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Lee DJ, Grose E, Brenna CTA, Philteos J, Lightfoot D, Kirubalingam K, Chan Y, Palmer JN, Adappa ND, Lee JM. The benefits and risks of non-steroidal anti-inflammatory drugs for postoperative analgesia in sinonasal surgery: a systematic review and meta-analysis. Int Forum Allergy Rhinol 2023; 13:1738-1757. [PMID: 36762711 DOI: 10.1002/alr.23140] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/26/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Non-steroidal anti-inflammatory drugs (NSAIDs) have emerged as an alternative to opioids for optimal postoperative pain management. However, the adoption of NSAIDs in sinonasal surgery has been impeded by a theoretical concern for postoperative bleeding. Our objective is to systematically review the efficacy and safety of NSAIDs for patients undergoing sinonasal surgery. METHODS MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL, and the WHO International Clinical Trials Registry Platform were searched from inception to January 27, 2022. Randomized controlled trials (RCTs) and comparative observational studies in any language were considered. Screening, data extraction, and risk of bias assessment were performed in duplicate. Our outcomes were postoperative pain scores, requirement for rescue analgesia, and postoperative adverse events (epistaxis, nausea/vomiting). RESULTS Out of 4661 records, 15 RCTs (enrolling 1210 patients) and two observational studies were included. Following endoscopic sinus surgery, there was no difference in pain scores between NSAIDs and non-NSAIDs groups (standardized mean differences [SMD] 0.44 units better, 95% CI -0.18 to 1.05). Following septorhinoplasty, NSAIDs decreased pain scores compared to non-NSAID regimens (SMD 1.14 units better, 95% CI 0.61 to 1.67 units better). Overall, NSAIDs reduced the need for rescue medication with a relative risk (RR) of 0.45 (95% CI 0.24 to 0.84). In addition, NSAIDs decreased the risk of nausea with an RR of 0.62 (95% CI 0.42 to 0.91) and did not increase the risk of epistaxis (RR 0.72, 95% CI 0.23-2.22). CONCLUSION Among patients undergoing sinonasal surgery, NSAIDs are beneficial in postoperative pain management and avoidance of postoperative nausea without increasing the risk of postoperative epistaxis.
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Affiliation(s)
- Daniel J Lee
- Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elysia Grose
- Division of Rhinology, Department of Otolaryngology - Head & Neck Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Connor T A Brenna
- Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Justine Philteos
- Division of Rhinology, Department of Otolaryngology - Head & Neck Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - David Lightfoot
- St. Michael's Hospital Health Sciences Library, Unity Health Toronto, Toronto, Ontario, Canada
| | | | - Yvonne Chan
- Division of Rhinology, Department of Otolaryngology - Head & Neck Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - James N Palmer
- Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nithin D Adappa
- Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John M Lee
- Division of Rhinology, Department of Otolaryngology - Head & Neck Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
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Li Y, Zou H, Zheng Z, Liu Z, Hu H, Wu W, Wang T. Advances in the Study of Bioactive Nanoparticles for the Treatment of HCC and Its Postoperative Residual Cancer. Int J Nanomedicine 2023; 18:2721-2735. [PMID: 37250475 PMCID: PMC10216871 DOI: 10.2147/ijn.s399146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 05/04/2023] [Indexed: 05/31/2023] Open
Abstract
Primary hepatocellular carcinoma (HCC, hepatocellular carcinoma) is the third leading cause of tumor death in the world and the second leading cause in China. The high recurrence rate at 5 years after surgery also seriously affects the long-term survival of HCC patients. For reasons such as poor liver function, large tumors, or vascular invasion, only relatively limited palliative treatment is available. Therefore, effective diagnostic and therapeutic strategies are needed to improve the complex microenvironment and block the mechanism of tumor development in order to treat the tumor and prevent recurrence. A variety of bioactive nanoparticles have been shown to have therapeutic effects on hepatocellular carcinoma and have the advantages of improving drug solubility, reducing drug side effects, preventing degradation in the blood, increasing drug exposure time, and reducing drug resistance. The development of bioactive nanoparticles is expected to complete the current clinical therapeutic approach. In this review, we discuss the therapeutic advances of different nanoparticles for hepatocellular carcinoma and discuss their potential for postoperative applications with respect to possible mechanisms of hepatocellular carcinoma recurrence. We further discuss the limitations regarding the application of NPs and the safety of NPs.
