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Stephens C, Ortega-Alonso A, Medina-Cáliz I, Robles-Díaz M, Castiella A, Otazua P, Zapata E, Gomez-Moreno E, López-Nevot M, Ruiz-Cabello F, Soriano G, Roman E, Hallal H, Andrade R, Lucena M. Autoantibody presentation in Drug-Induced Liver Injury (DILI) and idiopathic Autoimmune Hepatitis (AIH): The influence of HLA alleles. Clin Ther 2015. [DOI: 10.1016/j.clinthera.2015.05.342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Perdices EV, Medina-Cáliz I, Hernando S, Ortega A, Martín-Ocaña F, Navarro JM, Peláez G, Castiella A, Hallal H, Romero-Gómez M, González-Jiménez A, Robles-Díaz M, Lucena MI, Andrade RJ. Hepatotoxicity associated with statin use: analysis of the cases included in the Spanish Hepatotoxicity Registry. Rev Esp Enferm Dig 2014; 106:246-54. [PMID: 25075655 DOI: pmid/25075655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The hepatotoxic potential of statins is controversial. The objectives of this study were to describe the relative frequency of hepatotoxicity caused by statins and the phenotypes found in Spain. PATIENTS AND METHODS The incidence of hepatotoxicity attributed to statins in the Spanish Hepatotoxicity Registry (REH) were studied and compared with those attributed to other drugs. RESULTS Between April 1994 and August 2012, the REH included a total of 858 cases of which 47 (5.5 %) were attributed to statins. Of these, 16 were due to atorvastatin (34 %); 13 to simvastatin (27.7 %); 12 to fluvastatin (25.5 %); 4 to lovastatin (8.5 %) and 2 to pravastatin (4.3 %). Statins represented approximately half of the cardiovascular group which occupied 3rd place (10 %), after anti-infectious agents (37 %) and central nervous system drugs (14 %). The hepatocellular pattern was predominant, especially in the simvastatin group (85%), the cholestatic/mixed pattern was more frequent with fluvastatin (66 %) and had a similar distribution to atorvastatin. Patients with statin-induced toxicity were older (62 years versus 53 years, p < 0.001) and more often demonstrated anautoimmune hepatitis phenotype (8.5 % versus 1.4 %, p < 0.003). CONCLUSIONS Statins are not a common cause of hepatotoxicity in Spain. Atorvastatin is the statin involved in the greatest number of incidents. The liver injury pattern varies among the different statins. The hepatitis phenotype with autoimmune features appears to be a characteristic signature of statin-induced hepatotoxicity.
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Lucena MI, Kaplowitz N, Hallal H, Castiella A, García-Bengoechea M, Otazua P, Berenguer M, Fernandez MC, Planas R, Andrade RJ. Recurrent drug-induced liver injury (DILI) with different drugs in the Spanish Registry: the dilemma of the relationship to autoimmune hepatitis. J Hepatol 2011; 55:820-7. [PMID: 21338638 DOI: 10.1016/j.jhep.2010.12.041] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 12/20/2010] [Accepted: 12/22/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Multiple instances of DILI in the same patient with drugs of similar structure or function as well as completely unrelated drugs are not well understood and poorly documented. We have sought evidence of the frequency and characteristics of patients who have experienced two DILI episodes due to different drugs. METHODS All cases of DILI systematically collected in the Spanish DILI Registry between 1994 and 2009 were retrieved. Data on demographics, clinical, laboratory and pathological findings, and outcome were analyzed. RESULTS Nine patients (mean age 67 years, four women) out of 742, 1.21%, had evidence of two DILI episodes caused by different drugs. In four cases DILI was associated with structurally related drugs and in an additional two cases the drugs had a common target. In another case, unrelated antibiotics were implicated. In only two cases, the two drugs/herbals were not related in structure or function. All but one patient exhibited hepatocellular damage. The type of damage was consistent in both DILI episodes. Four cases presented as autoimmune hepatitis (AIH) in the second episode. CONCLUSIONS Multiple episodes of DILI in association with different drugs occur infrequently. In each individual, the type of injury was similar during the two DILI episodes, regardless of the causative drug. Second episodes of DILI are more likely to be associated with features of AIH. It remains uncertain if this is drug-induced unmasking of true AIH or DILI with autoimmune features. These cases illustrate the dilemma faced by clinicians in distinguishing these possibilities.
