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Fitz V, Graca S, Mahalingaiah S, Liu J, Lai L, Butt A, Armour M, Rao V, Naidoo D, Maunder A, Yang G, Vaddiparthi V, Witchel SF, Pena A, Spritzer PM, Li R, Tay C, Mousa A, Teede H, Ee C. Inositol for Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis to Inform the 2023 Update of the International Evidence-based PCOS Guidelines. J Clin Endocrinol Metab 2024; 109:1630-1655. [PMID: 38163998 PMCID: PMC11099481 DOI: 10.1210/clinem/dgad762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/18/2023] [Accepted: 12/27/2023] [Indexed: 01/03/2024]
Abstract
CONTEXT Insulin resistance is common in women with polycystic ovary syndrome (PCOS). Inositol may have insulin sensitizing effects; however, its efficacy in the management of PCOS remains indeterminate. OBJECTIVE To inform the 2023 international evidence-based guidelines in PCOS, this systematic review and meta-analysis evaluated the efficacy of inositol, alone or in combination with other therapies, in the management of PCOS. DATA SOURCES Medline, PsycInfo, EMBASE, All EBM, and CINAHL from inception until August 2022. STUDY SELECTION Thirty trials (n = 2230; 1093 intervention, 1137 control), with 19 pooled in meta-analyses were included. DATA EXTRACTION Data were extracted for hormonal, metabolic, lipids, psychological, anthropometric, reproductive outcomes, and adverse effects by 1 reviewer, independently verified by a second. DATA SYNTHESIS Thirteen comparisons were assessed, with 3 in meta-analyses. Evidence suggests benefits for myo-inositol or D-chiro-inositol (DCI) for some metabolic measures and potential benefits from DCI for ovulation, but inositol may have no effect on other outcomes. Metformin may improve waist-hip ratio and hirsutism compared to inositol, but there is likely no difference for reproductive outcomes, and the evidence is very uncertain for body mass indexI. Myo-inositol likely causes fewer gastrointestinal adverse events compared with metformin; however, these are typically mild and self-limited. CONCLUSION The evidence supporting the use of inositol in the management of PCOS is limited and inconclusive. Clinicians and their patients should consider the uncertainty of the evidence together with individual values and preferences when engaging in shared decision-making regarding the use of inositol for PCOS.
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Affiliation(s)
- Victoria Fitz
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Sandro Graca
- School of Health and Society, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton WV1 1LY, UK
| | - Shruthi Mahalingaiah
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Jing Liu
- NICM Health Research Institute, Western Sydney University, Penrith 2751, Australia
| | - Lily Lai
- Primary Care Research Centre, University of Southampton, Southampton SO17 1BJ, UK
| | - Ali Butt
- NICM Health Research Institute, Western Sydney University, Penrith 2751, Australia
| | - Mike Armour
- NICM Health Research Institute, Western Sydney University, Penrith 2751, Australia
| | - Vibhuti Rao
- NICM Health Research Institute, Western Sydney University, Penrith 2751, Australia
| | - Dhevaksha Naidoo
- NICM Health Research Institute, Western Sydney University, Penrith 2751, Australia
| | - Alison Maunder
- NICM Health Research Institute, Western Sydney University, Penrith 2751, Australia
| | - Guoyan Yang
- NICM Health Research Institute, Western Sydney University, Penrith 2751, Australia
| | | | - Selma F Witchel
- UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Alexia Pena
- Discipline of Paediatrics, The University of Adelaide and Robinson Research Institute, Adelaide 5005, Australia
| | - Poli Mara Spritzer
- Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Clinicas de Porto Alegre; Department of Physiology, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul 91509-900, Brazil
| | - Rong Li
- Department of OB & GYN, Reproductive Medical Center, Peking University Third Hospital, Beijing 100191, China
| | - Chau Tay
- Monash Centre for Health Research and Implementation, Monash University, Clayton 3800, Australia
| | - Aya Mousa
- Monash Centre for Health Research and Implementation, Monash University, Clayton 3800, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Monash University, Clayton 3800, Australia
| | - Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Penrith 2751, Australia
- Caring Futures Institute, Flinders University, Bedford Park 5042, Australia
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Goldberg A, Graca S, Liu J, Rao V, Witchel SF, Pena A, Li R, Mousa A, Tay CT, Pattuwage L, Teede H, Yildiz BO, Ee C. Anti-obesity pharmacological agents for polycystic ovary syndrome: A systematic review and meta-analysis to inform the 2023 international evidence-based guideline. Obes Rev 2024; 25:e13704. [PMID: 38355887 DOI: 10.1111/obr.13704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 12/18/2023] [Accepted: 01/13/2024] [Indexed: 02/16/2024]
Abstract
This systematic review and meta-analysis evaluated the efficacy of anti-obesity agents for hormonal, reproductive, metabolic, and psychological outcomes in polycystic ovary syndrome (PCOS) to inform the 2023 update of the International Evidence-based Guideline on PCOS. We searched Medline, EMBASE, PsycInfo, and CINAHL until July 2022 with a 10-year limit to focus on newer agents. Eleven trials (545 and 451 participants in intervention and control arms respectively, 12 comparisons) were included. On descriptive analyses, most agents improved anthropometric outcomes; liraglutide, semaglutide and orlistat appeared superior to placebo for anthropometric outcomes. Meta-analyses were possible for two comparisons (exenatide vs. metformin and orlistat + combined oral contraceptive pill [COCP] vs. COCP alone). On meta-analysis, no differences were identified between exenatide versus metformin for anthropometric, biochemical hyperandrogenism, and metabolic outcomes, other than lower fasting blood glucose more with metformin than exenatide (MD: 0.10 mmol/L, CI 0.02-0.17, I2 = 18%, 2 trials). Orlistat + COCP did not improve metabolic outcomes compared with COCP alone (fasting insulin MD: -8.65 pmol/L, -33.55 to 16.26, I2 = 67%, 2 trials). Published data examining the effects of anti-obesity agents in women with PCOS are very limited. The role of these agents in PCOS should be a high priority for future research.
