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Kazatsker MM, Sharabi-Nov A, Meiri H, Sammour R, Sammar M. Augmented Placental Protein 13 in Placental-Associated Extracellular Vesicles in Term and Preterm Preeclampsia Is Further Elevated by Corticosteroids. Int J Mol Sci 2023; 24:12051. [PMID: 37569423 PMCID: PMC10419231 DOI: 10.3390/ijms241512051] [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: 05/29/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Placental protein 13 (PP13) is a regulatory protein involved in remodeling the vascular system of the pregnancy and extending the immune tolerance of the mother to the growing fetus. PP13 is localized on the surface of the syncytiotrophoblast. An ex vivo placental model shows that the PP13 is released via placental-associated extracellular vesicles (PEVs) to the maternal uterine vein. This exploratory study aimed to determine PEV-associated PP13 in the maternal circulation as compared to the known soluble fraction since each has a specific communication pathway. Patients admitted to Bnai Zion Medical Center for delivery were recruited, and included 19 preeclampsia (PE) patients (7 preterm PE gestational age < 37 weeks' gestation), 16 preterm delivery (PTD, delivery at GA < 37 weeks' gestation), and 15 matched term delivery controls. Treatment by corticosteroids (Celestone), which is often given to patients with suspected preterm PE and PTD, was recorded. The PEV proteome was purified from the patients' plasma by size exclusion chromatography (SEC) to separate the soluble and PEV-associated PP13. The total level of PP13 (soluble and PEV-associated) was determined using mild detergent that depleted the PEV proteome. PP13 fractions were determined by ELISA with PP13 specific antibodies. ELISA with alkaline phosphatase (PLAP)- and cluster differentiation 63 (CD63)-specific antibodies served to verify the placental origin of the PEVs. SPSS was used for statistical analysis. The patients' medical, pregnancy, and delivery records in all groups were similar except, as expected, that a larger number of PE and PTD patients had smaller babies who were delivered earlier, and the PE patients had hypertension and proteinuria. The SEC analysis detected the presence of PP13 in the cargo of the PEVs and on their surface, in addition to the known soluble fraction. The median soluble PP13 was not significantly different across the PE, PTD, and term delivery control groups. However, after depleting the PEV of their proteome, the total PP13 (soluble and PEV-associated) was augmented in the cases of preterm PE, reaching 2153 pg/mL [IQR 1866-2838] but not in cases of PTD reaching 1576 pg/mL [1011-2014] or term delivery groups reaching 964 pg/mL [875-1636]), p < 0.01. On the surface of the circulating PEV from PTD patients, there was a decrease in PP13. Corticosteroid treatment was accompanied by a massive depletion of PP13 from the PEV, especially in preterm PE patients. This exploratory study is, thus, the first to determine PEV-associated PP13 in maternal circulation, providing a quantitative determination of the soluble and the PEV-associated fractions, and it shows that the latter is the larger. We found an increase in the amount of PP13 carried via the PEV-associated pathway in PE and PTD patients compared to term delivery cases, which was further augmented when the patients were treated with corticosteroids, especially in preterm PE. The signal conveyed by this novel communication pathway warrants further research to investigate these two differential pathways for the liberation of PP13.
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Affiliation(s)
- Marina Marks Kazatsker
- Maternal and Fetal Medicine Unit, Department of Obstetrics and Gynecology, Bnai-Zion University Medical Center, Haifa 3498838, Israel; (M.M.K.); (R.S.)
| | - Adi Sharabi-Nov
- Department of Statistics, Tel Hai Academic College, Tel Hai 122103, Israel;
- Department of Statistics, Ziv Medical Center, Safed 131000, Israel
| | - Hamutal Meiri
- Hy-Laboratories Ltd., Rehovot 7670606, Israel;
- TeleMarpe Ltd., 21 Beit El St., Tel Aviv 6908742, Israel
| | - Rami Sammour
- Maternal and Fetal Medicine Unit, Department of Obstetrics and Gynecology, Bnai-Zion University Medical Center, Haifa 3498838, Israel; (M.M.K.); (R.S.)
