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Gurgel MHC, Ponte CMM, Fontes R, Rocha ÍV, Batista LAA, Sousa TCS, Montenegro Junior RM. Establishment of reference interval for thyroid-stimulating hormone using electrochemiluminescence assay in a healthy adult population from Fortaleza, Brazil. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2020; 64:362-368. [PMID: 32725064 PMCID: PMC10522077 DOI: 10.20945/2359-3997000000264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 01/21/2020] [Indexed: 06/11/2023]
Abstract
Objective This study aimed to determine the thyroid-stimulating hormone (TSH) reference interval (RI) and to assess the influence of the use of thyroid ultrasonography (TUS) on reference individual selection from a healthy adult population in Fortaleza, Brazil. Subjects and methods This cross-sectional study recruited patients (N = 272; age = 18-50 years) with normal thyroid function (NTF) and placed them in three groups according to their test results: NTF (n = 272; all participants), TUS (n = 170; participants who underwent thyroid US), RI (n = 124; reference individuals with normal TSH levels). TSH, FT4, TT3, TgAb, and TPOAb concentrations were determined by electrochemiluminescence assay. TUS was performed using a 7-12 MHz multifrequency linear transducer by two radiologists. The 2.5th and 97.5th percentiles of the distribution curve corresponded to lower and upper TSH RI levels, respectively. Results The mean TSH level was 1.74 ± 0.96 mIU/L, and TSH range was 0.56-4.45 mIU/L. There was no difference in the TSH concentrations between men and women nor between the groups. TUS did not appear to be an essential tool for the reference group selection. Conclusion The upper limit of TSH was comparable to the reference interval provided by the assay manufacturer (4.45 vs. 4.20 mIU/L) but the lower limit was not (0.56 vs. 0.27 mIU/L). This finding may have a clinical impact since these values may lead to the misdiagnosis of euthyroid patients with subclinical hyperthyroidism.
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Affiliation(s)
- Maria Helane C Gurgel
- Programa de Pós-graduação em Ciências Médicas, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - Clarisse M M Ponte
- Programa de Pós-graduação em Ciências Médicas, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | | | | | - Lívia A A Batista
- Programa de Pós-graduação em Ciências Médicas, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - Tamara C S Sousa
- Faculdade de Medicina, Centro Universitário Christus, Fortaleza, CE, Brasil
| | - Renan M Montenegro Junior
- Programa de Pós-graduação em Ciências Médicas, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil
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Mirjanic-Azaric B, Avram S, Stojakovic-Jelisavac T, Stojanovic D, Petkovic M, Bogavac-Stanojevic N, Ignjatovic S, Stojanov M. Direct Estimation of Reference Intervals for Thyroid Parameters in the Republic of Srpska. J Med Biochem 2017; 36:137-144. [PMID: 28680357 PMCID: PMC5471646 DOI: 10.1515/jomb-2017-0008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 02/03/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the reference values for thyrotropin (TSH), thyroid hormones (total and free thyroxine, T4 and fT4; total and free triiodothyronine, T3 and fT3), thyroglobulin (Tg) and thyroid antibodies (thyroid peroxidase, TPOAb and thyroglobulin antibody, TgAb) in the population of the Republic of Srpska. METHODS A total of 250 euthyroid subjects were enrolled in this study. A direct method for choosing reference subjects was used to establish reference intervals. The hormones and thyroid antibodies were measured by an electrochemiluminescence immunoassay method (ECLIA, Roche Diagnostics, Mannheim, Germany). We calculated the reference intervals by MedCalc, version 12.1.4.0 (MedCalc software, Belgium) as recommended by the IFCC (CLSI C28-A3). RESULTS Using guidelines recommended by the National Academy of Clinical Biochemistry (NACB) and based on standard statistical approaches, the reference intervals derived for TSH, fT4, T4, fT3, T3 were 0.75-5.32 mIU/L, 12.29-20.03 pmol/L, 73.49-126,30 nmol/L, 4.11-6.32 pmol/L, 1.15-2.32 nmol/L and for Tg, TPOAb, TgAb were 3.63-26.00 μg/L, <18.02 mIU/L, < 98.00 mIU/L, respectively. We found a significant difference (p<0.05) in TSH and fT3 values between different age groups as well as in T4, fT4 and fT3 values between ge nder groups. CONCLUSIONS The established reference values for the population of the Republic of Srpska were significantly different from the values recommended by the manufacturer of reagents (Roche Diagnostics). Our results showed that a laboratory needs to establish its own reference values in order to set up a proper diagnosis, as well as to treat patients successfully.
