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Automatic 1-year follow-up appointment creation and reminders can improve long-term follow-up after carotid revascularization. Am J Surg 2024; 227:57-62. [PMID: 37827870 PMCID: PMC10797636 DOI: 10.1016/j.amjsurg.2023.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/17/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Long-term follow-up (LTFU) following carotid revascularization is important for post-surgical care, stroke risk optimization and post-market surveillance of new technologies. METHODS We instituted a quality improvement project to improve LTFU rates for carotid revascularizations (primary outcome) by scheduling perioperative and one-year follow-up appointments at time of surgery discharge. A temporal trends analysis (Q1 2019 through Q1 2022), multivariable regression, and interrupted time series (ITS) were performed to compare pre-post intervention LTFU rates. RESULTS 269 consecutive patients were included (151 pre-intervention, 118 post-intervention; mean 71 ± 12 years-old, 39% female, 77% White). The overall LTFU rate improved (64.9%-78.8%; P = 0.013) after the intervention. After controlling for patient factors, procedures performed after the intervention were associated with increased odds of being seen for 1-year follow-up (OR: 2.2 95%CI: 1.2-4.0). Quarterly ITS analysis corroborated this relationship (P = 0.01). CONCLUSIONS Time-of-surgery appointment creation and automated patient reminders can improve LTFU rates following carotid revascularizations.
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Corrigendum: Implementation of a patient-centered remote wound monitoring system for management of diabetic foot ulcers. Front Endocrinol (Lausanne) 2023; 14:1235970. [PMID: 37424861 PMCID: PMC10328416 DOI: 10.3389/fendo.2023.1235970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 07/11/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fendo.2023.1157518.].
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Implementation of a patient-centered remote wound monitoring system for management of diabetic foot ulcers. Front Endocrinol (Lausanne) 2023; 14:1157518. [PMID: 37293494 PMCID: PMC10244728 DOI: 10.3389/fendo.2023.1157518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/09/2023] [Indexed: 06/10/2023] Open
Abstract
Background Regular clinical assessment is critical to optimize lower extremity wound healing. However, family and work obligations, socioeconomic, transportation, and time barriers often limit patient follow-up. We assessed the feasibility of a novel, patient-centered, remote wound management system (Healthy.io Minuteful for Wound Digital Management System) for the surveillance of lower extremity wounds. Methods We enrolled 25 patients from our outpatient multidisciplinary limb preservation clinic with a diabetic foot ulcer, who had undergone revascularization and podiatric interventions prior to enrollment. Patients and their caregivers were instructed on how to use the digital management system and asked to perform one at-home wound scan per week for a total of 8 weeks using a smartphone application. We collected prospective data on patient engagement, smartphone app useability, and patient satisfaction. Results Twenty-five patients (mean age 65.5 ± 13.7 years, 60.0% male, 52.0% Black) were enrolled over 3 months. Mean baseline wound area was 18.0 ± 15.2 cm2, 24.0% of patients were recovering from osteomyelitis, and post-surgical WiFi stage was 1 in 24.0%, 2 in 40.0%, 3 in 28.0%, and 4 in 8.00% of patients. We provided a smartphone to 28.0% of patients who did not have access to one that was compatible with the technology. Wound scans were obtained by patients (40.0%) and caregivers (60.0%). Overall, 179 wound scans were submitted through the app. The mean number of wound scans acquired per patient was 0.72 ± 0.63 per week, for a total mean of 5.80 ± 5.30 scans over the course of 8 weeks. Use of the digital wound management system triggered an early change in wound management for 36.0% of patients. Patient satisfaction was high; 94.0% of patients reported the system was useful. Conclusion The Healthy.io Minuteful for Wound Digital Management System is a feasible means of remote wound monitoring for use by patients and/or their caregivers.
