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Dhami A, Rutland CD, Momeni A, Waheed U. Acellular Dermal Matrix: Imaging Features With Histopathology Correlation. JOURNAL OF BREAST IMAGING 2025; 7:75-84. [PMID: 39248808 DOI: 10.1093/jbi/wbae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Indexed: 09/10/2024]
Abstract
Acellular dermal matrix (ADM) is an immunologically inert graft, typically from cadaveric skin, often used in postmastectomy breast reconstruction. Created from decellularized dermal tissues that have been treated to remove DNA and antigenic donor cells (leaving extracellular matrix), ADM is often used as a structural scaffold or sling to reinforce and support the structure and position of a breast implant during postoperative integration in implant-based breast reconstruction; ADM can also be used to fill cosmetic defects. Advantages of ADM use include improved cosmesis and reduced capsular contracture rates. On US, ADM can be seen as a subtle band with variable echogenicity adjacent to the implant. When folded on itself or redundant, ADM may present as a palpable oval mass with indistinct or circumscribed margins and variable echogenicity. On mammography, ADM can be seen as a circumscribed oval equal density mass when redundant and folded on itself; a layered appearance may be evident on tomosynthesis. On MRI, presence and absence of enhancement have been documented. Imaging findings likely vary depending on the degree of host tissue remodeling and incorporation, and when biopsied, histopathologically, ADM may be difficult to distinguish from scarring. Successful imaging diagnosis of ADM is aided by clinical knowledge of the intraoperative use and configuration of ADM, which may help differentiate ADM from new or recurrent malignancy and avoid unnecessary biopsy.
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Affiliation(s)
- Alysha Dhami
- Breast Imaging Division, Department of Radiology, Stanford University Medical Center, Stanford, CA, USA
| | - Cooper D Rutland
- Department of Pathology, Stanford University Medical Center, Stanford, CA, USA
| | - Arash Momeni
- Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Uzma Waheed
- Breast Imaging Division, Department of Radiology, Stanford University Medical Center, Stanford, CA, USA
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Ho IW, Chichura A, Pederson HJ, Xavier BA, Ritner J, Schwarz GS. Current State of Evidence-Based Long-Term Monitoring Protocols for Breast Plastic Surgery Patients. Ann Surg Oncol 2024; 31:8372-8382. [PMID: 39103688 PMCID: PMC11466996 DOI: 10.1245/s10434-024-16003-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 07/23/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Recommendations for breast surveillance following breast plastic surgery are frequently changing. Establishing guidelines for long-term monitoring protocols may help identify treatable conditions and prevent untoward sequelae. We sought to evaluate the current state of evidence-based long-term monitoring protocols for patients following breast augmentation, reduction, and breast reconstruction. METHODS Official guidelines from various American societies and international societies were analyzed for alignment in evidence-based recommendations regarding breast surveillance. RESULTS The most recent US FDA update recommends magnetic resonance imaging or ultrasound starting 5-6 years after surgery and every 2-3 years thereafter. Discrepancies exist among professional societies: the American Society of Plastic Surgeons (ASPS) aligns with the FDA, while the American Society of Breast Surgeons and American College of Radiology (ACR) find no role for imaging for asymptomatic cases. Ultrasound is first-line for any implant concerns, with MRI if necessary. European societies oppose routine breast implant imaging. Breast reduction patients lack unique screening protocols; monitoring aligns with age and cancer risk factors. Following mastectomy and breast reconstruction, most organizations advocate for annual clinical examinations, with more frequent examinations initially. Evidence suggests that physical examination is sufficient to detect local cancer recurrence, with imaging only indicated if there is concern for recurrence. No surveillance imaging is recommended by the American Society of Clinical Oncology, National Comprehensive Cancer Network, or ASPS; however, ACR recommends mammography for autologous reconstruction only. CONCLUSION Multispecialty and regulatory body alignment may promote provider and patient adherence. Ongoing studies of long-term outcomes are needed to strengthen the level of evidence for monitoring guidelines.
