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Aquino NJ, Goobie SM, Staffa SJ, Eastburn E, Ganor O, Jones CT. Implementation of an Enhanced Recovery after Surgery Pathway for Transgender and Gender-Diverse Individuals Undergoing Chest Reconstruction Surgery: An Observational Cohort Study. J Clin Med 2023; 12:7083. [PMID: 38002695 PMCID: PMC10672389 DOI: 10.3390/jcm12227083] [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: 09/19/2023] [Revised: 11/05/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
Enhanced Recovery After Surgery (ERAS) protocols are associated with improved clinical outcomes in cisgender breast surgery patients. However, a paucity of research exists regarding transgender and gender-diverse individuals (TGD) in the ERAS framework. The primary objective of this observational cohort study is to describe the implementation of a gender-affirming ERAS protocol and its relationship to hospital length of stay (LOS) in TGD patients following chest reconstruction surgery. The secondary aim is to identify intraoperative predictors of LOS and define variables associated with adverse outcomes. We identified 362 patients in three epochs: a traditional group (n = 144), a partial ERAS implementation group (n = 92), and an ERAS group (n = 126). Exploratory multivariable median regression modeling was performed to identify independent predictors of LOS. We report that the traditional group's median hospital LOS was 1.1 days compared to 0.3 days in the ERAS group. Intraoperative tranexamic acid administration was associated with significantly shorter LOS (p < 0.001), reduced postoperative drainage (p < 0.001), and fewer returns to the operating room within 24 h (p = 0.047). Our data suggest that implementing a multimodal ERAS gender-affirming pathway was associated with improved patient-centered surgical outcomes such as decreased return to the operating room for hematoma evacuation, higher rates of discharge home, and reduced postoperative drainage output.
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Affiliation(s)
- Nelson J. Aquino
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Susan M. Goobie
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Steven J. Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Elizabeth Eastburn
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Oren Ganor
- Center for Gender Surgery, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Cathie T. Jones
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA
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Hur M, Kim JY, Kim DH, Yoo JY, Shin HB, Park B, Kim M, Park E, Park SY. Antitussive effect of a magnesium infusion during anesthetic emergence in patients with double-lumen endotracheal tube: a randomized controlled trial. J Thorac Dis 2020; 12:5691-5699. [PMID: 33209401 PMCID: PMC7656382 DOI: 10.21037/jtd-20-1977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background A double-lumen endotracheal tube (DLT) inserted into the bronchus can stimulate the respiratory tracts, causing coughing. Opioids have been introduced to prevent emergence cough. However, the administration of a significant opioid dose at the end of surgery may result in undesirable events. Magnesium, common intracellular ion, suppress bronchial smooth muscle contraction and have antitussive effect. We investigated the antitussive effects of a magnesium infusion during anesthetic emergence in patients who underwent thoracic surgery requiring one-lung ventilation (OLV) anesthesia with a DLT. Methods One-hundred forty patients undergoing OLV anesthesia with a DLT were enrolled in this prospective, randomized double-blinded trial. In combination with a low dose of remifentanil, patients were randomly allocated to receive either magnesium sulphate (infusion of 15 mg/kg/hour after a single bolus of 30 mg/kg) or normal saline during the operation and emergence. Primary outcomes were the severity and incidence of cough during emergence. Results The severity of cough was assessed by the cough severity grading score: 0, no cough; 1, single cough; 2, cough persistence <5 seconds; 3, cough persistence ≥5 seconds. There was a significant difference in the severity score of cough between the groups [median (IQR): 2 (0 to 3) in control group vs. 0 (0 to 1) in magnesium group, P=0.003]. However, there was no significant difference in the overall incidence of cough between both groups [42 (64.6%) in control group vs. 31 (47.7%) in magnesium group, P=0.077]. Conclusions Magnesium attenuated the severity of cough during emergence after OLV anesthesia using a DLT without adverse events.
