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Runnebaum IB, Kather A, Vorwergk J, Cruz JJ, Mothes AR, Beteta CR, Boer J, Keller M, Pölcher M, Mustea A, Sehouli J. Ovarian cancer prevention by opportunistic salpingectomy is a new de facto standard in Germany. J Cancer Res Clin Oncol 2023; 149:6953-6966. [PMID: 36847838 PMCID: PMC10374707 DOI: 10.1007/s00432-023-04578-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 01/06/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE The most prevalent and aggressive subtype of epithelial ovarian carcinoma (EOC), high-grade serous carcinoma (HGSC), originates in many cases from the fallopian tubes. Because of poor prognosis and lack of effective screening for early detection, opportunistic salpingectomy (OS) for prevention of EOC is being implemented into clinical routine in several countries worldwide. Taking the opportunity of a gynecological surgery in women at average cancer risk, extramural fallopian tubes are completely resected preserving the ovaries with their infundibulopelvic blood supply. Until recently, only 13 of the 130 national partner societies of the International Federation of Obstetrics and Gynecology (FIGO) have published a statement on OS. This study aimed to analyze the acceptance of OS in Germany. METHODS (1) Survey of German gynecologists in 2015 and 2022 by the Department of Gynecology of the Jena University Hospital in co-operation with the Department of Gynecology at Charité-University Medicine Berlin with support of NOGGO e. V. and AGO e. V. (2) Salpingectomy numbers in Germany for years 2005-2020 as retrieved from the Federal Statistical Office of Germany (Destatis). RESULTS (1) Survey: Number of participants was 203 in 2015 and 166 in 2022, respectively. Nearly all respondents (2015: 92%, 2022: 98%) have already performed bilateral salpingectomy without oophorectomy in combination with benign hysterectomy with the intention to reduce the risk for malignant (2015: 96%, 2022: 97%) and benign (2015: 47%, 2022: 38%) disorders. Compared to 2015 (56.6%), considerably more survey participants performed OS in > 50% or in all cases in 2022 (89.0%). Recommendation of OS for all women with completed family planning at benign pelvic surgery was approved by 68% in 2015 and 74% in 2022. (2) Case number analysis: In 2020, four times more cases of salpingectomy were reported by German public hospitals compared to 2005 (n = 50,398 vs. n = 12,286). Of all inpatient hysterectomies in German hospitals in 2020, 45% were combined with salpingectomy, and more than 65% in women at the age of 35 to 49 years. CONCLUSION Mounting scientific plausibility regarding involvement of fallopian tubes in the pathogenesis of EOC led to change of clinical acceptance of OS in many countries including in Germany. Case number data and widespread expert judgment demonstrate that OS has become a routine procedure in Germany and a de facto standard for primary prevention of EOC.
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Van der Kolk WL, Van der Zee AGJ, Slomovitz BM, Baldwin PJW, Van Doorn HC, De Hullu JA, Van der Velden J, Gaarenstroom KN, Slangen BFM, Kjolhede P, Brännström M, Vergote I, Holland CM, Coleman R, Van Dorst EBL, Van Driel WJ, Nunns D, Widschwendter M, Nugent D, DiSilvestro PA, Mannel RS, Tjiong MY, Boll D, Cibula D, Covens A, Provencher D, Runnebaum IB, Monk BJ, Zanagnolo V, Tamussino K, Oonk MHM. Unilateral inguinofemoral lymphadenectomy in patients with early-stage vulvar squamous cell carcinoma and a unilateral metastatic sentinel lymph node is safe. Gynecol Oncol 2022; 167:3-10. [PMID: 36085090 DOI: 10.1016/j.ygyno.2022.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/18/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Optimal management of the contralateral groin in patients with early-stage vulvar squamous cell carcinoma (VSCC) and a metastatic unilateral inguinal sentinel lymph node (SN) is unclear. We analyzed patients who participated in GROINSS-V I or II to determine whether treatment of the contralateral groin can safely be omitted in patients with a unilateral metastatic SN. METHODS We selected the patients with a unilateral metastatic SN from the GROINSS-V I and II databases. We determined the incidence of contralateral additional non-SN metastases in patients with unilateral SN-metastasis who underwent bilateral inguinofemoral lymphadenectomy (IFL). In those who underwent only ipsilateral groin treatment or no further treatment, we determined the incidence of contralateral groin recurrences during follow-up. RESULTS Of 1912 patients with early-stage VSCC, 366 had a unilateral metastatic SN. Subsequently, 244 had an IFL or no treatment of the contralateral groin. In seven patients (7/244; 2.9% [95% CI: 1.4%-5.8%]) disease was diagnosed in the contralateral groin: five had contralateral non-SN metastasis at IFL and two developed an isolated contralateral groin recurrence after no further treatment. Five of them had a primary tumor ≥30 mm. Bilateral radiotherapy was administered in 122 patients, of whom one (1/122; 0.8% [95% CI: 0.1%-4.5%]) had a contralateral groin recurrence. CONCLUSION The risk of contralateral lymph node metastases in patients with early-stage VSCC and a unilateral metastatic SN is low. It appears safe to limit groin treatment to unilateral IFL or inguinofemoral radiotherapy in these cases.
