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Aminde LN, Phung HN, Phung D, Cobiac LJ, Veerman JL. Dietary Salt Reduction, Prevalence of Hypertension and Avoidable Burden of Stroke in Vietnam: Modelling the Health and Economic Impacts. Front Public Health 2021; 9:682975. [PMID: 34150712 PMCID: PMC8213032 DOI: 10.3389/fpubh.2021.682975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
Dietary salt reduction has been recommended as a cost-effective population-wide strategy to prevent cardiovascular disease. The health and economic impact of salt consumption on the future burden of stroke in Vietnam is not known. Objective: To estimate the avoidable incidence of and deaths from stroke, as well as the healthy life years and healthcare costs that could be gained from reducing salt consumption in Vietnam. Methods: This was a macrosimulation health and economic impact assessment study. Data on blood pressure, salt consumption and stroke epidemiology were obtained from the Vietnam 2015 STEPS survey and the Global Burden of Disease study. A proportional multi-cohort multistate lifetable Markov model was used to estimate the impact of achieving the Vietnam national salt targets of 8 g/day by 2025 and 7 g/day by 2030, and to the 5 g/day WHO recommendation by 2030. Probabilistic sensitivity analysis was conducted to quantify the uncertainty in our projections. Results: If the 8 g/day, 7 g/day, and 5 g/day targets were achieved, the prevalence of hypertension could reduce by 1.2% (95% uncertainty interval [UI]: 0.5 to 2.3), 2.0% (95% UI: 0.8 to 3.6), and 3.5% (95% UI: 1.5 to 6.3), respectively. This would translate, respectively, to over 80,000, 180,000, and 257,000 incident strokes and over 18,000, 55,000, and 73,000 stroke deaths averted. By 2025, over 56,554 stroke-related health-adjusted life years (HALYs) could be gained while saving over US$ 42.6 million in stroke healthcare costs. By 2030, about 206,030 HALYs (for 7 g/day target) and 262,170 HALYs (for 5 g/day target) could be gained while saving over US$ 88.1 million and US$ 122.3 million in stroke healthcare costs respectively. Conclusion: Achieving the national salt reduction targets could result in substantial population health and economic benefits. Estimated gains were larger if the WHO salt targets were attained and if changes can be sustained over the longer term. Future work should consider the equity impacts of specific salt reduction programs.
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Affiliation(s)
| | - Hai N Phung
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Dung Phung
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Linda J Cobiac
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Physical Activity and Diet Quality Modify the Association between Comorbidity and Disability among Stroke Patients. Nutrients 2021; 13:nu13051641. [PMID: 34068135 PMCID: PMC8152968 DOI: 10.3390/nu13051641] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Comorbidity is common and causes poor stroke outcomes. We aimed to examine the modifying impacts of physical activity (PA) and diet quality on the association between comorbidity and disability in stroke patients. Methods: A cross-sectional study was conducted on 951 stable stroke patients in Vietnam from December 2019 to December 2020. The survey questionnaires were administered to assess patients’ characteristics, clinical parameters (e.g., Charlson Comorbidity Index items), health-related behaviors (e.g., PA using the International Physical Activity Questionnaire- short version), health literacy, diet quality (using the Dietary Approaches to Stop Hypertension Quality (DASH-Q) questionnaire), and disability (using the World Health Organization Disability Assessment Schedule II (WHODAS II)). Linear regression models were used to analyze the associations and interactions. Results: The proportion of comorbidity was 49.9% (475/951). The scores of DASH-Q and WHODAS II were 29.2 ± 11.8, 32.3 ± 13.5, respectively. Patients with comorbidity had a higher score of disability (regression coefficient, B, 8.24; 95% confidence interval, 95%CI, 6.66, 9.83; p < 0.001) as compared with those without comorbidity. Patients with comorbidity and higher tertiles of PA (B, −4.65 to −5.48; p < 0.05), and a higher DASH-Q score (B, −0.32; p < 0.001) had a lower disability score, as compared with those without comorbidity and the lowest tertile of PA, and the lowest score of DASH-Q, respectively. Conclusions: Physical activity and diet quality significantly modified the negative impact of comorbidity on disability in stroke patients. Strategic approaches are required to promote physical activity and healthy diet which further improve stroke rehabilitation outcomes.
