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Huffman WH, Ayotte SR, Jia L, Pirruccio K, Li X, Kelly JD, Parisien RL. The Delayed Presentation and Diagnosis of Youth Wrestling Injuries: A 20-Year Analysis of National Injury Data. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202405000-00010. [PMID: 38722968 PMCID: PMC11081623 DOI: 10.5435/jaaosglobal-d-23-00150] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/15/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION The nature of wrestling may lead athletes to mask injuries with the delayed presentations of youth wrestling-related injuries not being well characterized. METHODS This descriptive epidemiological study queried the National Electronic Injury Surveillance System database to characterize delayed presentations of wrestling-related injuries in middle and high-school athletes. Data collection consisted of national estimates, demographics, and injury characteristics of patients with delayed (D) presentations (≥1 day) and same-day (S) presentations to US emergency departments after sustaining a wrestling-related injury during the scholastic wrestling season (December to February, 2000 to 2019). RESULTS Of middle and high-school wrestlers presenting to US emergency departments, 5.6% (95% confidence interval [CI] 4.3% to 7.1%) reported delayed presentations for a total of 1,110 patients (CI, 591 to 1,630) annually. Most commonly (P < 0.001), injuries were sustained on Saturdays in both cohorts (D, 28.2%; CI, 22.4% to 34.8%; S, 29.6%; CI, 24.3% to 35.5%). Patients reporting delayed presentations were less likely to sustain fractures (D, 11.5%; CI, 8.3% to 15.6%; S, 18.9%; CI, 15.0% to 23.5%; P = 0.019) and injuries of the head/neck (D, 20.0%; CI, 16.5 to 24.1%; S, 26.2%; CI, 21.4% to 31.7%; P = 0.011). DISCUSSION A substantial proportion of adolescent wrestlers report delayed presentations of injuries. This emphasizes the need for vigilance in detecting subtle signs of injury.
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Affiliation(s)
- William H. Huffman
- From the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Mr. Huffman, Mr. Ayotte, and Ms. Jia); the Department of Orthopaedic Surgery, Yale-New Haven Hospital, New Haven, CT (Dr. Pirruccio); the Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA (Dr. Li); the Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA (Dr. Kelly IV); and the Department of Orthopaedic Surgery, Mount Sinai, New York, NY (Dr. Parisien)
| | - Steven R. Ayotte
- From the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Mr. Huffman, Mr. Ayotte, and Ms. Jia); the Department of Orthopaedic Surgery, Yale-New Haven Hospital, New Haven, CT (Dr. Pirruccio); the Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA (Dr. Li); the Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA (Dr. Kelly IV); and the Department of Orthopaedic Surgery, Mount Sinai, New York, NY (Dr. Parisien)
| | - Lori Jia
- From the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Mr. Huffman, Mr. Ayotte, and Ms. Jia); the Department of Orthopaedic Surgery, Yale-New Haven Hospital, New Haven, CT (Dr. Pirruccio); the Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA (Dr. Li); the Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA (Dr. Kelly IV); and the Department of Orthopaedic Surgery, Mount Sinai, New York, NY (Dr. Parisien)
| | - Kevin Pirruccio
- From the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Mr. Huffman, Mr. Ayotte, and Ms. Jia); the Department of Orthopaedic Surgery, Yale-New Haven Hospital, New Haven, CT (Dr. Pirruccio); the Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA (Dr. Li); the Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA (Dr. Kelly IV); and the Department of Orthopaedic Surgery, Mount Sinai, New York, NY (Dr. Parisien)
| | - Xinning Li
- From the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Mr. Huffman, Mr. Ayotte, and Ms. Jia); the Department of Orthopaedic Surgery, Yale-New Haven Hospital, New Haven, CT (Dr. Pirruccio); the Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA (Dr. Li); the Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA (Dr. Kelly IV); and the Department of Orthopaedic Surgery, Mount Sinai, New York, NY (Dr. Parisien)
| | - John D. Kelly
- From the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Mr. Huffman, Mr. Ayotte, and Ms. Jia); the Department of Orthopaedic Surgery, Yale-New Haven Hospital, New Haven, CT (Dr. Pirruccio); the Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA (Dr. Li); the Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA (Dr. Kelly IV); and the Department of Orthopaedic Surgery, Mount Sinai, New York, NY (Dr. Parisien)
| | - Robert L. Parisien
- From the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Mr. Huffman, Mr. Ayotte, and Ms. Jia); the Department of Orthopaedic Surgery, Yale-New Haven Hospital, New Haven, CT (Dr. Pirruccio); the Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA (Dr. Li); the Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA (Dr. Kelly IV); and the Department of Orthopaedic Surgery, Mount Sinai, New York, NY (Dr. Parisien)
