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[PMID]: 29517984
[Au] Autor:Wander P; Castaneda D; D'Souza L; Singh S; Serouya S; Velazquez AI; Mamun R; Voaklander R; Benias P; Carr-Locke DL
[Ad] Address:Department of Internal Medicine, Mount Sinai St Luke's and West Hospital.
[Ti] Title:Single Center Experience of a New Endoscopic Clip in Managing Nonvariceal Upper Gastrointestinal Bleeding.
[So] Source:J Clin Gastroenterol;52(4):307-312, 2018 Apr.
[Is] ISSN:1539-2031
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: To assess the safety and efficacy of the Instinct clip in the acute endoscopic treatment of upper gastrointestinal bleeding (UGIB). MATERIALS AND METHODS: This is the first large series reporting this clip in achieving hemostasis. A retrospective descriptive chart review was performed on patients presenting with recent overt GI bleeding treated with endoclip therapy at Mount Sinai Beth Israel Medical Center between May 2013 and January 2016. Results are expressed in absolute numbers, percentages, and trends. RESULTS: In total, 178 consecutive patients with UGIB were included. Source of bleeding was identified as duodenal ulcer (29.2%), gastric ulcer (22.5%), gastro-esophageal junction tear (8.4%), anastomosis (5.6%), erosive gastropathy (5.6%), Dieulafoy (5.1%), gastric polyp (4.5%), postendoscopic procedure (3.9%), angioectasia (3.4%), esophageal ulcer (2.8%), benign duodenal mass (2.8%), peg tube site (2.3%), gastric neoplasm (1.7%), esophagitis (1.1%), and small bowel ulcer (1.1%). Lesions demonstrated active bleeding in 47.5% (11.3% spurting and 36.2% oozing) and nonbleeding lesions in 52.5% (25.0% visible vessel, 11.9% hematin in ulcer base, 10.0% adherent clot, 5.6% flat spot). Initial hemostasis was achieved in 96.6%. Additional methods were used in 24.1% (argon plasma coagulation and epinephrine injection in 21.3%, surgery in 0.6%, and interventional radiology in 2.2%). There were no adverse events. In-hospital rebleeding was 7.3% and 3.9% presented with rebleeding within 30 days. Average procedure duration was 22.9 minutes and average length of hospital stay was 11.3 days. CONCLUSIONS: The Instinct clip, when used for UGIB, seems to be safe and effective with similar rebleeding rates compared with other modalities.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:In-Data-Review
[do] DOI:10.1097/MCG.0000000000000785

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[PMID]: 29511278
[Au] Autor:Refaeli R; Chodick G; Haj S; Goren S; Shalev V; Muhsen K
[Ad] Address:Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
[Ti] Title:Relationships of H. pylori infection and its related gastroduodenal morbidity with metabolic syndrome: a large cross-sectional study.
[So] Source:Sci Rep;8(1):4088, 2018 Mar 06.
[Is] ISSN:2045-2322
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:The few published studies on the relationship between Helicobacter pylori infection and metabolic homeostasis were relatively small and yielded inconsistent results. We examined the prevalence of metabolic syndrome in relation to H. pylori infection and its symptoms in a large and unselected population. Coded data from the computerised database of a large health maintenance organisation in Israel were accessed for 147,936 individuals 25-95 years of age who performed the urea breath test during 2002-2012. The classification of metabolic syndrome followed a modified definition of the international diabetes federation. Prevalences of H. pylori infection and metabolic syndrome were 52.0% and 11.4% respectively. H. pylori infected patients had increased likelihood of metabolic syndrome: adjusted odds ratio (aOR) 1.15 (95% confidence intervals (CI) 1.10-1.19), as did patients with gastric ulcer: aOR 1.15 (95% CI 1.03-1.28) vs patients without these conditions. Duodenal ulcer was associated with metabolic syndrome only in persons aged 25-34 years: aOR 1.59 (95% CI 1.19-2.13), but not in older persons (P = 0.001 for heterogeneity). In conclusion, the likelihood of metabolic syndrome appeared significantly increased in relation to H. pylori infection and gastric and duodenal ulcers. These findings suggest that H. pylori long-term gastric inflammation might play a role in metabolic homeostasis.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180307
[Lr] Last revision date:180307
[St] Status:In-Data-Review
[do] DOI:10.1038/s41598-018-22198-9

