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Ölander C, Feychting M, Eriksson PO, Laurell G, Talbäck M, Ek S. Fall-related injury among patients with vestibular schwannoma. PLoS One 2024; 19:e0304184. [PMID: 38875269 PMCID: PMC11178211 DOI: 10.1371/journal.pone.0304184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/06/2024] [Indexed: 06/16/2024] Open
Abstract
Vestibular schwannoma can cause vestibular dysfunction; however, conflicting evidence exists regarding whether this affects the incidence of fall-related injuries in this patient population. This matched cross-sectional and cohort study assess the risk of fall-related injuries in patients with vestibular schwannoma. The study included patients with vestibular schwannoma treated at a tertiary referral hospital in Sweden between 1988 and 2014. Information on fall-related injuries was obtained from the National Patient Register, and matched population comparisons were randomly selected in a 1:25 ratio. Fall-related injuries occurring pre- (within 5 years before the diagnosis of vestibular schwannoma) and post-diagnostically (up to 3 years after diagnosis or intervention) were registered. The association between vestibular schwannoma and fall-related injuries was estimated using logistic regression and Cox proportional hazards analyses. We identified 1153 patients with vestibular schwannoma (569 [49%] women and 584 [51%] men), and 28815 population comparisons. Among the patients, 9% and 7% had pre- and post-diagnostic fall-related injuries, respectively, and among the comparisons, 8% and 6% had pre- and post-diagnostic fall-related injuries, respectively. There was no increased risk of pre- (OR 1.14; CI 0.92-1.41) or post-diagnostic 1 year (HR 1.16; CI 0.87-1.54) or 3 years (HR 1.11; CI 0.89-1.29) fall-related injury among the total patient cohort. In age-stratified analyses, we found an increased risk of pre-diagnostic fall-related injury among patients aged 50-69 years (OR 1.42; CI 1.10-1.88). Patients who underwent middle fossa surgery, regardless of age, had an increased risk of post-surgery fall-related injury within 3 years of follow-up (HR 2.68; CI 1.06-6.81). We conclude that patients with vestibular schwannoma have a low risk of enduring fall-related injuries. Middle-aged patients with dizziness and fall-related injuries should be considered for a vestibular clinical evaluation. Our results highlight the importance of rehabilitation in avoiding future fall-related injuries among patients undergoing middle fossa surgery.
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Affiliation(s)
- Christine Ölander
- Department of Surgical Sciences, Section of Otolaryngology and Head Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Per Olof Eriksson
- Department of Surgical Sciences, Section of Otolaryngology and Head Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Göran Laurell
- Department of Surgical Sciences, Section of Otolaryngology and Head Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Mats Talbäck
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Stina Ek
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
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Aryan R, Zobeiri OA, Millar JL, Schubert MC, Cullen KE. Effect of vestibular loss on head-on-trunk stability in individuals with vestibular schwannoma. Sci Rep 2024; 14:3512. [PMID: 38347021 PMCID: PMC10861475 DOI: 10.1038/s41598-024-53512-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/01/2024] [Indexed: 02/15/2024] Open
Abstract
The vestibulo-collic reflex generates neck motor commands to produce head-on-trunk movements that are essential for stabilizing the head relative to space. Here we examined the effects of vestibular loss on head-on-trunk kinematics during voluntary behavior. Head and trunk movements were measured in individuals with vestibular schwannoma before and then 6 weeks after unilateral vestibular deafferentation via surgical resection of the tumor. Movements were recorded in 6 dimensions (i.e., 3 axes of rotation and 3 axes of translation) using small light-weight inertial measurement units while participants performed balance and gait tasks. Kinematic measures differed between individuals with vestibular schwannoma (at both time points) and healthy controls for the more challenging exercises, namely those performed in tandem position or on an unstable surface without visual input. Quantitative assessment of the vestibulo-ocular reflex (VOR) revealed a reduction in VOR gain for individuals with vestibular schwannoma compared to control subjects, that was further reduced following surgery. These findings indicated that the impairment caused by either the tumor or subsequent surgical tumor resection altered head-on-trunk kinematics in a manner that is not normalized by central compensation. In contrast, we further found that head-on-trunk kinematics in individuals with vestibular schwannoma were actually comparable before and after surgery. Thus, taken together, our results indicate that vestibular loss impacts head-on-trunk kinematics during voluntary balance and gait behaviors, and suggest that the neural mechanisms mediating adaptation alter the motion strategies even before surgery in a manner that may be maladaptive for long-term compensation.
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Affiliation(s)
- Raabeae Aryan
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, 720 Rutland Ave, Traylor 504, Baltimore, MD, 21205-2109, USA
| | - Omid A Zobeiri
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, 720 Rutland Ave, Traylor 504, Baltimore, MD, 21205-2109, USA
- Department of Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - Jennifer L Millar
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael C Schubert
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Kathleen E Cullen
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, 720 Rutland Ave, Traylor 504, Baltimore, MD, 21205-2109, USA.
