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R Burgos

Publications and source records attributed to R Burgos.

At least 19 recordsLinked to original sources
PubMed2007

Effects of varying doses of supplemental conjugated linoleic acid on production and energetic variables during the transition period.

Supplementing a high dose of dietary conjugated linoleic acid (CLA) inhibits milk fat synthesis in dairy cows immediately postpartum. During negative net energy balance (EBAL), it appears that moderate CLA-induced milk fat depression causes a positive response in milk yield; however, as milk fat depression becomes more severe, the milk yield response diminishes. Multiparous Holstein cows (n = 31) were randomly assigned to 1 of 3 treatments beginning 9 +/- 6 d before expected calving and ceased at 40 d in milk (DIM): 1) 578 g/d of a rumen-inert (RI) palm fatty acid distillate (control), 2) 600 g/d of RI-CLA for the entire trial period (CLA-1), and 3) 600 g/d of RI-CLA until 10 DIM followed by 200 g/d for the remainder of the trial (CLA-2). Each dose provided equal amounts of fatty acids by replacing and balancing each treatment with a RI palm fatty acid distillate. Doses provided a total of 522 g of fatty acids/ d and 0, 174, or 58 (depending upon DIM) g of CLA (mixed isomers)/d. To improve palatability, doses were mixed with 600 g/d of dried molasses; one-half of the supplement was fed at 0800 h, and the remainder at 1900 h. Individual milk yield, dry matter intake, and body weight were recorded daily and milk composition determined every other day. There was no overall CLA effect on either the content or yield of milk protein or lactose. Both CLA treatments decreased overall milk fat content (26.0 and 18.3%) and yield (22.5 and 17.3%) with CLA-induced milk fat depression becoming significant by d 8. The CLA-induced milk fat depression increased in magnitude with progressing DIM until reaching a plateau on d 18 for CLA-1 (43%) and on d 14 for CLA-2 (33%), although neither milk fat trans-10, cis-12 CLA content (1.8 mg/g) nor its transfer efficiency (6.3%) changed over time. Treatments had no effect on overall dry matter intake or milk yield, but there was a treatment x time interaction for milk production, as cows fed either CLA treatment had increased milk yield after the second week of lactation. Cows fed either CLA treatment had a significant improvement in overall EBAL (-5.1 vs. -1.8 Mcal/d), a decrease in nonesterified fatty acid levels (12%), and an increase in glucose levels (11%). A dietary supplement containing trans-10, cis-12 CLA markedly improves EBAL and bioenergetic variables and increases milk yield in the total mixed ration-fed transitioning dairy cow.

Animals↗
PubMed2006

Durability of a cardiac valve leaflet made of calf pericardium: fatigue and energy consumption.

We studied the mechanical behavior of membranes of calf pericardium, similar to those employed in prosthetic valve leaflets, when subjected to tensile fatigue. The objective was to assess its durability, as a fundamental property of cardiac bioprosthesis, and analyze the energy consumption. For this purpose, the authors built a hydraulic simulator to subject a spherical valve leaflet made of calf pericardium to cyclic stress mimicking cardiac function. A total of 522 assays were performed in 40 samples, subjected to cyclic pressures greater than 6 atm, and 482 subjected to pressures ranging between 2 and 6 atm. The mathematical expression that establishes the relationship between the pressure exerted and the frequency was obtained. If we assume that the function is continuous, this equation provides the range of fatigue tolerated for a given number of cycles. Using the optimal values (the five highest values per series), the expression was found to be y = 9.95x(-0 1214) (R(2) = 0.955), where x represents the frequency in cycles per second and y the pressure in atmospheres. In addition, we established the mathematical relationship between the energy consumed and the frequency, which was a function of the pressure exerted, regardless of the region or zone from which the samples had been obtained. The methods of manual and morphology-based selection employed produced widely dispersed results. When a mechanical criterion was included, the similarity in the energy consumed during fatigue testing markedly improved the correlation, with a coefficient of determination between paired samples of R(2) = 0.7477. A mechanical criterion, such as energy consumption, can help to improve sample selection and produce more consistent results. Finally, we obtained the mathematical expression that relates the energy consumed to the pressure exerted and the number of cycles per second to which the valve leaflet was subjected. This procedure enables us to establish the limit to the energy that a biomaterial can consume over a period of time during which it is subjected to a working pressure and, thus, calculate more precisely its durability.

