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Elliott J, Liu K, Motan T. Directive clinique n° 444 : Hirsutisme : Évaluation et traitement. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:102273. [PMID: 38049279 DOI: 10.1016/j.jogc.2023.102273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
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Elliott J, Liu K, Motan T. Guideline No. 444: Hirsutism: Evaluation and Treatment. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:102272. [PMID: 38049282 DOI: 10.1016/j.jogc.2023.102272] [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] [Indexed: 12/06/2023]
Abstract
OBJECTIVE This guideline reviews the etiology, diagnosis, evaluation, and treatment of hirsutism. TARGET POPULATION Women with hirsutism. OPTIONS Three approaches to management include: 1) mechanical hair removal; 2) suppression of androgen production; and 3) androgen receptor blockade. OUTCOMES The main limitations of the management options include the adverse effects, costs, and duration of treatment. BENEFITS, HARMS, AND COSTS Implementation of the recommendations in this guideline may improve the management of hirsutism in women with this condition. Adverse effects and a potential long duration of treatment are the main drawbacks to initiating treatment, as is the possibility of significant financial costs for certain treatments. EVIDENCE A comprehensive literature review was updated to April 2022, following the same methods as for the prior Society of Obstetricians and Gynaecologists of Canada (SOGC) Hirsutism guidelines. Results were restricted to systematic reviews, randomized controlled trials, controlled clinical trials, and observational studies. There were no date limits, but results were limited to English- or French-language materials. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, along with the option of designating a recommendation as a "good practice point." See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE Primary care providers, family medicine physicians, obstetricians and gynaecologists, reproductive endocrinologists and others who manage the care of patients with hirsutism. TWEETABLE ABSTRACT Management of hirsutism involves a 3-pronged approach of mechanical hair removal, suppression of androgen production, and androgen receptor blockade. SUMMARY STATEMENTS RECOMMENDATIONS.
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Ma M, Wu T, Sun G, Zhang S. Determination of testosterone in serum by magnetic molecularly imprinted polymer-coupled nano-ESI-MS. Anal Biochem 2022; 653:114719. [PMID: 35618034 DOI: 10.1016/j.ab.2022.114719] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/21/2022] [Accepted: 05/03/2022] [Indexed: 11/01/2022]
Abstract
Monitoring clinical biomarkers, such as testosterone in serum, is important for disease assessment. Due to the very low concentration of testosterone in serum, we have developed a new strategy for its enrichment in serum samples by magnetic molecularly imprinted polymers (MMIPs) technology and detection by nano-electrospray ionization mass spectrometry (Nano-ESI-MS). Testosterone was selectively extracted and enriched by the imprinted polymers on the surface of magnetic particles and the complex matrix was eliminated from the serum. The linear calibration curve was in the range of 0.1-10 μg/L and the limit of detection was 11.4 ng/L. The recovery and repeatability of the spiked serum were satisfactory. These results demonstrate that the proposed method is a promising approach for quantitative analysis of testosterone in serum.
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Affiliation(s)
- Mingying Ma
- Department of Chemistry, Tsinghua University, Beijing, 100084, China
| | - Tianhao Wu
- Department of Chemistry, Tsinghua University, Beijing, 100084, China
| | - Gongwei Sun
- Department of Chemistry, Tsinghua University, Beijing, 100084, China.
| | - Sichun Zhang
- Department of Chemistry, Tsinghua University, Beijing, 100084, China.
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Ma M, Wu T, Hu Z, Sun G, Zhang S. Fe3O4@UiO-66 as solid-phase extraction sorbent coupled with Nano-ESI-MS for the analysis of androgens in serum. Microchem J 2022. [DOI: 10.1016/j.microc.2021.106916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Combined Effects of Exercise and Phytoanabolic Extracts in Castrated Male and Female Mice. Nutrients 2021; 13:nu13041177. [PMID: 33918334 PMCID: PMC8066446 DOI: 10.3390/nu13041177] [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: 02/22/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 11/21/2022] Open
Abstract
Dry extracts from the Eurasian plants, Ajuga turkestanica, Eurycoma longifolia, and Urtica dioica have been used as anabolic supplements, despite the limited scientific data on these effects. To assess their actions on early sarcopenia signs, male and female castrated mice were supplemented with lyophilized extracts of the three plants, isolated or in association (named TLU), and submitted to resistance exercise. Ovariectomy (OVX) led to body weight increase and non-high-density cholesterol (HDL) cholesterol elevation, which had been restored by exercise plus U. dioica extract, or by exercise and TLU, respectively. Orchiectomy (ORX) caused skeletal muscle weight loss, accompanied by increased adiposity, being the latter parameter reduced by exercise plus E. longifolia or U. dioica extracts. General physical activity was improved by exercise plus herbal extracts in either OVX or ORX animals. Exercise combined with TLU improved resistance to fatigue in OVX animals, though A. turkestanica enhanced the grip strength in ORX mice. E. longifolia or TLU also reduced the ladder climbing time in ORX mice. Resistance exercise plus herbal extracts partly altered gastrocnemius fiber size frequencies in OVX or ORX mice. We provide novel data that tested ergogenic extracts, when combined with resistance exercise, improved early sarcopenia alterations in castrated male and female mice.
