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Aldamouni MB, Albitar MH, Alhosainy ZH, Aljohani HN, Alshail E. Challenges in Grisel's Syndrome Management in a Two-Month-Old Infant. Cureus 2023; 15:e35128. [PMID: 36950002 PMCID: PMC10027574 DOI: 10.7759/cureus.35128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 02/20/2023] Open
Abstract
Grisel's syndrome (GS) is a rare neurosurgical condition involving nontraumatic rotatory subluxation of the atlantoaxial joint. This case report presents a two-month-old infant girl, the youngest reported case of this syndrome based on our literature review to the date of this publication. The infant was initially referred to our hospital as a case of the arachnoid cyst but was subsequently neuroradiologically diagnosed with GS, which was believed to be secondary to a retropharyngeal abscess. After developing weakness and developmental delay as well as failing conservative management for two years, the infant underwent C1 laminectomy and occipitocervical sublaminar wire fusion with favorable outcomes. GS should be considered a differential even if the patient does not present with typical signs such as torticollis and neck pain. If not identified early and treated effectively, it can result in severe neurological damage. The management plan largely depends on the Fielding-Hawkins grade of subluxation and the timing of diagnosis.
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Affiliation(s)
- Maeen B Aldamouni
- Department of Neurosurgery, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
- College of Medicine, Alfaisal University, Riyadh, SAU
| | | | | | - Hanan N Aljohani
- Department of Neurosurgery, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Essam Alshail
- Department of Neurosurgery, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
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Nakai A, Uehara M, Miyaoka Y, Oba H, Ikegami S, Takizawa T, Munakata R, Hatakenaka T, Kamanaka T, Kurogochi D, Fukuzawa T, Takahashi J. A case of adult-onset Grisel's syndrome. Br J Neurosurg 2022:1-3. [PMID: 35393919 DOI: 10.1080/02688697.2022.2061420] [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: 07/18/2021] [Revised: 01/03/2022] [Accepted: 03/29/2022] [Indexed: 11/02/2022]
Abstract
Aim: Grisel's syndrome is a non-traumatic subluxation of the atlanto-axial joint that occurs after infection or inflammation in the otolaryngological area, primarily in children.Method: This report describes the clinical characteristics of an extremely rare case of adult-onset Grisel's syndrome.Result: A 77-year-old woman presented with neck and bilateral shoulder pain and stiffness. Her temperature was 37.6 °C. Blood testing revealed a mildly elevated inflammatory response, although blood cultures were negative. Computed tomography (CT) showed atlanto-axial subluxation and joint destruction. T2-weighted magnetic resonance imaging (MRI) displayed high signals in the soft tissues in the anterior space of the atlas and axis, posterior wall of the pharynx, and interspinous ligament, indicating spinal cord compression at the C1 level. Differential diagnoses of inflammation and diseases causing atlanto-axial subluxation included rheumatoid arthritis, amyloidosis, pyogenic spondylitis due to posterior pharyngeal abscess, and crowned dens syndrome. After the systematic elimination of each condition, we considered Grisel's syndrome and began non-surgical treatment with intravenous antibiotics and a Philadelphia neck collar. Her inflammatory response and neck pain gradually decreased. Six months later, there was no progression of instability. She was able to walk unaided and live normally with the use of a neck collar as needed.Conclusion: Grisel's syndrome occurs predominantly in children, but can also afflict adults. Since early diagnosis and treatment can improve symptoms in some cases and prevent progressive atlanto-axial instability, prompt evaluation of the atlanto-axial joint using CT or MRI is advised in patients with neck pain and limited range of motion.
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Affiliation(s)
- Ami Nakai
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Masashi Uehara
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Yoshinari Miyaoka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Hiroki Oba
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Shota Ikegami
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Takashi Takizawa
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Ryo Munakata
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Terue Hatakenaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Takayuki Kamanaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Daisuke Kurogochi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Takuma Fukuzawa
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
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Shen Y, Yang L, Liu X, Xie Y, Dai X, Wang C. Grisel's syndrome associated with mumps: A case report. Front Pediatr 2022; 10:916538. [PMID: 36245735 PMCID: PMC9557164 DOI: 10.3389/fped.2022.916538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
Grisel's syndrome (GS) is defined as atlantoaxial rotatory subluxation/fixation not associated with trauma or bone disease, usually following head and neck infection/inflammation or ear, nose, and throat (ENT) surgery. Many conditions could lead to Grisel's syndrome, of which mumps is rarely to be seen. This report discusses a case of GS in children with Type I atlantoaxial joint subluxation and previously diagnosed mumps. A 6-year-old boy who had cervical pain and torticollis for 2 weeks was admitted to our hospital. There was no trauma and he had not had ENT surgery but was diagnosed with mumps 2 weeks previously due to swelling of the left cheek and cervical lymph node. Physical examination and computed tomography confirmed a diagnosis of Grisel's syndrome with an ADI (atlanto-dens interval) of 1.6 mm. The patient then received occipito-mandibular traction for 6 days and recovered. No recurrence was observed at 1 year follow-up. Physicians should raise awareness of this rare complication of mumps to avoid life-threatening neurological impairments owing to Grisel's syndrome.
