101
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Dorr LD, Thomas DJ, Zhu J, Dastane M, Chao L, Long WT. Outpatient total hip arthroplasty. J Arthroplasty 2010; 25:501-6. [PMID: 19640672 DOI: 10.1016/j.arth.2009.06.005] [Citation(s) in RCA: 144] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Accepted: 06/06/2009] [Indexed: 02/01/2023] Open
Abstract
Patients younger than 65 years were studied to determine what percentage of patients would enroll in a study of outpatient total hip arthroplasty, its safety, and benefits of the program. Of 192 eligible patients, 69 (36%) enrolled, and 53 (77%) of these went home the same day of surgery. Of 53, 44 maintained a diary for the first 3, weeks and 52 completed a satisfaction questionnaire at 6 weeks. Patients were followed for 6 months for occurrence of complications. There were no medical readmissions. Of 52 patients who completed a 6 week questionnaire, 50 (96%) were satisfied with the decision to have outpatient total hip arthroplasty. There were no objective physical benefits identified. This study reports the distribution of acceptance and completion of same day discharge for patients with total hip arthroplasty in a metropolitan population. It confirms safety in selected patients.
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Affiliation(s)
- Lawrence D Dorr
- The Arthritis Institute at Good Samaritan Hospital, Los Angeles, CA 90017, USA
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102
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Campbell D, Smith P, Lewis P, Bruce W. Controversies of thrombophylaxis following knee arthroplasty surgery. ANZ J Surg 2010; 80:391-5. [DOI: 10.1111/j.1445-2197.2010.05306.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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103
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Treasure T, Chong LY, Sharpin C, Wonderling D, Head K, Hill J. Developing guidelines for venous thromboembolism for The National Institute for Clinical Excellence. ACTA ACUST UNITED AC 2010; 92:611-6. [DOI: 10.1302/0301-620x.92b5.24448] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Following the publication in 2007 of the guidelines from the National Institute for Health and Clinical Excellence (NICE) for prophylaxis against venous thromboembolism (VTE) for patients undergoing surgery, concerns were raised by British orthopaedic surgeons as to the appropriateness of the recommendations for their clinical practice. In order to address these concerns NICE and the British Orthopaedic Association agreed to engage a representative panel of orthopaedic surgeons in the process of developing expanded VTE guidelines applicable to all patients admitted to hospital. The functions of this panel were to review the evidence and to consider the applicability and implications in orthopaedic practice in order to advise the main Guideline Development Group in framing recommendations. The panel considered both direct and indirect evidence of the safety and efficacy, the cost-effectiveness of prophylaxis and its implication in clinical practice for orthopaedic patients. We describe the process of selection of the orthopaedic panel, the evidence considered and the contribution of the panel to the latest guidelines from NICE on the prophylaxis against VTE, published in January 2010.
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Affiliation(s)
- T. Treasure
- Clinical Operational Research Unit, Department of Mathematics, University College, 4 Taviton Street, London WC1H 0BT, UK
| | - L.-Y. Chong
- National Clinical Guidelines Centre, Royal College of Physicians, 1 St. Andrews Place, Regents Park, London NW1 4LE, UK
| | - C. Sharpin
- National Clinical Guidelines Centre, Royal College of Physicians, 1 St. Andrews Place, Regents Park, London NW1 4LE, UK
| | - D. Wonderling
- National Clinical Guidelines Centre, Royal College of Physicians, 1 St. Andrews Place, Regents Park, London NW1 4LE, UK
| | - K. Head
- National Clinical Guidelines Centre, Royal College of Physicians, 1 St. Andrews Place, Regents Park, London NW1 4LE, UK
| | - J. Hill
- National Clinical Guidelines Centre, Royal College of Physicians, 1 St. Andrews Place, Regents Park, London NW1 4LE, UK
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104
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McNally MA. The impact of national guidelines for the prophylaxis of venous thromboembolism on the complications of arthroplasty of the lower limb. THE JOURNAL OF BONE AND JOINT SURGERY. BRITISH VOLUME 2010; 92:747. [PMID: 20436017 DOI: 10.1302/0301-620x.92b4.24578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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105
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Abstract
Deep venous thrombosis (DVT) is the end result of a complex interaction of events including the activation of the clotting cascade in conjunction with platelet aggregation. Patients undergoing major lower extremity orthopedic surgery, especially total joint arthroplasty (TJA), are at high risk for developing a postoperative DVT or a subsequent pulmonary embolus. Venous thromboembolic (VTE) prophylaxis, most commonly pharmacologic prophylaxis, has become the standard of care for patients undergoing elective TJA. However, the controversy between the efficacy of VTE prophylaxis and the increased risk for bleeding in the postoperative period continues to exist. This review addresses the controversy underlying VTE prophylaxis by outlining 2 guidelines and demonstrating the pros and cons of different DVT prophylaxis regimens based on the available evidence-based literature.
