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Dutta S, Hornung S, Taha HB, Bitan G. Biomarkers for parkinsonian disorders in CNS-originating EVs: promise and challenges. Acta Neuropathol 2023; 145:515-540. [PMID: 37012443 PMCID: PMC10071251 DOI: 10.1007/s00401-023-02557-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/27/2023] [Accepted: 03/07/2023] [Indexed: 04/05/2023]
Abstract
Extracellular vesicles (EVs), including exosomes, microvesicles, and oncosomes, are nano-sized particles enclosed by a lipid bilayer. EVs are released by virtually all eukaryotic cells and have been shown to contribute to intercellular communication by transporting proteins, lipids, and nucleic acids. In the context of neurodegenerative diseases, EVs may carry toxic, misfolded forms of amyloidogenic proteins and facilitate their spread to recipient cells in the central nervous system (CNS). CNS-originating EVs can cross the blood-brain barrier into the bloodstream and may be found in other body fluids, including saliva, tears, and urine. EVs originating in the CNS represent an attractive source of biomarkers for neurodegenerative diseases, because they contain cell- and cell state-specific biological materials. In recent years, multiple papers have reported the use of this strategy for identification and quantitation of biomarkers for neurodegenerative diseases, including Parkinson's disease and atypical parkinsonian disorders. However, certain technical issues have yet to be standardized, such as the best surface markers for isolation of cell type-specific EVs and validating the cellular origin of the EVs. Here, we review recent research using CNS-originating EVs for biomarker studies, primarily in parkinsonian disorders, highlight technical challenges, and propose strategies for overcoming them.
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Affiliation(s)
- Suman Dutta
- International Institute of Innovation and Technology, New Town, Kolkata, India
| | - Simon Hornung
- Division of Peptide Biochemistry, TUM School of Life Sciences, Technical University of Munich, Freising, Germany
| | - Hash Brown Taha
- Department of Integrative Biology and Physiology, University of California Los Angeles, Los Angeles, CA, USA
- Department of Neurology, David Geffen School of Medicine at UCLA, University of California Los Angeles, 635 Charles E. Young Drive South/Gordon 451, Los Angeles, CA, 90095, USA
| | - Gal Bitan
- Department of Neurology, David Geffen School of Medicine at UCLA, University of California Los Angeles, 635 Charles E. Young Drive South/Gordon 451, Los Angeles, CA, 90095, USA.
- Brain Research Institute, University of California Los Angeles, Los Angeles, CA, USA.
- Molecular Biology Institute, University of California Los Angeles, Los Angeles, CA, USA.
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Randall A, Larner AJ. Primary progressive aphasia: misdiagnosis with ‘normal imaging’. PROGRESS IN NEUROLOGY AND PSYCHIATRY 2020. [DOI: 10.1002/pnp.663] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- A Randall
- Dr Randall is a Specialist Registrar in Neurology at Walton Centre for Neurology and Neurosurgery Liverpool
| | - AJ Larner
- Dr Larner is a Consultant Neurologist at Walton Centre for Neurology and Neurosurgery Liverpool
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Larner AJ. Functional cognitive disorders: update on diagnostic status. Neurodegener Dis Manag 2020; 10:67-72. [DOI: 10.2217/nmt-2019-0038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Many patients referred to cognitive disorders clinics are not found to have evidence of any neurological disorder(s) to account for their symptoms. Many demonstrate incongruence between their subjective cognitive symptoms and preserved social and occupational functions. The term ‘functional cognitive disorders’ (FCD) has been used to denote this diagnostic category. This article aims to review the current state of knowledge regarding FCD. Studies of FCD are in their infancy, but available evidence suggests positive diagnosis may be made based on typical clinical profiles, including language discourse and simple clinical signs. Concurrent mood disorder and sleep disturbance are common, as well as other functional disorders. Pathogenesis is yet to be determined, but a disorder of metamemory has been suggested.