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[PMID]: 29427761
[Au] Autor:Markovska R; Boyanova L; Yordanov D; Stankova P; Gergova G; Mitov I
[Ad] Address:Department of Medical Microbiology, Medical University of Sofia, 1431 Sofia, Bulgaria. Electronic address: markovska73@abv.bg.
[Ti] Title:Status of Helicobacter pylori cag pathogenicity island (cagPAI) integrity and significance of its individual genes.
[So] Source:Infect Genet Evol;59:167-171, 2018 Feb 07.
[Is] ISSN:1567-7257
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:One of the most important virulence factors of H. pylori is the intact cagPAI. The aim of the present study is to investigate cagPAI intactness among Bulgarian H. pylori isolates, its associations with clinical outcomes and vacA alleles, and to evaluate the significance of individual cagPAI genes. MATERIAL AND METHODS: Totally, 156 isolates from 156 patients with endoscopic findings for duodenal or gastric ulcer (33 subjects), non-ulcer disease (121) and other diseases, such as Crohn's disease and hepatitis (2) were tested. Polymerase chain reaction (PCR) was used to detect 14 essential cagPAI genes, including cagA, as well as vacA s, i and m alleles. RESULTS: CagA positive were 81.4% of all H. pylori isolates. Intact cagPAI was found in 64.1% of the all isolates, 16.7% and 19.2% showed complete and partial cagPAI absence, respectively. The prevalence of all cagPAI genes and intact cagPAI was significantly higher in isolates from ulcer patients compared with those from non-ulcer patients (p = 0.001). The most frequently missing genes among the isolates with partially deleted cagPAIs were cagE or/and cagY (28 of 30 isolates). Overall prevalence of vacA s1a allele was 80.1% and that of vacA i1 was 64.1%. The vacA s1a, m1 and i1 alleles were more prevalent in H. pylori isolates from ulcer patients (p = 0.03, p = 0.009, and p = 0.0003, respectively) and were associated with isolates with intact cagPAI. CONCLUSIONS: In Bulgaria the prevalence of intact cagPAI was high. cagE or/and cagY absence was the most important predictor of cagPAI status.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180305
[Lr] Last revision date:180305
[St] Status:Publisher

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[PMID]: 29496075
[Au] Autor:Jia Z; Wang W
[Ad] Address:Department of Interventional Radiology, No. 2 People's Hospital of Changzhou, Nanjing Medical University, Changzhou, 213003, China.
[Ti] Title:Yttrium-90 radioembolization for unresectable metastatic neuroendocrine liver tumor: A systematic review.
[So] Source:Eur J Radiol;100:23-29, 2018 Mar.
[Is] ISSN:1872-7727
[Cp] Country of publication:Ireland
[La] Language:eng
[Ab] Abstract:OBJECTIVE: To evaluate the value of yttrium-90 ( Y) microspheres in the management of unresectable liver metastases secondary to neuroendocrine tumors (NETs). MATERIALS AND METHODS: PubMed, EMBASE, the Cochrane Database of Systematic Reviews, and the "gray" literature (Google Scholar) were searched for all studies related to Y therapy for unresectable liver metastases of NETs. RESULTS: A total of 11 studies and 7 abstracts involving 870 patients were included in the final analysis. In 11 of these studies, 19.8% (77/388) of patients had undergone transarterial bland embolization (TABE) or transarterial chemoembolization (TACE) before Y therapy. The median disease control rate among all patients was 86% at 3 months after Y therapy. The median survival was 28 months, with 1-, 2-, and 3-year survival rates of 72.5%, 57%, and 45%, respectively. The median survival values for patients who received resin- and glass-based Y treatment were 27.6 and 31.7 months, respectively. The survival values for patients with carcinoid, pancreatic, and unclassified origin of NETs were 56, 31, and 28 months, respectively; the survival values for patients with grade I, II, and III NETs were 71, 56, and 28 months, respectively. Carcinoid syndrome was reported in 52.4% (55/105) of patients, and 69.1% of those with clinical symptoms demonstrated improvement in symptoms after Y radioembolization. Complications were reported in 9 studies, including radiation gastritis (n = 4), duodenal ulcer (n = 2), death due to liver failure (n = 1), and radiation cholecystitis (n = 1). The most common side effects were abdominal pain (median, 32.6%), nausea/vomiting (median, 32.5%), and fatigue (median, 30.4%). CONCLUSIONS: Y radioembolization can be used as an alternative therapy for unresectable liver metastases of NETs, with an improved survival rate and tumor response. This treatment is also effective for patients who have undergone unsuccessful TABE/TACE therapy and for the relief of symptoms in patients with carcinoid syndrome.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1803
[Cu] Class update date: 180302
[Lr] Last revision date:180302
[St] Status:In-Process

