The Association of Intraoperative driving pressure with postoperative pulmonary complications in open versus closed abdominal surgery patients – a posthoc propensity score–weighted cohort analysis of the LAS VEGAS study
| العنوان: | The Association of Intraoperative driving pressure with postoperative pulmonary complications in open versus closed abdominal surgery patients – a posthoc propensity score–weighted cohort analysis of the LAS VEGAS study |
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| المؤلفون: | Mazzinari, G., Serpa Neto, A., Hemmes, S. N. T., Hedenstierna, G., Jaber, S., Hiesmayr, M., Hollmann, M. W., Mills, G. H., Vidal Melo, M. F., Pearse, R. M., Putensen, C., Schmid, W., Severgnini, P., Wrigge, H., Cambronero, O. D., Ball, L., de Abreu, M. G., Pelosi, P., Schultz, M. J., Kroell, W., Metzler, H., Struber, G., Wegscheider, T., Gombotz, H., Urbanek, B., Kahn, D., Momeni, M., Pospiech, A., Lois, F., Forget, P., Grosu, I., Poelaert, J., van Mossevelde, V., van Malderen, M. -C., Dylst, D., van Melkebeek, J., Beran, M., de Hert, S., De Baerdemaeker, L., Heyse, B., Van Limmen, J., Wyffels, P., Jacobs, T., Roels, N., De Bruyne, A., van de Velde, S., Leva, B., Damster, S., Plichon, B., Juros-Zovko, M., Djonovic-Omanovic, D., Pernar, S., Zunic, J., Miskovic, P., Zilic, A., Kvolik, S., Ivic, D., Azenic-Venzera, D., Skiljic, S., Vinkovic, H., Oputric, I., Juricic, K., Frkovic, V., Kopic, J., Mirkovic, I., Karanovic, N., Carev, M., Dropulic, N., Saric, J. P., Erceg, G., Dvorscak, M. B., Mazul-Sunko, B., Pavicic, A. M., Goranovic, T., Maldini, B., Radocaj, T., Gavranovic, Z., Mladic-Batinica, I., Sehovic, M., Stourac, P., Harazim, H., Smekalova, O., Kosinova, M., Kolacek, T., Hudacek, K., Drab, M., Brujevic, J., Vitkova, K., Jirmanova, K., Volfova, I., Dzurnakova, P., Liskova, K., Dudas, R., Filipsky, R., el Kafrawy, S., Abdelwahab, H. H., Metwally, T., Abdel-Razek, A., El-Shaarawy, A. M., Hasan, W. F., Ahmed, A. G., Yassin, H., Magdy, M., Abdelhady, M., Mahran, M., Herodes, E., Kivik, P., Oganjan, J., Aun, A., Sormus, A., Sarapuu, K., Mall, M., Karjagin, J., Futier, E., Petit, A., Gerard, A., Marret, E., Solier, M., Prades, A., Krassler, J., Merzky, S., Uhlig, C., Kiss, T., Bundy, A., Bluth, T., Gueldner, A., Spieth, P., Scharffenberg, M., Thiem, D. T., Koch, T., Treschan, T., Schaefer, M., Bastin, B., Geib, J., Weiss, M., Kienbaum, P., Pannen, B., Gottschalk, A., Konrad, M., Westerheide, D., Schwerdtfeger, B., Simon, P., Reske, A., Nestler, C., Valsamidis, D., Stroumpoulis, K., Antholopoulos, G., Andreou, A., Karapanos, D., Theodoraki, K., Gkiokas, G., Tasoulis, M. -K., Sidiropoulou, T., Zafeiropoulou, F., Florou, P., Pandazi, A., Tsaousi, G., Nouris, C., Pourzitaki, C., Bystritski, D., Pizov, R., Eden, A., Pesce, C. V., Campanile, A., Marrella, A., Grasso, S., De Michele, M., Bona, F., Giacoletto, G., Sardo, E., Giancarlo, L., Sottosanti, V., Solca, M., Volta, C. A., Spadaro, S., Verri, M., Ragazzi, R., Zoppellari, R., Cinnella, G., Raimondo, P., La Bella, D., Mirabella, L., D'Antini, D., Molin, A., Brunetti, I., Gratarola, A., Pellerano, G., Sileo, R., Pezzatto, S., Montagnani, L., Pasin, L., Landoni, G., Zangrillo, A., Beretta, L., Di