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Nathan Goodyear

Sex hormones as immunomodulators in heal... [Int Immunopharmacol. 2001] - PubMed - NCBI - 0 views

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    Estradiol in mice predisposed to Lupus have increased inflammation and characteristics of Lupus.  In contrast, Estradiol in those without predisposition, do not.  Clearly this is an inflammatory signaling problem.  Studies have shown an Interferon gamma signaling deficit in those with Lupus.  Testosterone decreases the above inflammation signaling.
wheelchairindia9

Recliner Wheelchair - 0 views

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    Reclining wheelchairs, since the product class is built around one key feature: the capability to adjust the backrest and/or footrest into a reclined position. This feature is especially important to users who find it difficult or impossible to sit in a fully upright position, and users who sleep in their chairs frequently. For those that are looking for a more portable chair. When compared with a similar, non-reclining chair, a reclining wheelchair tends to weigh more and - unlike other manual models - manual wheelchairs that recline typically aren't foldable. reclining wheelchair compensates mechanically for body positioning by automatically readjusting armrests and lateral supports.

    Recliner wheelchair is low profile allowing to comfortably fit under tables and desks. Enjoy numerous activities with increased comfort such as stretching, napping and watching television. The ability to recline also improves circulation and the ability for sore spots to heal.

    Karma Reclining Wheelchair KM 5000:
    The karma reclining wheelchair km-5000 Transport Wheelchair is an ultra lightweight folding aluminum reclining wheelchair. With full length padded armrests, an adjustable height head pillow, and more this wheelchair has added comfort for any user. This chair also features swing-away elevating footrests and adjustable length leg supports and footplates. With a weight of 33 Lbs this chair can be transported with ease.

    Karma Reclining Wheelchair KM 5000 Features:
    Folding 6061 T-6 Aircraft-grade aluminum frame in black
    powder coat finish
    Backrest Reclines 90°~163° and includes anti-tippers
    Full length padded detachable armrests with side panels
    Swing-away detachable elevating footrests
    Adjustable length leg supports & footplates
    Adjustable-height head pillow
    14" Mag wheels with flat free polyurethane tires
    7" x 1" Flat free front polyurethane casters
    Adjustab
Nathan Goodyear

Licorice reduces serum testosterone in heal... [Steroids. 2004 Oct-Nov] - PubMed - NCBI - 0 views

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    Licorice root extract, also known as glycyrrhizic acid, found to quickly reduce endogenous Testosterone production in women.  The proposed mechanism is via inhibition of 17-hydroxysteroid dehydrogenase and 17-20 Lyase.  This is a good adjuvant in the treatment of PCOS.
Mark Bublitz

What Is Frequency Imprinting? - 0 views

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    What Is Frequency Imprinting? The act of imprinting water, also known as programming water begins with water that has already been structured. (see what is structured water). Once water is structured in it's hexagonal state it will pick up the template of information you are exposing it to. Most will put a substance into the water to do this.
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    What Is Frequency Imprinting? The act of imprinting water, also known as programming water begins with water that has already been structured. (see what is structured water). Once water is structured in it's hexagonal state it will pick up the template of information you are exposing it to. Most will put a substance into the water to do this.
star yu

Son Riñones Self Healing para la Enfermedad Renal Crónica - 0 views

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    Sabes, algunos tejidos del cuerpo humano pueden curarse a sí mismos, por ejemplo, la fibrosis hepática y la cirrosis hepática es las manifestaciones patológicas de la regeneración hepática y reparación Sabes, algunos tejidos del cuerpo humano pueden curarse a sí mismos, por ejemplo, la fibrosis hepática y la cirrosis hepática es las manifestaciones patológicas de la regeneración hepática y reparación.Entonces, para los pacientes con enfermedad renal crónica, son los riñones auto sanación?
wheelchairindia9

Thigh Support - 0 views

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    Thigh Support Applications Mild support to quadriceps and hamstrings. Relieves inflammation and stiffness. Firm compression and therapeutic warmth. Psychological support to geriatric patients. Sports injury, sprains and strains. Post-surgical rehabilitation. Burn care. Thigh Support Features Strong Compression. Four way stretch. Dermophillic. Durable. Breathable and comfortable. Thigh Support Measurements Measure circumference around mid thigh - approximately 6 inches above knee. Size Chart - Size Inches CM Small 14.8 to 17.2 37 to 43 Medium 17.2 to 19.6 43 to 49 Large 19.6 to 22.0 49 to 55
wheelchairindia9