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Shi X, Tang T, Lin Q, Liu H, Qin Y, Liang X, Cong P, Mo D, Liu X, Chen Y, He Z. Efficient generation of bone morphogenetic protein 15-edited Yorkshire pigs using CRISPR/Cas9†. Biol Reprod 2020; 103:1054-1068. [PMID: 32761111 DOI: 10.1093/biolre/ioaa138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/25/2020] [Accepted: 08/06/2020] [Indexed: 12/15/2022] Open
Abstract
Bone morphogenetic protein 15 (BMP15), a member of the transforming growth factor beta superfamily, plays an essential role in ovarian follicular development in mono-ovulatory mammalian species. Studies using a biallelic knockout mouse model revealed that BMP15 potentially has just a minimal impact on female fertility and ovarian follicular development in polyovulatory species. In contrast, our previous study demonstrated that in vivo knockdown of BMP15 significantly affected porcine female fertility, as evidenced by the dysplastic ovaries containing significantly decreased numbers of follicles and an increased number of abnormal follicles. This finding implied that BMP15 plays an important role in the regulation of female fertility and ovarian follicular development in polyovulatory species. To further investigate the regulatory role of BMP15 in porcine ovarian and follicular development, here, we describe the efficient generation of BMP15-edited Yorkshire pigs using CRISPR/Cas9. Using artificial insemination experiments, we found that the biallelically edited gilts were all infertile, regardless of different genotypes. One monoallelically edited gilt #4 (Δ66 bp/WT) was fertile and could deliver offspring with a litter size comparable to that of wild-type gilts. Further analysis established that the infertility of biallelically edited gilts was caused by the arrest of follicular development at preantral stages, with formation of numerous structurally abnormal follicles, resulting in streaky ovaries and the absence of obvious estrous cycles. Our results strongly suggest that the role of BMP15 in nonrodent polyovulatory species may be as important as that in mono-ovulatory species.
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Affiliation(s)
- Xuan Shi
- State Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, P.R. China
| | - Tao Tang
- State Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, P.R. China
| | - Qiyuan Lin
- State Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, P.R. China
| | - Hongbo Liu
- State Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, P.R. China
| | - Yufeng Qin
- State Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, P.R. China
| | - Xinyu Liang
- State Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, P.R. China
| | - Peiqing Cong
- State Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, P.R. China
| | - Delin Mo
- State Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, P.R. China
| | - Xiaohong Liu
- State Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, P.R. China
| | - Yaosheng Chen
- State Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, P.R. China
| | - Zuyong He
- State Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, P.R. China
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Hazegh K, Bravo MD, Kamel H, Dumont L, Kanias T. The prevalence and demographic determinants of blood donors receiving testosterone replacement therapy at a large USA blood service organization. Transfusion 2020; 60:947-954. [PMID: 32176332 PMCID: PMC7643804 DOI: 10.1111/trf.15754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 02/13/2020] [Accepted: 02/13/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Blood donors receiving testosterone replacement therapy (TRT) often require therapeutic phlebotomy due to erythrocytosis. Red blood cells (RBCs) donated by eligible TRT donors are approved for collection and transfusion. This study was aimed at defining the prevalence and demographic determinants of TRT donors at a large USA blood service organization. STUDY DESIGN Donation data from TRT donors and matched controls was collected from a de-identified electronic donor database across 16 blood centers in 2017-2018. Demographic determinants included race, sex, age, hemoglobin (Hb), body mass index (BMI), mean arterial pressure (MAP), and the frequency of donations in the 2-year period. RESULTS TRT donors comprised 1.6% of the donor population and produced 2.2% of RBC units during 2018. TRT donors were likely to be middle-aged white or Hispanic men, with high prevalence of obesity (50.8% of TRT donors had BMI ≥30 kg/m2 compared with 36.2% in controls) and intensive donation frequency (1 to 29 donations in 2 years vs. 1 to 12 in controls). TRT donors had significantly (p < 0.0001) higher MAP and Hb compared with controls (MAP 99.9 ± 9.81 vs. 96.5 ± 10.1 mmHg; Hb 17.8 ± 1.44 vs. 15.6 ± 1.37 g/dL). One year of donations was associated with significant decreases in MAP and Hb for TRT donors. CONCLUSIONS TRT is associated with high prevalence of erythrocytosis and obesity that may explain the intensive donation frequency, high MAP, and Hb. Frequent phlebotomies had a moderately positive effect on blood pressure and Hb levels. Potential implications of TRT on the quality of the RBC products require further evaluation.