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Affiliation(s)
- Yanrong Shen
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, China.,West China Medical School of Sichuan University, Chengdu, China
| | - Lixia Yang
- West China Medical School of Sichuan University, Chengdu, China.,The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Chengdu, China
| | - Xiaoliang Liu
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, China.,West China Medical School of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Chengdu, China.,Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yawen Xie
- West China Medical School of Sichuan University, Chengdu, China
| | - Xiaohui Dai
- Department of Ultrasonography, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Chuan Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, China.,West China Medical School of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Chengdu, China.,Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, China
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Wenger KJ, Hattingen E, Porto L. Magnetic Resonance Imaging as the Primary Imaging Modality in Children Presenting with Inflammatory Nontraumatic Atlantoaxial Rotatory Subluxation. CHILDREN-BASEL 2021; 8:children8050329. [PMID: 33922701 PMCID: PMC8144996 DOI: 10.3390/children8050329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/15/2021] [Accepted: 04/20/2021] [Indexed: 11/16/2022]
Abstract
Inflammatory nontraumatic atlantoaxial rotatory subluxation (AAS) in children is an often-missed diagnosis, especially in the early stages of disease. Abscess formation and spinal cord compression are serious risks that call for immediate surgical attention. Neither radiographs nor non-enhanced computed tomography (CT) images sufficiently indicate inflammatory processes. Magnetic resonance imaging (MRI) allows a thorough evaluation of paraspinal soft tissues, joints, and ligaments. In addition, it can show evidence of vertebral distraction and spinal cord compression. After conducting a scoping review of the literature, along with scientific and practical considerations, we outlined a standardized pediatric MRI protocol for suspected inflammatory nontraumatic AAS. We recommend contrast-enhanced MRI as the primary diagnostic imaging modality in children with signs of torticollis in combination with nasopharyngeal inflammatory or ear nose and throat (ENT) surgical history.
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Chua AJK, Tan BWS, Tan TY, Heah HHW. Grisel's Syndrome in an Adult After Endoscopic Nasopharyngectomy. Laryngoscope Investig Otolaryngol 2019; 4:504-507. [PMID: 31637293 PMCID: PMC6793604 DOI: 10.1002/lio2.298] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 07/18/2019] [Accepted: 07/24/2019] [Indexed: 11/13/2022] Open
Abstract
Background Grisel's syndrome is rare in adults, and is characterized by nontraumatic atlanto‐axial subluxation secondary to infection. Here, we report a case of Grisel's syndrome occurring after endoscopic nasopharyngectomy. Methods A 67‐year‐old man complained of fever and neck pain with reduced lateral rotation after an endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma. Flexion and extension X‐rays of the cervical spine demonstrated atlanto‐axial subluxation, and magnetic resonance imaging showed infective changes with cervical osteomyelitis. A diagnosis of Grisel's syndrome with cervical spine osteomyelitis was made. A later computed tomography (CT) scan demonstrated subluxation of C1 on C2, as well as the occipital‐C1 joint. Results The patient was treated with intravenous antibiotics and offered surgery for spinal stabilization, but declined. He remained well 15 months post‐op on a cervical collar with minimal pain and no neurologic deficits. Conclusion A high index of suspicion for Grisel's syndrome is suggested in patients who have neck pain with reduced range of motion postnasopharyngectomy, and imaging is useful in clinching the diagnosis. Level of Evidence 4
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Affiliation(s)
- Andy J. K. Chua
- Department of OtolaryngologySingapore General HospitalSingaporeSingapore
| | - Bernard W. S. Tan
- Department of OtolaryngologySingapore General HospitalSingaporeSingapore
| | - Tiong Yong Tan
- Department of RadiologyChangi General HospitalSingaporeSingapore
| | - Harold H. W. Heah
- Department of OtolaryngologySingapore General HospitalSingaporeSingapore
