<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2011-7582</journal-id>
<journal-title><![CDATA[Revista Colombiana de Cirugía]]></journal-title>
<abbrev-journal-title><![CDATA[rev. colomb. cir.]]></abbrev-journal-title>
<issn>2011-7582</issn>
<publisher>
<publisher-name><![CDATA[Asociación Colombiana de Cirugía]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2011-75822020000300391</article-id>
<article-id pub-id-type="doi">10.30944/20117582.121</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Descripción de las características clínicas y la respuesta a tratamiento en pacientes con miastenia grave sin timoma sometidos a timectomía en una institución de alta complejidad de Cali, Colombia, 2010-2017]]></article-title>
<article-title xml:lang="en"><![CDATA[Description of the clinical characteristics and response to treatment in patients with myasthenia gravis without thymoma undergoing thymectomy in a tertiary level care institution in Cali, Colombia, 2010-2017]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[PadiNa-Londoño]]></surname>
<given-names><![CDATA[Natalia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Martínez-Ruiz]]></surname>
<given-names><![CDATA[Diana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Sánchez]]></surname>
<given-names><![CDATA[Álvaro J.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Velásquez]]></surname>
<given-names><![CDATA[Mauricio]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad Icesi Facultad de Ciencias de la Salud Departamento de Medicina]]></institution>
<addr-line><![CDATA[Cali ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Fundación Valle del Lili  ]]></institution>
<addr-line><![CDATA[Cali ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Fundación Valle del Lili Departamento de Cirugía de Tórax ]]></institution>
<addr-line><![CDATA[Cali ]]></addr-line>
<country>Colombia</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>09</month>
<year>2020</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>09</month>
<year>2020</year>
</pub-date>
<volume>35</volume>
<numero>3</numero>
<fpage>391</fpage>
<lpage>397</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_arttext&amp;pid=S2011-75822020000300391&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_abstract&amp;pid=S2011-75822020000300391&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_pdf&amp;pid=S2011-75822020000300391&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Introducción.  La miastenia grave es una enfermedad autoinmunitaria con una prevalência mundial de 150 a 250 casos por 1'000.000 de habitantes. El tratamiento recomendado para la miastenia grave sin timoma es la timectomía total, la cual es la única alternativa de curación.  Métodos.  Se llevó a cabo un estudio descriptivo y retrospectivo de una serie de casos de pacientes adultos con miastenia grave sin timoma sometidos a timectomía, durante el periodo de 2010 a 2017. En el análisis estadístico descriptivo, se utilizaron frecuencias absolutas y porcentajes para las variables cualitativas y, para las variables cuantitativas, se utilizaron la mediana y el rango intercuartílico.  Resultados.  Veintiocho pacientes con miastenia grave sin timoma se sometieron a timectomía desde el año 2oio hasta el 2017. Se categorizaron según la clasificación del estado posterior a la intervención de la Myasthenia Gravis Foundation of America y se evidenció que 4 (14,3 %) pacientes presentaban remisión completa y el grado 3 de manifestaciones clínicas mínimas fue el más frecuente en 19 (67,9 %); 26 (92,9 %) tuvieron mejoría con respecto al cambio del estado clínico, en 2 (7,1 %) no se documentaron cambios y en ningún paciente hubo empeoramiento, exacerbación o muerte secundaria a la enfermedad.  Conclusiones.  A lo largo de siete años se practicó timectomía a 28 pacientes con diagnóstico de miastenia grave sin timoma, aproximadamente, en el 15 % de los pacientes hubo remisión completa, el grado 3 de manifestaciones mínimas fue el más frecuente y el 93 % presentó mejoría de su estatus clínico.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction:  Myasthenia gravis is an autoimmune disease with a worldwide prevalence of 150 to 250 cases per 1,000,000 inhabitants. The recommended treatment for myasthenia gravis without thymoma is total thymectomy, which is the only cure alternative.  Methods:  A descriptive and retrospective study of a series of cases of adult patients with myasthenia gravis without thymoma undergoing thymectomy was conducted during the period from 2010 to 2017. In the descriptive statistical analysis, absolute frequencies and percentages were used for the qualitative variables, and for the quantitative variables the median and the interquartile range were used.  Results:  Twenty-eight patients with myasthenia gravis without thymoma underwent thymectomy from 2010 to 2017. They were categorized according to the Myasthenia Gravis Foundation of America post-intervention status classification, and it was found that four (14,3 %) patients had complete remission, and grade 3 of minimal clinical manifestations was the most frequent in 19 (67,9 %); 26 (92,9 %) had improvement with respect to the change of the clinical state, in two (7,1 %) no changes were documented and in no patient there was worsening, exacerbation or death secondary to the disease.  Conclusion:  Over seven years, 28 patients diagnosed with myasthenia gravis without thymoma underwent thymectomy. Approximately in 15 % of patients achieve complete remission, grade 3 of minimal manifestations was the most frequent and 93 % presented improvement in their clinical status.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[miastenia gravis]]></kwd>
