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Zhu GQ, Wu XM, Cao DH. High frequency jet ventilation at the distal end of tracheostenosis during flexible bronchoscopic resection of large intratracheal tumor: Case series. Medicine (Baltimore) 2020; 99:e19929. [PMID: 32569155 PMCID: PMC7310889 DOI: 10.1097/md.0000000000019929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 02/04/2020] [Accepted: 03/17/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Resection of a large intratracheal tumor with severe obstruction via flexible bronchoscope remains a formidable challenge to anesthesiologists. Many artificial airways positioned proximal to tracheal obstruction can not ensure adequate oxygen supply. How to ensure effective gas exchange is crucial to the anesthetic management. PATIENT CONCERNS Five patients of intratracheal tumor occupying 70% to 85% of the tracheal lumen were scheduled for tumor resection via flexible bronchoscope. DIAGNOSIS The patients were diagnosed with intratracheal tumor based on their symptoms, radiographic findings and tracheoscopy. INTERVENTIONS We describe a technique of high frequency jet ventilation (HFJV) using an endobronchial suction catheter distal to tracheostenosis during the surgery, which ensured the good supply of oxygen. We applied general anesthesia with preserved spontaneous breathing. A comprehensive anesthesia protocol that emphasizes bilateral superior laryngeal nerve (SLN) block and sufficient topical anesthesia. An endobronchial suction catheter was introduced transnasally into the trachea and then advanced through the tracheostenosis with the tip proximal to the carina under direct vision with the aid of fiber bronchoscope. HFJV was then performed through the suction catheter. OUTCOMES The SPO2 maintained above 97% during the surgery. Carbon dioxide retention was alleviated obviously when adequate patency of the trachea lumen achieved about 30 min after the beginning of surgery. HFJV was ceased and all patients had satisfactory spontaneous breathing at the end of the procedure. CONCLUSION HFJV at the distal end of tracheostenosis is a suitable ventilation strategy during flexible bronchoscopic resection of a large intratracheal tumor.
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Affiliation(s)
| | - Xiao-Mai Wu
- Department of Respiratory Medicine, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, China
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Comparison of monitored anaesthesia care and general anaesthesia in endobronchial coil treatment. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2019. [DOI: 10.1016/j.tacc.2019.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Behrens KM, Galgon RE. Supraglottic airway versus endotracheal tube during interventional pulmonary procedures - a retrospective study. BMC Anesthesiol 2019; 19:196. [PMID: 31672120 PMCID: PMC6823941 DOI: 10.1186/s12871-019-0872-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 10/21/2019] [Indexed: 02/08/2023] Open
Abstract
Background As the field of interventional pulmonology (IP) expands, anesthesia services are increasingly being utilized when complex procedures of longer duration are performed on sicker patients with high risk co-morbidities and lung pathology. Yet, evidence on the optimal anesthetic management for these patients remains lacking. Our aim was to characterize the airway management and, secondarily anesthetic maintenance patterns used for IP procedures at our institution. Methods From 2894 identified encounters, charts of 783 patients undergoing an IP procedure with general anesthesia over a 5-year period, employing an endotracheal tube (ETT) or a supraglottic airway (SGA) for airway maintenance, were identified and reviewed after exclusions. Patients posted for a concurrent thoracic surgical procedure and those already intubated at presentation were excluded. Baseline patient demographics, procedure, proceduralist type, anesthesia maintenance modality, neuromuscular blocking drug (NMBD) use, and airway management characteristics were extracted and analyzed. Results Inhaled general anesthesia with an ETT for airway maintenance was most commonly employed; however, SGAs were used in one-third of patients with a very low conversion rate (0.4%), and their use was associated with a significant reduction in NMBD use. Conclusions In this large series of patients receiving general anesthesia for IP procedures, inhaled anesthetic agents and ETTs were favored. However, in appropriately selected patients, SGA use was effective for airway maintenance and allowed for a reduction in NMBD use, which may have implications in this patient population who may have an increased risk for pulmonary complications and warrants further investigation.
