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Rosa GM, Scagliola R, Ghione P, Valbusa A, Brunelli C, Carbone F, Montecucco F, Monacelli F. Predictors of cardiovascular outcome and rehospitalization in elderly patients with heart failure. Eur J Clin Invest 2019; 49:e13044. [PMID: 30368802 DOI: 10.1111/eci.13044] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 10/22/2018] [Accepted: 10/23/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Heart failure (HF) is a major public health problem and represents the only cardiac disease continuing to increase in prevalence, in particular among elderly patients. The frequent rehospitalizations have a negative impact on quality of life of patients with HF, constituting a substantial cost for patients and the health system. The aim of this review was to look into biochemical, echocardiographic and socioeconomical parameters as predictors of clinical outcomes and rehospitalizations. METHODS This narrative review is based on the material searched for and obtained via PubMed from January 2000 up to March 2018. The search terms we used were as follows: "elderly, heart failure, cardiovascular" in combination with "biomarker, echocardiography and hospitalization." RESULTS This review analyses the potential predictive role of biochemical and echocardiographic and socioeconomical parameters on clinical outcomes (particularly cardiovascular) and hospital readmissions in patients with chronic HF. We focused on risk stratification of elderly patients with HF, who constitute a category of frail subjects at higher risk for readmission to hospital. CONCLUSIONS In elderly subjects with chronic HF, the risk stratification could benefit of a multiparametric approach combining biochemical, echocardiographic, demographic and socioeconomical parameters, thus ensuring a better quality of life and at the same time a better allocation of financial resources.
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Affiliation(s)
- Gian M Rosa
- Clinic of Cardiovascular Diseases, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy
| | | | - Paola Ghione
- Clinic of Cardiovascular Diseases, University of Genoa, Genoa, Italy
| | - Alberto Valbusa
- IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy
| | - Claudio Brunelli
- Clinic of Cardiovascular Diseases, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy
| | - Federico Carbone
- Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa, Genoa, Italy
| | - Fabrizio Montecucco
- IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy.,Department of Internal Medicine, and Centre of Excellence for Biomedical Research (CEBR), First Clinic of Internal Medicine, University of Genoa, Genoa, Italy
| | - Fiammetta Monacelli
- IRCCS Ospedale Policlinico San Martino Genoa, Genoa, Italy.,Department of Internal Medicine, Geriatric Unit, University of Genoa, Genoa, Italy
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Zhang S, Hu Y, Zhou L, Chen X, Wang Y, Wu J, He H, Gao Y. Correlations between serum intact parathyroid hormone (PTH) and N-terminal-probrain natriuretic peptide levels in elderly patients with chronic heart failure (CHF). Arch Gerontol Geriatr 2015; 60:359-65. [DOI: 10.1016/j.archger.2014.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 11/16/2014] [Accepted: 11/18/2014] [Indexed: 01/18/2023]
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Rozentryt P, Nowak J, Niedziela J, Hudzik B, Doehner W, Jankowska EA, von Haehling S, Partyka R, Kawecka E, Myrda K, Rywik T, Szyguła B, Kokocińska D, Anker SD, Ponikowski P, Poloński L. Serum phosphorus level is related to degree of clinical response to up-titration of heart failure pharmacotherapy. Int J Cardiol 2014; 177:248-54. [DOI: 10.1016/j.ijcard.2014.09.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 09/16/2014] [Indexed: 01/13/2023]
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Abstract
Secondary hyperparathyroidism in heart failure is a consequence of renin-angiotensin-aldosterone activation, chronic hyperaldosteronism, and loop diuretic usage, resulting in calcium excretion. The result is an inflammatory state with adverse effects on myocardial remodeling and systemic complications. Recent literature has suggested that elevated parathyroid hormone predicts adverse outcomes in patients with heart failure independent of serum calcium and phosphate, vitamin D deficiency, and renal insufficiency. Parathyroid hormone has been correlated with elevated brain natriuretic peptide levels, an established biomarker of heart failure severity. There are several limitations to the utilization of parathyroid hormone as a biomarker for heart failure, and further prospective studies need to be conducted to assess the value of multiple parathyroid hormone measurements over time and elucidate the role of parathyroid hormone in diastolic dysfunction. Pending further validation, there is promise for parathyroid hormone as a complementary biomarker in heart failure.