<kwd lng="es"><![CDATA[timo]]></kwd>
<kwd lng="es"><![CDATA[timectomía]]></kwd>
<kwd lng="es"><![CDATA[cirugía torácica]]></kwd>
<kwd lng="es"><![CDATA[resultado del tratamiento]]></kwd>
<kwd lng="en"><![CDATA[myasthenia gravis]]></kwd>
<kwd lng="en"><![CDATA[thymus gland]]></kwd>
<kwd lng="en"><![CDATA[thymectomy]]></kwd>
<kwd lng="en"><![CDATA[thoracic surgery]]></kwd>
<kwd lng="en"><![CDATA[treatment outcome]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Gilhus]]></surname>
<given-names><![CDATA[NE]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Myasthenia gravis]]></article-title>
<source><![CDATA[N Engl J Med]]></source>
<year>2016</year>
<numero>375</numero>
<issue>375</issue>
<page-range>2570-81</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Drachman]]></surname>
<given-names><![CDATA[DB]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Miastenia grave y otras enfermedades de la unión neuromuscular]]></article-title>
<person-group person-group-type="editor">
<name>
<surname><![CDATA[Serrano]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Merediz]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Sánchez]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
</person-group>
<source><![CDATA[Principios de Medicina Interna]]></source>
<year>2012</year>
<edition>18</edition>
<page-range>3480-6</page-range><publisher-loc><![CDATA[Ciudad de México ]]></publisher-loc>
<publisher-name><![CDATA[McGraw-Hill Education]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Tapias-Vargas]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Tapias-Vargas]]></surname>
<given-names><![CDATA[LF]]></given-names>
</name>
<name>
<surname><![CDATA[Tapias]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Miastenia gravis y el timo: pasado, presente y futuro]]></article-title>
<source><![CDATA[Rev Colomb Cir]]></source>
<year>2011</year>
<numero>24</numero>
<issue>24</issue>
<page-range>269-82</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Sánchez]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Uribe]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Franco]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Jiménez]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Arcos-Burgos]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Palacio]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Prevalencia de la miastenia grave en Antioquia, Colombia]]></article-title>
<source><![CDATA[Rev Neurol]]></source>
<year>2002</year>
<numero>34</numero>
<issue>34</issue>
<page-range>1010-2</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Nieto]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Robledo]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Pajuelo]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Montes]]></surname>
<given-names><![CDATA[JAR]]></given-names>
</name>
<name>
<surname><![CDATA[Girón]]></surname>
<given-names><![CDATA[JG]]></given-names>
</name>
<name>
<surname><![CDATA[Alonso]]></surname>
<given-names><![CDATA[JG]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Prognostic factors for myasthenia gravis treated by thymectomy: Review of 61 cases]]></article-title>
<source><![CDATA[Ann Thorac Surg]]></source>
<year>1999</year>
<numero>67</numero>
<issue>67</issue>
<page-range>1568-71</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Werneck]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Cunha]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Scola]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Myasthenia gravis: A retrospective study comparing thymectomy to conservative treatment]]></article-title>
<source><![CDATA[Acta Neurol Scand]]></source>
<year>2000</year>
<numero>101</numero>
<issue>101</issue>
<page-range>41-6</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Jaretzki]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Steinglass]]></surname>
<given-names><![CDATA[KM]]></given-names>
</name>
<name>
<surname><![CDATA[Sonett]]></surname>
<given-names><![CDATA[JR]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Thymectomy in the management of myasthenia gravis]]></article-title>
<source><![CDATA[Semin Neurol]]></source>
<year>2004</year>
<numero>24</numero>
<issue>24</issue>
<page-range>49-59</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kaufman]]></surname>
<given-names><![CDATA[AJ]]></given-names>
</name>
<name>
<surname><![CDATA[Palatt]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Sivak]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Raimondi]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Lee]]></surname>
<given-names><![CDATA[DS]]></given-names>
</name>
<name>
<surname><![CDATA[Wolf]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Thymectomy for myasthenia gravis: Complete stable remission and associated prognostic factors in over 1000 cases]]></article-title>
<source><![CDATA[Semin Thorac Cardiovasc Surg]]></source>
<year>2016</year>
<numero>28</numero>
<issue>28</issue>
<page-range>561-8</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Jaretzki]]></surname>
<given-names><![CDATA[AI]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Thymectomy for myasthenia gravis: Analysis of controversies - Patient management]]></article-title>
