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1.
Artigo em Inglês | MEDLINE | ID: mdl-34849991

RESUMO

COVID -19 stimulated enormous focus on, and change in, infection prevention and control (IPC), not just in the healthcare sector but also among the general public. While global cooperation and guidance are important, there is also an essential role and benefit from national policies that respect local circumstances and cultural differences. Hospitals will have a new role and data sharing and cooperation between areas such as acute and long-term care will be even more important. Further integration of infection control, microbiology and infectious diseases staff in IPC teams is needed. The digital and AI revolutions have roles to play in how and where patients are seen and diagnosed. The built environment may have longer-term influence on changing the behaviour of health professionals than education and training. One constant is the need for highly trained, flexible and motivated staff in these IPC teams.

2.
Artigo em Inglês | MEDLINE | ID: mdl-34890027

RESUMO

OBJECTIVE: The purpose of this guide is to illustrate an arthroscopic rotator cuff repair (RCR) with two techniques for biologically enhanced patch augmentation. INDICATIONS: Massive rotator cuff tears (> 5 cm) and revision RCR. CONTRAINDICATIONS: Active joint or systemic infection; severe fatty muscle atrophy; severe glenohumeral arthropathy; American Society of Anesthesiologists Physical Status (ASA PS) IV. SURGICAL TECHNIQUE: Dermal allograft patch augmented with concentrated bone marrow aspirate (cBMA), platelet-rich plasma (PRP) and platelet-poor plasma (PPP); or Regeneten patch augmented with bursa, PRP, PPP, and autologous thrombin. POSTOPERATIVE MANAGEMENT: A 30° abduction sling for 6 weeks; unrestricted active-assisted external rotation and forward elevation after 12 weeks; focus on restoration of scapular stability and strength. RESULTS: A total of 22 patients received revision massive RCR using a dermal allograft patch enhanced with cBMA and PRP with a mean follow-up of 2.5 years (1.0-5.8 years). There was a significant improvement in the preoperative Simple Shoulder Test (SST). There was also a trend towards improved pain and American Shoulder and Elbow Surgeons (ASES) Shoulder Score. In this cohort, 45% reached the minimal clinically important difference (MCID), 41% achieved substantial clinical benefit (SCB), and 32% had a patient-acceptable symptomatic state (PASS) for the ASES score. Preliminary data using the Regeneten patch technique with bursa, PRP, PPP, and autologous thrombin was prospectively collected in five patients between 05/2020 and 03/2021 at the author's institution. Mean follow-up was 6.5 ± 1.3 (6-8 months). There was an improvement from preop to postop in pain, ASES, SANE, Constant-Murley (CM) score and active range of motion.

3.
Annu Int Conf IEEE Eng Med Biol Soc ; 2021: 5527-5530, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34892376

RESUMO

Cardiomyopathies diseases affects a great number of the elderly population. An adequate identification of the etiology of a cardiomyopathy patient is still a challenge. The aim of this study was to classify patients by their etiology in function of indexes extracted from the characterization of the pulse transit time (PTT). This time series represents the time taken by the pulse pressure to propagate through the length of the arterial tree and corresponding to the time between R peak of ECG and the mid-point of the diastolic to systolic slope in the blood pressure signal. For each patient, the PTT time series was extracted. Thirty cardiomyopathy patients (CMP) classified as ischemic (ICM - 15 patients) and dilated (DCM - 15 patients) were analyzed. Forty-three healthy subjects (CON) were used as a reference. The PTT time series was characterized through statistical descriptive indices and the joint symbolic dynamics method. The best indices were used to build support vector machine models. The optimal model to classify ICM versus DCM patients achieved 89.6% accuracy, 78.5% sensitivity, and 100% specificity. When comparing CMP patients and CON subjects, the best model achieved 91.3% accuracy, 91.3% sensitivity, and 88.3% specificity. Our results suggests a significantly lower pulse transit time in ischemic patients.Clinical relevance- This study analyzed the suitability of the pulse transit time for the classification of ICM and DCM patients.