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Falsaperla R, Piattelli G, Marino S, Marino SD, Fontana A, Pavone P. Grisel's syndrome caused by Mycoplasma pneumoniae infection: a case report and review of the literature. Childs Nerv Syst 2019; 35:523-527. [PMID: 30209598 DOI: 10.1007/s00381-018-3970-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/04/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Grisel's syndrome is a non-traumatic subluxation of the atlantoaxial joints, which is caused by an inflammatory process involving the upper neck. Torticollis, neck pain, and reduced neck mobility are the main clinical signs of presentation. Predisposing factors are trauma, hyperlaxity of the transverse and alar ligaments of the atlantoaxial joints, and surgical interventions carried out in this area. Several viral and bacterial pathogens have been reported as causative events of Grisel's syndrome, including Epstein-Barr virus, Kawasaki disease, Streptococcus pyogenes, Staphylococcus aureus, and other infectious agents. Grisel's syndrome linked to Mycoplasma pneumoniae infection as the trigger has not previously been reported. Mycoplasma pneumoniae is a small prokaryotic microbe and a frequent etiologic factor of respiratory tract infections and, less frequently, of extrapulmonary body organs. The recognition of the Grisel's syndrome is based on clinical and neuroradiological investigations, and early diagnosis and specific treatment are crucial to the successful outcome of the disease. RESULTS We report the case of an 8-year-old girl with Grisel's syndrome caused by an upper respiratory tract infection due to Mycoplasma pneumoniae. Diagnostic suspicion and treatment of Grisel's syndrome were established quickly by anamnestic and clinical data and confirmed by radiological findings. The girl was immediately treated with specific antibiotic therapy and cervical immobilization, thus preventing the most dangerous complications of the disorder. CONCLUSION Mycoplasma pneumoniae, among the other infectious agents, may be cause of scute torticollis and Gresel's syndrome.
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Affiliation(s)
- Raffaele Falsaperla
- Pediatric Emergency Department, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Gianluca Piattelli
- Department of Neurosurgery, University Hospital "Giannina Gaslini", Genoa, Italy
| | - Silvia Marino
- Pediatric Emergency Department, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Simona Domenica Marino
- Pediatric Emergency Department, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Alessandra Fontana
- Department of Pediatrics, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Piero Pavone
- Department of Pediatrics, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy.
- Department of Pediatrics, AOU Policlinico-Vittorio Emanuele, University of Catania, Via S. Sofia 78, 95123, Catania, Italy.
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Iaccarino C, Francesca O, Piero S, Monica R, Armando R, de Bonis P, Ferdinando A, Trapella G, Mongardi L, Cavallo M, Giuseppe C, Franco S. Grisel's Syndrome: Non-traumatic Atlantoaxial Rotatory Subluxation-Report of Five Cases and Review of the Literature. ACTA NEUROCHIRURGICA. SUPPLEMENT 2019; 125:279-288. [PMID: 30610334 DOI: 10.1007/978-3-319-62515-7_40] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND In children, when unresponsive neck rigidity and distress are observed after ear, nose and throat (ENT) surgical treatment or nasopharyngeal inflammation, Grisel's syndrome should be suspected. This is a rare syndrome involving non-traumatic rotatory subluxation of the atlantoaxial joint. Conservative management with external cervical orthoses and empirical antibiotic, muscle relaxant and analgesic therapy should be the first choice of treatment. Surgical stabilization is indicated when high-grade instability or failure of stable reduction are observed. The instability is graded according to the classification system devised by Fielding and Hawkins. Several recommendations for treatment are available in the literature, but there are no common guidelines. In this paper, the authors discuss the need for prompt diagnosis and treatment considerations. CASE DESCRIPTION Five children with Fielding type I-III rotatory subluxation are reported. Three patients were treated with a cervical collar, and one patient was treated with skull traction and sternal-occipital-mandibular immobilizer (SOMI) brace application. Surgical treatment was necessary for one patient after failure of initial conservative management. The intervals between the onset of torticollis and radiological diagnosis ranged from 12 to 90 days. A relationship between an increased grade of instability and delayed diagnosis was observed. CONCLUSION In children with painful torticollis following ENT procedures or nasopharyngeal inflammation, Grisel's syndrome should always be suspected. Cervical magnetic resonance imaging (MRI) allows prompt and safe diagnosis, and a three-dimensional computed tomography (CT) scan provides better classification of the instability. Surgery, which is indicated in cases of high-grade instability or failure of conservative treatment, may be avoided with prompt diagnosis.
