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Ross MG. Threshold of metabolic acidosis associated with newborn cerebral palsy: medical legal implications. Am J Obstet Gynecol 2019; 220:348-353. [PMID: 30529344 DOI: 10.1016/j.ajog.2018.11.1107] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 08/12/2018] [Revised: 10/30/2018] [Accepted: 11/30/2018] [Indexed: 12/15/2022]
Abstract
Obstetricians and gynecologists belong to 1 of the medical specialties with the highest rate of litigation claims. Among birth injury cases, those cases with cerebral palsy outcomes account for litigation settlements or judgments often in the millions of dollars. In cases of potential perinatal asphyxia, a threshold level of metabolic acidosis (base deficit ≥12 mmol/L) is necessary to attribute neonatal encephalopathy to an intrapartum hypoxic event. With increasing duration or severity of a hypoxic stress resulting in metabolic acidosis, newborn infant umbilical artery base deficit increases. It may be alleged that, as base deficit levels increase beyond 12 mmol/L, there is an increased likelihood and severity of cerebral palsy. As a corollary, it may be claimed that an earlier delivery (by minutes) would reduce the base deficit and prevent or reduce the severity of cerebral palsy. This issue is of relevance to obstetricians as defendants, because retrospective "expert" analysis of cases may suggest that optimal management decisions would have resulted in an earlier delivery. In addressing the association of metabolic acidosis and cerebral palsy, base deficit should be measured as the extracellular component (base deficitextracellular fluid) rather than the commonly used base deficitblood. Studies suggest that, beyond the base deficit threshold of 12 mmol/L, the incidence and severity of cerebral palsy does not significantly increase (until ≥20 mmol/L), although the risk of neonatal death rises markedly. Thus, among most infants with hypoxia-associated neonatal encephalopathy, the occurrence of cerebral palsy is unlikely to be impacted by delivery time variation of few minutes, and this argument should not serve as the basis for medical legal claims.
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Affiliation(s)
- Michael G Ross
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Department of Obstetrics and Gynecology, Geffen School of Medicine at UCLA, Los Angeles, CA.
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Ali MM, Brown M, Karnitis VJ. Third trimester insulin levels are not correlated with fetal macrosomia or delivery complications. J Reprod Med 2014; 59:293-298. [PMID: 24937972] [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: 06/03/2023]
Abstract
OBJECTIVE To examine the relationship of glucose and insulin levels during the 1-hour gestational diabetes screening test to determine their relation to gestational diabetes mellitus (GDM) and possible resulting pregnancy complications. STUDY DESIGN This is a prospective observational study of the delivery records of 784 patients who obtained third trimester screening for both glucose and insulin levels during routine 1-hour 50 g oral glucose load. RESULTS Insulin levels were positively correlated with glucose levels (p < 0.001). GDM was diagnosed in 17 patients (2.2%). Mean birth weight was not significantly different with glucose levels < 130 pmol/L, 130-140 pmol/L, or > 140 pmol/L (3,282 g, 3,409 g, and 3,310 g, respectively, p = 0.13), nor were 5-minute Apgar scores (p = 0.66). No difference in mean fetal birth weight was found in insulin ranges < 30 pmol/L, 30-60 pmol/L, and > 60 pmol/L (3,330 g, 3,306 g, and 3,276 g, respectively, p = 0.56). Moreover, no significant differences in 5-minute Apgar scores were observed between those groups (p = 0.05). Women who underwent cesarean section (n = 230) had significantly higher glucose and insulin levels than did those who had vaginal deliveries (n = 554) (p = 0.01 and p = 0.003, respectively). CONCLUSION Our data indicates that neither insulin nor glucose levels are predictive of fetal macrosomia, low Apgar scores, or birth injuries.
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Meyer S, Gottschling S, Baghai A, Polcher T, Strittmatter M, Gortner L. [The role of S100B-protein in neonatology, pediatric intensive care, and pediatrics]. Klin Padiatr 2006; 218:49-56. [PMID: 16506102 DOI: 10.1055/s-2005-836607] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
During the last years neuromonitoring with various biochemical markers such as S100B protein has been introduced into the clinical settings of neonatal and pediatric intensive care. Several investigations have been undertaken to correlate S100B protein concentrations to the diagnosis and prognosis of neonates and children with severe cerebral disorders. This articles gives a review on the current knowledge, indications and limitations on the use of S100B protein after non-traumatic and traumatic brain injury in neonates and children.