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Affiliation(s)
- Alyse Goldberg
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sandro Graca
- School of Health and Society, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, West Midlands, UK
- Department of Research, Northern College of Acupuncture, York, North Yorkshire, UK
| | - Jing Liu
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Vibhuti Rao
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Selma Feldman Witchel
- UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alexia Pena
- Discipline of Paediatrics, Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Rong Li
- Department of OB & GYN, Reproductive Medical Center, Peking University Third Hospital, Beijing, China
| | - Aya Mousa
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia
| | - Chau Thien Tay
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia
- Department of Diabetes and Vascular Medicine, Monash Health, Melbourne, Victoria, Australia
| | - Loyal Pattuwage
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia
- Department of Diabetes and Vascular Medicine, Monash Health, Melbourne, Victoria, Australia
| | - Bulent O Yildiz
- Division of Endocrinology and Metabolism, Hacettepe University School of Medicine, Ankara, Turkey
| | - Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
- Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
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Scannell N, Mantzioris E, Rao V, Pandey C, Ee C, Mousa A, Moran L, Villani A. Type and Frequency in Use of Nutraceutical and Micronutrient Supplementation for the Management of Polycystic Ovary Syndrome: A Systematic Scoping Review. Biomedicines 2023; 11:3349. [PMID: 38137570 PMCID: PMC10742329 DOI: 10.3390/biomedicines11123349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/13/2023] [Accepted: 12/16/2023] [Indexed: 12/24/2023] Open
Abstract
Lifestyle strategies are considered first-line treatment for the management of polycystic ovary syndrome (PCOS). However, complementary therapies, including nutrient supplementation, have been identified as a potential adjunct therapy. Therefore, we systematically mapped the available literature to identify the type and frequency of the use of nutraceutical and micronutrient supplementation for the management of PCOS features. A systematic search of the literature was conducted using CINAHL, Cochrane reviews, Medline, PsycINFO, Scopus and LILACS. All types of study designs were included if they reported on the use of nutraceuticals and/or micronutrient supplementation on features of PCOS in women aged ≥18 years. A total of 344 articles were included. Forty-one supplements were identified, with the most frequently investigated being inositols (n = 86), vitamin D (n = 53), N-acetylcysteine (n = 27) and omega-3 fatty acids (n = 25). Reproductive outcomes were the most commonly reported (n = 285; 83%), followed by metabolic (n = 229; 67%), anthropometric (n = 197; 57%) and psychological (n = 8; 2%). Our results identified that nutraceutical and micronutrient supplementation require further investigation of psychological outcomes in women with PCOS. Moreover, adequately powered primary studies are warranted to investigate therapeutic doses needed for clinical benefits.
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Affiliation(s)
- Nicole Scannell
- School of Health, University of the Sunshine Coast, Sunshine Coast, QLD 4556, Australia;
| | - Evangeline Mantzioris
- UniSA Clinical & Health Sciences, Alliance for Research in Exercise, Nutrition, and Activity (ARENA), University of South Australia, Adelaide, SA 5000, Australia;
| | - Vibhuti Rao
- NICM Health Research Institute, Western Sydney University, Penrith, NSW 2145, Australia; (V.R.); (C.E.)
| | - Chhiti Pandey
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (C.P.); (A.M.); (L.M.)
| | - Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Penrith, NSW 2145, Australia; (V.R.); (C.E.)
| | - Aya Mousa
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (C.P.); (A.M.); (L.M.)
| | - Lisa Moran
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; (C.P.); (A.M.); (L.M.)
| | - Anthony Villani
- School of Health, University of the Sunshine Coast, Sunshine Coast, QLD 4556, Australia;
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Cance JD, Adams ET, D'Amico EJ, Palimaru A, Fernandes CSF, Fiellin LE, Bonar EE, Walton MA, Komro KA, Knight D, Knight K, Rao V, Youn S, Saavedra L, Ridenour TA, Deeds B. Leveraging the Full Continuum of Care to Prevent Opioid Use Disorder. Prev Sci 2023; 24:30-39. [PMID: 37261635 PMCID: PMC10689575 DOI: 10.1007/s11121-023-01545-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/02/2023]
Abstract
Substance use disorder prevention programs are most effective when matched appropriately to the baseline risk of the population. Individuals who misuse opioids often have unique risk profiles different from those who use other substances such as alcohol or cannabis. However, most substance use prevention programs are geared toward universal audiences, neglecting key inflection points along the continuum of care. The HEAL Prevention Cooperative (HPC) is a unique cohort of research projects that represents a continuum of care, from community-level universal prevention to indicated prevention among older adolescents and young adults who are currently misusing opioids or other substances. This paper describes the theoretical basis for addressing opioid misuse and opioid use disorder across the prevention continuum, using examples from research projects in the HPC.
