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Monden M, Murata N, Takahashi K, Fukamachi D, Okumura Y. Repeated Cerebral Infarction Immediately after Bypass Graft Angiography: A Case Report. Int J Angiol 2023; 32:250-252. [PMID: 37927833 PMCID: PMC10624535 DOI: 10.1055/s-0041-1725182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
A cerebral infarction (CI) is a common complication of coronary angiography (CAG); however, repeated CIs in the immediate period after a CAG have not been reported yet. The patient in the present study experienced left upper quadrant blindness immediately after internal thoracic arteriography, and magnetic resonance imaging (MRI) showed a high-intensity area in the right occipital lobe. Despite the administration of antithrombotic therapy, the patient became transiently comatose for 6 hours. MRI showed a new high-intensity area in the left thalamus. A noninvasive assessment should be considered before internal thoracic arteriography to prevent the risk of complications.
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Affiliation(s)
- Masaki Monden
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Nobuhiro Murata
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Kurara Takahashi
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Daisuke Fukamachi
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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2
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Uyanik M, Yildirim U, Avci B, Soylu K. Assessment of silent brain injury in patients undergoing elective percutaneous coronary intervention due to chronic total occlusion. Scand Cardiovasc J Suppl 2023; 57:25-30. [PMID: 36443919 DOI: 10.1080/14017431.2022.2150786] [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: 11/30/2022]
Abstract
Objective: Silent brain infarcts (SBI) are thromboembolic complications associated with cardiac surgery, diagnostic angiography, and percutaneous interventions. Serum neuron-specific enolase (NSE) is the proven biomarker for measuring neuronal damage. This study aimed to evaluate the incidence of SBI, defined as elevated NSE after coronary chronic total occlusion (CTO) intervention and elective coronary stenting. Design: The study population consisted of two patient groups: the CTO group included consecutive patients with coronary CTO intervention, and the control group consisted of patients who underwent elective coronary intervention. NSE blood levels were measured before and 12-18 h after the procedure. NSE blood levels of >20 ng/mL were considered SBI. Results: A total of 108 patients were included in the study. Of these, 55 (50.9%) had SBI after the procedure. The SBI rate was 59.7% in the CTO group and 39.1% in the control group. Patients with SBI were more likely to have diabetes mellitus, hyperlipidemia, higher HbA1c, higher total stent length, and longer procedural time. Multivariate logistic regression analysis showed that CTO procedure (odds ratio [OR]: 3.129; 95% confidence interval [CI]: 1.246-7.858; p < 0.015) and diabetes mellitus (OR: 2.93; 95% CI: 1.185-7.291; p < 0.020) are independent predictors of SBI. Conclusion: Our data suggest that SBI occurs more frequently after CTO intervention than after non-CTO intervention. Intervention complexity and patient clinical characteristics may explain the increased incidence.
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Affiliation(s)
- Muhammet Uyanik
- Faculty of Medicine, Department of Cardiology, Ondokuz Mayıs University, Samsun, Turkey
| | - Ufuk Yildirim
- Faculty of Medicine, Department of Cardiology, Ondokuz Mayıs University, Samsun, Turkey
| | - Bahattin Avci
- Faculty of Medicine, Department of Biochemistry, Ondokuz Mayıs University, Samsun, Turkey
| | - Korhan Soylu
- Faculty of Medicine, Department of Cardiology, Ondokuz Mayıs University, Samsun, Turkey
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Kasprzak D, Kaczmarek-Majer K, Rzeźniczak J, Klamecka-Pohl K, Ganowicz-Kaatz T, Słomczyński M, Budzianowski J, Pieszko K, Hiczkiewicz J, Tykarski A, Burchardt P. Cognitive Impairment in Cardiovascular Patients after Myocardial Infarction: Prospective Clinical Study. J Clin Med 2023; 12:4954. [PMID: 37568355 PMCID: PMC10420195 DOI: 10.3390/jcm12154954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/18/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
(1) Background: Assessment of cognitive function is not routine in cardiac patients, and knowledge on the subject remains limited. The aim of this study was to assess post-myocardial infarction (MI) cognitive functioning in order to determine the frequency of cognitive impairment (CI) and to identify factors that may influence it. (2) Methods: A prospective study included 468 patients hospitalized for MI. Participants were assessed twice: during the first hospitalization and 6 months later. The Mini-Mental State Examination was used to assess the occurrence of CI. (3) Results: Cognitive dysfunction based on the MMSE was found in 37% (N-174) of patients during the first hospitalization. After 6 months, the prevalence of deficits decreased significantly to 25% (N-91) (p < 0.001). Patients with CI significantly differed from those without peri-infarction deficits in the GFR, BNP, ejection fraction and SYNTAX score, while after 6 months, significant differences were observed in LDL and HCT levels. There was a high prevalence of non-cognitive mental disorders among post-MI patients. (4) Conclusions: There is a high prevalence of CI and other non-cognitive mental disorders, such as depression, sleep disorders and a tendency to aggression, among post-MI patients. The analysis of the collected material indicates a significant impact of worse cardiac function expressed as EF and BNP, greater severity of coronary atherosclerosis expressed by SYNTAX results, and red blood cell parameters and LDL levels on the occurrence of CI in the post-MI patient population.
