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Wang W, Zhu L, Li X, Liu Z, Lv H, Qian G. Emerging evidence of microbial infection in causing systematic immune vasculitis in Kawasaki disease. Front Microbiol 2023; 14:1313838. [PMID: 38188572 PMCID: PMC10771848 DOI: 10.3389/fmicb.2023.1313838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
Kawasaki disease (KD) is a systematic vasculitis that is often complicated by coronary artery lesions and is a leading cause of acquired heart disease in developed countries. Previous studies have suggested that genetic susceptibility, together with an inducing infectious agent, could be involved in KD pathogenesis; however, the precise causative agent of this disease remains unknown. Moreover, there are still debates concerning whether KD is an infectious disease or an autoimmune disease, although many studies have begun to show that various pathogens functioning as critical inducers could activate different kinds of immune cells, consequently leading to the dysfunction of endothelial cells and systematic vasculitis. Here in this review, we attempt to summarize all the available evidence concerning pathogen infections associated with KD pathogenesis. We also discuss the related mechanisms, present a future perspective, and identify the open questions that remain to be investigated, thereby providing a comprehensive description of pathogen infections and their correlations with the host immune system in leading to KD.
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Affiliation(s)
- Wang Wang
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Liyan Zhu
- Department of Experimental Center, Medical College of Soochow University, Suzhou, China
| | - Xuan Li
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhiheng Liu
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Haitao Lv
- Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Guanghui Qian
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
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Farahmand M, Ahmadi-Vasmehjani A, Esteghamati A, Sayyahfar S, Minaeian S, Khanaliha K, Naghdalipour M, Tavakoli A. A meta-analysis on association between viral infections and Kawasaki disease in children. Future Virol 2021. [DOI: 10.2217/fvl-2020-0212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: To investigate the association between different viral infections and the development of Kawasaki disease (KD) in children. Materials & methods: Electronic databases were searched for relevant studies published from inception to May 2020. The pooled odds ratios (ORs) of the association of different viral pathogens with KD were estimated using a random-effects model weighted by the inverse variance method. Results: The strongest associations were found between KD and human parvovirus B19 viremia (OR = 41.05; 95% CI: 5.13–328.28; I-square = 0%), EBV IgM seropositivity (OR = 7.18; 95% CI: 3.65–14.12, I-square = 0%) and human herpesvirus-6 IgG seropositivity (OR = 5.83; 95% CI: 1.06–32.01). Conclusion: Human parvovirus B19, EBV and human herpesvirus-6 are highly suspected to be key contributors to the development of KD.
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Affiliation(s)
- Mohammad Farahmand
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran 1416753955, Iran
| | - Abbas Ahmadi-Vasmehjani
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran 1416753955, Iran
| | - Abdoulreza Esteghamati
- Research Center of Pediatric Infectious Diseases, Institute of Immunology & Infectious Diseases, Iran University of Medical Sciences, Tehran 1449614535, Iran
| | - Shirin Sayyahfar
- Research Center of Pediatric Infectious Diseases, Institute of Immunology & Infectious Diseases, Iran University of Medical Sciences, Tehran 1449614535, Iran
| | - Sara Minaeian
- Antimicrobial Resistance Research Center, Institute of Immunology & Infectious Diseases, Iran University of Medical Sciences, Tehran 1449614535, Iran
| | - Khadijeh Khanaliha
- Research Center of Pediatric Infectious Diseases, Institute of Immunology & Infectious Diseases, Iran University of Medical Sciences, Tehran 1449614535, Iran
| | - Mehri Naghdalipour
- Research Center of Pediatric Infectious Diseases, Institute of Immunology & Infectious Diseases, Iran University of Medical Sciences, Tehran 1449614535, Iran
| | - Ahmad Tavakoli
- Research Center of Pediatric Infectious Diseases, Institute of Immunology & Infectious Diseases, Iran University of Medical Sciences, Tehran 1449614535, Iran
- Department of Medical Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran 1449614535, Iran
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Amirfakhryan H. Kawasaki-like disease in children with COVID-19: A hypothesis. Med Hypotheses 2020; 143:110117. [PMID: 32721809 PMCID: PMC7367792 DOI: 10.1016/j.mehy.2020.110117] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 01/18/2023]
Abstract
With rapid spread of severe acute respiratory syndrome- corona virus-2 (SARS-COV-2) globally, some new aspects of the disease have been reported. Recently, it has been reported the incidence of Kawasaki-like disease among children with COVID-19. Since, children had been known to be less severely affected by the virus in part due to the higher concentration of Angiotensin converting enzyme (ACE)-2 receptor, this presentation has emerged concerns regarding the infection of children with SARS-COV2. ACE2 has anti-inflammatory, anti-fibrotic and anti-proliferative characteristics through converting angiotensin (Ag)-II to Ang (1-7). ACE2 receptor is downregulated by the SARS-COV through the spike protein of SARS-CoV (SARS-S) via a process that is tightly coupled with Tumor necrosis factor (TNF)-α production. TNF-α plays a key role in aneurysmal formation of coronary arteries in Kawasaki disease (KD). Affected children by COVID-19 with genetically-susceptible to KD might have genetically under-expression of ACE2 receptor that might further decrease the expression of ACE2 due to the downregulation of the receptor by the virus in these patients. It appears that TNF- α might be the cause and the consequence of the ACE2 receptor downregulation which results in arterial walls aneurysm. Conclusion: Genetically under-expression of ACE2 receptor in children with genetically-susceptible to KD who are infected with SARS-CoV-2 possibly further downregulates the ACE2 expression by TNF-α and leads to surge of inflammation including TNF-α and progression to Kawasaki-like disease.
