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Sachdeva A, Pickering EM, Lee HJ. From electrocautery, balloon dilatation, neodymium-doped:yttrium-aluminum-garnet (Nd:YAG) laser to argon plasma coagulation and cryotherapy. J Thorac Dis 2016; 7:S363-79. [PMID: 26807284 DOI: 10.3978/j.issn.2072-1439.2015.12.12] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Over the past decade, there has been significant advancement in the development/application of therapeutics in thoracic diseases. Ablation methods using heat or cold energy in the airway is safe and effective for treating complex airway disorders including malignant and non-malignant central airway obstruction (CAO) without limiting the impact of future definitive therapy. Timely and efficient use of endobronchial ablative therapies combined with mechanical debridement or stent placement results in immediate relief of dyspnea for CAO. Therapeutic modalities reviewed in this article including electrocautery, balloon dilation (BD), neodymium-doped:yttrium-aluminum-garnet (Nd:YAG) laser, argon plasma coagulation (APC), and cryotherapy are often combined to achieve the desired results. This review aims to provide a clinically oriented review of these technologies in the modern era of interventional pulmonology (IP).
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Affiliation(s)
- Ashutosh Sachdeva
- 1 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, University Maryland, Baltimore, MD 21201, USA ; 2 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Edward M Pickering
- 1 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, University Maryland, Baltimore, MD 21201, USA ; 2 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Hans J Lee
- 1 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, University Maryland, Baltimore, MD 21201, USA ; 2 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
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Changes in Quality of Life, Dyspnea Scores, and Lung Function in Lung Cancer Patients With Airway Obstruction After a Therapeutic Bronchoscopy. J Bronchology Interv Pulmonol 2013; 20:134-9. [DOI: 10.1097/lbr.0b013e3182917280] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Amdo T, Godoy MCB, Ost D, Naidich DP. Imaging-bronchoscopic correlations for interventional pulmonology. Thorac Surg Clin 2010; 20:103-19. [PMID: 20378063 DOI: 10.1016/j.thorsurg.2009.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The improvements to patient care that can be achieved by combining advanced imaging techniques and bronchoscopy are considerable. In this regard, CT imaging often plays an indispensable role in both the selection of appropriate candidates tor therapy as well as the choice of optimal interventional techniques. However, it is apparent that alternate methods for evaluating the airways and lung including ultrasound and electromagnetic navigation will likely play an increasingly important diagnostic role, necessitating a thorough understanding of their advantages and limitations. Disease-specific applications for which imaging technologies, including CT and VB, are either currently routinely used or show the greatest promise are for suspected or diagnosed lung cancers, central and peripheral, and emphysema. It may be anticipated that with growing experience, the potential for additional indications of these remarkable technologies are likely to increase in the near future.
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Affiliation(s)
- Tshering Amdo
- Division of Pulmonary and Critical Care Medicine, New York University-Langone Medical Center, Tisch Hospital, 560 First Avenue, New York, NY 10016, USA
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Lyu J, Song JW, Hong SB, Oh YM, Shim TS, Lim CM, Lee SD, Koh Y, Kim WS, Kim DS, Choi CM. Bronchoscopic Cryotherapy in Patients with Central Airway Obstruction. Tuberc Respir Dis (Seoul) 2010. [DOI: 10.4046/trd.2010.68.1.6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jiwon Lyu
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Woo Song
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Bum Hong
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeon-Mok Oh
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Sun Shim
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chae-Man Lim
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Do Lee
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Younsuck Koh
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo Sung Kim
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Soon Kim
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Min Choi
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Amdo T, Godoy MCB, Ost D, Naidich DP. Imaging-bronchoscopic correlations for interventional pulmonology. Radiol Clin North Am 2009; 47:271-87. [PMID: 19249456 DOI: 10.1016/j.rcl.2008.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The development and rapid advancement of both bronchoscopic, CT and ultrasound imaging technology has had considerable impact on the management of a wide variety of pulmonary diseases. The synergy between these newer imaging modalities and advanced interventional endoscopic procedures has led to a revolution in diagnostic and therapeutic options in patients with both central and peripheral airway disease. Given the broad clinical implications of these technological advances, only the most important areas of interventional pulmonology in which imaging has had a major impact will be selectively reviewed to highlight fundamental principles.