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Affiliation(s)
- Isabel W Ho
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Anna Chichura
- Department of Breast Surgery, Cleveland Clinic, Cleveland, OH, USA
- Department of Subspecialty Gynecology, Cleveland Clinic, Cleveland, OH, USA
| | - Holly J Pederson
- Department of Breast Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Brian A Xavier
- Department of Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Julie Ritner
- Department of Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Graham S Schwarz
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA.
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Durando M, Ferrando PM, Dianzani C, Galioto F, Mariscotti G, Regini E, Bartoli G, Malan F, Bogetti P, Fonio P. Acellular dermal matrix imaging features in breast reconstructive surgery: a pictorial review. Br J Radiol 2024; 97:505-512. [PMID: 38419148 DOI: 10.1093/bjr/tqad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 10/29/2023] [Accepted: 11/29/2023] [Indexed: 03/02/2024] Open
Abstract
Acellular dermal matrices (ADMs) are biological engineered tissues, which may provide an immunologically inert scaffold in breast reconstruction. Since the literature on imaging features of ADMs is limited, radiologists must be aware of the common imaging appearances of ADM, to differentiate normal conformation from residual or recurrent disease. Our purpose is to review the current role of ADMs in implant-based breast reconstruction, describing the normal imaging findings at ultrasound, mammography, and MRI also considering the possible changes over time. In this pictorial essay, we reviewed imaging features of ADMs described in the literature and we reported our experience in patients who underwent reconstructive surgery with human or animal ADM for newly diagnosed breast cancer.
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Affiliation(s)
- Manuela Durando
- Radiology - University of Turin; Department of Diagnostic Imaging and Interventional Radiology; Presidio Ospedaliero Molinette - A. O. U. Città della Salute e della Scienza di Torino; Via Genova 3, Torino, 10126, Italy
| | - Pietro Maria Ferrando
- Plastic Surgery Department; Presidio ospedaliero CTO - A. O. U. Città della Salute e della Scienza di Torino; Via Zuretti, 29, Torino, 10126, Italy
| | - Chiara Dianzani
- Radiology - University of Turin; Department of Diagnostic Imaging and Interventional Radiology; Presidio Ospedaliero Molinette - A. O. U. Città della Salute e della Scienza di Torino; Via Genova 3, Torino, 10126, Italy
| | - Francesca Galioto
- Radiology - University of Turin; Department of Diagnostic Imaging and Interventional Radiology; Presidio Ospedaliero Molinette - A. O. U. Città della Salute e della Scienza di Torino; Via Genova 3, Torino, 10126, Italy
| | - Giovanna Mariscotti
- Radiology - University of Turin; Department of Diagnostic Imaging and Interventional Radiology; Presidio Ospedaliero Molinette - A. O. U. Città della Salute e della Scienza di Torino; Via Genova 3, Torino, 10126, Italy
| | - Elisa Regini
- Radiology - University of Turin; Department of Diagnostic Imaging and Interventional Radiology; Presidio Ospedaliero Molinette - A. O. U. Città della Salute e della Scienza di Torino; Via Genova 3, Torino, 10126, Italy
| | - Germana Bartoli
- Radiology - University of Turin; Department of Diagnostic Imaging and Interventional Radiology; Presidio Ospedaliero Molinette - A. O. U. Città della Salute e della Scienza di Torino; Via Genova 3, Torino, 10126, Italy
| | - Fabrizio Malan
- Plastic Surgery Department; Presidio ospedaliero CTO - A. O. U. Città della Salute e della Scienza di Torino; Via Zuretti, 29, Torino, 10126, Italy
| | - Paolo Bogetti
- Structure of Reconstructive and Aesthetic Plastic Surgery - University of Turin; Department of Surgical Sciences; Presidio Ospedaliero Molinette - A.O.U. Città della Salute e della Scienza di Torino; Torino, 10126, Italy
| | - Paolo Fonio
- Radiology - University of Turin; Department of Diagnostic Imaging and Interventional Radiology; Presidio Ospedaliero Molinette - A. O. U. Città della Salute e della Scienza di Torino; Via Genova 3, Torino, 10126, Italy
