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Flegar L, Huber J, Putz J, Thomas C, Apel H, Wullich B, Friedersdorff F, Fechner G, Ritter M, Kernig K, Weigand K, Heynemann H, Stöckle M, Zeuschner P. Multicenter evaluation of complex urinary diversion for renal transplantation: outcomes of complex surgical solutions. World J Urol 2024; 42:239. [PMID: 38630278 PMCID: PMC11023965 DOI: 10.1007/s00345-024-04934-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/18/2023] [Indexed: 04/19/2024] Open
Abstract
PURPOSE An abnormal lower urinary tract poses significant challenges for transplant surgeons. Besides the ureteral anastomosis to an ileal conduit, there are diverse complex reconstructive solutions. Due to its rarity, standardization and teaching of complex urinary diversion is extremely difficult. METHODS The indications and outcomes of complex urinary diversions after kidney transplantation (KT) were retrospectively investigated at eight urologic transplant centers including a current follow-up. RESULTS Of 37 patients with 21 (56%) males, vesicoureteral reflux (24%), spina bifida (22%), and glomerulonephritis (12%) were the most common causes of terminal renal failure. In 30 (81%) patients, urinary diversion was performed before KT, at a median of 107.5 (range, 10; 545) months before. Transplantations were held at a median patient age of 43 (10; 68) years, including six (16%) living donations. Urinary diversion was modified during 12 (32%) transplantations. After KT, the ileal conduit was the most common incontinent urinary diversion in 25 (67%) patients; a Mainz pouch I and bladder augmentation were the most frequent continent diversions (each n = 3). At a median follow-up of 120 months (range 0; 444), 12 (32%) patients had a graft failure with a 5-year graft survival of 79% (95%CI 61; 90). The median overall survival was 227 months (168; 286) and the 5-year overall survival 89% (69.3; 96.4). CONCLUSION The mid-term kidney transplant function with complex urinary diversion appears to be comparable to transplants with regular urinary diversions. Hence, complex urinary diversion should always be considered as a surgical option, even during transplantation, if necessary.
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Affiliation(s)
- Luka Flegar
- Department of Urology, Philipps-University Marburg, Baldinger Street, 35043, Marburg, Germany.
| | - Johannes Huber
- Department of Urology, Philipps-University Marburg, Baldinger Street, 35043, Marburg, Germany
| | - Juliane Putz
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Christian Thomas
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Hendrik Apel
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Transplant Center Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Bernd Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Transplant Center Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Frank Friedersdorff
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Guido Fechner
- Department of Urology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Manuel Ritter
- Department of Urology, University Medical Center Bonn (UKB), Bonn, Germany
| | | | - Karl Weigand
- Department of Urology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Hans Heynemann
- Department of Urology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Michael Stöckle
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Philip Zeuschner
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
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2
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Basiri A, Dadpour M, Madani MH, Amini E. Radical cystectomy, bilateral lymphadenectomy and native ureteral ligation in a patient with history of kidney transplantation. J Surg Case Rep 2022; 2022:rjac447. [PMID: 36324764 PMCID: PMC9613118 DOI: 10.1093/jscr/rjac447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/03/2022] [Indexed: 01/24/2023] Open
Abstract
We reported radical cystectomy (RC), bilateral lymphadenectomy and orthotopic ileal neobladder reconstruction in a patient with history of kidney transplant. A 71-year-old man was referred to us with bladder tumor, elevated serum creatinine (1.9 mg/dl), hydroureteronephrosis in transplanted kidney and a 5-6-cm sessile mass in the right bladder wall with involvement of transplanted ureter orifice. The patient was candidate for RC. The native ureters were ligated permanently. Extended lymphadenectomy in left side and limited lymphadenectomy in right side were performed. The patient underwent ileal orthotopic neobladder reconstruction, and the graft ureter was reimplanted to ascending loop of the pouch with end-to-end anastomosis. In conclusion, bilateral lymphadenectomy is feasible in patients with a history of kidney transplantation during RC. Permanent ligation of native ureters is better to perform to reduce the time of surgery and prevent late probable morbidities due to uretero-intestinal reimplantation complications.
