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Evolution of REperfusion Strategies and impact on mortality in Old and Very OLD STEMI patients. The RESOVOLD-e-MUST study. Age Ageing 2024; 53:afad215. [PMID: 38167925 PMCID: PMC10762506 DOI: 10.1093/ageing/afad215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The use of myocardial reperfusion-mainly via angioplasty-has increased in our region to over 95%. We wondered whether old and very old patients have benefited from this development. METHODS Setting: Greater Paris Area (Ile-de-France). DATA Regional registry, prospective, including since 2003, data from 39 mobile intensive care units performing prehospital treatment of patients with ST segment elevation myocardial infarction (STEMI) (<24 h). PARAMETERS Demographic, decision to perform reperfusion and outcome (in-hospital mortality). PRIMARY ENDPOINT Reperfusion decision rate by decade over age 70. SECONDARY ENDPOINT Outcome. RESULTS We analysed the prehospital management of 27,294 patients. There were 21,311 (78%) men and 5,919 (22%) women with a median age of 61 (52-73 years). Among these patients, 8,138 (30%) were > 70 years, 3,784 (14%) > 80 years and 672 (2%) > 90 years.The reperfusion decision rate was 94%. It decreased significantly with age: 93, 90 and 76% in patients in their seventh, eighth and ninth decade, respectively. The reperfusion decision rate increased significantly over time. It increased in all age groups, especially the higher ones. Mortality was 6%. It increased significantly with age: 8, 16 and 25% in patients in their seventh, eighth and ninth decade, respectively. It significantly decreased over time in all age groups. The odds ratio of the impact of reperfusion decision on mortality reached 0.42 (0.26-0.68) in patients over 90 years. CONCLUSION the increase in the reperfusion decision rate was the greatest in the oldest patients. It reduced mortality even in patients over 90 years of age.
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[e-MUST Registry - Evaluation of prehospital medical management of STEMI in Île-de-France]. Ann Cardiol Angeiol (Paris) 2023; 72:101687. [PMID: 37948923 DOI: 10.1016/j.ancard.2023.101687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 10/09/2023] [Indexed: 11/12/2023]
Abstract
The e-MUST registry has continuously and comprehensively documented ST-segment elevation myocardial infarctions (STEMIs) managed in the prehospital setting by the 39 Mobile Emergency and Resuscitation Services (SMUR) of the 8 Emergency Medical Assistance System (SAMU) and subsequently managed in the 36 interventional cardiology services in Île-de-France since 2000. This encompasses a population of over 12 million residents. To date, nearly 44,000 patients have been enrolled. The analysis of these findings reflects the real-world management of these patients and the evolution of their care. The results are shared annually with the investigators' teams and have led to around twenty publications. The latest acquired results have demonstrated, in a series of over 630 patients aged over 90, that nonagenarians particularly benefit from prehospital coronary reperfusion decisions, resulting in a nearly 60% reduction in mortality.
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[Registry CARDIO-ARSIF - Database on coronary angiography and percutaneous coronary invasive performed in Île-de-France]. Ann Cardiol Angeiol (Paris) 2023; 72:101685. [PMID: 37918329 DOI: 10.1016/j.ancard.2023.101685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/09/2023] [Indexed: 11/04/2023]
Abstract
The CARDIO-ARSIF registry has been continuously collecting comprehensive data on coronary angiography and percutaneous coronary interventions (PCI) performed in the 36 catheterization laboratories across the Île-de-France region since 2000. Over the period from 2003 to 2022, this registry has recorded information from more than 330,000 patients, encompassing more than one million procedures. Among these procedures, 58% consisted of coronary angiography, 13% were percutaneous coronary interventions (PCI), and the remaining 28% were PCI performed on an ad-hoc basis. This extensive dataset serves as a valuable resource for both qualitative and quantitative assessments of practices and the relevance of procedures in the field of coronary invasive cardiology. The results of these analyses undergo annual validation by a dedicated scientific committee and are shared with the teams of investigators. The exploitation of this data has led to scientific publications, with one notable finding being a consistent reduction in the radiation doses received by patients, regardless of the type of procedure.
