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Cortese A, Casarella A, Howard CM, Claudio PP. Epi-Mucosa Fixation and Autologous Platelet-Rich Fibrin Treatment in Medication-Related Osteonecrosis of the Jaw. Dent J (Basel) 2021; 9:dj9050050. [PMID: 33946237 PMCID: PMC8146740 DOI: 10.3390/dj9050050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/21/2021] [Accepted: 04/29/2021] [Indexed: 11/16/2022] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) frequently affects patients after treatments with bisphosphonates or denosumab, especially with high doses in patients with bone osteoporosis, neoplastic metastases, or possibly anti-angiogenic treatment for cancer. The aim of this article was to show a new treatment planning for stage 2 and stage 3 MRONJ using platelet-rich fibrin (PRF) at the surgical field to enhance healing in association with a new epi-mucosal fixation technique to prevent or treat mandibular fracture. Two cases were treated by epi-mucosa fixation and autologous PRF use for prevention of mandibular fracture risks related to necrotic bone resection or a narrow fracture reduction. Both cases were successfully treated by this new technique of epi-mucosa fixation combined with autologous PRF and achieved good results and good quality of life. Ability to wear prosthesis with good mastication in the absence of side effect such as infection, plate and screw mobilization, pain, and other disabilities or extension of necrosis was reported. After surgical removal of necrotic bone, no infection was detected without any extension of the necrosis.
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Affiliation(s)
- Antonio Cortese
- Unit of Maxillofacial Surgery, Department of Medicine and Surgery, University of Salerno, 84084 Fisciano, Italy;
- Correspondence: (A.C.); (P.P.C.)
| | - Antonio Casarella
- Unit of Maxillofacial Surgery, Department of Medicine and Surgery, University of Salerno, 84084 Fisciano, Italy;
| | - Candace M. Howard
- Department of Radiology, University of Mississippi Medical Center, Jackson, MS 39216, USA;
| | - Pier Paolo Claudio
- Department of Biomolecular Sciences, Maxillofacial Surgery, University of Mississippi, Jackson, MS 39216, USA
- Correspondence: (A.C.); (P.P.C.)
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Cortese A, Tomeo M, Borri A, Claudio PP. New strategy treatment by epi-mucosa fixation and autologous platelet-rich fibrin in medical related osteonecrosis of the jaws. MINERVA STOMATOLOGICA 2019; 68:274-275. [PMID: 31822053 DOI: 10.23736/s0026-4970.19.04226-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Antonio Cortese
- Unit of Maxillofacial Surgery, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Matteo Tomeo
- Unit of Maxillofacial Surgery, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Antonio Borri
- Unit of Maxillofacial Surgery, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Pier P Claudio
- Department of BioMolecular Sciences, University of Mississippi, Jackson, MS, USA - .,Department of Maxillofacial Surgery, University of Mississippi Medical Center, Jackson, MS, USA
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New Technique for Mandibular Symphyseal Distraction by a Double-Level Anchorage and Fixation System: Advantages and Results. J Craniofac Surg 2018; 27:1469-75. [PMID: 27607116 DOI: 10.1097/scs.0000000000002831] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION A surgical technique to widen the mandible is the mandibular midline distraction: the most common indications for mandibular midline distraction are severe mandibular anterior crowding, severe mandibular transverse deficiency, uni- or bilateral crossbite, impacted anterior teeth with inadequate space, and tipped teeth. Commonly used distraction devices can be divided into 2 systems: bone-borne distraction system appliance, dental-borne distraction systems. Each system has peculiar advantages, disadvantages, and different indications. To combine advantages of both systems we developed a new technique adopting an immediate basal bone widening with fixation after osteotomy and a dental borne rigid lingual system for distraction. AIM The aim of this work is to show a new technique for symphysis mandibular distraction based on a double-level anchorage and fixation system on clinical patients showing final results and advantages. METHODS Two patients affected by dento-alveolar and basal bone maxillary and mandibular transversal collapse even in association with other skeletal malocclusion were selected. Patients were clinically and radiographically studied and analyzed at different times before and after surgery. Dental and basal bone measurements were performed clinically and radiographically. RESULTS The results were optimal with perfect dental arches alignment followed by closing of the open bites with multiple-segmented surgery in a second surgical time. No misalignment of the 2 mandibular halves was noticed during the distraction procedure. DISCUSSION Dental-bone discrepancies correction is mandatory before orthodontic treatment alignment. Transversal jaw expansion can be achieved safely and stably by distraction of both maxillae for the combination of osteogenesis and histogenesis with augmentation of both bone and soft tissue. Bone-borne distraction will result in more stable results; dental-borne devices will result in more simple and aesthetically rewarding procedures. Hybrid techniques usually show mixed results depending on the characteristics of the device. For this reason we developed a combination of both the aforementioned systems which is not a hybrid system but the combination of an immediate expansion of the symphysis and fixation by 1 miniplate with only 2 screws acting like hinges during distraction, combined with a lingual distraction system at the alveolar bone level. CONCLUSIONS Bone-borne distraction systems result in more efficient basal bone mandibular widening with increased stability for dental results. For dental-borne appliance the advantages consist in no second surgery need for their removal, no transmucosal hardware emergence and better aesthetic, especially when lingual devices were used. Our technique combines advantages of both procedures.
