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Thromboembolic Events Secondary to Endoscopic Cyanoacrylate Injection: Can We Foresee Any Red Flags? Can J Gastroenterol Hepatol 2018; 2018:1940592. [PMID: 29850452 PMCID: PMC5903199 DOI: 10.1155/2018/1940592] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/20/2018] [Accepted: 01/31/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Gastric varices (GV) are associated with high morbidity and mortality in patients with portal hypertension. Endoscopic cyanoacrylate injection is the first-line recommended therapy for GV obliteration. This study aims to explore the reason behind related adverse events and better prevent its occurrence. METHODS A retrospective case series study was conducted from January 1, 2013, to December 31, 2016, to identify patients who experienced severe adverse events secondary to endoscopic cyanoacrylate injection. A literature review of similar cases was performed on two medical databases, Medline and Embase. RESULTS A total of 652 patients underwent cyanoacrylate injection at our center within the study duration. Five cases of severe adverse events related to the use of tissue adhesives were identified. Detailed clinical presentation, patient treatment, and outcomes were reviewed and analyzed. Twenty-seven similar cases were identified based on the literature review providing further insight into the study. CONCLUSION Although rare in incidence, systemic embolism associated with cyanoacrylate injection is often fatal or debilitating. This report may raise awareness in treatment protocol, including the necessity of preoperative angiographic studies, to avoid similar adverse events in clinical practice.
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Korde JM, Kandasubramanian B. Biocompatible alkyl cyanoacrylates and their derivatives as bio-adhesives. Biomater Sci 2018; 6:1691-1711. [DOI: 10.1039/c8bm00312b] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Cyanoacrylate adhesives and their homologues have elicited interest over the past few decades owing to their applications in the biomedical sector, extending from tissue adhesives to scaffolds to implants to dental material and adhesives, because of their inherent biocompatibility and ability to polymerize solely with moisture, thanks to which they adhere to any substrate containing moisture such as the skin.
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Affiliation(s)
- Jay M. Korde
- Biocomposite Fabrication Lab
- Department of Metallurgical and Materials Engineering
- DIAT (DU)
- Ministry of Defence
- Pune-411025
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The Efficacy and the Safety of Prophylactic N-Butyl-2-Cyanoacrylate Injection for Gastric Varices Using a Modified Injection Technique. Surg Laparosc Endosc Percutan Tech 2017; 26:e85-90. [PMID: 27403617 DOI: 10.1097/sle.0000000000000296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Primary prophylactic N-butyl-2-cyanoacrylate (NBC) injection for nonbleeding gastric varices (GVs) remains controversial. In addition, there is still no consensus concerning the technique, its safety, and long-term results. AIM To analyze the safety and the efficacy of NBC for primary prophylaxis of GVs using a modified injection technique. METHODS Between February 2004 and June 2014, a total of 72 patients with GVs with a high risk of bleeding, who received undiluted NBC injection using a modified "sandwich" method for primary prophylaxis in General Hospital of Chengdu Military Command, were enrolled in this retrospective study. All patients were followed up at 1 to 2 weeks, 3 months, 6 months, and thereafter every 6 months or whenever required, using endoscope detection. The rate of obliteration, bleeding, recurrence, and complications was evaluated. RESULTS According to the standard Sarin classification, 28 patients were IGV1 and 44 patients were GEV2. Hepatitis B virus infection was the major cause of portal hypertension. The mean number of sessions were 1.4 (1 to 3) and the mean volume of NBC per session was 3.5 mL (1 to 6 mL). One injection per session was used in 41 patients (56.9%) and 2 or more injections were used in the remaining 31 patients (43.1%). During the follow-up (27 mo; range, 12 to 67 mo), complete obliteration of GVs was achieved in 93.1% of the patients (67/72). One session of NBC injection was enough to obliterate GVs in 49 patients (68.1%), and 2 or more sessions were needed in 23 patients (31.9%). In addition, the bleeding and the recurrence rate were 11.1% (8/72) and 15.3% (11/72), respectively, during the follow-up. The cumulative bleeding-free rate at 1, 3, and 5 years was 95.8%, 91.7%, and 88.9%, respectively. Worsening of esophageal varices was observed in 13 patients (9 in GEV2 and 4 in IGV1). No serious complications, such as distal embolism, were observed in all patients. CONCLUSIONS Prophylactic endoscopic NBC injection using a modified injection technique may be a safe and effective treatment for gastric fundal varices with a high risk of bleeding.
