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المؤلفون: Habib Emami, Atefeh Abedini, Maryam Hassanzad, Ghazal Zoghi, Hoseinali Ghaffaripour, Arda Kiani, Niloufar Alizadeh, Ali Akbar Velayati, Saeed Hashemi
المصدر: BMC Pulmonary Medicine, Vol 21, Iss 1, Pp 1-10 (2021)
BMC Pulmonary Medicineمصطلحات موضوعية: Pulmonary and Respiratory Medicine, Male, medicine.medical_specialty, Adolescent, Pleural effusion, Atelectasis, Iran, Cystic fibrosis, Sensitivity and Specificity, Young Adult, Diseases of the respiratory system, Ultrasound, medicine, Humans, Pulmonary exacerbation, Child, Lung, Ultrasonography, Receiver operating characteristic, RC705-779, business.industry, Research, Gold standard (test), medicine.disease, Pleural Effusion, medicine.anatomical_structure, Cross-Sectional Studies, Female, Radiology, business, Body mass index
الوصف: Background High-resolution computed tomography (HRCT) is the gold standard for the evaluation of cystic fibrosis (CF) lung disease; however, lung ultrasound (LUS) is being increasingly used for the assessment of lung in these patients due to its lower cost, availability, and lack of irradiation. We aimed to determine the diagnostic performance of LUS for the evaluation of CF pulmonary exacerbation. Methods This cross-sectional study included patients with CF pulmonary exacerbation admitted to Masih Daneshvari Hospital, Tehran, Iran, from March 21, 2020 to March 20, 2021. Age, gender, and body mass index (BMI) of the patients were recorded. All patients underwent chest X-ray (CXR), HRCT, and LUS on admission. Pleural thickening, atelectasis, air bronchogram, B-line, and consolidation were noted in LUS and then compared with the corresponding findings in CXR and HRCT. Taking HRCT findings as reference, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (DA) of LUS and CXR for the detection of each pulmonary abnormality were determined. Results Of the 30 patients included in this study, with a mean age of 19.62 ± 5.53 years, 14 (46.7%) were male. Of the 15 patients aged 2–20 years, BMI was below the 5th percentile in 10 (66.7%), within the 5–10 percentiles in 1 (6.7%), 10–25 percentiles in 3 (20%), and 25-50 percentiles in 1 (6.7%). The mean BMI for 15 patients > 20 years was 18.03 ± 2.53 kg/m2. LUS had better diagnostic performance compared to CXR for the detection of air bronchogram, consolidation, and pleural thickening (area under the receiver operating characteristic curve [AUROC]: 0.966 vs. 0.483, 0.900 vs. 0.575, and 0.656 vs. 0.531, respectively). Also, LUS was 100% and 96.7% specific for the diagnosis of pleural effusion and atelectasis, respectively. Conclusions LUS appears to be superior to CXR and comparable with HRCT for the evaluation of CF pulmonary exacerbation, especially in terms of air bronchogram and consolidation detection. LUS can be used to lengthen the HRCT evaluation intervals in this regard or utilized along with HRCT for better evaluation of CF pulmonary exacerbation.
