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Pandya HC, Mulla H, Hubbard M, Cordell RL, Monks PS, Yakkundi S, McElnay JC, Nunn AJ, Turner MA. Essential medicines containing ethanol elevate blood acetaldehyde concentrations in neonates. Eur J Pediatr 2016; 175:841-7. [PMID: 26997167 PMCID: PMC4868857 DOI: 10.1007/s00431-016-2714-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 03/03/2016] [Accepted: 03/08/2016] [Indexed: 01/15/2023]
Abstract
UNLABELLED Neonates administered ethanol-containing medicines are potentially at risk of dose-dependent injury through exposure to ethanol and its metabolite, acetaldehyde. Here, we determine blood ethanol and acetaldehyde concentrations in 49 preterm infants (median birth weight = 1190 g) dosed with iron or furosemide, medicines that contain different amounts of ethanol, and in 11 control group infants (median birth weight = 1920 g) who were not on any medications. Median ethanol concentrations in neonates administered iron or furosemide were 0.33 (range = 0-4.92) mg/L, 0.39 (range = 0-72.77) mg/L and in control group infants were 0.15 (range = 0.03-5.4) mg/L. Median acetaldehyde concentrations in neonates administered iron or furosemide were 0.16 (range = 0-8.89) mg/L, 0.21 (range = 0-2.43) mg/L and in control group infants were 0.01 (range = 0-0.14) mg/L. There was no discernible relationship between blood ethanol or acetaldehyde concentrations and time after medication dose. CONCLUSION Although infants dosed with iron or furosemide had low blood ethanol concentrations, blood acetaldehyde concentrations were consistent with moderate alcohol exposure. The data suggest the need to account for the effects of acetaldehyde in the benefit-risk analysis of administering ethanol-containing medicines to neonates. WHAT IS KNOWN • Neonates are commonly treated with ethanol-containing medicines, such as iron and furosemide. • However, there is no data on whether this leads to appreciable increases in blood concentrations of ethanol or its metabolite, acetaldehyde. What is New: • In this study, we find low blood ethanol concentrations in neonates administered iron and/or furosemide but markedly elevated blood acetaldehyde concentrations in some infants receiving these medicines. • Our data suggest that ethanol in drugs may cause elevation of blood acetaldehyde, a potentially toxic metabolite.
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Affiliation(s)
- H. C. Pandya
- />Department of Infection, Immunity and Inflammation, University of Leicester, University Road, Leicester, LE1 9HN UK
| | - H. Mulla
- />Department of Pharmacy, University of Hospitals Leicester NHS Trust, Leicester, UK
| | - M. Hubbard
- />Neonatal Unit University of Hospitals Leicester NHS Trust, Leicester, UK
| | - R. L. Cordell
- />Department of Chemistry, University of Leicester, Leicester, UK
| | - P. S. Monks
- />Department of Chemistry, University of Leicester, Leicester, UK
| | - S. Yakkundi
- />Department of Pharmacy, Queen’s University Belfast, Belfast, UK
| | - J. C. McElnay
- />Department of Pharmacy, Queen’s University Belfast, Belfast, UK
| | - A. J. Nunn
- />Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - M. A. Turner
- />Department of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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Yang JY, Kwak HS, Han JY, Choi JS, Ahn HK, Oh YJ, Velázquez-Armenta EY, Nava-Ocampo AA. Linear Versus Non-Linear Dose-Response Relationship Between Prenatal Alcohol Exposure and Meconium Concentration of Nine Different Fatty Acid Ethyl Esters. Dose Response 2015; 13:10.2203_dose-response.14-056_Yang. [PMID: 26691866 PMCID: PMC4679215 DOI: 10.2203/dose-response.14-056_yang] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Presence of individual fatty acid ethyl esters (FAEEs) in meconium is considered to be a reliable biomarker of prenatal alcohol exposure, and their concentration has been found to be linearly associated with poor postnatal development, supporting the widely extended idea that ethanol is a non-threshold teratogen. However, a growing number of epidemiological studies have consistently found a lack of adverse short- and long-term fetal outcomes at low exposure levels. We therefore aimed to investigate the relationship between the concentration of individual FAEEs and prenatal alcohol exposure in meconium samples collected within the first 6 to 12?h after birth from 182 babies born to abstainer mothers and from 54 babies born to women who self-reported either light or moderate alcohol ingestion in the second or third trimester of pregnancy. In most cases, the individual FAEE concentrations were negligible and not significantly different (P >0.05) between exposed and control babies. The concentrations appeared to increase linearly with the dose only in the few babies born to mothers who reported >3 drinks/week. These results provide evidence that the correlation between prenatal alcohol exposure and individual FAEE concentrations in meconium is non-linear shape, with a threshold probably at 3 drinks/week.
