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Abouelgreed TA, Koritenah AK, Badran Y, Tagreda I, Algammal M, Abozied H, Eldamanhory HA, Shouman HA, Khattab AA, Ali M, Alnajem MT, Abdelwahed AA. Evaluation of Rezum therapy as a minimally invasive modality for management of Benign Prostatic Hyperplasia: A prospective observational study. Arch Ital Urol Androl 2023; 95:12026. [PMID: 38193224 DOI: 10.4081/aiua.2023.12026] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/13/2023] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVE To evaluate safety and efficacy of Rezum therapy as a minimally invasive modality for management of benign prostatic hyperplasia in patients with prostate volume < 80cc and those with prostate volume > 80cc. METHODS Between June 2020 and February 2023, A total of 98 patients diagnosed with BPH and managed by Rezum were included in this study. Patients were divided based on their prostate volume of either less than 80 cc or greater than 80 cc. We evaluated several parameters related to their condition, including prostate volume, post-voiding residual (PVR) before and after surgery, number of treatments received, maximum urine flow rate (Qmax) before and after surgery and mean follow- up periods. RESULTS The mean age was 68 years (SD 11.2). The median prostatic volume was 62 cc (IQR 41, 17). A maximum of 9 treatments were administered. Six months was determined to be the average post-operative follow-up period (IQR: 3.5-7.2). The mean preoperative total PSA was 2.7 (IQR 1, 2), preoperative mean PVR was 79.8 cm3, preoperative mean Qmax was 8.2 ml/s (IQR 4.7-10.5), and median post-operative days until catheter removal was four days (IQR 3,1). Post-operative PVR was 24.7 cm3 (IQR 18.2, 29.4) and the mean post-operative Qmax was 18.3 ml/s (SD 6.3). Qmax levels significantly increased, by an average of 8.2 ml/s (SD 7.13) (p < 0.001). Similarly, a decrease of average PVR of 97.28 cm3 (SD 95.85) (p < 0.001) was detected, which is a substantial reduction. Between prostates less 80cc and those over 80cc, there were no appreciable differences in Qmax or PVR (p-values: 0.435 and 0.431, respectively). CONCLUSIONS From our study, we conclude that Rezum water vapor thermal therapy, as a minimally invasive modality, is an effective and safe surgical option for management of benign prostatic hyperplasia of men with moderate to severe lower urinary tract symptoms (LUTS). This procedure has been shown to be effective in patients with varying larger prostate volumes.
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Affiliation(s)
- Tamer A Abouelgreed
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt; Gulf Medical University, Ajman.
| | - Ayman K Koritenah
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Yasser Badran
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Ibrahim Tagreda
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Mohamed Algammal
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Hesham Abozied
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo.
| | | | - Hossam A Shouman
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo.
| | | | - Munira Ali
- Department of Radiology, Thumbay University Hospital, Ajman.
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Mohamed HI, Aly M, Badran Y, Fawzy M, El-damanhory H, Gomma A, Ghoneimy OM, Abdelaleem MF, Elsharkawy M, Fayad S, Zidan AM, Soltan HA, Samih TA, Aboelsaad AY, Abdel Gawad AM, Moustafa BEA, Abbas H, Aly NM, Elhawary R, Hasan A. Recent advances in three-dimensional ultrasound virtual cystoscopy in modeling and local staging for urothelial carcinoma with histopathological correlation: a cohort prospective study. Ann Med Surg (Lond) 2023; 85:5365-5371. [PMID: 37915685 PMCID: PMC10617848 DOI: 10.1097/ms9.0000000000001345] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/16/2023] [Indexed: 11/03/2023] Open
Abstract
