Vol 35, No 1 (2018)

Cover Page
Articles
Metabolic aspects of acute stage ischemic stroke
Izhbuldina G.I., Novikova L.B., Timerbayeva D.A., Sharipova E.V., Murzabayeva R.V.

Abstract

Aim. To study the influence of hyperglycemia on the course of ischemic stroke in its acute period.

Materials and methods. 116 patients with primary ischemic stroke, associated with arterial hypertension, and with no diabetes mellitus in anamnesis were examined. Fasting blood glucose, glycolyzed hemoglobin, immunoreactive insulin and C-peptide levels were determined.

Results. Raised levels of glycemia to 5.31 ± 0.68 mmol/l, C-peptide to 0.90 ± 0.31 nmol/l and decreased level of insulin to 9.38 ± 4.34 mcIU/ml were detected. C-peptide to insulin ratio values were reliably higher in patients with severe course of stroke (by 35.6 %, p < 0.05) and unfavorable outcome of disease (by 39.6 %, p < 0.05).

Conclusions. Development of ischemic stroke is accompanied by high blood C-peptide levels against the background of normo-and-hypoinsulinemia, hyperglycemia. Manifestation of disorders is connected with severity and clinical outcome of this disease.

Perm Medical Journal. 2018;35(1):5-11
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Current view on pathogenetic approach in surgical treatment of patients with diabetic foot syndrome
Okroyan V.P., Ibragimov T.R., Galimov O.V., Khanov V.O.

Abstract

Aim. To improve the immediate and long-term results of diabetic foot syndrome treatment, using modern surgical techniques.

Materials and methods. The results of treatment of 264 patients were analyzed. For these patients with purulo-necrotic affection of extremities against the background of diabetes mellitus, complex treatment, including the techniques of extremity revascularization as well as modern hydrocolloid bandage materials, depending on the stage of wound process, was used; different variants of foot unloading at the clinical and ambulatory stages were offered. The method of treatment of purulo-necrotic wounds against the background of diabetes mellitus, based on differentiated use of ozonotherapy combined with application of biomaterials for closing ulcerous defects, was developed and introduced by the authors.

Results. The systemic approach and criteria for choosing surgical strategy of diabetic foot syndrome treatment were worked out and presented. The immediate and long-term results of using the introduced scheme of the management of patients were studied.

Conclusions. The developed complex approach is aimed at preservation of the foot and supporting function of the lower extremity; its clinical use permits to decrease the percent of amputations and lethality, improving patients’ quality of life indices.

Perm Medical Journal. 2018;35(1):12-20
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Problem of endometriosis diagnosis within the framework of systemic disease
Padrul M.M., Shirinkina E.V., Makhmudova S.E.

Abstract

Aim. To study the clinical cases of extragenital endometriosis, reveal the key moments of diagnosis and study the risk factors for the development of this disease.

Materials and methods. The study was carried out on the basis of gynecological hospitals of Perm in 2000-2015. Retrospective analysis of case histories of 22 patients with extragenital endometriosis of different localization was performed. Prospective analysis by means of questionnaire survey of 20 patients, operated for extragenital endometriosis, was used to assess the quality of life, working ability, prognosis regarding recovery.

Results. A mean age of the examined women was 35 ± 3.5 years. Genital endometriosis was diagnosed in 81.8 % of patients, burdened obstetric-gynecological anamnesis – in 86.3 %. The main patients’ complaints were the following: dysmenorrhea and hyperpolymenorrhea (90.9 %), sterility (77.3 %), pain syndrome, dysfunction and hemorrhagic discharges from the damaged organs, cyclically coinciding with menstrual cycle. All patients (100 %) underwent surgical treatment of different forms of extragenital endometriosis, and by the results of histological study of surgical material, stromal and epithelial endometrial cells were detected. Prospectively: prognosis regarding life and working ability was beneficial, as for recovery – doubtful in 55 % of cases, recurrences – 45 % both in previously damaged and other organs.