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Affiliation(s)
- Min Hur
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Jong Yeop Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Dae Hee Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Ji Young Yoo
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Han-Bit Shin
- Office of Biostatistics, Medical Research Collaboration Center, Ajou Research Institute for Innovative Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Bumhee Park
- Office of Biostatistics, Medical Research Collaboration Center, Ajou Research Institute for Innovative Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Myungseob Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Eunjeong Park
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Sung Yong Park
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea
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Shaylor R, Verenkin V, Matot I. Anesthesia for Patients Undergoing Anesthesia for Elective Thoracic Surgery During the COVID-19 Pandemic: A Consensus Statement From the Israeli Society of Anesthesiologists. J Cardiothorac Vasc Anesth 2020; 34:3211-3217. [PMID: 32798170 PMCID: PMC7373002 DOI: 10.1053/j.jvca.2020.07.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 02/08/2023]
Abstract
Anesthesia for thoracic surgery requires specialist intervention to provide adequate operating conditions and one-lung ventilation. The pandemic caused by severe acute respiratory syndrome–associated coronavirus 2 (SARS-CoV-2) is transmitted by aerosol and droplet spread. Because of its virulence, there is a risk of transmission to healthcare workers if appropriate preventive measures are not taken. Coronavirus disease 2019 (COVID-19) patients may show no clinical signs at the early stages of the disease or even remain asymptomatic for the whole course of the disease. Despite the lack of symptoms, they may be able to transfer the virus. Unfortunately, during current COVID-19 testing procedures, about 30% of tests are associated with a false-negative result. For these reasons, standard practice is to assume all patients are COVID-19 positive regardless of swab results. Here, the authors present the recommendations produced by the Israeli Society of Anesthesiologists for use in thoracic anesthesia for elective surgery during the COVID-19 pandemic for both the general population and COVID-19–confirmed patients. The objective of these recommendations is to make changes to some routine techniques in thoracic anesthesia to augment patients’ and the medical staff's safety.
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Affiliation(s)
- Ruth Shaylor
- Division of Anesthesia, Pain and Intensive Care, Tel Aviv Sourasky Medical Center, Tel Aviv University, the Sackler Faculty of Medicine, Tel Aviv, Israel.
| | - Vladimir Verenkin
- Division of Anesthesia, Pain and Intensive Care, Tel Aviv Sourasky Medical Center, Tel Aviv University, the Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Idit Matot
- Division of Anesthesia, Pain and Intensive Care, Tel Aviv Sourasky Medical Center, Tel Aviv University, the Sackler Faculty of Medicine, Tel Aviv, Israel
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Trujillo A. Response to Wen and Li, Anesthesia Procedure of Emergency Operation for Patients with Suspected or Confirmed COVID-19 (DOI: 10.1089/sur.2020.040). Surg Infect (Larchmt) 2020; 21:398. [PMID: 32223697 DOI: 10.1089/sur.2020.088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alexander Trujillo
- Department of Surgery, Faculty of Health Sciences, Caldas University, Manizales, Caldas, Colombia; Faculty of Health Sciences, Medicine Program, Universidad de Manizales, Manizales, Colombia; Anesthesia Department, Clínica San Marcel, Manizales, Colombia
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Sevoflurane Impairs Short-Term Memory by Affecting PSD-95 and AMPA Receptor in the Hippocampus of a Mouse Model. Behav Neurol 2019; 2019:1068260. [PMID: 31772680 PMCID: PMC6854262 DOI: 10.1155/2019/1068260] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/23/2019] [Accepted: 09/10/2019] [Indexed: 11/18/2022] Open
Abstract
