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1.
目的 探讨基质金属蛋白酶-13(MMP-13)与乳腺癌临床病理特征的关系及其对乳腺癌总体生存率的影响.方法 选取包含生存资料的159点乳腺癌组织芯片MMP-13(126例病例),免疫组织化学方法测定组织芯片中MMP-13的表达.统计分析MMP-13在乳腺癌组织、癌组织与癌旁组织中的表达差异;MMP-13表达与乳腺癌肿瘤大小、组织学分级、TNM分期、淋巴结转移、ER表达、PR表达、HER2表达的相关性;高MMP-13表达组与低MMP-13表达组的乳腺癌总体生存率的差异.结果 MMP-13在乳腺癌组织(54.4%)中的表达明显高于癌旁组织(27.5%)(P=0.003);MMP-13表达与淋巴结转移(r=0.257,P=0.006)、临床TNM分期(r=0.310,P =0.001)、HER2表达(r=0.192,P=0.041)呈正相关,而与肿瘤大小(r=0.143,P=0.128)、肿瘤组织学分级(r=0.010,P=0.915)、ER/PR表达的相关性差异均无统计学意义.MMP-13高表达组乳腺癌病例总体生存率较低表达组明显降低.结论 MMP-13高表达是乳腺癌淋巴结转移的高危因素和独立的小良预后因素.  相似文献   

2.
乳腺癌ER|PR与HER-2|p53的表达及其相关性   总被引:1,自引:0,他引:1       下载免费PDF全文
目的探讨乳腺癌组织中ER,PR与HER-2,p53的表达及它们的相关性。方法对收治的368例乳腺癌患者ER,PR,HER-2及p53的表达及它们的相关性进行回顾性分析。结果淋巴结转移患者ER,PR阳性表达率低,HER-2及p53阳性表达率高,差异有统计学意义(P0.05);ER与PR表达呈显著正相关(r=0.644,P0.05),HER-2与p53表达呈低度正相关(r=0.197,P0.05);ER,PR与HER-2,p53表达呈负相关(r=-0.312,r=-0.511,r=-0.300,r=-0.464,P0.05)。结论 ER,PR与HER-2,p53的检测对乳腺癌预后评估有重要意义。  相似文献   

3.
乳腺癌组织中survivin,p53蛋白的表达与预后的关系   总被引:17,自引:6,他引:11       下载免费PDF全文
目的探讨乳腺癌组织中survivin基因和p53基因的表达与预后的关系。方法用免疫组化S P法检测80例乳腺癌组织中survivin、p53的表达,分析其与腋淋巴结转移和5年无病生存率之间的关系。结果survivin基因在乳腺癌中阳性表达率为68.75%(55/80)、p53基因阳性表达率为46.25%(37/80),均与腋淋巴结转移相关(P<0.05),与5年无病生存率相关(P<0.05)。survivin和p53表达与肿瘤病理类型、发病年龄、临床分期无明显相关性(P>0.05);survivin和p53基因表达相关(P=0.0025)。结论survivin和p53基因可能在乳腺癌的发生、发展过程中起重要作用,联合检测能更好地判断乳腺癌的预后。  相似文献   

4.
目的探讨雌激素受体α(ERα)、雌激素受体β(ERβ)、孕激素受体(PR)、人类表皮生长因子受体2(HER2)在乳腺癌组织中的表达及其与TNM分期和腋窝淋巴结状况的关系。方法随机选择我院在2004年12月至2007年12月收治的HER2高表达(+++)51例与无表达(-)53例乳腺浸润性导管癌病例,分别检测乳腺癌组织的ERα、ERβ、PR的表达水平,分析其与TNM分期、腋窝淋巴结转移等临床指标的相关性。结果104例乳腺癌患者,TNM分期为I期的占14.42%,Ⅱ期占62.50%,Ⅲ期占19.23%,Ⅳ期占3.85%;HER2阳性的淋巴结转移率为41.18%,HER2阴性的转移率为47.5%;ERα、ERβ、PR的阳性表达率分别为52.88%、63.46%、73.08%。ERβ与ERα、PR的表达呈正相关(P〈0.01),与HER2的表达负相关(P〈0.01);ERα与PR的表达正相关(P〈0.01),与HER2负相关(P〈0.01),PR与HER2的表达负相关(P〈0.05);ERα、ERβ、PR、HER2的表达与淋巴结转移情况及TNM分期无显著相关性。结论HER2作为乳腺癌预后不良的重要指标与作为乳腺癌预后良好的重要指标ERα、ERβ、PR的表达呈负相关,与TNM分期及腋窝淋巴结转移状态未显示明显相关性。  相似文献   

