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Arkoubi AY. Effect of Compression Garments on Post-Abdominoplasty Outcomes: A systematic Review of the current Evidence. JPRAS Open 2024; 41:128-137. [PMID: 39021663 PMCID: PMC11253148 DOI: 10.1016/j.jpra.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 05/25/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction It is commonly believed that using abdominal binders or compression garments (CGs) after an abdominoplasty could encourage fluid to drain, which would prevent fluid from building up at the surgical site and reduce the risk of seroma and other similar problems. Objective To evaluate the effect of the use of abdominal binders or CG on the post-operative outcomes following abdominoplasty. Design Systematic review. Method Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to select relevant studies from 2004 to 2024. Data from the included studies were extracted to assess the quality and risk of bias using a modified Jadaad score. Main outcome Post-operative seroma formation. Secondary outcome Ventilatory function, intra-abdominal pressure (IAP), and subcutaneous edema were the outcomes of interest. Results Only 5 trials totaling 130 patients were included in this review. Utilizing post-operative CG following abdominoplasty showed a non-significant tendency to decrease seroma development, ventilatory function, and subcutaneous edema. The limited evidence available also suggested that using post-operative CG increases IAP. Conclusion Weak evidence supports the beneficial use of abdominal binders following abdominoplasty. Limitations Low-quality scientific evidence available from the scant data and low caliber of the literature support the use of CG post-abdominoplasty. Therefore, unified outcome reporting and rigid randomized clinical trials are necessary to obtain valid data.
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Affiliation(s)
- Amr Youssef Arkoubi
- Department of Anesthesia and Surgery, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
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Liang NE, Abrajano C, Dalusag KS, Chiu B. Management and outcomes of pilonidal patients with secondary sinuses-a cohort study. Pediatr Surg Int 2024; 40:227. [PMID: 39145895 DOI: 10.1007/s00383-024-05821-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Patients with pilonidal disease (PD) can present with concurrent draining secondary sinus at the superior gluteal cleft. The natural disease course in the setting of this severe phenotype is poorly characterized. We present the largest cohort of patients with PD and concurrent secondary sinus. METHODS Patients with PD and concurrent secondary sinus who underwent Gips procedure with secondary sinus excision from 2019 to 2023 were prospectively followed. Patient demographics, drainage recurrence, symptom resolution, treatment, and follow-up period were recorded. Recurrent drainage from previous secondary sinus site was defined as isolated painless serous drainage after the wound had closed for > 3 weeks; recurrent PD was characterized as recurrent pain and bloody drainage after excision. RESULTS One hundred and five patients (seventy-one males) with a median age of 17.2 years [interquartile range (IQR):15.4-19.0] underwent excision of their disease and were followed for a median of 367.0 days (IQR: 173.2-658.8). Without regular epilation, six patients (5.7%, five males, one female) had recurrent PD. With regular epilation, three patients (2.8%, three males) had recurrent PD. Eight patients (7.5%, six males, two females) had recurrent secondary sinus site drainage. Median time to recurrent drainage was 75.5 days (IQR: 65.2-216.2) after excision and for recurrent drainage to resolve was 72 days (IQR: 49-81). Recurrent secondary sinus site drainage was treated with antibiotics, silver nitrate, debridement, or no treatment. CONCLUSION Patients who present with PD in the setting of concurrent secondary sinus have a unique, more severe disease phenotype. Excision can be complicated by recurrent drainage from the secondary sinus site that can resolve without repeat surgical excision.
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Affiliation(s)
- Norah E Liang
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Stanford, CA, 94305, USA
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Claire Abrajano
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Stanford, CA, 94305, USA
| | - Kyla Santos Dalusag
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Stanford, CA, 94305, USA
| | - Bill Chiu
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Stanford, CA, 94305, USA.
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Ormseth BH, Schoenbrunner AR, Janis JE. Letter to the editor regarding: "Effect of compression garments on post-abdominoplasty outcomes: A systematic review of the current evidence". J Plast Reconstr Aesthet Surg 2024:S1748-6815(24)00425-X. [PMID: 39089985 DOI: 10.1016/j.bjps.2024.07.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 07/22/2024] [Indexed: 08/04/2024]
Affiliation(s)
- Benjamin H Ormseth
- Department of Plastic and Reconstructive Surgery, University of Texas Southwestern, Dallas, TX, United States
| | - Anna R Schoenbrunner
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Jeffrey E Janis
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States.
