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Januschowski K, Rickmann A, Smith J, Pastor-Idoate S, Pastor JC. Vision loss associated with silicone oil endotamponade in vitreoretinal surgery - a review. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06520-y. [PMID: 38888804 DOI: 10.1007/s00417-024-06520-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/25/2024] [Accepted: 05/08/2024] [Indexed: 06/20/2024] Open
Abstract
PURPOSE To clarify the definition, prevalence and classification of different types of unexplained vision loss associated with silicone oil (SO) endotamponades (SO in situ (SOIS) or after removal of SO (ROSO)) in vitreoretinal surgery and identifying the most specific clinical findings and suggesting possible causes. METHODS Review of the literature regarding randomized clinical trials (RCTs), retrospective case-control, cohort studies and case series evaluating the risk of using SO, published in English between 1994 and 2023, conducting a computer-based search of the following databases: PubMed, Web of Science, Scopus and Embase. The search was supplemented using the Medline option 'Related Articles' and consulting review articles on the topic. RESULTS Findings from reported clinical examinations in SOIS and ROSO are analyzed and finally different theories regarding the underlying pathophysiology are described. From the clinical point of view, findings have been found in OCT, OCTA, microperimetry and electrophysiological studies. Other clearly identifiable causes of vision loss related to the use of SO are listed and commented as differential diagnosis. Finally, the different physiopathological theories of the two types of causes of unexplained vision have been analyzed. CONCLUSION Unexpected vision loss under or after SO tamponade (SOIS and ROSO) is a significant concern which is probably underestimated because it is not a clearly defined and known entity. The most frequently described changes were in the ganglion cell complex but this unexpected vision loss remains a serious and unexplained concern for vitreoretinal surgeons and should be identified by clinicians, addressed by manufacturers and reported to Health Authorities as a serious incident according to the new regulation.
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Affiliation(s)
- Kai Januschowski
- Mount St. Peter Eye Clinic, Max-Planck-Str. 14-16, 54296, Trier, Germany
- Medical Department, University of Tuebingen, Tuebingen, Germany
| | - Annekatrin Rickmann
- Medical Department, University of Tuebingen, Tuebingen, Germany.
- Ophthalmology Department, Knappschaft Hospital Sulzbach, Sulzbach/Saar, Germany.
| | - Jonathan Smith
- Sunderland Eye Infirmary, Queen Alexandra Road, Sunderland, SR2 9HP, UK
| | - Salvador Pastor-Idoate
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, Valladolid, Spain
- Ophthalmology Department, Hospital Clinico Universitario, Valladolid, Spain
| | - Jose Carlos Pastor
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, Valladolid, Spain
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Riboni N, Ribezzi E, Marraffa E, Mora P, Bellucci C, Bianchi F, Careri M. An ex vivo headspace gas chromatography-mass spectrometry method for the determination of short-chain siloxanes in silicon oil tamponades used in ophthalmic surgery. J Pharm Biomed Anal 2024; 238:115871. [PMID: 38006704 DOI: 10.1016/j.jpba.2023.115871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/02/2023] [Accepted: 11/20/2023] [Indexed: 11/27/2023]
Abstract
Being able to facilitate retinal reattachment by preventing water migration into the subretinal space, silicone oils are widely used as long-term intraocular tamponade to treat cases of retinal detachment. Various commercial tamponades constituted by linear polydimethylsiloxane polymers with different molecular weights and cyclic impurities are available. In this study, for the first time, an untargeted headspace-gas-chromatography-mass spectrometry (HS-GC-MS) method was developed to identify low-molecular weight contaminants in three different types of silicone oil tamponades, namely Siluron 2000, RS-OIL ECS5000 and Densiron Xtra. Both commercial and post-operative tamponades were analysed to screen for the different classes of compounds present in the samples. The most abundant classes were short-chain siloxanes, fluorinated compounds, and hydrocarbons. To quantify the siloxanes present in the samples, a targeted HS-GS-MS was optimized using a central composite design and validated according to guidelines for bioanalytical methods. Lower limits of quantification in the low μg/L range, good precision with RSD% < 12% and accuracy with recovery rates in the 81 ( ± 7) - 96 ( ± 4) % range were achieved. Short-chain siloxanes were quantified in both commercial and post-operative tamponades, being the RS-OIL ECS5000 characterized by the highest concentration levels of the investigated analytes. By contrast, Densiron Xtra tamponades showed the lowest amount of short-chain siloxanes, observing a general decrease in their concentration levels according to the residence time in the eyes.
