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Wu J, Shen X, Wang T, Li J, Chen X, Lei Y, Tang B, Zhang P. Ultrasound-guided techniques for managing length- unstable femoral shaft fractures in children. BMC Musculoskelet Disord 2024; 25:622. [PMID: 39103800 DOI: 10.1186/s12891-024-07740-3] [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: 05/28/2023] [Accepted: 07/26/2024] [Indexed: 08/07/2024] Open
Abstract
OBJECTIVE The management of length-unstable femoral shaft fractures(LUFSFs) in pediatric patients is still controversial. This study aims to explore the clinical efficacy of ultrasound-guided closed reduction combined with external fixation for treating LUFSFs in children. METHODS We conducted a retrospective analysis of clinical data from 19 pediatric patients with LUFSFs who underwent ultrasound-guided closed reduction and external fixation between January 2018 and January 2023. Ultrasound was employed not only to facilitate closed reduction of the fracture but also to guide real-time insertion of Schanz pins and monitor pin length as it traversed the opposite cortex. Surgical time, intraoperative fluoroscopy count, hospital stay length, fracture fixation duration, complication incidence, fracture reduction quality at the final follow-up were recorded. RESULTS The patients' average age was 7.5 years( range: 5 to 11 years). The mean surgical duration was 70.4 min (range: 48-105 min), and the average intraoperative fluoroscopy count was 6.5 (range: 2-16). Fracture fixation lasted an average of 10.9 weeks (range: 7-20 weeks). All patients were followed up for more than one year. 6 cases of superficial pin tract infection occurred, which resolved with oral antibiotics and enhanced needle tract care. No deep infections were observed. Temporary stiffness of the knee joint was observed in 2 patients. According to Flynn's efficacy evaluation system, fracture reduction quality at the final follow-up was rated as excellent in 11 cases and satisfactory in 8 cases, yielding a combined success rate of 100% (19/19). CONCLUSIONS The technique of ultrasound-guided closed reduction combined with external fixation offers favorable outcomes for children aged 5 to 11 years with LUFSFs, reducing reliance on fluoroscopic guidance.
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Affiliation(s)
- Ji Wu
- Department of Pediatric Orthopedics, Wuhan Children's Hospital(Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, 100 Xianggang Road, Jiang'an District, Wuhan, China
| | - Xiantao Shen
- Department of Pediatric Orthopedics, Wuhan Children's Hospital(Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, 100 Xianggang Road, Jiang'an District, Wuhan, China
| | - Teng Wang
- Department of Pediatric Orthopedics, Wuhan Children's Hospital(Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, 100 Xianggang Road, Jiang'an District, Wuhan, China
| | - Jun Li
- Department of Pediatric Orthopedics, Wuhan Children's Hospital(Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, 100 Xianggang Road, Jiang'an District, Wuhan, China
| | - Xiaoliang Chen
- Department of Pediatric Orthopedics, Wuhan Children's Hospital(Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, 100 Xianggang Road, Jiang'an District, Wuhan, China
| | - Yuanxue Lei
- Department of Pediatric Orthopedics, Wuhan Children's Hospital(Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, 100 Xianggang Road, Jiang'an District, Wuhan, China
| | - Bingrong Tang
- Department of Medical Record Statistics, Wuhan Children's Hospital(Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, 100 Xianggang Road, Jiang'an District, Wuhan, China.
| | - Ping Zhang
- Department of Pediatric Orthopedics, Wuhan Children's Hospital(Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, 100 Xianggang Road, Jiang'an District, Wuhan, China.
