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Scherman P, Hansdotter P, Holmberg E, Viborg Mortensen F, Petersen SH, Rizell M, Naredi P, Syk I. High resection rates of colorectal liver metastases after standardized follow-up and multimodal management: an outcome study within the COLOFOL trial. HPB (Oxford) 2023; 25:766-774. [PMID: 36967324 DOI: 10.1016/j.hpb.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/27/2022] [Revised: 01/27/2023] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Outcome after colorectal liver metastases (CRLM) resection has improved over time, despite increased resection rates. Hence, it's crucial to identify all patients possible to treat with curative intent. The objectives of this study were to map recurrence pattern, treatment strategy and survival depending on treatment and follow-up strategy. METHODS In the COLOFOL-trial, patients with radically resected stage II-III colorectal cancer were randomized to high-frequency (6, 12, 18, 24 and 36 months; HF) or low-frequency (12 and 36 months; LF) follow-up. In this study, all CRLM within 5 years were identified and medical files scrutinized. Overall survival (OS) was analysed in uni- and multivariable analyses. Primary endpoint was 5-year OS. RESULTS Of 2442 patients, 235 (9.6%) developed metachronous CRLM of which 123 (52.3%) underwent treatment with curative intent, resulting in 5-year OS of 58%. Five-year OS for patients with CRLM was 43% after HF versus 24% after LF. The survival benefit was confirmed for HF 8 years from resection of the primary tumour, HR 0.63 (CI 0.46-0.85). CONCLUSION A high proportion of metachronous CRLM was possible to treat with curative intent, yielding high survival rates. More intense follow-up after colorectal cancer resection might be of value in high-risk patients.
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Affiliation(s)
- Peter Scherman
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden.
| | - Pernilla Hansdotter
- Department of Surgery, Clinical Sciences Malmö, Lund University, Lund, Sweden; Department of Surgery, Skane University Hospital, Malmö, Sweden
| | - Erik Holmberg
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Sune H Petersen
- Section of Paediatric Haematology and Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Magnus Rizell
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Transplantation, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Naredi
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ingvar Syk
- Department of Surgery, Clinical Sciences Malmö, Lund University, Lund, Sweden; Department of Surgery, Skane University Hospital, Malmö, Sweden
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Hansdotter P, Scherman P, Nikberg M, Petersen SH, Holmberg E, Rizell M, Naredi P, Syk I. Treatment and survival of patients with metachronous colorectal lung metastases. J Surg Oncol 2023; 127:806-814. [PMID: 36607235 DOI: 10.1002/jso.27188] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/06/2022] [Accepted: 12/11/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The lungs are the second most common site for metachronous metastases in colorectal cancer. No treatment algorithm is established, and the role of adjuvant chemotherapy is unclear. This study aimed to map pulmonary recurrences in a modern multimodal treated population, and to evaluate survival depending on management. METHODS Retrospective study based on the COLOFOL-trial population of 2442 patients, radically resected for colorectal cancer stage II-III. All recurrences within 5 years were identified and medical records were scrutinized. RESULTS Of 165 (6.8%) patients developing lung metastases as first recurrence, 89 (54%) were confined to the lungs. Potentially curative treatment was possible in 62 (37%) cases, of which 33 with surgery only and 29 with surgery and chemotherapy combined. The 5-year overall survival (5-year OS) for all lung recurrences was 28%. In patients treated with chemotherapy only the 5-year OS was 7.5%, compared with 55% in patients treated with surgery, and 72% when surgery was combined with chemotherapy. Hazard ratio for mortality was 2.9 (95% confidence interval 1.40-6.10) for chemotherapy only compared to surgery. CONCLUSION A high proportion of metachronous lung metastases after colorectal surgery were possible to resect, yielding good survival. The combination of surgery and chemotherapy might be advantageous for survival.
