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Fetal
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[
1
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On
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[
4
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.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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I
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874
Fu
r
th
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m
o
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,
C
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is
a
s
s
o
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with
ab
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o
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m
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b
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d
ev
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m
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[
5
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.
Fetal
cir
cu
l
ato
r
y
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is
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d
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s
ca
n
d
ir
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ter
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ailab
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ai
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[
6
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T
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s
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f
n
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m
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th
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o
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n
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e
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e
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ce
o
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ater
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al
Do
p
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ler
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alies,
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d
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ir
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eig
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Ad
v
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n
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s
in
p
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s
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atal
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r
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h
a
v
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d
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m
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s
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r
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[
7
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4
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e
n
p
er
y
ea
r
w
o
r
ld
wid
e
,
1
0
0
0
liv
e
b
ir
th
s
,
in
clu
d
in
g
I
n
d
o
n
esia.
Ab
o
u
t 3
0
0
,
0
0
0
o
f
th
ese
ca
s
es a
r
e
class
if
ied
a
s
s
ev
er
e
co
n
g
en
ital h
ea
r
t d
is
ea
s
e
th
at
u
s
u
ally
r
eq
u
ir
es
a
g
r
ad
u
al
s
u
r
g
er
y
to
s
u
r
v
i
v
e.
T
h
e
in
cid
e
n
ce
o
f
co
n
g
en
ital
h
ea
r
t
d
ef
e
cts
in
I
n
d
o
n
esia
is
esti
m
ated
to
r
ea
ch
4
3
,
2
0
0
o
u
t
o
f
4
.
8
m
illi
o
n
liv
e
b
ir
th
s
(
9
:
1
0
0
0
liv
e
b
ir
th
s
)
p
er
y
ea
r
[
8
]
.
Alth
o
u
g
h
co
n
g
en
ital
h
ea
r
t
d
e
f
ec
ts
,
s
u
ch
as
m
ild
ab
n
o
r
m
alities
at
b
ir
t
h
,
m
ay
n
o
t
b
e
k
n
o
wn
f
o
r
wee
k
s
,
m
o
n
t
h
s
,
o
r
y
ea
r
s
,
an
d
m
ay
ev
en
b
e
d
is
co
v
er
ed
later
in
li
f
e
af
ter
r
ea
ch
i
n
g
ad
u
lth
o
o
d
.
Ma
n
y
ch
ild
r
e
n
with
co
n
g
en
it
al
h
ea
r
t
d
is
ea
s
e
g
o
u
n
d
iag
n
o
s
ed
,
an
d
s
o
m
e
ca
s
es
b
ec
o
m
e
m
o
r
e
s
ev
er
e
,
lead
i
n
g
to
life
-
th
r
ea
ten
in
g
c
o
n
d
itio
n
s
,
o
r
g
an
d
am
a
g
e,
p
u
lm
o
n
a
r
y
h
y
p
er
ten
s
io
n
,
a
n
d
in
f
ec
tio
n
s
(
e.
g
.
,
in
f
ec
tiv
e
e
n
d
o
ca
r
d
itis
,
s
ep
s
is
)
.
Scr
ee
n
in
g
an
d
o
b
s
er
v
atio
n
ch
ec
k
s
with
in
2
4
h
o
u
r
s
b
ef
o
r
e
d
is
ch
ar
g
e
f
r
o
m
th
e
h
o
s
p
ital
in
n
ewb
o
r
n
s
an
d
at
6
wee
k
s
o
f
ag
e
f
o
r
s
ig
n
s
o
f
co
n
g
en
ital h
ea
r
t d
is
ea
s
e
ar
e
ea
r
ly
d
etec
tio
n
s
tr
ateg
ies ca
r
r
ied
o
u
t in
h
ea
lth
ca
r
e
f
o
r
all
in
f
a
n
ts
[
9
]
.
T
h
e
n
o
r
m
a
l
v
a
l
u
e
o
f
f
e
t
a
l
h
e
a
r
t
r
a
t
e
i
s
1
2
0
–
1
6
0
b
p
m
p
e
r
m
i
n
u
t
e
.
H
o
w
e
v
e
r
,
t
h
e
f
r
e
q
u
e
n
c
y
o
f
t
h
e
h
e
a
r
t
r
a
t
e
c
a
n
e
x
c
e
e
d
1
6
0
b
e
a
ts
p
e
r
m
i
n
u
t
e
,
w
h
i
c
h
c
a
n
b
e
c
a
u
s
e
d
b
y
v
a
r
i
o
u
s
f
a
c
t
o
r
s
.
T
h
e
d
e
v
i
c
e
th
a
t
d
e
t
e
c
ts
t
h
e
f
e
t
a
l
h
e
a
r
t
r
a
t
e
i
s
c
a
ll
e
d
a
f
e
t
a
l
D
o
p
p
l
e
r
,
w
h
e
r
e
t
h
e
t
o
o
l
u
s
e
d
m
u
s
t
d
i
s
p
l
a
y
a
n
a
c
c
u
r
a
t
e
b
p
m
s
o
t
h
a
t
t
h
e
r
e
a
r
e
n
o
e
r
r
o
r
s
i
n
t
h
e
f
e
t
a
l
e
x
a
m
i
n
a
ti
o
n
.
T
h
e
f
e
t
a
l
h
e
a
r
t
r
at
e
c
a
n
b
e
ass
e
s
s
e
d
u
s
i
n
g
D
o
p
p
l
e
r
u
l
t
r
as
o
u
n
d
,
w
h
i
c
h
i
s
t
h
e
s
t
a
n
d
a
r
d
m
e
t
h
o
d
t
h
a
t
c
a
n
a
s
s
e
s
s
t
h
e
d
eg
r
e
e
o
f
h
e
a
l
t
h
o
f
t
h
e
f
e
t
u
s
.
