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TEAS Timing for Gastrectomy Recovery (TEAS-TIME Trial)

15. července 2026 aktualizováno: Zhou Yanbing, The Affiliated Hospital of Qingdao University

Effect of Perioperative vs Postoperative-Only Transcutaneous Electrical Acupoint Stimulation on Gastrointestinal Recovery and Pain Control After Laparoscopic Radical Gastrectomy: A Multicenter, Three-Arm, Randomized, Sham-Controlled Trial

The goal of this clinical trial is to learn if transcutaneous electrical acupoint stimulation (TEAS) works to help people recover faster after laparoscopic surgery for stomach cancer. TEAS is a treatment that uses small electrical pulses through sticky pads on the skin. It does not use needles.

The main questions it aims to answer are:

Does TEAS help people pass gas (a sign that the digestive system is waking up) sooner after surgery?

Does TEAS help lower pain after surgery?

Does TEAS reduce the need for extra pain medication after surgery?

Researchers will compare three groups to see if TEAS works better when given before, during, and after surgery compared with only after surgery.

Group 1 receives TEAS before, during, and after surgery.

Group 2 receives a sham (inactive) treatment before and during surgery, and real TEAS after surgery.

Group 3 receives sham treatment at all time points.

All participants will receive the same standard pain relief and recovery care after surgery.

Participants will:

Be randomly assigned (like flipping a coin) to one of the three groups

Receive TEAS or sham treatment for 30 minutes before surgery, during surgery, and for 30 minutes each day on the first 3 days after surgery

Rate their pain on a 0-10 scale at 6, 12, 24, 48, and 72 hours after surgery

Complete quality-of-life questionnaires before surgery, on day 4 after surgery, and 30 days after surgery

Have a follow-up visit or phone call 30 days after leaving the hospital

This study includes 300 adults aged 18 to 80 years who are scheduled to have laparoscopic surgery for stomach cancer at 13 hospitals in Shandong Province, China.

Přehled studie

Detailní popis

This study is a prospective, multicenter, three-arm, parallel-group, randomized, sham-controlled trial conducted at 13 tertiary hospitals in Shandong Province, China. A total of 300 eligible participants scheduled for laparoscopic radical gastrectomy for stage I-III gastric cancer will be enrolled and randomly assigned in a 1:1:1 ratio to one of three groups: Peri-TEAS (transcutaneous electrical acupoint stimulation administered before, during, and after surgery), Post-TEAS (sham treatment before and during surgery, with real TEAS after surgery), or Sham-TEAS (sham treatment at all time points). Randomization will be performed using a centralized system with stratification by study center and a randomized block design with randomly assigned block sizes. Allocation concealment is ensured by the system, with group assignments revealed only after participant enrollment.

TEAS is delivered using a standardized electroacupuncture device (SDZ-V, Suzhou Medical Products Factory) with a dense-disperse wave (2 Hz alternating with 100 Hz, 5s/10s duty cycle) at individually titrated intensities. Four bilateral acupoints are selected: Hegu (LI4), Neiguan (PC6), Zusanli (ST36), and Shangjuxu (ST37), following WHO standard acupoint locations. For the Peri-TEAS group, stimulation begins 30 minutes before anesthesia induction at the individually determined maximal tolerable threshold, continues throughout surgery at the same intensity, and resumes postoperatively for 30 minutes daily on postoperative days 1 through 3. For the Post-TEAS group, sham stimulation is applied before and during surgery, with real TEAS administered postoperatively using the same protocol as the Peri-TEAS group. The Sham-TEAS group receives sham stimulation at all time points. To maintain blinding, the device screen is shielded, and operators use standardized scripts to avoid unblinding.

All participants receive a standardized enhanced recovery after surgery (ERAS) protocol, including no bowel preparation, preoperative carbohydrate loading, minimally invasive incisions, goal-directed fluid therapy, no routine nasogastric tubes, early removal of drains and urinary catheters (within 24 hours), early mobilization, and a stepwise enteral nutrition plan. Postoperative analgesia is provided via patient-controlled intravenous analgesia (PCIA) with sufentanil (2 μg/kg in 100 mL normal saline, background infusion 2 mL/h, bolus 2 mL, lockout 15 min), supplemented with flurbiprofen axetil 50 mg twice daily. Rescue analgesia (morphine 2-4 mg IV or equivalent) is administered for breakthrough pain (NRS ≥ 4), with all rescue doses converted to morphine equivalent dose for analysis.

