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Lecoindre A, Lecoindre P, Cadoré JL, Chevallier M, Guerret S, Derré G, Mcdonough SP, Simpson KW. Focal intestinal lipogranulomatous lymphangitis in 10 dogs. J Small Anim Pract 2016; 57:465-71. [PMID: 27359251 DOI: 10.1111/jsap.12522] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 04/06/2016] [Accepted: 04/21/2016] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To describe the clinical and pathological features of canine focal lipogranulomatous lymphangitis, to evaluate its underlying infectious cause and to compare it with human Crohn's disease. METHODS Retrospective review of case records with a histopathological diagnosis of focal lipogranulomatous lymphangitis. Bacterial and fungal colonisation was evaluated using fluorescence in situ hybridisation and histochemical staining, respectively. A comparison with Crohn's disease was performed by a human pathologist. RESULTS Ten dogs were evaluated. The historical complaints were predominantly chronic diarrhoea (10/10) and vomiting (5/10). The biochemical abnormalities included hypoalbuminaemia (6/10) and hypocobalaminaemia (4/6). Abdominal sonography revealed a thickened distal ileum±ileocolic junction. Colonoscopy showed a swollen caecal ostium and oedematous caecum in 7/10 dogs. A stenotic ileo-colic opening prevented endoscopic intubation in all dogs. Histology from the resected lesions revealed granulomatous inflammation involving the muscularis and serosa. Fluorescence in situ hybridization demonstrated invasive bacteria in 2/10 dogs. Post-resection, all dogs received metronidazole and tapering immunosuppressive doses of prednisolone. Remission (median 17 months) was achieved in 8/10 dogs. CLINICAL SIGNIFICANCE Focal lipogranulomatous lymphangitis is a rare and severe form of canine inflammatory bowel disease with preferential localisation to the ileum and the ileocolic junction. An underlying infectious aetiology was not identified.
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Affiliation(s)
- A Lecoindre
- Service de Médecine Interne, VetAgro Sup Campus Vétérinaire, Université de Lyon, 69280 Marcy l'Etoile, 69007 Lyon, France
| | - P Lecoindre
- CVC Clinique des Cerisioz, Route de Saint-Symphorien-d'Ozon, 69800 Lyon, France
| | - J L Cadoré
- Service de Médecine interne, VetAgro Sup Campus Vétérinaire, Université de Lyon, 69280 Marcy l'Etoile, 69007 Lyon, France
| | - M Chevallier
- Laboratoire Biomnis, 17/19 avenue Tony Garnier, 69007, Lyon, France
| | - S Guerret
- Laboratoire Biomnis, 17/19 avenue Tony Garnier, 69007, Lyon, France
| | - G Derré
- Clinique Vétérinaire de la Plage, 1 Promenade George Pompidou, 13008, Marseille, France
| | - S P Mcdonough
- Department of Biomedical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, 14853, USA
| | - K W Simpson
- College of Veterinary Medicine, Cornell University, Ithaca, New York, 14853, USA
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Abstract
Gastroparesis, or delayed gastric emptying, has many origins and can wax and wane depending on the underlying cause. Not only do the symptoms significantly alter quality of life, but the clinical consequences can also be life threatening. Once a patient develops protracted nausea and vomiting, providing adequate nutrition, hydration, and access to therapeutics such as prokinetics and antiemetics can present an exceptional challenge to clinicians. This article reviews the limited evidence available for oral nutrition, as well as enteral and parenteral nutritional support therapies. Practical strategies are provided to improve the nutritional depletion that often accompanies this debilitating condition.
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Affiliation(s)
- Carol Rees Parrish
- Department of Nutrition Services, University of Virginia Health System, PO Box 800673, Charlottesville, VA 22908-0673, USA.
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Teo M, Chung S, Chitti L, Tran C, Kritas S, Butler R, Cummins A. Small bowel bacterial overgrowth is a common cause of chronic diarrhea. J Gastroenterol Hepatol 2004; 19:904-9. [PMID: 15242494 DOI: 10.1111/j.1440-1746.2004.03376.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Often a cause for chronic non-specific diarrhea (> or =3 stools per day for more than 4 weeks) is not identified. Small bowel bacterial overgrowth (SBO) can occur without morphological damage and remains difficult to diagnose. Often diarrhea is treated empirically with antibiotics with a good response. The aims of the present study were first to investigate the prevalence of SBO in a consecutive series of patients with chronic diarrhea and second to compare the utility of duodenal fluid culture and (14)C-d-xylose breath/lactulose test in diagnosing SBO. METHODS In the first study, the cause of chronic diarrhea was prospectively diagnosed in 87 subjects. In the second study, tests of SBO were compared in 18 subjects with chronic diarrhea and 15 subjects with reflux oesophagitis used as control subjects. Duodenal fluid was aspirated at endoscopy and cultured and later a (14)C-d-xylose breath/lactulose test was performed. RESULTS In the first study, SBO was present in 48% of those with chronic diarrhea. In the second study, the diarrhea group had an average (range) stool frequency of 5.5 (3-10) per day and had normal duodenal biopsies. A total of 33%, 50%, 67% of subjects had SBO by duodenal culture alone, by a (14)C-d-xylose breath/lactulose test alone and by a combination of both tests, respectively. In the control group, 0%, 13% and 13% had SBO by duodenal culture alone, by (14)C-d-xylose breath/lactulose test alone and by combination of tests, respectively. CONCLUSION Small bowel bacterial overgrowth is a common (33-67%) cause of chronic diarrhea.