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Affiliation(s)
| | - Katarzyna Kaczmarek-Majer
- Stochastic Methods Department, System Research Institute, Polish Academy of Sciences, 01-447 Warsaw, Poland
- Analyx Sp. z o.o. sp.k., 61-887 Poznań, Poland
| | | | | | | | | | - Jan Budzianowski
- Faculty of Medicine and Health Sciences, University of Zielona Góra, 65-417 Zielona Góra, Poland
| | - Konrad Pieszko
- Faculty of Medicine and Health Sciences, University of Zielona Góra, 65-417 Zielona Góra, Poland
| | - Jarosław Hiczkiewicz
- Faculty of Medicine and Health Sciences, University of Zielona Góra, 65-417 Zielona Góra, Poland
| | - Andrzej Tykarski
- Department of Hypertension, Angiology, and Internal Medicine, Poznan University of Medical Sciences, 61-848 Poznań, Poland
| | - Paweł Burchardt
- Department of Cardiology, J. Strus Hospital, 61-285 Poznań, Poland
- Department of Hypertension, Angiology, and Internal Medicine, Poznan University of Medical Sciences, 61-848 Poznań, Poland
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Observation of the Effect of Nursing BPR on Thrombolytic Efficacy and Prognosis of Patients with Cerebral Infarction Based on CT Images. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:3106904. [PMID: 36176929 PMCID: PMC9492414 DOI: 10.1155/2022/3106904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/27/2022] [Accepted: 08/17/2022] [Indexed: 12/02/2022]
Abstract
Cerebral infarction has become the main cause of death among Chinese residents, especially ischemic cerebral infarction. The existing CT technology is not very effective for the detection of cerebral infarction, and some angiography has problems such as blurring and shadowing. In order to understand the treatment methods and effects of patients with cerebral infarction, this article observes the effect of nursing BPR on thrombolytic efficacy and prognosis of patients with cerebral infarction based on CT images. The patients were divided into thrombolytic group and nonthrombolytic group, and a simple rating scale was used to assess the motor function of the patients' limbs, and the stroke scale was used to assess the patient's neurological function. Compare the baseline data, the time of admission, 24 hours and 7 days, the scores before and after treatment, and the ratio between the two groups. According to the monitoring, record each time point. The analysis of the occurrence of primary endpoint was events and secondary endpoint events and risk factors affecting limb motor function. The results of the study found that, based on the computer scanning observation of nursing BPR, compared with the traditional model, the patient's bleeding was significantly reduced, and the time required for nursing was also reduced by more than 50% compared with the traditional model. Compared with the traditional nursing model, the satisfaction of patients with the BPR nursing model is nearly 40% higher than that of the traditional nursing model. This shows that the observation of thrombolytic effect in patients with cerebral infarction based on computed tomography and BPR nursing can produce good therapeutic effects.