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Lei L, Bao J, Guo Y, Wang Q, Peng J, Huang C. Effects of diurnal temperature range on first-ever strokes in different seasons: a time-series study in Shenzhen, China. BMJ Open 2020; 10:e033571. [PMID: 33444167 PMCID: PMC7682471 DOI: 10.1136/bmjopen-2019-033571] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Diurnal temperature range (DTR) is an important meteorological indicator of global climate change; high values of DTR may induce stroke morbidity, while the related high-risk periods and sensitive populations are not clear. This study aims to evaluate the effects of DTR on first-ever strokes in different seasons and in relation to sensitive populations. METHODS We collected data on 142 569 first-ever strokes during 2005-2016 in Shenzhen. We fitted a time-series Poisson model in our study, estimating the associations between DTR and first-ever strokes, with a distributed lag non-linear model. Then, we calculated strokes attributable to high DTR in different genders, age groups, education levels and stroke subtypes. RESULTS High DTR had a significant association with first-ever strokes, and the risk of stroke increased with the rise of DTR in the summer and winter. In total, 3.65% (95% empirical CI (eCI) 1.81% to 5.53%) of first-ever strokes were attributable to high DTR (5.5°C and higher) in the summer, while 2.42% (95% eCI 0.05% to 4.42%) were attributable to high DTR (8°C and higher) in the winter. In the summer, attributable fraction (AF) was significant in both genders, middle-aged and old patients, patients with different levels of education, as well as patients with cerebral infarction (CBI); in the winter, AF was significant in middle-aged patients, patients with primary and lower education level, as well as patients with CBI. CONCLUSIONS High DTR may trigger first-ever strokes in the summer and winter, and CBI is more sensitive than intracerebral haemorrhage to DTR. Most people are sensitive to high DTR in the summer, while middle-aged and low-education populations are sensitive in the winter. It is recommended that the DTR values be reported and emphasised in weather forecast services, together with the forecasts of heat and cold.
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Affiliation(s)
- Lin Lei
- Department of Non-Communicable Disease Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Junzhe Bao
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
- School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yanfang Guo
- Department of Non-Communicable Disease Control and Prevention, Bao'an District Hospital for Chronic Diseases Prevention and Cure, Shenzhen, Guangdong, China
| | - Qiong Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Shanghai Typhoon Institute, China Meteorological Administration, Shanghai, China
| | - Ji Peng
- Department of Non-Communicable Disease Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Cunrui Huang
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
- School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Shanghai Typhoon Institute, China Meteorological Administration, Shanghai, China
- Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Service, Shanghai, China
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Reid KA, Barlasm RS, Mamas MA, Clark AB, Kwok CS, Wong CW, Kongbunkiat K, Bettencourt-Silva JH, Sawanyawisuth K, Kasemsap N, Tiamkao S, Myint PK. Infective endocarditis is associated with worse outcomes in stroke: A Thailand National Database Study. Int J Clin Pract 2020; 74:e13614. [PMID: 32688452 DOI: 10.1111/ijcp.13614] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 07/06/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND There is lack of data on the association between infective endocarditis (IE) and outcomes of mortality and complications in stroke. We aimed to compare characteristics and outcomes of stroke patients with and without IE. METHODS We retrospectively examined the above association using data obtained from an insurance database which covers ~75% of the Thai population. All hospitalised strokes between 8 January 2003 and 31 December 2013 were included in the current study. Characteristics and outcomes were compared between stroke patients with or without IE, and then between two main stroke types. Multiple logistic regression models including propensity score-matched analyses were constructed to assess study outcomes controlling for age, sex, stroke type and comorbidities. RESULTS A total of 590 115 stroke patients (mean (SD) age = 64.2 ± 13.7 years; ischaemic = 51.7%; haemorrhagic = 32.6%; undetermined = 15.7%) were included, of whom 2129 (0.36%) had stroke associated with IE. After adjustment, we found that IE was significantly associated with the following complications: arrhythmias (adjusted odds ratio (95% CI) 6.94 (6.29-7.66)), sepsis (1.24 (1.01-1.52)), pneumonia (1.34 (1.17-1.53)), respiratory failure (1.43 (1.24-1.66)) and in-hospital mortality (1.29 (1.13-1.47)) (P for all <.001). Patients with haemorrhagic stroke with IE had poorer outcomes for in-hospital mortality and respiratory failure compared with their counterparts with ischaemic stroke. Propensity score-matched analysis showed similar results. CONCLUSIONS Our results suggest that stroke patients with IE differ from that of the general stroke population and these patients have worse outcomes. Future studies are needed to determine the best treatment strategies for stroke patients with IE.
