Spandidos Publications Logo
  • About
    • About Spandidos
    • Aims and Scopes
    • Abstracting and Indexing
    • Editorial Policies
    • Reprints and Permissions
    • Job Opportunities
    • Terms and Conditions
    • Contact
  • Journals
    • All Journals
    • Oncology Letters
      • Oncology Letters
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Oncology
      • International Journal of Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular and Clinical Oncology
      • Molecular and Clinical Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Experimental and Therapeutic Medicine
      • Experimental and Therapeutic Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Molecular Medicine
      • International Journal of Molecular Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Biomedical Reports
      • Biomedical Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Oncology Reports
      • Oncology Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular Medicine Reports
      • Molecular Medicine Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • World Academy of Sciences Journal
      • World Academy of Sciences Journal
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Functional Nutrition
      • International Journal of Functional Nutrition
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Epigenetics
      • International Journal of Epigenetics
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Medicine International
      • Medicine International
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
  • Articles
  • Information
    • Information for Authors
    • Information for Reviewers
    • Information for Librarians
    • Information for Advertisers
    • Conferences
  • Language Editing
Spandidos Publications Logo
  • About
    • About Spandidos
    • Aims and Scopes
    • Abstracting and Indexing
    • Editorial Policies
    • Reprints and Permissions
    • Job Opportunities
    • Terms and Conditions
    • Contact
  • Journals
    • All Journals
    • Biomedical Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Experimental and Therapeutic Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Epigenetics
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Functional Nutrition
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Molecular Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Medicine International
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular and Clinical Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular Medicine Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Oncology Letters
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Oncology Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • World Academy of Sciences Journal
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
  • Articles
  • Information
    • For Authors
    • For Reviewers
    • For Librarians
    • For Advertisers
    • Conferences
  • Language Editing
Login Register Submit
  • This site uses cookies
  • You can change your cookie settings at any time by following the instructions in our Cookie Policy. To find out more, you may read our Privacy Policy.

    I agree
Search articles by DOI, keyword, author or affiliation
Search
Advanced Search
presentation
Experimental and Therapeutic Medicine
Join Editorial Board Propose a Special Issue
Print ISSN: 1792-0981 Online ISSN: 1792-1015
Journal Cover
March-2020 Volume 19 Issue 3

Full Size Image

Sign up for eToc alerts
Recommend to Library

Journals

International Journal of Molecular Medicine

International Journal of Molecular Medicine

International Journal of Molecular Medicine is an international journal devoted to molecular mechanisms of human disease.

International Journal of Oncology

International Journal of Oncology

International Journal of Oncology is an international journal devoted to oncology research and cancer treatment.

Molecular Medicine Reports

Molecular Medicine Reports

Covers molecular medicine topics such as pharmacology, pathology, genetics, neuroscience, infectious diseases, molecular cardiology, and molecular surgery.

Oncology Reports

Oncology Reports

Oncology Reports is an international journal devoted to fundamental and applied research in Oncology.

Experimental and Therapeutic Medicine

Experimental and Therapeutic Medicine

Experimental and Therapeutic Medicine is an international journal devoted to laboratory and clinical medicine.

Oncology Letters

Oncology Letters

Oncology Letters is an international journal devoted to Experimental and Clinical Oncology.

Biomedical Reports

Biomedical Reports

Explores a wide range of biological and medical fields, including pharmacology, genetics, microbiology, neuroscience, and molecular cardiology.

Molecular and Clinical Oncology

Molecular and Clinical Oncology

International journal addressing all aspects of oncology research, from tumorigenesis and oncogenes to chemotherapy and metastasis.

World Academy of Sciences Journal

World Academy of Sciences Journal

Multidisciplinary open-access journal spanning biochemistry, genetics, neuroscience, environmental health, and synthetic biology.

International Journal of Functional Nutrition

International Journal of Functional Nutrition

Open-access journal combining biochemistry, pharmacology, immunology, and genetics to advance health through functional nutrition.

International Journal of Epigenetics

International Journal of Epigenetics

Publishes open-access research on using epigenetics to advance understanding and treatment of human disease.