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Affiliation(s)
- Yanxu Li
- Medical College of Yangzhou University, Yangzhou University, Yangzhou City, Jiangsu Province, People’s Republic of China
| | - Hao Zou
- Dalian Medical University, Affiliated Hospital of Yangzhou University, Yangzhou City, Jiangsu Province, People’s Republic of China
| | - Zekun Zheng
- Dalian Medical University, Affiliated Hospital of Yangzhou University, Yangzhou City, Jiangsu Province, People’s Republic of China
| | - Zhuoheng Liu
- Dalian Medical University, Affiliated Hospital of Yangzhou University, Yangzhou City, Jiangsu Province, People’s Republic of China
| | - Huiyuan Hu
- Dalian Medical University, Affiliated Hospital of Yangzhou University, Yangzhou City, Jiangsu Province, People’s Republic of China
| | - Wei Wu
- Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou City, Jiangsu Province, People’s Republic of China
| | - Tao Wang
- College of Veterinary Medicine, Yangzhou University, Yangzhou City, Jiangsu Province, People’s Republic of China
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Lee JT, Levine CG, Overdevest JB, Higgins TS, Manes RP, Myhill JA, Soler ZM. American Rhinologic Society expert practice statement: Postoperative pain management and opioid use after sinonasal surgery. Int Forum Allergy Rhinol 2021; 11:1296-1307. [PMID: 34251080 DOI: 10.1002/alr.22847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023]
Abstract
The goal of this American Rhinologic Society expert practice statement (EPS) is to provide clinically applicable, evidence-based recommendations regarding pain management in sinonasal surgery. This EPS was developed following the recommended methodology and approval process as previously outlined. The topics of interest included preoperative counseling, local anesthesia, use of opioids for postoperative pain, use of nonopioid medication for postoperative pain, nonsteroidal anti-inflammatory drugs and bleeding, and use of gabapentin for pain control. Following a modified Delphi approach, 6 statements were developed, 5 of which reached consensus and 1 that did not. These statements and accompanying evidence are summarized along with an assessment of future needs.
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Affiliation(s)
- Jivianne T Lee
- Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Corinna G Levine
- Department of Otolaryngology-Head and Neck Surgery, University of Miami School of Medicine, Miami, FL
| | - Jonathan B Overdevest
- Department of Otolaryngology-Head and Neck Surgery, Columbia University School of Medicine, New York, NY
| | - Thomas S Higgins
- Division of Otolaryngology-Head and Neck Surgery, University of Louisville School of Medicine, Louisville, KY
| | - R Peter Manes
- Department of Otolaryngology-Head and Neck Surgery, Yale School of Medicine, New Haven, CT
| | - Jeffrey A Myhill
- Otolaryngology and Allergy, North East Arkansas Baptist Clinic, Jonesboro, AR
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
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Wang X, Li T. Postoperative pain pathophysiology and treatment strategies after CRS + HIPEC for peritoneal cancer. World J Surg Oncol 2020; 18:62. [PMID: 32234062 PMCID: PMC7110707 DOI: 10.1186/s12957-020-01842-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/20/2020] [Indexed: 02/08/2023] Open
Abstract
Background Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment choice for peritoneal cancer. However, patients commonly suffer from severe postoperative pain. The pathophysiology of postoperative pain is considered to be from both nociceptive and neuropathic origins. Main body The recent advances on the etiology of postoperative pain after CRS + HIPEC treatment were described, and the treatment strategy and outcomes were summarized. Conclusion Conventional analgesics could provide short-term symptomatic relief. Thoracic epidural analgesia combined with opioids administration could be an effective treatment choice. In addition, a transversus abdominis plane block could also be an alternative option, although further studies should be performed.
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Affiliation(s)
- Xiao Wang
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Road, Yangfangdian, Haidian District, Beijing, 100038, China
| | - Tianzuo Li
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Road, Yangfangdian, Haidian District, Beijing, 100038, China.
