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D'Agostino J, Souki A, Lohse A, Carvajal Alegria G, Dernis E, Richez C, Truchetet ME, Wendling D, Toussirot E, Perdriger A, Gottenberg JE, Felten R, Fautrel B, Chiche L, Hilliquin P, Le Henaff C, Dervieux B, Direz G, Chary-Valckenaere I, Cornec D, Guellec D, Marhadour T, Nowak E, Saraux A, Devauchelle-Pensec V. Concordance and agreement between different activity scores in polymyalgia rheumatica. RMD Open 2024; 10:e003741. [PMID: 38490696 PMCID: PMC10946364 DOI: 10.1136/rmdopen-2023-003741] [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: 09/19/2023] [Accepted: 02/27/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE The C reactive protein polymyalgia rheumatica activity score (CRP-PMR-AS) is a composite index that includes CRP levels and was developed specifically for PMR. As treatments such as interleukin-6 antagonists can normalise CRP levels, the erythrocyte sedimentation rate (ESR) of PMR-AS, the clinical (clin)-PMR-AS and the imputed-CRP (imp-CRP)-PMR-AS have been developed to avoid such bias. Our primary objective was to measure the correlation of these activity scores. Our secondary objective was to evaluate the concordance between different cutoffs of the PMR-ASs. METHOD Data from the Safety and Efficacy of tocilizumab versus Placebo in Polymyalgia rHeumatica With glucocORticoid dEpendence (SEMAPHORE) trial, a superiority randomised double-blind placebo-controlled trial, were subjected to post hoc analysis to compare the efficacy of tocilizumab versus placebo in patients with active PMR. The CRP-PMR-AS, ESR-PMR-AS, clin-PMR-AS and imp-CRP-PMR-AS were measured at every visit. The concordance and correlation between these scores were evaluated using kappa correlation coefficients, Bland-Altman correlations, intraclass correlation coefficients (ICCs) and scatter plots. RESULTS A total of 101 patients were included in the SEMAPHORE trial, and 100 were analysed in this study. The correlation between the PMR-ASs was excellent, as the ICC and kappa were >0.85 from week 4 until week 24 (CRP-PMR-AS ≤10 or >10). Bland-Altman plots revealed that the differences between the CRP-PMR-AS and the other threescores were low. The cut-off values for the clin-PMR-AS were similar to those for the CRP-PMR-AS 86% of the time. CONCLUSION The correlation between all the PMR-ASs was excellent, reflecting the low weight of CRP. In clinical trials using drugs that have an impact on CRP, the derived activity scores can be used. TRIAL REGISTRATION NUMBER NTC02908217.
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Affiliation(s)
- Justine D'Agostino
- Department of Rheumatology, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Aghiles Souki
- Public Agency for Clinical Research and Innovation (DRCI), Brest University Hospital, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Anne Lohse
- Hopital Nord Franche-Comte-Site de Belfort, Belfort, France
| | | | - Emanuelle Dernis
- Department of Rheumatology, Centre Hospitalier Le Mans, Le Mans, France
| | - Christophe Richez
- Department of Rheumatology, Centre Hospitalier Universitaire de Bordeaux Groupe Hospitalier Pellegrin, Bordeaux, France
- UMR CNRS 5164, Université de Bordeaux Collège Sciences de la Santé, Bordeaux, France
| | - Marie-Elise Truchetet
- Department of Rheumatology, Centre Hospitalier Universitaire de Bordeaux Groupe Hospitalier Pellegrin, Bordeaux, France
| | - Daniel Wendling
- Rheumatology and EA4266 Franche-Comté University, Centre Hospitalier Universitaire de Besancon, Besancon, France
| | - Eric Toussirot
- INSERM Clinical Investigation Center 1431, Centre Hospitalier Universitaire de Besancon, Besancon, France
- Department of Rheumatology, Centre Hospitalier Universitaire de Besancon, Besancon, France
| | - Aleth Perdriger
- Department of Rheumatology, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Jacques-Eric Gottenberg
- Department of Rheumatology, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Renaud Felten
- Department of Rheumatology, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Bruno Fautrel
- Department of Rheumatology, Assistance Publique-Hopitaux de Paris, Paris, France
- INSERM UMR-S 1136, Pierre Louis Epidemiology and Public Health Research Institute, Paris, France
| | - Laurent Chiche
- Internal Medicine, Marseille Public University Hospital System, Marseille, France
| | - Pascal Hilliquin
- Department of Rhumatology, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - Catherine Le Henaff
- Department of Rheumatology, Pays de Morlaix Hospital Centre, Morlaix, France
| | - Benjamin Dervieux
- Department of Rhuamtology, GHR Mulhouse Sud Alsace, Mulhouse, France