F
et
a
l
h
e
a
r
t
e
x
a
m
i
n
at
i
o
n
u
s
i
n
g
f
e
ta
l
D
o
p
p
l
e
r
i
s
m
o
r
e
c
o
n
v
e
n
i
e
n
t
f
o
r
p
r
e
g
n
a
n
t
w
o
m
e
n
[
1
0
]
.
I
f
t
h
e
r
e
i
s
a
n
e
r
r
o
r
i
n
t
h
e
e
x
a
m
i
n
a
t
i
o
n
,
it
c
a
n
r
e
s
u
lt
i
n
v
a
r
i
o
u
s
f
a
c
t
o
r
s
,
i
n
c
l
u
d
i
n
g
f
e
t
al
h
y
p
o
x
i
a
,
a
n
e
m
i
a
,
a
n
d
s
o
o
n
.
F
e
t
al
D
o
p
p
l
e
r
is
o
n
e
o
f
t
h
e
m
e
d
ic
a
l
d
e
v
i
c
es
th
a
t
is
a
n
a
s
s
e
t
t
h
at
d
i
r
e
c
t
l
y
i
m
p
r
o
v
e
s
t
h
e
q
u
a
l
it
y
o
f
l
i
f
e
o
f
p
r
e
g
n
a
n
t
w
o
m
e
n
a
n
d
th
e
i
r
f
e
t
u
s
e
s
.
I
f
t
h
e
c
o
n
t
i
n
u
o
u
s
u
s
e
o
f
f
et
a
l
D
o
p
p
l
e
r
a
l
l
o
ws
f
o
r
d
i
f
f
e
r
e
n
ce
s
o
r
b
i
as
i
n
v
a
l
u
es
t
h
at
c
a
n
l
e
a
d
t
o
m
is
d
i
a
g
n
o
s
i
s
a
n
d
f
a
ta
l
r
i
s
k
s
i
n
p
at
i
e
n
ts
[
1
1
]
.
M
e
d
i
c
a
l
e
q
u
i
p
m
e
n
t
(
f
e
t
al
D
o
p
p
l
e
r
s
)
r
eq
u
i
r
e
s
c
al
i
b
r
a
ti
o
n
,
m
a
i
n
te
n
a
n
ce
,
r
e
p
a
i
r
,
u
s
e
r
t
r
a
i
n
i
n
g
,
a
n
d
d
ea
c
t
i
v
a
ti
o
n
a
c
ti
v
i
t
ie
s
a
r
e
u
s
u
a
l
l
y
m
a
n
a
g
e
d
b
y
t
ec
h
n
i
c
i
a
n
s
.
M
e
d
i
c
a
l
e
q
u
i
p
m
e
n
t
r
e
q
u
i
r
e
s
s
c
h
e
d
u
l
e
d
a
n
d
u
n
s
c
h
ed
u
l
e
d
m
a
i
n
t
e
n
a
n
c
e
d
u
r
i
n
g
i
t
s
l
i
f
et
i
m
e
[
1
2
]
.
M
o
r
e
o
v
e
r
,
f
e
t
a
l
D
o
p
p
l
e
r
s
n
ee
d
t
o
b
e
c
a
l
i
b
r
a
t
e
d
i
n
o
r
d
e
r
t
o
d
e
t
e
r
m
i
n
e
w
h
e
t
h
e
r
t
h
e
y
a
r
e
s
u
i
t
a
b
le
f
o
r
u
s
e
o
n
p
at
i
e
n
ts
o
r
n
o
t
.
T
h
e
c
al
i
b
r
a
t
i
o
n
f
u
n
c
t
i
o
n
en
s
u
r
e
s
a
n
d
m
o
n
i
t
o
r
s
w
h
e
t
h
e
r
th
e
i
n
s
t
r
u
m
e
n
t
is
s
ti
ll
a
c
c
u
r
a
t
e
o
r
f
u
n
c
t
i
o
n
i
n
g
p
r
o
p
e
r
l
y
,
a
n
d
f
i
n
d
s
o
u
t
h
o
w
m
u
c
h
d
e
v
i
a
t
i
o
n
f
r
o
m
t
h
e
i
n
s
t
r
u
m
e
n
t
[
1
3
]
.
I
n
p
r
ev
i
o
u
s
r
esear
ch
,
th
er
e
h
a
v
e
b
ee
n
s
ev
er
al
s
tu
d
ies
th
at
h
av
e
m
ad
e
f
etal
Do
p
p
le
r
s
im
u
latio
n
s
f
o
r
th
e
d
etec
tio
n
o
f
co
n
g
en
ital
h
e
ar
t
d
ef
ec
ts
.
On
e
o
f
h
is
s
tu
d
ies
in
v
o
lv
es
in
cr
ea
s
in
g
b
ea
t
p
er
m
in
u
te
(
B
PM
)
f
r
o
m
6
0
to
2
4
0
b
y
in
cr
ea
s
in
g
3
0
with
s
elen
iu
m
in
s
tead
o
f
h
ea
r
t
r
ate.
T
h
en
d
esig
n
an
d
b
u
ild
a
D
o
p
p
ler
f
etal
ca
lib
r
ato
r
with
an
L
C
D
d
is
p
lay
u
s
in
g
Ar
d
u
in
o
Un
o
[
1
4
]
.
Fu
r
th
er
m
o
r
e
,
th
e
r
e
is
r
esear
c
h
o
n
th
e
d
esig
n
o
f
a
m
in
i
-
Do
p
p
ler
d
etec
to
r
s
y
s
tem
f
o
r
h
ea
r
t
r
ate
co
n
tr
o
l.
T
h
e
r
e
is
a
Do
p
p
ler
f
etal
ca
lib
r
ato
r
with
a
m
icr
o
co
n
tr
o
ller
b
ase
th
at
em
b
ed
s
a
s
te
th
o
s
co
p
e
s
en
s
o
r
an
d
a
co
n
d
en
s
er
m
i
c
am
p
lifie
r
,
wh
o
s
e
d
ata
r
esu
lts
ar
e
s
h
o
wn
o
n
an
L
C
D
s
cr
ee
n
with
a
B
PM
in
d
ic
ato
r
.
