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Singh S. Delayed Surgical Intervention in Cranio-Maxillofacial Splinter Injury: Report of a Case and A Literature Review. J Maxillofac Oral Surg 2024; 23:394-401. [PMID: 38601233 PMCID: PMC11001846 DOI: 10.1007/s12663-023-02061-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/07/2023] [Indexed: 04/12/2024] Open
Abstract
Introduction In the context of Indian combat scenario, maxillofacial injuries from gunshots are uncommon. Methods The first section of this study is a case report of a rare instance of metal foreign bodies that were lodged in the parapharyngeal space, deeper to the deep lobe of the parotid right next to the carotid space in the neck. The second section focusses on the unique treatment for blast injuries as well as the variety of imaging procedures that are readily available to assist with surgery, such as plain film, CT, angiography, and occasionally MR imaging. Result and Conclusion According to the study, understanding the pertinent anatomy, precise imaging of the penetrating object in relation to vital structures, meticulously planned and conducted surgical removal of the foreign body, and repair of damaged structures are the key elements of a successful treatment.
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Affiliation(s)
- Shagun Singh
- Department of Oral and Maxillofacial Surgery, 3 Corps Dental Unit, Armed Forces, Dimapur, India
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2
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Sarat Ravi Kiran B, Choudhary R. Brutality of ‘Sword’ Injuries in a Rare Maxillofacial Region: 2 Case Reports. CLINICAL MEDICINE INSIGHTS: CASE REPORTS 2022; 15:11795476221081589. [PMID: 35620397 PMCID: PMC9127847 DOI: 10.1177/11795476221081589] [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: 01/02/2022] [Accepted: 01/26/2022] [Indexed: 11/17/2022] Open
Abstract
Oral and maxillofacial trauma consists of various injuries but penetrating injuries are very rare and frequently require a multidisciplinary approach to treatment. The primary survey is always the initial step in trauma management before continuing with further evaluation and treatment. The following case reports discuss the clinical strategy of our rare encounter of penetrating injuries at the same time. These cases demonstrate that complex penetrating injuries of the oral and maxillofacial region require a structured and multidisciplinary approach to prevent further side effects and obtain an ideal clinical outcome.
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Liu H, Hu S, Qin W. Traumatic prolapse of the globe into the anterior cranial fossa: a case report. BMC Ophthalmol 2020; 20:128. [PMID: 32245433 PMCID: PMC7119161 DOI: 10.1186/s12886-020-01403-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/24/2020] [Indexed: 11/25/2022] Open
Abstract
Background Orbital fracture associated with traumatic intracranial prolapse of the eyeball is rare. In all previously reported cases, vision was severely impaired with no light perception. Herein, we report a case of traumatic prolapse of the globe into the anterior cranial fossa, in which the patient’s vision was preserved by early repositioning. Case presentation The present case report focused on a man hit by a steel pipe, leading to prolapse of the globe of the right eye into the anterior cranial fossa through fractures in the superior orbit roof, accompanied by cerebral contusion. The eyeball was immediately repositioned into the orbital cavity, along which the wound tract was debrided and the skull base was repaired. The patient underwent a follow-up period of 12 months, during which the visual acuity increased to 12/20 without any intracranial infections. However, the patient’s ptosis persisted and was associated with complete loss of supraduction. Conclusions In this case, early diagnosis and proper globe repositioning with reconstruction of the orbital roof could allow recovery of vision, as well as prevention of intracranial infection.
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Affiliation(s)
- Hui Liu
- Department of Ophthalmology, Chengdu Aier Eye Hospital, Chengdu, China.,Department of Ophthalmology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Shengli Hu
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Wei Qin
- Department of Ophthalmology, Southwest Hospital, Third Military Medical University, Chongqing, China. .,Department of Ophthalmology, Chungking General Hospital, Chongqing, China.