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Affiliation(s)
- Tshering Amdo
- Division of Pulmonary and Critical Care Medicine, New York University-Langone Medical Center, Tisch Hospital, 560 First Avenue, New York, NY 10016, USA
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Kim JH, Choi JM, Song SE, Lee EM, Lee SJ, Oak CH, Jang TW, Jung MH, Jang HK. Comparison of Forcep-biopsy and Cryo-biopsy by a Flexible Bronchoscopy. Tuberc Respir Dis (Seoul) 2009. [DOI: 10.4046/trd.2009.66.2.110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jae Hyun Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Jung Min Choi
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Sung Eun Song
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Eun Mi Lee
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Song Ju Lee
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Chul Ho Oak
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Tae Won Jang
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Man Hong Jung
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Hee Kyung Jang
- Department of Pathology, Kosin University College of Medicine, Busan, Korea
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Tsutsui H, Kubota M, Yamada M, Suzuki A, Usuda J, Shibuya H, Miyajima K, Sugino K, Ito K, Furukawa K, Kato H. Airway stenting for the treatment of laryngotracheal stenosis secondary to thyroid cancer. Respirology 2008; 13:632-8. [PMID: 18513246 DOI: 10.1111/j.1440-1843.2008.01309.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Airway stenting can be a valuable therapeutic option for symptomatic airway stenosis, but its role in the palliation of advanced thyroid cancers invading the upper airway is unclear. This study examined the hypothesis that durable and replaceable silicone stents would give better results than self-expanding metallic stents. METHODS A retrospective analysis was conducted of consecutive patients stented for laryngotracheal obstruction due to thyroid cancer. Stenting was performed via a rigid bronchoscope when airway patency after dilatation was <or=50% of normal. Symptomatic improvement, Hugh-Jones (H-J) classification, Eastern Cooperative Oncology Group performance status (PS), and complications were analysed. RESULTS There were 37 stenotic lesions treated in 35 patients. The most common sites for these lesions were in the inclusive area extending from the cricoid cartilage to the first tracheal ring (26/37 lesions, 70%). Forty-five stents (12 silicone, 20 metallic, 13 T-tubes) were used in 43 interventions. All patients showed immediate symptomatic relief and significant improvement in both PS and H-J classifications. Critical complications were supraglottic stenosis (5/43 interventions, 12%) and, of those same five cases, stent migration was seen in all but one (4/45 implantations, 9%). As these complications occurred only in patients in whom the silicone stents had been placed in close proximity to the cricoid cartilage (5/10 patients, 50%), this emphasizes the unsuitability of silicone stents in such cases. The median survival time from stenting was 8 months. The 1-year survival rate was 40%. CONCLUSIONS Airway stenting can achieve significant palliation in patients with thyroid cancer and airway obstruction. The study showed that for the most common lesions, the uncovered Ultraflex stent is associated with fewer critical complications than the silicone stents.
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Affiliation(s)
- Hidemitsu Tsutsui
- Department of Chest and Thyroid Surgery, Tokyo Medical University Hospital, Tokyo, Japan
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Jung JY, Lee SY, Kim DH, Lee KJ, Lee EJ, Kang EH, Jung KH, Kim JH, Shin C, Shim JJ, In KH, Kang KH, Yoo SH. Clinical Benefits and Complications of Cryotherapy in Advanced Lung Cancer with Central Airway Obstruction. Tuberc Respir Dis (Seoul) 2008. [DOI: 10.4046/trd.2008.64.4.272] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Jin Yong Jung
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sung Yong Lee
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Dae Hyun Kim
- Guro Hospital, Korea University Medical Center, Seoul, Korea
| | - Kyung Joo Lee
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Eun Joo Lee
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Eun Hae Kang
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Ki Hwan Jung
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Je Hyeong Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Chol Shin
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jae Jeong Shim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Kwang Ho In
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Kyung Ho Kang
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Se Hwa Yoo
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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Herth FJF, Eberhardt R, Ernst A. The future of bronchoscopy in diagnosing, staging and treatment of lung cancer. Respiration 2006; 73:399-409. [PMID: 16775411 DOI: 10.1159/000093369] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Bronchoscopy is a central technique in diagnosing lung cancer, but also in different therapeutic approaches. A lot of techniques are available. The most common indication for bronchoscopy is for tissue sampling and determining the extent of lung cancer. Established diagnostic techniques are forceps biopsy, aspiration or brush cytology sampling, or needle aspiration. Laser therapy, electrocautery, cryotherapy and stenting are well-described techniques for the palliation of symptoms due to airway involvement in patients with advanced stages. Newer technologies, with an established role in clinical practice, are endobronchial ultrasound, autofluorescence bronchoscopy, and electromagnetic navigation. Other technologies, such as magnification, narrow-band imaging and confocal fluorescence microendoscopy, are in development for the use within the airways.
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Affiliation(s)
- Felix J F Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.
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Choi JC, Yu CM, Ryu YJ, Jeon K, Choi KA, Kwon OJ, Kim H. The role of endoscopic surgery for completely obstructive endobronchial benign tumor. Korean J Intern Med 2006; 21:15-9. [PMID: 16646559 PMCID: PMC3891058 DOI: 10.3904/kjim.2006.21.1.15] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The improving techniques of therapeutic bronchoscopy have been replacing conventional surgery for resecting endobronchial benign tumor. However, there could be some limitation for performing bronchoscopic intervention for the patients with complete bronchial obstruction. To evaluate the role of endoscopic surgery for completely obstructive endobronchial benign tumor, we retrospectively reviewed the medical records of 7 patients who underwent bronchoscopic resection due to completely obstructive benign tumor. METHODS Rigid bronchoscopy was performed under general anesthesia. After the stalk of tumor was identified with using a 1 mm biopsy forceps as a probe, a Nd-YAG laser was used to coagulate the stalk of tumor. The tumor was then removed. RESULTS Bronchoscopic resection was successful in 6 out of 7 patients. The histological diagnoses were 3 leiomyomas, 3 harmatomas and 1 lipoma. There was no mortality in our study. Pneumomediastinum developed in 1 patient, and this patient was treated with 3 days of oxygen therapy. In 5 out of the 6 successful patients, there was no recurrence for a median of 35 months. In 1 patient, leiomyoma recurred after 17 months, and this was treated by pneumonectomy. CONCLUSIONS Endoscopic surgery could be applied to the patients with completely obstructive endobronchial benign tumor.