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Affiliation(s)
- J Y Yang
- National Institute of of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Seoul, Republic of Korea ; Department of Systems Biology, Yonsei University, Seoul, Republic of Korea
| | - H S Kwak
- Department of Laboratory Medicine, Cheil General Hospital and Women's Healthcare Center, Kwandong University School of Medicine, Seoul, Republic of Korea
| | - J Y Han
- The Korean Motherisk Program, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University School of Medicine, Seoul, Republic of Korea
| | - J S Choi
- The Korean Motherisk Program, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University School of Medicine, Seoul, Republic of Korea
| | - H K Ahn
- The Korean Motherisk Program, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University School of Medicine, Seoul, Republic of Korea
| | - Y J Oh
- Department of Systems Biology, Yonsei University, Seoul, Republic of Korea
| | - E Y Velázquez-Armenta
- PharmaReasons - Pharmacological Research & Applied Solutions, Toronto, Ontario, Canada
| | - A A Nava-Ocampo
- PharmaReasons - Pharmacological Research & Applied Solutions, Toronto, Ontario, Canada ; Department of Pharmacology & Toxicology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada ; Division of Clinical Pharmacology & Toxicology, Hospital for Sick Children, Toronto, Ontario, Canada
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3
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Thierauf A, Große Perdekamp M, Auwärter V. Maximale Blutalkoholkonzentration nach forciertem Konsum von alkoholfreiem Bier. Rechtsmedizin (Berl) 2012. [DOI: 10.1007/s00194-012-0835-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Littner Y, Cudd TA, O'Riordan MA, Cwik A, Bearer CF. Elevated fatty acid ethyl esters in meconium of sheep fetuses exposed in utero to ethanol--a new animal model. Pediatr Res 2008; 63:164-8. [PMID: 18091344 PMCID: PMC4104189 DOI: 10.1203/pdr.0b013e31815f651e] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Specific fatty acid ethyl esters (FAEE) in meconium of newborns have been shown to correlate with maternal ethanol exposure. An animal model is needed to assess the validity of this biomarker. We hypothesized that the pregnant/fetal sheep is a feasible animal model for validating FAEE as a biomarker of prenatal ethanol exposure. Nine pregnant ewes were treated during the third trimester with different i.v. ethanol doses. The control group consisted of 14 pregnant ewes exposed to similar volumes of saline. On gestational d 133, the fetuses were delivered and meconium samples removed. FAEEs were quantified by gas chromatography-flame ionization detection. FAEEs were found in both control and ethanol exposed fetuses. Ethyl oleate, ethyl linoleate, and ethyl arachidonate levels were significantly higher in the ethanol-exposed sheep. Ethyl oleate was the FAEE that correlated most strongly with alcohol ingestion during pregnancy and had the greatest area under the curve (0.94). Using a cut-off value of 131 ng/g ethyl oleate dry weight, sensitivity was 89% and specificity was 100%. In conclusion, pregnant ewes are a feasible model for validating biomarkers of prenatal ethanol exposure. Ethyl oleate, ethyl linoleate, and ethyl arachidonate may be useful biomarkers of prenatal alcohol exposure.
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Affiliation(s)
- Yoav Littner
- Department of Pediatrics, Case Western Reserve University and Rainbow Babies and Children's Hospital, Cleveland, Ohio 44106, USA.
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5
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Caprara DL, Nash K, Greenbaum R, Rovet J, Koren G. Novel approaches to the diagnosis of fetal alcohol spectrum disorder. Neurosci Biobehav Rev 2006; 31:254-60. [PMID: 16934870 DOI: 10.1016/j.neubiorev.2006.06.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2006] [Accepted: 06/12/2006] [Indexed: 11/30/2022]
Abstract
The diagnosis of fetal alcohol spectrum disorder is a difficult task, especially in cases where clear, physical markers of in utero alcohol exposure are not apparent. Reviewed in the following paper are some older tools for screening alcohol use in pregnancy and present novel approaches to the diagnosis of FASD, including ethanol biomarker development to behavioural phenotyping. Improving current FASD diagnostic methodology through more novel approaches may provide the possibility of earlier and wider diagnosis, allowing intervention and treatment at stages where the advanced effects of alcohol can still be mitigated.