Ankle Support - 0 views

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    Tynor Knee Cap Pair Knee Caps are tubular supports widely used in orthopaedic practice to provide mild compression warmth & support to the limbs and joints, to allay pain and inflammation, generally associated with old age, arthritis, sports injury etc. Hypoallergenic Four way stretch Uniform compression Simple pull on application Tynor Knee Cap (Pair) Features Bilayered , cotton on the inside Dermophillic interpahse with the skin Better sweat absorption Better comfort Better patient compliance. No allergies or rash Bilayered, nylon on the outside Ensures long life Excellent aesthetics Color fastness. Two layers enclose air space retains body heat effectively Provides therapeutic warmth and assuring support to the knee. Four-way stretchable seamless tubular fabric Effective compression Enhanced comfort. No vaso constriction. Adjusts compression even on uneven diameters
wheelchairindia9

Tynor Walker Boot - 0 views

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    Tynor Walker Boot is designed by the Tynor to rehabilitate the person after injury or fracture. It allows easy movement as well as supports the ankle and leg. This can be a great substitute for cast and also useful during early cast removal. It can also be used during sprain in the foot and this walker gives great relief to the pain. It can easily do any mild activity. It also works for the persons with a lower leg and will give an equal level of the lower feet as well as reduces the pressure. It effectively enclosed the muscles of the leg or foot during the fracture and gives comfort without disturbing the recovery process. This walker boot is made up from the good quality material. It has Aluminum lateral bars that are corrosion free. It is light in weight and provides enhanced mobility. It gives sturdy support to feet and leg. Its Hook Loop system allows to adjust it according to the comfort. It is also infused with Foam liner and Pad set that gives soft feet and also provides great support. It is available in different sizes. Tynor Walker Boot Tynor Walker Boot is designed for rehabilitation after injury, fracture , sprains or surgery of foot, ankle or lower leg. The boots provide support to the ankle and leg without inhibiting mobility. They can be a substitute for cast or can be used in case of early cast removal. With a wider rocker bottom, these boots promote a natural gait, reduced plantar pressure, enhanced stability and comfort to the lower leg. Light weight. Sturdy Support. Enhanced mobility. Maintains normal gait. Tynor Walker Boot Features Moulded foot Improves gait Rocker sole-helps in easy ambulation Offers stabilization of the foot ankle and the lower leg Comfortable positioning and protection of the foot Aluminum lateral bars Rigid support-Improved immobilization of the ankle and the lower leg Malleable, shape can be customized for better fitting and support Foam liner and Pad set Ensure extreme comfort Ensure per
wheelchairindia9

PF Night Splint Derotation - 0 views

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    PF Night Splint (Derotation) Applications Prevention and correction of foot drop. Night splint for early healing. Ambulatory, can be used as a day splint. Perfect post-operative immobilisation and derotation. Peroneal / Peritibial nerve or muscle damage. Ankle or Plantar flexion contracture and functional alignment. Can be used to protect the diabetic/ injured ankle & foot. PF Night Splint (Derotation) Features Removable de-rotation bar. Moulded foot casing, aesthetically pleasing and durable. Effective Liner, improved comfort. Highly functional Design, customized degree of dorsiflexion. Double strapping mechanism, better grip.
wheelchairindia9

Functional Knee Support - 0 views

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    Tynor Functional Knee Support Functional knee Support is an anterior opening device, which offers the advantage of controlled compression around the knee and a rigid lateral support and immobilization. It allows normal flexion and free movement of the knee joint. Anterio Open able Easy application Controlled compression. Perfect lateral splinting. Anatomical design. Tynor Functional Knee Support Features Bi axial heavy duty aluminum hinge Mimics the natural knee joint Ensures full weight bearing. Allows free flexion movement Four way stretchable fabric Controlled and comfortable compression No buckling No vaso constriction Enhanced comfort Open patella design Release patellar pressure Hold the patella in position Can be used for Patellofemoral diseases Wrap design with anterior closing Easy application and removal on swollen or asymmetric knees Easy application and removal for weak or geriatric patients. Allows customized compression Offers flexibility in sizing Ergonomic design Anti tourniquet effect - ensures no constriction to blood flow Better grip of the product to the body. Anatomic construction- Better functionality and Snug fit.
Nathan Goodyear