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Kiani SN, Yellin JL, Huffman WH, Guzek RH, Shea KG, Nguyen JC, Ganley TJ. Patella and Trochlea Osteochondritis Dissecans: Demographics and Treatment Paradigms. J Pediatr Orthop 2024; 44:e138-e143. [PMID: 38108383 DOI: 10.1097/bpo.0000000000002588] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
OBJECTIVE Previous research on patellar and trochlear groove osteochondritis dissecans (OCD) is limited by small sample sizes. This study aims to describe the presentation of patients with OCD lesions of the patella and trochlea and characterize the outcomes of operative and nonoperative treatments. METHODS This retrospective cohort study identified all patients from a single institution from 2008 to 2021 with patellar and/or trochlear OCD lesions. Patients were excluded from the study if surgical records were unavailable or if the patient had knee surgery for a different injury at index surgery or in the 12 months postoperative. Minimum follow-up was 12 months. Outcomes included a return to sports (RTS), pain resolution, radiographic healing, and treatment "success" (defined as full RTS, complete pain resolution, and full healing on imaging). RESULTS A total of 68 patients (75 knees) were included-45 (60%) with patellar OCD and 30 (40%) with trochlear. Of the patients, 69% were males. The median age at knee OCD diagnosis was 14 years. At the final follow-up, 62% of knees (n = 44) recovered sufficiently to allow a full RTS and 54% of knees (n = 39) had full pain resolution. Of the 46 knees with radiographic imaging at least 1 year apart, 63% had full healing of the lesion. There was no significant difference in RTS, pain resolution, radiographic healing, or overall success when comparing treatments. CONCLUSIONS This study provides valuable epidemiologic demographic and outcome data regarding the scarcely reported patellar and trochlear OCD. While over half of patients fully returned to sports and reported full pain resolution, a large proportion continued to experience symptoms over a year after presentation. Future research should aim to better define the treatment algorithms for these OCD subtypes. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Sara N Kiani
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Joseph L Yellin
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - William H Huffman
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Ryan H Guzek
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Kevin G Shea
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA
| | - Jie C Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Theodore J Ganley
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
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Huffman WH, Gupta R, Ayotte SR, Lawrence JTR. Pediatric Fractures Associated With Riding Bicycles: A National 20-year Analysis. J Pediatr Orthop 2024; 44:e1-e6. [PMID: 37798855 DOI: 10.1097/bpo.0000000000002522] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
BACKGROUND Biking is a popular childhood activity with an intrinsic risk of injury. While advocacy groups have promoted protective equipment to help mitigate these risks, trends in the national health burden of fractures associated with biking in the pediatric population have not been explored in depth. METHODS The National Electronic Injury Surveillance System database was queried between 2001 and 2020 to identify patients aged 18 years or below with fractures presenting to US emergency departments associated with riding bicycles. The patient narratives were analyzed to exclude patients not actively riding bicycles and to note helmet use and collisions with motor vehicles (MVs). RESULTS A total of 33,955 fractures were identified in the database, representing an estimated 1,007,714 fractures from 2001 to 2020, or 50,331 fractures annually. Linear regression noted a significant decrease in fractures over the period ( R2 =0.899; P <0.001). Most fractures occurred in patients who were male (71.8%, 95% CI: 70.4% to 73.2%), White (53.1%, 46.0% to 60.0%), and aged 10 to 12 (30.6%, 29.6% to 31.7%) or 13 to 15 years (24.8%, 23.4% to 26.2%). Fractures occurred most frequently in the forearm (25.2%, 22.8% to 27.8%), wrist (21.2%, 19.5% to 22.9%), and shoulder (10.5%, 9.7% to 11.3%). Patients who sustained fractures after being struck by a MV were >6 times more likely to be admitted to the hospital (36.0%, 28.6% to 44.2%) compared with patients not struck by a MV (5.4%, 4.3% to 6.8%). When helmet use was recorded in patients with skull fractures, most patients were not wearing helmets at the time of injury (85.7%, 74.6% to 92.5%). CONCLUSIONS Although the national burden of fractures associated with riding bicycles in pediatric populations has steadily decreased, it remains a significant cause of injury for children. Fractures involving MV more often require hospitalization, and an alarming number of skull fractures are noted in children not wearing helmets. These data support continued efforts to promote consistent helmet use and safer riding environments around MV in all children, but especially among 10- to 15-year-old males. LEVEL OF EVIDENCE Level III-prognostic.