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Affiliation(s)
- Bosa Mirjanic-Azaric
- University Clinical Centre of the Republic of SrpskaBanja Luka, Bosnia and Herzegovina, Serbia
| | - Sanja Avram
- University Clinical Centre of the Republic of SrpskaBanja Luka, Bosnia and Herzegovina, Serbia
| | | | - Darja Stojanovic
- Health Centre Laktasi, the Republic of Srpska, Bosnia and HerzegovinaSerbia
| | - Mira Petkovic
- Institute for Sport and Occupational Medicine Banja Luka, Bosnia and HerzegovinaSerbia
| | | | - Svetlana Ignjatovic
- Institute of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Serbia
- Center for Medical Biochemistry, Clinical Center of Serbia, Belgrade, Serbia
| | - Marina Stojanov
- Institute of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Serbia
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Rosario PW, Carvalho M, Calsolari MR. TSH reference values in the first trimester of gestation and correlation between maternal TSH and obstetric and neonatal outcomes: a prospective Brazilian study. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2016; 60:314-8. [PMID: 26886091 PMCID: PMC10118726 DOI: 10.1590/2359-3997000000132] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/29/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To define the normal range of TSH in the first trimester of gestation and to evaluate the correlation between maternal TSH and obstetric and neonatal outcomes. SUBJECTS AND METHODS Prospective study. Women without known or clinically suspected thyroid disease and without risk factors for thyroid dysfunction, who became pregnant spontaneously and were initially evaluated up to week 12 of gestation, were included. Women with positive anti-thyroperoxidase antibodies, twin pregnancy, hyperemesis gravidarum, and trophoblastic disease were excluded. RESULTS In the 660 pregnant women, the mean, median, and 2.5th and 97.5th percentiles of TSH were 0.9, 0.96, 0.04 and 2.68 mIU/L, respectively. TSH was undetectable in 2%, < 0.5 mIU/L in 17.4%, > 2 mIU/L in 9.7%, > 2.5 mIU/L in 4.7%, and > 3 mIU/L in 1%. None of the women received levothyroxine or antithyroid drugs during pregnancy. In addition, there was no difference in obstetric or neonatal outcomes when women with TSH ≤ 0.1, between 0.1 and 2.5, and between 2.5 and 4 mIU/L were compared. CONCLUSION In the population studied, the TSH value corresponding to the 97.5th percentile was 2.68 mIU/L in the first trimester of gestation.
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Rosario PW, Calsolari MR. TSH reference range in older adults: a Brazilian study. ACTA ACUST UNITED AC 2014; 58:389-93. [DOI: 10.1590/0004-2730000003065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 11/15/2013] [Indexed: 11/21/2022]
Abstract
Objective: To establish serum TSH reference values for a population of Brazilian elderly, and to compare them to those found in the adult population. Subjects and methods: Healthy volunteers aged 70 to 85 years, without known thyroid disease or risk factors for thyroid dysfunction, who did not use any medication that could potentially interfere with TSH, were selected. Subjects with goiter, palpable thyroid nodules, anti-thyroperoxidase antibodies, or altered free T4 were excluded. The sample consisted of 360 older adults (180 per sex). Results: TSH values corresponding to the 2.5th and 97.5th percentile of the sample were 0.2 and 4.62 mIU/L, respectively. TSH > 2.5 mIU/L was seen in 25.26% of the volunteers, > 3 mIU/L in 15.26%, and > 4 mIU/L in 6.1% of them. TSH values were slightly higher than those previously reported for adults (18-60 years). Conclusion: This study suggests an upper limit for normal TSH of approximately 4.6 mIU/L for the Brazilian elderly population.
