Vol 81, No 3 (2009)

Articles
Respiratory diseases and tobacco smoking
Chuchalin A.G., Chuchalin A.G.
Abstract
Terapevticheskii arkhiv. 2009;81(3):5-8
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Phenotypes of patients with chronic obstructive pulmonary disease
Aver'yanov A.V., Chuchalin A.G., Polivanova A.E., Polivanov G.E., Chernyak A.V., Neklyudova G.V., Naumenko Z.K., Averianov A.V., Chuchalin A.G., Polivanova A.E., Polivanov G.E., Chernyak A.V., Neklyudova G.V., Naumenko Z.K.
Abstract
Aim. To study characteristics of phenotypes of chronic obstructive pulmonary disease (COPD) basing on the findings of modern clinical, functional and roentgenomorphological tests in the course of the disease. Material and methods. Basing on the results of high performance computed tomography, 64 COPD patients aged 46-75 years (FEV1 51 ± 24%) were divided into two groups: 53 patients with emphysematous phenotype (group 1) and 11 patients with bronchytic phenotype (group 2). The groups were compared by constitutional, clinical, functional and roentgenological parameters. Results. Group 1 patients had significantly less body mass index, more severe edema by Borg's scale, low FEV1, FEV1/FLC, diffuse lung capacity and lung tissue density compared to group 2. Bronchoectases occurred more frequently in group 1 (33 and 9%, respectively). Conclusion. Heterogenous COPD phenotypes differ not only at the stage of chronic respiratory insufficiency but also at all stages of the disease.
Terapevticheskii arkhiv. 2009;81(3):9-14
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Hepatopulmonary syndrome characteristics in hepatic cirrhosis associated with COPD
Nevzorova V.A., Pestrikova T.L., Kochetkova E.A., Osval'd M., Dutrele S., Massard Z., Nevzorova V.A., Pestrikova T.L., Kochetkova E.A., Oswald M., Doutreleau S., Massard G.
Abstract
Aim. To evaluate specific features of hepatopulmonary syndrome (HPS) in patients with cirrhosis and cirrhosis associated with chronic obstructive pulmonary disease (COPD). Material and methods. We made a retrospective analysis of case histories of 75 patients with hepatic cirrhosis (HC) of different etiology. The patients were divided into two groups: 23 patients with HC and COPD (group 1); 52 patients with HC without COPD (group 2). The patients were examined with spirography, gasometry. Single-breath carbon monoxide diffusion capacity (Dlco), TCO and TCO/VA were estimated. Transthoracic contrast-enhanced echocardiography was conducted for detection of intrapulmonary bypass in AaDO2 > 15 mm Hg. Results. COPD stage I and II were diagnosed in 14 of 23 and 9 of 23 patients of group 1, respectively. TCO and TCO/VA had a trend to lowering in group 1 (p > 0.05). PaO2 was lower (p < 0.05) while AaDO2 was higher (p < 0.05) in group 1. Four patients of group 1 had intrapulmonary bypasses: of the first degree (2 patients with hypoxemia) and of the first and second degree (2 patients with normoxemia). In group 2 three patients had intrapulmonary bypasses: of the fourth degree in 1 patient with hypoxemia and of the first and second degree in 2 patients with normoxemia. Conclusion. HC patients with COPD had more severe hypoxemia. Mild and moderate HPS were registered in both groups. In COPD the risk of HPS is 3 times higher.
Terapevticheskii arkhiv. 2009;81(3):15-18
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Activity of systemic inflammatory reaction in patients with chronic obstructive pulmonary disease in regard to small intestinal absorption function
Beloborodova E.I., Akimova L.A., Burkovskaya V.A., Asanova A.V., Semenenko E.V., Beloborodova E.I., Akimova L.A., Burkovskaya V.A., Asanova A.V., Semenenko E.V.