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Lee JH, Choi BG, Lee WS, Seo MG, Park BY, Kim YS, Park DY, Kim IK. Long-Term Ultrasonographic and Histologic Changes in Acellular Dermal Matrix in Implant-Based Breast Reconstructions. Plast Reconstr Surg 2023; 152:514-522. [PMID: 36827483 DOI: 10.1097/prs.0000000000010321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND Acellular dermal matrix (ADM) is composed of extracellular matrix (ECM) and is widely used in implant-based breast reconstructions. However, long-term changes in the ADM around implants have not been established. This study aimed to investigate long-term changes in the ADM covering breast implants using serial ultrasound and histologic evaluations. METHODS The authors evaluated the ultrasound results of 145 patients who underwent implant-based breast reconstructions with ADM coverings. The ultrasound results obtained within 18 months of surgery and those obtained 5 years postoperatively were analyzed to determine the change in ADM thickness. For histologic analysis, the ADM was harvested from 30 patients who underwent secondary breast surgery. Histologic features of the ECM and cellular components within the ADM were compared at specific intervals from ADM implantation and the second operation (early ADM group, <18 months; late ADM group, >5 years postoperatively). RESULTS The ADM thickness on ultrasound examination was significantly decreased in the late ADM group compared with that in the early ADM group ( P < 0.001). Histologic analyses revealed that the late ADM group had less thickness with lower ECM levels versus the early ADM group. Increased infiltration of host cells, such as vascular endothelial cells, myofibroblasts, and immune cells, occurred in the late ADM group. CONCLUSIONS Implanted ADMs underwent gradual thinning over time, in addition to ECM reduction and infiltration of host cells. These findings are useful in understanding the natural course of ADMs currently used in implant-based breast reconstructions. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
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Affiliation(s)
- Jun-Ho Lee
- From the Departments of Plastic and Reconstructive Surgery
| | - Bong Gyu Choi
- From the Departments of Plastic and Reconstructive Surgery
| | - Won Seob Lee
- From the Departments of Plastic and Reconstructive Surgery
| | - Min-Gi Seo
- From the Departments of Plastic and Reconstructive Surgery
| | - Bo-Yoon Park
- From the Departments of Plastic and Reconstructive Surgery
| | | | - Do Young Park
- Ophthalmology, Yeungnam University College of Medicine
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Il-Kug Kim
- From the Departments of Plastic and Reconstructive Surgery
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Acellular Dermal Matrix Mimicking a New Retroareolar Mass After Central Pillar Neonipple Reconstruction. Ann Plast Surg 2022; 89:500-501. [PMID: 36156504 DOI: 10.1097/sap.0000000000003270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
ABSTRACT Acellular dermal matrix (ADM) is an increasingly popular alloplastic cadaveric dermis used to enhance postmastectomy reconstruction. Acellular dermal matrix can be used as a nipple-shaped cylinder in central pillar nipple reconstruction to help maintain long-term projection. We report a unique presentation of ADM mimicking a retroareolar mass after central pillar neonipple reconstruction. A 49-year-old woman with a history of invasive ductal carcinoma underwent delayed nipple reconstruction after lumpectomy and oncoplastic closure using an inframammary V-Y advancement flap.The nipple reconstruction was performed using pretattoo and articulated tab flaps. A rolled tube of acellular dermal matrix was placed in the central aspect of the neonipple reconstruction for projection. At 4 months postoperative, a screening mammogram and ultrasound noted a new retroareolar mass classified as BIRADS 4 necessitating a breast biopsy. Biopsy revealed portions of fibrous connective tissue consistent with partially incorporated acellular dermal matrix allograft. There was no evidence of malignancy. To mitigate the risk of future radiographic or clinical misinterpretation of ADM in nipple reconstruction, the placement of radiopaque markers such as microclips on the ADM implant could be a useful adjunct. Radiologists and surgeons should include ADM artifact in their differential diagnosis of radiologic imaging when evaluating a new mass in the proximity of prior ADM placement in neonipple reconstruction of the breast.