| | - Marei Sammar
- Prof. Ephraim Katzir Department of Biotechnology Engineering, Braude Academic College of Engineering, 51 Snunit St., Karmiel 2161002, Israel
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Bayard KE, Fabricant SP, White JD, Gordon B, Nguyen BT. Infectious outcomes following immediate postplacental intrauterine device placement in the setting of chorioamnionitis: An exploratory, retrospective study. Contraception 2023; 119:109913. [PMID: 36473509 DOI: 10.1016/j.contraception.2022.11.004] [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: 03/22/2022] [Revised: 11/18/2022] [Accepted: 11/18/2022] [Indexed: 12/07/2022]
Abstract
OBJECTIVE To evaluate infectious outcomes following postplacental intrauterine device (PPIUD) placement in patients with suspected chorioamnionitis. STUDY DESIGN This retrospective cohort study identified individuals desiring PPIUD who subsequently developed suspected chorioamnionitis, treated with antibiotics. We followed 12-month infectious outcomes amongst two cohorts: (1) those who received PPIUD and (2) those with placement deferred. RESULTS Of 55 followed, 18 of 22 PPIUDs were placed before chorioamnionitis was suspected; 33 placements were deferred. Neither group experienced acute infectious complications. Notably, IUDs were more often deferred when chorioamnionitis was more clearly diagnosed (20/33, 60.6% vs 4/22, 18.2% p < 0.01). Overdiagnosis of chorioamnionitis prevented IUD uptake in 10 of 55 (18.2%) individuals in this sample. CONCLUSIONS PPIUD placement in individuals with early signs of chorioamnionitis may not result in severe morbidity, in a study limited by sample size. Larger, prospective studies are needed in well-defined cohorts. IMPLICATIONS Incidental, immediate postplacental IUD placement in individuals with treated, suspected chorioamnionitis was not associated with severe morbidity within 1-year postpartum. Larger-scale, prospective studies are needed to guide the management of incidentally-placed, postplacental IUDs in the setting of mild chorioamnionitis.
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Affiliation(s)
- Katherine E Bayard
- Keck School of Medicine of the University of Southern California; Los Angeles, CA, United States
| | - Sonya P Fabricant
- Department of Obstetrics and Gynecology, Los Angeles County + University of Southern California Medical Center; Los Angeles, CA, United States
| | - Jessica D White
- Keck School of Medicine of the University of Southern California; Los Angeles, CA, United States
| | - Brian Gordon
- Department of Obstetrics and Gynecology, Los Angeles County + University of Southern California Medical Center; Los Angeles, CA, United States
| | - Brian T Nguyen
- Department of Obstetrics and Gynecology, Los Angeles County + University of Southern California Medical Center; Los Angeles, CA, United States.
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Peng J, Chen Y, Wan S, Zhou T, Chang YS, Zhao X, Hua X. Predictors for histological chorioamnionitis among women with preterm prelabour rupture of membranes after dexamethasone treatment: a retrospective study. BJOG 2023. [PMID: 36808206 DOI: 10.1111/1471-0528.17431] [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: 07/09/2022] [Revised: 12/12/2022] [Accepted: 01/17/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE To investigate reliable biomarkers for predicting histological chorioamnionitis (HCA) in women with preterm prelabour rupture of membranes (PPROM). DESIGN A retrospective study. SETTING A maternity care hospital in Shanghai. POPULATION Women with PPROM before 34+0/7 weeks of gestation. METHODS Mean values of biomarkers were compared by two-way analysis of variance (ANOVA). Log-binomial regression models were used to assess the association between biomarkers and risk of HCA. A stepwise logistic regression model was used to develop a multi-biomarker prediction model and identify the independent predictors. The area under the receiver operating characteristic curve (AUC) was used to assess prediction performance. MAIN OUTCOME MEASURES The ability of the individual biomarker and the combination of multiple biomarkers to predict HCA. RESULTS In 157 mothers with PPROM, 98 (62.42%) women had HCA and 59 (37.58%) women did not have HCA. No significant differences were observed between the two groups in white blood cell, neutrophil or lymphocyte counts, whereas both high-sensitivity C-reactive protein (hsCRP) and procalcitonin (PCT) were significantly higher in the HCA group. HsCRP and PCT were found to be independently associated with the risk of HCA, and PCT had a larger AUC value than hsCRP (p < 0.05). The optimal multi-biomarker prediction model for HCA (AUC = 93.61%) included hsCRP at 72 hours and PCT at 48 and 72 hours, and PCT had a stronger prediction capacity than hsCRP. CONCLUSIONS PCT could be a reliable biomarker for the early prediction of HCA in women with PPROM within 72 hours of dexamethasone treatment.
