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Brennan DJ, Duda J, Ware JB, Whyte J, Choi JY, Gugger J, Focht K, Walter AE, Bushnik T, Gee JC, Diaz‐Arrastia R, Kim JJ. Spatiotemporal profile of atrophy in the first year following moderate-severe traumatic brain injury. Hum Brain Mapp 2023; 44:4692-4709. [PMID: 37399336 PMCID: PMC10400790 DOI: 10.1002/hbm.26410] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 06/04/2023] [Accepted: 06/12/2023] [Indexed: 07/05/2023] Open
Abstract
Traumatic brain injury (TBI) triggers progressive neurodegeneration resulting in brain atrophy that continues months-to-years following injury. However, a comprehensive characterization of the spatial and temporal evolution of TBI-related brain atrophy remains incomplete. Utilizing a sensitive and unbiased morphometry analysis pipeline optimized for detecting longitudinal changes, we analyzed a sample consisting of 37 individuals with moderate-severe TBI who had primarily high-velocity and high-impact injury mechanisms. They were scanned up to three times during the first year after injury (3 months, 6 months, and 12 months post-injury) and compared with 33 demographically matched controls who were scanned once. Individuals with TBI already showed cortical thinning in frontal and temporal regions and reduced volume in the bilateral thalami at 3 months post-injury. Longitudinally, only a subset of cortical regions in the parietal and occipital lobes showed continued atrophy from 3 to 12 months post-injury. Additionally, cortical white matter volume and nearly all deep gray matter structures exhibited progressive atrophy over this period. Finally, we found that disproportionate atrophy of cortex along sulci relative to gyri, an emerging morphometric marker of chronic TBI, was present as early as 3 month post-injury. In parallel, neurocognitive functioning largely recovered during this period despite this pervasive atrophy. Our findings demonstrate msTBI results in characteristic progressive neurodegeneration patterns that are divergent across regions and scale with the severity of injury. Future clinical research using atrophy during the first year of TBI as a biomarker of neurodegeneration should consider the spatiotemporal profile of atrophy described in this study.
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Affiliation(s)
- Daniel J. Brennan
- CUNY Neuroscience Collaborative, The Graduate CenterCity University of New YorkNew YorkNew YorkUnited States
- Department of Molecular, Cellular, and Biomedical SciencesCUNY School of Medicine, The City College of New YorkNew YorkNew YorkUnited States
| | - Jeffrey Duda
- Department of RadiologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUnited States
- Penn Image Computing and Science LaboratoryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUnited States
| | - Jeffrey B. Ware
- Department of RadiologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUnited States
| | - John Whyte
- Moss Rehabilitation Research Institute, Einstein Healthcare NetworkElkins ParkPennsylvaniaUnited States
| | - Joon Yul Choi
- Department of Molecular, Cellular, and Biomedical SciencesCUNY School of Medicine, The City College of New YorkNew YorkNew YorkUnited States
- Department of Biomedical EngineeringYonsei UniversityWonjuRepublic of Korea
| | - James Gugger
- Department of NeurologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUnited States
| | - Kristen Focht
- Widener University School for Graduate Clinical PsychologyChesterPennsylvaniaUnited States
| | - Alexa E. Walter
- Department of NeurologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUnited States
| | - Tamara Bushnik
- NYU Grossman School of MedicineNew YorkNew YorkUnited States
| | - James C. Gee
- Department of RadiologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUnited States
- Penn Image Computing and Science LaboratoryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUnited States
| | - Ramon Diaz‐Arrastia
- Department of NeurologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUnited States
| | - Junghoon J. Kim
- CUNY Neuroscience Collaborative, The Graduate CenterCity University of New YorkNew YorkNew YorkUnited States
- Department of Molecular, Cellular, and Biomedical SciencesCUNY School of Medicine, The City College of New YorkNew YorkNew YorkUnited States
