1
|
Jamshidzadeh A, Heidari R, Shams M, Ebrahimi-sharghi M, Marashi SM. Carnitine in Alleviation of Complications Caused by Acute Valproic Acid Toxicity; an Exprimental Study on Mice. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2023; 12:e20. [PMID: 38371450 PMCID: PMC10871053 DOI: 10.22037/aaem.v12i1.2146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Introduction Hyperammonemia and hepatotoxicity are well-known complications of valproic acid (VPA) poisoning. The objective of this study is to evaluate the potential role of carnitine in mitigating the adverse effects of acute VPA toxicity in mice. Methods 54 male mice (25-30 g) were randomly assigned to one of three categories, including acute, sub-acute, and chronic poisoning. Each category contained 3 groups, each consisting of 6 mice (Group 1: control, Group 2: VPA treated, and Group 3: VPA + carnitine treated). The animals were sacrificed 24 hours after the initial injection, and their blood, liver, and brain samples were compared between groups of each category regarding liver function biomarkers, oxidative stress markers, ammonia level, and liver histopathologic changes using one-way ANOVA followed by Tukey's multiple comparison test. Results The administration of VPA increased the serum level of aspartate aminotransferase (AST) (p=0.003) and alanine aminotransferase (ALT) (p=0.001), as well as serum, and brain level of ammonia (p=0.0001 for both) in the intervention group. Elevated levels of lipid peroxidation and oxidative stress (p=0.0001 for both) in the liver tissue, decreased liver glutathione (p=0.0001) and ferric ion-reducing antioxidant power (FRAP) (p=0.0001), and histopathologic changes in the form of moderate to severe inflammation were observed. Administration of VPA + carnitine reduced AST (p=0.05) and ALT (p=0.01), increased the FRAP, reduced free oxygen radicals and liver lipid peroxidation (p=0.0001 for all), and decreased tissue damage in the form of moderate inflammation. The administration of carnitine was ineffective in reducing brain or plasma ammonia levels in acute VPA-treated animals (p = 0.0115). Conclusions Although the administration of carnitine has been suggested as a protective remedy in cases of VPA toxicity, according to the present study, it did not have an antidotal effect and did not prevent encephalopathy or liver injury in acute VPA toxicity.
Collapse
Affiliation(s)
- Akram Jamshidzadeh
- Department of Pharmacology Toxicology, School of Pharmacy, Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Heidari
- Department of Pharmacology Toxicology, School of Pharmacy, Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahdie Shams
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Melika Ebrahimi-sharghi
- Student Research Committee of Pharmacy School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sayed Mahdi Marashi
- Department of Forensic Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
2
|
Etemad L, Roohbakhsh A, Abbaspour A, Alizadeh Ghamsari A, Amin F, Moshiri M. The effect of sodium benzoate, L-carnitine, and phenylacetate on valproate-induced hyperammonemia in Male Wistar rats. INTERNATIONAL JOURNAL OF PHYSIOLOGY, PATHOPHYSIOLOGY AND PHARMACOLOGY 2022; 14:324-331. [PMID: 36741198 PMCID: PMC9890203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 06/28/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION L-carnitine (LC) is commonly used in the treatment of valproate-induced hyperammonemia (VIHA). LC prevents the production of ammonia with no significant effect on renal ammonia excretion. This study was conducted to evaluate the effect of sodium benzoate (SB) and phenyl acetate (PA) on reducing VIHA. MATERIALS AND METHODS Eight groups treated with Sodium Valproate (SV) at 300 mg/kg and 15 minutes later with normal saline, SB (144 mg/kg), PA (0.3 g/kg), LC (2.5 g/kg), SB (144 mg/kg) plus PA (0.3 g/kg), or SB (144 mg/kg) plus PA (0.3 g/kg) plus LC (2.5 g/kg), intraperitoneally. Other groups were exposed to normal saline, SB, LC or PA alone. Animal's motor function and serum ammonia, lactate, and sodium levels were assessed at 0.5, 1, and 1.5 hours after the SV injection. RESULTS The results showed that LC reduced SV-induced hyperammonemia just at one and half-hour after treatment (P<0.001). PA, alone or in combination with other antidotes, reduced serum ammonia at all evaluated times (P<0.001). LC improved the impaired motor function of animals only at 1.5 hours, while PA, alone or in combination decreased the motor function scores at different times. However, SB administration alone did not change SV-induced hyperammonemia or motor function impairment. There was no significant difference in the level of serum aminotransferases, blood urea nitrogen, and creatinine between groups. CONCLUSION These findings define that PA had a better therapeutic effect on valproate-induced hyperammonemia in comparison with SB. Co-administration of LC with PA ameliorated the elevated levels of ammonia and may relieve potential therapeutic application against acute SV intoxication.
