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Mohsenian L, Noroozi Z, Farahmand F. A Possible Case of Hypertensive Crisis With Aortic Dissection After an Anti-COVID-19 Vaccine. Angiology 2024:33197241232619. [PMID: 38308612 DOI: 10.1177/00033197241232619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Abstract
Aortic dissection, a potentially fatal event, usually presents with acute intense chest or back pain. Painless aortic dissections constitute about 10% of all cases. High blood pressure is a common finding in both painless and painful aortic dissections. During the coronavirus disease (COVID-19) pandemic, various anti-COVID vaccines have been massively used. Although these vaccines are generally safe, there is a small risk of adverse effects which are mostly mild and transient, but sometimes they could be life-threatening. We report a case of painless aortic dissection that occurred within minutes of receiving the COVID-19 inactivated vaccine. A 65-year-old woman with chronic controlled systemic hypertension developed slurred speech, decreased level of consciousness, generalized weakness, and dyspnea without chest, back, or abdominal pain a few minutes after receiving the second dose of inactivated COVID-19 vaccine; she had a systolic blood pressure of 220 mmHg and left-sided pleural effusion. Drainage of the pleural effusion revealed gross blood and a spiral chest and mediastinum CT with intravenous contrast showed a penetrating atherosclerotic ulcer in the descending aorta. Therefore, thoracic endovascular aortic repair (TEVAR) was carried out, and the patient was discharged in satisfactory condition after 3 days.
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Affiliation(s)
- Leila Mohsenian
- Department of Emergency Medicine, School of Medicine, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
- Emergency Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Noroozi
- General Practitioner, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Faramarz Farahmand
- Department of Emergency Medicine, School of Medicine, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
- Emergency Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Ohta R, Sano C. Aortic Dissection and Hypotension Without Cardiac Tamponade: A Case Report. Cureus 2023; 15:e44418. [PMID: 37791163 PMCID: PMC10543440 DOI: 10.7759/cureus.44418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 10/05/2023] Open
Abstract
Ascending aortic dissection is typically characterized by severe chest or back pain. However, its presentation can be atypical, leading to diagnostic challenges, especially in settings where classic symptomatology may not be evident. In this report, we described the case of a 74-year-old woman who presented to the emergency room of a rural community hospital with chief complaints of vertigo, nausea, and vomiting, without the classic symptoms of chest or back pain associated with aortic dissection. Despite initial treatment for autonomic dysregulation, the patient's symptoms persisted. Subsequent comprehensive assessments, including computed tomography angiography, revealed an ascending aortic dissection extending to the bilateral common carotid arteries. This atypical presentation, characterized by cerebral hypoperfusion and systemic hypotension without tachycardia, emphasizes the need to maintain a high suspicion index, even in the absence of hallmark symptoms. This case underscores the importance of considering the possibility of ascending aortic dissection in patients with nontraditional symptoms. Recognizing these atypical presentations is crucial for timely intervention, especially in rural settings with limited advanced diagnostic tools. This case also highlights potential sex disparities in symptom presentation, emphasizing the need for clinicians to recognize nontraditional symptoms in women. Rapid identification, evaluation, and management are imperative to prevent severe outcomes, and a multidisciplinary approach has proven to be the most effective in such cases.
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Affiliation(s)
| | - Chiaki Sano
- Community Medicine Management, Shimane University Faculty of Medicine, Izumo, JPN
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Chawla K, Al-Embideen S, Riordan C. Quiet & deadly: Painless aortic dissection. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 16:200175. [PMID: 36874044 PMCID: PMC9975238 DOI: 10.1016/j.ijcrp.2023.200175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 01/21/2023]
Abstract
Aortic dissection is a life-threatening condition that classically presents as a sudden, sharp pain with a ripping sensation. This disease is caused by a weakened area within the aortic arterial wall, which can be classified using the Stanford classifications into type A or type B dissections, depending on the location of the tear. It is described that 17.6% of patients died before arriving at the hospital, and 45.2% of patients died within 30 days of diagnosis (Melvinsdottir et al., 2016). However, 10% of patients present without pain, leading to delayed diagnosis. In this case, a 53-year-old male with prior history of hypertension, sleep apnea, and diabetes mellitus presented to the emergency department with complaints of chest pain earlier that day. However, he was asymptomatic on presentation. He had no cardiac history. He was admitted, and a subsequent workup was performed to rule out myocardial infarction. The following morning a slight bump in troponin consistent with a Non-ST Elevated Myocardial Infarction (NSTEMI) was noted. An echocardiogram was ordered and showed aortic regurgitation. This was followed by computed tomography angiography (CTA), which revealed acute type A ascending aortic dissection. He was transferred to our facility and underwent an emergent Bentall procedure. Ultimately, the patient tolerated the surgery well and is recovering. This case is essential because it emphasizes the painless presentation of type A aortic dissection. Mis- or undiagnosed, this condition often leads to death.
