, BC, Canada.,Centre for Blood Research, 4.401-2350 Health Sciences Mall, Vancouver, V6T 1Z3, BC, Canada.,Swissmedic, Swiss Agency for Therapeutics Products, Hallerstrasse 7, P.O. Box, Bern 9, CH-3000, Switzerland
| | - Ulrich Eckhard
- Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, 4.401-2350 Health Sciences Mall, Vancouver, V6T 1Z3, BC, Canada.,Centre for Blood Research, 4.401-2350 Health Sciences Mall, Vancouver, V6T 1Z3, BC, Canada
| | - Nestor Solis
- Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, 4.401-2350 Health Sciences Mall, Vancouver, V6T 1Z3, BC, Canada.,Centre for Blood Research, 4.401-2350 Health Sciences Mall, Vancouver, V6T 1Z3, BC, Canada
| | - Theo Klein
- Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, 4.401-2350 Health Sciences Mall, Vancouver, V6T 1Z3, BC, Canada.,Centre for Blood Research, 4.401-2350 Health Sciences Mall, Vancouver, V6T 1Z3, BC, Canada
| | - Reinhild Kappelhoff
- Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, 4.401-2350 Health Sciences Mall, Vancouver, V6T 1Z3, BC, Canada.,Centre for Blood Research, 4.401-2350 Health Sciences Mall, Vancouver, V6T 1Z3, BC, Canada
| | - Nikolaus Fortelny
- Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, 4.401-2350 Health Sciences Mall, Vancouver, V6T 1Z3, BC, Canada.,Centre for Blood Research, 4.401-2350 Health Sciences Mall, Vancouver, V6T 1Z3, BC, Canada.,Department of Biochemistry and Molecular Biology, University of British Columbia, 4.401-2350 Health Sciences Mall, Vancouver, V6T 1Z3, BC, Canada
| | - Parker Jobin
- Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, 4.401-2350 Health Sciences Mall, Vancouver, V6T 1Z3, BC, Canada.,Centre for Blood Research, 4.401-2350 Health Sciences Mall, Vancouver, V6T 1Z3, BC, Canada.,Department of Biochemistry and Molecular Biology, University of British Columbia, 4.401-2350 Health Sciences Mall, Vancouver, V6T 1Z3, BC, Canada
| | - Jacob Rozmus
- Department of Pediatrics, Child and Family Research Institute and BC Children's Hospital, University of British Columbia, 3110A-950 West 28th Av, Vancouver, V5Z 4H4, BC, Canada
| | - Jennifer Mark
- Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, 4.401-2350 Health Sciences Mall, Vancouver, V6T 1Z3, BC, Canada.,Centre for Blood Research, 4.401-2350 Health Sciences Mall, Vancouver, V6T 1Z3, BC, Canada
| | - Paul Pavlidis
- Centre for High Throughput Biology, University of British Columbia, 2125 East Mall, Vancouver, V6T 1Z3, BC, Canada.,Department of Psychiatry, University of British Columbia, 2125 East Mall, Vancouver, V6T 1Z3, BC, Canada
| | - Vincent Dive
- Commissariat a l'Energie Atomique (CEA) CE-Saclay, Labex LERMIT, Service d'Ingenierie Moleculaire des Proteines, Bat 152, Gif/Yvette, 91191, France
| | - Sean J Barbour
- Department of Medicine, University of British Columbia, 2775 Laurel St, Vancouver, V6T 1Z3, BC, Canada
| | - Christopher M Overall
- Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, 4.401-2350 Health Sciences Mall, Vancouver, V6T 1Z3, BC, Canada. .,Centre for Blood Research, 4.401-2350 Health Sciences Mall, Vancouver, V6T 1Z3, BC, Canada. .,Department of Biochemistry and Molecular Biology, University of British Columbia, 4.401-2350 Health Sciences Mall, Vancouver, V6T 1Z3, BC, Canada.
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4
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Vaney C, Heinzel-Gutenbrunner M, Jobin P, Tschopp F, Gattlen B, Hagen U, Schnelle M, Reif M. Efficacy, safety and tolerability of an orally administered cannabis extract in the treatment of spasticity in patients with multiple sclerosis: a randomized, double-blind, placebo-controlled, crossover study. Mult Scler 2016; 10:417-24. [PMID: 15327040 DOI: 10.1191/1352458504ms1048oa] [Citation(s) in RCA: 167] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: Cannabis may alleviate some symptoms associated with multiple sclerosis (MS). This study investigated the effect of an orally administered standardized Cannabis sativa plant extract in MS patients with poorly controlled spasticity. Methods: During their inpatient rehabilitation programme, 57 patients were enrolled in a prospective, randomized, double-blind, placebo-controlled crossover study of cannabis-extract capsules standardized to 2.5 mg tetrahydrocannabinol (THC) and 0.9 mg cannabidiol (CBD) each. Patients in group A started with a drug escalation phase from 15 to maximally 30 mg THC by 5 mg per day if well tolerated, being on active medication for 14 days before starting placebo. Patients in group B started with placebo for seven days, crossed to the active period (14 days) and closed with a three-day placebo period (active drug dose escalation and placebo sham escalation as in group A). Measures used included daily self-report of spasm frequency and symptoms, Ashworth Scale, Rivermead Mobility Index, 10-m timed walk, nine-hole peg test, paced auditory serial addition test (PASAT), and the digit span test. Results: In the 50 patients included into the intention-to-treat analysis set, there were no statistically significant differences associated with active treatment compared to placebo, but trends in favour of active treatment were seen for spasm frequency, mobility and getting to sleep. In the 37 patients (per-protocol set) who received at least 90% of their prescribed dose, improvements in spasm frequency (P- 0.013) and mobility after excluding a patient who fell and stopped walking were seen (P- 0.01). Minor adverse events were slightly more frequent and severe during active treatment, and toxicity symptoms, which were generally mild, were more pronounced in the active phase. Conclusion: A standardized Cannabis sativa plant extract might lower spasm frequency and increase mobility with tolerable side effects in MS patients with persistent spasticity not responding to other drugs.
