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D'Ercole M, Izzo A, Fuggetta F, Rapisarda A, Burattini B, Montano N. The impact of strategies to manage the COVID-19 pandemic on patients with intrathecal baclofen therapy. J Neurosurg Sci 2023; 67:605-608. [PMID: 34342200 DOI: 10.23736/s0390-5616.21.05410-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The activities related to intrathecal baclofen (ITB) therapy could not be interrupted at the outbreak of COVID-19 pandemic due to possible life-threatening related complications such as withdrawal and over dosage syndromes. In this study we reported the different adopted strategies to manage patients with an ITB implanted infusion pump during the pandemic period and studied the impact of these strategies on experiences reported from patients and their caregivers, assessed through a specific survey. METHODS Thirty-five patients (mean age: 43.71±12.33 years) were included. Their clinical and medical data were recorded and observed from March 2020 to March 2021 and different strategies implemented in order to limit patients and providers risk of exposure to COVID-19. The impact of these strategies was assessed trough a survey that was performed after the first two months of pandemic (coinciding with the period of general lockdown) and after one year from the pandemic onset. RESULTS We observed a statistically significant improvement of the following items: difficulties in reaching medical clinic (P=0.0072), continuation of physical therapy (P=0.0021) and feelings of anxiety in medical conditions (P=0.0006). Considering the difficulties in communications with the medical staff we obtained optimal scores both at the beginning of pandemic and after one year from the pandemic onset without significant difference. CONCLUSIONS Our survey showed that the adopted strategies provided a feeling of confidence and safety among ITB patients and their caregivers during the COVID-19 pandemic. We think that a clear communication is always of paramount importance to manage these patients.
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Affiliation(s)
- Manuela D'Ercole
- Section of Neurosurgery, Department of Neuroscience, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Alessandro Izzo
- Section of Neurosurgery, Department of Neuroscience, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Filomena Fuggetta
- Section of Neurosurgery, Department of Neuroscience, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Alessandro Rapisarda
- Section of Neurosurgery, Department of Neuroscience, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Benedetta Burattini
- Section of Neurosurgery, Department of Neuroscience, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Nicola Montano
- Section of Neurosurgery, Department of Neuroscience, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy -
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Izzo A, D'Ercole M, Rapisarda A, Polli FM, Fuggetta F, Olivi A, Visocchi M, Montano N. Spinal Cord High-Frequency Stimulation. The Current Experience and Future Directions. Acta Neurochir Suppl 2023; 135:203-207. [PMID: 38153470 DOI: 10.1007/978-3-031-36084-8_31] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Spinal cord stimulation (SCS) is a neuromodulation technology that has emerged as a valid treatment for chronic intractable neuropathic pain. After conventional tonic SCS, new waveforms of stimulation, like high frequency (HF), have proved that they can provide safe and effective pain relief. In addition, SCS is now being utilized more broadly as a potential treatment for a range of indications, including motor disorders and spasticity. Our study presents a retrospective analysis of 20 patients with heterogenous aetiologies of neuropathic pain treated with HF stimulation, after a standardized protocol in a temporary trial. We observed a significant improvement in pain relief according to comparisons of numerical rating scale (NRS) scores before the procedure, after the clinical trial and at latest follow-up. Two unusual clinical cases were also reported, and the pertinent literature was discussed.
