Spinal kem immobilisation siv lub pob txha caj qaum: lub hom phiaj, kev qhia thiab kev txwv ntawm kev siv
Kev txwv kev txwv ntawm tus txha caj qaum siv lub rooj tsavxwm ntev ntev thiab lub ncauj tsev menyuam caj dab yog siv thaum muaj kev raug mob, thaum qee cov txheej txheem tau ua tiav, los pab txo qis kev raug mob ntawm tus txha caj qaum.
Indications rau kev siv ntawm tus hlwb kev txwv kev txav yog a GCS tsawg dua 15, pov thawj ntawm intoxication, rhiab los yog mob nyob rau hauv nruab nrab ntawm lub lub caj dab los yog rov qab, focal neurological cim thiab/los yog cov tsos mob, anatomical deformity ntawm tus txha nraub qaum, thiab cuam tshuam cov xwm txheej los yog raug mob.
Taw qhia rau tus txha caj qaum: thaum twg thiab vim li cas tus txha caj qaum xav tau
Kev raug mob blunt raug mob yog qhov ua rau mob txha caj qaum hauv Tebchaws Meskas thiab ntau lub tebchaws, nrog rau ib xyoos ib zaug muaj txog 54 tus neeg mob ib lab tus tib neeg thiab kwv yees li 3% ntawm tag nrho cov tsev kho mob nkag mus rau blunt trauma.[1]
Txawm hais tias kev raug mob txha caj qaum tsuas yog ib feem me me ntawm kev raug mob blunt trauma, lawv yog cov koom nrog ntau tshaj plaws rau kev mob thiab kev tuag.[2][3]
Yog li ntawd, xyoo 1971, American Academy of Orthopedic Surgeons tau thov kom siv cov kev kho mob. pojniam quav cab thiab ntev txha caj dab txhawm rau txwv tus txha caj qaum hauv cov neeg mob uas xav tias raug mob qaum qaum, tsuas yog nyob ntawm lub tshuab ntawm kev raug mob.
Thaum lub sij hawm, qhov no yog raws li kev pom zoo es tsis yog pov thawj.[4]
Nyob rau hauv lub xyoo caum txij li kev txwv kev txav ntawm tus txha caj qaum, siv lub ncauj tsev menyuam caj dab thiab lub caj dab ntev ntev tau dhau los ua tus qauv hauv kev kho mob ua ntej.
Nws tuaj yeem pom hauv ntau cov lus qhia, suav nrog Advanced Trauma Life Support (ATLS) thiab Prehospital Trauma Life Support (PHTLS) cov lus qhia.
Txawm hais tias lawv siv dav, qhov ua tau zoo ntawm cov kev coj ua no tau raug hu mus rau lo lus nug.
Nyob rau hauv ib txoj kev tshawb fawb thoob ntiaj teb sib piv cov neeg uas tau txais kev txwv txoj kev txha caj qaum rau cov neeg uas tsis ua, txoj kev tshawb fawb pom tau tias cov neeg uas tsis tau txais kev saib xyuas niaj hnub nrog kev txwv kev txha caj qaum muaj tsawg dua kev raug mob ntawm lub paj hlwb nrog kev tsis taus.
Txawm li cas los xij, nws yuav tsum raug sau tseg tias cov neeg mob no tsis sib haum rau qhov raug mob hnyav.[5]
Siv cov tub ntxhais hluas tuaj yeem pab dawb noj qab haus huv, lwm txoj kev tshawb fawb tau saib ntawm cov leeg txha nraub qaum ntawm lub nraub qaum ntev piv rau lub txaj txaj thiab pom tias lub rooj zaum ntev ntev tau tso cai rau cov lus tsa suab ntau dua.[6]
Xyoo 2019, kev tshawb nrhiav rov qab, kev soj ntsuam, ntau lub koom haum prehospital tshawb xyuas seb puas muaj kev hloov pauv ntawm tus txha caj qaum tom qab siv EMS raws tu qauv uas txwv kev ceev faj ntawm tus txha caj qaum tsuas yog cov uas muaj teeb meem tseem ceeb lossis kev kuaj pom tsis zoo thiab pom tias muaj tsis muaj qhov sib txawv ntawm qhov tshwm sim ntawm kev raug mob qaum qaum.[7]
ZOO TSHAJ PLAWS ZOO TSHAJ PLAWS? Mus ntsib SPENCER BOOTH ntawm EMERGENCY EXPO
Tam sim no tsis muaj kev tswj hwm qib siab randomized sim los txhawb lossis tsis lees paub kev siv cov kev txwv ntawm tus txha caj qaum
Nws tsis zoo li yuav muaj tus neeg mob tuaj yeem pab dawb rau txoj kev tshawb fawb uas tuaj yeem ua rau tuag tes tuag taw mus tas li ua txhaum txoj cai coj ncaj ncees tam sim no.
