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1.
Proc Natl Acad Sci U S A ; 121(4): e2314396121, 2024 Jan 23.
Artículo en Inglés | MEDLINE | ID: mdl-38236736

RESUMEN

In our quest to leverage the capabilities of the emerging single-atom catalysts (SACs) for wastewater purification, we confronted fundamental challenges related to electron scarcity and instability. Through meticulous theoretical calculations, we identified optimal placements for nitrogen vacancies (Nv) and iron (Fe) single-atom sites, uncovering a dual-site approach that significantly amplified visible-light absorption and charge transfer dynamics. Informed by these computational insights, we cleverly integrated Nv into the catalyst design to boost electron density around iron atoms, yielding a potent and flexible photoactivator for benign peracetic acid. This exceptional catalyst exhibited remarkable stability and effectively degraded various organic contaminants over 20 cycles with self-cleaning properties. Specifically, the Nv sites captured electrons, enabling their swift transfer to adjacent Fe sites under visible light irradiation. This mechanism accelerated the reduction of the formed "peracetic acid-catalyst" intermediate. Theoretical calculations were used to elucidate the synergistic interplay of dual mechanisms, illuminating increased adsorption and activation of reactive molecules. Furthermore, electron reduction pathways on the conduction band were elaborately explored, unveiling the production of reactive species that enhanced photocatalytic processes. A six-flux model and associated parameters were also applied to precisely optimize the photocatalytic process, providing invaluable insights for future photocatalyst design. Overall, this study offers a molecule-level insight into the rational design of robust SACs in a photo-Fenton-like system, with promising implications for wastewater treatment and other high-value applications.

2.
Environ Sci Technol ; 58(27): 12155-12166, 2024 Jul 09.
Artículo en Inglés | MEDLINE | ID: mdl-38934735

RESUMEN

The rising in situ chemical oxidation (ISCO) technologies based on polymerization reactions have advanced the removal of emerging contaminants in the aquatic environment. However, despite their promise, uncertainties persist regarding their effectiveness in eliminating structurally complex contaminants, such as sulfonamide antibiotics (SAs). This study elucidated that oligomerization, rather than mineralization, predominantly governs the removal of SAs in the carbon materials/periodate system. The amine groups in SAs played a crucial role in forming organic radicals and subsequent coupling reactions due to their high f- index and low bond orders. Moreover, the study highlighted the robust adhesion of oligomers to the catalyst surface, facilitated by enhanced van der Waals forces and hydrophobic interactions. Importantly, plant and animal toxicity assessments confirmed the nontoxic nature of oligomers deposited on the carbon material surface, affirming the efficacy of carbon material-based ISCO in treating contaminated surface water and groundwater. Additionally, a novel classification approach, Δlog k, was proposed to differentiate SAs based on their kinetic control steps, providing deeper insights into the quantitative structure-activity relationship (QSAR) and facilitating the selection of optimal descriptors during the oligomerization processes. Overall, these insights significantly enhance our understanding of SAs removal via oligomerization and demonstrate the superiority of C-ISCO based on polymerization in water decontamination.


Asunto(s)
Antibacterianos , Carbono , Sulfonamidas , Antibacterianos/química , Carbono/química , Sulfonamidas/química , Contaminantes Químicos del Agua/química , Purificación del Agua
3.
Biotechnol Appl Biochem ; 71(4): 701-711, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-38409880

