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Marchese S, Huckins LM. Trauma Matters: Integrating Genetic and Environmental Components of PTSD. ADVANCED GENETICS (HOBOKEN, N.J.) 2023; 4:2200017. [PMID: 37766803 PMCID: PMC10520418 DOI: 10.1002/ggn2.202200017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/28/2022] [Indexed: 09/29/2023]
Abstract
Trauma is ubiquitous, but only a subset of those who experience trauma will develop posttraumatic stress disorder (PTSD). In this review, it is argued that to determine who is at risk of developing PTSD, it is critical to examine the genetic etiology of the disorder and individual trauma profiles of those who are susceptible. First, the state of current PTSD genetic research is described, with a particular focus on studies that present evidence for trauma type specificity, or for differential genetic etiology according to gender or race. Next, approaches that leverage non-traditional phenotyping approaches are reviewed to identify PTSD-associated variants and biology, and the relative advantages and limitations inherent in these studies are reflected on. Finally, it is discussed how trauma might influence the heritability of PTSD, through type, risk factors, genetics, and associations with PTSD symptomology.
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Affiliation(s)
- Shelby Marchese
- Pamela Sklar Division of Psychiatric GenomicsIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
| | - Laura M. Huckins
- Pamela Sklar Division of Psychiatric GenomicsIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Seaver Autism Center for Research and TreatmentIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Present address:
Department of PsychiatryYale University School of MedicineNew HavenCT06511USA
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Sbisa AM, Madden K, Toben C, McFarlane AC, Dell L, Lawrence-Wood E. Potential peripheral biomarkers associated with the emergence and presence of posttraumatic stress disorder symptomatology: A systematic review. Psychoneuroendocrinology 2023; 147:105954. [PMID: 36308820 DOI: 10.1016/j.psyneuen.2022.105954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Evidence suggests posttraumatic stress disorder (PTSD) involves an interplay between psychological manifestations and biological systems. Biological markers of PTSD could assist in identifying individuals with underlying dysregulation and increased risk; however, accurate and reliable biomarkers are yet to be identified. METHODS A systematic review following the PRISMA guidelines was conducted. Databases included EMBASE, MEDLINE, and Cochrane Central. Studies from a comprehensive 2015 review (Schmidt et al., 2015) and English language papers published subsequently (between 2014 and May 2022) were included. Forty-eight studies were eligible. RESULTS Alterations in neuroendocrine and immune markers were most commonly associated with PTSD symptoms. Evidence indicates PTSD symptoms are associated with hypothalamic-pituitary-adrenal axis dysfunction as represented by low basal cortisol, a dysregulated immune system, characterized by an elevated pro-inflammatory state, and metabolic dysfunction. However, a considerable number of studies neglected to measure sex or prior trauma, which have the potential to affect the biological outcomes of posttraumatic stress symptoms. Mixed findings are indicative of the complexity and heterogeneity of PTSD and suggest the relationship between allostatic load, biological markers, and PTSD remain largely undefined. CONCLUSIONS In addition to prospective research design and long-term follow up, it is imperative future research includes covariates sex, prior trauma, and adverse childhood experiences. Future research should include exploration of biological correlates specific to PTSD symptom domains to determine whether underlying processes differ with symptom expression, in addition to subclinical presentation of posttraumatic stress symptoms, which would allow for greater understanding of biomarkers associated with disorder risk and assist in untangling directionality.
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Affiliation(s)
- Alyssa M Sbisa
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Kelsey Madden
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Catherine Toben
- Discipline of Psychiatry, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | | | - Lisa Dell
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ellie Lawrence-Wood
- Phoenix Australia - Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
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3
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Piazza JR, Landes SD, Stawski RS. Age differences in allostatic load among veterans: The importance of combat exposure. J Trauma Stress 2022; 35:257-268. [PMID: 34637556 DOI: 10.1002/jts.22731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 06/16/2021] [Accepted: 06/20/2021] [Indexed: 11/09/2022]
Abstract
The current study examinedage differences in allostatic load among nonveterans, noncombat veterans, and combat veterans. Participants included 280 individuals from the Midlife Development in the United States (MIDUS) survey, including 164 veterans (n = 48 combat veterans; n = 116 noncombat veterans) and 116 nonveterans. Age differences in allostatic load were similar among nonveterans and noncombat veterans, B = 0.002, SE = .011, p = .878, with older adults showing higher levels of allostatic load than their comparatively younger counterparts. Among combat veterans, however, a different pattern emerged. In this group, levels of allostatic load were similar across age, seemingly due to higher levels of allostatic load among younger combat veterans, B = -0.029, SE = .014, p = .031, ƞp 2 = .022. Results reveal the importance of considering combat exposure when examining health outcomes of military veterans, particularly in the context of age.