Parma, A. L., Tarzia, V., Dossi, R., Sassone, M. E., Sances, D., Tredici, S., Spano, G., Castellani, G., Delunas, L., Peradze, S., Venturino, M., Arpino, I., Sher, S., Tommasino, C., Rapido, F., Morelli, P., Vargas, M., Servillo, G., Cortegiani, A., Raineri, S. M., Montalto, F., Russotto, V., Giarratano, A., Baciarello, M., Generali, M., Cerati, G., Leykin, Y., Bressan, F., Bartolini, V., Zamidei, L., Brazzi, L., Liperi, C., Sales, G., Pistidda, L., Brugnoni, E., Musella, G., Bacuzzi, A., Muhardri, D., Gecaj-Gashi, A., Sada, F., Bytyqi, A., Karbonskiene, A., Aukstakalniene, R., Teberaite, Z., Salciute, E., Tikuisis, R., Miliauskas, P., Jurate, S., Kontrimaviciute, E., Tomkute, G., Xuereb, J., Bezzina, M., Borg, F. J., Hemmes, S., Schultz, M., Hollmann, M., Wiersma, I., Binnekade, J., Bos, L., Boer, C., Duvekot, A., in 't Veld, B., Werger, A., Dennesen, P., Severijns, C., De Jong, J., Hering, J., van Beek, R., Ivars, S., Jammer, I., Breidablik, A., Hodt, K. S., Fjellanger, F., Avalos, M. V., Mellin-Olsen, J., Andersson, E., Shafi-Kabiri, A., Molina, R., Wutai, S., Morais, E., Tareco, G., Ferreira, D., Amaral, J., de Lurdes Goncalves Castro, M., Cadilha, S., Appleton, S., Parente, S., Correia, M., Martins, D., Monteirosa, A., Ricardo, A., Rodrigues, S., Horhota, L., Grintescu, I. M., Mirea, L., Grintescu, I. C., Corneci, D., Negoita, S., Dutu, M., Garotescu, I. P., Filipescu, D., Prodan, A. B., Droc, G., Fota, R., Popescu, M., Tomescu, D., Petcu, A. M., Tudoroiu, M. I., Moise, A., Guran, C. -T., Gherghina, I., Costea, D., Cindea, I., Copotoiu, S. -M., Copotoiu, R., Barsan, V., Tolcser, Z., Riciu, M., Moldovan, S. G., Veres, M., Gritsan, A., Kapkan, T., Gritsan, G., Korolkov, O., Kulikov, A., Lubnin, A., Ovezov, A., Prokoshev, P., Lugovoy, A., Anipchenko, N., Babayants, A., Komissarova, I., Zalina, K., Likhvantsev, V., Fedorov, S., Lazukic, A., Pejakovic, J., Mihajlovic, D., Kusnierikova, Z., Zelinkova, M., Bruncakova, K., Polakovicova, L., Sobona, V., Novak-Supe, B., Pekle-Golez, A., Jovanov, M., Strazisar, B., Markovic-Bozic, J., Novak-Jankovic, V., Voje, M., Grynyuk, A., Kostadinov, I., Spindler-Vesel, A., Moral, V., Unzueta, M. C., Puigbo, C., Fava, J., Canet, J., Moret, E., Rodriguez Nunez, M., Sendra, M., Brunelli, A., Rodenas, F., Monedero, P., Martinez, F. H., Temino, M. J. Y., Martinez Simon, A., de Abajo Larriba, A., Lisi, A., Perez, G., Martinez, R., Granell, M., Vivo, J. T., Ruiz, C. S., de Andres Ibanez, J. A., Pastor, E., Soro, M., Ferrando, C., Defez, M., Alvares-Santullano, C. A., Perez, R., Rico, J., Jawad, M., Saeed, Y., Gillberg, L., Bengisun, Z. K., Kazbek, B. K., Coskunfirat, N., Boztug, N., Sanli, S., Yilmaz, M., Hadimioglu, N., Senturk, N. M., Camci, E., Kucukgoncu, S., Sungur, Z., Sivrikoz, N., Ozgen, S. U., Toraman, F., Selvi, O., Senturk, O., Yildiz, M., Kuvaki, B., Gunenc, F., Kucukguclu, S., Ozbilgin, S., Maral, J., Canli, S., Arun, O., Saltali, A., Aydogan, E., Akgun, F. N., Sanlikarip, C., Karaman, F. M., Mazur, A., Vorotyntsev, S., Rousseau, G., Barrett, C., Stancombe, L., Shelley, B., Scholes, H., Limb, J., Rafi, A., Wayman, L., Deane, J., Rogerson, D., Williams, J., Yates, S., Rogers, E., Pulletz, M., Moreton, S., Jones, S., Venkatesh, S., Burton, M., Brown, L., Goodall, C., Rucklidge, M., Fuller, D., Nadolski, M., Kusre, S., Lundberg, M., Everett, L., Nutt, H., Zuleika, M., Carvalho, P., Clements, D., Creagh-Brown, B., Watt, P., Raymode, P., Pearse, R., Mohr, O., Raj, A., Creary, T., Chishti, A., Bell, A., Higham, C., Cain, A., Gibb, S., Mowat, S., Franklin, D., West, C., Minto, G., Boyd, N., Mills, G., Calton, E., Walker, R., Mackenzie, F., Ellison, B., Roberts, H., Chikungwa, M., Jackson, C., Donovan, A., Foot, J., Homan, E., Montgomery, J., Portch, D., Mercer, P., Palmer, J., Paddle, J., Fouracres, A., Datson, A., Andrew, A., Welch, L., Rose, A., Varma, S., Simeson, K., Rambhatla, M., Susarla, J., Marri, S., Kodaganallur, K., Das, A., Algarsamy, S., Colley, J., Davies, S., Szewczyk, M., Smith, T., Fernandez-Bustamante, A., Luzier, E., Almagro, A., Melo, M. V., Fernando, L., Sulemanji, D., Sprung, J., Weingarten, T., Kor, D., Scavonetto, F., Tze, Y. |
| المساهمون: | Mazzinari G., Serpa Neto A., Hemmes S.N.T., Hedenstierna G., Jaber S., Hiesmayr M., Hollmann M.W., Mills G.H., Vidal Melo M.F., Pearse R.M., Putensen C., Schmid W., Severgnini P., Wrigge H., Cambronero O.D., Ball L., de Abreu M.G., Pelosi P., Schultz M.J., Kroell W., Metzler H., Struber G., Wegscheider T., Gombotz H., Urbanek B., Kahn D., Momeni M., Pospiech A., Lois F., Forget P., Grosu I., Poelaert J., van Mossevelde V., van Malderen M.-C., Dylst D., van Melkebeek J., Beran M., de Hert S., De Baerdemaeker L., Heyse B., Van Limmen J., Wyffels P., Jacobs T., Roels N., De Bruyne A., van de Velde S., Leva B., Damster S., Plichon B., Juros-Zovko M., Djonovic-Omanovic D., Pernar S., Zunic J., Miskovic P., Zilic A., Kvolik S., Ivic D., Azenic-Venzera D., Skiljic S., Vinkovic H., Oputric I., Juricic K., Frkovic V., Kopic J., Mirkovic I., Karanovic N., Carev M., Dropulic N., Saric J.P., Erceg G., Dvorscak M.B., Mazul-Sunko B., Pavicic A.M., Goranovic T., Maldini B., Radocaj T., Gavranovic Z., Mladic-Batinica I., Sehovic M., Stourac P., Harazim H., Smekalova O., Kosinova M., Kolacek T., Hudacek K., Drab M., Brujevic J., Vitkova K., Jirmanova K., Volfova I., Dzurnakova P., Liskova K., Dudas R., Filipsky R., el Kafrawy S., Abdelwahab H.H., Metwally T., Abdel-Razek A., El-Shaarawy A.M., Hasan W.F., Ahmed A.G., Yassin H., Magdy M., Abdelhady M., Mahran M., Herodes E., Kivik P., Oganjan J., Aun A., Sormus A., Sarapuu K., Mall M., Karjagin J., Futier E., Petit A., Gerard A., Marret E., Solier M., Prades A., Krassler J., Merzky S., Uhlig C., Kiss T., Bundy A., Bluth T., Gueldner A., Spieth P., Scharffenberg M., Thiem D.T., Koch T., Treschan T., Schaefer M., Bastin B., Geib J., Weiss M., Kienbaum P., Pannen B., Gottschalk A., Konrad M., Westerheide D., Schwerdtfeger B., Simon P., Reske A., Nestler C., Valsamidis D., Stroumpoulis K., Antholopoulos G., Andreou A., Karapanos D., Theodoraki K., Gkiokas G., Tasoulis M.