Side Effects of imipenem: A Synthesis of Findings from 28 Studies

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Original Abstract of the Article

Main Research Findings

Imipenem is a carbapenem antibiotic that is effective against a wide range of bacteria. However, it can also cause side effects, such as seizures, blood abnormalities, and neurotoxicity. 26 found that imipenem can cause seizures by interacting with GABA receptors. 28 found that imipenem is effective in treating respiratory infections. 16 found that imipenem can cause a decrease in white blood cells and platelets. 20 found that imipenem is effective in treating meningitis. 25 found that imipenem is effective in treating febrile neutropenia. 21 found that imipenem is effective in treating nocardiosis. 19 found that imipenem is effective in treating infections caused by resistant bacteria. 23 found that imipenem is effective in treating Clostridium difficile infection. 17 found that imipenem is effective in treating severe pancreatitis. 1 found that imipenem can cause neurotoxicity, especially in patients with kidney disease. 14 found that imipenem is effective in treating diabetic foot infections. 10 found that there is a lack of safety data for imipenem in children. 13 found that imipenem is effective in treating nocardiosis. 11 found that imipenem can cause seizures, even in patients without prior CNS disorder. 3 found that imipenem is effective in treating complicated urinary tract infections. 18 found that imipenem is effective in treating diabetic foot infections caused by multidrug-resistant Pseudomonas aeruginosa. 27 found that imipenem is effective in treating mixed infections. 24 found that imipenem can cause seizures in pediatric cancer patients. 12 found that there is a lack of safety data for imipenem in neonates. 7 found that imipenem is effective in treating multidrug-resistant tuberculosis. 15 found that increasing the dose of imipenem can prevent the emergence of resistant bacteria. found that imipenem can affect liver function in pediatric patients. 6 found that imipenem can cause side effects. 9 found that imipenem is effective in treating febrile neutropenia in patients who have received hematopoietic stem cell transplantation. 8 found that imipenem can cause psychosis. 22 found that imipenem can cause seizures.

Reasons for Side Effects

The reasons why imipenem causes side effects are not fully understood. 26 shows that imipenem interacts with GABA receptors. GABA receptors play a role in inhibiting nerve activity by blocking the action of the neurotransmitter GABA. Imipenem may interact with GABA receptors, leading to excessive nerve activity and causing convulsions. 1 shows that imipenem can cause neurotoxicity in patients with kidney disease. This is thought to be because imipenem is excreted by the kidneys, and in patients with kidney disease, the concentration of imipenem in the body may increase and cause neurotoxicity. 8 shows that imipenem can cause psychosis. This is thought to be due to the fact that imipenem disrupts the balance of neurotransmitters in the brain.

Common Side Effects

Seizures

Imipenem can interact with GABA receptors and cause seizures. 26 found seizures in rats given imipenem. In addition, 24 shows that imipenem can cause seizures in pediatric cancer patients. 11 shows that imipenem can cause seizures in patients without prior CNS disorder. 12 found that imipenem can cause seizures in infants.

Blood Abnormalities

Imipenem can reduce the number of white blood cells and platelets in the blood. 16 showed a decrease in white blood cells and platelets in a 4-year-old child who was given imipenem.

Liver Dysfunction

Imipenem can cause liver dysfunction. shows that imipenem can affect liver function in pediatric patients.

Neurotoxicity

Imipenem can cause neurotoxicity. 1 shows that imipenem can cause neurotoxicity in patients with kidney disease.

Psychosis

Imipenem can cause psychosis. 8 reported a case in which imipenem caused psychosis.

Countermeasures for Side Effects

Seizures

If you have seizures due to imipenem, you should receive appropriate treatment, such as anticonvulsant drugs, under the guidance of a doctor.

Blood Abnormalities

If you have blood abnormalities due to imipenem, you should receive appropriate treatment, such as blood transfusion, under the guidance of a doctor.

Liver Dysfunction

If you have liver dysfunction due to imipenem, you should receive appropriate treatment to improve liver function under the guidance of a doctor.

Neurotoxicity

If you have neurotoxicity due to imipenem, you should receive appropriate treatment under the guidance of a doctor.

Psychosis

If you have psychosis due to imipenem, you should receive appropriate treatment under the guidance of a doctor.

Comparison between Studies

Common Points of Studies

These studies suggest that imipenem is effective in the treatment of bacterial infections. They also suggest that imipenem can cause side effects.

Differences between Studies

These studies suggest that the severity and type of side effects of imipenem may vary depending on the patient. 26 shows that imipenem interacts with GABA receptors. 16 shows that imipenem reduces the number of white blood cells and platelets in the blood. 1 shows that imipenem can cause neurotoxicity in patients with kidney disease. 8 shows that imipenem can cause psychosis. These studies suggest that the side effects of imipenem may vary from patient to patient.