| | - Guillaume Direz
- Department of Rheumatology, Centre Hospitalier Le Mans, Le Mans, France
| | | | - Divi Cornec
- Department of Rheumatology, Centre Hospitalier Universitaire de Brest, Brest, France
- INSERM 1227, Université de Bretagne Occidentale, Brest, France
| | - Dewi Guellec
- Department of Rheumatology, Centre Hospitalier Universitaire de Brest, Brest, France
- INSERM Clinical Investigations Centre 1412, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Thierry Marhadour
- Department of Rheumatology, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Emmanuel Nowak
- Public Agency for Clinical Research and Innovation (DRCI), Brest University Hospital, Centre Hospitalier Universitaire de Brest, Brest, France
- Centre Hospitalier Universitaire de Brest, Brest, INSERM Clinical Investigations Centre (CIC) 1412, France
| | - Alain Saraux
- Department of Rheumatology, Centre Hospitalier Universitaire de Brest, Brest, France
- INSERM 1227, Université de Bretagne Occidentale, Brest, France
| | - Valérie Devauchelle-Pensec
- Department of Rheumatology, Centre Hospitalier Universitaire de Brest, Brest, France
- INSERM 1227, Université de Bretagne Occidentale, Brest, France
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Araneda R, Ebner-Karestinos D, Paradis J, Klöcker A, Saussez G, Demas J, Bailly R, Bouvier S, Carton de Tournai A, Herman E, Souki A, Le Gal G, Nowak E, Sizonenko SV, Newman CJ, Dinomais M, Riquelme I, Guzzetta A, Brochard S, Bleyenheuft Y. Changes Induced by Early Hand-Arm Bimanual Intensive Therapy Including Lower Extremities in Young Children With Unilateral Cerebral Palsy: A Randomized Clinical Trial. JAMA Pediatr 2024; 178:19-28. [PMID: 37930692 PMCID: PMC10628844 DOI: 10.1001/jamapediatrics.2023.4809] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/10/2023] [Indexed: 11/07/2023]
Abstract
Importance Intensive interventions are provided to young children with unilateral cerebral palsy (UCP), classically focused on the upper extremity despite the frequent impairment of gross motor function. Hand-Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) effectively improves manual dexterity and gross motor function in school-aged children. Objective To verify if HABIT-ILE would improve manual abilities in young children with UCP more than usual motor activity. Design, Setting, and Participants This prospective randomized clinical trial (November 2018 to December 2021), including 2 parallel groups and a 1:1 allocation, recruitment took place at European university hospitals, cerebral palsy specialized centers, and spontaneous applications at 3 sites: Brussels, Belgium; Brest, France; and Pisa, Italy. Matched (age at inclusion, lesion type, cause of cerebral palsy, and affected side) pairs randomization was performed. Young children were assessed at baseline (T0), 2 weeks after baseline (T1), and 3 months after baseline (T2). Health care professionals and assessors of main outcomes were blinded to group allocation. At least 23 young children (in each group) aged 12 to 59 months with spastic/dyskinetic UCP and able to follow instructions were needed. Exclusion criteria included uncontrolled seizures, scheduled botulinum toxin injections, orthopedic surgery scheduled during the 6 months before or during the study period, severe visual/cognitive impairments, or contraindications to magnetic resonance imaging. Interventions Two weeks of usual motor activity including usual rehabilitation (control group) vs 2 weeks (50 hours) of HABIT-ILE (HABIT-ILE group). Main Outcomes and Measures Primary outcome: Assisting Hand Assessment (AHA); secondary outcomes: Gross Motor Function Measure-66 (GMFM-66), Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT), and Canadian Occupational Performance Measure (COPM). Results Of 50 recruited young children (26 girls [52%], median age; 35.3 months for HABIT-ILE group; median age, 32.8 months for control group), 49 were included in the final analyses. Change in AHA score from T0 to T2 was significantly greater in the HABIT-ILE group (adjusted mean score difference [MD], 5.19; 95% CI, 2.84-7.55; P < .001). Changes in GMFM-66 (MD, 4.72; 95% CI, 2.66-6.78), PEDI-CAT daily activities (MD, 1.40; 95% CI, 0.29-2.51), COPM performance (MD, 3.62; 95% CI, 2.91-4.32), and satisfaction (MD, 3.53; 95% CI, 2.70-4.36) scores were greater in the HABIT ILE group. Conclusions and Relevance In this clinical trial, early HABIT-ILE was shown to be an effective treatment to improve motor performance in young children with UCP. Moreover, the improvements had an impact on daily life activities of these children. Trial registration ClinicalTrials.gov Identifier: NCT04020354.