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Antabak A, Boršćak N, Čagalj M, Ivelj R, Bumči I, Papeš D, Ćavar S, Bogović M, Bulić K, Luetić T. TREATMENT OF PEDIATRIC FEMORAL FRACTURES IN THE CITY OF ZAGREB. Acta Clin Croat 2020; 59:686-695. [PMID: 34285439 PMCID: PMC8253082 DOI: 10.20471/acc.2020.59.04.15] [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: 12/19/2016] [Accepted: 10/29/2018] [Indexed: 11/24/2022] Open
Abstract
Femur fractures in children can be treated with a number of operative and conservative methods. Numerous factors determine which method is optimal for a specific fracture. The aim of this research was to analyze distribution of femur fractures in children living in the urban communities of Zagreb and Zagreb County by localization, type and frequency of treatment methods used according to age and fracture mechanism. The research included 103 children aged up to 18 years, treated for femur fractures at the Zagreb University Hospital Centre and Zagreb Children’s Hospital. Data were collected from these institutions and a retrospective study covered the 2010-2015 period. The cause of fracture and diagnosis were coded with the help of the International Statistical Classification of Diseases and Related Health Problems. Operative treatment was applied in 55% of cases, which is contrary to previous researches. The highest incidence of femur fractures was recorded in the 0- to 4-year age groups, accounting for 49.1% of all fractures. These fractures mostly occurred due to falls and were more often treated with non-operative methods. All other age groups were mostly treated with operative methods. Coxofemoral immobilization and traction were used as non-operative methods, whereas flexible intramedullary nailing was the most frequently used operative method. The treatment depended on age, complexity of the fracture, fracture type, fragment displacement, and associated injuries. The cause was also an important factor on choosing the treatment method. Non-operative treatment was mostly used for fractures caused by falls (64.71% of cases due to falls) and operative treatment was mostly used for fractures caused by traffic accidents (79.4% of cases due to traffic accidents). It is a wide-known opinion that the best treatment for femur fractures in children is non-operative treatment. However, recent studies have shown that the use of operative methods in femur fracture treatment is growing. Our cohort of children treated during a five-year period (2010-2015) also underwent operative treatment more often than non-operative one. Two non-operative and eight operative methods were used. With such a large number of methods, it is clear that there is no unique method for all fractures. However, it is clear that the trend of using operative treatment is connected to the perennial trend of considerable sociodemographic and socioeconomic changes in urban settings such as Zagreb. Lifestyle changes directly affect the prevalence of femur fractures among children, as well as approach to treatment choice. General opinion is that most of fractures that occur at an early age can be treated with non-operative methods. Our research on femur fractures in children confirmed this rule. The youngest age group that had the highest incidence of fractures (49.1% of all fractures) was treated with non-operative methods in 75% of cases. Operative methods prevailed in other age groups. Similar results have been published by other authors. In conclusion, nearly half of all femur fractures (49.1%) occurred at a young age (0-4 years). Diaphysis fractures were most common. Most of the fractures that occurred during the 2010-2015 period were treated with operative methods, mostly in children aged 5-9 years. Out of eight different operative methods, elastic stable intramedullary osteosynthesis was most frequently used (60%). Coxofemoral immobilization and traction were used as non-operative methods.
