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Uchishiba M, Yamamoto S, Takeda A, Arakaki R, Arata M, Noguchi H, Aoki H, Tamura K, Maeda T, Minato S, Nii M, Inui H, Kamada S, Kinouchi R, Yamamoto Y, Yoshida K, Yagi S, Kato T, Kaji T, Nishimura M, Ino K, Iwasa T. Progesterone treatment reduces food intake and body weight in ovariectomized female rats. Steroids 2024; 203:109367. [PMID: 38266463 DOI: 10.1016/j.steroids.2024.109367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 12/20/2023] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
While the effects of progesterone on body weight and appetite in pre-menopausal conditions have been well elucidated, its effects in post-menopausal conditions have not been clarified. On the contrary, the effects of estrogen on body weight and appetite in post-menopausal conditions have been well established. In this study, the effects of progesterone treatment on body weight, appetite, and fat mass in ovariectomized rats were evaluated. In addition, the central and/or peripheral levels of oxytocin (OT), leptin, and their receptors, which are potent anorectic factors, were examined. Female rats were ovariectomized and divided into control, progesterone-treated, and estrogen-treated groups. Body weight, food intake, and subcutaneous fat mass were lower in both the progesterone and estrogen groups than in the control group. The estrogen group exhibited higher serum OT levels than the control group, whereas the OT levels of the progesterone and control groups did not differ. The serum leptin levels of both the progesterone and estrogen groups were lower than those of the control group. Gene expression analysis of OT, leptin, and their receptors in the hypothalamus and adipose tissue found few significant differences among the groups. Hypothalamic neuropeptide Y (NPY) and pro-opiomelanocortin (POMC) mRNA levels involved in appetite regulation were slightly altered in the progesterone and estrogen groups. These findings suggest that progesterone treatment may have favorable effects on body weight, appetite, and fat mass regulation in post-menopausal conditions and that the mechanisms underlying these effects of progesterone differ from those underlying the effects of estrogen.
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Affiliation(s)
- Maimi Uchishiba
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Graduate School, Tokushima University, Tokushima 770-8501, Japan; Department of Obstetrics and Gynecology, School of Medicine, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Shota Yamamoto
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Graduate School, Tokushima University, Tokushima 770-8501, Japan; Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo 060-0808, Japan
| | - Asuka Takeda
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Graduate School, Tokushima University, Tokushima 770-8501, Japan
| | - Ryosuke Arakaki
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Graduate School, Tokushima University, Tokushima 770-8501, Japan
| | - Moeka Arata
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Graduate School, Tokushima University, Tokushima 770-8501, Japan
| | - Hiroki Noguchi
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Graduate School, Tokushima University, Tokushima 770-8501, Japan
| | - Hidenori Aoki
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Graduate School, Tokushima University, Tokushima 770-8501, Japan
| | - Kou Tamura
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Graduate School, Tokushima University, Tokushima 770-8501, Japan
| | - Takaaki Maeda
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Graduate School, Tokushima University, Tokushima 770-8501, Japan
| | - Saki Minato
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Graduate School, Tokushima University, Tokushima 770-8501, Japan
| | - Mari Nii
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Graduate School, Tokushima University, Tokushima 770-8501, Japan
| | - Hiroaki Inui
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Graduate School, Tokushima University, Tokushima 770-8501, Japan
| | - Shuhei Kamada
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Graduate School, Tokushima University, Tokushima 770-8501, Japan
| | - Riyo Kinouchi
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Graduate School, Tokushima University, Tokushima 770-8501, Japan
| | - Yuri Yamamoto
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Graduate School, Tokushima University, Tokushima 770-8501, Japan
| | - Kanako Yoshida
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Graduate School, Tokushima University, Tokushima 770-8501, Japan
| | - Shigetaka Yagi
- Department of Obstetrics and Gynecology, School of Medicine, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Takeshi Kato
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Graduate School, Tokushima University, Tokushima 770-8501, Japan
| | - Takashi Kaji
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Graduate School, Tokushima University, Tokushima 770-8501, Japan
| | - Masato Nishimura
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Graduate School, Tokushima University, Tokushima 770-8501, Japan
| | - Kazuhiko Ino
- Department of Obstetrics and Gynecology, School of Medicine, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Takeshi Iwasa
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Graduate School, Tokushima University, Tokushima 770-8501, Japan.