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Empagliflozin add-on therapy to closed-loop insulin delivery in type 1 diabetes: a 2 × 2 factorial randomized crossover trial. Nat Med 2022; 28:1269-1276. [PMID: 35551290 DOI: 10.1038/s41591-022-01805-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 03/28/2022] [Indexed: 11/09/2022]
Abstract
There is a need to optimize closed-loop automated insulin delivery in type 1 diabetes. We assessed the glycemic efficacy and safety of empagliflozin 25 mg d-1 as add-on therapy to insulin delivery with a closed-loop system. We performed a 2 × 2 factorial randomized, placebo-controlled, crossover two-center trial in adults, assessing 4 weeks of closed-loop delivery versus sensor-augmented pump (SAP) therapy and empagliflozin versus placebo. The primary outcome was time spent in the glucose target range (3.9-10.0 mmol l-1). Primary comparisons were empagliflozin versus placebo in each of closed-loop or SAP therapy; the remaining comparisons were conditional on its significance. Twenty-four of 27 randomized participants were included in the final analysis. Compared to placebo, empagliflozin improved time in target range with closed-loop therapy by 7.2% and in SAP therapy by 11.4%. Closed-loop therapy plus empagliflozin improved time in target range compared to SAP therapy plus empagliflozin by 6.1% but by 17.5% for the combination of closed-loop therapy and empagliflozin compared to SAP therapy plus placebo. While no diabetic ketoacidosis or severe hypoglycemia occurred during any intervention, uncomplicated ketosis events were more common on empagliflozin. Empagliflozin 25 mg d-1 added to automated insulin delivery improves glycemic control but increases ketone concentration and ketosis compared to placebo.
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Alleviating Carbohydrate Counting With a FiASP-plus-Pramlintide Closed-Loop Delivery System (Artificial Pancreas): Feasibility and Pilot Studies. Can J Diabetes 2021. [DOI: 10.1016/j.jcjd.2021.09.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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A fully artificial pancreas versus a hybrid artificial pancreas for type 1 diabetes: a single-centre, open-label, randomised controlled, crossover, non-inferiority trial. LANCET DIGITAL HEALTH 2021; 3:e723-e732. [PMID: 34580055 DOI: 10.1016/s2589-7500(21)00139-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/14/2021] [Accepted: 06/23/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND For people with type 1 diabetes, there is currently no automated insulin delivery system that does not require meal input. We aimed to assess the efficacy of a novel faster-acting insulin aspart (Fiasp) plus pramlintide fully closed-loop system that does not require meal input. METHODS In this open-label, randomised controlled, crossover, non-inferiority trial we compared the Fiasp (Novo Nordisk, Bagsværd, Denmark) plus pramlintide closed-loop system with no meal input (fully artificial pancreas) and the Fiasp-alone closed-loop system with precise carbohydrate counting (hybrid artificial pancreas). Adults (≥18 years) who had a clinical diagnosis of type 1 diabetes for at least 12 months, had glycated haemoglobin 12% or lower, and had been on insulin pump therapy for at least 6 months were enrolled at McGill University Health Centre, Montreal, QC, Canada. The Fiasp plus pramlintide fully closed-loop system delivered pramlintide in a basal-bolus manner with a fixed ratio of 10 μg:U relative to insulin. A research staff member counted the carbohydrate content of meals to input in the hybrid closed-loop system. Participants completed the two full-day crossover interventions in a random order allocated by a computer-generated code implementing a blocked randomisation (block size of four). The primary outcome was the percentage of time spent within the glucose target range (3·9-10·0 mmol/L), with a 6% non-inferiority margin, assessed in all participants who completed both interventions. This trial is registered with ClinicalTrials.gov, NCT03800875. FINDINGS Between Feb 8, 2019, and Sept 19, 2020, we enrolled 28 adults, of whom 24 completed both interventions and were included in analyses. The percentage of time spent in the target range was 74·3% (IQR 61·5-82·8) with the fully closed-loop system versus 78·1% (66·3-87·5) with the hybrid Fiasp-alone closed-loop system (paired difference 2·6%, 95% CI -2·4 to 12·2; non-inferiority p=0·28). Eight (33%) participants had at least one hypoglycaemia event (<3·3 mmol/L) with the fully closed-loop system compared with 14 (58%) participants with the hybrid closed-loop system (2200-2200 h). Non-mild nausea was reported by three (13%) participants and non-mild bloating by one (4%) participant with the fully closed-loop system compared with zero participants with the hybrid closed-loop system. INTERPRETATION The Fiasp plus pramlintide fully closed-loop system was not non-inferior to the Fiasp-alone hybrid closed-loop system for the overall percentage of time in the glucose target range. However, participants still spent a high percentage of time within the target range with the fully-closed loop system. Outpatient studies comparing the fully closed-loop hybrid systems with patient-estimated, rather than precise, carbohydrate counting are warranted. FUNDING Diabetes Canada.