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Affiliation(s)
- Neil P Sheth
- Department of Orthopaedic Surgery, Rush University, Midwest Orthopaedics, 1725 West Harrison Street, Chicago, IL 60612, USA
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106
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Greenwood MT, Burnett RSJ. Acupuncture and Total Joint Replacement Surgery: An Energy Strategy for Selected Patients. Med Acupunct 2010. [DOI: 10.1089/acu.2009.0725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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107
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Memtsoudis SG, Della Valle AG, Besculides MC, Esposito M, Koulouvaris P, Salvati EA. Risk factors for perioperative mortality after lower extremity arthroplasty: a population-based study of 6,901,324 patient discharges. J Arthroplasty 2010; 25:19-26. [PMID: 19106028 DOI: 10.1016/j.arth.2008.11.010] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Accepted: 11/15/2008] [Indexed: 02/01/2023] Open
Abstract
The goal of this study was to provide nationally representative data on characteristics of patients who died after hip and knee arthroplasty and to determine risk factors for such outcome. Using national in-patient data collected between 1990 and 2004, we identified a cumulative in-hospital mortality rate of 0.35% among an estimated 6,901,324 procedures. The strongest independent risk factors for in-hospital mortality were pulmonary embolism and cerebrovascular complications, which increased the odds for a fatal outcome by approximately 40-fold. Preoperative risk factors for in-hospital mortality were revision total hip arthroplasty, advanced age, and the presence of a number of comorbid diseases, predominantly dementia, renal, and cerebrovascular disease. Our results can be used to identify patients at risk for fatal outcome and implement interventions to reduce such risk.
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Affiliation(s)
- Stavros G Memtsoudis
- Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York 10021, USA
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108
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High incidence of complications from enoxaparin treatment after arthroplasty. Clin Orthop Relat Res 2010; 468:115-9. [PMID: 19669848 PMCID: PMC2795811 DOI: 10.1007/s11999-009-1020-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Accepted: 07/22/2009] [Indexed: 01/31/2023]
Abstract
UNLABELLED Pulmonary embolism (PE) complicates 1% to 10% of total joint arthroplasties and generally requires immediate anticoagulation. Low-molecular-weight heparins have supplanted unfractionated heparin as the treatment of choice for PE and hold a 1A recommendation from the American College of Chest Physicians for this indication. However, the complications of enoxaparin treatment begun in close proximity to arthroplasty surgery are not well described. We examined the records of 135 patients who underwent total joint arthroplasty, experienced an in-hospital PE, and received treatment with enoxaparin at therapeutic doses (1 mg/kg body weight). The type and frequency of complications were determined and classified as major or minor. Twenty-seven percent of patients experienced minor complications and 10% experienced major complications. The incidence of major bleeding was substantially higher than rates reported for nonsurgical patients. The overall complication rate of enoxaparin treatment is similar to the rate of complications reported for unfractionated heparin treatment in this setting, but the complications are less severe. LEVEL OF EVIDENCE Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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109
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Memtsoudis SG, Besculides MC, Gaber L, Liu S, González Della Valle A. Risk factors for pulmonary embolism after hip and knee arthroplasty: a population-based study. INTERNATIONAL ORTHOPAEDICS 2009; 33:1739-45. [PMID: 18925395 PMCID: PMC2899166 DOI: 10.1007/s00264-008-0659-z] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 08/05/2008] [Accepted: 08/06/2008] [Indexed: 10/21/2022]
Abstract
Pulmonary embolism (PE) is a cause of death after total hip and knee arthroplasty (THA, TKA). We characterised the patient population suffering from in-hospital PE and identified perioperative risk factors associated with PE using nationally representative data. Data from the National Hospital Discharge Survey between 1990 and 2004 on patients who underwent primary or revision THA/TKA in the United States were analysed. Multivariate regression analysis was performed to determine if perioperative factors were associated with increased risk of in-hospital PE. An estimated 6,901,324 procedures were identified. The incidence of in-hospital PE was 0.36%. Factors associated with an increased risk for the diagnosis of PE included: revision THA, female gender, dementia, obesity, renal and cerebrovascular disease. An increased association with PE was found among patients with diagnosis of Adult Respiratory Distress Syndrome (ARDS), psychosis (confusion), and peripheral thrombotic events. Our findings may be useful in stratifying the individual patient's risk of PE after surgery.