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Affiliation(s)
| | - Radhika Gupta
- Perelman School of Medicine at the University of Pennsylvania
| | - Steven R Ayotte
- Perelman School of Medicine at the University of Pennsylvania
| | - J Todd R Lawrence
- Perelman School of Medicine at the University of Pennsylvania
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
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Huffman WH, Ayotte SR, Johnson MA, Cipriano CA. Removing or Only Moving a Barrier? Screening Applications with US Medical Licensing Examination Step 2CK Instead of Step 1 May Benefit Women but Not Underrepresented Minorities in Orthopaedics. JB JS Open Access 2023; 8:JBJSOA-D-22-00140. [PMID: 37255670 PMCID: PMC10226614 DOI: 10.2106/jbjs.oa.22.00140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Most orthopaedic surgery program directors report using a minimum score cutoff for the US Medical Licensing Examination Step 1 examination when evaluating residency applicants. The transition to a Pass/Fail grading system beginning in the 2022-2023 application cycle will alter applicant evaluation in the interview selection process. The impact of this change, particularly on women and underrepresented minority (URM) applicants, remains unclear. This study was designed to evaluate how a shift to screening applications using Step 2 Clinical Knowledge (CK) instead of Step 1 scores could impact selection for residency interviews. Methods We reviewed all 855 Electronic Residency Application Service applications submitted to the University of Pennsylvania's orthopaedic surgery residency program in the 2020-2021 cycle. Applicant age, sex, medical school of graduation, self-identified race, and permanent zip code were evaluated for association with Step 1 and Step 2CK scores using a 2-sample t test. A multivariable linear regression analysis was conducted to understand the predictive value of demographic features and medical school features on Step 1 and 2CK scores. Results Multivariable linear regression revealed both Step 1 and 2CK scores were lower for applicants of URM status (Step 1: p < 0.001; Step 2CK: p < 0.001) and from international medical schools (p = 0.043; p = 0.006). Step 1 scores but not Step 2CK scores were lower for applicants who were women (p < 0.001; p = 0.730), ≥30 years of age (p < 0.001; p = 0.079), and from medical schools outside the top 25 in National Institutes of Health (NIH) funding or US News and World Report (USNWR) ranking (p = 0.001; p = 0.193). Conclusions Conversion of Step 1 grading to Pass/Fail may reduce barriers for groups with lower average Step 1 scores (URM, female, ≥30 years of age, and from institutions with lower NIH funding or USNWR rankings). However, if Step 2CK scores replace Step 1 as a screening tool, groups with lower Step 2CK scores, notably URM applicants, may not experience this benefit. Level of Evidence Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- William H. Huffman
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven R. Ayotte
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mitchell A. Johnson
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cara A. Cipriano
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Huffman WH, Jia L, Pirruccio K, Li X, Hecht AC, Parisien RL. Acute Vertebral Fractures in Skiing and Snowboarding: A 20-Year Sex-Specific Analysis of National Injury Data. Orthop J Sports Med 2022; 10:23259671221105486. [PMID: 35837441 PMCID: PMC9274405 DOI: 10.1177/23259671221105486] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/23/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The epidemiology of acute vertebral fractures (AVFs) sustained while skiing
and snowboarding remains poorly defined in the United States. Hypothesis: It was hypothesized that there would be no significant differences across sex
and a greater number of AVFs in younger age groups associated with skiing
and snowboarding. Study Design: Descriptive epidemiological study. Methods: The authors utilized the National Electronic Injury Surveillance System to
identify patients who were reported in emergency departments in the United
States from 2000 to 2019. All patients were noted to have sustained AVFs
during skiing or snowboarding. National estimates and demographic analysis
were performed. Results: A total of 466 AVFs were identified, or roughly 23.3 AVFs per year. Compared
with women, men accounted for the majority of AVFs sustained in both skiing
and snowboarding: 67.8% (95% CI, 62.6%-73.0%) during skiing and 82.1% (95%
CI, 76.3%-87.8%) during snowboarding. This represented a significantly
larger percentage of AVFs while snowboarding compared with skiing
(P = .002). Women accounted for 32.2% (95% CI,
27.0%-37.4%) of AVFs while skiing and 17.9% (95% CI, 12.2%-23.7%) while
snowboarding, which indicated a significantly larger percentage of AVFs
sustained during skiing compared with snowboarding (P =
.002). Snowboarders were more likely than skiers to sustain an AVF in the
region of the coccyx (21.5% [95% CI, 14.3%-28.7%] vs 11.5% [95% CI,
3.5%-16.9%], respectively; P = .003) and as a result of a
fall at ground level (69.2% [95% CI, 62.1%-76.4%] vs 52.8% [95% CI,
43.2%-62.4%], respectively; P = .009). A significant
decrease in the number of snowboarding-related AVFs was identified over the
20-year study period: 899 in 2000-2003 versus 283 in 2016-2019
(P < .01). The change in skiing-related AVFs over
the study period was not statistically significant (694 vs 462;
P = .5). Conclusion: This national study of AVFs sustained while skiing and snowboarding
identified critical sex- and age-specific differences in the population at
risk, anatomic location of injury, and mechanism of injury. The national
data generated from this study over a 20-year period may be utilized to
better inform public health injury awareness and prevention initiatives in
the rapidly growing sports of skiing and snowboarding.