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Affiliation(s)
- Alessandro Izzo
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Manuela D'Ercole
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Rapisarda
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Maria Polli
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Filomena Fuggetta
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Massimiliano Visocchi
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicola Montano
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy
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Caccavella VM, Giordano M, Colicchio G, Izzo A, D’Ercole M, Rapisarda A, Polli FM, Fuggetta F, Olivi A, Montano N. Palliative surgery for drug resistant epilepsy in adult patients. A systematic review of the literature and a pooled analysis of outcomes. World Neurosurg 2022; 163:132-140.e1. [DOI: 10.1016/j.wneu.2022.03.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 11/28/2022]
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Quintiliani M, Bianchi F, Fuggetta F, Chieffo DPR, Ramaglia A, Battaglia DI, Tamburrini G. Role of high-density EEG (hdEEG) in pre-surgical epilepsy evaluation in children: case report and review of the literature. Childs Nerv Syst 2021; 37:1429-1437. [PMID: 33604716 PMCID: PMC8084826 DOI: 10.1007/s00381-021-05069-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 02/02/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Electrical source imaging (ESI) and especially hdEEG represent a noninvasive, low cost and accurate method of localizing epileptic zone (EZ). Such capability can greatly increase seizure freedom rate in surgically treated drug resistant epilepsy cases. Furthermore, ESI might be important in intracranial record planning. CASE REPORT We report the case of a 15 years old boy suffering from drug resistant epilepsy with a previous history of DNET removal. The patient suffered from heterogeneous seizure semiology characterized by anesthesia and loss of tone in the left arm, twisting of the jaw to the left and dysarthria accompanied by daze; lightheadedness sometimes associated with headache and dizziness and at a relatively short time distance negative myoclonus involving the left hand. Clinical evidence poorly match scalp and video EEG monitoring thus requiring hdEEG recording followed by SEEG to define surgical target. Surgery was also guided by ECoG and obtained seizure freedom. DISCUSSION ESI offers an excellent estimate of EZ, being hdEEG and intracranial recordings especially important in defining it. We analyzed our results together with the data from the literature showing how in children hdEEG might be even more crucial than in adults due to the heterogeneity in seizures phenomenology. The complexity of each case and the technical difficulties in dealing with children, stress even more the importance of a noninvasive tool for diagnosis. In fact, hdEEG not only guided in the presented case SEEG planning but may also in the future offer the possibility to replace it.
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Affiliation(s)
- Michela Quintiliani
- Infantile Neuropsychiatry, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Federico Bianchi
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168, Rome, Italy.
| | - Filomena Fuggetta
- Infantile Neuropsychiatry, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | | | - Antonia Ramaglia
- Institute of Radiology, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Domenica Immacolata Battaglia
- Infantile Neuropsychiatry, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianpiero Tamburrini
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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Grande E, Tufo T, Ciavarro M, Di Muccio I, Fuggetta F, Silvestri M, Bevacqua G, Lanzone J, Assenza G. The Impact of COVID-19 Lockdown on People With Epilepsy and Vagal Nerve Stimulation. Front Neurol 2021; 12:640581. [PMID: 33716943 PMCID: PMC7952610 DOI: 10.3389/fneur.2021.640581] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 12/11/2020] [Accepted: 01/27/2021] [Indexed: 01/08/2023] Open
Abstract
Objectives: Restrictive measures adopted during the COVID-19 pandemic, in order to limit contagion, have had a severe impact on mental health. The burden of lockdown has been particularly heavy on patients with chronic neurologic diseases such as People with Epilepsy (PwE). Our survey aims to describe the struggles and needs of Drug-Resistant (DR) PwE with implanted Vagal Nerve Stimulator (VNS) during the first wave of the COVID-19 lockdown in order to find strategies that help patients cope with present or future periods of restriction. Methods: We collected answers from 30 respondents who underwent an online survey including socio-demographic and clinical information and COVID-19-related information. Depression, anxiety symptoms, and sleep quality were investigated in patients through BDI II, GAD-7, and the PSQI scale. Results: In all, 46% of our sample reported an increase in the number of seizures; the entire sample complained of epilepsy-related issues (medication availability, VSN adjustments, anxiety, sleep disturbance); one out of three participants reported major epilepsy issues felt urgent; 30% had to postpone scheduled examination. Significantly higher scores for depression and anxiety scales were found in patients who perceived seizure frequency worsening and reported major epilepsy-related issues. Conclusion: Preliminary findings showed that the first lockdown influenced the clinical and psychological status of PwE and was related to seizures worsening. The lack of medical assistance and control on VNS therapy left patients to cope with the situation without a chance to contact a specialist. We discuss how a wider implementation of telemedicine programs could facilitate remote assistance of PwE with a VNS implant.