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Affiliation(s)
- M I Lucena
- Servicio de Farmacología Clínica, Grupo de Estudio para las Hepatopatías Asociadas a Medicamentos, Co-ordinating Centre, Hospital Universitario Virgen de la Victoria, Facultad de Medicina, Campus Universitario de Teatinos s/n, Málaga, Spain.
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Pérez-Cuadrado E, Más P, Hallal H, Shanabo J, Muñoz E, Ortega I, López Martín A, Torrella E, López Higueras A, Martín A, Carballo F. Double-balloon enteroscopy: a descriptive study of 50 explorations. Rev Esp Enferm Dig 2006; 98:73-81. [PMID: 16566639 DOI: 10.4321/s1130-01082006000200002] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM To evaluate the utility of double-balloon enteroscopy for small-bowel disease. DESIGN A prospective study of 50 consecutive enteroscopies performed from December 2004 to July 2005 to analyze diagnoses and treatments. PATIENTS 44 patients (33 had undergone a previous capsule endoscopy) with indications for obscure digestive hemorrhage, angiodysplasia, Peutz-Jeghers syndrome, ulcer, suspected Crohn's disease, tumors, and refractory celiac disease. RESULTS We carried out enteroscopy studies in 44 patients by the oral route and, in 6 additional patients, by both the oral and anal routes. We reached the ileon with the oral route in all cases but one (jejunal stenosis), and in 4 cases out of 7 with the anal route, with an average duration of 73 minutes. We found angiodysplasia in 19 cases, as well as NSAID-related enteropathy, Crohn's disease, diverticulosis, and Waldenström's disease. We performed biopsies in 31% of cases with diagnoses of adenocarcinoma, lymphangiectasia secondary to tumor in celiac disease, and Whipple's disease. We treated 19 patients with angiodysplasia (1 to 20 synchronous lesions) with argon, and 4 patients with polyps using polipectomy (sporadic polyps or Peutz-Jeghers syndrome). A retained capsule in one patient with stenosis was removed. CONCLUSIONS Double-balloon enteroscopy is a useful and effective technique in the diagnosis and treatment of small intestine diseases, thus complementing capsule endoscopy. More studies are needed to analyze its impact on the management of this condition.
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Affiliation(s)
- E Pérez-Cuadrado
- Unit of Small Bowel, Section of Digestive Diseases, Hospital General Universitario Morales Meseguer, Murcia, Spain.
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Hallal H, Egea JM, Mas P, García MD, Pérez-Cuadrado E, Carballo F. A shortened, 2-hour rifampin test: a useful tool in Gilbert's syndrome. Gastroenterol Hepatol 2006; 29:63-5. [PMID: 16448605 DOI: 10.1016/s0210-5705(06)71601-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Diagnosis of Gilbert's disease often involves unnecessary testing and patient anxiety. Rifampin test can support the diagnosis; it has been described in short series and lacks standardization in dose, collection times, result presentation and interpretation. Our objective was to compare the response to oral rifampin in a series of patients with Gilbert's disease, 2 and 4 h after drug administration. PATIENTS AND METHODS Eighty-nine patients with Gilbert's disease (elevated total bilirubin with no hepatopathy or hemolysis) were recruited. After a basal blood collection, 900 mg rifampin were administered per os and new samples were drawn 2 and 4 h later. Total and esterified bilirubin were measured in every sample. Haptoglobin concentration was also analyzed. RESULTS When expressed as relative increase with respect to basal values, variations observed 2 h after rifampin intake were all above 15%. A significant correlation (r = 0.902; p = 0.000) was found between relative increases 2 and 4 h after drug administration. No significant variations were found in haptoglobin concentrations. CONCLUSION Rifampin test is useful in diagnosing Gilbert's disease, but variations in total bilirubin concentrations (basal and post-rifampin) make that no absolute cut-off value can be used. Correlation between 2- and 4-h relative increases suggests that a shortened version could simplify the test.
