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Etain B, Godin O, Boudebesse C, Aubin V, Azorin J, Bellivier F, Bougerol T, Courtet P, Gard S, Kahn J, Passerieux C, Leboyer M, Henry C. Sleep quality and emotional reactivity cluster in bipolar disorders and impact on functioning. Eur Psychiatry 2020; 45:190-197. [DOI: 10.1016/j.eurpsy.2017.06.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/29/2017] [Accepted: 06/29/2017] [Indexed: 12/24/2022] Open
Abstract
AbstractObjective:Bipolar disorders (BD) are characterized by sleep disturbances and emotional dysregulation both during acute episodes and remission periods. We hypothesized that sleep quality (SQ) and emotional reactivity (ER) defined clusters of patients with no or abnormal SQ and ER and we studied the association with functioning.Method:We performed a bi-dimensional cluster analysis using SQ and ER measures in a sample of 533 outpatients patients with BD (in remission or with subsyndromal mood symptoms). Clusters were compared for mood symptoms, sleep profile and functioning.Results:We identified three clusters of patients: C1 (normal ER and SQ, 54%), C2 (hypo-ER and low SQ, 22%) and C3 (hyper-ER and low SQ, 24%). C1 was characterized by minimal mood symptoms, better sleep profile and higher functioning than other clusters. Although highly different for ER, C2 and C3 had similar levels of subsyndromal mood symptoms as assessed using classical mood scales. When exploring sleep domains, C2 showed poor sleep efficiency and a trend for longer sleep latency as compared to C3. Interestingly, alterations in functioning were similar in C2 and C3, with no difference in any of the sub-domains.Conclusion:Abnormalities in ER and SQ delineated three clusters of patients with BD and significantly impacted on functioning.
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Benard V, Etain B, Vaiva G, Boudebesse C, Yeim S, Benizri C, Brochard H, Bellivier F, Geoffroy PA. Sleep and circadian rhythms as possible trait markers of suicide attempt in bipolar disorders: An actigraphy study. J Affect Disord 2019; 244:1-8. [PMID: 30290235 DOI: 10.1016/j.jad.2018.09.054] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [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] [Received: 05/13/2018] [Revised: 08/09/2018] [Accepted: 09/15/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND The poor prognostic of Bipolar disorders (BD) is closely linked to deaths by suicide. Sleep and circadian abnormalities are observed during all phases of BD and are also associated with suicide attempt (SA). In this context, this study sought to identify specific sleep and circadian rhythms markers associated with suicidal attempt in euthymic patients with BD. METHODS The sample (N = 236) comprised 3 groups: 147 patients with BD including 57 with a history of SA and 90 without (NoSA), and 89 healthy controls (HC). All participants were recorded during 21 days with actigraphy. RESULTS SA was associated with women gender (p = 0.03), familial history of SA (p = 0.03), mixed episodes (p = 0.001), and benzodiazepines (p = 0.019). SA, compared to noSA, had a morning phase preference (p = 0.04), and were more vigorous on the circadian type inventory (p = 0.04), and tended to suffer more from insomnia (45% versus 25% respectively, p = 0.10). SA was also associated with an earlier onset of daily activity assessed with actigraphy (M10 onset: p = 0.01). Backward stepwise linear regression indicated that a combination of four variables (Gender, vigour, insomnia, M10onset) significantly differentiated patients with SA from NoSA (p = 0.03). LIMITATIONS Cross-sectional design, and no examination of suicidal behaviors' subgroups such as first attempters or repeaters, or violent suicide attempt. CONCLUSIONS Woman gender, vigorous circadian type, insomnia and an earlier daily activity appeared independently associated with SA in BD. If these biomarkers are confirmed in prospective studies, they should be screened and used to prevent suicide, with the development of personal and targeted chronobiological treatments.
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Affiliation(s)
- V Benard
- Univ. Lille, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Lille F-59000, France; Univ. Lille, CHRU Lille, Clinique de Psychiatrie, Unité CURE, Lille F-59000 France; Univ. Lille, Hôpital Fontan CHRU Lille F-59000, France
| | - B Etain
- AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris cedex 10 75475, France; Inserm, U1144, Paris F-75006, France; Université Paris Descartes, UMR-S 1144, Paris F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris F-75013, France; Fondation FondaMental, Créteil 94000, France
| | - G Vaiva
- Univ. Lille, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Lille F-59000, France; Univ. Lille, CHRU Lille, Clinique de Psychiatrie, Unité CURE, Lille F-59000 France; Univ. Lille, Hôpital Fontan CHRU Lille F-59000, France
| | - C Boudebesse
- AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris cedex 10 75475, France
| | - S Yeim
- AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris cedex 10 75475, France
| | - C Benizri
- AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris cedex 10 75475, France
| | - H Brochard
- AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris cedex 10 75475, France
| | - F Bellivier
- AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris cedex 10 75475, France; Inserm, U1144, Paris F-75006, France; Université Paris Descartes, UMR-S 1144, Paris F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris F-75013, France; Fondation FondaMental, Créteil 94000, France
| | - P A Geoffroy
- AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris cedex 10 75475, France; Inserm, U1144, Paris F-75006, France; Université Paris Descartes, UMR-S 1144, Paris F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris F-75013, France; Fondation FondaMental, Créteil 94000, France.
