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Takahashi S, Katayama K, Watanabe M, Kodama H, Taguchi T, Kurosaki T, Imai K, Sueda T. Preoperative Tissue Doppler Imaging-Derived Atrial Conduction Time Predicts Postoperative Atrial Fibrillation in Patients Undergoing Mitral Valve Surgery for Mitral Valve Regurgitation. Circ J 2016; 80:101-9. [DOI: 10.1253/circj.cj-15-0796] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shinya Takahashi
- Department of Cardiovascular Surgery, Hiroshima University Hospital
| | - Keijiro Katayama
- Department of Cardiovascular Surgery, Hiroshima University Hospital
| | | | - Hiroshi Kodama
- Department of Cardiovascular Surgery, Hiroshima University Hospital
| | - Takahiro Taguchi
- Department of Cardiovascular Surgery, Hiroshima University Hospital
| | - Tatsuya Kurosaki
- Department of Cardiovascular Surgery, Hiroshima University Hospital
| | - Katsuhiko Imai
- Department of Cardiovascular Surgery, Hiroshima University Hospital
| | - Taijiro Sueda
- Department of Cardiovascular Surgery, Hiroshima University Hospital
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Buber J, Luria D, Sternik L, Kuperstein R, Grupper A, Goldenberg I, Raanani E, Feinberg MS, Nof E, Eldar M, Glikson M. Morphological features of the P-waves at surface electrocardiogram as surrogate to mechanical function of the left atrium following a successful modified maze procedure. Europace 2013; 16:578-86. [DOI: 10.1093/europace/eut248] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Nakai K, Oka T, Okabayashi H, Tsuboi J, Fukuhiro Y, Fukushima A, Suwabe A, Itoh M, Yoshizawa M. Three-dimensional spectral map of atrial fibrillation by a 64-channel magnetocardiogram. J Electrocardiol 2008; 41:123-30. [PMID: 17884079 DOI: 10.1016/j.jelectrocard.2007.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Accepted: 06/20/2007] [Indexed: 11/24/2022]
Abstract
We verified the significance of 3-dimensional (3D) spectral mapping during atrial fibrillation (AFIB) using a 64-channel magnetocardiogram (MCG). The study consisted of 16 patients with valvular heart disease who had chronic AFIB. All 16 patients had surgical pulmonary vein (PV) isolation followed by valvular repair. We performed spectral mapping by fast Fourier transform analysis in nonaveraged 64-channel MCG data. The 3D spectral map was superimposed on a 3D heart polygon. At 1 year after surgical PV isolation for AFIB, followed by valve repair, 7 patients had restoration to sinus rhythm, and 9 patients remained in persistent AFIB. The preoperative mean 3D frequency of AFIB was 6.1 +/- 0.9 Hz in patients with restored sinus rhythm and 7.2 +/- 0.7 Hz in patients with sustained AFIB after PV isolation (P = .02). In addition, the preoperative 3D spectrum was distributed on the right side of the heart in patients with persistent AFIB. In conclusion, 3D spectral mapping using 64-channel MCG may represent a meaningful noninvasive strategy for patients with AFIB who receive an interventional procedure.
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Affiliation(s)
- Kenji Nakai
- Department of Laboratory Medicine, Iwate University, Morioka, Japan.