An
o
th
er
s
tu
d
y
s
p
ec
if
ically
lo
o
k
ed
at
th
e
e
f
f
ec
t
o
f
h
ea
r
t
r
ate
v
alu
e
o
n
d
u
t
y
cy
cle
in
test
in
g
Ar
d
u
in
o
-
b
ased
f
etal
s
im
u
lato
r
s
.
T
h
e
r
esu
lts
f
o
u
n
d
th
at
th
e
av
er
a
g
e
er
r
o
r
in
th
e
f
etal
s
im
u
lato
r
was
0
.
0
8
2
b
p
m
,
wh
ich
h
as
h
ig
h
s
tab
ilit
y
ac
cu
r
ac
y
[
1
5
]
.
I
n
th
e
ex
p
lan
atio
n
a
b
o
v
e
,
th
er
e
i
s
n
o
ca
lib
r
ato
r
th
at
ca
n
m
ea
s
u
r
e
th
e
Do
p
p
ler
f
eta
l
f
r
o
m
th
e
s
m
allest
m
ea
s
u
r
e
m
en
t
o
f
u
n
ity
o
r
d
ec
im
al
b
p
m
.
T
h
e
au
th
o
r
s
h
av
e
d
ev
elo
p
e
d
a
ca
lib
r
ato
r
f
o
r
th
e
f
etal
Do
p
p
ler
o
f
th
ese
f
in
d
in
g
s
.
I
n
a
d
d
itio
n
,
th
is
ca
lib
r
ato
r
c
an
b
e
a
s
o
lu
tio
n
to
im
p
r
o
v
e
t
h
e
ac
cu
r
ac
y
o
r
p
r
ec
i
s
io
n
o
f
f
etal
h
ea
r
t r
ate
m
ea
s
u
r
em
en
t r
esu
lts
.
2.
M
E
T
H
O
D
T
h
is
s
tu
d
y
u
s
ed
s
ev
er
al
s
tag
es
to
ca
r
r
y
o
u
t
th
e
im
p
lem
en
tat
io
n
o
f
th
is
tech
n
o
l
o
g
ical
n
o
v
e
lty
,
wh
ich
is
d
escr
ib
ed
b
elo
w:
2
.
1
.
Resea
rc
h
m
e
t
ho
do
lo
g
y
T
h
is
r
esear
ch
is
ca
r
r
ied
o
u
t
in
co
llab
o
r
atio
n
an
d
th
e
d
ev
elo
p
m
en
t
o
f
m
eth
o
d
o
l
o
g
ies
to
d
ev
elo
p
p
r
o
to
ty
p
es.
T
h
e
r
esear
ch
p
r
o
c
ess
is
ca
r
r
ied
o
u
t
th
r
o
u
g
h
s
tag
es,
in
clu
d
in
g
:
liter
atu
r
e
r
ev
ie
w,
p
r
o
to
ty
p
e
d
esig
n
,
cr
ea
tin
g
a
p
r
o
to
ty
p
e,
in
teg
r
ate
d
s
y
s
tem
,
test
in
g
th
e
p
r
o
to
ty
p
e,
r
esu
lt
ev
al
u
atio
n
,
an
d
co
n
cl
u
s
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e
3
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3
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al
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is
s
h
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wn
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Fig
u
r
e
4
.
T
h
e
p
r
o
t
o
ty
p
e
d
esig
n
is
m
ad
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s
s
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s
th
e
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ain
f
r
am
e
o
f
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e
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o
x
,
wh
er
e
t
h
e
f
r
am
e
is
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ap
p
ed
in
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r
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T
h
e
o
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ter
d
is
p
lay
f
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tu
r
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f
o
u
r
p
u
s
h
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tt
o
n
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to
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t
th
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o
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n
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o
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d
is
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o
n
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e
OL
E
D.
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h
e
tr
an
s
d
u
ce
r
p
r
o
b
e
h
o
le
is
m
ad
e
cir
cu
lar
to
f
it
th
e
s
ize
o
f
th
e
p
o
ck
et
f
etal
Do
p
p
ler
.
T
h
e
co
n
ten
ts
o
f
th
e
p
r
o
to
ty
p
e
b
o
x
ar
e
th
e
p
lace
w
h
er
e
th
e
elec
tr
o
n
ic
co
m
p
o
n
en
ts
ar
e
em
b
ed
d
ed
with
th
e
p
o
wer
b
an
k
as
a
s
to
r
a
g
e
a
n
d
s
u
p
p
ly
o
f
elec
tr
ical
en
e
r
g
y
.
T
h
is
p
r
o
to
t
y
p
e
is
also
a
p
o
r
t
ab
le
an
d
m
o
b
ile
ca
lib
r
ato
r
f
o
r
ca
lib
r
atin
g
f
etal
Do
p
p
ler
s
.
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,
th
is
p
r
o
to
ty
p
e
is
ea
s
y
f
o
r
u
s
er
s
to
u
s
e.
T
h
is
s
tu
d
y
u
s
ed
th
e
C
lan
g
u
ag
e
in
th
e
m
ic
r
o
co
n
tr
o
ll
er
with
Ar
d
u
in
o
I
DE
in
Fig
u
r
e
5
.
T
h
en
,
in
th
is
p
r
o
to
ty
p
e,
f
o
u
r
p
u
s
h
b
u
tto
n
s
wer
e
u
s
ed
to
in
c
r
ea
s
e
o
r
d
ec
r
ea
s
e
th
e
B
PM
s
ettin
g
wh
en
th
e
p
r
o
to
t
y
p
e
ca
lib
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ate
d
a
f
etal
Do
p
p
le
r
.
Me
an
wh
ile,
th
e
s
witch
o
f
th
is
p
r
o
to
ty
p
e
is
at
th
e
b
o
tto
m
to
s
to
p
o
r
co
n
tin
u
e.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
0
8
8
-
8
6
9
4
I
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t J Po
w
E
lec
&
Dr
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t
,
Vo
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16
,
No
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2
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J
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20
25
:
8
7
3
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876
Fig
u
r
e
2
.