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Affiliation(s)
- Karan Chawla
- University of Toledo College of Medicine and Life Sciences, Toledo, OH 43614, USA
| | - Somya Al-Embideen
- University of Toledo College of Medicine and Life Sciences; Department of Surgery, Toledo, OH 43614, USA
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Liang T, Zhu H, Zhang L, Li S, He X, Zhao K, Jing Z, Zhou J. Long-term results of type B aortic dissection patients with tumor after endovascular repair or optimal medical therapy: a single-center and retrospective cohort study. BMC Surg 2021; 21:330. [PMID: 34407788 PMCID: PMC8371793 DOI: 10.1186/s12893-021-01327-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The effect of thoracic endovascular aortic repair (TEVAR) for acute Type B aortic has been confirmed, However, when patients with malignant disease suffer from acute type B aortic dissection (ATBAD), the effect of TEVAR intervention is still unclear. METHODS ATBAD patients were identified from electronic medical records between 2009 and 2019. The 5 year overall and aortic-disease free survival rates were analyzed and compared between the two groups. RESULTS Of the 40 enrolled patients, 27 (67.5%) received TEVAR and 13 (32.5%) received OMT. The baseline characteristics of the two groups were not significantly different. Kaplan‒Meier survival curve showed that the 5 year overall survival and 5 year aortic-disease free survival of the TEVAR group were better than those of the OMT group. The Cox proportional hazard model with unadjusted risk showed an 83.0% decrease in 5 year overall mortality (HR, 0.17; 95% CI, 0.05-0.56) and a lower aortic-disease related risk (HR, 0.08; 95% CI, 0.02-0.39) in TEVAR group compared to OMT group. After adjusted for age, gender, smoking, drinking and comorbidities (diabetes mellitus, hypertension and coronary artery diseases), the hazard ratio of 5 year overall mortality was 78.0% lower (HR, 0.22; 95% CI, 0.06.0.81) and the risk of aortic-disease related mortality was 93.0% lower (HR, 0.07; 95% CI, 0.01-0.61) in TEVAR group compared to OMT group. In the cohort stratified by age, sex, the risk of the 5 year overall or aortic-disease related mortality in TEVAR group was relatively reduced compared to OMT group. CONCLUSIONS Compared to OMT, TEVAR improves the 5 year overall and aortic-disease free survival rates in the cohort of ATBAD patients with a single type of malignant tumors.
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Affiliation(s)
- Taiping Liang
- Department of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Hongqiao Zhu
- Department of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Lei Zhang
- Department of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Shuangshuang Li
- Department of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Xiaomin He
- Department of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Kaiwen Zhao
- Department of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, 200433, China.
| | - Jian Zhou
- Department of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, 200433, China.
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Muramatsu KI, Nagasawa H, Takeuchi I, Yanagawa Y. Transient Left Hemiparesis Due to Aortic Dissection. J Emerg Trauma Shock 2020; 13:99-100. [PMID: 32395062 PMCID: PMC7204948 DOI: 10.4103/jets.jets_144_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 11/06/2019] [Accepted: 11/18/2019] [Indexed: 12/03/2022] Open
Affiliation(s)
- Ken-Ichi Muramatsu
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni, Shizuoka, Japan E-mail:
| | - Hiroki Nagasawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni, Shizuoka, Japan E-mail:
| | - Ikuto Takeuchi
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni, Shizuoka, Japan E-mail:
| | - Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni, Shizuoka, Japan E-mail:
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Tatsuoka Y, Mano Y, Ishikawa S, Shinozaki S. Primary Antiphospholipid Antibody Syndrome Complicated with Cerebellar Hemorrhage and Aortic Dissection: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1852-1856. [PMID: 31822651 PMCID: PMC6916662 DOI: 10.12659/ajcr.919649] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Antiphospholipid antibody syndrome (APS) is a systemic autoimmune disease associated with arterial and venous thromboembolism and pregnancy complications. There have been several reports of APS with systemic lupus erythematosus (SLE) complicated with aortic dissection. However, none of them has been primary APS, which is APS without SLE. CASE REPORT A 42-year-old woman with primary APS and APS nephropathy on warfarin and aspirin therapy presented with coma due to cerebellar hemorrhage. The effect of warfarin was immediately reversed with prothrombin complex concentrate. We performed emergent evacuation of the hematoma, and her level of consciousness improved to normal on postoperative day (POD) 1. She had acute hypertension on arrival, which was resistant to multiple antihypertensives and was stabilized on POD 3. She also had exacerbation of chronic kidney disease after using contrast and prothrombin concentrate complex, and was on temporary renal replacement therapy from POD 3. Aortic dissection was found accidentally on echocardiography on POD 7, and she was subsequently treated medically. She was transferred to the rehabilitation hospital with mild dysarthria and truncal ataxia on POD 59. CONCLUSIONS We report the first case in the English literature of primary APS complicated with cerebellar hemorrhage and aortic dissection. Acute hypertension following hemorrhage and exacerbation of APS nephropathy likely triggered the dissection of the aortic wall, the integrity of which might have been compromised by longstanding antiphospholipid antibody and vasa vasorum thrombosis.