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[PMID]: 29424988
[Au] Autor:Fedotova IV; Chernikova EF
[Ti] Title:[Stress as an occupational risk factor among policemen of road patrol service].
[So] Source:Gig Sanit;95(7):617-22, 2016.
[Is] ISSN:0016-9900
[Cp] Country of publication:Russia (Federation)
[La] Language:rus
[Ab] Abstract:The hygienic evaluation of occupational factors which characterized working conditions of traffic policemen of road patrol service was performed. The authors found that along with high neuro-emotional occupational stress in traffic policemen, they exposed to unfavorable microclimate, higher level of noise, vibration and their work was classified as heavy. Also, traffic policemen presented subjective complaints about negative impact of polluted air of motorways on their health status. Prevalence of chronic diseases was analyzed in group of 431 traffic policemen. The authors revealed a leading role of the following diseases: musculoskeletal diseases, diseases of connective tissue, digestive diseases, diseases of the nerve system, circulation system; their portion in the morbidity structure was 86.0%. The association of these diseases with occupation was confirmed by the increasing of their incidence with increasing of length of duration of service. Calculation of indices of relative occupational risk showed (that especially important) the increase of the length of service led to the increase in the risk ofpathologies, in which stress played a significant role. In examined group, the authors revealed such diseases as hypertension, autonomous-vascular dystonia, gastric and duodenal ulcer. Risk of the development of these diseases in some age/length of service groups is classified as high and very high. Obtained results provide the evidence that measures aimed to the decrease of the exposure to occupational factors will promote prevention of stress-stipulated diseases among traffic policemen.
[Mh] MeSH terms primary: Occupational Stress
Police/psychology
Vehicle Emissions/analysis
[Mh] MeSH terms secundary: Accidents, Traffic/legislation & jurisprudence
Accidents, Traffic/prevention & control
Adult
Air Pollutants/adverse effects
Air Pollutants/analysis
Humans
Male
Noise, Transportation/adverse effects
Occupational Exposure/adverse effects
Occupational Exposure/analysis
Occupational Exposure/prevention & control
Occupational Health/standards
Occupational Health/statistics & numerical data
Occupational Stress/epidemiology
Occupational Stress/etiology
Occupational Stress/prevention & control
Russia/epidemiology
[Pt] Publication type:JOURNAL ARTICLE
[Nm] Name of substance:0 (Air Pollutants); 0 (Vehicle Emissions)
[Em] Entry month:1803
[Cu] Class update date: 180301
[Lr] Last revision date:180301
[Js] Journal subset:IM
[Da] Date of entry for processing:180210
[St] Status:MEDLINE

  6 / 28592 MEDLINE  
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[PMID]: 29484934
[Au] Autor:Barrett-Lee J; Vatish J; Vazirian-Zadeh M; Waterland P
[Ad] Address:Dudley Group NHS Foundation Trust , UK.
[Ti] Title:Routine blood group and antibody screening prior to emergency laparoscopy.
[So] Source:Ann R Coll Surg Engl;:1-4, 2018 Feb 27.
[Is] ISSN:1478-7083
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Introduction Studies show that rates of blood transfusion associated with general surgical laparoscopy are low. Currently, there are no national guidelines in the UK regarding blood group and antibody screening (G&S) for patients undergoing emergency laparoscopy. The aim of this study was to assess whether using G&S before emergency laparoscopic general surgery routinely is worthwhile by identifying rates of perioperative transfusion. Methods Data were collected retrospectively on all emergency laparoscopic procedures at a single district general hospital between January 2014 and 31 December 2016. Emergency laparoscopic general surgical cases were included and gynaecological cases excluded. Records were reviewed to ascertain whether G&S was performed, whether antibodies were detected and whether patients were transfused. Results A total of 562 emergency laparoscopic cases were performed. The median age was 28 years (range: 6-95 years). Laparoscopic appendicectomy (n=446), diagnostic laparoscopy (n=47) and laparoscopic cholecystectomy (n=25) were the most common procedures. Of the total patient cohort, 514 (91.5%) and 349 (70.1%) had a first and second G&S respectively while 30 (5.3%) had no G&S. Four patients (0.71%) had antibodies detected. One patient (0.18%) received a transfusion. This patient had undergone laparoscopic repair of a perforated duodenal ulcer and there was no major intraoperative haemorrhage but he was transfused perioperatively for chronic anaemia. Conclusions These results demonstrate a low rate of blood transfusion in emergency laparoscopic general surgery. The majority of these patients had a low risk of major intraoperative haemorrhage and we therefore argue that G&S was not warranted. We propose a more targeted approach to the requirement for preoperative G&S and the use of O negative blood in the event of acute haemorrhage from major vessel injury.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180227
[Lr] Last revision date:180227
[St] Status:Publisher
[do] DOI:10.1308/rcsann.2018.0033