Abstract
Aim. To study the effect of systemic inflammatory reaction in patients with chronic obstructive pulmonary disease (COPD) in association with absorption of the small intestine. Material and methods. Small intestinal absorption was studied in 93 COPD patients (22, 36 and 35 patients at stage I, II and III, respectively) in a clinically stable stage of the disease and in 35 healthy controls. The absorption was investigated biochemically and with application of radionuclide methods, blood concentration of TNFalpha was measured with enzyme immunoassay. Results. The small intestine of patients with moderate and severe COPD showed subnormal absorption of fats, protein, carbohydrates. With the disease progression, this disorder aggravated. The same trend was seen in relation to TNFalpha concentration. A strong direct correlation was found between a high concentration of TNFalpha and a low absorption of 131I-albumin and fatty acids, this high concentration correlated negatively with low absorption of d-xilose. Conclusion. Relationships between inflammation severity and small intestinal absorption of fats, protein, carbohydrates in patients with moderate and severe COPD means loss of essential nutrients, primarily protein and fats. This is important in understanding of pathobiological processes of development of extrapulmonary (intestinal) manifestations in COPD patients.
Terapevticheskii arkhiv. 2009;81(3):19-22
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Inferon clinicoimmunological efficacy in chronic obstructive pulmonary disease
Farkhutdinov U.R., Farkhutdinov S.U., Abdrakhmanova L.M., Farkhutdinov U.R., Farkhutdinov S.U., Abdrakhmanova L.M.
Abstract
Aim. To study efficacy of leukocytic interferon - inferon in combined treatment of patients with chronic obstructive pulmonary disease (COPD). Material and methods. The trial included 57 COPD patients (mean age 61.2 ± 1.04 years). Of them, 29 patients received standard treatment (antibiotics, broncholytics, mucolytics). Inferon was added to standard treatment of 28 patients. Results. Standard treatment alone was not highly effective in COPD patients as the symptoms often persisted and immune status was deficient. Adjuvant inferon activated immunity and raised efficacy of COPD therapy. Conclusion. Inferon enhanced immunity in COPD patients and improved treatment results.
Terapevticheskii arkhiv. 2009;81(3):23-27
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Effects of β1-adrenoblocker bisoprolol on endothelial dysfunction in patients with stable angina pectoris in combination with chronic obstructive pulmonary disease
Grigor'eva N.Y., Sharabrin E.G., Kuznetsov A.N., Mazalov K.V., Kontorshchikova K.N., Koroleva E.F., Grigorieva N.Y., Sharabrin E.G., Kuznetsov A.N., Mazalov K.V., Kontorschikova K.N., Koroleva E.F.
Abstract
Aim. To study effects of a cardioselective beta-adrenoblocker bisoprolol on vascular wall endothelium and external respiration function in stable angina of effort combined with chronic obstructive pulmonary disease (COPD). Material and methods. Endothelial function and external respiration were studied before and after 4-week treatment with bisoprolol in 36 patients with stable angina and COPD using assessment of endothelium-dependent vasodilatation (EDVD) and concentrations of nitric oxide metabolites. Results. Significant improvement of endothelial function was achieved due to bisoprolol 4-week treatment which did not affect external respiration function. Conclusion. Bisoprolol is effective and safe drug in the treatment of stable angina combined with COPD. It can noticeably improve endothelial function.
Terapevticheskii arkhiv. 2009;81(3):28-30
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Polymorphism -930A > G of the cytochrome b gene is a novel genetic marker of predisposition to bronchial asthma
Polonikov A.V., Ivanov V.P., Solodilova M.A., Kozhukhov M.A., Panfilov V.I., Bulgakova I.V., Polonikov A.V., Ivanov V.P., Solodilova M.A., Kozhukhov M.A., Panfilov V.I., Bulgakova I.V.