Collapse
Affiliation(s)
- Leila Etemad
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical SciencesMashhad, Iran
| | - Ali Roohbakhsh
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical SciencesMashhad, Iran,Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical SciencesMashhad, Iran
| | - Abolfazl Abbaspour
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical SciencesMashhad, Iran
| | - Anahita Alizadeh Ghamsari
- Medical Toxicology Research Center, School of Medicine, Mashhad University of Medical SciencesMashhad, Iran
| | - Fatemeh Amin
- Department of Physiology and Pharmacology, School of Medicine, Rafsanjan University of Medical SciencesRafsanjan, Iran
| | - Mohammad Moshiri
- Medical Toxicology Research Center, School of Medicine, Mashhad University of Medical SciencesMashhad, Iran,Department of Clinical Toxicology, Imam Reza Hospital, Mashhad University of Medical SciencesMashhad, Iran
| |
Collapse
|
3
|
Levy A, Very E, Montastruc F, Birmes P, Jullien A, Richaud L. Case Report: A Case of Valproic Acid-Induced Hyperammonemic Encephalopathy Associated With the Initiation of Lithium: A Re-duplicable Finding. Front Psychiatry 2022; 13:875636. [PMID: 35586415 PMCID: PMC9108155 DOI: 10.3389/fpsyt.2022.875636] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/05/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Hyperammonemic encephalopathy (HAE) is a serious adverse effect of valproate semisodium, which is facilitated by the potential for drug interaction. However, despite frequent co-prescription of valproate semisodium and lithium, the role of this combination in the occurrence of HAE has not been defined in the literature. This case report concerns the occurrence of HAE concomitant with the initiation of lithium in a 29-year-old patient who had been placed on valproate semisodium for a schizoaffective disorder. CASE REPORT Due to a relapse while on a combined antipsychotic and mood-stabilizing therapy (paliperidone palmitate and valproate semisodium), a cross-taper from valproate semisodium to lithium was proposed. The initiation of lithium was accompanied by an acute confusional syndrome, an elevated serum valproate level and hyperammonemia suggestive of drug-induced HAE. The discontinuation of lithium and reduction of valproate semisodium led to neurological improvement, until a recrudescence of psychiatric symptoms justified a rechallenge of the combination within the framework of a new cross-taper. As soon as Lithium was re-initiated, an increase in the serum valproate level and hyperammonemia were again noted. DISCUSSION The mechanisms of valproate-related HAE involve various metabolic pathways. In this case, exploration of the iatrogenic hypothesis focused on the imputability of concomitant cannabis use and co-prescriptions of benzodiazepines, antipsychotics, and in all likelihood, mood stabilizers. CONCLUSION Therefore, this case study suggests that Lithium plays a role in serum valproate level elevation, and supports the hypothesis of an association between an elevated serum valproate level, hyperammonemia and reversible encephalopathy. A more in-depth pharmacokinetic exploration would provide a better understanding of the mechanisms of these interactions and support for the benefit-risk balance associated with this frequent co-prescription.
