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Liu X, Dong H, Huang B, Miao H, Xu Z, Yuan Y, Qiu F, Chen J, Zhang H, Liu Z, Quan X, Zhu L, Zhang Z. Native Coronary Collateral Microcirculation Reserve in Rat Hearts. J Am Heart Assoc 2020; 8:e011220. [PMID: 30819021 PMCID: PMC6474916 DOI: 10.1161/jaha.118.011220] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background We occasionally noticed that native collateral blood flow showed a recessive trend in the early stages of acute myocardial infarction in rats, which greatly interferes with the accurate assessment of native collateral circulation levels. Here, we sought to recognize the coronary collateral circulation system in depth, especially the microcirculation part, on this basis. Methods and Results In this study, we detected native collateral flow with positron emission tomography perfusion imaging in rats and found that the native flow is relatively abundant when it is initially recruited. However, this flow is extremely unstable in the early stage of acute myocardial infarction and quickly fails. We used tracers to mark the collateral in an ischemic area and a massive preformed collateral network was labeled. The ultrastructures of these collateral microvessels are flawed, which contributes to extensive leakage and consequent interstitial edema in the ischemic region. Conclusions An unrecognized short-lived native coronary collateral microcirculation reserve is widely distributed in rat hearts. Recession of collateral blood flow transported by coronary collateral microcirculation reserve contributes to instability of native collateral blood flow in the early stage of acute myocardial infarction. The immature structure determines that these microvessels are short-lived and provide conditions for the development of early interstitial edema in acute myocardial infarction.
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Affiliation(s)
- Xiucheng Liu
- Department of Thoracic Cardiovascular SurgeryAffiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Hongyan Dong
- Morphological Research Experiment CenterXuzhou Medical UniversityXuzhouChina
| | - Bing Huang
- Department of Thoracic Cardiovascular SurgeryAffiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Haoran Miao
- Department of Thoracic Cardiovascular SurgeryAffiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Zhiwei Xu
- Department of Cardiovascular SurgeryShanghai Chest HospitalShanghai Jiaotong UniversityShanghaiChina
| | - Yanliang Yuan
- Department of Thoracic Cardiovascular SurgeryAffiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Fan Qiu
- Department of Thoracic Cardiovascular SurgeryAffiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Jiali Chen
- Department of Thoracic Cardiovascular SurgeryAffiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Hao Zhang
- Department of Thoracic Cardiovascular SurgeryAffiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Zhiwei Liu
- Morphological Research Experiment CenterXuzhou Medical UniversityXuzhouChina
| | - Xiaoyu Quan
- Department of Thoracic Cardiovascular SurgeryAffiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Lidong Zhu
- Department of Thoracic Cardiovascular SurgeryAffiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Zhongming Zhang
- Department of Thoracic Cardiovascular SurgeryAffiliated Hospital of Xuzhou Medical UniversityXuzhouChina
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Effect of prompt revascularization on outcomes in diabetic patients with stable ischemic heart disease and previous myocardial infarction in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial. Coron Artery Dis 2017; 28:301-306. [DOI: 10.1097/mca.0000000000000492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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SCHUTT ROBERTC, YOUNG SHIUM, LIU LING, LIPSON LEWISC, KEELEY ELLENC. The Association of Angiographic Collaterals with Long-Term Clinical Outcomes in Patients with Chronic Stable Angina. J Interv Cardiol 2014; 27:225-32. [DOI: 10.1111/joic.12124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- ROBERT C. SCHUTT
- Department of Medicine; University of Virginia; Charlottesville Virginia
| | - SHIU M. YOUNG
- Department of Medicine; University of Virginia; Charlottesville Virginia
| | - LING LIU
- Department of Medicine; University of Virginia; Charlottesville Virginia
- Division of Cardiology; University of Virginia; Charlottesville Virginia
| | - LEWIS C. LIPSON
- Department of Medicine; University of Virginia; Charlottesville Virginia
- Division of Cardiology; University of Virginia; Charlottesville Virginia
| | - ELLEN C. KEELEY
- Department of Medicine; University of Virginia; Charlottesville Virginia
- Division of Cardiology; University of Virginia; Charlottesville Virginia
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Seiler C, Meier P. Historical aspects and relevance of the human coronary collateral circulation. Curr Cardiol Rev 2014; 10:2-16. [PMID: 23859295 PMCID: PMC3968590 DOI: 10.2174/1573403x113099990028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 02/28/2013] [Accepted: 04/19/2013] [Indexed: 11/28/2022] Open
Abstract
