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Zimmermann F, Pijls N, De Bruyne B, Bech JW, van Schaardenburgh P, Gould KL, Johnson N, Kirkeeide RL. TCT-537 What can intracoronary pressure measurements tell us about flow reserve? Pressure-bounded CFR and its application to the randomized DEFER trial. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.674] [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: 10/20/2022]
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Gould KL, Johnson NP. Ischemia in Aortic Stenosis. J Am Coll Cardiol 2016; 68:698-701. [DOI: 10.1016/j.jacc.2016.05.070] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 05/18/2016] [Indexed: 10/21/2022]
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van Lavieren MA, van de Hoef TP, Sjauw KD, Piek JJ, Ferrara A, De Bruyne B, Gould KL. How should I treat a patient with refractory angina and a single stenosis with normal FFR but abnormal CFR? EUROINTERVENTION 2016; 11:125-8. [PMID: 25982657 DOI: 10.4244/eijv11i1a23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kobayashi Y, Johnson N, Berry C, De Bruyne B, Gould KL, Jeremias A, Oldroyd K, Pijls N, Fearon W. INFLUENCE OF LESION LOCATION ON THE DIAGNOSTIC ACCURACY OF ADENOSINE-FREE CORONARY PRESSURE WIRE MEASUREMENTS: THE CONTRAST (CAN CONTRAST INJECTION BETTER APPROXIMATE FFR COMPARED TO PURE RESTING PHYSIOLOGY?) SUBSTUDY. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30031-6] [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: 11/15/2022]
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Patel MB, Bui LP, Kirkeeide RL, Gould KL. Imaging Microvascular Dysfunction and Mechanisms for Female-Male Differences in CAD. JACC Cardiovasc Imaging 2016; 9:465-82. [DOI: 10.1016/j.jcmg.2016.02.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/08/2016] [Accepted: 02/10/2016] [Indexed: 11/28/2022]
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Johnson NP, Jeremias A, Zimmermann FM, Adjedj J, Witt N, Hennigan B, Koo BK, Maehara A, Matsumura M, Barbato E, Esposito G, Trimarco B, Rioufol G, Park SJ, Yang HM, Baptista SB, Chrysant GS, Leone AM, Berry C, De Bruyne B, Gould KL, Kirkeeide RL, Oldroyd KG, Pijls NH, Fearon WF. Continuum of Vasodilator Stress From Rest to Contrast Medium to Adenosine Hyperemia for Fractional Flow Reserve Assessment. JACC Cardiovasc Interv 2016; 9:757-767. [DOI: 10.1016/j.jcin.2015.12.273] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 12/28/2015] [Accepted: 12/29/2015] [Indexed: 01/29/2023]
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Gould KL, Johnson NP. Coronary Blood Flow After Acute MI: Alternative Truths. JACC Cardiovasc Interv 2016; 9:614-7. [PMID: 27013162 DOI: 10.1016/j.jcin.2016.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 02/09/2016] [Indexed: 11/15/2022]
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Gould KL. Intense Exercise and Native Collateral Function in Stable Moderate Coronary Artery Disease: Incidental, Causal, or Clinically Important? Circulation 2016; 133:1431-4. [PMID: 26979084 DOI: 10.1161/circulationaha.116.022037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gould KL, Johnson NP. Myocardial Bridges: Lessons in Clinical Coronary Pathophysiology. JACC Cardiovasc Imaging 2016; 8:705-9. [PMID: 26068287 DOI: 10.1016/j.jcmg.2015.02.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 02/10/2015] [Indexed: 11/29/2022]
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Gould KL, Johnson NP. Exercise PET: More insight or more complex? J Nucl Cardiol 2015; 22:1281-4. [PMID: 25802178 DOI: 10.1007/s12350-015-0099-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 02/15/2015] [Indexed: 10/23/2022]
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Johnson NP, Kirkeeide RL, Gould KL. History and Development of Coronary Flow Reserve and Fractional Flow Reserve for Clinical Applications. Interv Cardiol Clin 2015; 4:397-410. [PMID: 28581927 DOI: 10.1016/j.iccl.2015.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We discuss the historical development of clinical coronary physiology, emphasizing coronary flow reserve (CFR) and fractional flow reserve (FFR). Our analysis focuses on the clinical motivations and technologic advances that prompted and enabled the application of physiology for patient diagnosis. CFR grew from the general concepts of physiologic and coronary reserve, linking the anatomic severity of a lesion to its impact on hyperemic flow. FFR developed from existing models relating pressure measurements to the potential for flow to increase after removing a stenosis. Because pressure measurements have proved easier and more robust than flow measurements, FFR has become the dominant metric.
