<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1130-0108</journal-id>
<journal-title><![CDATA[Revista Española de Enfermedades Digestivas]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. esp. enferm. dig.]]></abbrev-journal-title>
<issn>1130-0108</issn>
<publisher>
<publisher-name><![CDATA[Sociedad Española de Patología Digestiva]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1130-01082018000400002</article-id>
<article-id pub-id-type="doi">10.17235/reed.2018.5262/2017</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Seguridad de la sedación profunda con propofol controlada por el endoscopista en la colangiopancreatografía retrógrada endoscópica (CPRE). Estudio prospectivo en un hospital terciario]]></article-title>
<article-title xml:lang="en"><![CDATA[The safety of deep sedation with propofol controlled by the endoscopist in endoscopic retrograde cholangiopancreatography (ERCP): a prospective study in a tertiary hospital]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Luzón-Solanas]]></surname>
<given-names><![CDATA[Lara]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ollero-Domenche]]></surname>
<given-names><![CDATA[Leticia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Sierra-Moros]]></surname>
<given-names><![CDATA[Eva-María]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Val-Pérez]]></surname>
<given-names><![CDATA[José]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Soria-San-Teodoro]]></surname>
<given-names><![CDATA[María-Teresa]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Giménez-Júlvez]]></surname>
<given-names><![CDATA[Teresa]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Uribarrena-Amezaga]]></surname>
<given-names><![CDATA[Rafael]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital Universitario Miguel Servet Servicio de Aparato Digestivo ]]></institution>
<addr-line><![CDATA[Zaragoza ]]></addr-line>
<country>Spain</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Hospital Universitario Miguel Servet Servicio de Medicina Preventiva y Salud Pública ]]></institution>
<addr-line><![CDATA[Zaragoza ]]></addr-line>
<country>Spain</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2018</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2018</year>
</pub-date>
<volume>110</volume>
<numero>4</numero>
<fpage>217</fpage>
<lpage>222</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_arttext&amp;pid=S1130-01082018000400002&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_abstract&amp;pid=S1130-01082018000400002&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_pdf&amp;pid=S1130-01082018000400002&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN  Introducción:  el propofol, administrado por el endoscopista con una enfermera entrenada, ha evolucionado como alternativa a la monitorización anestésica y es cada vez más frecuente en la práctica clínica habitual, incluso en endoscopia avanzada.  Objetivo:  evaluar la seguridad de la sedación profunda con propofol controlada por el endoscopista en pacientes sometidos a colangiopancreatografía retrógrada endoscópica (CPRE).  Material y métodos:  estudio prospectivo en los pacientes a los que se les realizó CPRE bajo sedación profunda con propofol. Se incluyeron diferentes variables relacionadas con el paciente y se registraron los datos iniciales y finales de la saturación de oxígeno (SatO2), la tensión arterial (TA), y la frecuencia cardiaca (FC) para determinar la presencia de eventos adversos a la sedación (hipoxemia, hipotensión o bradicardia).  Resultados:  un total de 661 pacientes fueron sometidos a CPRE bajo sedación con propofol durante un periodo de 24 meses. La tasa de eventos adversos registrada fue del 9,7%. La más frecuente fue la hipoxemia (5,7%), seguida de la bradicardia (2,4%) y de la hipotensión (1,6%). En el análisis univariante, la aparición de eventos adversos a la sedación (EAS) se asoció a una clasificación de ASA &#8805; III (p = 0,026), a pacientes de edad más avanzada (p = 0,009), mayor IMC (p = 0,002) y a un tiempo de exploración más prolongado (p = 0,034). La dosis de inducción de propofol también se relacionó con mayor probabilidad de eventos adversos (p = 0,045), pero no la dosis total de propofol administrado (p = 0,153). En el análisis de regresión logística multivariante, la edad, el índice de masa corporal (IMC) y la duración de la exploración se registran como predictores independientes de EAS (p &lt; 0,05).  Conclusión:  la sedación profunda con propofol controlada por personal de endoscopia entrenado es un método seguro en procedimientos endoscópicos complejos como la CPRE.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT  Introduction:  propofol administered by an endoscopist with a trained nurse has evolved as an alternative to anesthesia monitoring and is increasingly common in the routine clinical practice, even in advanced endoscopy.  