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Keenan RA, Nic An Riogh AU, Brennan D, Morrin M, Lee MJ, Davis NF, Ferede AA, Little DM. Lean body mass in living kidney donors impacts postoperative renal function. World J Urol 2024; 42:214. [PMID: 38581460 PMCID: PMC10998768 DOI: 10.1007/s00345-024-04908-3] [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: 01/08/2024] [Accepted: 02/26/2024] [Indexed: 04/08/2024] Open
Abstract
PURPOSE A living donor kidney transplant is the optimal treatment for chronic renal impairment. Our objective is to assess if lean skeletal muscle mass and donor factors such as body mass index, hypertension, and age impact on renal function following donor nephrectomy. METHODS Potential donors undergo CT angiography as part of their work-up in our institution. Using dedicated software (Horos®), standardized skeletal muscle area measured at the L3 vertebrae was calculated. When corrected for height, skeletal muscle index can be derived. Skeletal muscle mass index below predefined levels was classified as sarcopenic. The correlation of CT-derived skeletal muscle index and postoperative renal function at 12 months was assessed. Co-variables including donor gender, age, body mass index (BMI), and presence of pre-op hypertension were also assessed for their impact on postoperative renal function. RESULTS 275 patients who underwent living donor nephrectomy over 10 years were included. Baseline pre-donation glomerular filtration rate (GFR) and renal function at one year post-op were similar between genders. 29% (n = 82) of patients met the criteria for CT-derived sarcopenia. Sarcopenic patients were more likely to have a higher GFR at one year post-op (69.3 vs 63.9 mL/min/1.73 m2, p < 0.001). The main factors impacting better renal function at one year were the presence of sarcopenia and younger age at donation. CONCLUSION When selecting donors, this study highlights that patients with low skeletal mass are unlikely to underperform in terms of recovery of their renal function postoperatively at one year when compared to patients with normal muscle mass and should not be a barrier to kidney donation.
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Affiliation(s)
- Robert A Keenan
- Department of Surgical Affairs, Royal College of Surgeons, Dublin, Ireland.
- National Kidney Transplant Service, Beaumont Hospital, Dublin, Ireland.
| | - Aisling U Nic An Riogh
- Department of Surgical Affairs, Royal College of Surgeons, Dublin, Ireland
- National Kidney Transplant Service, Beaumont Hospital, Dublin, Ireland
| | - David Brennan
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Martina Morrin
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Michael J Lee
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Niall F Davis
- Department of Surgical Affairs, Royal College of Surgeons, Dublin, Ireland
- National Kidney Transplant Service, Beaumont Hospital, Dublin, Ireland
| | - Atakelet A Ferede
- National Kidney Transplant Service, Beaumont Hospital, Dublin, Ireland
| | - Dilly M Little
- National Kidney Transplant Service, Beaumont Hospital, Dublin, Ireland
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Yığman M, Tangal S. Effects of body fat components on early renal functions of individuals following kidney donation. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221109411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Obesity stands as a risk factor for the chronic kidney disease. The objective of this study was to investigate the relationship between early renal function following kidney donation and the measurements of body fat components. Methods: In total, 86 donors followed up for at least 6 months postoperatively were included. Height and weight measurements and results of laboratory analysis of all donors were recorded retrospectively. Visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), hepatic fat (HF), pancreatic fat (PF) and splenic fat (SF) measurements were performed, and pancreatic splenic fat fraction difference (P−S) and pancreatic splenic fat fraction ratio (P/S) were calculated by a radiologist using the records of preoperative computed tomography scans of donors. Results: The estimated glomerular filtration rate (eGFR), serum creatinine and spot urinary microalbumin/creatinine ratio values of the donors at the sixth month postoperatively were statistically different from those of the preoperative values ( p < 0.001). In addition, the individuals were divided into two categories based on the postoperative eGFR: ⩾ 60 mL/min/1.73 m2 and < 60 mL/min/1.73 m2. Age, low-density lipoprotein (LDL) level and VAT/SAT ratio were lower in group eGFR: ⩾ 60 ( p < 0.001, p = 0.03, p = 0.007, respectively). Age and VAT/SAT ratio were the parameters found to be affecting the eGFR significantly, and VAT/SAT ratio (0.729, 95% CI: 0.602–0.856, p = 0.007) had higher predictive value in receiver operating characteristic curve (ROC). Conclusion: Preoperative measurements of body fat components may provide significant information to predict postoperative renal functions of kidney donor candidates. Level of evidence: Not applicable.