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Affiliation(s)
- Hamideh Amirfakhryan
- Preventative Cardiovascular Medicine, Faculty of Health Science, University of South Wales, UK.
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MacIntyre CR, Kpozehouen E, Kunasekaran M, Harriman K, Conaty S, Rosewell A, Druce J, Martin N, Heywood AE, Gidding HF, Wood J, Nicholl S. Measles control in Australia - threats, opportunities and future needs. Vaccine 2018; 36:4393-4398. [PMID: 29934234 DOI: 10.1016/j.vaccine.2018.06.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 06/07/2018] [Accepted: 06/08/2018] [Indexed: 11/18/2022]
Abstract
Control of measles was the focus of a national workshop held in 2015 in Sydney, Australia, bringing together stakeholders in disease control and immunisation to discuss maintaining Australia's measles elimination status in the context of regional and global measles control. The global epidemiology of measles was reviewed, including outbreaks in countries that have achieved elimination, such as the Disneyland outbreak in the United States and large outbreaks in Sydney, Australia. Transmission of measles between Australia and New Zealand occurs, but has not been a focus of control measures. Risk groups, the genetic and seroepidemiology of measles as well as surveillance, modelling and waning vaccine-induced immunity were reviewed. Gaps in policy, research and practice for maintaining measles elimination status in Australia were identified and recommendations were developed. Elimination of measles globally is challenging because of the infectiousness of measles and the need for 2-dose vaccine coverage rates in excess of 95% in all countries to achieve it. Until this occurs, international travel will continue to permit measles importation from endemic countries to countries that have achieved elimination. When measles cases are imported, failure to diagnose and isolate cases places the health system at risk of measles outbreaks. Vaccine funding models can result in gaps in vaccine coverage for adults and migrants. Australia introduced a whole-of-life immunisation register in 2016 and catch-up vaccination for at-risk communities, which will improve measles control. Research on diagnosis, immunology, case management and modelling of vaccination strategies are important to ensure continued control of measles.
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Affiliation(s)
- C Raina MacIntyre
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia; Kirby Institute, Biosecurity Program, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - Elizabeth Kpozehouen
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia.
| | - Mohana Kunasekaran
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
| | | | - Stephen Conaty
- Public Health Unit, South Western Sydney Local Health District, Australia
| | - Alexander Rosewell
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - Julian Druce
- Victorian Infectious Diseases Reference Laboratory, Australia; VIDRL, Doherty Institute, Australia
| | - Nicolee Martin
- Victorian Infectious Diseases Reference Laboratory, Australia
| | - Anita E Heywood
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia; National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
| | - Heather F Gidding
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia; National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
| | - James Wood
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
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Abstract
Vasculitis may be associated with infection, immunization or anti-microbial drugs. Infections are responsible for a number of different types of vasculitis. Conversely, patients with vasculitis may develop infections, which sometimes mimic relapse. The aim of this review is to summarize the various aspects of the inter-relationship between vasculitis and infection, and the physiopathological mechanisms involved, in light of our current knowledge from animal models. Currently, a causal relationship between infection and vasculitis has only been established in a few instances and many mechanisms remain hypothetical. This inter-relationship is further assessed from the point of view of clinical presentation and therapeutic options, based on case reports and prospective observational data.