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Affiliation(s)
- J D Cance
- RTI International, Research Triangle Park, Durham, NC, USA.
| | - E T Adams
- RTI International, Research Triangle Park, Durham, NC, USA
| | | | | | | | - L E Fiellin
- Yale University School of Medicine, New Haven, CT, USA
| | - E E Bonar
- University of Michigan, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, Ann Arbor, MI, USA
| | - M A Walton
- University of Michigan, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, Ann Arbor, MI, USA
| | - K A Komro
- Rollins School of Public Health, Emory University, Atlanta, USA
| | - D Knight
- Texas Christian University, Fort Worth, TX, USA
| | - K Knight
- Texas Christian University, Fort Worth, TX, USA
| | - V Rao
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - S Youn
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - L Saavedra
- RTI International, Research Triangle Park, Durham, NC, USA
| | - T A Ridenour
- RTI International, Research Triangle Park, Durham, NC, USA
| | - B Deeds
- National Institute on Drug Abuse, MD, Bethesda, USA
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Sastry RA, Poggi J, King VA, Rao V, Spake CSL, Abdulrazeq H, Shao B, Kwan D, Woo AS, Klinge PM, Svokos KA. Superficial temporal artery injury and delayed post-cranioplasty infection. Neurochirurgie 2023; 69:101422. [PMID: 36868135 DOI: 10.1016/j.neuchi.2023.101422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 03/05/2023]
Abstract
OBJECTIVE Complications after cranioplasty after decompressive craniectomy (DC) have been reported to be as high as 40%. The superficial temporal artery (STA) is at substantial risk for injury in standard reverse question-mark incisions that are typically used for unilateral DC. The authors hypothesize that STA injury during craniectomy predisposes patients to post-cranioplasty surgical site infection (SSI) and/or wound complication. METHODS A retrospective study of all patients at a single institution who underwent cranioplasty after decompressive craniectomy and who underwent imaging of the head (computed tomography angiogram, magnetic resonance imaging with intravenous contrast, or diagnostic cerebral angiography) for any indication between the two procedures was undertaken. The degree of STA injury was classified and univariate statistics were used to compare groups. RESULTS Fifty-four patients met inclusion criteria. Thirty-three patients (61%) had evidence of complete or partial STA injury on pre-cranioplasty imaging. Nine patients (16.7%) developed either an SSI or wound complication after cranioplasty and, among these, four (7.4%) experienced delayed (>2 weeks from cranioplasty) complications. Seven of 9 patients required surgical debridement and cranioplasty explant. There was a stepwise but non-significant increase in post-cranioplasty SSI (STA present: 10%, STA partial injury: 17%, STA complete injury: 24%, P=0.53) and delayed post-cranioplasty SSI (STA present: 0%, STA partial injury: 8%, STA complete injury: 14%, P=0.26). CONCLUSIONS There is a notable but statistically non-significant trend toward increased rates of SSI in patients with complete or partial STA injury during craniectomy.
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Affiliation(s)
- R A Sastry
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI, 02903, United States.
| | - J Poggi
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI, 02903, United States
| | - V A King
- Department of Plastic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, 02903, United States
| | - V Rao
- Department of Plastic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, 02903, United States
| | - C S L Spake
- Department of Plastic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, 02903, United States
| | - H Abdulrazeq
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI, 02903, United States
| | - B Shao
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI, 02903, United States
| | - D Kwan
- Department of Plastic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, 02903, United States
| | - A S Woo
- Department of Plastic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, 02903, United States
| | - P M Klinge
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI, 02903, United States
| | - K A Svokos
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI, 02903, United States
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Cowan S, Lim S, Alycia C, Pirotta S, Thomson R, Gibson-Helm M, Blackmore R, Naderpoor N, Bennett C, Ee C, Rao V, Mousa A, Alesi S, Moran L. Lifestyle management in polycystic ovary syndrome - beyond diet and physical activity. BMC Endocr Disord 2023; 23:14. [PMID: 36647089 PMCID: PMC9841505 DOI: 10.1186/s12902-022-01208-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 11/09/2022] [Indexed: 01/18/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is a common condition affecting reproductive-aged women with reproductive, metabolic and psychological consequences. Weight and lifestyle (diet, physical activity and behavioural) management are first-line therapy in international evidence-based guidelines for PCOS. While these recommend following population-level diet and physical activity guidelines, there is ongoing interest and research in the potential benefit of including psychological and sleep interventions, as well as a range of traditional, complimentary and integrative medicine (TCIM) approaches, for optimal management of PCOS. There is limited evidence to recommend a specific diet composition for PCOS with approaches including modifying protein, carbohydrate or fat quality or quantity generally having similar effects on the presentations of PCOS. With regards to physical activity, promising evidence supports the provision of vigorous aerobic exercise, which has been shown to improve body composition, cardiorespiratory fitness and insulin resistance. Psychological and sleep interventions are also important considerations, with women displaying poor emotional wellbeing and higher rates of clinical and subclinical sleep disturbance, potentially limiting their ability to make positive lifestyle change. While optimising sleep and emotional wellbeing may aid symptom management in PCOS, research exploring the efficacy of clinical interventions is lacking. Uptake of TCIM approaches, in particular supplement and herbal medicine use, by women with PCOS is growing. However, there is currently insufficient evidence to support integration into routine clinical practice. Research investigating inositol supplementation have produced the most promising findings, showing improved metabolic profiles and reduced hyperandrogenism. Findings for other supplements, herbal medicines, acupuncture and yoga is so far inconsistent, and to reduce heterogeneity more research in specific PCOS populations, (e.g. defined age and BMI ranges) and consistent approaches to intervention delivery, duration and comparators are needed. While there are a range of lifestyle components in addition to population-recommendations for diet and physical activity of potential benefit in PCOS, robust clinical trials are warranted to expand the relatively limited evidence-base regarding holistic lifestyle management. With consumer interest in holistic healthcare rising, healthcare providers will be required to broaden their knowledge pertaining to how these therapies can be safely and appropriately utilised as adjuncts to conventional medical management.