Abstract
Aim. To evaluate the link between promotional polymorphism -930A > G of the cytochrome b gene (CYBA) and onset of bronchial asthma; to examine effects of this locus on the risk of the disease development depending on the pro- and antioxidant action of environmental factors. Material and methods. We studied samples of DNA obtained from 214 healthy individuals and 215 patients with bronchial asthma treated in Regional Kursk Hospital. We used polymerase chain reaction and analysed polymorphism of restriction fragments lengths for genotyping of -930A > G polymorphism of CYBA gene. Results. Incidence of a variant allele -930G of CYBA gene among men with nonallergic bronchial asthma (nBA) was higher than in healthy men (OR 1.95; CI 1.02-3.73; p = 0.04). The homozygous variant genotype -930G/G was associated with a high risk of nBA in males (OR 2.66; CI 1.14-6.20; p = 0.02). In healthy individuals polymorphisms -930A > G and 640A > G were in negative linkage equilibrium (D = -0.057; p < 0.001) while in patients such associations were not registered. Male smokers with genotype -930G/G had the highest risk of nBA (OR 2.86; CI 1.06-7.77; p = 0.04) while non-smokers with this genotype had no risk of the disease (OR 1.50; CI 0.11-19.64; p = 0.70). Males with -930G/G on low or no vegetable diet had the highest risk of nBA (OR 3.11; CI 1.01-9.63; p = 0.04) while regular vegetable eaters had no risk to develop nBA (OR 0.73; CI 0.30-1.82; p = 0.50). Conclusion. We were the first to find relations between -930A > G polymorphism of CYBA gene and predisposition to nBA. This association exists in males and depends on the smoking status and vegetable diet.
Terapevticheskii arkhiv. 2009;81(3):31-35
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Efficacy of one combined inhalation drug in the treatment of patients with bronchial asthma depending on the disease duration
Ovcharenko S.I., Akulova M.N., Ovcharenko S.I., Akulova M.N.
Abstract
Aim. To assess an effect of long-term administration of one combined inhaled drug containing glucocorticosteroids (GCS) and long-acting beta2-agonists (LABA) on patient compliance. Material and methods. The trial included 47 patients (14 males and 33 females, mean age 48.8 ± 13.2 years) with bronchial asthma (BA) of different severity and duration (from 1 month to 42 years). The patients were divided into two groups by BA duration: 20 patients with newly diagnosed BA and 27 patients with a long history of BA. Cooperation was judged by the questionnaire Index of Cooperation in Bronchial Asthma. Control of BA for the last 4 weeks was determined according to Asthma Control Test. Results. Patients with BA of new onset have low mean rating of compliance. One combined inhaled drug improved compliance in both groups but the improvement was less in patients with new-onset BA. The ACT-test showed that the above inhaled improve control of BA. Conclusion. Therapy with one combined inhaled drug containing GCS and LABA is highly effective in patients with BA of different severity. This promotes higher compliance and, finally, produces better effect.
Terapevticheskii arkhiv. 2009;81(3):36-39
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Immunity and lymphocytic-thrombocytic adhesion in community-aquired pneumonia
Vitkovskiy Y.A., Golodnykh Y.V., Kuznik B.I., Likhanov I.D., Solpov A.V., Vitkovsky Y.A., Golodnykh Y.V., Kuznik B.I., Likhanov I.D., Solpov A.V.
Abstract
Aim. To investigate immunity and lymphocytic-thrombocytic adhesion in pneumonia patients. Material and methods. The examination of 59 male patients with pneumonia aged 18-21 years included calculation of total leucocyte count, lymphocyte subpopulations, relative and absolute count of lymphocytic-thrombocytic aggregates (LTA), measurement of IgA, IgM, IgG concentrations. Results. Pneumonia patients have high count of leukocytes and low count of total and relative count of lymphocytes, low number of main lymphocytic subpopulations (CD4+, CD8+, CD16+, CD22+). Patients with uncomplicated pneumonia demonstrated high ability of lymphocytes for forming coaggregates with platelets. Patients with severe pneumonia complications may have either very high count of LTA (mean 403 ± 45.6) or very low (mean 42.6 ± 8.1). Percent of lymphocytes able to adhere to platelets (CD4+ with CD16+) in pneumonia is low. No correlation was found between LTA and the level of IgA, IgG, IgG. Conclusion. LTA is an objective indicator of cellular immunity status in pneumonia patients.