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Kitkungvan D, Vejpongsa P, Korrane KP, Sdringola S, Gould KL. Clinical Utility of Enhanced Relative Activity Recovery on Systolic Myocardial Perfusion SPECT: Lessons from PET. J Nucl Med 2015; 56:1882-8. [PMID: 26272807 DOI: 10.2967/jnumed.115.153759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 07/16/2015] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED SPECT and PET myocardial perfusion images show greater myocardial intensity and homogeneity in systole than diastole because of greater systolic myocardial thickness, less partial volume loss, and enhanced activity recovery. Consequently, conventional myocardial perfusion images obtained from whole cardiac cycles have lower myocardial intensity and greater heterogeneity than systolic images. Considering relative activity distribution on SPECT systolic images may add clinical utility to whole-cycle images and wall motion. METHODS Patients undergoing coronary angiogram within 4 mo after SPECT myocardial perfusion imaging were reviewed. Images were interpreted by 2 masked interpreters using a 17-segment, 5-point scale to determine summed rest scores (SSS), summed stress scores, and summed difference scores on conventional and systolic images in 603 patients (55.6% no coronary artery disease [no-CAD] and 44.4% CAD). Studies were considered normal when the SSS was less than 4 and summed difference score was less than 2. RESULTS In the no-CAD group, systolic SSS was lower than SSS from conventional images (2 ± 2.3 vs. 3 ± 2.6, P < 0.001). In contrast, SSS derived from systolic and conventional images were not different in the obstructive CAD group (9.1 ± 7.6 vs. 9.2 ± 7.4, P = 0.559). When systolic images were considered, true-negative studies increased from 27.2% to 43.3% (P < 0.001) whereas false-positive studies decreased from 28.4% to 12.3% (P < 0.001). True-positive (38% vs. 37.2%, P = 0.505) and false-negative studies (6.5% vs. 7%, P = 0.450) were not significantly changed. Diagnostic accuracy increased from 65.2% to 80.8% (P < 0.001). CONCLUSION For gated SPECT myocardial perfusion imaging, when relative activity distribution on systolic images was considered, false-positive studies were reduced and diagnostic accuracy was improved.
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Johnson NP, Johnson DT, Kirkeeide RL, Berry C, De Bruyne B, Fearon WF, Oldroyd KG, Pijls NH, Gould KL. Repeatability of Fractional Flow Reserve Despite Variations in Systemic and Coronary Hemodynamics. JACC Cardiovasc Interv 2015. [DOI: 10.1016/j.jcin.2015.01.039] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Bateman TM, Lance Gould K, Di Carli MF. Proceedings of the Cardiac PET Summit, 12 May 2014, Baltimore, MD : 3: Quantitation of myocardial blood flow. J Nucl Cardiol 2015; 22:571-8. [PMID: 25907353 DOI: 10.1007/s12350-015-0127-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 03/10/2015] [Indexed: 12/22/2022]
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Roby AE, Johnson NP, Gould KL. An Analysis of 3 Common CardioGen-82 82Rb Infusion System Injection Methods and Their Impact on Clinical Volume and Image Counts. J Nucl Med Technol 2015; 43:113-6. [PMID: 25956692 DOI: 10.2967/jnmt.114.152702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 04/02/2015] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED In the wake of the Food and Drug Administration (FDA) recall, many clinics have had to reduce their examination volumes to meet the new generator volume usage requirements. This review tests 3 common infusion methods and how they affect patient dose, generator volume usage, image counts, and generator volume limits. METHODS Three common configurations of the (82)Rb infusion system settings--standard 50-mL, volume-limiting, and bolus methods--were tested to determine how they affect patient dose, generator volume, and image counts. Each injection configuration was tested daily for the duration of 3 consecutive generators by injection into separate vials. Each injection configuration was also infused into a beaker and imaged to determine the impact of image counts for each method. The total estimated volumes for multiple examination and quality assurance clinical situations were simulated to observe the use of each method relative to the new FDA volume alert and expiration limits. RESULTS Vial tests confirmed that the bolus method used the least amount of volume per infusion and stayed the most consistent throughout the life of the generator. The bolus method also produced a lower patient dose after approximately 10 d of use. The beaker tests in the scanner showed that the standard 50-mL method produced the greatest number of total counts for the flow and uptake images. On the basis of the estimated total volume simulations, the bolus method allowed for the most examinations over the life of the generator while staying within the new FDA limits. CONCLUSION All 3 methods for augmenting the (82)Rb infusion system produced different outcomes for patient dose, image counts, and total generator volume use. The standard 50-mL method ensured the maximum amount of counts available for imaging throughout the life of the generator. The bolus method provided a consistent and predictable amount of volume use. The volume-limiting method fell somewhere in the middle of volume predictability and count preservation.