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Affiliation(s)
- Metin Yığman
- Department of Urology, Faculty of Medicine, Dr. Ridvan Ege Hospital, Ufuk University, Turkey
| | - Semih Tangal
- Department of Urology, Faculty of Medicine, Dr. Ridvan Ege Hospital, Ufuk University, Turkey
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Pinar U, Mageau A, Renard Y, Rod X, Lebacle C, Barrou B, Zaidan M, Irani J, Bessede T. Pre-transplant morphometry by computed tomography scan and post-transplant dialysis risk in overweight or obese kidney transplant recipients. Int Urol Nephrol 2021; 53:2469-2475. [PMID: 34536192 DOI: 10.1007/s11255-021-02995-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/12/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Adipose distribution and sarcopenia could better assess kidney transplantation outcomes than body mass index (BMI) and have been poorly evaluated among obese and overweight recipients. We aimed to evaluate morphometric radiologic markers to predict post-operative dialysis within this population. METHODS We conducted a retrospective study including patients with a BMI > 25 kg/m2 undergoing kidney transplantation during 5 years. Subcutaneous adipose tissue surface (SAT), visceral adipose tissue surface (VAT), and psoas surface were measured on CT scans sections. A model predictive of post-transplantation dialysis was elaborated through a multivariable logistic regression and was compared to a model including only BMI. RESULTS Overall, 248 patients were included whom mean (SD) BMI and age were, respectively, 29.7 kg/m2 (3.6) and 56 years (12.7). Of them, 83 (33.5%) needed dialysis: 14 (5.7%) for primary kidney failure and 69 (27.8%) for delayed kidney function. On multivariable analysis, SAT, VAT and deceased donor were significantly associated with post-operative dialysis (respectively, OR [95%CI]:1.6 [1.1-2.6], 1.6[1.1-2.6], and 7.5 [1.6-56]). The area under the curve of this predictive model was 0.70 versus 0.64 for a BMI-based model. CONCLUSION High VAT and SAT were associated with post-transplantation dialysis. A predictive model based on these morphometrics could provide a better appreciation of graft recovery after transplantation among obese and overweight recipients. External validation is needed.
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Affiliation(s)
- Ugo Pinar
- Department of Urology and Transplantation Surgery, Hôpital de Bicêtre, AP-HP. Université Paris Saclay, 78 rue du général Leclerc, Le Kremlin-Bicêtre, 94270, Paris, France.
| | - Arthur Mageau
- Department of Internal Medicine, Hôpital Henri Mondor, AP-HP, Université Paris Saclay, Créteil, 94010, Paris, France
| | - Yohann Renard
- Department of Visceral Surgery, Reims, Champagne-Ardenne University, Robert Debré University Hospital, Reims, France
| | - Xavier Rod
- Department of Urology and Kidney Transplantation, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, AP-HP. Sorbonne Université, 75013, Paris, France
| | - Cédric Lebacle
- Department of Urology and Transplantation Surgery, Hôpital de Bicêtre, AP-HP. Université Paris Saclay, 78 rue du général Leclerc, Le Kremlin-Bicêtre, 94270, Paris, France
| | - Benoit Barrou
- Department of Urology and Kidney Transplantation, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, AP-HP. Sorbonne Université, 75013, Paris, France
| | - Mohamad Zaidan
- Department of Nephrology, Hôpital de Bicêtre, AP-HP. Université Paris Saclay, Le Kremlin-Bicêtre, 94270, Paris, France
| | - Jacques Irani
- Department of Urology and Transplantation Surgery, Hôpital de Bicêtre, AP-HP. Université Paris Saclay, 78 rue du général Leclerc, Le Kremlin-Bicêtre, 94270, Paris, France
| | - Thomas Bessede
- Department of Urology and Transplantation Surgery, Hôpital de Bicêtre, AP-HP. Université Paris Saclay, 78 rue du général Leclerc, Le Kremlin-Bicêtre, 94270, Paris, France.,U1195, Université Paris-Saclay, Inserm, Le Kremlin-Bicêtre, 94276, Paris, France