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Affiliation(s)
- S Meyer
- Klinik für Allgemeine Pädiatrie und Neonatologie.
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Vasil'eva EM, Shor TA, Poddubnaia AE. [Changes of the thyroid hormone status in children with cerebral palsy and other neurological pathology]. Zh Nevrol Psikhiatr Im S S Korsakova 2005; 105:10-4. [PMID: 16281373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Content of thyroid hormones (T3 and T4) and thyrotropin (TTG) hormone in blood plasma has been studied in 142 children with neurological pathology (cerebral palsy, perinatal CNS lesion). In most cases, there was a significant increase of T3 and T4 and reduction of TTG as compared to control group of healthy children. The changes of thyroid hormones content depended on the patient's age and severity of a pathological condition. A mother pregnancy course impacted on the hormones level. The content of T3 and T4 in blood plasma was higher in case of cystitis in mother's anamnesis or a persistent threat of preterm delivery. In patients, a TTG reduction correlated with mental retardation. In those with marked dysplasia of osseous tissue (osteoclast, osteopathy), the TTG content was higher comparing to patients without such malformations.
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Kravchenko SV. [A trial of the use of the multivitamin Multitabs in the combined treatment of patients with a perinatal brain lesion]. Lik Sprava 1997:101-4. [PMID: 9333457] [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: 02/05/2023]
Abstract
Pediatric patients in early childhood presenting with perinatal affection of the nervous system benefit much from incorporation into their combined treatment of multivitamins "Multitabs", as evidenced by improvement in their general health, as well as in the red blood parameters and immunity status. Thus, use of the above multivitamins for children presenting with perinatal cerebral pathology is considered liable to be of benefit making for optimization of the process of treatment.
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Abstract
OBJECTIVE Our goal was to update our experience with nucleated red blood cells as a marker for fetal asphyxia and to determine whether a relationship exists between the presence of nucleated red blood cells and long-term neurologic impairment. STUDY DESIGN Nucleated red blood cell data from 153 singleton term neurologically impaired neonates were compared with cord blood nucleated red blood cells of 83 term nonasphyxiated newborns. Newborns with anemia, intrauterine growth restriction, and maternal diabetes were excluded. The group of neurologically impaired neonates was separated into the following subgroups: group I, persistent nonreactive fetal heart rate pattern from admission to delivery (n = 69); group II, reactive fetal heart rate on admission followed by tachycardia with decelerations and absent variability (n = 47); group III, reactive fetal heart rate on admission followed by an acute prolonged deceleration (n = 37). The first and highest nucleated red blood cell value and the time of nucleated red blood cell disappearance were assessed. RESULTS The mean number of initial nucleated red blood cells was significantly higher in the group of neurologically impaired neonates (30.3 +/- 77.5, range 0 to 732 per 100 white blood cells) than in the control group (3.4 +/- 3.0, range 0 to 12 per 100 white blood cells) (p < 0.000001). When the group of neurologically impaired neonates was separated on the basis of timing of the neurologic impairment, distinct nucleated red blood cell patterns were observed. Significant differences were obtained between each of the three groups of neurologically impaired neonates and the normal group, with respect to initial nucleated red blood cells (group I, 48.6 +/- 106.9; group II, 11.4 +/- 9.8; group III, 12.6 +/- 13.4; p < or = 0.000002). Maximum nucleated red blood cell values were higher in group I (mean 51.5 +/- 108.9) than in groups II and III combined (mean 12.7 +/- 11.9) (p = 0.0005). Group I also had a longer clearance time (119 +/- 123 hours) than groups II and III combined (mean 59 +/- 64 hours) (p < 0.001). CONCLUSION Our ongoing study indicates that nucleated red blood cells identify the presence of fetal asphyxia. When fetal asphyxia is present, distinct nucleated red blood cell patterns are observed that relate to the timing of fetal injury. In general, intrapartum injuries are associated with lower nucleated red blood cell values. Thus our data continue to support the concept that nucleated red blood cell levels may assist in determining the timing of fetal neurologic injury.