RESUMEN

Sepsis-associated encephalopathy (SAE) is characterized by high incidence and mortality rates, with limited treatment options available. The underlying mechanisms and pathogenesis of SAE remain unclear. Annexin A1 (ANXA1), a membrane-associated protein, is involved in various in vivo pathophysiological processes. This study aimed to explore the neuroprotective effects and mechanisms of a novel bioactive ANXA1 tripeptide (ANXA1sp) in SAE. Forty Sprague-Dawley rats were randomly divided into four groups (n = 10 each): control, SAE (intraperitoneal injection of lipopolysaccharide), vehicle (SAE + normal saline), and ANXA1sp (SAE + ANXA1sp) groups. Changes in serum inflammatory factors (interleukin-6 [IL-6], tumor necrosis factor-α [TNF-α]), hippocampal reactive oxygen species (ROS), mitochondrial membrane potential (MMP), and adenosine triphosphate (ATP) levels were measured. The Morris water maze and Y maze tests were used to assess learning and memory capabilities in the rats. Further, changes in peroxisome proliferator-activated receptor-gamma (PPAR-γ) and apoptosis-related protein expression were detected using western blot. The IL-6, TNF-α, and ROS levels were significantly increased in the SAE group compared with the levels in the control group. Intraperitoneal administration of ANXA1sp led to a significant decrease in the IL-6, TNF-α, and ROS levels (p < 0.05). Compared with the SAE group, the ANXA1sp group exhibited reduced escape latency on day 5, a significant increase in the number of platform crossings and the percent spontaneous alternation, and significantly higher hippocampal MMP and ATP levels (p < 0.05). Meanwhile, the expression level of PPAR-γ protein in the ANXA1sp group was significantly increased compared with that in the other groups (p < 0.05). The expressions of apoptosis-related proteins (nuclear factor-kappa B [NF-κB], Bax, and Caspase-3) in the SAE and vehicle groups were significantly increased, with a noticeable decrease in Bcl-2 expression, compared with that noted in the control group. Moreover, the expressions of NF-κB, Bax, and Caspase-3 were significantly decreased in the ANXA1sp group, and the expression of Bcl-2 was markedly increased (p < 0.05). ANXA1sp can effectively reverse cognitive impairment in rats with SAE. The neuroprotective effect of ANXA1sp may be attributed to the activation of the PPAR-γ pathway, resulting in reduced neuroinflammatory response and inhibition of apoptosis.


Asunto(s)
Anexina A1 , Fármacos Neuroprotectores , Ratas Sprague-Dawley , Encefalopatía Asociada a la Sepsis , Animales , Anexina A1/metabolismo , Anexina A1/farmacología , Ratas , Fármacos Neuroprotectores/farmacología , Masculino , Encefalopatía Asociada a la Sepsis/tratamiento farmacológico , Encefalopatía Asociada a la Sepsis/metabolismo , Encefalopatía Asociada a la Sepsis/patología , Especies Reactivas de Oxígeno/metabolismo , Apoptosis/efectos de los fármacos , PPAR gamma/metabolismo , Potencial de la Membrana Mitocondrial/efectos de los fármacos
4.
BMC Chem ; 18(1): 49, 2024 Mar 07.
Artículo en Inglés | MEDLINE | ID: mdl-38454508

RESUMEN

Carbazole derivatives can be used as antioxidants in the lubricating oil industry. The alkylation of carbazole with 2-chloro-2-methylpropane and 2-bromopropane catalyzed by anhydrous aluminum chloride was studied. Initially, 3,6-di-iso-propylcarbazole and 3,6-di-tert-butylcarbazole were using dichloromethane and dibromomethane as solvents at room temperature, respectively. The synthesis conditions were optimized. Subsequently, the effects of reaction time, catalyst dosage, and molar ratio of carbazole to alkylating agent were investigated, and orthogonal experiments were performed. The structures of the carbazole derivatives were characterized by Fourier infrared spectroscopy (FT-IR), mass spectrum (MS) and nuclear magnetic resonance spectroscopy (NMR). The thermal stability of the synthesized carbazole derivatives was investigated by differential scanning calorimetry (DSC). The carbazole derivatives were added into the lubricating oil with a mass fraction of 0.8% and the miscibility, stability and oxidation resistance of the mixed system were evaluated by mechanical stirring and a rotary pressure vessel oxidation test (RPVOT). The DSC results showed that there was good thermal stability for the carbazole derivatives. The mechanical stirring method revealed good solubility and stability for the mixture of oil and carbazole derivatives. The RPVOT results showed that isopropyl carbazole derivatives could increase the oxidation induction period of lubricating oil to 1.39 times, and tert-butyl carbazole derivatives could increase the oxidation induction period of lubricating oil to 1.91 times. The antioxidant effect of tert-butyl carbazole derivatives was better than that of isopropyl carbazole derivatives.