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Affiliation(s)
- H Hallal
- Digestive Diseases Section, Hospital General Universitario Morales Meseguer, Murcia, Spain.
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Hallal H, Martínez-Gómez D, Carballo F. Tricobezoar gástrico complicado con úlcera gástrica perforada. Gastroenterol Hepatol 2004. [DOI: 10.1157/13068146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Hallal H, Más Mercader P, Alberca de las Parras F, López Martín A, Alajarín Cervera M, Torrella Cortés E, Ortega González I, Shanabo JA. [Eosinophilic gastroenteritis and CA-125 elevation]. Gastroenterol Hepatol 2004; 27:292-3. [PMID: 15056417 DOI: 10.1157/13059359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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López Martín A, Hallal H, Barón JM, Vera FJ, Jiménez M, Conesa FJ. [Gastrointestinal alterations in a female patient with common variable immunodeficiency]. Gastroenterol Hepatol 2002; 25:156-8. [PMID: 11864538 DOI: 10.1016/s0210-5705(02)79010-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We present the case of a 33-year-old woman who complained of intermittent diarrhea over the previous 8 years and who was diagnosed with common variable immunodeficiency. The woman presented antral atrophic gastritis, partial atrophy of the duodenal villi, nodular lymphoid hyperplasia of the small intestine and lymphocytic colitis. We also review the literature.
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Affiliation(s)
- A López Martín
- Sección de Aparato Digestivo del Hospital Morales Meseguer. Murcia. Spain
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Vera-Mémdez FJ, Barón JM, Hallal H, García-Solano J, Martínez-Albadalejo M. [Primary undifferentiated small cell carcinoma of the esophagus: case report and literature review]. Gastroenterol Hepatol 2001; 24:410-1. [PMID: 11674963 DOI: 10.1016/s0210-5705(01)70211-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Barón JM, Hallal H, Vera F, Martínez-Albaladejo M, González-Costea Martínez R. [Adenosquamous carcinoma of the colon]. Gastroenterol Hepatol 2001; 24:318-9. [PMID: 11459571 DOI: 10.1016/s0210-5705(01)70183-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Affiliation(s)
- S Montesinos
- Servicio de Farmacia y aSección de Aparato Digestivo. Hospital Santa María del Rosell. Cartagena. Murcia
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Barón JM, Hallal H, Jiménez M, Alguacil GF. [Retroperitoneal benign schwannoma]. Gastroenterol Hepatol 2000; 23:460. [PMID: 11126048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Alcalde Encinas MM, Pérez-Gracia A, Hallal H, Bautista De Prado J, Conesa Pallarés FJ, Vilaplana García R. [Cerebral venous sinus thrombosis and ulcerative colitis]. Rev Esp Enferm Dig 2000; 92:105-8. [PMID: 10757868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Hypercoagulability is a extraintestinal manifestation of inflammatory bowel disease, which could provoke thromboembolic phenomena. Central nervous system venous thrombosis is a rare complication and could be unnoticed. We report on a patient with ulcerative colitis who presented cerebral venous sinus thrombosis as the first manifestation of a hypercoagulable state. We review the literature and discuss about the pathogenic mechanisms of such complication.
