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Tandlich M, Williamson K. Bilateral Central Retinal Vein Occlusion as a First Presentation of Multiple Myeloma: A Case Report. Clin Pract Cases Emerg Med 2022. [DOI: 10.5811/1/cpcem.2022.4.55710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction: Acute presentation of multiple myeloma in the emergency department (ED) is an uncommon yet life-threatening clinical entity. Case Report: A 42-year-old male presented to the ED with severe generalized fatigue and vision changes most notable in his left eye. Bilateral central retinal vein occlusion (CRVO) was diagnosed on dilated fundus exam in the ED. Conclusion: The most common cause of CRVO in adults over age 50 is vascular disease, but in younger adults, conditions of systemic inflammation or hyperviscosity must be considered. Diagnosis of CRVO requires emergent ophthalmology consultation and further treatment with phototherapy, steroids, and potentially anti-vascular endothelial growth factor. Ultimately, patients require hematology/oncology and ongoing management of acute hyperviscosity syndrome. We present this case to increase awareness surrounding this diagnosis among emergency physicians. Multiple myeloma should be considered in young patients who present to the ED with bilateral CRVO, acute renal failure, and symptomatic anemia.
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Affiliation(s)
- Michael Tandlich
- Northwestern University, Department of Emergency Medicine, Chicago, Illinois
| | - Kelly Williamson
- Northwestern University, Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois
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Sangamithira M, Rajasekar K, Sathya G. Self-harm induced bilateral CRVO. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2022. [DOI: 10.4103/tjosr.tjosr_2_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Hasani H, Hakak-Zargar B, Mohammad Poor Nami S, Mohammadian Khonsari N. Bilateral Central Retinal Vein Occlusion and Stevens-Johnson Syndrome Associated with Coronavirus-19: A Case Report. J Curr Ophthalmol 2022; 34:121-123. [PMID: 35620362 PMCID: PMC9128436 DOI: 10.4103/joco.joco_277_21] [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: 09/06/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 11/04/2022] Open
Abstract
Purpose To report a case of bilateral central retinal vein occlusion (CRVO) associated with coronavirus-19 (COVID-19) infection. Methods A 43-year-old man presented to the emergency department with flu-like symptoms, severe erythema, a rash on his face, and respiratory distress. He was admitted to the intensive care unit, and the reverse transcriptase-polymerase chain reaction test was positive for the severe acute respiratory syndrome coronavirus-2 virus. The routine blood work was unremarkable. The dermatologist noted positive Nikolsky's sign, and the patient was diagnosed with Stevens-Johnson syndrome (SJS), which affected 18% of his body and was later confirmed by skin biopsy. Later, he reported worsening vision. Results Ophthalmic examination and fundus fluorescein angiography showed bilateral CRVO. Despite best medical efforts, including treatment with systemic dexamethasone and remdesivir, the patient died on the 6 days of his hospitalization. Conclusion This was a rare bilateral CRVO and SJS case in a young patient, probably caused by the COVID-19 infection.
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Affiliation(s)
- Hamidreza Hasani
- Department of Ophthalmology, Madani Hospital, Alborz University of Medical Sciences, Karaj, Iran
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Kuo HH, Shen EP. Hyperviscosity retinopathy as the initial presentation of aggressive multiple myeloma. Tzu Chi Med J 2020; 32:401-403. [PMID: 33163389 PMCID: PMC7605289 DOI: 10.4103/tcmj.tcmj_214_19] [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: 09/17/2019] [Revised: 11/15/2019] [Accepted: 12/30/2019] [Indexed: 11/25/2022] Open
Abstract
Multiple myeloma (MM) is a hematologic malignancy resulting from the uncontrolled proliferation of neoplastic plasma cells and the excessive production of monoclonal immunoglobulins, both of which may lead to hyperviscosity retinopathy. Here, we present a 56-year-old male who had progressive painless loss of vision for 1 month. Ophthalmic examination revealed hyperviscosity retinopathy with bilateral central retinal vein occlusion-like appearance. Hematologic assessment revealed immunoglobulin A MM. Although the patient was treated with chemotherapy and autologous stem cell transplantation soon after referral, he did not survive due to the aggressive course of the disease. We highlight the importance of the ophthalmic presentation of MM. Early recognition and referral to an oncologist can lead to timely diagnosis and appropriate management.