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Affiliation(s)
- L M Korst
- Department of Obstetrics and Gynecology, Pomona Valley Hospital Medical Center, CA, USA
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Abstract
To evaluate the effects of interventions during delivery on the maternal and neonatal C-reactive protein (CRP) we prospectively measured CRP by immunoturbidometry in 238 mother-infant pairs (179 normal vaginal deliveries, 36 cesarean sections and 23 vacuum extractions) at 24 and 72 hours after delivery. We additionally measured CRP in peripheral maternal and neonatal blood immediately after birth in 29 uncomplicated vaginal deliveries. CRP values in the mothers and their offspring were low at birth, but rose significantly during the first day after vaginal delivery. Cesarean section induced a pronounced elevation of maternal CRP, but had no effect on neonatal values. Delivery by vacuum extraction produced a transient elevation of both maternal and neonatal CRP at 24 hours after birth. Neonatal CRP values were not associated with presence or size of superficial birth tissue trauma evaluated simultaneously with blood sampling. Increased CRP release in mothers and their infants after interventions during delivery may be associated with varying degrees of tissue trauma and can complicate assessment of the presence of infection.
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Affiliation(s)
- P Kääpä
- Department of Pediatrics, Central Hospital of North Carelia, Joensuu, Finland
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Kuint J, Pipano S, Linder N, Reichman B, Sela BA. Serum macro creatine kinase type 2 in asphyxiated newborn infants. Clin Biochem 1993; 26:117-20. [PMID: 8485857 DOI: 10.1016/0009-9120(93)90038-8] [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] [Indexed: 01/31/2023]
Abstract
The presence of macro creatine kinase type 2 (MCK2) activity was noted in the serum of seven out of 32 newborn infants with perinatal asphyxia or birth trauma. MCK2 isoenzyme, when present, represented 15-35% of the total creatine kinase (CK) activity. The clinical and biochemical features of the seven MCK2-positive and 25 MCK2-negative newborns were compared. The infants with MCK2 activity were all males and clinically appeared to be more severely injured, requiring longer hospitalization. Total CK activity was similar in the two groups and CK-MB and CK-BB isoenzyme fractions were present in a similar proportion of infants in both groups. Two infants in each group had long-term neurological disorders. Although the presence of MCK2 has been noted in adult patients with end-stage metastatic solid tumors, the presence of this isoenzyme has not previously been reported in newborn infants.
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Affiliation(s)
- J Kuint
- Department of Neonatology, Chaim Sheba Medical Center, Tel Hashomer Hospital, Israel
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Zagorodnikova OA, Slepushkin VD, Zaika GE, Masenko VP, Titova NM. [Plasma cortisol levels in the newborn infants with hypoxic and traumatic injuries of the spinal cord]. Akush Ginekol (Mosk) 1991:28-30. [PMID: 1789340] [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: 12/28/2022]
Abstract
Adrenal glucocorticoid function was studied in 56 newborns with natal injuries of the cervical section of the spine and the contribution of the hypoxic factor to such injuries defined. The babies were examined by the cliniconeurologic and electron-neuromyographic methods in order to specify the level of the injury. Blood serum and umbilical blood hydrocortisone levels were radioimmunoassayed immediately at birth and on days 5-7 of life. Spinal injury at the C1-C4 level was associated with low hydrocortisone levels, that may be regarded as an additional criterion for the differentiation of the level of injury in traumas of the cervical portion of the spine in the newborns.
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Michurina LS, Zozuliakova SV, Podosinnikov IS. [Fibrinogen and fibrin degradation products in newborn infants with intracranial birth injuries]. Pediatriia 1985:43-4. [PMID: 4000829] [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: 01/08/2023]
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Bagnoli F, Bruchi S, Sardelli S, Vispi L, Buonocore G, Franchi F, Bracci R. Calcitonin and parathyroid hormone in newborn infants with fracture of the clavicle. Calcif Tissue Int 1984; 36:357-60. [PMID: 6435834 DOI: 10.1007/bf02405346] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Determinations of serum calcium (Ca), phosphorus (P), calcitonin (CT), and parathyroid hormone (PTH) were carried out in 36 full-term newborn infants with fracture of the clavicle (CF) and in 46 normal neonates (N). At the 6th hour of life the CF neonates demonstrated lower serum Ca and higher serum CT in comparison with normal infants. In the hours following, no significant differences between the two groups for the Ca levels were found, whereas serum CT remained significantly higher in the CF newborns at the 24th, 48th, and 72nd hour of life. Significant differences between normal and CF infants in the PTH serum levels were detected only at the 48th hour, when PTH was lower in the CF newborns. The results of this investigation indicate that the fracture of the clavicle is a significant and peculiar factor in stimulating CT secretion. Serum Ca level appeared to be controlled by CT rather than auto-regulating the secretion of the hormone.