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Affiliation(s)
- Abbas Basiri
- Urology and Nephrology Research Center, Erfan and Labbafinejad Hospital, Urology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Dadpour
- Correspondence address. Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Urology ward, 9th Boostan, Pasdaran Avenue, Tehran 1666663111, Iran. Tel: +98-9111750239; E-mail:
| | - Mohammad Hamidi Madani
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Urology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Erfan Amini
- Uro-Oncology Research Center, Tehran University of Medical Sciences, Urology Department, Tehran, Iran
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Jue JS, Alameddine M, Gonzále J, Cianci G. Risk factors, management, and survival of bladder cancer after kidney transplantation. Actas Urol Esp 2021; 45:427-438. [PMID: 34147429 DOI: 10.1016/j.acuroe.2020.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION AND OBJECTIVES Kidney transplantation is associated with an increased risk of bladder cancer; however guidelines have not been established on the management of bladder cancer after kidney transplantation. MATERIALS AND METHODS A systematic literature review using PubMed was performed in accordance with the PRISMA statement to identify studies concerning the prevalence and survival of bladder cancer after kidney transplantation. The risk factors and management of bladder cancer after kidney transplantation were also reviewed and discussed. RESULTS A total of 41 studies, published between 1996 and 2018, reporting primary data on bladder cancer after kidney transplantation were identified. Marked heterogeneity in bladder cancer prevalence, time to diagnosis, non-muscle invasive/muscle-invasive bladder cancer prevalence, and survival was noted. Four studies, published between 2003 and 2017, reporting primary data on bladder cancer treated with Bacillus Calmette-Guérin (BCG) after kidney transplantation were identified. Disease-free survival, cancer-specific survival, and overall survival were similar between BCG studies (75-100%). CONCLUSIONS Carcinogen exposure that led to ESRD, BKV, HPV, immunosuppressive agents, and the immunosuppressed state likely contribute to the increased risk of bladder cancer after renal transplantation. Non-muscle invasive disease should be treated with transurethral resection. BCG can be safely used in transplant recipients and likely improves the disease course. Muscle-invasive disease should be treated with radical cystectomy, with special consideration to the dissection and urinary diversion choice. Chemotherapy and immune checkpoint inhibitors can be safely used in regionally advanced bladder cancer with potential benefit. mTOR inhibitors may reduce the risk of developing bladder cancer, and immunosuppression medications should be reduced if malignancy develops.
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Affiliation(s)
- J S Jue
- Department of Urology, Lenox Hill Hospital, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, New York, United States; Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - M Alameddine
- Department of Surgery, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, United States; Miami Transplant Institute, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, United States; Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J Gonzále
- Department of Surgery, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, United States; Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - G Cianci
- Department of Surgery, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, United States; Department of Urology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, United States; Miami Transplant Institute, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, United States; Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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4
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Jue J, Alameddine M, González J, Ciancio G. Risk factors, management, and survival of bladder cancer after kidney transplantation. Actas Urol Esp 2021. [PMID: 33994047 DOI: 10.1016/j.acuro.2020.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES Kidney transplantation is associated with an increased risk of bladder cancer; however guidelines have not been established on the management of bladder cancer after kidney transplantation. MATERIALS AND METHODS A systematic literature review using PubMed was performed in accordance with the PRISMA statement to identify studies concerning the prevalence and survival of bladder cancer after kidney transplantation. The risk factors and management of bladder cancer after kidney transplantation were also reviewed and discussed. RESULTS A total of 41 studies, published between 1996 and 2018, reporting primary data on bladder cancer after kidney transplantation were identified. Marked heterogeneity in bladder cancer prevalence, time to diagnosis, non-muscle invasive/muscle-invasive bladder cancer prevalence, and survival was noted. Four studies, published between 2003 and 2017, reporting primary data on bladder cancer treated with Bacillus Calmette-Guérin (BCG) after kidney transplantation were identified. Disease-free survival, cancer-specific survival, and overall survival were similar between BCG studies (75-100%). CONCLUSIONS Carcinogen exposure that led to ESRD, BKV, HPV, immunosuppressive agents, and the immunosuppressed state likely contribute to the increased risk of bladder cancer after renal transplantation. Non-muscle invasive disease should be treated with transurethral resection. BCG can be safely used in transplant recipients and likely improves the disease course. Muscle-invasive disease should be treated with radical cystectomy, with special consideration to the dissection and urinary diversion choice. Chemotherapy and immune checkpoint inhibitors can be safely used in regionally advanced bladder cancer with potential benefit. mTOR inhibitors may reduce the risk of developing bladder cancer, and immunosuppression medications should be reduced if malignancy develops.