Raws li qhov tshwm sim ntawm cov kev tshawb fawb no thiab lwm cov kev tshawb fawb, cov lus qhia tshiab pom zoo kom txwv tsis pub siv cov leeg txha caj qaum ntev txwv rau cov neeg uas muaj kev cuam tshuam txog kev raug mob lossis cuam tshuam txog cov cim lossis cov tsos mob raws li tau piav qhia tom qab hauv kab lus no thiab txwv lub sijhawm uas tus neeg mob siv immobilized. .
Cov lus qhia rau kev siv lub pob txha caj qaum
Hauv Denis txoj kev xav, kev raug mob rau ob lossis ntau kab yog suav tias yog ib qho kev puas tsuaj tsis ruaj khov rau kev raug mob ntawm tus txha caj qaum uas nyob hauv tus txha caj qaum.
Qhov txiaj ntsig ntawm qhov kev txwv ntawm tus txha caj qaum yog tias los ntawm kev txo qis ntawm tus txha caj qaum, ib qho tuaj yeem txo qhov muaj peev xwm rau cov leeg txha caj qaum raug mob los ntawm cov pob txha tsis ruaj khov thaum lub sij hawm extrication, thauj, thiab ntsuam xyuas cov neeg mob raug mob.[9]
Cov lus qhia txog kev txwv txoj kev txha caj qaum yog nyob ntawm cov txheej txheem tsim los ntawm cov thawj coj saib xyuas kev kho mob xwm txheej ceev hauv zos thiab yuav txawv raws li.
Txawm li cas los xij, American College of Surgeons Committee on Trauma (ACS-COT), American College of Emergency Physicians (ACEP), thiab National Association of EMS Physicians (NAEMSP) tau tsim cov lus sib koom ua ke ntawm kev txwv kev txha caj qaum hauv cov neeg laus blunt trauma cov neeg mob. xyoo 2018 thiab tau teev cov lus qhia hauv qab no:[10]
- Hloov qib ntawm kev nco qab, cov cim qhia ntawm kev qaug cawv, GCS <15
- Midline spinal tenderness los yog mob
- Focal neurologic cov cim qhia lossis cov tsos mob xws li lub cev tsis muaj zog, loog loog
- Anatomy deformity ntawm tus txha caj qaum
- Kev cuam tshuam kev raug mob lossis xwm txheej (xws li, pob txha, kub hnyiab, kev xav nyuaj siab, language barrier, thiab lwm yam)
Tib daim ntawv tshaj tawm kuj tau pom zoo rau cov neeg mob blunt trauma cov neeg mob, sau tseg tias hnub nyoog thiab kev muaj peev xwm sib txuas lus yuav tsum tsis yog qhov tseem ceeb hauv kev txiav txim siab rau kev kho mob prehospital spinal.
Cov hauv qab no yog lawv cov lus pom zoo: [10]
- Kev tsis txaus siab ntawm caj dab mob
- Torticollis
- Neurological tsis txaus
- Kev hloov ntawm kev puas siab puas ntsws, suav nrog GCS <15, qaug zog, thiab lwm yam cim (kev ntxhov siab, apnea, hypopnea, somnolence, thiab lwm yam)
- Kev koom tes hauv kev sib tsoo lub tsheb uas muaj kev pheej hmoo siab, kev raug mob siab dhia dhia, lossis muaj kev raug mob ntawm lub cev ntau heev
Contraindications nyob rau hauv kev siv ntawm tus txha nqaj qaum
Ib tug txheeb ze contraindication nyob rau hauv cov neeg mob uas nkag mus rau lub taub hau, caj dab, los yog lub cev tsis muaj zog los yog kev tsis txaus siab.[11]
Raws li kev tshawb fawb luam tawm nyob rau hauv Eastern Association for the Surgery of Trauma (EAST) thiab Phau ntawv Journal of Trauma, cov neeg mob uas nkag mus rau qhov kev raug mob ntawm tus txha caj qaum yog ob zaug yuav tuag li cov neeg mob uas tsis tau.