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Affiliation(s)
| | | | | | - Larry Dumont
- Vitalant Research Institute, Denver
- Department of Pathology, University of Colorado Denver
Anschutz Medical Campus, Aurora, Colorado
- Department of Pathology and Laboratory Medicine, Geisel
School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Tamir Kanias
- Vitalant Research Institute, Denver
- Department of Pathology, University of Colorado Denver
Anschutz Medical Campus, Aurora, Colorado
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Luo Q, Zhao H, Jiang Y, Guo J, Lv N, Tang J, Li S, Zhang D, Bai R, Chen G. Association of blood metal exposure with testosterone and hemoglobin: A cross-sectional study in Hangzhou Birth Cohort Study. ENVIRONMENT INTERNATIONAL 2020; 136:105451. [PMID: 31924581 DOI: 10.1016/j.envint.2019.105451] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 12/24/2019] [Accepted: 12/25/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Few epidemiological studies have investigated associations of exposure to multiple metals with testosterone homeostasis and erythropoiesis, especially for the pregnant women. METHODS Among all the 1644 participants enrolled in Hangzhou Birth Cohort Study (HBCS) at baseline, a total of 918 pregnant women with complete data of interest were analyzed. The whole blood metals levels were examined by inductively coupled plasma mass spectrometry (ICP-MS), and serum testosterone level was evaluated by chemiluminescent microparticle immunoassay (CMIA), and erythropoietic parameters values were extracted from medical record. Multivariable linear regression models were applied to estimate the relationships between metals levels and testosterone level, and between metals levels and erythropoietic parameters, and potential confounders were adjusted. RESULTS Single metal model analysis revealed a significant association of blood As, Mn and Pb level with serum testosterone level. After controlling for multiple testing, the dose-response trend with statistical significance (FDR-adjusted p trend <0.05) was observed across tertiles of Pb with testosterone. This association, when by stratified by gender, remained in pregnant women with a male fetus but did not reach significant in those with a female fetus. Furthermore, blood Pb level was positively associated with red blood cell counts, hemoglobin level and hematocrit. Serum testosterone level was positively associated with red blood cell counts, hemoglobin level and hematocrit. Mediation analyses indicated that testosterone might act as a mediator in the association between Pb exposure and erythropoietic parameters. CONCLUSIONS Serum testosterone level and hemoglobin level was positively related to blood Pb level among Chinese pregnant women, and testosterone might mediate the effect of Pb exposure on hemoglobin. Additional prospective studies are warranted to confirm the causality.
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Affiliation(s)
- Qiong Luo
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Reproductive Genetics (Ministry of Education), Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hao Zhao
- Department of Public Health, and Department of Reproductive Endocrinology of Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ying Jiang
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jing Guo
- Department of Public Health, and Department of Reproductive Endocrinology of Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Na Lv
- Department of Public Health, and Department of Reproductive Endocrinology of Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jun Tang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Shuai Li
- Department of Clinical Laboratory, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dan Zhang
- Key Laboratory of Reproductive Genetics (Ministry of Education), Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Rongpan Bai
- Bioelectromagnetics Laboratory, Institute of Environmental Health, Zhejiang University School of Medicine, Hangzhou, China.
| | - Guangdi Chen
- Department of Public Health, and Department of Reproductive Endocrinology of Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China; Bioelectromagnetics Laboratory, Institute of Environmental Health, Zhejiang University School of Medicine, Hangzhou, China.