Collapse
Affiliation(s)
- Anna Levy
- Department of Psychiatry, Psychotherapy, and Art therapy, University Hospital Toulouse (CHU Toulouse), Toulouse, France
| | - Etienne Very
- Department of Psychiatry, Psychotherapy, and Art therapy, University Hospital Toulouse (CHU Toulouse), Toulouse, France.,Toulouse NeuroImaging Center, Universit9 de Toulouse, Inserm, UPS, Toulouse, France
| | - François Montastruc
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital, Faculty of Medicine, Toulouse, France
| | - Philippe Birmes
- Department of Psychiatry, Psychotherapy, and Art therapy, University Hospital Toulouse (CHU Toulouse), Toulouse, France.,Toulouse NeuroImaging Center, Universit9 de Toulouse, Inserm, UPS, Toulouse, France
| | - Adeline Jullien
- Department of Pharmacy, University Hospital Toulouse (CHU Toulouse), Paule de Viguier Hospital, Toulouse, France
| | - Louis Richaud
- Department of Psychiatry, Psychotherapy, and Art therapy, University Hospital Toulouse (CHU Toulouse), Toulouse, France
| |
Collapse
|
4
|
Nicholson C, Fowler M, Mullen C, Cunningham B. Evaluation of levocarnitine, lactulose, and combination therapy for the treatment of valproic acid-induced hyperammonemia in critically ill patients. Epilepsy Res 2021; 178:106806. [PMID: 34763268 DOI: 10.1016/j.eplepsyres.2021.106806] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 10/05/2021] [Accepted: 10/29/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Critically ill patients treated with valproic acid are at risk for hyperammonemic encephalopathy. Both levocarnitine and lactulose, either alone or in combination, have been used for the treatment of hyperammonemia associated with valproic acid, however they have not been directly compared in the literature. The aim of this study was to compare the effect of levocarnitine, lactulose, and combination therapy for the treatment of valproic acid-induced hyperammonemia in critically ill patients. METHODS This was a retrospective, system-wide, cohort study of critically ill patients who received valproic acid and levocarnitine, lactulose, or combination therapy from January 1, 2012 to October 31, 2019. The primary outcome of the study was the change in ammonia level from baseline to the lowest point within the first 48 h of treatment. Secondary outcomes included the change in ammonia levels within the first 7 days, the incidence of a clinically significant reduction, ICU length of stay, hospital length of stay, and hospital mortality. RESULTS A total of 371 charts were reviewed and 114 patients (levocarnitine [n = 15], lactulose [n = 72], and combination [n = 27]) were included. No difference in the primary outcome was observed (levocarnitine [11umol/L] vs. lactulose [20 umol/L] vs. combination [23 umol/L], p = 0.605). The incidence of a clinically significant reduction in ammonia levels at 48 h did not differ between groups, nor did mortality. CONCLUSION In critically ill patients with valproic acid-induced hyperammonemia, there was no significant difference in the reduction in ammonia levels in the first 48 h of treatment between levocarnitine, lactulose, and combination therapy.
Collapse
Affiliation(s)
- Carli Nicholson
- Cleveland Clinic Akron General, 1 Akron General Avenue, Akron, OH 44307, United States; Licking Memorial Health System, 1320 West Main Street, Newark, OH 43055, United States.
| | - Melissa Fowler
- Cleveland Clinic Akron General, 1 Akron General Avenue, Akron, OH 44307, United States.
| | - Chanda Mullen
- Cleveland Clinic Akron General, 1 Akron General Avenue, Akron, OH 44307, United States.
| | - Brittany Cunningham
- Cleveland Clinic Akron General, 1 Akron General Avenue, Akron, OH 44307, United States.
| |
Collapse
|
5
|
L-Carnitine and Acylcarnitines: Mitochondrial Biomarkers for Precision Medicine. Metabolites 2021; 11:metabo11010051. [PMID: 33466750 PMCID: PMC7829830 DOI: 10.3390/metabo11010051] [Citation(s) in RCA: 136] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 12/11/2022] Open
Abstract
Biomarker discovery and implementation are at the forefront of the precision medicine movement. Modern advances in the field of metabolomics afford the opportunity to readily identify new metabolite biomarkers across a wide array of disciplines. Many of the metabolites are derived from or directly reflective of mitochondrial metabolism. L-carnitine and acylcarnitines are established mitochondrial biomarkers used to screen neonates for a series of genetic disorders affecting fatty acid oxidation, known as the inborn errors of metabolism. However, L-carnitine and acylcarnitines are not routinely measured beyond this screening, despite the growing evidence that shows their clinical utility outside of these disorders. Measurements of the carnitine pool have been used to identify the disease and prognosticate mortality among disorders such as diabetes, sepsis, cancer, and heart failure, as well as identify subjects experiencing adverse drug reactions from various medications like valproic acid, clofazimine, zidovudine, cisplatin, propofol, and cyclosporine. The aim of this review is to collect and interpret the literature evidence supporting the clinical biomarker application of L-carnitine and acylcarnitines. Further study of these metabolites could ultimately provide mechanistic insights that guide therapeutic decisions and elucidate new pharmacologic targets.