B
lo
ck
d
iag
r
am
o
f
th
e
p
r
o
to
ty
p
e
ca
lib
r
ato
r
Fig
u
r
e
3
.
W
ir
in
g
o
f
th
e
p
r
o
t
o
ty
p
e
Fig
u
r
e
4
.
Desig
n
o
f
th
e
p
r
o
to
t
y
p
e
2
.
4
.
I
nte
g
ra
t
ed
s
y
s
t
em
At
th
is
s
tag
e
is
th
e
p
r
o
to
ty
p
e
wo
r
k
f
lo
w
to
ca
lib
r
ate
th
e
Do
p
p
ler
f
etal
f
r
o
m
s
tar
t
to
f
in
is
h
.
T
h
is
s
y
s
tem
is
d
escr
ib
ed
in
Fig
u
r
e
6
.
I
n
Fig
u
r
e
6
,
it
is
e
x
p
lain
ed
t
h
at
th
e
i
n
itial
p
r
o
ce
s
s
o
f
th
e
u
s
er
m
u
s
t
tu
r
n
o
n
th
e
p
r
o
to
ty
p
e
p
o
wer
s
u
p
p
ly
to
d
is
tr
ib
u
te
th
eir
elec
tr
ical
en
er
g
y
.
Nex
t,
th
e
u
s
er
s
ets
th
e
B
PM
am
o
u
n
t
to
p
r
o
v
id
e
th
e
s
o
len
o
id
s
p
ee
d
wh
er
e
t
h
e
B
PM
v
alu
e
is
al
s
o
d
is
p
lay
ed
o
n
th
e
OL
E
D.
T
h
e
n
,
th
e
u
s
er
p
u
ts
th
e
tr
an
s
d
u
ce
r
p
r
o
b
e
in
th
e
p
r
o
to
t
y
p
e
h
o
le
to
m
ea
s
u
r
e
th
e
am
o
u
n
t
o
f
B
PM
v
alu
e
f
r
o
m
th
e
ca
lib
r
at
o
r
.
T
h
e
B
PM
am
o
u
n
t
o
f
th
e
Do
p
p
ler
f
etal
with
a
ca
lib
r
ato
r
is
r
ec
o
r
d
ed
f
o
r
an
al
y
s
is
o
f
its
s
ig
n
if
ican
ce
lev
el.
Af
ter
th
e
m
ea
s
u
r
em
en
t,
th
e
u
s
er
ca
n
p
r
ess
th
e
p
o
wer
b
u
tto
n
to
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r
n
o
f
f
th
e
p
o
we
r
o
f
th
e
p
r
o
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ty
p
e'
s
elec
tr
ical
e
n
er
g
y
.
Fu
r
th
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m
o
r
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e
d
ev
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ar
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ter
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Fig
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I
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A
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Flo
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RE
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h
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ata
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I
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x
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I
n
th
e
m
ea
s
u
r
em
en
t
r
esu
lts
,
s
ig
n
if
ican
t
r
esu
lts
h
av
e
b
ee
n
o
b
tain
ed
th
at
th
e
ca
lib
r
ato
r
ca
n
wo
r
k
well
in
ca
lib
r
atin
g
th
e
Do
p
p
ler
f
etal.
T
h
e
d
ata
s
tated
th
at
ea
c
h
m
ea
s
u
r
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en
t
e
x
p
er
im
e
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t
r
ec
e
iv
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a
co
r
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tio
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f
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ly
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e
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en
tire
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r
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T
h
e
r
esu
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o
f
th
is
m
ea
s
u
r
em
en
t
ar
e
an
in
d
icato
r
of
th
e
f
ea
s
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o
f
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Do
p
p
ler
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am
i
n
in
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th
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ea
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t
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n
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a
n
t
wo
m
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Pre
v
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s
tu
d
ies
h
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s
tated
th
at
to
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u
ar
an
tee
ac
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r
ate,
r
eliab
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a
n
d
s
af
e
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d
in
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s
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d
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ts
i
n
th
e
t
r
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a
n
d
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iag
n
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r
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ce
s
s
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af
ety
a
n
d
p
er
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o
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m
an
ce
test
in
g
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n
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ar
y
as
p
ar
t
o
f
a
n
ef
f
icien
t
ca
li
b
r
atio
n
p
r
o
ce
d
u
r
e
.
C
alib
r
atio
n
h
as
s
ev
er
al
b
en
ef
its
wh
ich
ar
e
b
r
ief
ly
lis
ted
as
f
o
ll
o
ws
[
1
6
]
:
-
Acc
u
r
ac
y
an
d
p
r
ec
i
s
io
n
:
T
h
e
ac
cu
r
ac
y
o
f
m
ed
i
ca
l
eq
u
ip
m
en
t
h
as
a
d
ir
e
ct
in
f
lu
en
ce
o
n
th
e
q
u
al
i
ty
o
f
p
at
ien
t
c
ar
e
.
I
n
ac
cu
r
a
te
m
e
a
s
u
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s
c
an
le
ad
to
m
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s
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o
s
i
s
,
in
co
r
r
ec
t
tr
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en
t
,
an
d
n
eg
at
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ef
f
e
ct
s
.
-
Patien
t
s
af
et
y
:
Pro
p
er
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lib
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o
f
m
ed
ical
eq
u
i
p
m
en
t
is
ess
en
tial
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o
r
p
atien
t
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ety
.
I
n
ac
cu
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ate
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ca
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co
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elay
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en
tial tr
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,
o
r
u
n
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ec
ess
ar
y
s
u
r
g
er
y
.
-
Diag
n
o
s
tic
ac
cu
r
acy
:
C
alib
r
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en
s
u
r
es
th
at
d
iag
n
o
s
tic
d
ev
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p
r
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v
id
e
co
n
s
is
ten
t
an
d
p
r
ec
is
e
r
esu
lts
,
allo
win
g
h
ea
lth
ca
r
e
p
r
o
f
ess
io
n
als to
m
ak
e
tim
ely
an
d
ac
cu
r
at
e
d
iag
n
o
s
es.