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Morris G, Talaulikar V. Hormone replacement therapy in women with history of thrombosis or a thrombophilia. Post Reprod Health 2023; 29:33-41. [PMID: 36573625 DOI: 10.1177/20533691221148036] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Findings from the Women's Health Initiative (WHI) randomised placebo-controlled trial (RCT) were published at the beginning of this century. They suggested that hormone replacement therapy (HRT) use increased the risk of cardiovascular disease and venous thromboembolism including pulmonary embolism and deep vein thrombosis The findings led to a decline in HRT prescriptions and negative publicity about the use of HRT for women with significant menopausal symptoms. Subsequent studies have shown that the risk of thrombosis with HRT relates to whether estrogen is combined with a progestogen and the route of administration of estrogen. In healthy women with no background medical problems, transdermal hormone replacement is not associated with an increased risk of thrombosis. However, much less is known about the safety of various HRT preparations in women with a high background risk of thrombosis. These cases can often be challenging for clinicians with uncertainties around testing for thrombophilia, use of anticoagulation and striking a balance between the risks and benefits of prescribing HRT. This article will review the mechanism of thrombosis with differing types of HRT and present the evidence from the relevant trials. The article will also present the evidence that specifically relates to women with a personal history of thrombosis or thrombophilia (heritable and acquired) to enable clinicians to better individualise the risk assessment for each woman requesting HRT and understand the role of thrombophilia screening or concomitant anticoagulation in such situations.
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Affiliation(s)
- Guy Morris
- Subspecialty Trainee in Reproductive Medicine and Surgery, St Michael's Hospital, 1984University Hospitals Bristol, and Weston NHS Foundation Trust, Bristol, UK
| | - Vikram Talaulikar
- Reproductive Medicine Unit, EGA Wing, 8964University College London Hospital, London, UK
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Toor S, Yardley JE, Momeni Z. Type 1 Diabetes and the Menstrual Cycle: Where/How Does Exercise Fit in? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2772. [PMID: 36833469 PMCID: PMC9957258 DOI: 10.3390/ijerph20042772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
Regular exercise is associated with substantial health benefits for individuals with type 1 diabetes (T1D). However, the fear of hypoglycemia (low blood glucose) due to activity-induced declines in blood glucose levels acts as a major barrier to partaking in exercise in this population. For females with T1D, hormonal fluctuations during the menstrual cycle and their effects on blood glucose levels can act as an additional barrier. The impact that these cyclic changes may have on blood glucose and insulin needs and the consequent risk of hypoglycemia during or after exercise are still unknown in this population. Therefore, in this narrative review, we gathered existing knowledge about the menstrual cycle in T1D and the effects of different cyclic phases on substrate metabolism and glucose response to exercise in females with T1D to increase knowledge and understanding around exercise in this underrepresented population. This increased knowledge in such an understudied area can help to better inform exercise guidelines for females with T1D. It can also play an important role in eliminating a significant barrier to exercise in this population, which has the potential to increase activity, improve mental health and quality of life, and decrease the risk of diabetes-related complications.
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Affiliation(s)
- Saru Toor
- Physical Activity and Diabetes Laboratory, Alberta Diabetes Institute, Edmonton, AB T6G 2E1, Canada
- Immunology and Infection Program, Department of Biological Sciences, University of Alberta, Edmonton, AB T6G 2E9, Canada
| | - Jane E. Yardley
- Physical Activity and Diabetes Laboratory, Alberta Diabetes Institute, Edmonton, AB T6G 2E1, Canada
- Augustana Faculty, University of Alberta, Camrose, AB T4V 2R3, Canada
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB T6G 2H9, Canada
- Women’s and Children’s Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Zeinab Momeni
- Physical Activity and Diabetes Laboratory, Alberta Diabetes Institute, Edmonton, AB T6G 2E1, Canada
- Augustana Faculty, University of Alberta, Camrose, AB T4V 2R3, Canada
- Women’s and Children’s Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada
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Kaemmle LM, Stadler A, Janka H, von Wolff M, Stute P. The impact of micronized progesterone on cardiovascular events - a systematic review. Climacteric 2022; 25:327-336. [PMID: 35112635 DOI: 10.1080/13697137.2021.2022644] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Biologically identical menopausal hormone therapy (MHT) including micronized progesterone (MP) has gained much attention. We aimed to assess the impact of MP in combined MHT on venous and arterial thromboembolism (VTE/ATE) (e.g. deep venous thrombosis/pulmonary embolism, myocardial infarction [MI] and ischemic stroke). Articles were eligible if they provided endpoints regarding cardiovascular events and use of exogenous MP. Literature searches were designed and executed for the databases Medline, Embase, CINAHL, the Cochrane Library, ClinicalTrials.gov and interdisciplinary database Web of Science. Twelve studies consisting of randomized controlled trials (RCTs), case-control studies and prospective or retrospective cohort studies were included, and risk of bias was assessed. Only a minority assessed thromboembolic events as a primary endpoint, showing that in contrast to norpregnane derivatives, primary and recurrent VTE risk was not altered by combining estrogens with MP, which was also true for ischemic stroke risk. Similarly, in placebo-controlled RCTs assessing VTE/ATE as adverse events there were no significant intergroup differences. Studies on MI as a primary endpoint are missing. In conclusion, while available data suggest that MP as a component in combined MHT may have a neutral effect on the vascular system, more RCTs investigating the impact of MP alone or in combined MHT on vascular primary endpoints are needed.