5.
Food Chem ; 444: 138594, 2024 Jun 30.
Artículo en Inglés | MEDLINE | ID: mdl-38309076

RESUMEN

Herein, a novel electrochemiluminescence (ECL) and differential pulse voltammetry (DPV) dual-mode-based molecularly imprinted (MIP) sensor had been established for the detection of enrofloxacin (ENR) in eggs. Firstly, bismuth sulfide quantum dots (Bi2S3 QDs) as ECL luminophore were synthesized. Furthermore, a MIP film with ionic liquid (ILs), Bi2S3 QDs, and ENR was prepared via the electrochemical polymerization procedure on the electrode. As ENR was identified and captured by the imprinted cavities, the electron transfer pathway was blocked on the electrochemical interface, resulting in the decrease of both DPV signals and ECL signals. As a novel synchronous dual-mode sensing strategy, a pulsed voltage was applied to produce both the DPV signal and ECL signal simultaneously. The ECL and DPV response showed the good linear relationships with the concentration of ENR with the ranges of 0.5 Nm-25 µM and 5 nM-25 µΜ and the detection limits of 0.13 nM and 1.59 nM, respectively.


Asunto(s)
Técnicas Biosensibles , Impresión Molecular , Puntos Cuánticos , Enrofloxacina , Impresión Molecular/métodos , Mediciones Luminiscentes/métodos , Técnicas Electroquímicas/métodos , Límite de Detección , Técnicas Biosensibles/métodos
6.
Sci Total Environ ; 946: 174251, 2024 Oct 10.
Artículo en Inglés | MEDLINE | ID: mdl-38936736

RESUMEN

Recently, bisphenol AF (BPAF) as most commonly used bisphenol A analogs had the increasing higher level in the environment with unknown risks. Herein, a synchronous dual-mode sensor had been established based on differential pulse voltammetry (DPV) and electrochemiluminescence (ECL) for the detection of BPAF in pond mud. Firstly, the sensing molecularly imprinted polymer (MIP) films were prepared by electrochemical polymerization procedure with 3,4-ethoxylene dioxy thiophene (EDOT) as the functional monomer, BPAF as the template molecule and MXene as the supporting electrolyte. Due to unique characters of PEDOT and MXene, the constructed MIP films were stable and highly conductive. Meanwhile, zinc-doped bismuth sulfide quantum dots (Zn-Bi2S3 QDs) were synthesized as a nano-emitter to generate strong ECL signals in the MIP film. In the sensing process, a pulsed voltage applied to the PEDOT/MXene MIP film to generate both DPV and ECL signals for simultaneous dual-mode detection. Additionally, the liquid-liquid extraction with deep eutectic solvent (menthol: octanol 1:1) was used for the pre-concentration of the BPAF in the pond mud. Based on the sensing system, the ECL and DPV response showed the good linear relationships with the concentration of BPAF with the ranges of 0.01 µM-50 µM and 0.1 µM-50 µM and the detection limits of 0.0060 µM and 0.059 µM, respectively.

7.
Acta Physiol (Oxf) ; 240(8): e14184, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-38822624

RESUMEN

AIM: Sepsis-induced myocardial injury (SIMI) may be associated with insufficient mitophagy in cardiomyocytes, but the exact mechanism involved remains unknown. Sirtuin 3 (Sirt3) is mainly found in the mitochondrial matrix and is involved in repairing mitochondrial function through means such as the activation of autophagy. Previously, we demonstrated that the annexin-A1 small peptide (ANXA1sp) can promote Sirt3 expression in mitochondria. In this study, we hypothesized that the activation of Sirt3 by ANXA1sp induces mitophagy, thereby providing a protective effect against SIMI in mice. METHODS: A mouse model of SIMI was established via cecal ligation and puncture. Intraperitoneal injections of ANXA1sp, 3TYP, and 3MA were administered prior to modeling. After successful modeling, IL-6, TNF-α, CK-MB, and CTn-I levels were measured; cardiac function was assessed using echocardiography; myocardial mitochondrial membrane potential, ROS, and ATP production were determined; myocardial mitochondrial ultrastructure was observed using transmission electron microscopy; and the expression levels of Sirt3 and autophagy-related proteins were detected using western blotting. RESULTS: ANXA1sp significantly reduced serum IL-6, TNF-α, CK-MB, and CTn-I levels; decreased myocardial ROS production; increased mitochondrial membrane potential and ATP synthesis; and improved myocardial mitochondrial ultrastructure in septic mice. Furthermore, ANXA1sp promoted Sirt3 expression and activated the AMPK-mTOR pathway to induce myocardial mitophagy. These protective effects of ANXA1sp were reversed upon treatment with the Sirt3 blocker, 3-TYP. CONCLUSION: ANXA1sp can reverse SIMI, and the underlying mechanism may be related to the activation of the AMPK-mTOR pathway following upregulation of Sirt3 by ANXA1sp, which, in turn, induces autophagy.