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Nakai K, Kawazoe K, Izumoto H, Tsuboi J, Oshima Y, Oka T, Yoshioka K, Shozushima M, Suwabe A, Itoh M, Kobayashi K, Shimizu T, Yoshizawa M. Construction of a Three-dimensional Outline of the Heart and Conduction Pathway by Means of a 64-channel Magnetocardiogram in Patients with Atrial Flutter and Fibrillation. Int J Cardiovasc Imaging 2005; 21:555-61; discussion 563-4. [PMID: 16175446 DOI: 10.1007/s10554-005-0652-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2004] [Accepted: 01/14/2005] [Indexed: 11/25/2022]
Abstract
BACKGROUND Magnetocardiography (MCG) has the potential for collecting three-dimensional (3D) intracardiac electric information, because the magnetic field is unaffected by the shape of the lungs and torso. In the present study, we report on the generation of a 3D heart outline and conduction pathway by means of a current density map using a 64-channel SQUID system, and an evaluation of its significance in patients with atrial flutter (AFL) and atrial fibrillation (AFIB). METHODS The subjects consisted of 20 healthy volunteers, and 3 patients with AFL and 4 patients with AFIB. A 64-channel MCG was recorded after digitization at 500 Hz, and a 3D current density was reconstructed from the magnetic fields using a space filter in conjunction with the minimum normalization method of Tikhonov. A 3D heart outline was generated from the integrated current density by the space filter. The conduction pathway was superimposed on a heart outline generated by a magnetic field. The heart outline was verified by the silhouette on the magnetic resonance (MR) images. An MCG was recorded pre- and post interventional therapy, and therapeutic efficacy was evaluated. RESULTS The 3D heart outline of the atrium and ventricle corresponded to the silhouette of the right atrium and left ventricle, respectively, on an MR image. The serial conduction pathway of the QRS segment superimposed on the 3D heart outline map demonstrated the conduction pattern generated within the heart. The MCG revealed a counter-clockwise rotation in patients with AFL, and random micro-reentry in the case of AFIB. After interventional therapy, restoration of the sinus rhythm was verified in patients with both AFL and AFIB. CONCLUSIONS A 64-channel MCG was used to evaluate the 3D heart outline and conduction pathway in patients with AFL and AFIB without the need for MR images. Condensed Abstract A 64-channel MCG was used to evaluate the 3D heart out line and conduction pathway in patients with AFL and AFIB.
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Affiliation(s)
- Kenji Nakai
- The Department of Laboratory Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, Japan, 020-8505.
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Millar RC, Arcidi JM, Alison PJ. The maze III procedure for atrial fibrillation: should the indications be expanded? Ann Thorac Surg 2000; 70:1580-6. [PMID: 11093491 DOI: 10.1016/s0003-4975(00)01707-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND We favor the maze III procedure over nonsurgical treatments for atrial fibrillation and have advocated addition of the maze in symptomatic patients with other compelling indications for cardiac surgery. METHODS Characteristics and perioperative outcomes of our 76 cumulative maze recipients between 1993 to 1998 were reviewed. The original maze III technique was employed without modification. RESULTS Isolated maze III was performed in 19 patients (25%) and combined with other procedures in 57 patients (75%), 49 of these involving one or more valves. Patients having combined procedures were taking fewer antiarrhythmics (p < 0.0001), but were older (p < 0.01), more often female (p < 0.05), and more often had chronic atrial fibrillation (p < 0.01) compared with isolated maze III recipients. The mean duration of aortic clamping and cardiopulmonary bypass for isolated maze was 69 +/- 11 and 145 +/- 22 minutes, and for combined valve procedures it was 122 +/- 38 and 205 +/- 47 minutes. There was no operative mortality. Complications occurred in 15 patients (19.7%). At 3 months atrial fibrillation was cured in 73 of 75 patients (97.3%). Sick sinus syndrome required pacemaker implantation in 3 patients (4.0%). CONCLUSIONS The maze III can be performed alone or as a combined procedure with equivalent success, and technical modifications may be unnecessary. A lower threshold for its expanded use in symptomatic patients with atrial fibrillation who require isolated or combined operations is appropriate.