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Affiliation(s)
- Stephanie Cowan
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia.
| | - Siew Lim
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Chelsea Alycia
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Stephanie Pirotta
- Health and Social Care Unit, Monash University, Clayton, Victoria, Australia
| | - Rebecca Thomson
- Robinson Research Institute, The University of Adelaide, North Adelaide, South Australia, Australia
| | - Melanie Gibson-Helm
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
- Te Tātai Hauora o Hine - National Centre for Women's Health Research Aotearoa, Te Herenga Waka - Victoria University of Wellington, Wellington, New Zealand
| | - Rebecca Blackmore
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Negar Naderpoor
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Christie Bennett
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
| | - Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Westmead, New South Wales, Australia
| | - Vibhuti Rao
- NICM Health Research Institute, Western Sydney University, Westmead, New South Wales, Australia
| | - Aya Mousa
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Simon Alesi
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Lisa Moran
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
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Rao V, Giczewska A, Chiswell K, Felker GM, Wang A, Parikh K, Vemulapalli S. Clinical outcomes among distinct groups of patients with severe tricuspid valve regurgitation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Severe tricuspid valve regurgitation (TR) is associated with increased 1-year morbidity and mortality. Characterization by valve etiology (primary, secondary, and lead-associated), a classification borrowed from mitral valve disease, has not been universally shown to correlate with outcomes.
Purpose
Among a large, racially diverse cohort with newly identified severe TR, we aimed to 1) characterize outcomes of severe TR by etiology, and 2) assess whether unsupervised phenoclustering or supervised outcome-driven prediction trees were more effective in establishing subgroups of TR with differential clinical risk profiles.
Methods
We retrospectively analyzed outcomes of 5-year all-cause death and a composite of death or heart failure hospitalization (HFH) among adult patients with new severe TR identified by echocardiography between 2007 to 2018 at a large academic tertiary referral center in the United States. Patients were initially categorized by etiology of TR, including primary, secondary, and lead-associated. Second, we separately applied unsupervised hierarchical clustering to identify distinct clusters using demographics, clinical, and echo data at the time of diagnosis. Third, we applied a supervised recursive partitioning algorithm (survival trees) by each outcome to identify distinct TR subgroups. We estimated the cumulative incidence of death and composite death or HFH over 5 years by 1) etiology of TR, 2) distinct clusters, and 3) groups identified by supervised learning (prediction trees).
Results
Among 2,379 consecutive patients with newly identified severe TR, the median age was 70 years, 61% were female, and 40% were Black. Event rates (95% CI) were 30.9 (29.0 to 32.8) events/100 PY for death and 49.0 (45.9 to 52.2) events/100 PY for composite death or HFH over median follow-up of 1.6 years. Event rates were similarly high across TR etiology groups for both death and composite death or HFH (Figure 1). Multiple methods of unsupervised clustering did not yield distinct clusters by patient demographic and imaging characteristics. After applying supervised survival tree modeling, four phenoclusters with distinct clinical prognoses were separately identified for death and composite death or HFH (Figure 2). Variables identified to partition the cohort to discriminate both death and composite death or HFH were age, albumin, blood urea nitrogen, right ventricular contractility, and right ventricular systolic pressure (all p<0.05).
Conclusions
Five-year cumulative incidence of adverse events among patients with newly diagnosed severe TR was 69% for death and 80% for composite death or HFH. TR etiology did not stratify prognosis, while supervised survival tree models identified phenoclusters with distinct clinical risk. The identified subgroups of severe TR with differential outcomes offer insights towards enrichment in clinical trials of TR and risk/benefit analysis in patients undergoing TR therapies.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Abbott
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Affiliation(s)
- V Rao
- Duke Clinical Research Institute , Durham , United States of America
| | - A Giczewska
- Duke Clinical Research Institute , Durham , United States of America
| | - K Chiswell
- Duke Clinical Research Institute , Durham , United States of America
| | - G M Felker
- Duke Clinical Research Institute , Durham , United States of America
| | - A Wang
- Duke University Medical Center , Durham , United States of America
| | - K Parikh
- Duke Clinical Research Institute , Durham , United States of America
| | - S Vemulapalli
- Duke University Medical Center , Durham , United States of America
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Bray M, Krieg A, Esagoff A, Bryant B, Salas R, Rao V, Peters M. Polysomnography Following Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Eur Psychiatry 2022. [PMCID: PMC9567999 DOI: 10.1192/j.eurpsy.2022.2091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Sleep disturbances are common following traumatic brain injury (TBI) worsening morbidity and other neuropsychiatric symptoms. Post-TBI alterations in sleep architecture require further study.
Objectives
(1) To evaluate polysomnographic measures of sleep architecture in participants with history of TBI compared to controls and as meta-analyses of pooled means. (2) To evaluate effects of timing and severity of TBI on polysomnographic outcomes.
Methods
PRISMA compliant systematic review was conducted of MEDLINE, PsycINFO, EMBASE and Scopus. Inclusion criteria: 1) reporting polysomnography in the context of TBI and 2) operationalizing TBI using clear/formalized criteria. Data were pooled in random-effects meta-analyses with outcomes expressed as mean differences (MD).
Results
In participants with TBI, sleep was comprised of 19.39% REM sleep, 8.13% N1, 51.18% N2, and 17.53% N3, as determined by meta-analyses of single means. Total sleep time was reduced in chronic (>6 months) TBI compared to acute-intermediate TBI (<6 months) (p=0.01). Compared to controls, participants with TBI differed with increased N1 sleep (MD=0.64%; 95%CI=0.02,1.25; p=0.04), reduced sleep efficiency (MD=-1.65%; 95%CI=-3.18,-0.12; p=0.03), and reduced sleep latency on the multiple sleep latency test (MD=-5.90mins; 95%CI=-10.09,-1.72; p<0.01). On sub-group analyses, participants with mild TBI differed from controls with reduced total sleep time (MD=-29.22mins, 95%CI=-54.16,-4.27; p=0.02). Similarly, participants with acute-intermediate TBI exhibited increased sleep latency compared to controls (MD=8.96mins; 95%CI=4.07,13.85; p<0.01) and differed significantly from participants with chronic TBI (X2(1,N=608)=6.54; p=0.01).