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Affiliation(s)
| | - Nikolina Boršćak
- 1Zagreb University Hospital Centre, Department of Surgery, Division of Pediatric Surgery, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Zagreb Children's Hospital, Department of Surgery, Division of Traumatology, Zagreb, Croatia
| | - Marija Čagalj
- 1Zagreb University Hospital Centre, Department of Surgery, Division of Pediatric Surgery, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Zagreb Children's Hospital, Department of Surgery, Division of Traumatology, Zagreb, Croatia
| | - Renato Ivelj
- 1Zagreb University Hospital Centre, Department of Surgery, Division of Pediatric Surgery, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Zagreb Children's Hospital, Department of Surgery, Division of Traumatology, Zagreb, Croatia
| | - Igor Bumči
- 1Zagreb University Hospital Centre, Department of Surgery, Division of Pediatric Surgery, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Zagreb Children's Hospital, Department of Surgery, Division of Traumatology, Zagreb, Croatia
| | - Dino Papeš
- 1Zagreb University Hospital Centre, Department of Surgery, Division of Pediatric Surgery, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Zagreb Children's Hospital, Department of Surgery, Division of Traumatology, Zagreb, Croatia
| | - Stanko Ćavar
- 1Zagreb University Hospital Centre, Department of Surgery, Division of Pediatric Surgery, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Zagreb Children's Hospital, Department of Surgery, Division of Traumatology, Zagreb, Croatia
| | - Marko Bogović
- 1Zagreb University Hospital Centre, Department of Surgery, Division of Pediatric Surgery, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Zagreb Children's Hospital, Department of Surgery, Division of Traumatology, Zagreb, Croatia
| | - Krešimir Bulić
- 1Zagreb University Hospital Centre, Department of Surgery, Division of Pediatric Surgery, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Zagreb Children's Hospital, Department of Surgery, Division of Traumatology, Zagreb, Croatia
| | - Tomislav Luetić
- 1Zagreb University Hospital Centre, Department of Surgery, Division of Pediatric Surgery, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Zagreb Children's Hospital, Department of Surgery, Division of Traumatology, Zagreb, Croatia
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Kuroda T, Okano I, Sawada T, Okamoto S, Midorikawa Y, Tachibana T, Yagi T, Inagaki K. Recurrent femoral shaft fractures in a child with gnathodiaphyseal dysplasia: a case report. BMC Musculoskelet Disord 2019; 20:92. [PMID: 30797234 PMCID: PMC6387549 DOI: 10.1186/s12891-019-2464-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 02/12/2019] [Indexed: 12/13/2022] Open
Abstract
Background Gnathodiaphyseal dysplasia (GDD) is an extremely rare autosomal dominant disease characterized by cemento-osseous lesions in the jawbones, bone fragility, and diaphyseal sclerosis of the tubular bones. Patients with GDD are prone to sustain fractures by minor accidents. Although over 80 cases have been reported, detailed information about the orthopedic treatment of the fractures is limited. Case presentation A 9-year-old Japanese girl with a known history of GDD presented with pain and deformity in the left thigh after a minor fall. She had a displaced transverse fracture in the mid-shaft of the left femur and underwent a closed reduction and external fixation. In the 25th week after the initial surgery, she had another fracture in the left femur at one of the half-pin insertion sites. She underwent an external fixation again. After this operation, the patient sustained another refracture at the same fracture site and one supracondylar fracture at the distant site of the femur. The supracondylar fracture occurred without any triggering activity before beginning a weight-bearing exercise. The supracondylar fracture was successfully treated conservatively, but she sustained two more diaphyseal fractures at half-pin insertion sites one after another. She eventually underwent a revision surgery with a flexible intramedullary nail. At 3 months postoperatively, the fracture was healed and the patient maintained her ambulatory status without further refracture. Conclusions Patients with GDD might have narrower safety ranges of biomechanical and physiological drawbacks, which are considered to be acceptable in ordinary cases. The choice of treatment should be aimed at minimizing these negative effects. We recommend intramedullary devise as the first-choice implant for the treatment of isolated femoral shaft fracture in GDD patients in this age group.
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Affiliation(s)
- Takuma Kuroda
- Department of Orthopedic Surgery, Showa University Northern Yokohama Hospital, Chigasaki-chuo 35-1, Tsuzuki-ku, Yokohama-shi, Kanagawa, 224-8503, Japan.,Department of Orthopedic Surgery, Ohta-Nisihinouchi hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan.,Department of Orthopedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Ichiro Okano
- Department of Orthopedic Surgery, Ohta-Nisihinouchi hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan.