In 1669, anastomoses between the right and left coronary artery were first documented by Richard Lower of Amsterdam. Using post-mortem imaging, a debate followed on the existence of structural inter-coronary anastomoses, which was not resolved before the first half of the 20 ieth century in case of the presence of coronary artery disease (CAD), and not before the early 1960 ies in case of the normal human coronary circulation by William Fulton. Functional coronary collateral measurements during coronary interventions were first performed only in the 1970 ies, respectively in the early 1980 ies. In humans, the existence of functional coronary collaterals in the absence of CAD has not been documented before 2003. Though the coronary collateral circulation has been recognized as an alternative source of blood supply to ischemic myocardium, its prognostic significance for the CAD population as a whole has been controversial until recently. The debate was due to different populations examined (acute versus chronic CAD, varying severity of CAD), to variable definitions of the term "prognosis", to insufficient statistical power of the investigation with rare occurrence of prognostic endpoints, to short duration of follow-up and to blunt instruments employed for collateral assessment. Individually, it has been acknowledged that a well functioning collateral supply to a myocardial area at risk for necrosis reduces infarct size, preserves ventricular function, prevents ventricular remodelling and aneurysm formation. Collectively, evidence has accumulated only recently that an extensive coronary collateral circulation is a beneficial prognosticator quoad vitam. In a recent meta-analysis on the topic, the risk ratio to die from any cause for high vs low or absent collateralization in patients with subacute myocardial infarction was 0.53 (95% confidence interval 0.15-1.92; p=0.335), and for patients with acute myocardial infarction, it was 0.63 (95% confidence interval 0.29-1.39; p=0.257)¸ the relative risk to die from any cause for well vs poorly developed collaterals in patients with stable CAD was 0.59 (95% confidence interval 0.39-0.89), p=0.012.
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Affiliation(s)
| | - Pascal Meier
- University Hospital, Freiburgstrasse, CH-3010 Bern, Switzerland.
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Seiler C, Stoller M, Pitt B, Meier P. The human coronary collateral circulation: development and clinical importance. Eur Heart J 2013; 34:2674-82. [PMID: 23739241 DOI: 10.1093/eurheartj/eht195] [Citation(s) in RCA: 183] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Coronary collaterals are an alternative source of blood supply to myocardium jeopardized by ischaemia. In comparison with other species, the human coronary collateral circulation is very well developed. Among individuals without coronary artery disease (CAD), there are preformed collateral arteries preventing myocardial ischaemia during a brief vascular occlusion in 20-25%. Determinants of such anastomoses are low heart rate and the absence of systemic arterial hypertension. In patients with CAD, collateral arteries preventing myocardial ischaemia during a brief occlusion are present in every third individual. Collateral flow sufficient to prevent myocardial ischaemia during coronary occlusion amounts to one-fifth to one-fourth the normal flow through the open vessel. Myocardial infarct size, the most important prognostic determinant after such an event, is the product of coronary artery occlusion time, area at risk for infarction, and the inverse of collateral supply. Well-developed coronary collateral arteries in patients with CAD mitigate myocardial infarcts and improve survival. Approximately one-fifth of patients with CAD cannot be revascularized by percutaneous coronary intervention or coronary artery bypass grafting. Therapeutic promotion of collateral growth is a valuable treatment strategy in those patients. It should aim at growth of large conductive collateral arteries (arteriogenesis). Potential arteriogenic approaches include the treatment with granulocyte colony-stimulating factor, physical exercise training, and external counterpulsation.
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Affiliation(s)
- Christian Seiler
- Department of Cardiology, University Hospital, Bern CH-3010, Switzerland
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Gagnor A, Tomassini F, Montali N, Tizzani E, Giolitto S, Infantino V, Favro E, Varbella F. Chronic total occlusion treatment as a health insurance: collateral recruitability and bidirectionality. J Cardiovasc Med (Hagerstown) 2012; 14:899-901. [PMID: 22472848 DOI: 10.2459/jcm.0b013e3283528fcb] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Andrea Gagnor
- Divisione di Cardiologia, Ospedale degli Infermi, Rivoli (TO), Italy
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McMurtry MS, Lewin AM, Knudtson ML, Ghali WA, Galbraith PD, Schulte F, Norris CM, Graham MM. The Clinical Profile and Outcomes Associated With Coronary Collaterals in Patients With Coronary Artery Disease. Can J Cardiol 2011; 27:581-8. [DOI: 10.1016/j.cjca.2011.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 02/24/2011] [Accepted: 02/24/2011] [Indexed: 01/04/2023] Open
