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Yuxuan L, Junchao L, Wenya L. The role of sarcopenia in treatment-related outcomes in patients with renal cell carcinoma: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e31332. [PMID: 36316941 PMCID: PMC9622586 DOI: 10.1097/md.0000000000031332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND in recent years, more attention has been paid to the fuzzy relationship between skeletal muscle components and renal cell carcinoma (RCC). This study attempts to conduct a meta-analysis using all relevant research evidence to explore the impact of sarcopenia on the final survival and recurrence outcome of RCC patients and the change process of this impact after treatment. METHODS This systematic review and Meta-analysis study took "sarcopenia", "kidney" and "tumor" and their synonyms as the main search terms, and comprehensively searched all relevant literatures published in PubMed, web of science, SpringerLink, EMBASE, Cochrane Library, Ovid (Lww oup), Wiley, ScienceDirect and Scopus databases since February 2, 2022. Multivariate hazard ratio (HR) and 95% confidence interval (CI) of overall survival (OS), cancer specific survival (CSS), and progression free survival (PFS), as well as rough data of Kaplan-Meier survival curve, were combined as the main analysis results. Subgroup analyses based on cohort characteristics (treatment, ethnicity, and BMI factors) for each study were used as secondary outcomes. The combined effect was estimated by random effect model or fixed effect model, and the heterogeneity was evaluated by I2 value. Because this study belongs to secondary literature, the medical ethics committee of the First Affiliated Hospital of Xinjiang Medical University considers that ethical review is unnecessary. RESULTS Eighteen retrospective studies involving 3591 patients with RCC were analyzed, of which 71.5% were men and the median age of the cohort was 61.6. The prevalence of sarcopenia was 43% (38-48%). Sarcopenia is an independent predictor of OS (HR: 1.83, 95% CI = [1.41, 2.37]), and this prognostic value can also be reflected in Asian populations (HR: 2.59, 95% CI = [1.90, 3.54]) and drug treated patients (HR: 2.07, 95% CI = [1.07, 4.04]). Sarcopenia can also be used as an independent predictor of CSS (HR: 1.78, 95% CI = [1.34, 2.36]) and PFS (HR: 1.98, 95% CI = [1.34, 2.92]). The effect of low skeletal muscle mass on OS and CSS increased slowly from 1 to 5 years. CONCLUSION Sarcopenia can be used as a comprehensive prognostic factor in RCC population, but the detailed effects from ethnic characteristics and treatment mechanism need to be further studied.
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Affiliation(s)
- Li Yuxuan
- Imaging Department, the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangdong, China
| | - Li Junchao
- Imaging Department, the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangdong, China
| | - Liu Wenya
- Imaging Department, the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangdong, China
- * Correspondence: Liu Wenya, Imaging Department, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830000, China (e-mail:)
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Pennington Z, Larry Lo SF, Sciubba DM. In Reply to the Letter to the Editor Regarding “Surgical Approaches to Tumors of the Occipito-Cervical, Subaxial Cervical, and Cervicothoracic Spine: An Algorithm for Standard versus Extended Anterior Cervical Access”. World Neurosurg 2022; 164:473. [DOI: 10.1016/j.wneu.2022.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022]
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Elsamadicy AA, Havlik JL, Reeves B, Sherman J, Koo AB, Pennington Z, Hersh AM, Sandhu MRS, Kolb L, Larry Lo SF, Shin JH, Mendel E, Sciubba DM. Assessment of Frailty Indices and Charlson Comorbidity Index for Predicting Adverse Outcomes in Patients Undergoing Surgery for Spine Metastases: A National Database Analysis. World Neurosurg 2022; 164:e1058-e1070. [PMID: 35644519 DOI: 10.1016/j.wneu.2022.05.101] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 05/21/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this study was to assess the predictive ability of Metastatic Spinal Tumor Frailty Index (MSTFI) and the Modified 5-Item Frailty Index (mFI-5) on adverse outcomes, compared with the known Charlson Comorbidity Index (CCI). METHODS A retrospective cohort study was performed using National Surgical Quality Improvement Program database from 2011 to 2019. All adult patients undergoing various procedures for extradural spinal metastases were identified. Patients were stratified into frail and nonfrail cohorts based on CCI, mFI-5, and MSTFI scores. A multivariate logistic regression analysis was used to identify independent predictors of prolonged length of stay, nonroutine discharge, adverse events, and unplanned readmission. RESULTS Of the 1613 patients included in this study, 21.4% had a CCI >0, 56.6% had an mFI-5 >0, and 76.7% of patients had an MSTFI >0. On multivariate analysis, all 3 indices were found to be predictive of nonroutine discharge (CCI: adjusted odds ratio [aOR], 1.41 vs. mFI-5: aOR, 1.37 vs. MSTFI: aOR, 1.5) and adverse events (CCI: aOR, 1.53 vs. mFI-5: aOR, 1.23 vs. MSTFI: aOR, 1.43). High CCI (adjusted relative risk, 1.67) and MSTFI (adjusted relative risk, 1.14), but not mFI-5, were also associated with a prolonged length of stay, whereas MSTFI was found to be the only significant predictor of unplanned readmission (aOR, 1.22). CONCLUSIONS Our study suggests that MSTFI frailty index may be more sensitive than both CCI and mFI-5 in identifying adverse outcomes after spine surgery for metastases.