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Affiliation(s)
- Nicolò Riboni
- University of Parma, Department of Chemistry, Life Sciences and Environmental Sustainability, Parco Area delle Scienze, 17/A, 43124 Parma, Italy.
| | - Erika Ribezzi
- University of Parma, Department of Chemistry, Life Sciences and Environmental Sustainability, Parco Area delle Scienze, 17/A, 43124 Parma, Italy
| | - Enrico Marraffa
- University of Parma, Department of Chemistry, Life Sciences and Environmental Sustainability, Parco Area delle Scienze, 17/A, 43124 Parma, Italy
| | - Paolo Mora
- Ophthalmology Unit, University Hospital of Parma, Via Gramsci 14, 43100 Parma, Italy
| | - Carlo Bellucci
- Ophthalmology Unit, University Hospital of Parma, Via Gramsci 14, 43100 Parma, Italy
| | - Federica Bianchi
- University of Parma, Department of Chemistry, Life Sciences and Environmental Sustainability, Parco Area delle Scienze, 17/A, 43124 Parma, Italy.
| | - Maria Careri
- University of Parma, Department of Chemistry, Life Sciences and Environmental Sustainability, Parco Area delle Scienze, 17/A, 43124 Parma, Italy
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Hammer M, Schickhardt S, Munro DJ, Scheuerle A, Mayer CS, Auffarth GU. Physicochemical Properties of Explanted Silicone Oil After Use as an Intraocular Tamponade. Transl Vis Sci Technol 2022; 11:3. [PMID: 35103801 PMCID: PMC8819347 DOI: 10.1167/tvst.11.2.3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose We studied the effects of exposure to biological media within the eye, such as contamination with lipophilic and amphiphilic substances, on the physicochemical parameters of silicone oil used as an intraocular tamponade. Methods We removed silicone oil with visible emulsification from 15 patients and measured each sample for shear viscosity and surface tension. We induced in vitro emulsification with balanced salt solution. Using the zeta-potential, we evaluated the emulsion droplet's electrochemical stability. We repeated all experiments in a control group of unused oil. Electrochemical stability and viscosity were additionally measured in oils with high-molecular-weight components. Results We recovered silicone oils implanted between 30 and 506 days (mean, 196 days). Viscosity did not differ between explanted and control groups. Surface tension and zeta potential remained unchanged (P = 0.61 and P = 0.84, respectively). All oils showed a significant correlation of viscosity with temperature (P < 0.01 for all). Oils with added high-molecular-weight components showed a lower emulsion stability. Conclusions Prolonged contact to hydrophilic biological media does not alter high-viscosity silicone oil's physicochemical parameters. During typical durations of intraocular use, lipophilic and amphiphilic molecules had no deleterious effect. The addition of high-molecular-weight components might decrease the silicone oil's electrochemical emulsion stability, possibly easing the confluence of emulsion droplets. Translational Relevance Although the physicochemical parameters of silicone oils are not altered after clinically relevant durations within the eye, emulsion stability significantly differs between oil types.