Cautions for Applying the Research Results to Real Life

Imipenem is an effective drug for the treatment of bacterial infections, but it can cause side effects. If you are taking imipenem, it is important to consult your doctor and take it as directed. In particular, patients with kidney or liver disease, the elderly, and pregnant or breastfeeding women should consult their doctor before taking imipenem.

Limitations of Current Research

There is still insufficient research on the side effects of imipenem. In particular, there is a lack of safety data on imipenem in children and neonates. There is also a lack of research on the long-term effects of imipenem.

Future Research Directions

Further research on the side effects of imipenem is needed. In particular, research on the safety of imipenem in children and neonates, research on the long-term effects of imipenem is needed. The development of new treatments to reduce the side effects of imipenem is also needed.

Conclusion

Imipenem is an effective drug for the treatment of bacterial infections, but it can cause side effects. If you are taking imipenem, it is important to consult your doctor and take it as directed. Further research is needed on the side effects of imipenem, and the development of new treatments to reduce the side effects of imipenem is also needed.

Literature analysis of 28 papers
Positive Content
19
Neutral Content
3
Negative Content
6
Article Type
3
1
1
4
28
1.

Ertapenem-induced neurotoxicity in an end-stage renal disease patient on intermittent haemodialysis: a case report.

Author: ShaharShamira, ArimuthuDurga A, MazlanSadanah Aqashiah

Neurotoxicity

Carbapenem-induced neurotoxicity is an unusual side effect, with seizure being the most common symptom. Imipenem-cilastin is associated with the most severe neurotoxicity, and dose adjustment is necessary for patients with chronic kidney disease (CKD). Ertapenem-associated neurotoxicity is increasingly reported in CKD patients, but it is less common with recommended dose adjustments.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

2.

Safety profile of carbapenems: Data mining of the FDA adverse events reporting system.

Author: GeWei, HuHaixia, LiChen, WangLing, XiaJielai

Carbapenem use
Drug ineffective

Carbapenems are associated with serious and fatal adverse drug events. Infections and infestations were the strongest signals detected in meropenem and imipenem.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

3.

Carbapenems vs alternative antibiotics for the treatment of complicated urinary tract infection: A systematic review and network meta-analysis.

Author: TanXinmei, PanQiwen, MoChanggan, LiXianshu, LiangXueyan, LiYan, LanYingnian, ChenLingyuan

cUTI treatment

This study focuses on complicated urinary tract infections (cUTIs) and explores the use of carbapenem antibiotics. Due to limited randomized controlled trials, a network meta-analysis was used to compare different carbapenem antibiotics for cUTI, aiming to inform optimal treatment choices.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

5.

Therapeutic drug monitoring of imipenem and the incidence of toxicity and failure in hospitalized patients: a retrospective cohort study.

Author: BricheuxA, LenggenhagerL, HughesS, KarmimeA, LescuyerP, HuttnerA

Antibiotic treatment
Drug resistance

Therapeutic drug monitoring (TDM) of beta-lactam antibiotics is becoming more common.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

6.

Signal Detection of Imipenem Compared to Other Drugs from Korea Adverse Event Reporting System Database.

Author: ParkKyounghoon, SoukavongMick, KimJungmee, KwonKyoung Eun, JinXue Mei, LeeJoongyub, YangBo Ram, ParkByung Joo

Cardiac arrest
Cardiac failure
Hypokalemia
Myocardial infarction
Parkinson's syndrome
Prostate enlargement

This data mining study using the Korea Institute of Drug Safety & Risk Management-Korea adverse event reporting system database found new signals that were not listed on the drug labels of nine countries.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

7.

Effectiveness and safety of imipenem/clavulanate and linezolid to treat multidrug and extensively drug-resistant tuberculosis at a referral hospital in Brazil.

Author: ArbexM A, BoniniE H, Kawakame PirollaG, D'AmbrosioL, CentisR, MiglioriG B

Tuberculosis treatment

This observational study evaluated the use of imipenem/clavulanate (IC) and linezolid in treating multidrug-resistant (MDR-) and extensively drug-resistant tuberculosis (XDR-TB). The study found that both IC and linezolid were effective in treating these severe forms of TB, with good tolerability and few side effects.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Observational StudyResearch that observes and collects data on participants' behavior and outcomes in their natural state, without intervention.

Language : English

8.

Imipenem-cilastatin-induced psychosis: a case report.

Author: NinanJacob, GeorgeGemy Maria

Psychiatric side effects
Psychosis

This case report describes a patient who developed psychiatric side effects from imipenem-cilastatin, an antibiotic. This report highlights the potential for psychiatric adverse effects from antibiotics, particularly in elderly patients.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

9.

Piperacillin-tazobactam vs. imipenem-cilastatin as empirical therapy in hematopoietic stem cell transplantation recipients with febrile neutropenia.