| | - Takatoshi Sawada
- Department of Orthopedic Surgery, Ohta-Nisihinouchi hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
| | - Satoshi Okamoto
- Department of Orthopedic Surgery, Ohta-Nisihinouchi hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan.,Department of Orthopedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Yuki Midorikawa
- Department of Orthopedic Surgery, Ohta-Nisihinouchi hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
| | - Tetsuya Tachibana
- Department of Orthopedic Surgery, Ohta-Nisihinouchi hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
| | - Toshio Yagi
- Department of Orthopedic Surgery, Ohta-Nisihinouchi hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan.,Department of Orthopedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Katsunori Inagaki
- Department of Orthopedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku, Tokyo, 142-8555, Japan
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Comparison between external fixation and elastic stable intramedullary nailing for the treatment of femoral shaft fractures in children younger than 8 years of age. J Pediatr Orthop B 2016; 25:471-7. [PMID: 27261769 DOI: 10.1097/bpb.0000000000000342] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The main objective of this study was to compare external fixation (EF) with elastic stable intramedullary nailing (ESIN) for the treatment of femoral shaft fractures in children aged 8 or younger. Fifteen children with femoral shaft fractures treated by EF and 23 children with femoral shaft fractures treated by ESIN were retrospectively reviewed. All patients were pain free at the last follow-up, with good ranges of motion in the hip and knee. Partial and full weight bearing occurred sooner in patients treated with EF than with ESIN, although more polytrauma patients were present in the ESIN group. In conclusion, EF and ESIN can be considered as safe and effective methods for femoral shaft fracture treatment in children younger than 8 years of age.
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Guo YC, Feng GM, Xing GW, Yin JN, Xia B, Dong YZ, Niu XQ, He Q, Hu P. A meta-analysis of flexible intramedullary nailing versus external fixation for pediatric femoral shaft fractures. J Pediatr Orthop B 2016; 25:466-70. [PMID: 27294706 DOI: 10.1097/bpb.0000000000000336] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To compare the difference in efficacy following flexible intramedullary nailing (FIN) and external fixation (EF) for pediatric femoral shaft fractures. A systematic search was performed on PubMed, Embase, Medline, and Cochrane library for relevant studies. We included controlled trials comparing complications between FIN and EF for pediatric femoral shaft fractures published before 25 November 2014. Modified Jadad scores were utilized to assess the methodological quality of the studies included. The meta-analysis was carried out using Stata 12.0 software. Six studies involving 237 patients were included. On comparison of EF, a low incidence of overall complications [relative risk (RR)=0.30, 95% confidence interval (CI): 0.19-0.46; P<0.001] and pin-tract infection (RR=0.286, 95% CI: 0.13-0.61; P=0.001), but a high risk of soft tissue irritation (RR=1.86, 95% CI: 1.35-2.56; P<0.001) were found in patients treated with the FIN approach. No significant differences in other complications were found. On the basis of current evidence, the use of FIN leads to fewer complications than EF and may be considered as the first-line approach in the treatment of femoral shaft fractures.
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Affiliation(s)
- Yong Cheng Guo
- aDepartment of Orthopedics, the Third Affiliated Hospital of Zhengzhou University bDepartment of Internal Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou,China
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Wani MM, Rashid M, Dar RA, Bashir A, Sultan A, Wani I, Rashid S, O'Sullivan M. Use of external fixator versus flexible intramedullary nailing in closed pediatric femur fractures: comparing results using data from two cohort studies. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 26:223-30. [PMID: 26754113 DOI: 10.1007/s00590-015-1737-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 12/21/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE Although external fixation and flexible intramedullary nailing have been extensively used in the management of pediatric femur fractures, there are very few studies, which have compared the results. The purpose of the study was to compare the results of external fixation and flexible intramedullary nailing in pediatric femur fractures. METHODS Two groups of patients were treated by external fixator (EF) and flexible intramedullary nailing (FIN) over two different but successive time periods and results compared. The first group (EF) consisted of 45 patients, and the second group had 50 patients. RESULTS The age in EF group ranged from 6 to 14 years (average 9.93 years), and the age in FIN group ranged from 6 to 11 years (average 7.66 years). In the EF group, fixator was removed at an average of 12.23 weeks. In the FIN group, radiographic union was evident at an average time of 10.06 weeks. Pin-site infection was common in EF group. One patient had a re-fracture in EF group, and one patient had to be re-operated in FIN group after he developed anterior angulation of more than 30°. CONCLUSION We believe that it is the discretion of the surgeon to operate on the femur fracture using either of the treatment modalities. Further randomized studies need to be conducted between these two treatment modalities.