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Parker SG, Joyner J, Thomas R, Van Dellen J, Mohamed S, Jakkalasaibaba R, Blake H, Shanmuganandan A, Albadry W, Panascia J, Gray W, Vig S. A Ventral Hernia Management Pathway; A "Getting It Right First Time" approach to Complex Abdominal Wall Reconstruction. Am Surg 2024; 90:1714-1726. [PMID: 38584505 DOI: 10.1177/00031348241241650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
INTRODUCTION Abdominal wall reconstruction (AWR) is an emerging specialty, involving complex multi-stage operations in patients with high medical and surgical risk. At our hospital, we have developed a growing interest in AWR, with a commitment to improving outcomes through a regular complex hernia MDT. An MDT approach to these patients is increasingly recognized as the path forward in management to optimize patients and improve outcomes. METHODS We conducted a literature review and combined this with our experiential knowledge of managing these cases to create a pathway for the management of our abdominal wall patients. This was done under the auspices of GIRFT (Getting It Right First Time) as a quality improvement project at our hospital. RESULTS We describe, in detail, our current AWR pathway, including the checklists and information documents we use with a stepwise evidence and experience-based approach to identifying the multiple factors associated with good outcomes. We explore the current literature and discuss our best practice pathway. CONCLUSION In this emerging specialty, there is limited guidance on the management of these patients. Our pathway, the "Complex Hernia Bundle," currently provides guidance for our abdominal wall team and may well be one that could be adopted/adapted by other centers where challenging hernia cases are undertaken.
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Affiliation(s)
- Samuel G Parker
- The Abdominal Wall Unit, Croydon University Hospital, Thornton Heath, London, UK
| | - James Joyner
- The Abdominal Wall Unit, Croydon University Hospital, Thornton Heath, London, UK
| | - Rhys Thomas
- The Abdominal Wall Unit, Croydon University Hospital, Thornton Heath, London, UK
| | - Jonathan Van Dellen
- The Abdominal Wall Unit, Croydon University Hospital, Thornton Heath, London, UK
| | - Said Mohamed
- The Abdominal Wall Unit, Croydon University Hospital, Thornton Heath, London, UK
| | | | - Helena Blake
- The Abdominal Wall Unit, Croydon University Hospital, Thornton Heath, London, UK
| | - Arun Shanmuganandan
- The Abdominal Wall Unit, Croydon University Hospital, Thornton Heath, London, UK
| | - Waleed Albadry
- Plastics Surgery Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Julia Panascia
- The Abdominal Wall Unit, Croydon University Hospital, Thornton Heath, London, UK
| | - William Gray
- The Abdominal Wall Unit, Croydon University Hospital, Thornton Heath, London, UK
| | - Stella Vig
- The Abdominal Wall Unit, Croydon University Hospital, Thornton Heath, London, UK
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Kosloski FR, Barbosa MVJ, Rodrigues MA, Martins MRC, Ferreira LM, Nahas FX. Effect of Compression Garments on the Ventilatory Function After Abdominoplasty. Aesthet Surg J 2024; 44:174-182. [PMID: 37477908 DOI: 10.1093/asj/sjad231] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/27/2023] [Accepted: 07/20/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND The use of compression garments in the postoperative period of abdominoplasty seems to be a consensus, but the incidents of complications arising from this have been described, related to an increase in intraabdominal pressure and reduction of the femoral vein blood flow that may facilitate thromboembolic events. There are no studies that have evaluated the isolated effect of postoperative compression garments on respiratory function. OBJECTIVES The purpose of this study was to evaluate the effect of compression garments on respiratory function after abdominoplasty. METHODS Thirty-four female patients who underwent standard abdominoplasty were divided into 2 groups, the garment group (n = 18) and the no garment group (n = 16). Respiratory function assessment (with spirometry and manovacuometry) was performed in the preoperative and postoperative periods. RESULTS Forced vital capacity assessment revealed a greater ventilatory restriction in the garment group. Forced expiratory volume in 1 second (FEV1) showed differences between the evaluation time points in the garment group; the intergroup comparisons showed that the no garment group had a lower FEV1. Slow vital capacity was evaluated with no significant differences found on both intergroup comparisons. The inspiratory capacity was reduced in the garment group, representing ventilatory restriction. Measurements of the maximum inspiratory pressure showed no significant differences between the groups. The maximum expiratory pressure showed significantly lower values on postoperative day 7 in the garment group. CONCLUSIONS The use of compression garments after abdominoplasty impairs ventilatory function. Not wearing this type of garment can improve ventilation, decreasing the risk of pulmonary complications. LEVEL OF EVIDENCE: 3
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Nahas FX, Ferreira LM. Management of the Musculoaponeurotic Layer in Abdominoplasty. Clin Plast Surg 2024; 51:59-69. [PMID: 37945076 DOI: 10.1016/j.cps.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Abdominoplasty has evolved in the last few decades, especially the treatment of the myoaponeurotic deformities. Bulging, lack of definition of the abdominal contour, should be understood and treated according to the individual deformity. Many types of deformities have been recognized and treatment respects the local anatomy in most cases. Scientific basis that consolidate these treatments are discussed as well as possible recurrences and pitfalls of these techniques. The histological composition of muscles and fascia are also discussed and anatomical details help to enrich the knowledge of the correction of this layer. Specific types of sutures are suggested for both plications and muscle advancement.