4.
Artigo em Inglês | MEDLINE | ID: mdl-34906718

RESUMO

OBJECTIVES: Antibiotic resistance requires continuous monitoring by experts to decide whether empirical antibiotic therapies (EATs) should be replaced by alternative antibiotics. The exact moment and criteria for this change are unclear and generally based on consensus between experts. This scoping review aims to identify from the literature the resistance thresholds used for a change in EAT and the criteria on which they are based. METHODS: Scoping review for which a comprehensive structured literature search was conducted. Rayyan, software for systematic reviews, was used for the screening of abstracts and titles. Data sources were Pubmed and a hand-search of reference lists and grey literature. Papers were eligible if they concerned any type of bacterial infectious disease and mentioned or defined antibiotic resistance thresholds for decision-making purposes for EAT. The inclusion and analysis of articles was done by two researchers; any conflicts were resolved through discussion or by consulting a third reviewer. RESULTS: We identified 3146 unique papers. Following title/abstract screening, 125 papers were comprehensively read, and 16 papers were included. The included papers gave thresholds for urinary tract infections, respiratory tract infections, meningitis, skin and soft tissue infections, gonorrhoea, and bone and joint infections. Six criteria were found that were commonly used to base the thresholds on. These were: disease severity, efficacy of treatment, adverse drug events, risk of Clostridioides difficile infection, costs, and increased resistance. The number of criteria used to define each threshold varied from one to six between papers. CONCLUSIONS: The thresholds used for EATs are few, commonly based on expert opinion estimates, and can therefore have broad ranges. Used criteria underlying reported thresholds are heterogenous and require standardization. Considering the rising trend in resistance, there is a clear need for rigid tools to determine thresholds in order to support guideline development with the best and timely evidence.

5.
Artigo em Inglês | MEDLINE | ID: mdl-34767511

RESUMO

Comparing competing mathematical models of complex processes is a shared goal among many branches of science. The Bayesian probabilistic framework offers a principled way to perform model comparison and extract useful metrics for guiding decisions. However, many interesting models are intractable with standard Bayesian methods, as they lack a closed-form likelihood function or the likelihood is computationally too expensive to evaluate. In this work, we propose a novel method for performing Bayesian model comparison using specialized deep learning architectures. Our method is purely simulation-based and circumvents the step of explicitly fitting all alternative models under consideration to each observed dataset. Moreover, it requires no hand-crafted summary statistics of the data and is designed to amortize the cost of simulation over multiple models, datasets, and dataset sizes. This makes the method especially effective in scenarios where model fit needs to be assessed for a large number of datasets, so that case-based inference is practically infeasible. Finally, we propose a novel way to measure epistemic uncertainty in model comparison problems. We demonstrate the utility of our method on toy examples and simulated data from nontrivial models from cognitive science and single-cell neuroscience. We show that our method achieves excellent results in terms of accuracy, calibration, and efficiency across the examples considered in this work. We argue that our framework can enhance and enrich model-based analysis and inference in many fields dealing with computational models of natural processes. We further argue that the proposed measure of epistemic uncertainty provides a unique proxy to quantify absolute evidence even in a framework which assumes that the true data-generating model is within a finite set of candidate models.

6.
Strahlenther Onkol ; 2021 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-34735577

RESUMO

PURPOSE: The prognosis of an early relapse of diffuse large B-cell lymphoma (DLBCL) appears to be poor following autologous stem cell transplantation (ASCT). The aim of this study is to contribute data to the open question on whether additional radiotherapy can improve the outcome. PATIENTS AND METHODS: Forty-eight patients with an early relapse (median 4 months after the end of initial immunochemotherapy, range 1-11) of DLBCL have been treated in our institution with high-dose therapy (usually the BEAM protocol) and ASCT since 2008 (median age 61 years, range 28-73). Twenty-three patients received ASCT in a second treatment line, 25 in a third line (19 refractory to second-line salvage therapy, 5 after second relapse). Fifteen of these 48 patients received radiotherapy (36-50 Gy, median 40) of residual masses after ASCT. RESULTS: Three-year overall survival (OS) and progression-free survival (PFS) after second-line ASCT were 61 and 57%, after third-line ASCT 47 and 44%, respectively, without significant differences. A prognostic factor was the International Prognostic Index (IPI) at the start of salvage therapy. Three-year OS and PFS in low-risk patients were 69 and 69%, in low-intermediate-risk 63 and 53%, and in high-intermediate-risk 23 and 23%, respectively (p = 0.033). Twenty-three patients achieved a sustained complete remission (13-146 months, median 62). CONCLUSION: Sustained long-term remissions can be achieved in patients with early relapse of DLBCL following ASCT in a second or third treatment line, particularly in patients with low- and low-intermediate-risk IPI, following radiotherapy of residual disease after ASCT. Further investigations are required to clarify which patients need an alternative therapy (potentially CAR T­cells or allogeneic transplantation).