Medicine International

Medicine International

An International Open Access Journal Devoted to General Medicine.

Journal Cover
March-2020 Volume 19 Issue 3

Full Size Image

Sign up for eToc alerts
Recommend to Library

  • Article
  • Citations
    • Cite This Article
    • Download Citation
    • Create Citation Alert
    • Remove Citation Alert
    • Cited By
  • Similar Articles
    • Related Articles (in Spandidos Publications)
    • Similar Articles (Google Scholar)
    • Similar Articles (PubMed)
  • Download PDF
  • Download XML
  • View XML
Article Open Access

Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section

  • Authors:
    • Yichen Yang
    • Chengjun Song
    • Chengwei Song
    • Chengwen Li
  • View Affiliations / Copyright

    Affiliations: Department of Anesthesiology, Zoucheng People's Hospital, Zoucheng, Shandong 273500, P.R. China, Department of Anesthesiology, Jining No. 1 People's Hospital, Jining Medical University, Jining, Shandong 272011, P.R. China, Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, P.R. China
    Copyright: © Yang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Pages: 1747-1754
    |
    Published online on: January 7, 2020
       https://doi.org/10.3892/etm.2020.8429
  • Expand metrics +
Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )
Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )
Cited By (CrossRef): 0 citations Loading Articles...

This article is mentioned in:



Abstract

The aim of the present study was to evaluate the effectiveness and safety of the combination of epidural dexmedetomidine and morphine in providing anesthesia during cesarean surgery and analgesia for post‑cesarean pain relief when added to epidural ropivacaine. A total of 80 females at term scheduled for elective cesarean delivery were randomly assigned to two groups (n=40/group): In the morphine group (group M), patients received an epidural injection of 0.75% ropivacaine (12 ml) and morphine (2 mg) for surgical anesthesia, and epidural infusion of morphine (2 mg) in 100 ml 0.2% ropivacaine at 2 ml/h for 48‑h post‑operative analgesia; and in the morphine combined with dexmedetomidine group (group DM), patients received an epidural injection of 0.75% ropivacaine (12 ml) and morphine (2 mg) combined with dexmedetomidine (0.5 µg/kg) for surgical anesthesia, and epidural infusion of morphine (2 mg) and dexmedetomidine (200 µg) in 100 ml 0.2% ropivacaine at 2 ml/h for 48‑h post‑operative analgesia. The primary outcomes included blockade and analgesic effects, sedation and adverse reactions associated with the drugs. Neonatal outcome was also assessed by determining the Apgar score and umbilical cord blood analysis. There was no significant difference between the groups in the cephalad levels of sensory blockade at 20 min post‑injection, or in muscle relaxation scores or pain intensity scores at rest or upon movement at 4, 12, 24 or 48 h post‑injection (P>0.05). The maternal patients in the DM group experienced more complete motor blockade at 20 min post‑injection, better sedation during surgery and following delivery, and less visceral pain caused by peritoneal traction during surgery and by uterine contraction after delivery, compared with those in group M (P<0.05). The patients in group M had a lower incidence and severity score of post‑operative nausea than those in the DM group (P<0.05). There was no significant difference between the groups in terms of Apgar score or umbilical cord blood gas values (P>0.05). In conclusion, epidural dexmedetomidine reduces intra‑operative and post‑operative visceral pain and produces better sedation during surgery and following delivery, without any significant influence on morphine‑associated side effects and post‑operative analgesia, in females undergoing elective cesarean section under epidural anesthesia with morphine and ropivacaine (registration number ChiCTR1900027942; retrospectively registered with the Chinese Clinical Registry Center on December 6, 2019).
View Figures
View References

1 

Yousef AA, Salem HA and Moustafa MZ: Effect of mini-dose epidural dexmedetomidine in elective cesarean section using combined spinal-epidural anesthesia: A randomized double-blinded controlled study. J Anesth. 29:708–714. 2015. View Article : Google Scholar : PubMed/NCBI

2 

Hanoura SE, Hassanin R and Singh R: Intraoperative conditions and quality of postoperative analgesia after adding dexmedetomidine to epidural bupivacaine and fentanyl in elective cesarean section using combined spinal-epidural anesthesia. Anesth Essays Res. 7:168–172. 2013. View Article : Google Scholar : PubMed/NCBI