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المؤلفون: Paul-Christian Krueger, Martin Kraemer, Hans-Joachim Mentzel, Joachim Boettcher, Florian Streitparth, Juergen R. Reichenbach, Jochen G. Mainz, Karl-Heinz Herrmann, Martin Stenzel, Ulf K. Teichgraeber, Bernd Gruhn, Matthias Waginger, Karim Kentouche, D. Renz, Alexander Pfeil
المصدر: European Radiology. 32:1833-1842
مصطلحات موضوعية: Male, medicine.medical_specialty, Adolescent, Image quality, media_common.quotation_subject, Breath Holding, Imaging, Three-Dimensional, medicine, Humans, Contrast (vision), Radiology, Nuclear Medicine and imaging, Child, Lung, media_common, Neuroradiology, medicine.diagnostic_test, business.industry, Ultrasound, Magnetic resonance imaging, General Medicine, Gold standard (test), Magnetic Resonance Imaging, medicine.anatomical_structure, Child, Preschool, Female, Ultrashort echo time, Radiology, Tomography, X-Ray Computed, business
الوصف: Objectives To compare the diagnostic value of ultrashort echo time (UTE) magnetic resonance imaging (MRI) for the lung versus the gold standard computed tomography (CT) and two T1-weighted MRI sequences in children. Methods Twenty-three patients with proven oncologic disease (14 male, 9 female; mean age 9.0 + / − 5.4 years) received 35 low-dose CT and MRI examinations of the lung. The MRI protocol (1.5-T) included the following post-contrast sequences: two-dimensional (2D) incoherent gradient echo (GRE; acquisition with breath-hold), 3D volume interpolated GRE (breath-hold), and 3D high-resolution radial UTE sequences (performed during free-breathing). Images were evaluated by considering image quality as well as distinct diagnosis of pulmonary nodules and parenchymal areal opacities with consideration of sizes and characterisations. Results The UTE technique showed significantly higher overall image quality, better sharpness, and fewer artefacts than both other sequences. On CT, 110 pulmonary nodules with a mean diameter of 4.9 + / − 2.9 mm were detected. UTE imaging resulted in a significantly higher detection rate compared to both other sequences (p p Conclusion The UTE technique for lung MRI is favourable in children with generally high diagnostic performance compared to standard T1-weighted sequences as well as CT. Key Points • Due to the possible acquisition during free-breathing of the patients, the UTE MRI sequence for the lung is favourable in children. • The UTE technique reaches higher overall image quality, better sharpness, and lower artefacts, but not higher contrast compared to standard post-contrast T1-weighted sequences. • In comparison to the gold standard chest CT, the detection rate of small pulmonary nodules small nodules ≤ 4 mm and subtle parenchymal areal opacities is higher with the UTE imaging than standard T1-weighted sequences.
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المؤلفون: Yi Chen, Zhi-yi Zhang, Xiao-xia Chen, Jing-wei Zhao, Ting Liu, Gui-sheng Wang, Jin Liu, Xue-ting Qi
المصدر: Scientific Reports, Vol 11, Iss 1, Pp 1-9 (2021)
Scientific Reportsمصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Adolescent, Science, Tissue Adhesions, Article, Young Adult, Postoperative Complications, Abdomen, medicine, Artificial pneumoperitoneum, Postoperative results, Humans, Child, Gastrointestinal diseases, Aged, Abdominal adhesions, Multidisciplinary, medicine.diagnostic_test, business.industry, Gold standard (test), Middle Aged, Abdominal adhesion, body regions, medicine.anatomical_structure, Angiography, Medicine, Female, Radiology, Intestinal diseases, medicine.symptom, Tomography, X-Ray Computed, business, Pneumoperitoneum, Artificial, Subcutaneous emphysema
الوصف: To retrospectively analyze the use of artificial pneumoperitoneum in CT scans, to explore its operation methods and technical points, and to lay the foundation for the widespread application of artificial pneumoperitoneum in CT. A total of 331 patients who underwent artificial pneumoperitoneum with CT angiography from January 1, 2013, to November 1, 2019, were recruited. All patients underwent standardized artificial pneumoperitoneum in the horizontal, left and right lateral, and prone positions during CT thin-layer scans of the abdomen and 3D reconstruction. Taking the surgical results as the gold standard, and using kappa test to verify the consistency of surgical results and imaging results. In all 331 patients, 43 patients had a normal peritoneal space, and 288 patients had an abnormal peritoneal space. And only 22 patients developed complications of subcutaneous emphysema, accounting for 6.6% of all 331 patients. In terms of the postoperative results, 28 were normal, and 303 were abnormal. The sensitivity, specificity and accuracy of CT diagnosis of abdominal adhesions using artificial pneumoperitoneum were 100%, 95.04%, and 95.46%, respectively. According to the Kappa consistency test, the imaging diagnosis from the CT scan with artificial pneumoperitoneum had a high consistency with the surgical results (kappa = 0.796, P