Conclusions. The presented clinical cases demonstrate that endometriosis is an interdisciplinary problem, which needs complex approach to diagnosis and management. Thoroughly collected anamnesis, including obstetric and gynecological as well as questioning, performed by other specialists is required. Patients with the revealed extragenital forms of endometriosis should be treated together with obstetricians and gynecologists.

Perm Medical Journal. 2018;35(1):21-26
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Study of multiple sclerosis pathogenesis as the basis of its target therapy
Baidina T.V., Kuklina E.M., Selyanina N.V., Trushnikova T.N., Sursyakova N.V., Danchenko I.Y., Arbuzova E.E.

Abstract

Aim. To study the antigen-presenting ability of B-cells, class IV semaphorin Sema4D (CD100) and CD72 receptor expression in the immune system of patients with multiple sclerosis (MS); to study the interaction between the KIF1B gene polymorphisms and the variants of response to preparation, changing the course of multiple sclerosis in MS patients.

Materials and methods. Patients with the established diagnosis of “Multiple sclerosis” by McDonald criteria 2010 with remitting type of the disease course were examined. Clinical method, psychometric testing, immune-enzyme analysis, immunologic method, PCR technique were used.

Results. Among patients with MS, the antigen-presenting function of B-lymphocytes was changed, semaphorin Sema4D/CD100 expression level on T-lymphocyte membrane was elevated, CD72 receptor expression on B-lymphocyte membrane was decreased. The studied phenomena are associated with a number of clinical characteristics that permits to consider them to participate in the pathogenesis of this disease.

Conclusions. Pathogenetic characteristics of multiple sclerosis are added by new data, which can be the targets for therapeutic strategies in the form of using anti-Sema4D- and anti-B-lymphocytic antibodies as immunomodulating therapy of MS.

Perm Medical Journal. 2018;35(1):27-32
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Arterial stiffness in young patients with chronic glomerulonephritis
Khachatryan A.V., Nekrutenko L.N., Vasilets L.M.

Abstract

Aim. To study the presence of the phenomenon of stiffness of the arterial vessels in young patients with chronic glomerulonephritis.

Materials and methods. The parameters of malleolar-brachial index (while chronic kidney disease (CKD) progression) were studied in 47 young patients with chronic glomerulonephritis and 24 comparable by age healthy volunteers.

Results. There was detected the elevation of malleolar-brachial index in young patients with chronic glomerulonephritis, when having stage 3-5 CKD.

Conclusions. Malleolar-brachial index, as an index of arterial stiffness, grows with CKD progression, that is a marker of early aging of vessels and cardiovascular remodeling in young patients with chronic glomerulonephritis.

Perm Medical Journal. 2018;35(1):33-37
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Significance of connective tissue dysplasia in duodenal arteriomesenterial compression origin
Repin M.V., Patlusova E.S.

Abstract

Aim. To study the morphological changes in the duodenum in case of its arteriomesenterial compression and estimate their interaction with connective tissue dysplasia.

Materials and methods. 70 patients (mean age 29.3 ± 2.6 years) with arteriomesenterial compression of the duodenum underwent morphological study of its wall and correlation analysis with histological changes in biopsy material of the skin.

Results. Significant correlation of morphological indices of stromal-glandular changes in the duodenal mucosa with the signs of destruction and reorganization of connective tissue in histological preparations of the skin were established.

Conclusions. Duodenal arteriomesenterial compression is a disease, conditioned by patient’s constitution. Its course is determined by peculiar features of connective tissue dysplasia. Morphological changes in duodenal wall confirm atrophy, the degree of manifestation of which corresponds to the stage of disease and is a reliable criterion for choosing rational therapeutic tactics.

Perm Medical Journal. 2018;35(1):38-46
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Hygienic characteristic of conditions for patients’ treatment at stomatological hospital of clinical multiprofile medical center after reconstruction
Koryukina I.P., Barannikov V.G., Kirichenko L.V., Ryazanova E.A., Mammayeva M.G., Pozdeyeva O.V.

Abstract

Aim. To fulfill the in-depth sanitary-and-hygienic assessment of the internal environment of stomatological hospital after its reconstruction.