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L’indoxyl sulfate inhibe la régénération musculaire via l’inhibition de Myf6. Nephrol Ther 2022. [DOI: 10.1016/j.nephro.2022.07.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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5
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Étude SeroCOVIDial : évaluation de la séroprévalence SARS-CoV2 chez les patients hémodialysés chroniques et leurs soignants après la 1re vague et avant la campagne vaccinale, une étude de cohorte. Nephrol Ther 2021. [PMCID: PMC8435305 DOI: 10.1016/j.nephro.2021.07.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Introduction Les patients hémodialysés chroniques (HD) constituent une population à haut risque de COVID-19 sévère, et ne peuvent rester confinés. La prévalence de l’immunisation contre le SARS-CoV-2 parmi les patients HD et les soignants, après la première vague de COVID-19 et avant la campagne de vaccination, reste inconnue. Description PHRC inter-régional, étude de cohorte prospective réalisée entre juin et décembre 2020 dans 4 grands centres de dialyse d’Aix–Marseille (dépistage systématique des symptômes et mesures d’isolement des malades infectés dès le début de la pandémie). Méthodes Séroprévalence SARS-CoV2 évaluée par test sérologique rapide (Biosynex®) chez les patients et leurs soignants en juin (M0), septembre(M3) et décembre (M6) 2020. Résultats En juin 2020, 451 patients HD et 238 soignants ont été inclus. La séroprévalence SARS-CoV2 à M0 était de 8,4 % chez les patients et 6,7 % chez les soignants. Parmi les participants immunisés, 26,3 % des patients et 6,3 % des soignants n’avaient présenté aucun symptôme de COVID-19. Parmi les participants ayant eu une infection SARS-CoV2 documentée avant M0, 87 % des patients et 90 % des soignants étaient immunisés à M0. La séroprévalence est restée stable à M3, et a augmenté à M6 lors de la 2e vague épidémique, atteignant 13,8 % des patients et 12,6 % des soignants. À M6, 38 (8,4 %) patients étaient décédés dont 9 (2 %) de COVID-19, et 12 autres ont été hospitalisés pour COVID-19. Deux patients immunisés à M0 ont présenté une COVID-19 non sévère au cours du suivi. Conclusion Dans cette large cohorte de patients HD et de soignants, la prévalence de l’immunisation SARS-CoV2 après la première vague épidémique était relativement faible, ce qui reflète probablement l’efficacité des mesures de protection mises en place. L’immunisation n’était pas toujours persistante chez les participants, et certains patients immunisés à M0 ont pu être infectés, ce qui souligne l’intérêt de la vaccination systématique de cette population.