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Lee CB, Kim YS, Lee SE. Imaging features of volume replacement using an acellular dermal matrix in oncoplastic breast conserving surgery: A case report. Radiol Case Rep 2022; 17:2146-2149. [PMID: 35469303 PMCID: PMC9034281 DOI: 10.1016/j.radcr.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/26/2022] [Accepted: 03/02/2022] [Indexed: 11/18/2022] Open
Abstract
An acellular dermal matrix (ADM) is a type of allograft that can be made from human, bovine, or porcine dermis and is used to support or reconstruct soft tissue. During breast reconstructive surgeries, ADMs are widely used to partially cover breast implants following a mastectomy to correct for insufficient subcutaneous tissue. Recently, ADMs have been used as a filling material for volume replacement in oncoplastic breast conserving surgery. In this report, we present the case of a female, middle-aged patient who underwent breast conserving surgery with volume replacement using an ADM.
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Abnormal Ultrasonographic Findings of Acellular Dermal Matrix in Implant-Based Breast Reconstruction: Correlations with Histopathology. J Clin Med 2022; 11:jcm11041057. [PMID: 35207330 PMCID: PMC8877379 DOI: 10.3390/jcm11041057] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Acellular dermal matrix (ADM) in implant-based breast reconstruction can show various ultrasound (US) findings. However, there are limited reports on the US features of the ADM. The aims of this study were to evaluate US findings of the ADM in implant-based breast reconstruction and correlate them with histopathological findings. Methods: Between January 2015 and August 2020, 250 women who underwent implant-based breast reconstruction with ADM and a breast US examination at 6 months to 1 year after reconstruction were retrospectively analyzed. Abnormal US findings were classified as type 1 (focal thickening with decreased echogenicity), 2 (diffusely hyperechoic), or 3 (bright echogenic spots). ADM biopsy was performed in 33 patients who underwent second stage or revisional surgeries. Results: In total, 176 consecutive women with 207 US findings were analyzed. The US findings were normal in 52.2% of the women. The percentages of type 1, 2, and 3 patients were 13.5%, 11.1%, and 23. 2%, respectively. These patients had microscopic findings that showed patchy areas with chronic inflammatory infiltrates, dense collagen bundles without degenerative or inflammatory changes, and empty spaces or degenerated foci unaccompanied by inflammation. Conclusion: Knowing the various ADM presentations on US can help avoid unnecessary invasive procedures.
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Lowes S, MacNeill F, Martin L, O'Donoghue JM, Pennick MO, Redman A, Wilson R. Breast imaging for aesthetic surgery: British Society of Breast Radiology (BSBR), Association of Breast Surgery Great Britain & Ireland (ABS), British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS). J Plast Reconstr Aesthet Surg 2018; 71:1521-1531. [PMID: 30213745 DOI: 10.1016/j.bjps.2018.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 06/16/2018] [Accepted: 07/28/2018] [Indexed: 10/28/2022]
Abstract
This is an overview of the guidelines for breast imaging before and after aesthetic (cosmetic) breast surgery, which includes but is not limited to implants, lipomodelling and mammoplasty procedures. The guidelines are based on a review of the literature and consensus of breast imaging and aesthetic breast surgery specialists. 1. Pre-aesthetic surgery 2. Post-aesthetic surgery If breast imaging or breast assessment is required, it should be performed in a designated breast facility with access to specialist breast imaging and a complete breast multidisciplinary team in accordance with national guidelines and recommendations.