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Lopes MR, Ribeiro PAB, Ledur P, Souza GC, Clausell N, Schaan BD. Vitamin D insufficiency is associated with lower physical function in patients with heart failure and diabetes. J Diabetes Res 2014; 2014:320930. [PMID: 25243195 PMCID: PMC4158566 DOI: 10.1155/2014/320930] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 08/11/2014] [Indexed: 12/27/2022] Open
Abstract
Vitamin D deficiency is frequent among patients with heart failure (HF) and diabetes, disorders associated with exercise intolerance and muscle weakness. This study aims to search for associations between vitamin D sufficiency and physical function indexes in patients with HF and diabetes. A cross-sectional study of 146 HF patients, 39.7% with diabetes, at a Brazilian tertiary outpatient clinic was performed. Patients underwent clinical evaluation, 6-minute walk test (6 MWT), handgrip strength, physical activity level (IPAQ), and biochemical evaluations including serum 25-hydroxyvitamin D. Classification was done according to vitamin D status (≥ 30 ng/dL, sufficient) and presence/absence of diabetes in vitamin sufficient, no diabetes (DS-C, n = 25), vitamin sufficient, diabetes (DS-DM, n = 18), vitamin deficient, no diabetes (DD-C, n = 63), and vitamin deficient, diabetes (DD-DM, n = 40). Patients age was 55.4 ± 8 yrs; 70.5% had vitamin D deficiency. Clinical characteristics were similar among groups. Total time expended in physical activity was similar among groups (P = 0.26). DS-C covered higher distances in the 6 MWT (392 ± 60 m) versus DD-DM (309 ± 116 m); P = 0.024. Handgrip strength was similar among groups but tended to lower levels in DD-DM (P = 0.074) even after being adjusted to physical activity (P = 0.069). Vitamin D deficiency can influence physical function in HF diabetic patients.
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Affiliation(s)
- M. R. Lopes
- Endocrinology Post-Graduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Paula A. B. Ribeiro
- Cardiology Post-Graduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Priscila Ledur
- Endocrinology Post-Graduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Gabriela C. Souza
- Department of Internal Medicine, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Nadine Clausell
- Cardiology Post-Graduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Department of Internal Medicine, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Beatriz D. Schaan
- Endocrinology Post-Graduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Cardiology Post-Graduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Department of Internal Medicine, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Endocrinology Division, Hospital de Clínicas de Porto Alegre, Serviço de Endocrinologia, Rua Ramiro Barcelos 2350, Prédio 12, 4° Andar, 90035-003 Porto Alegre, RS, Brazil
- *Beatriz D. Schaan:
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Bassil D, Rahme M, Hoteit M, Fuleihan GEH. Hypovitaminosis D in the Middle East and North Africa: Prevalence, risk factors and impact on outcomes. DERMATO-ENDOCRINOLOGY 2013; 5:274-98. [PMID: 24194968 PMCID: PMC3772916 DOI: 10.4161/derm.25111] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 05/10/2013] [Accepted: 05/21/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND The Middle East and North Africa (MENA) region registers some of the highest rates of hypovitaminosis D worldwide. AIM We systematically reviewed the prevalence of hypovitaminosis D, rickets and osteomalacia, their predictors and impact on major outcomes, in the region. METHODS Medline, Pubmed and Embase search engines, entering keywords and concepts, combined with individual countries of interest, were used. Search was limited years 2000-2012; and review articles were used for the period preceding year 2000. RESULTS Rickets and osteomalacia still occur in this sunny region. Hypovitaminosis D prevails, with rates varying 30-90%, considering a desirable serum 25 hydroxy-vitamin D [25(OH)D] of 20 ng/ml. Advancing age, female gender, multi-parity, clothing style, season, socio-economic status and urban living are recognized predictors of hypovitaminosis D in adults. Prolonged breastfeeding without vitamin D supplementation and low dietary calcium intake are the recognized risk factors for rickets and hypovitaminosis D in children.. Associations with pain score and disease activity in rheumatologic disorders, viral load and interleukins in hepatitis C, BMI, lipids and insulin sensitivity, blood pressure, heart failure and mortality are described. Sun exposure in adults decreased prevalence of metabolic syndrome in one study. Few randomized vitamin D trials revealed that the majority of mothers or children failed to achieve a desirable 25(OH)D level, even with doses by far exceeding current recommendations. A trial in adolescent girls reveals substantial bone and lean mass increments. CONCLUSION Hypovitaminosis D is prevalent in MENA. The lack of populations based studies, gaps in studies in infants, pre-pubertal children and pregnant women, hinder the development of region specific guidelines and constitute a major obstacle to impact this chronic and most often subclinical disease.