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Affiliation(s)
- Rodrigo Araneda
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
- Exercise and Rehabilitation Science Institute, Faculty of Rehabilitation Science, Universidad Andres Bello, Santiago, Chile
| | - Daniela Ebner-Karestinos
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
- Exercise and Rehabilitation Science Institute, Faculty of Rehabilitation Science, Universidad Andres Bello, Santiago, Chile
| | - Julie Paradis
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Anne Klöcker
- Haute Ecole Léonard de Vinci, Parnasse-ISEI, Brussels, Belgium
| | - Geoffroy Saussez
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
- Forme et Fonctionnement Humain Unit, Department of Motor Sciences, CeREF - Haute Ecole Louvain en Hainaut, Belgium
| | - Josselin Demas
- Université d’Angers, Laboratoire Angevin de Recherche en Ingénierie des Systèmes (LARIS) – EA7315 F-49000 France
- Instituts de formation du Centre Hospitalier de Laval, Laval, France
| | - Rodolphe Bailly
- INSERM UMR 1101, LaTIM, Brest, France
- Pediatric Rehabilitation Department, Fondation Ildys, Brest, France
| | - Sandra Bouvier
- Pediatric Rehabilitation Department, Fondation Ildys, Brest, France
- Western Brittany University, Brest, France
| | | | - Enimie Herman
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | | | - Grégoire Le Gal
- University Hospital of Brest, Brest, France
- INSERM CIC 1412, Brest, France
| | - Emmanuel Nowak
- University Hospital of Brest, Brest, France
- INSERM CIC 1412, Brest, France
| | - Stephane V. Sizonenko
- Division of Child Development and Growth, Department of Pediatrics, University of Geneva, Geneva, Switzerland
| | - Christopher J. Newman
- Paediatric Neurology and Neurorehabilitation Unit, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Mickael Dinomais
- Université d’Angers, Laboratoire Angevin de Recherche en Ingénierie des Systèmes (LARIS) – EA7315 F-49000 France
- CHU Angers, Département de Médecine Physique et de Réadaptions, CHU Angers-Capucins, F- 49933, France
| | - Inmaculada Riquelme
- Department of Nursing and Physiotherapy and Research Institute on Health Sciences (UINICS-Idisba), University of the Balearic Islands, Palma de Mallorca, Spain
| | - Andrea Guzzetta
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sylvain Brochard
- INSERM UMR 1101, LaTIM, Brest, France
- Pediatric Rehabilitation Department, Fondation Ildys, Brest, France
- Western Brittany University, Brest, France
- University Hospital of Brest, Brest, France
| | - Yannick Bleyenheuft
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
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Saraux A, Le Henaff C, Dernis E, Carvajal-Alegria G, Tison A, Quere B, Petit H, Felten R, Jousse-Joulin S, Guellec D, Marhadour T, Kervarrec P, Cornec D, Querellou S, Nowak E, Souki A, Devauchelle-Pensec V. Abatacept in early polymyalgia rheumatica (ALORS): a proof-of-concept, randomised, placebo-controlled, parallel-group trial. Lancet Rheumatol 2023; 5:e728-e735. [PMID: 38251563 DOI: 