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Affiliation(s)
- Pernilla Hansdotter
- Department of Surgery, Skåne University Hospital, Malmö, Sweden.,Institute of Clinical Sciences Malmö, Section of Surgery, Lund University, Lund, Sweden
| | - Peter Scherman
- Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden
| | - Maziar Nikberg
- Department of Surgery, Centre for Clinical Research of Uppsala University, Västmanland's Hospital, Västerås, Sweden
| | - Sune H Petersen
- Department of Paediatrics & Adolescent Medicine, Section of Paediatric Haematology & Oncology, Copenhagen, Denmark
| | - Erik Holmberg
- Department of Oncology, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Magnus Rizell
- Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.,Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Naredi
- Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ingvar Syk
- Department of Surgery, Skåne University Hospital, Malmö, Sweden.,Institute of Clinical Sciences Malmö, Section of Surgery, Lund University, Lund, Sweden
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Hansdotter P, Scherman P, Petersen SH, Mikalonis M, Holmberg E, Rizell M, Naredi P, Syk I. Patterns and resectability of colorectal cancer recurrences: outcome study within the COLOFOL trial. BJS Open 2021; 5:6328206. [PMID: 34308474 PMCID: PMC8311321 DOI: 10.1093/bjsopen/zrab067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/15/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Improvements in surgery, imaging, adjuvant treatment, and management of metastatic disease have led to modification of previous approaches regarding the risk of recurrence and prognosis in colorectal cancer. The aims of this study were to map patterns, risk factors, and the possibility of curative treatment of recurrent colorectal cancer in a multimodal setting. METHODS This was a cohort study based on the COLOFOL trial population of patients who underwent radical resection of stage II or III colorectal cancer. The medical files of all patients with recurrence within 5 years after resection of the primary tumour were scrutinized. Follow-up time was 5 years after the first recurrence. Primary endpoints were cumulative incidence, site, timing, and risk factors for recurrence, and rate of potentially curative treatment. A secondary endpoint was survival. RESULTS Of 2442 patients, 471 developed recurrences. The 5-year cumulative incidence was 21.4 (95 per cent c.i. 19.5 to 23.3) per cent. The median time to detection was 1.1 years after surgery and 87.3 per cent were detected within 3 years. Some 98.2 per cent of patients who had potentially curative treatment were assessed by a multidisciplinary tumour board. A total of 47.8 per cent of the recurrences were potentially curatively treated. The 5-year overall survival rate after detection was 32.0 (95 per cent c.i. 27.9 to 36.3) per cent for all patients with recurrence, 58.6 (51.9 to 64.7) per cent in the potentially curatively treated group and 7.7 (4.8 to 11.5) per cent in the palliatively treated group. CONCLUSION Time to recurrence was similar to previous results, whereas the 21.4 per cent risk of recurrence was somewhat lower. The high proportion of patients who received potentially curative treatment, linked to a 5-year overall survival rate of 58.6 per cent, indicates that it is possible to achieve good results in recurrent colorectal cancer following multidisciplinary assessment.
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Affiliation(s)
- P Hansdotter
- Department of Surgery, Skåne University Hospital, Malmö, Sweden.,Institute of Clinical Sciences Malmö, Section of Surgery, Lund University, Lund, Sweden
| | - P Scherman
- Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden
| | - S H Petersen
- Department of Paediatrics and Adolescent Medicine, Section of Paediatric Haematology and Oncology, Rigshospitalet, Copenhagen, Denmark
| | - M Mikalonis
- Department of Surgery, Aalborg Hospital, Aalborg, Denmark
| | - E Holmberg
- Department of Oncology, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - M Rizell
- Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.,Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - P Naredi
- Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - I Syk
- Department of Surgery, Skåne University Hospital, Malmö, Sweden.,Institute of Clinical Sciences Malmö, Section of Surgery, Lund University, Lund, Sweden
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Petersen SH, Kua LF, Nakajima S, Yong WP, Kono K. Chemoradiation induces upregulation of immunogenic cell death-related molecules together with increased expression of PD-L1 and galectin-9 in gastric cancer. Sci Rep 2021; 11:12264. [PMID: 34112882 PMCID: PMC8192931 DOI: 10.1038/s41598-021-91603-7] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/26/2021] [Indexed: 12/22/2022] Open
Abstract
Surgery alone or combined with chemo- and/or radiation therapy remains the primary treatment for gastric cancer (GC) to date and immunotherapeutic tools such as monoclonal antibodies are only slowly being implemented. This is partly due to the fact that the immune microenvironment in GC during chemoradiation and other treatment modalities is still poorly understood. 7 gastric cancer (GC) cell lines were tested for their response to chemoradiation using 5-FU in combination with X-ray irradiation. We conducted flow cytometric analysis to determine the cells’ ability to undergo immunogenic cell death (ICD) and their expression of the two immunosuppressive proteins programmed death-ligand 1 (PD-L1) and galectin-9 (Gal-9). We evaluated the overall immunogenicity of two cell lines (MKN7, MKN74) in co-culture experiments with human monocyte-derived dendritic cells (Mo-DCs). Chemoradiation induces distinct responses in different GC cell lines. We observe ICD in vitro in all tested GC cell lines in the form of calreticulin (CRT) translocation to the plasma membrane. As a resistance mechanism, these cells also upregulated Gal-9 and PD-L1. Mo-DC maturation experiments showed that GCs provoked the maturation of Mo-DCs after chemoradiation in vitro. The addition of α-PD-L1 blocking antibody further enhanced the immunogenicity of these cells while improving DC viability. Blocking Tim-3, as the main receptor for Gal-9, had no such effect. Our findings suggest that the benefits of chemoradiation can substantially depend on tumor subtype and these benefits can be offset by induced immune evasion in GC. Combination treatment using checkpoint inhibitors could potentially lead to enhanced immune responses and yield better patient outcomes.