Animals↗
PubMed2005

Effect of increased milking frequency in early lactation with or without recombinant bovine somatotropin.

Multiparous Holstein cows (n = 300) were assigned to 1 of 2 milking frequency treatments at parturition. Cows were either milked 6 times (6x) or 3 times (3x) daily to determine effects on early lactation milk yields and subsequent lactation persistency with or without use of recombinant bST (rbST). Treatments included a control group milked 3x and 3 groups milked 6x for either the first 7, 14, or 21 days in milk (DIM). Those 4 groups of cows all received rbST starting at 63 DIM. The fifth treatment group was also milked 6x for the first 21 DIM but those cows received no rbST during the entire lactation. All cows returned to 3x milking after their respective treatment periods ended. Cows milked 3x tended to produce more milk (43.2 vs. 41.5 and 41.0 +/- 1.1 kg/d) during the first 9 wk of lactation compared with cows milked 6x for 7 or 21 DIM, respectively. Group milk yields after wk 9 averaged 38.3 +/- 0.7 kg/d and did not differ among various groups assigned to an increased milking frequency in early lactation. Percentages of milk fat (3.8 +/- 0.12%) and protein (2.9 +/- 0.06%) did not differ among treatments during the first 9 wk after calving. Early lactation milk yield (41.9 +/- 1.2 kg/d) did not differ between the 2 groups of cows milked 6x for 21 DIM. However, cows subsequently administered rbST (at 63 DIM) produced more milk (38.8 vs. 34.2 +/- 0.9 kg/d) from wk 10 to 44. The number of cows sent to the hospital during the 305-d trial for mastitis (97), digestive disorders (14), respiratory issues (9), lameness (22), or retained placenta (16), were not affected by treatments (chi(2) = 0.49). Under the conditions of this commercial dairy herd in Arizona, increasing milking frequency to 6 times daily for 7 to 21 d at the start of lactation conditions did not increase milk yield nor improve lactation persistency.

Animals↗
PubMed2004

Nutritional status among adult patients admitted to an university-affiliated hospital in Spain at the time of genoma.

BACKGROUND: Although malnutrition in hospitalized patients is generally associated with increasing morbidity and mortality, it is yet a widely unknown problem in hospitals. OBJECTIVES: The aim of this study was to assess the nutritional status of patients admitted to a university-affiliated hospital in Spain using anthropometry measurements and the Subjective Global Assessment (SGA) technique. METHODS: We enrolled 400 patients selected at random using a computer software program. The primary end-point was nutritional status determined within 48 h of admission by anthropometric data (body mass index, triceps skinfold thickness, and upper arm muscle circumference) and by the SGA technique. Using anthropometric data, patients were considered to have normonutrition or malnutrition. Those with malnutrition, were subdivided in patients with low (undernutrition) or high (overnutrition) body weight. Through SGA patients were classified as having normonutrition or malnutrition (moderate and severe). Secondary end-points were hospital length of stay (LOS), mortality, and readmissions (total and non-elective readmissions) over the next 6 months. Overall population, patients scheduled admitted, patients admitted from emergency room, and those with any cancer were individually analyzed. RESULTS: The frequency of malnutrition varied from 72.7% assessed by anthropometry (undernutrition in 26.7% and overnutrition in 46.0%), to 46% using SGA. Malnutrition was not related to the type of admission neither to the diagnosis of cancer. Of 400 patients analyzed, two patients died (0.5%). Using SGA, LOS was significantly higher in patients with malnutrition vs. those with normonutrition, in the overall population and in patients scheduled admitted, and there were more total and non-elective readmissions in patients with malnutrition than in patients with normonutrition in the overall population, in patients scheduled admitted and in those with cancer. When we used anthropometric data, LOS was superior in undernutrition compared to normo and overnutrition in scheduled admitted patients alone. Although there were more total readmissions in undernutrition than in normonutrition and overnutrition in overall population, no significant differences were observed with the non-elective readmission rate. CONCLUSIONS: A high prevalence of malnutrition was found in this study. At a time, a high prevalence of overnutrition was observed. Anthropometric data and SGA technique are not concordant, reflecting the limitations of markers of nutritional status. While with SGA malnutrition was detected in patients with normal to high BMI, with anthropometry overnutrition was diagnosed. SGA seems to be more accurate than anthropometry to anticipate hospital LOS and readmission rate. Due to the increased LOS and readmission rates found in patients with malnutrition, further steps among health care professionals are warranted to identify and control them.

