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Moreno-Ramírez D, Silva-Clavería F, Fernández-Orland A, Eiris N, Ruiz de Casas A, Férrandiz L. Surgery for Cutaneous Squamous Cell Carcinoma and its Limits in Advanced Disease. Dermatol Pract Concept 2021; 11:e2021167S. [PMID: 34877075 DOI: 10.5826/dpc.11s2a167s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2021] [Indexed: 10/31/2022] Open
Abstract
Surgery remains the first-line therapeutic option for most patients with cutaneous squamous cell carcinoma (cSCC). However, in the current therapeutic landscape, surgery must attempt to the complete tumor resection (R0 resection) with the lowest risk of surgical complications. This double aim is usually accomplished through standard excision with clinical margins in patients with low-risk tumors or by some of the micrographically controlled surgery procedures for patients with tumors at high-risk of local recurrence and metastasis. Surgery is also a first-line treatment for nodal metastases of cSCC as well as an option to consider in patients who develop recurrences while receiving immunotherapy, or as a palliation procedure in patients with advanced tumors. Neoadjuvant immunotherapy, that is the use of a medical treatment before surgery, is under investigation in patients with cSCC. The decision-making process and guidelines recommendations regarding cSCC surgery are reviewed in this manuscript.
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Affiliation(s)
- David Moreno-Ramírez
- Department of Medical-&-Surgical Dermatology. University Hospital Virgen Macarena. Medicine School, University of Sevilla. Seville, Spain
| | - Francisca Silva-Clavería
- Department of Medical-&-Surgical Dermatology. University Hospital Virgen Macarena. Medicine School, University of Sevilla. Seville, Spain
| | - Almudena Fernández-Orland
- Department of Medical-&-Surgical Dermatology. University Hospital Virgen Macarena. Medicine School, University of Sevilla. Seville, Spain
| | - Noemí Eiris
- Department of Medical-&-Surgical Dermatology. University Hospital Virgen Macarena. Medicine School, University of Sevilla. Seville, Spain
| | - Andrés Ruiz de Casas
- Department of Medical-&-Surgical Dermatology. University Hospital Virgen Macarena. Medicine School, University of Sevilla. Seville, Spain
| | - Lara Férrandiz
- Department of Medical-&-Surgical Dermatology. University Hospital Virgen Macarena. Medicine School, University of Sevilla. Seville, Spain
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Nonmelanoma Skin Cancer at Critical Facial Sites: Results and Strategies of the Surgical Treatment of 102 Patients. J Skin Cancer 2019; 2019:4798510. [PMID: 31346477 PMCID: PMC6617868 DOI: 10.1155/2019/4798510] [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: 05/01/2019] [Accepted: 06/11/2019] [Indexed: 11/18/2022] Open
Abstract
Background To evaluate the surgical treatment results of a consecutive series of patients with nonmelanoma skin cancer in critical facial regions such as the nose, lip, eyelid, ear, forehead, cheek, and chin. Methods This was a prospective observational cohort study evaluating the surgical treatment results of 102 patients with nonmelanoma skin cancer who underwent surgical excision and required some type of reconstruction. The reconstruction strategy used, histological type and margins, aesthetic result, and complications were evaluated. Results The most common facial site was the nose (48.01%), followed by the eyelid, ear, cheek, forehead, and lip. The most frequently used type of reconstruction was the advancement flap (30.39%), followed by transposition flap (27,45%), rotation flap (14.70%), and grafts (10.78%). Basal cell carcinoma was the most frequent histological type, accounting for 90.19% of the sample, with 54.90% of these cases being of the nodular subtype. Disease-free margins were obtained in 94.11% of the patients, and only one patient presented compromised margins and underwent marginal extension. A good cosmetic result was found in 93.13% of the participants. Conclusion Surgical treatment can provide excellent oncological, functional, and cosmetic results in the treatment of patients with nonmelanoma skin cancer at critical facial sites.