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Affiliation(s)
- M M Alcalde Encinas
- Servicio de Medicina Interna, Hospital "Santa María del Rosell, Cartagena, Murcia, España
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Hallal H, Vilaplana-García R, García-Solano J, Pérez-Milá L. [Metastatic melanoma in the gallbladder]. Gastroenterol Hepatol 1999; 22:161-2. [PMID: 10228331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Rausell V, Hallal H, Salinas E, Pérez-Gracia A. [Ebrotidine-induced acute hepatitis]. Gastroenterol Hepatol 1999; 22:28. [PMID: 10089709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Vilaplana-García R, Pérez-Gracia A, García-Pérez B, Hallal H. [Pulmonary nodule: a rare manifestation of ulcerative colitis]. Rev Esp Enferm Dig 1997; 89:729-31. [PMID: 9445549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Alguacil GF, Moreno J, Ortolano A, Hallal H. [A malabsorption syndrome, gastrointestinal leishmaniasis and HIV infection]. Gastroenterol Hepatol 1997; 20:386. [PMID: 9377243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Hallal H, Pérez Gracia A, Solano J, Pérez-Milá L, García Pérez B. [Hemoperitoneum as the first manifestation of ileal leiomyoma]. An Med Interna 1996; 13:409-10. [PMID: 8983374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Martínez-Albaladejo M, Barnés-Sosa M, Hallal H. [Delayed intestinal obstruction due to a seatbelt]. Rev Esp Enferm Dig 1995; 87:531-3. [PMID: 7662421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
During blunt abdominal trauma the small bowel and/or its mesentery may be injured; if abdominal trauma occurs after compression by an incorrectly-applied seat belt, underlying viscera may be crushed between the vertebral and the seat belt; ischemia or infarction of the intestinal wall, and delayed fibrosis and stenosis may occur. We present a patient, operated on two months after blunt abdominal trauma, with small bowel obstruction secondary to post-traumatic intestinal fibrosis. Assuming that this condition is rarely suspected, a delayed diagnosis and treatment of these patients may occur.
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Affiliation(s)
- M Martínez-Albaladejo
- Servicio de Medicina Interna, Hospital Comarcal del Noroeste, Caravaca de la Cruz, Murcia
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Hallal H, Pérez-Gracia A, Alguacil-García GF. [Diversion colitis]. Rev Esp Enferm Dig 1994; 86:898-900. [PMID: 7873265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- H Hallal
- Hospital Santa María del Rosell, Cartagena
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Hallal H, Pérez Gracia A, Pascual Saura H, Conesa Pallarés J. [Crohn's disease and primary hyperparathyroidism: a casual association?]. Rev Esp Enferm Dig 1994; 86:857-8. [PMID: 7848701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Hallal H, Albaladejo Méndez J, Macańas G, García García JF, Pérez Gracia A, Gil Sánchez FJ. [Hyperprolactinemia associated with acute intermittent porphyria]. An Med Interna 1993; 10:601-3. [PMID: 8049327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Galactorrhea as the result of hyperprolactinemia has been described in very rare cases associated to acute outbreaks of intermittent acute porphyria (IAP). In our country, any of such cases have been published or analytically documented. We present the case of a patient admitted in our hospital for the study of abdominal pain and galactorrhea, with latter diagnosis of IAP, supported by the assessment of the activity of the enzyme showing a deficit in the red blood cells.
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Affiliation(s)
- H Hallal
- Servicio de Medicina Interna, Hospital Santa María del Rosell, Cartagena
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Abstract
The authors report a patient with a primary lymphoma of the adrenal glands presenting as acute adrenal failure. Fine-needle aspiration biopsy of the adrenal glands revealed a non-Hodgkin lymphoma of predominantly small cleaved cells and a low degree of malignancy. The absence of abnormal findings in clinical, bone marrow, and computed tomography scan examinations supports the diagnosis of primary non-Hodgkin lymphoma of the adrenal glands. Chemotherapy produced a complete functional recovery, and tumoral masses disappeared after the first three cycles of treatment.
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Affiliation(s)
- S Serrano
- Department of Internal Medicine, Hospital Comarcal del Noroeste, Caravaca, Murcia, Spain
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Alguacil GF, Hallal H, García B, Serrano S. [Colon involvement in Schoenlein-Henoch purpura]. Rev Clin Esp 1992; 190:162-3. [PMID: 1561463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Garciá B, Alguacil G, Hallal H, Solano J, Boluda F. [Bone metastasis as the first manifestation of hepatocarcinoma]. An Med Interna 1991; 8:50-1. [PMID: 1655073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Alguacil García GF, García B, Hallal H, Mendiburu L. [Antithrombin III]. Med Clin (Barc) 1989; 93:439. [PMID: 2607807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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