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[PMID]: 27797160
[Au] Autor:Orr JE; Malhotra A; Sands SA
[Ad] Address:Division of Pulmonary and Critical Care Medicine, University of California San Diego, La Jolla, California, USA.
[Ti] Title:Pathogenesis of central and complex sleep apnoea.
[So] Source:Respirology;, 2016 Oct 31.
[Is] ISSN:1440-1843
[Cp] Country of publication:Australia
[La] Language:ENG
[Ab] Abstract:Central sleep apnoea (CSA) - the temporary absence or diminution of ventilatory effort during sleep - is seen in a variety of forms including periodic breathing in infancy and healthy adults at altitude and Cheyne-Stokes respiration in heart failure. In most circumstances, the cyclic absence of effort is paradoxically a consequence of hypersensitive ventilatory chemoreflex responses to oppose changes in airflow, that is elevated loop gain, leading to overshoot/undershoot ventilatory oscillations. Considerable evidence illustrates overlap between CSA and obstructive sleep apnoea (OSA), including elevated loop gain in patients with OSA and the presence of pharyngeal narrowing during central apnoeas. Indeed, treatment of OSA, whether via continuous positive airway pressure (CPAP), tracheostomy or oral appliances, can reveal CSA, an occurrence referred to as complex sleep apnoea. Factors influencing loop gain include increased chemosensitivity (increased controller gain), reduced damping of blood gas levels (increased plant gain) and increased lung to chemoreceptor circulatory delay. Sleep-wake transitions and pharyngeal dilator muscle responses effectively raise the controller gain and therefore also contribute to total loop gain and overall instability. In some circumstances, for example apnoea of infancy and central congenital hypoventilation syndrome, central apnoeas are the consequence of ventilatory depression and defective ventilatory responses, that is low loop gain. The efficacy of available treatments for CSA can be explained in terms of their effects on loop gain, for example CPAP improves lung volume (plant gain), stimulants reduce the alveolar-inspired PCO2 difference and supplemental oxygen lowers chemosensitivity. Understanding the magnitude of loop gain and the mechanisms contributing to instability may facilitate personalized interventions for CSA.
[Pt] Publication type:REVIEW; JOURNAL ARTICLE
[Em] Entry month:1610
[Cu] Class update date: 161031
[Lr] Last revision date:161031
[St] Status:Publisher
[do] DOI:10.1111/resp.12927

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[PMID]: 27797159
[Au] Autor:Churilla TM; Egleston B; Bleicher R; Dong Y; Meyer J; Anderson P
[Ad] Address:Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania. thomas.churilla@fccc.edu.
[Ti] Title:Disparities in the Local Management of Breast Cancer in the US according to Health Insurance Status.
[So] Source:Breast J;, 2016 Oct 31.
[Is] ISSN:1524-4741
[Cp] Country of publication:United States
[La] Language:ENG
[Ab] Abstract:Although standard practice guidelines for breast cancer are clear, the interplay between insurance and practice patterns for the US is poorly defined. This study was performed to test for associations between patient insurance status and presentation of breast cancer as well as local therapy patterns in the US, via a large national dataset. We queried the NCI Surveillance, Epidemiology, and End Results data base for breast cancer cases diagnosed from 2007 to 2011 in women aged 18-64 with nonmetastatic ductal/lobular cancers, treated surgically. We tested for associations between insurance status (insured/Medicaid/uninsured) and choice of surgical procedure (mastectomy/breast conserving surgery [BCS]), omission of radiotherapy (RT) following BCS, and administration of post-mastectomy radiation (PMRT). There were 129,565 patients with localized breast cancer analyzed. The health insurance classification included insured (84.5%), Medicaid (11.5%), uninsured (2.1%) and unknown (1.9%). Medicaid or uninsured status was associated with large, node positive tumors, black race, and low income. The BCS rate varied by insurance status: insured (52.2%), uninsured (47.7%), and Medicaid (45.2%), p < 0.001. In multivariable analysis, Medicaid insurance remained significantly associated with receipt of mastectomy (OR [95% CI] = 1.07 [1.03-1.11]), while RT was more frequently omitted after BCS in both Medicaid (OR [95% CI] = 1.14 [1.07-1.21]) and uninsured (OR [95% CI] = 1.29 [1.14-1.47]) patients. Insurance status was associated with significant variations in breast cancer care in the US. Although patient choice cannot be determined from this dataset, departure from standard of care is associated with specific types of insurance coverage. Further investigation into the reasons for these departures is strongly suggested.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1610
[Cu] Class update date: 161031
[Lr] Last revision date:161031
[St] Status:Publisher
[do] DOI:10.1111/tbj.12705

  3 / 4612282 MEDLINE  
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[PMID]: 27797157
[Au] Autor:Golestanirad L; Angelone LM; Iacono MI; Katnani H; Wald LL; Bonmassar G
[Ad] Address:Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA. lgolestanirad@mgh.harvard.edu.