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Affiliation(s)
| | | | - Donald J Munro
- David J Apple Laboratory for Vision Research, Heidelberg, Germany
| | - Alexander Scheuerle
- David J Apple Laboratory for Vision Research, Heidelberg, Germany.,University Eye Hospital Heidelberg, Heidelberg, Germany
| | - Christian S Mayer
- David J Apple Laboratory for Vision Research, Heidelberg, Germany.,University Eye Hospital Heidelberg, Heidelberg, Germany
| | - Gerd U Auffarth
- David J Apple Laboratory for Vision Research, Heidelberg, Germany.,University Eye Hospital Heidelberg, Heidelberg, Germany
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Physical Characterization and In Vitro Toxicity Test of PDMS Synthesized from Low-Grade D4 Monomer as a Vitreous Substitute in the Human Eyes. J Funct Biomater 2022; 13:jfb13010003. [PMID: 35076527 PMCID: PMC8788430 DOI: 10.3390/jfb13010003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/20/2021] [Accepted: 12/27/2021] [Indexed: 02/05/2023] Open
Abstract
Polydimethylsiloxane (PDMS) is one of the most superior materials and has been used as a substitute for vitreous humor in the human eye. In previous research, we have succeeded in producing PDMS with low and medium viscosity using octamethylcyclotetrasiloxane (D4) monomer with a low grade of 96%. Both have good physical properties and are comparable to commercial product PDMS and PDMS synthesized using D4 monomer with a high grade of 98%. An improvement of the synthesis process is needed to ensure that PDMS synthesized from a low-grade D4 monomer under specific synthesis conditions can repeatedly produce high-quality PDMS. Apart from good physical properties, the PDMS as a substitute for vitreous humor must also be safe and not cause other disturbances to the eyes. Here, we reported the process of synthesizing and characterizing the physical properties of low- and medium-viscosity PDMS using a low-grade D4 monomer. We also reported for the first time the in vitro toxicity test using the Hen’s Egg Test Chorioallantoic Membrane (HET-CAM) test method. We have succeeded in obtaining PDMS with viscosities of 1.15 Pa.s, 1.17 Pa.s, and 1.81 Pa.s. All samples have good physical properties such as refractive index, surface tension, and functional groups that are similar to commercial PDMS. The HET-CAM test results showed that all samples did not show signs of irritation indicating that samples were non-toxic. From the results of this study, it can be concluded that PDMS synthesized from a low-grade D4 monomer under specific synthesis conditions by the ROP method is very safe and has the potential to be developed as a substitute for vitreous humor in human eyes.
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Chen Y, Lam Ip Y, Zhou L, Li PY, Chan YM, Lam WC, Li KKW, Steel DH, Chan YK. What Is the Cause of Toxicity of Silicone Oil? MATERIALS 2021; 15:ma15010269. [PMID: 35009415 PMCID: PMC8745808 DOI: 10.3390/ma15010269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/17/2021] [Accepted: 12/25/2021] [Indexed: 11/16/2022]
Abstract
Purpose: To investigate the toxicity of the low-molecular-weight components (LMWCs) in ophthalmic silicone oils (SilOils) on retinal cell lines. Methods: The toxicity of six types of LMWCs were studied and compared with conventional SilOil 1000 cSt. In vitro cytotoxic tests of LMWCs, in both liquid and emulsified forms, on three retinal cell lines (Müller cells (rMC-1), photoreceptor cells (661W) and retinal pigment epithelial cells (ARPE-19)) were conducted using a transwell cell culturing system. The morphology and viability of cells were assessed by light microscopy and Cell Counting Kit-8 (CCK-8) assay at different time points (6, 24 and 72 h). The ARPE-19 apoptotic pathway was investigated by Mitochondrial Membrane Potential/Annexin V Apoptosis Kit at different time points (6, 24 and 72 h). Results: Apart from dodecamethylpentasiloxane (L5), all liquid LMWCs showed varying degrees of acute cytotoxicity on retinal cell lines within 72 h. Emulsified LMWCs showed comparable cytotoxicity with liquid LMWCs on retinal cell lines. Cyclic LMWCs, octamethylcyclotetrasiloxane (D4) and decamethylcyclopentasiloxane (D5) had significantly higher cytotoxicity when compared with their linear counterparts decamethyltetrasiloxane (L4) and L5 with similar molecular formula. Using ARPE-19 cells as an example, we showed that LMWCs induce the apoptosis of retinal cells. Conclusions: Most LMWCs, in both liquid and emulsified forms, can induce acute cytotoxicity. In addition, cyclic LMWCs are suspected to have higher cytotoxicity than their linear counterparts. Therefore, LMWCs are suspected to be the main cause of the long-term toxicity of ophthalmic SilOil, due to their toxicity and propensity to cause ophthalmic SilOil to emulsify. The amount of LMWCs should be considered as the paramount parameter when referring to the quality of SilOil.