Collapse
|
6
|
Zulfiqar Ali Q, Marques P, Selvarajah A, Tabarestani S, Sadoway T, Andrade DM. Starting stiripentol in adults with Dravet syndrome? Watch for ammonia and carnitine. Epilepsia 2020; 61:2435-2441. [DOI: 10.1111/epi.16684] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/10/2020] [Accepted: 08/13/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Quratulain Zulfiqar Ali
- Epilepsy Genetics Research Program Krembil Brain Institute Toronto Western Hospital University Health Network University of Toronto Toronto ON Canada
| | - Paula Marques
- Epilepsy Genetics Research Program Krembil Brain Institute Toronto Western Hospital University Health Network University of Toronto Toronto ON Canada
| | - Arunan Selvarajah
- Epilepsy Genetics Research Program Krembil Brain Institute Toronto Western Hospital University Health Network University of Toronto Toronto ON Canada
- Institute of Medical Science University of Toronto Toronto ON Canada
| | - Sepideh Tabarestani
- Epilepsy Genetics Research Program Krembil Brain Institute Toronto Western Hospital University Health Network University of Toronto Toronto ON Canada
| | - Tara Sadoway
- Epilepsy Genetics Research Program Krembil Brain Institute Toronto Western Hospital University Health Network University of Toronto Toronto ON Canada
| | - Danielle M. Andrade
- Epilepsy Genetics Research Program Krembil Brain Institute Toronto Western Hospital University Health Network University of Toronto Toronto ON Canada
- Institute of Medical Science University of Toronto Toronto ON Canada
- Division of Neurology University Health Network University of Toronto Toronto ON Canada
| |
Collapse
|
7
|
Janković SM, Janković SV. Lessons learned from the discovery of sodium valproate and what has this meant to future drug discovery efforts? Expert Opin Drug Discov 2020; 15:1355-1364. [PMID: 32686964 DOI: 10.1080/17460441.2020.1795125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The discovery of the anticonvulsant properties of valproic acid and the development of valproic acid/valproate to market authorization for specific epilepsy types and syndromes, as well as their repurposing for other indications, are illustrative examples of both the strengths and weaknesses of drug development strategies. AREAS COVERED This review summarizes and interprets the development and repurposing history of valproic acid/valproate. The article is based on articles, including original studies and systematic reviews obtained from PubMed, Scopus, EBSCO, SCIndeks and Google Scholar databases. EXPERT OPINION Random screening and careful observation of the experimental effects of tested substances were crucial for discovering the anticonvulsant effects of valproic acid, while rational drug design and clinical observation strategies led to repurposing valproic acid and valproate for bipolar disorder maintenance treatmentand prevention of migraine attacks. Early planning and feasibility studies of future clinical trials are essential for obtaining marketing authorization of new substances or new indications of old anticonvulsants. Significant progress has been made recently toward understanding, treatment and prevention of hepatotoxicity caused by valproic acid/valproate, making its long-term administration safer. There are ongoing efforts to repurpose valproic acid/valproate for augmentation with antipsychotic drugs for the treatment of schizophrenia.
Collapse
Affiliation(s)
| | - Snežana V Janković
- Faculty of Medical Sciences, University of Kragujevac , Kragujevac, Serbia
| |
Collapse
|
8
|
Mithani F, Cullum S, Chacko R. Valproic acid rechallenge after valproate-induced hyperammonemic encephalopathy. Proc (Bayl Univ Med Cent) 2020; 33:471-472. [PMID: 32675993 DOI: 10.1080/08998280.2020.1767460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/01/2020] [Accepted: 05/07/2020] [Indexed: 10/24/2022] Open
Abstract
A 24-year-old man with a past medical history of behavioral disturbances and spastic tetraplegia secondary to traumatic brain injury presented to the psychiatry consult service with acute exacerbation of agitation and aggression. The patient's behavioral disturbances were previously reduced with 1500 mg daily of valproic acid (VPA). Prior to admission, VPA was discontinued due to elevated serum ammonia levels of 96 μmol/L and clinical findings consistent with valproate-induced hyperammonemic encephalopathy (VIHE), such as lethargy, confusion, frank delirium, and ataxia. Current guidelines for treating VIHE suggest either a complete discontinuation of the drug or a drug rechallenge with the addition of levocarnitine or carglumic acid supplementation. In this case, VPA was rechallenged without supplementation to decrease the risk of noncompliance. The patient received a lower dose of VPA with subsequent up-titration. His ammonia level decreased to an acceptable level. This case report discusses the challenges of managing VIHE in patients requiring VPA and discusses opportunities for further research in preventing VIHE.