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Al-Hillawi L, Wong T, Tritto G, Berry PA. Pitfalls in histoacryl glue injection therapy for oesophageal, gastric and ectopic varices: A review. World J Gastrointest Surg 2016; 8:729-734. [PMID: 27933134 PMCID: PMC5124701 DOI: 10.4240/wjgs.v8.i11.729] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 07/19/2016] [Accepted: 09/08/2016] [Indexed: 02/06/2023] Open
Abstract
Histoacryl glue is used increasingly for the treatment of gastric and ectopic varices, and there is experience in its use for oesophageal varices. It is an effective treatment, yet numerous reports of complications have accumulated. This review of the literature describes the technique, explores circulatory and vascular consideration unique to portal hypertension and categorises the complications into: “Embolisation”, “local venous thrombosis”, “fistulisation and extravascular injection”, “ulceration, erosion and extrusion”, and “nidus of infection”. A case is then made for standardisation of the technique and the consent process.
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Ribeiro JP, Matuguma SE, Cheng S, Herman P, Sakai P, D'Albuquerque LAC, Maluf-Filho F. Results of treatment of esophageal variceal hemorrhage with endoscopic injection of n-butyl-2-cyanoacrylate in patients with Child-Pugh class C cirrhosis. Endosc Int Open 2015; 3:E584-9. [PMID: 26716117 PMCID: PMC4683151 DOI: 10.1055/s-0034-1392600] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 06/16/2015] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND AND STUDY AIMS The results of endoscopic treatment with elastic band ligation for esophageal variceal bleeding in patients with Child-Pugh class C cirrhosis remain poor. In comparison with treatment with elastic band ligation, we have found lower rates of rebleeding and mortality with n-butyl-2-cyanoacrylate injections. Thus, the aim of the current study was to describe our unit's 10 years of experience with injection of n-butyl-2-cyanoacrylate to control esophageal variceal ruptures in patients with Child-Pugh class C cirrhosis. PATIENTS AND METHODS A single-center, retrospective study was conducted. Sixty-three patients with Child-Pugh class C cirrhosis had been admitted to the center with an acute episode of esophageal variceal bleeding. All were treated with injection of n-butyl-2-cyanoacrylate. The patients were assigned to 1 of 2 groups according to their Child-Pugh class C cirrhosis scores: group I (score range, 10 through 13 points) and group II (score, 14 or 15 points). The 3 variables studied were rates of initial failure to control bleeding, failure to prevent rebleeding (secondary prophylaxis), and mortality. Patients in the 2 groups (group I, n = 50; group II, n = 13) had similar characteristics. RESULTS Bleeding was successfully controlled in almost 75 % of the patients during the first 5 days after treatment, with no significant differences observed between groups I and II. There were no significant differences between the 2 groups with respect to mortality rate for the first 5 days after treatment. Thirty-four patients (54 %) were free of bleeding at 6 weeks after treatment, with a significant difference noted between the groups: group I, 64 %, versus group II, 15.4 % (P < 0.001). The overall mortality rate was 44.4 %, with a significant difference noted between the groups: group I, 34 %, versus group II, 84.6 % (P < 0.001). CONCLUSION Endoscopic injection of n-butyl-2-cyanoacrylate is a valid treatment option to control esophageal variceal bleeding in patients with a Child-Pugh class C cirrhosis score in the range of 10 through 13 points.