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Affiliation(s)
- Stavros G. Memtsoudis
- Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY USA
| | - Melanie C. Besculides
- Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY USA
| | - Licia Gaber
- LKG Consulting, 24-07 Aspen Drive, Plainsboro, NJ USA
| | - Spencer Liu
- Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY USA
| | - Alejandro González Della Valle
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021 USA
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110
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Sugano N, Miki H, Nakamura N, Aihara M, Yamamoto K, Ohzono K. Clinical efficacy of mechanical thromboprophylaxis without anticoagulant drugs for elective hip surgery in an Asian population. J Arthroplasty 2009; 24:1254-7. [PMID: 19577898 DOI: 10.1016/j.arth.2009.05.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2008] [Accepted: 05/11/2009] [Indexed: 02/01/2023] Open
Abstract
To evaluate the clinical efficacy of mechanical thromboprophylaxis after elective hip surgery, we reviewed 3016 patients who underwent hip surgery at 5 centers. Primary total hip arthroplasty (THA), revision THA, and pelvic or femoral osteotomies were performed in 2648, 298, and 70 patients, respectively. Epidural anesthesia, intraoperative calf bandage, early mobilization, and intermittent pneumatic compression postoperatively with additional use of elastic stockings were the basic regimen for thromboprophylaxis. Postoperatively, no cases of fatal pulmonary embolism (PE) were encountered. One symptomatic PE and 4 symptomatic deep vein thrombosis cases were identified, all of which were successfully treated using heparin and warfarin. By 6 months, no deaths had occurred. We conclude that mechanical thromboprophylaxis without anticoagulant drugs is safe and effective for elective hip surgeries in our patient population.
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Affiliation(s)
- Nobuhiko Sugano
- Department of Orthopedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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111
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Venous thromboembolism prophylaxis after major orthopaedic surgery: a pooled analysis of randomized controlled trials. J Arthroplasty 2009; 24:77-83. [PMID: 19628366 DOI: 10.1016/j.arth.2009.06.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Accepted: 06/02/2009] [Indexed: 02/01/2023] Open
Abstract
The use of aspirin for venous thromboembolism (VTE) prophylaxis after major orthopaedic surgery is controversial. The hypothesis of the present study is that aspirin will decrease the rate of operative site bleeding without increasing thromboembolic events when aspirin is used for VTE prophylaxis after major orthopaedic surgery. A pooled analysis of 14 randomized controlled trials (RCTs) cited by the American College of Chest Physicians (ACCP) guidelines was performed to determine pooled rates of symptomatic deep vein thromboses, pulmonary emboli (PE), fatal PE, and operative site bleeding rates. The VTE rates with aspirin were not significantly different than the rates for vitamin K antagonists (VKA), low molecular weight heparins (LMWH), and pentasaccharides. The operative site bleeding relative risks of VKA, LMWH, and pentasaccharides versus aspirin, are 4.9, 6.4, and 4.2, respectively. A pooled analysis of RCTs supports the use of aspirin for VTE prophylaxis after major orthopaedic surgery.