The primary endpoint is time to first flatus after surgery. Key secondary endpoints include the area under the curve of movement-evoked pain NRS scores over 0-72 hours and total rescue analgesic consumption in morphine equivalent dose. Additional secondary endpoints encompass gastrointestinal recovery parameters (time to first bowel movement, tolerance of liquid/semi-liquid/solid diets), pain and analgesic use (resting pain AUC, time to first PCIA press, total PCIA presses, intraoperative propofol and remifentanil dosages), ambulation and recovery (time to first independent ambulation ≥5 meters, postoperative hospital stay meeting uniform discharge criteria), and safety outcomes (incidence and severity of nausea, vomiting, abdominal distension, postoperative complications graded by Clavien-Dindo classification, and 30-day readmission rate). Patient-reported outcomes are assessed using the EORTC QLQ-C30 and QLQ-STO22 questionnaires, and perioperative fatigue is evaluated using the ICFS-10, all administered preoperatively, on postoperative day 4, and at 30 days after surgery. Exploratory endpoints include inflammatory cytokines (CRP, IL-6, IL-1β, TNF-α), gastrointestinal hormones (motilin, gastrin, substance P, VIP, cholecystokinin), and immunoglobulins (IgA, IgG, IgM) measured from fasting blood samples on postoperative days 1, 3, and 5 (or at discharge if earlier).

Blinding is implemented for participants, surgeons, anesthesiologists, outcome assessors, and statisticians. TEAS operators are not blinded but are strictly prohibited from participating in any post-treatment clinical assessments or data collection. The success of blinding will be evaluated using Bang's Blinding Index. An independent Data Monitoring Committee, composed of one statistician and two external experts, will regularly review safety and compliance data.

Sample size calculation: Based on pilot data showing a mean difference of 8.22 hours in time to first flatus between Peri-TEAS and Post-TEAS (SD 18.36) and 15.35 hours between Peri-TEAS and Sham-TEAS (SD 25.74), with α = 0.05 (two-sided) and power = 80%, 80 participants per group are required. Accounting for a 20% dropout rate, the target enrollment is 300 participants (100 per group).

The statistical analysis will follow a fixed-sequence testing procedure to control the overall type I error at α = 0.05. Analyses will be performed on the full analysis set (intention-to-treat principle), with per-protocol analysis for sensitivity. All tests will be two-sided, with statistical significance set at P < 0.05, using SAS 9.4.

The study protocol and informed consent form have been approved by the Ethics Committee of the Affiliated Hospital of Qingdao University and each participating center. The results will be disseminated through peer-reviewed academic journals.

Typ studie

Intervenční

Zápis (Odhadovaný)

300

Fáze

  • Nelze použít

Kontakty a umístění

Tato část poskytuje kontaktní údaje pro ty, kteří studii provádějí, a informace o tom, kde se tato studie provádí.

Studijní kontakt

Studijní záloha kontaktů

Studijní místa

    • Shandong
      • Dongying, Shandong, Čína, 257091
        • Dongying People's Hospital
        • Kontakt:
          • Hao Wang
      • Qingdao, Shandong, Čína, 266000
        • Qingdao Municipal Hospital
        • Kontakt:
          • Hong Qi, MD
      • Qingdao, Shandong, Čína, 266000
        • Department of Gastrointestinal Surgery, Qingdao University Affiliated Hospital
        • Kontakt:
      • Qingdao, Shandong, Čína, 266041
        • The Third People's Hospital of Qingdao
        • Kontakt:
          • Xiaolei Liu
      • Qingdao, Shandong, Čína, 266042
        • Qingdao Central Hospital, University of Health and Rehabilitation Sciences
        • Kontakt:
          • Zhiwei Wang
      • Qingdao, Shandong, Čína, 266109
        • Peking University People's Hospital Qingdao
        • Kontakt:
          • Deju Wang
      • Qingdao, Shandong, Čína, 266109
        • Qingdao Chengyang District People's Hospital
        • Kontakt:
          • Baolian Song
      • Qingdao, Shandong, Čína, 266200
        • The People's Hospital of Jimo, Qingdao
        • Kontakt:
          • Hongbo Wang
      • Rizhao, Shandong, Čína, 276826
        • The People's Hospital of Rizhao
        • Kontakt:
          • Yang Yu
      • Weifang, Shandong, Čína, 261041
        • Weifang People's Hospital
        • Kontakt:
          • Jianjun Qu
      • Weihai, Shandong, Čína, 264400
        • Weihai Central Hospital
        • Kontakt:
          • Xinjian Wang
      • Weihai, Shandong, Čína, 264200
        • Weihai Municipal Hospital
        • Kontakt:
          • Shaowei Sun
      • Yantai, Shandong, Čína, 264000
        • Yantai Yuhuangding Hospital
        • Kontakt:
          • Jinchen Hu