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Reed GW, Krishnaswamy A, Kapadia SR. Silent brain infarction after TAVR: common but of unclear significance. Eur Heart J 2021; 42:1016-1018. [PMID: 33693578 DOI: 10.1093/eurheartj/ehaa1110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Grant W Reed
- Heart, Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Cleveland Clinic, OH, USA
| | - Amar Krishnaswamy
- Heart, Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Cleveland Clinic, OH, USA
| | - Samir R Kapadia
- Heart, Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Cleveland Clinic, OH, USA
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Indja B, Woldendorp K, Vallely MP, Grieve SM. Silent Brain Infarcts Following Cardiac Procedures: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2020; 8:e010920. [PMID: 31017035 PMCID: PMC6512106 DOI: 10.1161/jaha.118.010920] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Silent brain infarcts (SBI) are increasingly being recognized as an important complication of cardiac procedures as well as a potential surrogate marker for studies on brain injury. The extent of subclinical brain injury is poorly defined. Methods and Results We conducted a systematic review and meta‐analysis utilizing studies of SBIs and focal neurologic deficits following cardiac procedures. Our final analysis included 42 studies with 49 separate intervention groups for a total of 2632 patients. The prevalence of SBIs following transcatheter aortic valve implantation was 0.71 (95% CI 0.64‐0.77); following aortic valve replacement 0.44 (95% CI 0.31‐0.57); in a mixed cardiothoracic surgery group 0.39 (95% CI 0.28‐0.49); coronary artery bypass graft 0.25 (95% CI 0.15‐0.35); percutaneous coronary intervention 0.14 (95% CI 0.10‐0.19); and off‐pump coronary artery bypass 0.14 (0.00‐0.58). The risk ratio of focal neurologic deficits to SBI in aortic valve replacement was 0.22 (95% CI 0.15‐0.32); in off‐pump coronary artery bypass 0.21 (95% CI 0.02‐2.04); with mixed cardiothoracic surgery 0.15 (95% CI 0.07‐0.33); coronary artery bypass graft 0.10 (95% CI 0.05‐0.18); transcatheter aortic valve implantation 0.10 (95% CI 0.07‐0.14); and percutaneous coronary intervention 0.06 (95% CI 0.03‐0.14). The mean number of SBIs per patient was significantly higher in the transcatheter aortic valve implantation group (4.58 ± 2.09) compared with both the aortic valve replacement group (2.16 ± 1.62, P=0.03) and the percutaneous coronary intervention group (1.88 ± 1.02, P=0.03). Conclusions SBIs are a very common complication following cardiac procedures, particularly those involving the aortic valve. The high frequency of SBIs compared with strokes highlights the importance of recording this surrogate measure in cardiac interventional studies. We suggest that further work is required to standardize reporting in order to facilitate the use of SBIs as a routine outcome measure.
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Affiliation(s)
- Ben Indja
- 1 Sydney Translational Imaging Laboratory Heart Research Institute Charles Perkins Centre The University of Sydney Camperdown Sydney NSW Australia.,2 Sydney Medical School The University of Sydney Camperdown Sydney NSW Australia
| | - Kei Woldendorp
- 2 Sydney Medical School The University of Sydney Camperdown Sydney NSW Australia.,4 Department of Cardiothoracic Surgery Royal Prince Alfred Hospital Camperdown Sydney NSW Australia
| | - Michael P Vallely
- 2 Sydney Medical School The University of Sydney Camperdown Sydney NSW Australia.,3 Sydney Heart and Lung Surgeons Camperdown Sydney NSW Australia
| | - Stuart M Grieve
- 1 Sydney Translational Imaging Laboratory Heart Research Institute Charles Perkins Centre The University of Sydney Camperdown Sydney NSW Australia.,2 Sydney Medical School The University of Sydney Camperdown Sydney NSW Australia.,5 Department of Radiology Royal Prince Alfred Hospital Camperdown Sydney NSW Australia
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Silent cerebral infarction after percutaneous coronary intervention of chronic total occlusions (CTO) and non-CTOs. Int J Cardiovasc Imaging 2020; 36:2107-2113. [PMID: 32681317 DOI: 10.1007/s10554-020-01939-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Abstract
Silent cerebral infarctions (SCI) determined by neuron specific enolase (NSE) elevation may develop more during chronic total occlusion (CTO) percutaneous coronary interventions (PCI) than non-CTO interventions. Our aim was to examine CTO and non-CTO PCIs for SCI development. 100 consecutive CTO and 100 non-CTO PCI patients were enrolled. SCI was detected by serum NSE measurements performed at baseline and 12 h after the interventions. New NSE elevations > 12 ng/mL after the procedure were counted as SCI. Post-procedural NSE levels were found to be significantly higher in the CTO PCI group and NSE positivity was more prevalent in the CTO PCI group (56 (56%) vs. 31 (31%), p < 0.001), but PCI of CTOs did not independently increase risk of SCI (OR: 2.39 (0.85-6.73), p: 0.10). Patients who developed SCI after PCI had the characteristics of tough PCI interventions. In the multivariate analysis, two parameters were found to be independently associated with SCI development, namely more contrast volume (OR: 1.014 (1.005-1.023), p: 0.003) and longer procedural time (OR: 1.030 (1.010-1.051), p: 0.003). It has been firstly demonstrated in the literature that CTO PCIs, by its nature, have increased rates of SCI when compared to non-CTO PCIs but presence of a CTO was not an independent predictor of SCI. Mainly, procedural characteristics of the PCIs, especially longer procedural times and more contrast consumption, observed more in CTO PCIs, have been found to be independently associated with elevations of plasma NSE levels.
