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Chowdhury B, Luu V, Luu A, Kabir M, Pan Y, Teoh H, Quan A, Connelly K, Mazer C, Verma S. THE SGLT2 INHIBITOR EMPAGLIFLOZIN REDUCES MORTALITY IN EXPERIMENTAL PULMONARY HYPERTENSION. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Garg V, Verma S, Connelly K. Mechanistic insights regarding the role of SGLT2 inhibitors and GLP1 agonist drugs on cardiovascular disease in diabetes. Prog Cardiovasc Dis 2019; 62:349-357. [PMID: 31381891 DOI: 10.1016/j.pcad.2019.07.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 07/19/2019] [Indexed: 12/22/2022]
Abstract
The treatment landscape for patients with established or at high risk for cardiovascular disease and type 2 diabetes mellitus has entirely changed over the past decade, with the introduction of several anti-hyperglycemic agents. Sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) agonists are two anti-hyperglycemic classes which have been of special interest after multiple large cardiovascular disease (CVD) outcomes studies have demonstrated superiority of these agents compared to placebo for major adverse CVD events and in some cases, hospitalization for heart failure. Despite the dramatic results of these trials, only recently have we began to understand the mechanisms underlying these CVD benefits. Here we review the underlying mechanisms which have the greatest plausibility for both of these agents including the impact of ventricular loading conditions, direct effects on cardiac structure and function, myocardial energetics and sodium/hydrogen exchange for SGLT2 inhibitors, and the anti-atherosclerotic, anti-inflammatory, and modulation of endothelial function for GLP-1 agonists.
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Woo V, Connelly K, Lin P, McFarlane P. The role of sodium glucose cotransporter-2 (SGLT-2) inhibitors in heart failure and chronic kidney disease in type 2 diabetes. Curr Med Res Opin 2019; 35:1283-1295. [PMID: 30767677 DOI: 10.1080/03007995.2019.1576479] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Heart failure (HF) and chronic kidney disease (CKD) are responsible for substantial morbidity and mortality in individuals with type 2 diabetes (T2D). Methods: This review discusses the significance of these comorbidities of T2D and current options for managing them, with a focus on sodium-glucose cotransporter-2 (SGLT-2) inhibitors. Based on a focused literature search of cardiovascular outcomes trials (CVOTs), this review assessed the effects of SGLT-2 inhibitors in individuals with T2D with or without established cardiovascular disease (CVD). Results: In addition to effective glycemic control and weight loss, SGLT-2 inhibitor treatment of T2D prevents adverse cardiovascular and renal outcomes in individuals with and without these comorbidities. Reduced rate of hospitalization due to HF (HHF) and improved renal outcomes appear to be class effects of SGLT-2 inhibitors. Reduction in CV events may be more significant in individuals with established cardiovascular disease. Conclusions: CVOTs and other studies confirm that the SGLT-2 inhibitors, mostly used in combination with other glucose-lowering drugs, offer several clinical benefits beyond improved glycemic control. These include reducing HHF risk and improving renal outcomes. HF and renal benefits are observed in individuals with and without established CVD, which may simplify therapeutic selection. Ongoing SGLT-2 inhibitor CVOTs will help clarify the potential of these drugs to treat T2D comorbid with different forms of HF (HF with preserved vs reduced ejection fraction) and different degrees of renal dysfunction, and in individuals with T2D vs pre-diabetes or normal glucose metabolism.
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Gandhi S, Eckstein J, Fam N, Edwards J, Connelly K. Transfemoral mitral valve-in-valve implantation for prosthetic mitral regurgitation. Eur Heart J Cardiovasc Imaging 2019; 20:485. [PMID: 30561540 DOI: 10.1093/ehjci/jey205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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30
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Johri AM, Poirier P, Dorian P, Fournier A, Goodman JM, McKinney J, Moulson N, Pipe A, Philippon F, Taylor T, Connelly K, Baggish AL, Krahn A, Sharma S. Canadian Cardiovascular Society/Canadian Heart Rhythm Society Joint Position Statement on the Cardiovascular Screening of Competitive Athletes. Can J Cardiol 2019; 35:1-11. [DOI: 10.1016/j.cjca.2018.10.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 10/29/2018] [Accepted: 10/29/2018] [Indexed: 12/15/2022] Open
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31
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Zahrani M, Connelly K, Leong-Poi H, Chow C, Edwards J, Gandhi S, Limoges M, Lu J. THE TREND OF APPROPRIATE USE OF STRESS ECHOCARDIOGRAPHY AT A TEACHING HOSPITAL. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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32
