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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Takotsubo syndrome &#40;TTS&#41; is a multi-faceted phenomenon&#44; particularly in terms of its morphological and pathogenetic characteristics&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#8211;4</span></a> Interestingly&#44; estrogen depletion has been universally suggested for the creation of a predisposing milieu for the evolution of TTS in response to stressful triggers&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;2&#44;4</span></a> The recent report by Br&#225;s et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> described an atypical case of TTS evolution in a young female patient while breastfeeding&#46; The authors placed particular emphasis on the protective role of estrogen in the evolution of TTS&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> We fully agree with the notion that estrogen depletion due to prolactin upsurge during breastfeeding might have significantly facilitated TTS evolution in response to emotional and&#47;or physical triggers in the patient&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> In other terms&#44; she might possibly have been TTS-free despite the emerging stressful trigger&#40;s&#41; if she had not been breastfeeding her child&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> We would&#44; therefore&#44; like to comment further on the implications of prolactin in the context of TTS evolution&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In recent years&#44; prolactin&#44; the nursing hormone&#44; which is known to increase substantially during late gestation and in the post-partum period&#44; has been thought to have a potential role in the evolution of certain cardiovascular conditions including peripartum cardiomyopathy &#40;PCMP&#41; and preeclampsia &#40;PE&#41;&#44; particularly in women with placental abnormalities &#40;hypoperfusion&#44; etc&#46;&#41; and&#47;or primary or secondary disturbances in anti-oxidant protective mechanisms&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5&#8211;7</span></a> In this context&#44; enhanced fragmentation of mature 23 kDa prolactin&#44; largely due to overproduction of placental matrix metalloproteinases and&#47;or augmented oxidative stress leading to overexpression of proteolytic enzymes including myocardial cathepsin D&#44; generally results in substantial levels of 16 kDa prolactin fragment&#46; This may exert strong anti-angiogenic and pro-apoptotic effects on cardiovascular system&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5&#8211;7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">On the other hand&#44; enhanced oxidative stress&#44; due to various internal or external sources&#44; has been recently suggested as an important contributory factor in the evolution of TTS&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;8</span></a> Based on this notion&#44;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;8</span></a> the pathogenetic mechanisms of oxidative stress in TTS evolution&#44; may&#44; in part&#44; be based on the increased generation of 16 kDa prolactin fragment during periods of physiological &#40;during breastfeeding&#41; or pathological &#40;in case of prolactin-secreting tumors&#41; hyperprolactinemia&#44; particularly in susceptible women &#40;those who are vulnerable to oxidative stress&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5&#8211;7&#44;9</span></a> Significant levels of 16 kDa prolactin fragment may significantly reduce the threshold for TTS evolution in a similar manner to estrogen deficiency<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;2&#44;9</span></a> in response to various stressful triggers&#46; In the context of TTS evolution&#44; the adverse impact of 16 kDa prolactin fragment might be even stronger and more persistent compared with prolactin-related estrogen depletion due to the association of this fragment with apoptosis and impaired angiogenesis<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5&#8211;7</span></a> leading to residual myocardial abnormalities &#40;subclinical myocardial dysfunction&#44; persistent diastolic dysfunction&#41; following TTS recovery&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The report by Br&#225;s et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> may have important implications&#58; first&#44; the patient may have further TTS recurrences along with an increased risk for PCMP and&#47;or PE evolution&#44; particularly during breastfeeding in future pregnancies&#46; Therefore&#44; the patient may be strongly discouraged from future breastfeeding&#44; including the prophylactic initiation of certain dopaminergic agents including bromocriptine and cabergoline to suppress prolactin secretion may also be considered during puerperium&#44; where necessary&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> It is noteworthy that even after emergence of overt myocardial disease associated with prolactin &#40;in the form of TTS or PCMP&#41;&#44; initiation of anti-prolactin agents&#44; on top of conventional heart failure medications&#44; might significantly speed up myocardial recovery and hence improve the overall prognosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5&#8211;7</span></a> Accordingly&#44; the use of bromocriptine in the patient&#44; possibly based on the presumption of an existing PCMP&#44; may have significantly improved the prognosis of her TTS episode&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> Second&#44; the patient might have suffered a subclinical form of myocardial dysfunction that might present with exercise intolerance following her discharge&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;3</span></a> This could be diagnosed with advanced echocardiographic parameters including strain and strain rate as well as diastolic stress testing&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> We wonder about the results of these tests &#40;if any&#41;&#46; Finally&#44; the patient might have an increased risk for future cardiovascular events possibly due to the generalized endothelial dysfunction that might be induced by toxic prolactin fragments&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> and needs close monitoring&#46; We also wonder about the surveillance schedule for the patient&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion&#44; prolactin may have important implications in TTS evolution during breastfeeding&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;2&#44;5&#8211;7&#44;9</span></a> However&#44; the adverse impact of prolactin in the general context of cardiovascular disease might not be exclusively attributable to estrogen depletion&#44;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;2</span></a> but might also be due to toxic prolactin fragments in susceptible females&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5&#8211;7&#44;9</span></a> In general&#44; the primary goal should be to combat hyperprolactinemia with the implementation of certain strategies &#40;discouragement from breastfeeding and&#47;or future pregnancies&#44; use of anti-prolactin agents during puerperium&#44; etc&#46;&#41; for the prevention or management of prolactin-associated cardiovascular conditions &#40;including TTS associated with breastfeeding and PCMP&#44; etc&#46;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5&#8211;7</span></a> However&#44; further aspects related to prolactin in the setting of cardiovascular disease still need to be established&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Letter to the Editor
Takotsubo syndrome during breastfeeding: Further insights into prolactin and its implications
Síndrome de Takotsubo durante a amamentação: mais informações sobre a prolactina e suas implicações
Kenan Yaltaa,
Autor para correspondência
kyalta@gmail.com

Corresponding author.