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Affiliation(s)
- Eleonora Grande
- Department of Neuroscience, Imaging and Clinical Sciences, University "Gabriele d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Tommaso Tufo
- Neurosurgery, Policlinico A. Gemelli Foundation Istituto di Ricovero e Cura a Carattere Scientifico, Catholic University, Rome, Italy
| | - Marco Ciavarro
- Neuromed for Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, Italy
| | | | - Filomena Fuggetta
- Neurosurgery, Policlinico A. Gemelli Foundation Istituto di Ricovero e Cura a Carattere Scientifico, Catholic University, Rome, Italy
| | - Martina Silvestri
- Neurosurgery, Policlinico A. Gemelli Foundation Istituto di Ricovero e Cura a Carattere Scientifico, Catholic University, Rome, Italy
| | - Giuseppina Bevacqua
- Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| | - Jacopo Lanzone
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Giovanni Assenza
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
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Miraglia F, Vecchio F, Vollomo C, Fuggetta F, Cioni B, Rossini PM. O155 Pre-seizure brain networks architecture as index of prediction in epileptic seizure. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.07.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Vecchio F, Miraglia F, Vollono C, Fuggetta F, Bramanti P, Cioni B, Rossini PM. Pre-seizure architecture of the local connections of the epileptic focus examined via graph-theory. Clin Neurophysiol 2016; 127:3252-8. [DOI: 10.1016/j.clinph.2016.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 06/13/2016] [Accepted: 07/16/2016] [Indexed: 12/28/2022]
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Affiliation(s)
- Catello Vollono
- From the Institute of Neurology (C.V., G.D.M.) and the Institute of Neurosurgery (F.F., B.C.), Catholic University, Rome, Italy.
| | - Filomena Fuggetta
- From the Institute of Neurology (C.V., G.D.M.) and the Institute of Neurosurgery (F.F., B.C.), Catholic University, Rome, Italy
| | - Beatrice Cioni
- From the Institute of Neurology (C.V., G.D.M.) and the Institute of Neurosurgery (F.F., B.C.), Catholic University, Rome, Italy
| | - Giacomo Della Marca
- From the Institute of Neurology (C.V., G.D.M.) and the Institute of Neurosurgery (F.F., B.C.), Catholic University, Rome, Italy
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Colicchio G, Montano N, Fuggetta F, Papacci F, Signorelli F, Meglio M. Vagus nerve stimulation in drug-resistant epilepsies. Analysis of potential prognostic factors in a cohort of patients with long-term follow-up. Acta Neurochir (Wien) 2012; 154:2237-40. [PMID: 23086106 DOI: 10.1007/s00701-012-1524-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 10/03/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND The results of vagus nerve stimulation (VNS) for the treatment of drug-resistant epilepsies are highly variable due to the lack of defined patient's selection criteria and a follow-up of published studies being generally too short. Here we report the outcome of VNS in a series with long-term follow-up and try to identify subgroups of patients who could be better candidates for this procedure. METHOD We studied 53 patients (33 male, 20 female) with a prospectively recorded follow-up (mean, 55.96 ± 43.53 months). The monthly average seizure frequency for each patient at baseline, 3, 6, 12 months, and each year until the latest follow-up after implant was measured and the percentage of "responders" and response time (RT) were calculated. We investigated the following potential prognostic role of these factors: age of onset of epilepsy, pre-implant epilepsy duration, etiology, and age at implant. RESULTS Globally, 40 % of patients responded to VNS (mean RT, 14.85 ± 16.85 months). Lesional etiology (p = 0.0179, logrank test), particularly ischemia (p = 0.011, Fisher exact test) and tuberous sclerosis (p = 0.0229, Fisher exact test), and age at implant <18 years (p = 0.0242, logrank test) were associated to better response to VNS. In the lesional subgroup the best results were observed in patients with a pre-implant epilepsy duration <15 years (p = 0.0204, logrank test) and an age at implant <18 years (p = 0.0187 logrank test). CONCLUSIONS The best candidate to VNS seems to be a patient with lesional etiology epilepsy (particularly post-ischemic and tuberous sclerosis) and a short duration of epilepsy who undergo VNS younger than 18 years.