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Affiliation(s)
- Hua-Hsuan Kuo
- Department of Ophthalmology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Elizabeth P Shen
- Department of Ophthalmology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
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Zhang HW, Lin CW, Kok VC, Tseng CH, Lin YP, Li TC, Sung FC, Wen CP, Hsiung CA, Hsu CY. Incidence of retinal vein occlusion with long-term exposure to ambient air pollution. PLoS One 2019; 14:e0222895. [PMID: 31550294 PMCID: PMC6759191 DOI: 10.1371/journal.pone.0222895] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/08/2019] [Indexed: 02/07/2023] Open
Abstract
This study aimed to investigate whether long-term exposure to airborne hydrocarbons, including volatile organic compounds, increases the risk of developing retinal vein occlusion (RVO) among the population of Taiwan. A retrospective cohort study involving 855,297 people was conducted. Cox proportional hazards regression analysis fitted the multiple pollutant models for two targeted pollutants, including total hydrocarbons (THC), nonmethane hydrocarbons (NMHC) were used, and the risk of RVO was estimated. The chi-squared test and one-way analysis of variance were used to test differences in demographics and comorbidity distribution among tertiles of the targeted pollutants. Before controlling for multiple pollutants, hazard ratios for the overall population were 19.88 (95% CI: 17.56-22.50) at 0.51-ppm increases in THC and 4.33 (95% CI: 3.97-4.73) at 0.27-ppm increases in NMHC. The highest adjusted hazard ratios for different multiple pollutant models of each targeted pollutant were statistically significant (all p values were ≤0.05) for all patients at 29.67 (95% CI: 25.57-34.42) for THC and 16.24 (95% CI: 14.14-18.65) for NMHC. Our findings suggest that long-term exposure to THC and NMHC contribute to RVO development.
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Affiliation(s)
- Han-Wei Zhang
- PhD Program for Aging, China Medical University, Taichung, Taiwan
- Institute of Electrical Control Engineering, Department of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
- * E-mail:
| | - Chao-Wen Lin
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Victor C. Kok
- Disease Informatics Research Group, Asia University Taiwan, Taichung, Taiwan
- Department of Internal Medicine, Kuang Tien General Hospital, Taichung, Taiwan
| | - Chun-Hung Tseng
- Department of Neurology, China Medical University Hospital, and School of Medicine, China Medical University, Taichung, Taiwan
| | - Yuan-Pei Lin
- Institute of Electrical Control Engineering, Department of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, Taiwan
| | - Tsai-Chung Li
- Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, Taiwan
- Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan
| | - Fung-Chang Sung
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chi Pang Wen
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Chao A. Hsiung
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Chung Y. Hsu
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan
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Abstract
We report on a 30-year-old male patient presenting with acute bilateral loss of vision. Fundus examination showed bilateral retinal hemorrhages, cotton-wool spots, macular edema and optic disk hyperemia. The blood pressure was elevated. The patient was referred to the emergency department with the diagnosis of severe stage IV hypertensive retinopathy. Further examination revealed a previously unknown IgA glomerulonephritis with terminal renal failure and secondary blood pressure derailment. Hypertensive retinopathy can be a first sign of acute renal failure. In cases of hypertensive retinopathy the differential diagnosis including systematic screening is of utmost importance.
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Bilateral Central Retinal Vein Occlusion in a patient with Ulcerative Colitis and Antiphospholipid Antibody Syndrome. J Pediatr Gastroenterol Nutr 2016; 62:e25-6. [PMID: 24762452 DOI: 10.1097/mpg.0000000000000404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Castro-Navarro V, Odaibo SG, Ghodasra DH, Besirli CG. Bilateral BRVO in a patient with recurrent prostate cancer. BMJ Case Rep 2015; 2015:bcr-2015-212463. [PMID: 26491002 DOI: 10.1136/bcr-2015-212463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Bilateral cases of branch retinal vein occlusions (BRVO) are infrequent and often related to systemic disease. A 72-year-old man with biochemical recurrence of prostate cancer was referred for decreased vision in his left eye. Fundus examination and fluorescein angiography disclosed bilateral BRVO with patches of peripheral non-perfusion and macular oedema in the left eye. A systemic work up revealed elevated fibrinogen and reduced free protein S antigen, consistent with an underlying hypercoagulable state. Cancer is a well-known cause of hypercoagulability. We report the first case of bilateral BRVO related to biochemical recurrence of prostate cancer and a proven coagulation derangement.