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Affiliation(s)
- Jing Peng
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China.,Obstetrics Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ying Chen
- Obstetrics Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Sheng Wan
- Obstetrics Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Tianfan Zhou
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yu-Sin Chang
- Department of Mathematics, Milwaukee School of Engineering, Milwaukee, USA
| | - Xiaobo Zhao
- Obstetrics Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiaolin Hua
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China.,Obstetrics Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
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Balciuniene G, Kvederaite-Budre G, Gulbiniene V, Dumalakiene I, Viliene R, Pilypiene I, Drasutiene GS, Ramasauskaite D. Neutrophil-lymphocyte ratio for the prediction of histological chorioamnionitis in cases of preterm premature rupture of membranes: a case-control study. BMC Pregnancy Childbirth 2021; 21:656. [PMID: 34579660 PMCID: PMC8474740 DOI: 10.1186/s12884-021-04101-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 08/29/2021] [Indexed: 12/02/2022] Open
Abstract
Background The neutrophil-lymphocyte ratio (NLR) is easily calculated blood test parameter, which can be used as marker to predict many inflammatory disorders. The aim of this study was to assess and compare the NLR in maternal blood with the white blood cell (WBC) count and C-reactive protein (CRP) concentration for the prediction of histological chorioamnionitis. Methods This was a case-control study of 137 woman with preterm premature rupture of membranes (PPROM) at a gestational age between 22+ 0 and 34+ 6 weeks. Blood samples, collected less than 48 h before delivery and at least 48 h after the administration of corticosteroids, were selected for the analysis. The NLR was calculated by dividing the number of neutrophils by the number of lymphocytes. Chorioamnionitis was diagnosed by the histopathological evaluation of placental membranes and chorionic plate. Results Patients with diagnosed histological chorioamnionitis (HCA) had significantly higher levels of WBC, CRP and NLR (p-value < 0.001). Levels of WBC, CRP and NLR predicted HCA with an area under the curve (AUC) of 0.81, 0.81 and 0.89, respectively. NLR had statistically significantly higher AUC than WBC, but no significant difference was found between AUCs of NLR and CRP. The cut-off level of NLR was found to be 5,97, which had a sensitivity of 77 % and a specificity of 95 %. Conclusion NLR has a good predictive value for HCA and could be used as an additional diagnostic marker for predicting histological chorioamnionitis in cases with preterm premature rupture of membranes before 34 weeks of gestation.