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Affiliation(s)
- AJ Larner
- Cognitive Function Clinic, Walton Centre for Neurology & Neurosurgery, Liverpool, UK
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Van Stavern GP, Bei L, Shui YB, Huecker J, Gordon M. Pupillary light reaction in preclinical Alzheimer's disease subjects compared with normal ageing controls. Br J Ophthalmol 2018; 103:971-975. [PMID: 30206156 DOI: 10.1136/bjophthalmol-2018-312425] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/01/2018] [Accepted: 08/06/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND/AIMS We wished to determine whether the pupillary light reaction can differentiate preclinical Alzheimer's disease (AD) subjects from normal ageing controls. We performed a prospective study evaluating the pupillary light reaction in a cohort of well-characterised subjects with preclinical AD versus normal ageing controls. METHODS We recruited 57 subjects from our institution's Memory and Aging Project, part of our Alzheimer's Disease Research Center. All subjects completed PET-PiB imaging, cerebrospinal fluid analysis and at least 1 neuropsychiatric assessment after their baseline assessment. All participants were assigned a clinical dementia rating and underwent a complete neuro-ophthalmic examination. Participants were divided into a dementia biomarker+ (preclinical AD) and biomarker- (normal ageing) group based on preclinical risk for Alzheimer's dementia. Pupillometry measurements were performed by using the NeurOptics PLR-200 Pupillometer. RESULTS A total of 57 subjects were recruited with 24 dementia biomarker+ and 33 dementia biomarker- individuals. A variety of pupil flash response (PLR) parameters were assessed. Comparisons between groups were analysed using generalised estimating equations. None of the pupillary parameters showed a significant difference between groups. CONCLUSIONS We found no significant differences in PLR between preclinical AD subjects and normal ageing controls. This suggests that the disease effect on the PLR may be small and difficult to detect at the earliest stages of the disease. Future studies could include larger sample size and chromatic pupillometry.
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Affiliation(s)
- Gregory P Van Stavern
- Department of Ophthalmology and Visual Sciences, Washington University in St Louis School of Medicine, St. Louis, Missouri, USA
| | - Ling Bei
- Department of Ophthalmology and Visual Sciences, Washington University in St Louis School of Medicine, St. Louis, Missouri, USA
| | - Ying-Bo Shui
- Department of Ophthalmology and Visual Sciences, Washington University in St Louis School of Medicine, St. Louis, Missouri, USA
| | - Julie Huecker
- Department of Ophthalmology and Visual Sciences, Washington University in St Louis School of Medicine, St. Louis, Missouri, USA
| | - Mae Gordon
- Department of Ophthalmology and Visual Sciences, Washington University in St Louis School of Medicine, St. Louis, Missouri, USA
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Population Base Rates and Disease Course of Common Psychiatric and Neurodegenerative Disorders. Neuropsychol Rev 2017; 27:284-301. [PMID: 28939959 DOI: 10.1007/s11065-017-9357-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 07/25/2017] [Indexed: 12/11/2022]
Abstract
Knowledge of population base rates of neurological and psychiatric disorders is fundamental for diagnostic decision making. Consideration of relevant probabilistic information can improve diagnostic efficiency and accuracy. However, such data continue to be misused or underutilized, which can lead to misdiagnoses and negative patient outcomes. The aim of the current review is to create an easily accessible and comprehensive reference of existing age of onset as well as prevalence and incidence data for common neurodegenerative and psychiatric disorders in adults. Relevant epidemiological data were compiled from well-respected and frequently-cited textbooks and scholarly studies. Reviews were collected from PubMed, and publicly-available sources were gathered from Google Scholar. Results are organized and presented in several tables and a figure, which can be used as a diagnostic guide for students and clinicians across healthcare disciplines.