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Affiliation(s)
- Marcus Teo
- Department of Gastroenterology and Hepatology, The Queen Elizabeth Hospital, Woodville South, South Australia 5011, Australia
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Johnston KL, Lamport AI, Ballèvre OP, Batt RM. Effects of oral administration of metronidazole on small intestinal bacteria and nutrients of cats. Am J Vet Res 2000; 61:1106-12. [PMID: 10976744 DOI: 10.2460/ajvr.2000.61.1106] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine effects of oral administration of metronidazole on the number and species of duodenal bacteria and selective nutrients of cats. ANIMALS 6 healthy domestic shorthair cats. PROCEDURE Undiluted duodenal fluid was obtained for quantitative and qualitative bacterial culture to determine species and number of bacteria in healthy cats. Blood samples were assayed for taurine, total protein, albumin, cobalamin, and folate concentrations. Cats then were given metronidazole (20 mg/kg of body weight, PO, q 12 h) for 1 month, after which bacterial cultures and serum assays of nutrients were repeated. Nine months after cessation of antibiotic treatment, duodenal bacteria were re-evaluated and serum was assayed for total protein, albumin, cobalamin, and folate concentrations. RESULTS Oral administration of metronidazole caused a significant decrease in aerobic and anaerobic bacterial counts in the duodenum of healthy cats, accompanied by emergence of Streptococcus spp and Corynebacterium spp. Serum concentrations of cobalamin and albumin increased when duodenal bacterial counts were decreased, although changes in folate or taurine concentrations were not detected. Measured variables did not differ, when comparing results obtained before and 9 months after cessation of metronidazole. CONCLUSIONS AND CLINICAL RELEVANCE Oral administration of metronidazole decreased the number of aerobic bacteria and altered indigenous flora in the small bowel of cats. Normal duodenal flora appeared to be stable, because species of bacteria were re-established by 9 months after cessation of metronidazole. Bacterial flora appeared to have an impact on nutrients, because albumin and cobalamin increased during antibiotic administration and returned to preadministration concentrations after cessation of the antimicrobial.
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Affiliation(s)
- K L Johnston
- Department of Small Animal Medicine and Surgery, The Royal Veterinary College, University of London, Hertfordshire, UK
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 25-1990. Abdominal pain and vomiting in a 64-year-old man with chronic malabsorption and diarrhea. N Engl J Med 1990; 322:1796-806. [PMID: 2111879 DOI: 10.1056/nejm199006213222508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Krasinski SD, Russell RM, Samloff IM, Jacob RA, Dallal GE, McGandy RB, Hartz SC. Fundic atrophic gastritis in an elderly population. Effect on hemoglobin and several serum nutritional indicators. J Am Geriatr Soc 1986; 34:800-6. [PMID: 3771980 DOI: 10.1111/j.1532-5415.1986.tb03985.x] [Citation(s) in RCA: 137] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The ratio of pepsinogen I to pepsinogen II in the circulation decreases progressively with increasing severity of atrophic gastritis of the fundic gland mucosa. Fasting blood was obtained from 359 free-living and institutionalized elderly people (age range, 60 to 99 years). A pepsinogen I/pepsinogen II ratio less than 2.9, indicating atrophic gastritis, was found in 113 (31.5%) subjects. The prevalence of atrophic gastritis increased significantly with advancing age (P less than .05). Within the atrophic gastritis group, 84 had a pepsinogen I level greater than or equal to 20 micrograms/L, indicating mild to moderate atrophic gastritis, and 29 had a pepsinogen I level less than 20 micrograms/L, indicating severe atrophic gastritis or gastric atrophy. A significant increase in the prevalences of elevated serum gastrin levels (P less than .005), low serum vitamin B12 levels (P less than .005), circulating intrinsic factor antibody (P less than .005), and anemia (P less than .025) was observed with stepwise increases in severity of atrophic gastritis. Subjects with atrophic gastritis exhibited a lower mean serum vitamin B12 level (P less than .05) and a higher mean folate level (P less than .05), but no difference was detected in mean hemoglobin levels or serum levels of iron, ferritin, retinol or alpha-tocopherol. It is concluded that serum pepsinogen I and pepsinogen II levels can be used to determine the prevalence and severity of atrophic gastritis, that atrophic gastritis is common in an elderly population, and that atrophic gastritis is associated with vitamin B12 deficiency and anemia. Further, higher folate levels in atrophic gastritis may be related to an accumulation of 5-methyl tetrahydrofolate in serum due to vitamin B12 deficiency and/or greater folate synthesis by the intestinal flora resulting from bacterial overgrowth secondary to hypo- or achlorhydria.