Objective To explore the effects of sevoflurane on the latency and error times of the passive avoidance and levels of PSD-95 and AMPA receptors in the hippocampus. We evaluated the effects of sevoflurane on short-term memory in adult mice and explored the possible mechanism. Methods 144 Kunming mice (2-3 months, 30-35 g) were randomly divided into two groups A (n = 64) and B (n = 80) and received the dark-avoidance (DA) and step-down avoidance (SA) tests, respectively. The groups DA and SA were further divided into control (inhaled 40% O2 2 h) and sevoflurane (3.3% sevoflurane and 40% O2 2 h) subgroups. Before inhalation intervention, all mice were trained to be familiar with the Morris water maze (MWM). According to the test points of behavioral indicators, 8 mice were randomly selected from each subgroup at point 12 h (T1), 24 h (T2), 48 h (T3), and 72 h (T4) after inhalation intervention. The step-through latency and error times were measured in 5 min. After the behavioral test, the mice were killed and the tissues of the hippocampus were taken for hematoxylin and eosin (H&E) staining. The expression level of PSD-95 and AMPA receptors in the hippocampus was detected by immunohistochemistry and Western Blot. The changes of synaptic transmission were measured via electrophysiology analysis of hippocampal slices. Results The mice in the control subgroups found the platform in a shorter pathway than those in the sevoflurane subgroups during an MWM test. The step-through latency of T1 and T2 in the sevoflurane subgroup was shorter than baseline time, and the error times were increased in 5 min and higher than baseline time when compared with the control subgroup (P < 0.05) in the A and B groups. Compared with the control subgroup, the expression level of PSD-95 and AMPA receptors in the hippocampus was decreased at T1 and T2 in the sevoflurane subgroup (P < 0.05). The nerve cells were partially swelling. Electrophysiology analysis showed that the levels of PSD-95 and AMPA receptor expression were associated with synaptic transmission. Conclusion Sevoflurane impaired short-term memory in adult mice by inhibiting the expression of PSD-95 and AMPA receptors in the hippocampus, which led to the decrease in synaptic transmission.
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Effect-site concentration of remifentanil for smooth emergence from sevoflurane anesthesia in patients undergoing endovascular neurointervention. PLoS One 2019; 14:e0218074. [PMID: 31185050 PMCID: PMC6559654 DOI: 10.1371/journal.pone.0218074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 04/12/2019] [Indexed: 11/25/2022] Open
Abstract
During emergence from general anesthesia, coughing caused by the endotracheal tube frequently occurs and is associated with various adverse complications. In patients undergoing endovascular neurointervention, achieving smooth emergence from general anesthesia without coughing is emphasized since coughing is associated with intracranial hypertension. Therefore, the up-and-down method was introduced to determine the effective effect-site concentration (Ce) of remifentanil to prevent coughing in 50% and 95% (EC50 and EC95) of patients during emergence from sevoflurane anesthesia for endovascular neurointervention. A total of 43 participants, American Society of Anesthesiologists class I or II participants, aged from 20 to 70 years who were undergoing endovascular neurointervention through transfemoral catheter for cerebrovascular disease were enrolled. Using the up-and-down method with isotonic regression, the EC50 and EC95 of remifentanil to prevent coughing during emergence from sevoflurane anesthesia were determined. We also investigated differences of hemodynamic and recovery profiles between the cough suppression group and the cough group. In total, 38 of 43 patients were included for estimation of EC50 and EC95. The EC50 and EC95 of remifentanil to prevent coughing were 1.42 ng/mL (95% confidence interval [CI], 1.28–1.56 ng/mL) and 1.70 ng/mL (95% CI, 1.67–2.60 ng/mL), respectively. There was comparable emergence and recovery data between the cough suppression group (n = 22) and the cough group (n = 16). However, the Ce of remifentanil and total dose of remifentanil were significantly higher in the cough suppression group (P = 0.002 and P = 0.004, respectively). Target-controlled infusion of remifentanil at 1.70 ng/mL could effectively prevent extubation-related coughing in 95% of neurointervention patients, which could ensure smooth emergence.
