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Chigerwe M, Blasczynski SJ, Abi‐Nader BA, Condy PM, Kretsch CM, Depenbrock SM. Continuous fluid infusion per rectum compared with intravenous fluid infusion in pigs. J Vet Intern Med 2023; 37:1580-1587. [PMID: 37226649 PMCID: PMC10365029 DOI: 10.1111/jvim.16733] [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: 11/04/2022] [Accepted: 04/19/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Peripheral blood vessels in pigs are not easily accessible, making placement of intravenous catheters difficult. Alternative methods to intravenous administration of fluids, such as administering fluids via the rectum (proctoclysis), are warranted in pigs. HYPOTHESIS Administration of polyionic crystalloid fluids via proctoclysis results in hemodilution changes similar to intravenous administration. The objectives of this study were to evaluate the tolerance for proctoclysis in pigs and compare analytes before and after intravenous or proctoclysis therapy. ANIMALS Six healthy, growing, academic institution-owned pigs. METHODS Randomized, cross-over design clinical trial, with 3 treatments (control, intravenous, and proctoclysis) with a 3-day washout period. The pigs were anesthetized and jugular catheters were placed. A polyionic fluid (Plasma-Lyte A 148) was administered at 4.4 mL/kg/h during the intravenous and proctoclysis treatments. Laboratory analytes, including PCV, plasma, and serum total solids, albumin, and electrolytes were measured over 12 h at T0 , T3 , T6 , T9 , and T12 . Effects of treatment and time on analytes were determined by analysis of variance. RESULTS Proctoclysis was tolerated by pigs. Albumin concentrations decreased during the IV treatment between T0 and T6 (least square mean of 4.2 vs 3.9 g/dL; 95% CI of mean difference = -0.42, -0.06; P = .03). Proctoclysis did not significantly affect any laboratory analytes at any time points (P > .05). CONCLUSIONS AND CLINICAL IMPORTANCE Proctoclysis did not demonstrate hemodilution similar to intravenous administration of polyionic fluids. Proctoclysis might not be an effective alternative to the intravenous administration of polyionic fluids in healthy euvolemic pigs.
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Affiliation(s)
- Munashe Chigerwe
- Department of Veterinary Medicine and EpidemiologyUniversity of California Davis, School of Veterinary MedicineDavisCaliforniaUSA
| | - Sarah J. Blasczynski
- William R. Pritchard Veterinary Medical Teaching HospitalUniversity of California Davis, School of Veterinary MedicineDavisCaliforniaUSA
| | - Bailey A. Abi‐Nader
- William R. Pritchard Veterinary Medical Teaching HospitalUniversity of California Davis, School of Veterinary MedicineDavisCaliforniaUSA
| | - Paige M. Condy
- William R. Pritchard Veterinary Medical Teaching HospitalUniversity of California Davis, School of Veterinary MedicineDavisCaliforniaUSA
| | - Cileah M. Kretsch
- William R. Pritchard Veterinary Medical Teaching HospitalUniversity of California Davis, School of Veterinary MedicineDavisCaliforniaUSA
| | - Sarah M. Depenbrock
- Department of Veterinary Medicine and EpidemiologyUniversity of California Davis, School of Veterinary MedicineDavisCaliforniaUSA
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Parkinson L. Fluid Therapy in Exotic Animal Emergency and Critical Care. Vet Clin North Am Exot Anim Pract 2023:S1094-9194(23)00022-1. [PMID: 37308371 DOI: 10.1016/j.cvex.2023.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Many new concepts are emerging in the understanding of fluid therapy in human and mammalian medicine, including the role of the glycocalyx, increased understanding of fluid, sodium, and chloride overload, and the advantages of colloid administration in the form of albumin. None of these concepts, however, appear to be directly applicable to non-mammalian exotic patients, and careful consideration of their alternate physiology is required when formulating fluid plans for these patients.
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Affiliation(s)
- Lily Parkinson
- Brookfield Zoo, Chicago Zoological Society, 3300 Golf Road, Brookfield, IL 60513, USA.