10.1016/s2665-9913(23)00246-1] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Medium-dose glucocorticoids can improve symptoms in nearly all patients with polymyalgia rheumatica. According to its good safety profile, abatacept could be used instead of glucocorticoids in early polymyalgia rheumatica. We aimed to determine whether the efficacy of abatacept is sufficient to justify larger studies in early polymyalgia rheumatica. METHODS To evaluate whether abatacept allows low disease activity without glucocorticoids in early polymyalgia rheumatica, we conducted a proof-of-concept, randomised, double-blind, placebo-controlled, parallel-group trial. Participants were recruited from five centres in France (in Brest, Le Mans, Morlaix, Dinan and Saint Malo, and Strasbourg) and were included if they had recent-onset (<6 months) polymyalgia rheumatica with a C-reactive protein (CRP) polymyalgia rheumatica activity score (PMR-AS) of more than 17 without any signs or symptoms of giant cell arteritis (clinical and [18F]fluorodeoxyglucose PET-CT evaluation). Participants were randomly assigned (1:1) to receive weekly subcutaneous abatacept (125 mg) or matching placebo, with glucocorticoid rescue therapy allowed in cases of high disease activity, for 12 weeks, and then glucocorticoid treatment based on disease activity, until week 36. Investigators, patients, outcome assessors, and sponsor personnel were masked to group assignments. The primary endpoint was low disease activity (CRP PMR-AS ≤10) at week 12 without glucocorticoids and without rescue treatment. The study was powered to demonstrate a 60% difference in response rates between groups. Open-ended adverse events were collected at each visit by clinicians and were categorised following system organ class classification after study completion. The ALORS trial is registered with ClinicalTrials.gov, NCT03632187. FINDINGS 34 patients (22 women and 12 men) were randomly assigned between Dec 13, 2018, and Oct 21, 2021. All patients who had been randomly assigned were included in the analysis. The primary endpoint was reached by eight (50%) of 16 patients in the abatacept group and four (22%) of 18 patients in the placebo group (relative risk 2·2 [0·9-5·5]); crude p=0·15; adjusted p=0·070). Eight (50%) patients in the abatacept and 15 (83%) in the placebo group had adverse events. Four patients (one [6%] in the abatacept group and three [17%] in the placebo group) had serious adverse events. There were no deaths or new safety concerns. INTERPRETATION This study suggests that the effect of abatacept alone is not strong enough to justify larger studies in early polymyalgia rheumatica. This is only a first step in deciding whether a larger study should be conducted in early polymyalgia rheumatica and does not exclude a potential effect of abatacept in glucocorticoid-dependent polymyalgia rheumatica. FUNDING BMS Pharma France.
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Affiliation(s)
- Alain Saraux
- Rheumatology Unit, Hôpital de la Cavale Blanche, Brest, France; Université de Bretagne Occidentale (Univ Brest), CHU Brest, INSERM (U1227), Brest, France.