Asunto(s)
Anexina A1 , Mitofagia , Sepsis , Sirtuina 3 , Animales , Sepsis/complicaciones , Sepsis/metabolismo , Mitofagia/efectos de los fármacos , Sirtuina 3/metabolismo , Sirtuina 3/genética , Ratones , Anexina A1/metabolismo , Masculino , Ratones Endogámicos C57BL , Miocitos Cardíacos/metabolismo , Miocitos Cardíacos/patología , Modelos Animales de Enfermedad , Autofagia , Péptidos
8.
Stress Biol ; 4(1): 7, 2024 Jan 25.
Artículo en Inglés | MEDLINE | ID: mdl-38270818

RESUMEN

Previously we isolated three Fusarium strains (a F. sacchari strain namely GXUF-1, and another two F. commune strains namely GXUF-2 and GXUF-3), and we verified that GXUF-3 was able to cause sugarcane root rot to the chewing cane cultivar Badila. Considering that Fusarium spp. are a group of widely distributed fungal pathogens, we tested whether these three Fusarium isolates were able to cause root rot to Badila as well as sugar-making cane cultivar (Guitang42), using a suitable inoculation method established based on infection assays using Badila. We found that the three Fusarium strains were able to cause root rot symptoms to both Badila and Guitang42, to different extents. To better investigate the potential pathogenicity mechanisms, we performed Illumina high-throughput sequencing and analyzed the whole genomic sequence data of these three Fusarium strains. The results reveal that the assembly sizes of the three Fusarium strains were in a range of 44.7-48.2 Mb, with G + C contents of 48.0-48.5%, and 14,154-15,175 coding genes. The coding genes were annotated by multiple public databases, and potential pathogenic genes were predicted using proprietary databases (such as PHI, DFVF, CAZy, etc.). Furthermore, based on evolutionary analysis of the coding sequence, we found that contraction and expansion of gene families occurred in the three Fusarium strains. Overall, our results suggest a potential risk that the root rot disease may occur to the sugar-making canes although it was initially spotted from fruit cane, and provide clues to understand the pathogenic mechanisms of Fusarium spp. causing sugarcane root rot.

9.
Nat Commun ; 15(1): 4718, 2024 Jun 03.
Artículo en Inglés | MEDLINE | ID: mdl-38830881

RESUMEN

Artificial photosynthesis using carbon nitride (g-C3N4) holds a great promise for sustainable and cost-effective H2O2 production, but the high carrier recombination rate impedes its efficiency. To tackle this challenge, we propose an innovative method involving multispecies iodine mediators (I-/I3-) intercalation through a pre-photo-oxidation process using potassium iodide (suspected deteriorated "KI") within the g-C3N4 framework. Moreover, we introduce an external electric field by incorporating cationic methyl viologen ions to establish an auxiliary electron transfer channel. Such a unique design drastically improves the separation of photo-generated carriers, achieving an impressive H2O2 production rate of 46.40 mmol g-1 h-1 under visible light irradiation, surpassing the most visible-light H2O2-producing systems. Combining various advanced characterization techniques elucidates the inner photocatalytic mechanism, and the application potential of this photocatalytic system is validated with various simulation scenarios. This work presents a significative strategy for preparing and applying highly efficient g-C3N4-based catalysts in photochemical H2O2 production.