Immobilizing tus neeg mob yog cov txheej txheem siv sijhawm, nyob nruab nrab ntawm 2 mus rau 5 feeb, uas tsis tsuas yog ncua kev thauj mus los rau kev saib xyuas meej tab sis kuj ncua lwm yam kev kho mob ua ntej vim qhov no yog ob tus neeg txheej txheem.[12][13]
LUB SIJ HAWM ROV QAB NTAWM LUB NTIAJ TEB? Mus ntsib EMS RADIO BOOTH ntawm Emergency EXPO
Cov cuab yeej tsim nyog rau txha caj qaum immobilisation: lub dab tshos, lub caj dab ntev thiab luv luv
cov cov khoom tsim nyog rau kev txwv kev txav ntawm tus txha caj qaum yuav tsum muaj lub pob txha caj qaum (txawm ntev lossis luv) thiab lub ncauj tsev menyuam caj dab.
Long Spine Boards
Cov nqaj qaum ntev tau pib siv, ua ke nrog lub ncauj tsev menyuam caj dab, txhawm rau txhawm rau txha nraub qaum raws li nws tau xav tias kev tuav tsis raug hauv lub tshav pob tuaj yeem ua rau lossis ua rau tus txha caj qaum raug mob.
Lub rooj tsavxwm ntev ntev kuj tseem pheej yig thiab ua haujlwm yooj yim rau kev thauj cov neeg mob uas tsis nco qab, txo qis kev txav mus los, thiab npog thaj av tsis sib xws.[14]
Short Spine Boards
Cov pob txha luv luv, tseem hu ua intermediate-stage extrication devices, feem ntau nqaim dua li lawv cov khoom siv ntev dua.
Lawv luv luv ntev tso cai rau lawv siv nyob rau hauv kaw los yog kaw, feem ntau nyob rau hauv lub tsheb sib tsoo.
Lub rooj tsavxwm luv luv txhawb nqa lub thoracic thiab lub ncauj tsev menyuam qaum kom txog thaum tus neeg mob tuaj yeem muab tso rau ntawm lub rooj tsavxwm ntev.
Ib hom ntawm luv luv spine board yog tus Kendrick Extrication Device, uas txawv los ntawm classic luv luv txha caj qaum board nyob rau hauv uas nws yog ib nrab-rigid thiab extends lateralally encompass lub flanks thiab lub taub hau.
Zoo ib yam li cov nqaj qaum ntev, cov no kuj tau siv nrog rau lub ncauj tsev menyuam dab tshos.
Cervical dab tshos: "C dab tshos"
Cervical dab tshos (los yog C dab tshos) tuaj yeem muab faib ua ob pawg dav: mos lossis tawv.
Hauv qhov chaw raug mob, lub ncauj tsev menyuam txhav txhav yog cov immobilizer ntawm kev xaiv vim lawv muab kev txwv lub ncauj tsev menyuam zoo dua.[15]
Cervical dab tshos feem ntau yog tsim los kom muaj ib qho khoom tom qab uas siv cov leeg trapezius ua cov qauv kev txhawb nqa thiab ib qho anterior piece uas txhawb nqa lub mandible thiab siv lub sternum thiab clavicles ua cov qauv kev txhawb nqa.
Cervical dab tshos los ntawm lawv tus kheej tsis muab lub ncauj tsev menyuam txaus immobilization thiab yuav tsum tau ntxiv lateral kev txhawb nqa cov qauv, feem ntau nyob rau hauv daim ntawv ntawm Velcro ua npuas ncauj pads pom nyob rau hauv cov nqaj qaum ntev.
KEV PAB CUAM THAWJ XEEB? Mus ntsib DMC DINAS Cov Kws Pab Tswv Yim Kho Mob Hauv Tsev Kho Mob EXPO
Txheej txheem
Ntau cov tswv yim muaj rau kev tso ib tug neeg nyob rau hauv qhov kev txwv ntawm tus txha caj qaum, ib qho ntawm feem ntau yog cov txheej txheem supine log-roll txheej txheem teev tseg hauv qab no thiab ua tiav, qhov zoo tshaj plaws, nrog 5-tus neeg pab pawg, tab sis tsawg kawg, ib pab pawg ntawm plaub.[16 ]
Rau ib pab neeg ntawm tsib
Ua ntej immobilization, kom tus neeg mob hla lawv txhais tes hla lawv lub hauv siab.
