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Mansour W, Miceli F, Di Girolamo A, Dajci A, Marzano A, Cangiano R, Ascione M, di Marzo L. Long-Term Results of Surgical Treatment for Popliteal Artery Entrapment Syndrome. Diagnostics (Basel) 2024; 14:1302. [PMID: 38928717 PMCID: PMC11202412 DOI: 10.3390/diagnostics14121302] [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: 05/23/2024] [Revised: 06/07/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Popliteal artery entrapment syndrome (PAES) is a rare disease of the lower limbs, mainly affecting young patients, due to extrinsic compression of the neurovascular bundle at the popliteal fossa. The aim of this study was to describe our experience during a median 15-year period. METHODS Patients treated for PAES in our institution from 1979 to 2024 were included. Preoperative, intraoperative, and postoperative data were analyzed. RESULTS A total of 47 patients with a total of 78 limbs were treated. Duplex ultrasound with active maneuvers was performed in all limbs (100%). Angiography was performed in almost all patients (97.4%), computed tomography angiography in 56 (71.8%), and magnetic resonance angiography in 22 (28.2%). Concerning surgical treatment, musculotendinous section was performed in 60 limbs (76.9%), and autologous venous bypass was achieved in 18 limbs (23.1%). The rates for freedom from target lesion revascularization-meaning that no significant stenosis or occlusion during follow-up required revascularization-and 15-year primary patency were 92.4% and 98%, respectively. CONCLUSION Long-term results of surgical treatment for PAES seem to be very satisfying. Myotomy with or without arterial reconstruction using venous bypass can lead to good patency at 15 years of follow-up.
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Affiliation(s)
- Wassim Mansour
- Vascular and Endovascular Surgery Division, Department of General Surgery and Surgical Specialties, Policlinico Umberto I, “Sapienza” University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (A.D.G.); (A.D.); (A.M.); (R.C.); (M.A.); (L.d.M.)
| | - Francesca Miceli
- Vascular and Endovascular Surgery Division, Department of General Surgery and Surgical Specialties, Policlinico Umberto I, “Sapienza” University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (A.D.G.); (A.D.); (A.M.); (R.C.); (M.A.); (L.d.M.)
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Hamdan R, Chapelon B, Kisterman JP, Baldassini AL, Falchero C, Chrétien N, Marx P, Van Der Bol Murat D. Severe ischemia due to popliteal artery occlusion in a young patient: Evidence of type 3 popliteal artery entrapment syndrome on Doppler ultrasound. JOURNAL DE MEDECINE VASCULAIRE 2024; 49:112-114. [PMID: 38697707 DOI: 10.1016/j.jdmv.2024.01.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/17/2024] [Indexed: 05/05/2024]
Affiliation(s)
- Rémy Hamdan
- Explorations fonctionnelles de médecine vasculaire, centre hospitalier de Mâcon, 350, boulevard Louis-Escande, 71000 Mâcon, France.