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Brochard H, Godin O, Geoffroy PA, Yeim S, Boudebesse C, Benizri C, Benard V, Maruani J, Leboyer M, Bellivier F, Etain B. Metabolic syndrome and actigraphy measures of sleep and circadian rhythms in bipolar disorders during remission. Acta Psychiatr Scand 2018; 138:155-162. [PMID: 29845615 DOI: 10.1111/acps.12910] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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] [Accepted: 05/14/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This study explored the correlations between sleep and circadian rhythm measures and the metabolic syndrome (MetS) components in remitted patients with bipolar disorder (BD). METHOD Euthymic patients with BD (n = 67) were recorded by 3 weeks with actigraphy. We used nonparametric correlations to study the links between the MetS parameters, atherogenic index of plasma (AIP), sleep efficacy, sleep latency, fragmentation index, and phase and amplitude of rhythms. We performed multivariable analyses to take into account potential confounding factors such as sleep apnea risk, antipsychotics use, and smoker status. RESULTS We found correlations between lower sleep efficiency and higher triglyceride levels (P = 0.002), lower M10 onset (beginning of the 10 most active hours during the 24-h cycle) and higher systolic blood pressure (P = 0.03), higher fragmentation index and higher systolic blood pressure (P = 0.009), lower sleep efficiency, higher fragmentation index, and higher AIP (respectively P = 0.02 and P = 0.04). These correlations mostly remained significant when adjusting for confounders, with the exception of M10 onset and systolic blood pressure. CONCLUSION Sleep efficiency and fragmentation index might contribute to the cardiovascular risk of patients with BD independently of major confounding factors. Although these associations did not imply causality, proposing interventions on sleep quality and circadian rhythm regularity might contribute to reduce cardiovascular risk in patients with BD.
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Affiliation(s)
- H Brochard
- Pôle sectoriel, Centre Hospitalier Fondation Vallée, Gentilly, France
| | - O Godin
- Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Sorbonne Universités, Université Pierre et Marie Curie, Paris, France.,INSERM, UMR_S 1136, Paris, France.,Fondation FondaMental, Créteil, France
| | - P A Geoffroy
- Fondation FondaMental, Créteil, France.,Département de Psychiatrie et de Médecine Addictologique, AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Paris, France.,Sorbonne Paris Cité, Université Paris Diderot, Paris, France.,INSERM U1144, Paris, France
| | - S Yeim
- Département de Psychiatrie et de Médecine Addictologique, AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Paris, France.,Sorbonne Paris Cité, Université Paris Diderot, Paris, France
| | - C Boudebesse
- AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie et d'Addictologie, Créteil, France
| | - C Benizri
- Equipe Psychiatrie Translationnelle, INSERM U955, Créteil, France
| | | | - J Maruani
- Département de Psychiatrie et de Médecine Addictologique, AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Paris, France
| | - M Leboyer
- Fondation FondaMental, Créteil, France.,AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie et d'Addictologie, Créteil, France.,Equipe Psychiatrie Translationnelle, INSERM U955, Créteil, France
| | - F Bellivier
- Fondation FondaMental, Créteil, France.,Département de Psychiatrie et de Médecine Addictologique, AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Paris, France.,Sorbonne Paris Cité, Université Paris Diderot, Paris, France.,INSERM U1144, Paris, France
| | - B Etain
- Fondation FondaMental, Créteil, France.,Département de Psychiatrie et de Médecine Addictologique, AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Paris, France.,Sorbonne Paris Cité, Université Paris Diderot, Paris, France.,INSERM U1144, Paris, France