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Affiliation(s)
- Yoshio Tatsuoka
- Department of Neurosurgery, Japanese Red Cross Ishinomaki Hospital, Ishinomaki, Miyagi, Japan
| | - Yui Mano
- Department of Neurosurgery, Japanese Red Cross Ishinomaki Hospital, Ishinomaki, Miyagi, Japan
| | - Shuichi Ishikawa
- Department of Neurosurgery, Japanese Red Cross Ishinomaki Hospital, Ishinomaki, Miyagi, Japan
| | - Shigeru Shinozaki
- Department of Critical Care Medicine, Japanese Red Cross Ishinomaki Hospital, Ishinomaki, Miyagi, Japan
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Stöllberger C, Schäffl-Doweik L, Korn M, Finsterer J. Atrial fibrillation and stroke as initial manifestations of painless type A aortic dissection. Neurol Neurochir Pol 2017; 51:507-509. [PMID: 28803639 DOI: 10.1016/j.pjnns.2017.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 07/11/2017] [Accepted: 07/12/2017] [Indexed: 11/28/2022]
Abstract
Aortic dissection is diagnostically challenging, especially in pain-free patients. Detection of acute ischemic stroke secondary to painless aortic dissection is a challenge for emergency physicians and neurologists. We report a previously healthy 58-years old female, admitted because of nausea, dizziness, somnolence, a left-sided hemiparesis and arterial hypotension. The electrocardiogram showed atrial fibrillation with ST-elevations and ST-depressions. Perfusion CT-imaging showed a dilatation of the aortic arch and intraluminal structures indicating an intima flap of aortic dissection. Four hours after onset of symptoms the patient died on the way to the cardiac surgery. In conclusion, apart from imaging the aortic arch by computed tomography in acute stroke patients, the electrocardiogram may be indicative for aortic dissection if it shows signs for myocardial ischemia in previously healthy patients.
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Affiliation(s)
| | | | - Maria Korn
- KA Rudolfstiftung, Juchgasse 25, A-1030 Vienna, Austria.
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Fatima S, Sharma K. Painless Aortic Dissection-Diagnostic Dilemma With Fatal Outcomes: What Do We Learn? J Investig Med High Impact Case Rep 2017; 5:2324709617721252. [PMID: 28815188 PMCID: PMC5542327 DOI: 10.1177/2324709617721252] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 06/21/2017] [Accepted: 06/22/2017] [Indexed: 02/03/2023] Open
Abstract
Aortic dissection is the most catastrophic clinical condition that involves the aorta. It has a high mortality as well as high rate of misdiagnosis due to frequent unusual presentation. Typically, it presents with acute chest, back, and tearing abdominal pain. However, it can present atypically with minimal or no pain, making diagnosis difficult. Physicians should always suspect acute aortic dissection in patients with certain clinical conditions like difficult-to-control hypertension, giant cell arteritis, bicuspid aortic valve, intracranial aneurysms, simple renal cysts, family history of aortic disease, and Marfan syndrome, especially when a patient presents with ischemic symptoms involving multiple organ without an obvious cause.