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Gould KL, Johnson NP, Kaul S, Kirkeeide RL, Mintz GS, Rentrop KP, Sdringola S, Virmani R, Narula J. Patient Selection for Elective Revascularization to Reduce Myocardial Infarction and Mortality. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.114.003099. [DOI: 10.1161/circimaging.114.003099] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Johnson NP, Gould KL. Regadenoson versus dipyridamole hyperemia for cardiac PET imaging. JACC Cardiovasc Imaging 2015; 8:438-447. [PMID: 25797122 DOI: 10.1016/j.jcmg.2014.11.016] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 11/16/2014] [Accepted: 11/20/2014] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The goal of this study was to compare regadenoson and dipyridamole hyperemia for quantitative myocardial perfusion imaging. BACKGROUND Regadenoson is commonly used for stress perfusion imaging. However, no study in nuclear cardiology has employed a paired design to compare quantitative hyperemic flow from regadenoson to more traditional agents such as dipyridamole. Additionally, the timing of regadenoson bolus relative to tracer administration can be expected to affect quantitative flow. METHODS Subjects underwent 2 rest/stress cardiac positron emission tomography scans using an Rb-82 generator. Each scan employed dipyridamole and a second drug in random sequence, either regadenoson according to 5 timing sequences or repeated dipyridamole. A validated retention model quantified absolute flow and coronary flow reserve. RESULTS A total of 176 pairs compared regadenoson (126 pairs, split unevenly among 5 timing sequences) or repeated dipyridamole (50 pairs). The cohort largely had few symptoms, only risk factors, and nearly normal relative uptake images, with 8% typical angina or dyspnea, 20% manifest coronary artery disease, and a minimum quadrant average of 80% (interquartile range: 76% to 83%) on dipyridamole scans. Hyperemic flow varied among regadenoson timing sequences but showed consistently lower stress flow and coronary flow reserve compared with dipyridamole. A timing sequence most similar to the regadenoson package insert achieved about 80% of dipyridamole hyperemia, whereas further delaying radiotracer injection reached approximately 90% of dipyridamole hyperemia. Because of the small numbers of pairs for each regadenoson timing protocol and a paucity of moderate or large perfusion defects, we did not observe a difference in relative uptake. CONCLUSIONS With the standard timing protocol from the package insert, regadenoson achieved only 80% of dipyridamole hyperemia quantitatively imaged by cardiac positron emission tomography using Rb-82. A nonstandard protocol using a more delayed radionuclide injection after the regadenoson bolus improved its effect to 90% of dipyridamole hyperemia.