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Alleviating carbohydrate counting with a FiASP-plus-pramlintide closed-loop delivery system (artificial pancreas): Feasibility and pilot studies. Diabetes Obes Metab 2021; 23:2090-2098. [PMID: 34047449 DOI: 10.1111/dom.14447] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/18/2021] [Accepted: 05/23/2021] [Indexed: 01/07/2023]
Abstract
AIM To assess whether a FiASP-and-pramlintide closed-loop system has the potential to replace carbohydrate counting with a simple meal announcement (SMA) strategy (meal priming bolus without carbohydrate counting) without degrading glycaemic control compared with a FiASP closed-loop system. MATERIALS AND METHODS We conducted a 24-hour feasibility study comparing a FiASP system with full carbohydrate counting (FCC) with a FiASP-and-pramlintide system with SMA. We conducted a subsequent 12-day outpatient pilot study comparing a FiASP-and-placebo system with FCC, a FiASP-and-pramlintide system with SMA, and a FiASP-and-placebo system with SMA. Basal-bolus FiASP-and-pramlintide were delivered at a fixed ratio (1 U:10 μg). Glycaemic outcomes were measured, surveys evaluated gastrointestinal symptoms and diabetes distress, and participant interviews helped establish a preliminary coding framework to assess user experience. RESULTS Seven participants were included in the feasibility analysis. Time spent in 3.9-10 mmol/L was similar between both interventions (81%-84%). Four participants were included in the pilot analysis. Time spent in 3.9-10 mmol/L was similar between the FiASP-and-placebo with FCC and FiASP-and-pramlintide with SMA interventions (70%), but was lower in the FiASP-and-placebo with SMA intervention (60%). Time less than 3.9 mmol/L and gastrointestinal symptoms were similar across all interventions. Emotional distress was moderate at baseline, after the FiASP-and-placebo with FCC and SMA interventions, and fell after the FiASP-and-pramlintide with SMA intervention. SMA reportedly afforded participants flexibility and reduced mealtime concerns. CONCLUSIONS The FiASP-and-pramlintide system has the potential to substitute carbohydrate counting with SMA without degrading glucose control.
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Comparison Between Closed-Loop Insulin Delivery System (the Artificial Pancreas) and Sensor-Augmented Pump Therapy: A Randomized-Controlled Crossover Trial. Diabetes Technol Ther 2021; 23:168-174. [PMID: 33050728 PMCID: PMC7906861 DOI: 10.1089/dia.2020.0365] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective: Several studies have shown that closed-loop automated insulin delivery (the artificial pancreas) improves glucose control compared with sensor-augmented pump therapy. We aimed to confirm these findings using our automated insulin delivery system based on the iPancreas platform. Research Design and Methods: We conducted a two-center, randomized crossover trial comparing automated insulin delivery with sensor-augmented pump therapy in 36 adults with type 1 diabetes. Each intervention lasted 12 days in outpatient free-living conditions with no remote monitoring. The automated insulin delivery system used a model predictive control algorithm that was a less aggressive version of our earlier dosing algorithm to emphasize safety. The primary outcome was time in the range 3.9-10.0 mmol/L. Results: The automated insulin delivery system was operational 90.2% of the time. Compared with the sensor-augmented pump therapy, automated insulin delivery increased time in range (3.9-10.0 mmol/L) from 61% (interquartile range 53-74) to 69% (60-73; P = 0.006) and increased time in tight target range (3.9-7.8 mmol/L) from 37% (30-49) to 45% (35-51; P = 0.011). Automated insulin delivery also reduced time spent below 3.9 and 3.3 mmol/L from 3.5% (0.8-5.4) to 1.6% (1.1-2.7; P = 0.0021) and from 0.9% (0.2-2.1) to 0.5% (0.2-1.1; P = 0.0122), respectively. Time spent below 2.8 mmol/L was 0.2% (0.0-0.6) with sensor-augmented pump therapy and 0.1% (0.0-0.4; P = 0.155) with automated insulin delivery. Conclusions: Our study confirms findings that automated insulin delivery improves glucose control compared with sensor-augmented pump therapy. ClinicalTrials.gov no. NCT02846831.