Malnutrition and Clinical Outcomes: The Case for Medical Nutrition Therapy - ScienceDirect - 0 views

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    40-55% of adults hospitalized found to be malnourished or at risk for malnutrition with a whopping 12% severely malnourished.
herbnclay

Calcium Bentonite Clay Benefits - Internal and External Uses - 0 views

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    HERB n' CLAY provides you with 100 percent all natural Calcium Bentonite Clay. Bentonite clay has microscopic layers through which it absorbs the toxins in our bowels. It contains silica with high traces of Calcium. In addition there are more than 50 trace elements in Calcium Bentonite Clay.
herbnclay

Herb n Clay Face Mask - 0 views

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    Calcium Bentonite Clay Rose Mask. Apply it at night and rinse off after 20 mins. Repeat twice a week for best results. Get #herbnclay now--> https://goo.gl/aGm6vG #healingclay #facemask #thanksgiving
trungtamnamkhoa

Learn More About Foreskin Disease - Men's Health Clinic In Viet Nam - 1 views

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    Semi-glans It is a situation in which the boy is still "open his eyes" but is either very difficult or painful or requires the help of slipping from the homeowner. Having opened the eyes is not necessarily good in this case because soon enough the foreskin will form a tightening ring just below, obstructing the healed blood, leading to edema, and when the penis is hard, everything even worse.
Nathan Goodyear

Induction of metastasis, cancer stem cell phenotype, and oncogenic metabolism in cancer... - 0 views

  • More than half of cancer patients are treated with IR at some point during their treatment
  • fractionation schedule is the delivery of 1.8–2.0 Gy per day, five days per week
  • Nuclear DNA is the primary target of IR; it causes DNA damage (genotoxic stress) by direct DNA ionization
  • ...121 more annotations...
  • IR also indirectly induces DNA damage by stimulating reactive oxygen species (ROS) production
  • IR is known to induce EMT in vitro
  • p53 is activated in response to IR-induced DNA damage
  • IR paradoxically also promotes tumour recurrence and metastasis
  • DNA double-strand breaks (DSBs)
  • cancer cells undergoing EMT acquire invasive and metastatic properties
  • changes in the tumour microenvironment (TME)
  • IR seems to induce EMT and CSC phenotypes by regulating cellular metabolism
  • EMT, stemness, and oncogenic metabolism are known to be associated with resistance to radiotherapy and chemotherapy
  • Hanahan and Weinberg proposed ten hallmarks of cancer that alter cell physiology to enhance malignant growth: 1) sustained proliferation, 2) evasion of growth suppression, 3) cell death resistance, 4) replicative immortality, 5) evasion of immune destruction, 6) tumour-promoting inflammation, 7) activation of invasion and metastasis, 8) induction of angiogenesis, 9) genome instability, and 10) alteration of metabolism
  • EMT is a developmental process that plays critical roles in embryogenesis, wound healing, and organ fibrosis
  • IR is known to induce stemness and metabolic alterations in cancer cells
  • transforming growth factor-β [TGF-β], epidermal growth factor [EGF]) and their associated signalling proteins (Wnt, Notch, Hedgehog, nuclear-factor kappa B [NF-κB], extracellular signal-regulated kinase [ERK], and phosphatidylinositol 3-kinase [PI3K]/Akt
  • activate EMT-inducing transcription factors, including Snail/Slug, ZEB1/δEF1, ZEB2/SIP1, Twist1/2, and E12/E47
  • Loss of E-cadherin is considered a hallmark of EMT
  • IR has been shown to induce EMT to enhance the motility and invasiveness of several cancer cells, including those of breast, lung, and liver cancer, and glioma cells
  • IR may increase metastasis in both the primary tumour site and in normal tissues under some circumstance
  • sublethal doses of IR have been shown to enhance the migratory and invasive behaviours of glioma cells
  • ROS are known to play an important role in IR-induced EMT
  • High levels of ROS trigger cell death by causing irreversible damage to cellular components such as proteins, nucleic acids, and lipids, whereas low levels of ROS have been shown to promote tumour progression—including tumour growth, invasion, and metastasis
  • hypoxia-inducible factor-1 (HIF-1) is involved in IR-induced EMT
  • Treatment with the N-acetylcysteine (NAC), a general ROS scavenger, prevents IR-induced EMT, adhesive affinity, and invasion of breast cancer cells
    • Nathan Goodyear
       