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Newberry CI, McCrary HC, Cerrati EW. The Efficacy of Oral Celecoxib Following Surgical Rhinoplasty. Facial Plast Surg Aesthet Med 2020; 22:100-104. [PMID: 32069423 DOI: 10.1089/fpsam.2019.29014.new] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Importance: Exploring potential methods of controlling postoperative rhinoplasty pain with non-narcotic medications. Objective: To examine the effects of celecoxib in reducing pain and possible opioid consumption after rhinoplasty surgery. Design, Setting, and Participants: This is a prospective cohort study of 51 consecutive patients who had undergone rhinoplasty surgery between July 2018 and May 2019 by a single facial plastic surgeon. A questionnaire regarding pain medication usage and complications was given to each patient at his or her initial 1-week postoperative visit. Patients were separated into groups based on whether celecoxib had been used perioperatively or not. Main Outcomes and Measures: In addition to demographic information, the following outcome measures were recorded for each group: type(s) of pain medications used, total opioid consumption, refills required, surgical complications, and related analgesic adverse effects. Results: Of the 51 patients included, 17 patients were provided celcoxib. Mean oxycodone-acetaminophen tablets taken in the celecoxib cohort was 4.2 (CI = 2.4-6.1), whereas mean tablets taken among controls was 14.8 (CI = 11.1-18.4) (p = 0.0006). Mean oxycodone-acetaminophen dose taken in the celecoxib cohort was 17.6 mg (CI = 9.0-26.3), whereas the mean among controls was 73.8 mg (CI = 55.5-92.0) (p = 0.0001). Mean total oral morphine equivalents (OMEs) were also reduced with an average of 26.5 OME (CI = 13.5-39.4) in the celecoxib cohort and 110.7 OMEs (CI = 83.3-138.0) in the control group (p = 0.001). Postoperative nausea and vomiting were significantly reduced in the celecoxib cohort versus the control group (p = 0.02). Overall, with the addition of celecoxib, there was a 76.2% decrease in milligrams of opioid use and an 83.4% decrease in incidence of nausea/vomiting. Conclusions and Relevance: Oral celecoxib appears to be effective in decreasing opioid consumption and nausea/vomiting rates after rhinoplasty without increasing surgical complications. Level of Evidence: 2.
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Affiliation(s)
- Christopher Ian Newberry
- Department of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Hilary C McCrary
- Department of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Eric W Cerrati
- Department of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah.,Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine Salt Lake City, Utah
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Abstract
Surgery is a mainstay treatment for patients with solid tumours. However, despite surgical resection with a curative intent and numerous advances in the effectiveness of (neo)adjuvant therapies, metastatic disease remains common and carries a high risk of mortality. The biological perturbations that accompany the surgical stress response and the pharmacological effects of anaesthetic drugs, paradoxically, might also promote disease recurrence or the progression of metastatic disease. When cancer cells persist after surgery, either locally or at undiagnosed distant sites, neuroendocrine, immune, and metabolic pathways activated in response to surgery and/or anaesthesia might promote their survival and proliferation. A consequence of this effect is that minimal residual disease might then escape equilibrium and progress to metastatic disease. Herein, we discuss the most promising proposals for the refinement of perioperative care that might address these challenges. We outline the rationale and early evidence for the adaptation of anaesthetic techniques and the strategic use of anti-adrenergic, anti-inflammatory, and/or antithrombotic therapies. Many of these strategies are currently under evaluation in large-cohort trials and hold promise as affordable, readily available interventions that will improve the postoperative recurrence-free survival of patients with cancer.
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Flurbiprofen Axetil Provides Effective Analgesia Without Changing the Pregnancy Rate in Ultrasound-Guided Transvaginal Oocyte Retrieval: A Double-Blind Randomized Controlled Trial. Anesth Analg 2017; 125:1269-1274. [PMID: 28430684 DOI: 10.1213/ane.0000000000002025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND In this prospective double-blind randomized study, we evaluated the analgesic effect and potential effect on pregnancy rate of the nonsteroidal anti-inflammatory drug flurbiprofen axetil in patients undergoing ultrasound-guided transvaginal oocyte retrieval under propofol-remifentanil anesthesia. METHODS A total of 200 patients scheduled to undergo ultrasound-guided transvaginal oocyte retrieval were randomly allocated to receive 1.5 mg/kg of flurbiprofen axetil (FA group) or placebo (control group) 30 minutes before the procedure. Postoperative pain scores, embryo implantation rate, and pregnancy rate were recorded. Neuroendocrine biomarkers and prostaglandin E2 levels in follicular fluid were tested after oocyte retrieval. RESULTS Patients in the FA group awakened earlier after surgery than patients in the control group (3.3 ± 2.6 vs 5.3 ± 3.4 minutes, P < .05) and had lower pain scores than patients in the control group (2.0 [0.0, 2.8] vs 5.0 [3.0, 5.0], P< .001). The difference in pregnancy rates between the 2 groups (44%-44%) was 0% (conventional 2-sided 95% confidence interval, -13.8% to 13.8%). The lower limit of the 90% 1-sided confidence interval for this difference was -9.0%, which was within the predefined noninferiority margin of -15.0%. The concentration of prostaglandin E2 in follicular fluid was decreased in the FA group (24.51 ± 1.52 vs 25.15 ± 1.49 pg/mL, P = .039), although the difference does not appear to be clinically important. CONCLUSIONS Flurbiprofen axetil given before ultrasound-guided transvaginal oocyte retrieval for patients under propofol-remifentanil general anesthesia relieves pain without any detrimental effect on clinical pregnancy rate.
