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Wallin, Ewa
Publications (10 of 15) Show all publications
Elfwen, L., Lagedal, R., Nordberg, P., James, S., Oldgren, J., Bohm, F., . . . Svensson, L. (2019). Direct or subacute coronary angiography in out-of-hospital cardiac arrest (DISCO)-An initial pilot-study of a randomized clinical trial. Resuscitation, 139, 253-261
Open this publication in new window or tab >>Direct or subacute coronary angiography in out-of-hospital cardiac arrest (DISCO)-An initial pilot-study of a randomized clinical trial
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2019 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 139, p. 253-261Article in journal (Refereed) Published
Abstract [en]

Background: The clinical importance of immediate coronary angiography, with potentially subsequent percutaneous coronary intervention (PCI), in out-of-hospital cardiac arrest (OHCA) patients without ST-elevation on the ECG is unclear. In this study, we assessed feasibility and safety aspects of performing immediate coronary angiography in a pre-specified pilot phase of the 'DIrect or Subacute Coronary angiography in Out-of-hospital cardiac arrest' (DISCO) randomized controlled trial (ClinicalTrials.gov ID: NCT02309151). Methods: Resuscitated bystander witnessed OHCA patients > 18 years without ST-elevation on the ECG were randomized to immediate coronary angiography versus standard of care. Event times, procedure related adverse events and safety variables within 7 days were recorded. Results: In total, 79 patients were randomized to immediate angiography (n = 39) or standard of care (n = 40). No major differences in baseline characteristics between the groups were found. There were no differences in the proportion of bleedings and renal failure. Three patients randomized to immediate angiography and six patients randomized to standard care died within 24 h. The median time from EMS arrival to coronary angiography was 135 min in the immediate angiography group. In patients randomized to immediate angiography a culprit lesion was found in 14/38 (36.8%) and PCI was performed in all these patients. In 6/40 (15%) patients randomized to standard of care, coronary angiography was performed before the stipulated 3 days. Conclusion: In this out-of-hospital cardiac arrest population without ST-elevation, randomization to a strategy to perform immediate coronary angiography was feasible although the time window of 120 min from EMS arrival at the scene of the arrest to start of coronary angiography was not achieved. No significant safety issues were reported.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2019
Keywords
Out-of-hospital, Cardiac arrest, Coronary angiography, Percutaneous coronary intervention
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-387925 (URN)10.1016/j.resuscitation.2019.04.027 (DOI)000470076000033 ()31028826 (PubMedID)
Funder
Swedish Research CouncilSwedish Heart Lung Foundation
Note

De 2 sista författarna delar sistaförfattarskapet.

Available from: 2019-06-27 Created: 2019-06-27 Last updated: 2019-06-27Bibliographically approved
Wallin, E., Larsson, I.-M., Kristofferzon, M.-L., Larsson, E.-M., Raininko, R. & Rubertsson, S. (2018). Acute brain lesions on magnetic resonance imaging in relation to neurological outcome after cardiac arrest. Acta Anaesthesiologica Scandinavica, 62(5), 635-647
Open this publication in new window or tab >>Acute brain lesions on magnetic resonance imaging in relation to neurological outcome after cardiac arrest
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2018 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, no 5, p. 635-647Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Magnetic resonance imaging (MRI) of the brain including diffusion-weighted imaging (DWI) is reported to have high prognostic accuracy in unconscious post-cardiac arrest (CA) patients. We documented acute MRI findings in the brain in both conscious and unconscious post-CA patients treated with target temperature management (TTM) at 32-34°C for 24 h as well as the relation to patients' neurological outcome after 6 months.

METHODS:

A prospective observational study with MRI was performed regardless of the level of consciousness in post-CA patients treated with TTM. Neurological outcome was assessed using the Cerebral Performance Categories scale and dichotomized into good and poor outcome.

RESULTS:

Forty-six patients underwent MRI at 3-5 days post-CA. Patients with good outcome had minor, mainly frontal and parietal, lesions. Acute hypoxic/ischemic lesions on MRI including DWI were more common in patients with poor outcome (P = 0.007). These lesions affected mostly gray matter (deep or cortical), with or without involvement of the underlying white matter. Lesions in the occipital and temporal lobes, deep gray matter and cerebellum showed strongest associations with poor outcome. Decreased apparent diffusion coefficient, was more common in patients with poor outcome.