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Affiliation(s)
- Kyle M Behrens
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL, 60064, USA.
| | - Richard E Galgon
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., B6/319, Madison, WI, 53792, USA
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Piccioni F, Codazzi D, Paleari MC, Previtali P, Delconte G, Fumagalli L, Manzi R, Faustini M, Persiani L, Rizzi M, Sodi F, Masci E. Endosonographic evaluation of the mediastinum through the i-gel O 2 supraglottic airway device. TUMORI JOURNAL 2019; 107:86-90. [PMID: 31462167 DOI: 10.1177/0300891619871104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Endobronchial ultrasound (EBUS) is an endoscopic diagnostic procedure combining flexible fibrobronchoscopy with ultrasound techniques; it allows transbronchial needle aspiration biopsy for the diagnosis and staging of mediastinal masses. We present our preliminary experience with the use of the i-gel O2 supraglottic airway device for management of EBUS procedures. METHODS An observational study on 39 patients who underwent EBUS under general anesthesia was performed. Airways were managed with i-gel O2 by anesthesiologists unfamiliar with it. Data collected included patient characteristics, i-gel O2 positioning, mechanical ventilation, procedure, and complications occurring during and after the EBUS. RESULTS The i-gel airway was successfully positioned during the first attempt in 34/39 cases (87.2%). No failed positioning was recorded. The EBUS scope easily passed through the i-gel in all patients and in 14 (35.6%) cases it was also inserted through the esophagus allowing the examination or fine needle aspiration of paraesophageal lymph nodes. In one case, during the EBUS procedure, the i-gel was dislocated but easily put in place again. During EBUS, air leakages were significant in 2 cases (5.1%) and minimal in 14 cases (35.9%). A brief self-solved laryngospasm and a bronchospasm during bronchoscopy were recorded. After recovery, no patients had dysphagia; mild odynophagia and pharyngodinia were referred by 2 (5.1%) and 12 (30.1%) patients, respectively. CONCLUSIONS The i-gel O2 airway is easy to position and manage even for anesthesiologists unfamiliar with it. This supraglottic airway device is suitable for a complete endosonographic evaluation of the mediastinum.
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Affiliation(s)
- Federico Piccioni
- Department of Critical and Supportive Therapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Daniela Codazzi
- Department of Critical and Supportive Therapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maria C Paleari
- School of Anesthesia and Intensive Care, University of Milan, Milan, Italy
| | - Paola Previtali
- Department of Critical and Supportive Therapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gabriele Delconte
- Diagnostic and Therapeutic Endoscopic Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Fumagalli
- Department of Critical and Supportive Therapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Renato Manzi
- Department of Critical and Supportive Therapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Faustini
- Department of Critical and Supportive Therapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Laura Persiani
- Department of Critical and Supportive Therapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maurilia Rizzi
- Department of Critical and Supportive Therapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federico Sodi
- School of Anesthesia and Intensive Care, University of Milan, Milan, Italy
| | - Enzo Masci
- Diagnostic and Therapeutic Endoscopic Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Moser B, Keller C, Audigé L, Dave MH, Bruppacher HR. Fiberoptic intubation of severely obese patients through supraglottic airway: A prospective, randomized trial of the Ambu ® AuraGain™ laryngeal mask vs the i-gel™ airway. Acta Anaesthesiol Scand 2019; 63:187-194. [PMID: 30088266 DOI: 10.1111/aas.13242] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/05/2018] [Accepted: 07/07/2018] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Airway management in severely obese patients remains a challenging issue for anaesthetists and may lead to life-threatening situations. Supraglottic airway devices, such as the i-gel™ or the AuraGain™, were developed, with the possibility to ventilate the patient or use them as a conduit for endotracheal intubation. METHODS In our randomized prospective trial, we hypothesized a 10 seconds faster fiberoptic trans-device intubation time through the AuraGain™ laryngeal mask compared to the i-gel™ laryngeal mask in severely obese patients. We randomly assigned 44 patients to the AuraGain or i-gel group and measured trans-device intubation time after 5 minutes of successful ventilation through the device. Secondary parameters relating to the trans-device intubation success, oropharyngeal leak pressure, and parameters regarding insertion of the supraglottic airway devices were measured. Postoperative airway morbidity was determined 5 hours after surgery. RESULTS Mean (SD) intubation time was 55.7 (5.8) seconds for the AuraGain™ vs 54.1 (8.5) for i-gel™ mask (95% CI -2.7 to 5.9; P = 0.474), respectively, on a mean body mass index (BMI) of 39.4 kg/m2 in the AuraGain™ group vs 38.9 kg/m2 in i-gel™ group. No difference could be found in the other studied parameters. CONCLUSIONS Time for intubation through both supraglottic airway devices was similar. Attributed to fast possibility of securing the airway with both supraglottic airway devices, we believe that both, AuraGain™ and i-gel™, can be a good alternative in the airway management in obese patients.