Tus thawj coj ntawm pab pawg yuav tsum raug xa mus rau lub taub hau ntawm tus neeg mob uas yuav ua kom muaj kev ruaj ntseg ntawm tus neeg mob los ntawm kev tuav tus neeg mob lub xub pwg nyom nrog lawv cov ntiv tes nyob rau sab nraub qaum ntawm lub trapezius thiab lawv tus ntiv tes xoo ntawm sab xub ntiag nrog lub forearms nias ruaj khov rau sab nraud ntawm tus neeg mob lub taub hau kom txwv kev txav mus los thiab ruaj khov ntawm lub ncauj tsev menyuam nqaj qaum.
Yog tias muaj, lub ncauj tsev menyuam yuav tsum muab tso rau lub sijhawm no yam tsis tau nqa tus neeg mob lub taub hau tawm hauv av. Yog tias tsis muaj, tswj qhov kev ruaj khov no thaum lub sij hawm log yob txheej txheem.
Pab neeg ob yuav tsum tau muab tso rau ntawm lub thorax, pab neeg peb ntawm lub duav, thiab pab neeg plaub ntawm ob txhais ceg nrog lawv txhais tes nyob rau sab deb ntawm tus neeg mob.
Pab neeg tsib yuav tsum npaj kom xaub lub rooj tsavxwm ntev ntev hauv qab tus neeg mob tom qab lawv dov.
Ntawm pab pawg neeg 1 cov lus txib (feem ntau yog suav ntawm peb), pab pawg 1 txog 4 yuav dov tus neeg mob, thaum lub sij hawm pab pawg neeg tsib yuav swb lub pob txha ntev hauv qab tus neeg mob.
Ib zaug ntxiv, ntawm pab pawg neeg ib qho lus txib, tus neeg mob yuav raug dov mus rau lub rooj tsavxwm ntev.
Muab tus neeg mob tso rau ntawm lub rooj tsavxwm thiab tuav lub cev nrog cov hlua ua raws li lub plab thiab sab ceg.
Ua kom lub taub hau ruaj ntseg los ntawm kev muab cov ntaub so ntswg dov rau ntawm ob sab los yog cov khoom lag luam muag thiab tom qab ntawd muab daim kab xev hla lub hauv pliaj thiab ruaj ntseg rau cov npoo ntawm cov nqaj qaum ntev.
Rau Pab Pawg Plaub
Ib zaug ntxiv, tus thawj coj pab pawg yuav tsum raug xa mus rau tus neeg mob lub taub hau thiab ua raws li cov txheej txheem uas tau teev tseg saum toj no.
Cov neeg koom tes ob yuav tsum tau muab tso rau ntawm lub thorax nrog ib txhais tes ntawm lub xub pwg nyom thiab lwm qhov ntawm lub duav deb.
Pab neeg peb yuav tsum tau muab tso rau ntawm ob txhais ceg, nrog ib txhais tes tso rau ntawm lub duav nyob deb thiab lwm qhov ntawm txhais ceg deb.
Nco ntsoov tias nws raug pom zoo kom cov caj npab ntawm cov neeg koom tes hla ib leeg ntawm lub duav.
Pab neeg plaub yuav swb lub rooj tsavxwm ntev ntev hauv qab tus neeg mob, thiab lwm yam txheej txheem yog ua raws li tau teev tseg saum toj no.
Cov teeb meem ntawm kev siv tus txha nqaj qaum hauv qhov txha caj qaum immobilisation
Kev raug mob hnyav
Ib qho teeb meem uas muaj feem cuam tshuam rau cov uas tau txais kev ncua ntev ntawm cov nqaj qaum thiab lub ncauj tsev menyuam txha caj qaum yog qhov mob siab, nrog rau qhov xwm txheej tau tshaj tawm txog li 30.6%.[17]
Raws li National Pressure Ulcer Advisory Panel, cov kab mob siab tau tam sim no tau muab faib ua kev raug mob siab.