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Rosario PW, Xavier ACM, Calsolari MR. TSH reference values for adult Brazilian population. ACTA ACUST UNITED AC 2010; 54:603-6. [DOI: 10.1590/s0004-27302010000700003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 08/21/2010] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: To establish limits of normal serum TSH for the adult (18 to 60 years) Brazilian population according to recommendations of the National Academy of Clinical Biochemistry. SUBJECTS AND METHODS: Healthy volunteers were evaluated and those fulfilling the following clinical criteria were selected: absence of known thyroid disease; no use of any interfering medications; no history of head and neck external radiotherapy, type 1 diabetes or autoimmune disease; no family history of thyroid disease, and absence of goiter or palpable nodules. Subjects with anti-thyroperoxidase antibodies and/or altered free T4 were excluded. The sample consisted of 960 subjects (480 males and 480 females). RESULTS: TSH values corresponding to the 2.5th and 97.5th percentiles of the sample were 0.43 and 3.24 mIU/L, respectively. TSH values > 2.5 mIU/L were observed in 9.15% of the volunteers and levels > 3 mIU/L in 3.11%. CONCLUSION: The present study suggests an upper limit of normal TSH of approximately 3.5 mIU/L.
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Walter MA, Schindler C, Christ-Crain M, Müller-Brand J, Müller B. Different strategies to overcome the effect of carbimazole on high- and low-dose radioiodine therapy: results from continuous dose-effect models. Eur J Clin Invest 2009; 39:51-7. [PMID: 19087129 DOI: 10.1111/j.1365-2362.2008.02061.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Until now, it remains elusive which strategy - antithyroid drug withdrawal or increased radioiodine target doses - should be preferred to avoid the detrimental effect of antithyroid drugs in high- and low-dose radioiodine therapy, respectively. METHODS We explored the effects of carbimazole on the 1-year post-radioiodine success and hypothyroidism rates by continuous dose-effect models, whereas success was defined as elimination of hyperthyroidism. Euthyroidism rates with and without carbimazole were calculated by numerical integration of the area between success and hypothyroidism curves. Target dose amplification factors for equal chance of success with and without carbimazole were calculated using logistic regression. RESULTS Two hundred and twenty-eight patients were included in this study. Radioiodine target doses between 33 and 839 Gy were applied. Overall, the euthyroidism rates were 16.5% and 64.8%, while the hypothyroidism rates were 37.6% and 14.8% in Graves' disease and toxic nodular goitre, respectively. The success rate with simultaneous carbimazole (median dose 15 mg day(-1); range 2.5-60 mg day(-1)) was reduced over the entire target dose range in Graves' disease and toxic nodular goitre. The areas between curves for euthyroidism without and with simultaneous carbimazole were 127 and 43 Gy in Graves' disease and 178 and 128 Gy in toxic nodular goitre. The estimated radioiodine target dose amplification factor was 5.5 for Graves' disease and 3.0 for toxic nodular goitre. CONCLUSIONS Simultaneous carbimazole reduces the euthyroidism rate, the aim of low-dose radioiodine therapy, over the entire target dose range in both Graves' disease and toxic nodular goitre. Therefore, antithyroid drug discontinuation should be preferred in low-dose radioiodine therapy. Conversely, escalation of the target dose should be preferred in high-dose radioiodine therapy.
