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Garret M, Pestronk A. Sarcoidosis, granulomas and myopathy syndromes: A clinical-pathology review. J Neuroimmunol 2022; 373:577975. [PMID: 36228383 DOI: 10.1016/j.jneuroim.2022.577975] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 09/24/2022] [Accepted: 09/29/2022] [Indexed: 11/29/2022]
Abstract
Muscle involvement in sarcoidosis is common by pathologic analysis, but symptomatic disorders are less frequent. Sarcoidosis-related muscle pathology includes non-caseating granulomas, muscle fiber changes that are diffuse or anatomically related to granulomas, and perimysial connective tissue with histiocyte-associated damage. The mechanisms by which granulomas form, enlarge and damage muscle tissues are incompletely understood. Sarcoidosis-related clinical syndromes with muscle involvement include: chronic myopathies with proximal weakness; nodular disorders; subacute onset disorders involving proximal or eye muscles; myalgia or fatigue syndromes; and, possibly, inclusion body myositis-like disorders. Corticosteroid treatment may benefit some syndromes, but clinical trials are necessary.
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Affiliation(s)
- Mark Garret
- Departments of Neurology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Alan Pestronk
- Departments of Neurology, Washington University School of Medicine, Saint Louis, MO, USA; Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO, USA.
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2
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Clinical characteristics and outcome in muscular sarcoidosis: a retrospective cohort study and literature review. Neuromuscul Disord 2022; 32:557-563. [PMID: 35654706 DOI: 10.1016/j.nmd.2022.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 11/23/2022]
Abstract
We evaluated the clinical features and treatment response of patients with muscular sarcoidosis. A retrospective cohort of 12 patients showed muscle weakness in 11 and myalgia in seven. One had focal myositis. Four had a negative medical history for sarcoidosis. Muscle imaging showed muscle edema in all and replacement of muscle tissue by fat in half of patients. Muscle biopsy showed non-caseating granulomas in six of nine patients and inflammation without granulomas in three. None of the muscle biopsies showed features of inclusion body myositis. Imaging in three patients without muscle biopsy showed focal intramuscular masses or a 'tiger man' appearance typical for muscular sarcoidosis. Treatment consisted of glucocorticoids in 11, additional methotrexate or azathioprine in seven and infliximab in two patients. Half of the patients had symptoms leading to substantial disability (modified Rankin scale score >1) at last follow-up. A literature review of articles describing more than one muscular sarcoidosis patient published in the last 25 years identified 153 additional patients. We found muscular sarcoidosis to be a rare and often disabling disease which may be recognized by typical muscle imaging characteristics and add focal myositis to the muscular phenotypes of sarcoidosis.
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Ellatif M, Bhasin P, Urigo C, Sahu A. Symptomatic nodular myopathy: an atypical presentation of sarcoidosis. BMJ Case Rep 2021; 14:14/5/e241206. [PMID: 34031077 DOI: 10.1136/bcr-2020-241206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Symptomatic myopathy is a very rare extrapulmonary manifestation of sarcoidosis that may not be readily recognised in the absence of a known history of sarcoid. Nodular myopathy is the most uncommon subtype of musclar sarcoidosis and, when encountered, establishing the diagnosis can be challenging. We present a case of symptomatic nodular myopathy as a first presentation of sarcoidosis in a young man who required a multidisciplinary approach to diagnose. The patient presented to our radiology department following a short period of flu-like illness and multiple soft tissue lesions. Biopsy of the lesions demonstrated noncaseating granulomata, and a diagnosis of sarcoidosis was established after important differential diagnoses were excluded. We present a literature review of sarcoid-related myopathy and the multimodality imaging characteristics of the different subtypes.
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Affiliation(s)
- Mostafa Ellatif
- Radiology Department, London North West Healthcare NHS Trust, Harrow, UK
| | | | - Carlo Urigo
- Radiology Department, London North West Healthcare NHS Trust, Harrow, UK
| | - Ajay Sahu
- Radiology Department, Ealing Hospital, London, UK
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Lee S, Lee IS, Mok J, Song YS, Choi KU. Muscular sarcoidosis involving the chest and abdominal walls: case report with MR imaging. Skeletal Radiol 2018; 47:407-411. [PMID: 29038921 DOI: 10.1007/s00256-017-2787-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/21/2017] [Accepted: 10/02/2017] [Indexed: 02/02/2023]
Abstract
Sarcoidosis is an inflammatory disorder that is characterized by the presence of noncaseating granulomas in tissues, involving many organs and tissues. Extra-pulmonary, especially muscular sarcoidosis is a rare condition. The most common location of the muscular sarcoidosis is known to be the proximal muscles of the extremities; however, there have been no cases of diffuse involvement of the chest and abdominal wall muscles. Here, we report a rare muscular sarcoidosis with infiltrative pattern in the chest and abdominal wall muscles and describe the MR imaging findings that were mistaken as lymphoma at initial diagnosis. Although our case did not show characteristic MR findings of muscular sarcoidosis, clinicians or radiologists who are aware of these imaging features can perform early systemic survey for sarcoidosis. Also muscle biopsy is very important to confirm the sarcoidosis and distinguish it from other tumors.