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Panarello D, Quaglia M, Mantica G, Cantaluppi V, Krengli M, Volpe A, Terrone C. Bladder cancer following renal transplantation: experiences with radical cystectomy and adjuvant radiotherapy. MINERVA CHIR 2020; 75:378-380. [PMID: 32773747 DOI: 10.23736/s0026-4733.20.08377-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Daniele Panarello
- Division of Urology, Department of Surgical and Integrated Surgical Sciences, IRCCS San Martino University Hospital, University of Genoa, Genoa, Italy
| | - Marco Quaglia
- Unit of Nephrology and Kidney Transplantation, Department of Translational Medicine, Maggiore della Carità University Hospital, University of Eastern Piedmont, Novara, Italy
| | - Guglielmo Mantica
- Division of Urology, Department of Surgical and Integrated Surgical Sciences, IRCCS San Martino University Hospital, University of Genoa, Genoa, Italy -
| | - Vincenzo Cantaluppi
- Unit of Nephrology and Kidney Transplantation, Department of Translational Medicine, Maggiore della Carità University Hospital, University of Eastern Piedmont, Novara, Italy
| | - Marco Krengli
- Division of Radiotherapy, Department of Translational Medicine, Maggiore della Carità University Hospital, University of Eastern Piedmont, Novara, Italy
| | - Alessandro Volpe
- Division of Urology, Department of Translational Medicine, Maggiore della Carità University Hospital, University of Eastern Piedmont, Novara, Italy
| | - Carlo Terrone
- Division of Urology, Department of Surgical and Integrated Surgical Sciences, IRCCS San Martino University Hospital, University of Genoa, Genoa, Italy
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6
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Nierentransplantation in Harnableitungen. Urologe A 2019; 59:27-31. [DOI: 10.1007/s00120-019-01093-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hickman LA, Sawinski D, Guzzo T, Locke JE. Urologic malignancies in kidney transplantation. Am J Transplant 2018; 18:13-22. [PMID: 28985026 DOI: 10.1111/ajt.14533] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 09/22/2017] [Accepted: 09/26/2017] [Indexed: 01/25/2023]
Abstract
With advances in immunosuppression, graft and patient outcomes after kidney transplantation have improved considerably. As a result, long-term complications of transplantation, such as urologic malignancies, have become increasingly important. Kidney transplant recipients, for example, have a 7-fold risk of renal cell carcinoma (RCC) and 3-fold risk of urothelial carcinoma (UC) compared with the general population. While extrapolation of data from the general population suggest that routine cancer screening in transplant recipients would allow for earlier diagnosis and management of these potentially lethal malignancies, currently there is no consensus for posttransplantation RCC or UC screening as supporting data are limited. Further understanding of risk factors, presentation, optimal management of, and screening for urologic malignancies in kidney transplant patients is warranted, and as such, this review will focus on the incidence, surveillance, and treatment of urologic malignancies in kidney transplant recipients.