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3
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Liu J, Qiu H, Yuan Y, Liu C, Mo S, He F, Fu X. Efficacy and safety of early enteral and intravenous fluid resuscitation in severe acute pancreatitis: a systematic review and meta-analysis. Int J Colorectal Dis 2023; 38:36. [PMID: 36781508 DOI: 10.1007/s00384-023-04335-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVE To compare the efficacy and safety of enteral fluid resuscitation (via nasointestinal tube or colorectal tube) and intravenous fluid resuscitation (via intravenous route) in the early treatment of severe acute pancreatitis. METHODS In this study, 8 electronic databases (PubMed, Web of Science, Embase, Cochrane Library, Scopus, China HowNet database, Wanfang database, and VIP database) were searched to collect clinical studies from inception to June 12, 2022. After the quality evaluation and data extraction of the included studies, the RevMan 5.3 software was used for analysis. RESULTS A total of seven studies including 580 patients were studied in this meta-analysis, in which 291 cases were treated with enteral fluid resuscitation and 289 cases were treated with intravenous fluid resuscitation. Compared with the intravenous route group, the enteral route resuscitation group reduced the incidence of new organ failure (OR = 0.23, 95% CI: 0.12-0.43, P < 0.00001), the incidence of persistent organ failure (OR = 0.38, 95% CI: 0.22-0.64, P = 0.0003), the incidence of mechanical ventilation (OR = 0.15, 95% CI: 0.03-0.69, P = 0.01), the incidence of ICU care (OR = 0.49, 95% CI: 0.27-0.88, P = 0.02), and the incidence of pancreatic infection (OR = 0.38, 95% CI: 0.17-0.83, P = 0.02). There were no statistically significant differences in mortality (OR = 0.77, 95% CI: 0.35-1.66, P = 0.50), surgical intervention rate (OR = 0.47, 95% CI: 0.19-1.18, P = 0.11), and incidence of localized ascites (OR = 0.65, 95% CI: 0.25-1.73, P = 0.39). CONCLUSION Early enteral fluid resuscitation is safe and effective for in severe pancreatitis. But this conclusion needs to be verified by more additional multi-centre randomized controlled trials with large samples.
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Affiliation(s)
- Jiao Liu
- General Surgery Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
- General Surgery Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Huifang Qiu
- General Surgery Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
- General Surgery Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yanfang Yuan
- Nursing Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
- Nursing Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Chengjiang Liu
- Department of General Medicine, Affiliated Anqing First People's Hospital of Anhui Medical University, Anqing, 246000, China
| | - Shaojian Mo
- General Surgery Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
- General Surgery Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Fang He
- General Surgery Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China.
- General Surgery Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Xifeng Fu
- General Surgery Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
- General Surgery Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
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Hobbs KJ, DeNotta SL, Gallastegui A, Elane GL, Rivero LA, Adkins P, Gomez DE. Obstipation in pet pigs: 24 cases. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2021; 62:843-848. [PMID: 34341596 PMCID: PMC8281943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Clinical features and patient outcomes for pet pigs with obstipation are poorly defined. This retrospective study reports the clinical findings from 24 pet (non-production) pigs with obstipation presented to 2 veterinary teaching hospitals. Clinical features of obstipated pet pigs included anorexia or hyporexia in 24 pigs (100%), pain on abdominal palpation in 22 (90%), lethargy in 21 (88%), tachypnea in 19 (79%), vomiting in 14 (58%), and tachycardia in 13 (54%). Frequently observed hematologic and biochemical abnormalities included leukopenia in 36% (8/22) of the pigs, lymphopenia in 75% (17/22), toxic changes in neutrophils in 63% (14/22), hypokalemia in 50% (9/18), and hypoglycemia in 28% (5/18). Diagnostic imaging via radiography and/or computed tomography frequently identified gastric distention and accumulation of ingesta and gas throughout the gastrointestinal tract. Medical treatments included fluid therapy, anti-emetics, oral administration of carbonated beverages, non-steroidal anti-inflammatory drugs, and systemic antimicrobials. Surgical intervention was performed in 7/29% of pigs. In this study, obstipation in pet pigs carried a fair to favorable prognosis for survival, with 70% of patients surviving to discharge.