Lawv tshwm sim los ntawm lub siab, feem ntau dhau ntawm cov pob txha prominences, rau lub sij hawm ntev uas ua rau muaj kev puas tsuaj rau ntawm daim tawv nqaij thiab cov nqaij mos.
Nyob rau theem pib, daim tawv nqaij tseem zoo lawm tab sis tej zaum yuav ua rau mob rau hauv cov theem tom qab.[18]
Lub sijhawm nws siv sijhawm los tsim kev raug mob siab sib txawv, tab sis tsawg kawg ib txoj kev tshawb fawb pom tau tias kev raug mob ntawm cov nqaij mos yuav pib tsawg li 30 feeb hauv cov neeg ua haujlwm noj qab haus huv.[19]
Lub caij no, lub sij hawm nruab nrab siv immobilized rau ntawm lub rooj tsavxwm ntev ntev yog nyob ib ncig ntawm 54 mus rau 77 feeb, kwv yees li 21 feeb ntawm cov uas tau txais hauv ED tom qab thauj.[20][21]
Nrog rau qhov no hauv siab, txhua tus kws kho mob yuav tsum sim txo qis lub sij hawm cov neeg mob siv immobilized txawm nyob rau hauv cov txha nraub qaum ntev los yog nrog lub ncauj tsev menyuam dab tshos vim ob qho tib si yuav ua rau raug mob siab.
Ua pa tsis haum
Ntau qhov kev tshawb fawb tau pom tias txo qis hauv kev ua pa ntawm txoj hlab ntsws vim cov hlua siv rau ntawm cov nqaj qaum ntev.
Hauv cov tub ntxhais hluas noj qab haus huv tuaj yeem pab dawb, kev siv cov hlua txha nraub qaum ntev dhau ntawm lub hauv siab ua rau txo qis ntawm ntau lub ntsws tsis muaj zog, suav nrog lub peev xwm tseem ceeb, yuam kom tas sij hawm, thiab yuam kev mid-kub ntws tawm ua rau muaj kev txwv.
Nyob rau hauv ib txoj kev tshawb no nrog cov me nyuam, muaj ib tug txo qhov yuam kev tseem ceeb muaj peev xwm mus rau 80% ntawm cov hauv paus ntsiab lus.[23] Hauv lwm txoj kev tshawb fawb, ob lub rooj tsav xwm nruj thiab lub tshuab nqus tsev tau pom tias txwv kev ua pa los ntawm qhov nruab nrab ntawm 17% hauv cov neeg tuaj yeem noj qab haus huv.[24]
Ua tib zoo saib xyuas yuav tsum tau them thaum cov neeg mob immobilization, tshwj xeeb tshaj yog rau cov neeg uas muaj kab mob ntsws ua ntej, nrog rau cov menyuam yaus thiab cov neeg laus.
mob
Feem ntau, cov ntaub ntawv muaj teeb meem zoo ntawm qhov ntev ntawm tus txha nqaj qaum board txwv tsis pub txav yog qhov mob, ua rau tsawg li 30 feeb.
Mob feem ntau tshwm sim nrog mob taub hau, mob nraub qaum, thiab mob mandible.[25]
Ib zaug ntxiv, thiab los ntawm tam sim no lub ntsiab lus rov tshwm sim, lub sij hawm siv rau ntawm lub rooj tsavxwm ntev ntev yuav tsum tau txo kom txo tau qhov mob.
Clinical tseem ceeb ntawm kev raug mob ntawm tus txha caj qaum: lub luag hauj lwm ntawm dab tshos thiab txha nraub qaum
Blunt force trauma tuaj yeem ua rau tus txha caj qaum raug mob thiab, yog li ntawd, tus txha caj qaum puas tuaj yeem ua rau mob hnyav thiab tuag taus.
Nyob rau xyoo 1960 thiab 1970s, kev txwv kev txav ntawm tus txha caj qaum tau ua haujlwm los txo lossis tiv thaiv kev mob hlwb uas xav tias yog qhov thib ob rau cov leeg txha caj qaum.