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Sadek EY, Elbarbary A, Safe II. Periorbital Trauma: A New Classification. Craniomaxillofac Trauma Reconstr 2019; 12:228-240. [PMID: 31428248 DOI: 10.1055/s-0039-1677808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 12/15/2018] [Indexed: 10/27/2022] Open
Abstract
Overlooked injured structures in periorbital trauma could lead to aesthetic and functional deficits. As trauma may affect superficial, middle, and deep components, meticulous survey guided by a structured periorbital trauma classification is needed for proper management. Thus, a new classification for periorbital trauma is proposed to serve this purpose. Periorbital region was defined anatomically by anthropometric landmarks. The periorbital injuries were categorized according to anatomical and clinical basis. The new classification was used to study periorbital trauma cases received at Ain Shams University Hospitals between July 2013 and July 2016 retrospectively. The study included 260 patients: 196 (75.38%) males and 64 (24.62%) females. The type and severity of injury, time of primary intervention, type of surgery performed, and patients' visits to the outpatient clinic were evaluated. The status of the postinjury and postoperative (primary surgery) aesthetic status and functional status were evaluated. The periorbital region was identified. Anatomical categorization of periorbital injuries included periocular, frontal, temporal, and malar regions. Injuries/deficits were categorized into simple, composite, complex, and isolated bony injuries according to the depth and involved tissues. Subsequently, the classification was formulated. In the retrospective study, the incidence of extended simple injuries was the highest, while the least was the extended complex injuries. Functional deficits occurred in 24 patients (9.23%) and aesthetic deficits occurred in 55 patients (21.15%). Required secondary operations for this group included redo of fixation, correction of medial canthal ligament, repair of canalicular system, scar revisions, fat grafting, and creation of natural creases. The results of this study demonstrated that unsatisfactory aesthetic and functional results occurred when injuries of important structures were overlooked, aesthetic units were not respected, and when management was delayed. A three-dimensional, oriented, new classification of periorbital trauma based on anatomical and clinical categorization is proposed to help in identifying injured structures, stimulate the search for other injuries, structure preoperative evaluation, and recommend a surgical plan that would ultimately achieve precise primary repair with best aesthetic and functional outcome.
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Affiliation(s)
- Eman Yahya Sadek
- Plastic Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amir Elbarbary
- Plastic Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ikram I Safe
- Plastic Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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El Sayed M, Hassan Saad R, Fereir A. Undiagnosed impacted knife blade from a penetrative orbital injury: A case report. Int J Surg Case Rep 2018; 53:254-258. [PMID: 30445357 PMCID: PMC6258364 DOI: 10.1016/j.ijscr.2018.10.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/06/2018] [Accepted: 10/11/2018] [Indexed: 11/30/2022] Open
Abstract
The mode of entry of the foreign body was unique as well as the force required to impale and break a knife blade in bone. The authors present a minimally invasive technique for dealing with this type of injury and highlight its challenges. This case report emphasis the need for baseline radiology in cases of traumatology especially those with vague history. The patient was examined by multiple physicians who did not detect the foreign body which could raise medico-legal issues.
Introduction Impacted foreign bodies in the complex maxillofacial region is uncommon and their safe removal is a challenge. Case presentation The authors report an unusual case of a 41 year old male patient who suffered from violence-related orbital trauma with a knife. The presence of this foreign body was not diagnosed for a period of 20 months. After proper clinical and radiologic examination it was localized and extracted in the theater in a safe controlled manner. Although the tip of the blade was left in situ, the patient had a rapid uneventful recovery and follow up. Discussion The path of penetration of the foreign body in presented case didn't follow the predicted patterns of orbital injury described in literature. A dilemma exists as to how aggressive such injuries should be managed. Thus the surgical approach implemented for retrieving the current foreign body was highlighted. Conclusion Radiographs are a crucial element for early diagnosis and proper management of foreign body injuries. Rapid postoperative recovery can be achieved with simple safe surgical retrieval maneuvers.
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Affiliation(s)
- Mohamed El Sayed
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Benha University, Benha, Egypt; Department of Oral and Maxillofacial Surgery, National Bank Hospital For Integral Care, El Katameya, Cairo, Egypt
| | - Reem Hassan Saad
- Department of Cranio-Maxillofacial Surgery, Nasser Institute for Research and Treatment, Cairo, Egypt; Department of Oral and Maxillofacial Surgery, National Bank Hospital For Integral Care, El Katameya, Cairo, Egypt.
| | - Ahmed Fereir
- Department of Oral and Maxillofacial Surgery, Faculty of oral and dental medicine, Future University, New Cairo, Cairo, Egypt; Department of Oral and Maxillofacial Surgery, National Bank Hospital For Integral Care, El Katameya, Cairo, Egypt
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Santos LM, Bernardino IM, Ferreira Porto AV, Nórbrega Barbosa KG, Marques da Nóbrega L, d'Avila S. Aggression Using a Knife or Other Sharp Instruments and Oral-Maxillofacial Trauma: Incidence, Risk Factors, and Epidemiologic Trends. J Oral Maxillofac Surg 2018; 76:1953.e1-1953.e11. [PMID: 29425751 DOI: 10.1016/j.joms.2018.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 01/07/2018] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of the present study was to characterize the profile of victims of interpersonal physical violence (IPV) caused by a knife or other sharp instrument, identify the factors associated with maxillofacial trauma, and examine the incidence of maxillofacial trauma over time. PATIENTS AND METHODS In a retrospective cohort study, we evaluated 569 medicolegal and social records of IPV victims by knife or other sharp instruments treated at a forensic medicine and dentistry center in Brazil during a 4-year consecutive period. The variables investigated were related to the sociodemographic characteristics of the victims, circumstances of the aggression, and trauma patterns. Descriptive and multivariate statistics through Poisson regression and trend analysis with the creation of polynomial regression models were used. RESULTS The cumulative incidence of oral-maxillofacial trauma was 19.3%. The mean age of the victims was 31.29 ± 13.82 years. Cases of trauma affecting more than one region of the face prevailed (45.5%). Based on the final Poisson regression model, unemployed people were more likely to exhibit maxillofacial trauma (relative risk [RR] 1.86; 95% confidence interval [CI] 1.03-3.35; P = .039). In addition, individuals were more likely to experience maxillofacial trauma on Wednesdays (RR 1.85; 95% CI 1.01-3.37; P = .045). The trend analysis revealed a significant increase in oral-maxillofacial injuries over time (P < .05). CONCLUSIONS The incidence of oral-maxillofacial trauma was high, and the main factors associated with trauma were the victim's employment status and day of occurrence. Future studies will focus on assessing the effect of maxillofacial trauma on the quality of life and well-being of violence victims.