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van Egmond S, Wakkee M, van Rengen A, Bastiaens M, Nijsten T, Lugtenberg M. Factors influencing current low-value follow-up care after basal cell carcinoma and suggested strategies for de-adoption: a qualitative study. Br J Dermatol 2019; 180:1420-1429. [PMID: 30597525 PMCID: PMC6850416 DOI: 10.1111/bjd.17594] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Providing follow-up to patients with low-risk basal cell carcinoma (BCC) can be considered as low-value care. However, dermatologists still provide substantial follow-up care to this patient group, for reasons not well understood. OBJECTIVES To identify factors influencing current BCC follow-up practices among dermatologists and suggested strategies to de-adopt this low-value care. In addition, views of patients regarding follow-up care were explored. METHODS A qualitative study was conducted consisting of 18 semistructured interviews with dermatologists and three focus groups with a total of 17 patients with low-risk BCC who had received dermatological care. The interviews focused on current follow-up practices, influencing factors and suggested strategies to de-adopt the follow-up care. The focus groups discussed preferred follow-up schedules and providers, as well as the content of follow-up. All (group) interviews were transcribed verbatim and analysed by two researchers using ATLAS.ti software. RESULTS Factors influencing current follow-up care practices among dermatologists included complying with patients' preferences, lack of trust in general practitioners (GPs), financial incentives and force of habit. Patients reported varying needs regarding periodic follow-up visits, preferred to be seen by a dermatologist and indicated a need for improved information provision. Suggested strategies by dermatologists to de-adopt the low-value care encompassed educating patients with improved information, educating GPs to increase trust of dermatologists, realizing appropriate financial reimbursement and informing dermatologists about the low value of care. CONCLUSIONS A mixture of factors appear to contribute to current follow-up practices after low-risk BCC. In order to de-adopt this low-value care, strategies should be aimed at dermatologists and GPs, and also patients.
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Affiliation(s)
- S. van Egmond
- Department of DermatologyErasmus MC Cancer InstituteRotterdamthe Netherlands
- Department of Public HealthErasmus MC University Medical CenterRotterdamthe Netherlands
| | - M. Wakkee
- Department of DermatologyErasmus MC Cancer InstituteRotterdamthe Netherlands
| | - A. van Rengen
- Department of DermatologyMohs KliniekenDordrechtthe Netherlands
| | - M.T. Bastiaens
- Department of DermatologyElisabeth‐TweeSteden HospitalTilburgthe Netherlands
| | - T. Nijsten
- Department of DermatologyErasmus MC Cancer InstituteRotterdamthe Netherlands
| | - M. Lugtenberg
- Department of DermatologyErasmus MC Cancer InstituteRotterdamthe Netherlands
- Department of Public HealthErasmus MC University Medical CenterRotterdamthe Netherlands
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Mohanna M, Hofbauer G. Pronounced local skin reaction to ingenol mebutate against actinic keratosis in kidney transplant recipient without systemic adverse events. JAAD Case Rep 2016; 1:S19-22. [PMID: 27051801 PMCID: PMC4809621 DOI: 10.1016/j.jdcr.2015.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Mosab Mohanna
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland; Department of Dermatology, Taibah University, Medina, Saudi Arabia
| | - Günther Hofbauer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
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El-Khattouti A, Selimovic D, Hannig M, Taylor EB, Abd Elmageed ZY, Hassan SY, Haikel Y, Kandil E, Leverkus M, Brodell RT, Megahed M, Hassan M. Imiquimod-induced apoptosis of melanoma cells is mediated by ER stress-dependent Noxa induction and enhanced by NF-κB inhibition. J Cell Mol Med 2015; 20:266-86. [PMID: 26578344 PMCID: PMC4727561 DOI: 10.1111/jcmm.12718] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 09/15/2015] [Indexed: 12/21/2022] Open
Abstract