Conclusions
Sleep architecture is altered following TBI with potential implications regarding functional outcomes and recovery. These alterations appear to differ based on severity of injury and time since injury.
Disclosure
No significant relationships.
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Pasupneti S, Tulu Z, Rao V, MacArthur J, Mooney J, Dhillon G. Comparing Outcomes of COVID-19 vs NonCOVID-19 Lung Transplant Recipients on ECMO as a Bridge to Transplant. J Heart Lung Transplant 2022. [PMCID: PMC8988582 DOI: 10.1016/j.healun.2022.01.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Purpose Methods Results Conclusion
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Vuong V, Rao V, Ee C. Mindfulness-based Interventions and Yoga for Managing Obesity/Overweight After Breast Cancer: A Scoping Review. Integr Cancer Ther 2022; 21:15347354221137321. [DOI: 10.1177/15347354221137321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Weight gain after breast cancer is common, and obesity after breast cancer increases breast cancer recurrence and mortality. Mindfulness-based interventions (MBIs) and yoga have been shown to be effective in managing obesity/overweight in people without breast cancer. There is a need to systematically map the extent and range of evidence on yoga and MBIs for managing obesity/overweight after breast cancer in order to aid planning and commissioning of future research. Methods We conducted a scoping review informed by methods described by Levac et al. Five electronic databases were searched for any peer-reviewed original research (including systematic reviews) that examined the role of yoga and/or MBIs for managing overweight/obesity after breast cancer. Data were extracted on study, population, intervention, comparator and outcome characteristics, and described narratively. Results: We found 18 publications representing 15 unique studies (11 clinical trials, 2 systematic reviews, and 2 observational studies). There were 10 studies on yoga, and 5 on MBIs. Of the clinical trials, only 4/11 examined a weight-related outcome as the primary outcome. The remaining trials examined lifestyle or metabolic outcomes (5/11) or unrelated outcomes such as psychological health (2/11). Gaps in the literature included small sample sizes, lack of cultural diversity amongst participants, inadequate reporting of the intervention, few lifestyle co-interventions offered, lack of active comparator groups, and inadequate safety reporting. Conclusions: There is a need for adequately-powered RCTs that adhere to reporting guidelines. The use of gold-standard methods for measuring outcomes, and active comparator groups, is also recommended.
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Affiliation(s)
- Vicki Vuong
- School of Medicine, Western Sydney University, NSW, Australia
| | - Vibhuti Rao
- WNICM Health Research Institute, Western Sydney University, NSW, Australia
| | - Carolyn Ee
- WNICM Health Research Institute, Western Sydney University, NSW, Australia
- Translational Health Research Institute, Western Sydney University, NSW, Australia
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Armstrong SM, Basso C, Bendeck M, Berthiaume J, Bonafiglia QA, Buja LM, Butany J, d’Amati G, Fishbein GA, Fishbein MC, Giordano C, Gotlieb AI, Hammers J, Hoit B, Jensen B, Kirk J, Lai CK, Lau RP, Lelenwa L, Lyon R, Maleszewski JJ, McDonald M, McManus B, Michaud K, Mitchell RN, Mori M, Nair V, Ottaviani G, Ranek M, Rao V, Rizzo S, Rodriguez ER, Romero ME, Sakamoto A, Sampson B, Santos-Martins C, Sato Y, Schoen FJ, Segura A, Seidman MA, Seki A, Sheikh F, Singaravel S, Stone JR, Stram M, Tan CD, Thavendiranathan P, Thiene G, Tolend M, Vaideeswar P, Veinot JP, Virmani R, Wang J, Willis M, Zhao B. List of contributors. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00029-3] [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: 11/30/2022] Open
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Alesi S, Ee C, Moran LJ, Rao V, Mousa A. Nutritional Supplements and Complementary Therapies in Polycystic Ovary Syndrome. Adv Nutr 2021; 13:1243-1266. [PMID: 34970669 PMCID: PMC9340985 DOI: 10.1093/advances/nmab141] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/25/2021] [Accepted: 11/17/2021] [Indexed: 12/17/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) affects 1 in 5 women of reproductive age, and is characterized by menstrual irregularities, clinical or biochemical hyperandrogenism, and the presence of polycystic ovary morphology. One of the recommended treatment strategies in the international evidence-based guidelines is lifestyle modification, which includes diet and exercise, with the aim of improving a range of health outcomes. The incurable nature of PCOS reinforces the importance of developing novel and innovative symptomatic relief strategies, which are currently the only available approaches for improving quality of life for these women. Women with PCOS tend to be nutrient deficient in many common vitamins and minerals, thought to be associated with the psychological (depression, anxiety, etc.) and physiological (insulin resistance, diabetes, infertility, etc.) sequelae of the condition. Nutrient supplementation and the integration of complementary medicine as adjuncts to traditional lifestyle-based therapies in PCOS could therefore provide additional benefits to these women. In this review, we synthesize the evidence regarding nutrient supplementation and complementary therapies in PCOS, predominantly from randomized controlled trials, systematic reviews, and meta-analyses, to provide an overview of the state of knowledge in this field. The evidence to date suggests that specific vitamins (B-12, inositols, folate, vitamins D, E, and K), vitamin-like nutrients (bioflavonoids and α-lipoic acid), minerals (calcium, zinc, selenium, and chromium picolinate), and other formulations (melatonin, ω-3 fatty acids, probiotics, and cinnamon), as well as some complementary approaches such as acupuncture and yoga may be beneficial in PCOS. However, there remain areas of uncertainty and key limitations in the literature that must be overcome before these therapies can be integrated into routine clinical practice.