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Chikovani MI, Aripova AA, Petrichuk SV, Nartssissov RP. [Diagnostic value of the study of lymphocyte succinate dehydrogenase activity in premature infants with intracranial birth]. Pediatriia 1981:17-19. [PMID: 7322742] [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: 05/21/2023]
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Iurkov IA, Safonova TI, Ladygina VE. [Nicotinamide coenzyme (NAD and NAD-H2) content in the blood of premature infants with intracranial birth injury]. Pediatriia 1979:56-8. [PMID: 225722] [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: 12/13/2022]
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Budyka LA, Zus'man RT. [Serum protein study of newborn infants with intracranial birth injury and asphyxia]. Vopr Okhr Materin Det 1978; 23:29-32. [PMID: 676192] [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: 12/23/2022]
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Safonova TI, Iatsyk GV, Volkova LD. [Fatty acid makeup of the total serum lipids in premature infants with intracranial birth trauma]. Vopr Okhr Materin Det 1978; 23:24-30. [PMID: 664514] [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: 12/23/2022]
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Orekhov KV, Gurkova GP, Izmest'eva LN, Shik AA. [Blood glycogen dynamics in healthy newborn infants and in those with intracranial birth injury]. Pediatriia 1976:25-7. [PMID: 972812] [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: 12/25/2022]
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Shantarina AV, Krylov VI, Borodzich SI, Moiseenko SP, Petrushina AD. [Characteristics of certain blood lipids in newborn infants with intracranial birth injury]. Vopr Okhr Materin Det 1976; 21:47-50. [PMID: 969312] [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: 12/25/2022]
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Miroshnichenko VP, Siniavina AI. [Several blood coagulation indices in infants delivered by cesarean section]. Pediatr Akus Ginekol 1975:40-3. [PMID: 1128942] [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: 12/25/2022]
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Mingers AM, Ströder J. [Coagulation studies in Cephalhematomas]. Monatsschr Kinderheilkd (1902) 1974; 122:689-90. [PMID: 4408957] [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: 01/10/2023]
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Prishchepova NF. [Erythrokinetics in full-term newborn infants with intracranial birth injury]. Pediatriia 1974:57-61. [PMID: 4467102] [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: 01/10/2023]
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Selezneva LA, Golubev AP. [Condition of the blood coagulation system in newborn infants with intracranial birth trauma and asphyxia]. Pediatriia 1973; 52:55-6. [PMID: 4769445] [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: 01/12/2023]
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Safronova ON, Varvashenia SM. [The erythrocyte system in newborn infants under normal conditions and in various pathologic states]. Vopr Okhr Materin Det 1972; 17:88-9. [PMID: 4673225] [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: 01/11/2023]
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Khosh GM, Budyka LA. [Amino acids of whole blood in neonates with intracranial birth injury]. Vopr Okhr Materin Det 1972; 17:90. [PMID: 5024225] [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: 01/13/2023]
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Kapranova EI. [Acid-base equilibrium, and the level of glucose and pyruvic acid in healthy premature infants and infants with intracranial birth trauma]. Pediatriia 1970; 49:26-9. [PMID: 5422786] [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: 01/15/2023]
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Sultanova GF, Sogrina KA. [Fetal hemoglobin levels in several conditions of premature infants]. Vopr Okhr Materin Det 1968; 13:84. [PMID: 5752982] [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: 01/16/2023]
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Apostolov BG, Budyka LA. [Some indices of the blood coagulation system in the newborn with intracranial birth trauma]. Vopr Okhr Materin Det 1968; 13:38-42. [PMID: 5712198] [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: 01/16/2023]
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Rett A, Stöckl W. [Studies on the ammonia content in the serum of children with brain damage with special reference to hyperammonemia]. Wien Med Wochenschr 1968; 118:311-4. [PMID: 4233690] [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: 01/09/2023]
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