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Affiliation(s)
- Jennifer R Piazza
- Department of Public Health, California State University, Fullerton, Fullerton, California, USA
| | - Scott D Landes
- Department of Sociology, Syracuse University, Syracuse, New York, USA
| | - Robert S Stawski
- Department of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
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Rajkumar RP. Harnessing the Neurobiology of Resilience to Protect the Mental Well-Being of Healthcare Workers During the COVID-19 Pandemic. Front Psychol 2021; 12:621853. [PMID: 33815205 PMCID: PMC8012770 DOI: 10.3389/fpsyg.2021.621853] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/22/2021] [Indexed: 01/26/2023] Open
Abstract
Healthcare workers are at a high risk of psychological morbidity in the face of the COVID-19 pandemic. However, there is significant variability in the impact of this crisis on individual healthcare workers, which can be best explained through an appreciation of the construct of resilience. Broadly speaking, resilience refers to the ability to successfully adapt to stressful or traumatic events, and thus plays a key role in determining mental health outcomes following exposure to such events. A proper understanding of resilience is vital in enabling a shift from a reactive to a proactive approach for protecting and promoting the mental well-being of healthcare workers. Research in the past decade has identified six areas that provide promising leads in understanding the biological basis of individual variations in resilience. These are: (1) the key role played by the monoamines noradrenaline and serotonin, (2) the centrality of the hypothalamic-pituitary-adrenal axis in influencing stress vulnerability and resilience, (3) the intimate links between the immune system and stress sensitivity, (4) the role of epigenetic modulation of gene expression in influencing the stress response, (5) the role played by certain neuropeptides as a natural “brake” mechanism in the face of stress, and (6) the neurobiological mechanisms by which environmental factors, such as exercise, diet, and social support, influence resilience to subsequent life events. Though much of this research is still in its early stages, it has already provided valuable information on which strategies – including dietary changes, lifestyle modification, environmental modification, psychosocial interventions, and even pharmacological treatments – may prove to be useful in fostering resilience in individuals and groups. This paper examines the above evidence more closely, with a specific focus on the challenges faced by healthcare workers during the COVID-19 pandemic, and provides suggestions regarding how it may be translated into real-world interventions, as well as how the more tentative hypotheses advanced in this field may be tested during this critical period.
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Affiliation(s)
- Ravi Philip Rajkumar
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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5
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Flanagan JC, Hand A, Jarnecke AM, Moran-Santa Maria MM, Brady KT, Joseph JE. Effects of oxytocin on working memory and executive control system connectivity in posttraumatic stress disorder. Exp Clin Psychopharmacol 2018; 26:391-402. [PMID: 30070567 PMCID: PMC6075739 DOI: 10.1037/pha0000197] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Posttraumatic stress disorder (PTSD) is a chronic, debilitating condition for which effective medications are scant and little is known about neural correlates of risk versus resilience. Oxytocin is a hypothalamic neuropeptide that has demonstrated promise in modulating neurobiological and behavioral correlates of PTSD. Cognitive deficits in areas such as working memory and executive control are highly prevalent among individuals with PTSD and oxytocin might modulate these impairments in individuals with PTSD. Using a double-blind, placebo-controlled design, this study employed functional MRI (fMRI) and the n-back working memory task to examine the effects of oxytocin (24 IU) versus placebo on working memory and dorsolateral prefrontal cortex (DLPFC) connectivity among individuals with PTSD (n = 16) as compared with a trauma-exposed control group (n = 18). Results indicate that individuals with PTSD on oxytocin performed better in the 2-back condition of the n-back task compared with individuals with PTSD on placebo. Results also indicate that connectivity between DLPFC and anterior cingulate increased in the 2-back condition among individuals with PTSD on oxytocin as compared with placebo. These findings provide preliminary evidence of an effect of oxytocin on working memory among individuals with PTSD and insights into the neurobiological mechanisms underlying this association. Future studies are necessary to understand the mechanisms responsible for working memory deficits in PTSD and to examine the potential of oxytocin for use as a treatment for PTSD. (PsycINFO Database Record
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Affiliation(s)
- Julianne C. Flanagan
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Anne Hand
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC
| | - Amber M. Jarnecke
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | | | - Kathleen T. Brady
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC
- Ralph H. Johnson VAMC, Charleston, SC
| | - Jane E. Joseph