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المؤلفون: Pierre Goussard, Andrea Zouvani, Susan Lucas, Savvas Andronikou
المصدر: Pediatric Pulmonology. 56:3657-3663
مصطلحات موضوعية: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Tuberculosis, Disease, Tuberculosis, Lymph Node, Lung injury, Parenchyma, medicine, Humans, Clinical significance, Child, Lung, business.industry, Gold standard, Mediastinum, Lung Injury, respiratory system, medicine.disease, respiratory tract diseases, medicine.anatomical_structure, Pediatrics, Perinatology and Child Health, Radiology, Tomography, X-Ray Computed, business, Airway
الوصف: Lymphobronchial tuberculosis (LBTB) is tuberculous lymphadenopathy affecting the airways, which is particularly common in children with primary TB. Airway compression by lymphadenopathy causes downstream parenchymal pathology, which may ultimately result in irreversible lung destruction, if not treated timeously. CT is considered the “gold standard” for detecting mediastinal lymph nodes in children with TB. CT is also the best way of imaging the airways of children with LBTB. The CT findings of the parenchymal complications and associations of LBTB on CT have been described, but no severity classification was provided to aid management decisions. Identifying the parenchymal complications of LBTB and recognising their severity has clinical relevance. Using prior publications on LBTB and post obstructive lung injury we have used an image bank of CT scans in children with pulmonary TB, presenting with airway symptoms, to create a CT severity staging of lung injury in LBTB. The staging focuses on distinguishing non-salvageable destruction [non-enhancing or cavitated lung] from salvageable lung parenchymal disease [enhancing and non-cavitated] to inform the management decisions, which range from bronchoscopic airway clearance to surgical decompression of the compressing nodes.
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المؤلفون: Ismihan Selen Onan, Pelin Ayyıldız, Erkut Öztürk, Cagdas Topel, Alper Güzeltaş, Ibrahim Cansaran Tanidir, Sertaç Haydin, Aysel Türkvatan, Hacer Kamalı
المصدر: Revista Portuguesa de Cardiologia, Vol 40, Iss 8, Pp 583-590 (2021)
Revista Portuguesa de Cardiologia (English Edition), Vol 40, Iss 8, Pp 583-590 (2021)مصطلحات موضوعية: Heart Defects, Congenital, medicine.medical_specialty, Heart disease, Computed Tomography Angiography, Diagnostic accuracy, Criança, law.invention, 03 medical and health sciences, 0302 clinical medicine, Angiotomografia computorizada, law, Multidetector computed tomography, Multidetector Computed Tomography, medicine, Humans, Diseases of the circulatory (Cardiovascular) system, Cardiopatia congénita, cardiovascular diseases, 030212 general & internal medicine, Child, Computed tomography angiography, General Environmental Science, medicine.diagnostic_test, business.industry, Echo (computing), Angiography, Gold standard (test), medicine.disease, Intensive care unit, Cardiac malformations, 030228 respiratory system, Echocardiography, RC666-701, General Earth and Planetary Sciences, Radiology, Cardiology and Cardiovascular Medicine, business, Ecocardiografia
الوصف: Introduction: Echocardiography (echo) is the primary non-invasive imaging modality for the assessment of congenital heart disease (CHD). Computed tomography angiography (CTA) also has potential to examine the anatomy of complex heart anomalies as well as extracardiac involvement. Objectives: The aim of this study is to determine the impact of new CTA technology in the diagnosis of CHD and to compare echo and CTA in terms of diagnostic accuracy. Methods: Forty-five patients who underwent preoperative echo and CTA assessment in the intensive care unit were included in this study. The results were assessed for three main types of CHD (cardiac malformations, cardiac-major vessel connections and major vessels). The main groups were also divided into subgroups according to surgical features in order to assess them more objectively. Imaging methods were compared for diagnostic accuracy, sensitivity and specificity, while surgical findings were accepted as the gold standard. Results: Patients’ median age and weight were two months (three days-eight years) and 12 kg (2.5-60 kg), respectively. In 45 operated cases, 205 subgroup malformations were assessed. Diagnostic accuracy was significantly greater in echo (echo vs. CTA: 98.4% and 96.2% [chi-square=6.4, p=0.011]). During surgery, 84 cardiac malformations (echo vs. CTA: 97.4% and 95.1% [chi-square=4.9, p=0.03]), 47 cardiac-major vessel connections (echo vs. CTA: 98.3% and 95.4% [chi-square=7.5, p=0.03]), and 74 major vessel malformations (echo vs. CTA: 96% and 98% [chi-square=1.8, p=0.48]) were confirmed. Conclusion: Echocardiography and CTA are imaging methods with high diagnostic accuracy in children with CHD. The use of echocardiography together with CTA, especially