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Affiliation(s)
- Berthold Moser
- Department of Anaesthesiology; Schulthess Clinic; Zürich Switzerland
| | - Christian Keller
- Department of Anaesthesiology; Schulthess Clinic; Zürich Switzerland
| | - Laurent Audigé
- Research and Development Department; Schulthess Clinic; Zürich Switzerland
| | - Mital H. Dave
- Department of Anaesthesiology; Schulthess Clinic; Zürich Switzerland
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Grande B, Loop T. Anaesthesia management for bronchoscopic and surgical lung volume reduction. J Thorac Dis 2018; 10:S2738-S2743. [PMID: 30210826 DOI: 10.21037/jtd.2018.02.46] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Optimizing the patient's condition before the lung volume reduction (LVR) according to recommendations by American College of Cardiology/American Heart Association (ACC/AHA) guideline on perioperative cardiovascular evaluation is mandatory. Implementation of a multimodal analgesia concept and the use short-acting anaesthetics enhances recovery and avoids postoperative pulmonary complications. Normovolemia, normothermia, lung protective ventilation and an evidence-based concept of airway management (i.e., double-lumen tube, bronchus blocker) are suggested for intraoperative management of surgical lung volume reduction (SLVR). General anaesthesia (using remifentanil, propofol and mivacurium) with an i-gel® supraglottic airway device should be used for bronchoscopic lung volume reduction (BLVR). Jet ventilation through rigid bronchoscopy or with a jet catheter may be an alternative concept. Experienced consultants should perform anaesthesia for LVR.
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Affiliation(s)
- Bastian Grande
- Institute of Anaesthesiology, University Hospital Zurich, Switzerland
| | - Torsten Loop
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center, Freiburg, Germany
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Pérez-Herrero MA, de la Varga O, Flores M, Sánchez-Ruano J, Otero M, Buisán F. Descriptive study of ultrasound images of the upper airway obtained after insertion of laryngeal mask. ACTA ACUST UNITED AC 2018; 65:434-440. [PMID: 29970248 DOI: 10.1016/j.redar.2018.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/05/2018] [Accepted: 05/11/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate clinical usefulness of ultrasound images of the upper airway in order to check correct laryngeal mask placement. MATERIAL AND METHODS A prospective observational study was conducted on patients scheduled for abdominal surgery under general anaesthesia, in whom the patency of the upper airway was ensured using an Ambu®AuraGainTM laryngeal mask. An ultrasound scan was performed of the upper-airway in the cranio-caudal direction and with longitudinal scans in the anterior midline and parasagittal axis, in three moments: before, after inserting and after removing the mask. All recorded images were evaluated in a second time by a radiologist-expert in upper airway ultrasound. Subsequently, the ultrasound data were related to the clinical difficulty of the insertion and presence of air leaks. RESULTS Data was collected from 30 patients (20 females and 10 males) being operated on for abdominal hysterectomy (15), eventroplasty (6), uterine myomectomy (3), and umbilical (4) and inguinal herniorrhaphy (2). The blind insertion of the masks did not present difficulties in 24 (80%) patients. Air leakage was detected in 8 (26.7%) patients, which was moderate in 7 cases and severe in one of them. The ultrasound findings confirmed good mask placement in 22 (73.3%) patients. Anatomical airway changes after laryngeal mask extraction were only observed in 3 (12%) patients, all of them minor. There was a statistically significant association (P<.05) between difficulty in inserting the device and the level of air leakage. CONCLUSIONS Upper airway ultrasound is a useful diagnostic method to evaluate laryngeal mask placement. Laryngeal oedema was not observed after removal of the device.
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Affiliation(s)
- M A Pérez-Herrero
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Valladolid, Valladolid, España.
| | - O de la Varga
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - M Flores
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - J Sánchez-Ruano
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - M Otero
- Servicio de Radiodiagnóstico, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - F Buisán
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Valladolid, Valladolid, España
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Krecmerova M, Schutzner J, Michalek P, Johnson P, Vymazal T. Laryngeal mask for airway management in open tracheal surgery-a retrospective analysis of 54 cases. J Thorac Dis 2018; 10:2567-2572. [PMID: 29997917 DOI: 10.21037/jtd.2018.04.73] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Airway management in tracheal resections presents many challenges. The aim of this retrospective analysis is to report the efficacy and complications associated with the use of the laryngeal mask airway in this procedure. Methods The charts of 54 consecutive patients operated for tracheal stenosis during the period 2009-2016 were reviewed. This cohort included only resections of the trachea. We evaluated total success rate of laryngeal mask insertion (%), insertion success rate on the first attempt, the quality of intraoperative ventilation through the laryngeal mask, the quality of fibre optic view through the device, incidence of bleeding during the first 24 h, signs of dehiscence of the anastomosis within 48 h and 30-day mortality. Results The laryngeal mask airway provided a patent airway throughout the procedure in 52 (96.4%) patients. Insertion of the device failed in 1 (1.8%) patient due to abnormal upper airway anatomy. Another patient (1.8%) developed laryngeal mask malposition during intraoperative neck extension subsequently requiring tracheal intubation. Fibre optic view through the devices including insertion of the flexible bronchoscope was satisfactory in 52 (96.4%) patients. Serious complications, such as pulmonary aspiration, early postoperative bleeding or suture dehiscence were not observed in this cohort. Conclusions Based on this analysis of 54 patients, we would consider the laryngeal mask airway a feasible alternative to the tracheal tube for airway management and ventilation during open tracheal surgery.