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Affiliation(s)
- Ying Chen
- Department of Ophthalmology, The University of Hong Kong, Hong Kong, China; (Y.C.); (Y.L.I.); (L.Z.); (P.Y.L.); (Y.M.C.); (W.C.L.)
| | - Yan Lam Ip
- Department of Ophthalmology, The University of Hong Kong, Hong Kong, China; (Y.C.); (Y.L.I.); (L.Z.); (P.Y.L.); (Y.M.C.); (W.C.L.)
| | - Liangyu Zhou
- Department of Ophthalmology, The University of Hong Kong, Hong Kong, China; (Y.C.); (Y.L.I.); (L.Z.); (P.Y.L.); (Y.M.C.); (W.C.L.)
| | - Pik Yi Li
- Department of Ophthalmology, The University of Hong Kong, Hong Kong, China; (Y.C.); (Y.L.I.); (L.Z.); (P.Y.L.); (Y.M.C.); (W.C.L.)
| | - Yee Mei Chan
- Department of Ophthalmology, The University of Hong Kong, Hong Kong, China; (Y.C.); (Y.L.I.); (L.Z.); (P.Y.L.); (Y.M.C.); (W.C.L.)
| | - Wai Ching Lam
- Department of Ophthalmology, The University of Hong Kong, Hong Kong, China; (Y.C.); (Y.L.I.); (L.Z.); (P.Y.L.); (Y.M.C.); (W.C.L.)
| | | | - David H. Steel
- Sunderland Eye Infirmary, Sunderland SR2 9HP, UK;
- Bioscience Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
- Department of Eye and Vision Science, University of Liverpool, Liverpool L69 3BX, UK
| | - Yau Kei Chan
- Department of Ophthalmology, The University of Hong Kong, Hong Kong, China; (Y.C.); (Y.L.I.); (L.Z.); (P.Y.L.); (Y.M.C.); (W.C.L.)
- Correspondence:
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Zhou W, Ye C, Huang X, Zhang P, Zheng S, Qin L, Chen Y. Efficacy of Cleaning Methods for Ophthalmic Microscopic Instruments: A Comparison Study. AORN J 2021; 112:112-121. [PMID: 32716540 DOI: 10.1002/aorn.13105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 09/07/2019] [Accepted: 09/23/2019] [Indexed: 11/12/2022]
Abstract
The combination of silicone oil and blood is difficult to remove from ophthalmic surgical instruments during cleaning and decontamination processes. We sought to establish the most efficient cleaning procedure for this type of contaminated instrument. We uniformly contaminated microscopic instruments made of titanium alloy and stainless steel with either blood alone or blood and silicone oil. We randomly assigned each instrument to one of four types of cleaning procedures that involved combinations of water, a multi-enzyme detergent, or an alkaline detergent. After completing the designated cleaning procedure, a sterile processing technician used an adenosine triphosphate cleaning verification test to evaluate the cleaning efficacy. When cleaning blood- and silicone oil-contaminated titanium-alloy and stainless-steel instruments, the alkaline detergent immersion followed by a multi-enzyme detergent ultrasonic cleaning yielded the highest cleaning effectiveness score (92.5%), which indicates this was the most effective of the four cleaning procedures that we tested.
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Chen Y, Kearns VR, Zhou L, Sandinha T, Lam WC, Steel DH, Chan YK. Silicone oil in vitreoretinal surgery: indications, complications, new developments and alternative long-term tamponade agents. Acta Ophthalmol 2021; 99:240-250. [PMID: 32930501 DOI: 10.1111/aos.14604] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/27/2020] [Accepted: 08/01/2020] [Indexed: 01/01/2023]
Abstract
Silicone oil (SO) has been used as a long-term tamponade agent in the treatment of complicated vitreoretinal diseases for about half a century, during which time many advances in surgical techniques and technologies have been made. This review summarizes the chemical and physical properties of SO, its indications and complications, including particularly emulsification. The mechanisms and risk factors for emulsification are discussed, as well as novel strategies for its effective removal. Finally, the review focuses on new improved formulations of SO, including research into slow-release pharmacological agents within SO and provides an overview of alternatives to SO for the purpose of long-term tamponade that are being developed.