-
E
f
f
icac
y
o
f
tr
e
atm
en
t
:
C
alib
r
a
tio
n
en
s
u
r
es
ac
cu
r
ate
d
o
s
ag
e
a
n
d
tr
ea
tm
en
t,
lead
in
g
to
in
c
r
e
ased
ef
f
icac
y
o
f
th
e
th
er
ap
y
.
-
Dis
ea
s
e
m
o
n
ito
r
in
g
an
d
m
an
ag
em
en
t:
C
alib
r
atio
n
o
f
th
is
d
ev
ice
is
ess
en
tial
f
o
r
p
r
o
p
er
ly
tr
ac
k
in
g
t
h
e
p
r
o
g
r
ess
io
n
o
f
th
e
d
is
ea
s
e
an
d
ad
ju
s
tin
g
th
e
tr
ea
tm
e
n
t
p
r
o
g
r
am
,
th
er
eb
y
im
p
r
o
v
in
g
th
e
p
atien
t'
s
tr
ea
tm
en
t
o
u
tco
m
es.
Fu
r
th
er
m
o
r
e
,
th
e
m
ea
s
u
r
e
m
en
t
r
esu
lts
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o
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ed
a
p
<0
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0
5
v
alu
e
,
wh
er
e
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in
d
icate
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a
s
ig
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if
ican
t
r
esu
lt
f
o
r
th
e
f
etal
Do
p
p
ler
f
ea
s
ib
ilit
y
af
ter
b
ein
g
ca
lib
r
ated
with
th
is
ca
lib
r
ato
r
.
C
alib
r
ated
m
ed
ical
eq
u
ip
m
e
n
t
p
r
o
v
id
es
ac
cu
r
ate
d
ata
an
d
m
ea
s
u
r
em
en
ts
,
allo
win
g
h
ea
lth
ca
r
e
p
r
a
ctitio
n
er
s
to
m
ak
e
in
f
o
r
m
e
d
d
ec
is
io
n
s
an
d
p
r
o
v
i
d
e
o
p
tim
al
ca
r
e
to
p
atien
ts
[
1
7
]
.
Failu
r
e
to
ca
lib
r
ate
m
ed
i
ca
l
eq
u
ip
m
en
t
ca
n
r
esu
lt
in
in
ac
cu
r
ate
r
ea
d
in
g
s
,
m
is
d
iag
n
o
s
is
,
im
p
r
o
p
er
p
r
es
cr
ib
in
g
,
an
d
ev
en
life
-
th
r
ea
te
n
in
g
er
r
o
r
s
.
T
h
is
is
b
ec
au
s
e
ca
lib
r
atio
n
im
p
r
o
v
es
th
e
ef
f
icien
cy
an
d
co
s
t
-
ef
f
ec
ti
v
en
ess
o
f
th
e
h
ea
lth
ca
r
e
s
y
s
t
em
b
y
elim
in
atin
g
th
e
n
ee
d
to
r
ep
ea
t
test
s
an
d
tr
ea
tm
en
ts
d
u
e
to
in
co
r
r
ec
t
f
i
n
d
in
g
s
[
1
8
]
.
Me
d
ical
eq
u
ip
m
en
t
p
lay
s
an
im
p
o
r
tan
t
r
o
le
in
im
p
r
o
v
in
g
th
e
ef
f
icac
y
an
d
q
u
ality
o
f
h
ea
lth
ca
r
e
s
er
v
ices.
Fo
r
th
e
h
ea
lth
ca
r
e
in
d
u
s
tr
y
,
wh
eth
er
it'
s
h
o
s
p
itals
o
r
m
ed
ical
d
ev
ice
m
an
u
f
ac
tu
r
er
s
,
n
o
th
in
g
is
m
o
r
e
im
p
o
r
tan
t
th
an
p
atien
t
s
af
e
ty
.
I
n
r
ec
en
t
y
ea
r
s
,
m
o
r
e
an
d
m
o
r
e
p
atien
ts
ar
e
ex
p
er
ien
cin
g
a
d
v
er
s
e
o
u
tco
m
es r
elate
d
to
m
ed
ical
eq
u
ip
m
en
t
[
1
9
]
.
T
h
is
ca
lib
r
ato
r
h
as
a
tech
n
iq
u
e
to
ca
lib
r
ate
th
e
Do
p
p
ler
f
etal
,
wh
er
e
th
e
r
ec
o
m
m
en
d
ed
c
alib
r
atio
n
tech
n
iq
u
e
h
as
s
ev
er
al
ad
v
an
ta
g
es
[
2
0
]
.
B
ased
o
n
o
th
er
m
ed
ical
eq
u
ip
m
en
t
ca
lib
r
atio
n
s
tu
d
ies,
th
is
tech
n
iq
u
e
in
clu
d
es
an
ac
cu
r
ate
d
i
g
ital
s
am
p
lin
g
ap
p
r
o
ac
h
to
m
ea
s
u
r
e
v
ar
io
u
s
E
C
G
wav
ef
o
r
m
s
,
s
u
ch
as
s
q
u
ar
e,
tr
ian
g
u
lar
,
a
n
d
n
o
r
m
al
s
in
e.
Seco
n
d
,
r
ea
l
-
tim
e
ch
ar
ac
te
r
izatio
n
o
f
d
if
f
er
e
n
tial
am
p
l
if
ier
s
ca
n
r
ed
u
c
e
er
r
o
r
s
[
2
1
]
.
E
v
er
y
m
ed
ical
eq
u
ip
m
en
t
r
eq
u
ir
es
ca
lib
r
atio
n
,
m
ain
ten
an
ce
,
r
e
p
air
,
u
s
er
tr
ain
in
g
,
an
d
d
ec
o
m
m
is
s
io
n
in
g
ac
tiv
ities
ar
e
u
s
u
ally
m
a
n
ag
ed
b
y
tech
n
ic
ian
s
.