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Keeley EC, Moorman JR, Liu L, Gimple LW, Lipson LC, Ragosta M, Taylor AM, Lake DE, Burdick MD, Mehrad B, Strieter RM. Plasma chemokine levels are associated with the presence and extent of angiographic coronary collaterals in chronic ischemic heart disease. PLoS One 2011; 6:e21174. [PMID: 21731663 PMCID: PMC3120847 DOI: 10.1371/journal.pone.0021174] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 05/21/2011] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In patients with chronic ischemic heart disease (IHD), the presence and extent of spontaneously visible coronary collaterals are powerful determinants of clinical outcome. There is marked heterogeneity in the recruitment of coronary collaterals amongst patients with similar degrees of coronary artery stenoses, but the biological basis of this heterogeneity is not known. Chemokines are potent mediators of vascular remodeling in diverse biological settings. Their role in coronary collateralization has not been investigated. We sought to determine whether plasma levels of angiogenic and angiostatic chemokines are associated with of the presence and extent of coronary collaterals in patients with chronic IHD. METHODOLOGY/PRINCIPAL FINDINGS We measured plasma concentrations of angiogenic and angiostatic chemokine ligands in 156 consecutive subjects undergoing coronary angiography with at least one ≥90% coronary stenosis and determined the presence and extent of spontaneously visible coronary collaterals using the Rentrop scoring system. Eighty-eight subjects (56%) had evidence of coronary collaterals. In a multivariable regression model, the concentration of the angiogenic ligands CXCL5, CXCL8 and CXCL12, hyperlipidemia, and an occluded artery were associated with the presence of collaterals; conversely, the concentration of the angiostatic ligand CXCL11, interferon-γ, hypertension and diabetes were associated with the absence of collaterals (ROC area 0.91). When analyzed according to extent of collateralization, higher Rentrop scores were significantly associated with increased concentration of the angiogenic ligand CXCL1 (p<0.0001), and decreased concentrations of angiostatic ligands CXCL9 (p<0.0001), CXCL10 (p = 0.002), and CXCL11 (p = 0.0002), and interferon-γ (p = 0.0004). CONCLUSIONS/SIGNIFICANCE Plasma chemokine concentrations are associated with the presence and extent of spontaneously visible coronary artery collaterals and may be mechanistically involved in their recruitment.
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Affiliation(s)
- Ellen C Keeley
- Division of Cardiology, University of Virginia, Charlottesville, Virginia, United States of America.
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Rieber J, Sheth TN, Mooyaart EAQ, Shapiro MD, Butler J, Ferencik M, Brady TJ, Klauss V, Hoffmann U. Assessment of the presence and extent of coronary collateralization by coronary computed tomographic angiography in patients with total occlusions. Int J Cardiovasc Imaging 2008; 25:331-7. [DOI: 10.1007/s10554-008-9384-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Accepted: 10/24/2008] [Indexed: 10/21/2022]
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Meier P, Gloekler S, Zbinden R, Beckh S, de Marchi SF, Zbinden S, Wustmann K, Billinger M, Vogel R, Cook S, Wenaweser P, Togni M, Windecker S, Meier B, Seiler C. Beneficial effect of recruitable collaterals: a 10-year follow-up study in patients with stable coronary artery disease undergoing quantitative collateral measurements. Circulation 2007; 116:975-83. [PMID: 17679611 DOI: 10.1161/circulationaha.107.703959] [Citation(s) in RCA: 222] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The prognostic relevance of the collateral circulation is still controversial. The goal of this study was to assess the impact on survival of quantitatively obtained, recruitable coronary collateral flow in patients with stable coronary artery disease during 10 years of follow-up. METHODS AND RESULTS Eight-hundred forty-five individuals (age, 62+/-11 years), 106 patients without coronary artery disease and 739 patients with chronic stable coronary artery disease, underwent a total of 1053 quantitative, coronary pressure-derived collateral measurements between March 1996 and April 2006. All patients were prospectively included in a collateral flow index (CFI) database containing information on recruitable collateral flow parameters obtained during a 1-minute coronary balloon occlusion. CFI was calculated as follows: CFI = (P(occl) - CVP)/(P(ao) - CVP) where P(occl) is mean coronary occlusive pressure, P(ao) is mean aortic pressure, and CVP is central venous pressure. Patients were divided into groups with poorly developed (CFI < 0.25) or well-grown collateral vessels (CFI > or = 0.25). Follow-up information on the occurrence of all-cause mortality and major adverse cardiac events after study inclusion was collected. Cumulative 10-year survival rates in relation to all-cause deaths and cardiac deaths were 71% and 88%, respectively, in patients with low CFI and 89% and 97% in the group with high CFI (P=0.0395, P=0.0109). Through the use of Cox proportional hazards analysis, the following variables independently predicted elevated cardiac mortality: age, low CFI (as a continuous variable), and current smoking. CONCLUSIONS A well-functioning coronary collateral circulation saves lives in patients with chronic stable coronary artery disease. Depending on the exact amount of collateral flow recruitable during a brief coronary occlusion, long-term cardiac mortality is reduced to one fourth compared with the situation without collateral supply.