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Affiliation(s)
- C Vaney
- Neurologische Rehabilitations- & MS-Abteilung, Berner Klinik, Montana, Switzerland.
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5
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Li Y, Bouchlaka MN, Wolff J, Grindle KM, Lu L, Qian S, Zhong X, Pflum N, Jobin P, Kahl BS, Eickhoff JC, Wuerzberger-Davis SM, Miyamoto S, Thomas CJ, Yang DT, Capitini CM, Rui L. FBXO10 deficiency and BTK activation upregulate BCL2 expression in mantle cell lymphoma. Oncogene 2016; 35:6223-6234. [PMID: 27157620 DOI: 10.1038/onc.2016.155] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 02/29/2016] [Accepted: 03/11/2016] [Indexed: 12/17/2022]
Abstract
Targeting Bruton tyrosine kinase (BTK) by ibrutinib is an effective treatment for patients with relapsed/refractory mantle cell lymphoma (MCL). However, both primary and acquired resistance to ibrutinib have developed in a significant number of these patients. A combinatory strategy targeting multiple oncogenic pathways is critical to enhance the efficacy of ibrutinib. Here, we focus on the BCL2 anti-apoptotic pathway. In a tissue microarray of 62 MCL samples, BCL2 expression positively correlated with BTK expression. Increased levels of BCL2 were shown to be due to a defect in protein degradation because of no or little expression of the E3 ubiquitin ligase FBXO10, as well as transcriptional upregulation through BTK-mediated canonical nuclear factor-κB activation. RNA-seq analysis confirmed that a set of anti-apoptotic genes (for example, BCL2, BCL-XL and DAD1) was downregulated by BTK short hairpin RNA. The downregulated genes also included those that are critical for B-cell growth and proliferation, such as BCL6, MYC, PIK3CA and BAFF-R. Targeting BCL2 by the specific inhibitor ABT-199 synergized with ibrutinib in inhibiting growth of both ibrutinib-sensitive and -resistant cancer cells in vitro and in vivo. These results suggest co-targeting of BTK and BCL2 as a new therapeutic strategy in MCL, especially for patients with primary resistance to ibrutinib.
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Affiliation(s)
- Y Li
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - M N Bouchlaka
- Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - J Wolff
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - K M Grindle
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - L Lu
- Wisconsin Institute for Discovery and Laboratory of Genetics, University of Wisconsin, Madison, WI, USA
| | - S Qian
- Wisconsin Institute for Discovery and Laboratory of Genetics, University of Wisconsin, Madison, WI, USA
| | - X Zhong
- Wisconsin Institute for Discovery and Laboratory of Genetics, University of Wisconsin, Madison, WI, USA
| | - N Pflum
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - P Jobin
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - B S Kahl
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - J C Eickhoff
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - S M Wuerzberger-Davis
- Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - S Miyamoto
- Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - C J Thomas
- Division of Preclinical Innovation, National Institutes of Health Chemical Genomics Center, National Center for Advancing Translational Sciences, Bethesda, MD, USA
| | - D T Yang
- Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - C M Capitini
- Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - L Rui
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Jobin P, Doyon D, Busy F, Daireaux P, Gallaire C. [Radiologic study of the nasal fossa. Value of a vasoconstrictor test]. J Radiol 1984; 65:267-73. [PMID: 6207292] [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: 01/19/2023]
Abstract
The advantages of a vasoconstrictor test during standard radiologic imaging of the nasal fossae are discussed. After a brief anatomic and physiologic review, results are presented of the use of a prednazoline test in 23 patients with radiologically evident nasal obstruction. Results emphasize the diagnostic value of the use of the vasoconstrictor, which enables precise study of morphology of the nasal fossae and, in certain cases, their functional exploration.
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Jobin P. [Rôle of universities and professional associations in permanent medical education]. Vie Med Can Fr 1972; 1:16-20. [PMID: 4639140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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8
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Jobin P. [Continuing education: a necessity]. Laval Med 1970; 41:955-6. [PMID: 5509493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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9
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Jobin P. [Is there an hindrance to continuing medical education?]. Can Med Assoc J 1967; 96:971-972. [PMID: 6020350 PMCID: PMC1922804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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10
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Jobin P. [Not Available]. Can Med Assoc J 1943; 49:529-530. [PMID: 20322960 PMCID: PMC1827984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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