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Affiliation(s)
- Simon Lowes
- Breast Screening and Assessment Unit, Queen Elizabeth Hospital, Gateshead Health NHS Foundation Trust, Sheriff Hill, Gateshead, NE9 6SX, United Kingdom.
| | - Fiona MacNeill
- Breast Surgery Unit, The Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, United Kingdom
| | - Lee Martin
- Breast Unit, Aintree University Hospital, Lower Lane, Liverpool, Merseyside, L9 7AL, United Kingdom
| | - Joe M O'Donoghue
- Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, United Kingdom
| | - Mandana O Pennick
- Department of Breast Surgery, Glan Clwyd Hospital, Rhuddlan Road, Rhyl, Denbighshire, LL18 5UJ, North Wales, United Kingdom
| | - Alan Redman
- Breast Screening and Assessment Unit, Queen Elizabeth Hospital, Gateshead Health NHS Foundation Trust, Sheriff Hill, Gateshead, NE9 6SX, United Kingdom
| | - Robin Wilson
- Department of Clinical Radiology, The Royal Marsden Hospital NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, United Kingdom
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Lee CU, Bobr A, Torres-Mora J. Radiologic-Pathologic Correlation: Acellular Dermal Matrix (Alloderm ®) Used in Breast Reconstructive Surgery. J Clin Imaging Sci 2017; 7:13. [PMID: 28515964 PMCID: PMC5385699 DOI: 10.4103/jcis.jcis_7_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 02/17/2017] [Indexed: 11/16/2022] Open
Abstract
Acellular dermal matrix (ADM) such as Alloderm® is sometimes used in tissue reconstruction in primary and reconstructive breast surgeries. As ADM is incorporated into the native tissues, the evolving imaging findings that would correlate with varying degrees of host migration and neoangiogenesis into the matrix can be challenging to recognize. In the setting of a palpable or clinical area of concern after breast reconstructive surgery following breast cancer, confident diagnosis of a mass representing ADM rather than recurring or developing disease can be challenging. Such diagnostic imaging uncertainties generally result in short-term imaging and clinical follow-up, but occasionally, biopsy is performed for histopathological confirmation of benignity. A case of biopsy-proven Alloderm® is described. To the best of our knowledge, this is the first radiologic-pathologic correlation of ADM in the literature.
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Affiliation(s)
| | - Aleh Bobr
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Jorge Torres-Mora
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Seon Kim Y. Ultrasonography Findings of AlloDerm ® Used in Postmastectomy Alloplastic Breast Reconstruction: A Case Report and Literature Review. IRANIAN JOURNAL OF RADIOLOGY 2016; 13:e38252. [PMID: 27878067 PMCID: PMC5110931 DOI: 10.5812/iranjradiol.38252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 04/21/2016] [Indexed: 11/16/2022]
Abstract
AlloDerm® (LifeCell Corp.; Brancburg, NJ) is an acellular dermal matrix (ADM) that serves as an immunologically inert scaffold in plastic surgery. In breast reconstruction, it is used as a filler for lumpectomy defects and can be used to create the inferolateral portion of the tissue expander pocket or implant pocket in postmastectomy patients. However, there are limited reports of the radiologic findings of AlloDerm® in patients who have undergone postmastectomy reconstruction. Familiarity with the imaging features of AlloDerm® is essential for correct diagnosis. We report the ultrasonography features of AlloDerm® in a 43-year-old female patient 3 months after postmastectomy reconstruction. It may help distinguish AlloDerm® from tumor recurrence or other foreign body materials such as gossypiboma. This is important as misdiagnosis can often lead to unnecessary surgical intervention.
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Affiliation(s)
- Young Seon Kim
- Department of Radiology, College of Medicine, Yeungnam University, Daegu, Korea
- Corresponding author: Young Seon Kim, Department of Radiology, College of Medicine, Yeungnam University, 170, Hyeonchung-ro, Nam-gu, Daegu, Korea. Tel: +82-26204129, Fax: +50-43738795, E-mail:
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Acellular dermal matrices and revision parotid surgery. Laryngoscope 2015; 125:2123-4. [DOI: 10.1002/lary.25301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 03/03/2015] [Accepted: 03/09/2015] [Indexed: 11/07/2022]
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