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Affiliation(s)
- Katie A Reid
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Raphae S Barlasm
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Mamas A Mamas
- Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
- Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Allan B Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Chun Shing Kwok
- Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
- Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Chun W Wong
- Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
- Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Kannikar Kongbunkiat
- Neurology Division, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | | | - Narongrit Kasemsap
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- North-eastern Stroke Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Somsak Tiamkao
- Neurology Division, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- North-eastern Stroke Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Phyo K Myint
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Phuoc LV, Tuan NHN, Khoa LV, Bao NVT, Tu PD, Hoan DD, Thao PTN, Khoi NV. Initial Results of Management for Acute Ischemic Stroke due to Large Vessel Occlusion by a Direct Aspiration First Pass Technique at a Vietnamese Hospital. Asian J Neurosurg 2020; 15:65-69. [PMID: 32181175 PMCID: PMC7057864 DOI: 10.4103/ajns.ajns_258_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/14/2019] [Indexed: 01/01/2023] Open
Abstract
Background: The development of novel revascularization devices has improved procedural and clinical outcomes in acute ischemic stroke (AIS). A direct aspiration first pass technique (ADAPT) has been introduced as a rapid simple method for achieving good recanalization and clinical outcomes using large bore aspiration catheters in the treatment of AIS due to large vessel occlusion (LVO). Objectives: The aim of this study was to assess the safety and efficacy of ADAPT in the treatment of AIS due to LVO in the Vietnamese patient population. Materials and Methods: A retrospective analysis of a hospital database was conducted on all patients undergoing stroke therapy with the ADAPT technique at the institution from January 2017 to December 2017. Efficacy and safety were evaluated by the variables: revascularization rates (thrombolysis in cerebral infarction [TICI] score), time to revascularization, procedural complications, and clinical outcomes (modified Rankin scale [mRS] score) at the 90-day follow-up visit. Results: From the database review, 37 AIS patients treated with ADAPT were identified. The mean NIHSS score at presentation was 17.3 and improved to 8.9 at discharged. The average time arterial puncture to revascularization was 32.5 min. TICI 2b/3 revascularization was achieved in 30/37 (81.1%) patients, good clinical outcomes were achieved (mRS 0–2) in 21/37 (56.7%) patients, and mortality rate was 6/37 (16.2%) during follow-up. Conclusions: ADAPT utilizing large bore aspiration catheters appears to be a fast, simple, safe, and effective method for the management of AIS in the Vietnamese patient population.
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Affiliation(s)
- Le Van Phuoc
- Department of Radiology, Cho Ray Hospital, Ho Chi Minh, Vietnam
| | | | - Le Van Khoa
- Department of Radiology, Cho Ray Hospital, Ho Chi Minh, Vietnam
| | | | - Pham Dang Tu
- Department of Radiology, Cho Ray Hospital, Ho Chi Minh, Vietnam
| | - Duong Dinh Hoan
- Department of Radiology, Cho Ray Hospital, Ho Chi Minh, Vietnam
| | | | - Nguyen Van Khoi
- Department of Vascular Surgery, Cho Ray Hospital, Ho Chi Minh, Vietnam
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Bao J, Guo Y, Wang Q, He Y, Ma R, Hua J, Jiang C, Morabito M, Lei L, Peng J, Huang C. Effects of heat on first-ever strokes and the effect modification of atmospheric pressure: A time-series study in Shenzhen, China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 654:1372-1378. [PMID: 30841410 DOI: 10.1016/j.scitotenv.2018.11.101] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 11/07/2018] [Accepted: 11/07/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Stroke is a leading cause of death globally. Extreme temperatures may induce stroke, but evidence on the effects of heat on first-ever strokes is not clear. Low air pressure can lead to depression and an increase in blood pressure, and it may exacerbate the health impact of heat. In this study, we aimed to evaluate the effects of heat on first-ever strokes, the possible sensitive populations, and the effect of modification of atmospheric pressure. METHODS We collected data on 142,569 first-ever strokes during 2005-2016 in Shenzhen, a coastal city in southern China, with subtropical oceanic monsoon climate. We fitted a time-series Poisson model in our study, estimating the association between daily mean temperature and first-ever strokes in hot months, with a distributed lag non-linear model with 7 days of lag. We calculated strokes attributable to heat in various gender, age groups, household register types, stroke subtypes, and atmospheric pressure levels. RESULTS Heat had a significant cumulative association with first-ever strokes, and the risk of strokes increased with the rise in temperature after it was higher than 30 °C (the 85th percentile). In total, 1.95% (95% empirical CI 0.63-3.20%) of first-ever strokes were attributable to high temperature. The attributable fraction and attributable number of heat were statistically significant in male, female, middle-aged and old patients, immigrant patients, and CBI patients. The fraction attributable to heat was 3.33% in the low atmospheric pressure group, and the number of estimated daily attributable strokes at low atmospheric pressure levels was higher than that of medium and high atmospheric pressure levels (p < 0.01). CONCLUSIONS High temperatures in hot months may trigger first-ever strokes, and low atmospheric pressure may exacerbate the effect. We mainly found associations between heat and first-ever strokes for intracerebral hemorrhage, middle-aged and old patients, as well as immigrant patients.