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Mancini GBJ, Cheng AY, Connelly K, Fitchett D, Goldenberg R, Goodman S, Leiter LA, Lonn E, Paty B, Poirier P, Stone J, Thompson D, Verma S, Woo V, Yale JF. CardioDiabetes: Core Competencies for Cardiovascular Clinicians in a Rapidly Evolving Era of Type 2 Diabetes Management. Can J Cardiol 2018; 34:1350-1361. [DOI: 10.1016/j.cjca.2018.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 07/13/2018] [Accepted: 07/13/2018] [Indexed: 12/18/2022] Open
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Connelly K, Desjardins J, Zhang Y, Kabir G, Thai K, Gilbert R. DELINEATING THE MECHANISMS THAT CONTRIBUTE TO REDUCED HEART FAILURE WITH EMPAGLIFLOZIN IN THE EXPERIMENTAL SETTING. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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34
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McGuinty C, Dorian P, Connelly K, Chan R, Adler A, Rakowski H, Aves T, Landry C. HOW ACCURATE IS THE ECG IN SCREENING FOR HYPERTROPHIC CARDIOMYOPATHY? Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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35
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Hausleiter J, Ruf T, Connelly K, Ho E, Braun D, Schulz E, Nabauer M, Von Bardeleben RS, Fam N. P1591Novel transcatheter repair system for the treatment of severe tricuspid regurgitation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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36
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Ho E, Fam N, Connelly K, Ong G, Edwards J, Pozzoli A, Kuwata S, Gulmez G, Nietlispach F, Zuber M, Hahn R, Maisano F, Taramasso M. 5324Reduction in heart failure admission rate after transcatheter edge-to-edge tricuspid valve repair for severe tricuspid regurgitation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Connelly K, Gandhi S, Horton E. Lifestyle and CV Risk in Patients With Diabetes: Time to Get "Back to Basics". J Am Coll Cardiol 2018; 71:2877-2879. [PMID: 29929609 DOI: 10.1016/j.jacc.2018.04.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 04/24/2018] [Indexed: 11/29/2022]
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38
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Fam N, Ho E, Ahmed N, Connelly K. Transcatheter edge-to-edge repair of lead-associated tricuspid regurgitation. EUROINTERVENTION 2017; 13:1166-1167. [DOI: 10.4244/eij-d-17-00693] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Desjardins J, Zhang Y, Thai K, Kabir G, Gilbert R, Connelly K. CARDIAC EFFECTS OF COMBINED SGLT 1/2 INHIBITION FOLLOWING EXPERIMENTAL MYOCARDIAL INFARCTION IN THE RAT. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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40
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Connolly K, Kuhlmann M, Ong G, Levitt K, Abdel-Qadir H, Ho E, Chow C, Leong-Poi H, Connelly K. USE OF THE VALVE VISUALIZATION ON ECHOCARDIOGRAPHY GRADE (VVEG) TOOL IMPROVES NEGATIVE PREDICTIVE VALUE OF TRANSTHORACIC ECHOCARDIOGRAM FOR RULING OUT VALVULAR VEGETATION. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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41
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Desjardins J, Zhang Y, Thai K, Kabir G, Gilbert R, Connelly K. EMPAGLIFLOZIN REDUCES LV MASS AND IMPROVES DIASTOLIC FUNCTION IN AN EXPERIMENTAL MODEL OF HEART FAILURE WITH PRESERVED EF. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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42
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Song N, Brezden-Masley C, Barfett J, Freeman M, Chan K, Haq R, Petrella T, Dhir V, Jimenez-Juan L, Chacko B, Kotha V, Connelly K, Yan A. SERIAL MEASUREMENT OF DIASTOLIC FUNCTION BY CARDIAC MRI IN EARLY STAGE BREAST CANCER PATIENTS ON TRASTUZUMAB: A PROSPECTIVE OBSERVATIONAL STUDY. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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43
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Ong P, Wald R, Goldstein M, Leipsic J, Kiaii M, Deva D, Connelly K, Kirpalani A, Jimenez-Juan L, Bello O, Azizi P, Wald R, Yan A. LEFT VENTRICULAR STRAIN ANALYSIS USING CARDIAC MRI IN PATIENTS UNDERGOING IN-CENTRE NOCTURNAL HEMODIALYSIS. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Taramasso M, Hahn R, Alessandrini H, Latib A, Attinger A, Braun D, Brochet E, Calen C, Connelly K, Denti P, Deuschl F, Fam N, Frerker C, Hausleiter J, Juliard JM, Kaple R, Kuck KH, Kuwata S, Ancona M, Mehr M, Nazif T, Nickenig G, Nietlispach F, Schofer J, Pozzoli A, Schäfer U, Schueler R, Tang G, Webb J, Yzeiraj E, Maisano F, Leon M. TCT-86 Which patients are undergoing transcatheter tricuspid repair today? An update from the International Multicenter Transcatheter Tricuspid Valve Therapies (TriValve) Registry. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kennedy R, Williams C, Sawyer P, Lo A, Connelly K, Nassel A, Brown C. LIFE-SPACE PREDICTS HEALTHCARE UTILIZATION IN COMMUNITY-DWELLING OLDER ADULTS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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46
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Rajagopalan S, Alaiti MA, Broadwater K, Goud A, Gaztanaga J, Connelly K, Fares A, Shirazian S, Kreatsoulas C, Farkouh M, Dobre M, Fink JC, Weir MR. Design of the Magnetic Resonance Imaging Evaluation of Mineralocorticoid Receptor Antagonism in Diabetic Atherosclerosis (MAGMA) Trial. Clin Cardiol 2017; 40:633-640. [PMID: 28555959 DOI: 10.1002/clc.22718] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 03/15/2017] [Accepted: 03/21/2017] [Indexed: 12/13/2022] Open