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Affiliation(s)
- Aladine A Elsamadicy
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.
| | - John L Havlik
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Benjamin Reeves
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Josiah Sherman
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Andrew B Koo
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Zach Pennington
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew M Hersh
- Department of Neurosurgery, John Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Mani Ratnesh S Sandhu
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Luis Kolb
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sheng-Fu Larry Lo
- Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ehud Mendel
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, John Hopkins School of Medicine, Baltimore, Maryland, USA; Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York, USA
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Hersh AM, Pennington Z, Hung B, Patel J, Goldsborough E, Schilling A, Feghali J, Antar A, Srivastava S, Botros D, Elsamadicy AA, Lo SFL, Sciubba DM. Comparison of frailty metrics and the Charlson Comorbidity Index for predicting adverse outcomes in patients undergoing surgery for spine metastases. J Neurosurg Spine 2022; 36:849-857. [PMID: 34826820 DOI: 10.3171/2021.8.spine21559] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 08/24/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Frailty-the state defined by decreased physiological reserve and increased vulnerability to physiological stress-is exceedingly common in oncology patients. Given the palliative nature of spine metastasis surgery, it is imperative that patients be healthy enough to tolerate the physical insult of surgery. In the present study, the authors compared the association of two frailty metrics and the widely used Charlson Comorbidity Index (CCI) with postoperative morbidity in spine metastasis patients. METHODS A retrospective cohort of patients who underwent operations for spinal metastases at a comprehensive cancer center were identified. Data on patient demographic characteristics, disease state, medical comorbidities, operative details, and postoperative outcomes were collected. Frailty was measured with the modified 5-item frailty index (mFI-5) and metastatic spinal tumor frailty index (MSTFI). Outcomes of interest were length of stay (LOS) greater than the 75th percentile of the cohort, nonroutine discharge, and the occurrence of ≥ 1 postoperative complication. RESULTS In total, 322 patients were included (mean age 59.5 ± 12 years; 56.9% of patients were male). The mean ± SD LOS was 11.2 ± 9.9 days, 44.5% of patients had nonroutine discharge, and 24.0% experienced ≥ 1 postoperative complication. On multivariable analysis, increased frailty on mFI-5 and MSTFI was independently predictive of all three outcomes: prolonged LOS (OR 1.67 per point, 95% CI 1.06-2.63, p = 0.03; and OR 1.63 per point, 95% CI 1.29-2.05, p < 0.01, respectively), nonroutine discharge (OR 2.65 per point, 95% CI 1.74-4.04, p < 0.01; and OR 1.69 per point, 95% CI 1.36-2.11, p < 0.01), and ≥ 1 complication (OR 1.95 per point, 95% CI 1.23-3.09, p = 0.01; and OR 1.41 per point, 95% CI 1.12-1.77, p < 0.01). CCI was found to be independently predictive of only the occurrence of ≥ 1 postoperative complication (OR 1.45 per point, 95% CI 1.22-1.72, p < 0.01). CONCLUSIONS Frailty measured with either mFI-5 or MSTFI scores was a more robust independent predictor of adverse postoperative outcomes than the more widely used CCI. Both mFI-5 and MSTFI were significantly associated with prolonged LOS, higher complication rates, and nonroutine discharge. Further investigation in a prospective multicenter cohort is merited.