<source><![CDATA[Neurologist]]></source>
<year>2003</year>
<numero>9</numero>
<issue>9</issue>
<page-range>77-92</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Jaretzki]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Barohn]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Ernstoff]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Kaminski]]></surname>
<given-names><![CDATA[HJ]]></given-names>
</name>
<name>
<surname><![CDATA[Keesey]]></surname>
<given-names><![CDATA[JC]]></given-names>
</name>
<name>
<surname><![CDATA[Penn]]></surname>
<given-names><![CDATA[AS]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Myasthenia gravis: Recommendations for clinical research standards]]></article-title>
<source><![CDATA[Neurology]]></source>
<year>2000</year>
<numero>55</numero>
<issue>55</issue>
<page-range>16-23</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Luo]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Pan]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Chen]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Zhu]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Wang]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Zhang]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Effectiveness of thymectomy in non-thymomatous myasthenia gravis: A systematic review]]></article-title>
<source><![CDATA[J Huazhong Univ Sci Technol Med Sci]]></source>
<year>2014</year>
<numero>34</numero>
<issue>34</issue>
<page-range>942-9</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bachmann]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Burkhardt]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Schreiter]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Kaifi]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Schurr]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Busch]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Thymectomy is more effective than conservative treatment for myasthenia gravis regarding outcome and clinical improvement]]></article-title>
<source><![CDATA[Surgery]]></source>
<year>2009</year>
<numero>145</numero>
<issue>145</issue>
<page-range>392-8</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Papatestas]]></surname>
<given-names><![CDATA[AE]]></given-names>
</name>
<name>
<surname><![CDATA[Genkins]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Kornfeld]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Eisenkraft]]></surname>
<given-names><![CDATA[JB]]></given-names>
</name>
<name>
<surname><![CDATA[Fagerstrom]]></surname>
<given-names><![CDATA[RP]]></given-names>
</name>
<name>
<surname><![CDATA[Pozner]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Effects of thymectomy in myasthenia gravis]]></article-title>
<source><![CDATA[Ann Surg]]></source>
<year>1987</year>
<numero>206</numero>
<issue>206</issue>
<page-range>79-88</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[De]]></surname>
<given-names><![CDATA[Perrot M]]></given-names>
</name>
<name>
<surname><![CDATA[Licker]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Spiliopoulos]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Factors influencing improvement and remission rates after thymectomy for myasthenia gravis]]></article-title>
<source><![CDATA[Respiration]]></source>
<year>2001</year>
<numero>68</numero>
<issue>68</issue>
<page-range>601-5</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[El-Medany]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Hajjar]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
<name>
<surname><![CDATA[Essa]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Al-Kattan]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Hariri]]></surname>
<given-names><![CDATA[Z]]></given-names>
</name>
<name>
<surname><![CDATA[Ashour]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Predictors of outcome for myasthenia gravis after thymectomy]]></article-title>
<source><![CDATA[Asian Cardiovasc Thorac Ann]]></source>
<year>2003</year>
<numero>11</numero>
<issue>11</issue>
<page-range>323-7</page-range></nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Venuta]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Rendina]]></surname>
<given-names><![CDATA[EA]]></given-names>
</name>
<name>
<surname><![CDATA[Giacomo]]></surname>
<given-names><![CDATA[TD]]></given-names>
</name>
<name>
<surname><![CDATA[Rocca]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Antonini]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Ciccone]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Thymectomy for myasthenia gravis: A 27-year experience 1]]></article-title>
<source><![CDATA[Eur J Cardio-thoracic Surg]]></source>
<year>1999</year>
<numero>15</numero>
<issue>15</issue>
<page-range>621-5</page-range></nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Barboi]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Amato]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Shaibani]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Katirji]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Lecky]]></surname>
<given-names><![CDATA[BRF]]></given-names>
</name>
<name>
<surname><![CDATA[Buckley]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Randomized trial of thymectomy in myasthenia gravis]]></article-title>
<source><![CDATA[N Engl J Med]]></source>
<year>2016</year>
<numero>375</numero>
<issue>375</issue>
<page-range>511-22</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