Background Bladder urothelial carcinoma is an alarming urologic malignancy. Complex factors like modelling and local staging can affect treatment strategy. However, local staging, particularly the muscle invasion status, significantly influences decisions regarding treatment strategies. Therefore, this study aims to evaluate the novel advances of three-dimensional (3D) ultrasound (US) imaging to assess local staging in comparison with conventional cystoscopy. Methods Forty-three patients with painless haematuria and conventional cystoscopy findings of bladder mass underwent 3D US virtual cystoscopy. All specimens from conventional cystoscopy were processed histologically. Results Out of 43 participants, 18 (41.9%) patients proved to have invasive urothelial carcinoma by histopathology. The 3D US had a sensitivity of 97.5% and a specificity of 100%; however conventional cystoscopy was accurate in only 53.5% of the studied cases. Furthermore, in the case of malignant ulcers, mural extension into both the submucosal and the muscle layers was more readily appreciated in multiplanar images. Conclusion 3D US updates are promising for use in bladder tumour modelling and local staging; however, they can be of value in evaluating mural and extramural tumour extent and have proven accuracy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Hassan A. Soltan
- Department of Radiology, Faculty of Medicine, Aswan University, Aswan
| | - Tamer A.A. Samih
- Department of Radiology, Faculty of Medicine, Benha University, Benha
| | | | | | | | | | - Noha M. Aly
- Department of Pathology, Faculty of Medicine for Girls, Al-Azhar University
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Abouelgreed TA, Elgarhy AM, Elatreisy A, Ewieda TM, Ibrahim WM, Yahia OS, Elnaggar AM, Elbadawy MA, Alkumity AA, Badran Y, Ali M, Gomaa A, Elebiary MF, Aboelnasr M. Is quadratus lumborum block combined with low dose-spinal anesthesia an effective alternative to general anesthesia in patients undergoing percutaneous nephrolithotomy? Arch Ital Urol Androl 2023; 95:11584. [PMID: 37791553 DOI: 10.4081/aiua.2023.11584] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/01/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND General anesthesia in high-risk patients has many complications and needs long preoperative preparations and postoperative intensive care unit (ICU). Therefore the present study aimed to evaluate the efficacy of combined low-dose spinal anesthesia with quadratus lumborum block (QLB) as an alternative to general anesthesia for patients undergoing percutaneous nephrolithotomy. PATIENTS AND METHODS A prospective study was conducted at the urology department of Al-Azhar University Hospitals in Cairo, Egypt, from January 2021 to January 2022. The study included 60 patients of ASA ll-lll scheduled for percutaneous nephrolithotomy. All patients received low-dose spinal anesthesia (5 mg bupivacaine) and QLB (QL1-QL2-QL3) approaches. The primary observation parameter was the efficacy of this technique as an alternative to general anesthesia. The secondary parameters measured were evaluation of need for intraoperative narcotics, postoperative pain score (VAS), and patients satisfaction as assessed using a 5-point Likert Scale. RESULTS None of the patients was given general anesthesia, and intraoperative sedation was given to nineteen patients (32.2%). No hemodynamic changes were observed in all patients. There was a significant correlation between the use of intraoperative sedation and stone site, intraoperative blood loss, and hospital stay. Pain intensity on VAS at rest and movement was low until the 24th postoperative hour. Patient satisfaction score was 3, 4, and 5 in 1 (1.7%), 4 (6.7%), and 55 (91.6%) patients, respectively. CONCLUSIONS Combined low-dose spinal anesthesia with quadratus lumborum block is an effective alternative to general anesthesia in patients undergoing PCNL procedures with good postoperative analgesia. Patients with lower calyceal punctures have a lower incidence of intraoperative sedation requirements.
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Affiliation(s)
| | | | - Adel Elatreisy
- Department of Urology, Faculty of medicine, Al-Azhar University, Cairo.
| | | | | | | | | | | | | | - Yasser Badran
- Department of Urology, Faculty of medicine, Al-Azhar University, Cairo.
| | - Mahmoud Ali
- Department of Urology, Faculty of medicine, Al-Azhar University, Cairo.
| | - Aly Gomaa
- Department of Urology, Faculty of medicine, Al-Azhar University, Cairo.
| | - Mohame F Elebiary
- Department of Urology, Faculty of medicine, Al-Azhar University, Cairo.
| | - Mahmoud Aboelnasr
- Department of Urology, Faculty of medicine, Al-Azhar University, Cairo.