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Kim HY, Kim JY, Ahn SH, Lee SY, Park HY, Kwak HJ. Predicting effective remifentanil concentration in 95% of patients to prevent emergence cough after laryngomicroscopic surgery. Medicine (Baltimore) 2018; 97:e11258. [PMID: 29952995 PMCID: PMC6039629 DOI: 10.1097/md.0000000000011258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Smooth emergence or cough prevention is a clinically important concern in patients undergoing laryngomicroscopic surgery (LMS). The purpose of this study was to estimate the effective concentration of remifentanil in 95% of patients (EC95) for the prevention of emergence cough after LMS under propofol anesthesia using the biased coin design (BCD) up-down method.A total of 40 adult patients scheduled to undergo elective LMS were enrolled. Anesthesia induction and maintenance were performed with target-controlled infusion of propofol and remifentanil. Effective effect-site concentration (Ce) of remifentanil in 95% of patients for preventing emergence cough was estimated using a BCD method (starting from 1 ng/mL with a step size of 0.4 ng/mL). Hemodynamic and recovery profiles were observed after anesthesia.According to the study protocol, 20 patients were allocated to receive remifentanil Ce of 3.0 ng/mL, and 20 patients were assigned to receive lower concentrations of remifentanil, from 1.0 to 2.6 ng/mL. Based on isotonic regression with a bootstrapping method, EC95 (95% CI) of remifentanil Ce for the prevention of emergence cough from LMS was found to be 2.92 ng/mL (2.72-2.97 ng/mL). Compared with patients receiving lower concentrations of remifentanil, the incidence of hypoventilation before extubation and extubation time were significantly higher in those receiving remifentanil Ce of 3.0 ng/mL. However, hypoventilation incidence after extubation and staying time in the recovery room were comparable between the 2 groups.Using a BCD method, the EC95 of remifentanil Ce for the prevention of emergence cough was estimated to be 2.92 ng/mL (95% CI: 2.72-2.97 ng/mL) after LMS under propofol anesthesia.
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Affiliation(s)
- Ha Yeon Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon
| | - Jong Yeop Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon
| | - Soo Hwan Ahn
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon
| | - Sook Young Lee
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon
| | - Hee Yeon Park
- Department of Anesthesiology and Pain Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon, Republic of Korea
| | - Hyun Jeong Kwak
- Department of Anesthesiology and Pain Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon, Republic of Korea
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Shi NJ, Zhang WX, Zhang N, Zhong LN, Wang LP. Correlation of MDR1 gene polymorphisms with anesthetic effect of sevoflurane-remifentanil following pediatric tonsillectomy. Medicine (Baltimore) 2017; 96:e7002. [PMID: 28614221 PMCID: PMC5478306 DOI: 10.1097/md.0000000000007002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The motive of this study was to investigate the collaboration between MDR1 gene polymorphisms and anesthetic effects following pediatric tonsillectomy. METHODS All together 178 children undergoing tonsillectomy with preoperative sevoflurane-remifentanil anesthesia were selected. In order to determine MDR1 gene polymorphisms of 3435C > T, 1236C > T, and 2677G > T/A, polymerase chain reaction-restriction fragment length polymorphism was used. Mean arterial pressure (MAP), diastolic blood pressure (DBP), systolic blood pressure (SBP), and heart rate (HR) at T0 (5 mins after the repose), T1 (0 min after tracheal intubation), T2 (5 mins after the tracheal intubation), T3 (0 min after the tonsillectomy), T4 (0 min after removal of the mouth-gag) and T5 (5 min after the extubation) were observed. The visual analog scale (VAS), the face, legs, activity, cry, and consolability (FLACC) pain assessment, and Ramsay sedation score were recorded after the patients gained consciousness. The adverse reactions were also observed. RESULTS As compared to the CT + TT genotype of MDR1 1236C > T, the time of induction, respiration recovery, eye-opening, and extubation of children with the CC genotype was found to be shorter (all P <.05); the MAP, SBP, DBP, and HR were significantly reduced at T5 in children that possessed the CC genotype (all P <.05), the VAS at postoperative 1, 2, 4, and 8 hours and Ramsay sedation score were decreased, while the FLACC score increased (all P <.05). It was found that the adverse reaction rate was lower in children bearing the CC genotype (P <.05). CONCLUSION It could be concluded that anesthetic effect in patients with the MDR1 1236C > T CC genotype was found to be superior to those carrying the CT + TT genotype.