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Dong A, Toledo JB, Honnorat N, Doshi J, Varol E, Sotiras A, Wolk D, Trojanowski JQ, Davatzikos C. Heterogeneity of neuroanatomical patterns in prodromal Alzheimer's disease: links to cognition, progression and biomarkers. Brain 2017; 140:735-747. [PMID: 28003242 PMCID: PMC5837514 DOI: 10.1093/brain/aww319] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 10/12/2016] [Accepted: 10/21/2016] [Indexed: 02/03/2023] Open
Abstract
See Coulthard and Knight (doi:10.1093/aww335) for a scientific commentary on this article.Individuals with mild cognitive impairment and Alzheimer's disease clinical diagnoses can display significant phenotypic heterogeneity. This variability likely reflects underlying genetic, environmental and neuropathological differences. Characterizing this heterogeneity is important for precision diagnostics, personalized predictions, and recruitment of relatively homogeneous sets of patients into clinical trials. In this study, we apply state-of-the-art semi-supervised machine learning methods to the Alzheimer's disease Neuroimaging cohort (ADNI) to elucidate the heterogeneity of neuroanatomical differences between subjects with mild cognitive impairment (n = 530) and Alzheimer's disease (n = 314) and cognitively normal individuals (n = 399), thereby adding to an increasing literature aiming to establish neuroanatomical and neuropathological (e.g. amyloid and tau deposition) dimensions in Alzheimer's disease and its prodromal stages. These dimensional approaches aim to provide surrogate measures of heterogeneous underlying pathologic processes leading to cognitive impairment. We relate these neuroimaging patterns to cerebrospinal fluid biomarkers, white matter hyperintensities, cognitive and clinical measures, and longitudinal trajectories. We identified four such atrophy patterns: (i) individuals with largely normal neuroanatomical profiles, who also turned out to have the least abnormal cognitive and cerebrospinal fluid biomarker profiles and the slowest clinical progression during follow-up; (ii) individuals with classical Alzheimer's disease neuroanatomical, cognitive, cerebrospinal fluid biomarkers and clinical profile, who presented the fastest clinical progression; (iii) individuals with a diffuse pattern of atrophy with relatively less pronounced involvement of the medial temporal lobe, abnormal cerebrospinal fluid amyloid-β1-42 values, and proportionally greater executive impairment; and (iv) individuals with notably focal involvement of the medial temporal lobe and a slow steady progression, likely representing in early Alzheimer's disease stages. These four atrophy patterns effectively define a 4-dimensional categorization of neuroanatomical alterations in mild cognitive impairment and Alzheimer's disease that can complement existing dimensional approaches for staging Alzheimer's disease using a variety of biomarkers, which offer the potential for enabling precision diagnostics and prognostics, as well as targeted patient recruitment of relatively homogeneous subgroups of subjects for clinical trials.
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Affiliation(s)
- Aoyan Dong
- 1 Department of Radiology, Perelman School of Medicine at the University
of Pennsylvania, PA, USA
- 2 Center for Biomedical Image Computing and Analytics, Perelman School
of Medicine at the University of Pennsylvania, PA, USA
| | - Jon B. Toledo
- 2 Center for Biomedical Image Computing and Analytics, Perelman School
of Medicine at the University of Pennsylvania, PA, USA
- 3 Department of Pathology and Laboratory Medicine and Center for
Neurodegenerative Disease Research, Perelman School of Medicine at the University of
Pennsylvania, PA, USA
- 4 Department of Neurology, Houston Methodist Hospital, Houston, TX,
USA
| | - Nicolas Honnorat
- 1 Department of Radiology, Perelman School of Medicine at the University
of Pennsylvania, PA, USA
- 2 Center for Biomedical Image Computing and Analytics, Perelman School
of Medicine at the University of Pennsylvania, PA, USA
| | - Jimit Doshi
- 1 Department of Radiology, Perelman School of Medicine at the University
of Pennsylvania, PA, USA
- 2 Center for Biomedical Image Computing and Analytics, Perelman School
of Medicine at the University of Pennsylvania, PA, USA
| | - Erdem Varol
- 1 Department of Radiology, Perelman School of Medicine at the University
of Pennsylvania, PA, USA
- 2 Center for Biomedical Image Computing and Analytics, Perelman School
of Medicine at the University of Pennsylvania, PA, USA