Txawm hais tias dav siv raws li tus qauv ntawm kev saib xyuas, cov ntaub ntawv tsis muaj qhov ua tau zoo, cov pov thawj-raws li kev tshawb fawb uas tshawb xyuas seb qhov kev txwv ntawm tus txha caj qaum puas muaj kev cuam tshuam rau cov txiaj ntsig neurological.[26]
Tsis tas li ntawd, nyob rau hauv xyoo tas los no tau muaj lub cev loj hlob ntawm cov pov thawj qhia txog qhov muaj feem cuam tshuam ntawm kev txwv kev txha caj qaum.[17][22][25][20]
Yog li ntawd, cov lus qhia tshiab tau pom zoo tias kev txwv kev txav ntawm tus txha caj qaum yuav raug siv txiav txim siab hauv cov neeg mob tshwj xeeb.[10]
Txawm hais tias qhov kev txwv ntawm tus txha caj qaum tuaj yeem muaj txiaj ntsig zoo hauv qee qhov xwm txheej, tus kws kho mob yuav tsum paub txog ob qho tib si cov lus qhia thiab cov teeb meem muaj feem cuam tshuam rau cov kws kho mob kom zoo dua los siv cov tswv yim no thiab txhim kho cov txiaj ntsig ntawm tus neeg mob.
Txhim kho cov txiaj ntsig ntawm Pab Pawg Saib Xyuas Kev Noj Qab Haus Huv
Cov neeg mob uas tau koom nrog hauv kev raug mob hnyav tuaj yeem tshwm sim nrog ntau yam tsos mob.
Nws yog ib qho tseem ceeb rau cov kws kho mob lub luag haujlwm rau qhov kev ntsuam xyuas thawj zaug ntawm cov neeg mob no kom paub txog cov kev qhia, contraindications, muaj teeb meem, thiab cov txheej txheem tsim nyog ntawm kev siv cov kev txwv kev txha caj qaum.
Muaj ntau cov lus qhia muaj peev xwm los pab txiav txim seb cov neeg mob twg ua tau raws li cov txheej txheem rau kev txwv txoj kev txha caj qaum.
Tej zaum cov lus qhia paub zoo tshaj plaws thiab tau txais txiaj ntsig zoo tshaj plaws yog cov lus qhia sib koom ua ke los ntawm American College of Surgeons Committee on Trauma (ACS-COT), National Association of EMS Physicians (NAEMSP), thiab American College of Emergency Physicians (ACEP). )[10] Txawm hais tias cov no yog cov lus qhia tam sim no thiab cov lus pom zoo, tsis muaj qhov zoo tshaj plaws randomized tswj kev sim mus rau hnub tim, nrog cov lus pom zoo raws li kev soj ntsuam kev tshawb fawb, cov pab pawg rov qab, thiab cov ntaub ntawv tshawb fawb.[26]
Ntxiv nrog rau kev paub txog cov lus qhia thiab contraindications rau kev txwv kev txav ntawm tus txha caj qaum, nws tseem ceeb heev rau cov kws kho mob kom paub txog cov teeb meem xws li mob, mob siab, thiab ua pa nyuaj.
Thaum siv qhov kev txwv ntawm tus txha caj qaum, txhua tus tswv cuab ntawm cov kws kho mob sib koom tes yuav tsum paub txog lawv cov txheej txheem nyiam thiab siv kev sib txuas lus zoo los ua kom tiav cov txheej txheem kom raug thiab txo qis cov leeg txha caj qaum. Cov kws saib xyuas kev noj qab haus huv tseem yuav tsum lees paub tias lub sijhawm siv sijhawm ntev ntawm tus txha nqaj qaum yuav tsum tau txo qis kom txo tau cov teeb meem.
Thaum hloov kev saib xyuas, pab pawg EMS yuav tsum sib txuas lus tag nrho cov sij hawm siv rau ntawm lub rooj tsavxwm ntev.
Siv cov lus qhia tseeb, paub txog cov teeb meem uas paub, txwv lub sijhawm siv rau ntawm lub rooj tsavxwm ntev ntev, thiab siv cov kev sib txuas lus zoo tshaj plaws rau cov neeg mob no tuaj yeem ua kom zoo dua. [Qib 3]
References:
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[2]Chen Y,Tang Y,Vogel LC,Devivo MJ, Ua rau mob txha caj qaum. Cov ntsiab lus hauv kev raug mob qaum qaum kev kho mob. 2013 Lub caij ntuj no; [PubMed PMID: 23678280]
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