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Affiliation(s)
- Fabio Xerfan Nahas
- Adjunct Professor of Plastic Surgery, Federal University of São Paulo, UNIFESP, EPM, Av. Brasil 275, São Paulo, São Paulo 01431-000, Brazil.
| | - Lydia Masako Ferreira
- Head and Full Professor, Federal University of São Paulo, UNIFESP, EPM, R. Napoleão de Barros, 715 - 4o. andar, São Paulo, São Paulo 04024-002, Brazil
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Ortiz PR, Lorenz E, Meyer F, Croner R, Lünse S, Hunger R, Mantke R, Benz-Weisser A, Zarras K, Huenerbein M, Paasch C. The effect of an abdominal binder on postoperative outcome after open incisional hernia repair in sublay technique: a multicenter, randomized pilot trial (ABIHR-II). Hernia 2023; 27:1263-1271. [PMID: 37466732 PMCID: PMC10533646 DOI: 10.1007/s10029-023-02838-4] [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: 04/06/2023] [Accepted: 07/05/2023] [Indexed: 07/20/2023]
Abstract
INTRODUCTION Although the evidence is minimal, an abdominal binder is commonly prescribed after open incisional hernia repair (IHR) to reduce pain. This study aimed to investigate this common postoperative treatment. METHODS The ABIHR-II trial was a national prospective, randomized, multicenter non-AMG/MPG pilot study with two groups of patients (wearing an abdominal binder (AB) for 2 weeks during daytime vs. not wearing an AB following open IHR with the sublay technique). Patient enrollment took place from July 2020 to February 2022. The primary endpoint was pain at rest on the 14th postoperative day (POD) using the visual analog scale (VAS). The use of analgesics was not systematically recorded. Mixed-effects linear regression models were used. RESULTS A total of 51 individuals were recruited (25 women, 26 men; mean age 61.4 years; mean body mass index 30.65 kg/m2). The per-protocol analysis included 40 cases (AB group, n = 21; No-AB group, n = 19). Neither group showed a significant difference in terms of pain at rest, limited mobility, general well-being, and seroma formation and rate. Patients among the AB group had a significantly lower rate of surgical site infection (SSI) on the 14th POD (AB group 4.8% (n = 1) vs. No-AB group 27.8% (n = 5), p = 0.004). CONCLUSION Wearing an AB did not have an impact on pain and seroma formation rate but it may reduce the rate of postoperative SSI within the first 14 days after surgery. Further trials are mandatory to confirm these findings.
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Affiliation(s)
- P. R. Ortiz
- Charité Universitätsmedizin-Berlin, Berlin, Germany
- Department of General, Abdominal and Cancer Surgery, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - E. Lorenz
- Department of General, Abdominal, Vascular and Transplant Surgery, Otto-Von-Guericke University Hospital Magdeburg, Magdeburg, Germany
| | - F. Meyer
- Department of General, Abdominal, Vascular and Transplant Surgery, Otto-Von-Guericke University Hospital Magdeburg, Magdeburg, Germany
| | - R. Croner
- Department of General, Abdominal, Vascular and Transplant Surgery, Otto-Von-Guericke University Hospital Magdeburg, Magdeburg, Germany
| | - S. Lünse
- Department of General and Abdominal Surgery, Clinic for General and Abdominal Surgery, University Hospital Brandenburg an der Havel, Hochstrasse 29, 14770 Brandenburg an der Havel, Germany
| | - R. Hunger
- Faculty of Medicine, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
| | - R. Mantke
- Department of General and Abdominal Surgery, Clinic for General and Abdominal Surgery, University Hospital Brandenburg an der Havel, Hochstrasse 29, 14770 Brandenburg an der Havel, Germany
- Faculty of Medicine, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - A. Benz-Weisser
- Department of General, Abdominal Vascular and Transplant Surgery, Westpfalz-Klinikum GmbH, Kaiserslautern, Germany
| | - K. Zarras
- Department of Abdominal Minimally Invasive and Cancer Surgery, Marien Hospital Düsseldorf, Düsseldorf, Germany
| | - M. Huenerbein
- Charité Universitätsmedizin-Berlin, Berlin, Germany
- Department of Surgery, Oberhavel Clinic Oranienburg, Oranienburg, Germany
| | - C. Paasch
- Department of General and Abdominal Surgery, Clinic for General and Abdominal Surgery, University Hospital Brandenburg an der Havel, Hochstrasse 29, 14770 Brandenburg an der Havel, Germany
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Ormseth BH, Livermore NR, Schoenbrunner AR, Janis JE. The Use of Postoperative Compression Garments in Plastic Surgery-Necessary or Not? A Practical Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5293. [PMID: 37753333 PMCID: PMC10519563 DOI: 10.1097/gox.0000000000005293] [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: 05/19/2023] [Accepted: 08/14/2023] [Indexed: 09/28/2023]
Abstract