| | - Aristeidis Sotiras
- 1 Department of Radiology, Perelman School of Medicine at the University
of Pennsylvania, PA, USA
- 2 Center for Biomedical Image Computing and Analytics, Perelman School
of Medicine at the University of Pennsylvania, PA, USA
| | - David Wolk
- 5 Department of Neurology, Perelman School of Medicine at the University
of Pennsylvania, PA, USA
| | - John Q. Trojanowski
- 3 Department of Pathology and Laboratory Medicine and Center for
Neurodegenerative Disease Research, Perelman School of Medicine at the University of
Pennsylvania, PA, USA
| | - Christos Davatzikos
- 1 Department of Radiology, Perelman School of Medicine at the University
of Pennsylvania, PA, USA
- 2 Center for Biomedical Image Computing and Analytics, Perelman School
of Medicine at the University of Pennsylvania, PA, USA
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Larner AJ. Integrated care pathways in dementia: a challenge to National Institute for Health and Clinical Excellence/Social Care Institute for Excellence guidance. ACTA ACUST UNITED AC 2016. [DOI: 10.1258/jicp.2007.007174] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
An integrated care pathway (ICP) is proposed for the diagnosis of dementia syndromes, encompassing the various disciplines which may be involved (psychiatry, geriatrics, neurology, clinical genetics) due to the heterogeneity of presentation at the clinical and aetiological level. This proposed ICP challenges guidance recently issued by the National Institute for Health and Clinical Excellence (NICE) and the Social Care Institute for Excellence (SCIE), which requires a ‘single point of referral’ to access all dementia services. The proposal is prompted by the non-unitary nature of dementia, which may be envisaged as a ‘boundary’ condition transcending traditional professional categories and involving a wide array of professional groups in patient diagnosis in secondary care. Diversity rather than uniformity may best serve patient needs in such a heterogeneous syndrome.
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Affiliation(s)
- A J Larner
- Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool, UK
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Affiliation(s)
| | - AJ Larner
- Consultant Neurologist, in the Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool L9 7LJ
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Matchwick C, Domone R, Leroi I, Simpson J. Perceptions of Cause and Control in People With Alzheimer’s Disease. THE GERONTOLOGIST 2013; 54:268-76. [DOI: 10.1093/geront/gnt014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Objective: There is an extensive corpus of knowledge about how misinformation may distort autobiographical memories. A diagnostic error can be conceptualised as a form of misinformation.Methods: The authors discuss the case of a 58-year-old woman who was given a misdiagnosis of Alzheimer's disease.Results: The patient was deeply convinced that the diagnosis was correct, even when she was confronted with contradictory evidence.Conclusion: A diagnosis is not a neutral piece of information. It profoundly affects the lives of patients. The consequences of a misdiagnosis may be similar to persistent false memories.
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Affiliation(s)
- Harald Merckelbach
- Faculty of Psychology and Neurosciences, Maastricht University, Maastricht, The Netherlands
| | - Marko Jelicic
- Faculty of Psychology and Neurosciences, Maastricht University, Maastricht, The Netherlands
| | - Cees Jonker
- Department of Psychiatry/Alzheimer Centre, VU University Medical Center, Amsterdam, The Netherlands
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McNeill R, Sare GM, Manoharan M, Testa HJ, Mann DMA, Neary D, Snowden JS, Varma AR. Accuracy of single-photon emission computed tomography in differentiating frontotemporal dementia from Alzheimer's disease. J Neurol Neurosurg Psychiatry 2007; 78:350-5. [PMID: 17158559 PMCID: PMC2077783 DOI: 10.1136/jnnp.2006.106054] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2006] [Revised: 11/06/2006] [Accepted: 11/22/2006] [Indexed: 12/12/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) and frontotemporal dementia (FTD) are the commonest causes of presenile dementia. In the absence of a biological marker, diagnosis is reliant on clinical evaluation. Confirmation is often sought from neuroimaging, including single-photon emission computed tomography (SPECT). Most previous SPECT studies lack pathological validation. AIM To examine