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Open Versus Closed Reduction of Maxillary Fractures: Complications and Resource Utilization. J Craniofac Surg 2017; 28:1797-1802. [PMID: 28834837 DOI: 10.1097/scs.0000000000003776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Maxillary fractures are frequently managed depending on the surgeon's preferences, nature of the injury, presence of associated injuries, and comorbidities. Current literature advocates open reduction with plating versus closed techniques. However, data defining associated costs and complications comparing the 2 approaches remains lacking. METHODS National Inpatient Sample (2006-2011) was examined for patients undergoing closed or open (76.73-76.74) reduction of maxillary fractures. Treatment-related complications were regarded as re-exploration of surgical site, hemorrhage, hematoma, seroma, wound infection, and dehiscence. RESULTS Overall, 22,157 patients were identified. There were 18,874 closed and 3283 open procedures. Median age was 35 (interquartile range 27). Median length of stay (LOS) was 4 days. Median total charges were reported as 51486.80 USD. Males comprised 77% of the cohort. 68% of patients were Caucasian. Private payer/HMO accounted for the largest source of health care coverage (43.5%). On risk-adjusted multivariate analysis, there was no difference in surgical approach regarding incidence of postoperative complications. Males (2.73), nonprivate insurer payer (P = 0.002), South region (2.49), and transferred patients (2.55) had higher incidence of complications. Presence of chronic pulmonary disease (2.87) and coagulopathy (6.62) also increased risk of complications. Length of stay was shorter for open reduction (0.68) versus closed. Total charges were also less for open approach (0.37). CONCLUSION While surgical approach did not affect complications, open approach favorably affected LOS and total charges. Future studies should focus on comorbidities, demographics, and associated injuries in relation to resource utilization for maxillary fractures. In current economic environment, such information might further dictate management options.
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Pereira MD, Farfel V, Prado GPR, Ferreira LM. One-Step Surgical Correction of Transverse and Anteroposterior Maxillary Deficiencies Using Wire Fixation. A New Approach and Long-Term Stability. J Oral Maxillofac Surg 2017; 75:1498-1513. [DOI: 10.1016/j.joms.2017.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 03/14/2017] [Accepted: 03/14/2017] [Indexed: 10/19/2022]
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Cortese A, Barbaro R, Troisi D, D'Alessio G, Amato M, Lo Giudice R, Paolo Claudio P. Distraction techniques for face and smile aesthetic preventing ageing decay. Open Med (Wars) 2017; 11:433-442. [PMID: 28352833 PMCID: PMC5329864 DOI: 10.1515/med-2016-0077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 08/23/2016] [Indexed: 11/25/2022] Open
Abstract
Modern concepts in the world of beauty arise from popular models, beautiful faces of actors document a bi-protrusive asset with high tension for soft tissues. Facial symmetry has been proposed as a marker of development and stability that may be important in human mate choice. For various traits any deviation from perfect symmetry can be considered a reflection of imperfect development. Additionally, bi-protrusive profile is dependent on the hormonal level regardless of male or female sex. The goal of maxillofacial surgery is to provide best results both for aesthetic and functional aspects. Following these new concepts of aesthetic of the face, new surgical procedure by osteodistraction techniques will lead to a very natural result by harmonizing the face also preventing aesthetic decay in aging faces. Ten cases with a feedback on the aesthetic results using the fivepoint scale of Likert after orthognatic surgery performed following distraction new techniques in combination with ancillary surgical procedures. The aesthetic results in all patients were highly satisfactory. All the patients accepted the new aesthetic of the face avoiding elements of discrepancy and consequently medico-legal problems.