      NAC for all patients receiving radiation therapy
  • Snail has been shown to play a crucial role in IR-induced EMT, migration, and invasion
  • IR activates the p38 MAPK pathway, which contributes to the induction of Snail expression to promote EMT and invasion
  • NF-κB signalling that promotes cell migration
  • ROS promote EMT to allow cancer cells to avoid hostile environments
  • HIF-1 is a heterodimer composed of an oxygen-sensitive α subunit and a constitutively expressed β subunit.
  • Under normoxia, HIF-1α is rapidly degraded, whereas hypoxia induces stabilisation and accumulation of HIF-1α
  • levels of HIF-1α mRNA are enhanced by activation of the PI3K/Akt/mammalian target of rapamycin (mTOR)
  • IR is known to increase stabilisation and nuclear accumulation of HIF-1α, since hypoxia is a major condition for HIF-1 activation
  • IR induces vascular damage that causes hypoxia
  • ROS is implicated in IR-induced HIF-1 activation
  • IR causes the reoxygenation of hypoxic cancer cells to increase ROS production, which leads to the stabilisation and nuclear accumulation of HIF-1
  • IR increases glucose availability under reoxygenated conditions that promote HIF-1α translation by activating the Akt/mTOR pathway
  • The stabilised HIF-1α then translocates to the nucleus, dimerizes with HIF-1β, and increases gene expression— including the expression of essential EMT regulators such as Snail—to induce EMT, migration, and invasion
  • TGF-β signalling has been shown to play a crucial role in IR-induced EMT
  • AP-1 transcription factor is involved in IR-induced TGF-β1 expression
  • Wnt/β-catenin signalling is also implicated in IR-induced EMT
  • Notch signalling is known to be involved in IR-induced EMT
  • IR also increases Notch-1 expression [99]. Notch-1 is known to induce EMT by upregulating Snail
  • PAI-1 signalling is also implicated in IR-induced Akt activation that increases Snail levels to induce EMT
  • EGFR activation is known to be associated with IR-induced EMT, cell migration, and invasion by activating two downstream pathways: PI3K/Akt and Raf/MEK/ERK
  • ROS and RNS are also implicated in IR-induced EGFR activation
  • IR has also been shown to activate Hedgehog (Hh) signalling to induce EMT
  • IR has been shown to induce Akt activation through several signalling pathways (EGFR, C-X-C chemokine receptor type 4 [CXCR4]/C-X-C motif chemokine 12 [CXCL12], plasminogen activator inhibitor 1 [PAI-1]) and upstream regulators (Bmi1, PTEN) that promote EMT and invasion
  • CSCs possess a capacity for self-renewal, and they can persistently proliferate to initiate tumours upon serial transplantation, thus enabling them to maintain the whole tumour
  • Conventional cancer treatments kill most cancer cells, but CSCs survive due to their resistance to therapy, eventually leading to tumour relapse and metastasis
  • identification of CSCs, three types of markers are utilised: cell surface molecules, transcription factors, and signalling pathway molecules
  • CSCs express distinct and specific surface markers; commonly used ones are CD24, CD34, CD38, CD44, CD90, CD133, and ALDH
  • Transcription factors, including Oct4, Sox2, Nanog, c-Myc, and Klf4,
  • signalling pathways, including those of TGF-β, Wnt, Hedgehog, Notch, platelet-derived growth factor receptor (PDGFR), and JAK/STAT
  • microRNAs (miRNAs), including let-7, miR-22, miR-34a, miR-128, the miR-200 family, and miR-451
  • Non-CSCs can be reprogrammed to become CSCs by epigenetic and genetic changes
  • EMT-inducing transcription factors, such as Snail, ZEB1, and Twist1, are known to confer CSC properties
  • Signalling pathways involved in EMT, including those of TGF-β, Wnt, and Notch, have been shown to play important roles in inducing the CSC phenotype
  • TGF-β1 not only increases EMT markers (Slug, Twist1, β-catenin, N-cadherin), but also upregulates CSC markers (Oct4, Sox2, Nanog, Klf4) in breast and lung cancer cells
  • some CSC subpopulations arise independently of EMT
  • IR has been shown to induce the CSC phenotype in many cancers, including breast, lung, and prostate cancers, as well as melanoma
  • Genotoxic stress due to IR or chemotherapy promotes a CSC-like phenotype by increasing ROS production
  • IR has been shown to induce reprogramming of differentiated cancer cells into CSCs
  • In prostate cancer patients, radiotherapy increases the CD44+ cell population that exhibit CSC properties
  • IR also induces the re-expression of stem cell regulators, such as Sox2, Oct4, Nanog, and Klf4, to promote stemness in cancer cells
  • EMT-inducing transcription factors and signalling pathways, including Snail, STAT3, Notch signalling, the PI3K/Akt pathway, and the MAPK cascade, have been shown to play important roles in IR-induced CSC properties
  • STAT3 directly binds to the Snail promoter and increases Snail transcription, which induces the EMT and CSC phenotypes, in cisplatin-selected resistant cells
  • Other oncogenic metabolic pathways, including glutamine metabolism, the pentose phosphate pathway (PPP), and synthesis of fatty acids and cholesterol, are also enhanced in many cancers
  • metabolic reprogramming
  • HIF-1α, p53, and c-Myc, are known to contribute to oncogenic metabolism
  • metabolic reprogramming
  • tumour cells exhibit high mitochondrial metabolism as well as aerobic glycolysis
  • occurring within the same tumour