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Affiliation(s)
- Laura A Hickman
- Department of Surgery, Division of Transplantation, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Deirdre Sawinski
- Department of Medicine, Renal Electrolyte and Hypertension Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Thomas Guzzo
- Department of Urology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jayme E Locke
- Department of Surgery, Division of Transplantation, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
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8
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Management of Bladder Cancer After Renal Transplantation. Transplant Proc 2017; 49:293-296. [DOI: 10.1016/j.transproceed.2016.11.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/14/2016] [Accepted: 11/22/2016] [Indexed: 11/19/2022]
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Ederer IA, Lucca I, Hofbauer SL, Haidinger M, Haitel A, Susani M, Shariat SF, Klatte T. Histopathology and prognosis of de novo bladder tumors following solid organ transplantation. World J Urol 2015; 33:2087-93. [DOI: 10.1007/s00345-015-1554-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 04/01/2015] [Indexed: 12/11/2022] Open
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10
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Wang Z, Vathsala A, Tiong HY. Haematuria in postrenal transplant patients. BIOMED RESEARCH INTERNATIONAL 2015; 2015:292034. [PMID: 25918706 PMCID: PMC4395992 DOI: 10.1155/2015/292034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 02/20/2015] [Accepted: 02/20/2015] [Indexed: 12/25/2022]
Abstract
Haematuria has a prevalence of 12% in the postrenal transplant patient population. It heralds potentially dangerous causes which could threaten graft loss. It is important to consider causes in light of the unique, urological, and immunological standpoints of these patients. We review the literature on common causes of haematuria in postrenal transplant patients and suggest the salient approach to the evaluation of this condition. A major cause of haematuria is urinary tract infections. There should be a higher index of suspicion for mycobacterial, fungal, and viral infection in this group of immunosuppressed patients. Measures recommended in the prevention of urinary tract infections include early removal of foreign bodies as well as prophylactic antibiotics during the early transplant phase. Another common cause of haematuria is that of malignancies, in particular, renal cell carcinomas. When surgically managing cancer in the setting of a renal transplant, one has to be mindful of the limited retropubic space and the need to protect the anastomoses. Other causes include graft rejections, recurrences of primary disease, and calculus formation. It is important to perform a comprehensive evaluation with the aid of an experienced multidisciplinary transplant team.
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Affiliation(s)
- Ziting Wang
- Department of Urology, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074
| | - Anantharaman Vathsala
- Division of Nephrology, Department of Medicine, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074
- National University Centre for Organ Transplantation, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074
| | - Ho Yee Tiong
- Department of Urology, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074
- National University Centre for Organ Transplantation, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074
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Rodríguez Faba O, Breda A, Gausa L, Palou J, Villavicencio H. [De novo urologic tumors in kidney transplant patients]. Actas Urol Esp 2015; 39:122-7. [PMID: 24996779 DOI: 10.1016/j.acuro.2014.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 05/12/2014] [Indexed: 01/20/2023]
Abstract
CONTEXT The ability of a transplant recipient to accept a graft depends on the ability of immunosuppressive drugs to regulate the immune system. Such treatments have been associated with tumor promotion and progression. EVIDENCE ACQUISITION A systematic literature review was carried out. Electronic searches were performed in PubMed database. The searching criterion was "urological tumors in kidney transplant recipients". The most important issues regarding incidence, urological tumor-specific features, and relevant ones about the treatment are summarized. SYNTHESIS OF EVIDENCE In renal transplant, 15% of all tumors are urological neoplasias; furthermore, they are the leading neoplastic cause of death. In transplant population the incidence rate of renal cell carcinoma (RCC), transitional cell bladder carcinoma (TCBC), testicular carcinoma (TC) and prostate cancer are increased 15, 3, 3 and 2 times respectively. Treatments used in transplant patients are similar to those employed in the general population:radical nephrectomy for the native kidney and conservative surgery for the graft are indicated for RCC. Radical prostatectomy is technically feasible for localized PC.Regarding to transitional cell carcinoma BCG or MMC is not contraindicated. CONCLUSIONS The incidence rate of cancer has increased among transplant population. These tumors can be managed following the same criteria than in general population. Because in this population the prognosis is worse for the immunosuppression, closer monitoring is required.
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Affiliation(s)
- O Rodríguez Faba
- Unidad de Trasplante Renal, Servicio de Urología, Fundació Puigvert, Barcelona, España; Unidad de Urología Oncológica, Servicio de Urología, Fundació Puigvert, Barcelona, España.
| | - A Breda
- Unidad de Trasplante Renal, Servicio de Urología, Fundació Puigvert, Barcelona, España; Unidad de Urología Oncológica, Servicio de Urología, Fundació Puigvert, Barcelona, España
| | - L Gausa
- Unidad de Trasplante Renal, Servicio de Urología, Fundació Puigvert, Barcelona, España; Unidad de Urología Oncológica, Servicio de Urología, Fundació Puigvert, Barcelona, España
| | - J Palou
- Unidad de Urología Oncológica, Servicio de Urología, Fundació Puigvert, Barcelona, España
| | - H Villavicencio
- Unidad de Urología Oncológica, Servicio de Urología, Fundació Puigvert, Barcelona, España
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Rodríguez Faba O, Breda A, Gausa L, Palou J, Villavicencio H. De novo urologic tumors in kidney transplant patients. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.acuroe.2014.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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