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Affiliation(s)
- Luzia Michelle Santos
- Dentist, Department of Dentistry, Universidade Estadual da Paraíba, Campina Grande, Paraíba, Brazil
| | - Italo M Bernardino
- Master in Dentistry, Department of Dentistry, Universidade Estadual da Paraíba, Campina Grande, Paraíba, Brazil
| | | | | | - Lorena Marques da Nóbrega
- Master in Dentistry, Department of Dentistry, Universidade Estadual da Paraíba, Campina Grande, Paraíba, Brazil
| | - Sérgio d'Avila
- Professor, Department of Dentistry, Universidade Estadual da Paraíba, Campina Grande, Paraíba, Brazil.
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The Transcranial Stab Wound and the Life-Saving Zygomatic Arch Clinical Report. J Craniofac Surg 2016; 28:218-219. [PMID: 27941553 DOI: 10.1097/scs.0000000000003285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A 58-year-old man presented to the neurosurgical emergencies for a transzygomatic transcranial stab wound with a retained broken knife. The patient was neurologically intact. After radiographic evaluation the knife was found to be penetrating the temporal lobe, neighboring the intracavernous portion of the carotid artery. The patient was successfully managed in a conservative way. No abnormalities were seen at 12 months of follow-up. Dealing with penetrating head injuries is a usual condition in neurosurgical practice. Some situations are though really challenging, especially when the offending object is still in place, with a close connection to vital structures. This clinical reports an unusual penetrating head injury, highlighting the importance of careful radiographic evaluation and trying to discuss clear management options.
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8
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Penetrant injury of the nose with a foreign material. J Craniofac Surg 2014; 24:1853-6. [PMID: 24036798 DOI: 10.1097/scs.0b013e318293f900] [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] Open
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9
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Kim MS, Sim SY. Traumatic aneurysm of the callosomarginal artery-cortical artery junction from penetrating injury by scissors. J Korean Neurosurg Soc 2014; 55:222-5. [PMID: 25024829 PMCID: PMC4094750 DOI: 10.3340/jkns.2014.55.4.222] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 11/06/2013] [Accepted: 04/15/2014] [Indexed: 12/14/2022] Open
Abstract
Traumatic intracranial aneurysms (TICAs) are rare and are associated with high rates of morbidity and mortality. TICAs usually result from head injuries caused by traffic accidents, industrial accidents, or gunshots. We report a traumatic aneurysm of the callosomarginal artery-cortical artery junction arising from a penetrating injury by scissors. A 51-year-old woman was admitted to our hospital after suffering a penetrating injury caused by scissors. Computed tomography (CT) and CT-angiography demonstrated a right orbital roof fracture, subarachnoid hemorrhage, frontal lobe hemorrhage, intraventricular hemorrhage, and a traumatic aneurysm of the right callosomarginal artery-cortical artery junction. We trapped the traumatic aneurysm and repositioned a galeal flap. Postoperative CT showed a small infarction in the left frontal lobe. Follow-up angiography two months later showed no residual aneurysm. We suggest that an aggressive surgical intervention be performed whenever TICA is diagnosed.
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Affiliation(s)
- Myoung Soo Kim
- Department of Neurosurgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Sook Young Sim
- Department of Neurosurgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Abstract
A retrospective study was carried out wherein 10 patients with glass particle injury reporting to the Department of Oral and Maxillofacial Surgery between January 2011 and March 2012 were included. Preoperative photographs and radiographs were done, and detailed surgical planning followed. Ninety percent of the patients were males with involvement of the right side of the face in 70% of the cases. The most common presenting symptom was patient sensation, which was the reason for availing delayed treatment in 70% of cases, followed by delayed or fibrotic healing (20%) and pain (10%). The diagnosis and planning were done based on computed tomographic scan (50% cases), plain radiographs (30%), needle as tactile aid (10%), and palpation (10%). Eighty percent of cases were diagnosed/presented late. The timely diagnosis of glass particle injuries requires a high degree of suspicion for the same. A systematic diagnosis and treatment planning for such injuries can minimize the morbidity and prevent such injuries from being overlooked at time of primary injury.