Kritéria účasti

Výzkumníci hledají lidi, kteří odpovídají určitému popisu, kterému se říká kritéria způsobilosti. Některé příklady těchto kritérií jsou celkový zdravotní stav osoby nebo předchozí léčba.

Kritéria způsobilosti

Věk způsobilý ke studiu

  • Dospělý
  • Starší dospělý

Přijímá zdravé dobrovolníky

Ne

Popis

Inclusion Criteria:

Age 18 to 80 years, both sexes

Endoscopically and radiographically confirmed resectable stage I-III gastric cancer (AJCC 8th edition)

Scheduled to undergo laparoscopic radical gastrectomy

Willing to sign the informed consent form and able to comply with all study procedures

Exclusion Criteria:

American Society of Anesthesiologists (ASA) physical status ≥ IV

Clinical stage IV gastric cancer

Severe hepatic, renal, cardiovascular, or cerebrovascular diseases, or uncontrolled psychiatric disorders that may affect compliance or safety assessment

Participation in another clinical trial or receipt of any form of acupoint stimulation (acupuncture, electroacupuncture, TEAS, etc.) within 1 month prior to enrollment

Continuous use of opioids for more than 3 months prior to enrollment, with a daily dose ≥ 30 mg oral morphine equivalent

Implanted cardiac pacemaker or other electronic stimulation device, or skin infection/lesion at the stimulation site

Pregnancy or lactation

Emergency surgery due to bleeding, perforation, obstruction, etc.

Planned epidural anesthesia for the surgery

Studijní plán

Tato část poskytuje podrobnosti o studijním plánu, včetně toho, jak je studie navržena a co studie měří.

Jak je studie koncipována?

Detaily designu

  • Primární účel: Léčba
  • Přidělení: Randomizované
  • Intervenční model: Paralelní přiřazení
  • Maskování: Trojnásobný

Zbraně a zásahy

Skupina účastníků / Arm
Intervence / Léčba
Experimentální: Peri-TEAS Group
Participants receive active transcutaneous electrical acupoint stimulation (TEAS) before, during, and after surgery. Stimulation begins 30 minutes before anesthesia induction, continues throughout the surgery, and is repeated for 30 minutes daily on postoperative days 1 through 3.
Transcutaneous electrical acupoint stimulation (TEAS) using the Hwato SDZ-V electronic acupuncture device (Suzhou Medical Appliance Factory Co., Ltd., China). Four bilateral acupoints are stimulated: Hegu (LI4), Neiguan (PC6), Zusanli (ST36), and Shangjuxu (ST37), following WHO standard locations. Stimulation parameters: dense-disperse wave (2 Hz alternating with 100 Hz, 5s/10s duty cycle, pulse width 0.2 ms ± 30%). Intensity is individually titrated to the maximal tolerable threshold using a dual-threshold calibration method.
Experimentální: Post-TEAS Group
Participants receive sham (inactive) TEAS before and during surgery, and active TEAS after surgery. Postoperative stimulation is given for 30 minutes daily on postoperative days 1 through 3.
Transcutaneous electrical acupoint stimulation (TEAS) using the Hwato SDZ-V electronic acupuncture device (Suzhou Medical Appliance Factory Co., Ltd., China). Four bilateral acupoints are stimulated: Hegu (LI4), Neiguan (PC6), Zusanli (ST36), and Shangjuxu (ST37), following WHO standard locations. Stimulation parameters: dense-disperse wave (2 Hz alternating with 100 Hz, 5s/10s duty cycle, pulse width 0.2 ms ± 30%). Intensity is individually titrated to the maximal tolerable threshold using a dual-threshold calibration method.
Falešný srovnávač: Sham-TEAS Group
Participants receive sham (inactive) TEAS at all time points: before surgery, during surgery, and after surgery (postoperative days 1 through 3, 30 minutes daily).
Sham TEAS using the same Hwato SDZ-V device with identical appearance, indicator lights, and audible signals. The output leads are internally disconnected to deliver no electrical current. The operator performs the same procedural steps, including simulated dial adjustments, to maintain participant blinding.