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Abstract
[This corrects the article DOI: 10.1097/MD.0000000000003291.][This corrects the article DOI: 10.1097/MD.0000000000003731.][This corrects the article DOI: 10.1097/MD.0000000000003791.][This corrects the article DOI: 10.1097/MD.0000000000003805.][This corrects the article DOI: 10.1097/MD.0000000000003827.][This corrects the article DOI: 10.1097/MD.0000000000003863.][This corrects the article DOI: 10.1097/MD.0000000000003878.][This corrects the article DOI: 10.1097/MD.0000000000003879.][This corrects the article DOI: 10.1097/MD.0000000000003884.][This corrects the article DOI: 10.1097/MD.0000000000003900.][This corrects the article DOI: 10.1097/MD.0000000000003513.][This corrects the article DOI: 10.1097/MD.0000000000003631.][This corrects the article DOI: 10.1097/MD.0000000000003644.][This corrects the article DOI: 10.1097/MD.0000000000003692.][This corrects the article DOI: 10.1097/MD.0000000000003701.][This corrects the article DOI: 10.1097/MD.0000000000003706.][This corrects the article DOI: 10.1097/MD.0000000000003712.][This corrects the article DOI: 10.1097/MD.0000000000003767.][This corrects the article DOI: 10.1097/MD.0000000000003781.][This corrects the article DOI: 10.1097/MD.0000000000003808.][This corrects the article DOI: 10.1097/MD.0000000000003831.][This corrects the article DOI: 10.1097/MD.0000000000003837.][This corrects the article DOI: 10.1097/MD.0000000000003839.][This corrects the article DOI: 10.1097/MD.0000000000003842.][This corrects the article DOI: 10.1097/MD.0000000000003843.][This corrects the article DOI: 10.1097/MD.0000000000003847.][This corrects the article DOI: 10.1097/MD.0000000000003848.][This corrects the article DOI: 10.1097/MD.0000000000003850.][This corrects the article DOI: 10.1097/MD.0000000000003861.][This corrects the article DOI: 10.1097/MD.0000000000003862.][This corrects the article DOI: 10.1097/MD.0000000000003864.][This corrects the article DOI: 10.1097/MD.0000000000003866.][This corrects the article DOI: 10.1097/MD.0000000000003871.][This corrects the article DOI: 10.1097/MD.0000000000003872.][This corrects the article DOI: 10.1097/MD.0000000000003880.][This corrects the article DOI: 10.1097/MD.0000000000003878.][This corrects the article DOI: 10.1097/MD.0000000000003873.][This corrects the article DOI: 10.1097/MD.0000000000003876.][This corrects the article DOI: 10.1097/MD.0000000000003879.][This corrects the article DOI: 10.1097/MD.0000000000003881.][This corrects the article DOI: 10.1097/MD.0000000000003884.][This corrects the article DOI: 10.1097/MD.0000000000003885.][This corrects the article DOI: 10.1097/MD.0000000000003888.][This corrects the article DOI: 10.1097/MD.0000000000003889.][This corrects the article DOI: 10.1097/MD.0000000000003891.][This corrects the article DOI: 10.1097/MD.0000000000003893.][This corrects the article DOI: 10.1097/MD.0000000000003894.][This corrects the article DOI: 10.1097/MD.0000000000003897.][This corrects the article DOI: 10.1097/MD.0000000000003899.][This corrects the article DOI: 10.1097/MD.0000000000003900.][This corrects the article DOI: 10.1097/MD.0000000000003901.][This corrects the article DOI: 10.1097/MD.0000000000003902.][This corrects the article DOI: 10.1097/MD.0000000000003903.][This corrects the article DOI: 10.1097/MD.0000000000003904.][This corrects the article DOI: 10.1097/MD.0000000000003908.][This corrects the article DOI: 10.1097/MD.0000000000003910.][This corrects the article DOI: 10.1097/MD.0000000000003912.][This corrects the article DOI: 10.1097/MD.0000000000003916.][This corrects the article DOI: 10.1097/MD.0000000000003917.][This corrects the article DOI: 10.1097/MD.0000000000003918.][This corrects the article DOI: 10.1097/MD.0000000000003920.][This corrects the article DOI: 10.1097/MD.0000000000003921.][This corrects the article DOI: 10.1097/MD.0000000000003923.][This corrects the article DOI: 10.1097/MD.0000000000003924.][This corrects the article DOI: 10.1097/MD.0000000000003925.][This corrects the article DOI: 10.1097/MD.0000000000003934.][This corrects the article DOI: 10.1097/MD.0000000000003941.][This corrects the article DOI: 10.1097/MD.0000000000003944.][This corrects the article DOI: 10.1097/MD.0000000000003970.].
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