Melanoma is characterized by dysregulated intracellular signalling pathways including an impairment of the cell death machinery, ultimately resulting in melanoma resistance, survival and progression. This explains the tumour's extraordinary resistance to the standard treatment. Imiquimod is a topical immune response modifier (imidazoquinoline) with both antiviral and antitumour activities. The mechanism by which imiquimod triggers the apoptosis of melanoma cells has now been carefully elucidated. Imiquimod‐induced apoptosis is associated with the activation of apoptosis signalling regulating kinase1/c‐Jun‐N‐terminal kinase/p38 pathways and the induction of endoplasmic stress characterized by the activation of the protein kinase RNA‐like endoplasmic reticulum kinase signalling pathway, increase in intracellular Ca2+ release, degradation of calpain and subsequent cleavage of caspase‐4. Moreover, imiquimod triggers the activation of NF‐κB and the expression of the inhibitor of apoptosis proteins (IAPs) such as, X‐linked IAP (XIAP) together with the accumulation of reactive oxygen species (ROS). Also, imiquimod triggers mitochondrial dysregulation characterized by the loss of mitochondrial membrane potential (Δψm), the increase in cytochrome c release, and cleavage of caspase‐9, caspase‐3 and poly(ADP‐ribose) polymerase (PARP). Inhibitors of specific pathways, permit the elucidation of possible mechanisms of imiquimod‐induced apoptosis. They demonstrate that inhibition of NF‐kB by the inhibitor of nuclear factor kappa‐B kinase (IKK) inhibitor Bay 11‐782 or knockdown of XIAP induces melanoma apoptosis in cells exposed to imiquimod. These findings support the use of either IKK inhibitors or IAP antagonists as adjuvant therapies to improve the effectiveness topical imiquimod in the treatment of melanoma.
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Affiliation(s)
| | - Denis Selimovic
- Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital of Saarland, Homburg/Saar, Germany
| | - Matthias Hannig
- Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital of Saarland, Homburg/Saar, Germany
| | - Erin B Taylor
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Sofie Y Hassan
- Clinic of Dermatology, University Hospital of Aachen, Aachen, Germany
| | - Youssef Haikel
- Institut National de la Santé et de la Recherche Médicale, University of Strasbourg, Strasbourg, France.,Department of Operative Dentistry and Endodontics, Dental Faculty, University of Strasbourg, Strasbourg, France
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Martin Leverkus
- Clinic of Dermatology, University Hospital of Aachen, Aachen, Germany
| | - Robert T Brodell
- Department of Dermatology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Mosaad Megahed
- Clinic of Dermatology, University Hospital of Aachen, Aachen, Germany
| | - Mohamed Hassan
- Cancer Institute, University of Mississippi Medical Center, Jackson, MS, USA.,Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital of Saarland, Homburg/Saar, Germany.,Institut National de la Santé et de la Recherche Médicale, University of Strasbourg, Strasbourg, France.,Department of Pathology, University of Mississippi Medical Center, Jackson, MS, USA
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Erlendsson AM, Egekvist H, Lorentzen HF, Philipsen PA, Stausbøl-Grøn B, Stender IM, Haedersdal M. Actinic keratosis: a cross-sectional study of disease characteristics and treatment patterns in Danish dermatology clinics. Int J Dermatol 2015; 55:309-16. [PMID: 26276415 DOI: 10.1111/ijd.12874] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 09/11/2014] [Accepted: 09/25/2014] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The incidence of actinic keratosis (AK) is increasing, and several treatment options are available. The aim of this study was to describe clinical characteristics and treatment patterns in patients with AK treated by Danish dermatologists. METHODS A multicenter, non-interventional, cross-sectional study was conducted. Three dermatology hospital departments and seven private dermatology clinics enrolled eligible AK patients consecutively during one week. RESULTS A total of 312 patients were included. Non-melanoma skin cancer (NMSC) was previously reported in 51.0% of patients and currently suspected in 9.4% of AK-affected anatomical regions. Lesions of AK were located primarily on the face (38.6%), scalp (12.8%), and hands (11.2%). Actinic keratosis commonly presented with multiple AK lesions (38.6%) and field cancerization (38.5%). The treatments used most frequently were cryotherapy (57.7%) and photodynamic therapy (PDT) with methyl aminolevulinate (17.1%) and imiquimod (11.2%). The likelihood of receiving cryotherapy was higher for men (odds ratio [OR] 1.65, 95% confidence interval [CI] 1.10-2.47) and increased with age (2.2% per year, 0.4-4.0%). PDT represented the most frequently applied treatment for severe actinic damage and was more likely to be prescribed to women (OR 4.08, 95% CI 2.22-7.47) and young patients (OR 0.97 per year, 95% CI 0.95-0.99). The prevalence of severe actinic damage (17.3% versus 9.6%) and intake of immunosuppressive medication (29.0 versus 2.0) were higher among hospital patients compared with those treated in private practices (P < 0.0001). CONCLUSIONS The majority of AK patients in Danish dermatology clinics have a history of skin cancer, and NMSC is suspected in almost 10% of AK-affected regions. Cryotherapy is the most frequently used treatment overall, except in instances of severe actinic damage, in which PDT is the first-choice treatment.
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Affiliation(s)
- Andrés M Erlendsson
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Peter A Philipsen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Merete Haedersdal
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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van Rijsingen MC, Vossen R, van Huystee BE, Gorgels WJ, Gerritsen MJP. Skin Tumour Surgery in Primary Care: Do General Practitioners Need to Improve Their Surgical Skills? Dermatology 2015; 230:318-23. [DOI: 10.1159/000371812] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 12/13/2014] [Indexed: 11/19/2022] Open
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Menezes AC, Raposo S, Simões S, Ribeiro H, Oliveira H, Ascenso A. Prevention of Photocarcinogenesis by Agonists of 5-HT1A and Antagonists of 5-HT2A Receptors. Mol Neurobiol 2015; 53:1145-1164. [DOI: 10.1007/s12035-014-9068-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 12/29/2014] [Indexed: 12/13/2022]
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Hessam S, Georgas D, Sand M, Bechara FG. Complete skin resection of the dorsum of the hand: a prophylactic approach using a dermal regeneration template. J Cutan Med Surg 2014; 18:56-9. [PMID: 24377475 DOI: 10.2310/7750.2013.13061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Surgical treatment of multiple and recurring invasive carcinomas on the dorsum of the hand often results in a reconstructive challenge. Reconstruction is limited due to reduced adjacent tissue. Preserving the functionality of the hand is pivotal and needs to be respected while planning reconstruction. OBJECTIVE We present a case of extensive, multiple, and recurring invasive squamous cell carcinoma on the dorsum of the hand and describe a prophylactic surgical approach. METHODS We performed a radical excision of the skin on the dorsum of the hand and surgical reconstruction using a bilayer dermal skin substitute and split-thickness skin grafting. RESULTS After a 1-year follow-up, we observed an excellent cosmetic and functional result with no signs of recurrence. CONCLUSIONS In case of extensive invasive squamous cell carcinoma on the dorsum of the hand, prophylactic resection and surgical reconstruction using a dermal regeneration template should be considered.
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Basal Cell Carcinoma Aggressiveness, Molecular Factors And Therapy: A Clinician Perspective. ARS MEDICA TOMITANA 2013. [DOI: 10.2478/v10307-012-0011-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Basal cell carcinoma represents the most common skin and epithelial cancer. Most of the patients are cured by surgery. However, some cases display fullblown aggressiveness which has a dual connotation. The tumour may reach an impressive size being locally destructive while in rare cases, basal cell carcinomas may metastasize. If this agressivetumour is located on the face or neck, the surgeon is confronted with a clinical dilemma since total removal of the lesion with clear margins is impossible. Therefore, nonsurgical approaches need to be adopted in these cases. A better understand of the molecular pathways could theoretically lead to new improved therapeutic treatments. The current paper presents an update on the molecular factors with clinical importance for the treatment of basal cell carcinoma in parallel with presentation of an aggressive case as well as a review of the current therapeutic methods.