- Department of Biomedical Engineering, McGill University, Montreal, QC, Canada.
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, USA.
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, USA.
- Kavli Neuroscience Discovery Institute, Johns Hopkins University, Baltimore, MD, USA.
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Oussou G, Magnani C, Bargiotas I, Lamas G, Tankere F, Vidal C. A New Sensitive Test Using Virtual Reality and Foam to Probe Postural Control in Vestibular Patients: The Unilateral Schwannoma Model. Front Neurol 2022; 13:891232. [PMID: 35693011 PMCID: PMC9174985 DOI: 10.3389/fneur.2022.891232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/05/2022] [Indexed: 11/13/2022] Open
Abstract
Vestibular schwannomas (VS) are benign tumors of the vestibular nerve that may trigger hearing loss, tinnitus, rotatory vertigo, and dizziness in patients. Vestibular and auditory tests can determine the precise degree of impairment of the auditory nerve, and superior and inferior vestibular nerves. However, balance is often poorly quantified in patients with untreated vestibular schwannoma, for whom validated standardized assessments of balance are often lacking. Balance can be quantified with the EquiTest. However, this device was developed a long time ago and is expensive, specific, and not sensitive enough to detect early deficits because it assesses balance principally in the sagittal plane on a firm platform. In this study, we assessed postural performances in a well-defined group of VS patients. We used the Dizziness Handicap Inventory (DHI) and a customized device consisting of a smartphone, a mask delivering a fixed or moving visual scene, and foam rubber. Patients were tested in four successive sessions of 25 s each: eyes open (EO), eyes closed (EC), fixed visual scene (VR0), and visual moving scenes (VR1) delivered by the HTC VIVE mask. Postural oscillations were quantified with sensors from an android smartphone (Galaxy S9) fixed to the back. The results obtained were compared to those obtained with the EquiTest. Vestibulo-ocular deficits were also quantified with the caloric test and vHIT. The function of the utricle and saccule were assessed with ocular and cervical vestibular-evoked myogenic potentials (o-VEMPs and c-VEMPs), respectively. We found that falls and abnormal postural oscillations were frequently detected in the VS patients with the VR/Foam device. We detected no correlation between falls or abnormal postural movements and horizontal canal deficit or age. In conclusion, this new method provides a simpler, quicker, and cheaper method for quantifying balance. It will be very helpful for (1) determining balance deficits in VS patients; (2) optimizing the optimal therapy indications (active follow-up, surgery, or gamma therapy) and follow-up of VS patients before and after treatment; (3) developing new rehabilitation methods based on balance training in extreme conditions with disturbed visual and proprioceptive inputs.
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Affiliation(s)
- Grâce Oussou
- Centre Borelli, CNRS UMR-9010, Université Paris Descartes, Paris, France
- Department of ENT, Salpetriere Hospital, Paris, France
| | - Christophe Magnani
- Centre Borelli, CNRS UMR-9010, Université Paris Descartes, Paris, France
| | - Ioannis Bargiotas
- Centre Borelli, CNRS UMR-9010, Université Paris Descartes, Paris, France
| | - Georges Lamas
- Department of ENT, Salpetriere Hospital, Paris, France
| | | | - Catherine Vidal
- Centre Borelli, CNRS UMR-9010, Université Paris Descartes, Paris, France
- Department of ENT, Salpetriere Hospital, Paris, France
- *Correspondence: Catherine Vidal
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Nilsen KS, Lund-Johansen M, Nordahl SHG, Finnkirk M, Goplen FK. Long-term Effects of Conservative Management of Vestibular Schwannoma on Dizziness, Balance, and Caloric Function. Otolaryngol Head Neck Surg 2019; 161:846-851. [DOI: 10.1177/0194599819860831] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
ObjectivesTo study the development of dizziness, caloric function, and postural sway during long-term observation of untreated vestibular schwannoma patients.Study DesignRetrospective review of a prospectively maintained longitudinal cohort.SettingTertiary referral hospital.Subjects and MethodsPatients with vestibular schwannoma undergoing wait-and-scan management were included—specifically, those who did not require treatment during a minimum radiologic follow-up of 1 year. Baseline data and follow-up included magnetic resonance imaging, posturography, bithermal caloric tests, and a dizziness questionnaire. Main outcomes were prevalence of moderate to severe dizziness, canal paresis, and postural instability at baseline and follow-up, as compared with McNemar’s test.ResultsOut of 433 consecutive patients with vestibular schwannoma, 114 did not require treatment during follow-up and were included. Median radiologic follow-up was 10.2 years (interquartile range, 4.5 years). Age ranged from 31 to 78 years (mean, 59 years; SD, 10 years; 62% women). Median tumor volume at baseline was 139 mm3(interquartile range, 314 mm3). This did not change during follow-up ( P = .446). Moderate to severe dizziness was present in 27% at baseline and 19% at follow-up ( P = .077). Postural unsteadiness was present in 17% at baseline and 21% at follow-up ( P = .424). Canal paresis was present in 51% at baseline and 56% at follow-up ( P = .664).ConclusionsThere was no significant change in the prevalence of dizziness, postural sway, or canal paresis during conservative management of vestibular schwannoma, while tumor volume remained unchanged. This indicates a favorable prognosis in these patients with regard to vestibular symptoms.