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC
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Wolf EJ, Maniates H, Nugent N, Maihofer AX, Armstrong D, Ratanatharathorn A, Ashley-Koch AE, Garrett M, Kimbrel NA, Lori A, Aiello AE, Baker DG, Beckham JC, Boks MP, Galea S, Geuze E, Hauser MA, Kessler RC, Koenen KC, Miller MW, Ressler KJ, Risbrough V, Rutten BP, Stein MB, Ursano RJ, Vermetten E, Vinkers CH, Uddin M, Smith AK, Nievergelt CM, Logue MW. Traumatic stress and accelerated DNA methylation age: A meta-analysis. Psychoneuroendocrinology 2018; 92:123-134. [PMID: 29452766 PMCID: PMC5924645 DOI: 10.1016/j.psyneuen.2017.12.007] [Citation(s) in RCA: 152] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/07/2017] [Accepted: 12/12/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Recent studies examining the association between posttraumatic stress disorder (PTSD) and accelerated aging, as defined by DNA methylation-based estimates of cellular age that exceed chronological age, have yielded mixed results. METHODS We conducted a meta-analysis of trauma exposure and PTSD diagnosis and symptom severity in association with accelerated DNA methylation age using data from 9 cohorts contributing to the Psychiatric Genomics Consortium PTSD Epigenetics Workgroup (combined N = 2186). Associations between demographic and cellular variables and accelerated DNA methylation age were also examined, as was the moderating influence of demographic variables. RESULTS Meta-analysis of regression coefficients from contributing cohorts revealed that childhood trauma exposure (when measured with the Childhood Trauma Questionnaire) and lifetime PTSD severity evidenced significant, albeit small, meta-analytic associations with accelerated DNA methylation age (ps = 0.028 and 0.016, respectively). Sex, CD4T cell proportions, and natural killer cell proportions were also significantly associated with accelerated DNA methylation age (all ps < 0.02). PTSD diagnosis and lifetime trauma exposure were not associated with advanced DNA methylation age. There was no evidence of moderation of the trauma or PTSD variables by demographic factors. CONCLUSIONS Results suggest that traumatic stress is associated with advanced epigenetic age and raise the possibility that cells integral to immune system maintenance and responsivity play a role in this. This study highlights the need for additional research into the biological mechanisms linking traumatic stress to accelerated DNA methylation age and the importance of furthering our understanding of the neurobiological and health consequences of PTSD.
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Affiliation(s)
- Erika J. Wolf
- National Center for PTSD at VA Boston Healthcare System,Department of Psychiatry, Boston University School of Medicine
| | | | - Nicole Nugent
- Bradley Hasbro Children’s Research Center, Rhode Island Hospital,Departments of Psychiatry and Human Behavior and Pediatrics, Brown Medical School
| | | | - Don Armstrong
- University of Illinois Urbana-Champaign, Carl R. Woese Institute for Genomic Biology
| | | | | | - Melanie Garrett
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center
| | - Nathan A. Kimbrel
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center,VA Mid-Atlantic, Mental Illness Research, Education, and Clinical Center,Durham VA Medical Center
| | - Adriana Lori
- Department of Psychiatry and Behavioral Sciences, Emory University
| | | | - Allison E. Aiello
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health
| | - Dewleen G. Baker
- University of California San Diego, Department of Psychiatry,Veterans Affairs San Diego Healthcare System,Veterans Affairs Center of Excellence for Stress and Mental Health
| | - Jean C. Beckham
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center,VA Mid-Atlantic, Mental Illness Research, Education, and Clinical Center,Durham VA Medical Center
| | - Marco P. Boks
- University Medical Center Utrecht, Brain Center Rudolf Magnus, Department of Psychiatry, Utrecht the Netherlands
| | | | - Elbert Geuze
- University Medical Center Utrecht, Brain Center Rudolf Magnus, Department of Psychiatry, Utrecht the Netherlands,Ministry of Defence, Military Mental Healthcare, Utrecht the Netherlands
| | - Michael A. Hauser
- Duke Molecular Physiology Institute, Duke University School of Medicine
| | | | - Karestan C. Koenen
- Harvard T.H. Chan School of Public Health, Department of Epidemiology,Massachusetts General Hospital, Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, and Department of Psychiatry
| | - Mark W. Miller
- National Center for PTSD at VA Boston Healthcare System,Department of Psychiatry, Boston University School of Medicine
| | - Kerry J. Ressler
- Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA, USA
| | - Victoria Risbrough
- University of California San Diego, Department of Psychiatry,Veterans Affairs San Diego Healthcare System,Veterans Affairs Center of Excellence for Stress and Mental Health
| | - Bart P.F. Rutten
- School for Mental Health and Neuroscience and the European Graduate School of Neuroscience (EURON), Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Murray B. Stein
- University of California San Diego, Department of Psychiatry,Veterans Affairs San Diego Healthcare System,University of California San Diego, Department of Family Medicine and Public Health
| | - Robert J. Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences
| | - Eric Vermetten