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Affiliation(s)
- Simon Alesi
- Monash Centre for Health Research and Implementation (MCHRI), Monash University, Clayton, Victoria, Australia
| | - Carolyn Ee
- The National Institute of Complementary Medicine, Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation (MCHRI), Monash University, Clayton, Victoria, Australia
| | - Vibhuti Rao
- The National Institute of Complementary Medicine, Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Aya Mousa
- Address correspondence to AM (e-mail: )
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Lohith G, Sekar K, Patil S, Bandemagal M, Murugan K, M V, Thungappa S, Rao V, Kudpaje A, Ramasamy M, Ramachandrappa S, Bharathan A, Rao G, Rao D, kumar B. A Randomized Control Trial Comparing Time to Healing of Radiation Induced Acute Skin Reactions Using Biological Membrane Dressing or Topical Methyl Pararosaniline Dye. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.626] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Clemens P, Connolly A, Harper A, Mah J, McDonald C, Rao V, Smith E, Zaidman C, Nakagawa T, Hoffman E. DMD - TREATMENT. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.165] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Rao V, Byrne B, Shieh P, Salabarria S, Berthy J, Corti M, Redican S, Lawrence J, Brown K, Shanks C, Spector S, Gonzalez P, Schneider J, Morris C, Clary C. CLINICAL TRIAL HIGHLIGHTS. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Brahmbhatt D, Vishram-Nielsen J, Lee D, Alhussein M, Moayedi Y, Posada JD, Ross H, Rakowski H, Rao V, Billia F. Continuous-Flow Left Ventricular Assist Device Support for Patients with Hypertrophic Cardiomyopathy: A Single Centre Experience. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.542] [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] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Vishram-Nielsen J, Lambadaris M, Amadio J, Husain S, Rao V, Billia F, Alba A. Association between Continuous Flow Left Ventricular Assist Device Infections Requiring Long-Term Antibiotic Use and Post Heart Transplant Morbidity and Mortality. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1155] [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] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Bertic M, Worme M, Foroutan F, Ross H, Rao V, Alba A, Billia F. Predictors of Mortality in Patients with Cardiac Arrest Treated with ECPR. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.610] [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] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Yu F, Alvarez J, Ribeiro R, Rosales R, Adamson M, Xin L, Gellner B, Meenakshi S, Chopra C, Wu J, Zhang Y, Rahmani A, Alie E, Rao V, Badiwala M. DIALYSIS IMPROVES MYOCARDIAL PRESERVATION DURING EX SITU HEART PERFUSION. Can J Cardiol 2020. [DOI: 10.1016/j.cjca.2020.07.224] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Krosschell K, Brown L, Hoffman K, Weigel C, Munson H, Bidwell J, DiDonato C, Kuntz N, Rao V. SMA: REGISTRIES, BIOMARKERS & OUTCOME MEASURES. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.178] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gomes B, Ribeiro R, Alvarez J, Ribeiro R, Honjeu A, Gazzalle A, Bissoondath V, Yu F, Adamson M, Meineri M, Rao V, Badiwala M, Keshavjee S, Cypel M. Normothermic Regional Perfusion (NRP) during Heart DCD Recovery: Is Lung Quality Impacted? A Pre-Clinical Study. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Netuka I, Pya Y, Zimpfer D, Potapov E, Garbade J, Rao V, Morshuis M, Marasco S, Beyersdorf F, Gazzola C, Sood P, Schmitto J. First Long-Term 5-years Experience with the HeartMate 3 LVAS in Multicentric Clinical Trial. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Alba A, Foroutan F, Buchan T, Alvarez J, Kinsella A, Clark K, Lau K, Zhu A, McGuinty C, Aleksova N, Vishram-Nielsen J, Malik A, Francis T, Stanimirovic A, Bielecki J, Fan E, Rao V, Ross H, Rac V, Billia F. Mortality in Patients with Cardiogenic Shock Supported with Veno-Arterial Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis Evaluating the Impact of Etiology. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.773] [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] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Ribeiro R, Alvarez J, Gomes B, Hondjeu A, Yu F, Adamson M, Ribeiro R, Bissoondath V, Meineri M, Rao V, Cypel M, Badiwala M. Assessment of Cerebral Perfusion and Activity during Normothermic Regional Perfusion in a Porcine Model of Donation after Circulatory Death. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Chang J, Guo X, Rao V, Gromisch E, Chung S, Kluger H, Cha C, Gorelick F, Testani J, Safirstein R, Crowley S, Peixoto A, Desir G. Identification of Two Forms of Human Plasma Renalase, and Their Association With All-Cause Mortality. Kidney Int Rep 2020; 5:362-368. [PMID: 32154458 PMCID: PMC7056858 DOI: 10.1016/j.ekir.2019.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/15/2019] [Accepted: 12/06/2019] [Indexed: 01/13/2023] Open
Affiliation(s)
- J. Chang
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Veterans Affairs Connecticut Health System, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - X. Guo
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - V. Rao
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - E.S. Gromisch
- Veterans Affairs Connecticut Health System, University of Connecticut School of Medicine, Farmington, Connecticut, USA
- Department of Neurology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health of New England, Hartford, Connecticut, USA
- Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut, USA
- Department of Medical Sciences, Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut, USA
| | - S. Chung
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - H.M. Kluger
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Section of Medical Oncology, Yale School of Medicine, New Haven, Connecticut, USA
| | - C. Cha
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - F. Gorelick
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Veterans Affairs Connecticut Health System, University of Connecticut School of Medicine, Farmington, Connecticut, USA
- Department of Cell Biology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - J. Testani
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - R. Safirstein