This practical review critically evaluates the evidence behind the widespread use of postoperative compression therapy intended to improve surgical outcomes, such as reduced edema, ecchymosis, pain, and seroma formation. A literature search of PubMed was conducted to identify relevant studies concerning the use of compression garments after aesthetic surgery, including rhinoplasty, facelift, neck lift, mammoplasty, abdominoplasty, limb contouring, and others. Additionally, reconstructive and therapeutic procedures closely related in anatomy or technique to these cosmetic operations, such as breast reconstruction, mastectomy, and hernia repair, were also considered to provide further perspective. After study extraction, the volume, quality, and agreement of the evidence found was highly heterogenous depending on the context of specific operations and outcomes evaluated. The most well-supported indications for the use of postoperative compression garments are to mitigate edema and ecchymosis after rhinoplasty and to reduce postoperative pain after breast and abdominal procedures, although no effect on seroma rate was demonstrated. Any potential benefit must be balanced against the associated costs and possible complications of compression, including patient discomfort, increased venous stasis, and skin defects. Thus, we encourage surgeons to critically reassess their use of compression garments. In many settings, such as brachioplasty, there is limited high-quality evidence to inform best practice, and we urge the community to continue researching this important topic so that more definitive and comprehensive guidelines may be established.
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Affiliation(s)
- Benjamin H. Ormseth
- From the Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Nina R. Livermore
- Division of Plastic & Reconstructive Surgery, Spectrum Health/Michigan State University College of Human Medicine, Grand Rapids, Mich
| | - Anna R. Schoenbrunner
- From the Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jeffrey E. Janis
- From the Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Fontes de Moraes BZ, Ferreira LM, Martins MRC, Rostom L, Castro HASD, Nahas FX. Do Compression Garments Prevent Subcutaneous Edema After Abdominoplasty? Aesthet Surg J 2023; 43:329-336. [PMID: 36282895 DOI: 10.1093/asj/sjac273] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The main disadvantages of wearing a compression garment following abdominoplasty are the increase in intra-abdominal pressure and risk of venous stasis. On the one hand, the wearing of garments may increase the risk of venous thromboembolism. On the other hand, it may be beneficial in decreasing edema formation after surgery. OBJECTIVES The authors sought to evaluate the effectiveness of compression garments in reducing subcutaneous edema after abdominoplasty. METHODS Thirty-two women aged 19 to 50 years were selected and randomly allocated to either the garment (n = 16) or no-garment (n = 16) group. All patients underwent abdominoplasty and received 10 sessions of manual lymphatic drainage during the postoperative period. Postoperative edema formation was assessed by perimetry and bioimpedance, and seroma formation was assessed by ultrasound. Statistical tests included t test, mixed linear models, analysis of variance with repeated measures, and the Kolmogorov-Smirnov test, which were performed at a significance level α of .05 (P ≤ .05). RESULTS The no-garment group showed a trend toward lower mean waist circumference at 29 days following abdominoplasty and significantly lower waist circumference after postoperative day 35 compared with the garment group (P < .001). The mean total body water was slightly lower in the no-garment group than in the garment group 7 days after surgery (P = .05). CONCLUSIONS Patients who did not wear a compression garment after abdominoplasty showed less subcutaneous edema formation after 24 days of surgery than those who wore the garment.
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Affiliation(s)
| | - Lydia Masako Ferreira
- Division of Plastic Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | - Lucas Rostom
- Hospital São Paulo, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | - Fabio Xerfan Nahas
- Division of Plastic Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Keane AM, Keane GC, Tenenbaum MM. Commentary on: Do Compression Garments Prevent Subcutaneous Edema After Abdominoplasty? Aesthet Surg J 2023; 43:337-339. [PMID: 36380465 DOI: 10.1093/asj/sjac298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Alexandra M Keane
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University, St. Louis, MO, USA
| | - Grace C Keane
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University, St. Louis, MO, USA
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Turer DM. Commentary on: Do Abdominal Binders Prevent Seroma Formation and Recurrent Diastasis Following Abdominoplasty? Aesthet Surg J 2022; 42:1303-1304. [PMID: 35917566 DOI: 10.1093/asj/sjac209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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