Terapevticheskii arkhiv. 2009;81(3):40-42
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Total non-elastic pulmonary resistance and permeability of the alveolar capillary membrane in community-acquired pneumonia
Tetenev F.F., Ageeva T.S., Krivonogov N.G., Levchenko A.V., Kashuta A.Y., Tetenev K.F., Tetenev F.F., Ageeva T.S., Krivonogov N.G., Levchenko A.V., Kashuta A.Y., Tetenev K.F.
Abstract
Aim. To study alveolar capillary membrane permeability (ACMP) and total non-elastic pulmonary resistance (TNPR) in patients with community-acquired pneumonia (CAP) in an acute period. Material and methods. ACMP of the lungs was studied in 35 CAP patients with ventilation pulmonoscintigraphy. Integral and regional TNPR were registered at inhalation and expiration. Integral TNPR was estimated by simultaneous registration of transpulmonal pressure and spirogram, regional TNPR (in the upper, middle and lower zones of the lungs) - by simultaneous registration of zonal rheograms of ventilation and transpulmonal pressure. Bronchial resistance was measured by bodyplethismograph (Masterlab pro, Erich Jaeger, Germany). Results. In acute CAP integral TNPR rose while regional values varied. Both integral and regional ACMP for affected and intact lungs were significantly elevated showing systemic impairment of the structures of alveolar-capillary membrane of the lungs. More severe alterations of integral ACMP were seen in the affected lung, of regional - in the affected zones. Conclusion. Changes registered in regional TNPR and ACMP may indicate enhanced mechanical activity of the lungs in these zones. This enhanced activity contributes to TNPR overcoming.
Terapevticheskii arkhiv. 2009;81(3):43-46
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Estimation of plasmic concentration of the brain natriuretic peptide in interstitial pulmonary diseases with pulmonary hypertension: clinical role
Mukhin N.A., Fomin V.V., Popova E.N., Kuznetsova A.V., Popova I.A., Churganova L.Y., Osipenko V.I., Mukhin N.A., Fomin V.V., Popova E.N., Kuznetsova A.V., Popova I.A., Churganova L.Y., Osipenko V.I.
Abstract
Aim. To study a plasmic concentration of the brain natriuretic peptide (BNUP) in patients with interstitial pulmonary disease (IPD) as a possible diagnostic parameter in pulmonary hypertension (PH). Material and methods. Plasmic BNUP concentration, external respiration function were studied in 24 patients with IPD. The following tests were also made: 6-min walk, echocardiography (echo-CG) with estimation of systolic pressure in the pulmonary artery, multislice computed tomography of the chest with measurement of the mean diameter of the pulmonary artery trunk. Results. As shown by echo-CG and chest MSCT half of the IPD patients had PH. IPD patients with PH had a significant elevation of plasmic BNUP concentration which, in intact left ventricular contractile function indicates development of secondary PH characterized by reduction of volume parameters of the respiratory pulmonary function. The rise of BNUP concentration correlated with reduction of 6-min walk distance and functional lung capacity. Conclusion. Plasmic BNUP can be used for diagnosis of PH in IPD patients.
Terapevticheskii arkhiv. 2009;81(3):47-50
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Efficacy of ingavirin in influenza treatment in adults
Kolobukhina L.V., Merkulova L.N., Shchelkanov M.Y., Burtseva E.I., Isaeva E.I., Malyshev N.A., L'vov D.K., Kolobukhina L.V., Merkulova L.N., Schelkanov M.Y., Burtseva E.I., Isaeva E.I., Malyshev N.A., Lvov D.K.