- University Medical Center Utrecht, Brain Center Rudolf Magnus, Department of Psychiatry, Utrecht the Netherlands,Ministry of Defence, Military Mental Healthcare, Utrecht the Netherlands,Arq Psychotrauma Expert Group
| | - Christiaan H. Vinkers
- University Medical Center Utrecht, Brain Center Rudolf Magnus, Department of Psychiatry, Utrecht the Netherlands
| | - Monica Uddin
- University of Illinois Urbana-Champaign, Carl R. Woese Institute for Genomic Biology,University of Illinois Urbana-Champaign, Department of Psychology
| | - Alicia K. Smith
- Department of Psychiatry and Behavioral Sciences, Emory University,Department of Gynecology and Obstetrics, Emory University
| | - Caroline M. Nievergelt
- University of California San Diego, Department of Psychiatry,Veterans Affairs San Diego Healthcare System,Veterans Affairs Center of Excellence for Stress and Mental Health
| | - Mark W. Logue
- National Center for PTSD at VA Boston Healthcare System,Department of Psychiatry, Boston University School of Medicine,Biomedical Genetics, Boston University School of Medicine
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Ghaffarzadegan N, Ebrahimvandi A, Jalali MS. A Dynamic Model of Post-Traumatic Stress Disorder for Military Personnel and Veterans. PLoS One 2016; 11:e0161405. [PMID: 27716776 PMCID: PMC5055362 DOI: 10.1371/journal.pone.0161405] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 07/11/2016] [Indexed: 11/19/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) stands out as a major mental illness; however, little is known about effective policies for mitigating the problem. The importance and complexity of PTSD raise critical questions: What are the trends in the population of PTSD patients among military personnel and veterans in the postwar era? What policies can help mitigate PTSD? To address these questions, we developed a system dynamics simulation model of the population of military personnel and veterans affected by PTSD. The model includes both military personnel and veterans in a “system of systems.” This is a novel aspect of our model, since many policies implemented at the military level will potentially influence (and may have side effects on) veterans and the Department of Veterans Affairs. The model is first validated by replicating the historical data on PTSD prevalence among military personnel and veterans from 2000 to 2014 (datasets from the Department of Defense, the Institute of Medicine, the Department of Veterans Affairs, and other sources). The model is then used for health policy analysis. Our results show that, in an optimistic scenario based on the status quo of deployment to intense/combat zones, estimated PTSD prevalence among veterans will be at least 10% during the next decade. The model postulates that during wars, resiliency-related policies are the most effective for decreasing PTSD. In a postwar period, current health policy interventions (e.g., screening and treatment) have marginal effects on mitigating the problem of PTSD, that is, the current screening and treatment policies must be revolutionized to have any noticeable effect. Furthermore, the simulation results show that it takes a long time, on the order of 40 years, to mitigate the psychiatric consequences of a war. Policy and financial implications of the findings are discussed.
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Affiliation(s)
- Navid Ghaffarzadegan
- Industrial and Systems Engineering, Virginia Tech, Blacksburg, Virginia, United States of America
| | - Alireza Ebrahimvandi
- Industrial and Systems Engineering, Virginia Tech, Blacksburg, Virginia, United States of America
| | - Mohammad S. Jalali
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- * E-mail:
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Watson IPB, Brüne M, Bradley AJ. The evolution of the molecular response to stress and its relevance to trauma and stressor-related disorders. Neurosci Biobehav Rev 2016; 68:134-147. [PMID: 27216210 DOI: 10.1016/j.neubiorev.2016.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 04/29/2016] [Accepted: 05/11/2016] [Indexed: 02/08/2023]
Abstract
The experience of "stress", in its broadest meaning, is an inevitable part of life. All living creatures have evolved multiple mechanisms to deal with such threats and challenges and to avoid damage to the organism that may be incurred from these stress responses. Trauma and stressor-related disorders are psychiatric conditions that are caused specifically by the experience of stress, though depression, anxiety and some other disorders may also be unleashed by stress. Stress, however, is not a mandatory criterion of these diagnoses. This article focuses on the evolution of the neurochemicals involved in the response to stress and the systems in which they function. This includes the skin and gut, and the immune system. Evidence suggests that responses to stress are evolutionarily highly conserved, have wider involvement than the hypothalamic pituitary adrenal stress axis alone, and that excessive stress responses can produce stressor-related disorders in both humans and animals.
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Affiliation(s)
- Ian P Burges Watson
- University of Tasmania, Department of Psychiatry, Hobart, Tasmania 7005, Australia
| | - Martin Brüne
- LWL University Hospital, Department of Psychiatry, Division of Cognitive Neuropsychiatry, Ruhr-University Bochum, Germany.
| | - Adrian J Bradley
- School of Biomedical Sciences, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Queensland 4072, Australia
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