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Affiliation(s)
- Daniela L Caprara
- Division of Clinical Pharmacology/Toxicology and Motherisk Program, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, Ont., Canada M5G 1X8
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6
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Gareri J, Klein J, Koren G. Drugs of abuse testing in meconium. Clin Chim Acta 2006; 366:101-11. [PMID: 16413011 DOI: 10.1016/j.cca.2005.10.028] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2004] [Revised: 10/20/2005] [Accepted: 10/21/2005] [Indexed: 10/25/2022]
Abstract
Prenatal substance abuse is an ongoing concern with significant impact on neonatal health and development across socioeconomic lines. Meconium, passed by neonates during their first post-natal bowel movements, is a matrix unique to the developing fetus and contains a long history of prenatal metabolism. Over the last two decades, the use of meconium as a matrix for assessing prenatal exposure to drugs of abuse has yielded methods exhibiting higher sensitivity, easier collection, and a larger window of detection than traditional matrices. Recently, a method has been developed for the analysis of fatty acid ethyl esters in meconium as a biomarker of fetal alcohol exposure, potentially facilitating the future diagnosis of Fetal Alcohol Spectrum Disorder in situations where gestational alcohol consumption history is unknown. Screening for prenatal exposure to illicit and abused licit drugs in meconium is possible by use of a variety of immunoassay methods with conformational analysis usually occurring by GCMS or LCMS. In spite of increased sample preparation time relative to blood and urine, the long metabolic history, coupled with the ease and wide window of collection of meconium make it the ideal matrix for determining fetal drug exposure.
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Affiliation(s)
- Joey Gareri
- Motherisk Program, Division of Clinical Pharmacology/Toxicology, Hospital for Sick Children, Toronto, University of Toronto, Toronto, Ontario, Canada
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7
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Chan D, Caprara D, Blanchette P, Klein J, Koren G. Recent developments in meconium and hair testing methods for the confirmation of gestational exposures to alcohol and tobacco smoke. Clin Biochem 2004; 37:429-38. [PMID: 15183290 DOI: 10.1016/j.clinbiochem.2004.01.010] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2003] [Revised: 01/26/2004] [Accepted: 01/27/2004] [Indexed: 11/28/2022]
Abstract
The use of alcohol and tobacco is prevalent among pregnant women despite the well-known adverse effects of these substances imposed on the developing fetus and immense public health education efforts. Confirmation of gestational exposures to these compounds have relied mostly on maternal self-reporting, which is often underestimated because of guilt, embarrassment, and fear of punitive action. The presence of fatty acid ethyl esters in various biological matrices as a result of alcohol consumption initiated the development of neonatal screening tests for these emerging biological markers in meconium and hair. The levels of nicotine and cotinine in hair have long been used as objective indices for the quantification of exposure to active and passive smoking. Maternal segmental hair analysis in the study of pharmacokinetic changes in nicotine metabolism in the obstetric population is a novel application of this traditional analytical method. The latest developments and novel applications of meconium and hair testing for the confirmation of prenatal alcohol and tobacco exposure are discussed in this review.
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Affiliation(s)
- Daphne Chan
- The Hospital for Sick Children, Toronto, Ontario, Canada
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8
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Chan D, Bar-Oz B, Pellerin B, Paciorek C, Klein J, Kapur B, Farine D, Koren G. Population baseline of meconium fatty acid ethyl esters among infants of nondrinking women in Jerusalem and Toronto. Ther Drug Monit 2003; 25:271-8. [PMID: 12766552 DOI: 10.1097/00007691-200306000-00004] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The detection of fatty acid ethyl esters (FAEE) in meconium may provide an objective estimate of prenatal alcohol exposure independent of maternal history. The authors report the results of the first population-based study conducted to investigate basal FAEE levels in the meconium of neonates not exposed to alcohol. Two hundred seven nondrinking women and their neonates were recruited from Toronto and Jerusalem. FAEE were extracted from meconium by solid-phase extraction and analyzed by GC/FID. Similar procedures were conducted in six neonates born to confirmed heavy drinkers. Low levels of meconium FAEE were detected from both cohorts (mean, 1.37 nmol/g vs. 2.08 nmol/g, Toronto vs. Jerusalem). Ethyl stearate, oleate, and linoleate were below the limit of detection in >80% of all samples, whereas ethyl laurate and palmitate were detected in >50% of the samples. Ethyl myristate was the FAEE most commonly detected (>80%). All six meconium samples with confirmed maternal drinking histories tested positive for FAEE at significantly higher levels (mean, 11.08 nmol/g). The use of 2 nmol total FAEE/g meconium as the positive cutoff, when lauric and myristic acid ethyl esters were excluded, yielded the greatest sensitivity (100%) and specificity (98.4%). The authors conclude that certain FAEE are present at measurable levels in the meconium of neonates not exposed to maternal drinking, and correction is needed to allow high specificity.