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Caractéristiques cliniques des patients dialysés chroniques atteints par la COVID-19. Nephrol Ther 2021. [PMCID: PMC8435313 DOI: 10.1016/j.nephro.2021.07.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Introduction L’infection à virus SARS-CoV2 est responsable d’une maladie protéiforme et est particulièrement sévère chez les personnes âgées et/ou présentant des comorbidités cardiovasculaires. Les patients dialysés chroniques sont particulièrement à risque mais peu de données existent. Une étude rétrospective multicentrique a donc été menée. Méthodes Cette étude rétrospective multicentrique conduite en France lors de la première vague épidémique, a rassemblé les données cliniques, paracliniques, thérapeutiques et évolutives des patients dialysés chroniques (> 3 mois) atteints par la COVID-19. Après une analyse descriptive clinique, les données formes graves (admission en réanimation ou décès) versus non-grave ont été comparées puis une analyse multivariée a été menée pour déterminer les facteurs associés au risque de décès. Résultats Quinze centres ont inclus 136 patients. Parmi la population étudiée âgée de 69,4 ans et présentant de nombreuses comorbidités (HTA 91 %, diabète 44 %) les symptômes les plus fréquents étaient : fièvre, toux et asthénie. Peu de formes digestives isolées et de confusions on été observées. Parmi les patients, 77,9 % ont été hospitalisés, 32,4 % ont reçu des antipaludéens de synthèse (APS), 3 % ont développé des complications thromboemboliques, 15,4 % ont été admis en réanimation et 22,1 % sont décédés. Les caractéristiques des patients ayant développé une forme grave étaient : l’âge plus élevé, l’existence de pathologies chroniques cardiovasculaires ou respiratoires, la présence initiale de signes respiratoires dont l’oxygénorequérance et un taux faible de vitamine D plasmatique. Les facteurs associés au risque de décès étaient : l’âge > 70 ans, l’existence d’une pathologie respiratoire au préalable ou d’une artériopathie et les patients n’ayant pas reçu d’APS. Conclusion Notre cohorte confirme l’excès de mortalité dans la population dialysée chronique et des facteurs de risque déjà identifiés (maladie respiratoire, maladie cardiovasculaire). La présentation clinique ne semble pas différente mais on observe le rôle protecteur possible des APS et de la vitamine D.
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Effect of age, gender, and time of day on pain-to-call times in patients with acute ST-segment elevation myocardial infarction: the CLOC’AGE study. EMERGENCIAS : REVISTA DE LA SOCIEDAD ESPANOLA DE MEDICINA DE EMERGENCIAS 2021; 33:181-186. [PMID: 33978331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND The time lapse between onset of symptoms and a call to an emergency dispatch center (pain-to-call time) is a critical prognostic factor in patients with chest pain. It is therefore important to identify factors related to delays in calling for help. OBJECTIVES To analyze whether age, gender, or time of day influence the pain-to-call delay in patients with acute STsegment elevation myocardial infarction (STEMI). MATERIAL AND METHODS Data were extracted from a prospective registry of STEMI cases managed by 39 mobile intensive care ambulance teams before hospital arrival within 24 hours of onset in our region, the greater metropolitan area of Paris, France. We analyzed the relation between pain-to-call time and the following factors: age, gender, and the time of day when symptoms appeared. We also assessed the influence of pain-to-call time on the rate of prehospital decisions to implement reperfusion therapy. RESULTS A total of 24 662 consecutive patients were included; 19 291 (78%) were men and 4371 (22%) were women. The median age was 61 (interquartile range, 52-73) years (men, 59 [51-69] years; women, 73 [59-83] years; P .0001). The median pain-to-call time was 60 (24-164) minutes (men, 55 [23-150] minutes; women, 79 [31-220] minutes; P .0001). The delay varied by time of day from a median of 40 (17-101) minutes in men between 5 pm and 6 pm to 149 (43-377) minutes in women between 2 am and 3 am. The delay was longer in women regardless of time of day and increased significantly with age in both men and women (P .001). A longer pain-to-call time was significantly associated with a lower rate of implementation of myocardial reperfusion (P .001). CONCLUSION Pain-to-call delays were longer in women and older patients, especially at night. These age and gender differences identify groups that would benefit most from health education interventions.