[Ti] Title:Local SAR near deep brain stimulation (DBS) electrodes at 64 and 127 MHz: A simulation study of the effect of extracranial loops.
[So] Source:Magn Reson Med;, 2016 Oct 31.
[Is] ISSN:1522-2594
[Cp] Country of publication:United States
[La] Language:ENG
[Ab] Abstract:PURPOSE: MRI may cause brain tissue around deep brain stimulation (DBS) electrodes to become excessively hot, causing lesions. The presence of extracranial loops in the DBS lead trajectory has been shown to affect the specific absorption rate (SAR) of the radiofrequency energy at the electrode tip, but experimental studies have reported controversial results. The goal of this study was to perform a systematic numerical study to provide a better understanding of the effects of extracranial loops in DBS leads on the local SAR during MRI at 64 and 127 MHz. METHODS: A total of 160 numerical simulations were performed on patient-derived data, in which relevant factors including lead length and trajectory, loop location and topology, and frequency of MRI radiofrequency (RF) transmitter were assessed. RESULTS: Overall, the presence of extracranial loops reduced the local SAR in the tissue around the DBS tip compared with straight trajectories with the same length. SAR reduction was significantly larger at 127 MHz compared with 64 MHz. SAR reduction was significantly more sensitive to variable loop parameters (eg, topology and location) at 127 MHz compared with 64 MHz. CONCLUSION: Lead management strategies could exist that significantly reduce the risks of 3 Tesla (T) MRI for DBS patients. Magn Reson Med, 2016. © 2016 International Society for Magnetic Resonance in Medicine.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1610
[Cu] Class update date: 161031
[Lr] Last revision date:161031
[St] Status:Publisher
[do] DOI:10.1002/mrm.26535

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[PMID]: 27797154
[Au] Autor:Masheb RM; Dorflinger LM; Rolls BJ; Mitchell DC; Grilo CM
[Ad] Address:Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.
[Ti] Title:Binge abstinence is associated with reduced energy intake after treatment in patients with binge eating disorder and obesity.
[So] Source:Obesity (Silver Spring);, 2016 Oct 31.
[Is] ISSN:1930-739X
[Cp] Country of publication:United States
[La] Language:ENG
[Ab] Abstract:OBJECTIVE: Binge eating disorder (BED) is strongly associated with obesity and related medical and psychiatric morbidities. Cognitive behavioral therapy (CBT) has consistently been shown to reduce binge eating frequency and improve psychological functioning, as well as to produce abstinence rates of roughly 50%. This study examined the relationship between binge abstinence and dietary and psychological outcomes after CBT for BED. METHODS: Fifty adult patients with BED received 6-month treatments using a combination of CBT and dietary counseling. Trained interviewers conducted two 24-hour dietary recall interviews on randomly selected days at baseline and at 6 months. RESULTS: Participants had significant reductions in energy, macronutrient, and sugar intake and an increase in fruit intake. They reported significant reductions in BMI and binge eating frequency (from mean = 14.24 to mean = 1.90 binge eating episodes during the previous 28 days), as well as improvements in psychological functioning. Those who became binge abstinent reported eating roughly 400 fewer calories per day and experienced greater improvements in psychological functioning than those who did not. CONCLUSIONS: Findings from this study suggest that individuals who achieve complete cessation from binge eating have significantly improved dietary and psychological outcomes that could potentially improve weight status, compared with those who continue to binge eat post-treatment.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1610
[Cu] Class update date: 161031
[Lr] Last revision date:161031
[St] Status:Publisher
[do] DOI:10.1002/oby.21664

  5 / 4612282 MEDLINE  
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[PMID]: 27797142
[Au] Autor:Hu L; Gao Y; Cao Y; Zhang Y; Xu M; Wang Y; Jing Y; Guo S; Jing F; Hu X; Zhu Z
[Ad] Address:Cancer Center, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, People's Republic of China.