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Fully Automated Artificial Pancreas for Adults With Type 1 Diabetes Using Multiple Hormones: Exploratory Experiments. Can J Diabetes 2021; 45:734-742. [PMID: 33888413 DOI: 10.1016/j.jcjd.2021.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 02/11/2021] [Accepted: 02/14/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES A fully automated insulin-pramlintide-glucagon artificial pancreas that alleviates the burden of carbohydrate counting without degrading glycemic control was iteratively enhanced until convergence through pilot experiments on adults with type 1 diabetes. METHODS Nine participants (age, 37±13 years; glycated hemoglobin, 7.7±0.7%) completed two 27-hour interventions: a fully automated multihormone artificial pancreas and a comparator insulin-alone artificial pancreas with carbohydrate counting. The baseline algorithm was a model-predictive controller that administered insulin and pramlintide in a fixed ratio, with boluses triggered by a glucose threshold, and administered glucagon in response to low glucose levels. RESULTS The baseline multihormone dosing algorithm resulted in noninferior time in target range (3.9 to 10.0 mmol/L) (71%) compared with the insulin-alone arm (70%) in 2 participants, with minimal glucagon delivery. The algorithm was modified to deliver insulin and pramlintide more aggressively to increase time in range and maximize the benefits of glucagon. The modified algorithm displayed a similar time in range for the multihormone arm (79%) compared with the insulin-alone arm (83%) in 2 participants, but with undesired glycemic fluctuations. Subsequently, we reduced the glucose threshold that triggers glucagon boluses. This resulted in inferior glycemic control for the multihormone arm (81% vs 91%) in 2 participants. Thereafter, a model-based meal-detection algorithm to deliver insulin and pramlintide boluses closer to mealtimes was added and glucagon was removed. The final dual-hormone system had comparable time in range (81% vs 83%) in the last 3 participants. CONCLUSION The final version of the fully automated system that delivered insulin and pramlintide warrants a randomized controlled trial.
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A Novel Dual-Hormone Insulin-and-Pramlintide Artificial Pancreas for Type 1 Diabetes: A Randomized Controlled Crossover Trial. Diabetes Care 2020; 43:597-606. [PMID: 31974099 DOI: 10.2337/dc19-1922] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 11/22/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The rapid insulin-alone artificial pancreas improves glycemia in type 1 diabetes but daytime control remains suboptimal. We propose two novel dual-hormone artificial pancreas systems. RESEARCH DESIGN AND METHODS We conducted a randomized crossover trial comparing a rapid insulin-alone artificial pancreas with rapid insulin-and-pramlintide and with regular insulin-and-pramlintide artificial pancreas systems in adults with type 1 diabetes. Participants were assigned to the interventions in random order during three 24-h inpatient visits. Each visit was preceded by an outpatient hormonal open-loop run-in period of 10-14 days. The dual-hormone artificial pancreas delivered pramlintide in a basal-bolus manner, using a novel dosing algorithm, with a fixed ratio relative to insulin. The primary outcome was time in the range 3.9-10.0 mmol/L. RESULTS Compared with the rapid insulin-alone artificial pancreas system, the rapid insulin-and-pramlintide system increased the time in range from 74% (SD 18%) to 84% (13%) (P = 0.0014), whereas the regular insulin-and-pramlintide system did not change the time in range (69% [19%]; P = 0.22). The increased time in range with the rapid insulin-and-pramlintide system was due to improved daytime control (daytime time in range increased from 63% [23%] to 78% [16%], P = 0.0004). There were 11 (1 per 2.5 days) hypoglycemic events (<3.3 mmol/L with symptoms or <3.0 mmol/L irrespective of symptoms) with the rapid insulin-alone system, compared with 12 (1 per 2.3 days) and 18 (1 per 1.4 days) with the rapid and regular insulin-and-pramlintide systems, respectively. Gastrointestinal symptoms were reported after 0% (0 of 112) of meals with the rapid insulin-alone system, compared with 6% (6 of 108) and 11% (11 of 104) with the rapid and regular insulin-and-pramlintide systems, respectively; none of the symptoms were severe. CONCLUSIONS A novel rapid insulin-and-pramlintide artificial pancreas improves glucose control compared with a rapid insulin-alone artificial pancreas (ClinicalTrials.gov number NCT02814123).
