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Spady MA, Gohari A. Middle Rectal Artery Pseudoaneurysm: A Case of Massive Lower Gastrointestinal Bleeding Managed With Coil Embolization. Cureus 2024; 16:e61573. [PMID: 38962653 PMCID: PMC11221194 DOI: 10.7759/cureus.61573] [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: 05/26/2024] [Indexed: 07/05/2024] Open
Abstract
Pseudoaneurysms of the middle rectal artery are rare. When encountered, these have the potential for significant morbidity and mortality due to bleeding and potential rupture. Endovascular embolization is a feasible option in the management of these pseudoaneurysms. The present report describes a case of a 43-year-old male presenting with hemorrhagic shock secondary to lower gastrointestinal bleeding one day after undergoing excision of an external perineal condyloma, incision and drainage of a perirectal abscess, and biopsy of a perianal mass. Angiographic imaging revealed a right middle rectal artery pseudoaneurysm. Selective embolization of the right middle rectal artery and bilateral superior rectal arteries was successfully performed. At the two-week post-embolization follow-up, hemoglobin was stable, and the patient reported normal bowel movements with no episodes of bleeding per rectum.
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Affiliation(s)
| | - Arash Gohari
- Radiology, NYC Health + Hospitals/Lincoln, Bronx, USA
- Radiology, Albert Einstein College of Medicine, Bronx, USA
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2
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Singer AJ, Abraham NS, Ganti L, Peacock WF, Dark J, Ishaq H, Negrete A, Mount B, Neuenschwander J. Evaluation and treatment of gastrointestinal bleeding in patients taking anticoagulants presenting to the emergency department. Int J Emerg Med 2024; 17:70. [PMID: 38822267 PMCID: PMC11141076 DOI: 10.1186/s12245-024-00649-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/21/2024] [Indexed: 06/02/2024] Open
Abstract
This manuscript is a consensus document of an expert panel on the Evaluation and Treatment of Gastrointestinal Bleeding in Patients Taking Anticoagulants Presenting to the Emergency Department, sponsored by the American College of Emergency Physicians.
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Affiliation(s)
| | | | - Latha Ganti
- Orlando College of Osteopathic Medicine, Winter Garden, FL, USA.
- Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | | | - Janaé Dark
- HCA Houston Healthcare, Clear Lake, TX, USA
| | | | - Ana Negrete
- Methodist University Hospital, Memphis, TN, USA
| | - Brandon Mount
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
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3
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Redondo-Cerezo E, Tendero-Peinado C, López-Tobaruela JM, Fernandez-García R, Lancho A, Ortega-Suazo EJ, López-Vico M, Martínez-Cara JG, Jiménez-Rosales R. Risk factors for massive gastrointestinal bleeding occurrence and mortality: A prospective single-center study. Am J Med Sci 2024; 367:259-267. [PMID: 38278359 DOI: 10.1016/j.amjms.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 11/15/2023] [Accepted: 01/19/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Massive gastrointestinal bleeding is a life-threatening condition without a well-established definition. We aimed to analyze the characteristics, risk factors, and outcomes of patients with massive upper gastrointestinal bleeding. METHODS Our study analyzed a prospective registry of patients admitted between 2013 and 2020 with variceal and non-variceal causes. Severe bleeding was defined as ongoing bleeding requiring transfusion of more than 2 units of packed red blood cells within 24 hours, accompanied by signs of shock. The main outcomes were 30-day and 6-month mortality, rebleeding within 7 days, persistent bleeding, and severe complications during admission. RESULTS Out of 1213 patients, 171 had massive gastrointestinal bleeding, with a predominance of males. The massive bleeding group had higher rates of chronic kidney disease, cirrhosis, in-patient status, disseminated malignancy, alcoholism, and ASA score ≥3. All major outcomes, including 30-day mortality, 6-month mortality, rebleeding, persistent bleeding, and severe complications, were more common in the massive bleeding group. Multivariate logistic regression identified inpatient status, systemic diseases, malignancy, active bleeding in endoscopy, and severe complications as risk factors for massive bleeding and mortality. CONCLUSIONS Inpatient status and comorbidities, especially systemic diseases, and malignancies, were associated with a higher risk of massive bleeding. Mortality was linked to chronic kidney disease, cirrhosis, severe comorbidities, and alcohol consumption. We observed increased 6-months mortality, probably related to a health status in which gastrointestinal bleeding heralded poor outcomes, some of them potentially preventable. Innovative healthcare interventions, such as Emergency Department-based intermediate care areas or Intensive Care Units, and multidisciplinary follow-up, could potentially improve survival.