5.
目的探讨p16,p53,CDK4/cyclinD1在乳腺癌组织中的表达和与预后的关系。方法检测86例术前均未作放化疗的乳腺癌组织中p16,p53,CDK4,cyclinD1的表达,分析其与临床病理参数的关系。结果(1)p16,p53,CDK4在I,II级浸润性导管癌中p16,p53,CDK4的阳性表达存在差异,cyclinD1无差异;淋巴结阴性组与淋巴结阳性组中的阳性表达均存在差异;年龄≤50岁组和>50岁组阳性表达无差异;ER阴性和阳性组p53阳性表达存在差异,p16,CDK4,cyclinD1表达无差异;PR阴性和阳性组p53阳性表达存在差异,余无差异。(2)p16与p53表达、与CDK4表达、与cy clinD1表达相关(P均<0.01);CDK4与cyclinD1表达相关(P<0.05),p53和CDK4与cyclinD1不相关。(3)单因素分析提示,影响总生存率的因素有组织学分级,淋巴结转移,ER,PR,p16,p53,CDK4/cyclinD1的表达(P<0.05)。(4)多因素生存分析结果表明,p16和淋巴结转移是影响乳腺癌患者总生存率的独立预后因素(P<0.01))。结论p16,p53,CDK4/cyclinD1与乳腺癌的发生,发展密切相关,可作为判断肿瘤浸润转移,指导治疗和估计预后的参考指标,特别是p16蛋白的表达水平及淋巴结转移可能是判断乳腺癌术后生存的独立有效指标,而综合应用上述指标可能更有助于预后的判断。  相似文献   

6.
目的:研究乙醛脱氢酶1(aldehyde dehydrogenase,ALDH1)亚型ALDH1A1在乳腺癌组织中的表达及其与乳腺癌淋巴结转移和临床预后的关系。方法:采用免疫组化方法检测72例原发性乳腺癌组织中ALDH1A1的表达,分析其表达与乳腺癌病人淋巴结转移、肿瘤分化、TNM分期及病人总生存期等临床因素间的关系。结果:72例乳腺癌病人中,淋巴结转移组(n=37)ALDH1A1阳性表达21例,占56.8%;非淋巴结转移组(n=35)ALDH1A1阳性表达8例,占22.9%,两组具有统计学差异(P<0.01)。ALDH1A1在伴淋巴结转移乳腺癌病人的表达显著高于不伴淋巴结转移者(P0.05)。Kaplan-Meier生存分析表明,ALDH1A1高表达组病人的总生存期、无病生存期、5年生存率和5年无病生存率均显著低于ALDH1A1低表达组,两组具有统计学差异(P<0.05)。单因素及多因素统计分析显示,ALDH1A1表达、淋巴结转移和TNM分期是与乳腺癌预后相关的重要独立因素,ALDH1A1高表达组病人预后显著差于ALDH1A1低表达组(P<0.05)。结论:乳腺癌ALDH1A1表达与淋巴结转移及预后显著相关,可作为预测乳腺癌淋巴结转移以及判断病人临床预后的重要指标。  相似文献   

7.
目的探讨老年乳腺癌的临床病理和预后特点。方法收集2003年1月至2012年12月73例接受住院治疗Ⅰ~ⅢA期≥65岁乳腺癌患者的资料,分析临床病理特征、预后特点。结果73例患者中65~69岁有42例,≥70岁有31例。≥70岁患者伴有合并症的比率较65~69岁患者的高(72.4%vs 42.6%,P=0.009),≥70岁患者ER/PR阳性的比率较65~69岁患者的高(80.6%vs57.1%,P=0.045),≥70岁患者未接受辅助化疗的比率较65~69岁患者的高(58.1 vs 26.2%,P=0.045)。中位随访85个月,无病生存率为82.2%,总生存率86.3%。单因素分析发现乳腺癌的无病生存与肿瘤大小(P=0.020)、淋巴结转移(P=0.010)相关,总生存与HER2状态(P=0.001)相关;多因素分析发现老年乳腺癌的预后与年龄(P=0.644)、合并症(P=0.314)、肿瘤大小(P=0.363)、淋巴结状态(P=0.387)、ER/PR(P=0.250)、HER2(P=0.579)、手术方式(P=0.666)、辅助化疗(P=0.787)、放疗(P=0.107)、内分泌治疗(P=0.340)无明显关系。单因素分析和多因素分析均发现年龄、合并症、ER/PR、手术方式、辅助化疗、放疗、内分泌治疗均与DFS和OS无明显相关。结论随着年龄的增长,老年乳腺癌患者ER/PR阳性比率增加,伴有内科合并症多,应全面综合评估患者的耐受性和获益程度选择治疗方式。  相似文献   