, Cihan Ozturka, Murat Goka, Tulin Yaltab
a Trakya University, Cardiology Department, Edirne, Turkey
b Trakya University, Pathology Department, Edirne, Turkey
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Takotsubo syndrome &#40;TTS&#41; is a multi-faceted phenomenon&#44; particularly in terms of its morphological and pathogenetic characteristics&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#8211;4</span></a> Interestingly&#44; estrogen depletion has been universally suggested for the creation of a predisposing milieu for the evolution of TTS in response to stressful triggers&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;2&#44;4</span></a> The recent report by Br&#225;s et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> described an atypical case of TTS evolution in a young female patient while breastfeeding&#46; The authors placed particular emphasis on the protective role of estrogen in the evolution of TTS&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> We fully agree with the notion that estrogen depletion due to prolactin upsurge during breastfeeding might have significantly facilitated TTS evolution in response to emotional and&#47;or physical triggers in the patient&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> In other terms&#44; she might possibly have been TTS-free despite the emerging stressful trigger&#40;s&#41; if she had not been breastfeeding her child&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> We would&#44; therefore&#44; like to comment further on the implications of prolactin in the context of TTS evolution&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In recent years&#44; prolactin&#44; the nursing hormone&#44; which is known to increase substantially during late gestation and in the post-partum period&#44; has been thought to have a potential role in the evolution of certain cardiovascular conditions including peripartum cardiomyopathy &#40;PCMP&#41; and preeclampsia &#40;PE&#41;&#44; particularly in women with placental abnormalities &#40;hypoperfusion&#44; etc&#46;&#41; and&#47;or primary or secondary disturbances in anti-oxidant protective mechanisms&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5&#8211;7</span></a> In this context&#44; enhanced fragmentation of mature 23 kDa prolactin&#44; largely due to overproduction of placental matrix metalloproteinases and&#47;or augmented oxidative stress leading to overexpression of proteolytic enzymes including myocardial cathepsin D&#44; generally results in substantial levels of 16 kDa prolactin fragment&#46; This may exert strong anti-angiogenic and pro-apoptotic effects on cardiovascular system&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5&#8211;7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">On the other hand&#44; enhanced oxidative stress&#44; due to various internal or external sources&#44; has been recently suggested as an important contributory factor in the evolution of TTS&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;8</span></a> Based on this notion&#44;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;8</span></a> the pathogenetic mechanisms of oxidative stress in TTS evolution&#44; may&#44; in part&#44; be based on the increased generation of 16 kDa prolactin fragment during periods of physiological &#40;during breastfeeding&#41; or pathological &#40;in case of prolactin-secreting tumors&#41; hyperprolactinemia&#44; particularly in susceptible women &#40;those who are vulnerable to oxidative stress&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5&#8211;7&#44;9</span></a> Significant levels of 16 kDa prolactin fragment may significantly reduce the threshold for TTS evolution in a similar manner to estrogen deficiency<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;2&#44;9</span></a> in response to various stressful triggers&#46; In the context of TTS evolution&#44; the adverse impact of 16 kDa prolactin fragment might be even stronger and more persistent compared with prolactin-related estrogen depletion due to the association of this fragment with apoptosis and impaired angiogenesis<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5&#8211;7</span></a> leading to residual myocardial abnormalities &#40;subclinical myocardial dysfunction&#44; persistent diastolic dysfunction&#41; following TTS recovery&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The report by Br&#225;s et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> may have important implications&#58; first&#44; the patient may have further TTS recurrences along with an increased risk for PCMP and&#47;or PE evolution&#44; particularly during breastfeeding in future pregnancies&#46; Therefore&#44; the patient may be strongly discouraged from future breastfeeding&#44; including the prophylactic initiation of certain dopaminergic agents including bromocriptine and cabergoline to suppress prolactin secretion may also be considered during puerperium&#44; where necessary&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> It is noteworthy that even after emergence of overt myocardial disease associated with prolactin &#40;in the form of TTS or PCMP&#41;&#44; initiation of anti-prolactin agents&#44; on top of conventional heart failure medications&#44; might significantly speed up myocardial recovery and hence improve the overall prognosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5&#8211;7</span></a> Accordingly&#44; the use of bromocriptine in the patient&#44; possibly based on the presumption of an existing PCMP&#44; may have significantly improved the prognosis of her TTS episode&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> Second&#44; the patient might have suffered a subclinical form of myocardial dysfunction that might present with exercise intolerance following her discharge&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;3</span></a> This could be diagnosed with advanced echocardiographic parameters including strain and strain rate as well as diastolic stress testing&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> We wonder about the results of these tests &#40;if