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Affiliation(s)
- Pascal Meier
- Department of Cardiology, University Hospital, CH-3010 Bern, Switzerland
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King SB, Aversano T, Ballard WL, Beekman RH, Cowley MJ, Ellis SG, Faxon DP, Hannan EL, Hirshfeld JW, Jacobs AK, Kellett MA, Kimmel SE, Landzberg JS, McKeever LS, Moscucci M, Pomerantz RM, Smith KM, Vetrovec GW, Creager MA, Holmes DR, Newby LK, Weitz HH, Merli G, Piña I, Rodgers GP, Tracy CM. ACCF/AHA/SCAI 2007 Update of the Clinical Competence Statement on Cardiac Interventional Procedures. Circulation 2007; 116:98-124. [PMID: 17592076 DOI: 10.1161/circulationaha.107.185159] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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12
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King SB, Aversano T, Ballard WL, Beekman RH, Cowley MJ, Ellis SG, Faxon DP, Hannan EL, Hirshfeld JW, Jacobs AK, Kellett MA, Kimmel SE, Landzberg JS, McKeever LS, Moscucci M, Pomerantz RM, Smith KM, Vetrovec GW, Creager MA, Hirshfeld JW, Holmes DR, Newby LK, Weitz HH, Merli G, Piña I, Rodgers GP, Tracy CM. ACCF/AHA/SCAI 2007 Update of the Clinical Competence Statement on Cardiac Interventional Procedures. J Am Coll Cardiol 2007; 50:82-108. [PMID: 17601554 DOI: 10.1016/j.jacc.2007.05.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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King SB, Aversano T, Ballard WL, Beekman RH, Cowley MJ, Ellis SG, Faxon DP, Hannan EL, Hirshfeld JW, Jacobs AK, Kellett MA, Kimmel SE, Landzberg JS, McKeever LS, Moscucci M, Pomerantz RM, Smith KM, Vetrovec GW. ACCF/AHA/SCAI 2007 update of the clinical competence statement on cardiac interventional procedures a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians task Force on Clinical Competence and Training (writing committee to update the 1998 clinical competence statement on recommendations for the assessment and maintenance of proficiency in coronary interventional procedures). Catheter Cardiovasc Interv 2007. [DOI: 10.1002/ccd.21313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Nathoe HM, Koerselman J, Buskens E, van Dijk D, Stella PR, Plokker THW, Doevendans PAFM, Grobbee DE, de Jaegere PPT. Determinants and prognostic significance of collaterals in patients undergoing coronary revascularization. Am J Cardiol 2006; 98:31-5. [PMID: 16784916 DOI: 10.1016/j.amjcard.2006.01.050] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2005] [Revised: 01/17/2006] [Accepted: 01/17/2006] [Indexed: 01/08/2023]
Abstract
There is evidence that coronary collaterals improve the prognosis in patients with acute myocardial infarction (MI). However, there is limited clinical information on the protective role of collaterals in patients with stable coronary artery disease. This information may help risk stratification and the development of novel therapies, such as arteriogenesis and angiogenesis. The relation between collaterals and cardiac death or MI at 1 year after coronary revascularization was studied in 561 patients who were enrolled in a randomized study that compared stent implantation with bypass grafting. Collaterals were assessed on an angiogram using Rentrop's classification and considered present with a Rentrop grade >1. Unadjusted and adjusted odds ratios for cardiac death or MI at 1 year were calculated using univariate and multivariate regression analyses. In addition, determinants of collaterals were assessed using univariate and multivariate analyses. Collaterals were present in 176 patients (31%). The adjusted odds ratio of cardiac death or infarction was 0.18 (95% confidence interval 0.04 to 0.78) in the presence of collaterals. Independent determinants of collaterals were age (odds ratio 0.97, 95% confidence interval 0.95 to 0.99), multivessel disease (odds ratio 1.60, 95% confidence interval 1.02 to 2.51), impaired ventricular function (odds ratio 1.85, 95% confidence interval 1.04 to 3.29), type C lesion (odds ratio 3.72, 95% confidence interval 2.33 to 5.95), and stenosis severity >90% (odds ratio 9.08, 95% confidence interval 4.65 to 17.73). In conclusion, in patients with a low risk profile, the presence of collaterals protects against cardiac death and MI at 1 year after coronary revascularization. Variables that reflect the duration and severity of the atherosclerotic and ischemic burden determine their presence.
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Osswald BR. How to overcome difficulties in the evaluation of best possible decision-making in redo-revascularization? Eur Heart J 2005; 27:375-6. [PMID: 16311235 DOI: 10.1093/eurheartj/ehi669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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