10.
Water Res ; 260: 121907, 2024 Aug 15.
Artículo en Inglés | MEDLINE | ID: mdl-38878318

RESUMEN

The combination of ozone (O3) and ferrate (Fe(VI)) oxidation technology demonstrates substantial potential for practical applications, though it has been underreported, resulting in gaps in comprehensive activity assessments and thorough exploration of its mechanisms. This study reveals that the previous use of a borate buffer solution obscured certain synergistic reactions between O3 and Fe(VI), causing a reduction of activity by ∼40 % when oxidizing the electron-deficient pollutant atrazine. Consequently, we reassessed the activity and mechanisms using a buffer-salt-free O3/Fe(VI) system. Our findings showed that the hydroxyl radical (·OH) served as the predominant active species, responsible for an impressive 95.9 % of the oxidation activity against electron-deficient pollutants. Additional experiments demonstrated that the rapid production of neglected and really important superoxide radicals (·O2-) could facilitate the decomposition of O3 to generate ·OH and accelerate the reduction of Fe(VI) to Fe(V), reactivating O3 to produce ·OH anew. Intriguingly, as the reaction progressed, the initially depleted Fe(VI) was partially regenerated, stabilizing at over 50 %, highlighting the significant potential of this combined system. Moreover, this combined system could achieve a high mineralization efficiency of 80.4 % in treating actual coking wastewater, complemented by extensive toxicity assessments using Escherichia coli, wheat seeds, and zebrafish embryos, showcasing its robust application potential. This study revisits and amends previous research on the O3/Fe(VI) system, providing new insights into its activity and synergistic mechanisms. Such a combined technology has potential for the treatment of difficult-to-degrade industrial wastewater.


Asunto(s)
Hierro , Oxidación-Reducción , Ozono , Contaminantes Químicos del Agua , Ozono/química , Hierro/química , Contaminantes Químicos del Agua/química , Contaminantes Químicos del Agua/toxicidad , Animales , Radical Hidroxilo/química , Atrazina/química , Atrazina/toxicidad , Electrones , Pez Cebra
11.
Int J Surg ; 110(7): 4132-4142, 2024 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-38537085

RESUMEN

BACKGROUND: Robotic gastrectomy is a safe and feasible approach for gastric cancer (GC); however, its long-term oncological efficacy remains unclear. The authors evaluated the long-term survival outcomes and recurrence patterns of patients with locally advanced proximal GC who underwent robotic total gastrectomy (RTG). METHODS: This prospective study (FUGES-014 study) enrolled 48 patients with locally advanced proximal GC who underwent RTG between March 2018 and February 2020 at a tertiary referral teaching hospital. Patients who underwent laparoscopic total gastrectomy (LTG) in the FUGES-002 study were enrolled in a 2:1 ratio to compare the survival outcomes between RTG and LTG. The primary endpoint of the FUGES-014 study was postoperative 30-day morbidity and has been previously reported. Here, the authors reported the results of 3-year disease-free survival (DFS), 3-year overall survival (OS), and recurrence patterns. RESULTS: After propensity score matching, 48 patients in the RTG and 96 patients in the LTG groups were included. The 3-year DFS rates were 77.1% (95% CI: 66.1-89.9%) for the RTG and 68.8% (95% CI: 60.1-78.7%) for the LTG groups ( P =0.261). The 3-year OS rates were not significantly different between the groups (85.4 vs. 74.0%, P =0.122). Recurrence occurred in nine patients (18.8%) in the RTG and 27 (28.1%) patients in the LTG groups ( P =0.234). Recurrence patterns and causes of death were similar between the groups ( P >0.05). CONCLUSIONS: The oncological outcome of RTG was noninferior to that of LTG. Thus, RTG might be an alternative surgical treatment for locally advanced proximal GC.


Asunto(s)
Gastrectomía , Procedimientos Quirúrgicos Robotizados , Neoplasias Gástricas , Humanos , Neoplasias Gástricas/cirugía , Neoplasias Gástricas/mortalidad , Neoplasias Gástricas/patología , Gastrectomía/métodos , Gastrectomía/mortalidad , Procedimientos Quirúrgicos Robotizados/mortalidad , Procedimientos Quirúrgicos Robotizados/métodos , Masculino , Femenino , Estudios Prospectivos , Persona de Mediana Edad , Anciano , Puntaje de Propensión , Resultado del Tratamiento , Recurrencia Local de Neoplasia , Supervivencia sin Enfermedad , Laparoscopía/mortalidad , Tasa de Supervivencia
12.
Int J Surg ; 110(3): 1420-1429, 2024 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-38116657