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Affiliation(s)
- S H Petersen
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, 117599, Singapore.
| | - L F Kua
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, 117599, Singapore
| | - S Nakajima
- Department of Immunology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan.,Department of Gastrointestinal Tract Surgery, Faculty of Medicine, Fukushima Medical University, Fukushima, Japan.,Department of Progressive DOHaD Research, Faculty of Medicine, Fukushima Medical University, Fukushima, 1 Hikariga-oka, Fukushima city, Fukushima, 960-1295, Japan
| | - W P Yong
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, 117599, Singapore.,Department of Haematology-Oncology, National University Hospital of Singapore, Singapore, 119228, Singapore
| | - K Kono
- Department of Gastrointestinal Tract Surgery, Faculty of Medicine, Fukushima Medical University, Fukushima, Japan.
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Wille-Jørgensen P, Syk I, Smedh K, Laurberg S, Nielsen DT, Petersen SH, Renehan AG, Horváth-Puhó E, Påhlman L, Sørensen HT. Effect of More vs Less Frequent Follow-up Testing on Overall and Colorectal Cancer-Specific Mortality in Patients With Stage II or III Colorectal Cancer: The COLOFOL Randomized Clinical Trial. JAMA 2018; 319:2095-2103. [PMID: 29800179 PMCID: PMC6583244 DOI: 10.1001/jama.2018.5623] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Intensive follow-up of patients after curative surgery for colorectal cancer is common in clinical practice, but evidence of a survival benefit is limited. OBJECTIVE To examine overall mortality, colorectal cancer-specific mortality, and colorectal cancer-specific recurrence rates among patients with stage II or III colorectal cancer who were randomized after curative surgery to 2 alternative schedules for follow-up testing with computed tomography and carcinoembryonic antigen. DESIGN, SETTING, AND PARTICIPANTS Unblinded randomized trial including 2509 patients with stage II or III colorectal cancer treated at 24 centers in Sweden, Denmark, and Uruguay from January 2006 through December 2010 and followed up for 5 years; follow-up ended on December 31, 2015. INTERVENTIONS Patients were randomized either to follow-up testing with computed tomography of the thorax and abdomen and serum carcinoembryonic antigen at 6, 12, 18, 24, and 36 months after surgery (high-frequency group; n = 1253 patients) or at 12 and 36 months after surgery (low-frequency group; n = 1256 patients). MAIN OUTCOMES AND MEASURES The primary outcomes were 5-year overall mortality and colorectal cancer-specific mortality rates. The secondary outcome was the colorectal cancer-specific recurrence rate. Both intention-to-treat and per-protocol analyses were performed. RESULTS Among 2555 patients who were randomized, 2509 were included in the intention-to-treat analysis (mean age, 63.5 years; 1128 women [45%]) and 2365 (94.3%) completed the trial. The 5-year overall patient mortality rate in the high-frequency group was 13.0% (161/1253) compared with 14.1% (174/1256) in the low-frequency group (risk difference, 1.1% [95% CI, -1.6% to 3.8%]; P = .43). The 5-year colorectal cancer-specific mortality rate in the high-frequency group was 10.6% (128/1248) compared with 11.4% (137/1250) in the low-frequency group (risk difference, 0.8% [95% CI, -1.7% to 3.3%]; P = .52). The colorectal cancer-specific recurrence rate was 21.6% (265/1248) in the high-frequency group compared with 19.4% (238/1250) in the low-frequency group (risk difference, 2.2% [95% CI, -1.0% to 5.4%]; P = .15). CONCLUSIONS AND RELEVANCE Among patients with stage II or III colorectal cancer, follow-up testing with computed tomography and carcinoembryonic antigen more frequently compared with less frequently did not result in a significant rate reduction in 5-year overall mortality or colorectal cancer-specific mortality. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00225641.