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Affiliation(s)
- Darina Bassil
- Calcium Metabolism and Osteoporosis Program; WHO Collaborating Center for Metabolic Bone Disorder; Faculty of Medicine; American University of Beirut Medical Center; Beirut, Lebanon
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Islami F, Pourshams A, Vedanthan R, Poustchi H, Kamangar F, Golozar A, Etemadi A, Khademi H, Freedman ND, Merat S, Garg V, Fuster V, Wakefield J, Dawsey SM, Pharoah P, Brennan P, Abnet CC, Malekzadeh R, Boffetta P. Smoking water-pipe, chewing nass and prevalence of heart disease: a cross-sectional analysis of baseline data from the Golestan Cohort Study, Iran. Heart 2013; 99:272-8. [PMID: 23257174 PMCID: PMC3671096 DOI: 10.1136/heartjnl-2012-302861] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Water-pipe and smokeless tobacco use have been associated with several adverse health outcomes. However, little information is available on the association between water-pipe use and heart disease (HD). Therefore, we investigated the association of smoking water-pipe and chewing nass (a mixture of tobacco, lime and ash) with prevalent HD. DESIGN Cross-sectional study. SETTING Baseline data (collected in 2004-2008) from a prospective population-based study in Golestan Province, Iran. PARTICIPANTS 50 045 residents of Golestan (40-75 years old; 42.4% men). MAIN OUTCOME MEASURES ORs and 95% CIs from multivariate logistic regression models for the association of water-pipe and nass use with HD prevalence. RESULTS A total of 3051 (6.1%) participants reported a history of HD, and 525 (1.1%) and 3726 (7.5%) reported ever water-pipe or nass use, respectively. Heavy water-pipe smoking was significantly associated with HD prevalence (highest level of cumulative use vs never use, OR=3.75; 95% CI 1.52 to 9.22; p for trend=0.04). This association persisted when using different cut-off points, when restricting HD to those taking nitrate compound medications, and among never cigarette smokers. There was no significant association between nass use and HD prevalence (highest category of use vs never use, OR=0.91; 95% CI 0.69 to 1.20). CONCLUSIONS Our study suggests a significant association between HD and heavy water-pipe smoking. Although the existing evidence suggesting similar biological consequences of water-pipe and cigarette smoking make this association plausible, results of our study were based on a modest number of water-pipe users and need to be replicated in further studies.
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Affiliation(s)
- Farhad Islami
- Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- The Tisch Cancer Institute and Institute for Transitional Epidemiology, Mount Sinai School of Medicine, New York, United States
| | - Akram Pourshams
- Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Rajesh Vedanthan
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, United States
| | - Hossein Poustchi
- Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farin Kamangar
- Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, United States
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, United States
| | - Asieh Golozar
- Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, United States
| | - Arash Etemadi
- Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, United States
| | - Hooman Khademi
- Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- International Agency for Research on Cancer, Lyon, France
| | - Neal D. Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, United States
| | - Shahin Merat
- Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Vaani Garg
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, United States
| | - Valentin Fuster
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, United States
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Jon Wakefield
- Departments of Biostatistics and Statistics, University of Washington, Seattle, United States
| | - Sanford M. Dawsey
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, United States
| | - Paul Pharoah
- Departments of Oncology and Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Paul Brennan
- International Agency for Research on Cancer, Lyon, France
| | - Christian C. Abnet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, United States
| | - Reza Malekzadeh
- Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Paolo Boffetta
- The Tisch Cancer Institute and Institute for Transitional Epidemiology, Mount Sinai School of Medicine, New York, United States
- International Prevention Research Institute, Lyon, France
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Aluoch AO, Jessee R, Habal H, Garcia-Rosell M, Shah R, Reed G, Carbone L. Heart failure as a risk factor for osteoporosis and fractures. Curr Osteoporos Rep 2012; 10:258-69. [PMID: 22915207 DOI: 10.1007/s11914-012-0115-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Although heart failure (HF) and osteoporosis are common diseases, particularly in elderly populations, patients with HF have an increased risk for osteoporosis. The relationship of HF with osteoporosis is modified by gender and the severity of HF. In addition, shared risk factors, medication use, and common pathogenic mechanisms affect both HF and osteoporosis. Shared risk factors for these 2 conditions include advanced age, hypovitaminosis D, renal disease, and diabetes mellitus. Medications used to treat HF, including spironolactone, thiazide diuretics, nitric oxide donors, and aspirin, may protect against osteoporosis. In contrast, loop diuretics may make osteoporosis worse. HF and osteoporosis appear to share common pathogenic mechanisms, including activation of the renin-angiotensin-aldosterone system, increased parathyroid hormone levels, and/or oxidative/nitrosative stress. HF is a major risk factor for mortality following fractures. Thus, in HF patients, it is important to carefully assess osteoporosis and take measures to reduce the risk of osteoporotic fractures.