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Affiliation(s)
- Greta Balciuniene
- Clinic of Obstetrics, and Gynecology, Institute of Clinical Medicine, Faculty of Medicine of Vilnius University, M.K. Ciurlionio st. 21, 03101, Vilnius, Lithuania.,Center of Obstetrics and Gynecology, Vilnius University Hospital Santaros Klinikos, Santariskiu st. 2, 08661, Vilnius, Lithuania
| | - Greta Kvederaite-Budre
- Clinic of Obstetrics, and Gynecology, Institute of Clinical Medicine, Faculty of Medicine of Vilnius University, M.K. Ciurlionio st. 21, 03101, Vilnius, Lithuania
| | - Violeta Gulbiniene
- Clinic of Obstetrics, and Gynecology, Institute of Clinical Medicine, Faculty of Medicine of Vilnius University, M.K. Ciurlionio st. 21, 03101, Vilnius, Lithuania.,Center of Obstetrics and Gynecology, Vilnius University Hospital Santaros Klinikos, Santariskiu st. 2, 08661, Vilnius, Lithuania
| | - Irena Dumalakiene
- Department of Immunology, State Research Institute Centre for Innovative Medicine, Santariskiu st. 5, 08410, Vilnius, Lithuania
| | - Rita Viliene
- Department of Immunology, State Research Institute Centre for Innovative Medicine, Santariskiu st. 5, 08410, Vilnius, Lithuania
| | - Ingrida Pilypiene
- Center of Obstetrics and Gynecology, Vilnius University Hospital Santaros Klinikos, Santariskiu st. 2, 08661, Vilnius, Lithuania
| | - Grazina S Drasutiene
- Clinic of Obstetrics, and Gynecology, Institute of Clinical Medicine, Faculty of Medicine of Vilnius University, M.K. Ciurlionio st. 21, 03101, Vilnius, Lithuania.,Center of Obstetrics and Gynecology, Vilnius University Hospital Santaros Klinikos, Santariskiu st. 2, 08661, Vilnius, Lithuania
| | - Diana Ramasauskaite
- Clinic of Obstetrics, and Gynecology, Institute of Clinical Medicine, Faculty of Medicine of Vilnius University, M.K. Ciurlionio st. 21, 03101, Vilnius, Lithuania. .,Center of Obstetrics and Gynecology, Vilnius University Hospital Santaros Klinikos, Santariskiu st. 2, 08661, Vilnius, Lithuania.
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Celik K, Ekinci D, Asena M, Matur NO. Can Hematological Parameters be a Indicator Risk Factor in the Development of Retinopathy of Prematurity? KLINISCHE PADIATRIE 2020; 233:216-220. [PMID: 33207376 DOI: 10.1055/a-1289-0105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Hematological parameters have been investigated as being indicative of increased inflammatory response in morbidity of very preterm infants. This study aims to determine whether the hematologic parameters and ratios of preterms can be an indicative risk factor for the development of retinopathy of prematurity (ROP). MATERIALS-METHODS This retrospective cohort study examined newborns born before 32 weeks. Twenty-three patients treated with the diagnosis of ROP were included in the patient group. The control group included 23 patients who did not have ROP (no-ROP). Medical records of eligible preterm infants were retrospectively reviewed. Hemogram samples obtained from all patients during the first 24 h of life and samples of their mothers obtained before delivery were evaluated. The hemogram parameters of white blood cell (WBC) count, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, lymphocyte/monocyte ratio, and platelet mass index were calculated. RESULTS No difference was observed between the groups in terms of demographic data. In terms of hematological parameters, maternal WBC counts of ROP patients were significantly higher than those of no-ROP patients and WBC counts of ROP patients were significantly lower than those of no-ROP patients. CONCLUSIONS This study found that high WBC counts in mothers before delivery and/or low WBC counts in preterms during the first postnatal day were higher in developed ROP. These results could lead to the development of prospective studies to assess the real prognostic value of WBC in ROP.
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Affiliation(s)
| | - Dilbade Ekinci
- Ophthalmolgy, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir
| | - Muhammet Asena
- Pediatry, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir
| | - Nilufer Okur Matur
- Neonatology, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir
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Jobe AH, Milad MA, Peppard T, Jusko WJ. Pharmacokinetics and Pharmacodynamics of Intramuscular and Oral Betamethasone and Dexamethasone in Reproductive Age Women in India. Clin Transl Sci 2020; 13:391-399. [PMID: 31808984 PMCID: PMC7070803 DOI: 10.1111/cts.12724] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 10/24/2019] [Indexed: 01/23/2023] Open
Abstract
High-dose betamethasone and dexamethasone are standard of care treatments for women at risk of preterm delivery to improve neonatal respiratory and mortality outcomes. The dose in current use has never been evaluated to minimize exposures while assuring efficacy. We report the pharmacokinetics and pharmacodynamics (PDs) of oral and intramuscular treatments with single 6 mg doses of dexamethasone phosphate, betamethasone phosphate, or a 1:1 mixture of betamethasone phosphate and betamethasone acetate in reproductive age South Asian women. Intramuscular or oral betamethasone has a terminal half-life of 11 hours, about twice as long as the 5.5 hours for oral and intramuscular dexamethasone. The 1:1 mixture of betamethasone phosphate and betamethasone acetate shows an immediate release of betamethasone followed by a slow release where plasma betamethasone can be measured out to 14 days after the single dose administration, likely from a depo formed at the injection site by the acetate. PD responses were: increased glucose, suppressed cortisol, increased neutrophils, and suppressed basophils, CD3CD4 and CD3CD8 lymphocytes. PD responses were comparable for betamethasone and dexamethasone, but with longer times to return to baseline for betamethasone. The 1:1 mixture of betamethasone phosphate and betamethasone acetate caused much longer adrenal suppression because of the slow release. These results will guide the development of better treatment strategies to minimize fetal and maternal drug exposures for women at risk of preterm delivery.