-K., Sidiropoulou T., Zafeiropoulou F., Florou P., Pandazi A., Tsaousi G., Nouris C., Pourzitaki C., Bystritski D., Pizov R., Eden A., Pesce C.V., Campanile A., Marrella A., Grasso S., De Michele M., Bona F., Giacoletto G., Sardo E., Giancarlo L., Sottosanti V., Solca M., Volta C.A., Spadaro S., Verri M., Ragazzi R., Zoppellari R., Cinnella G., Raimondo P., La Bella D., Mirabella L., D'antini D., Molin A., Brunetti I., Gratarola A., Pellerano G., Sileo R., Pezzatto S., Montagnani L., Pasin L., Landoni G., Zangrillo A., Beretta L., Di Parma A.L., Tarzia V., Dossi R., Sassone M.E., Sances D., Tredici S., Spano G., Castellani G., Delunas L., Peradze S., Venturino M., Arpino I., Sher S., Tommasino C., Rapido F., Morelli P., Vargas M., Servillo G., Cortegiani A., Raineri S.M., Montalto F., Russotto V., Giarratano A., Baciarello M., Generali M., Cerati G., Leykin Y., Bressan F., Bartolini V., Zamidei L., Brazzi L., Liperi C., Sales G., Pistidda L., Brugnoni E., Musella G., Bacuzzi A., Muhardri D., Gecaj-Gashi A., Sada F., Bytyqi A., Karbonskiene A., Aukstakalniene R., Teberaite Z., Salciute E., Tikuisis R., Miliauskas P., Jurate S., Kontrimaviciute E., Tomkute G., Xuereb J., Bezzina M., Borg F.J., Hemmes S., Hollmann M., Wiersma I., Binnekade J., Bos L., Boer C., Duvekot A., in 't Veld B., Werger A., Dennesen P., Severijns C., De Jong J., Hering J., van Beek R., Ivars S., Jammer I., Breidablik A., Hodt K.S., Fjellanger F., Avalos M.V., Mellin-Olsen J., Andersson E., Shafi-Kabiri A., Molina R., Wutai S., Morais E., Tareco G., Ferreira D., Amaral J., de Lurdes Goncalves Castro M., Cadilha S., Appleton S., Parente S., Correia M., Martins D., Monteirosa A., Ricardo A., Rodrigues S., Horhota L., Grintescu I.M., Mirea L., Grintescu I.C., Corneci D., Negoita S., Dutu M., Garotescu I.P., Filipescu D., Prodan A.B., Droc G., Fota R., Popescu M., Tomescu D., Petcu A.M., Tudoroiu M.I., Moise A., Guran C.-T., Gherghina I., Costea D., Cindea I., Copotoiu S.-M., Copotoiu R., Barsan V., Tolcser Z., Riciu M., Moldovan S.G., Veres M., Gritsan A., Kapkan T., Gritsan G., Korolkov O., Kulikov A., Lubnin A., Ovezov A., Prokoshev P., Lugovoy A., Anipchenko N., Babayants A., Komissarova I., Zalina K., Likhvantsev V., Fedorov S., Lazukic A., Pejakovic J., Mihajlovic D., Kusnierikova Z., Zelinkova M., Bruncakova K., Polakovicova L., Sobona V., Novak-Supe B., Pekle-Golez A., Jovanov M., Strazisar B., Markovic-Bozic J., Novak-Jankovic V., Voje M., Grynyuk A., Kostadinov I., Spindler-Vesel A., Moral V., Unzueta M.C., Puigbo C., Fava J., Canet J., Moret E., Rodriguez Nunez M., Sendra M., Brunelli A., Rodenas F., Monedero P., Martinez F.H., Temino M.J.Y., Martinez Simon A., de Abajo Larriba A., Lisi A., Perez G., Martinez R., Granell M., Vivo J.T., Ruiz C.S., de Andres Ibanez J.A., Pastor E., Soro M., Ferrando C., Defez M., Alvares-Santullano C.A., Perez R., Rico J., Jawad M., Saeed Y., Gillberg L., Bengisun Z.K., Kazbek B.K., Coskunfirat N., Boztug N., Sanli S., Yilmaz M., Hadimioglu N., Senturk N.M., Camci E., Kucukgoncu S., Sungur Z., Sivrikoz N., Ozgen S.U., Toraman F., Selvi O., Senturk O., Yildiz M., Kuvaki B., Gunenc F., Kucukguclu S., Ozbilgin S., Maral J., Canli S., Arun O., Saltali A., Aydogan E., Akgun F.N., Sanlikarip C., Karaman F.M., Mazur A., Vorotyntsev S., Rousseau G., Barrett C., Stancombe L., Shelley B., Scholes H., Limb J., Rafi A., Wayman L., Deane J., Rogerson D., Williams J., Yates S., Rogers E., Pulletz M., Moreton S., Jones S., Venkatesh