  • CSCs can be highly glycolytic-dependent or oxidative phosphorylation (OXPHOS)-dependen
  • mitochondrial function is crucial for maintaining CSC functionality
  • cancer cells depend on mitochondrial metabolism and increase mitochondrial production of ROS that cause pseudo-hypoxia
  • HIF-1 then enhances glycolysis
  • CAFs have defective mitochondria that lead to the cells exhibiting the Warburg effect; the cells take up glucose, and then secrete lactate to 'feed' adjacent cancer cells
  • lactate transporter, monocarboxylate transporter (MCT)
  • nutrient microenvironment
  • Epithelial cancer cells express MCT1, while CAFs express MCT4. MCT4-positive, hypoxic CAFs secrete lactate by aerobic glycolysis, and MCT1-expressing epithelial cancer cells then uptake and use that lactate as a substrate for the tricarboxylic acid (TCA) cycle
  • MCT4-positive cancer cells depend on glycolysis and then efflux lactate, while MCT1-positive cells uptake lactate and rely on OXPHOS
  • metabolic heterogeneity induces a lactate shuttle between hypoxic/glycolytic cells and oxidative/aerobic tumour cells
  • bulk tumour cells exhibit a glycolytic phenotype, with increased conversion of glucose to lactate (and enhanced lactate efflux through MCT4), CSC subsets depend on oxidative phosphorylation; most of the glucose entering the cells is converted to pyruvate to fuel the TCA cycle and the electron transport chain (ETC), thereby increasing mitochondrial ROS production
  • the major fraction of glucose is directed into the pentose phosphate pathway, to produce redox power through the generation of NADPH and ROS scavengers
  • HIF-1α, p53, and c-Myc, are known to contribute to oncogenic metabolism
  • regulatory molecules involved in EMT and CSCs, including Snail, Dlx-2, HIF-1, STAT3, TGF-β, Wnt, and Akt, are implicated in the metabolic reprogramming of cancer cells
  • HIF-1 induces the expression of glycolytic enzymes, including the glucose transporter GLUT, hexokinase, lactate dehydrogenase (LDH), and MCT, resulting in the glycolytic switch
  • HIF-1 represses the expression of pyruvate dehydrogenase kinase (PDK), which inhibits pyruvate dehydrogenase (PDH), thereby inhibiting mitochondrial activity
  • STAT3 has been implicated in EMT-induced metabolic changes as well
  • TGF-β and Wnt play important roles in the metabolic alteration of cancer cells
  • Akt is also implicated in the glycolytic switch and in promoting cancer cell invasiveness
  • EMT, invasion, metastasis, and stemness
  • pyruvate kinase M2 (PKM2), LDH, and pyruvate carboxylase (PC), are implicated in the induction of the EMT and CSC phenotypes
  • decreased activity of PKM2 is known to promote an overall shift in metabolism to aerobic glycolysis
  • LDH catalyses the bidirectional conversion of lactate to pyruvate
  • High levels of LDHA are positively correlated with the expression of EMT and CSC markers
  • IR has been shown to induce metabolic changes in cancer cells
  • IR enhances glycolysis by upregulating GAPDH (a glycolysis enzyme), and it increases lactate production by activating LDHA, which converts pyruvate to lactate
  • IR enhances glycolysis by upregulating GAPDH (a glycolysis enzyme), and it increases lactate production by activating LDHA, which converts pyruvate to lactate
  • IR also elevates MCT1 expression that exports lactate into the extracellular environment, leading to acidification of the tumour microenvironment
  • IR increases intracellular glucose, glucose 6-phosphate, fructose, and products of pyruvate (lactate and alanine), suggesting a role for IR in the upregulation of cytosolic aerobic glycolysis
  • Lactate can activate latent TGF-
  • lactate stimulates cell migration and enhances secretion of hyaluronan from CAF that promote tumour metastasis
  • promote tumour survival, growth, invasion, and metastasis; enhance the stiffness of the ECM; contribute to angiogenesis; and induce inflammation by releasing several growth factors and cytokines (TGF-β, VEGF, hepatocyte growth factor [HGF], PDGF, and stromal cell-derived factor 1 [SDF1]), as well as MMP
  • tumours recruit the host tissue’s blood vessel network to perform four mechanisms: angiogenesis (formation of new vessels), vasculogenesis (de novo formation of blood vessels from endothelial precursor cells), co-option, and modification of existing vessels within tissues.
  • immunosuppressive cells such as tumour-associated macrophages (TAM), MDSCs, and regulatory T cells, and the immunosuppressive cytokines, TGF-β and interleukin-10 (IL-10)
  • immunosuppressive cells such as tumour-associated macrophages (TAM), MDSCs, and regulatory T cells, and the immunosuppressive cytokines, TGF-β and interleukin-10 (IL-10)
  • intrinsic immunogenicity or induce tolerance
  • cancer immunoediting’
  • three phases: 1) elimination, 2) equilibrium, and 3) escape.
  • The third phase, tumour escape, is mediated by antigen loss, immunosuppressive cells (TAM, MDSCs, and regulatory T cells), and immunosuppressive cytokines (TGF-β and IL-10).
  • IR can elicit various changes in the TME, such as CAF activity-mediated ECM remodelling and fibrosis, cycling hypoxia, and an inflammatory response
  • IR activates CAFs to promote the release of growth factors and ECM modulators, including TGF-β and MMP
  • TGF-β directly influences tumour cells and CAFs, promotes tumour immune escape, and activates HIF-1 signalling
    • Nathan Goodyear
       