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Abstract
Background: FreeStyle Libre is a factory-calibrated continuous 14-day glucose sensor. Little is known about the accuracy of FreeStyle Libre as a function of sensor age. Methods: We assessed the accuracy of FreeStyle Libre in 14 adults with type 1 diabetes. Each study participant attended our research facility for two or three 24-h visits, during which they wore a FreeStyle Libre aged 0-1 day, 5-7 days, or 13-14 days. Plasma glucose levels were measured every 10-30 min using YSI2300 STAT Plus Analyser. Participants also wore Dexcom G5® glucose sensor aged 1-2 days. We assessed sensors' accuracy using mean absolute relative difference (MARD) between FreeStyle Libre, the Dexcom G5 sensor, and plasma glucose. Results: We had 1930 pairs of FreeStyle Libre sensor-plasma glucose measurements, collected from 36 FreeStyle Libre sensors, 18 of which were sensors aged 0-1 day, 9 were sensors aged 5-7 days, and 9 were sensors aged 13-14 days. The mean and median MARD for FreeStyle Libre sensors aged 0-1 days were 14.5% and 11.2%, respectively, and for sensors aged 13-14 days were 14.7% and 11.2%, respectively, but for sensors aged 5-7 days were 7.8% and 6.6%, respectively (P = 0.03 vs. sensors aged 0-1 days, and P = 0.06 vs. sensors aged 13-14 days). The percentage of points falling in the potentially dangerous zones C, D, or E in Clarke's error grid analysis were 1.9% for FreeStyle Libre sensors aged 0-1 day, 0.2% for sensors aged 5-7 days, and 0.4% for sensors aged 13-14 days. The overall accuracy of FreeStyle Libre and Dexcom G5 sensor was the same (mean MARD 12.8% and 12.5%, respectively; P = 0.57). Conclusions: FreeStyle Libre's accuracy is adequate during its entire lifetime but is least accurate during its first and last days. ClinicalTrials.gov Identifier: NCT02814123.
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The Efficacy of Basal Rate and Carbohydrate Ratio Learning Algorithm for Closed-Loop Insulin Delivery (Artificial Pancreas) in Youth with Type 1 Diabetes in a Diabetes Camp. Diabetes Technol Ther 2020; 22:185-194. [PMID: 31596127 DOI: 10.1089/dia.2019.0270] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background: Optimizing programmed basal rates and carbohydrate ratios may improve the performance of the artificial pancreas. We tested, in a diabetes camp, the efficacy of a learning algorithm that updates daily basal rates and carbohydrate ratios in the artificial pancreas. Materials and Methods: We conducted a randomized crossover trial in campers and counselors aged 8-21 years with type 1 diabetes on pump therapy. Participants underwent 2 days of artificial pancreas alone and 6 days of artificial pancreas with learning. During the artificial pancreas with learning, programmed basal rates and carbohydrate ratios were updated daily based on the learning algorithm's recommendations. All algorithm recommendations were reviewed for safety by camp physicians. The primary outcome was the time in target range (3.9-10 mmol/L) of the last 2 days of each intervention. Results: Thirty-four campers (age 13.9 ± 3.9, hemoglobin A1c 8.3% ± 0.2%) were included. Ninety-six percent of algorithm recommendations were approved by the camp physicians. Participants were in closed-loop mode 74% of the time. There was no difference between interventions in time in target (55%-55%; P = 0.71) nor in hypoglycemia events (0.8-0.9 events per day; P = 0.63). This was despite changes in programmed basal rate ranging from -21% to +117%, and changes in breakfast, lunch, and supper carbohydrate ratios from -17% to +40%, -36% to +37%, and -35% to +63%, respectively. Morever, postprandial hyperglycemia and hypoglycemia did not decrease in participants whose carbohydrate ratios were decreased (more insulin boluses) and increased (less insulin boluses), respectively. Conclusions: In camp settings, despite adjustments to programmed basal rates and carbohydrate ratios, the learning algorithm did not change glycemia, which may point toward limited effect of these adjustments in environments with large day-to-day variability in insulin needs. Longer randomized studies in real-world settings are required to further assess the efficacy of automatic adjustments of programmed basal rates and carbohydrate ratios.