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Affiliation(s)
- R C Millar
- Division of Cardiovascular and Thoracic Surgery, LDS Hospital, Salt Lake City, Utah, USA
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Ueshima K, Nasu M, Segawa I, Kamata J, Kobayashi N, Nakamura M, Chiba N, Hiramori K. What determines the heart rate response to exercise in patients with atrial fibrillation? JAPANESE HEART JOURNAL 2000; 41:445-50. [PMID: 11041095 DOI: 10.1536/jhj.41.445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We evaluated the factors that determine the heart rate response to exercise in 60 patients with atrial fibrillation (25 men and 35 women, with a mean age of 61+/-10 years) who underwent symptom limited cardiopulmonary exercise testing with blood sampling of atrial natriuretic peptide (ANP), 2-dimensional echocardiography and cardiac catheterization. Atrial muscles resected during the Maze operation were examined histologically in 12 patients. The heart rate response to exercise depended on the severity of the atrial organic injury, which was expressed as left atrial diameter, ANP secretion during the maximal exercise testing and the histological findings of atrial tissue. Conversely, we believe that the severity of the atrial injury can be predicted from the heart rate response to exercise in patients with atrial fibrillation.
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Affiliation(s)
- K Ueshima
- Memorial Heart Center, Second Department of Internal Medicine, Iwate Medical University, Japan
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Jessurun ER, van Hemel NM, Defauw JA, Stofmeel MA, Kelder JC, de la Rivière AB, Ernst JM. Results of maze surgery for lone paroxysmal atrial fibrillation. Circulation 2000; 101:1559-67. [PMID: 10747350 DOI: 10.1161/01.cir.101.13.1559] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND If drug refractoriness to paroxysmal atrial fibrillation (PAF) occurs, arrhythmia surgery that involves channelling and the exclusion of specific atrial areas can abolish atrial fibrillation. The purpose of this study was to establish the effectiveness and safety of maze III surgery to abolish PAF. METHODS AND RESULTS Surgery was performed in 41 selected patients who had long-standing, symptomatic, drug-refractory, lone PAF. At discharge, 35 patients (85%) were arrhythmia free, and 6 patients (15%) showed PAF and paroxysmal atrial tachycardia. Death or stroke did not occur during a mean follow-up of 31+/-16 months. At the end of follow-up, 39 patients (95%) had no PAF; however, in 2 patients (5%), PAF persisted and eventually required His bundle ablation and pacing. Three months after surgery, nodal escape rhythm was observed in only 1 patient, whereas sick-sinus syndrome emerged late after surgery in 2 patients. Antiarrhythmic drugs were used in 20% of patients during follow-up. The quality of life improved markedly after surgery and remained unchanged afterward. Echocardiographic findings did not alter, but exercise capacity increased. CONCLUSIONS This pilot study demonstrates the effectiveness and safety of maze III surgery for lone PAF. In patients without sick-sinus syndrome, this intervention offers a sensible alternative to His bundle ablation and lifelong pacemaker dependency.
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Affiliation(s)
- E R Jessurun
- Departments of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
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Izumoto H, Kawazoe K, Eishi K, Kamata J. Medium-term results after the modified Cox/Maze procedure combined with other cardiac surgery. Eur J Cardiothorac Surg 2000; 17:25-9. [PMID: 10735408 DOI: 10.1016/s1010-7940(99)00346-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Long-term results after the modified Cox/Maze III procedure combined with other cardiac procedure for the treatment of organic heart disease and chronic atrial fibrillation (AF) has not been clarified. This report describes our medium-term results after such operation. METHODS Between March 1993 and August 1995, 104 consecutive patients with chronic AF underwent the modified Cox/Maze III procedure combined with other cardiac procedure. There were 100 long-term survivors. There were 45 men and 55 women, with ages ranging from 21 to 77 years (mean 59.7). Patients were followed up and changes in rhythm, need for pacemaker implantation, and the incidence of CNS (central nervous system) complications were retrospectively studied. RESULTS The follow-up was complete in 103 patients and 99 long-term survivors (99%). The mean follow-up period was 44.6 +/- 1.1 months. In the immediate postoperative period, 73 patients regained sinus rhythm (SR group), 21 patients were in AF (AF group), and six patients underwent pacemaker implantation because of sick sinus syndrome (SSS). During the follow-up period, eight patients died. One- and 5-year survival rates (Kaplan-Meier) after surgery was 95.1 +/- 2.3 and 87.8 +/- 3.4% for the entire group. Preoperative NYHA class was 2.5 +/- 0.7 and medium-term NYHA class was 1.5 +/- 0.5. (P < 0.001) Changes in rhythm for the SR group were followed. Fifty-two patients of the SR group stayed in SR (72%), 16 patients converted back to AF (22%), and four patients had newly-developed SSS (6%) at follow-up period. Probability in SR maintenance for SR group at 1 year was 88.8 +/- 3.7% and at 5 years was 64.8 +/- 7.5%. Five patients experienced the CNS complication during the follow-up period. Two of the AF group and two of the SR group patients developed cerebral/cerebellar infarction. One of the SR group patients experienced small cerebral bleeding. CONCLUSIONS The medium-term results after the modified Cox/Maze III procedure concomitant with other cardiac procedure are good with improved functional status and good survival rate. However, there seems to be gradual but constant attrition in the rate of SR maintenance in SR group.