[Ti] Title:Association of plasma arginine with breast cancer molecular subtypes in women of Liaoning province.
[So] Source:IUBMB Life;, 2016 Oct 31.
[Is] ISSN:1521-6551
[Cp] Country of publication:England
[La] Language:ENG
[Ab] Abstract:Arginine is one of the human nonessential amino acids critical for the growth of human cancers. The aim of this study is to investigate the variation of arginine between breast cancer (BC) patients and benign mammary gland disease (control) patients to determine its value in predicting the risk of BC. We also explore the associations between arginine levels and breast cancer subtypes. Preoperative blood samples were obtained from 267 patients (102 BC and 165 controls) in 2015. Plasma arginine values were determined for all preoperative blood samples using liquid chromatography-tandem mass spectrometry (LC-MS/MS) to analyse differences in arginine levels between BC patients and control patients and the correlations between arginine and clinicopathologic parameters in BC. The arginine levels of BC patients were significantly lower than those of control patients (5.96 [3.76-12.47] vs. 12.54 [7.14-24.94], P = 0.000). The area under the curve (AUC) for arginine was 0.721 (95% CI, 0.660-0.782, P < 0.0001). The concentration of arginine was significantly different among different molecular BC subtypes (P = 0.030). Our results suggested that plasma arginine was associated with breast cancer molecular subtypes. © 2016 IUBMB Life, 2016.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1610
[Cu] Class update date: 161031
[Lr] Last revision date:161031
[St] Status:Publisher
[do] DOI:10.1002/iub.1581

  6 / 4612282 MEDLINE  
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[PMID]: 27797139
[Au] Autor:Switon K; Kotulska K; Janusz-Kaminska A; Zmorzynska J; Jaworski J
[Ad] Address:Laboratory of Molecular and Cellular Neurobiology, International Institute of Molecular and Cell Biology, Warsaw, Poland.
[Ti] Title:Tuberous sclerosis complex: From molecular biology to novel therapeutic approaches.
[So] Source:IUBMB Life;, 2016 Oct 31.
[Is] ISSN:1521-6551
[Cp] Country of publication:England
[La] Language:ENG
[Ab] Abstract:Tuberous sclerosis complex (TSC) is a rare multi-system disorder, primary manifestations of which are benign tumors and lesions in various organs of the body, including the brain. TSC patients often suffer from epilepsy, mental retardation, and autism spectrum disorder (ASD). Therefore, TSC serves as a model of epilepsy, ASD, and tumorigenesis. TSC is caused by the lack of functional Tsc1-Tsc2 complex, which serves as a major cellular inhibitor of mammalian Target of Rapamycin Complex 1 (mTORC1). mTORC1 is a kinase controlling most of anabolic processes in eukaryotic cells. Consequently, mTORC1 inhibitors, such as rapamycin, serve as experimental or already approved drugs for several TSC symptoms. However, rapalogs, although quite effective, need to be administered chronically and likely for a lifetime, since therapy discontinuation results in tumor regrowth and epilepsy recurrence. Recent studies revealed that metabolism and excitability (in the case of neurons) of cells lacking Tsc1-Tsc2 complex are changed, and these features may potentially be used to treat some of TSC symptoms. In this review, we first provide basic facts about TSC and its molecular background, to next discuss the newest findings in TSC cell biology that can be used to improve existing therapies of TSC and other diseases linked to mTORC1 hyperactivation. © 2016 The Authors IUBMB Life published by Wiley Periodicals, Inc. on behalf of International Union of Biochemistry and Molecular Biology, 2016.