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Veterans Affairs Connecticut Health System, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - S. Crowley
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Veterans Affairs Connecticut Health System, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - A.J. Peixoto
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - G.V. Desir
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Veterans Affairs Connecticut Health System, University of Connecticut School of Medicine, Farmington, Connecticut, USA
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Fukunaga N, Ribeiro R, Bissoondath V, Billia F, Badiwala M, Rao V. GHRELIN INHIBITS INFLAMMATORY RESPONSE AND APOPTOSIS DURING ISCHEMIA-REPERFUSION INJURY FOLLOWING A MURINE HEART TRANSPLANTATION MODEL. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.605] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Ribeiro R, Yu F, J Alvarez, Adamson M, Paradiso E, Xin L, Gellner B, Bissoondath V, Meineri M, Rao V, Badiwala M. EX SITU HEART PERFUSION IMPROVES PRESERVATION OF ENDOTHELIAL FUNCTION IN BOTH DBD AND DCD HEARTS. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.063] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Clemens P, Rao V, Connolly A, Zaidman C, Harper A, Mah J, Morgenroth L, Yamashita T, Hoffman E. P.337Dystrophin restoration by exon 53 skipping in patients with Duchenne muscular dystrophy after viltolarsen treatment: phase 2 study update. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ribeiro R, Alvarez J, Paradiso E, Yu F, Adamson M, Foroutan F, Bissoondath V, Meineri M, Rao V, Badiwala M. FUNCTIONAL ASSESSMENT OF DCD HEARTS FOLLOWING NORMOTHERMIC REGIONAL PERFUSION CAN PREDICT POST-TRANSPLANTATION CONTRACTILITY. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.595] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Ribeiro R, Gomes B, Hondjeu A, Yu F, Adamson M, R Ribeiro, J Alvarez, Bissoondath V, Meineri M, Rao V, M Cypel, Badiwala M. ASSESSMENT OF CEREBRAL PERFUSION AND ACTIVITY DURING NORMOTHERMIC REGIONAL PERFUSION IN A PORCINE MODEL OF DONATION AFTER CIRCULATORY DEATH. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Ivey-Miranda J, Stewart B, Gomez N, Thomas A, Wycallis E, Pattoli M, Struyk G, Fleming J, Shamlian P, Barnett J, Raghavendra P, Mahoney D, Griffin M, Rao V, Testani J. Discordance between Estimate Glomerular Filtration Rate with Creatinine and Cystatin is Associated with Inflammation and Worsened Survival in Heart Failure. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.057] [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] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Barnett J, Stewart B, Gomez N, Thomas A, Wycallis E, Pattoli M, Struyk G, Fleming J, Shamlian P, Raghavendra P, Mahoney D, Ivey-Miranda J, Griffin M, Rao V, Testani J. Urine Growth Differentiation Factor-15 is Not an Independent Biomarker of Cardio-Renal Interactions in Patients with Heart Failure. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.063] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Griffin M, Flemming J, Pattoli M, Stewart B, Gomez N, Barnett J, Thomas A, Wycallis E, Struyk G, Shamlian P, Mahoney D, Ivey-Miranda J, Ivey-Miranda J, Rao V, Testani J. Safety and Efficacy of an Auto-Titrating Diuretic Protocol: A Pilot. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.147] [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] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ivey-Miranda J, Stewart B, Gomez N, Barnett J, Thomas A, Wycallis E, Pattoli M, Struyk G, Fleming J, Shamlian P, Raghavendra P, Mahoney D, Griffin M, Rao V, Testani J. Sarcopenia Strongly Affects Serum Levels of Cystatin C in Patients with Heart Failure. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.059] [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] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Rao V, Turner J, Mahoney D, Griffin M, Asher J, Ivey-Miranda J, Gomez N, Finkelstein F, Testani J. First in Human Experience with Direct Sodium Removal Using a Zero Sodium Peritoneal Solution. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.027] [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] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Stewart B, Gomez N, Barnett J, Thomas A, Wycallis E, Pattoli M, Struyk G, Fleming J, Shamlian P, Raghavendra P, Mahoney D, Ivey-Miranda J, Griffin M, Rao V, Testani J. FGF-23 and Cardio-Renal Interactions in Heart Failure. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.545] [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] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rao V, Guo X, Chang J, Peixoto A, Testani J, Desir G. MON-334 TWO FORMS OF RENALASE (BOUND AND FREE) IDENTIFIED IN HUMAN PLASMA BY A NEW ELISA. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.180] [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] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Strati P, Alcedo Andreade P, Sano D, Rao V, Singh P, Miranda R, Gunther J, Pinnix C, Dabaja B, Lee H, Steiner R. RELAPSED AND REFRACTORY NODULAR LYMPHOCYTE-PREDOMINANT HODGKIN LYMPHOMA (NLPHL): A US ANALYSIS FROM MD ANDERSON CANCER CENTER. Hematol Oncol 2019. [DOI: 10.1002/hon.182_2631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- P. Strati
- Lymphoma and Myeloma; MD Anderson Cancer Center; Houston United States
| | | | - D. Sano
- Lymphoma and Myeloma; MD Anderson Cancer Center; Houston United States
| | - V. Rao
- Lymphoma and Myeloma; MD Anderson Cancer Center; Houston United States
| | - P. Singh
- Lymphoma and Myeloma; MD Anderson Cancer Center; Houston United States
| | - R. Miranda
- Hematopathology; MD Anderson Cancer Center; Houston United States
| | - J. Gunther
- Radiation Oncology; MD Anderson Cancer Center; Houston United States
| | - C. Pinnix
- Radiation Oncology; MD Anderson Cancer Center; Houston United States
| | - B. Dabaja
- Radiation Oncology; MD Anderson Cancer Center; Houston United States
| | - H.J. Lee
- Lymphoma and Myeloma; MD Anderson Cancer Center; Houston United States
| | - R. Steiner
- Lymphoma and Myeloma; MD Anderson Cancer Center; Houston United States