| | - Benoît Chapelon
- Service d'angiologie, centre hospitalier du Pays Charolais Brionnais, Paray-le-Monial, France
| | | | - Anne-Laure Baldassini
- Explorations fonctionnelles de médecine vasculaire, centre hospitalier de Mâcon, 350, boulevard Louis-Escande, 71000 Mâcon, France
| | - Catherine Falchero
- Explorations fonctionnelles de médecine vasculaire, centre hospitalier de Mâcon, 350, boulevard Louis-Escande, 71000 Mâcon, France
| | - Nicolas Chrétien
- Service de chirurgie vasculaire, centre hospitalier de Mâcon, Mâcon, France
| | - Pierre Marx
- Service d'imagerie médicale, centre hospitalier de Mâcon, Mâcon, France
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Ghaffarian AA, Hemingway J, Quiroga E, Tran N, Starnes BW, Singh N. Dynamic Imaging is the Ideal Modality for the Diagnosis of Popliteal Artery Entrapment Syndrome. Ann Vasc Surg 2023; 97:106-112. [PMID: 37356661 DOI: 10.1016/j.avsg.2023.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Popliteal Artery Entrapment Syndrome (PAES) is a rare vascular condition with significant equipoise on how to properly diagnose and evaluate relevant imaging. This can lead to misdiagnosis and delay in surgical management. The objective of this study is to describe and compare distinct imaging features of dynamic versus static images to help determine the ideal imaging modality for diagnosis of PAES. METHODS This is a retrospective review of patients referred for PAES at a single institution. We reviewed noninvasive imaging studies, diagnostic arteriograms, and cross-sectional images which include computed tomography angiography (CTA) or magnetic resonance angiography (MRA). For each affected and unaffected extremity, the characteristic collaterals for PAES were named and measured on arteriogram using Picture Archiving and Communication Software. Available cross-sectional images were also analyzed and compared with arteriogram and intraoperative findings during surgical exploration. RESULTS There were 23 patients referred for PAES who underwent diagnostic evaluation and surgical management between 2013 and 2022. All patients had a duplex ultrasound that revealed a mean popliteal peak systolic velocity of 78 cm/sec at rest. With forced plantar flexion, the peak systolic velocity increased to a mean 175 cm/sec. A total of 12 extremities had complete loss of flow with provocation during duplex ultrasound. All patients underwent diagnostic angiography of 46 extremities. All limbs with PAES (n = 35) exhibited complete popliteal artery occlusion during angiography with forced plantar flexion. Distinct angiographic findings on resting images included a well-developed medial sural artery in 100% of limbs with PAES with a mean diameter of 2.7 mm. In limbs without PAES, only 80% had a visualized medial sural artery on arteriogram with a mean diameter of 2.0 mm (P = 0.1). A lateral sural artery was seen in 85% of affected extremities (mean diameter of 1.8 mm), while an anterior tibial recurrent artery was seen in 59% of affected extremities (mean diameter of 1.3 mm). In unaffected limbs, there were no visible lateral sural or anterior tibial recurrent arteries. The mean contrast used with diagnostic arteriograms was 58 milliliters (range 10-100 milliliters). Axial imaging was available for 9 affected extremities. Five had a previous MRA with only 1 being truly positive for arterial compression. Four extremities had previous CTA with 3 being falsely negative despite having type 3 PAES discovered during surgical exploration. CONCLUSIONS Dynamic imaging with angiography provides immediate surgeon feedback by visualizing popliteal artery compression and enlarged sural collaterals during resting arteriography. The medial sural collateral is enlarged in patients with PAES and often the lateral sural and anterior tibial recurrent arteries can be visualized as well. CTA and MRA are associated with high false-negative rates, and therefore cause delays in diagnosis and surgical management of PAES. Dynamic imaging should, therefore, be the gold standard for the diagnosis of PAES.
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Affiliation(s)
- Amir A Ghaffarian
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA
| | - Jake Hemingway
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA
| | - Elina Quiroga
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA
| | - Nam Tran
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA
| | - Benjamin W Starnes
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA
| | - Niten Singh
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA.
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Keddie D, Abdulrehman Y, Shiau G. Reporting lower extremity CT angiography for treatment planning. Diagn Interv Imaging 2022; 103:387-393. [PMID: 35843841 DOI: 10.1016/j.diii.2022.06.010] [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: 03/08/2022] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 11/03/2022]
Abstract
Diagnostic radiologists play an important role in the evaluation of patients presenting with signs and symptoms of lower extremity peripheral vascular disease, including critical limb ischemia in both acute and chronic settings, and intermittent claudication. The complications associated with tissue and/or limb loss related to acute limb ischemia and critical limb ischemia of the lower extremity make rapid diagnosis and early intervention critical in the management of these patients. Computed tomography angiography (CTA) is an effective, widely available, easily reproducible, non-invasive imaging modality that offers a rapid and accurate means to diagnose and grade the extent of vascular disease. However, CTA run-off reports are usually dictated in free text form, and referring and treating physicians may be unsure whether an anatomic structure has been evaluated if it has not been specifically mentioned in the report. In this article, the vascular anatomy and anatomic variants of the lower extremity, the most common lower extremity vascular pathologies are reviewed and clinically important CTA imaging findings are outlined. This provides a framework for radiologists to accurately evaluate lower extremity vascular pathologies and convey clinically relevant imaging findings for management by vascular surgeons or interventional radiologists.