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Affiliation(s)
- Mubashir Maqbool Wani
- Department of Orthopaedics, Medical College Srinagar, Hospital for Bone and Joint Surgery, Barzulla, J&K, 190005, India.
| | - Mubashir Rashid
- Department of Orthopaedics, SKIMS Medical College, Srinagar, J&K, 190018, India
| | - Riyaz Ahmad Dar
- Department of Orthopaedics, Medical College Srinagar, Hospital for Bone and Joint Surgery, Barzulla, J&K, 190005, India
| | - Arshad Bashir
- Department of Orthopaedics, Medical College Srinagar, Hospital for Bone and Joint Surgery, Barzulla, J&K, 190005, India
| | - Asif Sultan
- Department of Orthopaedics, Medical College Srinagar, Hospital for Bone and Joint Surgery, Barzulla, J&K, 190005, India
| | - Iqbal Wani
- Department of Orthopaedics, Medical College Srinagar, Hospital for Bone and Joint Surgery, Barzulla, J&K, 190005, India
| | - Shakir Rashid
- Department of Orthopaedics, Medical College Srinagar, Hospital for Bone and Joint Surgery, Barzulla, J&K, 190005, India
| | - Mark O'Sullivan
- Department of Orthopaedics, Royal Children's Hospital, Melbourne, Australia
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Nozaka K, Shimada Y, Miyakoshi N, Yamada S, Kasukawa Y, Noguchi A. Pathological fracture of the femur in Alagille syndrome that was treated with low-intensity pulsed ultrasound stimulation and an Ilizarov ring fixator: a case report. BMC Musculoskelet Disord 2014; 15:225. [PMID: 25004954 PMCID: PMC4109381 DOI: 10.1186/1471-2474-15-225] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 07/04/2014] [Indexed: 01/20/2023] Open
Abstract
Background Alagille syndrome is a multisystem disorder, which is characterized by hypoplasia of the intrahepatic bile ducts, malformations of the cardiovascular system, eyes, and vertebral column, and abnormal facies. Several of the characteristics of Alagille syndrome may result in an especially high risk of fracture. The majority of patients suffer from chronic cholestasis, which can have a variety of adverse effects on bone metabolism. In Alagille syndrome, fractures primarily occur in the lower limb long bones in the absence of significant trauma. Case presentation A 9-year-old Japanese girl with Alagille syndrome was admitted to our institution with marked hyperbilirubinemia and a pathological fracture of the femur. She had been diagnosed with biliary atresia at the age of 1 month and treated with surgical bile duct reconstruction, vitamins D and K, and ursodeoxycholic acid. However, her liver dysfunction and hyperbilirubinemia worsened. The pathological fracture of the femur was treated with low-intensity pulsed ultrasound stimulation (LIPUS) and an Ilizarov ring fixator. Seventy-four days after surgery, the patient had anatomically and functionally recovered. There was no leg-length discrepancy and no angular malalignment of the lower extremities as measured clinically and radiographically. The range of motion of the hip, knee, and ankle of the patient’s operative leg matched the range of motion in the nonoperative leg. Conclusion To the best of our knowledge, there are no reports on use of the Ilizarov frame and LIPUS in diaphyseal femoral fractures in Alagille syndrome. This case report provides evidence that this procedure is successful for managing such diaphyseal fractures in Alagille syndrome.
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Affiliation(s)
- Koji Nozaka
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Hondo, Akita 010-8543, Japan.
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