Adolescent↗
PubMed2004

Micronutrient supplementation in mild Alzheimer disease patients.

OBJECTIVE: To evaluate if nutritional supplementation with or without micronutrient enhancement prevent weight loss and the progression of the disease in mild Alzheimer's Disease (AD) patients. DESIGN: Mild AD patients were recruited from an Alzheimer Day Centre. Subjects received oral liquid supplements with (Study-group: S) or without (Control-group: C) micronutrient enhancement. Intake assessment, nutritional status, biochemical parameters, cognitive function, and eating behaviour disorders were determined at baseline and at 6 months of treatment. RESULTS: At baseline both groups were not different in any variable measured. They were norm nourished, with normal biochemical parameters. Blandford scale demonstrated a mild alteration of feeding behaviour, the cognitive scale classified the patients as impaired and there was presence of memory complaints. After 6 months of nutritional supplements, a similar increase in energy consumption was observed in both groups of patients (P<0.05). In the within-group analysis, we found a trend (P=0.05) to increase body mass index; a significant increase in triceps skin fold thickness, mid-upper-arm circumference and serum magnesium, zinc and selenium, and a significant reduction in serum vitamin E (P<0.001, each). Serum cholesterol decreased substantially only in the S-group (P=0.025). No significant differences at baseline, within-group, neither between-group analysis in feeding behaviour nor in cognitive function were observed. CONCLUSIONS: According to our results no benefits in the progression of the disease was observed with micronutrient enhancement supplements. Effectiveness of nutritional supplements in preventing weight loss in mild AD patients showed a similar behaviour as observed in other populations. Due to the beneficial evolution of serum cholesterol in the S-group, this intervention deserves further investigation.

Aged↗
PubMed2003

High incidence of severe infections in heart transplant recipients receiving tacrolimus.

BACKGROUND: Tacrolimus (FK) is being increasingly used as an alternative to cyclosporine (CyA) in heart transplantation (HTx). It is believed to engender slightly more powerful protection against acute rejection. However, the increased immunosuppression could result in an excess of infectious complications. METHODS: Our study compared the incidence of major infections (MInf), defined as life-threatening infectious episodes requiring admission and intravenous (IV) antimicrobial therapy, among a series of HTx recipients treated with either FK (n=30) or CyA (n=84). RESULTS: A total of 21 patients received FK in an elective protocol and 9 patients initially treated with CyA were converted to FK. Tacrolimus was combined with azathioprine and prednisone in 21 cases, and with mycophenolate mofetil and steroids in 8 recipients. After a follow-up between 6 and 37 months, 11 patients (37%) in the FK group developed 13 episodes of MInf, most (85%) occurring during the first posttransplant year. Conversely, CyA patients (n=84), a group with similar characteristics and follow-up, showed a MInf incidence of 12% (P<.05). Among the FK group, the most common site of MInf was pulmonary (69%). A variety of opportunistic agents caused MInf in 54% of cases, whereas the remaining ones were attributed to nosocomial bacteria. There were three deaths (27% of all MInf), all in azathioprine-treated patients with initial FK therapy. CONCLUSIONS: Tacrolimus therapy seems to be associated with an increased incidence of severe infections in HTx recipients. We recommend aggressive diagnostic and therapeutic approaches for patients on FK who develop signs or symptoms of infection in the first year after HTx.

Aged↗
PubMed2003

The importance of clinical factors in parenteral nutrition-associated hypertriglyceridemia.