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Abouelgreed TA, Ismail H, Ali SS, Koritenah AK, Badran Y, Ali M, Ahmed R, Algammal M, Alrefaey A, Gomaa A, Elebiary MF, Eldamanhory HA, Khattab AA, Abdelmonem NM, Alnajem MT, Abdelhamid TG, Abdelwahed AA, Abdelkader SF. Safety and efficacy of percutaneous nephrolithotripsy in comorbid patients: A 3 years prospective observational study. Arch Ital Urol Androl 2023; 95:11581. [PMID: 37791554 DOI: 10.4081/aiua.2023.11581] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/01/2023] [Indexed: 10/05/2023] Open
Abstract
PURPOSE To report the result of percutaneous nephrolithotripsy (PCNL) via standard nephrostomy tract in a single training institution. The perioperative complications in relation to the comorbid state are particularly assessed. PATIENTS AND METHODS A prospective interventional study between January 2019 to November 2022, included 210 patients scheduled for PCNL. The average age was 40.3 ± 11.8 years (range 18- 67 years). Patients were categorized into two groups. The first group comprised 146 cases (69 .5%) with no associated co-morbidities while the second group 64 (30.5%) had co-morbidities such as obesity in 4 cases (1.9%), hypertension (HTN) in 24 cases (11.4%) cases, diabetes mellitus (DM) in 17 (8.1%) cases, history of recurrent stone surgery in 11 (5.2%) cases and more than one in 8 cases (3.8%). Co-morbidities, stone burden, location of stone, time of surgery, stay in the hospital, further operations, and negative events were among the reported data. Complications and the stone-free rate were the main outcome indicators. RESULTS Intraoperative complications were reported in 40 (18.8%) patients (18 group 1 and 22 group 2) during PCNL. Bleeding occurred in 22 (10.5%) patients (9 group 1 and 13 group 2), blood transfusions were needed in 4 (1.9%) (2 group 1 and 2 group 2), extravasation was observed in 11 patients (5.2%) (6 group 1 and 5 group 2) and cardiac arrhythmia in 3 (1.4%) (1 group 1 and 2 group 2) patients. Postoperative complications occurred in 61 patients (29%) (24 group 1 and 37 group 2) in the form of fever in 10 patients (4.8 %) (3 group 1 and 7 group 2) and prolonged leakage in 50 patients (23.8%) (21 group 1 and 29 group 2). One patient of group 2 died from postoperative sepsis. Extravasation and postoperative leakage were higher in diabetic patients than in non-diabetics. Stonefree rate was 60.5% (127 of 210). Clinically significant residual fragments (CSRFs) found in 70 cases (33.3%) (33 group 1 and 37 group 2). In 13 cases (6.2%) (5 group 1 and 8 group 2), clinically insignificant residual fragments (CIRFs) were found. In 8 (3 group 1 and 5 group 2) of the 13 cases, spontaneous stone passage was observed within 4-6 weeks of surgery. Residual stones in three cases (1 group 1 and 2 group 2) were asymptomatic and 4 mm or less, whereas stones increased in two cases of group 2. Among all factors studied, stone burden was significantly correlated to both intraoperative and postoperative complications. The occurrence of postoperative fever increased with large stone burden. CONCLUSIONS PCNL is a therapeutic modality that is effective, feasible, and safe for a wide range of patients with concurrent medical issues. A steep curve is required to reduce intraoperative and postoperative complications.
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Affiliation(s)
| | - Hassan Ismail
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Sameh S Ali
- Department of Radiology, Sheikh Khalifa general Hospital, UAQ.
| | - Ayman K Koritenah
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Yasser Badran
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Mahmoud Ali
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Rasha Ahmed
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Mohamed Algammal
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Ahmed Alrefaey
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Aly Gomaa
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Mohame F Elebiary
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo.
| | | | | | | | | | | | - Ahmed A Abdelwahed
- Department of Radiology, Faculty of Medicine, Ain shams University, Cairo.
| | - Salma F Abdelkader
- Department of Radiology, Faculty of Medicine, Ain shams University, Cairo.
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Shalkamy O, Elsalhy M, Alghamdi SM, Beaiti M, Abdel-Al I, Faisal M, Abouelgreed TA, Badran Y, Abdrabu A, Al-Ayafi M, Bosily MJ, Shebl SE, Nematallah I, Shafiea A, Elatreisy A. Erectile function after different techniques of bulbar urethroplasty: does urethral transection make a difference? BMC Urol 2023; 23:140. [PMID: 37620812 PMCID: PMC10463440 DOI: 10.1186/s12894-023-01281-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 06/28/2023] [Indexed: 08/26/2023] Open
Abstract
PURPOSE We aimed to compare the impact of urethral transection after different techniques of bulbar urethroplasty on erectile function outcome. MATERIALS AND METHODS We retrospectively reviewed the records for 245 patients who underwent different urethroplasty techniques for bulbar urethral stricture between February 2013 and January 2021. The comparison between the transecting and non-transecting cohorts included patients' demographics, clinicopathological features of the urethral stricture, post-urethroplasty erectile function, and success of urethroplasty. Outcomes were erectile function status verified by IIEF5-15 score at preoperative, three months, and 12 months post-surgery. We defined Post-urethroplasty ED as a decrease of 5 points or more. RESULTS The urethroplasty success rate of the entire cohort was 86.9% after a mean follow-up of 45.59 ± 21 months. Out of 245 patients, 18 (7.3%) experienced 90-day complications. Transecting bulbar urethroplasty techniques were performed in 74 patients (30.2%), while non-transecting techniques were performed in 171 patients (69.8%). there were no differences between the cohorts regarding urethroplasty success (87.8% Vs. 86.5%, Mantel-Cox test p = 0.93) or postoperative complications (8.1% Vs. 7%, p = 0.73). Transient ED was evident in the transecting cohort as reported in 8.1% compared to 2.9% for the non-transecting (p = 0.07).Still, but de novo permanent ED was comparable (4.1% Vs. 2.9%, p = 0.65), for transecting and non-transecting, respectively. CONCLUSIONS Unfortunately, some patients who undergo transecting techniques of bulbar urethroplasty experience transient erectile dysfunction that can improve within the first post- urethroplasty year; however, de novo permanent erectile dysfunction is uncommon after different techniques of bulbar urethroplasty and is not predisposed by urethral transection.