CONCLUSIONS:

Extensive acute hypoxic/ischemic MRI lesions in the cortical regions, deep gray matter and cerebellum detected by visual analysis as well as low apparent diffusion coefficient values from quantitative measurements were associated with poor outcome. Patients with good outcome had minor hypoxic/ischemic changes, mainly in the frontal and parietal lobes.

National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-340789 (URN)10.1111/aas.13074 (DOI)000429532400007 ()29363101 (PubMedID)
Available from: 2018-02-02 Created: 2018-02-02 Last updated: 2018-06-19Bibliographically approved
Wallin, E., Larsson, I.-M., Nordmark-Grass, J., Rosenqvist, I., Kristofferzon, M.-L. & Rubertsson, S. (2018). Characteristics of jugular bulb oxygen saturation in patients after cardiac arrest: A prospective study. Acta Anaesthesiologica Scandinavica, 62(9), 1237-1245
Open this publication in new window or tab >>Characteristics of jugular bulb oxygen saturation in patients after cardiac arrest: A prospective study
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2018 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, no 9, p. 1237-1245Article in journal (Refereed) Published
Abstract [en]

Background: Using cerebral oxygen venous saturation post-cardiac arrest (CA) is limited because of a small sample size and prior to establishment of target temperature management (TTM). We aimed to describe variations in jugular bulb oxygen saturation during intensive care in relation to neurological outcome at 6 months post- CA in cases where TTM 33 degrees C was applied.

Method: Prospective observational study in patients over 18 years, comatose immediately after resuscitation from CA. Patients were treated with TTM 33 degrees C M and received a jugular bulb catheter within the first 26 hours post-CA. Neurological outcome was assessed at 6 months using the Cerebral Performance Categories (CPC) and dichotomized into good (CPC 1-2) and poor outcome (CPC 3-5).

Results: Seventy-five patients were included and 37 (49%) patients survived with a good outcome at 6 months post-CA. No differences were found between patients with good outcome and poor outcome in jugular bulb oxygen saturation. Higher values were seen in differences in oxygen content between central venous oxygen saturation and jugular bulb oxygen saturation in patients with good outcome compared to patients with poor outcome at 6 hours (12 [8-21] vs 5 [-0.3 to 11]% P = .001) post-CA. Oxygen extraction fraction from the brain illustrated lower values in patients with poor outcome compared to patients with good outcome at 96 hours (14 [9-23] vs 31 [25-34]% P = .008).

Conclusions: Oxygen delivery and extraction differed in patients with a good outcome compared to those with a poor outcome at single time points. Based on the present findings, the usefulness of jugular bulb oxygen saturation for prognostic purposes is uncertain in patients treated with TTM 33 degrees C post-CA.

Keywords
cardiac arrest, intensive care, jugular bulb saturation, neurological outcome, prognostication, target temperature management
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-364137 (URN)10.1111/aas.13162 (DOI)000443673500008 ()29797705 (PubMedID)
Available from: 2018-11-05 Created: 2018-11-05 Last updated: 2018-11-05Bibliographically approved
Lagedal, R., Elfwén, L., James, S. K., Oldgren, J., Erlinge, D., Östlund, O., . . . Nordberg, P. (2018). Design of DISCO-Direct or Subacute Coronary Angiography in Out-of-Hospital Cardiac Arrest study. American Heart Journal, 197, 53-61, Article ID S0002-8703(17)30376-9.
Open this publication in new window or tab >>Design of DISCO-Direct or Subacute Coronary Angiography in Out-of-Hospital Cardiac Arrest study
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2018 (English)In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 197, p. 53-61, article id S0002-8703(17)30376-9Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Acute coronary syndrome is a common cause of out-of-hospital cardiac arrest (OHCA). In patients with OHCA presenting with ST elevation, immediate coronary angiography and potential percutaneous coronary intervention (PCI) after return of spontaneous circulation are recommended. However, the evidence for this invasive strategy in patients without ST elevation is limited. Observational studies have shown a culprit coronary artery occlusion in about 30% of these patients, indicating the electrocardiogram's (ECG's) limited sensitivity. The aim of this study is to determine whether immediate coronary angiography and subsequent PCI will provide outcome benefits in OHCA patients without ST elevation.

METHODS/DESIGN: We describe the design of the DIrect or Subacute Coronary angiography in Out-of-hospital cardiac arrest study (DISCO)-a pragmatic national, multicenter, randomized, clinical study. OHCA patients presenting with no ST elevation on their first recorded ECG will be randomized to a strategy of immediate coronary angiography or to standard of care with admission to intensive care and angiography after 3days at the earliest unless the patient shows signs of acute ischemia or hemodynamic instability. Primary end point is 30-day survival. An estimated 1,006 patients give 80% power (α = .05) to detect a 20% improved 30-day survival rate from 45% to 54%. Secondary outcomes include good neurologic recovery at 30days and 6months, and cognitive function and cardiac function at 6months.