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Esber A, Kopera A, Radosa MP, Runnebaum IB, Mothes HK, Mothes AR. “Locus minoris resistentiae” and connective tissue weakness in older women: a case report and literature review on pelvic organ prolapse with inguinal bladder hernia. BMC Womens Health 2021; 21:425. [PMID: 34930209 PMCID: PMC8690437 DOI: 10.1186/s12905-021-01554-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/29/2021] [Indexed: 11/15/2022] Open
Abstract
Background Conditions such as genital prolapse and hernia are known to be related to connective tissue dysfunction. In this report on cases of the rare simultaneous finding of large genital prolapse and post-prolapse repair female inguinal bladder hernia, we aim to contribute to the discussion of a possible clinical definition of connective tissue weakness, for its clinical assessment and preoperative patient counselling. Case presentation Three cases of medial third-grade (MIII, Aachen classification) inguinal bladder hernia developing or enlarging after successful stage-IV pelvic organ prolapse (POP) repair at a university pelvic floor centre are presented. All patients were aged ≥ 80 years with long-standing postmenopausal status. One patient was followed for 5 years and two patients were followed for 6 months. In all patients, ultrasound revealed that the hernia sac contained the urinary bladder, which had herniated through the inguinal hernia orifice. A literature search revealed only one case report of direct female inguinal bladder hernia and few investigations of the simultaneous occurrence of POP and hernia in general. Conclusion The simultaneous occurrence of inguinal hernia and female POP can lead to bladder herniation following prolapse surgery in the sense of a “locus minoris resistentiae”. Clinical examination for simultaneous signs of connective tissue weakness and counselling prior to pelvic reconstructive surgery could help to increase patients’ compliance with further surgical treatment for hernia.
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Mothes AR, Mothes HK, Kather A, Altendorf-Hofmann A, Radosa MP, Radosa JC, Runnebaum IB. Inverse correlation between urethral length and continence before and after native tissue pelvic floor reconstruction. Sci Rep 2021; 11:22011. [PMID: 34759288 PMCID: PMC8580999 DOI: 10.1038/s41598-021-01565-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/22/2021] [Indexed: 01/10/2023] Open
Abstract
Urethral length was evaluated retrospectively in patients with prolapse undergoing anterior native-tissue repair. Effects of age, prolapse stage, defect pattern, urodynamic and clinical stress test findings, and tension-free vaginal tape (TVT) surgery indication were analyzed using Mann-Whitney and Wilcoxon tests and linear and logistic regression. Of 394 patients, 61% had stage II/III and 39% had stage IV prolapse; 90% of defects were central (10% were lateral). Median pre- and postoperative urethral lengths were 14 and 22 mm (p < 0.01). Preoperative urethral length was greater with lateral defects [p < 0.01, B 6.38, 95% confidence interval (CI) 4.67-8.08] and increased stress incontinence risk (p < 0.01, odds ratio 1.07, 95% CI 1.03-1.12). Postoperative urethral length depended on prolapse stage (p < 0.01, B 1.61, 95% CI 0.85-2.38) and defect type (p = 0.02, B - 1.42, 95% CI - 2.65 to - 0.2). Postoperatively, TVT surgery was indicated in 5.1% of patients (median 9 months), who had longer urethras than those without this indication (p = 0.043). Native-tissue prolapse repair including Kelly plication increased urethral length, reflecting re-urethralization, particularly with central defects. The functional impact of urethral length in the context of connective tissue aging should be examined further.