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Schneider ALC, Gottesman RF, Krauss GL, Gugger J, Diaz-Arrastia R, Kucharska-Newton A, Huang J, Johnson EL. Association of Head Injury With Late-Onset Epilepsy: Results From the Atherosclerosis Risk in Communities Cohort. Neurology 2022; 98:e808-e817. [PMID: 34921108 PMCID: PMC8883511 DOI: 10.1212/wnl.0000000000013214] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 11/30/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Late-onset epilepsy (LOE; i.e., epilepsy starting in later adulthood) affects a significant number of individuals. Head injury is also a risk factor for acquired epilepsy, but the degree to which prior head injury may contribute to LOE is less well understood. Our objective was to determine the association between head injury and subsequent development of LOE. METHODS Included were 8,872 participants enrolled in the Atherosclerosis Risk in Communities (ARIC) study with continuous Centers for Medicare Services fee-for-service (FFS) coverage (55.1% women, 21.6% Black). We identified head injuries through 2018 from linked Medicare fee for service claims for inpatient/emergency department care, active surveillance of hospitalizations, and participant self-report. LOE cases through 2018 were identified from linked Medicare FFS claims. We used Cox proportional hazards models to evaluate associations of head injury with LOE, adjusting for demographic, cardiovascular, and lifestyle factors. RESULTS The adjusted hazard ratio (HR) for developing LOE after a history of head injury was 1.88 (95% confidence interval [CI] 1.44-2.43). There was evidence for dose-response associations with greater risk for LOE with increasing number of prior head injuries (HR 1.37, 95% CI 1.01-1.88 for 1 prior head injury and HR 3.55, 95% CI 2.51-5.02 for 2+ prior head injuries, compared to no head injuries) and with more severe head injury (HR 2.53, 95% CI 1.83-3.49 for mild injury and HR 4.90, 95% CI 3.15-7.64 for moderate/severe injury, compared to no head injuries). Associations with LOE were significant for head injuries sustained at older age (age ≥67 years: HR 4.01, 95% CI 2.91-5.54), but not for head injuries sustained at younger age (age < 67 years: HR 0.98, 95% CI 0.68-1.41). DISCUSSION Head injury was associated with increased risk of developing LOE, particularly when head injuries were sustained at an older age, and there was evidence for higher risk for LOE after a greater number of prior head injuries and after more severe head injuries. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that an increased risk of late-onset epilepsy is associated with head injury and that this risk increases further with multiple and more severe head injuries.
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Affiliation(s)
- Andrea L C Schneider
- From the Department of Neurology (A.L.C.S., J.G., R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Stroke Branch (R.F.G.), National Institutes of Neurological Disorders and Stroke Intramural Research Program, Bethesda; Department of Neurology (G.L.K., E.L.J.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; and Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson.
| | - Rebecca F Gottesman
- From the Department of Neurology (A.L.C.S., J.G., R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Stroke Branch (R.F.G.), National Institutes of Neurological Disorders and Stroke Intramural Research Program, Bethesda; Department of Neurology (G.L.K., E.L.J.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; and Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson
| | - Gregory L Krauss
- From the Department of Neurology (A.L.C.S., J.G., R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Stroke Branch (R.F.G.), National Institutes of Neurological Disorders and Stroke Intramural Research Program, Bethesda; Department of Neurology (G.L.K., E.L.J.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; and Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson
| | - James Gugger
- From the Department of Neurology (A.L.C.S., J.G., R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Stroke Branch (R.F.G.), National Institutes of Neurological Disorders and Stroke Intramural Research Program, Bethesda; Department of Neurology (G.L.K., E.L.J.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; and Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson
| | - Ramon Diaz-Arrastia
- From the Department of Neurology (A.L.C.S., J.G., R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Stroke Branch (R.F.G.), National Institutes of Neurological Disorders and Stroke Intramural Research Program, Bethesda; Department of Neurology (G.L.K., E.L.J.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; and Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson
| | - Anna Kucharska-Newton