Materials and methods. Sanitary-and-hygienic assessment was fulfilled by means of modern devices, subjected to metrological check. Microclimate (temperature, relative humidity, air speed, temperature of guarding surfaces), aeroionization regime (light negative and positive air ions), natural and artificial light, noise load and electromagnetic radiation value were determined. The study was carried out during cold (January-February) and warm (June) periods of the year.

Results. Hygienic characteristic of conditions for patients’ treatment at stomatological hospital showed the sanitary parameters to correspond to the existing standards.

Conclusions. The reconstruction of stomatological hospital carried out permitted to improve the environmental parameters, contributing to effective treatment of patients.

Perm Medical Journal. 2018;35(1):47-51
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Specific peculiar features of activity in medical personnel, rendering pediatric palliative care
Podluzhnaya M.Y., Voronova E.A., Rudakova E.A., Smirnova K.A., Podluzhnaya M.A.

Abstract

Aim. To study the medicosocial characteristic of children with incurable diseases, peculiar features of their treatment and nursing, to single out specific character of personnel training on pediatric palliative care.

Materials and methods. Medicosocial characteristic of children’s contingent with incurable diseases, included into the register of Perm Krai, was studied. The experience of work on pediatric palliative care over the period of 2014–2017 was summarized. Specific character of physicians’ and nurses’ training regarding their work in pediatric palliative service was singled out and described.

Conclusions. Rendering of palliative care to children and development of pediatric palliative service requires joint efforts and close collaboration among specialists of different profiles not only in practical activity, but when training personnel as well.

Perm Medical Journal. 2018;35(1):52-59
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Efficacy of using virtual reality in post-stroke upper limb paresis
Dolganov M.V., Karpova M.I.

Abstract

Aim. To estimate the efficacy of using training by means of virtual reality in restoration of the upper limb function in patients during the acute period of stroke.

Materials and methods. 48 patients in the acute period of stroke (average time from the onset of stroke 4.5 ± 1.3 days, mean age 67 (45; 72.1) years were randomized into 2 groups: the main group (standard therapy + virtual reality) and the control (standard therapy alone). Patients of the main group underwent a course of virtual reality training, lasting for 15 minutes, twice a day for 10 days. The functional status before the onset of training course and after it was evaluated using Fugl-Meyer Assessment Scores (FMA), Motor Assessment Scale (MAS), Ashworth Scale, Modified Barthel Index Score (MBI), Action Research Arm Test (ARAT), 9-Hole Peg Test, Rankin Scale, Function Independence Measure (FIM) and dynamometry.

Results. When assessing FMA of “upper limb” (p = 0.029), “wrist” (p = 0.04), “hand speed” (p = 0.02); MAS  (p = 0.042), 9-Hole Peg Test (p = 0.028), paretic hand dynamometry (p = 0.03) and FIM (p = 0.045), patients of the main group demonstrated statistically significant improvement versus the control group.

Conclusions. The results detected that inclusion of a short training course, using virtual reality, improves the upper limb function in patients during the acute period of stroke.

Perm Medical Journal. 2018;35(1):60-67
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Retrospective analysis of events of death at home among patients under follow-up observation
Sandakov Y.P.

Abstract

Aim. To study the peculiarities of asking for medical care by patients from among those dead at home, who had been under follow-up observation.

Materials and methods. The data, received from ambulatory medical records of 100 dead at home patients with follow-up, were analyzed using the methods of descriptive and inductive statistics.

Results. A mean age of death was 74.9 ± 13.4 years, men – 65.8 ± 14.1 years, women – 79.2 ± 10.9 years. Cardiovascular diseases were the cause of follow-up observation in 78 % of cases and the cause of death in 85 %; in 30 % of patients the disease was detected while carrying out prophylactic medical examination. A mean duration of disease by the moment of death was 13.0 ± 8.0 years, among pensioners 13.7 ± 8.5 years, in able-bodied  persons 9.6 ± 4.3 years. A mean duration of follow-up observation was 9.2 ± 5.8 years. An average number of planned visits was 2.8 ± 0.89, but the number of real visits during the last year of follow-up observation was 2.4 ± 1.2. Disability was registered in 77.6 % of patients, concomitant diseases – in all patients. For the last year, exacerbations were recorded in 92 % of patients, emergency calls – in 80 %, hospitalization events – 52 %, including 55.8 % – urgent ones.