Me
d
ical
eq
u
ip
m
en
t
r
e
q
u
ir
es
s
ch
ed
u
led
a
n
d
u
n
s
ch
ed
u
led
m
ain
ten
a
n
ce
th
r
o
u
g
h
o
u
t
its
life
tim
e
,
in
cl
u
d
i
n
g
f
etal
D
o
p
p
ler
[
2
2
]
.
M
o
r
e
o
v
er
,
d
o
cto
r
s
r
ely
h
ea
v
ily
o
n
clin
ical
d
ata
to
d
e
ter
m
in
e
th
e
p
atien
t'
s
d
o
s
ag
e.
I
n
ac
cu
r
ate
r
esu
lts
ca
n
lead
to
im
p
r
o
p
e
r
r
ec
ip
es.
Patien
ts
ca
n
tr
u
s
t
p
r
ac
titi
o
n
er
s
an
d
h
ea
lth
ca
r
e
o
r
g
an
izatio
n
s
if
th
ey
k
n
o
w
th
at
t
h
e
tech
n
o
lo
g
y
u
s
ed
is
r
eliab
le
[
2
3
]
.
An
o
th
er
r
esear
c
h
r
ev
ea
le
d
th
at
ca
lib
r
atio
n
o
f
ea
ch
h
ea
l
th
wo
r
k
u
n
it
m
u
s
t
ca
r
r
y
o
u
t
p
r
o
p
er
m
ea
s
u
r
em
e
n
t
an
d
esti
m
atio
n
o
f
o
r
ien
tatio
n
.
A
m
ed
ical
d
ev
ice
will
n
o
lo
n
g
er
m
ee
t
th
e
s
tated
ac
cu
r
ac
y
li
m
it
s
tan
d
ar
d
s
if
th
e
ch
ar
ac
ter
is
tics
o
f
u
s
in
g
a
n
in
t
eg
r
ated
s
en
s
o
r
m
ay
c
h
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g
e
o
v
er
a
lo
n
g
p
er
io
d
o
r
in
v
ar
iab
le
tem
p
er
atu
r
es,
a
n
d
r
ec
alib
r
atio
n
ac
tiv
ities
ar
e
r
eq
u
ir
ed
[
2
4
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Po
w
E
lec
&
Dr
i Sy
s
t
I
SS
N:
2088
-
8
6
9
4
A
n
o
ve
l fe
ta
l D
o
p
p
ler ca
lib
r
a
to
r
:
en
h
a
n
cin
g
th
e
p
r
ec
is
io
n
o
f
…
(
E
kh
a
R
ifki F
a
u
z
i
)
879
T
h
is
ca
lib
r
ato
r
ca
n
h
elp
r
eso
lv
e
th
e
f
etal
Do
p
p
ler
f
ea
s
ib
il
ity
b
ef
o
r
e
it
is
u
s
ed
b
y
th
e
d
o
cto
r
to
ex
am
in
e
th
e
p
atien
t.
Step
s
t
o
en
s
u
r
e
th
e
f
ea
s
ib
ilit
y
o
f
m
ed
ical
d
ev
ices
at
h
ea
lth
p
r
o
v
id
er
s
th
at
ar
e
in
ac
co
r
d
an
ce
with
s
er
v
ice
s
tan
d
ar
d
s
,
s
af
ety
,
b
en
ef
its
,
s
ec
u
r
it
y
,
b
e
n
ef
its
,
an
d
q
u
ality
r
eq
u
i
r
em
en
ts
,
n
ee
d
to
b
e
ca
lib
r
ated
[
2
5
]
.
C
o
n
s
eq
u
en
tly
,
m
an
y
h
ea
lth
d
ev
ices
o
n
ly
a
s
s
es
s
tr
en
d
s
an
d
n
ee
d
ca
lib
r
a
tio
n
,
in
clu
d
in
g
th
e
f
etal
Do
p
p
ler
.
I
n
ad
d
itio
n
,
m
e
d
ical
d
ev
ices
ar
e
ca
lib
r
ated
t
o
im
p
r
o
v
e
t
h
e
ef
f
icien
c
y
an
d
c
o
s
t
-
ef
f
ec
tiv
en
ess
o
f
m
ain
ten
an
ce
a
n
d
h
ea
lth
ca
r
e
s
y
s
tem
s
b
y
m
in
im
izin
g
th
e
n
ee
d
f
o
r
r
e
p
etitiv
e
test
s
an
d
p
r
o
ce
d
u
r
es
d
u
e
to
in
ac
cu
r
ate
r
esu
lts
.
Patien
ts
ca
n
h
av
e
co
n
f
id
en
ce
r
eg
ar
d
in
g
t
h
e
f
ea
s
ib
ilit
y
o
f
th
e
m
ed
ical
d
ev
ices
u
s
ed
in
t
h
eir
tr
ea
tm
en
t a
n
d
ca
r
e
[
2
6
]
.
4.
CO
NCLU
SI
O
N
T
h
e
r
esu
lts
o
f
th
is
s
tu
d
y
s
tate
th
at
th
e
ca
lib
r
ato
r
ca
n
ca
lib
r
ate
well
o
n
th
e
Do
p
p
ler
f
etal
,
wh
er
e
t
h
e
ev
id
en
ce
is
th
at
th
e
p
-
v
alu
e
is
s
ig
n
if
ican
t.
Nex
t,
th
e
f
etal
Do
p
p
ler
o
b
tain
s
th
e
ac
cu
r
ac
y
a
n
d
p
r
ec
is
io
n
o
f
B
PM
m
ea
s
u
r
em
en
ts
f
r
o
m
th
e
ca
lib
r
ato
r
.
T
h
e
n
,
a
p
r
o
to
ty
p
e
o
f
th
is
to
o
l
ca
n
b
e
d
e
v
elo
p
ed
with
a
n
in
tellig
en
t
s
y
s
tem
to
r
ec
o
r
d
all
th
e
ca
lib
r
atio
n
d
a
ta
f
r
o
m
ea
c
h
Do
p
p
ler
f
etal.