Abstract
Aim. To compare therapeutic efficacy and safety of ingavirin and arbidol in patients with influenza. Material and methods. The trial included 105 patients with a verified diagnosis of influenza, definite clinical symptoms, body temperature at least 38°C and duration of the disease 36 hours maximum. Ingavirin efficacy was analysed basing on the evidence for 100 patients with uncomplicated influenza. The patients were randomized into three groups: taking ingavirin in a single daily dose 90 mg (n = 33), placebo (n = 36) or arbidol (200 mg 4 times a day). The duration of the treatment was 5 days. Results. Intake of ingavirin in initial 24-36 hours of the disease significantly reduced fever compared to placebo and arbidol (34.5, 72.0 and 48.4 hours, respectively). Ingaverin was less toxic and had no side effects. Conclusion. Ingaverin is safe and effective in the treatment of influenza. By some criteria it is more effective than arbidol.
Terapevticheskii arkhiv. 2009;81(3):51-53
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Arterial stiffness and risk factors of cardiovascular disease
Rebrov A.P., Nikitina N.M., Karoli N.A., Magdeeva N.A., Kharitonova I.A., Kondakova D.A., Rebrov A.P., Nikitina N.M., Karoli N.A., Magdeeva N.A., Kharitonova I.A., Kondakova D.A.
Abstract
Aim. To investigate arterial stiffness (AS) in healthy subjects and its correlation with standard cardiovascular risk factors (CRF). Material and methods. AS was estimated on Tensioclinic arteriograph (Tensiomed, Hungary) in 97 subjects (76 females and 21 males) having symptoms of neither atherosclerosis nor coronary heart disease (CHD). Detection of CRF was made by questionnaire survey. 10-year CHD risk and cardiovascular death risk (SCORE) were estimated. Results. With age, there was a rise of augmentation index (AI) (r = 0.76; p < 0.001) and pulse wave velocity (PWV) in the aorta (r = 0.61; p < 0.001), AI changes arose earlier than those of aortic PWV. Arterial hypertension is an independent factor of arterial stiffness deterioration. High blood cholesterol, AS, body mass index, smoking index directly correlate with AI and PWV in young subjects. CHD risk and SCORE rise with an AS increase (r = 0.30; p < 0.05 and r = 0.34; p < 0.05, respectively). Conclusion. Of CRF, most significant determinant of AS are arterial hypertension and age. AI is a more sensitive marker of AS in young subjects. Increased aortic PWV is more typical for persons over 50 years of age. The study of pulse wave characteristics with application of Tensioclinic arteriograph is a simple and significant method of detecting early changes in AS.
Terapevticheskii arkhiv. 2009;81(3):54-57
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Heart rate variability in patients with thyrotoxicosis before and after thyroid resection
Shpak L.V., Volkova Y.A., Shpak L.V., Volkova Y.A.
Abstract
Aim. To evaluate parameters of variation pulsometry, heart rate variability (HRV) before and after surgical treatment of patients with thyrotoxicosis. Material and methods. Enzyme immunoassay measured blood levels of TTH and free thyroxin (T4f), HRV was traced for 5 min with variation pulsometry, frequency and time course analysis in 124 patients (37 males, 87 females, age 20-74, mean age 50.4 ± 1.7 years) with manifest (n = 73) and complicated (n = 51) thyrotoxicosis in diffuse (n = 36) or multinodular (n = 88) toxic goiter before and 7 days after thyroid resection. Results. Aggrovation of thyroxinemia with progression of thyrotoxicosis was accompanied with sympathicotonia change for vagotonia showing depletion of adaptive mechanisms in a complicated form of the disease. The weaker was sympathicotony in manifest thyrotoxicosis and the stronger was parasympathetic tension in complicated thyrotoxicosis, the higher were SDNN, RMSSD, TF, HF and LF/HF. Early after surgery (thyroid resection) thyrotoxicosis relieved with attenuation of thyroxinemia, vegetative regulation rearranged for adaptation up to achievement of vagosympathetic balance. This was more frequent in a manifest (56.1%) than in a complicated form of the disease (41.1%). Conclusion. HRV provides an objective assessment of the effects of surgical treatment on the status of the autonomic nervous system.