8.
乳腺癌组织中c-erbB-2、p53和PCNA的表达及与预后因素的关系   总被引:3,自引:0,他引:3  
目的探讨生物学指标c-erbB-2、p53和增殖细胞核抗原(PCNA)在乳腺癌中的表达及与临床乳腺癌预后因素的关系。方法应用免疫组织化学方法对1180例乳腺癌组织切片c-erbB-2、p53、PcNA的表达进行检测。结果c-erbB-2表达与患者年龄(≥35岁)、临床期别、腋淋巴结状态、组织学分级呈负相关,与ER、PR受体呈正相关;p53蛋白的表达与患者的临床期别、组织学分级、病理类型呈负相关。与腋淋巴结状态呈正相关;PCNA的表达与患者的临床期别、腋淋巴结状况呈负相关,与ER、腿呈正相关。结论生物学指标c-erbB-2、p53、PCNA应与临床预后因素临床期别、组织学分级、腋淋巴结状态及病理类型等联合应用,有助于提高对乳腺癌预后评价的正确性。  相似文献   

9.
176例Ⅱ、Ⅲ期乳腺癌腋淋巴结转移临床病理相关因素分析   总被引:6,自引:0,他引:6  
目的探讨乳腺癌腋淋巴结转移的临床病理相关因素,为乳腺癌患者病情判断、选择合理手术方式及术后辅助治疗方案提供依据。方法回顾性分析经手术治疗的176例Ⅱ、Ⅲ期乳腺癌患者与腋淋巴结转移相关临床病理资料。结果影响Ⅱ、Ⅲ期乳腺癌腋淋巴结转移及转移数目的重要因素有乳腺癌的病理类型、分期、肿瘤大小、部位以及ER/PR和HER2表达状况。结论乳腺癌腋窝淋巴结转移受多种因素影响。  相似文献   

10.
探讨术前外周血中性粒细胞和淋巴细胞比值(NLR)、血小板和淋巴细胞比值(PLR)及系统性免疫性炎症指数(SII)与乳腺癌临床病理特征的关系。回顾性分析初次行手术治疗的乳腺癌患者的临床病理资料。术前NLR与乳腺癌患者TNM分期有关(P=0.033),与肿瘤大小、雌激素受体(ER)、孕激素受体(PR)、人类表皮生长因子受体-2(HER-2)、淋巴结转移和乳腺癌分子分型之间无相关性(P>0.05);术前PLR与乳腺癌患者TNM分期有关(P=0.042),与肿瘤大小、ER、PR、HER-2、淋巴结转移和乳腺癌分子分型无相关性(P>0.05);术前SII与乳腺癌患者TNM分期(P=0.021)和淋巴结转移(P=0.038)有关,与肿瘤大小、ER、PR、HER-2和乳腺癌分子分型无相关性(P>0.05)。术前外周血较高的NLR、PLR、SII值与乳腺癌TNM分期有关,提示可能与乳腺癌预后相关。  相似文献   

11.
Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI2) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI2), TXB2 (stabile metabolite of thromboxane A2) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI2 release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB2 (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI2 release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A2, presumably contributing to hemodynamic stability within 30 min after MT.  相似文献   

12.
Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.  相似文献   

13.
Don Dame 《Artificial organs》1996,20(5):613-617
Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.  相似文献   

14.
Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.  相似文献   

15.
Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H2O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg−1 followed by 0.15 mg · kg−1 · h−1, n=8) or verapamil (0.1 mg · kg−1 followed by 0.3 mg · kg−1 · h−1, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.  相似文献   

16.
Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.  相似文献   

17.
Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.  相似文献   

18.
Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.  相似文献   

19.
Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.  相似文献   

20.
Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg?1 · min?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min?1 · m?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO2I) and oxygen consumption index (VO2I) were also significantly increased in the dopexamine group (DO2I: from 416±91 to 717±110 ml/m2 · m2; VO2I: from 98±25 to 157±22 ml/m2 · m2), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.  相似文献   

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