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Mahale R, Mehta A, Konnur A, Acharya P, Srinivasa R. Upper Limb Monochorea Due to Cerebral Venous Sinus Thrombosis: Rare Occurrence. Neurol India 2019; 67:1138-1139. [PMID: 31512659 DOI: 10.4103/0028-3886.266255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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John AA, Javali M, Mahale R, Mehta A, Acharya PT, Srinivasa R. Clinical impression and Western Aphasia Battery classification of aphasia in acute ischemic stroke: Is there a discrepancy? J Neurosci Rural Pract 2019; 8:74-78. [PMID: 28149086 PMCID: PMC5225728 DOI: 10.4103/0976-3147.193531] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Language disturbance is a common symptom of stroke, a prompt identifier of the event, and can cause devastating cognitive impairments. There are many inconsistencies and discrepancies between the different methods used for its evaluation. The relationship between Western Aphasia Battery (WAB) and a simple bedside clinical examination is not clear. Aim: The aim of this study is to determine if bedside clinical impression of aphasia type can reliably predict WAB classification of aphasia and to describe the discrepancies between them. Materials and Methods: Eighty-two consecutive cases of acute ischemic stroke and aphasia were evaluated with bedside aphasia assessment, handedness by Edinburgh Handedness Inventory and WAB scoring was done. Kappa statistics was used to find the overall agreement of clinical impression and WAB. Results: Disagreement was seen predominantly for the nonfluent aphasias when the clinical impression was compared with WAB classification. WAB also had diagnosed three cases as having anomic aphasia using taxonomic classification, but same cases had normal language by aphasia quotient scoring of WAB. There was an overall agreement of 63.4% between patient's bedside clinical impression and WAB classification of aphasia, with a P < 0.001. Conclusion: Clinical impression was fairly reliable, as compared to WAB in assessing the type of aphasia. Clinical impression was appropriate in an acute setting, but WAB was required to quantify the severity of deficit, which may help in accessing prognosis, monitoring progression, and rehabilitation planning. Along with WAB, a bedside clinical impression should be done for all the patients to strengthen the description of aphasic deficit.
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Mehta A, Mahale R, Buddaraju K, Majeed A, Sharma S, Javali M, Acharya P, Srinivasa R. Intravenous Thrombolysis for Acute Ischemic Stroke: Review of 97 Patients. J Neurosci Rural Pract 2019; 8:38-43. [PMID: 28149079 PMCID: PMC5225719 DOI: 10.4103/0976-3147.193558] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Intravenous thrombolysis (IVT) has now become a standard treatment in eligible patients with acute ischemic stroke (AIS) who present within 4.5 h of symptom onset. OBJECTIVE To determine the usefulness of IVT and the subset of patients who will benefit from IVT in AIS within 4.5 h. MATERIALS AND METHODS Patients with AIS within 4.5 h of symptom onset who underwent IVT were studied prospectively. The study period was from October 2011 to October 2015. RESULTS A total of 97 patients were thrombolysed intravenously. The mean onset to needle time in all patients was 177.2 ± 62 min (range: 60-360). At 3 months follow-up, favorable outcome was seen in 65 patients (67.1%) and poor outcome including death in the remaining 32 patients (32.9%). Factors predicting favorable outcome was age <65 years (P = 0.02), the National Institute of Health Stroke Scale (NIHSS) <15 (P < 0.001), small vessel occlusion (P = 0.006), cardioembolism (P = 0.006), and random blood sugar (RBS) <250 mg/dl (P < 0.001). Factors predicting poor outcome was diabetes mellitus (P = 0.01), dyslipidemia (P = 0.01), NIHSS at admission >15 (P = 0.03), RBS >250 mg/dl (P = 0.01), Dense cerebral artery sign, age, glucose level on admission, onset-to-treatment time, NIHSS on admission score >5 (P = 0.03), and occlusion of large artery (P = 0.02). CONCLUSION Milder baseline stroke severity, blood glucose <250 mg/dL, younger patients (<65 years), cardioembolic stroke, and small vessel occlusion benefit from recombinant tissue plasminogen activator.