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Gould KL, Johnson NP. Physiologic stenosis severity, binary thinking, revascularization, and "hidden reality". Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.114.002970. [PMID: 25596144 DOI: 10.1161/circimaging.114.002970] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Delgado RI, Swint JM, Lairson DR, Johnson NP, Gould KL, Sdringola S. Cost Analysis of PET and Comprehensive Lifestyle Modification for the Reversal of Atherosclerosis. J Nucl Med 2013; 55:80-7. [DOI: 10.2967/jnumed.113.119511] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Jeremias A, Maehara A, Généreux P, Asrress KN, Berry C, De Bruyne B, Davies JE, Escaned J, Fearon WF, Gould KL, Johnson NP, Kirtane AJ, Koo BK, Marques KM, Nijjer S, Oldroyd KG, Petraco R, Piek JJ, Pijls NH, Redwood S, Siebes M, Spaan JAE, van 't Veer M, Mintz GS, Stone GW. Multicenter core laboratory comparison of the instantaneous wave-free ratio and resting Pd/Pa with fractional flow reserve: the RESOLVE study. J Am Coll Cardiol 2013; 63:1253-1261. [PMID: 24211503 DOI: 10.1016/j.jacc.2013.09.060] [Citation(s) in RCA: 266] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 09/22/2013] [Accepted: 09/22/2013] [Indexed: 01/10/2023]
Abstract
OBJECTIVES This study sought to examine the diagnostic accuracy of the instantaneous wave-free ratio (iFR) and resting distal coronary artery pressure/aortic pressure (Pd/Pa) with respect to hyperemic fractional flow reserve (FFR) in a core laboratory-based multicenter collaborative study. BACKGROUND FFR is an index of the severity of coronary stenosis that has been clinically validated in 3 prospective randomized trials. iFR and Pd/Pa are nonhyperemic pressure-derived indices of the severity of stenosis with discordant reports regarding their accuracy with respect to FFR. METHODS iFR, resting Pd/Pa, and FFR were measured in 1,768 patients from 15 clinical sites. An independent physiology core laboratory performed blinded off-line analysis of all raw data. The primary objectives were to determine specific iFR and Pd/Pa thresholds with ≥90% accuracy in predicting ischemic versus nonischemic FFR (on the basis of an FFR cut point of 0.80) and the proportion of patients falling beyond those thresholds. RESULTS Of 1,974 submitted lesions, 381 (19.3%) were excluded because of suboptimal acquisition, leaving 1,593 for final analysis. On receiver-operating characteristic analysis, the optimal iFR cut point for FFR ≤0.80 was 0.90 (C statistic: 0.81 [95% confidence interval: 0.79 to 0.83]; overall accuracy: 80.4%) and for Pd/Pa was 0.92 (C statistic: 0.82 [95% confidence interval: 0.80 to 0.84]; overall accuracy: 81.5%), with no significant difference between these resting measures. iFR and Pd/Pa had ≥90% accuracy to predict a positive or negative FFR in 64.9% (62.6% to 67.3%) and 48.3% (45.6% to 50.5%) of lesions, respectively. CONCLUSIONS This comprehensive core laboratory analysis comparing iFR and Pd/Pa with FFR demonstrated an overall accuracy of ~80% for both nonhyperemic indices, which can be improved to ≥90% in a subset of lesions. Clinical outcome studies are required to determine whether the use of iFR or Pd/Pa might obviate the need for hyperemia in selected patients.
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Johnson NP, Gould KL. Physiology of endothelin in producing myocardial perfusion heterogeneity: a mechanistic study using darusentan and positron emission tomography. J Nucl Cardiol 2013; 20:835-44. [PMID: 23842710 PMCID: PMC3779022 DOI: 10.1007/s12350-013-9756-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 06/23/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Heterogeneity of resting perfusion may be due in part to up-regulation of coronary vasoconstriction via endothelin (ET) type A receptors, as homogeneity increases during subsequent vasodilatory hyperemia. Therefore, we conducted a mechanistic study using an ET receptor antagonist to determine if it could alter the homogeneity of myocardial perfusion. METHODS Included subjects demonstrated a low myocardial perfusion homogeneity index (HI) compared to normal volunteers. Four serial cardiac positron emission tomography Rb-82 scans were performed 2 weeks apart. Before the middle two scans, subjects were randomized to receive either darusentan first then placebo or visa versa. Absolute flow and coronary flow reserve were quantified for each study. Rest flow was adjusted for the pressure-rate product (PRP). RESULTS We screened 37 subjects and randomized 20 who satisfied entry criteria. Rest HI increased significantly while taking darusentan (0.39 ± 0.10 vs 0.33 ± 0.04 on placebo, P = .030, compared to a normal range of 0.52 ± 0.10) without an increase in the PRP (6,859 ± 1,503 vs 6,976 ± 1,092, P = .79), leading to a higher adjusted flow at rest (0.69 ± 0.18 cc/minute/g at 7,000 PRP vs 0.59 ± 0.07 with placebo). CONCLUSIONS Antagonism of the type A ET receptor increases homogeneity of resting myocardial perfusion. The mechanism appears to be increased absolute rest flow without an increase in either the PRP or myocardial perfusion during hyperemia. Our translational results are consistent with one mechanism for the observed heterogeneity of myocardial perfusion in humans.
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Johnson NP, Kirkeeide RL, Gould KL. Mislabelled table entries in ADVISE Registry by Petraco and colleagues. EUROINTERVENTION 2013; 9:769-70. [DOI: 10.4244/eijv9i6a125] [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: 11/23/2022]
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