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Affiliation(s)
- Peer Wille-Jørgensen
- Abdominal Disease Center, Bispebjerg Hospital and Danish Colorectal Cancer Group, Copenhagen, Denmark
| | - Ingvar Syk
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | - Kenneth Smedh
- Department of Surgery, Vâstmanlands Hospital, Västerås, Sweden
| | - Søren Laurberg
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Dennis T. Nielsen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Sune H. Petersen
- Abdominal Disease Center, Bispebjerg Hospital and Danish Colorectal Cancer Group, Copenhagen, Denmark
| | - Andrew G. Renehan
- Manchester Cancer Research Centre and NIHR Manchester Biomedical Research Centre, the Christie NHS Foundation Trust, Division of Cancer Science, School of Medical Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, England
| | | | - Lars Påhlman
- Department of Surgical Science, Uppsala University, Uppsala, Sweden
| | - Henrik T. Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Health Research and Policy, Stanford University, Stanford, California
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Abstract
Intranasal irrigation with ZnSO4 solutions is used for experimental induction of anosmia. It is, however, unknown whether the trigeminal nerve is affected by the treatment. One day after irrigation (concentrations investigated were between 0.05-1%) the ability of food finding, an olfactory cue, was decreased in a concentration-dependent manner. The trigeminal effect was investigated from a reflexively induced decrease in respiratory rate due to n-propanol exposure. No impairment occurred at 1% ZnSO4. Anosmia was also seen 2-3 h after an irrigation with solutions of 0.05-1% ZnSO4. At the same time, 0.2 and 1% solutions in themselves decreased the respiratory rate due to reflexes from the upper and lower respiratory tract. A conspicuous systemic effect can be ruled out as the Zn++ antidote, CaNa2EDTA, had no effect on the decrease. A direct activation of the trigeminal nerve due to a reaction with a thiol group may explain the effect from the upper airways.
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Affiliation(s)
- L F Hansen
- National Institute of Occupational Health, Copenhagen, Denmark
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Nielsen GD, Petersen SH, Vinggaard AM, Hansen LF, Wolkoff P. Ventilation, CO2 production, and CO2 exposure effects in conscious, restrained CF-1 mice. Pharmacol Toxicol 1993; 72:163-8. [PMID: 8516266 DOI: 10.1111/j.1600-0773.1993.tb00310.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Respiratory rate (f), tidal volume (VT) and carbon dioxide production (VECO2) were measured in restrained, conscious CF-1 mice. Mean f +/- S.D. and mean VT +/- S.D. were 270 +/- 8 breaths/min. and 0.123 +/- 0.024 ml (STPD) for male, and 274 +/- 15 breaths/min. and 0.115 +/- 0.023 ml (STPD) for female mice, respectively. VECO2 was obtained from a rebreathing (closed loop) system. The maximum VECO2 (STPD) amounted to 95.5 +/- 15.4 ml/(kg min.) in males and to 72.7 +/- 4.2 ml/(kg min.) in females. The CO2 concentration in the closed loop system increased slowly during a 30 min. rebreathing period and reached a concentration of about 2.7%. No effect was seen on f and on VT. Dynamic (abrupt) exposure up to 10.3% CO2 had no effect on f in male mice, whereas VT increased from 112% (2.3% CO2) to 181% (10.3% CO2). The estimated O2 concentrations decreased from 20.5% to 18.7% with increasing CO2 exposure. The equivalent CO2 experiments with O2 kept at 16% by N2 administration showed that the lower O2 concentration added an additional drive on the respiratory centre.
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Affiliation(s)
- G D Nielsen
- Danish National Institute of Occupational Health, Copenhagen
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Manthorpe R, Petersen SH, Prause JU. Mucosolvan in the treatment of patients with primary Sjögren's syndrome. Results from a double-blind cross-over investigation. Acta Ophthalmol 1984; 62:537-41. [PMID: 6385607 DOI: 10.1111/j.1755-3768.1984.tb03965.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Thirty-six patients with primary Sjögren's syndrome were randomized to Mucosolvan (60 mg X 2 daily) or placebo, in a double-blind cross-over study. Each period of treatment was 3 weeks with 1 week wash-out in between. None of the objective ophthalmological tests (Schirmer-1-test, break-up time, van Bijsterveld score, cornea sensitivity, appearance of nuclear chromatin in conjunctival epithelial cells, tear lysozyme) improved during the investigation period.
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Abstract
Sixteen patients with chronic leg ulcers were treated with 10% benzoyl peroxide gel for 6 weeks. At the end of the treatment, patch tests with 2% benzoyl peroxide in petrolatum and 10% in a gel showed that nine patients (56%) had become sensitized. This high sensitization rate is in good accord with the results obtained by experimental investigations using human maximization tests and repeated insult patch tests. A strong sensitizer such as benzoyl peroxide should not be used in the routine treatment of chronic leg ulcers, despite its good healing effect.
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Jensen O, Petersen SH. [Treatment possibilities in louse infestation]. Ugeskr Laeger 1979; 141:1661-2. [PMID: 462617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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