CONCLUSION: This randomized clinical study will evaluate the effect of immediate coronary angiography after OHCA on 30-day survival in patients without ST elevation on their first recorded ECG.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-342766 (URN)10.1016/j.ahj.2017.11.009 (DOI)000425723700007 ()29447784 (PubMedID)
Available from: 2018-02-23 Created: 2018-02-23 Last updated: 2018-05-03Bibliographically approved
Israelsson, J., Bremer, A., Herlitz, J., Axelsson, A. B., Cronberg, T., Djarv, T., . . . Arestedt, K. (2017). Health status and psychological distress among in-hospital cardiac arrest survivors in relation to gender. Resuscitation, 114, 27-33
Open this publication in new window or tab >>Health status and psychological distress among in-hospital cardiac arrest survivors in relation to gender
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2017 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 114, p. 27-33Article in journal (Refereed) Published
Abstract [en]

Aim: To describe health status and psychological distress among in -hospital cardiac arrest (IHCA) survivors in relation to gender. Methods: This national register study consists of data from follow-up registration of IHCA survivors 3-6 months post cardiac arrest (CA) in Sweden. A questionnaire was sent to the survivors, including measurements of health status (EQ-5D-5L) and psychological distress (HADS). Results: Between 2013 and 2015, 594 IHCA survivors were included in the study. The median values for EQ-5D-5L index and EQVAS among survivors were 0.78 (ql-q3 = 0.67-0.86) and 70 (ql -q3 = 50-80) respectively. The values were significantly lower (p < 0.001) in women compared to men. In addition, women reported more problems than men in all dimensions of EQ-5D-5L, except self -care. A majority of the respondents reported no problems with anxiety (85.4%) and/or symptoms of depression (87.0%). Women reported significantly more problems with anxiety (p < 0.001) and symptoms of depression (p < 0.001) compared to men. Gender was significantly associated with poorer health status and more psychological distress. No interaction effects for gender and age were found. Conclusions: Although the majority of survivors reported acceptable health status and no psychological distress, a substantial proportion reported severe problems. Women reported worse health status and more psychological distress compared to men. Therefore, a higher proportion of women may be in need of support. Health care professionals should make efforts to identify health problems among survivors and offer individualised support when needed. (C) 2017 Elsevier B.V. All rights reserved.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2017
Keywords
Anxiety, Depression, Health status, Heart arrest, Hospitals, Gender
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-327055 (URN)10.1016/j.resuscitation.2017.02.006 (DOI)000402487800021 ()28216089 (PubMedID)
Available from: 2017-08-03 Created: 2017-08-03 Last updated: 2017-08-03Bibliographically approved
Wallin, E., Larsson, I.-M., Kristofferzon, M.-L., Rubertsson, S., Larsson, E.-M. & Raininko, R. (2015). Acute brain lesions on MRI in relation to neurological outcome 6 months after cardiac arrest treated with hypothermia.. Paper presented at Congress of European Resuscitation Council 2015, Prag, Czech Republic. Resuscitation, 96(Suppl1), 147
Open this publication in new window or tab >>Acute brain lesions on MRI in relation to neurological outcome 6 months after cardiac arrest treated with hypothermia.
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2015 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 96, no Suppl1, p. 147-Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Aim of the study: To document the acute magnetic resonance imaging (MRI) findings on the brain in cardiac arrest (CA) patients treated with therapeutic hypothermia (TH) and their relation to patients’ neurological outcome after 6 months.

Method: A prospective observational study with MRI was performed regardless the level of consciousness in 56 post-CA patients treated with TH.

Results: MRI of the brain was obtained at a median of 4 days  (3-13 days). At 6 months, 32/56 had survived with good neurological outcome. The MMSE was performed in 28/32 (88%) patients with a median of 28 (24-30). Acute ischemic lesions were found on diffusion-weighted MRI (DWI) in 34 (61%) patients and were more common in patients with poor outcome (p=0.006). Acute ischemic injuries affected mostly gray matter, deep or cortical and with or without involvement of the underlying white matter. Very few lesions were pure white matter lesions. Lesions in the occipital and temporal lobes, deep gray matter and cerebellum were most associated with poor outcome. Reductions in the apparent diffusion coefficient (ADC) were more common in patients with poor outcome, particularly in the occipital lobes. None of the patients with an ADC below 600x10-6 mm2/s in any region survived to 6 months.