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[PMID]: 29470633
[Au] Autor:Kim TH; Park JH; Jeong SH; Lee JK; Kwag SJ; Kim JY; Lee W; Woo JW; Jang JY; Song EJ; Park T; Jeong CY; Ju YT; Jung EJ; Hong SC; Choi SK; Ha WS; Lee YJ
[Ad] Address:Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea.
[Ti] Title:Feasibility of a novel laparoscopic technique with unidirectional knotless barbed sutures for the primary closure of duodenal ulcer perforation.
[So] Source:Surg Endosc;, 2018 Feb 22.
[Is] ISSN:1432-2218
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:BACKGROUND: Laparoscopic primary repair is one of the main procedures used for perforated gastric ulcers, and this technique requires reproducible and secure suturing. The aim of this study was to investigate the safety and efficacy of a novel continuous suture method with barbed sutures during laparoscopic repair for perforated peptic ulcers. PATIENTS AND METHODS: Clinical data from 116 consecutive patients undergoing laparoscopic repair for perforated peptic ulcers were collected between November 2009 and October 2015. Continuous suturing with 15-cm-long unidirectional absorbable barbed sutures was used for laparoscopic repair in the study group, termed group V (n = 51). Patients who underwent laparoscopic repair with conventional interrupted sutures were defined as group C (n = 65). The complication and operative data were compared between groups. RESULTS: Although there was no difference between group V and group C in the overall complication rate (15.7% vs. 24.6%; p = 0.259), the complication rate related to suturing was lower (3.9% vs. 15.4%; p = 0.04) in group V. Group V showed rates of 0% for leakage, 2% for intra-abdominal fluid collection, and 2% for stricture; the corresponding rates in group C were 3.1, 7.7, and 4.6%, respectively. Regarding operative data, the total operation time (V vs. C, 87.7min vs. 131.2min), total suture time (7.1min vs. 25.3min), and suture time per stitch (1.2min vs. 6.2min) were significantly shorter in group V than in group C (p < 0.001). CONCLUSION: The use of a continuous suture technique with unidirectional barbed sutures is as safe as the conventional suture technique and allows easier and faster suturing in the repair of perforated peptic ulcers.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180222
[Lr] Last revision date:180222
[St] Status:Publisher
[do] DOI:10.1007/s00464-018-6099-y

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[PMID]: 29467124
[Au] Autor:Chintalapati SP; Patel A; Conjeevaram H
[Ad] Address:Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA.
[Ti] Title:Gastric and duodenal ischaemia after transarterial chemoembolisation for hepatocellular carcinoma: an unexpected but significant complication.
[So] Source:BMJ Case Rep;2018, 2018 Feb 21.
[Is] ISSN:1757-790X
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Transarterial chemoembolisation (TACE) is commonly used for unresectable intermediate-stage hepatocellular carcinoma (HCC). TACE is usually well-tolerated. We report a case of a patient who presented with a gastrointestinal bleed from TACE. A 64-year-old man presented with chronic hepatitis C cirrhosis and multifocal bilobar HCC. He had previously undergone multiple TACE sessions, radiofrequency ablation and stereotactic body radiation therapy. In the evening of his TACE procedure, he developed abdominal pain and haematemesis. An oesophagogastroduodenoscopy (OGD) showed non-bleeding oesophageal varices and ulcerations in the stomach and duodenum, with pathology demonstrating mucosal necrosis. The patient recovered and was discharged on omeprazole. While TACE is considered safe with most patients only experiencing postembolisation syndrome, vascular complications have been reported. In our patient, OGD revealed ulcerations, with biopsies confirming ischaemic ulceration. The likely aetiology was seepage of the embolic particles into neighbouring arteries. Patients should be carefully selected for TACE and monitored post procedure.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180222
[Lr] Last revision date:180222
[St] Status:In-Process