7.
Cogn Emot ; : 1-23, 2021 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-34689718

RESUMO

Affective experience is inherently dynamic and short-term changes in affect are supposed to offer important insights into well-being. Past years have shown a tremendous rise in investigations into the relation between affect dynamics and well-being. The indicators that have been introduced to capture unique dynamical aspects of affect, however, have been criticised for being purely statistical measures without theoretical foundation and were shown to have little added value for explaining well-being over and above mean levels of affect. To address these concerns, we applied our newly developed theory-based MIVA model to data on daily affective experience. The MIVA model allows estimating parameters for anchoring, reactivity, and regulation based on affective states in combination with daily events. Everyday affective experience was measured with a high temporal resolution, multiple indicators of well-being (e.g. life satisfaction, depression) were assessed, and the incremental value of the MIVA model parameters in predicting well-being was determined. The MIVA model parameters reflect essential processes that accounted for observed fluctuations in affective experience. Incremental validity for predicting well-being over and above mean levels of affect, however, was low. Together, our results suggest that research on affect dynamics needs to identify how affect dynamics can be assessed more validly.

8.
Knee Surg Sports Traumatol Arthrosc ; 29(10): 3139-3141, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34482415
9.
BMC Musculoskelet Disord ; 22(1): 744, 2021 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-34461863

RESUMO

BACKGROUND: For the treatment of unstable thoraco-lumbar burst fractures, a combined posterior and anterior stabilization instead of a posterior-only instrumentation is recommend in the current literature due to the instability of the anterior column. Data on restoring the bi-segmental kyphotic endplate angle (BKA) with expandable vertebral body replacements (VBR) and on the mid- to long-term patient-reported outcome measures (PROM) is sparse. METHODS: A retrospective cohort study of patients with traumatic thoraco-lumbar spinal fractures treated with an expandable VBR implant (Obelisc™, Ulrich Medical, Germany) between 2001 and 2015 was conducted. Patient and treatment characteristics were evaluated retrospectively. Radiological data acquisition was completed pre- and postoperatively, 6 months and at least 2 years after the VBR surgery. The BKA was measured and fusion-rates were assessed. The SF-36, EQ-5D and ODI questionnaires were evaluated prospectively. RESULTS: Ninety-six patients (25 female, 71 male; age: 46.1 ± 12.8 years) were included in the study. An AO Type A4 fracture was seen in 80/96 cases (83.3%). Seventy-three fractures (76.0%) were located at the lumbar spine. Intraoperative reduction of the BKA in n = 96 patients was 10.5 ± 9.4° (p < 0.01). A loss of correction of 1.0 ± 2.8° at the first follow-up (t1) and of 2.4 ± 4.0° at the second follow-up (t2) was measured (each p < 0.05). The bony fusion rate was 97.9%. The total revision rate was 4.2%. Fifty-one patients (53.1% of included patients; age: 48.9 ± 12.4 years) completed the PROM questionnaires after 106.4 ± 44.3 months and therefore were assigned to the respondent group. The mean ODI score was 28.2 ± 18.3%, the mean EQ-5D VAS reached 60.7 ± 4.1 points. Stratified SF-36 results (ISS < and ≥ 16) were lower compared to a reference population. CONCLUSION: The treatment of traumatic thoraco-lumbar fractures with an expandable VBR implant lead to a high rate of bony fusion. A significant correction of the BKA could be achieved and no clinically relevant loss of reduction occurred during the follow-up. Even though health related quality of life did not reach the normative population values, overall satisfactory results were reported.