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Basson R, O'Loughlin JI, Weinberg J, Young AH, Bodnar T, Brotto LA. Dehydroepiandrosterone and cortisol as markers of HPA axis dysregulation in women with low sexual desire. Psychoneuroendocrinology 2019; 104:259-268. [PMID: 30909007 PMCID: PMC7343293 DOI: 10.1016/j.psyneuen.2019.03.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 01/15/2019] [Accepted: 03/04/2019] [Indexed: 11/30/2022]
Abstract
Previous research has found lower serum levels of dehydroepiandrosterone (DHEA) or its sulfated form, DHEA-S, in women diagnosed with Hypoactive Sexual Desire Disorder (HSDD). Given that DHEA and DHEA-S have multiple direct actions on the brain as well as anti-glucocorticoid properties, it is possible that lower levels of DHEA directly impact women's sexual functioning. To date, the significance of the lower DHEA levels remains unclear. To our knowledge, there has been no empirical study of stress hormones as markers of HPA dysregulation in women with HSDD. To attend to this gap, the present study utilized several measures of HPA axis function - morning and evening cortisol and DHEA, the cortisol awakening response (CAR), diurnal cortisol slope, and cortisol:DHEA ratio - and examined their relationship with sexual functioning in N = 275 women with (n = 137) and without (n = 138) HSDD. Results demonstrated multiple hormonal markers of HPA dysregulation in women diagnosed with HSDD compared to control participants, specifically, lower AM cortisol and AM DHEA levels, a flatter diurnal cortisol slope, and a lower CAR. Overall, results of the present study indicate that persistently low sexual desire in women is associated with HPA axis dysregulation, with both cortisol and DHEA alterations potentially detrimental to sexual desire.
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Affiliation(s)
- Rosemary Basson
- University of British Columbia, Department of Psychiatry, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada
| | - Julia I O'Loughlin
- University of British Columbia, Department of Counselling Psychology, 2125 Main Mall, Vancouver, BC V6T 1Z4, Canada
| | - Joanne Weinberg
- University of British Columbia, Department of Cellular & Physiological Sciences, 2350 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada
| | - Allan H Young
- King's College London, Centre for Affective Disorders, Department of Psychological Medicine, PO72, De Crespigny Park, Denmark Hill, London, SE5 8AF, Canada
| | - Tamara Bodnar
- University of British Columbia, Department of Cellular & Physiological Sciences, 2350 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada
| | - Lori A Brotto
- University of British Columbia, Department of Obstetrics and Gynaecology, 2775 Laurel Street, 6(th) Floor, Vancouver, BC V5Z 1M9, Canada.
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Kanakis GA, Tsametis CP, Goulis DG. Measuring testosterone in women and men. Maturitas 2019; 125:41-44. [PMID: 31133215 DOI: 10.1016/j.maturitas.2019.04.203] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/31/2019] [Accepted: 04/02/2019] [Indexed: 01/08/2023]
Abstract
Measurement of serum testosterone (T) level is of utmost importance for the evaluation of hypogonadism in men and androgen excess in women. Despite the advances in steroid hormone assessment, substantial variability exists regarding measurement of T concentrations. Several factors affect T measurement in men, including circadian rhythms, intra-individual daily variability and transient stressors, while T concentrations in women vary mainly according to the phase of the menstrual cycle. Most of the available immunoassays lack the required accuracy when dealing with T concentrations at the lower end of the normal range for men and across the entire range for females. Consequently, there is no universally accepted lower T threshold for healthy adult men and most immunoassays fail to detect states of mild androgen excess in women. Mass spectrometry is considered the gold-standard method for T measurement; however, due to its complexity and cost, it has not been widely adopted. To increase accuracy, T in men should be measured with a fasting morning sample and repeated if the level is found to be low; in women, measurement must be performed at the follicular phase of the cycle. In both cases, borderline results may be clarified by the assessment of free testosterone (fT). Since most fT assays are unreliable, calculated surrogates should be used instead. Collaborative efforts have been undertaken, with rigorous internal and external quality controls and the establishment of reference methods, to harmonise the commercial assays.
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Affiliation(s)
- George A Kanakis
- Department of Endocrinology, Athens Naval and Veteran Affairs Hospital, Greece.
| | - Christos P Tsametis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynaecology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynaecology, Medical School, Aristotle University of Thessaloniki, Greece
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Abstract
Although more than 80% of women experience some degree of psychological or physical symptoms around menopause, both women and clinicians have misconceptions about how hormonal changes relate to menopausal symptoms and psychological conditions. Recently, several large-scale, longitudinal studies have been conducted to better characterize symptoms and changes that occur around menopause. This article offers current evidence for symptoms that occur in the early menopause transition, including vasomotor symptoms, mood changes, sleep problems, and changes in sexual functioning.
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Letter to the Editor. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:976. [DOI: 10.1016/j.jogc.2017.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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