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Affiliation(s)
- H Izumoto
- Department of Cardiovascular Surgery, Iwate Medical University Memorial Heart Center, Iwate Medical University, Morioka, Japan
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Takami Y, Yasuura K, Takagi Y, Ohara Y, Watanabe T, Usui A, Masumoto H, Sakai Y, Teranishi K. Partial maze procedure is effective treatment for chronic atrial fibrillation associated with valve disease. J Card Surg 1999; 14:103-8. [PMID: 10709821 DOI: 10.1111/j.1540-8191.1999.tb00958.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The maze procedure may be performed in combination with valve operations to treat chronic atrial fibrillation associated with valve dysfunction. Although we initially used the modified Cox maze III procedure, a more limited partial maze procedure is now preferred because the left atrium might be considered as the electrical impetues for atrial fibrillation. In this study we compared the results of 30 patients (group I) who underwent the full biatrial modified Cox maze III and 20 (group II) patients the partial maze procedure. While the rates of restored sinus rhythm were the same in both groups at 6-month follow-up (I: 83.3%, vs II: 80%), the following advantages were noted in the patients undergoing the partial maze procedure: shorter operative times, lesser elevations of creatine phosphokinase, lower rate of blood transfusion, lower rate of junctional rhythm soon after the operation, and a higher P wave in those patients with restored sinus rhythm. The effectiveness of the partial maze procedure seems equal to that of the biatrial modified Cox maze III procedure for atrial fibrillation associated with valve disease. The partial maze procedure is simple and less invasive, and thus might be applied more frequently as an additional procedure to valve operations without additional risk.
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Affiliation(s)
- Y Takami
- Nagoya University School of Medicine, Department of Thoracic Surgery, Japan
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McComb JM. Surgery for atrial fibrillation. J Thromb Thrombolysis 1999; 7:39-44. [PMID: 10337359 DOI: 10.1023/a:1008875219550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- J M McComb
- Regional Cardiothoracic Center, Freeman Hospital, Newcastle upon Tyne, UK
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Izumoto H, Kawazoe K, Kitahara H, Kamata J. Operative results after the Cox/maze procedure combined with a mitral valve operation. Ann Thorac Surg 1998; 66:800-4. [PMID: 9768933 DOI: 10.1016/s0003-4975(98)00590-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There have been few reports on postoperative morbidity and mortality analyses after concomitant mitral valve operation and the Cox/maze procedure. METHODS Between April 1993 and August 1995, 87 consecutive patients with chronic atrial fibrillation underwent a mitral valve operation and concomitant Cox/maze procedure at Iwate Medical University. The patients were divided into the replacement group (n = 31) and repair group (n = 56) according to the method of mitral valve replacement. Our initial experience with the combined operative procedures is presented along with the operative mortality and morbidity rates. Univariate analysis on preoperative and intraoperative variables affecting early mortality and morbidity is carried out retrospectively. RESULTS Total cardiopulmonary bypass time in all patients was 177.2 +/- 70.1 minutes. Total aortic cross-clamp time was 121.7 +/- 30.8 minutes. Total intensive care unit stay was 5.3 +/- 7.9 days. The average intubation period was 55.5 +/- 187.6 hours. The intensive care unit stay and the intubation period of the replacement group were longer than those of the repair group. There were four operative deaths among the 87 patients (4.6%). All repair group patients survived operation, whereas 4 replacement group patients died after operation. In all patients, the New York Heart Association functional class was higher (p = 0.028) in those who died than in those who survived. The overall restoration rate from atrial fibrillation was 79.5% (66 of 83 survivors). Seventeen patients (20.5%) had persistent atrial fibrillation postoperatively. Sick sinus syndrome occurred in 7 patients (8.4%). In the repair group, the restoration rate was 76.8%, whereas in the replacement group it was 85.2% for the survivors. CONCLUSIONS The Cox/maze procedure can be combined with a mitral valve operation with acceptably low operative risk. Analysis of risk factors of early mortality revealed that the type of mitral valve operation (replacement versus repair) and higher preoperative New York Heart Association functional class were associated with mortality. Long-term results from this combined procedure should be clearly demonstrated before its universal acceptance.