the accuracy of SPECT in differentiating FTD from AD in patients with subsequent pathological confirmation. METHODS Technetium-99-labelled hexamethyl propylene amine oxime SPECT images obtained at initial evaluation in 25 pathologically confirmed cases of FTD were examined. These images were visually rated by an experienced blinded nuclear medicine consultant and compared with those of 31 patients with AD, also with pathological validation. RESULTS A reduction in frontal cerebral blood flow (CBF) was more common in FTD and was of diagnostic value (sensitivity 0.8, specificity 0.65 and likelihood ratio (LR) 2.25; 95% CI 1.35 to 3.77). A pattern of bilateral frontal CBF reduction without the presence of associated bilateral parietal CBF change is diagnostically more accurate (sensitivity 0.80, specificity 0.81 and +LR 4.13, 95% CI 1.96 to 8.71). Diagnostic categorisation (FTD or AD) on the basis of SPECT alone was less accurate than clinical diagnosis (based on neurology and detailed neuropsychological evaluation). One patient with FTD was initially clinically misdiagnosed as AD, owing to the lack of availability of full neuropsychological assessment. However, SPECT correctly diagnosed this patient, providing a diagnostic gain of 4%. CONCLUSION Technetium-99-labelled hexamethyl propylene amine oxime SPECT CBF patterns provide valuable information in the diagnosis of FTD and AD. These data can be better used as an adjunct to clinical diagnosis if pathology is to be correctly predicted in life.
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Affiliation(s)
- R McNeill
- Department of Neurology, Cerebral Function Unit, Greater Manchester Neurosciences Centre, Salford, Manchester, UK
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Abstract
Cases of transient global amnesia (TGA) seen by one consultant neurologist over a 4-year period (2002-2005 inclusive) were identified. Of 10 possible cases, eight fulfilled suggested diagnostic criteria. Five cases were seen as ward consultations, three in outpatient clinics; seven were seen in district general hospitals. Six of the eight cases had already been seen by hospital physicians, whose working diagnoses included stroke/TIA and epilepsy. In some cases, this had resulted in inappropriate investigation, treatment and advice. Although rare, TGA is a diagnosis both hospital physicians and general practitioners need to be aware of in order to avoid potential pitfalls. The critical importance of collateral history in reaching the diagnosis is emphasised.
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Affiliation(s)
- A J Larner
- Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool L9 7LJ, UK.
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Larner AJ. "Frontal variant Alzheimer's disease": a reappraisal. Clin Neurol Neurosurg 2005; 108:705-8. [PMID: 16102893 DOI: 10.1016/j.clineuro.2005.07.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2005] [Revised: 06/17/2005] [Accepted: 07/07/2005] [Indexed: 11/27/2022]
Abstract
Two cases of clinically diagnosed sporadic Alzheimer's disease with early and prominent behavioural features (social disinhibition, emotional blunting, stereotyped verbal utterances) sufficient to prompt an initial diagnosis of frontotemporal dementia are presented. It is suggested that the term "frontal variant AD" be used for this clinically defined phenotype, which has also been described in cases of inherited AD associated with certain presenilin-1 gene mutations. This differs from previous usage of the term "frontal variant AD" to describe AD with predominant frontal lobe neuropathological change (although the clinical phenotype may reflect regional distribution of pathology), but parallels the clinical definition of visual agnosic, aphasic and apraxic presentations of AD. The proposed usage would also emphasise differential diagnosis.
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Affiliation(s)
- Andrew J Larner
- Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Lower Lane, Fazakerley, Liverpool L9 7LJ, UK.
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Larner AJ. An audit of the Addenbrooke's Cognitive Examination (ACE) in clinical practice. Int J Geriatr Psychiatry 2005; 20:593-4. [PMID: 15962353 DOI: 10.1002/gps.1336] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Current awareness in geriatric psychiatry. Int J Geriatr Psychiatry 2005; 20:600-7. [PMID: 15997511 DOI: 10.1002/gps.1226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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