Conclusions. The absence of significant difference regarding the duration of disease between pensioners and able-bodied patients (т = 0.16, р = 1.43) as well as the absence of correlation between the age and duration of disease (χ2 = 0.19, p = 0.2) indirectly prove the influence of duration of disease on its outcome, but not the age. Attendance, characterizing clinical loyalty to treatment, does not depend on age (χ2 = –0.19,  р = 0.18), sex (т = 1.0, р = 0.32), way of detecting disease (f = 0.9, p = 0.4), class of main disease (f = 0.91,  p = 0.44), duration of disease (χ2 = –0.13, р = 0.49), exacerbations (χ2 = –0.17, р = 0.24), concomitant diseases (χ2 = 0.006, р = 0.9). The number of emergency calls, hospitalizations, urgent hospitalizations does not depend on duration of follow-up observation, regularity and number of real visits to a doctor (p > 0.05) that indicates unsatisfactory quality of follow-up observation.

Perm Medical Journal. 2018;35(1):68-74
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Antiglaucoma work in Perm: problems and ways of decision
Soloviyeva L.I., Gavrilova T.V., Sobyanin N.A.

Abstract

Aim. To analyze the state of antiglaucoma work in Perm and determine the necessary organizational measures, permitting to improve early detection of glaucoma and quality of patients’ follow-up observation.

Materials and methods. Retrospective analysis of reports of ophthalmologists from 15 treatment-and-prophylactic institutions of Perm and statistical reports of Medicosocial Examination Bureau for 7 years (2010–2016) was carried out.

Results. Morbidity index in Perm during 2010–2016 does not reveal an evident dynamics and ranges 0.69 to 0.7 per 1000 of the adult population. Prevalence of glaucoma is 10.95–11.8 per 1000 of the adult population. The share of patients with first-diagnosed degree I–II glaucomas ranged from 81.1 % to 86.4 %.

Conclusions. The centralized system of rendering qualified medical care permits to develop and observe specialized standards of antiglaucoma activity, to introduce the recent scientific designs, to train medical staff for management of patients.

Perm Medical Journal. 2018;35(1):75-81
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Dynamics of life quality, anxiety and depression symptoms among patients with chronic insomnia in complex sanatorium-and-health resort treatment with inclusion of transcranial magnetotherapy
Goryaev A.G.

Abstract

Aim. To evaluate the dynamics of the quality of life, symptoms of anxiety and depression in patients with chronic insomnia against the background of complex sanatorium-and-health resort treatment with inclusion of transcranial magnetotherapy (TCMT).

Materials and methods. 63 patients (mean age 53.1 ± 1.4 years) with verified diagnosis of chronic insomnia were examined. The patients were divided into 2 randomized groups by means of randomized sampling technique: 33 patients  of the main group were administered a basic sanatorium complex including nitric-siliceous baths with low content of radon, massage of head and collar zone,  terrencure, cognitive-behavioral therapy, group psychotherapy, transcerebral magnetotheprapy; 30 patients of the comparison group had the same therapy, but no TCMT.

Results. When analyzing the initial data before treatment, high levels of subclinical and clinically manifested anxiety and depression were revealed in all patients with insomnia. When comparing subjective complaints before and after treatment within both groups, a reliable dynamics in anxiety and depression assessment was detected. In the main group with TCMT used, the results of treatment were significantly better, than in the comparison group. In the comparison group, positive reliable dynamics of the quality of life indices was also noted, but it was statistically less significant by all scales, than in the main group.

Conclusions. Transcranial magnetotherapy, included into complex of sanatorium-and-health resort treatment of chronic insomnia patients, permits to reduce subjective clinical symptoms of anxiety and depression and improve patients’ quality of life, mostly of psychological component of their health status.