Assuntos
Fraturas da Coluna Vertebral , Fusão Vertebral , Adulto , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/efeitos adversos , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Resultado do Tratamento , Corpo Vertebral
11.
Complement Ther Med ; 61: 102771, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34450257

RESUMO

OBJECTIVES: The present study examined the effects of a yoga and mindfulness-based programme on the autonomic nervous system of primary school children by using heart rate variability parameters. DESIGN: A two-arm non-randomised controlled trial compared an integrated yoga and mindfulness-based programme (16 weeks) to conventional primary school lessons. SETTING: Primary school classrooms and conference rooms. INTERVENTIONS: Participants were allocated to a 16-week integrated yoga-based programme or conventional school lessons. A subgroup was randomised to receive 24h electrocardiogram-recordings. MAIN OUTCOME MEASURES: Heart rate variability indices were measured, both linear (time and frequency domain) and non-linear (symbolic dynamics, compression entropy), calculated from 30-minute extracts of Holter-electrocardiogram-recordings. Assessments were conducted at baseline and at the end of intervention. RESULTS: 40 participants (42.5% female) were included into the analysis of HRV. No significant changes in heart rate variability parameters were observed between the groups after 16 weeks. In the intervention group, a trend towards increased parasympathetic activity could be seen over time, although not significantly enhanced compared to the control group. CONCLUSION: Results obtained here do not clearly show that children in German primary school settings benefit from an integrated yoga-based intervention. However, exploratory post-hoc analyses point interestingly to an increased nocturnal parasympathetic activity in the intervention group. Further studies are required with high-quality study designs, larger sample sizes and longer-term follow-ups.


Assuntos
Meditação , Atenção Plena , Ioga , Sistema Nervoso Autônomo , Criança , Feminino , Humanos , Masculino , Instituições Acadêmicas
12.
Eur J Haematol ; 107(5): 543-552, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34288114

RESUMO

OBJECTIVE: To contribute data on long-term outcome and potential curative impact of ASCT in FL, especially following HDT with the BEAM protocol (BCNU, etoposide, cytarabine and melphalan), given very limited data on this topic in the literature. PATIENTS AND METHODS: Patients with FL (n = 76) were treated in our institution with HDT and ASCT. In the case of long-term remission (≥8 years), peripheral blood was tested for minimal residual disease by t(14;18)- and IGH-PCR, including the last follow-up. RESULTS: 10-year overall survival, progression-free survival, and freedom from progression (FFP) after first-line ASCT (n = 20) were 80%, 60%, and 69%, after second-line ASCT (n = 48, following BEAM) 66%, 38%, and 41%, after third/fourth-line ASCT (n = 8) 33%, 25%, and 25%, respectively. Prognostic factors for FFP were treatment line and FLIPI (Follicular Lymphoma International Prognostic Index). 10-year FFP for second-line ASCT and low-risk FLIPI at relapse was 69%, intermediate-risk 28%, and high-risk 25% (P < .05). 26 patients developed sustained long-term clinical and molecular remissions of up to 27 years. CONCLUSIONS: Sustained long-term clinical and molecular complete remissions up to 27 years can be achieved following ASCT (including HDT with BEAM in second treatment line), indicating a potential curative impact of ASCT in FL.

15.
J Intell ; 9(2)2021 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-34066281

RESUMO

In recent years, mathematical models of decision making, such as the diffusion model, have been endorsed in individual differences research. These models can disentangle different components of the decision process, like processing speed, speed-accuracy trade-offs, and duration of non-decisional processes. The diffusion model estimates individual parameters of cognitive process components, thus allowing the study of individual differences. These parameters are often assumed to show trait-like properties, that is, within-person stability across tasks and time. However, the assumption of temporal stability has so far been insufficiently investigated. With this work, we explore stability and change in diffusion model parameters by following over 270 participants across a time period of two years. We analysed four different aspects of stability and change: rank-order stability, mean-level change, individual differences in change, and profile stability. Diffusion model parameters showed strong rank-order stability and mean-level changes in processing speed and speed-accuracy trade-offs that could be attributed to practice effects. At the same time, people differed little in these patterns across time. In addition, profiles of individual diffusion model parameters proved to be stable over time. We discuss implications of these findings for the use of the diffusion model in individual differences research.