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Affiliation(s)
- Daphne Chan
- Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Toronto, Canada
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9
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Janda I, Alt A. Improvement of ethyl glucuronide determination in human urine and serum samples by solid-phase extraction. JOURNAL OF CHROMATOGRAPHY. B, BIOMEDICAL SCIENCES AND APPLICATIONS 2001; 758:229-34. [PMID: 11486833 DOI: 10.1016/s0378-4347(01)00186-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
An improved method for the determination of ethyl glucuronide (EtG) in human serum and urine was developed using solid-phase extraction (SPE) and gas chromatography (GC) with mass spectrometric detection (MS). EtG was isolated from serum and urine using aminopropyl SPE columns after deproteination with perchloric acid and hydrochloric acid, respectively. The chromatographic separation was performed on a DB 1701 fused-silica column. At a signal-to-noise ratio of 3:1, a quantification limit of 173 and 560 ng/ml and a detection limit of 37 and 168 ng/ml could be determined for serum and urine, respectively. This indicates high specificity and sensitivity of the described method. The mean absolute recovery was approximately 85%, while intra- and inter-day precision of the assay were all less than 7.5%. The linearity of the calibration curves was satisfying as indicated by correlation coefficients of >0.993. The presented method provides the basis for determination and identification of EtG in human serum and urine samples in a low-concentration range for monitoring alcohol consumption during treatment for alcohol dependence and comorbid alcohol abuse of psychotherapy patients.
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Affiliation(s)
- I Janda
- Department of Forensic Medicine, University of Ulm, Germany.
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10
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Logan BK, Jones AW. Endogenous ethanol 'auto-brewery syndrome' as a drunk-driving defence challenge. MEDICINE, SCIENCE, AND THE LAW 2000; 40:206-215. [PMID: 10976182 DOI: 10.1177/002580240004000304] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The concentration of ethanol in blood, breath or urine constitutes important evidence for prosecuting drunk drivers. For various reasons, the reliability of the results of forensic alcohol analysis are often challenged by the defence. One such argument for acquittal concerns the notion that alcohol could be produced naturally in the body, hence the term 'auto-brewery' syndrome. Although yeasts such as Candida albicans readily produce ethanol in-vitro, whether this happens to any measurable extent in healthy ambulatory subjects is an open question. Over the years, many determinations of endogenous ethanol have been made, and in a few rare instances (Japanese subjects with very serious yeast infections) an abnormally high ethanol concentration (> 80 mg/dl) has been reported. In these atypical individuals, endogenous ethanol appeared to have been produced after they had eaten carbohydrate-rich foods. A particular genetic polymorphism resulting in reduced activity of enzymes involved in hepatic metabolism of ethanol and a negligible first-pass metabolism might explain ethnic differences in rates of endogenous ethanol production and clearance. Other reports of finding abnormally high concentrations of ethanol in body fluids from ostensibly healthy subjects suffer from deficiencies in study design and lack suitable control experiments or used non-specific analytical methods. With reliable gas chromatographic methods of analysis, the concentrations of endogenous ethanol in peripheral venous blood of healthy individuals, as well as those suffering from various metabolic disorders (diabetes, hepatitis, cirrhosis) ranged from 0-0.08 mg/dl. These concentrations are far too low to have any forensic or medical significance. The notion that a motorist's state of intoxication was caused by endogenously produced ethanol lacks merit.
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Affiliation(s)
- B K Logan
- Washington State Toxicology Laboratory, University of Washington, Seattle 98134-2027, USA
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Channareddy S, Nguyen NT, Janes N. Saturable ethanol binding in rat liver mitochondria. BIOCHIMICA ET BIOPHYSICA ACTA 2000; 1463:291-300. [PMID: 10675507 DOI: 10.1016/s0005-2736(99)00220-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The binding of ethanol to rat liver mitochondria is shown to be saturable at physiologically relevant ethanol concentrations. This effect is reversible and is not observed in extracted mitochondrial phospholipids. Brief exposure of the mitochondria to heat abolishes saturable ethanol binding. Previously, saturable ethanol binding was reported in rat liver microsomes. Taken together, the studies indicate that saturable ethanol binding motifs may be widespread in cellular membranes. The possibility is raised that incomplete expression of the hydrophobic effect in membrane assembly results in the expression of amphipathic packing defects which display an affinity for and a sensitivity to ethanol. The presence of saturable binding modalities is reconciled with the long-standing consensus on the biodistribution of ethanol - that ethanol's interactions with tissue are negligible - on the grounds that the affinities of ethanol and of water for membranes are similar; consequently, free ethanol concentrations are insensitive to the presence of tissue despite significant ethanol binding. A fraction of the binding sites possess submillimolar affinities for ethanol consistent with published functional studies, both in vitro and in vivo, that reported submillimolar efficacies for ethanol.
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Affiliation(s)
- S Channareddy
- Department of Pathology, Anatomy, and Cell Biology, Medical College of Thomas Jefferson University, 1020 Locust Street, Philadelphia, PA 19107, USA
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Davidson D, Camara P, Swift R. Behavioral Effects and Pharmacokinetics of Low-Dose Intravenous Alcohol in Humans. Alcohol Clin Exp Res 1997. [DOI: 10.1111/j.1530-0277.1997.tb04451.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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