Perm Medical Journal. 2018;35(1):82-87
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Study of influence of blood thiazoline ammonium 4-chlorophenyl-2-hydroxy-4-oxo-2-butenoate concentration on anticoagulant effect upon subcutaneous administration
Starkova A.V., Karpenko Y.N., Syropyatov B.Y., Sobin F.V., Pulina N.A.

Abstract

Aim. To study the effect of blood thiazoline ammonium 4-chlorophenyl-2-hydroxy-4-oxo-2-butenoate content on the manifestation of anticoagulant effect upon subcutaneous administration to rabbits.

Materials and methods. The studies were fulfilled on outbred rabbits. The substance was administered subcutaneously in the dose of 35 mg/kg. The time of blood coagulation was determined using coagulometer “Minilab 701”, and blood concentration – by means of liquid micro-column chromatograph “Milichrom A-02”.

Results. The obtained results prove that maximum concentration of the compound in blood and maximum anticoagulant effect is reached in 30 minutes after subcutaneous administration. The substance  anticoagulant effect lasted for 120 minutes after its administration.  At present, the compound concentration in blood is equal to 519.8 ± 145.41 ng/ml.

Conclusions. The studied compound, when administered subcutaneously, is quickly absorbed and begins to render an anticoagulant effect. Efficacy of action of this compound depends on its blood concentration.

Perm Medical Journal. 2018;35(1):88-94
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Quantitative determination of flavonoids in Lavatera Thuringiaca L., growing in Altai krai territory
Fedoseeva L.M., Myznikova O.A.

Abstract

Aim. To determine the quantitative content of flavonoids in Lavatera thuringiaca L., the grass, growing in Altai Krai.

Materials and methods. The object of the study: Lavatera thuringiaca L. grass, stored at different phases of vegetation in Altai Krai territory. Quantitative determination of flavonoids in the investigated raw material was fulfilled, using differential spectrophotometry method.

Results. Maximum accumulation of flavonoids in Lavatera thuringiaca L. grass was found to occur in the period of budding (1.14 %) and blossoming (1.02 %). The sum of flavonoids in terms of rutin, extracted with 70 % ethanol from raw material, stored in different regions, is changed insignificantly and makes 1.00–1.23 %.

Perm Medical Journal. 2018;35(1):95-101
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Assessment of biliostatic properties of modern topic hemostatic means used in hepatic surgery
Timoshenkova A.V., Kuzmin M.V., Katanov E.S.

Abstract

Aim. To assess the biliostatic properties of modern topic hemostatic means and the developed glue composition for medical purpose, used in hepatic surgery in experiment.

Materials and methods. The studies, aimed at assessment of the properties of local hemostatic means, were carried out on Wistar rats weighing 178 ± 10 g. The device for determination of leak proofness  of hepatic stump with hydropression technique was used. Comparative estimation of elasticity and adhesive strength of hemostatic means, using tension testing machine “REM-10”, was fulfilled. Original polyurethane glue for medical purposes was developed and studied.

Results. The glue compositions “Bioglue”, hemostatic sponge “Tachocomb” and original polyurethane composition for medical purposes with adhesive strength > 600 Pa (mm H2O) (p < 0.05) possess the best adhesive properties. It was established on the basis of experimental data that the glue composition “Bioglue” and polyurethane glue composition have a high adhesive strength, elasticity and resistance to hydropression.

Conclusions. 1. Glue compositions possess higher adhesion and endure higher level of pressure as compared with sponges and plates. Original polyurethane composition has maximum adhesive strength, elasticity and hydropression resistance. 2. After application of original polyurethane glue composition on resected liver (in experiment), it is completely lysed in 30–35 days.

Perm Medical Journal. 2018;35(1):102-107
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Atypical variant of rolandic epilepsy (clinical observation)
Vasilyeva E.S., Malov A.G., Karakulova Y.V.