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Affiliation(s)
- Seunghyun Lee
- Department of Radiology, Pusan National University Hospital, Biomedical Research Institute, 1-10 Ami-dong, Seo-gu, Busan, 602-739, South Korea.,Pusan National University School of Medicine, Busan, South Korea
| | - In Sook Lee
- Department of Radiology, Pusan National University Hospital, Biomedical Research Institute, 1-10 Ami-dong, Seo-gu, Busan, 602-739, South Korea. .,Pusan National University School of Medicine, Busan, South Korea.
| | - Jeongha Mok
- Department of Internal Medicine, Pusan National University Hospital, Biomedical Research Institute, 1-10 Ami-dong, Seo-gu, Busan, 602-739, South Korea
| | - You Seon Song
- Department of Radiology, Pusan National University Hospital, Biomedical Research Institute, 1-10 Ami-dong, Seo-gu, Busan, 602-739, South Korea.,Pusan National University School of Medicine, Busan, South Korea
| | - Kyung-Un Choi
- Department of Pathology, Pusan National University Hospital, Biomedical Research Institute, 1-10 Ami-dong, Seo-gu, Busan, 602-739, South Korea
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MRI of nodular muscular sarcoidosis. Acta Neurol Belg 2016; 116:649-650. [PMID: 26702625 DOI: 10.1007/s13760-015-0584-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 12/09/2015] [Indexed: 10/22/2022]
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6
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Guidry C, Fricke RG, Ram R, Pandey T, Jambhekar K. Imaging of Sarcoidosis. Radiol Clin North Am 2016; 54:519-34. [DOI: 10.1016/j.rcl.2015.12.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Nessrine A, Zahra AF, Taoufik H. Musculoskeletal involvement in sarcoidosis. J Bras Pneumol 2014; 40:175-82. [PMID: 24831403 PMCID: PMC4083650 DOI: 10.1590/s1806-37132014000200012] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Accepted: 02/21/2014] [Indexed: 01/30/2023] Open
Abstract
Sarcoidosis is a multisystem inflammatory disorder of unknown cause. It most commonly
affects the pulmonary system but can also affect the musculoskeletal system, albeit
less frequently. In patients with sarcoidosis, rheumatic involvement is polymorphic.
It can be the presenting symptom of the disease or can appear during its progression.
Articular involvement is dominated by nonspecific arthralgia, polyarthritis, and
Löfgren's syndrome, which is defined as the presence of lung adenopathy, arthralgia
(or arthritis), and erythema nodosum. Skeletal manifestations, especially dactylitis,
appear mainly as complications of chronic, multiorgan sarcoidosis. Muscle involvement
in sarcoidosis is rare and usually asymptomatic. The diagnosis of rheumatic
sarcoidosis is based on X-ray findings and magnetic resonance imaging findings,
although the definitive diagnosis is made by anatomopathological study of biopsy
samples. Musculoskeletal involvement in sarcoidosis is generally relieved with
nonsteroidal anti-inflammatory drugs or corticosteroids. In corticosteroid-resistant
or -dependent forms of the disease, immunosuppressive therapy, such as treatment with
methotrexate or anti-TNF-α, is employed. The aim of this review was to present an
overview of the various types of osteoarticular and muscle involvement in
sarcoidosis, focusing on their diagnosis and management.