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Micromachined phase-shifted array-type Mirau interferometer for swept-source OCT imaging: design, microfabrication and experimental validation. BIOMEDICAL OPTICS EXPRESS 2019; 10:1111-1125. [PMID: 30891333 PMCID: PMC6420266 DOI: 10.1364/boe.10.001111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 01/24/2019] [Accepted: 01/24/2019] [Indexed: 06/09/2023]
Abstract
OCT instruments permit fast and non-invasive 3D optical biopsies of biological tissues. However, they are bulky and expensive, making them only affordable at the hospital and thus, not sufficiently used as an early diagnostic tool. Significant reduction of system cost and size is achieved by implementation of MOEMS technologies. We propose an active array of 4x4 Mirau microinterferometers where the reference micro-mirrors are carried by a vertical comb-drive microactuator, enabling the implementation of the phase-shifting technique that improves the sensitivity and eliminates unwanted interferometric terms. We focus on the design of the imaging system, the microfabrication and the assembly of the Mirau microinterferometer, and the swept-source OCT imaging.
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Elevated fraction of CTLA-4(+) and PD-1(+) T cells in peripheral blood with stimulation of Th1, Th2 and Th17 type immune response after stereotactic radiotherapy for early lung cancer – a prospective study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw381.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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PD-0424: Immune response profile assessment after stereotactic radiotherapy for lung cancer. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40420-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Calculating Indirect Costs - Differences Caused by Various Approaches to Unit Costs. Results of Move to Work Study (M2W). VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:A773. [PMID: 27202852 DOI: 10.1016/j.jval.2014.08.327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Work Productivity Loss Due To Rheumatoid Arthtiris (Ra), Crohn's Disease (Cd) And Psoriasis (Ps) In Poland. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:A382-A383. [PMID: 27200856 DOI: 10.1016/j.jval.2014.08.2627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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The dynamics of beta-endorphin release by the hypothalamic nuclei and pituitary gland in sheep under physiological and stress condition. EXPERIMENTAL AND CLINICAL ENDOCRINOLOGY 2009; 99:39-44. [PMID: 1628696 DOI: 10.1055/s-0029-1211130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The secretion of beta-endorphin (beta-End) by the infundibular nuclei--median eminence (IN-ME) and paraventricular nuclei (PVN) of the hypothalamus and the anterior lobe (AL) of the pituitary gland was determined in 18 anestrous ewes by RIA assay of this opioid in perfusates collected from these formations. Perfusion with Ringer-Locke solution was carried out on the animals under resting and stress-full conditions, using a pushpull cannula method. Electrical footshocks were used as stress stimuli. Two series of perfusion experiments were performed. In the first, the perfusions were carried out over two hours and perfusates were collected before and during stress for 1 h. In the second series of experiments the dynamics of the release of the opioid by the IN-ME and the pituitary gland were followed by collecting five or six perfusates in 20 min fractions before and during stress, respectively. The first series of experiments showed that the concentrations of beta-End in perfusates from the pituitary gland were much higher than those from the hypothalamic nuclei and that the concentrations of this opioid during stressing rose significantly only in perfusates from the IN-ME nuclei. In the second series of experiments the release of beta-End from the IN-ME and pituitary gland was altered by stress. The shift was very characteristic in that the concentrations of the opioid during stimulation initially significantly rose and then gradually declined. The concentration of the opioid in the peripheral blood also rose at the beginning of stimulation and declined as stimulation continued.(ABSTRACT TRUNCATED AT 250 WORDS)
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A note on modification of pancreatic
juice and bile collection method in sheep. JOURNAL OF ANIMAL AND FEED SCIENCES 2008. [DOI: 10.22358/jafs/66693/2008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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The comparison of efficacy and safety of selected diagnostic methods of non-palpable breast lesions: Systematic review and meta-analysis. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.17505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abomasal secretion and gastrin blood level in sheep
fed diets with different fibre content. JOURNAL OF ANIMAL AND FEED SCIENCES 2004. [DOI: 10.22358/jafs/73955/2004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Establishing nontension primary closure over implant and bone-grafted sites begins with proper soft tissue management. This paper will demonstrate the various soft tissue flap designs required to optimize postsurgical wound healing. Simple and advanced flap management techniques are described in a step-by-step manner utilizing drawings to show each step-by-step surgical procedure. Management of postoperative soft tissue complications will also be addressed.