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[PMID]: 29462085
[Au] Autor:Anderson JE; Brown IE; Olson KA; Iverson K; Cocanour CS; Galante JM
[Ad] Address:University of California Davis Health Department of Surgery.
[Ti] Title:Non-occlusive Mesenteric Ischemia in Patients with Methamphetamine Use.
[So] Source:J Trauma Acute Care Surg;, 2018 Feb 17.
[Is] ISSN:2163-0763
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Data suggest that methamphetamine may increase the risk of non-occlusive mesenteric ischemia (NOMI). We describe patterns of presentation and outcomes of patients with methamphetamine use who present with NOMI to a single institution. METHODS: This is an observational study of patients from January 2015 to September 2017 with methamphetamine use who presented with NOMI at an academic medical center in Northern California. We summarize patient co-morbidities, clinical presentation, operative findings, pathologic findings, hospital course, and survival. RESULTS: Ten patients with methamphetamine use and severe NOMI were identified. One patient was readmitted with a perforated duodenal ulcer, for a total of 11 encounters. Most presented with acute (n=3) or acute-on-chronic (n=4) abdominal pain. Distribution of ischemia ranged from perforated duodenal ulcer (n=3), ischemia of the distal ileum (n=1), ischemia of entire small bowel (n=2), and patchy necrosis of entire small bowel and colon (n=5). Six patients died, three within one week of admission and three between 3-8 months. CONCLUSION: Methamphetamine use may be associated with significant microvascular compromise, increasing the risk of mesenteric ischemia. Providers in areas with high prevalence of methamphetamine use should have a high index of suspicion for intestinal ischemia in this patient population. Patients with methamphetamine use admitted for trauma or other pathology may be at particular risk of ischemia and septic shock, especially in the setting of dehydration. Use of vasoconstrictors in this patient population may also exacerbate intestinal ischemia. LEVEL OF EVIDENCE: Level 5; Case series.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180221
[Lr] Last revision date:180221
[St] Status:Publisher
[do] DOI:10.1097/TA.0000000000001855

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[PMID]: 29462169
[Au] Autor:Huang WC; Lee IK; Chen YC; Tsai CY; Liu JW
[Ad] Address:Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
[Ti] Title:Characteristics and predictors for gastrointestinal hemorrhage among adult patients with dengue virus infection: Emphasizing the impact of existing comorbid disease(s).
[So] Source:PLoS One;13(2):e0192919, 2018.
[Is] ISSN:1932-6203
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Gastrointestinal (GI) bleeding is a leading cause of death in dengue. This study aims to identify predictors for GI bleeding in adult dengue patients, emphasizing the impact of existing comorbid disease(s). METHODS: Of 1300 adults with dengue virus infection, 175 (mean age, 56.513.7 years) patients with GI bleeding and 1,125 (mean age, 49.215.6 years) without GI bleeding (controls) were retrospectively analyzed. RESULTS: Among 175 patients with GI bleeding, dengue hemorrhagic fever was found in 119 (68%) patients; the median duration from onset dengue illness to GI bleeding was 5 days. Gastric ulcer, erythematous gastritis, duodenal ulcer, erosive gastritis, and hemorrhagic gastritis were found in 52.3%, 33.3%, 28.6%, 28.6%, and 14.3% of 42 patients with GI bleeding who had undergone endoscopic examination, respectively. Overall, nine of the 175 patients with GI bleeding died, giving an in-hospital mortality rate of 5.1%. Multivariate analysis showed age ≥60 years (cases vs. controls: 48% vs. 28.3%) (odds ratio [OR]: 1.663, 95% confidence interval [CI]: 1.128-2.453), end stage renal disease with additional comorbidities (cases vs. controls: 1.7% vs. 0.2%) (OR: 9.405, 95% CI: 1.4-63.198), previous stroke with additional comorbidities (cases vs. controls: 7.4% vs. 0.6%) (OR: 9.772, 95% CI: 3.302-28.918), gum bleeding (cases vs. controls: 27.4% vs. 11.5%) (OR: 1.732, 95% CI: 1.1-2.727), petechiae (cases vs. controls: 56.6% vs. 29.1%) (OR: 2.109, 95% CI: 1.411-3.153), and platelet count <50109 cells/L (cases vs. controls: 53.1% vs. 25.8%) (OR: 3.419, 95% CI: 2.103-5.558) were independent predictors of GI bleeding in patients with dengue virus infection. CONCLUSIONS: Our study is the first to disclose that end stage renal disease and previous stroke, with additional comorbidities, were strongly significant associated with the risk of GI bleeding in patients with dengue virus infection. Identification of these risk factors can be incorporated into the patient assessment and management protocol of dengue virus infection to reduce its mortality.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180220
[Lr] Last revision date:180220
[St] Status:In-Data-Review
[do] DOI:10.1371/journal.pone.0192919


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