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Affiliation(s)
- H Izumoto
- Department of Cardiovascular Surgery, Iwate Medical University Memorial Heart Center, Iwate Medical University, Morioka, Japan
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Lozano IF, Montes JM, Gallego Page JC, Fernández MS, Bautista A, Cavero Gibanel MÁ, González González M, Artaza Andrade MD, Basterrechea JU. Técnica de MAZE para el tratamiento de la fibrilación auricular: experiencia inicial. Rev Esp Cardiol 1998. [DOI: 10.1016/s0300-8932(98)74837-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kamata J, Kawazoe K, Izumoto H, Kitahara H, Shiina Y, Sato Y, Nakai K, Ohkubo T, Tsuji I, Hiramori K. Predictors of sinus rhythm restoration after Cox maze procedure concomitant with other cardiac operations. Ann Thorac Surg 1997; 64:394-8. [PMID: 9262582 DOI: 10.1016/s0003-4975(97)00139-2] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND There have been sporadic cases of persistent atrial fibrillation and sick sinus syndrome after the maze procedure. The purpose of this study was to identify the predictors of sinus rhythm restoration after operation. METHODS Between March 1993 and June 1995, we evaluated retrospectively 96 consecutive patients who underwent the maze procedure (maze III) in combination with another type of cardiac operation. Four patients who died and 6 patients who required permanent pacemaker implantation because of sick sinus syndrome were excluded. Ambulatory electrocardiographic monitoring was evaluated 1 year after operation. Multiple logistic regression analysis was applied to identify the predictors of sinus rhythm restoration. RESULTS The final population comprised 86 patients (mean age, 59.8 years; 67 patients with mitral valve disease). Overall, sinus rhythm was restored in 68 of 86 patients (79.1%). The magnitude of the atrial fibrillatory wave positively predicted postoperative sinus rhythm restoration. Conversely, left atrial diameter was inversely related to postoperative sinus rhythm restoration. The odds ratio of having both a fine atrial fibrillatory wave (< 1.0 mm) and enlarged left atrial diameter (> or = 65 mm) for patients with sinus rhythm restoration was 0.04 (95% confidence interval, 0.01 to 0.28). CONCLUSIONS Atrial fibrillatory wave and left atrial diameter were independent predictors of sinus rhythm restoration after the maze procedure in patients with chronic atrial fibrillation and organic heart disease.
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Affiliation(s)
- J Kamata
- Third Department of Surgery, Iwate Medical University, Japan
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Takami Y, Yasuura K, Takagi Y, Ohara Y, Watanabe T, Usui A, Masumoto H, Sakai Y, Teranishi K. Partial Maze Procedure Is Effective Treatment for Chronic Atrial Fibrillation Associated with Valve Disease. Echocardiography 1985. [DOI: 10.1111/j.1540-8175.1985.tb01255.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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