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An investigation into vascular prosthesis modified with an electron beam. Polim Med 1998; 27:19-26. [PMID: 9513250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The present paper shows the results of an investigation into the effect of implanted electric charge on blood platelet adhesion to woven surfaces of "Dallon" polyester vascular prosthesis. The electrets were formed using the electron beam method. The assessment of the electret effect on blood platelet adhesion was performed on the basis of microscopic studies. It was shown that an implanted negative electric charge remarkably suppresses thrombocyte adhesion to the prosthesis surface. The electret effect was found to play a significant role in the process of preparing nonthrombogenic surfaces.
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24
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A study of the pharmacokinetics and tissue residues of an oral trimethoprim/sulphadiazine formulation in healthy pigs. J Vet Pharmacol Ther 1996; 19:423-30. [PMID: 8971670 DOI: 10.1111/j.1365-2885.1996.tb00078.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Twenty-six healthy female pigs weighing 19.5-33 kg were used in three separate experiments. The animals were fed individually twice a day. Trimethoprim/sulphadiazine (TMP/SDZ) formulation was added to feed in the amount of 6 mg/kg bw (TMP) and 30 mg/kg bw (SDZ). TMP and SDZ concentrations in blood plasma, muscles, liver and kidneys were measured. Pharmacokinetic parameters show that the absorption of TMP from the alimentary tract in pigs is faster than the absorption of SDZ, and the elimination of TMP is slower than that of SDZ. The absorption half-lives were 0.96 (TMP) and 2.24 h (SDZ), whereas elimination half-lives were 5.49 (TMP) and 4.19 h (SDZ). The observed TMP:SDZ ratios in blood plasma after multiple dose administration ranged from 1:11.4 to 1:23.2. One day after administration of the last dose of TMP/SDZ the plasma concentration ratio was 1:15.5, but in muscles, liver and kidneys it was much lower: 1:0.79, 1:0.14 and 1:1.53 respectively. The absolute TMP and SDZ tissue concentrations 1 day after the last multiple dose administration were very low (maximum TMP: 0.29 micrograms/g in liver; maximum SDZ: 0.23 micrograms/g in kidneys). Neither drug was detected in any tissue 8 days after the last administration of TMP/SDZ. Based on our results, it was concluded that there is no support for the TMP:SDZ pharmaceutical ratio 1:5 in oral formulations of these compounds for pigs. The administration oral TMP/SDZ formulations once a day may result in the absolute tissue concentrations of these drugs being too low for antibacterial activity. The withdrawal period for such an oral TMP/SDZ formulation for pigs (according to accepted guidelines in Europe for MRL of TMP < 0.05 mg/kg of tissue) should not be less than 5 days.
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25
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The effect of central sympathectomy by 6-hydroxydopamine (6-OHDA) on the response to morphine in conscious sheep. Vet Res Commun 1992; 16:205-14. [PMID: 1413481 DOI: 10.1007/bf01839157] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
When morphine, an opioid mu-agonist, was administered in vivo into the third cerebral ventricle (ICV) of conscious sheep at 20 and 40 micrograms/kg body weight, it caused psychomotor excitability for 2-3 h and a significant decrease in the reticuloruminal frequency for 45 min and in the mean amplitude of the primary contractions for 65 min. From 60 min after infusion, the same doses of morphine caused a significant increase in the average amplitude of the contractions for 45 min. This suggests that an inhibitory mu-opioid acceptor is involved in the central control of forestomach motility and general behaviour in sheep. All the effects of morphine were completely prevented by pretreatment with 18.2 micrograms/kg body weight 6-OHDA ICV. These results suggest that both morphine-induced inhibition of rumen motility and psychomotor excitability are due to central noradrenergic descending system activation. The exact location of the noradrenergic system remains to be determined.