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Olivero A, Basso L, Barabino E, Milintenda P, Testino N, Chierigo F, Dell'oglio P, Neumaier CE, Suardi N, Terrone C. The impact of visceral adipose tissue on post -operative renal Function after Radical Nephrectomy for renal cell carcinoma. Minerva Urol Nephrol 2021; 73:789-795. [PMID: 33769015 DOI: 10.23736/s2724-6051.21.04096-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The objective of this study was to evaluate the usefulness of pre-operative visceral (VAT) and subcutaneous adipose tissue (SAT) evaluation in the prediction of Acute Kidney Injury (AKI) and decrease of eGFR at 12 months after radical nephrectomy (RN). METHODS We relied on 112 patients who underwent RN between January 2010 and March 2017 at a single institution. Images from the pre-operatory CT scan were analyzed and both SAT and VAT assessments were carried out on a cross-sectional plane. eGFR was measured before surgery, at 7 days, and 12 months after surgery. ROC analysis was used to compare the diagnostic value of BMI, VAT ratio, and abdominal circumference in predicting AKI. Logistic regression models were fitted to predict the new onset of AKI, and the progression from chronic kidney disease (CKD) stage 1-3a to CKD stage 3b or from 3b to 4 at 12 months follow-up. Two logistic regression models were also performed to assess the predictors for AKI and CKD stage progression. The predictive accuracy was quantified using the receiver operating characteristic-derived area under the curve. RESULTS Sixty-six patients (58.9%) had AKI after RN. Thirty-five (31.3%) patients were upgraded to CKD IIIb or from CKD stage IIIb to CKD IV. In the ROC analysis, VAT% performed better than the BMI and abdominal circumference (AUC = 0.66 vs 0.49 and 0.54, respectively). At multivariable analyses, VAT reached an independent predictor status for AKI (OR: 1.03) and for CKD stage at 12 months Follow-up (OR: 1.05). Inclusion of VAT% into the multivariable models was associated with the highest accuracy both for AKI (AUC = 0.700 vs 0.570) and CKD stage progression (AUC = 0.848 vs 0.800). CONCLUSIONS In patients undergoing RN, preoperative visceral adipose tissue ratio significantly predicts AKI incidence and is significantly predictive of 12 months CKD stage worsening.
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Affiliation(s)
- Alberto Olivero
- Department of Urology, San Martino Policlinico Hospital, University of Genoa, Genova, Italy -
| | - Luca Basso
- Department of Radiology, San Martino Policlinico Hospital, University of Genoa, Genova, Italy
| | - Emanuele Barabino
- Department of Radiology, San Martino Policlinico Hospital, University of Genoa, Genova, Italy
| | - Paolo Milintenda
- Department of Urology, San Martino Policlinico Hospital, University of Genoa, Genova, Italy
| | - Nicolò Testino
- Department of Urology, San Martino Policlinico Hospital, University of Genoa, Genova, Italy
| | - Francesco Chierigo
- Department of Urology, San Martino Policlinico Hospital, University of Genoa, Genova, Italy
| | - Paolo Dell'oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Carlo E Neumaier
- Diagnostic imaging and senology, San Martino Policlinico Hospital, University of Genoa, Genova, Italy
| | - Nazareno Suardi
- Department of Urology, San Martino Policlinico Hospital, University of Genoa, Genova, Italy
| | - Carlo Terrone
- Department of Urology, San Martino Policlinico Hospital, University of Genoa, Genova, Italy
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Cockerill KJ, Kahn AE, Young SM, Ball CT, Mai ML, Taner CB, Perry DK, Thiel DD. Mayo Adhesive Probability (MAP) score of non-donated kidney aids in predicting post-operative renal function following donor nephrectomy. BMC Urol 2020; 20:124. [PMID: 32807136 PMCID: PMC7433049 DOI: 10.1186/s12894-020-00695-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 08/11/2020] [Indexed: 02/08/2023] Open
Abstract