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Incidence, Mortality, and Outcome-Predictors of Sudden Cardiac Arrest Complicating Myocardial Infarction Prior to Hospital Admission. Circ Cardiovasc Interv 2020; 12:e007081. [PMID: 30608874 DOI: 10.1161/circinterventions.118.007081] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mortality of ST-segment-elevation myocardial infarction (STEMI) decreased drastically, mainly through reduction in inhospital mortality. Prehospital sudden cardiac arrest (SCA) became one of the most feared complications. We assessed the incidence, outcome, and prognosis' predictors of prehospital SCA occurring after emergency medical services (EMS) arrival. METHODS AND RESULTS Data were taken between 2006 and 2014 from the e-MUST study (Evaluation en Médecine d'Urgence des Strategies Thérapeutiques des infarctus du myocarde) that enrolls all STEMI managed by EMS in the Greater Paris Area, including those dead before hospital admission. Among 13 253 STEMI patients analyzed, 749 (5.6%) presented EMS-witnessed prehospital SCA. Younger age, absence of cardiovascular risk factors, symptoms of heart failure, extensive STEMI, and short pain onset-to-call and call-to-EMS arrival delays were independently associated with increased SCA risk. Mortality rate at hospital discharge was 4.0% in the nonSCA group versus 37.7% in the SCA group ( P<0.001); 26.8% of deaths occurred before hospital admission. Factors associated with increased mortality after SCA were age, heart failure, and extensive STEMI, while male sex and cardiovascular risk factors were associated with decreased mortality. Among patients admitted alive, PCI was the most important mortality-reduction predictor (odds ratio, 0.40; 95% CI, 0.25-0.63; P<0.0001). CONCLUSIONS More than 1 of 20 STEMI presents prehospital SCA after EMS arrival. SCA occurrence is associated with a 10-fold higher mortality at hospital discharge compared with STEMI without SCA. PCI is the strongest survival predictor, leading to a twice-lower mortality. This highlights the persistently dramatic impact of SCA on STEMI and the major importance of PCI in this setting.
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Actions to improve chronic heart failure management in Paris and its suburbs, preliminary results. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Chronic Heart Failure treatment requires close collaboration between multiple health professionals (hospitals, general practitionners, cardiologists, nurses, pharmacists,...). Guidelines for management of chronic heart failure patients after hospitalization for heart failure were published in France in 2014.
In Paris and its suburbs (Ile de France) several indicators show that improvement of processes is required especially regarding linkage between hospital and ambulatory care (for example admission rate in emergency unit was 59,7% in 2014).
Actions
Since 2015 Regional Health Agency and Social Insurance have conducted several actions to improve patients care pathway: feed back to providers on their own results, support patients after hospital discharge, commitment of several hospitals to organize meetings with field professionals, setting up semi-urgent consultations in hospitals, bundled payment experience...
Preliminary Results
Indicators evolution from 2014 to 2017 is favorable for rate of admission in emergency unit (57,8% versus 59,7%), 6 months mortality (20,7% versus 23,1%), hospital readmission 6 months after index admission (24,4% versus 25,2%), but unfavorable for ambulatory clinical follow up rates (general practitionner consultation within fourteen days after hospital discharge (46,1% versus 52,5%), cardiologist consultation within sixty days after hospital discharge (47,1% versus 52,8%).
Conclusions
It is too early to assess the impact of each action and it will be difficult to conclude, because of interaction between actions. The evolution of outcome care indicators is satisfactory, which suggests the interest of acting on a whole care process. The worsening clinical follow up indicators leads to wonder about access to health care and requires an analysis by territory to adapt the actions.
Key messages
Actions to improve chronic heart failure management in Paris and its suburbs firsts outcomes are satisfactory. Acction adaptations are necessary and should be assessed in 2019/2020.
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P5646Risk factor paradox in STEMI-related sudden cardiac arrest. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiovascular risk factors (CVRF) are associated with an increased risk of atherosclerosis and ST-segment elevation myocardial infarction (STEMI). Sudden cardiac arrest (SCA) is currently the most feared complication of STEMI. The impact of CVRF on the rate of SCA is still unknown.
Purpose
To assess the association between CVRF and pre-hospital SCA during acute STEMI.
Methods
Data were taken between 2006 and 2014 from the e-MUST study that enrolls all STEMI managed by EMS in the Greater Paris Area, including those dead before hospital admission. Characteristics of patients who presented SCA were compared to those of patients who did not, and multivariable logistic regression was developed including all variables that differed between the two groups, in order to identify characteristics associated with an increased risk of SCA.
