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Trial registered on ANZCTR
Registration number
ACTRN12616001522404
Ethics application status
Approved
Date submitted
26/02/2016
Date registered
4/11/2016
Date last updated
29/01/2018
Type of registration
Prospectively registered
Titles & IDs
Public title
Does ketamine improve the quality of sedation of intranasal dexmedetomidine premedication in children
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Scientific title
The effects of ketamine on the quality of sedation of intranasal dexmedetomidine premedication in children undergoing elective tonsillectomy.
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Secondary ID [1]
288457
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None
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Tonsillitis
298633
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Condition category
Condition code
Respiratory
298698
298698
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0
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Other respiratory disorders / diseases
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
GroupDK received 2mg/kg intranasal dexmedetomidine and 2mg/kg intranasal ketamine premedication 30 min before general anaesthesia;the intervention and the participants will be monitored throughout the duration of the procedure
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Intervention code [1]
293790
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Treatment: Drugs
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Comparator / control treatment
GroupD received 2mg/kg intranasal dexmedetomidine premedication
30min before general anaesthesia
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Control group
Active
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Outcomes
Primary outcome [1]
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Sedation state will be evaluated by Modified Observer’s Assessment of Alertness/Sedation Scale(MOAA/S).
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Assessment method [1]
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Timepoint [1]
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Sedation state will be evaluated at 30min after premedication.
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Secondary outcome [1]
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Response to stimulation will be evaluated by Mask Acceptance Scale(MAS).
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Assessment method [1]
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Timepoint [1]
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Response to stimulation will be evaluated at 30min after premedication.
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Secondary outcome [2]
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Anxiety state will be evaluated by Parental Separation Anxiety Scale (PSAS).
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Assessment method [2]
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Timepoint [2]
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Anxiety state will be evaluated at 30min after premedication.
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Secondary outcome [3]
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The onset time is defined as the time from after premedication until the disappearance of eyelash reflex.The time of premedication and the time of the disappearance of eyelash reflex are recorded in a note.
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Assessment method [3]
325224
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Timepoint [3]
325224
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at time of onset of anaesthesia
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Secondary outcome [4]
325225
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The time of extubation is defined as the time from discontinuation of anesthesia until the tracheal catheter was extubated. The time of extubation is recorded in a note.
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Assessment method [4]
325225
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Timepoint [4]
325225
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at the time of extubation
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Secondary outcome [5]
325226
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The duration of PACU stay is defined as the time from the child entered PACU until he or she was ready to be discharged. It is assessed by review of medical records.
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Assessment method [5]
325226
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Timepoint [5]
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at time of PACU discharge
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Secondary outcome [6]
325227
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Emergence agitation will be evaluated by the Pediatric Anesthesia Emergence Delirium (PAED) scale. Emergence agitation is defined as the PAED scale >=10.
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Assessment method [6]
325227
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Timepoint [6]
325227
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Emergence agitation will be assesed at the emergence time.
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Secondary outcome [7]
325228
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All episodes of postoperative nausea and vomiting will be recorded through direct questioning by one anesthesiologist unaware of the type of medications given to the patients. Vomiting is defined as either vomiting (expulsion of stomach contents) or retching
(an involuntary attempt to vomit but not productive as regards stomach contents). Nausea is defined as a subjectively unpleasant sensation associated with awareness of the urge to vomit.
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Assessment method [7]
325228
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Timepoint [7]
325228
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the first 24 h after surgery
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Secondary outcome [8]
325229
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Cardiocap/5 is used to measure the heart rate during the time before premedication to the end of the operation. Bradycardia (30% lower than the basic value) need to be recored .
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Assessment method [8]
325229
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Timepoint [8]
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Bradycardia need to be recored every 5 minutes for the duration of the procedure.
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Secondary outcome [9]
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Cardiocap/5 is used to measure the blood pressure during the time before premedication to the end of the operation. Hypotension (30% lower than the basic value) need to be recored .
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Assessment method [9]
325767
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Timepoint [9]
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Hypotension need to be recored every 5 minutes for the duration of the procedure.
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Eligibility
Key inclusion criteria
Children were engaged in this study, who were with American Society of Anesthesiologists (ASA) physical status I or II, aged between 3 and 7 years old and scheduled to undergo elective tonsillectomy.