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Affiliation(s)
- Joao Paulo Ribeiro
- Department of Gastroenterology, University of São Paulo, São Paulo, Brazil
| | | | - Spencer Cheng
- Department of Gastroenterology, University of São Paulo, São Paulo, Brazil
| | - Paulo Herman
- Department of Gastroenterology, University of São Paulo, São Paulo, Brazil
| | - Paulo Sakai
- Department of Gastroenterology, University of São Paulo, São Paulo, Brazil,Laboratory of Investigation of University of São Paulo – LIM37, São Paulo, Brazil
| | - Luiz Augusto Carneiro D'Albuquerque
- Department of Gastroenterology, University of São Paulo, São Paulo, Brazil,Laboratory of Investigation of University of São Paulo – LIM37, São Paulo, Brazil
| | - Fauze Maluf-Filho
- Department of Gastroenterology, University of São Paulo, São Paulo, Brazil,Laboratory of Investigation of University of São Paulo – LIM37, São Paulo, Brazil,Corresponding author Fauze Maluf-Filho, MD, PhD Av. Brigadeiro Luis Antonio, 4161CEP 01402-001São Paulo – SPBrazil+55-11-3884-7599
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Ribeiro JP, Matuguma SE, Cheng S, Herman P, Sakai P, D'Albuquerque LAC, Maluf-Filho F. Results of treatment of esophageal variceal hemorrhage with endoscopic injection of n-butyl-2-cyanoacrylate in patients with Child-Pugh class C cirrhosis. Endosc Int Open 2015. [PMID: 26716117 DOI: 10.1055/s-0034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND AND STUDY AIMS The results of endoscopic treatment with elastic band ligation for esophageal variceal bleeding in patients with Child-Pugh class C cirrhosis remain poor. In comparison with treatment with elastic band ligation, we have found lower rates of rebleeding and mortality with n-butyl-2-cyanoacrylate injections. Thus, the aim of the current study was to describe our unit's 10 years of experience with injection of n-butyl-2-cyanoacrylate to control esophageal variceal ruptures in patients with Child-Pugh class C cirrhosis. PATIENTS AND METHODS A single-center, retrospective study was conducted. Sixty-three patients with Child-Pugh class C cirrhosis had been admitted to the center with an acute episode of esophageal variceal bleeding. All were treated with injection of n-butyl-2-cyanoacrylate. The patients were assigned to 1 of 2 groups according to their Child-Pugh class C cirrhosis scores: group I (score range, 10 through 13 points) and group II (score, 14 or 15 points). The 3 variables studied were rates of initial failure to control bleeding, failure to prevent rebleeding (secondary prophylaxis), and mortality. Patients in the 2 groups (group I, n = 50; group II, n = 13) had similar characteristics. RESULTS Bleeding was successfully controlled in almost 75 % of the patients during the first 5 days after treatment, with no significant differences observed between groups I and II. There were no significant differences between the 2 groups with respect to mortality rate for the first 5 days after treatment. Thirty-four patients (54 %) were free of bleeding at 6 weeks after treatment, with a significant difference noted between the groups: group I, 64 %, versus group II, 15.4 % (P < 0.001). The overall mortality rate was 44.4 %, with a significant difference noted between the groups: group I, 34 %, versus group II, 84.6 % (P < 0.001). CONCLUSION Endoscopic injection of n-butyl-2-cyanoacrylate is a valid treatment option to control esophageal variceal bleeding in patients with a Child-Pugh class C cirrhosis score in the range of 10 through 13 points.