      And now the receipts
  • MMPs degrade ECM that facilitates angiogenesis, tumour cell invasion, and metastasis
    • Nathan Goodyear
       
      Receipts and mechanisms
  • IR also promotes MMP-2/9 activation in cancer cells to promote EMT, invasion, and metastasis
  • IR-induced Snail increases MMP-2 expression to promote EMT
  • Radiotherapy has the paradoxical side-effect of increasing tumour aggressiveness
  • IR promotes ROS production in cancer cells, which may induce the activation of oncogenes and the inactivation of tumour suppressors, which further promote oncogenic metabolism
  • Metabolic alterations
  • oncogenic metabolism
  • elicit various changes in the TME
  • Although IR activates an antitumour immune response, this signalling is frequently suppressed by tumour escape mechanisms
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    Important review article.
indian-health

ভেন্ট্রিকুলার সেপ্টাল ডিফেক্ট সার্জারি ভারতে হার্ট নিরাময় - 0 views

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    ভারতে ভেন্ট্রিকুলার সেপ্টাল ডিফেক্ট সার্জারির খরচ বিশ্বের অন্যতম সস্তা। প্রতি বছর হাজার হাজার রোগী ভেন্ট্রিকুলার সেপ্টাল ডিফেক্ট সার্জারির জন্য ভারতে যান। ব্লগ পড়ুন https://bit.ly/3nKboCh
indian-health

Chirurgie de communication interventriculaire guérissant les cœurs en Inde - 0 views

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    Le coût de la chirurgie de la communication interventriculaire en Inde est l'un des moins chers au monde. Chaque année, des milliers de patients se rendent en Inde pour une chirurgie de communication interventriculaire en Inde. Lire le blog https://bit.ly/3lBRlEs
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