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Murphy MF, Sourial NA, Burman JF, Doyle DV, Tabaqchali S, Mollin DL. Megaloblastic anaemia due to vitamin B12 deficiency caused by small intestinal bacterial overgrowth: possible role of vitamin B12 analogues. Br J Haematol 1986; 62:7-12. [PMID: 3942698 DOI: 10.1111/j.1365-2141.1986.tb02894.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Megaloblastic anaemia due to bacterial overgrowth of the small intestine is due to vitamin B12 malabsorption. This report describes a patient with bacterial overgrowth of the small intestine who had megaloblastic anaemia and malabsorption of vitamin B12, but persistently normal levels of serum vitamin B12 and normal serum and red cell folate levels. However, there was evidence of vitamin B12 deficiency as shown by an abnormal deoxyuridine suppression test and by the response to treatment with physiological doses of vitamin B12. A relative increase in biologically inactive vitamin B12 analogues may be the explanation for the normal vitamin B12 level in this patient.
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Gracey M. Mechanisms of malabsorption in the "Contaminated Small-Bowel syndrome". DIE NAHRUNG 1984; 28:659-66. [PMID: 6493324 DOI: 10.1002/food.19840280630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The mucosa of the upper small intestine in humans is repeatedly exposed to potentially harmful environmental influences: infective, toxic and antigenic. One of the most significant manifestations of the control over environmental risks is how the upper intestinal milieu is kept relatively sterile and pathogen-free despite constant exposure to a potentially hostile and pathogen-ridden environment. This control is lost in the so-called "Contaminated Small-Bowel Syndrome" when profuse numbers of bacteria contaminate the contents of the upper bowel. This can occur in a vast array of clinical situations ranging from infancy to old age. The consequences of upper intestinal bacterial overgrowth are very diverse. The mechanisms causing diarrhoea and malabsorption in this syndrome illustrate facets of pathophysiology of many inter-relating processes of intestinal digestion and absorption.
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Batt R, Needham J, Carter M. Bacterial overgrowth associated with a naturally occurring enteropathy in the German shepherd dog. Res Vet Sci 1983. [DOI: 10.1016/s0034-5288(18)32200-8] [Citation(s) in RCA: 51] [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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Viddal KO. Intestinal bypass. A randomized, prospective clinical study of end-to-side and end-to-end jejunoileal bypass. Scand J Gastroenterol 1983; 18:627-34. [PMID: 6675183 DOI: 10.3109/00365528309181649] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Of 21 patients with morbid obesity 10 were randomly allocated to ES (end-to-side) and 11 to EE (end-to-end) jejunoileal bypass. Ten patients in each group were followed up for more than 3 years. Average weight loss 18 months after operation was 37 kg or 33% of preoperative body weight in the ES group and 40 kg or 37% in the EE group (p = 0.26). One year after operation the mean serum concentration of magnesium was 0.84 mmol/l in the ES group and 0.66 in the EE group (p = 0.02), and the serum concentration of folic acid was 11.5 nmol/l in the ES group and 6.0 in the EE group (p = 0.01). The liver biopsies showed significant (p = 0.01) increased steatosis 1 year after operation in the EE group compared with peroperative biopsies, and the difference between the two groups at the 12-month follow-up almost reached statistical significance in favour of the ES group (p = 0.07). In the EE group, interposition of an intestinal segment was performed in 4 patients 17-27 months after the primary operation because of electrolyte deficiency and/or ulcer in the ileocolic anastomosis. The results in this series indicate that the ES shunt is a better operation than the EE shunt.
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Ward K, Robinson A, McMurray M, Weir DG. Massive jejunal diverticulosis and subacute combined degeneration of the cord. Ir J Med Sci 1983; 152:289-91. [PMID: 6413450 DOI: 10.1007/bf02954801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Abstract
Contamination of the small bowel with an abnormal microflora causes a variety of disturbances of intraluminal digestion and of mucosal function resulting in malabsorption of fat, protein, carbohydrate, electrolytes and vitamin B12. Indirect clinical tests for the presence of small bowel bacterial overgrowth must be supported by careful roentgenologic examination of the small intestine and intestinal aspiration studies to establish a firm pretreatment diagnosis. However, the reversal of absorptive defects by antibacterial therapy is valuable confirmatory evidence.
