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Stephenson J, Chapman K, Mohammed S, Zebeljan D, Ahuja M, Donikian D, Pasalic L, Motum P, Hsu D, Brighton T, Favaloro EJ. A multicenter evaluation of the Technoscreen ADAMTS13 activity semi-quantitative screening test for thrombotic thrombocytopenic purpura diagnosis and exclusion. Int J Lab Hematol 2023. [PMID: 37078536 DOI: 10.1111/ijlh.14077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/10/2023] [Indexed: 04/21/2023]
Abstract
INTRODUCTION Thrombotic thrombocytopenic purpura (TTP) is a rare but potentially fatal microangiopathy, with an untreated mortality rate of around 90%. TTP is caused by severe deficiency in ADAMTS13, which results in accumulation of ultra large von Willebrand factor multimers, triggering a consumptive thrombocytopenia, microangiopathic hemolytic anemia and end-organ dysfunction and damage. Demonstration of severe ADAMTS13 deficiency is diagnostic for TTP, but long turnaround times for quantitative activity testing often necessitates empirical plasma exchange and/or caplacizumab treatment. METHODS Multisite (n = 4) assessment of the Technoscreen ADAMTS13 activity assay (semi-quantitative flow through screening assay) for diagnosis/exclusion of TTP compared to current standard practice of quantitative assays (ELISA or chemiluminescence AcuStar). RESULTS A total of 128 patient samples were analyzed, with quantitative ADAMTS13 values ranging from 0% to 150%. The Technoscreen assay demonstrated high sensitivity and negative predictive value (NPV) for ADAMTS13 deficiency, but low specificity and positive predictive value (PPV), especially with one lot of reagent. Good inter-observer reliability was demonstrated. Excluding one possibly compromised batch and other test failures, results of 80 samples yielded sensitivity of 100% (95% CI = 84-100), specificity of 90% (80-95), PPV 77% (58-89) and NPV 100% (93-100). CONCLUSION The Technoscreen assay appears to be a reliable screening test for ADAMTS13 activity to exclude TTP in routine clinical practice. However, the assay falsely identified ADAMTS13 deficiency in many cases, partially batch related, which mandates confirmation with a quantitative assay, as well as initial assessment of kits as 'fit for purpose' prior to use for patient testing.
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Affiliation(s)
- Jared Stephenson
- Haematology, NSW Health Pathology, Liverpool Hospital, New South Wales, Australia
| | - Kent Chapman
- Haematology, NSW Health Pathology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Soma Mohammed
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Diane Zebeljan
- Haematology, NSW Health Pathology, Liverpool Hospital, New South Wales, Australia
| | - Monica Ahuja
- Haematology, NSW Health Pathology, St George Hospital, New South Wales, Australia
| | - Dea Donikian
- Haematology, NSW Health Pathology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Leonardo Pasalic
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia
- Sydney Centres for Thrombosis and Haemostasis, Westmead, New South Wales, Australia
- Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia
| | - Penelope Motum
- Haematology, NSW Health Pathology, Liverpool Hospital, New South Wales, Australia
| | - Danny Hsu
- Haematology, NSW Health Pathology, Liverpool Hospital, New South Wales, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Timothy Brighton
- Haematology, NSW Health Pathology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Emmanuel J Favaloro
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia
- Sydney Centres for Thrombosis and Haemostasis, Westmead, New South Wales, Australia
- School of Dentistry and Medical Sciences, Faculty of Science and Health, Charles Sturt University, Wagga Wagga, New South Wales, Australia
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Westmead Hospital, Westmead, New South Wales, Australia
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Favaloro EJ, Mohammed S, Vong R, Chapman K, Kershaw G, Just S, Connelly L, Ryan M, Zebeljan D, Brighton T, Pasalic L. Harmonizing platelet function analyzer testing and reporting in a large laboratory network. Int J Lab Hematol 2022; 44:934-944. [PMID: 35754202 PMCID: PMC9545980 DOI: 10.1111/ijlh.13907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The platelet function analyzer (PFA) is a popular platelet function screening instrument, highly sensitive to von Willebrand disease (VWD) and to aspirin therapy, with moderate sensitivity to defects in platelet function and/or deficiencies in platelet number. There are two models, the original PFA-100 and the contemporary PFA-200. Normal reference ranges (NRRs) provided by the manufacturer are the same for both models, instead being based on the type of test cartridge, for which there are two main ones: collagen/epinephrine (C/Epi) and collagen/adenosine diphosphate (C/ADP). METHODS Comparative evaluations of PFA testing and reporting in six different sites of a large pathology network, aiming to harmonize NRRs and test reporting across all network sites. A separate comparative study of testing a range of samples (n > 150) on a PFA-100 versus that on a PFA-200. Review of contemporary literature. RESULTS Each site was identified to have a different reporting NRR, which after consolidating data permitted establishment of an agreed harmonized NRR for use across the network (C/Epi: 90-160; C/ADP: 70-124; based on n > 180). Similarly, each site reported and interpreted results in different ways, and after discussion and consolidation, a harmonized approach to interpretation and reporting was achieved. The separate comparative study of PFA-100 versus PFA-200 testing confirmed instrument equivalence. CONCLUSION We achieved harmonized NRRs and reporting for PFA testing across a large pathology network. Our approach may be useful for other laboratory networks wishing to harmonize PFA testing.