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Affiliation(s)
- Aloice O Aluoch
- Department of Medicine, University of TN Health Science Center, Memphis, 38163, USA
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McKeag NA, McKinley MC, Woodside JV, Harbinson MT, McKeown PP. The role of micronutrients in heart failure. J Acad Nutr Diet 2012; 112:870-86. [PMID: 22709814 DOI: 10.1016/j.jand.2012.01.016] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 01/19/2012] [Indexed: 02/07/2023]
Abstract
Heart failure is a common condition in the Western world, particularly among elderly persons and with an ever-aging population, the incidence is expected to increase. Diet in the setting of heart failure is important--patients with this condition are advised to consume a low-salt diet and monitor their weight closely. Nutritional status of patients with heart failure also is important--those with poor nutritional status tend to have a poor long-term prognosis. A growing body of evidence suggests an association between heart failure and micronutrient status. Reversible heart failure has been described as a consequence of severe thiamine and selenium deficiency. However, contemporary studies suggest that a more subtle relationship may exist between micronutrients and heart failure. This article reviews the existing literature linking heart failure and micronutrients, examining studies that investigated micronutrient intake, micronutrient status, and the effect of micronutrient supplementation in patients with heart failure, and focusing particularly on vitamin A, vitamin C, vitamin E, thiamine, other B vitamins, vitamin D, selenium, zinc, and copper.
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Affiliation(s)
- Nicholas A McKeag
- Centre for Public Health, Queen’s University Belfast, Institute of Clinical Science B, Belfast, United Kingdom.
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Bozic B, Loncar G, Prodanovic N, Lepic T, Radojicic Z, Cvorovic V, Dimkovic S, Popovic V. Parathyroid hormone response to vitamin D insufficiency in elderly males with chronic heart failure. Physiol Res 2011; 60:S155-63. [PMID: 21777017 DOI: 10.33549/physiolres.932185] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Secondary hyperparathyroidism (SHPT) may contribute to the systemic illness that accompanies chronic heart failure (CHF). Healthy elderly with vitamin D deficiency who did not develop hyperparathyroidism (functional hypoparathyroidism, FHPT) had lower mortality than those who did. This study was designed to examine determinants of the PTH response in the vitamin D insufficient CHF patients. Sixty five vitamin D insufficient males with NYHA class II and III and 20 control subjects age >/=55 years were recruited. Echocardiography, physical performance, NT-pro-BNP, PTH, 25-hydroxyvitamin D (25(OH)D), adiponectin and bone activity surrogate markers (OPG, RANKL, OC, beta-CTx) were assessed. Increased NYHA class was associated with SHPT, while physical performance was inferior compared to FHPT. SHPT was associated with lower left ventricular ejection fraction (LVEF) and flow mediated dilatation, but with higher left heart dimensions, left ventricular mass index and right ventricular systolic pressure. CHF patients with SHPT had increased NT-pro-BNP, adiponectin and bone markers, but decreased 25(OH)D compared to those with FHPT. Independent determinants for SHPT in CHF patients with vitamin D insufficiency were LVEF, adiponectin and beta-CTx, irrespective of renal function and serum vitamin D levels. In conclusion, increased PTH levels, but not low vitamin D, demonstrated close relation to CHF severity.
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Affiliation(s)
- B Bozic
- Institute for Medical Research, Military Medical Academy, Belgrade, Serbia
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Micronutrient Support in Heart Failure. TOP CLIN NUTR 2010. [DOI: 10.1097/tin.0b013e3181ff58cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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