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Han EJ, Jang YS, Lee IS, Lee JM, Kang S, Kim HS. Muscular sarcoidosis detected by F-18 FDG PET/CT in a hypercalcemic patient. J Korean Med Sci 2013; 28:1399-402. [PMID: 24015050 PMCID: PMC3763119 DOI: 10.3346/jkms.2013.28.9.1399] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 04/23/2013] [Indexed: 12/18/2022] Open
Abstract
Sarcoidosis is a systemic granulomatous disease of unknown etiology that involves many organs, occasionally mimicking malignancy. We herein report a 50-yr-old woman of muscular sarcoidosis of chronic myopathic type, manifested by hypercalcemia and muscle wasting. Besides insignificant hilar lymphadenopathy, her sarcoidosis was confined to generalized atrophic muscles and therefore, F-18 FDG PET/CT alone among conventional imaging studies provided diagnostic clues for the non-parathyroid-related hypercalcemia. On follow-up PET/CT during low-dose steroid treatment, FDG uptake in the muscles disappeared whereas that in the hilar lymph nodes remained. PET/CT may be useful in the evaluation of unexpected disease extent and monitoring treatment response in suspected or known sarcoidosis patients.
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Affiliation(s)
- Eun Ji Han
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yi Sun Jang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Suk Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong Min Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Siwon Kang
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hye Soo Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Tantisricharoenkul G, Tan EW, Fayad LM, McCarthy EF, McFarland EG. Malignant soft tissue tumors of the biceps muscle mistaken for proximal biceps tendon rupture. Orthopedics 2012; 35:e1548-52. [PMID: 23027496 DOI: 10.3928/01477447-20120919-28] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Tears of the proximal long head of the biceps tendon are among the most common tendon tears in the body. In most cases, the diagnosis is easily determined based on the history and physical examination. However, malignant soft tissue tumors can simulate proximal biceps tendon tears. Although tumors simulating tears of the distal biceps tendon at the elbow have been reported, to the authors' knowledge, no previous cases of tumors simulating or being mistaken for proximal biceps tendon tears have been reported.This article describes 2 cases of malignant sarcomas initially mistaken for tears of the long head of the biceps tendon. In the first case, a 62-year-old woman developed swelling in her arm after feeling a twinge in her shoulder. A magnetic resonance imaging scan was misread as a biceps tendon tear and not treated by the examining physician. In the second case, a mass appeared with little trauma in the brachium of a 70-year-old man. On physical examination, the mass was hard to palpation. In each case, biopsy revealed a soft tissue sarcoma. Both patients underwent wide excision with radiation and are currently disease free. These 2 cases emphasize the importance of obtaining a good history and of performing a thorough shoulder and arm examination in patients with deformities consistent with tears of the long head of the biceps tendon.
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Affiliation(s)
- Gof Tantisricharoenkul
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland 21224-2780 ., USA
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Abstract
We report a case of acute tenosynovitis from sarcoidosis and review previously reported cases of this entity. A woman with known pulmonary sarcoidosis rapidly developed painless nodules in the tendon sheaths of the dorsum of both hands and wrists. Sarcoid tenosynovitis is almost exclusively found in the upper extremity. The flexor and extensor tendons are equally affected. The condition may respond to medical therapy including corticosteroids and other immunomodulating medications. Surgical debulking and tendon sheathectomy have also been curative. The disease has also been reported to spontaneously resolve. Our patient dramatically improved while on methotrexate.
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MRI findings of neutrophilic fasciitis in a patient with acute febrile neutrophilic dermatosis (Sweet's syndrome). Skeletal Radiol 2011; 40:779-82. [PMID: 21298430 DOI: 10.1007/s00256-011-1104-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Revised: 12/19/2010] [Accepted: 01/13/2011] [Indexed: 02/02/2023]
Abstract
Acute febrile neutrophilic dermatosis (Sweet's syndrome) is a clinical condition that is histopathologically characterized by infiltration of the dermis with mature neutrophils with or without vessel wall destruction. Frequently, an extracutaneous systemic disease can be seen. We report magnetic resonance imaging (MRI) findings of neutrophilic fasciitis in a 62-year-old man with Sweet's syndrome and musculoskeletal involvement. The musculoskeletal system is rarely involved in Sweet's syndrome and, to our knowledge, no previous report of MRI findings of neutrophilic fasciitis with myofascial involvement exists in the literature.
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Akasbi N, Nessrine A, Tahiri L, Latifa T, Daoudi A, Abdelkarim D, Bendahou M, Mouhcine B, Harzy T, Taoufik H. Frohse's arcade syndrome revealing sarcoidosic myopathy. Joint Bone Spine 2011; 78:522-3. [PMID: 21549630 DOI: 10.1016/j.jbspin.2011.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 03/10/2011] [Indexed: 10/18/2022]
Abstract
We report the first case of an unusual sarcoidosic muscular involvement, complicated with radial nerve palsy. A 58-year-old woman suffering from a mediastinopulmonary sarcoidosis, was admitted for a driving deficit of the hands with a radially deviation during the wrist extension. She had been given a diagnosis of motor branch radial nerve entrapment syndrome. The patient had neurolysis with many muscle biopsies compatible with multiples sarcoidosic nodules, especially at the level of supinator muscle at the origin of the radial nerve compression.