| | | | | | | | - Alice Tison
- Université de Bretagne Occidentale (Univ Brest), CHU Brest, INSERM (U1227), Brest, France
| | - Baptiste Quere
- Université de Bretagne Occidentale (Univ Brest), CHU Brest, INSERM (U1227), Brest, France
| | - Hélène Petit
- Service de rhumatologie, Groupement Hospitalier Rance Emeraude, CH de Dinan, Dinan, France
| | - Renaud Felten
- Service de Rhumatologie, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Sandrine Jousse-Joulin
- Université de Bretagne Occidentale (Univ Brest), CHU Brest, INSERM (U1227), Brest, France
| | - Dewi Guellec
- Université de Bretagne Occidentale (Univ Brest), CHU Brest, INSERM (U1227), Brest, France
| | - Thierry Marhadour
- Université de Bretagne Occidentale (Univ Brest), CHU Brest, INSERM (U1227), Brest, France
| | - Patrice Kervarrec
- Université de Bretagne Occidentale (Univ Brest), CHU Brest, INSERM (U1227), Brest, France
| | - Divi Cornec
- Université de Bretagne Occidentale (Univ Brest), CHU Brest, INSERM (U1227), Brest, France
| | - Solene Querellou
- Department of Nuclear Medicine, Université de Bretagne Occidentale (Univ Brest), CHU Brest, INSERM, GETBO, Brest, France
| | - Emmanuel Nowak
- Clinical Research and Innovation Department (DRCI), INSERM, CHU Brest, Brest, France; Public Agency for Clinical Research and Innovation (DRCI), Brest University Hospital, Brest, France
| | - Aghiles Souki
- Clinical Research and Innovation Department (DRCI), INSERM, CHU Brest, Brest, France; Public Agency for Clinical Research and Innovation (DRCI), Brest University Hospital, Brest, France
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Fissah M, Saadaoui Y, Zioui A, Lafred W, Zitouni M, Souki A, Hadjeres A, Bounzira T, Jafjaf L, Bacha H, Boudjella M, Boucelma M. Place de l’Infliximab dans le traitement des uvéites réfractaires dans la maladie de Behçet : à propos de 6 cas. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.118] [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: 11/26/2022]
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Souki A, Chennouffi M, Zeghal D, Chelli D, Hendaoui M, Sfar E, Chelli H. Richter - type sacro-spinal fixation. Int J Gynaecol Obstet 2000. [DOI: 10.1016/s0020-7292(00)83486-4] [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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Chelli H, Chelli D, Zeghal D, Souki A, Chennoffi M, Tanfous B, Sfar E. Screening sexual transmitted diseases on single women candidates to abortion in a Tunisian hospital. Int J Gynaecol Obstet 2000. [DOI: 10.1016/s0020-7292(00)84595-6] [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: 10/26/2022]
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Chelli H, Chelli D, Chennouffi M, Souki A, Sfar E. Atypical Rokitansky-Kauster-Hauser syndrom. Int J Gynaecol Obstet 2000. [DOI: 10.1016/s0020-7292(00)85268-6] [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: 10/26/2022]
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Zambrano N, Quintero J, Falque L, Souki A, Arias N, Piñero M. [Food intake and biochemical variables: overall nutrition and metabolic status of a group of non-institutionalized elderly in Venezuela]. Arch Latinoam Nutr 1996; 46:196-202. [PMID: 9429621] [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: 02/05/2023]
Abstract
To evaluate the quality of life, and to establish local reference standards, the nutritional and metabolic status were assessed in two-hundred-eleven non-institutionalized adults divided in two groups: the experimental (> or = 60 years old), and the control (< 60 years old). The anthropometric nutritional status was assessed with the Quetelet Index with no significant differences between the age groups. The 24-hour recall method in the dietetic evaluation showed a high lipid and protein diet, which is characteristic of the region. The diet is deficient in energy, carbohydrates, fiber, copper, and zinc. Biochemical determinations of zinc, copper, total protein, albumin, alkaline phosphatase, triglyceride, total cholesterol, HDL-cholesterol, LDL-cholesterol, glucose, and insulin, were performed on 12-hours fasting subjects without significant (p < 0.05) age-based differences, except albumin levels, which reflects overall protein status. On the other hand, albumin, trygliceride, total cholesterol, HDL-cholesterol, LDL-cholesterol, and copper levels showed sex-based and age-sex-based significant differences (p < 0.05). Similar studies should be made on institutionalized or free-living individuals, from different socioeconomic levels and a nutritional status assessed by anthropometric measures, body composition, and food intake.
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Affiliation(s)
- N Zambrano
- Universidad del Zulia, Facultad de Medicina, Escuela de Nutrición y Dietética
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Chakroun M, Ben Romdhane F, Battikh R, Souki A, Bouzouaia N. Intérêt de la benzathine pénicilline dans la prévention des récidives d'érysipèle. Med Mal Infect 1994. [DOI: 10.1016/s0399-077x(05)80579-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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