Collapse
Affiliation(s)
- Farhan Mithani
- College of Medicine, Texas A&M Health Science CenterBryanTexas.,Department of Psychiatry, Houston Methodist HospitalHoustonTexas
| | - Stav Cullum
- College of Medicine, Texas A&M Health Science CenterBryanTexas.,Department of Psychiatry, Houston Methodist HospitalHoustonTexas
| | - Ranjit Chacko
- Department of Psychiatry, Houston Methodist HospitalHoustonTexas
| |
Collapse
|
9
|
Davoudi-Monfared E, Radmehr M, Ghaeli P, Mousavi M. A Case Series of Severe Hyperammonemia Encephalopathy Related to Valproate: Can Antipsychotics Increase the Risk? IRANIAN JOURNAL OF PSYCHIATRY 2019; 14:248-252. [PMID: 31598129 PMCID: PMC6778604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Valproate-induced hyperammonemia is a common side effect of valproate, which may occur either without any symptoms or may rarely cause symptoms of encephalopathy. Different risk factors have been defined for this side effect, including some nutritional deficiencies and polypharmacy (eg, other anticonvulsants). Three cases with psychiatric disorder who showed symptoms of severe hyperammonemia encephalopathy and had taken valproate with antipsychotics, especially risperidone, are presented here. In all cases, the symptoms were improved by discontinuation of valproate. Administration of antipsychotic may be considered as a risk factor for hyperammonemic encephalopathy related to valproate, specifically in some prone populations.
Collapse
Affiliation(s)
- Effat Davoudi-Monfared
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojan Radmehr
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Padideh Ghaeli
- Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Mousavi
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran; Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Corresponding Author: Address: Research Center for Rational Use of Drugs, 4th floor, No 92, Karimkhan Zand Avenue, Hafte Tir Square, Tehran, Iran. Tel: 98-2188814157, Fax: 98-2188814157,
| |
Collapse
|
10
|
Yamada H, Shishido T, Mukai T, Araki M, Naka H, Tokinobu H. [Valproic acid-induced hyperammonemic encephalopathy in a patient receiving valproic acid monotherapy]. Rinsho Shinkeigaku 2019; 59:258-263. [PMID: 31061301 DOI: 10.5692/clinicalneurol.cn-001254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A 79-year-old female was diagnosed with epilepsy because she experienced loss of consciousness twice in January and February and then had a seizure in June 2016. She was treated with 800 mg sodium valproate (sustained release). After 3 days, she experienced loss of appetite, and more than 3 days later, disturbance of consciousness. Serum valproic acid (VPA) concentration was 128.3 μg/ml and serum ammonia was 404 μmol/l. Cerebral edema and status epilepticus occurred. Severe neurological dysfunction remained, even after treatment with continuous hemodiafiltration and levocarnitine. VPA is widely used for the treatment of generalized epilepsy. VPA-induced hyperammonemic encephalopathy is a rare but serious adverse event of VPA. Thus, we must pay attention to serum ammonia levels when using VPA, even VPA monotherapy.
Collapse
Affiliation(s)
| | | | - Tomoya Mukai
- Department of Neurology, Hiroshima Prefectural Hospital
| | - Mutsuko Araki
- Department of Neurology, Hiroshima Prefectural Hospital
| | | | | |
Collapse
|
11
|
Izadi Firouzabadi L, Geer K, Mead P. Severe hyperammonaemic encephalopathy resulting from the overlap between hepatic and valproate encephalopathy. Postgrad Med J 2018; 94:664. [DOI: 10.1136/postgradmedj-2018-136029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 09/23/2018] [Accepted: 10/16/2018] [Indexed: 11/04/2022]
|