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112
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Cusick LA, Beverland DE. The incidence of fatal pulmonary embolism after primary hip and knee replacement in a consecutive series of 4253 patients. ACTA ACUST UNITED AC 2009; 91:645-8. [DOI: 10.1302/0301-620x.91b5.21939] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We studied 4253 patients undergoing primary joint replacement between November 2002 and November 2007, of whom 4060 received aspirin only as chemical prophylaxis; 46 were mistakenly given low molecular weight heparin initially, which was stopped and changed to aspirin; 136 received no chemoprophylaxis and 11 patients received warfarin because of a previous history of pulmonary embolism. We identified the rate of clinical thromboembolism before and after discharge, and the mortality from pulmonary embolism at 90 days. The overall death rate was 0.31% (13 of 4253) and the rate of fatal pulmonary embolism was 0.07% (3 of 4253). Our data suggest that fatal pulmonary embolism is not common following elective primary joint replacement, and with modern surgical practice elective hip and knee replacement should no longer be considered high-risk procedures.
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Affiliation(s)
- L. A. Cusick
- Orthopaedic Outcomes Department Musgrave Park Hospital, Stockman’s Lane, Belfast BT9 7JB, Northern Ireland
| | - D. E. Beverland
- Orthopaedic Outcomes Department Musgrave Park Hospital, Stockman’s Lane, Belfast BT9 7JB, Northern Ireland
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113
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Deep venous thrombosis prophylaxis in total joint replacement: American College of Chest Physicians versus American Academy of Orthopaedic Surgeons' guidelines. CURRENT ORTHOPAEDIC PRACTICE 2009. [DOI: 10.1097/bco.0b013e3181926c0c] [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]
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114
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Parvizi J, Azzam K, Rothman RH. Deep venous thrombosis prophylaxis for total joint arthroplasty: American Academy of Orthopaedic Surgeons guidelines. J Arthroplasty 2008; 23:2-5. [PMID: 18922368 DOI: 10.1016/j.arth.2008.06.028] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Accepted: 06/20/2008] [Indexed: 02/01/2023] Open
Abstract
The orthopedic community continues to face a challenge with regard to the prevention of thromboembolism after total joint arthroplasty. The first and foremost issue facing surgeons is how to select the best agent or modality that is effective in preventing the untoward consequences of thromboembolism without causing other complications that can have dire consequences. Other challenges include the uncertainty regarding the dose and duration of various agents, the value of mechanical prophylaxis alone, and the exact end points that should be used to measure the efficacy of prophylaxis. This article discusses some of the recent developments in prevention and management of thromboembolism after total joint arthroplasty, in particular highlighting the guidelines that were developed by American Academy of Orthopedic Surgeons.
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Affiliation(s)
- Javad Parvizi
- Rothman Institute of Orthopedics at Thomas Jefferson University, Philadelphia, PA 19107, USA
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115
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Affiliation(s)
- Michael H Huo
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390-8883, USA.
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116
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Potent anticoagulants are associated with a higher all-cause mortality rate after hip and knee arthroplasty. Clin Orthop Relat Res 2008; 466:2009-11; author reply 2012-4. [PMID: 18563509 PMCID: PMC2584252 DOI: 10.1007/s11999-008-0324-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Accepted: 05/14/2008] [Indexed: 01/31/2023]
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117
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Current World Literature. Curr Opin Anaesthesiol 2008; 21:523-7. [DOI: 10.1097/aco.0b013e32830d5bc4] [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]
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118
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Brand RA. 50 years ago in CORR: Postspinal anesthesia osteomyelitis of the lumbar spine P. L. Day MD and J. J. Hinchey MD CORR 1958;11:185-193. Clin Orthop Relat Res 2008; 466:1755-6. [PMID: 18427906 PMCID: PMC2505244 DOI: 10.1007/s11999-008-0257-9] [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] [Received: 03/31/2008] [Accepted: 04/01/2008] [Indexed: 01/31/2023]
Affiliation(s)
- Richard A. Brand
- Clinical Orthopaedics and Related Research, 3550 Market Street, Suite 220, Philadelphia, PA 19104 United States
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119
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Lundberg GD. Regional anesthesia, compression, and aspirin is the safest form of prophylaxis for hip and knee arthroplasty. MEDSCAPE JOURNAL OF MEDICINE 2008; 10:107. [PMID: 18596949 PMCID: PMC2438488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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