S., Burton M., Brown L., Goodall C., Rucklidge M., Fuller D., Nadolski M., Kusre S., Lundberg M., Everett L., Nutt H., Zuleika M., Carvalho P., Clements D., Creagh-Brown B., Watt P., Raymode P., Pearse R., Mohr O., Raj A., Creary T., Chishti A., Bell A., Higham C., Cain A., Gibb S., Mowat S., Franklin D., West C., Minto G., Boyd N., Mills G., Calton E., Walker R., Mackenzie F., Ellison B., Roberts H., Chikungwa M., Jackson C., Donovan A., Foot J., Homan E., Montgomery J., Portch D., Mercer P., Palmer J., Paddle J., Fouracres A., Datson A., Andrew A., Welch L., Rose A., Varma S., Simeson K., Rambhatla M., Susarla J., Marri S., Kodaganallur K., Das A., Algarsamy S., Colley J., Davies S., Szewczyk M., Smith T., Fernandez-Bustamante A., Luzier E., Almagro A., Melo M.V., Fernando L., Sulemanji D., Sprung J., Weingarten T., Kor D., Scavonetto F., Tze Y., Anesthesiology research group, Supporting clinical sciences, Anesthesiology, Guido, Mazzinari, Ary Serpa, Neto, Sabrine N, T Hemme, Goran, Hedenstierna, Samir, Jaber, Michael, Hiesmayr, Markus, W Hollmann, Gary, H Mill, Marcos, F Vidal Melo, Rupert, M Pearse, Christian, Putensen, Werner, Schmid, Paolo, Severgnini, Hermann, Wrigge, Oscar Diaz, Cambronero, Lorenzo, Ball, Marcelo Gama de, Abreu, Paolo, Pelosi, Marcus, J Schultz (LAS VEGAS study–investigator, PROtective VEntilation, Network, Clinical Trial Network of the European Society of, Anaesthesiology), Zangrillo, A, Landoni, G, Beretta, L, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Pulmonary medicine, IOO, ACS - Microcirculation, ACS - Heart failure & arrhythmias, ACS - Diabetes & metabolism, study–investigators, LAS VEGAS, NETwork, PROtective VEntilation, Anaesthesiology, Clinical Trial Network of the European Society of, Mazzinari, Guido, Serpa Neto, Ary, Hemmes, Sabrine N T, Hedenstierna, Goran, Jaber, Samir, Hiesmayr, Michael, Hollmann, Markus W, Mills, Gary H, Vidal Melo, Marcos F, Pearse, Rupert M, Putensen, Christian, Schmid, Werner, Severgnini, Paolo, Wrigge, Hermann, Cambronero, Oscar Diaz, Ball, Lorenzo, de Abreu, Marcelo Gama, Pelosi, Paolo, Schultz, Marcus, J, Servillo, G, Vargas, M, Intensive Care Medicine, APH - Quality of Care, ACS - Pulmonary hypertension & thrombosis, Pulmonology, APH - Global Health |
| المصدر: | BMC Anesthesiology the LAS VEGAS study–investigators, the PROtective VEntilation NETwork & the Clinical Trial Network of the European Society of Anaesthesiology 2021, ' The Association of Intraoperative driving pressure with postoperative pulmonary complications in open versus closed abdominal surgery patients – a posthoc propensity score–weighted cohort analysis of the LAS VEGAS study ', BMC Anesthesiology, vol. 21, no. 1, 84 . https://doi.org/10.1186/s12871-021-01268-yTest BMC Anesthesiology, BioMed Central, 2021, 21 (1), ⟨10.1186/s12871-021-01268-y⟩ BMC Anesthesiology, 21(1):84. BioMed Central r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA instname BMC Anesthesiology, Vol 21, Iss 1, Pp 1-15 (2021) r-IIS La Fe. Repositorio Institucional de Producción Científica del Instituto de Investigación Sanitaria La Fe BMC anesthesiology, 21(1):84. BioMed Central |