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Kirsche L, Jansen L, Petzold A, Gaßler N, Runnebaum IB, Dürst M. Intratumorale Heterogenität von HPV-Integraten in CIN3-Gewebe. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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George S, Jansen L, Weigand W, Runnebaum IB, Dürst M, Backsch C. Three-dimensional tumor spheroid models to investigate tumor-stroma-interactions under the influence of the tumorsuppressor gene ITIH5. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Häfner N, Fritsch F, Kache T, Noack S, Stein M, Diebolder H, Dürst M, Runnebaum IB. Identification and validation of a methylation marker panel for the blood-based detection of epithelial ovarian cancer (EOC) – the ASSURER project. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Bräuer D, Hoppe I, Nicolaus K, Runnebaum IB. Einfluss von Endometriose auf die ovarielle Reaktion während der kontrollierten ovariellen Stimulationsbehandlung, gemessen anhand FORT und der Anzahl der gewonnenen Oozyten. Geburtshilfe Frauenheilkd 2019. [DOI: 10.1055/s-0039-1692097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Häfner N, Noack S, Dürst M, Runnebaum IB. Etablierung von Methylierungsmarkern für zirkulierende Tumor-DNA von Ovarialkarzinomen – ASSURER Projekt. Geburtshilfe Frauenheilkd 2019. [DOI: 10.1055/s-0039-1692067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Rothen P, Diebolder H, Runnebaum IB, Häfner N. Untersuchung von Methylierungsmarkern für den Nachweis von Ovarialkarzinomen anhand von Bauchraumspülflüssigkeiten. Geburtshilfe Frauenheilkd 2019. [DOI: 10.1055/s-0039-1692071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Ziller N, Runnebaum IB, Dürst M, Backsch C. Epigenetische und genetische Aberrationen des Tumorsuppressorgens ITIH5 während der Zervixkarzinogenese. Geburtshilfe Frauenheilkd 2019. [DOI: 10.1055/s-0039-1692074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Backsch C, Daum AK, Runnebaum IB, Dürst M. Einfluss des Tumorsuppressorgens ITIH5 auf zwei Zervixkarzinom-Zelllinien in einem 3D Tumorsphäroid-Modell. Geburtshilfe Frauenheilkd 2019. [DOI: 10.1055/s-0039-1692073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Reckenbeil L, Nicolaus K, Runnebaum IB. Diagnose Endometriose: Art und Dauer der Symptome, Anzahl der Arztkonsultationen und Einfluss auf das Arbeits- und Privatleben der Patientinnen. Geburtshilfe Frauenheilkd 2019. [DOI: 10.1055/s-0039-1692105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Kroll L, Dürst M, Runnebaum IB, Häfner N. Immunhistochemische Untersuchung zur Korrelation vom Hormonrezeptor-Expression und RUNX3-Expression in Mamma- und Ovarialkarzinomen. Geburtshilfe Frauenheilkd 2019. [DOI: 10.1055/s-0039-1692072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Dargel S, Mothes A, Runnebaum IB. Analyse des klinischen Outcomes nach transzervikaler Radiofrequenzablation mit intrauteriner Ultraschallführung bei Uterusmyomen. Geburtshilfe Frauenheilkd 2019. [DOI: 10.1055/s-0039-1692101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Runnebaum IB, Hilpert F, du Bois A, Harter P. Therapy of ovarian cancer (OC) in Germany – Treatment characteristics QS OVAR 2016. Geburtshilfe Frauenheilkd 2019. [DOI: 10.1055/s-0039-1692077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Sczesny R, Bräuer D, Nicolaus K, Runnebaum IB. Sterilität, Nulliparität und geringe Myomgröße sind unabhängige Risikofaktoren für eine unerwartete koexistente Endometriose bei Frauen mit symptomatischen uterinen Myomen. Geburtshilfe Frauenheilkd 2019. [DOI: 10.1055/s-0039-1692106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Möbus V, Jackisch C, Lück HJ, du Bois A, Thomssen C, Kuhn W, Nitz U, Schneeweiss A, Huober J, Harbeck N, von Minckwitz G, Runnebaum IB, Hinke A, Konecny