- From the Department of Neurology (A.L.C.S., J.G., R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Stroke Branch (R.F.G.), National Institutes of Neurological Disorders and Stroke Intramural Research Program, Bethesda; Department of Neurology (G.L.K., E.L.J.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; and Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson
| | - Juebin Huang
- From the Department of Neurology (A.L.C.S., J.G., R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Stroke Branch (R.F.G.), National Institutes of Neurological Disorders and Stroke Intramural Research Program, Bethesda; Department of Neurology (G.L.K., E.L.J.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; and Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson
| | - Emily L Johnson
- From the Department of Neurology (A.L.C.S., J.G., R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Stroke Branch (R.F.G.), National Institutes of Neurological Disorders and Stroke Intramural Research Program, Bethesda; Department of Neurology (G.L.K., E.L.J.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; and Department of Neurology (J.H.), University of Mississippi Medical Center, Jackson
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Burke J, Gugger J, Ding K, Kim JA, Foreman B, Yue JK, Puccio AM, Yuh EL, Sun X, Rabinowitz M, Vassar MJ, Taylor SR, Winkler EA, Deng H, McCrea M, Stein MB, Robertson CS, Levin HS, Dikmen S, Temkin NR, Barber J, Giacino JT, Mukherjee P, Wang KKW, Okonkwo DO, Markowitz AJ, Jain S, Lowenstein D, Manley GT, Diaz-Arrastia R. Association of Posttraumatic Epilepsy With 1-Year Outcomes After Traumatic Brain Injury. JAMA Netw Open 2021; 4:e2140191. [PMID: 34964854 PMCID: PMC8717106 DOI: 10.1001/jamanetworkopen.2021.40191] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IMPORTANCE Posttraumatic epilepsy (PTE) is a recognized sequela of traumatic brain injury (TBI), but the long-term outcomes associated with PTE independent of injury severity are not precisely known. OBJECTIVE To determine the incidence, risk factors, and association with functional outcomes and self-reported somatic, cognitive, and psychological concerns of self-reported PTE in a large, prospectively collected TBI cohort. DESIGN, SETTING, AND PARTICIPANTS This multicenter, prospective cohort study was conducted as part of the Transforming Research and Clinical Knowledge in Traumatic Brain Injury study and identified patients presenting with TBI to 1 of 18 participating level 1 US trauma centers from February 2014 to July 2018. Patients with TBI, extracranial orthopedic injuries (orthopedic controls), and individuals without reported injuries (eg, friends and family of participants; hereafter friend controls) were prospectively followed for 12 months. Data were analyzed from January 2020 to April 2021. EXPOSURE Demographic, imaging, and clinical information was collected according to TBI Common Data Elements. Incidence of self-reported PTE was assessed using the National Institute of Neurological Disorders and Stroke Epilepsy Screening Questionnaire (NINDS-ESQ). MAIN OUTCOMES AND MEASURES Primary outcomes included Glasgow Outcome Scale Extended, Rivermead Cognitive Metric (RCM; derived from the Rivermead Post Concussion Symptoms Questionnaire), and the Brief Symptom Inventory-18 (BSI). RESULTS Of 3296 participants identified as part of the study, 3044 met inclusion criteria, and 1885 participants (mean [SD] age, 41.3 [17.1] years; 1241 [65.8%] men and 644 [34.2%] women) had follow-up information at 12 months, including 1493 patients with TBI; 182 orthopedic controls, 210 uninjured friend controls; 41 patients with TBI (2.8%) and no controls had positive screening results for PTE. Compared with a negative screening result for PTE, having a positive screening result for PTE was associated with presenting Glasgow Coma Scale score (8.1 [4.8] vs.13.5 [3.3]; P < .001) as well as with anomalous acute head imaging findings (risk ratio, 6.42 [95% CI, 2.71-15.22]). After controlling for age, initial Glasgow Coma Scale score, and imaging findings, compared with patients with TBI and without PTE, patients with TBI and with positive PTE screening results had significantly lower Glasgow Outcome Scale Extended scores (mean [SD], 6.1 [1.7] vs 4.7 [1.5]; P < .001), higher BSI scores (mean [SD], 50.2 [10.7] vs 58.6 [10.8]; P = .02), and higher RCM scores (mean [SD], 3.1 [2.6] vs 5.3 [1.9]; P = .002) at 12 months. CONCLUSIONS AND RELEVANCE In this cohort study, the incidence of self-reported PTE after TBI was found to be 2.8% and was independently associated with unfavorable outcomes. These findings highlight the need for effective antiepileptogenic therapies after TBI.