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Pradeep R, Gupta D, Mehta A, Srinivasa R, Javali M, Acharya PT. Wake-Up Sleepyhead: Unilateral Diencephalic Stroke Presenting with Excessive Sleepiness. J Neurosci Rural Pract 2019; 10:145-147. [PMID: 30765992 PMCID: PMC6337964 DOI: 10.4103/jnrp.jnrp_258_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Altered sleep architecture and stroke share a reciprocal relationship. More than half of the stroke patients display sleep abnormalities including hypersomnia, insomnia, parasomnia, periodic limb movements, or sleep-disordered breathing. Conversely, one of the major causes of severe organic hypersomnia is acute brainstem strokes, involving thalamic infarctions, which may be reversible over 6-12 months. Here, we report a patient with increased lethargy and drowsiness who was diagnosed to have a right thalamic and hypothalamic ischemic stroke.
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Gupta D, R. P, Mehta A, Javali M, Acharya PT, Srinivasa R. Paramedian Midbrain Infarction Presenting as Bilateral Asymmetric Ptosis: A Case Report and Review of Literature. ACTA ACUST UNITED AC 2019. [DOI: 10.1177/2516608519848942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Brainstem strokes can have protean ophthalmological manifestations including pupillary and extraocular muscle pareses. Incomplete paresis of oculomotor function is more common than complete paresis owing to the selective involvement of subnuclei or fascicles for various extraocular muscles. Here, we report a case of right paramedian midbrain stroke presented with asymmetric bilateral ptosis. We discuss the anatomical correlation of this presentation with the structure of oculomotor nerve nuclei and its fascicles.
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Gupta D, Javali M, Pradeep R, Mehta A, Acharya PT, Srinivasa R. Acute confusional state induced by diclofenac: Report and review of literature. Neurol India 2019; 67:858-861. [PMID: 31347566 DOI: 10.4103/0028-3886.263243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Bundy J, Hage A, Srinivasa R, Gemmete J, Srinivasa R, Jairath N, Anand R, Dasika N, Chauhan N, Chick J. 03:09 PM Abstract No. 249 Intra-arterial ampicillin and gentamicin and the incidence of splenic abscesses following splenic artery embolization: a 20-year case control study in 213 patients. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Mahale R, Mehta A, Buddaraju K, Javali M, Shankar A, John A, Srinivasa R. Longitudinally Extensive Transverse Myelitis with Aquaporin-4 Antibody Positivity in Renal Cell Carcinoma: Rare Occurrence. Neurol India 2019; 67:1087-1089. [DOI: 10.4103/0028-3886.266293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mahale R, Mehta A, Miryala A, Srinivasa R. HyperCKemia Can Occur Due to This! A Less Recognized Etiology. Neurol India 2019; 67:1136-1137. [DOI: 10.4103/0028-3886.266288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ramakrishnan TCR, Kumaravelu S, Narayan SK, Buddha SS, Murali C, Majeed PHA, Meenakshi-Sundaram S, Wadia RS, Sharma V, Basu I, Vijaya P, Salam KA, Barmare S, Vaid Z, Nirmal Raj KK, Wattamwar PR, Asokan K, Dhonge V, Nellikunja S, Namjoshi D, Srinivasa R, Laddhad DS, Deshpande SD, Raghunath B, Kalita J, Kumar M, Misra UK, Pradeep M. Efficacy and Safety of Intravenous Tenecteplase Bolus in Acute Ischemic Stroke: Results of Two Open-Label, Multicenter Trials. Am J Cardiovasc Drugs 2018; 18:387-395. [PMID: 29948822 DOI: 10.1007/s40256-018-0284-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Tenecteplase (TNK-tPA) is a promising third-generation plasminogen activator, because of its greater fibrin specificity and longer half-life than alteplase. There is a paucity of studies on intravenous thrombolysis using TNK-tPA in developing countries. The present study has been undertaken to compare the efficacy and safety of TNK-tPA with alteplase. METHODS Two studies were conducted. Study I was an open-label, randomized study in which two doses of TNK-tPA (0.1 and 0.2 mg/kg) were compared. Study II was an open-label study in which TNK-tPA 0.2 mg/kg bolus was compared with historical controls. The primary endpoint