for the visualization of extracardiac anatomy, provides additional information for clinicians. Resumo: Introdução: A ecocardiografia é a principal modalidade de imagem não invasiva na avaliação das cardiopatias congénitas (CC). A angiotomografia computorizada (ATC) tem também potencial para examinar as anomalias morfológicas cardíacas complexas, assim como do envolvimento extracardíaco. Objetivos: Determinar o impacto de avanços tecnológicos da ATC no diagnóstico de CC e comparar a ecocardiografia e a ATC em termos de precisão diagnóstica. Métodos: Foram incluídos neste estudo 45 doentes submetidos a avaliação por ECO e por ATC pré operatória (n=45) em unidade de cuidados intensivos. Os resultados foram avaliados nos três principais tipos de grupos de CC (malformações cardíacas, conexões vasculares anómalas em nível cardíaco e malformações dos grandes vasos). Estes grupos foram também divididos em subgrupos de acordo com as características das cirurgias, de modo a serem avaliados mais objetivamente. Os métodos de imagem foram comparados para precisão diagnóstica, sensibilidade e especificidade, enquanto os resultados cirúrgicos foram aceites como gold standard. Resultados: A média da idade e do peso dos doentes foi de dois meses (3 dias-8 anos) e 12 kgt (2,5-60 kg), respetivamente. Em 45 casos operados, foram avaliadas 205 malformações de subgrupos. A precisão diagnóstica foi significativamente superior na ECO (ECO versus ATC; 98,4% & 96,2%, (X2=6,4, p=0,011). Durante as 84 intervenções, foram confirmadas 84 malformações cardíacas (ECO versus ATC; 97,4% & 95,1% (X2=4,9, p=0,03), 47 conexões vasculares anómalas em nível cardíaco (ECO versus ATC; 98,3 & 95,4% (X2=7,5, p=0,03), 74 malformações dos grandes vasos (ECHO versus ATC; 96% & 98% (X2=1,8, p=0,48). Conclusão: A ecocardiografia e a ATC são métodos de imagem com elevado rigor diagnóstico em crianças com CC. A utilização da ecocardiografia juntamente com a ATC, especialmente na avaliação da anatomia extracardíaca, fornece informação adicional para os clínicos.
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المؤلفون: Basma Al Kalaawy, Aya Mohamed Bassam Hashem
المصدر: J Ultrasound
مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Adolescent, Radiography, Physical examination, 030218 nuclear medicine & medical imaging, Arthritis, Rheumatoid, Lesion, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Internal Medicine, medicine, Humans, Outpatient clinic, Radiology, Nuclear Medicine and imaging, Medical history, 030212 general & internal medicine, Child, Ultrasonography, Review Paper, medicine.diagnostic_test, business.industry, Ultrasound, General Medicine, Gold standard (test), Middle Aged, Magnetic Resonance Imaging, Orthopedic surgery, Feasibility Studies, Female, Radiology, medicine.symptom, business
الوصف: PURPOSE: To evaluate the diagnostic performance of both ultrasonography and MRI findings in finger lesions. METHODS: This study was carried out on seventy symptomatic patients (53 females and 17 males). Their ages ranged from 6 to 64 years. All patients were referred to the diagnostic radiology department from various outpatient clinics of general, orthopedic, cosmetic surgeries and rheumatology. All patients were subjected to history taking, clinical examination, laboratory investigations for rheumatoid arthritis patients and radiological investigations. Whenever we had a surgical and pathological final diagnosis, it was considered the gold standard of the results. When only ultrasound and MRI were correlated, MRI was considered the gold standard. RESULTS: In our study, we found that ultrasonography is useful for evaluating a variety of lesions of the finger. Its widespread availability, relatively low cost, and high spatial resolution make it an excellent tool for investigating finger disorders. MR is the best imaging modality for lesion characterization. By systematically using clinical history, lesion location, findings on radiographs and MR imaging features, the radiologist can differentiate between determinate and indeterminate lesions. CONCLUSION: We concluded that ultrasonography and MRI are complementary to reach a correct diagnosis in different etiologies of finger lesions.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::8df8fe9358558ca1902b52d6fb601c19
https://doi.org/10.1007/s40477-021-00593-9 -
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المؤلفون: Ashraf M. Aly, Sunil K. Jain, Soham Dasgupta, Joan Richardson
المصدر: Journal of Perinatology
مصطلحات موضوعية: Cardiac Catheterization, medicine.medical_specialty, Hypertension, Pulmonary, medicine.medical_treatment, Review Article, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, mental disorders, medicine, Humans, 030212 general & internal medicine, Child, Bronchopulmonary Dysplasia, Cardiac catheterization, business.industry, Echo (computing), Infant, Newborn, Obstetrics and Gynecology, Paediatrics, Gold standard (test), medicine.disease, Pulmonary hypertension, Review article, Bronchopulmonary dysplasia, Echocardiography, Pediatrics, Perinatology and Child Health, Medical imaging, Radiology, business, Pediatric population