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Esmann S, Jemec GBE. Patients' perceptions of topical treatments of actinic keratosis. J DERMATOL TREAT 2013; 25:375-9. [DOI: 10.3109/09546634.2012.757285] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Flohil SC, Proby CM, Forrest AD, van Tiel S, Saksela O, Pitkänen S, Ahti T, Micallef R, de Vries E. Basal cell carcinomas without histological confirmation and their treatment: an audit in four European regions. Br J Dermatol 2012; 167 Suppl 2:22-8. [PMID: 22881584 DOI: 10.1111/j.1365-2133.2012.11083.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Limited data are available on how often basal cell carcinomas (BCCs) are clinically diagnosed without histological confirmation and how they are treated. OBJECTIVES Within the framework of the EPIDERM project, an audit was conducted in four European countries to study the occurrence of clinically diagnosed BCCs without histological confirmation and to investigate how these are treated. METHODS In the Netherlands, Scotland, Finland and Malta studies were performed within different timeframes. Patients with one or more BCC(s) were selected and the number of clinically diagnosed BCCs without histological confirmation and their treatment was investigated by (manually) reviewing the (electronic) patient records and checking the (hospital) pathology databases to find evidence of histological confirmation. RESULTS In the Netherlands, 1089 patients with a first histologically confirmed BCC developed 1974 BCCs of which 1833 (92·9%) were histologically confirmed and 141 (7·1%) were not. A 4-month retrospective study conducted in Scotland selected 294 patients with 344 BCCs; 306 (89·0%) were histologically confirmed and 38 (11·0%) were not. A 3-month prospective study performed at the same centre in Scotland identified 44 patients who developed 58 BCCs; 44 (75·9%) of these were histologically confirmed and 14 (24·1%) were not. In Finland, there were 701 patients who developed 977 BCCs, of which 807 (82·6%) were histologically and 170 (17·4%) nonhistologically confirmed. In Malta, there were 420 patients with 477 BCCs. Only three (0·7%) of them were clinically diagnosed without histological confirmation. In the Netherlands and Finland, clinically diagnosed BCCs without histological confirmation were most often treated with cryotherapy, whereas in Scotland 5% imiquimod cream was the preferred treatment modality. CONCLUSIONS Although the frequency of clinically diagnosed BCCs without histological confirmation differed between the four European regions (range 0·7-24·1%), this confirms that the burden of BCC in Europe is underestimated when based on data from pathology and/or cancer registries.
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Affiliation(s)
- S C Flohil
- Department of Dermatology, Erasmus MC University Center, Rotterdam, The Netherlands
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Trakatelli M, Siskou S, Proby C, Tiplica G, Hinrichs B, Altsitsiadis E, Kitsou A, Ferrandiz L, Aquilina S, Apap C, Ulrich M, Fiorentini C, Magnoni C, de Vries E, Flohil S, Kalokasidis K, Moreno-Ramirez D, Ruiz-de-Casas A, Majewski S, Ranki A, Pitkänen S, Saksela O, Ioannides D, Sotiriadis D, Stockfleth E. The patient journey: a report of skin cancer care across Europe. Br J Dermatol 2012; 167 Suppl 2:43-52. [DOI: 10.1111/j.1365-2133.2012.11086.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Stockfleth E, Hinrichs B, Surber C, Christophers E. Prevention initiative for dermatological malignancies: where do we stand? Br J Dermatol 2012; 167 Suppl 2:v-vi. [DOI: 10.1111/j.1365-2133.2012.11135.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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