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Affiliation(s)
- Andrew M Hersh
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Zach Pennington
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bethany Hung
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jaimin Patel
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Earl Goldsborough
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew Schilling
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - James Feghali
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Albert Antar
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Siddhartha Srivastava
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David Botros
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Sheng-Fu Larry Lo
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel M Sciubba
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- 2Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York; and
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Bongers MER, Groot OQ, Buckless CG, Kapoor ND, Twining PK, Schwab JH, Torriani M, Bredella MA. Body composition predictors of mortality on computed tomography in patients with spinal metastases undergoing surgical treatment. Spine J 2022; 22:595-604. [PMID: 34699994 PMCID: PMC8957497 DOI: 10.1016/j.spinee.2021.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/28/2021] [Accepted: 10/12/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although survival of patients with spinal metastases has improved over the last decades due to advances in multi-modal therapy, there are currently no reliable predictors of mortality. Body composition measurements obtained using computed tomography (CT) have been recently proposed as biomarkers for survival in patients with and without cancer. Patients with cancer routinely undergo CT for staging or surveillance of therapy. Body composition assessed using opportunistic CTs might be used to determine survival in patients with spinal metastases. PURPOSE The purpose of this study was to determine the value of body composition measures obtained on opportunistic abdomen CTs to predict 90-day and 1-year mortality in patients with spinal metastases undergoing surgery. We hypothesized that low muscle and abdominal fat mass were positive predictors of mortality. STUDY DESIGN Retrospective study at a single tertiary care center in the United States. PATIENT SAMPLE This retrospective study included 196 patients between 2001 and 2016 that were 18 years of age or older, underwent surgical treatment for spinal metastases, and had a preoperative CT of the abdomen within three months prior to surgery. OUTCOME MEASURES Ninety-day and 1-year mortality by any cause. METHODS Quantification of cross-sectional areas (CSA) and CT attenuation of abdominal subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and paraspinous and abdominal skeletal muscle were performed on CT images at the level of L4 using an in-house automated algorithm. Sarcopenia was determined by total muscle CSA (cm2) divided by height squared (m2) with cutoff values of <52.4 cm2/m2 for men and <38.5 cm2/m2 for women. Bivariate and multivariate Cox proportional-hazard analyses were used to determine the associations between body compositions and 90-day and 1-year mortality. RESULTS The median age was 62 years (interquartile range=53-70). The mortality rate for 90-day was 24% and 1-year 54%. The presence of sarcopenia was associated with an increased 1-year mortality rate of 66% compared with a 1-year mortality rate of 41% in patients without sarcopenia (hazard ratio, 1.68; 95% confidence interval, 1.08-2.61; p=.02) after adjusting for various clinical factors including primary tumor type, ECOG performance status, additional metastases, neurology status, and systemic therapy. Additional analysis showed an association between sarcopenia and increased 1-year mortality when controlling for the prognostic modified Bauer score (HR, 1.58; 95%CI, 1.04-2.40; p=.03). Abdominal fat CSAs or muscle attenuation were not independently associated with mortality. CONCLUSIONS The presence of sarcopenia is associated with an increased risk of 1-year mortality for patients surgically treated for spinal metastases. Sarcopenia retained an independent association with mortality when controlling for the prognostic modified Bauer score. This implies that body composition measurements such as sarcopenia could serve as novel biomarkers for prediction of mortality and may supplement other existing prognostic tools to improve shared decision making for patients with spinal metastases that are contemplating surgical treatment.
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Affiliation(s)
- Michiel E R Bongers
- Department of Orthopaedic Surgery - Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, Yawkey 3A, 55 Fruit St, Boston, MA 02114, USA
| | - Olivier Q Groot
- Department of Orthopaedic Surgery - Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, Yawkey 3A, 55 Fruit St, Boston, MA 02114, USA
| | - Colleen G Buckless
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit St, Boston, MA 02114, USA
| | - Neal D Kapoor
- Department of Orthopaedic Surgery - Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, Yawkey 3A, 55 Fruit St, Boston, MA 02114, USA
| | - Peter K Twining
- Department of Orthopaedic Surgery - Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, Yawkey 3A, 55 Fruit St, Boston, MA 02114, USA
| | - Joseph H Schwab
- Department of Orthopaedic Surgery - Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School, Yawkey 3A, 55 Fruit St, Boston, MA 02114, USA
| | - Martin Torriani
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit St, Boston, MA 02114, USA
| | - Miriam A Bredella
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit St, Boston, MA 02114, USA.