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Affiliation(s)
- Eduardo Redondo-Cerezo
- Department of Gastroenterology Hospital Universitario Virgen de las Nieves Granada Spain; Department of Medicine The University of Granada School of Medicine Granada Spain; Instituto de Investigación Biosanitaria de Granada (ibs.Granada) Granada Spain.
| | | | | | - Raúl Fernandez-García
- Department of Gastroenterology Hospital Universitario Virgen de las Nieves Granada Spain
| | - Ana Lancho
- Department of Gastroenterology Hospital Universitario Virgen de las Nieves Granada Spain
| | | | - Manuel López-Vico
- Department of Gastroenterology Hospital Universitario Virgen de las Nieves Granada Spain
| | - Juan Gabriel Martínez-Cara
- Department of Gastroenterology Hospital Universitario Virgen de las Nieves Granada Spain; Instituto de Investigación Biosanitaria de Granada (ibs.Granada) Granada Spain
| | - Rita Jiménez-Rosales
- Department of Gastroenterology Hospital Universitario Virgen de las Nieves Granada Spain; Instituto de Investigación Biosanitaria de Granada (ibs.Granada) Granada Spain
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Rodríguez-Holguín F, Salcedo A, Leib P, Caicedo Y, Serna JJ, Toro L, Carvajal S, Riascos M, Parra MW, García A, Ordoñez CA. Is REBOA the Last Card to Control a Massive Gastrointestinal Bleeding? J Surg Res 2024; 296:735-741. [PMID: 38368774 DOI: 10.1016/j.jss.2023.12.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 12/11/2023] [Accepted: 12/30/2023] [Indexed: 02/20/2024]
Abstract
INTRODUCTION Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a potential tool for the management of massive gastrointestinal bleeding (MGB). This study aims to describe the experience of the use of REBOA as adjunctive therapy in patients with MGB and to evaluate its effectiveness. METHODS Serial cases of patients with hemorrhagic shock secondary to MGB in whom REBOA was placed were collected. Patient demographics, bleeding severity, etiology, management, and clinical outcomes were recorded. RESULTS Between 2017 and 2020, five cases were analyzed. All patients had a severe gastrointestinal bleeding (Glasgow Blatchford Bleeding Score range 12-17; Clinical Rockal Score range 5-9). The etiologies of MGB were perforated gastric or duodenal ulcers, esophageal varices, and vascular lesions. Systolic blood pressure increased after REBOA placement and total occlusion time was 25-60 min. REBOA provided temporary hemorrhage control in all cases and allowed additional hemostatic maneuvers to be performed. Three patients survived more than 24 h. All patients died in index hospitalization. The main cause of death was related to hemorrhagic shock. CONCLUSIONS Endovascular aortic occlusion can work as a bridge to further resuscitation and attempts at hemostasis in patients with MGB. REBOA provides hemodynamic support and may be used simultaneously with other hemostatic maneuvers, facilitating definitive hemorrhage control.