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Affiliation(s)
- Jae-Chol Choi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang Min Yu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yon Ju Ryu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeongman Jeon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung A Choi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - O Jung Kwon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Abstract
PURPOSE Urological malignancies are relatively common and patients often live many years with disease. There are many effective medical and surgical palliative treatments, although few comprehensive guidelines have been published. We reviewed the various palliative treatments available for the 3 most common urological malignancies, namely prostate cancer, bladder cancer and renal cancer. MATERIALS AND METHODS A literature search of the last 15 years was performed using MEDLINE/PubMed. In addition, relevant journals were targeted for specific information related to this review. Our clinical experience was combined with the current literature to create guidelines for palliative care. RESULTS Several effective treatments are available for the palliative care of patients with prostate, bladder or renal cancer. Options in palliative care are varied with regard to invasiveness, morbidity, risks and benefits. The algorithms described provide a framework to a sequential approach to achieving palliation. Urologists are central to initiating care and referrals to improve outcomes in these patients. CONCLUSIONS Palliative care includes disease directed treatment as well as functional, psychosocial and spiritual support. Disease directed therapy and palliative care should be provided simultaneously throughout illness. Improved quality of care and quality of life as well as physician satisfaction are frequent outcomes of this approach. Supportive care begins at initial diagnosis and it should be flexible to meet the changing needs of patients with cancer and their families.
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Affiliation(s)
- Joon-Ha Ok
- Department of Urology, University of California-Davis, Sacramento, California 95817, USA
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Chan AL, Juarez M, Allen R, Volz W, Albertson T. Pharmacokinetics and clinical effects of mono-l-aspartyl chlorin e6 (NPe6) photodynamic therapy in adult patients with primary or secondary cancer of the skin and mucosal surfaces. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2005; 21:72-8. [PMID: 15752124 DOI: 10.1111/j.1600-0781.2005.00138.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/PURPOSE Mono-L-aspartyl chlorin e6 (NPe6) is a photosensitizer that exhibits chemical purity, absorption at 664 nm wavelength and may be useful in photodynamic therapy (PDT). METHODS This open label phase I clinical trial at the University of California, Davis Medical Center examined the pharmacokinetic properties of Npe6 and clinical response to PDT with this photosensitizer. A single intravenous dose of Npe6 was administered to 14 cancer patients with superficial malignancies (basal cell carcinoma = 22 lesions, squamous cell cancer = 13 lesions, papillary carcinoma = 14 lesions). Patients received one of five ascending doses (0.5 mg/kg (n = 4), 1.0 mg/kg (n = 3), 1.65 mg/kg (n = 3), 2.5 mg/kg (n = 3), or 3.5 mg/kg (n = 1)) 4-8 h prior to light activation. The total light dose (range 25-200 J/cm2) depended on the tumor shape and size. Light was delivered using an argon-pumped tunable dye laser. Serum NPe6 concentrations were measured over a 28-day period. The toxicity and cutaneous clinical efficacy of NPe6 were observed. RESULTS Four weeks post-PDT, 20 of 22 basal cell carcinoma tumors (91%) showed a complete response. Eighteen of 27 other malignant cutaneous tumors showed a complete (n = 15/27, 56%) or partial (n = 3/27, 11%) response. Fewer non-responders were seen at an Npe6 dose level of 1.65 mg/kg or higher. Only 2 of 14 patients experienced an adverse event that was definitely related to NPe6 administration. Photosensitivity resolved within 1 week of NPe6 dosing in 12 of 14 patients. Analysis of serum levels of 11 individual patients indicated that a two-compartment model with a residual phase best fits the data. The mean alpha, beta, and terminal half-lives were 8.63+/-2.92, 105.90+/-37.59 and 168.11+/-53.40 h (+/-1 SD), respectively. The observed mean volume of distribution was 5.94+/-2.55 l, and the mean clearance was 0.0394+/-0.0132 l/h. These values were independent of the dose administered. CONCLUSION The photosensitizer, NPe6, was well tolerated with minimal phototoxic side effects, and demonstrated preliminary efficacy against cutaneous malignancies.
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Affiliation(s)
- Andrew L Chan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, University of California, Davis, CA, USA.
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Chan AL, Juarez MM, Albertson TE, Morrissey BM, Allen RP, Meyers FJ. Laser Treatment of Endobronchial Renal Cell Carcinoma. ACTA ACUST UNITED AC 2004. [DOI: 10.1097/00128594-200404000-00005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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