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26
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[Isolated so-called "alone" atrial fibrillation]. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 1989; 42:975-7. [PMID: 2640070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A 49-year-old man with paroxysmal atrial fibrillation was studied in hospital for detection of the cause of arrhythmia and was qualified into the group of the so called alone atrial fibrillation, with healthy cardiovascular system. He was treated successfully with amiodarone++. This type of atrial fibrillation occurs in only 6% of cases of atrial fibrillation, but is possible occurrence should be taken into consideration in differential diagnosis.
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27
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[Two cases of somnambulism]. PSYCHIATRIA POLSKA 1989; 23:343-6. [PMID: 2631132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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28
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[Paroxysmal atrial fibrillation as an integral part of sick (damaged) sinus syndrome]. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 1989; 42:13-9. [PMID: 2781799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
In a studied group of 1727 subjects in 101 cases (of either sex) the sick sinus syndrome with MAS attacks++ was diagnosed on the basis of clinical and electrocardiographic criteria. The most frequent cause of the syndrome with paroxysmal atrial fibrillation was ischaemic heart disease. In 42 cases atrial pacing was applied measuring the time of own rhythm return after the end of pacing, and His bundle potentials were recorded. For practical reasons the patients were divided in two groups. Trials of treatment with atropine or isopropylnoradrenaline derivatives++ were undertaken in group A, and in group B antiarrhythmic++ drugs were used (beta-blockers, quinidine, isoptin etc). In group I (38 patients with striking bradycardia) a good therapeutic effect was observed after pharmacological treatment in 8 cases (21%). In group II (63 cases of the tachy-bradycardia syndrome) a good effect was observed in 11 cases (17.4%).
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29
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[Disorders of cardiac rhythm and conduction in women during menopause]. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 1988; 41:700-3. [PMID: 3239007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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30
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31
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Waardenburg syndrome associated with Hirschsprung disease and other abnormalities. Pediatrics 1980; 65:368-9. [PMID: 7354993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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32
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A survey of child life programs. JOURNAL OF THE ASSOCIATION FOR THE CARE OF CHILDREN IN HOSPITALS 1979; 6:11-6. [PMID: 10307264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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33
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Body orientation, food deprivation and potentiation of restraint induced gastric lesions. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 1977; 1:539-43. [PMID: 892326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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34
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[Anatomical Variations of carotid arteries found in the course of surgery for complete denervation of the carotid sinus in bronchial asthma]. POLISH JOURNAL OF SURGERY 1975; 47:473-6. [PMID: 1135113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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35
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[Thrombopenia in a 4-year-old boy treated with serotonin]. PEDIATRIA POLSKA 1973; 48:237-8. [PMID: 4804865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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36
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[Case of Addison-Biermer disease in a 5-year-old boy]. PEDIATRIA POLSKA 1973; 48:81-4. [PMID: 4687767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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37
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[Dynamic studies of lipid metabolism in some disease entities]. POLSKI TYGODNIK LEKARSKI (WARSAW, POLAND : 1960) 1972; 27:1884-7. [PMID: 4645470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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38
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[Surgery of vagus nerve in chronic duodenal ulcer]. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 1972; 25:341-5. [PMID: 4551490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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39
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Management of planning process. HOSPITALS 1972; 46:57-60. [PMID: 5009096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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40
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[Epidemiology of muscoviscidosis in children in Poland]. PEDIATRIA POLSKA 1971; 46:677-84. [PMID: 5570509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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41
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[Advances in Polish surgery during the last 25 years (1944-1969)]. POLISH JOURNAL OF SURGERY 1969; 41:1328-31. [PMID: 4902665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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42
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Henryk Hoyer, M.D. 1834-1907. POLISH MEDICAL SCIENCE AND HISTORY BULLETIN 1969; 12:98-103. [PMID: 4894816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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43
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[Late results of radical denervation of the carotid sinus in the treatment of bronchial asthma]. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 1969; 22:705-11. [PMID: 5788877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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44
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[Acute kidney failure in shock]. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 1966; 19:1585-90. [PMID: 5977831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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45
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[Integrity of surgical training. Notes from a visit in Yugoslavia]. POLSKI TYGODNIK LEKARSKI (WARSAW, POLAND : 1960) 1966; 21:234-6. [PMID: 5907399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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