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Affiliation(s)
- Danae Keddie
- Faculty of Medicine and Dentistry, Walter C Mackenzie Health Sciences Center, University of Alberta, Edmonton, Alberta, T6G 2B7, Canada.
| | - Yaasin Abdulrehman
- Faculty of Medicine and Dentistry, Walter C Mackenzie Health Sciences Center, University of Alberta, Edmonton, Alberta, T6G 2B7, Canada; Department of Surgery, Walter C Mackenzie Health Sciences Center, University of Alberta, Edmonton, Alberta, T6G 2B7, Canada
| | - Gillian Shiau
- Faculty of Medicine and Dentistry, Walter C Mackenzie Health Sciences Center, University of Alberta, Edmonton, Alberta, T6G 2B7, Canada; Radiology and Diagnostic Imaging Department, Walter C Mackenzie Health Sciences Center, University of Alberta, Edmonton, Alberta, T6G 2B7, Canada
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Clinical Outcomes of a Diagnostic and Management Protocol for Popliteal Artery Entrapment Syndrome at a Large Referral Center. Ann Vasc Surg 2022; 87:140-146. [PMID: 35460858 DOI: 10.1016/j.avsg.2022.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Popliteal Artery Entrapment Syndrome (PAES) is a rare clinical entity without a standardized algorithm for diagnosis and treatment. The objective of this study was to evaluate the clinical outcomes of a unique diagnostic and management algorithm for patients with PAES managed at a quaternary referral center. METHODS We retrospectively reviewed patients diagnosed with PAES at a single institution between 2013 and 2021. Demographics, physical exam findings, non-invasive imaging results, and angiographic images were assessed to validate a diagnostic and management algorithm (Figure 1). Surgical findings, operative technique, post-operative complications, and symptomatic improvement were assessed to validate this clinical algorithm. RESULTS There were 35 extremities in 23 patients treated for PAES (Table 1). The mean age was 28 and 82.6% of patients were female. Physical exam revealed a decrement in pedal pulse with provocative maneuvers in 90% of treated limbs. Noninvasive studies to include treadmill exercise testing revealed a mean ABI drop of 0.28 and positional duplex demonstrated that the mean peak systolic velocity (PSV) in the popliteal artery was 78 cm/sec at rest which increased to 175 cm/sec with provocation. Diagnostic arteriography was performed in all patients and revealed well-developed geniculate and sural collaterals in 100% of treated limbs and complete effacement of the popliteal artery with active provocative maneuvers in all treated limbs (Figure 2). Surgical exposure was performed via a posterior approach and intraoperative completion duplex was performed in all cases. Type III PAES was discovered in 89% of cases. Arterial reconstruction was required in 2 patients who presented with an occluded popliteal artery. All but one patient was discharged on post-operative day one. Wound complications occurred in 4 limbs (3 patients) and included seroma and hypertrophic scarring. All patients experienced symptomatic relief with median follow-up of 4 months. CONCLUSIONS We report 100% technical and clinical success in patients with PAES diagnosed and managed using our clinical algorithm. Cross-sectional imaging is not necessary for the diagnosis. Dynamic angiography confirms the diagnosis and intraoperative duplex is essential for successful clinical outcome by confirming complete release of the popliteal artery.