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Legendre T, Boudebesse C, Henry C, Etain B. Antibiomania : penser au syndrome maniaque secondaire à une antibiothérapie. Encephale 2017; 43:183-186. [DOI: 10.1016/j.encep.2015.06.008] [Citation(s) in RCA: 6] [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: 04/30/2015] [Revised: 06/10/2015] [Accepted: 06/29/2015] [Indexed: 12/16/2022]
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Brochard H, Boudebesse C, Henry C, Godin O, Leboyer M, Étain B. Syndrome métabolique et troubles bipolaires : le sommeil est-il le chaînon manquant ? Encephale 2016; 42:562-567. [PMID: 27663044 DOI: 10.1016/j.encep.2015.08.007] [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: 02/12/2015] [Accepted: 08/31/2015] [Indexed: 01/13/2023]
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Geoffroy P, Fovet T, Micoulaud-Franchi JA, Boudebesse C, Thomas P, Etain B, Amad A. Luminothérapie et épisodes dépressifs saisonniers du trouble bipolaire. L'Encéphale 2015; 41:527-33. [DOI: 10.1016/j.encep.2015.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 04/13/2015] [Indexed: 10/22/2022]
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Geoffroy PA, Scott J, Boudebesse C, Lajnef M, Henry C, Leboyer M, Bellivier F, Etain B. Reply: Sleep in patients with remitted bipolar disorders: analyses stratified on actigraphy devices, age and gender. Acta Psychiatr Scand 2015; 131:400. [PMID: 25648100 DOI: 10.1111/acps.12400] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- P A Geoffroy
- Inserm, UMR-S 1144, Paris, France; AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, Pôle Neurosciences, Paris, France; Université Paris Descartes, UMR-S 1144, Paris, France; Université Paris Diderot, UMR-S 1144, Paris, France; Fondation FondaMental, Créteil, France.
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Geoffroy PA, Scott J, Boudebesse C, Lajnef M, Henry C, Leboyer M, Bellivier F, Etain B. Sleep in patients with remitted bipolar disorders: a meta-analysis of actigraphy studies. Acta Psychiatr Scand 2015; 131:89-99. [PMID: 25430914 DOI: 10.1111/acps.12367] [Citation(s) in RCA: 147] [Impact Index Per Article: 16.3] [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] [Accepted: 10/21/2014] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Sleep dysregulation is highly prevalent in bipolar disorders (BDs), with previous actigraphic studies demonstrating sleep abnormalities during depressive, manic, and interepisode periods. We undertook a meta-analysis of published actigraphy studies to identify whether any abnormalities in the reported sleep profiles of remitted BD cases differ from controls. METHOD A systematic review identified independent studies that were eligible for inclusion in a random effects meta-analysis. Effect sizes for actigraphy parameters were expressed as standardized mean differences (SMD) with 95% confidence intervals (95% CI). RESULTS Nine of 248 identified studies met eligibility criteria. Compared with controls (N=210), remitted BD cases (N=202) showed significant differences in SMD for sleep latency (0.51 [0.28-0.73]), sleep duration (0.57 [0.30-0.84]), wake after sleep onset (WASO) (0.28 [0.06-0.50]) and sleep efficiency (-0.38 [-0.70-0.07]). Moderate heterogeneity was identified for sleep duration (I2=44%) and sleep efficiency (I2=44%). Post hoc meta-regression analyses demonstrated that larger SMD for sleep duration were identified for studies with a greater age difference between BD cases and controls (β=0.22; P=0.03) and non-significantly lower levels of residual depressive symptoms in BD cases (β=-0.13; P=0.07). CONCLUSION This meta-analysis of sleep in remitted bipolar disorder highlights disturbances in several sleep parameters. Future actigraphy studies should pay attention to age matching and levels of residual depressive symptoms.