Objective:  to evaluate the safety of deep sedation with endoscopist-controlled propofol in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP).  Material and methods:  this was a prospective study in patients undergoing ERCP under deep sedation with propofol. Different patient-related variables were included and the initial and final data on oxygen saturation (SatO2), blood pressure (BP) and heart rate (HR) were recorded in order to determine the presence of adverse events due to sedation (hypoxemia, hypotension, or bradycardia).  Results:  a total of 661 patients underwent ERCP under sedation with propofol over a 24-month period. The rate of recorded adverse events was 9.7%. The most frequent adverse event was hypoxemia (5.7%), followed by bradycardia (2.4%) and hypotension (1.6%). According to the univariate analysis, the occurrence of adverse events due to sedation (AES) was associated with an ASA score &#8805; III (p = 0.026), older patients (p = 0.009), higher body mass index (BMI) (p = 0.002) and a longer exploration time (p = 0.034). The induction dose of propofol was also associated with a greater likelihood of adverse events (p = 0.045) but not the total dose of propofol administered (p = 0.153). According to the multivariate logistic regression analysis, age, body mass index (BMI) and the duration of the exploration were independent predictors of SAE (p &lt; 0.05).  Conclusion:  deep sedation with propofol controlled by trained endoscopy staff is a safe method in complex endoscopic procedures such as ERCP.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Sedación]]></kwd>
<kwd lng="es"><![CDATA[Propofol]]></kwd>
<kwd lng="es"><![CDATA[Colangiopancreatografía retrógrada endoscópica]]></kwd>
<kwd lng="es"><![CDATA[Complicaciones]]></kwd>
<kwd lng="en"><![CDATA[Sedation]]></kwd>
<kwd lng="en"><![CDATA[Propofol]]></kwd>
<kwd lng="en"><![CDATA[ERCP]]></kwd>
<kwd lng="en"><![CDATA[Complications]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Sedación en endoscopia digestiva Guía de práctica clínica de la Sociedad Española de Endoscopia Digestiva]]></article-title>
<person-group person-group-type="author">
<name>
<surname><![CDATA[Igea]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Casellas]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
<name>
<surname><![CDATA[González-Huix]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
</person-group>
<source><![CDATA[Rev Esp Enferm Dig]]></source>
<year>2014</year>
<volume>106</volume>
<page-range>195-211</page-range></nlm-citation>
</ref>
<ref id="B2">
<nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Propofol sedation for ERCP procedures a dilemma? Observations from an anesthesia perspective]]></article-title>
<person-group person-group-type="author">
<name>
<surname><![CDATA[Garewal]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Waikar]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
</person-group>
<source><![CDATA[Diagn Ther Endosc]]></source>
<year>2012</year>
<volume>2012</volume>
<page-range>639190</page-range></nlm-citation>
</ref>
<ref id="B3">
<nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Sedation in gastrointestinal endoscopy a prospective study comparing nonanesthesiologist-administered propofol and monitored anesthesia care]]></article-title>
<person-group person-group-type="author">
<name>
<surname><![CDATA[Paulo]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<source><![CDATA[Endosc Int Open]]></source>
<year>2015</year>
<page-range>7-13</page-range></nlm-citation>
</ref>
<ref id="B4">
<nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Propofol vs traditional sedative agents for endoscopic retrograde cholangiopancreatography a meta-analysis]]></article-title>
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bo]]></surname>
<given-names><![CDATA[LL]]></given-names>
</name>
<name>
<surname><![CDATA[Bai]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Bian]]></surname>
<given-names><![CDATA[J-J]]></given-names>
</name>
</person-group>
<source><![CDATA[World J Gastroenterol]]></source>
<year>2011</year>
<volume>17</volume>
<numero>30</numero>
<issue>30</issue>
<page-range>3538-43</page-range></nlm-citation>
</ref>
<ref id="B5">
<nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Propofol use in endoscopic retrograde cholangiopancreatography and endoscopic ultrasound]]></article-title>
<person-group person-group-type="author">
<name>
<surname><![CDATA[Cheriyan]]></surname>
<given-names><![CDATA[DG]]></given-names>
</name>
<name>
<surname><![CDATA[Byrne]]></surname>
<given-names><![CDATA[MF]]></given-names>
</name>
</person-group>
<source><![CDATA[World J Gastroenterol]]></source>
<year>2014</year>
<volume>20</volume>
<numero>18</numero>
<issue>18</issue>
<page-range>5171-6</page-range></nlm-citation>
</ref>
<ref id="B6">
<nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Deep sedation for endoscopic retrograde cholangiopacreatography]]></article-title>
<person-group person-group-type="author">
<name>
<surname><![CDATA[Chainaki]]></surname>
<given-names><![CDATA[IG]]></given-names>
</name>
<name>
<surname><![CDATA[Manolaraki]]></surname>
<given-names><![CDATA[MM]]></given-names>
</name>
<name>
<surname><![CDATA[Paspatis]]></surname>
<given-names><![CDATA[GA]]></given-names>
</name>
</person-group>
<source><![CDATA[World J Gastrointest Endosc]]></source>
<year>2011</year>
<volume>3</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>34-9</page-range></nlm-citation>
</ref>
<ref id="B7">
<nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Current role of non-anesthesiologist administered propofol sedation in advanced interventional endoscopy]]></article-title>
<person-group person-group-type="author">
<name>
<surname><![CDATA[Burtea]]></surname>
<given-names><![CDATA[DE]]></given-names>
</name>
<name>
<surname><![CDATA[Dimitriu]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Malos]]></surname>
<given-names><![CDATA[AE]]></given-names>
</name>
</person-group>
<source><![CDATA[World J Gastrointest Endosc]]></source>
<year>2015</year>
<volume>7</volume>
<numero>10</numero>
<issue>10</issue>
<page-range>981-6</page-range></nlm-citation>
</ref>
<ref id="B8">
<nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Incidence of sedation-related complications with propofol use during advanced endoscopic procedures]]></article-title>
<person-group person-group-type="author">
<name>
<surname><![CDATA[Coté]]></surname>
<given-names><![CDATA[GA]]></given-names>
</name>
<name>
<surname><![CDATA[Hovis]]></surname>
<given-names><![CDATA[RM]]></given-names>
</name>
<name>
<surname><![CDATA[Ansstas]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
</person-group>
<source><![CDATA[Clin Gastroenterol Hepatol]]></source>
<year>2010</year>
<volume>8</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>137-42</page-range></nlm-citation>
</ref>
<ref id="B9">
<nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Efficacy and safety of propofol-mediated sedation for outpatient endoscopic retrograde cholangiopancreatography (ERCP)]]></article-title>
<person-group person-group-type="author">
<name>
<surname><![CDATA[Yang]]></surname>
<given-names><![CDATA[JF]]></given-names>
</name>
<name>
<surname><![CDATA[Farooq]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Zwilling]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
</person-group>
<source><![CDATA[Dig Dis Sci]]></source>
<year>2016</year>
<volume>61</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>1686-91</page-range></nlm-citation>
</ref>
<ref id="B10">
<nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Sedation with propofol for routine ERCP in high-risk octogenarians a randomized, controlled study]]></article-title>
<person-group person-group-type="author">
<name>
<surname><![CDATA[Riphaus]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Stergiou]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Wehrmann]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
</person-group>
<source><![CDATA[Am J Gastroenterol]]></source>
<year>2005</year>
<volume>100</volume>
<numero>9</numero>
<issue>9</issue>
<page-range>1957-63</page-range></nlm-citation>
</ref>
<ref id="B11">
<nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[European curriculum for sedation training in gastrointestinal endoscopy: position statement of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA)]]></article-title>
<person-group person-group-type="author">
<name>
<surname><![CDATA[Riphaus]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Beilenhoff]]></surname>
<given-names><![CDATA[U]]></given-names>
</name>
<name>
<surname><![CDATA[Vilmann]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
</person-group>
<source><![CDATA[Endoscopy]]></source>
<year>2013</year>
<volume>45</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>496-504</page-range></nlm-citation>
</ref>
<ref id="B12">
<nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Non-anesthesiologist administration of propofol for gastrointestinal endoscopy European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy Nurses and Associates Guideline - Updated June]]></article-title>
<person-group person-group-type="author">
<name>
<surname><![CDATA[Dumonceau]]></surname>
<given-names><![CDATA[JM]]></given-names>
</name>
<name>
<surname><![CDATA[Riphaus]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Aparicio]]></surname>
<given-names><![CDATA[JR]]></given-names>
</name>
</person-group>
<source><![CDATA[Endoscopy]]></source>
<year>2015</year>
<volume>47</volume>
<page-range>1175-89</page-range></nlm-citation>
</ref>
<ref id="B13">
<nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Sedation in gastrointestinal endoscopy current issues]]></article-title>