16.
Artigo em Inglês | MEDLINE | ID: mdl-33885945

RESUMO

PURPOSE: Cell-based therapies are on the rise in treating intra and extraarticular pathologies, trying to avoid surgical intervention and support local repair processes. Therefore, the aim was to summarize current evidence-based treatment options for a cell-based therapy around the elbow. METHODS: Through a literature review up-to date treatment algorithms and therapies have been identified and have been rated according to their evidence level for clinical recommendation. RESULTS: Regarding the four extraarticular anatomical regions of the elbow (anterior, medial, posterior and lateral) and the joint itself, the lateral elbow and its´ tendinopathies as well as the use of cell-based treatment options have been extensively studied and, therefore, allow for clear and evidence-based recommendations. The remaining three regions as wells as the intraarticular application do not show enough evidence for a clinical recommendation. CONCLUSION: In conclusion the cell-based approach for treating elbow pathologies can only be recommended for the lateral elbow, as there has been shown sufficient evidence for the extraarticular application. It has to be mentioned, that the results from the lateral elbow maybe transferred to other extra-articular tendinopathies, as the lack of evidence may be due to the rare appearance of posterior, medial and anterior tendon affection. No recommendation can be given for intra-articular use. LEVEL OF EVIDENCE: IV.

17.
BMC Musculoskelet Disord ; 22(1): 378, 2021 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-33888115

RESUMO

BACKGROUND: While supraspinatus atrophy can be described according to the system of Zanetti or Thomazeau there is still a lack of characterization of isolated subscapularis muscle atrophy. The aim of this study was to describe patterns of muscle atrophy following repair of isolated subscapularis (SSC) tendon. METHODS: Forty-nine control shoulder MRI scans, without rotator cuff pathology, atrophy or fatty infiltration, were prospectively evaluated and subscapularis diameters as well as cross sectional areas (complete and upper half) were assessed in a standardized oblique sagittal plane. Calculation of the ratio between the upper half of the cross sectional area (CSA) and the total CSA was performed. Eleven MRI scans of patients with subscapularis atrophy following isolated subscapularis tendon tears were analysed and cross sectional area ratio (upper half /total) determined. To guarantee reliable measurement of the CSA and its ratio, bony landmarks were also defined. All parameters were statistically compared for inter-rater reliability, reproducibility and capacity to quantify subscapularis atrophy. RESULTS: The mean age in the control group was 49.7 years (± 15.0). The mean cross sectional area (CSA) was 2367.0 mm2 (± 741.4) for the complete subscapularis muscle and 1048.2 mm2 (± 313.3) for the upper half, giving a mean ratio of 0.446 (± 0.046). In the subscapularis repair group the mean age was 56.7 years (± 9.3). With a mean cross sectional area of 1554.7 mm2 (± 419.9) for the complete and of 422.9 mm2 (± 173.6) for the upper half of the subscapularis muscle, giving a mean CSA ratio of 0.269 (± 0.065) which was seen to be significantly lower than that of the control group (p < 0.05). CONCLUSION: Analysis of typical atrophy patterns of the subscapularis muscle demonstrates that the CSA ratio represents a reliable and reproducible assessment tool in quantifying subscapularis atrophy. We propose the classification of subscapularis atrophy as Stage I (mild atrophy) in case of reduction of the cross sectional area ratio < 0.4, Stage II (moderate atrophy) in case of < 0.35 and Stage III (severe atrophy) if < 0.3.