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Affiliation(s)
- Emmanuel J Favaloro
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia.,Sydney Centres for Thrombosis and Haemostasis, Westmead, New South Wales, Australia.,Faculty of Science and Health, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Soma Mohammed
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Ronny Vong
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Kent Chapman
- Haematology, NSW Health Pathology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Geoffrey Kershaw
- Haematology, NSW Health Pathology, Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Sarah Just
- Haematology, NSW Health Pathology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Lynne Connelly
- Haematology, NSW Health Pathology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Michael Ryan
- Haematology, NSW Health Pathology, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Diane Zebeljan
- Haematology, NSW Health Pathology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Timothy Brighton
- Haematology, NSW Health Pathology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Leonardo Pasalic
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia.,Sydney Centres for Thrombosis and Haemostasis, Westmead, New South Wales, Australia.,Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia
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Favaloro EJ, Mohammed S, Chapman K, Swanepoel P, Zebeljan D, Sefhore O, Malan E, Clifford J, Yuen A, Donikian D, Kondo M, Duncan E, Abraham S, Beggs J, Chatrapati R, Perel J, Coleman R, Klose N, Hsu D, Motum P, Tan CW, Brighton T, Pasalic L. A multicenter laboratory assessment of a new automated chemiluminescent assay for ADAMTS13 activity. J Thromb Haemost 2021; 19:417-428. [PMID: 33124748 DOI: 10.1111/jth.15157] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/21/2020] [Accepted: 10/26/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Thrombotic thrombocytopenic purpura (TTP) is a rare but potentially fatal disorder caused by ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) deficiency. Prompt identification/exclusion of TTP can thus be facilitated by rapid ADAMTS13 testing. The most commonly utilized (enzyme-linked immunosorbent assay [ELISA]-based) assay takes several hours to perform and so does not generally permit rapid testing. OBJECTIVES To evaluate the utility of a new automated test for ADAMTS13 activity, the HemosIL AcuStar ADAMTS13 Activity assay, based on chemiluminescence and able to be performed on an ACL AcuStar instrument within 33 minutes. PATIENTS/METHODS This multicenter (n = 8) assessment included testing of more than 700 test samples, with similar numbers of prospective (n = 348) and retrospective (n = 385) samples. The main comparator was the Technozym ADAMTS13 Activity ELISA. We also assessed comparative performance for detection of ADAMTS13 inhibitors using a Bethesda assay. RESULTS Overall, the chemiluminescent assay yielded similar results to the comparator ELISA, albeit with slight negative bias. ADAMTS13 inhibitor detection was also comparable, albeit with slight positive bias with the AcuStar assay. Assay precision was similar with both assays, and we also verified assay normal reference ranges. CONCLUSIONS The HemosIL AcuStar ADAMTS13 Activity assay provided results rapidly, which were largely comparable with the Technozym ADAMTS13 Activity ELISA assay, albeit lower on average. Conversely, inhibitor levels tended to be identified at a higher level on average. Thus, the HemosIL AcuStar ADAMTS13 Activity assay provides a fast and accurate means to quantitate plasma levels of ADAMTS13 for TTP/ADAMTS13 identification/exclusion, and potentially also for other applications.