Author: JingYu, LiJian, YuanLei, ZhaoXiaoli, WangQuanshun, YuLi, ZhouDaobin, HuangWenrong

Antibiotic efficacy
Febrile neutropenia treatment
Gastrointestinal side effects

This study compared the effectiveness and safety of piperacillin-tazobactam (PTZ) and imipenem-cilastatin (IMP) for treating febrile neutropenia in patients who have had hematopoietic stem cell transplantation (HSCT). IMP was more effective than PTZ but had more gastrointestinal side effects.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

10.

Pediatric post-marketing safety systems in North America: assessment of the current status.

Author: McMahonAnn W, WhartonGerold T, BonnelRenan, DeCelleMary, SwankKimberley, TestoniDaniela, CopeJudith U, SmithPhillip Brian, WuEileen, MurphyMary Dianne

Pediatric safety

The Food and Drug Administration has identified several post-marketing safety systems for pediatric drugs. These systems should include enough clinical and epidemiological detail to draw regulatory, public health, and clinical conclusions.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

11.

Ertapenem-associated seizures in a patient without prior CNS disorder or severe renal dysfunction.

Author: SoštaricNejc, BeovicBojana, MaticicMojca

New onset epilepsy
Seizures

A case report of a female patient with no prior central nervous disorder who developed seizures after 3 days of ertapenem therapy is presented. The dose of ertapenem was halved according to the calculated creatinine clearance in the first 2 days. Seizures stopped after the discontinuation of ertapenem and anti-epileptic prophylaxis with levetiracetam. This is the first report of ertapenem-related seizures in a patient with normal CNS function and the dose of ertapenem that was appropriate for her renal function.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

12.

Adverse events associated with meropenem versus imipenem/cilastatin therapy in a large retrospective cohort of hospitalized infants.

Author: HornikChristoph P, HerringAmy H, BenjaminDaniel K, CapparelliEdmund V, KearnsGregory L, van den AnkerJohn, Cohen-WolkowiezMichael, ClarkReese H, SmithP Brian,

Reduced mortality
Reduced seizure risk
Adverse events

Meropenem was associated with more frequent but less severe adverse events in hospitalized infants compared to imipenem/cilastatin.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

13.

Nocardia beijingensis pulmonary infection successfully treated with intravenous beta-lactam antibiotics and oral minocycline.

Author: OgawaTaku, KasaharaKei, YonekawaShinsuke, NakagawaChiyo, MaedaKoichi, KonishiMitsuru, MikasaKeiichi, KikuchiKen

Pulmonary infection treatment

This case report describes a patient who developed pulmonary infection caused by Nocardia beijingensis, a rare species, following renal transplantation. The patient was successfully treated with antibiotics other than trimethoprim-sulfamethoxazole (SXT), highlighting the potential for alternative therapies in Nocardia infections.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

14.

Piperacillin/tazobactam versus imipenem/cilastatin for severe diabetic foot infections: a prospective, randomized clinical trial in a university hospital.

Author: SaltogluN, DalkiranA, TetikerT, BayramH, TasovaY, DalayC, SertM

Diabetic Foot Infection Treatment
Amputation

Piperacillin/tazobactam showed a better clinical response rate than imipenem/cilastatin in treating severe diabetic foot infections, although the sample size was small and results did not reach statistical significance.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

16.

Linezolid-induced reversible bicytopenia in a 4-year-old boy with methicillin-resistant Staphylococcus aureus bacteremia.

Author: TavilBetul, BalciYasemin Isik, YildirimInci, TavilYusuf, SecmeerGulten, CeyhanMehmet, TuncerMurat

MRSA treatment
Cytopenia

Linezolid, an antibiotic, can induce cytopenias in children. A 4-year-old patient developed bicytopenia after 5 weeks of linezolid treatment. Hemoglobin and platelet counts recovered following cessation of linezolid therapy.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

17.

Early treatment of severe pancreatitis with imipenem: a prospective randomized clinical trial.

Author: RøkkeOla, HarbitzThorstein Bache, LiljedalJermund, PettersenTorkel, FetvedtTorunn, HeenLeif Øystein, SkredenKnut, VisteAsgaut

Severe pancreatitis treatment
Fungal infections
Resistant microbes

This study investigates the effectiveness of prophylactic imipenem treatment for severe pancreatitis. Patients with severe pancreatitis were randomized to receive either imipenem or no treatment. The study aimed to compare the rates of infectious complications, interventions, ICU days, morbidity, and mortality between the two groups.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

18.

Clinical and microbiological efficacy of colistin therapy alone or in combination as treatment for multidrug resistant Pseudomonas aeruginosa diabetic foot infections with or without osteomyelitis.