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Affiliation(s)
- Antonio Cortese
- Department of Medicine and Surgery, Unit of Maxillofacial Surgery, University of Salerno, Salerno, Italy
| | - Roberto Barbaro
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Donato Troisi
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | | | - Maurizio Amato
- Department of Clinical Medicine and Surgery, University of Naples Federico II, School of Medicine, Naples, Italy
| | - Roberto Lo Giudice
- Specialist in Oral Surgery, Medical Sciences and Stomatology Department, School of Dentistry, University of Messina, Messina, Italy
| | - Pier Paolo Claudio
- Department of Radiation Oncology, University of Mississippi, Jackson, MS, United States of America
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Carlino F, Pantaleo G, Borri A, Tripodi F, Cortese A. Alveolar distraction in elderly patients by implant: borne devices for functional-aesthetic dental rehabilitation of the jaws. Aging Clin Exp Res 2017; 29:197-204. [PMID: 28091960 DOI: 10.1007/s40520-016-0694-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/26/2016] [Indexed: 10/20/2022]
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Platelet-rich fibrin (PRF) in implant dentistry in combination with new bone regenerative technique in elderly patients. Int J Surg Case Rep 2016; 28:52-56. [PMID: 27689517 PMCID: PMC5043401 DOI: 10.1016/j.ijscr.2016.09.022] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 09/10/2016] [Indexed: 12/19/2022] Open
Abstract
PRF in association with a new split crest augmentation technique was analyzed. Ten patients five with the new technique and five by traditional one were treated. All cases were successful and all implants achieved osteointegration. Main advantages with this technique are soft tissues healing and bone regenerative properties.
Introduction Some studies have demonstrated that platelet rich fibrin (PRF) is a healing biomaterial with a great potential for bone and soft tissue regeneration, without any inflammatory reactions and may be used alone or in combination with bone grafts, promoting hemostasis, bone growth, and maturation. PRF appears as a natural and satisfactory aid in bone regenerative surgery in elderly patients with favorable results and low risks. Aim This study wants to demonstrate how PRF in association with a new split crest augmentation technique can be a great aid in implant rehabilitation, especially in the elderly patients, when bone regeneration is required. Materials and methods Ten patients were treated in this study, five following the flapless split crest new procedure and other five patients following traditional procedure without split crest as control. Five patients with an average age between 50 and 60 years were selected to be operated with a split crest flapless modified technique in order to optimize the regenerative conditions with a bone augmentation and implant insertion in one single stage procedure. For all the patients autologous PRF has been used to fill the split crest gap or simply as regenerative material. Orthopantomography, intraoral radiography and CT DentaScan/CT Cone beam were performed for every patient before the treatment and at follow-up time exeption made for CT. Results All cases were successful, there were no problems at surgery time, at post-operative and at osteointegration periods. All implants achieved osteointegration. These results were obtained by accurately managing immediate and late post operative period in all of the operated cases. Mean difference for height bone loss between the two groups of patients was 2.4 mm at T1 and 2.2 mm at T3. Discussion The rationale of this split crest flapless modified technique is to obtain a proper buccal cortex expansion preserving its vascular supply avoiding periosteal elevation for better cortical bone nourishing. Moreover, advantages are reported related to the use of PRF. The effectiveness of PRF is shown in promoting the healing of surgical wounds, it has, in fact, platelet growth factors that can improve the vascularisation of the surgical site, promoting neoangiogenesis. Furthermore, by simply changing the settings of the centrifuge, it is possible to obtain a normal gelling if it has to be used as regenerative and stimulating material, or more consistent substance to be used as a filler in the split crest gap. Conclusions The main advantages in using the platelet-rich fibrin are healing and bone regenerative properties in combination with its complete resorption after surgery, thus avoiding a second surgery time, important factor in the elderly patients. Currently, it is a minimally invasive technique with low risks and satisfactory clinical results such preventing complications or implant failure particularly in elderly patients for age related conditions.
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Zygomatic fractures: Technical modifications for better aesthetic and functional results in older patients. Int J Surg 2016; 33 Suppl 1:S9-S15. [DOI: 10.1016/j.ijsu.2016.05.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Terzi L, Esposito L, Maspero C. Espansione rapida palatale chirurgicamente assistita versus osteotomia di Le Fort I multisegmentata. DENTAL CADMOS 2015. [DOI: 10.1016/s0011-8524(15)30105-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Intraoral epimucosal fixation for reducible maxillary fractures of the jaws; surgical considerations in comparison to current techniques. J Craniofac Surg 2015; 25:2184-7. [PMID: 25318439 DOI: 10.1097/scs.0000000000001104] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Fractures of the jaw are often treated with rigid and stable internal fixation using plates or miniplates. Early surgery for jaw fractures is the optimal treatment; however, if a late treatment is begun, often the adoption of other protocols is needed. When the jaw fracture has one free bone fragment with 2 full-thickness lesions of mucoperiosteal soft tissues both on the buccal and palatal sides, the risk of resorption or necrosis is very high after elevating a mucoperiosteal flap for rigid fixation. For this reason, we developed an intraoral epimucosal fixation technique using self-locking screws and plates. Substantial advantages of this new technique, in comparison with other commonly used fixation techniques, consisted in the prevention of bone resorption or necrosis by safe and simple screw insertion procedure after manipulation of the fracture for reduction in closed surgery. Major indications for epimucosal fixation in closed surgery are the presence of jaw fractures without dislocation or reducible jaw fractures by manipulation particularly in edentulous patients.