ACK
NO
WL
E
DG
E
M
E
NT
S
W
e
wo
u
l
d
li
k
e
t
o
th
a
n
k
f
r
ie
n
d
s
,
r
el
ati
v
es
,
a
n
d
s
t
u
d
e
n
ts
wh
o
h
a
v
e
h
el
p
e
d
w
it
h
t
h
is
r
es
ea
r
c
h
,
esp
ec
i
all
y
th
e
r
es
ea
r
c
h
g
r
a
n
t
o
f
th
e
Di
r
e
cto
r
ate
G
en
er
al
o
f
Hi
g
h
e
r
E
d
u
c
ati
o
n
,
Mi
n
is
tr
y
o
f
Hi
g
h
e
r
E
d
u
ca
ti
o
n
,
Sci
e
n
ce
&
T
ec
h
n
o
l
o
g
y
o
f
I
n
d
o
n
esia
,
t
o
s
u
p
p
o
r
t
t
h
is
r
ese
ar
ch
.
T
h
is
r
ese
ar
ch
c
an
b
e
u
s
e
f
u
l
f
o
r
t
h
e
we
lf
ar
e
o
f
s
o
ci
et
y
.
F
UNDING
I
NF
O
R
M
A
T
I
O
N
T
h
is
r
esear
ch
was
f
u
n
d
ed
b
y
th
e
Dir
ec
to
r
ate
Gen
er
al
o
f
Hig
h
er
E
d
u
ca
tio
n
,
Min
is
tr
y
o
f
Hig
h
er
E
d
u
ca
tio
n
,
Scien
ce
&
T
ec
h
n
o
lo
g
y
o
f
I
n
d
o
n
esia.
T
h
e
f
in
a
n
c
ial
s
u
p
p
o
r
t
p
r
o
v
id
ed
m
ad
e
it
p
o
s
s
ib
le
to
d
e
v
elo
p
th
e
f
etal
Do
p
p
ler
ca
lib
r
ato
r
,
s
ig
n
if
ican
tly
en
h
an
cin
g
th
e
a
cc
u
r
ac
y
o
f
h
ea
r
t
r
ate
m
o
n
it
o
r
in
g
.
T
h
is
f
u
n
d
in
g
f
ac
ilit
ated
v
ar
io
u
s
s
tag
es
o
f
th
e
p
r
o
ject,
in
cl
u
d
in
g
t
h
e
d
esig
n
,
test
in
g
,
an
d
c
o
llab
o
r
atio
n
ef
f
o
r
ts
.
I
t
p
lay
e
d
a
cr
u
cial
r
o
le
in
ad
v
a
n
cin
g
in
n
o
v
atio
n
s
in
h
ea
lth
tech
n
o
lo
g
y
,
p
ar
ticu
lar
ly
in
th
e
f
ield
o
f
d
iag
n
o
s
tics
.
T
h
e
s
u
p
p
o
r
t
f
r
o
m
th
is
f
u
n
d
in
g
h
el
p
ed
f
o
s
ter
a
co
llab
o
r
ativ
e
e
n
v
ir
o
n
m
en
t,
en
a
b
lin
g
r
esear
c
h
er
s
to
wo
r
k
to
g
et
h
er
to
r
ef
in
e
an
d
im
p
r
o
v
e
th
e
tech
n
o
lo
g
y
.
B
y
in
v
esti
n
g
in
th
is
p
r
o
ject,
th
e
f
u
n
d
in
g
ag
en
c
y
co
n
tr
ib
u
ted
t
o
th
e
im
p
r
o
v
em
e
n
t
o
f
h
ea
lth
ca
r
e
m
o
n
ito
r
in
g
t
o
o
ls
,
wh
ich
co
u
ld
h
av
e
a
s
u
b
s
tan
tial
im
p
ac
t
o
n
th
e
p
r
ec
is
io
n
an
d
r
eliab
ilit
y
o
f
f
etal
h
ea
r
t r
ate
m
ea
s
u
r
em
en
ts
in
clin
ical
s
ettin
g
s
.
AUTHO
R
CO
NT
RI
B
UT
I
O
NS ST
A
T
E
M
E
N
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h
is
jo
u
r
n
al
u
s
es
th
e
C
o
n
tr
ib
u
to
r
R
o
les
T
ax
o
n
o
m
y
(
C
R
ed
iT)
to
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ec
o
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n
ize
in
d
iv
id
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al
au
th
o
r
co
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tr
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tio
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s
,
r
ed
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ce
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th
o
r
s
h
ip
d
is
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tes,
an
d
f
ac
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llab
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Na
m
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C
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Evaluation Warning : The document was created with Spire.PDF for Python.
I
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I
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Vo
l.
16
,
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2
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20
25
:
8
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880
DATA AV
AI
L
AB
I
L
I
T
Y
T
h
e
au
th
o
r
s
co
n
f
ir
m
th
at
th
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d
ata
b
ac
k
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g
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o
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clu
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f
th
is
s
tu
d
y
ar
e
p
u
b
licly
av
a
ilab
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d
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b
e
ac
ce
s
s
ed
d
i
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tly
th
r
o
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g
h
th
e
ar
ticle.
All
p
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e
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t d
a
tasets
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in
clu
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in
g
t
h
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c
o
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ata,
s
tatis
tical
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aly
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is
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ad
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itio
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m
ater
ials
,
ar
e
i
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teg
r
ated
in
t
o
th
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p
u
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licatio
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tr
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y
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d
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ep
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h
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les
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m
eth
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B
y
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ak
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ata
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ailab
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we
aim
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m
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p
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o
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id
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tific
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u
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ity
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ity
to
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with
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ticle,
a
n
y
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ch
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aw
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ad
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es,
ca
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f
r
o
m
th
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co
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esp
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au
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k
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atio
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ea
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ily
ac
ce
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s
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le,
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e
au
th
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s
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v
ite
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ex
am
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atio
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ep
licatio
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ly
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tio
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in
r
elate
d
a
r
ea
s
.