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Affiliation(s)
- Junzhe Bao
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Shenzhen Center for Chronic Disease Control, Shenzhen 518020, China
| | - Yanfang Guo
- Bao'an District Hospital for Chronic Diseases Prevention and Cure, Shenzhen 518100, China
| | - Qiong Wang
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yiling He
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Rui Ma
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Junjie Hua
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Chengsheng Jiang
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park 20742, MD, USA
| | - Marco Morabito
- Institute of Biometeorology, National Research Council, Florence 50145, Italy; Centre of Bioclimatology, University of Florence, Florence 50144, Italy
| | - Lin Lei
- Shenzhen Center for Chronic Disease Control, Shenzhen 518020, China
| | - Ji Peng
- Shenzhen Center for Chronic Disease Control, Shenzhen 518020, China.
| | - Cunrui Huang
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
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Carr C, Kahn L, Mathkour M, Biro E, Bui CJ, Dumont AS. The shifting burden of neurosurgical disease: Vietnam and the middle-income nations. Neurosurg Focus 2018; 45:E12. [DOI: 10.3171/2018.7.focus18297] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe Global Burden of Disease (GBD) is an international collaboration and the largest comprehensive investigation of global health disease burden ever conducted. It has been particularly insightful for understanding disease demographics in middle-income nations undergoing rapid development, such as Vietnam, where 6 of the top 10 causes of death are relevant to the neurosurgeon. The burden of stroke—the number one cause of death in Vietnam—is particularly impressive. Likewise, road injuries, with a disproportionate rate of traumatic brain injury, continue to increase in Vietnam following economic development. Low-back and neck pain is the number one cause of disability. Simultaneously, more patients have access to care, and healthcare spending is increased.METHODSIt is imperative that neurosurgical capital and infrastructure keep pace with Vietnam’s growth. The authors searched the existing literature for assessments of neurosurgical infrastructure or initiatives to address neurosurgical disease burden. Using GBD data, the authors also abstracted data for death by cause and prevalence of years of life lost due to disability (YLD) for common neurosurgical pathologies for Vietnam and comparison nations.RESULTSInterventions aimed at primary prevention of risk factors for neurosurgical disease and focused on the transference of self-sustainable technical skills were found to be analogous to those that have been successful in other regions. Efforts toward stroke prevention have been focused on causal risk factors. Multiple investigators have found that interventions aimed at increasing helmet use were successful in preventing traumatic brain injury. Government-led reforms and equipment donation programs have improved technical capacity. Nevertheless, Vietnam lags behind other nations in neurosurgeons per capita; cause-attributable death and YLD attributable to neurosurgical disease are considerably higher in Vietnam and middle-income nations compared to both lower-income nations and upper-income nations.CONCLUSIONSMore than two-thirds of deaths attributable to neurosurgical pathologies in Vietnam and other middle-income nations were due to stroke, and one-fifth of both cause-attributable death and YLD was associated with neurosurgical pathologies. Vietnam and other middle-income nations continue to assume a global burden of disease profile that ever more closely resembles that of developed nations, with particular cerebrovascular, neurotrauma, and spinal disease burdens, leading to exponentially increased demand for neurosurgeons that threatens to outpace the training of neurosurgeons.
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Affiliation(s)
- Christopher Carr
- 1Tulane University-Ochsner Clinic Foundation Program, Department of Neurosurgery, Tulane University Medical Center
| | - Lora Kahn
- 1Tulane University-Ochsner Clinic Foundation Program, Department of Neurosurgery, Tulane University Medical Center
| | - Mansour Mathkour
- 1Tulane University-Ochsner Clinic Foundation Program, Department of Neurosurgery, Tulane University Medical Center
| | - Erin Biro
- 2Department of Neurosurgery, Ochsner Health System; and
| | - Cuong J. Bui
- 2Department of Neurosurgery, Ochsner Health System; and
| | - Aaron S. Dumont
- 3Department of Neurosurgery, Tulane University Medical Center, New Orleans, Louisiana
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