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Affiliation(s)
- Ying Chen
- Ruian Traditional Chinese Medicine Hospital Ruian China
- Department of Ophthalmology University of Hong Kong Hong Kong Hong Kong SAR China
| | - Victoria R Kearns
- Department of Eye and Vision Science University of Liverpool Liverpool UK
| | - Liangyu Zhou
- Department of Ophthalmology University of Hong Kong Hong Kong Hong Kong SAR China
| | - Teresa Sandinha
- Department of Eye and Vision Science University of Liverpool Liverpool UK
- St. Paul's Eye Unit The Royal Liverpool University Hospital Liverpool UK
| | - Wai Ching Lam
- Department of Ophthalmology University of Hong Kong Hong Kong Hong Kong SAR China
| | - David H Steel
- Department of Eye and Vision Science University of Liverpool Liverpool UK
- Newcastle University Newcastle Upon Tyne UK
- Sunderland Eye Infirmary Sunderland UK
| | - Yau Kei Chan
- Department of Ophthalmology University of Hong Kong Hong Kong Hong Kong SAR China
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Comparison of hydrophilic ophthalmic media on silicone oil emulsification. PLoS One 2020; 15:e0235067. [PMID: 32559226 PMCID: PMC7304586 DOI: 10.1371/journal.pone.0235067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/08/2020] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to investigate whether and how the biological media which are in contact with silicone oil play a role in the silicone emulsification process. Commercially available Oxane 1300 silicone oil and potential hydrophilic phases of the emulsions in the eye (porcine aqueous humor, porcine vitreous and balanced salt solution) were investigated separately and in a mixture or emulsions by means of surface tension, rheological, zeta potential measurements and microscopic investigation. The surface tension of biological media (vitreous and aqueous humor) was significantly lower than that of non-biological media, especially in the case of aqueous humor, which indicates a remarkable emulsification tendency with these phases. The biological media are able to form both oil-in-water and water-in-oil emulsions, which can be observed in the clinical practice as well. It was established that the vitreous has a more expressed emulsification ability compared with the aqueous humor because smaller and more stable droplets can form with silicon oil when the vitreous is still there. It can be concluded that the vitreous has a higher impact on emulsification than the aqueous medium, which can predict that the vitreous remaining after vitrectomy has a key role in emulsion formation in the eye with silicone oil endotamponade.
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Mendichi R, Schieroni AG, Piovani D, Allegrini D, Ferrara M, Romano MR. Comparative Study of Chemical Composition, Molecular and Rheological Properties of Silicone Oil Medical Devices. Transl Vis Sci Technol 2019; 8:9. [PMID: 31588374 PMCID: PMC6753963 DOI: 10.1167/tvst.8.5.9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 07/08/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose We evaluated chemical composition, and molecular and rheological properties in 10 commercially available silicone oils (SilOils), focusing on siloxane chains of low molecular weight (LMW components, LMWC) that are known to be “impurities” produced during the SilOil synthesis process. Methods We assessed the type of SilOil polymer and molecular weight distribution (MWD) by spectroscopy and conventional size exclusion chromatography, respectively. From the Cumulative MWD, we calculated the fractions of LMWC with molecular weight (M): ≤2000, ≤5000, and ≤10,000 g/mol. Due to the low MW, the content of LMWC with M ≤1000 g/mol was determined by gas chromatography-mass spectrometry. The dynamic viscosity (η) was assessed by rotational rheometry. Results For all SilOils, the polymer was polydimethylsiloxane. The samples differed significantly in terms of MWD and relative LMWC fractions. Specifically, the relative fraction of all LMWC (M ≤10,000 g/mol) ranged from 2.31% to 9.40% and the content of LMWC with M ≤1000 g/mol also varied significantly (range, 51–1151 ppm). The η values were different between the SilOils, and, for many of them, from the declared viscosity. Conclusions Commercially available SilOils differ significantly in molecular and rheologic features. These compounds contain a significant amount of LMWC, “impurities” generated during the synthesis process, acting as emulsifier, potentially inducing ocular inflammation and toxicity. Translational Relevance The amount of impurities in different SilOils may influence significantly their biocompatibility.
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Affiliation(s)
| | | | - Daniele Piovani
- Istituto per lo Studio delle Macromolecole (CNR), Milan, Italy
| | | | | | - Mario R Romano
- Eye Center, Humanitas, Bergamo, Italy.,Department of Biomedical Sciences, Humanitas University, Milano, Italy
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Brunner S, Binder S. Surgery for Proliferative Diabetic Retinopathy. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00111-9] [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]
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