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Affiliation(s)
- L M Kaemmle
- Medical Faculty of the University of Bern, Bern, Switzerland
| | - A Stadler
- Medical Faculty of the University of Bern, Bern, Switzerland
| | - H Janka
- Medical Library, University Library Bern, University of Bern, Bern, Switzerland
| | - M von Wolff
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | - P Stute
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
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Oguz SH, Yildiz BO. An Update on Contraception in Polycystic Ovary Syndrome. Endocrinol Metab (Seoul) 2021; 36:296-311. [PMID: 33853290 PMCID: PMC8090477 DOI: 10.3803/enm.2021.958] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/15/2021] [Indexed: 12/15/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is a common endocrine disorder in reproductive-aged women, characterized by hyperandrogenism, oligo/anovulation, and polycystic ovarian morphology. Combined oral contraceptives (COCs), along with lifestyle modifications, represent the first-line medical treatment for the long-term management of PCOS. Containing low doses of estrogen and different types of progestin, COCs restore menstrual cyclicity, improve hyperandrogenism, and provide additional benefits such as reducing the risk of endometrial cancer. However, potential cardiometabolic risk associated with these agents has been a concern. COCs increase the risk of venous thromboembolism (VTE), related both to the dose of estrogen and the type of progestin involved. Arterial thrombotic events related to COC use occur much less frequently, and usually not a concern for young patients. All patients diagnosed with PCOS should be carefully evaluated for cardiometabolic risk factors at baseline, before initiating a COC. Age, smoking, obesity, glucose intolerance or diabetes, hypertension, dyslipidemia, thrombophilia, and family history of VTE should be recorded. Patients should be re-assessed at consecutive visits, more closely if any baseline cardiometabolic risk factor is present. Individual risk assessment is the key in order to avoid unfavorable outcomes related to COC use in women with PCOS.
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Affiliation(s)
- Seda Hanife Oguz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Bulent Okan Yildiz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
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Stevenson JC, Rozenberg S, Maffei S, Egarter C, Stute P, Römer T. Progestogens as a component of menopausal hormone therapy: the right molecule makes the difference. Drugs Context 2020; 9:dic-2020-10-1. [PMID: 33312219 PMCID: PMC7716720 DOI: 10.7573/dic.2020-10-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/13/2020] [Accepted: 11/14/2020] [Indexed: 12/25/2022] Open
Abstract
Optimizing menopausal hormone therapy (MHT) requires an awareness of the benefits and risks associated with the available treatments. This narrative review, which is based on the proceedings of an Advisory Board meeting and supplemented by relevant articles identified in literature searches, examines the role of progestogens in MHT, with the aim of providing practical recommendations for prescribing physicians. Progestogens are an essential component of MHT in menopausal women with a uterus to prevent endometrial hyperplasia and reduce the risk of cancer associated with using unopposed estrogen. Progestogens include natural progesterone, dydrogesterone (a stereoisomer of progesterone), and a range of synthetic compounds. Structural differences and varying affinities for other steroid receptors (androgen, glucocorticoid, and mineralocorticoid) confer a unique biological and clinical profile to each progestogen that must be considered during treatment selection. MHT, including the progestogen component, should be tailored to each woman, starting with an estrogen and a progestogen that has the safest profile with respect to breast cancer and cardiovascular effects, while addressing patient-specific needs, risk factors, and treatment goals. Micronized progesterone and dydrogesterone appear to be the safest options, with lower associated cardiovascular, thromboembolic, and breast cancer risks compared with other progestogens, and are the first-choice options for use in ‘special situations,’ such as in women with high-density breast tissue, diabetes, obesity, smoking, and risk factors for venous thromboembolism, among others.