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Affiliation(s)
- Veronica Castro-Navarro
- Hospital General Universitario de Valencia, Valencia, Spain Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Stephen G Odaibo
- Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Devon H Ghodasra
- Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Cagri G Besirli
- Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA
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Mrad M, Fekih-Mrissa N, Wathek C, Rannen R, Gabsi S, Gritli N. Thrombophilic risk factors in different types of retinal vein occlusion in Tunisian patients. J Stroke Cerebrovasc Dis 2014; 23:1592-8. [PMID: 24630828 DOI: 10.1016/j.jstrokecerebrovasdis.2013.12.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 10/30/2013] [Accepted: 12/29/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Retinal vein occlusion (RVO) is the second most common cause of vision loss because of retinal vascular disease. There are 2 types of RVO: branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO). The pathogenesis of RVO is multifactorial. The role of factor V Leiden (FVL) and prothrombin mutations was examined in patients with CRVO and BRVO. METHODS FVL and prothrombin were investigated by extracting DNA of 88 patients with RVO. Sixteen of the patients were diagnosed with CRVO, 4 with hemispheric retinal vein occlusion, and 68 with BRVO. The genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism. RESULTS Significant differences were found in the frequencies of the genotypes for both the FVL (G1691A) (P<10(-3), odds ratio [OR]=17.4, confidence interval [CI]=6.20-59) and prothrombin (G20210A) (P=.007, OR=5.11, CI=1.30-29) polymorphisms between RVO patients and healthy controls. Additionally, the frequency of the GA genotype for the G1691A polymorphism was significantly higher among the patients in a subset of BRVO compared with controls (P<10(-3), OR=21.4, CI=7.34-74.2). However, no statistically significant differences were found in the frequencies of the prothrombin G20210A polymorphism between the BRVO group and healthy controls (P=.09, OR=3.13, CI=64-19.9). The frequency of both G1691A and G20210A genotypes among the patients of a CRVO subgroup was significantly higher compared with controls (P<10(-3), OR=11.4, CI=2.94-44.2; P=.007, OR=10.8, CI=2.15-54.1, respectively), suggesting an association between these polymorphisms and CRVO. CONCLUSIONS Large study would be required to understand completely the contribution of these markers in the risk of all types of RVO.
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Affiliation(s)
- Meriem Mrad
- Faculté des Science de Tunis, Université Tunis el Manar, El Manar, Tunisie; Laboratoire de Biologie Moléculaire, Service d'Hématologie, Hôpital Militaire Principal d'Instruction de Tunis, Montfleury, Tunisie
| | - Najiba Fekih-Mrissa
- Laboratoire de Biologie Moléculaire, Service d'Hématologie, Hôpital Militaire Principal d'Instruction de Tunis, Montfleury, Tunisie; Académie Militaire Fondouk Jédid, Nabeul, Tunisie.
| | - Cheima Wathek
- Faculté de Médecine de Tunis, Université Tunis el Manar, Tunis, Tunisie; Service d'Ophtalmologie, Hôpital Militaire Principal d'Instruction de Tunis, Montfleury, Tunisie
| | - Riadh Rannen
- Faculté de Médecine de Tunis, Université Tunis el Manar, Tunis, Tunisie; Service d'Ophtalmologie, Hôpital Militaire Principal d'Instruction de Tunis, Montfleury, Tunisie
| | - Salem Gabsi
- Faculté de Médecine de Tunis, Université Tunis el Manar, Tunis, Tunisie; Service d'Ophtalmologie, Hôpital Militaire Principal d'Instruction de Tunis, Montfleury, Tunisie
| | - Nasreddine Gritli
- Laboratoire de Biologie Moléculaire, Service d'Hématologie, Hôpital Militaire Principal d'Instruction de Tunis, Montfleury, Tunisie; Faculté de Pharmacie, Université de Monastir, Monastir, Tunisie
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Mishra A, Luthra S, Baranwal VK, Parihar JKS. An interesting case of rubeosis iridis with neovascular glaucoma in a young patient. Med J Armed Forces India 2014; 69:187-9. [PMID: 24600098 DOI: 10.1016/j.mjafi.2012.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 03/26/2012] [Indexed: 10/27/2022] Open
Affiliation(s)
- Avinash Mishra
- Classified Specialist (Ophthalmology), Military Hospital, Ahmedabad, Gujarat, India
| | - Saurab Luthra
- Director, Drishti Eye Centre, Dehradun, Uttranchal, India
| | - V K Baranwal
- Senior Advisor (Ophthalmology), Command Hospital (CC), Lucknow, India
| | - J K S Parihar
- Consultant (Ophthalmology), HOD, Department of Ophthalmology, Army Hospital (R&R), New Delhi, India
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Kolling J, Scherer EBS, Siebert C, Hansen F, Torres FV, Scaini G, Ferreira G, de Andrade RB, Gonçalves CAS, Streck EL, Wannmacher CMD, Wyse ATS. Homocysteine induces energy imbalance in rat skeletal muscle: is creatine a protector? Cell Biochem Funct 2012; 31:575-84. [PMID: 23225327 DOI: 10.1002/cbf.2938] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 10/23/2012] [Accepted: 11/15/2012] [Indexed: 12/22/2022]