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Gaeta M, Mazziotti S, Minutoli F, Genitori A, Toscano A, Rodolico C, Blandino A. MR imaging findings of focal myositis: a pseudotumour that may mimic muscle neoplasm. Skeletal Radiol 2009; 38:571-8. [PMID: 19255757 DOI: 10.1007/s00256-009-0664-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2008] [Revised: 01/07/2009] [Accepted: 02/10/2009] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The authors describe magnetic resonance (MR) findings in eight patients with histologically confirmed focal myositis. MATERIALS AND METHODS In each patient, axial TSE T1-weighted and fast short-tau inversion recovery (STIR) images were obtained using a 1.5-T MR scanner. Three patients also underwent dynamic contrast-enhanced MR examination using a GE T1-weighted sequence. The following features were evaluated: anatomical distribution, extent of the involvement, signal intensity characteristics, dynamic enhancement pattern and outcome at follow-up examinations. RESULTS Seven of eight lesions were located in the lower extremities, one of eight in the arm; four of eight involved part of a muscle, two of eight diffusely involved a muscle and two of eight showed multifocal involvement of two or more muscles. All lesions were hyperintense on fast-STIR images: the hyperintensity was homogeneous in six of eight and inhomogeneous in two of eight. On T1-weighted unenhanced images, all lesions but two appeared isointense or slightly hypointense in comparison to normal muscles; two lesions showed a slight hyperintensity. Dynamic enhancement pattern corresponded to the type usually seen in benign soft tissue lesions. All lesions disappeared. CONCLUSION Focal myositis is an uncommon pseudotumour which should be considered in the differential diagnosis of muscular masses and myopathies.
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Affiliation(s)
- Michele Gaeta
- Department of Radiological Sciences, University of Messina, AOU Policlinico G Martino, Messina, Italy
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Nemoto I, Shimizu T, Fujita Y, Tateishi Y, Tsuji-Abe Y, Shimizu H. Tumour-like muscular sarcoidosis. Clin Exp Dermatol 2007; 32:298-300. [PMID: 17397354 DOI: 10.1111/j.1365-2230.2007.02371.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Sarcoidosis is a multisystem granulomatous disease of unknown aetiology with variable manifestations, which may affect virtually any organ. Muscular sarcoidosis is a rare entity, and among this group of muscular lesions, the tumour-like muscular sarcoidosis subtype is extremely rare. We report on two sarcoidosis cases that presented muscular sarcoid lesions with subcutaneous tumours.
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Affiliation(s)
- I Nemoto
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, Japan.
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Michel-Letonturier M, Aumaître O, Kemeny JL, Clavelou P, Soubrier M, Dubost JJ, Michel JL. Imagerie des localisations extra-thoraciques de la sarcoïdose. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s0181-9801(07)88851-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Usami O, Nara M, Tamada T, Kitamuro T, Tomaki M, Ashino Y, Onodera K, Miyazaki S, Moriya T, Hattori T. Systemic sarcoidosis associated with double cancers of the esophagus and stomach. Intern Med 2007; 46:2019-22. [PMID: 18084127 DOI: 10.2169/internalmedicine.46.0231] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
To discriminate between sarcoidosis and sarcoid reaction in the lymphadenopathy of malignancy is sometimes clinically important. We describe a case of sarcoidosis associated with double cancers of the esophagus and stomach. A patient who six months previously was found to have early gastric cancer, was then found to have esophagus cancer. The chest radiography demonstrated bilateral hilar lymphadenopathy. Pathological analysis of the lymph nodes and lungs showed non-caseating epithelioid cell granuloma, revealing the existence of sarcoidosis. The findings suggest that the possibility of systemic sarcoidosis should be considered in cases with established malignancy and newly disclosed radiographic findings.
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Affiliation(s)
- Osamu Usami
- Division of Infectious and Respiratory Diseases, Tohoku University, Sendai
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Chen HH, Hsieh TY, Chen DY, Lan HHC, Hsieh CW. Sonographic Features of Nodular-type Muscular Sarcoidosis. J Med Ultrasound 2007. [DOI: 10.1016/s0929-6441(08)60037-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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