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Affiliation(s)
- Fernando Rodríguez-Holguín
- División de Cirugía de Trauma y Emergencias, Fundación Valle del Lili, Cali, Colombia; Department of Trauma and Acute Care Surgery, Universidad Icesi, Cali, Colombia
| | - Alexander Salcedo
- División de Cirugía de Trauma y Emergencias, Fundación Valle del Lili, Cali, Colombia; Department of Trauma and Acute Care Surgery, Universidad Icesi, Cali, Colombia; División de Cirugía de Trauma y Emergencias, Universidad del Valle, Cali, Colombia
| | - Philip Leib
- Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia
| | - Yaset Caicedo
- Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia
| | - José Julián Serna
- División de Cirugía de Trauma y Emergencias, Fundación Valle del Lili, Cali, Colombia
| | - Luis Toro
- División de Cirugía de Trauma y Emergencias, Fundación Valle del Lili, Cali, Colombia
| | - Sandra Carvajal
- Departamento de Medicina de Emergencias, Fundación Valle del Lili, Cali, Colombia
| | - Manolo Riascos
- Departamento de Medicina de Emergencias, Fundación Valle del Lili, Cali, Colombia
| | - Michael W Parra
- Department of Trauma Critical Care, Broward General Level I Trauma Center, Fort Lauderdale, Florida
| | - Alberto García
- División de Cirugía de Trauma y Emergencias, Fundación Valle del Lili, Cali, Colombia; Department of Trauma and Acute Care Surgery, Universidad Icesi, Cali, Colombia; División de Cirugía de Trauma y Emergencias, Universidad del Valle, Cali, Colombia
| | - Carlos A Ordoñez
- División de Cirugía de Trauma y Emergencias, Fundación Valle del Lili, Cali, Colombia; Department of Trauma and Acute Care Surgery, Universidad Icesi, Cali, Colombia; División de Cirugía de Trauma y Emergencias, Universidad del Valle, Cali, Colombia.
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Piccirillo M, Pucinischi V, Mennini M, Strisciuglio C, Iannicelli E, Giallorenzi MA, Furio S, Ferretti A, Parisi P, Di Nardo G. Gastrointestinal bleeding in children: diagnostic approach. Ital J Pediatr 2024; 50:13. [PMID: 38263189 PMCID: PMC10807079 DOI: 10.1186/s13052-024-01592-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/07/2024] [Indexed: 01/25/2024] Open
Abstract
Different conditions may underlie gastrointestinal bleeding (GIB) in children. The estimated prevalence of GIB in children is 6.4%, with spontaneous resolution in approximately 80% of cases. Nonetheless, the initial approach plays a pivotal role in determining the prognosis. The priority is the stabilization of hemodynamic status, followed by a systematic diagnostic approach. GIB can originate from either upper or lower gastrointestinal tract, leading to a broad differential diagnosis in infants and children. This includes benign and self-limiting disorders, alongside serious conditions necessitating immediate treatment. We performed a nonsystematic review of the literature, in order to describe the variety of conditions responsible for GIB in pediatric patients and to outline diagnostic pathways according to patients' age, suspected site of bleeding and type of bleeding which can help pediatricians in clinical practice. Diagnostic modalities may include esophagogastroduodenoscopy and colonoscopy, abdominal ultrasonography or computed tomography and, when necessary, magnetic resonance imaging. In this review, we critically assess these procedures, emphasizing their respective advantages and limitations concerning specific clinical scenarios.
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Affiliation(s)
- Marisa Piccirillo
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Via Di Grottarossa1035-1039, 00189, Rome, Italy
| | - Valentina Pucinischi
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Via Di Grottarossa1035-1039, 00189, Rome, Italy
| | - Maurizio Mennini
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Via Di Grottarossa1035-1039, 00189, Rome, Italy
| | - Caterina Strisciuglio
- Department of Woman, Child and General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Elsa Iannicelli
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, Radiology Unit, Rome, Italy
| | - Maria Agostina Giallorenzi
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, Radiology Unit, Rome, Italy
| | - Silvia Furio
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Via Di Grottarossa1035-1039, 00189, Rome, Italy
| | - Alessandro Ferretti
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Via Di Grottarossa1035-1039, 00189, Rome, Italy
| | - Pasquale Parisi
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Via Di Grottarossa1035-1039, 00189, Rome, Italy
| | - Giovanni Di Nardo
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Via Di Grottarossa1035-1039, 00189, Rome, Italy.