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Affiliation(s)
- Martina Krecmerova
- Department of Anaesthesiology and Intensive Care Medicine, 2nd School of Medicine, Charles University, University Hospital, Motol, Prague, Czech Republic
| | - Jan Schutzner
- Department of Surgery, 1st School of Medicine, Charles University, University Hospital, Motol, Prague, Czech Republic
| | - Pavel Michalek
- Department of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.,Department of Anaesthesia, Antrim Area Hospital, Antrim, UK
| | - Paul Johnson
- Department of Anaesthesia, Antrim Area Hospital, Antrim, UK
| | - Tomas Vymazal
- Department of Anaesthesiology and Intensive Care Medicine, 2nd School of Medicine, Charles University, University Hospital, Motol, Prague, Czech Republic
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de Lima A, Kheir F, Majid A, Pawlowski J. Anesthesia for interventional pulmonology procedures: a review of advanced diagnostic and therapeutic bronchoscopy. Can J Anaesth 2018; 65:822-836. [PMID: 29623556 DOI: 10.1007/s12630-018-1121-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 01/17/2018] [Accepted: 01/17/2018] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Interventional pulmonology is a growing subspecialty of pulmonary medicine with flexible and rigid bronchoscopies increasingly used by interventional pulmonologists for advanced diagnostic and therapeutic purposes. This review discusses different technical aspects of anesthesia for interventional pulmonary procedures with an emphasis placed on pharmacologic combinations, airway management, ventilation techniques, and common complications. SOURCE Relevant medical literature was identified by searching the PubMed and Google Scholar databases for publications on different anesthesia topics applicable to interventional pulmonary procedures. Cited literature included case reports, original research articles, review articles, meta-analyses, guidelines, and official society statements. PRINCIPAL FINDINGS Interventional pulmonology is a rapidly growing area of medicine. Anesthesiologists need to be familiar with different considerations required for every procedure, particularly as airway access is a shared responsibility with pulmonologists. Depending on the individual case characteristics, a different selection of airway method, ventilation mode, and pharmacologic combination may be required. Most commonly, airways are managed with supraglottic devices or endotracheal tubes. Nevertheless, patients with central airway obstruction or tracheal stenosis may require rigid bronchoscopy and jet ventilation. Although anesthetic approaches may vary depending on factors such as the length, complexity, and acuity of the procedure, the majority of patients are anesthetized using a total intravenous anesthetic technique. CONCLUSIONS It is fundamental for the anesthesia provider to be updated on interventional pulmonology procedures in this rapidly growing area of medicine.
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Affiliation(s)
- Andres de Lima
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Fayez Kheir
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Division of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University Health Sciences Center, New Orleans, LA, USA
| | - Adnan Majid
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - John Pawlowski
- Department of Anesthesia, Division of Thoracic Anesthesia, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Road, Boston, MA, 02215, USA.
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Kendall MC, Robbins ZM, Cohen A, Minn M, Benzuly SE, Triebwasser AS, McCormick ZL, Gorgone M. Selected highlights in clinical anesthesia research. J Clin Anesth 2017; 43:90-97. [DOI: 10.1016/j.jclinane.2017.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 10/10/2017] [Accepted: 10/13/2017] [Indexed: 12/17/2022]
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Schmutz A, Dürk T, Idzko M, Koehler T, Kalbhenn J, Loop T. Feasibility of a Supraglottic Airway Device for Transbronchial Lung Cryobiopsy—A Retrospective Analysis. J Cardiothorac Vasc Anesth 2017; 31:1343-1347. [DOI: 10.1053/j.jvca.2017.02.055] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Indexed: 12/21/2022]
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