الوصف: Echocardiogram (echo) is a commonly used noninvasive modality for the diagnosis of bronchopulmonary dysplasia associated pulmonary hypertension (BPD-PH). Though not considered the gold standard for the diagnosis of BPD-PH, it is an extremely valuable tool in the neonatal and pediatric population, especially when cardiac catheterization is not feasible. In addition to the traditional echo parameters that are used to assess the presence of BPD-PH, much attention has been recently placed on newer bedside echo measures, the so-called functional echo parameters, to aid and assist in the diagnosis. This review article provides a brief introduction to BPD-PH, describes the pitfalls of traditional echo parameters and details the newer echo modalities currently available for the diagnosis of neonatal PH.
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المؤلفون: Daniela Pepino, Laura Petrarca, Ambra Nicolai, Elio Iovine, Fabio Midulla, Enrica Mancino, Domenico Paolo La Regina, Antonella Frassanito, Silvia Bloise, Raffaella Nenna, Greta Di Mattia, Marco Laudisa
المصدر: Pediatrics International. 63:448-453
مصطلحات موضوعية: medicine.medical_specialty, Concordance, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Community-acquired pneumonia, 030225 pediatrics, medicine, Humans, Child, Lung, Ultrasonography, business.industry, X-Rays, Ultrasound, Pneumonia, Gold standard (test), After discharge, medicine.disease, Lung ultrasound, chest x-ray, children, community-acquired pneumonia, lung disease, lung ultrasound, Community-Acquired Infections, medicine.anatomical_structure, Pediatrics, Perinatology and Child Health, Radiology, business
الوصف: BACKGROUND Community-acquired pneumonia (CAP) represents one of the most common infectious diseases among children. Diagnosis of CAP is mainly clinical. Chest X-ray (CXR) remains the gold standard for the diagnosis in severe or controversial conditions. Recently, some authors have focused on the application of ultrasound in lung diseases but the role of lung ultrasound (LUS) in the diagnosis of CAP is still debated. We aimed to study the concordance between LUS and CXR in evaluating specific signs of CAP. As a secondary aim, we sought to determine the sensitivity and specificity of LUS in CAP diagnosis compared with CXR. Finally, we evaluated the role of LUS during the follow up. METHODS We enrolled 68 children (
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المؤلفون: Gamal Niazi, Mohammad Abd Alkhalik Basha, Mohamed M. A. Zaitoun, Walid Feisal Ali Elsharkawi
المصدر: Academic Radiology. 28:68-76
مصطلحات موضوعية: Adult, Male, Osteoid osteoma, medicine.medical_specialty, Adolescent, Radiofrequency ablation, Visual analogue scale, Osteoma, Osteoid, Bone Neoplasms, Computed tomography, 030218 nuclear medicine & medical imaging, law.invention, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Quality of life, law, Humans, Medicine, Radiology, Nuclear Medicine and imaging, Prospective Studies, Major complication, Child, Vas score, Radiofrequency Ablation, medicine.diagnostic_test, business.industry, Gold standard, Middle Aged, medicine.disease, Treatment Outcome, 030220 oncology & carcinogenesis, Catheter Ablation, Quality of Life, Female, Radiology, Tomography, X-Ray Computed, business
الوصف: Rationale and Objectives Although computed tomography (CT) guided radiofrequency ablation (RFA) is accepted as the gold standard treatment for osteoid osteoma (OO) in extremities, most researchers have omitted OO in critical sites. We aimed to evaluate the efficacy and safety of CT-guided RFA in the management of OO in atypical sites. Materials and Methods A prospective interventional study conducted on 34 patients (12 women and 22 men; mean age, 22.3 ± 3.5 years; range, 12–48 years) with OO in atypical sites. All patients were treated with CT-guided RFA. All procedures were performed under general anesthesia using a single straight, rigid RF electrode for 6 minutes at 90°C. All patients were followed up; technical and clinical successes of treatment were evaluated. The severity of pain was assessed on a visual analogue scale (VAS). Results CT-guided RFA was performed in all patients with 100% technical success and 100% primary clinical success. All patients had complete pain relief and returned to their quality of life without further analgesics within 1 month after the procedure. All procedures were successfully completed without any major complications. The mean preprocedure VAS score dropped to zero by the end of the first week with a highly statistically significant difference (p Conclusion CT-guided RFA is a safe and effective procedure in the management of OO in atypical sites with 100% primary success rate, 0% long-term recurrence rate, and very low complication rate.