3 

Sun J, Wu X, Xu X, Jin L, Han N and Zhou R: A comparison of epidural magnesium and/or morphine with bupivacaine for postoperative analgesia after cesarean section. Int J Obstet Anesth. 21:310–316. 2012. View Article : Google Scholar : PubMed/NCBI

4 

Agarwal K, Agarwal N, Agrawal VK, Agarwal A and Sharma M: Efficacy of single dose epidural morphine versus intermittent low-dose epidural morphine along with bupivacaine for postcaesarean section analgesia. Anesth Essays Res. 6:25–28. 2012. View Article : Google Scholar : PubMed/NCBI

5 

Bonnet MP, Mignon A, Mazoit JX, Ozier Y and Marret E: Analgesic efficacy and adverse effects of epidural morphine compared to parenteral opioids after elective caesarean section: A systematic review. Eur J Pain. 14:894.e1–e9. 2010. View Article : Google Scholar

6 

Bhana N, Goa KL and McClellan KJ: Dexmedetomidine. Drugs. 59:263–268. 2000. View Article : Google Scholar : PubMed/NCBI

7 

Zhang X, Wang D, Shi M and Luo Y: Efficacy and safety of dexmedetomidine as an adjuvant in epidural analgesia and anesthesia: A systematic review and meta-analysis of randomized controlled trials. Clin Drug Investig. 37:343–354. 2017. View Article : Google Scholar : PubMed/NCBI

8 

Mo Y and Qiu S: Effects of dexmedetomidine in reducing post-cesarean adverse reactions. Exp Ther Med. 14:2036–2039. 2017. View Article : Google Scholar : PubMed/NCBI

9 

Zhang W and Li C: EC50 of epidural ropivacaine combined with dexmedetomidine for labor analgesia. Clin J Pain. 34:950–953. 2018.PubMed/NCBI

10 

Wangping Z and Ming R: Optimal dose of epidural dexmedetomidine added to ropivacaine for epidural labor analgesia: A pilot study. Evid Based Complement Alternat Med. 2017:79241482017. View Article : Google Scholar : PubMed/NCBI

11 

Zhao Y, Xin Y and Liu Y, Yi X and Liu Y: Effect of epidural dexmedetomidine combined with ropivacaine in labor analgesia: A randomized double-blinded controlled study. Clin J Pain. 33:319–324. 2017. View Article : Google Scholar : PubMed/NCBI

12 

Selim MF, Elnabtity AM and Hasan AM: Comparative evaluation of epidural bupivacaine-dexmedetomidine and bupivacaine-fentanyl on Doppler velocimetry of uterine and umbilical arteries during labor. J Prenat Med. 6:47–54. 2012.PubMed/NCBI

13 

Capogna G, Celleno D, Zangrillo A, Costantino P and Foresta S: Addition of clonidine to epidural morphine enhances postoperative analgesia after cesarean delivery. Reg Anesth. 20:57–61. 1995.PubMed/NCBI

14 

Bromage PR: A comparison of the hydrochloride and carbon dioxide salts of lidocaine and prilocaine in epidural analgesia. Acta Anaesthesiol Scand Suppl. 16:55–69. 1965. View Article : Google Scholar : PubMed/NCBI

15 

Ramsay MA, Savege TM, Simpson BR and Goodwin R: Controlled sedation with alphaxalone-alphadolone. Br Med J. 2:656–659. 1974. View Article : Google Scholar : PubMed/NCBI

16 

Sankar-Maharaj S, Chen D and Hariharan S: Postoperative shivering among cannabis users at a public hospital in trinidad, west indies. J Perianesth Nurs. 33:37–44. 2018. View Article : Google Scholar : PubMed/NCBI

17 

Hashemi SJ, Jabalameli M and Mokhtary F: Effects of different anesthetic techniques on neurologic and adaptation capacity in newborn with elective cesarean section. Adv Biomed Res. 4:2492015. View Article : Google Scholar : PubMed/NCBI