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Affiliation(s)
- Kallie J Hobbs
- University of Florida College of Veterinary Medicine, Gainesville, Florida, USA (Hobbs, DeNotta, Gallastegui, Elane); University of Missouri College of Veterinary Medicine, Columbia, Missouri, USA (Rivero, Adkins); Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada (Gomez)
| | - SallyAnne L DeNotta
- University of Florida College of Veterinary Medicine, Gainesville, Florida, USA (Hobbs, DeNotta, Gallastegui, Elane); University of Missouri College of Veterinary Medicine, Columbia, Missouri, USA (Rivero, Adkins); Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada (Gomez)
| | - Aitor Gallastegui
- University of Florida College of Veterinary Medicine, Gainesville, Florida, USA (Hobbs, DeNotta, Gallastegui, Elane); University of Missouri College of Veterinary Medicine, Columbia, Missouri, USA (Rivero, Adkins); Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada (Gomez)
| | - George L Elane
- University of Florida College of Veterinary Medicine, Gainesville, Florida, USA (Hobbs, DeNotta, Gallastegui, Elane); University of Missouri College of Veterinary Medicine, Columbia, Missouri, USA (Rivero, Adkins); Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada (Gomez)
| | - Luis A Rivero
- University of Florida College of Veterinary Medicine, Gainesville, Florida, USA (Hobbs, DeNotta, Gallastegui, Elane); University of Missouri College of Veterinary Medicine, Columbia, Missouri, USA (Rivero, Adkins); Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada (Gomez)
| | - Pamela Adkins
- University of Florida College of Veterinary Medicine, Gainesville, Florida, USA (Hobbs, DeNotta, Gallastegui, Elane); University of Missouri College of Veterinary Medicine, Columbia, Missouri, USA (Rivero, Adkins); Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada (Gomez)
| | - Diego E Gomez
- University of Florida College of Veterinary Medicine, Gainesville, Florida, USA (Hobbs, DeNotta, Gallastegui, Elane); University of Missouri College of Veterinary Medicine, Columbia, Missouri, USA (Rivero, Adkins); Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada (Gomez)
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Crabtree NE, Epstein KL. Current Concepts in Fluid Therapy in Horses. Front Vet Sci 2021; 8:648774. [PMID: 33855057 PMCID: PMC8039297 DOI: 10.3389/fvets.2021.648774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 03/03/2021] [Indexed: 11/13/2022] Open
Abstract
Despite the frequent inclusion of fluid therapy in the treatment of many conditions in horses, there are limited studies available to provide evidenced-based, species-specific recommendations. Thus, equine fluid therapy is based on the application of physiology and extrapolation from evidence in other veterinary species and human medicine. The physiologic principles that underly the use of fluids in medicine are, at first glance, straightforward and simple to understand. However, in the past 20 years, multiple studies in human medicine have shown that creating recommendations based on theory in combination with experimental and/or small clinical studies does not consistently result in best practice. As a result, there are ongoing controversies in human medicine over fluid types, volumes, and routes of administration. For example, the use of 0.9% NaCl as the replacement fluid of choice is being questioned, and the theoretical benefits of colloids have not translated to clinical cases and negative effects are greater than predicted. In this review, the current body of equine research in fluid therapy will be reviewed, connections to the controversies in human medicine and other veterinary species will be explored and, where appropriate, recommendations for fluid therapy in the adult horse will be made based on the available evidence. This review is focused on the decisions surrounding developing a fluid plan involving crystalloids, synthetic colloids, and plasma.
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Affiliation(s)
- Naomi E Crabtree
- Department of Large Animal Medicine, University of Georgia College of Veterinary Medicine, Athens, GA, United States
| | - Kira L Epstein
- Department of Large Animal Medicine, University of Georgia College of Veterinary Medicine, Athens, GA, United States
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Marques NR, Baker RD, Kinsky M, Lee JO, Jupiter D, Mitchell C, Herndon DN, Kramer G. Effectiveness of Colonic Fluid Resuscitation in a Burn-Injured Swine. J Burn Care Res 2020; 39:744-750. [PMID: 29931250 DOI: 10.1093/jbcr/irx035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
To determine the effectiveness of colonic fluid absorption as a route for fluid resuscitation of a major burn. In order to assess the feasibility and performance of colonic resuscitation, the authors compared plasma volume expansion and hemodynamic parameters of animals submitted to colonic or intravenous fluid resuscitation. Twelve anesthetized swine were submitted to a 40% full thickness flame burn. Thirty minutes later fluid resuscitation was initiated with either intravenous or colonic infusion of crystalloid based on the Parkland formula. This treatment lasted 4.5 hours. The volume of fluid infused was 86 ± 18 ml/kg for the intravenous treatment and 89 ± 14 ml/kg for the colonic treatment. The percentage of fluid absorbed by the colon at the end of the protocol was 30 ± 13% of the infused fluid. Enteral resuscitation was equally effective in expanding plasma volume at the end of the protocol. Laboratorial and hemodynamic parameters were similar between the two resuscitation strategies throughout the study. Urine output was significantly higher in the intravenous group (7.9 ± 4.2 ml/kg/hr vs 0.9 ± 0.3 ml/kg/hr, P = .03). This study demonstrates that colonic infusion of normal saline in a severe burn injury model can restore hemodynamic stability and expand plasma volume to a degree that rivals the effect of direct intravenous infusion for early burn resuscitation in a swine model.