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Affiliation(s)
- Emmanuel J Favaloro
- Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia
- NSW Health Pathology, NSW, Australia
- Sydney Centres for Thrombosis and Haemostasis, Westmead, NSW, Australia
| | - Soma Mohammed
- Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia
- NSW Health Pathology, NSW, Australia
| | - Kent Chapman
- NSW Health Pathology, NSW, Australia
- John Hunter Hospital, NSW Health Pathology, Newcastle, NSW, Australia
| | - Priscilla Swanepoel
- NSW Health Pathology, NSW, Australia
- John Hunter Hospital, NSW Health Pathology, Newcastle, NSW, Australia
| | - Diane Zebeljan
- NSW Health Pathology, NSW, Australia
- Liverpool Hospital, NSW Health Pathology, Liverpool, NSW, Australia
| | - Opelo Sefhore
- NSW Health Pathology, NSW, Australia
- Liverpool Hospital, NSW Health Pathology, Liverpool, NSW, Australia
| | | | | | - Agnes Yuen
- Monash Health, Melbourne, Vic., Australia
| | - Dea Donikian
- NSW Health Pathology, NSW, Australia
- Prince of Wales Hospital, NSW Health Pathology, Randwick, NSW, Australia
| | - Mayuko Kondo
- NSW Health Pathology, NSW, Australia
- Prince of Wales Hospital, NSW Health Pathology, Randwick, NSW, Australia
| | | | | | | | | | | | - Robyn Coleman
- Sullivan Nicolaides Pathology, Brisbane, Qld, Australia
| | - Nathan Klose
- Sullivan Nicolaides Pathology, Brisbane, Qld, Australia
| | - Danny Hsu
- NSW Health Pathology, NSW, Australia
- Liverpool Hospital, NSW Health Pathology, Liverpool, NSW, Australia
| | - Penelope Motum
- NSW Health Pathology, NSW, Australia
- Liverpool Hospital, NSW Health Pathology, Liverpool, NSW, Australia
| | - Chee Wee Tan
- SA Pathology, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Timothy Brighton
- NSW Health Pathology, NSW, Australia
- Prince of Wales Hospital, NSW Health Pathology, Randwick, NSW, Australia
| | - Leonardo Pasalic
- Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia
- NSW Health Pathology, NSW, Australia
- Sydney Centres for Thrombosis and Haemostasis, Westmead, NSW, Australia
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Favaloro EJ, Mohammed S, Donikian D, Kondo M, Duncan E, Yacoub O, Zebeljan D, Ng S, Malan E, Yuen A, Beggs J, Moosavi S, Coleman R, Klose N, Chapman K, Cavanaugh L, Pasalic L, Motum P, Tan CW, Brighton T. A multicentre assessment of contemporary laboratory assays for heparin induced thrombocytopenia. Pathology 2020; 53:247-256. [PMID: 33032809 DOI: 10.1016/j.pathol.2020.07.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/25/2020] [Accepted: 07/23/2020] [Indexed: 12/27/2022]
Abstract
Heparin induced thrombocytopenia (HIT) is a rare but potentially fatal complication of heparin therapy. In some patients, HIT causes platelet activation and thrombosis (sometimes abbreviated HITT), which leads to adverse clinical sequalae ('pathological HIT'). The likelihood of HIT is initially assessed clinically, typically using a scoring system, of which the 4T score is that most utilised. Subsequent laboratory testing to confirm or exclude HIT facilitates exclusion or diagnosis and management. The current investigation comprises a multicentre (n=9) assessment of contemporary laboratory testing for HIT, as performed over the past 1-3 years in each site and comprising testing of over 1200 samples. The primary laboratory test used by study participants (n=8) comprised a chemiluminescence procedure (HIT-IgG(PF4-H)) performed on an AcuStar instrument. Additional immunological testing performed by study sites included lateral flow (STiC, Stago), enzyme linked immunosorbent assay (ELISA), Asserachrom (HPIA IgG), PaGIA (BioRad), plus functional assays, primarily serotonin release assay (SRA) or platelet aggregation methods. The chemiluminescence procedure yielded a highly sensitive screening method for identifying functional HIT, given high area under the curve (AUC, generally ≥0.9) in a receiver operator characteristic (ROC) analysis against SRA as gold standard. ELISA testing resulted in lower ROC AUC scores (<0.8) and higher levels of false positives. Although there is clear association with the likelihood of HIT, the 4T score had less utility than literature suggests, and was comparable to a previous study reported by some of the authors.
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Affiliation(s)
- Emmanuel J Favaloro
- Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), Sydney Centres for Thrombosis and Haemostasis, Westmead Hospital, Westmead, NSW, Australia; NSW Health Pathology, NSW, Australia; School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia.