Conclusions: In visual analyses of acute MRI, extensive acute lesions were found in the cortical regions and gray matter and were associated with poor outcome. In ADC measurements, low values were associated with poor outcome. Patients with good outcome showed a minor pathological pattern mainly in the frontal and parietal lobes.

 

Keywords
cardiac arrest, hypothermia, MRI, diffusion brain acute lesions, neurological outcome
National Category
Anesthesiology and Intensive Care Neurology Radiology, Nuclear Medicine and Medical Imaging
Research subject
Medical Science; Anaesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-248025 (URN)
Conference
Congress of European Resuscitation Council 2015, Prag, Czech Republic
Available from: 2015-04-15 Created: 2015-03-26 Last updated: 2017-10-25
Wallin, E. (2015). Post Cardiac Arrest Care: Evaluation of prognostic tools, Patient outcomes and Relatives’ experiences at 6 months after the event. (Doctoral dissertation). Uppsala: Acta Universitatis Upsaliensis
Open this publication in new window or tab >>Post Cardiac Arrest Care: Evaluation of prognostic tools, Patient outcomes and Relatives’ experiences at 6 months after the event
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of the present thesis was to study post-resuscitation care of cardiac arrest (CA) patients treated with target temperature management 33°C with a focus on evaluation of two prognostic tools: variations in cerebral venous saturation and acute magnetic resonance imaging (MRI) findings on the brain post-CA. An additional aim was to investigate patients’ neurological outcome and relatives’ experiences 6 months after the event. Paper I describes the cerebral oxygen saturation of blood obtained from a jugular bulb (SjvO2) catheter The results showed that patients with poor outcome tended to have higher SjvO2values,but this difference was only significant at 96 and108 hours post-CA. The main findings of Paper II were that patients with good outcome displayed a pathological pattern mainly in the frontal and parietal lobes on MRI of the brain. Patients with poor outcome had an extensive pathological pattern in several brain regions. Furthermore, very low apparent diffusion coefficient (ADC) values were associated with poor outcome regardless of brain region. Paper III investigated physical and cognitive function over time, between one month and 6 months post-CA, as well as d life satisfaction at 6 months. The results showed that impairment in physical and cognitive function is common in CA survivors but tends to decrease over time. Despite a severe illness, which has impaired the physical and cognitive functions, satisfaction with life as a whole was reported by 70% of CA survivors. In Paper IV, relatives described their experiences 6 months after a significant others CA. The analysis resulted in three themes reflecting relatives’ everyday life 6 months after the event: Difficulties managing a changed life situation, Feeling like I come second and Feeling new hope for the future. In conclusion, the results of the present thesis have increased our understanding of the two prognostic tools that were investigated; they have generated new and revealed aspects that should be taken into account during prognostication and assessing neurological outcome of this group of patients. The thesis has also shown that the healthcare needs to improve its routines for follow-ups and information provision to both patients and their relatives.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2015. p. 90
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1094
Keywords
cardiac arrest, hypothermia, neurological outcome, cerebral oxygenation, MRI, relatives
National Category
Anesthesiology and Intensive Care
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-248044 (URN)978-91-554-9225-0 (ISBN)
Public defence
2015-05-22, Grönvallsalen, ing 70, bv., Akademiska sjukhuset, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2015-04-28 Created: 2015-03-26 Last updated: 2015-07-07
Lilja, G., Erlinge, D., Larsson, I.-M., Wallin, E., Åkerman, E. & Cronberg, T. (2015). Uppföljning av patient och närstående efter hjärtstopp varierar stort. Läkartidningen, 112
Open this publication in new window or tab >>Uppföljning av patient och närstående efter hjärtstopp varierar stort
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2015 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112Article in journal (Refereed) Published
Abstract [sv]

The return to a good life after successfully resuscitated cardiac arrest may be hindered by cardiovascular morbidity, psychological distress and the consequences of anoxic brain injury. To support the return to everyday life, patients and their relatives are in need of health care follow-up with multiple focuses. Usually, this follow-up consists of at least one of  three parallel tracks; cardiology for interventions and secondary prevention, post  intensive care follow-up to capture and prevent consequences of the traumatic event and the ICU stay, or neurological follow-up for patients with neurological sequels. None of these tracks include all patients. In addition, survivors are usually included and followed with patient related outcome measures (PROM) through the multiple Swedish national quality registers. The different clinical follow-up systems and the registers are not coordinated and assessments and questions may be repeated multiple times. A more integrated follow-up model has the potential to benefit the patient and their relatives and to reduce costs.