for study I and study II was an improvement of ≥ 8 points or a score of 0 on the National Institutes of Health Stroke Scale (NIHSS) [major neurological improvement (MNI)] at 24 h. Secondary endpoints for both studies were neurological improvement as assessed using the NIHSS score, modified Rankin Scale (mRS) score and the Barthel Index (BI) on days 7, 30 and 90. Minimal disability was defined as an mRS score of 0 or 1 and good functional recovery as a BI score of 50-90. Safety was assessed by the proportion of patients having symptomatic intracranial hemorrhage (sICH) within 36 h and asymptomatic intracranial hemorrhage at 48 h after treatment. RESULTS In study I, 20 patients received 0.1 mg/kg and 30 received 0.2 mg/kg TNK-tPA. There was no significant difference in MNI at 24 h between 0.1 and 0.2 mg/kg TNK-tPA doses. The patients given 0.2 mg/kg TNK-tPA had a significantly better 3-month outcome (minimal disability, p = 0.007). There was no sICH in study I. In study II, 62 patients (one lost to follow-up) received 0.2 mg/kg TNK-tPA. MNI was noted in ten patients (16.4%), 3-month minimal disability was noted in 37 patients (60.7%), and good functional recovery was seen in 33 patients (54.1%). sICH occurred in one patient, and four patients died. Pooled data of patients in study I and study II receiving 0.2 mg/kg TNK-tPA were compared with data from the historical National Institute of Neurological Disorders and Stroke (NINDS) trial. For comparison, the primary endpoint of the NINDS trial (improvement on NIHSS of ≥ 4 points or a score of 0 at 24 h) was taken. The primary endpoint though was not significantly different (58.2% vs. 47%, p = 0.08), but with TNK-tPA, greater neurological improvement, minimal disability (70.3 vs. 39%, p < 0.001) and good functional recovery (36.3 vs. 16%, p < 0.001) was noted at 3 months. There was a lower incidence of sICH (1.1 vs. 6.4%, p = 0.05) and lower 3-month mortality (5.5 vs. 17%, p = 0.01) noted with TNK-tPA compared with alteplase. CONCLUSIONS Intravenous TNK-tPA 0.2 mg/kg administered within 3 hours of symptom onset seems to be well tolerated and effective option in patients with acute ischemic stroke. TRIAL REGISTRATION Clinical Trials Registry-India, www.ctri.nic.in ; unique identifiers: CTRI/2009/091/000251 and CTRI/2015/02/005556.
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Srinivasa R, Chick J, Hage A, Shields J, Cooper K, Saad W, Majdalany B. Abstract No. 567 Transnasal and transgastric snare technique for the placement of retrograde primary jejunostomy tubes. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Srinivasa R, Chick J, Gemmete J. Abstract No. 598 Neonatal thoracic duct embolization: technical and clinical outcomes. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Bundy J, Srinivasa R, Gemmete J, Hage A, Majdalany B, Khaja M, Saad W, Chick J. Abstract No. 589 Vascular and lymphatic complications following thoracic duct cannulation: experience in 58 patients. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Bundy J, Srinivasa R, Gemmete J, Hage A, Majdalany B, Saad W, Chick J. 4:03 PM Abstract No. 168 Results of percutaneous cholecystostomy tube placement in 324 patients. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Hage A, Srinivasa R, Chick J. 3:45 PM Abstract No. 356 Technical Success, Complications, and Reinterventions of Sharp Recanalization for the Treatment of Chronic Venous Occlusions: Experience in 142 Patients. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Srinivasa R, Majdalany B, Saad W, Hage A, Gemmete J, Chick J. Abstract No. 419 Prone transradial catheterization for combined single-session endovascular and percutaneous interventions: approach, technical success, safety, and outcomes in 15 patients. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Mahale R, Mehta A, Hegde S, Buddaraju K, Javali M, Acharya P, Srinivasa R. Sporadic spinocerebellar ataxia, type 5: First report from India. Neurol India 2018; 66:230-231. [DOI: 10.4103/0028-3886.222857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mahale R, Mehta A, Shetty N, Srinivasa R. Does cerebral infarction ameliorate essential tremor? A mini-review. Neurol India 2018; 66:S152-S154. [DOI: 10.4103/0028-3886.226462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mahale RR, Mehta A, Miryala A, Srinivasa R. Spinocerebellar Ataxia Type 7 Sans Retinal Degeneration: A Phenotypic Variability. Ann Indian Acad Neurol 2017; 20:438-439. [PMID: 29184358 PMCID: PMC5682759 DOI: 10.4103/aian.aian_236_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mahale R, Mehta A, Srinivasa R. Proprioceptive-Induced Reflex Postinfarct Seizures: A Rare Occurrence. J Neurosci Rural Pract 2017; 8:687-689. [PMID: 29204045 PMCID: PMC5709908 DOI: 10.4103/jnrp.jnrp_263_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Javali M, Acharya P, Mehta A, John AA, Mahale R, Srinivasa R. Use of multiplex PCR based molecular diagnostics in diagnosis of suspected CNS infections in tertiary care setting-A retrospective study. Clin Neurol Neurosurg 2017; 161:110-116. [PMID: 28866263 DOI: 10.1016/j.clineuro.2017.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/22/2017] [Accepted: 08/27/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES CNS infections like meningitis and encephalitis pose enormous healthcare challenges due to mortality, sequelae and socioeconomic burden. In tertiary setting, clinical, microbiological, cytological and radiological investigations are not distinctive enough for diagnosing microbial etiology. Molecular diagnostics is filling this gap. We evaluated the clinical impact of a commercially available multiplex molecular diagnostic system - SES for diagnosing suspected CNS infections. PATIENTS AND METHODS This study was conducted in our tertiary level Neurology ICU. 110 patients admitted during Nov-2010 to April-2014 were included. CSF samples of patients clinically suspected of having CNS infections were subjected to routine investigation in our laboratory and SES test at XCyton Diagnostics. We studied the impact of SES in diagnosis of CNS infections and its efficacy in helping therapeutic management. RESULTS SES showed detection rate of 42.18% and clinical specificity of 100%. It had 10 times higher detection rate than conventional tests. Streptococcus pneumoniae and Mycobacterium tuberculosis were two top bacterial pathogens. VZV was most detected viral pathogen. SES results elicited changes in therapy in both positive and negative cases. We observed superior patient outcomes as measured by GCS scale. 75% and 82.14% of the patients positive and negative on SES respectively, recovered fully. CONCLUSION Detecting causative organism and ruling out infectious etiology remain the most critical aspect for management and prognosis of patients with suspected CNS infections. In this study, we observed higher detection rate of pathogens, target specific escalation and evidence based de-escalation of antimicrobials using SES. Institution of appropriate therapy helped reduce unnecessary use of antimicrobials.
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Mahale RR, Buddaraju K, Gireesh MS, Acharya P, Srinivasa R. Acute Generalized Chorea as Presenting Manifestation of Uremic Encephalopathy. J Neurosci Rural Pract 2017; 8:S156-S158. [PMID: 28936101 PMCID: PMC5602251 DOI: 10.4103/jnrp.jnrp_158_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Mahale RR, Mehta A, Srinivasa R. Photosensitive Posthypoxic Reflex Myoclonus in a Postcardiac Arrest Individual: An Interesting Finding. J Neurosci Rural Pract 2017; 8:489-490. [PMID: 28694648 PMCID: PMC5488589 DOI: 10.4103/jnrp.jnrp_13_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Mahale RR, Buddaraju K, Mehta A, Javali M, Acharya P, Srinivasa R. Acute Bilateral Supranuclear Vertical Gaze Palsy: Vertical One-and-a-one Syndrome - Report of Three Cases. J Neurosci Rural Pract 2017; 8:313-316. [PMID: 28479825 PMCID: PMC5402517 DOI: 10.4103/jnrp.jnrp_478_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Mahale R, Mehta A, Varma RG, Hegde AS, Acharya PT, Srinivasa R. Decompressive surgery in malignant cerebral venous sinus thrombosis: what predicts its outcome? J Thromb Thrombolysis 2017; 43:530-539. [DOI: 10.1007/s11239-017-1489-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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