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Affiliation(s)
| | - Robert D Baker
- Department of Human Physiology, University of Texas Medical Branch, Galveston, Texas
| | - Michael Kinsky
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas
| | - Jong O Lee
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Daniel Jupiter
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
| | - Charles Mitchell
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas
| | - David N Herndon
- Department of Surgery and Pediatrics, University of Texas Medical Branch, Galveston, Texas
| | - George Kramer
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas
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Markota A, Fluher J, Sinkovič A. Rectal Instillation of Cold Fluids for Targeted Temperature Management After Cardiac Arrest: A Case Report. Ther Hypothermia Temp Manag 2017; 8:59-61. [PMID: 28708472 DOI: 10.1089/ther.2017.0018] [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: 11/12/2022] Open
Abstract
The optimal method of temperature management after cardiac arrest remains unknown. Methods that are most effective are usually invasive and expensive. Noninvasive methods are not as effective and obstruct access to the patient. Temperature management via rectal cooling offers some potential advantages in survivors of cardiac arrest, namely, relatively large volumes of temperature-controlled fluids can be instilled, access to the patient is not obstructed, and fluid overload can be ameliorated by removal of a fraction of instilled fluid. We used rectal cooling in a 72-year-old male comatose survivor of cardiac arrest with an initial body temperature of 36.8°C. We instilled 3000 mL of normal saline at 4°C in 75 minutes, and ∼2000 mL of effluent fluid was removed via gravity at 105 minutes after instillation. At 135 minutes, temperature decreased to a minimum of 35.2°C. No leakage was observed. Standard procedures (insertion of central venous and arterial catheters, electrocardiography, echocardiography, chest radiography) were performed with a rectal catheter in situ. At 210 minutes after instillation, the catheter was removed and there were no clinical signs of rectal injury after removal. To conclude, rectal instillation of cold fluids resulted in a significant decrease of body temperature and we observed no major side effects. Fluid overloading was avoided by removing effluent fluid. Additional studies are needed if this technique is to gain more widespread use.
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Affiliation(s)
- Andrej Markota
- Medical Intensive Care Unit, University Medical Centre Maribor , Maribor, Slovenia
| | - Jure Fluher
- Medical Intensive Care Unit, University Medical Centre Maribor , Maribor, Slovenia
| | - Andreja Sinkovič
- Medical Intensive Care Unit, University Medical Centre Maribor , Maribor, Slovenia
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Abstract
Rabbits have the ability to hide their signs and often present in a state of decompensatory shock. Handling can increase susceptibility to stress-induced cardiomyopathy and specific hemodynamic changes. Careful monitoring with a specific reference range is important to detect early decompensation, change the therapeutic plan in a timely manner, and assess prognostic indicators. Fluid requirements are higher in rabbits than in other small domestic mammals and can be corrected both enterally and parenterally. Critical care in rabbits can be extrapolated to many hindgut fermenters, but a specific reference range and dosage regimen need to be determined.
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Affiliation(s)
- Minh Huynh
- Exotic Department, Centre Hospitalier Vétérinaire Frégis, 43 Avenue Aristide Briand, Arcueil 94110, France.
| | - Anaïs Boyeaux
- Department of Emergency and Critical Care, Centre Hospitalier Vétérinaire Frégis, 43 Avenue Aristide Briand, Arcueil 94110, France
| | - Charly Pignon
- Exotics Medicine Service, Alfort National Veterinary School, 7 avenue du Général de Gaulle, Maisons-Alfort 94700, France
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Beneficial effects of fluid resuscitation via the rectum on hemodynamic disorders and multiple organ injuries in an experimental severe acute pancreatitis model. Pancreatology 2015; 15:626-34. [PMID: 26424226 DOI: 10.1016/j.pan.2015.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 08/21/2015] [Accepted: 09/07/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Exaggerated hydration is harmful for patients with severe acute pancreatitis (SAP), and it can increase mortality rate. In this study, we investigated the role of fluid resuscitation via the rectum (FRVR) on the hemodynamic state and compared FRVR with intravenous fluid resuscitation (IVFR) on resuscitation effect and organ function in an early stage of SAP. METHODS We studied whether FRVR corrects hemodynamic disorders at an early stage of SAP in Spraque-Dawley (SD) rats and whether it mitigates organ dysfunction and whether FRVR is superior to IVFR. RESULTS In both IVFR and FRVR groups, we observed a rebound in the mean arterial pressure (MAP) after 5 h and 6 h of administration (p < 0.05), respectively. MAP of the FRVR group reached the same level as the SHAM group at the end of the treatment, with hematocrit declining compared with the non-fluid resuscitation (NFR) group (p < 0.05). A concomitant increase in abdominal ascites and the lung wet/dry ratio by IVFR was depressed in the FRVR group (p < 0.05). Liver function was ameliorated in both fluid resuscitation groups (p < 0.05), consistent with histopathological improvement. TNF-α in serum and MPO in the lungs and jejunum of the FRVR group were lower than the IVFR group (p < 0.05). Pancreas histopathological injuries were ameliorated by both IVFR and FRVR (p < 0.05). CONCLUSIONS Our findings suggested FRVR is a potential supplementary method for fluid management in an early stage of SAP and FRVR should be studied further.
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