[Pt] Publication type:REVIEW; JOURNAL ARTICLE
[Em] Entry month:1610
[Cu] Class update date: 161031
[Lr] Last revision date:161031
[St] Status:Publisher
[do] DOI:10.1002/iub.1579

  7 / 4612282 MEDLINE  
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[PMID]: 27797135
[Au] Autor:Seely JM; Verma R; Kielar A; Smyth KR; Hack K; Taljaard M; Gravel D; Ellison E
[Ad] Address:Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada. jeseely@ottawahospital.on.ca.
[Ti] Title:Benign Papillomas of the Breast Diagnosed on Large-Gauge Vacuum Biopsy compared with 14 Gauge Core Needle Biopsy - Do they require surgical excision?
[So] Source:Breast J;, 2016 Oct 31.
[Is] ISSN:1524-4741
[Cp] Country of publication:United States
[La] Language:ENG
[Ab] Abstract:To evaluate whether biopsy with vacuum-assisted biopsy (VAB) devices improves histologic underestimation rates of benign papillomas when compared to smaller bore core needle biopsy (CNB) devices. Patients with biopsy-proven benign papillomas with surgical resection or minimum 12 months follow-up were selected. Two breast pathologists reviewed all pathology slides of percutaneous and excisional biopsy specimens. Histologic underestimation rates for lesions biopsied with 10-12 Gauge (G) VAB were compared to those with 14G CNB. A total of 107 benign papillomas in 107 patients from two centers were included. There were 60 patients (mean age 57 years, SD 10.3 years) diagnosed with VAB and 47 patients (mean age 57.6 years, SD 11.3 years) with 14G CNB who underwent surgical excision or imaging follow-up. The upgrade rate to ductal carcinoma in situ or invasive carcinoma was 1.6% (1/60) with VAB and 8.5% (4/47) with 14G. Upgrade to atypia was 3.3% (2/60) after VAB and 10.6% (5/47) with CNB. The total underestimation rates were 5% (3/60) with VAB and 19.1% (9/47) with CNB. The odds of an upgrade to malignancy was 5.5 times higher with a 14G needle than VAB (95% CI: 0.592-50.853, p = 0.17). We observed a lower but not statistically significant upgrade rate to malignancy and atypia with the use of the 10-12 G VAB as compared with 14G CNB. When a papilloma without atypia is diagnosed with vacuum biopsy there is a high likelihood that it is benign; however, if surgical excision is not performed, long-term follow-up is still required.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1610
[Cu] Class update date: 161031
[Lr] Last revision date:161031
[St] Status:Publisher
[do] DOI:10.1111/tbj.12702

  8 / 4612282 MEDLINE  
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[PMID]: 27797130
[Au] Autor:Maimone S; McDonough M
[Ad] Address:Department of Radiology, Mayo Clinic Florida, Jacksonville, Florida. maimone.santo@mayo.edu.
[Ti] Title:Dense Breast Notification and Supplemental Screening: A Survey of Current Strategies and Sentiments.
[So] Source:Breast J;, 2016 Oct 31.