AIMS: The purpose of this study was to establish the relevance of several clinical factors associated with parenteral nutrition (PN) hypertriglyceridemia and to construct a predictive model for this complication. METHOD: This multicenter study included all patients with initial serum triglyceridemia <3 mmol and receiving a minimum of 7 days' PN therapy. The study ended for each patient when hypertriglyceridemia developed or PN was terminated. Two multivariate models were constructed, one to study the clinical factors and the second to predict plasma triglyceridemia. A total of 22 clinical factors studied as independent variables were included in the multiple-step regression models only when they showed a P-value over 0.1. Statistical significance was determined by the confidence interval of the odds ratio (OR) and the partial regression coefficient (b). RESULTS: The study included 260 patients from 14 hospitals. Lipid administration was 0.83+/-0.37 g/kg/day. Among the total, 68 patients (26.2%) showed hypertriglyceridemia. Variables included in both models were serum glucose (OR, 2.63; b, 0.06), renal failure (OR, 10.56; b, 1.70), corticoid administration >0.5 mg/kg (OR, 7.98; b, 0.97), pancreatitis (OR, 4.38; b, 0.64), sepsis (OR, 4.48; b, 0.24), lipids infused (OR, 3.03; b, 0.24) and heparin administration >3 mg/kg/day (OR, 0.11; b, -1.21). CONCLUSION: Although the rate of lipid infusion was low, certain clinical factors modified triglyceridemia. Nevertheless, relatively fast plasma clearance of lipids infused indicates that a reduction in lipid supply could be a quick, effective measure for controlling hypertriglyceridemia. Thus, careful monitoring of patients with clinical factors predicting risk in the model studied, with adjustment of lipid perfusion rates accordingly, is suggested to avoid hypertriglyceridemia.

Adult↗
PubMed2003

Male erectile dysfunction and health-related quality of life.

OBJECTIVE: The purpose of this work was to assess the health-related quality of life factors associated with erectile dysfunction (ED). METHODS: 2476 non-institutionalised Spanish males, age ranging from 25 to 70 years, were interviewed. ED was defined using two instruments: a simple self-assessment question (ED-sq) and the International Index of Erectile Function (IIEF). Health-related quality of life (HRQoL) was measured through the SF-36 questionnaire. RESULTS: The severity of ED (measured both through the ED-sq and with the IIEF) increased as the scores of the scales of the SF-36 decreased (Mantel-Hänszel chi(2)-test statistic range: [26-305]; p<0.001). The two summary components (physical and mental) showed a downward trend, more for the physical than for the mental component. CONCLUSION: We found a clear pattern of negative association between self-perceived erectile dysfunction and HRQoL. This association was clearer when ED-sq (rather than IIEF) was used, and stronger for the physical summary component than for the mental one.

Adult↗
PubMed2003

Left atrial thrombosis after heart transplantation.

Left atrial thrombosis in the absence of rheumatic heart disease and atrial fibrillation is a rare occurrence. We report two cases of left atrial pedunculated thrombus formation after orthotopic heart transplantation. Despite an uneventful post-operative course, sinus rhythm and normal contractility of the heart, large thrombi could be found several months following transplantation. Surgical thrombectomy was performed under cardiopulmonary bypass. Operative technique is proposed as one of the main factors that can contribute to left atrial thrombosis after heart transplantation.

Cardiomyopathy, Dilated↗
PubMed2002

Mechanical effects of increases in the load applied in uniaxial and biaxial tensile testing: Part I. Calf pericardium.

The authors analyzed the mechanical behavior of the calf pericardium employed in the construction of valve leaflets for cardiac bioprostheses. Forty samples of pericardium were subjected to uniaxial tensile testing, 20 as controls and 20 exposed to loads increasing stepwise until rupture, with a return to zero load between each new increment. Another 20 samples were used similarly in biaxial tensile tests involving loads increasing stepwise until rupture, again returning to zero load between steps. The ultimate stresses in the uniaxial study were very similar and were not influenced by the region of pericardial tissue being tested or the increments in load to which the tissue was exposed. The mean stresses at rupture in the stepwise biaxial assays were significantly greater (p<0.01). Using morphological and mechanical criteria for sample selection, it was possible to obtain mathematical fits for the stress/strain relationship in both types of assays, with excellent coefficients of determination (R (2)>0.90). In uniaxial tests in which the selection criteria were not applied, the correlation improved as the load increased, a phenomenon that did not occur in the biaxial studies. The values varied throughout the different cycles, adopting exponential forms when the strain was greatest. These variations, which demonstrate that the increase in the energy consumed is a function of the stress applied and of the strain produced, should be good parameters for assessing the changes in the collagen fiber architecture of pericardial tissue subjected to cyclic stress, and may help to detect early failure.

Journal Article↗
PubMed2002

Mechanical effects of increases in the load applied in uniaxial and biaxial tensile testing. Part II. Porcine pericardium.