Assuntos
Lesões do Manguito Rotador , Manguito Rotador , Artroscopia , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Atrofia Muscular/diagnóstico por imagem , Atrofia Muscular/patologia , Reprodutibilidade dos Testes , Manguito Rotador/diagnóstico por imagem , Manguito Rotador/patologia , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/patologia
19.
Orthop J Sports Med ; 9(2): 2325967120984264, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33738310

RESUMO

Background: Superior capsular reconstruction (SCR) represents a new option for the treatment of irreparable rotator cuff tears. Purpose/Hypothesis: This study aimed to evaluate the clinical and radiologic outcomes of SCR and compare them with the outcomes of partial repair (PR) of the infraspinatus tendon. The hypothesis was that there would be no significant differences between the clinical and radiologic outcome parameters of SCR and PR after a minimum follow-up of 2 years. Study Design: Cohort study; Level of evidence, 3. Methods: Of 21 patients who underwent SCR, 20 patients were matched in a 1:1 ratio according to sex, age, and tear configuration with 20 of 60 patients who had undergone PR; all patients were prospectively evaluated for a minimum follow-up of 2 years. The investigated outcome measures included the Constant score; Western Ontario Rotator Cuff (WORC) index; Disabilities of the Arm, Shoulder and Hand (DASH) score; and radiologic analysis of acromiohumeral distance (AHD) and humeral head centralization (HHC). Results: There were no differences in the demographic data between the SCR and PR groups. The mean age of both groups was 62.3 years (range, 47-79 years), the mean tear configuration was Bateman 3.0 and Patte 2.8, and the mean follow-up period was 29.4 months (range, 24-53 months). At final follow-up, no significant differences were seen between the SCR and PR groups with regard to Constant score (77.1 vs 82.7), age- and sex-adapted Constant score (85.5% vs 91.4%), DASH score (15.6 vs 7.8), or WORC index (81.1 vs 90.4). No significant differences in the AHD or HHC were seen between the groups. The reoperation rate was 4.8% (1/21) in the SCR cohort and 15% (9/60) in the PR cohort. Conclusion: Both SCR and PR resulted in significant improvements in patient-reported outcomes at 2-year follow-up, with no significant differences in clinical outcomes between the 2 techniques. Further follow-up is needed to determine whether there are long-term differences in HHC and development of cuff tear arthropathy. Further investigations should also focus on the cost-effectiveness of the respective procedures.

20.
Knee Surg Sports Traumatol Arthrosc ; 29(10): 3149-3158, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33755737

RESUMO

PURPOSE: Septic arthritis is a significant complication following arthroscopic surgery, with an estimated overall incidence of less than 1%. Despite the low incidence, an appropriate diagnostic and therapeutic pathway is required to avoid serious long-term consequences, eradicate the infection, and ensure good treatment outcomes. The aim of this current review article is to summarize evidence-based literature regarding diagnostic and therapeutic options of post-operative septic arthritis after arthroscopy. METHODS: Through a literature review, up-to-date treatment algorithms and therapies have been identified. Additionally, a supportive new algorithm is proposed for diagnosis and treatment of suspected septic arthritis following arthroscopic intervention. RESULTS: A major challenge in diagnostics is the differentiation of the post-operative status between a non-infected hyperinflammatory joint versus septic arthritis, due to clinical symptoms, (e.g., rubor, calor, or tumor) can appear identical. Therefore, joint puncture for microbiological evaluation, especially for fast leukocyte cell-count diagnostics, is advocated. A cell count of more than 20.000 leukocyte/µl with more than 70% of polymorphonuclear cells is the generally accepted threshold for septic arthritis. CONCLUSION: The therapy is based on arthroscopic or open surgical debridement for synovectomy and irrigation of the joint, in combination with an adequate antibiotic therapy for 6-12 weeks. Removal of indwelling hardware, such as interference screws for ACL repair or anchors for rotator cuff repair, is recommended in chronic cases. LEVEL OF EVIDENCE: IV.


Assuntos
Artrite Infecciosa , Artroscopia , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/etiologia , Artrite Infecciosa/terapia , Desbridamento , Humanos , Sinovectomia , Irrigação Terapêutica , Resultado do Tratamento
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