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المؤلفون: Haley C Neef, Shuemein J Mar, Alka Goyal, Jeremy Adler, Kelly C. Sandberg, George M. Zacur, Kelley Rose French, Shehzad Ahmed Saeed, Joseph A Picoraro, Sally J. Eder, Acham Gebremariam, Jeffery D. Lewis, J. Fernando Del Rosario, Andrew A.M. Singer, Joel R. Rosh, Christopher J. Moran, Jess L. Kaplan, Ila Moncion, Dawn R Ebach, Jonathan Moses, Lee M. Bass
المصدر: Inflammatory Bowel Diseases. 27:1585-1592
مصطلحات موضوعية: 0301 basic medicine, medicine.medical_specialty, Colon, Colonoscopy, Severity of Illness Index, 03 medical and health sciences, 0302 clinical medicine, Cohen's kappa, Crohn Disease, Humans, Immunology and Allergy, Medicine, Child, Reliability (statistics), Crohn's disease, medicine.diagnostic_test, business.industry, Gastroenterology, Reproducibility of Results, Intra-rater reliability, Gold standard (test), medicine.disease, Endoscopy, Clinical trial, 030104 developmental biology, 030211 gastroenterology & hepatology, Radiology, business
الوصف: Objectives Endoscopic mucosal improvement is the gold standard for assessing treatment efficacy in clinical trials of Crohn’s disease. Current endoscopic indices are not routinely used in clinical practice. The lack of endoscopic information in large clinical registries limits their use for research. A quick, easy, and accurate method is needed for assessing mucosal improvement for clinicians in real-world practice. We developed and tested a novel simplified endoscopic mucosal assessment for Crohn’s disease (SEMA-CD). Methods We developed a 5-point scale for ranking endoscopic severity of ileum and colon based on Simple Endoscopic Score for Crohn’s disease (SES-CD). Central readers were trained to perform SES-CD and SEMA-CD. Pediatric patients with Crohn’s disease undergoing colonoscopy were enrolled. Video recordings of colonoscopies were de-identified and randomly assigned to blinded central readers. The SES-CD and SEMA-CD were scored for each video. The SES-CD was considered the validated standard for comparison. Correlation was assessed with Spearman rho, inter- and intrarater reliability with kappa statistics. Results Fifty-seven colonoscopies were read a total of 212 times. Correlation between SEMA-CD and SES-CD was strong (rho = 0.98, P < 0.0001). Inter-rater reliability for SEMA-CD was 0.80, and intrarater reliability was 0.83. Central readers rated SEMA-CD as easier than SES-CD. Conclusion The SEMA-CD accurately and reproducibly correlates with the standard SES-CD. Central readers viewed SEMA-CD as easier than SES-CD. Use of SEMA-CD in practice should enable collecting mucosal improvement information in large populations of patients. This will improve the quality of research that can be conducted in clinical registries. External validation is needed.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::839c7603a13d4855d581d55051bf9314
https://doi.org/10.1093/ibd/izaa307
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