RE
F
E
R
E
NC
E
S
[
1
]
C
.
S
a
c
c
h
i
,
C
.
M
a
r
i
n
o
,
C
.
N
o
sart
i
,
A
.
V
i
e
n
o
,
S
.
V
i
se
n
t
i
n
,
a
n
d
A
.
S
i
mo
n
e
l
l
i
,
“
A
ss
o
c
i
a
t
i
o
n
o
f
i
n
t
r
a
u
t
e
r
i
n
e
g
r
o
w
t
h
r
e
s
t
r
i
c
t
i
o
n
a
n
d
smal
l
f
o
r
g
e
s
t
a
t
i
o
n
a
l
a
g
e
s
t
a
t
u
s
w
i
t
h
c
h
i
l
d
h
o
o
d
c
o
g
n
i
t
i
v
e
o
u
t
c
o
mes,
”
J
AM
A
Pe
d
i
a
t
ri
c
s
,
v
o
l
.
1
7
4
,
n
o
.
8
,
p
.
7
7
2
,
A
u
g
.
2
0
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0
,
d
o
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:
1
0
.
1
0
0
1
/
j
a
ma
p
e
d
i
a
t
r
i
c
s.
2
0
2
0
.
1
0
9
7
.
[
2
]
D
.
v
a
n
d
e
r
Li
n
d
e
e
t
a
l
.
,
“
B
i
r
t
h
p
r
e
v
a
l
e
n
c
e
o
f
c
o
n
g
e
n
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t
a
l
h
e
a
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d
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se
a
se
w
o
r
l
d
w
i
d
e
,
”
J
o
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r
n
a
l
o
f
t
h
e
Am
e
ri
c
a
n
C
o
l
l
e
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e
o
f
C
a
r
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y
,
v
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j
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.
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0
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1
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0
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0
2
5
.
[
3
]
H
.
E
.
S
a
l
m
a
n
a
n
d
H
.
C
.
Y
a
l
c
i
n
,
“
C
o
mp
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t
a
t
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o
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m
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n
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f
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mo
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mi
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mec
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p
m
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n
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d
d
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sea
s
e
,
”
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o
u
r
n
a
l
o
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C
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rd
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o
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s
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t
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se
,
v
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l
.
8
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2
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p
.
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,
Ja
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:
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c
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2
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4
.
[
4
]
H
.
E.
S
a
l
m
a
n
,
R
.
Y
.
K
a
m
a
l
,
Z
.
M
.
H
i
j
a
z
i
,
a
n
d
H
.
C
.
Y
a
l
c
i
n
,
“
H
e
m
o
d
y
n
a
mi
c
a
n
d
st
r
u
c
t
u
r
a
l
c
o
mp
a
r
i
s
o
n
o
f
h
u
ma
n
f
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t
a
l
h
e
a
r
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d
e
v
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l
o
p
me
n
t
b
e
t
w
e
e
n
n
o
r
ma
l
l
y
g
r
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w
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n
g
a
n
d
h
y
p
o
p
l
a
s
t
i
c
l
e
f
t
h
e
a
r
t
s
y
n
d
r
o
m
e
-
d
i
a
g
n
o
se
d
h
e
a
r
t
s,”
Fro
n
t
i
e
rs
i
n
Ph
y
si
o
l
o
g
y
,
v
o
l
.
1
3
,
M
a
r
.
2
0
2
2
,
d
o
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:
1
0
.
3
3
8
9
/
f
p
h
y
s.
2
0
2
2
.
8
5
6
8
7
9
.
[
5
]
C
.
M
.
O
r
t
i
n
a
u
e
t
a
l
.
,
“
E
a
r
l
y
-
e
mer
g
i
n
g
su
l
c
a
l
p
a
t
t
e
r
n
s
a
r
e
a
t
y
p
i
c
a
l
i
n
f
e
t
u
s
e
s
w
i
t
h
c
o
n
g
e
n
i
t
a
l
h
e
a
r
t
d
i
s
e
a
s
e
,
”
C
e
r
e
b
ra
l
C
o
r
t
e
x
,
v
o
l
.
2
9
,
n
o
.
8
,
p
p
.
3
6
0
5
–
3
6
1
6
,
J
u
l
.
2
0
1
9
,
d
o
i
:
1
0
.
1
0
9
3
/
c
e
r
c
o
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/
b
h
y
2
3
5
.
[
6
]
A.
-
C
.
L
u
c
a
e
t
a
l
.
,
“
O
p
t
i
ma
l
n
u
t
r
i
t
i
o
n
p
a
r
a
m
e
t
e
r
s
f
o
r
n
e
o
n
a
t
e
s
a
n
d
i
n
f
a
n
t
s
w
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t
h
c
o
n
g
e
n
i
t
a
l
h
e
a
r
t
d
i
se
a
se
,
”
N
u
t
ri
e
n
t
s
,
v
o
l
.
1
4
,
n
o
.
8
,
p
.
1
6
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1
,
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p
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.
2
0
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2
,
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:
1
0
.
3
3
9
0
/
n
u
1
4
0
8
1
6
7
1
.
[
7
]
Q.
-
L.
Z
h
a
n
g
e
t
a
l
.
,
“
R
e
l
a
t
i
o
n
s
h
i
p
b
e
t
w
e
e
n
d
i
s
o
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d
e
r
s
o
f
t
h
e
i
n
t
e
st
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n
a
l
mi
c
r
o
b
i
o
t
a
a
n
d
h
e
a
r
t
f
a
i
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n
f
a
n
t
s
w
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t
h
c
o
n
g
e
n
i
t
a
l
h
e
a
r
t
d
i
s
e
a
se
,
”
Fr
o
n
t
i
e
rs i
n
C
e
l
l
u
l
a
r
a
n
d
I
n
f
e
c
t
i
o
n
Mi
c
ro
b
i
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