Keywords
MRI, relaxivity, contrast agent, perfusion
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-269634 (URN)25825879 (PubMedID)
Available from: 2015-12-17 Created: 2015-12-17 Last updated: 2017-12-01
Wallin, E., Larsson, I.-M., Rubertsson, S. & Kristofferzon, M.-L. (2014). Cardiac arrest and hypothermia treatment-function and life satisfaction among survivors in the first 6 months. Resuscitation, 85(4), 538-543
Open this publication in new window or tab >>Cardiac arrest and hypothermia treatment-function and life satisfaction among survivors in the first 6 months
2014 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 85, no 4, p. 538-543Article in journal (Refereed) Published
Abstract [en]

Aim of the study: To describe differences over time in outcome, physical and cognitive function among survivors of cardiac arrest treated with hypothermia and to examine survivors' life satisfaction 6 months after cardiac arrest as well as gender differences. Methods: The study was prospective and included 45 cardiac arrest survivors admitted to three Swedish hospitals between 2008 and 2012. Participants were followed from intensive care unit discharge to one and six months after cardiac arrest. In addition to cerebral performance category (CPC), participants were asked to complete questionnaires regarding activities in daily life (Barthel index), cognitive function (mini mental state examination), and life satisfaction (LiSat-11). Results: Outcome measured using CPC scores improved over time. At 6 months, all participants were classified as having a good outcome. At one month, participants were impaired but improved over time in their activities in daily life and cognitive function. At 6 months satisfaction with "life as a whole" was seen in 70%. Conclusions: Cardiac arrest survivors are satisfied with life as a whole despite a severe illness that has impaired their physical and cognitive function, which seemed to improve over time. Predicting patients' functional outcome in early stages is difficult, and the CPC score alone is not sufficient to assess patients' function. It is a need to reach a consensus to which instruments best reflect physical and cognitive function as well as to specify a rehabilitation plan.

Keywords
Cardiac arrest, Hypothermia treatment, Intensive care, Neurological outcome, Cognitive function, Life satisfaction
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-223881 (URN)10.1016/j.resuscitation.2013.12.020 (DOI)000332778000030 ()
Available from: 2014-05-05 Created: 2014-04-28 Last updated: 2017-12-05Bibliographically approved
Larsson, I.-M., Wallin, E., Rubertsson, S. & Kristofferzon, M.-L. (2014). Health-related quality of life improves during the first six months after cardiac arrest and hypothermia treatment. Resuscitation, 85(2), 215-220
Open this publication in new window or tab >>Health-related quality of life improves during the first six months after cardiac arrest and hypothermia treatment
2014 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 85, no 2, p. 215-220Article in journal (Refereed) Published
Abstract [en]

Aim of the study: To investigate whether there were any changes in and correlations between anxiety, depression and health-related quality of life (HRQoL) over time, between hospital discharge and one and six months after cardiac arrest (CA), in patients treated with therapeutic hypothermia (TH).

Method: During a 4-year period at three hospitals in Sweden, 26 patients were prospectively included after CA treated with TH. All patients completed the questionnaires Hospital Anxiety and Depression Scale (HADS), Euroqol (EQ5D), Euroqol visual analogue scale (EQ-VAS) and Short Form 12 (SF12) at three occasions, at hospital discharge, and at one and 6 months after CA.

Result: There was improvement over time in HRQoL, the EQ5D index (p = 0.002) and the SF12 physical component score (PCS) (p = 0.005). Changes over time in anxiety and depression were not found. Seventy-three percent of patients had an EQ-VAS score below 70 (scale 0-100) on overall health status at discharge from hospital; at 6 months the corresponding figure was 41%. Physical problems were the most common complaint affecting HRQoL. A correlation was found between depression and HRQoL, and this was strongest at six months (rs = -0.44 to -0.71, p = 0.001).

Conclusion: HRQoL improves over the first 6 months after a CA. Patients reported lower levels of HRQoL on the physical as compared to mental component. The results indicate that the less anxiety and depression patients perceive, the better HRQoL they have and that time can be an important factor in recovery after CA.

National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-211415 (URN)10.1016/j.resuscitation.2013.09.017 (DOI)000332776200019 ()24096198 (PubMedID)
Available from: 2013-11-22 Created: 2013-11-22 Last updated: 2017-12-06Bibliographically approved
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