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Affiliation(s)
- M A Walter
- Institute of Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
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Kapelari K, Kirchlechner C, Högler W, Schweitzer K, Virgolini I, Moncayo R. Pediatric reference intervals for thyroid hormone levels from birth to adulthood: a retrospective study. BMC Endocr Disord 2008; 8:15. [PMID: 19036169 PMCID: PMC2645400 DOI: 10.1186/1472-6823-8-15] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2007] [Accepted: 11/27/2008] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Age- and sex-specific reference intervals are an important prerequisite for interpreting thyroid hormone measurements in children. However, only few studies have reported age- and sex-specific pediatric reference values for TSHbasal (TSH), free T3 (fT3), and free T4 (fT4) so far. Reference intervals are known to be method- and population-dependent. The aim of our study was to establish reference intervals for serum TSH, fT3, and fT4 from birth to 18 years and to assess sex differences. METHODS 2,194 thyroid hormone tests obtained from a hospital-based pediatric population were included into our retrospective analysis. Individuals with diagnoses or medications likely to affect thyroid function were primarily excluded, as well as the diagnostic groups, if different from the purely healthy subgroup (n = 414). Age groups were ranging from 1 day to 1 month, 1 - 12 months, and 1 - 5, 6 - 10, 11 - 14, and 15 - 18 years, respectively. Levels of fT3, fT4 and TSH were measured on Advia(R) Centaur automated immunoassay system. RESULTS The final sample size for reference data creation was 1,209 for TSH, 1,395 for fT3, and 1,229 for fT4. Median and 2.5/10/25/75/90/97.5 percentiles were calculated for each age group. Males had greater mean fT3 concentrations than females (p < 0.001). No sex-differences were found for TSH and fT4 between age-matched serum samples. Median concentrations of fT3, fT4 and TSH were greatest during the first month of life, followed by a continuous decline with age. CONCLUSION Our results corroborate those of previous studies showing that thyroid hormone levels change markedly during childhood, and that adult reference intervals are not universally applicable to children. Moreover, differences of our reference intervals compared to previous studies were observed, likely caused by different antibody characteristics of various analytical methods, different populations or undefined geographic covariates, e.g. iodine and selenium status.
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Affiliation(s)
- Klaus Kapelari
- Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria
| | - Christine Kirchlechner
- Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria
| | - Wolfgang Högler
- Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria
| | - Katharina Schweitzer
- Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria
| | - Irene Virgolini
- Department of Nuclear Medicine, Medical University of Innsbruck, Austria
| | - Roy Moncayo
- Department of Nuclear Medicine, Medical University of Innsbruck, Austria
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Bieglmayer C, Buchinger W, Födinger M, Müller MM, Sinha P, Vogl M, Weissel M, Zechmann W. Labordiagnostischer Leitfaden zur Abklärung von Funktionsstörungen und Erkrankungen der Schilddrüse. Wien Klin Wochenschr 2008; 120:370-82. [DOI: 10.1007/s00508-008-0984-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Moncayo H, Dapunt O, Moncayo R. Diagnostic accuracy of basal TSH determinations based on the intravenous TRH stimulation test: an evaluation of 2570 tests and comparison with the literature. BMC Endocr Disord 2007; 7:5. [PMID: 17678551 PMCID: PMC1950865 DOI: 10.1186/1472-6823-7-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2006] [Accepted: 08/02/2007] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Basal TSH levels reflect the metabolic status of thyroid function, however the definition and interpretation of the basal levels of TSH is a matter of controversial debate. The aim of this study was to evaluate basal TSH levels in relation to the physiological response to i.v. TRH stimulation. METHODS A series of 2570 women attending a specialized endocrine unit were evaluated. A standardized i.v. TRH stimulation test was carried out by applying 200 mug of TRH. TSH levels were measured both in the basal and the 30 minute blood sample. The normal response to TRH stimulation had been previously determined to be an absolute value lying between 2.5 and 20 mIU/l. Both TSH values were analyzed by cross tabulation. In addition the results were compared to reference values taken from the literature. RESULTS Basal TSH values were within the normal range (0.3 to 3.5 mIU/l) in 91,5% of cases, diminished in 3,8% and elevated in 4.7%. Based on the response to TRH, 82.4% were considered euthyroid, 3.3% were latent hyperthyroid, and 14.3% were latent hypothyroid. Combining the data on basal and stimulated TSH levels, latent hypothyroidism was found in the following proportions for different TSH levels: 5.4% for TSH < 2.0 mIU/l, 30.2% for TSH between 2.0 and 3.0 mIU/l, 65,5% for TSH between 3.0 and 3.50 mIU/l, 87.5% for TSH between 3.5 and 4.0 mIU/l, and 88.2% for TSH between 4 and 5 mIU/l. The use of an upper normal range for TSH of 2.5 mIU/l, as recommended in the literature, misclassified 7.7% of euthyroid cases. CONCLUSION Our analysis strategy allows us to delineate the predictive value of basal TSH levels in relation to latent hypothyroidism. A grey area can be identified for values between 3.0 and 3.5 mIU/l.