The mechanical behavior of porcine pericardium was analyzed to compare it with that of calf pericardium employed in valve leaflets for cardiac bioprostheses. Forty samples of pericardium were subjected to uniaxial tensile testing, 20 as controls and 20 exposed to loads increasing stepwise from 0.5 to 1.5 kg and to 3 kg, and thereafter to rupture, with a return to zero load between each new increment. Another 20 samples were used in biaxial tensile tests involving the application of loads increasing stepwise (to 0.5, 1.5, 3 and 5 kg) until rupture with a zero-load interval before each increment. The ultimate stresses were very similar, showing no statistically significant differences when compared in terms of type of assay, controls and study samples or region of pericardial tissue being tested. In the stepwise biaxial assays, the mean stresses at rupture were also very homogeneous. Using morphological and mechanical criteria for sample selection, it was possible to obtain mathematical fits for the stress/strain relationship, with excellent coefficients of determination. The relationship between the area under the stress/strain curve and the load applied or the strain observed was also studied in the biaxial assay as an equivalent to the cycles of hysteresis produced in the test. The increment in the area under the curve (the energy consumed) may be a good parameter for assessing the changes in the collagen fiber architecture of the pericardial tissue, changes that may help to detect early failure.

Journal Article↗
PubMed2001

Vitreous levels of vascular cell adhesion molecule and vascular endothelial growth factor in patients with proliferative diabetic retinopathy: a case-control study.

OBJECTIVE: To evaluate the intravitreous concentration of vascular cell adhesion molecule (VCAM)-1 in diabetic patients with proliferative diabetic retinopathy (PDR) and the relationship of VCAM-1 with vascular endothelial growth factor (VEGF). RESEARCH DESIGN AND METHODS: Serum and vitreous fluid samples were obtained simultaneously at the onset of vitrectomy from 20 diabetic patients with PDR and 20 nondiabetic control subjects with nonproliferative ocular disease. Both groups were matched by serum levels of VCGM-1 and VEGF. VCAM-1 and VEGF were determined by enzyme-linked immunosorbent assay. Statistics were determined using the Mann-Whitney U test and Spearman's rank correlation test. RESULTS: The intravitreous concentration of VCAM-1 was signifcantly elevated in diabetic patients with PDR compared with control subjects (26 ng/ml [19-118] vs. 22 ng/ml [20-47], P < 0.05). A direct correlation between VCAM-1 and total vitreous proteins was detected in diabetic patients (r = 0.64, P = 0.003), but not in control subjects. After adjusting for total intravitreous proteins, VCAM-1 was significantly lower in diabetic patients with PDR than in control subjects (8.2 ng/ml [4-31.4] vs. 43.1 ng/ml [9.7-100], P < 0.001). Intravitreous VEGF concentrations were higher in patients with PDR than in control subjects in absolute terms (1.34 ng/ml [0.16-6.22] vs. 0.009 ng/ml [0.009-0.044], P < 0.0001) and after correcting for total vitreal proteins (0.33 ng/ml [0.01-2.3] vs. 0.013 ng/ml [0.003-0.035], P = 0.0001). Finally, the vitreous ratio of VCAM-1 to proteins correlated with the vitreous ratio of VEGF to proteins in both diabetic patients (r = 0.74, P = 0.001) and control subjects (r = 0.84, P = 0.005). CONCLUSIONS: The low proportion of VCAM-1 in relation to total vitreal proteins observed in diabetic patients with PDR suggests that VCAM-1 is quenched by diabetic retina. In addition, the direct correlation detected between VCAM-1 and VEGF suggests that cellular adhesion and neovascularization may be linked processes.

Case-Control Studies↗
PubMed2000

[Infections related to parenteral nutrition catheter].

Infectious complications related to total parenteral nutrition (TPN) catheters were prospectively evaluated during a four-month period in a third level teaching hospital in which a protocol on parenteral nutrition is implemented. The study included 102 catheters inserted for a total of 1,448 days (mean 12.06 day/catheter). Local pain, redness, and fever were recorded among 1.9%, 9.8% and 10.7% of cases, respectively. In no case were the defined criteria for catheter related sepsis fulfilled. Catheter tips were cultured in 72.5% of the studied catheters. Tip colonization was observed in 4.1% of cultured tips whereas infection was detected in 8% of them according to microbiological criteria. During the same time period in the hospital, 15 episodes of catheter bacteremia among 6,874 inpatients were observed which were not related to parenteral nutrition, which represents 0.22% of inpatients. The conclusion of our study is that adhering to a parenteral nutrition protocol, with special emphasis in catheter and connection management involves a very low incidence of infectious complications related to parenteral nutrition.