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Mimicking Kawasaki disease in burned children: report of four cases. Burns 2008; 35:594-9. [PMID: 18539399 DOI: 10.1016/j.burns.2008.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2006] [Accepted: 03/06/2008] [Indexed: 10/22/2022]
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Rowley AH, Baker SC, Orenstein JM, Shulman ST. Searching for the cause of Kawasaki disease--cytoplasmic inclusion bodies provide new insight. Nat Rev Microbiol 2008; 6:394-401. [PMID: 18364728 PMCID: PMC7097362 DOI: 10.1038/nrmicro1853] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Although Kawasaki disease (KD) is the most common cause of acquired heart disease in children in the developed world, its aetiology remains unknown. In this Opinion, Anne Rowley and colleagues discuss evidence, including recently identified cytoplasmic inclusion bodies, which suggests that KD is caused by an infectious agent. Kawasaki disease (KD) has emerged as the most common cause of acquired heart disease in children in the developed world. The cause of KD remains unknown, although an as-yet unidentified infectious agent might be responsible. By determining the causative agent, we can improve diagnosis, therapy and prevention of KD. Recently, identification of an antigen-driven IgA response that was directed at cytoplasmic inclusion bodies in KD tissues has provided new insights that could unlock the mysteries of KD.
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Affiliation(s)
- Anne H Rowley
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, The Center for Kawasaki Disease, The Children's Memorial Hospital, Chicago, Illinois 60611, USA.
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Abstract
La enfermedad de Kawasaki es una vasculitis sistémica de etiología desconocida que afecta principalmente a niños menores de 5 años. Es actualmente la primera causa de cardiopatía adquirida en la infancia en los países desarrollados, lo que la convierte en una enfermedad de suma trascendencia en el momento actual. No se conoce su etiología, aunque existen fuertes sospechas de que sea infecciosa. El diagnóstico se realiza por criterios clínicos de fiebre persistente de al menos 5 días de duración y 4 de 5 criterios clínicos: cambios en extremidades, exantemas polimorfos, inyección conjuntival no exudativa, cambios en los labios y la mucosa oral y adenopatías > 1,5 cm, habitualmente unilateral. La complicación más frecuente es la dilatación y los aneurismas de las arterias coronarias, la cual ocurre en el 20-25% de los niños no tratados. El tratamiento estándar de la enfermedad es con gammaglobulina intravenosa en dosis de 2 g/kg, antes de los 10 días del comienzo de la enfermedad, más ácido acetilsalicílico oral en dosis antiinflamatorias. El riesgo de lesión coronaria en los niños tratados es del 3-5%.
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Burgner D, Harnden A. Kawasaki disease: what is the epidemiology telling us about the etiology? Int J Infect Dis 2005; 9:185-94. [PMID: 15936970 PMCID: PMC7110839 DOI: 10.1016/j.ijid.2005.03.002] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2004] [Revised: 03/14/2005] [Accepted: 03/22/2005] [Indexed: 12/15/2022] Open
Abstract
Kawasaki disease (KD) is an important and common inflammatory vasculitis of early childhood with a striking predilection for the coronary arteries. It is the predominant cause of paediatric acquired heart disease in developed countries. Despite 40 years of research, the aetiology of KD remains unknown and consequently there is no diagnostic test and treatment is non-specific and sub-optimal. The consensus is that KD is due to one or more widely distributed infectious agent(s), which evoke an abnormal immunological response in genetically susceptible individuals. The epidemiology of KD has been extensively investigated in many populations and provides much of the supporting evidence for the consensus regarding etiology. These epidemiological data are reviewed here, in the context of the etiopathogenesis. It is suggested that these data provide additional clues regarding the cause of KD and may account for some of the continuing controversies in the field.
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Affiliation(s)
- David Burgner
- School of Paediatrics and Child Health, University of Western Australia, Princess Margaret Hospital for Children, GPO Box D184, Perth WA 6840, Australia.
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Abstract
Kawasaki disease (KD) was first reported in Japan more than 30 years ago, but the original diagnostic clinical criteria defined by Dr. Kawasaki are still authentic. The cause of KD remains unknown. Several epidemiologic and clinical observations suggest that it is caused by one or multiple infectious agents, each of which can result in the clinical manifestation of the disease. Advances have been made in the management of the disease with the introduction of aspirin and intravenous immunoglobulin (IVIG) that have had a significant impact on lowering the rate of coronary artery aneurysms and death from the disease. Questions remain regarding the management of those patients whose disease does not respond to IVIG. Some patients with severe KD who are resistant to IVIG may benefit from IV pulse steroids therapy. It remains to be seen whether steroid or other anti-inflammatory agents play a role in the management of patients with KD. Further research studies are needed to identify the possible cause, define the treatment, and predict the long-term outcome of this enigmatic disease.
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Affiliation(s)
- Abraham Gedalia
- Departments of Pediatrics, LSU Health Sciences Center and Children's Hospital, 1542 Tulane Avenue, T8-1, New Orleans, LA 70112, USA.