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Li X, Li W, Wu Y, Liu Y. Varicose vein embolization and portal vein stenting in a patient with sinistral portal hypertension-induced gastrointestinal hemorrhage: a case report. Ann Med Surg (Lond) 2024; 86:485-488. [PMID: 38222742 PMCID: PMC10783337 DOI: 10.1097/ms9.0000000000001460] [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: 08/15/2023] [Accepted: 10/20/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction and importance Massive gastrointestinal hemorrhage is a severe hemorrhage that occurs in the gastrointestinal tract and is a life-threatening condition. Sinistral portal hypertension is a common etiology for massive gastrointestinal hemorrhage, whose occurrence might be derived from pathological changes induced by obstruction and/or increased blood flow to the portal vein system. However, there is a rare study reporting pancreatic disease-induced sinistral portal hypertension. Case presentation An 80-year-old female pancreatic cancer patient was admitted to our hospital on 22 January 2022 due to a massive gastrointestinal hemorrhage with shock after receiving radio-chemotherapy. Abdominal enhanced computerized tomography showed that the patient presented with pancreatic cancer-causing sinistral portal hypertension with massive collateral circulation, intrahepatic bile duct dilation, and the formation of massive ascites. Subsequent portography interventional procedure revealed the esophageal and gastric varix. Then, the varicose vein was embolized, and the stent was implanted at the lumen of the superior mesenteric vein accessing the portal vein. The patient recovered from pancreatic cancer-causing sinistral portal hypertension, and a normal direction of blood flow was observed in the superior mesenteric vein with a decreasing amount of ascites. In addition, a transfusion was also carried out, and the massive gastrointestinal hemorrhage was alleviated. Clinical discussion and conclusion This study emphasizes the successful treatment of massive gastrointestinal hemorrhage induced by pancreatic cancer-causing sinistral portal hypertension by varicose vein embolization and portal vein stenting, which could be considered an alternative opinion for these patients.
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Affiliation(s)
| | | | | | - Yuan Liu
- Department of Interventional Oncology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
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Nepal C, Kc O, Koirala M, Subedi A, Sharma R, Annangi S, Jabak S, Chaaban S. A Retrospective Study Comparing the Effect of Conventional Coagulation Parameters Vs. Thromboelastography-Guided Blood Product Utilization in Patients With Major Gastrointestinal Bleeding. J Clin Med Res 2023; 15:431-437. [PMID: 38189039 PMCID: PMC10769601 DOI: 10.14740/jocmr5022] [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: 09/06/2023] [Accepted: 10/28/2023] [Indexed: 01/09/2024] Open
Abstract
Background The use of thromboelastography (TEG) has demonstrated decreased blood product utilization in patients with specific etiologies of major gastrointestinal bleeding (GIB), such as variceal and non-variceal bleeding in cirrhosis patients; however, in a non-cirrhosis patient with GIB, there is far less evidence in the literature. Our retrospective study compares the effect of TEG-guided blood product utilization in patients with major GIB with all etiologies, including cirrhosis, admitted to medical intensive care unit (MICU). Methods A retrospective chart review was conducted on patients admitted to the MICU of a tertiary academic medical center diagnosed with GIB using ICD-9/10 codes from 2014 to 2018. A total of 1,889 patients were identified, and validation criteria such as "GI or hepatology consult note", type and screen, pantoprazole, or octreotide drip" were used, which resulted in 997 patients, out of which 369 had a diagnosis of cirrhosis. Propensity score matching was done for baseline variables (age, sex, and race), ICU length of stay, hospital length of stay, ventilator days, and vasopressor use. As a result, 88 patients were included in the final analysis, with 44 in TEG and 44 in non-TEG group. A sub-group analysis was done in 46 patients with cirrhosis, 23 in TEG group and 23 in non-TEG group after propensity score matching. Results There was significantly higher total blood volume (4,207 mL vs. 2,568 mL, P = 0.04) in the TEG group as compared to the non-TEG group, including total volume of cryoprecipitate (80 mL vs. 55 mL, P = 0.03) and total volume of platelet (543 mL vs. 327 mL, P = 0.03). In the cirrhosis sub-group, there was no significant difference in the amount of blood products transfused between the two groups. Conclusion This study revealed that TEG is not superior to conventional coagulation parameters in limiting the volume of blood product transfusion in major GIB patients in ICU settings.