any&#41;&#46; Finally&#44; the patient might have an increased risk for future cardiovascular events possibly due to the generalized endothelial dysfunction that might be induced by toxic prolactin fragments&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> and needs close monitoring&#46; We also wonder about the surveillance schedule for the patient&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion&#44; prolactin may have important implications in TTS evolution during breastfeeding&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;2&#44;5&#8211;7&#44;9</span></a> However&#44; the adverse impact of prolactin in the general context of cardiovascular disease might not be exclusively attributable to estrogen depletion&#44;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;2</span></a> but might also be due to toxic prolactin fragments in susceptible females&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5&#8211;7&#44;9</span></a> In general&#44; the primary goal should be to combat hyperprolactinemia with the implementation of certain strategies &#40;discouragement from breastfeeding and&#47;or future pregnancies&#44; use of anti-prolactin agents during puerperium&#44; etc&#46;&#41; for the prevention or management of prolactin-associated cardiovascular conditions &#40;including TTS associated with breastfeeding and PCMP&#44; etc&#46;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5&#8211;7</span></a> However&#44; further aspects related to prolactin in the setting of cardiovascular disease still need to be established&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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                    0 => array:2 [
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "K&#46; Yalta"
                            1 => "M&#46; Yilmaztepe"
                            2 => "C&#46; Zorkun"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.15420/cfr.2018:24:2"
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                        "tituloSerie" => "Card Fail Rev"
                        "fecha" => "2018"
                        "volumen" => "4"
                        "paginaInicial" => "14"
                        "paginaFinal" => "20"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29892470"
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                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "A cathepsin D-cleaved 16 kDa form of prolactin mediates postpartum cardiomyopathy"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46; Hilfiker-Kleiner"
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                            2 => "E&#46; Podewski"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.cell.2006.12.036"
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                        "tituloSerie" => "Cell"
                        "fecha" => "2007"
                        "volumen" => "128"
                        "paginaInicial" => "589"
                        "paginaFinal" => "600"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17289576"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0070"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prolactin fragmentation by trophoblastic matrix metalloproteinases as a possible contributor to peripartum cardiomyopathy and pre-eclampsia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46;Q&#46; Reuwer"
                            1 => "P&#46;J&#46; Reuwer"
                            2 => "J&#46;A&#46; van der Post"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.mehy.2009.08.029"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Hypotheses"
                        "fecha" => "2010"
                        "volumen" => "74"
                        "paginaInicial" => "348"
                        "paginaFinal" => "352"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19748190"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0075"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fontan circulation might be associated with peripartum cardiomyopathy&#58; a review of mechanistic and clinical aspects"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "K&#46; Yalta"
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                            2 => "G&#46; Taylan"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2174/1573403X17666210316121842"
                      "Revista" => array:3 [
                        "tituloSerie" => "Curr Cardiol Rev"
                        "fecha" => "2021"
                        "volumen" => "17"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Oxidative stress in Takotsubo syndrome &#8211; is it essential for an acute attack&#63; Indirect evidences support multisite impact including the calcium overload-energy failure hypothesis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46; Manousek"
                            1 => "P&#46; Kala"
                            2 => "P&#46; Lokaj"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3389/fcvm.2021.732708"
                      "Revista" => array:5 [
                        "tituloSerie" => "Front Cardiovasc Med"
                        "fecha" => "2021"
                        "volumen" => "8"
                        "paginaInicial" => "732708"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34738019"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "9"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Sindrome di Takotsubo nel puerperio&#58; caso clinico &#91;Takotsubo syndrome in a young woman during puerperium&#58; case report&#93;"
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                        0 => array:2 [
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                        ]
                      ]
                    ]
                  ]
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                        "tituloSerie" => "Monaldi Arch Chest Dis&#46;"
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                        "paginaFinal" => "92"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22128613"
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