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Affiliation(s)
- Joao Paulo Ribeiro
- Department of Gastroenterology, University of São Paulo, São Paulo, Brazil
| | | | - Spencer Cheng
- Department of Gastroenterology, University of São Paulo, São Paulo, Brazil
| | - Paulo Herman
- Department of Gastroenterology, University of São Paulo, São Paulo, Brazil
| | - Paulo Sakai
- Department of Gastroenterology, University of São Paulo, São Paulo, Brazil ; Laboratory of Investigation of University of São Paulo - LIM37, São Paulo, Brazil
| | - Luiz Augusto Carneiro D'Albuquerque
- Department of Gastroenterology, University of São Paulo, São Paulo, Brazil ; Laboratory of Investigation of University of São Paulo - LIM37, São Paulo, Brazil
| | - Fauze Maluf-Filho
- Department of Gastroenterology, University of São Paulo, São Paulo, Brazil ; Laboratory of Investigation of University of São Paulo - LIM37, São Paulo, Brazil
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Endoscopic treatment of esophageal varices in advanced liver disease patients: band ligation versus cyanoacrylate injection. Eur J Gastroenterol Hepatol 2011; 23:60-5. [PMID: 21084988 DOI: 10.1097/meg.0b013e3283415986] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The results of variceal band ligation (VBL) in patients with advanced liver disease are unknown. Cyanoacrylate injection (CI) might have a better outcome than VBL in the treatment of esophageal varices (EV) in these patients. AIM To compare VBL and CI in the treatment of EV in patients with advanced liver disease. PATIENTS AND METHODS Thirty-eight patients with medium or large EV and Child-Pugh index of at least eight were randomized into two groups: VBL (n=20) and CI (n=18). The patients were followed-up for at least 6 months after the end of treatment. Main outcomes were eradication, bleeding, mortality, complication, and recurrence rates. RESULTS Variceal eradication rates were similar in the VBL and CI groups (90 vs. 72%, P=0.39). Mean number of sessions until eradication was 3.17 and 3, respectively. Bleeding episodes until eradication were equally observed in both groups (P=0.17). Mortality (55 vs. 56%, P=0.52) and major complication rates (5 and 17%, P=0.32) were similar. Chest pain with dysphagia was more frequent in the CI group (55.6 vs. 10%, P=0.004). A higher risk of variceal recurrence was observed in the CI group (33 vs. 57%, P=0.04). CONCLUSION No significant differences between the VBL and CI groups were observed in the treatment of EV in patients with advanced liver disease regarding mortality, variceal eradication, and major complications rates. However, minor complications and variceal recurrence were significantly more common in the CI group. In addition, there was a clear trend toward more bleeding episodes in patients included in the CI group.
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Sato T, Yamazaki K. Evaluation of therapeutic effects and serious complications following endoscopic obliterative therapy with Histoacryl. Clin Exp Gastroenterol 2010; 3:91-5. [PMID: 21694852 PMCID: PMC3108656 DOI: 10.2147/ceg.s12189] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2010] [Indexed: 01/27/2023] Open
Abstract
Background and aims: Our aim was to evaluate the utility of endoscopic obliterative therapy with Histoacryl for gastric varices and to investigate the incidence of serious complications. Methods: Endoscopic obliterative therapy with Histoacryl was performed on 129 gastric variceal patients. Sixty-five patients had cardiofornical varices, and 64 had fundal varices. Forty-five of 129 patients were emergency cases and the other 84 patients were prophylactic cases. Endoscopic therapy was performed under fluoroscopy using 70% Histoacryl (Histoacryl diluted with 5% Lipiodol). Results: Endoscopic hemostasis of gastric varices was successful in 45/45 (100%) emergency cases. The recurrence rate of gastric varices was 17/120 (14.2%) among patients whose variceal eradication was achieved. Additional treatment was successfully performed in all recurrent cases. The incidence of serious complications was 4/129 (3.1%), including two cases of splenic infarction, one case of pulmonary embolism, and one case of an inflammatory tumor of pancreatic tail. The two patients with splenic infarction improved with conservative medical treatment. The patient with pulmonary embolism showed no respiratory symptoms, and died of liver failure. The patient with the pancreatic tumor, which was diagnosed as an inflammatory tumor, was treated surgically. Conclusions: Endoscopic obliterative therapy with Histoacryl is a useful and relatively safe method for treatment of bleeding gastric varices. Nonetheless, careful attention must be paid to avoid potentially serious complications.