| | - Soma Mohammed
- Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), Sydney Centres for Thrombosis and Haemostasis, Westmead Hospital, Westmead, NSW, Australia; NSW Health Pathology, NSW, Australia
| | - Dea Donikian
- NSW Health Pathology, NSW, Australia; Prince of Wales Hospital, Randwick, NSW, Australia
| | - Mayuko Kondo
- NSW Health Pathology, NSW, Australia; Prince of Wales Hospital, Randwick, NSW, Australia
| | | | | | - Diane Zebeljan
- NSW Health Pathology, NSW, Australia; Liverpool Hospital, Liverpool, NSW, Australia
| | - Sara Ng
- NSW Health Pathology, NSW, Australia; Liverpool Hospital, Liverpool, NSW, Australia
| | | | - Agnes Yuen
- Monash Health, Melbourne, Vic, Australia
| | | | | | - Robyn Coleman
- Sullivan Nicolaides Pathology, Brisbane, Qld, Australia
| | - Nathan Klose
- Sullivan Nicolaides Pathology, Brisbane, Qld, Australia
| | - Kent Chapman
- NSW Health Pathology, NSW, Australia; John Hunter Hospital, Newcastle, NSW, Australia
| | - Lauren Cavanaugh
- NSW Health Pathology, NSW, Australia; St George Hospital, Kogarah, NSW, Australia
| | - Leonardo Pasalic
- Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), Sydney Centres for Thrombosis and Haemostasis, Westmead Hospital, Westmead, NSW, Australia; NSW Health Pathology, NSW, Australia; School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Penelope Motum
- NSW Health Pathology, NSW, Australia; Liverpool Hospital, Liverpool, NSW, Australia
| | - Chee Wee Tan
- South Australia Pathology, Adelaide, SA, Australia; Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Timothy Brighton
- NSW Health Pathology, NSW, Australia; Prince of Wales Hospital, Randwick, NSW, Australia
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Motum P, Just S, Zebeljan D, Nicholls C, Kershaw G, Oliver S, Mohammed S, Favaloro EJ. A diagnosis of von Willebrand disease despite normal test results for factor VIII and von Willebrand factor antigen and activity. Am J Hematol 2019; 94:1425-1432. [PMID: 31423628 DOI: 10.1002/ajh.25618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/08/2019] [Accepted: 08/13/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Penelope Motum
- Haematology, NSW Health Pathology Liverpool Hospital New South Wales Australia
| | - Sarah Just
- Haematology, NSW Health Pathology Liverpool Hospital New South Wales Australia
| | - Diane Zebeljan
- Haematology, NSW Health Pathology Liverpool Hospital New South Wales Australia
| | - Catherine Nicholls
- Department of Genetic Pathology SA Pathology Adelaide South Australia Australia
| | - Geoffrey Kershaw
- Haematology, NSW Health Pathology Royal Prince Alfred Hospital New South Wales Australia
| | - Susan Oliver
- Department of Haematology Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital Westmead New South Wales Australia
| | - Soma Mohammed
- Department of Haematology Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital Westmead New South Wales Australia
| | - Emmanuel J. Favaloro
- Department of Haematology Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital Westmead New South Wales Australia
- Department of Haematology Sydney Centres for Thrombosis and Haemostasis Westmead New South Wales Australia
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Getta B, Muller N, Motum P, Hsu D, Zebeljan D, Rosenfeld D. Intermittent haemodialysis and continuous veno-venous dialysis are effective in mitigating major bleeding due to dabigatran. Br J Haematol 2014; 169:603-4. [PMID: 25425051 DOI: 10.1111/bjh.13236] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Bartlomiej Getta
- Department of Haematology; Liverpool Hospital; Sydney South West Pathology Service (SSWPS); Liverpool NSW Australia
| | - Niccolo Muller
- Department of Haematology; Liverpool Hospital; Sydney South West Pathology Service (SSWPS); Liverpool NSW Australia
| | - Penelope Motum
- Department of Haematology; Liverpool Hospital; Sydney South West Pathology Service (SSWPS); Liverpool NSW Australia
| | - Danny Hsu
- Department of Haematology; Liverpool Hospital; Sydney South West Pathology Service (SSWPS); Liverpool NSW Australia
| | - Diane Zebeljan
- Department of Haematology; Liverpool Hospital; Sydney South West Pathology Service (SSWPS); Liverpool NSW Australia
| | - David Rosenfeld
- Department of Haematology; Liverpool Hospital; Sydney South West Pathology Service (SSWPS); Liverpool NSW Australia
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Brennan SO, Zebeljan D, Ho LL. Thrombosis in association with a novel substitution (γ346Gly→Val) at an absolutely conserved site in the fibrinogen γ chain. Thromb Haemost 2013; 109:757-8. [PMID: 23348147 DOI: 10.1160/th12-11-0832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 12/25/2012] [Indexed: 11/05/2022]
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Favaloro EJ, Bonar R, Zebeljan D, Kershaw G, Marsden K. Laboratory investigation of lupus anticoagulants: mixing studies are sometimes required. J Thromb Haemost 2010; 8:2828-31. [PMID: 21029364 DOI: 10.1111/j.1538-7836.2010.04090.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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