Bacterial Infections↗
PubMed2000

Hepatocyte growth factor in vitreous and serum from patients with proliferative diabetic retinopathy.

BACKGROUND: Hepatocyte growth factor (HGF) is an endothelium specific growth factor that has been implicated in angiogenesis, a crucial event for the development of proliferative diabetic retinopathy (PDR). The aim of the study is to determine the intravitreous concentrations of HGF in diabetic patients with PDR, and to investigate whether its serum levels could contribute to its intravitreous concentration. METHODS: 17 diabetic patients and seven non-diabetic patients in whom a vitrectomy was performed were studied. Both groups were matched by serum levels of HGF. Venous blood and vitreous samples were collected simultaneously at the time of vitreoretinal surgery. Vitreous and serum HGF were determined by ELISA. RESULTS: Intravitreous concentrations of HGF (median and range) were higher in diabetic patients (17.04 ng/ml (9.98-80)) in comparison with non-diabetic patients (5.88 ng/ml (2.57-14.20); p=0. 003). Intravitreous HGF concentrations were strikingly higher than serum HGF concentrations both in diabetic patients (17.04 ng/ml (9. 98-80) v 0.66 ng/ml (0.26-1.26); p<0.001) and in the control group (5.88 ng/ml (2.57-14.20) v 0.68 ng/ml (0.49-0.96); p=0.003). No correlation was found between serum and vitreous levels of HGF in both groups (diabetic patients, r= -0.31; p=0.5 and control subjects r= -0.15; p=0.5). CONCLUSION: The high vitreous levels of HGF observed in diabetic patients with PDR cannot be attributed to serum diffusion across the blood-retinal barrier. Therefore, intraocular synthesis appears to be the main contributing factor for the high vitreous HGF concentrations in diabetic patients, a cytokine that seems to be directly involved in the pathogenesis of PDR.

Aged↗
PubMed2000

Vitreous levels of IGF-I, IGF binding protein 1, and IGF binding protein 3 in proliferative diabetic retinopathy: a case-control study.

OBJECTIVE: To evaluate vitreous levels of IGF-I and its binding proteins IGFBP-1 and IGFBP-3 in patients with proliferative diabetic retinopathy (PDR). Because intravitreal proteins are elevated in patients with PDR due to the disruption of the blood-retinal barrier, we have corrected vitreal IGF-I and IGFBPs by total vitreal proteins to avoid this confounding factor. RESEARCH DESIGN AND METHODS: We compared 21 diabetic patients with proliferative retinopathy (group A) and 13 nondiabetic patients (group B) in whom a vitrectomy was performed. Both groups were matched by age, serum IGF-I, IGFBP-1, and IGFBP-3 levels. Serum and vitreous levels of IGF-I, IGFBP-1, and IGFBP-3 were measured by immunological methods. Vitreal proteins were assessed by turbidimetric method. RESULTS: Vitreal levels of IGF-I were elevated in group A (median 1.35 ng/ml [range 0.3-8.7]) in comparison with group B (median 0.25 ng/ml [range 0-1.38]), P<0.001. After adjusting by vitreal proteins [ratio IGF-I (ng/ml)/protein (mg/ml)], the differences remain significant (P<0.005). Vitreal levels of IGFBP-1 and IGFBP-3 were also elevated in diabetic patients (IGFBP-1: group A, median 1.6 ng/ml [range 0.6-20.7]; group B, median 0.4 ng/ml [range 0.3-1.9], P<0.001. IGFBP-3: group A, median 102.6 ng/ml [range 53.9-350.8]; group B, median 29.0 ng/ml [range 3.2-87.8], P<0.001). However, when the ratio IGFBP/protein was considered, the differences were not significant. CONCLUSIONS: Intraocular synthesis contributes to elevated vitreous concentrations of IGF-I found in PDR. By contrast, unspecific increase of intravitreal proteins is the main factor explaining the elevated vitreous levels of IGFBP-1 and IGFBP-3 found in diabetic patients.

Case-Control Studies↗