<person-group person-group-type="author">
<name>
<surname><![CDATA[Triantafillidis]]></surname>
<given-names><![CDATA[JK]]></given-names>
</name>
<name>
<surname><![CDATA[Merikas]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Nikolakis]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<source><![CDATA[World J Gastroenterol]]></source>
<year>2013</year>
<volume>19</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>463-81</page-range></nlm-citation>
</ref>
<ref id="B14">
<nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Safety of gastroenterologist-guided sedation with propofol for upper gastrointestinal therapeutic endoscopy in elderly patients Compared with younger patients]]></article-title>
<person-group person-group-type="author">
<name>
<surname><![CDATA[Nonaka]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Gotoda]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Kusano]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
</person-group>
<source><![CDATA[Gut Liver]]></source>
<year>2015</year>
<volume>9</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>38-42</page-range></nlm-citation>
</ref>
<ref id="B15">
<nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Propofol versus traditional sedative agents for gastrointestinal endoscopy a meta-analisis]]></article-title>
<person-group person-group-type="author">
<name>
<surname><![CDATA[Qadeer]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
<name>
<surname><![CDATA[Vargo]]></surname>
<given-names><![CDATA[JJ]]></given-names>
</name>
<name>
<surname><![CDATA[Khandwala]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
</person-group>
<source><![CDATA[Clin Gastroenterol Hepatol]]></source>
<year>2005</year>
<volume>3</volume>
<numero>11</numero>
<issue>11</issue>
<page-range>1049-56</page-range></nlm-citation>
</ref>
<ref id="B16">
<nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[The use of propofol as a sedative agent in gastrointestinal endoscopy a meta-analysis]]></article-title>
<person-group person-group-type="author">
<name>
<surname><![CDATA[Wang]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Chen]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Chen]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<source><![CDATA[PLoS One]]></source>
<year>2013</year>
<volume>8</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>e53311</page-range></nlm-citation>
</ref>
<ref id="B17">
<nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Sedation and anesthesia in GI endoscopy]]></article-title>
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lichtenstein]]></surname>
<given-names><![CDATA[DR]]></given-names>
</name>
<name>
<surname><![CDATA[Jagannath]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Baron]]></surname>
<given-names><![CDATA[TH]]></given-names>
</name>
</person-group>
<source><![CDATA[Gastrointest Endosc]]></source>
<year>2008</year>
<volume>68</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>815-26</page-range></nlm-citation>
</ref>
<ref id="B18">
<nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Safety and risk factors for difficult endoscopist-directed ERCP sedation in daily practice a hospital-based case-control study]]></article-title>
<person-group person-group-type="author">
<name>
<surname><![CDATA[Pérez-Cuadrado-Robles]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[González-Ramírez]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Lancho-Seco]]></surname>
<given-names><![CDATA[Á]]></given-names>
</name>
</person-group>
<source><![CDATA[Rev Esp Enferm Dig]]></source>
<year>2016</year>
<volume>108</volume>
<page-range>240-5</page-range></nlm-citation>
</ref>
<ref id="B19">
<nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Propofol versus traditional sedative agents for advanced endoscopic procedures a meta-analysis]]></article-title>
<person-group person-group-type="author">
<name>
<surname><![CDATA[Sethi]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Wadhwa]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Thaker]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<source><![CDATA[Dig Endosc]]></source>
<year>2014</year>
<volume>26</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>515-24</page-range></nlm-citation>
</ref>
<ref id="B20">
<nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Sedation with propofol for interventional endoscopic procedures a risk factor analysis]]></article-title>
<person-group person-group-type="author">
<name>
<surname><![CDATA[Wehrmann]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Riphaus]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<source><![CDATA[Scand J Gastroenterol]]></source>
<year>2009</year>
<volume>43</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>368-74</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