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Affiliation(s)
- Takahiro Sato
- Department of Gastroenterology, Sapporo Kosei General Hospital, Sapporo, Japan
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Kurt M, Onal IK, Ibis M, Tas A, Ozderin YO, Okten RS. Splenic infarction: rare complication of N-butyl-2-cyanoacrylate injection for gastric varices. Dig Endosc 2010; 22:74-5. [PMID: 20078672 DOI: 10.1111/j.1443-1661.2009.00922.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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[Left renal vein thrombosis following sclerotherapy for gastric varices]. JOURNAL DE RADIOLOGIE 2009; 90:745-6. [PMID: 19623130 DOI: 10.1016/s0221-0363(09)74732-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Cerebral embolism following N-butyl-2-cyanoacrylate injection for esophageal postbanding ulcer bleed: a case report. Hepatol Int 2009; 3:504-8. [PMID: 19669253 DOI: 10.1007/s12072-009-9130-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Accepted: 04/13/2009] [Indexed: 12/12/2022]
Abstract
Systemic embolization is a rare but serious complication of variceal injection with cyanoacrylate. We report a case of cerebral embolism a few hours after an injection of Histoacryl into a bleeding esophageal post-banding ulcer. Echocardiogram revealed patent foramen ovale.
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Lee KM, Kim YB, Sin SJ, Hwang JC, Yoo BM, Jung JY, Kim JH, Cho SW. Hepatic failure requiring transplantation caused by portal vein embolism as a complication of N-buty-2-cyanoacrylate injection for a bleeding gastric varix. Gastrointest Endosc 2009; 69:967-9. [PMID: 19327488 DOI: 10.1016/j.gie.2008.05.064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Accepted: 05/28/2008] [Indexed: 12/10/2022]
Affiliation(s)
- Kee Myung Lee
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
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Marion-Audibert AM, Schoeffler M, Wallet F, Duperret S, Mabrut JY, Bancel B, Pere-Verge D, Wander L, Souquet JC. Acute fatal pulmonary embolism during cyanoacrylate injection in gastric varices. ACTA ACUST UNITED AC 2008; 32:926-30. [DOI: 10.1016/j.gcb.2008.07.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Revised: 07/26/2008] [Accepted: 07/28/2008] [Indexed: 12/13/2022]
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Yang TY, Huang SY, Shaw SW, Cheng PJ, Chueh HY, Soong YK. Successful treatment of twin-twin transfusion syndrome by occlusion of placental vessel anastomoses using enbucrilate. Taiwan J Obstet Gynecol 2008; 47:330-3. [PMID: 18935999 DOI: 10.1016/s1028-4559(08)60134-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Twin-twin transfusion syndrome is a serious obstetric complication unique to monochorionic twin gestations. Occlusion of vessel anastomoses is recommended to improve the perinatal outcome. CASE REPORT A 36-year-old, gravida 1, woman had a monochorionic twin pregnancy which was found to be affected by twin-twin transfusion syndrome at 26 weeks' gestation. The condition was successfully treated by occlusion of placental vessel anastomoses using enbucrilate under color Doppler ultrasonographic guidance. At 35 weeks of gestation, two male infants were delivered by cesarean section. The birth weights of the babies were 2,470 and 1,750 g, and both were thriving. CONCLUSION Targeted therapeutic ablation of vessel anastomoses involved in twin-twin transfusion syndrome using color Doppler ultrasonographic guidance is minimally invasive and may effectively obliterate interfetal transfusion, contributing to the survival of both twins.
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Affiliation(s)
- Ting-Yu Yang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, and Chang Gung University College of Medicine, Tao-Yuan, Taiwan
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Treatment of gastric varices by endoscopic sclerotherapy using butyl cyanoacrylate: 10 yearsʼ experience of 635 cases. Chin Med J (Engl) 2007. [PMID: 18167180 DOI: 10.1097/00029330-200712010-00004] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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