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Gilchrist IC, Lall SK. Risk of Stroke during Cardiac Catheterization: A Function of Access Site or Still a Question to Be Answered? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:888-889. [PMID: 32505487 DOI: 10.1016/j.carrev.2020.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Ian C Gilchrist
- Penn State University, College of Medicine, Heart & Vascular Institute, 500 University Drive, C1517, MS Hershey Medical Center, Hershey, PA 17033, United States of America.
| | - Sumeet K Lall
- Penn State University, College of Medicine, Heart & Vascular Institute, 500 University Drive, C1517, MS Hershey Medical Center, Hershey, PA 17033, United States of America
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Marchese N, Copetti M, Inchingolo V, Popolizio T, Fontana A, Simeone A, Vigna C. Cerebral Infarcts After Coronary Angiography and Percutaneous Coronary Intervention: A Prospective Propensity-Score-Adjusted Comparison of Right Radial, Left Radial, and Femoral Approaches. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:882-887. [PMID: 31761638 DOI: 10.1016/j.carrev.2019.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/07/2019] [Accepted: 11/11/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND New cerebral infarcts (CIs) detected at magnetic resonance imaging (MRI) are reported after cardiac procedures. Clinical and procedural aspects are implicated as potential causal factors. The aim of this study was to evaluate the incidence of new CIs after coronary angiography and percutaneous coronary intervention according to the arterial access site. METHODS 180 patients undergoing elective coronary angiography were studied with cerebral MRI the day before and the day after the procedure. Unadjusted and propensity score (PS) analyses were performed comparing the occurrence of CIs in right radial (RR), left radial (LR) and transfemoral (TF) access groups. RESULTS New CIs were observed in 14 patients (7.8% of the total sample, one with neurological sequelae). CIs were detected in 15.5% vs 4.9% vs 3.3% of RR, LR and TF groups, respectively (p = .026). In PS adjusted analyses, the RR approach was associated with more CIs compared with the TF approach (odds ratio [OR] estimate from logistic regression adjusted by PS quartiles: 0.158; 95% confidence interval: 0.031 to 0.814; p = .027) and the LR approach (OR: 0.266; 95% confidence interval: 0.066 to 1.080; p = .064). In a secondary analysis, a comparison of RR vs non-RR approach (TF + LR) was performed, showing that post-procedural CIs were more frequent in the RR group (OR: 0.170; 95% confidence interval: 0.050 to 0.574; p = .004). CONCLUSIONS Our study suggests that the RR approach may be associated with a higher rate of new CIs after coronary angiography compared with LR and TF approaches.
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Affiliation(s)
- Nicola Marchese
- Unit of Cardiology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
| | - Massimiliano Copetti
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Vincenzo Inchingolo
- Unit of Neurology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Teresa Popolizio
- Unit of Radiology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Andrea Fontana
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Annalisa Simeone
- Unit of Neurology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Carlo Vigna
- Unit of Cardiology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
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Cognitive and Emotional Impairment after Minor Stroke and Non-ST-Elevation Myocardial Infarction (NSTEMI): A Prevalence Study. Stroke Res Treat 2019; 2019:2527384. [PMID: 31057784 PMCID: PMC6463585 DOI: 10.1155/2019/2527384] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 11/17/2022] Open
Abstract
Aim To study the prevalence of cognitive and emotional impairment following a minor ischemic stroke compared to an age-matched group with non-ST-elevation myocardial infarction (NSTEMI). Methods We included patients aged 18-70 years with a minor ischemic stroke defined as modified Rankin Scale (mRS) 0-2 at day 7 or at discharge if before and age-matched NSTEMI patients with the same functional mRS. We applied a selection of cognitive tests and the patients completed a questionnaire comprising of Hospital Anxiety and Depression scale (HADS) and Fatigue Severity Scale (FSS) at follow-up 12 months after the vascular event. Results of cognitive tests were also compared to normative data. Results 325 ischemic stroke and 144 NSTEMI patients were included. There was no significant difference in cognitive functioning between ischemic stroke and NSTEMI patients. Minor stroke patients and to a lesser extent NSTEMI patients scored worse on more complex cognitive functions including planning and implementation of activities compared to validated normative data. For the minor stroke patients the location of the ischemic lesion had no influence on the result. The prevalence of anxiety, depression, and fatigue was significantly higher in the stroke group compared to the NSTEMI group. Depression was independently associated with reduced cognitive function. Discussion and Conclusion Minor ischemic stroke patients, and to lesser degree NSTEMI patients, had reduced cognitive function compared to normative data, especially executive functioning, on 12-month follow-up. The difference in cognitive function between stroke and NSTEMI patients was not significant. Depression was associated with low scores on cognitive tests highlighting the need to adequately address emotional sequelae when considering treatment options for cognitive disabilities.
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Louis DW, Kennedy K, Lima FV, Pancholy SB, Abbott JD, Gordon P, Aronow HD. Association Between Maximal Activated Clotting Time and Major Bleeding Complications During Transradial and Transfemoral Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2018; 11:1036-1045. [DOI: 10.1016/j.jcin.2018.01.257] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 12/26/2017] [Accepted: 01/23/2018] [Indexed: 11/28/2022]
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