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Affiliation(s)
- Alan H. Jobe
- Division of Pulmonary BiologyCincinnati Children's Hospital Medical CenterUniversity of CincinnatiCincinnatiOhioUSA
| | - Mark A. Milad
- Milad Pharmaceutical Consulting LLCPlymouthMichiganUSA
| | | | - William J. Jusko
- State University of New YorkSchool of Pharmacy and Pharmaceutical SciencesUniversity of BuffaloBuffaloNew YorkUSA
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Demirer S, Hocaoglu M, Turgut A, Karateke A, Komurcu-Bayrak E. Expression profiles of candidate microRNAs in the peripheral blood leukocytes of patients with early- and late-onset preeclampsia versus normal pregnancies. Pregnancy Hypertens 2020; 19:239-245. [PMID: 31899190 DOI: 10.1016/j.preghy.2019.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/12/2019] [Accepted: 11/09/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Maternal leucocytes play an important role in the pathogenesis of preeclampsia (PE). Circulating microRNAs (miRNAs) are small, noncoding RNA molecules. The purpose of this study was to investigate miR-518b, miR-155-5p, and miR-21-3p in the peripheral blood leukocytes of patients with PE, compared to controls. STUDY DESIGN Using real-time quantitative PCR method, the selected miRNAs which have been associated with PE were examined from early- onset PE (EOPE) (<34 weeks) (n = 48), late- onset PE (LOPE) (≥34 weeks) (n = 48), total cases of PE (n = 96), and healthy controls (n = 52). MAIN OUTCOME MEASURES The relative expression of the target miR in patient samples was compared to the calibrator and the results were expressed as relative quantification values. RESULTS Gestational age (GA) was significantly different between PE and controls. Univariate logistic regression analysis adjusted for GA at blood draw were fit to compare miR-518b, miR-155-5p, and miR-21-3p between PE and controls. The expression of miR-518b, miR-155-5p, and miR-21-3p were not significantly different in PE, compared to controls. The expression of miR-518b was upregulated in the EOPE and LOPE group, compared to controls, and the area under the receiver operating characteristic curve (AUC) of miR-518b was 0.65 and 0.62, respectively. miR-518b was positively correlated with WBC count, platelet count, serum levels of AST, ALT, LDH in EOPE. miR-21-3p expression level was negatively correlated with body mass index at blood draw and systolic blood pressure in the LOPE group. CONCLUSIONS Increased miR-518b expression levels were found to be associated with EOPE and LOPE.
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Affiliation(s)
- Selin Demirer
- Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Meryem Hocaoglu
- Department of Obstetrics and Gynecology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey.
| | - Abdulkadir Turgut
- Department of Obstetrics and Gynecology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey; Department of Obstetrics and Gynecology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ateş Karateke
- Department of Obstetrics and Gynecology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey; Department of Obstetrics and Gynecology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Evrim Komurcu-Bayrak
- Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.
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Bovbjerg ML. Current Resources for Evidence-Based Practice, January 2019. J Obstet Gynecol Neonatal Nurs 2019; 48:99-111. [DOI: 10.1016/j.jogn.2018.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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