[Is] ISSN:1524-4741
[Cp] Country of publication:United States
[La] Language:ENG
[Ab] Abstract:Dense breast parenchyma obscures breast lesions and has been shown to be an independent risk factor for development of breast cancer. An ever-increasing number of states have approved laws requiring patient notification of dense breast tissue. Reviews of supplemental screening imaging modalities are available, but there is no consensus and little discussion regarding what radiologists are specifically doing to manage patients with dense breasts. Our goal was to survey breast imagers facing these issues in an effort to simplify dense breast management. A survey was administered via email to the Society of Breast Imaging member directory, designed to collect information regarding current practices in dense breast notification and supplemental screening. There were 223 surveys completed to entirety, including 38% from respondents in states without mandatory breast density reporting laws and 62% from states with reporting laws. A majority of respondents from both groups, 60% and 51% in those without and with laws, respectively, felt they lacked adequate resources to offer or sustain supplemental screening. In those offering supplemental imaging, the modalities offered varied widely as did the manner of offering a supplemental exam. Levels of satisfaction, concerns, and standard practices of respondents were also queried. Strategizing optimal imaging approaches and algorithms to handle dense breast management issues is important to maintain efficiency in breast imaging departments. Sharing current ideas and practices may facilitate a smoother workflow in mandatory dense breast reporting and supplemental imaging, allowing breast imagers to correct or prevent systems-based flaws.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1610
[Cu] Class update date: 161031
[Lr] Last revision date:161031
[St] Status:Publisher
[do] DOI:10.1111/tbj.12712

  9 / 4612282 MEDLINE  
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[PMID]: 27797129
[Au] Autor:Desborough M; Hadjinicolaou AV; Chaimani A; Trivella M; Vyas P; Doree C; Hopewell S; Stanworth SJ; Estcourt LJ
[Ad] Address:Haematology/Transfusion Medicine, NHS Blood and Transplant, Oxford, UK.
[Ti] Title:Alternative agents to prophylactic platelet transfusion for preventing bleeding in people with thrombocytopenia due to chronic bone marrow failure: a meta-analysis and systematic review.
[So] Source:Cochrane Database Syst Rev;10:CD012055, 2016 Oct 31.
[Is] ISSN:1469-493X
[Cp] Country of publication:England
[La] Language:ENG
[Ab] Abstract:BACKGROUND: People with thrombocytopenia due to bone marrow failure are vulnerable to bleeding. Platelet transfusions have limited efficacy in this setting and alternative agents that could replace, or reduce platelet transfusion, and are effective at reducing bleeding are needed. OBJECTIVES: To compare the relative efficacy of different interventions for patients with thrombocytopenia due to chronic bone marrow failure and to derive a hierarchy of potential alternative treatments to platelet transfusions. SEARCH METHODS: We searched for randomised controlled trials (RCTs) in the Cochrane Central Register of Controlled Trials (the Cochrane Library 2016, Issue 3), MEDLINE (from 1946), Embase (from 1974), CINAHL (from 1937), the Transfusion Evidence Library (from 1980) and ongoing trial databases to 27 April 2016. SELECTION CRITERIA: We included randomised controlled trials in people with thrombocytopenia due to chronic bone marrow failure who were allocated to either an alternative to platelet transfusion (artificial platelet substitutes, platelet-poor plasma, fibrinogen concentrate, recombinant activated factor VII (rFVIIa), desmopressin (DDAVP), recombinant factor XIII (rFXIII), recombinant interleukin (rIL)6 or rIL11, or thrombopoietin (TPO) mimetics) or a comparator (placebo, standard of care or platelet transfusion). We excluded people undergoing intensive chemotherapy or stem cell transfusion. DATA COLLECTION AND ANALYSIS: Two review authors independently screened search results, extracted data and assessed trial quality. We estimated summary risk ratios (RR) for dichotomous outcomes. We planned to use summary mean differences (MD) for continuous outcomes. All summary measures are presented with 95% confidence intervals (CI).We could not perform a network meta-analysis because the included studies had important differences in the baseline severity of disease for the participants and in the number of participants undergoing chemotherapy. This raised important concerns about the plausibility of the transitivity assumption in the final dataset and we could not evaluate transitivity statistically because of the small number