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Affiliation(s)
- P A Geoffroy
- Inserm, UMR-S 1144, Paris, France; AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, Pôle Neurosciences, Paris Cedex 10, France; Université Paris Descartes, UMR-S 1144, Paris, France; Université Paris Diderot, UMR-S 1144, Paris, France; Fondation FondaMental, Créteil, France
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Boudebesse C, Geoffroy PA, Henry C, Germain A, Scott J, Lajnef M, Leboyer M, Bellivier F, Etain B. Links between sleep and body mass index in bipolar disorders: an exploratory study. Eur Psychiatry 2014; 30:89-93. [PMID: 24908150 DOI: 10.1016/j.eurpsy.2014.04.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [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] [Received: 01/15/2014] [Revised: 03/23/2014] [Accepted: 04/19/2014] [Indexed: 01/20/2023] Open
Abstract
STUDY OBJECTIVES Obesity and excess bodyweight are highly prevalent in individuals with bipolar disorders (BD) and are associated with adverse consequences. Multiple factors may explain increased bodyweight in BD including side effects of psychotropic medications, and reduced physical activity. Research in the general population demonstrates that sleep disturbances may also contribute to metabolic burden. We present a cross-sectional study of the associations between body mass index (BMI) and sleep parameters in patients with BD as compared with healthy controls (HC). METHODS Twenty-six French outpatients with remitted BD and 29 HC with a similar BMI completed a 21-day study of sleep parameters using objective (actigraphy) and subjective (PSQI: Pittsburgh Sleep Quality Index) assessments. RESULTS In BD cases, but not in HC, higher BMI was significantly correlated with lower sleep efficiency (P=0.009) and with several other sleep parameters: shorter total sleep time (P=0.01), longer sleep onset latency (P=0.05), higher fragmentation index (P=0.008), higher inter-day variability (P=0.05) and higher PSQI total score (P=0.004). CONCLUSIONS The findings suggest a link between a high BMI and several sleep disturbances in BD, including lower sleep efficiency. Physiological mechanisms in BD cases may include an exaggeration of phenomena observed in non-clinical populations. However, larger scale studies are required to clarify the links between metabolic and sleep-wake cycle disturbances in BD.
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Affiliation(s)
- C Boudebesse
- Inserm, U955, Créteil, France; AP-HP, Hôpital H.-Mondor-A.-Chenevier, Pôle de Psychiatrie, DHU PePSY, Créteil, France; Fondation Fondamental, Créteil, France.
| | - P-A Geoffroy
- Inserm, U955, Créteil, France; Fondation Fondamental, Créteil, France; Pôle de Psychiatrie, Université Lille Nord de France, CHRU de Lille, Lille, France
| | - C Henry
- Inserm, U955, Créteil, France; Université Paris Est, Faculté de Médecine, Créteil, France; AP-HP, Hôpital H.-Mondor-A.-Chenevier, Pôle de Psychiatrie, DHU PePSY, Créteil, France; Fondation Fondamental, Créteil, France
| | - A Germain
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - J Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Centre for Affective Disorders, Institute of Psychiatry, London, UK
| | | | - M Leboyer
- Inserm, U955, Créteil, France; Université Paris Est, Faculté de Médecine, Créteil, France; AP-HP, Hôpital H.-Mondor-A.-Chenevier, Pôle de Psychiatrie, DHU PePSY, Créteil, France; Fondation Fondamental, Créteil, France
| | - F Bellivier
- Fondation Fondamental, Créteil, France; AP-HP, GH Saint-Louis-Lariboisière-Fernand-Widal, Pôle Neurosciences, Paris, France; Université Paris-7 Paris-Diderot, UFR de Médecine, Paris, France
| | - B Etain
- Inserm, U955, Créteil, France; AP-HP, Hôpital H.-Mondor-A.-Chenevier, Pôle de Psychiatrie, DHU PePSY, Créteil, France; Fondation Fondamental, Créteil, France
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Etain B, Jamain S, Milhiet V, Lajnef M, Boudebesse C, Dumaine A, Mathieu F, Gombert A, Ledudal K, Gard S, Kahn JP, Henry C, Boland A, Zelenika D, Lechner D, Lathrop M, Leboyer M, Bellivier F. Association between circadian genes, bipolar disorders and chronotypes. Chronobiol Int 2014; 31:807-14. [DOI: 10.3109/07420528.2014.906445] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Geoffroy PA, Boudebesse C, Henrion A, Jamain S, Henry C, Leboyer M, Bellivier F, Etain B. An ASMT variant associated with bipolar disorder influences sleep and circadian rhythms: a pilot study. Genes, Brain and Behavior 2013; 13:299-304. [DOI: 10.1111/gbb.12103] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 10/21/2013] [Accepted: 11/08/2013] [Indexed: 11/28/2022]
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Boudebesse C, Lajnef M, Geoffroy PA, Bellivier F, Nieto I, Gard S, Olié E, Azorin JM, Kahn JP, Bougerol T, Passerieux C, Aubin V, Milhiet V, Folkard S, Leboyer M, Henry C, Etain B. Chronotypes of Bipolar Patients in Remission: Validation of the French Version of the Circadian Type Inventory in the FACE-BD Sample. Chronobiol Int 2013; 30:1042-9. [DOI: 10.3109/07420528.2013.798330] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Geoffroy P, Etain B, Scott J, Boudebesse C, Lajnef M, Leboyer M, Bellivier F. 1473 – Seasonal pattern in bipolar disorder: prevalence, clinical characteristics and gender influence. Eur Psychiatry 2013. [DOI: 10.1016/s0924-9338(13)76499-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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