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Birriel D, Ulahannan A, Ma J, Lazarte J, Martinu T, Singer L, Rao V, Keshavjee S, Delgado D, Tikkanen J, Juvet S. Recipient HLA-G Single Nucleotide Polymorphisms Predict Post-Lung Development of Donor Specific Antibodies. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.372] [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] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Stein M, O'Brien K, Foroutan F, Rao V, Ross H, Alba A. The Impact of Frailty on Survival in Patients Undergoing Advanced Therapies for Heart Failure. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.189] [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] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Ho LTS, Lenihan M, McVey MJ, Karkouti K, Wijeysundera DN, Rao V, Crowther M, Grocott HP, Pinto R, Scales DC, Achen B, Brar S, Morrison D, Wong D, Bussières JS, Waal T, Harle C, Médicis É, McAdams C, Syed S, Tran D, Waters T. The association between platelet dysfunction and adverse outcomes in cardiac surgical patients. Anaesthesia 2019; 74:1130-1137. [PMID: 30932171 DOI: 10.1111/anae.14631] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2019] [Indexed: 11/30/2022]
Abstract
Haemostatic activation during cardiopulmonary bypass is associated with prothrombotic complications. Although it is not possible to detect and quantify haemostatic activation directly, platelet dysfunction, as measured with point-of-care-assays, may be a useful surrogate. In this study, we assessed the association between cardiopulmonary bypass-associated platelet dysfunction and adverse outcomes in 3010 cardiac surgical patients. Platelet dysfunction, as measured near the end of the rewarming phase of cardiopulmonary bypass, was calculated as the proportion of non-functional platelets after activation with collagen. Logistic regression and multivariable analyses were applied to assess the relationship between platelet dysfunction and a composite of in-hospital death; myocardial infarction; stroke; deep vein thrombosis or pulmonary embolism; and acute kidney injury (greater than a two-fold increase in creatinine). The outcome occurred in 251 (8%) of 3010 patients. The median (IQR [range]) percentage platelet dysfunction was less for those without the outcome as compared with those with the outcome; 14% (8-28% [1-99%]) vs. 19% (11-45% [2-98%]), p < 0.001. After risk adjustment, platelet dysfunction was independently associated with the composite outcome (p < 0.001), such that for each 1% increase in platelet dysfunction there was an approximately 1% increase in the composite outcome (OR 1.012; 95%CI 1.006-1.018). This exploratory study suggests that cardiopulmonary bypass-associated platelet dysfunction has prognostic value and may be a useful clinical measure of haemostatic activation in cardiac surgery.
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Affiliation(s)
- L T S Ho
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, ON, Canada
| | - M Lenihan
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, ON, Canada
| | - M J McVey
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children, University of Toronto, ON, Canada
| | - K Karkouti
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, ON, Canada.,Toronto General Research Institute and the Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, ON, Canada
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Kinsella A, Rao V, Fan C, Manlhiot C, Stehlik J, Ross H, Alba A. Survival Outcomes in Heart Transplant Patients; Specific Focus on ACHD Patients and Their Outcomes as Compared to Dilated and Ischemic Cardiomyopathy Patients. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.445] [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] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Ribeiro R, Alvarez J, Gellner B, Xin L, Paradiso E, Yu F, Adamson M, Foroutan F, Bissoondath V, Meineri M, Rao V, Badiwala M. Contractility versus Metabolic Cardiac Assessment during Ex Situ Heart Perfusion: A Pre-Clinical Transplant Study. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Yu F, Alvarez J, Ribeiro R, Adamson M, Amin F, Degen M, Foroutan F, Posada JD, Yau T, Cusimano R, Billia F, Alba C, Badiwala M, Rao V. Does Left Atrial Appendage Occlusion in LVAD Patients Impact Outcomes: A Single Centre Study. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.414] [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] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Ribeiro R, Yu F, Alvarez J, Adamson M, Paradiso E, Xin L, Gellner B, Bissoondath V, Meineri M, Rao V, Badiwala M. Ex Situ Heart Perfusion Improves Preservation of Endothelial Function in Both DBD and DCD Hearts. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Shokuhfar T, Nazari P, Ansari S, Hurley M, Azmi S, Kuntz N, Rao V, Shaibani A. 03:54 PM Abstract No. 205 Transforaminal intrathecal access for injection of nusinersen in patients with spinal muscular atrophy. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.261] [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] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Adamson M, Vanin Pinto Ribeiro R, Alvarez J, Yu F, Yau T, Cusimano R, Ross H, Delgado D, Rao V, Badiwala M. RECIPIENT PROFILE AND OUTCOMES OVER 30 YEARS OF A SINGLE QUATERNARY HOSPITAL'S HEART TRANSPLANT PROGRAM. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.139] [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] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Vanin Pinto Ribeiro R, Alvarez J, Yu F, Adamson M, Paradiso E, Ruggeri G, Fukunaga N, Bissoondath V, Serrick C, Meineri M, Rao V, Badiwala M. IS COLD STORAGE POSSIBLE IN HEARTS DONATED AFTER CIRCULATORY DEATH? A PRE-CLINICAL STUDY. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.261] [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] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Alvarez J, Vanin Pinto Ribeiro R, Yu F, Adamson M, Yau T, Cusimano R, Ross H, Rao V, Badiwala M. CHANGING DONOR PROFILE OVER 30 YEARS OF A HEART TRANSPLANT PROGRAM. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.222] [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] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Shivalingegowda D, Rao V, Rathinam K, Pranesh G, Dwarakanath M, Mummadi S, Rao K. Uterine natural killer cell density as a predictor for implantation success or failure in fertile surrogates and in women with implantation failure. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.384] [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] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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