Co je měření studie?

Primární výstupní opatření

Měření výsledku
Popis opatření
Časové okno
Time to First Flatus After Surgery
Časové okno: Measured from the end of surgery up to hospital discharge (expected up to 7 days postoperatively)
Time from the end of surgery to the patient's first self-reported passage of flatus. Patients and their families are instructed to record the exact time (to the nearest minute) immediately upon first flatus using a postoperative recovery diary card. Bedside nurses verify and collect the diary cards three times daily during rounds. Bowel movements induced by glycerin suppository or enema are excluded.
Measured from the end of surgery up to hospital discharge (expected up to 7 days postoperatively)

Sekundární výstupní opatření

Měření výsledku
Popis opatření
Časové okno
Area Under the Curve of Movement-Evoked Pain NRS Scores Over 0-72 Hours
Časové okno: 0 to 72 hours postoperatively
Area under the curve (AUC) of Numerical Rating Scale (NRS) scores for movement-evoked pain (MEP) from 0 to 72 hours postoperatively. NRS is a 11-point scale (0 = no pain, 10 = worst possible pain). Pain is assessed immediately after coughing using standardized instructions ("Please hold your wound with one hand, take a deep breath, and cough forcefully") at 6, 12, 24, 48, and 72 hours after surgery by a blinded assessor. If the patient cannot perform a standard cough, pain during turning in bed is assessed as a替代, with the reason recorded in the CRF. AUC is calculated using the trapezoidal rule. Pain during turning and ambulation are recorded simultaneously as exploratory analyses.
0 to 72 hours postoperatively
Total Rescue Analgesic Consumption in Morphine Equivalent Dose
Časové okno: From PACU admission (T0) until PCIA discontinuation (expected up to 72 hours postoperatively)
Total dose of all rescue analgesic medications administered for breakthrough pain (NRS ≥ 4) from PACU admission (T0) until discontinuation of PCIA and transition to oral analgesia, converted to morphine equivalent dose (mg MEDD) according to standard conversion factors: IV morphine 1 mg = 1 mg MEDD; IV hydromorphone 0.2 mg = 1 mg MEDD; IV tramadol 10 mg = 1 mg MEDD; oral oxycodone 1 mg = 1.5 mg MEDD. The date, time, and dose of each administration are captured concurrently from nursing medication records and the CRF.
From PACU admission (T0) until PCIA discontinuation (expected up to 72 hours postoperatively)
Time to First Bowel Movement
Časové okno: Measured from the end of surgery up to hospital discharge (expected up to 7 days postoperatively)
Time from the end of surgery to the first bowel movement, excluding those induced by glycerin suppository or enema.
Measured from the end of surgery up to hospital discharge (expected up to 7 days postoperatively)
Time to First Tolerance of Liquid Diet
Časové okno: Measured from the end of surgery up to hospital discharge (expected up to 7 days postoperatively)
Time from the end of surgery to first tolerance of a liquid diet, defined as the absence of vomiting or severe abdominal distension within 2 hours after ingestion.
Measured from the end of surgery up to hospital discharge (expected up to 7 days postoperatively)
Time to First Tolerance of Semi-Liquid Diet
Časové okno: Measured from the end of surgery up to hospital discharge (expected up to 7 days postoperatively)
Time from the end of surgery to first tolerance of a semi-liquid diet, defined as the absence of vomiting or severe abdominal distension within 2 hours after ingestion.
Measured from the end of surgery up to hospital discharge (expected up to 7 days postoperatively)
Time to First Tolerance of Solid Diet
Časové okno: Measured from the end of surgery up to hospital discharge (expected up to 7 days postoperatively)
Time from the end of surgery to first tolerance of a solid diet, defined as the absence of vomiting or severe abdominal distension within 2 hours after ingestion.
Measured from the end of surgery up to hospital discharge (expected up to 7 days postoperatively)
Area Under the Curve of Resting Pain NRS Scores Over 0-72 Hours
Časové okno: 0 to 72 hours postoperatively
Area under the curve (AUC) of Numerical Rating Scale (NRS) scores for resting pain (PAR, Pain at Rest) from 0 to 72 hours postoperatively. NRS is a 11-point scale (0 = no pain, 10 = worst possible pain). Assessed by a blinded assessor at 6, 12, 24, 48, and 72 hours after surgery. AUC is calculated using the trapezoidal rule.