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Affiliation(s)
- Corrado Iaccarino
- Neurosurgery-Neurotraumatology Unit, University Hospital of Parma, Parma, Italy. .,Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Ormitti Francesca
- Department of Neuroradiology, University Hospital of Parma, Parma, Italy
| | - Spennato Piero
- Neurosurgery Department, Azienda Ospedaliera di Rilievo Nazionale "Santobono-Pausilipon-Annunziata" Children's Hospital, Naples, Italy
| | - Rubini Monica
- Division of Paediatric General and Emergency Care Unit, Children's Hospital of Parma, Parma, Italy
| | - Rapanà Armando
- Neurosurgery Unit, Lorenzo Bonomo Hospital, Andria, Italy
| | - Pasquale de Bonis
- Neurosurgery Department, University Hospital of Ferrara, Ferrara, Italy
| | - Aliberti Ferdinando
- Neurosurgery Department, Azienda Ospedaliera di Rilievo Nazionale "Santobono-Pausilipon-Annunziata" Children's Hospital, Naples, Italy
| | - Giorgio Trapella
- Neurosurgery Department, University Hospital of Ferrara, Ferrara, Italy
| | - Lorenzo Mongardi
- Neurosurgery Department, University Hospital of Ferrara, Ferrara, Italy
| | - Michele Cavallo
- Neurosurgery Department, University Hospital of Ferrara, Ferrara, Italy
| | - Cinalli Giuseppe
- Neurosurgery Department, Azienda Ospedaliera di Rilievo Nazionale "Santobono-Pausilipon-Annunziata" Children's Hospital, Naples, Italy
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Das S, Chakraborty S, Das S. Grisel Syndrome in Otolaryngology: A Case Series with Literature Review. Indian J Otolaryngol Head Neck Surg 2016; 71:66-69. [PMID: 31741933 DOI: 10.1007/s12070-016-1030-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/17/2016] [Indexed: 12/13/2022] Open
Abstract
Grisel's syndrome is non traumatic atlanto axial subluxation usually associated with inflammatory conditions of head and neck region. Non traumatic atlanto axial joint subluxation is a rare entity for an unsuspecting otolaryngologist. The condition if missed and not treated properly can have serious implications with possible neurological deficit. We attempt to review the existing literature on the disease condition and also to highlight the proper management of the condition. Retrospective analysis of hospital record of last five years and an internet based literature survey on the current concepts and management of the condition. We have come across five cases of Grisel's syndrome over the last five years. The clinicopathological and radiological features are described. Grisel syndrome may remain undiagnosed at initial presentation if not suspected. Delayed diagnosis may result in life long morbidity for the patient and the need for surgical intervention. Many of the early cases can be treated successfully by conservative approach.
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Affiliation(s)
- Soumyajit Das
- 1Department of ENT, Sikkim Manipal Institute of Medical Sciences, 5th Mile, Tadong, Gangtok, 737102 India
| | - Suvamoy Chakraborty
- 1Department of ENT, Sikkim Manipal Institute of Medical Sciences, 5th Mile, Tadong, Gangtok, 737102 India
| | - Subhajit Das
- Department of Radiology, Mazumder Shaw Medical Centre, Bommasandra, Bengaluru, Karnataka 560099 India
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Ismi O, Ozalp H, Hamzaoglu V, Bucioglu H, Vayısoglu Y, Gorur K. Grisel's syndrome accompanying a submandibular abscess. Braz J Otorhinolaryngol 2016; 86:658-661. [PMID: 27595925 PMCID: PMC9422572 DOI: 10.1016/j.bjorl.2016.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/04/2016] [Accepted: 07/30/2016] [Indexed: 11/08/2022] Open
Affiliation(s)
- Onur Ismi
- University of Mersin, Faculty of Medicine, Department of Otorhinolaryngology, Mersin, Turkey.
| | - Hakan Ozalp
- University of Mersin, Faculty of Medicine, Department of Neurosurgery, Mersin, Turkey
| | - Vural Hamzaoglu
- University of Mersin, Faculty of Medicine, Department of Neurosurgery, Mersin, Turkey
| | - Helen Bucioglu
- University of Mersin, Faculty of Medicine, Department of Otorhinolaryngology, Mersin, Turkey
| | - Yusuf Vayısoglu
- University of Mersin, Faculty of Medicine, Department of Otorhinolaryngology, Mersin, Turkey
| | - Kemal Gorur
- University of Mersin, Faculty of Medicine, Department of Otorhinolaryngology, Mersin, Turkey
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Akuter Schiefhals oder Grisel-Syndrom. MANUELLE MEDIZIN 2016. [DOI: 10.1007/s00337-016-0148-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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