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Affiliation(s)
- William H Huffman
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lori Jia
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kevin Pirruccio
- Department of Orthopaedic Surgery, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Xinning Li
- Boston University Medical Center, Boston, Massachusetts, USA
| | - Andrew C Hecht
- Department of Orthopaedic Surgery, Mount Sinai, New York, New York, USA
| | - Robert L Parisien
- Department of Orthopaedic Surgery, Mount Sinai, New York, New York, USA
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Jia L, Huffman WH, Cusano A, Trofa DP, Li X, Kelly JD, Parisien RL. The risk of COVID-19 transmission upon return to sport: a systematic review. PHYSICIAN SPORTSMED 2022; 51:203-209. [PMID: 35085475 DOI: 10.1080/00913847.2022.2035197] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To evaluate COVID-19 transmission rates in athletes upon return to sport (RTS), as well as the effectiveness of preventive and surveillance measures associated with RTS. METHODS In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the PubMed, Embase, and Cochrane Library databases were searched to identify all articles reporting on RTS during COVID-19. Articles were excluded on the basis of the following criteria: (1) non-English text, (2) only abstract available, (3) population not athlete-specific, (4) outcome not RTS-specific, (5) COVID-19 transmission data not quantified, (6) editorial, or (7) review article or meta-analysis. Study characteristics; athlete demographics; COVID-19 preventive, surveillance, and diagnostic measures; COVID-19 transmission outcomes; and RTS recommendations were collected from each included article and analyzed. RESULTS 10 studies were included in the final analysis, comprising over 97,000 athletes across a wide variety of sports, levels of play, and RTS settings. Of the 10 studies, eight identified low transmission rates and considered RTS to be safe/low risk. Overall, COVID-19 transmission rates were higher in athletes than in contacts, and more prevalent in the greater community than in athletes specifically. The risk of COVID-19 did not appear to be necessarily higher for athletes who played high-contact team sports, shared common facilities, or lived in communities impacted by high transmission rates, provided that rigorous COVID-19 safety and testing protocols were implemented and followed. Mask wearing and physical distancing during active play presented the greatest challenge to athletes. CONCLUSION Rigorous preventive and surveillance measures can mitigate the risk of COVID-19 transmission in athletes upon RTS. However, the heterogeneity of RTS playing conditions, availability of COVID-19 resources, rise of unforeseen novel variants, and undetermined long-term impact of vaccination on athletes remain a challenge to safe and effective RTS in the era of COVID-19.
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Affiliation(s)
- Lori Jia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - William H Huffman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Antonio Cusano
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - David P Trofa
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Xinning Li
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, MA, USA
| | - John D Kelly
- Department of Orthopaedic Surgery and Sports Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert L Parisien
- Department of Orthopaedic Surgery and Sports Medicine, Mount Sinai, New York, NY, USA
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Huffman AH, Whetten J, Huffman WH. Using technology in higher education: The influence of gender roles on technology self-efficacy. Computers in Human Behavior 2013. [DOI: 10.1016/j.chb.2013.02.012] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Huffman WH. Robert Fludd's "Declaratio brevis" to James I. Ambix 1978; 25:69-79. [PMID: 11615701 DOI: 10.1179/amb.1978.25.2.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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