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Zaghloul R, Naouli H, Bouarhroum A. Popliteal Artery Entrapment Syndrome: Report of 2 Critical Aspects Cases. Ann Vasc Surg 2015; 29:1662.e7-11. [PMID: 26315789 DOI: 10.1016/j.avsg.2015.06.088] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 05/31/2015] [Accepted: 06/03/2015] [Indexed: 11/19/2022]
Abstract
Popliteal artery entrapment syndrome is a rare and underdiagnosed cause of claudication in young adult. The typical clinical feature is calf claudication; the following case reports describe 2 rare clinical aspects, acute limb ischemia and pulsatile mass revealing a bilateral anatomic entrapment. These cases suggest that an early diagnosis is mandatory to avoid a dramatic clinical outcome and to limit the surgical treatment to a myotomy.
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Affiliation(s)
- Rachid Zaghloul
- Department of Vascular Surgery, Faculty of Medicine and Pharmacy of Fez UHC Hassan II Fez, Fez, Morocco.
| | - Hamza Naouli
- Department of Vascular Surgery, Faculty of Medicine and Pharmacy of Fez UHC Hassan II Fez, Fez, Morocco
| | - Abdelatif Bouarhroum
- Department of Vascular Surgery, Faculty of Medicine and Pharmacy of Fez UHC Hassan II Fez, Fez, Morocco
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Radowsky J, Patel B, Fox CJ. Delayed presentations of popliteal artery entrapment syndrome in a middle-aged military population. Ann Vasc Surg 2013; 27:1184.e1-6. [PMID: 23988539 DOI: 10.1016/j.avsg.2012.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Revised: 11/07/2012] [Accepted: 11/23/2012] [Indexed: 10/26/2022]
Abstract
Popliteal artery entrapment syndrome (PAES) is a rare but significant cause of disability usually diagnosed in young, healthy adults. Advancements in diagnostic imaging modalities have prompted a current report of our recent experience with PAES in a middle-aged military population at the Walter Reed National Military Medical Center. The addition of computed tomographic angiography (CTA) and magnetic resonance angiography (MRA) permit accurate and facile diagnosis of this complex syndrome.
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Affiliation(s)
- Jason Radowsky
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD; Norman M. Rich Department of Surgery, Division of Vascular Surgery, Uniformed University of the Health Sciences, Bethesda, MD
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Causey MW, Quan RW, Curry TK, Singh N. Ultrasound is a critical adjunct in the diagnosis and treatment of popliteal entrapment syndrome. J Vasc Surg 2013; 57:1695-7. [DOI: 10.1016/j.jvs.2012.10.116] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 10/24/2012] [Accepted: 10/25/2012] [Indexed: 11/30/2022]
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Karaman B, Battal B, Akgun V, Hamcan S, Bozkurt Y, Bozlar U. Popliteal artery entrapment syndrome with thrombosed popliteal aneurysm: multidetector computed tomography angiography findings of a case. Clin Imaging 2012; 36:850-3. [PMID: 23154022 DOI: 10.1016/j.clinimag.2012.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 12/01/2011] [Accepted: 01/03/2012] [Indexed: 11/16/2022]
Abstract
Popliteal artery entrapment syndrome (PAES) is a rare congenital vascular pathology caused by the compression of the popliteal artery by adjacent muscle and tendinous structures. Popliteal artery aneurysm associated with this syndrome is extremely rare. A 45-year-old male suffering from pain at the right lower extremity during exercise was admitted to our hospital. Physical examination and Doppler imaging revealed a weak pulse at the posterior tibial artery and no pulse at dorsalis pedis and anterior tibial arteries. The patient was further evaluated with multidetector computed tomography angiography (MDCTA). MDCTA revealed PAES due to compression of the accessory fibers of the gastrocnemius muscle and related thrombosed popliteal aneurysm.
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Affiliation(s)
- Bulent Karaman
- Department of Radiology, Gulhane Military Medical School, 06018, Etlik, Ankara, Turkey.