Author: TasciniC, GemignaniG, PalumboF, LeonildiA, TedeschiA, LambeletP, LucariniA, PiaggesiA, MenichettiF

Promote healing
Treat MDR P. aeruginosa
Acute renal failure
Pulmonary edema

This study retrospectively evaluated the safety and effectiveness of colistin in treating diabetic foot infections caused by multidrug-resistant Pseudomonas aeruginosa. Colistin demonstrated effectiveness in a multidisciplinary approach, but serious adverse events were observed in one patient.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

20.

Treatment of nosocomial meningitis due to a multidrug resistant Acinetobacter baumannii with intraventricular colistin.

Author: BukharyZakeya, MahmoodWafeeq, Al-KhaniAhmed, Al-AbdelyHail M

Meningitis treatment
Side effects

A 23-year-old woman developed serious nosocomial meningitis due to multidrug-resistant Acinetobacter baumannii after a posterior fossa craniotomy. The patient was unresponsive to high doses of imipenem, ciprofloxacin, and systemic colistin but responded well to intraventricular injections of colistin for 3 weeks. This case highlights the challenges of treating multidrug-resistant Acinetobacter baumannii meningitis and the potential benefits of intraventricular colistin administration.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

21.

Secular trends of nocardia infection over 15 years in a tertiary care hospital.

Author: MatulionyteR, RohnerP, UçkayI, LewD, GarbinoJ

Effective treatment
Delayed diagnosis
Side effects

Nocardia infection mainly affects immunocompromised patients and can be severe. Early diagnosis is crucial for better outcomes.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

22.

[Drug-induced seizures].

Author: ReutherLene Ørskov, PedersenSteffen Thirstrup, RønnAnita Mandrup

Epileptic seizures

This study examined the occurrence of drug-induced seizures, noting that they are relatively rare but may be increased by certain medications.

English AbstractA summary of a research paper/publication written in English for a wider audience.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : Danish

23.

Antimicrobial susceptibility of Clostridium difficile by E test.

Author: ChengS H, ChuF Y, LoS H, LuJ J

Effective treatment for C. difficile infection
Resistance to antibiotics

Metronidazole, teicoplanin, and vancomycin were very active against 44 clinical isolates of Clostridium difficile.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

24.

Incidence of seizures in pediatric cancer patients treated with imipenem/cilastatin.

Author: KaradenizC, OğuzA, CanterB, SerdaroğluA

Convulsions

This study investigated the incidence rate of convulsions associated with imipenem/cilastatin in children with systemic malignancies. 3.6% of patients experienced seizures, suggesting a potential risk in this population.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

25.

Efficacy of continuous infusion of ceftazidime for patients with neutropenic fever after high-dose chemotherapy and peripheral blood stem cell transplantation.

Author: EgererG, GoldschmidtH, SalwenderH, HegenbartU, EhrhardI, HaasR, HoA D

Cost reduction
Neutropenia treatment
Outpatient treatment

Continuous infusion of ceftazidime was safe and effective in managing fever in neutropenic patients after high-dose chemotherapy and peripheral blood stem cell transplantation, allowing for outpatient treatment in most cases and reducing hospital costs.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

26.

Low convulsive activity of a new carbapenem antibiotic, DK-35C, as compared with existing congeners.

Author: JinC, JungI, KuH J, YookJ, KimD H, KimM, ChoJ H, OhC H

Antibiotic treatment
Convulsive side effects

DK-35C, a new carbapenem antibiotic, has a weaker convulsive activity compared to other carbapenems and cephalosporins, suggesting a lower risk of convulsive side effects.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

27.

The role of beta-lactam/beta-lactamase inhibitors in the management of mixed infections.

Author: AkalinH E

Broad spectrum activity
Cost-effective
None mentioned

Sulbactam-ampicillin is a broad-spectrum antibiotic that is effective as monotherapy for the empiric management of polymicrobial infections. It has comparable efficacy to other treatments and is cost-beneficial.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

28.

[Imipenem/cilastatin sodium and other beta-lactams for respiratory tract infections: clinical benefit and treatment days for cure].

Author: OizumiK, RikimaruT, ShiraishiT, MotohiroA, YoshidaM, WatanabeK, MaruyamaR, IshibashiT, KitaharaY, KidoM, YoshiiC, HaraN, IkedaA, YamadaH, NinomiyaK, MatsuzakiY, IchinoseY, NambaK, KodamaT, KunitakeR, MiyazakiN, AbeK, MatsunagaR, IdeH, KamaeI

Effective for pulmonary infections
Shorter treatment duration
Laboratory abnormalities
Side effects

IPM/CS therapy significantly reduced the number of treatment days until cure for respiratory tract infections. No significant differences were observed between the groups with respect to parameters indicating side effects and laboratory abnormalities.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Controlled Clinical TrialA clinical trial that evaluates the effectiveness of a treatment by comparing a group that receives the intervention with a group that receives a placebo or standard treatment.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.

Language : Japanese

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