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Affiliation(s)
- John Burke
- Department of Neurosurgery, University of California, San Francisco
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - James Gugger
- Department of Neurology, University of Pennsylvania, Philadelphia
| | - Kan Ding
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas
| | - Jennifer A. Kim
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Brandon Foreman
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
| | - John K. Yue
- Department of Neurosurgery, University of California, San Francisco
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Ava M. Puccio
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Esther L. Yuh
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
- Department of Radiology, University of California. San Francisco
| | - Xiaoying Sun
- Department of Family Medicine and Public Health, University of California, San Diego
| | - Miri Rabinowitz
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mary J. Vassar
- Department of Neurosurgery, University of California, San Francisco
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Sabrina R. Taylor
- Department of Neurosurgery, University of California, San Francisco
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Ethan A. Winkler
- Department of Neurosurgery, University of California, San Francisco
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Hansen Deng
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Michael McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee
| | - Murray B. Stein
- Department of Psychiatry and Public Health, University of California, San Diego
| | - Claudia S. Robertson
- Departments of Neurosurgery and Critical Care, Baylor College of Medicine, Houston, Texas
| | - Harvey S. Levin
- Departments of Neurosurgery and Neurology, Baylor College of Medicine, Houston, Texas
| | - Sureyya Dikmen
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Nancy R. Temkin
- Department of Neurosurgery, University of Washington, Seattle
- Departments of Biostatistics, University of Washington, Seattle
| | - Jason Barber
- Departments of Biostatistics, University of Washington, Seattle
| | - Joseph T. Giacino
- Rehabilitation Neuropsychology, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pratik Mukherjee
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
- Department of Radiology, University of California. San Francisco
| | - Kevin K. W. Wang
- Department of Psychiatry and Neurosciences, McKnight Brain Institute, University of Florida, Gainesville
| | - David O. Okonkwo
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Amy J. Markowitz
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Sonia Jain
- Department of Family Medicine and Public Health, University of California, San Diego
| | | | - Geoffrey T. Manley
- Department of Neurosurgery, University of California, San Francisco
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
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Lederman YS, Balucani C, Lazar J, Steinberg L, Gugger J, Levine SR. Relationship between QT interval dispersion in acute stroke and stroke prognosis: a systematic review. J Stroke Cerebrovasc Dis 2014; 23:2467-2478. [PMID: 25282188 DOI: 10.1016/j.jstrokecerebrovasdis.2014.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [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: 04/07/2014] [Revised: 06/12/2014] [Accepted: 06/13/2014] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND QT dispersion (QTd) has been proposed as an indirect electrocardiography (ECG) measure of heterogeneity of ventricular repolarization. The predictive value of QTd in acute stroke remains controversial. We aimed to clarify the relationship between QTd and acute stroke and stroke prognosis. METHODS A systematic review of the literature was performed using prespecified medical subjects heading terms, Boolean logic, and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Eligible studies included ischemic or hemorrhagic stroke and provided QTd measurements. RESULTS Two independent reviewers identified 553 publications. Sixteen articles were included in the final analysis. There were a total of 888 stroke patients: 59% ischemic and 41% hemorrhagic. There was considerable heterogeneity in study design, stroke subtypes, ECG assessment time, control groups, and comparison groups. Nine studies reported a significant association between acute stroke and baseline QTd. Two studies reported that QTd increases are specifically related to hemorrhagic strokes, involvement of the insular cortex, right-side lesions, larger strokes, and increases in 3,4-dihydroxyphenylethylene glycol in hemorrhagic stroke. Three studies reported QTd to be an independent predictor of stroke mortality. One study each reported increases in QTd in stroke patients who developed ventricular arrhythmias and cardiorespiratory compromise. CONCLUSIONS There are few well-designed studies and considerable variability in study design in addressing the significance of QTd in acute stroke. Available data suggest that stroke is likely to be associated with increased QTd. Although some evidence suggests a possible prognostic role of QTd in stroke, larger and well-designed studies need to confirm these findings.
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Affiliation(s)
- Yitzchok S Lederman
- Department of Neurology, Stroke Center, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Clotilde Balucani
- Department of Neurology, Stroke Center, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Jason Lazar
- Department of Neurology, Stroke Center, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Cardiovascular Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Leah Steinberg
- Department of Neurology, Stroke Center, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - James Gugger
- Department of Neurology, Stroke Center, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Steven R Levine
- Department of Neurology, Stroke Center, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Neurology and Emergency Medicine, Kings County Hospital Center, Brooklyn, New York.
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Krastl G, Gugger J, Deyhle H, Zitzmann NU, Weiger R, Müller B. Impact of adhesive surface and volume of luting resin on fracture resistance of root filled teeth. Int Endod J 2011; 44:432-9. [DOI: 10.1111/j.1365-2591.2010.01846.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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