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Affiliation(s)
- Osama Shalkamy
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
| | - Mohamed Elsalhy
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | - Mohammed Beaiti
- Department of Urology, Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia
| | - Ibrahim Abdel-Al
- Department of Urology, Faculty of Medicine, Assiut Branch, Al-Azhar University, Assiut, Egypt
| | - Mahmoud Faisal
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Tamer A Abouelgreed
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Yasser Badran
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Abdrabu Abdrabu
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mahdi Al-Ayafi
- Department of Urology, Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia
| | - Mohanad Jebril Bosily
- Department of Urology, Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia
| | - Salah E Shebl
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ibrahim Nematallah
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Shafiea
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Adel Elatreisy
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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El Zayat A, Badran Y. The effect of transplantation of adipose-derived stem cells to spinal cord on the recovery of urinary bladder function in patients having spinal cord injuries: a urodynamic study. Egypt Rheumatol Rehabil 2018. [DOI: 10.4103/err.err_8_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ahmed AF, Shalaby E, Maarouf A, Badran Y, Eladl M, Ghobish A. Diuresis and inversion therapy to improve clearance of lower caliceal stones after shock wave lithotripsy: A prospective, randomized, controlled, clinical study. Indian J Urol 2015; 31:125-31. [PMID: 25878414 PMCID: PMC4397549 DOI: 10.4103/0970-1591.152813] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: To improve the clearance of lower caliceal stones (LCSs) after shock wave lithotripsy (SWL) using a combination of intra-operative forced diuresis and inversion therapy. Materials and Methods: One hundred and fifty-seven consecutive patients with symptomatic, single LCSs of 5–20 mm size were prospectively randomized into two groups. The first (study group, SG) underwent SWL at the time of the maximum diuresis with the patient in the Trendelenburg position with an angle of 30 degree, while the second group (control group, CG) underwent standard SWL. After the last SWL session, patients were followed-up regularly using plain abdominal X-ray and renal ultrasound. The primary endpoint of the study was the stone-free rate (SFR) at 12 weeks. Results: A total of 141 patients completed the study treatment protocol and follow-up: 69 patients in SG and 72 patients in CG. Both groups were comparable in baseline data. SG showed significantly higher SFR at all follow-up time points. At week 12, 78.3% of SG were rendered stone free, whereas only 61.1% were stone free in CG (P = 0.030). Also, there was a significantly higher SFR for larger stones (>10 mm) and stones with higher attenuation value (>500 Hounsfield units) in SG than CG. Mild non-significant complications were reported in both groups. Conclusion: SWL with intraoperative forced diuresis and inversion seems to be an effective measure with minimal extra cost to improve LCS clearance post-SWL.
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Affiliation(s)
- Abul-Fotouh Ahmed
- Department of Urology, Al-Azhar University, Cairo, Egypt ; Department of Urology, Salman bin Abdulaziz University, Al-kharj, Kingdom of Saudi Arabia
| | - Essam Shalaby
- Department of Urology, Suez Canal University, Ismailia, Egypt ; Department of Urology, El-Iman General Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Aref Maarouf
- Department of Urology, Zagazig University, Zagazig, Egypt ; Department of Urology, King Abdullah Hospital, Bisha, Kingdom of Saudi Arabia
| | - Yasser Badran
- Department of Urology, Al-Azhar University, Cairo, Egypt
| | - Mahmoud Eladl
- Department of Urology, Zagazig University, Zagazig, Egypt
| | - Ammar Ghobish
- Department of Urology, Suez Canal University, Ismailia, Egypt
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Ahmed AF, Shalaby E, Maarouf A, Badran Y, Eladl M, Ghobish A. MP38-02 DIURESIS AND INVERSION THERAPY TO IMPROVE CLEARANCE OF LOWER CALICEAL STONES AFTER SHOCK WAVE LITHOTRIPSY: A PROSPECTIVE, RANDOMIZED, CONTROLLED, CLINICAL STUDY. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.1377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Maarouf A, Ahmed AF, Shalaby E, Badran Y, Salem E, Zaiton F. Factors predicting the outcome of non-operative management of high-grade blunt renal trauma. African Journal of Urology 2015. [DOI: 10.1016/j.afju.2014.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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