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Affiliation(s)
- John C Stevenson
- National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK
| | - Serge Rozenberg
- Department of Obstetrics and Gynecology, CHU St Pierre, Laboratoire de santé génésique Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Silvia Maffei
- Cardiovascular Gynecological Endocrinology Unit, Cardiovascular Endocrinology and Metabolism Department, Italian National Research Council - Regione Toscana 'G. Monasterio Foundation', Pisa, Italy
| | - Christian Egarter
- Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
| | - Petra Stute
- Department of Obstetrics and Gynecology, University Women's Hospital, Bern, Switzerland
| | - Thomas Römer
- Department of Obstetrics and Gynecology, Evangelisches Klinikum Weyertal gGmbH, Academic Hospital, University of Cologne, Germany
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Effects of combined 17β-estradiol and progesterone on weight and blood pressure in postmenopausal women of the REPLENISH trial. ACTA ACUST UNITED AC 2020; 28:32-39. [PMID: 32932401 PMCID: PMC7769186 DOI: 10.1097/gme.0000000000001659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective: To examine the impact of a single-capsule 17β-estradiol (E2)/progesterone (P4) on weight and blood pressure (BP) when treating moderate to severe vasomotor symptoms in postmenopausal women with a uterus. Methods: Healthy postmenopausal women with a uterus (aged 40-65, body mass index ≤34 kg/m2, BP ≤140/90 mm Hg) were randomized to daily E2/P4 (mg/mg; 1/100, 0.5/100, 0.5/50, 0.25/50) or placebo in the phase 3 REPLENISH trial (NCT01942668). Changes in weight and BP from baseline to month 12 were evaluated. Potentially clinically important changes were defined as increases or decreases from baseline in weight by ≥15% and ≥11.3 kg, systolic BP by ≥20 mm Hg (absolute value ≥160 or ≤90 mm Hg), and diastolic BP by ≥15 mm Hg (absolute value ≥90 or ≤60 mm Hg). Results: Overall mean changes in weight and BP from baseline to month 12 with E2/P4 were modest and generally not statistically or clinically significant versus placebo. Incidence of potentially clinically important changes was low for weight (E2/P4 vs placebo: 1.1-2.6% vs 2.2%), systolic BP (0.3-1.1% vs 1.1%), and diastolic BP (1.4-4.2% vs 3.2%). A small number of women had treatment-related, treatment-emergent adverse events of weight gain (1.4-2.6% vs 1.3%) or hypertension (0.2-1.2% vs 0%). Few women who discontinued E2/P4 had weight gain (1.6%) or hypertension (0.6%) as a primary reason. Efficacy profile on VMS was consistent with previous findings and not modified by body mass index. Conclusions: Twelve-month use of E2/P4 had no clinically meaningful impact on weight or BP in postmenopausal women of the REPLENISH study.
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Konopelnuk VI, Kompanets IV, Svyatetska VM, Molozhavaya OS, Ostapchenko LI. Functional polarization of macrophages of rats with progesterone-induced obesity treated with melanin from the Antarctic yeast Nadsoniella nigra. REGULATORY MECHANISMS IN BIOSYSTEMS 2019. [DOI: 10.15421/021979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Progesterone-induced obesity develops in women who use this drug for contraception and the menopause treatment, though its mechanisms remain poorly understood. We studied functional M1 and M2 polarizations of the abdominal cavity macrophages of rats with progesterone induced obesity during 28 days of administration. The effect of melanin from the Antarctic yeast Nadsoniella nigra (Chaetothyriales, Herpotrichiellaceae, Nadsoniella Issatsch, 1914) was investigated. The NO level was determined by the accumulation of nitrites, ROS level was estimated by the NBT-test, arginase activity was assayed by the reaction of L-arginine hydrolysis. The body weights of rats administrated progesterone increased by 27% and continued to increase one month after withdrawal of progesterone (55% higher than control). Melanin prevents the weight gain when administered during one month after progesterone withdrawal. The NO production by peritoneal macrophages of obese animals intensified by 31% indicating their polarization towards pro-inflammatory M1 type. Production of ROS did not change. A 14% increase in arginase activity was observed, indicating the inhibition of M2 (anti-inflammatory) polarization. In the progesterone withdrawal group all these rates significantly decreased, indicating a reduction in the functional activity of peritoneal macrophages’. Melanin decreased the NO and ROS production by 60% and 18% respectively in comparison with the progesterone group and unexpectedly reduced arginase activity. Our data provide evidence of the spread of inflammation in response to progesterone-induced obesity. Peritoneal macrophages are involved in the inflammation in obesity, undergoing polarization towards the pro-inflammatory phenotype. The long-term consequences of such inflammation include the continuation of weight gain and likely the development of systemic inflammation associated with the exhaustion of the functional capacity of peritoneal cavity macrophages. Melanin has an anti-obesity effect and exhibits anti-inflammatory properties preventing progesterone-induced weight gain and macrophage M1 polarization. This requires detailed elucidation and can be valuable in designing countermeasures to prevent obesity outcomes.
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Neues und praktisch Relevantes der gynäkologischen Endokrinologie, Reproduktionsmedizin und Pränatalmedizin – Teil 2. GYNAKOLOGISCHE ENDOKRINOLOGIE 2019. [DOI: 10.1007/s10304-019-0253-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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