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Eliahou R, Sosna J, Bloom AI. Between a rock and a hard place: clinical and imaging features of vascular compression syndromes. Radiographics 2012; 32:E33-49. [PMID: 22236908 DOI: 10.1148/rg.321115011] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Vascular compression syndromes are caused by the entrapment of vessels between rigid or semirigid surfaces in a confined anatomic space. Chronic entrapment may lead to arterial ischemia and embolism, venous stasis and thrombosis, and hematuria. These syndromes are usually seen in otherwise healthy young patients, among whom underdiagnosis is common. Most occurrences of vascular compression are associated with an underlying anatomic abnormality. In a small percentage of cases, other contributing factors, including repetitive microtrauma, may cause pathologic changes leading to the onset of pain and other symptoms of vascular and neural compression. Hence, the diagnosis must be based on both clinical and radiologic findings. Because some cases of vascular entrapment become symptomatic only when specific physical maneuvers are performed, dynamic diagnostic imaging methods are especially useful. Digital subtraction angiography has been the mainstay of imaging-based diagnosis for most vascular compression syndromes, but other methods (eg, color Doppler ultrasonography, computed tomographic angiography, and magnetic resonance angiography) are used with increasing frequency for initial diagnostic evaluation. Because vascular compression syndromes are caused by the external compression of vessels, endoluminal treatment alone is rarely adequate and surgical decompression is likely to be required for optimal and durable clinical benefit. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.321115011/-/DC1.
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Affiliation(s)
- Ruth Eliahou
- Department of Radiology, Hadassah-Hebrew University Medical Center, PO Box 12000, Jerusalem 91120, Israel
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Molinaro V, Pagliasso E, Varetto G, Castagno C, Gibello L, Zandrino F, Suita R, Rispoli P. Popliteal artery entrapment syndrome in a young girl: case report of a rare finding. Ann Vasc Surg 2012; 26:572.e5-9. [PMID: 22321474 DOI: 10.1016/j.avsg.2011.11.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 10/02/2011] [Accepted: 11/06/2011] [Indexed: 10/14/2022]
Abstract
The popliteal artery (PA) entrapment syndrome, a rare cause of arterial thrombosis, is most often encountered in young male athletes. Here, we report a very unusual case of PA entrapment syndrome in a 14-year-old girl who presented with a 1-month history of calf claudication to our observation facility. Diagnostic work-up revealed obesity, sedentary lifestyle, and an aberrant accessory slip of the medial head of gastrocnemius around the PA. Arterial echo color Doppler ultrasonography and computed tomographic angiography studies were performed. Surgical treatment involved revascularization with resection of the medial head of gastrocnemius, the cause of the arterial entrapment, and enlargement angioplasty using an autologous saphenous vein patch, in combination with antiplatelet therapy, resulting in restitution ad integrum of the affected limb and, finally, an improved quality of life of the patient. This case underscores the importance of clinical suspicion, diagnosis, and treatment of lower-limb claudication in very young patients presenting with unusual symptoms. If missed, the condition may evolve dramatically. Prompt diagnosis and surgical treatment are key to complete recovery and the prevention of irreversible complications that may result in limb loss.
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Affiliation(s)
- Valentina Molinaro
- Division of Vascular Surgery, Department of Medical and Surgical Disciplines, Molinette Hospital, University of Turin, Turin, Italy
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Sinha S, Houghton J, Holt PJ, Thompson MM, Loftus IM, Hinchliffe RJ. Popliteal entrapment syndrome. J Vasc Surg 2012; 55:252-262.e30. [DOI: 10.1016/j.jvs.2011.08.050] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 08/16/2011] [Accepted: 08/21/2011] [Indexed: 10/15/2022]
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Role of CT Angiography in the Diagnosis and Treatment of Popliteal Vascular Entrapment Syndrome. AJR Am J Roentgenol 2011; 197:W1147-54. [PMID: 22109333 DOI: 10.2214/ajr.11.6789] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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