GE, Untch M, Kurbacher C. Ten-year results of intense dose-dense chemotherapy show superior survival compared with a conventional schedule in high-risk primary breast cancer: final results of AGO phase III iddEPC trial. Ann Oncol 2019; 29:178-185. [PMID: 29069370 DOI: 10.1093/annonc/mdx690] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Primary breast cancer (BC) patients with extensive axillary lymph-node involvement have a limited prognosis. The Arbeitsgemeinschaft fuer Gynaekologische Onkologie (AGO) trial compared intense dose-dense (idd) adjuvant chemotherapy with conventionally scheduled chemotherapy in high-risk BC patients. Here we report the final, 10-year follow-up analysis. Patients and methods Enrolment took place between December 1998 and April 2003. A total of 1284 patients with 4 or more involved axillary lymph nodes were randomly assigned to receive 3 courses each of idd sequential epirubicin, paclitaxel and cyclophosphamide (iddEPC) q2w or standard epirubicin/cyclophosphamide followed by paclitaxel (EC → P) q3w. Event-free survival (EFS) was the primary end point. Results A total of 658 patients were assigned to receive iddEPC and 626 patients were assigned to receive EC → P. The median duration of follow-up was 122 months. EFS was 47% (95% CI 43% to 52%) in the standard group and 56% (95% CI 52% to 60%) in the iddEPC group [hazard ratio (HR) 0.74, 95% CI 0.63-0.87; log-rank P = 0.00014, one-sided]. This benefit was independent of menopausal, hormone receptor or HER2 status. Ten-year overall survival (OS) was 59% (95% CI 55% to 63%) for patients in the standard group and 69% (95% CI 65% to 73%) for patients in the iddEPC group (HR = 0.72, 95% CI 0.60-0.87; log-rank P = 0.0007, two-sided). Nine versus two cases of secondary myeloid leukemia/myelodysplastic syndrome were observed in the iddEPC and the EC → P arm, respectively. Conclusion The previously reported OS benefit of iddEPC in comparison to conventionally dosed EC → P has been further increased and achieved an absolute difference of 10% after 10 years of follow-up.
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Mothes AR, Runnebaum IB. Vaginale ablative Erbium: YAG Lasertherapie bei Atrophie bedingten urogenitalen Symptomen post-menopausaler Mammakarzinom Patientinnen. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Dargel S, Mothes A, Runnebaum IB. Analyse des klinischen Outcomes nach transzervikaler Radiofrequenzablation mit intrauteriner Ultraschallführung bei Uterusmyomen. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Beiersdorf J, Scheungraber C, Schmitz M, Hansel A, Hoyer H, Gajda M, Greinke C, Runnebaum IB, Dürst M, Backsch C. Korrelation der chromosomalen Aberration 3q26 und Promotormethylierung bei Patientinnen mit CIN2/3 in Abhängigkeit vom Alter. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1670997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Mothes AR, Runnebaum IB. Rationale und Ergebnisse nach vaginaler ablativer Erbium:YAG Lasertherapie bei urogynäkologischen Symptomen. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Krüger-Rehberg S, Sobek JM, Scheungraber C, Runnebaum IB. Rezidivrisiko der Vulvären intraepithelialen Neoplasien (VIN) nach Lasertherapie. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Eberhardt M, Häfner N, Kritsch D, Rengsberger M, Dürst M, Runnebaum IB. BCL6 function and platin resistance in epithelial ovarian cancer. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Rengsberger M, Pachmann K, Runnebaum IB. Trajectory of circulating epithelial tumor cells (CTC/CETCs) during adjuvant chemotherapy in patients with primary breast cancer: Early detection of patients at risk of relapse. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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