Abstract
Mineralocorticoid receptor (MR) activation plays an essential role in promoting inflammation, fibrosis, and target organ damage. Currently, no studies are investigating MR antagonism in patients with type 2 diabetes mellitus (T2DM) with chronic kidney disease, at high risk for cardiovascular complications, who are otherwise not candidates for MR antagonism by virtue of heart failure. Further, there is limited information on candidate therapies that may demonstrate differential benefit from this therapy. We hypothesized that MR antagonism may provide additional protection from atherosclerosis progression in higher-risk patients who otherwise may not be candidates for such a therapeutic approach. In this double-blind, randomized, placebo-controlled trial, subjects with T2DM with chronic kidney disease (≥ stage 3) will be randomized in a 1:1 manner to placebo or spironolactone (12.5 mg with eventual escalation to 25 mg daily over a 4-week period). The co-primary efficacy endpoint will be percentage change in total atheroma volume in thoracic aorta and left ventricular mass at 52 weeks in patients treated with spironolactone vs placebo. Secondary outcomes include 24-hour mean systolic blood pressure, central aortic blood pressure, and insulin resistance (HOMA-IR) at 6 weeks. A novel measure in the study will be changes in candidate miRNAs that regulate expression of NR3C2 (MR gene) as well as measuring monocyte/macrophage polarization in response to therapy with spironolactone. We envision that our strategy of simultaneously probing the effects of a drug combined with analysis of mechanisms of action and predictive response will likely provide key information with which to design event-based trials.
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Mancini GBJ, Cheng AY, Connelly K, Fitchett D, Goldenberg R, Goodman SG, Leiter LA, Lonn E, Paty B, Poirier P, Stone J, Thompson D, Yale JF. Diabetes for Cardiologists: Practical Issues in Diagnosis and Management. Can J Cardiol 2016; 33:366-377. [PMID: 28340996 DOI: 10.1016/j.cjca.2016.07.512] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 07/13/2016] [Accepted: 07/13/2016] [Indexed: 02/06/2023] Open
Abstract
Diabetes mellitus (DM), a chronic metabolic disease characterized by hyperglycemia, is a profound cardiovascular (CV) risk factor. It compounds the effects of all other risk factors, leads to premature micro- and macrovascular disease, facilitates development of heart failure, worsens the clinical course of all CV diseases, and shortens life expectancy. Established DM, unrecognized DM, and dysglycemia that may progress to DM are all commonly present at the time of presentation of overt CV disease. Thus, CV specialists and trainees frequently treat patients with dysglycemia. The traditional and proven role of cardiologists in reducing the risk of macrovascular events in this population is through aggressive lipid and blood pressure treatment. However, a more proactive role in the detection and management of DM is likely to become increasingly important as the prevalence continues to increase and therapies continue to improve. The latter include antihyperglycemic therapies with proven cardiovascular safety profiles and CV event reduction properties not yet fully elucidated and not necessarily related to glycemic control. Accordingly, the purpose of this article is to (1) expand the interest of cardiologists in earlier stages of the natural history of DM, when prevention or early detection might help achieve greatest benefit; (2) highlight principles of optimal glycemic management, with an emphasis on add-on choices showing promising reduction of CV events and lacking CV adverse effects; and (3) encourage cardiologists to become proactive partners in the multidisciplinary care needed to ensure optimal lifelong vascular health in patients with, or who are at risk of, DM.
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Segan J, Connelly K, Cicuttini F, Wluka A. AB1013 Systematic Review of Patient Perceived Health Service Needs in Inflammatory Arthritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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49
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Van Orman JR, Connelly K, Albinmousa Z, Tousignant C. Early recovery of tricuspid annular isovolumic acceleration after mitral valve surgery – an observational study. Can J Anaesth 2016; 63:920-7. [DOI: 10.1007/s12630-016-0651-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 02/23/2016] [Accepted: 04/05/2016] [Indexed: 10/21/2022] Open
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50
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Landry C, Allan K, Connelly K, Morrison L, Dorian P. HOW USEFUL IS A PRE-PARTICIPATION SCREENING PROGRAM TO PREVENT CARDIAC ARREST DURING SPORT? INSIGHTS FROM A REGISTRY OF ALL SPORTS-RELATED CARDIAC ARRESTS IN A LARGE URBAN POPULATION. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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