Results
Over the study period, 13,253 STEMI patients were included (median age 60.1 [51.4 - 73.0], 78.1% males). Among them, 7,513 patients (58.1%) had ≥2 CVRF, 3,979 (30.8%) had 1 CVRF, and 1,432 (11.1%) did not present any CVRF. Pre-hospital SCA witnessed by emergency medical services occurred in 749 (5.6%) patients. SCA victims were younger compared to the non-SCA group (58.0 vs. 60.3 years (P<0.001), with a higher proportion of patients without known CVRF (17.2 vs. 10.7%, P<0.001). There was no statistical difference in sex ratio (77.5% vs. 78.2%, P=0.69) and presence of past history of coronary artery disease (18.7% vs. 19.5%, P=0.56). Patients with ≥2 CVRF had the lowest rate of SCA (4.6%), while the highest SCA rate occurred among patients without CVRF (8.9%). On multivariate analysis, the presence of ≥2 CVRF was associated with a twice-lower risk of SCA (OR 0.52, 95% CI 0.41–0.65, P<0.001, when the group without risk factors was taken as a reference group).
Conclusion
The prevalence of CVRF is high among patients presenting STEMI. However, once STEMI has occurred, presence of CVRF is associated with a lower rate of SCA per STEMI, creating a risk factor paradox in STEMI-related SCA.
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11
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Enquête nationale sur les opinions et pratiques médicales françaises en hémodiafiltration en ligne (HDFol). Nephrol Ther 2019. [DOI: 10.1016/j.nephro.2019.07.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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Données cliniques et biologiques d’une cohorte d’hémodialysés traités par rhéophérèse dans l’ischémie critique chronique de membres. Nephrol Ther 2019. [DOI: 10.1016/j.nephro.2019.07.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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13
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Angiography and Percutaneous Coronary Intervention for Chronic Total Coronary Occlusion in Daily Practice (from a Large French Registry [CARDIO-ARSIF]). Am J Cardiol 2019; 124:688-695. [PMID: 31307663 DOI: 10.1016/j.amjcard.2019.05.062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/19/2019] [Accepted: 05/21/2019] [Indexed: 02/03/2023]
Abstract
The aim of this study was to provide contemporary data on chronic total occlusion (CTO) prevalence and management in a large unselected population representing the daily activity of cathlabs, in the greater Paris area, and to compare percutaneous coronary intervention (PCI) features in patients with and without CTO. Procedures were collected from the CARDIO-ARSIF (Agence Régionale de Santé Ile de France) registry from 2012 to 2015. Patients with acute coronary syndrome or previous coronary artery bypass grafting were excluded. CTO features were assessed and PCIs with and without CTO were compared. Among 128,739 included patients, 10,468 (8.1%) had at least 1 CTO. Cardiovascular risk-factor burden was higher in the CTO group, which had more patients with multivessel disease (74% vs 24%) and with referral for interventional management (59% vs 33%). Of all PCIs during the study period, 5.7% involved a CTO; this proportion increased significantly over the study period. PCI success rate was 75.9% in the CTO group. CTO-PCI volume per center did not correlate with CTO-PCI success rate. In conclusion, CTO is common in patients who underwent scheduled coronary angiography. Invasive management is done more often in patients with than without CTO. The success rate of PCI in CTO is not associated with case volume per center.