Abstract

The clinical and neuropsychological analysis of atypical variant of rolandic epilepsy, usually benign, is presented in the paper. The patient was examined in dynamics from the age of 7 to the age of 11. The peculiar features of this observation were the following: frequent pharmacoresistant focal seisures, cognitive impairments in the form of disorders of attention, memory and manual dyspraxia, as well as protracted “rolandic” complexes on EEG.

Perm Medical Journal. 2018;35(1):108-112
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HYGIENIC CHARACTERISTICS OF THE CONDITIONS OF TREATMENT OF PATIENTS IN THE DENTAL HOSPITAL AFTER RECONSTRUCTION
Koryukina I., Barannikov V., Kirichenko L., Ryazanova E., Mammaeva M., Pozdeeva O.

Abstract

Aim. A thorough hygienic evaluation of environment dental hospital after its reconstruction.

Materials and methods. A sanitary-hygienic assessment of the internal environment of dental hospital after its reconstruction in cold and warm seasons of the year.

Results. Hygienic characteristics of the conditions of treatment of patients in the dental hospital has shown compliance with health parameters of the current regulations.

Conclusions. Reconstruction dental hospital has improved the internal environment that contributes to the effective treatment of patients.

Perm Medical Journal. 2018;35(1):
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Original studies
Evaluation of the biliostatic properties of modern topical hemostatic agents used in liver surgery
Timoshenkova A.V., Kuz"min M.V., Katanov E.S.

Abstract

Aim. To evaluate the biliostatic properties of modern topical hemostatic agents used in liver surgery in experiment.

Materials and methods. The analysis of applied topical hemostatics in medical institutions of Chuvash Republic with liver resection is performed. A number of studies on the evaluation of adhesion properties in Vistar rats weighing 180-200 g were carried out using a device for determining the hermeticity of the liver stump by hydroporation. A comparative evaluation of the elasticity and adhesion strength of hemostatic agents was carried out. The polyurethane glue for medical purposes was developed and studied in the experiment.

Results. To prevent bleeding and bile leakage, the most commonly used adhesive compositions are "Bioglue", "Tissucol", a gemostatic sponge, "Tachocomb", a gelatin sponge "Spongostan", a cellulose plate "Sergisel". The adhesive adhesives "Bioglue", "Tissucol" and the hemostatic sponge "Tachocomb" and the polyurethane composition of medical purpose with an adhesive strength of more than 600 mm of water column (mmW) at p <0.05 have the highest adhesion properties at p <0,05, based on the experimental. It has been established that a glue composition "Bioglue" and a polyurethane adhesive composition have a significant adhesive strength (more than 4.6 kgf / cm2) and elasticity (more than 140%).

Conclusions. For the reliable prevention of bile leakage after liver resection, it is necessary to use topical hemostatic agents with an adhesive strength of more than 600 mm. water column. More preferable in this case is the use of adhesive compositions; they have good elasticity, viscosity and form a large area of contact with the bile ducts as compared with the plates and sponges.

Perm Medical Journal. 2018;35(1):
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MEASURING OF FLAVONOIDS IN THE GARDEN LAVATERA THURINGIACA HERB FOUND ON THE TERRITORY OF ALTAI REGION
Fedoseyeva L., Myznikova O.

Abstract

Goal. Analysis of quantitative contents of flavonoids in the garden Lavatera thuringiaca herb found on the territory of Altai region.

Materials and methods. The research target is the garden Lavatera thuringiaca herb cut at different vegetative stages on the territory of Altai region. The quantity of flavonoids in the researched raw material has been measured by means of differential spectrophotometry.

Results. It is found that accumulation of the garden Lavatera thuringiaca herb flavonoids reaches its maximum in the bud-formation (1,14%) and flowering (1,02%) periods. The sum of flavonoids in equivalent to rutin changes in a minor way when being extracted by 70% ethanol and amounts from 1,00 to 1,23%.

Conclusion. The results of the research indicate feasibility of analyzing the garden Lavatera thuringiaca herb as a source of flavonoids.

Perm Medical Journal. 2018;35(1):
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