Background To examine the association of preoperative Mayo Adhesive Probability (MAP) scores in the donor (MAPd) and non-donor kidneys (MAPnd) with post-donation renal function. Methods Three hundred thirty-one patients undergoing hand assisted laparoscopic donor nephrectomy (HALDN) were reviewed. MAPd and MAPnd were obtained. Estimated glomerular filtration rate (eGFR) was recorded preoperatively and at 1 day, 1 month, and 6 months postoperatively. Results Two hundred females and 131 males were evaluated with median BMI 26.4 kg/m2 (range 17.1–39.6) and median age 45 years (range 19–78). MAPd score was 0 for 231 patients (69.8%) and > 0 for 100 patients (30.2%). MAPnd score was 0 for 234 patients (70.7%) and > 0 for 97 patients (29.3%). The median preoperative eGFR was 86.6 ml/min/1.73m2 (range 48.8–138.4). After adjusting for preoperative eGFR, BMI, ASA score, and kidney sidedness, postoperative eGFR was associated with MAP score in the non-donated kidney (p = 0.014) but not in the donated kidney (p = 0.24). Compared to donors with MAPnd = 0, donors with a MAPnd > 0, mean eGFR was − 2.33 ml/min/1.73m2 lower at postoperative day 1 (95% CI − 4.24 to − 0.41, p = 0.018), − 3.02 ml/min/1.73m2 lower at 1 month (95% CI − 5.11 to − 0.93, p = 0.005), and − 2.63 ml/min/1.73m2 lower at 6 months postoperatively (95% CI − 5.01 to − 0.26, p = 0.030). Conclusions MAP score > 0 in the non-donated kidney is associated with worse renal function in the 6 months following HALDN.
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Affiliation(s)
- Katherine J Cockerill
- Department of Urology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Amanda E Kahn
- Department of Urology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Stacy M Young
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - Colleen T Ball
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - Martin L Mai
- Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA
| | - C Burcin Taner
- Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA
| | - Dana K Perry
- Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA
| | - David D Thiel
- Department of Urology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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Pinar U, Renard Y, Bedretdinova D, Parier B, Hammoudi Y, Irani J, Bessede T. Temporary contraindication of obese recipients in kidney transplantation: A new morphometric tool for decision support. Clin Transplant 2020; 34:e13829. [PMID: 32065442 DOI: 10.1111/ctr.13829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/29/2020] [Accepted: 02/13/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Morbid obesity, based on body mass index (BMI) and/or clinical examination, can be a temporary contraindication (TCI) of kidney transplantation. However, BMI alone does not evaluate the intra- or extra-peritoneal distribution of fatty tissue, and clinical examination alone is subjective. The objective was to evaluate the interest of morphometric criteria to ensure reproducible and consensual decision of TCI. METHODS We retrospectively included patients with a BMI >30 transplanted or temporarily contraindicated because of their weight from 2012 to 2017. The following measurements were performed on CT scan sections using a semiautomatic Hounsfield density detection software: subcutaneous adipose tissue surface (SAT), visceral adipose tissue surface (VAT), vessel-to-skin distance (VSK), abdominal perimeter (AP), and psoas index. Performance of morphometric measures to predict TCI was assessed through ROC analysis. RESULTS Ninety-seven patients were included: 76 kidney transplant recipients and 21 on the TCI list. The area under the curve (AUC, 95%CI) for the BMI model to predict TCI was 0.81 (0.72-0.90). A 5-variable model including BMI, VAT, VSK, AP, and age gave an AUC of 0.88 (0.78-0.98). CONCLUSIONS Morphometric obesity parameters are associated with TCI decision-making for kidney transplantation: When combined with BMI in a "morphometric tool," they were predictive of a TCI decision.