18 

O'Neill P, Duarte F, Ribeiro I, Centeno MJ and Moreira J: Ropivacaine continuous wound infusion versus epidural morphine for postoperative analgesia after cesarean delivery: A randomized controlled trial. Anesth Analg. 114:179–185. 2012. View Article : Google Scholar : PubMed/NCBI

19 

Palmer CM, Emerson S, Volgoropolous D and Alves D: Dose-response relationship of intrathecal morphine for postcesarean analgesia. Anesthesiology. 90:437–444. 1999. View Article : Google Scholar : PubMed/NCBI

20 

Singh SI, Rehou S, Marmai KL and Jones PM: The efficacy of 2 doses of epidural morphine for postcesarean delivery analgesia: A randomized noninferiority trial. Anesth Analg. 117:677–685. 2013. View Article : Google Scholar : PubMed/NCBI

21 

Fuller JG, McMorland GH, Douglas MJ and Palmer L: Epidural morphine for analgesia after caesarean section: A report of 4880 patients. Can J Anaesth. 37:636–640. 1990. View Article : Google Scholar : PubMed/NCBI

22 

Zeng XZ, Xu YM, Cui XG, Guo YP and Li WZ: Low-dose epidural dexmedetomidine improves thoracic epidural anaesthesia for nephrectomy. Anaesth Intensive Care. 42:185–190. 2014. View Article : Google Scholar : PubMed/NCBI

23 

Karhade SS, Acharya SA and Harnagale K: Comparative analysis of epidural bupivacaine versus bupivacaine with dexmedetomidine for vaginal hysterectomy. Anesth Essays Res. 9:310–313. 2015. View Article : Google Scholar : PubMed/NCBI

24 

Sathyanarayana LA, Heggeri VM, Simha PP, Narasimaiah S, Narasimaiah M and Subbarao BK: Comparison of epidural bupivacaine, levobupivacaine and dexmedetomidine in patients undergoing vascular surgery. J Clin Diagn Res. 10:UC13–UC17. 2016.PubMed/NCBI

25 

Kaur S, Atti JP, Kaur G and Singh TP: Comparative evaluation of ropivacaine versus dexmedetomidine and ropivacaine in epidural anesthesia in lower limb orthopedic surgeries. Saudi J Anaesth. 8:463–469. 2014. View Article : Google Scholar : PubMed/NCBI

26 

Soni P: Comparative study for better adjuvant with ropivacaine in epidural anesthesia. Anesth Essays Res. 10:218–222. 2016. View Article : Google Scholar : PubMed/NCBI

27 

Ebert TJ, Hall JE, Barney JA, Uhrich TD and Colinco MD: The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology. 93:382–394. 2000. View Article : Google Scholar : PubMed/NCBI

28 

Hetta DF, Fares KM, Abedalmohsen AM, Abdel-Wahab AH, Elfadl GMA and Ali WN: Epidural dexmedetomidine infusion for perioperative analgesia in patients undergoing abdominal cancer surgery: Randomized trial. J Pain Res. 11:2675–2685. 2018. View Article : Google Scholar : PubMed/NCBI

29 

Bujedo BM: Spinal opioid bioavailability in postoperative pain. Pain Pract. 14:350–364. 2014. View Article : Google Scholar : PubMed/NCBI

30 

Ishii H, Kohno T, Yamakura T, Ikoma M and Baba H: Action of dexmedetomidine on the substantia gelatinosa neurons of the rat spinal cord. Eur J Neurosci. 27:3182–3190. 2008. View Article : Google Scholar : PubMed/NCBI

31 

Bi YH, Cui XG, Zhang RQ, Song CY and Zhang YZ: Low dose of dexmedetomidine as an adjuvant to bupivacaine in cesarean surgery provides better intraoperative somato-visceral sensory block characteristics and postoperative analgesia. Oncotarget. 8:63587–63595. 2017. View Article : Google Scholar : PubMed/NCBI