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Que s’est-il passé après 6 mois de sevrage en vitamine D chez des patients hémodialysés ? Données de l’étude VITADIAL. Nephrol Ther 2019. [DOI: 10.1016/j.nephro.2019.07.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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15
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Traitement de la calciphylaxie par rhéophérèse : série de cas. Nephrol Ther 2018. [DOI: 10.1016/j.nephro.2018.07.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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La myostatine et l’IGF1 sont de bons biomarqueurs de la force et de la masse musculaire chez les patients hémodialysés chroniques. Nephrol Ther 2018. [DOI: 10.1016/j.nephro.2018.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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L’indole-3-acétique acide, l’indoxyl sulfate et le para-cresyl sulfate ne sont pas corrélés aux marqueurs de l’anémie des patients hémodialysés chroniques. Nephrol Ther 2017. [DOI: 10.1016/j.nephro.2017.08.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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La concentration plasmatique en rétinol est principalement fonction de la transthyrétine chez les patients hémodialysés. Nephrol Ther 2017. [DOI: 10.1016/j.nephro.2017.08.163] [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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1203Evolution of early mortality from 2003 to 2013 according to age and use of primary PCI in MICU-transported STEMI patients. Data from the eMust registry in 23,562 patients in the greater Paris area. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.1203] [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: 11/13/2022] Open
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Time-Course Reduction in Patient Exposure to Radiation From Coronary Interventional Procedures. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.005268. [DOI: 10.1161/circinterventions.117.005268] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 06/26/2017] [Indexed: 11/16/2022]
Abstract
Background—
The frequency of complex percutaneous coronary interventions (PCIs) has increased in the last few years, with a growing concern on the radiation dose received by the patients. Multicenter data from large unselected populations on patients’ radiation doses during coronary angiography (CA) and PCI and temporal trends are lacking. This study sought to evaluate the temporal trends in patients’ exposure to radiation from CA and PCI.
Methods and Results—
Data were taken from the CARDIO-ARSIF registry that prospectively collects data on all CAs and PCIs performed in the 36 catheterization laboratories in the Greater Paris Area, the most populated regions in France with about 12 million inhabitants. Kerma area product and Fluoroscopy time from 152 684 consecutive CAs and 103 177 PCIs performed between 2009 and 2013 were analyzed. A continuous trend for a decrease in median [interquartile range] Kerma area product was observed, from 33 [19–55] Gy cm
2
in 2009 to 27 [16–44] Gy cm
2
in 2013 for CA (
P
<0.0001), and from 73 [41–125] to 55 [31–91] Gy cm
2
for PCI (
P
<0.0001). Time-course differences in Kerma area product remained highly significant after adjustment on Fluoroscopy time, PCI procedure complexity, change of x-ray equipment, and other patient- and procedure-related covariates.
Conclusions—
In a large patient population, a steady temporal decrease in patient radiation exposure during CA and PCI was noted between 2009 and 2013. Kerma area product reduction was consistent in all types of procedure and was independent of patient-related factors and PCI procedure complexity.
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Is near-time prevention for sudden cardiac arrest feasible? The e-MUST score. J Thorac Dis 2017; 9:E583-E584. [PMID: 28740704 DOI: 10.21037/jtd.2017.05.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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22
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Response by Karam et al to Letter Regarding Article, "Identifying Patients at Risk for Prehospital Sudden Cardiac Arrest at the Early Phase of Myocardial Infarction: The e-MUST Study (Evaluation en Médecine d'Urgence des Stratégies Thérapeutiques des infarctus du myocarde)". Circulation 2017; 135:e1048-e1049. [PMID: 28507257 DOI: 10.1161/circulationaha.117.027775] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Identifying Patients at Risk for Prehospital Sudden Cardiac Arrest at the Early Phase of Myocardial Infarction. Circulation 2016; 134:2074-2083. [DOI: 10.1161/circulationaha.116.022954] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 09/28/2016] [Indexed: 11/16/2022]
Abstract
Background:
In-hospital mortality of ST-segment–elevation myocardial infarction (STEMI) has decreased drastically. In contrast, prehospital mortality from sudden cardiac arrest (SCA) remains high and difficult to reduce. Identification of the patients with STEMI at higher risk for prehospital SCA could facilitate rapid triage and intervention in the field.
Methods:
Using a prospective, population-based study evaluating all patients with STEMI managed by emergency medical services in the greater Paris area (11.7 million inhabitants) between 2006 and 2010, we identified characteristics associated with an increased risk of prehospital SCA and used these variables to build an SCA prediction score, which we validated internally and externally.