Abstract
Homocystinuria is a neurometabolic disease caused by a severe deficiency of cystathionine beta-synthase activity, resulting in severe hyperhomocysteinemia. Affected patients present several symptoms including a variable degree of motor dysfunction. In this study, we investigated the effect of chronic hyperhomocysteinemia on the cell viability of the mitochondrion, as well as on some parameters of energy metabolism, such as glucose oxidation and activities of pyruvate kinase, citrate synthase, isocitrate dehydrogenase, malate dehydrogenase, respiratory chain complexes and creatine kinase in gastrocnemius rat skeletal muscle. We also evaluated the effect of creatine on biochemical alterations elicited by hyperhomocysteinemia. Wistar rats received daily subcutaneous injections of homocysteine (0.3-0.6 µmol/g body weight) and/or creatine (50 mg/kg body weight) from the 6th to the 28th days of age. The animals were decapitated 12 h after the last injection. Homocysteine decreased the cell viability of the mitochondrion and the activities of pyruvate kinase and creatine kinase. Succinate dehydrogenase was increased other evaluated parameters were not changed by this amino acid. Creatine, when combined with homocysteine, prevented or caused a synergistic effect on some changes provoked by this amino acid. Creatine per se or creatine plus homocysteine altered glucose oxidation. These findings provide insights into the mechanisms by which homocysteine exerts its effects on skeletal muscle function, more studies are needed to elucidate them. Although creatine prevents some alterations caused by homocysteine, it should be used with caution, mainly in healthy individuals because it could change the homeostasis of normal physiological functions.
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Affiliation(s)
- Janaína Kolling
- Laboratório de Neuroproteção e Doenças Neurometabólicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Laboratório de Erros Inatos do Metabolismo, Departamento de Bioquímica, ICBS, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Bilateral Simultaneous Central Retinal Vein Occlusions in an Otherwise Healthy Adult. J Neuroophthalmol 2011; 31:78-82. [DOI: 10.1097/wno.0b013e31820d0a34] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Campbell JP, Burkholder BM, Dunn JP. Catastrophic antiphospholipid antibody syndrome and cocaine abuse associated with bilateral retinal vascular occlusions. Retin Cases Brief Rep 2011; 5:318-322. [PMID: 25390424 DOI: 10.1097/icb.0b013e3181f66d3b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To describe a case of bilateral central retinal vein occlusion and central retinal artery occlusion associated with antiphospholipid antibody syndrome and cocaine abuse. METHODS A single case report of a 44-year-old woman with a history of cocaine abuse, vasculitis, and 3 spontaneous abortions who developed painless complete loss of vision in both eyes concurrently with progressive motor and sensory polyneuropathy. The patient underwent an extensive laboratory, radiographic, ophthalmologic, and pathologic workup. RESULTS Diagnosis of catastrophic antiphospholipid antibody syndrome was made based on established clinical and laboratory criteria, including a positive Russell's viper venom test, history of three spontaneous abortions and evidence of microvascular and macrovascular venous occlusions, and multiorgan failure. Urine toxicology screen was positive for cocaine metabolites. Her clinical course was remarkable for progressive mononeuritis multiplex and quadriplegia. She had no light perception on presentation, and fundus examination revealed extensive preretinal, intraretinal, and subretinal hemorrhages. Fluorescein angiography revealed complete occlusion of central retinal arteriolar and venular flow and retinal hemorrhages in both eyes. CONCLUSION Bilateral central retinal vein occlusion and central retinal artery occlusion have been rarely reported in the literature and are often associated with underlying thrombotic risk factors, such as antiphospholipid antibody syndrome. Workup for underlying hypercoagulability and/or cocaine use should be considered in atypical and bilateral cases of central vein or artery occlusion. In this case, bilateral central retinal artery and vein occlusions developed as manifestations of catastrophic antiphospholipid antibody syndrome, which has not been previously reported.
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Affiliation(s)
- John P Campbell
- From the Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland
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Simultaneous Bilateral Central Retinal Vein Occlusion As the Initial Presentation of Acute Myeloid Leukemia. Am J Med Sci 2010; 339:387-9. [PMID: 20186040 DOI: 10.1097/maj.0b013e3181cf31ac] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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