Terapevticheskii arkhiv. 2009;81(3):58-61
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Immunomodulating, metabolic and cardioprotective effects of AT1-angiotensin receptors blocker losartan in patients with coronary heart disease and type 2 diabetes mellitus
Teplyakov A.T., Mayanskaya S.D., Bolotskaya L.A., Vdovina T.V., Stepacheva T.A., Kuznetsova A.V., Lukinov A.V., Derbeneva N.V., Frants M.V., Shilov S.N., Teplyakov A.T., Mayanskaya S.D., Bolotskaya L.A., Vdovina T.V., Stepacheva T.A., Kuznetsova A.V., Lukinov A.V., Derbeneva N.V., Frants M.V., Shilov S.N.
Abstract
Aim. To evaluate effects of 6-month therapy with losartan in combination with indapamide on a clinical course, immunological, metabolic parameters, left ventricular function, exercise tolerance and quality of life in patients with coronary heart disease (CHD) associated with metabolic syndrome (MS). Material and methods. Forty six CHD patients with postinfarction cardiac dysfunction in MS were randomized into two groups. Group 1 consisted of 22 patients with impaired glucose tolerance, group 2 - of 24 type 2 diabetics. Treatment included combination of losartan (50 mg/day) with indapamide (1.5 mg/day), on demand nitrates, nebivolol. Basic therapy in diabetes included sugar-reducing drugs. Clinical condition, findings of echocardiography, parameters of lipid and carbohydrate metabolisms, immunoglobulins, circulating immune complexes, autoantibodies to cardiolipin (AB to CL), spectrum of proinflammatory cytokines were studied before and 3 months after course treatment. Results. Overactivation of cytokines (primarily IL-2, IL-1, TNFalpha) with high expression of IgA, IgG, CIC, AB to CL was found in CHD patients with type 2 diabetes mellitus and less evident in impaired glucose tolerance. Losartan in both groups had an antihypertensive effect, stabilized LV hypertrophy, improved clinical symptoms leading to cytokines expression decline: TNFalpha by 9.8%, IL-1 - by 6.1%, IL-6 - by 6.7%. Losartan was well tolerated, caused no negative metabolic effects. Conclusion. New original facts of cytokine overactivation and humoral immunity disturbances were discovered which play an essential role in pathogenesis of postinfarction dysfunction and LV remodeling developing in type 2 diabetes mellitus. Losartan 6-month treatment in the fixed combination has a positive effect on clinicohemodynamic and immunometabolic indices. This gives grounds for wider use of losartan in CHD combined with type 2 diabetes mellitus.
Terapevticheskii arkhiv. 2009;81(3):61-68
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Thiotropium in bronchial asthma
Avdeev S.N., Avdeev S.N.
Abstract
Terapevticheskii arkhiv. 2009;81(3):69-74
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Bronchoectases: approach of the therapist and surgeon
Sinopal'nikov A.I., Shoykhet Y.N., Sinopalnikov A.I., Shoikhet Y.N.
Abstract
Terapevticheskii arkhiv. 2009;81(3):75-81
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Chronic obstructive pulmonary disease in smokers: An early stage
Antonov N.S., Sakharova G.M., Antonov N.S., Sakharova G.M.
Abstract
Terapevticheskii arkhiv. 2009;81(3):82-84
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Pathophysiological features of osteopenic syndrome before and after transplantation of the lungs
Kochetkova E.A., Gel'tser B.I., Massard Z., Nevzorova V.A., Maystrovskaya Y.V., Kochetkova E.A., Geltser B.I., Massard J., Nevzorova V.A., Maistrovskaya Y.V.
Abstract
Terapevticheskii arkhiv. 2009;81(3):85-88
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The role of respiratory infection in the onset and development of chronic obstructive pulmonary disease and bronchial asthma
Fedoseev G.V., Trofimov V.I., Rovkina E.I., Yakovleva V.K., Fedoseev G.V., Trofimov V.I., Rovkina E.I., Yakovleva V.K.
Abstract
Terapevticheskii arkhiv. 2009;81(3):89-93
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K 100-letiyu so dnya rozhdeniya akademika Dmitriya Fedorovicha Chebotareva
- -.
Abstract
Terapevticheskii arkhiv. 2009;81(3):94-96
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