Results:
In the overall STEMI population (n=8112; median age, 60 years; 78% male), SCA occurred in 452 patients (5.6%). In multivariate analysis, younger age, absence of obesity, absence of diabetes mellitus, shortness of breath, and a short delay between pain onset and call to emergency medical services were the main predictors of SCA. A score built from these variables predicted SCA, with the risk increasing 2-fold in patients with a score between 10 and 19, 4-fold in those with a score between 20 and 29, and >18-fold in patients with a score ≥30 compared with those with scores <10. The SCA rate was 28.9% in patients with a score ≥30 compared with 1.6% in patients with a score ≤9 (
P
for trend <0.001). The area under the curve values were 0.7033 in the internal validation sample and 0.6031 in the external validation sample. Sensitivity and specificity varied between 96.9% and 10.5% for scores ≥10 and between 18.0% and 97.6% for scores ≥30, with scores between 20 and 29 achieving the best sensitivity and specificity (65.4% and 62.6%, respectively).
Conclusions:
At the early phase of STEMI, the risk of prehospital SCA can be determined through a simple score of 5 routinely assessed predictors. This score might help optimize the dispatching and management of patients with STEMI by emergency medical services.
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Les patients hémodialysés diabétiques mangent moins que les non diabétiques : plaidoyer pour un régime plus permissif. Nephrol Ther 2016. [DOI: 10.1016/j.nephro.2016.07.087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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25
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Activation d’aryl hydrocabon receptor et risque hémorragique dans une cohorte de patients hémodialysés. Nephrol Ther 2016. [DOI: 10.1016/j.nephro.2016.07.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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26
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La concentration plasmatique en 25-OH vitamine D est corrélée de façon indépendante à la force musculaire chez les patients hémodialysés. NUTR CLIN METAB 2016. [DOI: 10.1016/j.nupar.2016.09.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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27
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Prévalence et approche diagnostique de la sarcopénie chez le patient hémodialysé chronique. Nephrol Ther 2016. [DOI: 10.1016/j.nephro.2016.07.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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Longer pre-hospital delays and higher mortality in women with STEMI: the e-MUST Registry. EUROINTERVENTION 2016; 12:e542-9. [DOI: 10.4244/eijv12i5a93] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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29
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La concentration plasmatique en 25-OH vitamine D est corrélée de façon indépendante à la force musculaire chez les patients hémodialysés. Nephrol Ther 2015. [DOI: 10.1016/j.nephro.2015.07.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Les anticorps IgA anti-β2 glycoprotéine I ne sont pas un facteur indépendant de mortalité chez le patient en hémodialyse chronique. Nephrol Ther 2015. [DOI: 10.1016/j.nephro.2015.07.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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31
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Mais qui thrombose réellement son abord vasculaire ? Nephrol Ther 2015. [DOI: 10.1016/j.nephro.2015.07.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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32
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Outcomes of primary percutaneous coronary interventions in nonagenarians with acute myocardial infarction. Int J Cardiol 2015; 192:24-9. [DOI: 10.1016/j.ijcard.2015.04.227] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 03/23/2015] [Accepted: 04/29/2015] [Indexed: 01/25/2023]
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33
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Short-term exposure to environmental parameters and onset of ST elevation myocardial infarction. The CARDIO-ARSIF registry. Int J Cardiol 2015; 183:17-23. [PMID: 25662048 DOI: 10.1016/j.ijcard.2015.01.078] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 12/30/2014] [Accepted: 01/26/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Environmental parameters have been reported to be triggers of acute myocardial infarction (MI). However, the individual role of each parameter is unknown. We quantified the respective association of climate parameters, influenza epidemics and air pollutants with the onset of ST elevation MI (STEMI) in Paris and the surrounding small ring. METHODS Data from the CARDIO-ARSIF registry (Paris and small ring STEMI population), Météo France (Climate), GROG (Influenza epidemic) and AIRPARIF (Air Pollution) were analyzed. The association between short-term exposure (1 day lag time) to environmental parameters and STEMI occurrence was quantified by time series modeling of daily STEMI count data, using Poisson regression with generalized additive models. RESULTS Between 2003 and 2008, 11,987 <24H STEMI confirmed by angiography were adjudicated. There was a 5.0% excess relative risk (ERR) of STEMI per 10°C decrease in maximal temperature (95% CI 2.1% to 7.8%: p=0.001) and an 8.9% ERR (95% CI 3.2% to 14.9%: p=0.002) during an influenza epidemic after adjustment on week-days and holidays. Associations were consistent when short-term exposure varied from 2 to 7 days. Associations between lower temperatures and STEMI were stronger in magnitude when influenza epidemic was present. Short-term exposure to climatic parameters or pollutants was not associated with STEMI. CONCLUSIONS The present population based registry of STEMI suggests that short-term exposure to lower temperature and influenza epidemic is associated with a significant excess relative risk of STEMI. Subjects at risk for MI may benefit from specific protections against cold temperature and influenza infection.