RESUMEN

BACKGROUND: The results of several large randomized controlled trials (RCTs) have changed the clinical practice of bariatric surgery. However, the characteristics of global RCTs of bariatric surgery have not been reported internationally and whether there was research waste in these RCTs is unknown. METHODS: Search ClinicalTrials.gov for bariatric surgery RCTs registered between January 2000 and December 2022 with the keywords 'Roux-en-Y gastric-bypass' and 'Sleeve Gastrectomy'. The above analysis was conducted in January 2023. RESULTS: A total of 326 RCTs were included in this study. The number of RCTs registered for sleeve gastrectomy and gastric bypass surgery increased year by year globally. Europe has always accounted for the largest proportion, Asia has gradually increased, and North America has decreased. A total of 171 RCTs were included in the analysis of waste, of which 74 (43.8%) were published. Of the 74 published RCTs, 37 (37/74, 50.0%) were judged to be adequately reported and 36 (36/74, 48.6%) were judged to have avoidable design defects. In the end, 143 RCTs (143/171, 83.6%) had at least one research waste. Body weight change as the primary endpoint (OR: 0.266, 95% CI: 0.103-0.687, P =0.006) and enrolment greater than 100 (OR: 0.349, 95% CI: 0.146-0.832, P =0.018) were independent protective factors for research waste. CONCLUSIONS: This study for the first time describes the characteristic changes of the mainstream RCT of bariatric surgery globally in the last 20 years and identifies a high research waste burden and predictive factor in this area, which provides reference evidence for carrying out bariatric surgery RCTs more rationally.


Asunto(s)
Cirugía Bariátrica , Derivación Gástrica , Laparoscopía , Obesidad Mórbida , Humanos , Obesidad Mórbida/cirugía , Estudios Transversales , Pérdida de Peso , Ensayos Clínicos Controlados Aleatorios como Asunto , Derivación Gástrica/métodos , Gastrectomía/métodos , Resultado del Tratamiento , Laparoscopía/métodos
13.
Int J Surg ; 110(8): 4830-4838, 2024 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-38652275

RESUMEN

BACKGROUND: The safety and efficacy of neoadjuvant immunochemotherapy (nICT) for locally advanced gastric cancer (LAGC) remain controversial. METHODS: Patients with LAGC who received either nICT or neoadjuvant chemotherapy (nCT) at 3 tertiary referral teaching hospitals in China between January 2016 and October 2022 were analyzed. After propensity-score matching (PSM), comparing the radiological response, pathological response rate, perioperative outcomes, and early recurrence between the two groups. RESULTS: After PSM, 585 patients were included, with 195 and 390 patients comprising the nICT and nCT groups, respectively. The nICT group exhibited a higher objective response rate (79.5% vs. 59.0%; P <0.001), pathological complete response rate (14.36% vs. 6.41%; P =0.002) and major pathological response rate (39.49% vs. 26.15%; P =0.001) compared with the nCT group. The incidence of surgical complications (17.44% vs. 16.15%, P =0.694) and the proportion of perioperative textbook outcomes (80.0% vs. 81.0%; P =0.767) were similar in both groups. The nICT group had a significantly lower proportion of early recurrence than the nCT group (29.7% vs. 40.8%; P =0.047). Furthermore, the multivariable logistic analysis revealed that immunotherapy was an independent protective factor against early recurrence [odds ratio 0.62 (95% CI 0.41-0.92); P =0.018]. No significant difference was found in neoadjuvant therapy drug toxicity between the two groups (51.79% vs. 45.38%; P =0.143). CONCLUSIONS: Compared with nCT, nICT is safe and effective, which significantly enhanced objective and pathological response rates and reduced the risk for early recurrence among patients with LAGC. TRIAL REGISTRATION: Clinical Trials.gov.


Asunto(s)
Gastrectomía , Laparoscopía , Terapia Neoadyuvante , Neoplasias Gástricas , Humanos , Neoplasias Gástricas/terapia , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/cirugía , Masculino , Femenino , Persona de Mediana Edad , Terapia Neoadyuvante/efectos adversos , Gastrectomía/efectos adversos , Anciano , Laparoscopía/efectos adversos , Resultado del Tratamiento , China , Estudios Retrospectivos , Inmunoterapia/métodos , Inmunoterapia/efectos adversos , Puntaje de Propensión , Adulto
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