32 

Corrigan F, Wu Y, Tuke J, Coller JK, Rice KC, Diener KR, Hayball JD, Watkins LR, Somogyi AA and Hutchinson MR: Alcohol-induced sedation and synergistic interactions between alcohol and morphine: A key mechanistic role for Toll-like receptors and MyD88-dependent signaling. Brain Behav Immun. 45:245–252. 2015. View Article : Google Scholar : PubMed/NCBI

33 

Hannallah MS and Mundt DJ: Effect of epidural morphine on sedation requirements during regional anesthesia. J Clin Anesth. 6:10–13. 1994. View Article : Google Scholar : PubMed/NCBI

34 

Nelson LE, Lu J, Guo T, Saper CB, Franks NP and Maze M: The alpha2-adrenoceptor agonist dexmedetomidine converges on an endogenous sleep-promoting pathway to exert its sedative effects. Anesthesiology. 98:428–436. 2003. View Article : Google Scholar : PubMed/NCBI

35 

Hughes SC, Rosen MA, Shnider SM, Abboud TK, Stefani SJ and Norton M: Maternal and neonatal effects of epidural morphine for labor and delivery. Anesth Analg. 63:319–324. 1984. View Article : Google Scholar : PubMed/NCBI

36 

Zeng XZ, Lu ZF, Lv XQ, Guo YP and Cui XG: Epidural Co-administration of dexmedetomidine and levobupivacaine improves the gastrointestinal motility function after colonic resection in comparison to Co-administration of morphine and levobupivacaine. PLoS One. 11:e01462152016. View Article : Google Scholar : PubMed/NCBI

37 

Zeng X, Jiang J, Yang L and Ding W: Epidural dexmedetomidine reduces the requirement of propofol during total intravenous anaesthesia and improves analgesia after surgery in patients undergoing open thoracic surgery. Sci Rep. 7:39922017. View Article : Google Scholar : PubMed/NCBI

38 

Terada S, Irikoma S, Yamashita A and Murakoshi T: Incidence of respiratory depression after epidural administration of morphine for cesarean delivery: Findings using a continuous respiratory rate monitoring system. Int J Obstet Anesth. 38:32–36. 2019. View Article : Google Scholar : PubMed/NCBI

39 

Trifa M, Tumin D and Tobias JD: Dexmedetomidine as an adjunct for caudal anesthesia and analgesia in children. Minerva Anestesiol. 84:836–847. 2018.PubMed/NCBI

Related Articles

  • Abstract
  • View
  • Download
  • Twitter
Copy and paste a formatted citation
Spandidos Publications style
Yang Y, Song C, Song C and Li C: Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section. Exp Ther Med 19: 1747-1754, 2020.
APA
Yang, Y., Song, C., Song, C., & Li, C. (2020). Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section. Experimental and Therapeutic Medicine, 19, 1747-1754. https://doi.org/10.3892/etm.2020.8429
MLA
Yang, Y., Song, C., Song, C., Li, C."Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section". Experimental and Therapeutic Medicine 19.3 (2020): 1747-1754.
Chicago
Yang, Y., Song, C., Song, C., Li, C."Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section". Experimental and Therapeutic Medicine 19, no. 3 (2020): 1747-1754. https://doi.org/10.3892/etm.2020.8429
Copy and paste a formatted citation
x
Spandidos Publications style
Yang Y, Song C, Song C and Li C: Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section. Exp Ther Med 19: 1747-1754, 2020.
APA
Yang, Y., Song, C., Song, C., & Li, C. (2020). Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section. Experimental and Therapeutic Medicine, 19, 1747-1754. https://doi.org/10.3892/etm.2020.8429
MLA
Yang, Y., Song, C., Song, C., Li, C."Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section". Experimental and Therapeutic Medicine 19.3 (2020): 1747-1754.
Chicago
Yang, Y., Song, C., Song, C., Li, C."Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section". Experimental and Therapeutic Medicine 19, no. 3 (2020): 1747-1754. https://doi.org/10.3892/etm.2020.8429
Follow us
  • Twitter
  • LinkedIn
  • Facebook
About
  • Spandidos Publications
  • Careers
  • Cookie Policy
  • Privacy Policy
How can we help?
  • Help
  • Live Chat
  • Contact
  • Email to our Support Team