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Anticorps antiphospholipides et hémodialyse : une association fréquente corrélée à la thrombose de l’abord vasculaire. Nephrol Ther 2014. [DOI: 10.1016/j.nephro.2014.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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35
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La supplémentation nutritionnelle orale des patients hémodialysés n’augmente pas la phosphatémie ou la prise de poids interdialytique. Nephrol Ther 2014. [DOI: 10.1016/j.nephro.2014.07.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Corrigendum to “Changes in reperfusion strategy over time for ST segment elevation myocardial infarction in the Greater Paris Area: Results from the e-MUST Registry” [Int J Cardiol 168 (2013) 5149–5155]. Int J Cardiol 2014. [DOI: 10.1016/j.ijcard.2014.04.264] [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: 11/25/2022]
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37
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Incidence of Tako-Tsubo cardiomyopathy in urban agglomerations. Int J Cardiol 2013; 168:4536-8. [DOI: 10.1016/j.ijcard.2013.06.097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Accepted: 06/30/2013] [Indexed: 10/26/2022]
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38
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Épanchement péricardique au cours de l’insuffisance rénale : facteurs prédictifs du drainage chirurgical. Nephrol Ther 2013. [DOI: 10.1016/j.nephro.2013.07.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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39
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Facteurs de risque de survenue d’une infection à cytomégalovirus chez le patient transplanté : intérêt de l’immunophénotypage lymphocytaire avant greffe. Nephrol Ther 2013. [DOI: 10.1016/j.nephro.2013.07.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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40
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Acute coronary syndrome with ST-segment elevation (STEMI): "lives saved" before hospital. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p4021] [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: 11/13/2022] Open
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41
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Predicting SCD in the minutes prior to its occurrence? The e-MUST study. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.1740] [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: 11/12/2022] Open
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42
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What is the highest achievable resuscitation rate in EMS-witnessed SCD? The e-MUST study. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5630] [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: 11/12/2022] Open
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43
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Fitting with the recent guidelines: is the recommended delay between first medical contact to prehospital fibrinolysis reached? Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5567] [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: 11/14/2022] Open
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44
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Primary angioplasty in Nonagenarians. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1271] [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] Open
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45
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Acute myocardial infarction with ST segment elevation (STEMI): distribution of delays between first medical contact to primary percutaneous coronary intervention. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2284] [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: 11/12/2022] Open
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46
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Genetic diseases and molecular genetics. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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47
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Complémentarité du PMSI et du registre de cardiologie interventionnelle d’Île-de-France Cardio-Arsif. Rev Epidemiol Sante Publique 2013. [DOI: 10.1016/j.respe.2013.01.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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48
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Prise en charge de l’hypernatrémie aux urgences : une évaluation monocentrique. Nephrol Ther 2012. [DOI: 10.1016/j.nephro.2012.07.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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49
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ELISA spécifique pour le suivi des anticorps anti-PLA2R1 avant et après transplantation rénale. Nephrol Ther 2012. [DOI: 10.1016/j.nephro.2012.07.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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