of trials per comparison. Therefore, we could only perform direct pairwise meta-analyses of included interventions.We employed a random-effects model for all analyses. We assessed statistical heterogeneity using the I(2) statistic and its 95% CI. The risk of bias of each study included was assessed using the Cochrane 'Risk of bias' tool. The quality of the evidence was assessed using GRADE methods. MAIN RESULTS: We identified seven completed trials (472 participants), and four ongoing trials (recruiting 837 participants) which are due to be completed by December 2020. Of the seven completed trials, five trials (456 participants) compared a TPO mimetic versus placebo (four romiplostim trials, and one eltrombopag trial), one trial (eight participants) compared DDAVP with placebo and one trial (eight participants) compared tranexamic acid with placebo. In the DDAVP trial, the only outcome reported was the bleeding time. In the tranexamic acid trial there were methodological flaws and bleeding definitions were subject to significant bias. Consequently, these trials could not be incorporated into the quantitative synthesis. No randomised trial of artificial platelet substitutes, platelet-poor plasma, fibrinogen concentrate, rFVIIa, rFXIII, rIL6 or rIL11 was identified.We assessed all five trials of TPO mimetics included in this review to be at high risk of bias because the trials were funded by the manufacturers of the TPO mimetics and the authors had financial stakes in the sponsoring companies.The GRADE quality of the evidence was very low to moderate across the different outcomes.There was insufficient evidence to detect a difference in the number of participants with at least one bleeding episode between TPO mimetics and placebo (RR 0.86, 95% CI 0.56 to 1.31, four trials, 206 participants, low-quality evidence).There was insufficient evidence to detect a difference in the risk of a life-threatening bleed between those treated with a TPO mimetic and placebo (RR 0.31, 95% CI 0.04 to 2.26, one trial, 39 participants, low-quality evidence).There was insufficient evidence to detect a difference in the risk of all-cause mortality between those treated with a TPO mimetic and placebo (RR 0.74, 95%CI 0.52 to 1.05, five trials, 456 participants, very low-quality evidence).There was a significant reduction in the number of participants receiving any platelet transfusion between those treated with TPO mimetics and placebo (RR 0.76, 95% CI 0.61 to 0.95, four trials, 206 participants, moderate-quality evidence).There was no evidence for a difference in the incidence of transfusion reactions between those treated with TPO mimetics and placebo (pOR 0.06, 95% CI 0.00 to 3.44, one trial, 98 participants, very low-quality evidence).There was no evidence for a difference in thromboembolic events between TPO mimetics and placebo (RR 1.41, 95%CI 0.39 to 5.01, five trials, 456 participants, very-low quality evidence).There was no evidence for a difference in drug reactions between TPO mimetics and placebo (RR 1.12, 95% CI 0.83 to 1.51, five trials, 455 participants, low-quality evidence).No trial reported the number of days of bleeding per participant, platelet transfusion episodes, mean red cell transfusions per participant, red cell transfusion episodes, transfusion-transmitted infections, formation of antiplatelet antibodies or platelet refractoriness.In order to demonstrate a reduction in bleeding events from 26 in 100 to 16 in 100 participants, a study would need to recruit 514 participants (80% power, 5% significance). AUTHORS' CONCLUSIONS: There is insufficient evidence at present for thrombopoietin (TPO) mimetics for the prevention of bleeding for people with thrombocytopenia due to chronic bone marrow failure. There is no randomised controlled trial evidence for artificial platelet substitutes, platelet-poor plasma, fibrinogen concentrate, rFVIIa, rFXIII or rIL6 or rIL11, antifibrinolytics or DDAVP in this setting.
[Pt] Publication type:REVIEW; JOURNAL ARTICLE
[Em] Entry month:1610
[Cu] Class update date: 161031
[Lr] Last revision date:161031
[St] Status:Publisher

  10 / 4612282 MEDLINE  
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[PMID]: 27797126
[Au] Autor:Altundag K
[Ad] Address:Tria Residence, Ankara, Turkey. altundag66@yahoo.com.
[Ti] Title:Primary Surgery After or Before Systemic Treatment May Affect the Survival Results in Stage IV Breast Cancer Patients.
[So] Source:Breast J;, 2016 Oct 31.
[Is] ISSN:1524-4741
[Cp] Country of publication:United States
[La] Language:ENG
[Pt] Publication type:LETTER
[Em] Entry month:1610
[Cu] Class update date: 161031
[Lr] Last revision date:161031
[St] Status:Publisher
[do] DOI:10.1111/tbj.12700


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