| بيانات النشر: | BioMed Central Ltd, 2021. |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | Driving pressure, Laparoscopic surgery, Laparoscopy, PEEP, Perioperative ventilation, Pneumoperitoneum, Protective ventilation, Respiratory mechanics, Lung Diseases, Male, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Cohort Studies, Positive-Pressure Respiration, Postoperative Complications, 0302 clinical medicine, 030202 anesthesiology, Abdomen, Clinical endpoint, Middle Aged, 3. Good health, Driving pressure, Laparoscopic surgery, Laparoscopy, PEEP, Perioperative ventilation, Pneumoperitoneum, Protective ventilation, Respiratory mechanics, Female, Research Article, Cohort study, Adult, medicine.medical_specialty, Anestesi och intensivvård, Anesthesia, General, NO, lcsh:RD78.3-87.3, 03 medical and health sciences, medicine, Humans, Propensity Score, Adverse effect, Aged, Retrospective Studies, Anesthesiology and Intensive Care, business.industry, Kirurgi, 030208 emergency & critical care medicine, Odds ratio, medicine.disease, Respiration, Artificial, Surgery, Anesthesiology and Pain Medicine, lcsh:Anesthesiology, Relative risk, business, Abdominal surgery |
| الوصف: | Background It is uncertain whether the association of the intraoperative driving pressure (ΔP) with postoperative pulmonary complications (PPCs) depends on the surgical approach during abdominal surgery. Our primary objective was to determine and compare the association of time–weighted average ΔP (ΔPTW) with PPCs. We also tested the association of ΔPTW with intraoperative adverse events. Methods Posthoc retrospective propensity score–weighted cohort analysis of patients undergoing open or closed abdominal surgery in the ‘Local ASsessment of Ventilatory management during General Anaesthesia for Surgery’ (LAS VEGAS) study, that included patients in 146 hospitals across 29 countries. The primary endpoint was a composite of PPCs. The secondary endpoint was a composite of intraoperative adverse events. Results The analysis included 1128 and 906 patients undergoing open or closed abdominal surgery, respectively. The PPC rate was 5%. ΔP was lower in open abdominal surgery patients, but ΔPTW was not different between groups. The association of ΔPTW with PPCs was significant in both groups and had a higher risk ratio in closed compared to open abdominal surgery patients (1.11 [95%CI 1.10 to 1.20], P P P TW with intraoperative adverse events was also significant in both groups but had higher odds ratio in closed compared to open abdominal surgery patients (1.13 [95%CI 1.12– to 1.14], P P P Conclusions ΔP is associated with PPC and intraoperative adverse events in abdominal surgery, both in open and closed abdominal surgery. Trial registration LAS VEGAS was registered at clinicaltrials.gov (trial identifier NCT01601223). |
| وصف الملف: | application/pdf |
| اللغة: | English |
| تدمد: | 1471-2253 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::b7c355192fcae0483c6259e35ba72effTest http://hdl.handle.net/10447/519459Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....b7c355192fcae0483c6259e35ba72eff |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 14712253 |
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