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Barba C, Barbati G, Di Giuda D, Fuggetta F, Papacci F, Meglio M, Colicchio G. Diagnostic yield and predictive value of provoked ictal SPECT in drug-resistant epilepsies. J Neurol 2012; 259:1613-22. [DOI: 10.1007/s00415-011-6387-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Revised: 12/17/2011] [Accepted: 12/20/2011] [Indexed: 10/14/2022]
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Colicchio G, Barba C, Bruno I, Fuggetta F, Meglio M, Papacci F, Di Giuda D. S12.3 Efficacy and predictive value of provoked ictal spect: data at 2 and 5 years follow-up. Clin Neurophysiol 2011. [DOI: 10.1016/s1388-2457(11)60096-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Colicchio G, Policicchio D, Barbati G, Cesaroni E, Fuggetta F, Meglio M, Papacci F, Rychlicki F, Scerrati M, Zamponi N. Vagal nerve stimulation for drug-resistant epilepsies in different age, aetiology and duration. Childs Nerv Syst 2010; 26:811-9. [PMID: 20091042 DOI: 10.1007/s00381-009-1069-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 12/02/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of the study was to compare the outcome with respect to age of implant, aetiology and duration of epilepsy. METHODS One hundred thirty-five drug-resistant epileptic patients, excluded from ablative surgery, were submitted to vagal nerve stimulation (1995-2007). Aetiology was cryptogenic in 57 and symptomatic in 78 patients. Ages of implant were 0.5-6 years (18 patients), 7-12 years (32 patients), 13-18 years (31 patients) and more than 18 years (54 patients). Epilepsy types were Lennox-Gastaut (18 patients), severe multifocal epilepsy (33 patients) and partial (84 patients). Duration of epilepsy is 3 months to 57 years. Clinical outcome was determined by comparing the seizure frequency after stimulation at 3-6-12-18-24-36 months with the previous 3 months. 'Responders' were the patients experiencing a seizure frequency reduction of 50% or more during follow-up. In statistical analysis, Wilcoxon and McNemar tests, general linear model for repeated measures, logistic regression and survival analysis were used. RESULTS The seizure frequency reduction was significant in the group as a whole between baseline and the first follow-up (Wilcoxon test). The percentage of responder increases with time (McNemar test p = 0.04). Univariate analysis showed a significant effect of the age of implant on seizure frequency reduction: Adult patient had worst clinical outcome than children (p < 0.001) and adolescents (p = 0.08). Patients with severe multifocal epilepsy had better percentage seizure reduction compared with Lennox-Gastaut and partial (p = 0.03). Lesser duration of epilepsy had positive influence on outcome. Multivariate analysis confirmed age of implant to be the strongest factor influencing prognosis. Furthermore, positive is the association between lesional aetiology and young age. CONCLUSIONS The best responder could be a young lesional epileptic patient; after 3 years of follow-up, the percentage of responders is still in progress.
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Affiliation(s)
- Gabriella Colicchio
- Neurosurgery, Catholic University, Largo Agostino Gemelli 1, 00168, Rome, Italy.
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Chisci L, Mavino A, Perferi G, Sciandrone M, Anile C, Colicchio G, Fuggetta F. Real-Time Epileptic Seizure Prediction Using AR Models and Support Vector Machines. IEEE Trans Biomed Eng 2010; 57:1124-32. [DOI: 10.1109/tbme.2009.2038990] [Citation(s) in RCA: 173] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Barba C, Di Giuda D, Fuggetta F, Colicchio G. Provoked ictal SPECT in temporal and extratemporal drug-resistant epileptic patients: Comparison of Statistical Parametric Mapping and qualitative analysis. Epilepsy Res 2009; 84:6-14. [DOI: 10.1016/j.eplepsyres.2008.11.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2008] [Revised: 11/10/2008] [Accepted: 11/23/2008] [Indexed: 11/24/2022]
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Barba C, Di Giuda D, Fuggetta F, Colicchio G. MO05 Localising value of pharmacologically provoked ictal SPECT in epilepsy surgery. Clin Neurophysiol 2008. [DOI: 10.1016/s1388-2457(08)60026-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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