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Abstract
Development of diarrhea in a patient following gastric surgery can be a confusing problem. The clinician is forced to consider and exclude causes that may be independent of the surgery as well as those that are unique to the postgastrectomy state. An orderly approach is mandatory for appropriate workup and management.
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Campbell CB, Cowen AE, Harper J. Duodenal bacterial flora and bile salt patterns in patients with gastrointestinal disease. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1973; 3:339-48. [PMID: 4586512 DOI: 10.1111/j.1445-5994.1973.tb03104.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Thomas E, Grant AK, Holford M, Ringwood D, Derrington AW, Magarey JR. Bacterial flora in the duodenum of patients after biliary fenestration. Br J Surg 1973; 60:107-11. [PMID: 4346688 DOI: 10.1002/bjs.1800600203] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Abstract
Fasting duodenal aspirates were studied in 15 patients with a biliary fenestration, 5 patients with a single duodenal diverticulum, 1 patient with a biliary fenestration and duodenal diverticulum, and 11 control subjects. A colonic type of bacterial flora, consisting of coliforms, Clostridium welchii, and Streptococcus faecalis, was found in 10 patients with biliary fenestration, 4 patients with a duodenal diverticulum, the patient with a fenestration and duodenal diverticulum, and in 1 of the control subjects. A high incidence of deconjugation of biles salts (10 out of 15 patients) and of steatorrhoea (8 out of 15 patients) was noted in the patients with biliary fenestration, as well as in those with a duodenal diverticulum (5 and 3 patients out of 5 respectively). Above-normal serum-folate levels were observed in 3 subjects with coliform colonization.
It is possible that vague abdominal symptoms which may be experienced by patients after biliary fenestration, may be due to the presence of an abnormal bacterial flora in the duodenum.
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Bernstein LH, Gutstein S, Efron G, Wagle A, Graham E. Trichobezoar--an unusual cause of megaloblastic anemia and hypoproteinemia in childhood. THE AMERICAN JOURNAL OF DIGESTIVE DISEASES 1973; 18:67-71. [PMID: 4682019 DOI: 10.1007/bf01072241] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Hoffbrand AV, Tabaqchali S, Booth CC, Mollin DL. Small intestinal bacterial flora and folate status in gastrointestinal disease. Gut 1971; 12:27-33. [PMID: 4993410 PMCID: PMC1411460 DOI: 10.1136/gut.12.1.27] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Serumfolate folate levels and the bacteriology of the small intestine were studied in 13 patients with jejunal diverticulosis, 29 patients with partial gastrectomy, and five patients with ileal disease. The mean serum folate level in the patients with partial gastrectomy (7.2 mmug/ml) was similar to that of control subjects but the mean level in the patients with jejunal diverticulosis (14.6 mmug/ml) was significantly higher than the mean level of the control group (8.0 mmug/ml). Five of the 13 patients with jejunal diverticulosis and two of the patients with partial gastrectomy had levels above the upper limit of the control group (> 16.6 mmug/ml), and five of six patients with jejunal diverticulosis studied excreted raised amounts of folate in the urine (> 13.2 mug in 24 hours). Serum folate in one of these patients with jejunal diverticulosis was identified chromatographically as 5-methyltetrahydrofolic acid. The mean serum folate level (9.0 mmug/ml) in the patients with partial gastrectomy who had Esch. coli in the jejunal aspirates was significantly higher than in those without Esch. coli present (mean 4.2 mmug/ml). It is suggested that in gastrointestinal disease jejunal bacteria may contribute to the serum folate level even though this remains in an accepted normal range. Some patients had low serum folate levels despite having a large number of Esch. coli in the jejunum. No evidence of malabsorption of folic acid was found in three such patients even though one had lactobacilli capable of consuming folate in the jejunum. No relationship was found between serum folate level and ileal bacteriology.
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Tabaqchali S. Pathology of the Malabsorption Syndrome [ Abridged]. Proc R Soc Med 1969. [DOI: 10.1177/003591576906201001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Schiff ER, Dietschy JM. Steatorrhea associated with disordered bile acid metabolism. Micellar phase defects. THE AMERICAN JOURNAL OF DIGESTIVE DISEASES 1969; 14:432-46. [PMID: 4892101 DOI: 10.1007/bf02239366] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Cihak RJ, Keynes WM, Schiller KF. Gluten-induced enteropathy and stagnant loop syndrome in the same patient: case report with a view. Ann Surg 1969; 169:429-36. [PMID: 5380868 PMCID: PMC1387445 DOI: 10.1097/00000658-196903000-00019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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