0 to 72 hours postoperatively
Time to First PCIA Pump Press
Časové okno: Measured from the end of surgery up to 48 hours postoperatively
Time from the end of surgery to the patient's first postoperative patient-controlled intravenous analgesia (PCIA) pump activation.
Measured from the end of surgery up to 48 hours postoperatively
Total Number of PCIA Pump Presses Within 48 Hours Postoperatively
Časové okno: 0 to 48 hours postoperatively
Total number of patient-controlled intravenous analgesia (PCIA) pump presses (both effective and ineffective attempts) within the first 48 hours after surgery.
0 to 48 hours postoperatively
Intraoperative Propofol Dosage
Časové okno: During surgery (intraoperative)
Total intraoperative propofol dosage (mg) administered during surgery, recorded by the anesthesiologist.
During surgery (intraoperative)
Intraoperative Remifentanil Dosage
Časové okno: During surgery (intraoperative)
Total intraoperative remifentanil dosage (μg) administered during surgery, recorded by the anesthesiologist.
During surgery (intraoperative)
Time to First Independent Ambulation of ≥5 Meters
Časové okno: Measured from the end of surgery up to hospital discharge (expected up to 7 days postoperatively)
Time from the end of surgery to the patient's first independent ambulation of at least 5 meters.
Measured from the end of surgery up to hospital discharge (expected up to 7 days postoperatively)
Postoperative Hospital Stay
Časové okno: From the end of surgery to hospital discharge (expected up to 7 days postoperatively)
Duration of postoperative hospital stay (hours), defined as meeting the uniform discharge criteria: tolerance of oral analgesia, tolerance of a semi-liquid diet, passage of flatus, and absence of uncontrolled complications.
From the end of surgery to hospital discharge (expected up to 7 days postoperatively)
Incidence and Severity of Postoperative Nausea
Časové okno: 0 to 72 hours postoperatively
Incidence of postoperative nausea. Severity is assessed using the Numerical Rating Scale (NRS, 0 = no nausea, 10 = most severe nausea).
0 to 72 hours postoperatively
Incidence and Number of Episodes of Postoperative Vomiting
Časové okno: 0 to 72 hours postoperatively
Incidence and number of episodes of postoperative vomiting.
0 to 72 hours postoperatively
Rate of Rescue Antiemetic Use
Časové okno: 0 to 72 hours postoperatively
Rate of postoperative rescue antiemetic administration.
0 to 72 hours postoperatively
Incidence and Severity of Abdominal Distension
Časové okno: 0 to 72 hours postoperatively
Incidence of postoperative abdominal distension. Severity is assessed using the Numerical Rating Scale (NRS, 0 = no distension, 10 = most severe distension).
0 to 72 hours postoperatively
Incidence of Postoperative Complications
Časové okno: From the end of surgery up to 30 days post-discharge
Incidence of postoperative complications, graded by the Clavien-Dindo classification.
From the end of surgery up to 30 days post-discharge
30-Day Readmission Rate
Časové okno: 30 days after discharge
Rate of hospital readmission within 30 days after discharge.
30 days after discharge
Quality of Life - EORTC QLQ-C30
Časové okno: Preoperatively, on postoperative day 4, and at 30 days after surgery
Health-related quality of life assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). The questionnaire assesses 15 dimensions of HRQoL, including physical, psychological, and social functions.
Preoperatively, on postoperative day 4, and at 30 days after surgery
Quality of Life - EORTC QLQ-STO22
Časové okno: Preoperatively, on postoperative day 4, and at 30 days after surgery
Gastric cancer-specific quality of life assessed using the EORTC Quality of Life Questionnaire - Stomach Cancer Module (EORTC QLQ-STO22). The questionnaire includes five multi-item scales (dysphagia, pain, reflux, eating restrictions, anxiety) and four single items (dry mouth, body image, taste problems, hair loss). Higher scores indicate more severe symptoms.
Preoperatively, on postoperative day 4, and at 30 days after surgery
Perioperative Fatigue - ICFS-10
Časové okno: Preoperatively, on postoperative day 4, and at 30 days after surgery
Perioperative fatigue assessed using the Identity-Consequence Fatigue Scale-10 (ICFS-10). The scale contains 10 items; a total score > 24 indicates postoperative fatigue syndrome (POF).
Preoperatively, on postoperative day 4, and at 30 days after surgery