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Affiliation(s)
- Chhabindra Nepal
- Department of Pulmonology and Critical Care, Faith Regional Health Services, Norfolk, NE, USA
| | - Ojbindra Kc
- Department of Hospital Medicine, Faith Regional Health Services, Norfolk, NE, USA
| | - Manisha Koirala
- Department of Hospital Medicine, Faith Regional Health Services, Norfolk, NE, USA
| | - Ananta Subedi
- Department of Hospital Medicine, Avera McKennan Hospital and University Health Center, Sioux Falls, SD, USA
| | - Rakshya Sharma
- Department of Hospital Medicine, Avera McKennan Hospital and University Health Center, Sioux Falls, SD, USA
| | - Srinadh Annangi
- Division of Pulmonary and Critical Care, University of Kentucky, Lexington, KY, USA
| | - Suha Jabak
- Division of Gastroenterology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Said Chaaban
- Division of Pulmonary and Critical Care Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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Udrea D, Montano NJ, Cochran-Yu M. Novel Use of a Minnesota Tube for Enteral Feeding in a Critically Ill Patient With Gastroesophageal Bleeding. Cureus 2023; 15:e36340. [PMID: 37082483 PMCID: PMC10110406 DOI: 10.7759/cureus.36340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2023] [Indexed: 04/22/2023] Open
Abstract
Balloon tamponade of bleeding varices is a temporizing measure acting as a bridge for the treatment of massive gastrointestinal (GI) hemorrhage. After treatment, utilization of a gastric tube for feeding is challenging due to the risk of variceal rebleeding during placement. No literature to date has explored the use of the suction ports of a tamponade device as an alternative form of enteral access for medication and feeding administration in critically ill patients. We report a case of the novel use of a Minnesota tube for enteral feeds and medication administration in a critically ill patient awaiting liver transplantation after massive upper GI bleeding.
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Affiliation(s)
- Daniel Udrea
- Department of Critical Care Anesthesia/Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda, USA
| | - Nicholas J Montano
- Department of Critical Care Anesthesia/Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda, USA
| | - Megan Cochran-Yu
- Department of General Surgery, Division of Trauma and Acute Care Surgery, Loma Linda University Medical Center, Loma Linda, USA
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Xu D, Qian H, Lian L, Xie M, Zhang H. Management strategy of a carotid-esophageal fistula with a right common carotid artery pseudoaneurysm due to chicken bone ingestion: A case report and literature review. Front Surg 2023; 10:1129488. [PMID: 37114155 PMCID: PMC10126472 DOI: 10.3389/fsurg.2023.1129488] [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] [Received: 12/22/2022] [Accepted: 03/21/2023] [Indexed: 04/29/2023] Open
Abstract
Common carotid artery (CCA) pseudoaneurysm is a rare clinical disorder. CCA pseudoaneurysm that occurs with a carotid-esophageal fistula and causes massive upper gastrointestinal bleeding is especially uncommon but can be life-threatening. Accurate diagnosis and prompt managements are essential to save lives. Here, we report a case of a 58-year-old female who presented with dysphagia and throat pain after accidental ingestion of a chicken bone. The patient presented with active upper gastrointestinal bleeding which quickly developed into hemorrhage shock. Imaging studies confirmed a diagnosis of right CCA pseudoaneurysm and carotid-esophageal fistula. The patient had a satisfactory recovery after a right CCA balloon occlusion, right CCA pseudoaneurysm excision, and right CCA and esophageal repairs. We present and discuss this case here to remind physicians to rule out rare causes of upper gastrointestinal bleeding. A multidisciplinary approach is commonly required to achieve satisfactory outcomes in these cases.
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Affiliation(s)
- Dongming Xu
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Haichao Qian
- General Administration of Customs (Beijing) InternationalTravel Health Care Center, Beijing, China
| | - Lishan Lian
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Miaorong Xie
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hanyu Zhang
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Correspondence: Hanyu Zhang
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Carballo Álvarez F, Albillos Martínez A, Llamas Silero P, Orive Calzada A, Redondo-Cerezo E, Rodríguez de Santiago E, Crespo García J. Consensus document of the Sociedad Española de Patología Digestiva on massive nonvariceal gastrointestinal bleeding and direct-acting oral anticoagulants. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2022; 114:375-389. [DOI: 10.17235/reed.2022.8920/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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