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Kuijpers TW, Herweijer TJ, Schölvinck L, Wertheim-Van Dillen PM, Van De Veer EM. Kawasaki disease associated with measles virus infection in a monozygotic twin. Pediatr Infect Dis J 2000; 19:350-3. [PMID: 10783028 DOI: 10.1097/00006454-200004000-00018] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- T W Kuijpers
- Department of Pediatrics, Onze Lieve Vrouwe Gasthuis, Academic Medical Center, Amsterdam, The Netherlands.
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Abstract
Human lymphotropic viruses interacting with human immune systems may cause a wide spectrum of human diseases. Kawasaki disease has been thought to be related to events associated with infection, although a direct causative role has not been clearly demonstrated. In this concise review, the reported relationship between human lymphotropic viruses and Kawasaki disease is briefly described.
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Affiliation(s)
- M Okano
- Department of Pediatrics, Hokkaido University School of Medicine, Sapporo, Japan
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Simpson GR, Schulz TF, Whitby D, Cook PM, Boshoff C, Rainbow L, Howard MR, Gao SJ, Bohenzky RA, Simmonds P, Lee C, de Ruiter A, Hatzakis A, Tedder RS, Weller IV, Weiss RA, Moore PS. Prevalence of Kaposi's sarcoma associated herpesvirus infection measured by antibodies to recombinant capsid protein and latent immunofluorescence antigen. Lancet 1996; 348:1133-8. [PMID: 8888167 DOI: 10.1016/s0140-6736(96)07560-5] [Citation(s) in RCA: 454] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Kaposi's sarcoma-associated herpesvirus (KSHV), also known as human herpesvirus 8, may be the infectious cause of KS. Its prevalence in the general population, on the basis of detection of the virus genome, is controversial. To investigate the seroprevalence, we measured antibodies to a recombinant capsid-related (lytic cycle) KSHV antigen and a latent antigen complex. METHODS We selected potentially immunoreactive capsid-related proteins of KSHV by expressing them as recombinant proteins and testing them in western blot assays. We used a truncated recombinant protein encoded by KSHV open reading frame 65 (orf 65) to develop a diagnostic enzyme-linked immunosorbent assay (ELISA) and tested sera from HIV-infected individuals with KS, HIV-uninfected patients with "classic" KS, other HIV risk groups, and blood donors. We also compared the antibody response to this capsid-related protein to the response to latent antigen(s) in an immunofluorescence assay. FINDINGS 77/92 (84%) sera from KS patients reacted with the KSHV orf 65 protein and 84/103 (81.5%) reacted with KSHV latent antigen(s). The dominant immunogenic region of orf 65 is within the carboxyterminal 80 aminoacids, a region with little sequence similarity to the related Epstein-Barr virus, suggesting that orf 65 is a KSHV specific antigen. Only three sera from patients with haemophilia (1/84) or from intravenous drug users (2/63) had KSHV specific antibodies in the orf 65 assay whereas none of these sera reacted with latent antigen. Antibodies to KSHV were also infrequently found in UK and US blood donors by either assay (UK, 3/174 with orf 65 and 4/150 with latent antigen; US, 6/117 with orf 65 and 0/117 with latent antigen). They were more common among HIV-infected gay men without KS (5/16 by orf 65 ELISA, 10/33 by IFA), HIV-uninfected STD clinic attenders (14/166 by IFA), and Ugandan HIV-uninfected controls (6/17 by orf 65 ELISA, 9/17 by IFA). Antibody reactivity to the orf 65 protein (ELISA) and to latent antigen(s) (IFA) was concordant in 89% of 462 sera tested but reactive blood donor sera were discordant in both assays. Four AIDS-KS sera were unreactive in both assays. INTERPRETATION The distribution of antibodies to both a capsid-related recombinant protein and latent antigen(s) of KSHV strongly supports the view that infection with this virus is largely confined to individuals with, or at increased risk for, KS. However, infection with KSHV does occur, rarely, in the general UK and US population and is more common in Uganda. Antibodies to latent antigen(s) or to orf 65 encoded capsid protein will not detect all cases of KSHV infection, and a combination of several antigens will probably be required for accurate screening and confirmatory assays.
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Affiliation(s)
- G R Simpson
- Department of Medical Microbiology and Genitourinary Medicine, University of Liverpool, UK
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Hagiwara K, Yoshida T, Komura H, Kishi F, Kajii T. Isolation of human herpesvirus-6 from an infant with Kawasaki disease. Eur J Pediatr 1993; 152:176. [PMID: 8383052 DOI: 10.1007/bf02072502] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Hagiwara K, Komura H, Kishi F, Kaji T, Yoshida T. Isolation of human herpesvirus-6 from an infant with Kawasaki disease. Eur J Pediatr 1992; 151:867-8. [PMID: 1334835 DOI: 10.1007/bf01957946] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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