Další výstupní opatření

Měření výsledku
Popis opatření
Časové okno
Inflammatory Cytokines - CRP, IL-6, IL-1β, TNF-α
Časové okno: Postoperative days 1, 3, and 5 (or at discharge if earlier)
Serum levels of inflammatory cytokines, including C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α), measured from fasting blood samples to investigate whether TEAS exerts its effects through inhibition of systemic inflammation.
Postoperative days 1, 3, and 5 (or at discharge if earlier)
Gastrointestinal Hormones - Motilin, Gastrin, Substance P, VIP, CCK
Časové okno: Postoperative days 1, 3, and 5 (or at discharge if earlier)
Serum levels of gastrointestinal hormones, including motilin (MTL), gastrin (GAS), substance P (SP), vasoactive intestinal peptide (VIP), and cholecystokinin (CCK), measured from fasting blood samples.
Postoperative days 1, 3, and 5 (or at discharge if earlier)
Immunoglobulins - IgA, IgG, IgM
Časové okno: Postoperative days 1, 3, and 5 (or at discharge if earlier)
Serum levels of immunoglobulins, including IgA, IgG, and IgM, measured from fasting blood samples to explore whether TEAS attenuates postoperative immunosuppression.
Postoperative days 1, 3, and 5 (or at discharge if earlier)

Spolupracovníci a vyšetřovatelé

Zde najdete lidi a organizace zapojené do této studie.

Vyšetřovatelé

  • Studijní židle: Yanbing Zhou, The Affiliated Hospital of Qingdao University

Publikace a užitečné odkazy

Osoba odpovědná za zadávání informací o studiu tyto publikace poskytuje dobrovolně. Mohou se týkat čehokoli, co souvisí se studiem.

Obecné publikace

Termíny studijních záznamů

Tato data sledují průběh záznamů studie a předkládání souhrnných výsledků na ClinicalTrials.gov. Záznamy ze studií a hlášené výsledky jsou před zveřejněním na veřejné webové stránce přezkoumány Národní lékařskou knihovnou (NLM), aby se ujistily, že splňují specifické standardy kontroly kvality.

Hlavní termíny studia

Začátek studia (Odhadovaný)

1. července 2026

Primární dokončení (Odhadovaný)

1. července 2028

Dokončení studie (Odhadovaný)

1. srpna 2028

Termíny zápisu do studia

První předloženo

15. července 2026

První předloženo, které splnilo kritéria kontroly kvality

15. července 2026

První zveřejněno (Aktuální)

20. července 2026

Aktualizace studijních záznamů

Poslední zveřejněná aktualizace (Aktuální)

20. července 2026

Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality

15. července 2026

Naposledy ověřeno

1. července 2026

Více informací

Termíny související s touto studií

Plán pro data jednotlivých účastníků (IPD)

Plánujete sdílet data jednotlivých účastníků (IPD)?

NE

Popis plánu IPD

No plan for sharing individual participant data has been established for this investigator-initiated trial.

Informace o lécích a zařízeních, studijní dokumenty

Studuje lékový produkt regulovaný americkým FDA

Ne

Studuje produkt zařízení regulovaný americkým úřadem FDA

Ne

Tyto informace byly beze změn načteny přímo z webu clinicaltrials.gov. Máte-li jakékoli požadavky na změnu, odstranění nebo aktualizaci podrobností studie, kontaktujte prosím register@clinicaltrials.gov. Jakmile bude změna implementována na clinicaltrials.gov, bude automaticky aktualizována i na našem webu .

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