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Affiliation(s)
- Kathrin Skorpa Nilsen
- Norwegian National Advisory Unit on Vestibular Disorders, Haukeland University Hospital, Bergen, Norway
- Department of Otorhinolaryngology–Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Morten Lund-Johansen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
| | - Stein Helge Glad Nordahl
- Norwegian National Advisory Unit on Vestibular Disorders, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Monica Finnkirk
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
| | - Frederik Kragerud Goplen
- Norwegian National Advisory Unit on Vestibular Disorders, Haukeland University Hospital, Bergen, Norway
- Department of Otorhinolaryngology–Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Canbaz N, Atılgan E, Tarakcı E, Papaker MG. Evaluation of balance after surgery for cerebellopontine angle tumor. J Back Musculoskelet Rehabil 2019; 32:93-99. [PMID: 30248037 DOI: 10.3233/bmr-181198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The origin of about 10% of tumors located in the intracranial region is the cerebellopontine angle. Therefore Cerebellopontine Angle (CPA) tumors affect patients' balance. OBJECTIVE The aim of this study was to compare the balance in individuals who underwent surgery for CPA tumors with healthy individuals. METHODS Thirty patients who were being followed-up by the Department of Neurosurgery and had been operated on CPA tumor and 31 healthy individuals were included in the study as group 1 and group 2, respectively. The participants were evaluated using Romberg Test, Sharpened Romberg Test, One-leg Stance (OLS), Tandem Walking, Walk Across, Berg Balance Scale (BBS), Dizziness Handicap Inventory (DHI) and Short Form 36 (SF-36). RESULTS In comparison of the groups, OLS tests (p< 0.001), BBS (p< 0.05) and DHI (p< 0.05) were significantly different in favor of healthy group. SF-36 results revealed a significant difference between the groups, except for Bodily Pain and Vitality (p< 0.05). CONCLUSIONS The results of this study demonstrated a decrease in balance parameters and quality of life in individuals who underwent CPA tumor surgery in comparison to healthy individuals. Evaluation of balance in the preoperative and postoperative period should not be ignored in these patients and they are suggested to start rehabilitation in the early postoperative period.
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Affiliation(s)
- Nurayet Canbaz
- Department of Physiotherapy and Rehabilitation, Istanbul Medipol University Faculty of Health Sciences, Istanbul, Turkey
| | - Esra Atılgan
- Department of Physiotherapy and Rehabilitation, Istanbul Medipol University Faculty of Health Sciences, Istanbul, Turkey
| | - Ela Tarakcı
- Department of Neurological Physiotherapy and Rehabilitation, Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Meliha Gündağ Papaker
- Department of Neurosurgery of Bezmialem Vakıf University, Faculty of Medicine, Istanbul, Turkey
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Patient-Reported and Performance Outcomes Significantly Improved in Elderly Patients with Vestibular Impairment following Rehabilitation: A Retrospective Study. J Aging Res 2018; 2018:5093501. [PMID: 30225142 PMCID: PMC6129357 DOI: 10.1155/2018/5093501] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 06/19/2018] [Accepted: 07/25/2018] [Indexed: 11/26/2022] Open
Abstract
Objective To describe the results of a vestibular rehabilitation (VR) program in the timed up and go (TUG), gait speed (GS), and dizziness handicap inventory (DHI) scores for elderly vestibular patients in a developing country. Methods Descriptive study with retrospective data collected from the clinical records of vestibular patients. The following information was recorded: sex, age, type of vestibular disorder, DHI score, and performance in TUG and GS, before and after participation in a VR program taking place from January 1 to August 30, 2017. The VR program consisted of 10 twice weekly sessions in the clinic and daily exercises at the patient's home. We used Student's t-test for paired and Wilcoxon's test according to the data distribution. The level of significance was 5%. Results Data from 57 patients (49 females; 78 ± 5.8 years old) were used. There were statistically significant differences in TUG (12.52 versus 11.56), GS (0.81 versus 0.90 m/s), DHI total handicap (46 versus 24), physical (14 versus 8), emotional (14 versus 6), and functional (18 versus 12) domains. Conclusion The functional outcome measures reported, including TUG, gait speed, and DHI, reflect statistically significant improvements in elderly patients after vestibular rehabilitation; the DHI improvements are clinically relevant.