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Affiliation(s)
- Helga Moncayo
- Department of Obstetrics and Gynecology, University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
- WOMED, Karl-Kapferer-Strasse 5, 6020 Innsbruck, Austria
| | - Otto Dapunt
- Department of Obstetrics and Gynecology, University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
- WOMED, Karl-Kapferer-Strasse 5, 6020 Innsbruck, Austria
| | - Roy Moncayo
- Department of Obstetrics and Gynecology, University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
- Department of Nuclear Medicine, Medical University Innsbruck, Austria
- WOMED, Karl-Kapferer-Strasse 5, 6020 Innsbruck, Austria
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Reddy A, Dash C, Leerapun A, Mettler TA, Stadheim LM, Lazaridis KN, Roberts RO, Roberts LR. Hypothyroidism: a possible risk factor for liver cancer in patients with no known underlying cause of liver disease. Clin Gastroenterol Hepatol 2007; 5:118-23. [PMID: 17008133 DOI: 10.1016/j.cgh.2006.07.011] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND & AIMS Up to 25% of hepatocellular carcinomas (HCCs) seen in U.S. centers are of unknown etiology. Animal studies suggest that hypothyroidism can directly cause liver cell damage and might be a risk factor for HCC. We conducted a case-control study to evaluate the relationship between hypothyroidism and HCC. METHODS Cases (n = 54) were HCC patients seen at Mayo Clinic Rochester in whom no underlying etiology for chronic liver disease could be determined. Two groups of controls were selected, HCC patients with HCV (n = 57) and HCC patients with alcoholic liver disease (n = 49). Hypothyroidism was defined as thyroid-stimulating hormone level >5.0, history of hypothyroidism before HCC diagnosis, or a history of being on thyroid replacement at the time of HCC diagnosis. We used multivariate logistic regression to model the relationship between hypothyroidism and HCC etiology. RESULTS Of the 160 patients, 18 (11%) had a history of hypothyroidism. Twelve (22%) of those with no known etiology for HCC, 2 (4%) of those with HCV, and 4 (8%) of those with alcoholic liver disease had hypothyroidism. Patients with HCC of unknown etiology were significantly more likely to have a history of hypothyroidism as compared with HCC patients with HCV (adjusted odds ratio, 12.7; 95% confidence interval, 1.4-117.1) and as compared with all controls (adjusted odds ratio, 6.8; 95% confidence interval, 1.1-42.1). CONCLUSIONS Hypothyroidism is more prevalent in HCC patients with an unknown etiology. It should be further investigated as a potential risk factor in liver carcinogenesis.
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Affiliation(s)
- Arvind Reddy
- Miles and Shirley Fiterman Center for Digestive Diseases, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA
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Zöphel K, Wunderlich G, Kotzerke J. Should We Really Determine a Reference Population for the Definition of Thyroid-Stimulating Hormone Reference Interval? Clin Chem 2006; 52:329-30. [PMID: 16449219 DOI: 10.1373/clinchem.2005.060111] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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