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Chen CH, Liu KT. A case report of painless type A aortic dissection with intermittent convulsive syncope as initial presentation. Medicine (Baltimore) 2017; 96:e6762. [PMID: 28445305 PMCID: PMC5413270 DOI: 10.1097/md.0000000000006762] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
RATIONALE The initial presenting symptoms and signs of acute aortic dissection are so diverse that it makes early and accurate diagnosis arduous. Painless and convulsive syncope due to cardiac arrhythmia were not typical presentations of acute aortic dissection. PATIENT CONCERNS A 61-year-old male presenting with transient consciousness loss and suspected seizure attack was sent to emergency room (ER) by ambulance. Consciousness loss accompanying with upward gaze and limb convulsion was noted in ER, and electrocardiogram monitor recorded a transient cardiac asystole then spontaneous recovery of sinus rhythm. DIAGNOSES Chest X-ray revealed widening of the mediastinum. Subsequently, contrast-enhanced chest computed tomography demonstrated Stanford type A aortic dissection. LESSONS To the authors' knowledge, this is the first reported case that cardiac asystole may be related to painless type A aortic dissection and then leading to convulsive syncope as presenting symptoms.
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Affiliation(s)
- Chun-Hsien Chen
- Department of Emergency Medicine, Kaohsiung Medical University Hospital
| | - Kuan-Ting Liu
- Department of Emergency Medicine, Kaohsiung Medical University Hospital
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Marroush TS, Boshara AR, Parvataneni KC, Takla R, Mesiha NA. Painless Aortic Dissection. Am J Med Sci 2016; 354:513-520. [PMID: 29173364 DOI: 10.1016/j.amjms.2016.11.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 10/18/2016] [Accepted: 11/01/2016] [Indexed: 01/02/2023]
Abstract
Painless aortic dissection (PAoD) has been previously linked to poor outcomes. We recently encountered a case of a patient with PAoD presenting with dyspnea; the clue to diagnosis was the presence of a loud aortic diastolic murmur. A systematic review of the literature revealed 86 other cases, 62% of which occurred in men with a mean age of 65 years. Left-sided neurologic deficits were the most common presentation, followed by dyspnea and bilateral lower extremity deficits. Pulse asymmetry was found in 53% of patients, as 29% had right-left asymmetry and 24% had upper-lower asymmetry. Cumulatively, 88% of the cases were type A dissection and 51% of the patients died. Erroneous application of fibrinolysis and anticoagulation occurred in multiple instances. PAoD is rare but potentially fatal; a high index of suspicion and a thorough cardiovascular examination are needed to establish the diagnosis before applying possible harmful interventions such as fibrinolysis, vasodilation or anticoagulation.
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Affiliation(s)
- Tariq S Marroush
- Department of Internal Medicine, St. John Hospital and Medical Center, Detroit, Michigan.
| | - Andrew R Boshara
- Department of Internal Medicine, St. John Hospital and Medical Center, Detroit, Michigan
| | - Kesav C Parvataneni
- Department of Cardiovascular Diseases, St. John Hospital and Medical Center, Detroit, Michigan
| | - Robert Takla
- Department of Emergency Medicine, St. John Hospital and Medical Center, Detroit, Michigan
| | - Nancy A Mesiha
- Department of Cardiovascular Diseases, St. John Hospital and Medical Center, Detroit, Michigan
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Kumar A, Kumar K, Zeltser R, Makaryus AN. Nearly Asymptomatic Eight-Month Thoracic Aortic Dissection. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2016; 10:75-8. [PMID: 27257400 PMCID: PMC4881868 DOI: 10.4137/cmc.s38328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 04/10/2016] [Accepted: 04/13/2016] [Indexed: 11/05/2022]
Abstract
Thoracic aortic dissection is a rare, but lethal, medical condition that is either misdiagnosed as a myocardial infarction or overlooked completely. Though thoracic aortic dissections are commonly diagnosed in patients exhibiting sharp chest pain, there are some notable cases where patients do not report the expected severity of pain. We report a unique case of a patient with a thoracic aortic dissection who was initially nearly asymptomatic for eight months, in order to heighten awareness, highlight diagnosis protocol, and improve prognosis for this commonly misdiagnosed, but fatal, condition.
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Affiliation(s)
- Arjun Kumar
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY, USA
| | - Krishan Kumar
- NuHealth, Nassau University Medical Center, East Meadow, NY, USA
| | - Roman Zeltser
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY, USA.; Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - Amgad N Makaryus
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY, USA.; Hofstra Northwell School of Medicine, Hempstead, NY, USA
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Crucial role of carotid ultrasound for the rapid diagnosis of hyperacute aortic dissection complicated by cerebral infarction: A case report and literature review. Medicina (B Aires) 2016; 52:378-388. [DOI: 10.1016/j.medici.2016.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 09/14/2016] [Accepted: 11/08/2016] [Indexed: 01/16/2023] Open
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