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Emmanouil B, Browne K, Halliday D, Parry A. First report of the efficacy of vestibular rehabilitation in improving function in patients with Neurofibromatosis type 2: an observational cohort study in a clinical setting. Disabil Rehabil 2018; 41:1632-1638. [DOI: 10.1080/09638288.2018.1442505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Beatrice Emmanouil
- Oxford NF2 Unit, Department of Neurosciences, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Katherine Browne
- Oxford NF2 Unit, Department of Neurosciences, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Division of Vestibular Physiotherapy, Neuroscience Rehabilitation Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Dorothy Halliday
- Oxford NF2 Unit, Department of Neurosciences, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford Centre for Genomic Medicine, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Allyson Parry
- Oxford NF2 Unit, Department of Neurosciences, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Saman Y, Mclellan L, Mckenna L, Dutia MB, Obholzer R, Libby G, Gleeson M, Bamiou DE. State Anxiety Subjective Imbalance and Handicap in Vestibular Schwannoma. Front Neurol 2016; 7:101. [PMID: 27468274 PMCID: PMC4942454 DOI: 10.3389/fneur.2016.00101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/15/2016] [Indexed: 11/29/2022] Open
Abstract
Introduction Evidence is emerging for a significant clinical and neuroanatomical relationship between balance and anxiety. Research has suggested a potentially priming effect with anxiety symptoms predicting a worsening of balance function in patients with underlying balance dysfunction. We propose to show that a vestibular stimulus is responsible for an increase in state anxiety, and there is a relationship between increased state anxiety and worsening balance function. Aims (1) To quantify state anxiety following a vestibular stimulus in patients with a chronic vestibular deficit. (2) To determine if state anxiety during a vestibular stimulus would correlate with the severity of chronic balance symptoms and handicap. Methods Two separate cohorts of vestibular schwannoma (VS) patients underwent vestibular tests (electronystagmography, cervical and ocular vestibular evoked myogenic potentials, and caloric responses) and questionnaire assessments [vertigo handicap questionnaire (VHQ), vertigo symptom scale (VSS), and state-trait anxiety inventory (STAIY)]. Fifteen post-resection VS patients, with complete unilateral vestibular deafferentation, were assessed at a minimum of 6 months after surgery in Experiment 1 (Aim 1). Forty-five patients with VS in situ formed the cohort for Experiment 2 (Aim 2). Experiment 1: VS subjects (N = 15) with a complete post-resection unilateral vestibular deafferentation completed a state anxiety questionnaire before caloric assessment and again afterward with the point of maximal vertigo as the reference (Aim 1). Experiment 2: state anxiety measured at the point of maximal vertigo following a caloric assessment was compared between two groups of patients with VS in situ presenting with balance symptoms (Group 1, N = 26) and without balance symptoms (Group 2, N = 11) (Aim 2). The presence of balance symptoms was defined as having a positive score on the VSS–VER. Results In Experiment 1, a significant difference (p < 0.01) was found when comparing STAIY at baseline and at the peak of the subjective vertiginous response in post-resection patients with a unilateral vestibular deafferentation. In Experiment 2, VS in situ patients with balance symptoms had significantly worse state anxiety at the peak vertiginous response than patients without balance symptoms (p < 0.001), as did patients with a balance-related handicap (p < 0.001). Conclusion Anxiety symptoms during a vestibular stimulus may contribute to a priming effect that could explain worsening balance function.
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Affiliation(s)
- Yougan Saman
- Institute of Neurology, National Hospital for Neurology and Neurosurgery, UCL, London, UK; Nelson R. Mandela School of Medicine, UKZN, Durban, South Africa
| | - Lucie Mclellan
- Neuro-otology Department, National Hospital for Neurology and Neurosurgery , London , England
| | | | - Mayank B Dutia
- Centre for Integrative Physiology, University of Edinburgh , Edinburgh , UK
| | - Rupert Obholzer
- ENT and Skull Base Department, Guys Hospital, London, UK; ENT and Skull Base Department, Kings College Hospital, London, UK
| | - Gerald Libby
- Neurogastroenterology Group, Queen Mary University of London , London , UK
| | - Michael Gleeson
- Neuro-otology and Skull Base Department, National Hospital for Neurology and Neurosurgery , London , UK
| | - Doris-Eva Bamiou
- Neuro-otology Department, National Hospital for Neurology and Neurosurgery, London, England; Ear Institute, UCL, London, UK
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Whitney SL, Alghadir AH, Anwer S. Recent Evidence About the Effectiveness of Vestibular Rehabilitation. Curr Treat Options Neurol 2016; 18:13. [DOI: 10.1007/s11940-016-0395-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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