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New palatal distraction device by both bone-borne and tooth-borne force application in a paramedian bone anchorage site: surgical and occlusal considerations on clinical cases. J Craniofac Surg 2015; 25:589-95. [PMID: 24577304 DOI: 10.1097/scs.0000000000000674] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Maxillary constriction is a very common pathology with implications on dental occlusion, temporomandibular joint dysfunction, nasal breathing, and impairment on the smile and face esthetic.New techniques for expansion of the maxillary bones are particularly useful in relation to the new esthetic ideals of smile and face beauty.To achieve a bodily expansion of the maxillary bones, we developed a new rigid palatal distractor device with both tooth-borne and paramedian bone-borne anchorages to achieve a safe and simple anchorage site suitable also for orthodontic appliances.The reported cases show good results, with bodily maxillary expansion and cross-bite correction without any problems or complications. Substantial advantages of this new device and technique, in comparison with other commonly used palatal distractors, consisting of bodily maxillary movements, avoidance of relapse risks, and safe and simple screw insertion site for bone anchorage also suitable for orthodontic movements, are discussed.
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A new palatal distractor device for bodily movement of maxillary bones by rigid self-locking miniplates and screws system. J Craniofac Surg 2015; 24:1341-6. [PMID: 23851803 DOI: 10.1097/scs.0b013e31828041a7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
METHODS A new palatal distractor device for bodily movement of the maxillary bones after complete segmented Le Fort I osteotomy for 1-stage transversal distraction and tridimensional repositioning on 1 patient is presented. The new distractor has an intrinsic tridimensional rigidity also in the fixation system by self-locking miniplates and screws for better control of the 2 maxillary fragments during distraction. RESULTS Le Fort I distraction and repositioning procedure in association with a bilateral sagittal split osteotomy were performed on 1 patient with complete solution of the cross-bite and class III malocclusion. Results of dental and cephalometric analysis performed before surgery (T1), after surgery and distraction time (T2), and 18 months after surgery and orthodontic appliance removal (T3) are reported. CONCLUSIONS No complications were encountered using the new distractor device. Advantages of this device and technique are presented including improved rigidity of both distraction (jackscrew) and fixation (4 self-locking miniplates and screws) systems resulting in complete control of the position of the 2 maxillary fragments during distraction and surgery. In addition, this new device allows resuming palatal distraction in the event of cross-bite relapse without causing dental-related problems or the risks of screw slackening.
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Terbish M, Yoo SH, Kim HJ, Yu HS, Hwang CJ, Baik HS, Cha JY. Accelerated Bone Formation in Distracted Alveolar Bone After Injection of Recombinant Human Bone Morphogenetic Protein-2. J Periodontol 2015; 86:1078-86. [PMID: 25957054 DOI: 10.1902/jop.2015.140697] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND This study evaluates the effect of recombinant human bone morphogenetic protein-2 (rhBMP-2) on the quality and quantity of regenerated bone when injected into distracted alveolar bone. METHODS Sixteen adult beagle dogs were assigned to either the control or rhBMP-2 group. After distraction was completed, an rhBMP-2 dose of 330 μg in 0.33 mL was injected slowly into the distracted alveolar crest of the mesial, middle, and distal parts of the alveolar bone in the experimental group. Histologic and microcomputed tomography analyses of regenerated bone were done after 2 and 6 weeks of consolidation. RESULTS After 6 weeks of consolidation, the vertical defect height in the middle of the regenerated bone was significantly lower in the rhBMP-2 group (2.2 mm) than in the control group (3.4 mm) (P <0.05). Additionally, the width of the regenerated bone was significantly greater in the rhBMP-2 group (4.3 mm) than in the control group (2.8 mm) (P <0.05). The bone density and volume of regenerated bone in the rhBMP-2 group were greater than in the control group after 6 weeks of consolidation (P <0.001). CONCLUSION Injection of rhBMP-2 into regenerated bone after a distraction osteogenesis procedure significantly increased bone volume in the dentoalveolar distraction site and improved both the width and height of the alveolar ridge and increased the bone density.
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Affiliation(s)
- Munkhdulam Terbish
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, South Korea
| | - Seong-Hun Yoo
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, South Korea
| | - Hee-Jin Kim
- Division of Anatomy and Developmental Biology, Department of Oral Biology, Yonsei University
| | - Hyung-Seog Yu
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, South Korea
| | - Chung-Ju Hwang
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, South Korea
| | - Hyung-Seon Baik
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, South Korea
| | - Jung-Yul Cha
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, South Korea
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Terzi L, Esposito L, Maspero C. Disgiunzione maxillare chirurgica: osteotomia di Le Fort I multisegmentata. DENTAL CADMOS 2014. [DOI: 10.1016/s0011-8524(14)70190-4] [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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