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Associations of fat and muscle mass with overall survival in men with prostate cancer: a systematic review with meta-analysis. Prostate Cancer Prostatic Dis 2022; 25:615-626. [PMID: 34420038 PMCID: PMC9705235 DOI: 10.1038/s41391-021-00442-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND To systematically review and analyse the associations between fat and muscle mass measures with overall survival in men with prostate cancer. METHODS A systematic search was conducted in CINAHL, Cochrane Library, EMBASE, PubMed, and Web of Science databases from inception to December 2020, while abstracts from the American Society of Clinical Oncology (ASCO), Clinical Oncology Society of Australia (COSA), and the American College of Sports Medicine (ACSM) conferences were searched from 2014 to 2020. Eligible articles examined the association of body composition measures, such as fat mass (e.g., fat mass, visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and VAT/SAT) and muscle mass measures, with overall survival in prostate cancer patients at any treatment stage. The primary endpoint was overall survival. Random-effect meta-analysis was conducted for studies reporting multivariable or univariable analysis assessing the associations of fat mass measures (i.e., fat mass, VAT, SAT, VAT/SAT) and muscle mass measures with overall survival. RESULTS Sixteen cohort studies that comprised 4807 men with prostate cancer were included. Total adiposity (hazard ratio (HR) 0.98, 95% CI: 0.75-1.28, p = 0.888) and VAT (HR 1.03, 95% CI: 0.74-1.43, p = 0.873) were not significantly associated with overall survival, while higher subcutaneous adipose tissue levels were associated with higher survival (HR 0.68, 95% CI: 0.54-0.84, p = 0.001). Greater mortality risk was found in patients with localised (HR 1.91, 95% CI: 1.40-2.62, p < 0.001) and advanced disease (HR 1.43, 95% CI: 1.07-1.92, p = 0.020) presenting with low levels of muscle mass compared to those presenting with high levels. DISCUSSION These results indicate that although overall adiposity should be cautiously interpreted in regards to survival, high muscle mass and SAT, and low VAT/SAT ratio values are associated with overall survival in men with prostate cancer.
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Pennington Z, Ehresman J, Szerlip NJ, Sciubba DM. Hybrid Therapy for Metastatic Disease. Clin Spine Surg 2021; 34:369-376. [PMID: 33769974 DOI: 10.1097/bsd.0000000000001173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/24/2021] [Indexed: 11/25/2022]
Abstract
Metastatic spine disease represents a complex clinical entity, requiring a multidisciplinary treatment team to formulate treatment plans that treat disease, palliate symptoms, and give patients the greatest quality-of-life. With the improvement in focused radiation technologies, the role of surgery has changed from a standalone treatment to an adjuvant supporting other treatment modalities. As patients within this population are often exceptionally frail, there has been increased emphasis on the smallest possible surgery to achieve the team's treatment goals. Surgeons have increasingly turned to more minimally invasive techniques for treating spinal metastases. The use of these procedures, called separation surgery, centers around the goal of decompressing the neural elements, creating or maintaining mechanical stability, and allowing enough room for high-dose radiation to minimize cord dose.
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Affiliation(s)
- Zach Pennington
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Jeff Ehresman
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD
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Pennington Z, Ehresman J, Cottrill E, Lubelski D, Lehner K, Feghali J, Ahmed AK, Schilling A, Sciubba DM. To operate, or not to operate? Narrative review of the role of survival predictors in patient selection for operative management of patients with metastatic spine disease. J Neurosurg Spine 2021; 34:135-149. [PMID: 32916652 DOI: 10.3171/2020.6.spine20707] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/01/2020] [Indexed: 11/06/2022]
Abstract
Accurate prediction of patient survival is an essential component of the preoperative evaluation of patients with spinal metastases. Over the past quarter of a century, a number of predictors have been developed, although none have been accurate enough to be instituted as a staple of clinical practice. However, recently more comprehensive survival calculators have been published that make use of larger data sets and machine learning to predict postoperative survival among patients with spine metastases. Given the glut of calculators that have been published, the authors sought to perform a narrative review of the current literature, highlighting existing calculators along with the strengths and weaknesses of each. In doing so, they identify two "generations" of scoring systems-a first generation based on a priori factor weighting and a second generation comprising predictive tools that are developed using advanced statistical modeling and are focused on clinical deployment. In spite of recent advances, the authors found that most predictors have only a moderate ability to explain variation in patient survival. Second-generation models have a greater prognostic accuracy relative to first-generation scoring systems, but most still require external validation. Given this, it seems that there are two outstanding goals for these survival predictors, foremost being external validation of current calculators in multicenter prospective cohorts, as the majority have been developed from, and internally validated within, the same single-institution data sets. Lastly, current predictors should be modified to incorporate advances in targeted systemic therapy and radiotherapy, which have been heretofore largely ignored.
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Ehresman J, Ahmed AK, Schilling A, Pennington Z, Lubelski D, Cottrill E, Goodwin ML, Liddy A, Abu-Bonsrah N, Goodwin CR, Sciubba DM. Preoperative Nutrition Consults Associated with Decreased Postoperative Complication Rate and Decreased Length of Hospital Stay After Spine Metastasis Surgery. World Neurosurg 2020; 133:e173-e179. [DOI: 10.1016/j.wneu.2019.08.197] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/23/2019] [Accepted: 08/24/2019] [Indexed: 12/11/2022]
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