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Hiller JG, Sampurno S, Millen R, Kuruvilla N, Ho KM, Ramsay R, Riedel B. Impact of celecoxib on inflammation during cancer surgery: a randomized clinical trial. Can J Anaesth 2017; 64:497-505. [PMID: 28092065 DOI: 10.1007/s12630-017-0818-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 12/11/2016] [Accepted: 01/02/2017] [Indexed: 11/30/2022] Open
Abstract
PURPOSE During cancer surgery, prostaglandin-mediated inflammation may promote and activate micrometastatic disease with a consequent increase in long-term cancer recurrence. Cyclooxygenase-2 inhibitors, known to have anti-proliferative properties, may offset such perioperative perturbation. We investigated the effectiveness of these agents to minimize inflammatory changes during cancer surgery. METHODS Following ethics approval, 32 patients who were to undergo major intracavity cancer surgery were enrolled in this prospective, randomized, clinical trial. The treatment group received 400 mg celecoxib preoperatively followed by five 200 mg 12-hourly doses. The control group received no anti-inflammatory agents. Inflammatory and immunomodulatory end points were measured serially. The primary end points were the measured plasma and urinary prostaglandin E metabolite (PGEM) levels 48 hours following surgery. Secondary endpoints included interleukin levels, leucocyte profile, and clinical end points. RESULTS No differences in the 48-hr plasma or urinary PGEM levels were observed between the celecoxib and control groups. Linear mixed modeling, used to accommodate differences in baseline PGEM levels, showed that celecoxib (cf. control) administration lowered plasma PGEM over the entire 48-hr period following surgery (β-coefficient = -0.38 pg.ml-1; 95% confidence interval: -0.69 to -0.06; P = 0.021). Celecoxib administration also lowered postoperative pain scores. DISCUSSION Standard dosing of the cyclooxygenase-2 inhibitor celecoxib slightly reduced perioperative cyclooxygenase activity during cancer surgery. Given cyclooxygenase's role in cancer pathways, we recommend dose-finding studies be undertaken before prospective clinical trials are conducted testing the currently unsubstantiated hypothesis that perioperative anti-inflammatory administration improves long-term cancer outcomes. This trial was registered at: Australian New Zealand Clinical Trial Registry: ACTRN12615000041550; www.anzctr.org.au.
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Affiliation(s)
- Jonathan G Hiller
- Division of Surgical Oncology, Department of Cancer Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan Street, Melbourne, 3000, VIC, Australia. .,Differentiation and Transcription Laboratory, Peter MacCallum Cancer Centre, Melbourne, Australia. .,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia. .,Monash University, Melbourne, Australia.
| | - Shienny Sampurno
- Differentiation and Transcription Laboratory, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Rosemary Millen
- Differentiation and Transcription Laboratory, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Niketh Kuruvilla
- Division of Surgical Oncology, Department of Cancer Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan Street, Melbourne, 3000, VIC, Australia
| | - Kwok M Ho
- Department of Intensive Care Medicine, Royal Perth Hospital, Perth, Australia.,School of Veterinary & Life Sciences, Murdoch University, Perth, Australia
| | - Rob Ramsay
- Differentiation and Transcription Laboratory, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Bernhard Riedel
- Division of Surgical Oncology, Department of Cancer Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan Street, Melbourne, 3000, VIC, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
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Owusu-Agyemang P, Cata JP, Fournier KF, Zavala AM, Soliz J, Hernandez M, Hayes-Jordan A, Gottumukkala V. Evaluating the Impact of Total Intravenous Anesthesia on the Clinical Outcomes and Perioperative NLR and PLR Profiles of Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 2016; 23:2419-29. [DOI: 10.1245/s10434-016-5176-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Indexed: 01/28/2023]
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Hiller JG, Parat MO, Ben-Eliyahu S. The Role of Perioperative Pharmacological Adjuncts in Cancer Outcomes: Beta-Adrenergic Receptor Antagonists, NSAIDs and Anti-fibrinolytics. CURRENT ANESTHESIOLOGY REPORTS 2015. [DOI: 10.1007/s40140-015-0113-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Stammschulte T, Brune K, Brack A, Augenstein H, Arends G, Gundert-Remy U. Unerwartete Blutungskomplikationen im Zusammenhang mit Celecoxib. Anaesthesist 2014; 63:958-60. [DOI: 10.1007/s00101-014-2385-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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