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Minimum age
3
Years
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Maximum age
7
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Children were excluded from the study if they had significant renal or hepatic disorders, dysrhythmias, recent upper respiratory infection, asthma, nasal pathology, allergy or hypersensitive reaction to dexmedetomidine or ketamine, therapy of opioid or non-steroidal anti-inflammatory drug in the 24 hours prior to the study, and a medical history of mental illness.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people assessing the outcomes
The people analysing the results/data
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 3
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
20/11/2016
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Actual
3/01/2017
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Date of last participant enrolment
Anticipated
20/01/2017
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Actual
20/10/2017
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Date of last data collection
Anticipated
24/01/2017
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Actual
23/10/2017
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Sample size
Target
66
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Accrual to date
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Final
66
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Recruitment outside Australia
Country [1]
7593
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China
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State/province [1]
7593
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Fujian
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Funding & Sponsors
Funding source category [1]
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Hospital
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Name [1]
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Fujian Provincial Hospital
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Address [1]
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No.134,Dongjie,Fujian Provincial Hospital,Fuzhou,Fujian,China,350004,
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Country [1]
292892
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China
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Primary sponsor type
Individual
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Name
Yusheng Yao
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Address
No.134,Dongjie,Fujian Provincial Hospital,Fuzhou,Fujian,China,350004,
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Country
China
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Secondary sponsor category [1]
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Hospital
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Name [1]
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Fujian Provincial Hospital
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Address [1]
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No.134,Dongjie,Fujian Provincial Hospital,Fuzhou,Fujian,China,350004,
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Country [1]
291635
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China
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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The Biological-Medical Ethical Committee of Fujian Provincial Hospital
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Ethics committee address [1]
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No.134,Dongjie,Fujian Provincial Hospital,Fuzhou,Fujian,China,350004,
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Ethics committee country [1]
294502
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China
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Date submitted for ethics approval [1]
294502
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13/01/2016
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Approval date [1]
294502
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25/02/2016
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Ethics approval number [1]
294502
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K-2016-02-11
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Summary
Brief summary
Undergoing surgery can be a significant traumatic experience for younger children. Furthermore, preoperative crying increase the respiratory tract secretion and stress response, leading to increased heart rate (HR), blood pressure and airway hyperactivity.In order to reduce anxiety and promote the separation of parents, a variety of drugs have been advocated as premedication. Children's ideal preoperative medication should be easy to accept, fast and reliable with the minimum adverse effect. Dexmedetomidine is a selective a2 adrenergic agonist that produces analgesia as well as sedation effects via actions in the locus ceruleous without respiratory depression. Its induced sedation is similar to natural sleep, which is characterized by an easy and quick arousal. Dexmedetomidine also has some special pharmacodynamic properties, including decreased minimum alveolar concentration(MAC) and a conspicuous reduction in catecholamine secretion. Dexmedetomidine may be a suitable auxiliary medicine of ketamine, because it alleviates the cardiovascular stimulation effect of ketamine. Ketamine is the most commonly used drug for children that acts as an N-methyl-d-aspartate receptor antagonist with sedative, anesthetic, analgesic and amnesic effects and dissociation from the environment. The aim of this study was to evaluate and compare the sedative effect and safety of intranasal dexmedetomidine, intranasal ketamine and dexmedetomidine as a premedication before induction of anesthesia in pediatric tonsillectomy. Sixty children (both boys and girls) were engaged in this study, who were with ASA physical status I or II, aged between 3 and 7 years old and scheduled to undergo elective tonsillectomy. The subjects were randomly divided into two groups with thirty children each. Group Dexmedetomidine (Group D)received premedication of dexmedetomidine 2ug/kg 45 min before induction by LMA MAD. Group Dexmedetomidine + Ketamine (Group DK) received premedication of intranasal combined dexmedetomidine 2ug/kg and ketamine 2mg/kg. Sedation status was evaluated by the observer using the Modified Observer’s Assessment of Alertness/Sedation Scale (MOAA/S) at the baseline before premedication and 30 min after premedication. Patient’s response to separation from parents was assessed by the Parental Separation Anxiety Scale (PSAS), about 30 minutes after medication administration. After the patient was sent to operating room, the Patient’s Mask Acceptance Scale (MAS) score was calculated. Vital signs were continuously monitored and recorded every 15min until the child was ready to be discharged.The primary outcome of our study was the sedation score. The secondary outcomes included the separation from parents, facemask acceptance, oneset time, the time of extubation, duration of PACU stay, emergence agitation, and the incidence of adverse effects, such as nausea,vomiting. Bradycardia and hypotension (30% lower than the basic value) need to be recored during the operation.
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Trial website
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Trial related presentations / publications
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Public notes
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Attachments [1]
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/AnzctrAttachments/369976-Ethics approval forms.pdf
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Contacts
Principal investigator
Name
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A/Prof Yusheng Yao
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Address
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No.134,Dongjie,Fujian Provincial Hospital,Fuzhou,Fujian,China,350004,
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Country
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China
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Phone
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+86-13559939629
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Fax
62962
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Email
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[email protected]
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Contact person for public queries
Name
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Yusheng Yao
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Address
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No.134,Dongjie,Fujian Provincial Hospital,Fuzhou,Fujian,China,350004,
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Country
62963
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China
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Phone
62963
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+86-13559939629
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Fax
62963
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Email
62963
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[email protected]
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Contact person for scientific queries
Name
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Yusheng Yao
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Address
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No.134,Dongjie,Fujian Provincial Hospital,Fuzhou,Fujian,China,350004,
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Country
62964
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China
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Phone
62964
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+86-13559939629
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Fax
62964
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Email
62964
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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