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Natrella M, Duc L, Lunardi G, Cristoferi M, Fanelli G, Meloni T. Treatment of a transorbital penetrating injury: a particular endovascular approach. Interv Neuroradiol 2012; 18:191-4. [PMID: 22681735 DOI: 10.1177/159101991201800211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 03/03/2012] [Indexed: 11/17/2022] Open
Abstract
The management of craniocerebral penetrating injury currently represents a challenge for neurosurgeons and neuroradiologists and requires innovative planning. This report describes the case of a worker admitted to hospital with an intracranial piece of concrete-cutting saw stuck through the right eye. At the time of admission the patient was conscious and this fact influenced the choice of a particular approach. This patient escaped without neurological deficit or complications, except for the inevitable removal of an eye.
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Affiliation(s)
- M Natrella
- Department of Imaging and Interventional Radiology, Umberto Parini Regional Hospital, Aosta, Italy.
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12
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A rare case of a glass fragment impacted in the parapharyngeal space associated with neurovascular compromise. Int J Oral Maxillofac Surg 2010; 40:209-11. [PMID: 20817479 DOI: 10.1016/j.ijom.2010.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Revised: 05/04/2010] [Accepted: 07/27/2010] [Indexed: 11/22/2022]
Abstract
It is rare for foreign bodies to be found in the parapharyngeal space due to the protection of the mandibular ramus and zygomatic bone. The authors describe a rare case of a patient with an unusual penetrating neck injury caused by broken windshield glass in a traffic accident, which lodged in the parapharyngeal space and punctured the internal jugular vein and cranial nerves. 3 weeks later, a delayed exploration was performed on the patient after detailed evaluation of the relationship between the foreign body and the great vessels. The authors removed the glass fragment easily with no active bleeding because it had been surrounded by a fibrous envelope. This experience indicates that increasing the duration of foreign body retention in the parapharyngeal space may be helpful, allowing fibrosis to surround the foreign body, reducing the risk of active bleeding when it is removed.
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Meer M, Siddiqi A, Morkel JA, Janse van Rensburg P, Zafar S. Knife inflicted penetrating injuries of the maxillofacial region: a descriptive, record-based study. Injury 2010; 41:77-81. [PMID: 19524234 DOI: 10.1016/j.injury.2009.05.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 05/04/2009] [Accepted: 05/05/2009] [Indexed: 02/02/2023]
Abstract
UNLABELLED Penetrating knife injuries of the face are more common in South Africa than the rest of the world. These injuries can be life-threatening, especially where the major blood vessels of the face are involved. The approach to treatment should be multidisciplinary, beginning with the trauma unit to provide airway maintenance and haemodynamic stabilisation. An interventional radiologist may be consulted for angiography. The aim of the present study was to retrospectively analyse all cases of knife-inflicted penetrating injuries to the maxillofacial region with the knife in situ and subsequently develop a management protocol to be used by maxillofacial surgery registrars when presented with such cases. MATERIALS AND METHODS It was a retrospective, cross-sectional and record-based study, analysing all penetrating knife injuries reported at various hospitals for a period of 11 years. In this study, 24 cases of knife injuries were analysed. RESULTS Twenty-one patients (87.5%) in this series were male and three (12.5%) were female. Of these 24 patients, 13 (54.2%) were coloured and 11 (45.8%) were black. There were no white or Indian patients. Post-surgical recovery of all patients was rapid and uneventful, and there were no fatalities. CONCLUSION Patients with knife injuries to the face with no definite signs of vascular injury can thus be safely and accurately managed on the basis of physical examination and plain-film radiography. An angiogram is mandatory if the patient presents with excessive bleeding, an expanding haematoma or if the knife blade is in the region of any large vessels.
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Affiliation(s)
- M Meer
- Griffith University, School of Dentistry and Oral Health, Australia
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Mendonça-Caridad JJ, Juiz Lopez P, Francos L, Rodriguez M. Swordfish bill injury involving the pterygomaxillary fossae: surgical management and case report. J Oral Maxillofac Surg 2008; 66:1739-43. [PMID: 18634967 DOI: 10.1016/j.joms.2007.12.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Revised: 08/11/2007] [Accepted: 12/10/2007] [Indexed: 11/24/2022]
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Correction. J Craniofac Surg 2006. [DOI: 10.1097/01.scs.0000246743.30213.dc] [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] Open
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