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Affiliation(s)
- Ugo Pinar
- Department of Urology, Hôpital Bicêtre, AP-HP. Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Yohann Renard
- Department of Visceral Surgery, Champagne-Ardenne University, Robert Debré University Hospital, Reims, France
| | - Dina Bedretdinova
- Gender, sexual and reproductive health, CESP Centre for research in Epidemiology and Population Health, U1018, INSERM, Le Kremlin-Bicêtre, France
| | - Bastien Parier
- Department of Urology, Hôpital Bicêtre, AP-HP. Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Yacine Hammoudi
- Department of Urology, Hôpital Bicêtre, AP-HP. Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Jacques Irani
- Department of Urology, Hôpital Bicêtre, AP-HP. Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Thomas Bessede
- Department of Urology, Hôpital Bicêtre, AP-HP. Université Paris Saclay, Le Kremlin-Bicêtre, France.,Université Paris-Saclay, INSERM, Le Kremlin-Bicêtre, France
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Hori S, Morizawa Y, Gotoh D, Itami Y, Nakai Y, Miyake M, Anai S, Torimoto K, Aoki K, Yoneda T, Tanaka N, Yoshida K, Fujimoto K. Evaluation of Preoperative Abdominal Adipose Tissue-, Inflammation-, Muscle Mass-, and Nutritional Status-based Prognostic Markers to Assess Renal Dysfunction in Living Kidney Donors. Transplant Proc 2019; 51:1706-1716. [PMID: 31399161 DOI: 10.1016/j.transproceed.2019.04.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 04/05/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Living kidney donors (LKDs) are at high risk of renal dysfunction after undergoing a donor nephrectomy (DN), resulting in poor prognosis associated with the development of cardiovascular or cerebrovascular disease. Decreasing this risk can improve the survival rate of LKDs. We investigated the effects of preoperative conditions in LKDs on renal dysfunction after DN using abdominal adipose tissue, inflammation, nutritional status, and muscle mass as markers for this assessment. METHODS Our retrospective study included 79 LKDs. Body composition markers were assessed using preoperative unenhanced computed tomographic images. Inflammation- and nutritional status-based markers were assessed using preoperative laboratory blood tests. The association between each marker was investigated, and prognostic markers for renal dysfunction after DN were identified. RESULTS The LKDs in this cohort comprised 30 men and 49 women. The median age at the time of DN and the preoperative estimated glomerular filtration rate were 58 years and 81.9 mL/min/1.73 m2, respectively. Abdominal subcutaneous adipose tissue and muscle mass significantly differed between the sexes. Each adipose tissue-, inflammation-, nutritional status-, and muscle mass-based marker showed an association with each other. Abdominal visceral adipose tissue and nutritional status could be independent prognostic markers for renal dysfunction after DN. CONCLUSIONS Our findings suggest that the preoperative condition of LKDs (assessed using specific markers such as abdominal visceral adipose tissue mass per volume and nutritional status) could affect renal dysfunction after DN. Optimal preoperative management can lead to better outcomes in LKDs. Further research is needed to establish appropriate exercise programs and nutritional interventions.
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Affiliation(s)
- Shunta Hori
- Department of Urology, Nara Medical University, Kashihara, Japan
| | - Yosuke Morizawa
- Department of Urology, Nara Medical University, Kashihara, Japan
| | - Daisuke Gotoh
- Department of Urology, Nara Medical University, Kashihara, Japan
| | - Yoshitaka Itami
- Department of Urology, Nara Medical University, Kashihara, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, Kashihara, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, Kashihara, Japan
| | - Satoshi Anai
- Department of Urology, Nara Medical University, Kashihara, Japan
| | | | - Katsuya Aoki
- Department of Urology, Nara Medical University, Kashihara, Japan
| | - Tatsuo Yoneda
- Department of Urology, Nara Medical University, Kashihara, Japan
| | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, Kashihara, Japan
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Clinical impact of abdominal fat distribution measured by 3-D computed tomography volumetry on post-transplant renal function in recipients after living kidney transplantation: a retrospective study. Clin Exp Nephrol 2018; 23:415-424. [DOI: 10.1007/s10157-018-1643-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 08/30/2018] [Indexed: 01/23/2023]
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