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Article: Safety of gadolinium during pregnancy.

Garcia-Bournissen, Facundo / Shrim, Alon / Koren, Gideon

Canadian family physician Medecin de famille canadien

2006 Volume 52, Page(s) 309–310

Abstract: ... recommendations discourage the use of gadolinium-based contrast agents during pregnancy because their safety ... based on the available evidence, gadolinium-based contrast agents appear to be safe in pregnancy ... during pregnancy. What is the risk to her baby?: Answer: Current radiology practices and ...

Abstract	Question: A pregnant patient who underwent magnetic resonance imaging (MRI) because of an acute abdomen, was told that MRI contrast agents (ie, gadolinium-based contrast agents) are contraindicated during pregnancy. What is the risk to her baby? Answer: Current radiology practices and recommendations discourage the use of gadolinium-based contrast agents during pregnancy because their safety for the fetus has not yet been proven. In line, however, with the European Society of Radiology guidelines and based on the available evidence, gadolinium-based contrast agents appear to be safe in pregnancy. Gadolinium use should be considered when the diagnostic study is important for the health of the mother.
MeSH term(s)	Abdomen, Acute/diagnosis ; Abdomen, Acute/etiology ; Contraindications ; Contrast Media ; Female ; Gadolinium ; Humans ; Magnetic Resonance Imaging ; Practice Guidelines as Topic ; Pregnancy ; Pregnancy Complications/diagnosis
Chemical Substances	Contrast Media ; Gadolinium (AU0V1LM3JT)
Language	English
Publishing date	2006-03
Publishing country	Canada
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	603565-6
ISSN	0008-350X
ISSN	0008-350X
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Article ; Online: Safety of Magnetic Resonance Imaging in Pregnancy.

Maralani, Pejman Jabehdar / Pai, Vivek / Ertl-Wagner, Birgit B

Radiologie (Heidelberg, Germany)

2023 Volume 63, Issue Suppl 2, Page(s) 34–40

Abstract: ... during pregnancy should be avoided whenever feasible. ... its safe use in pregnancy may be a source of anxiety and avoidance for both patients and ... in pregnant personnel are also addressed. Exposure to gadolinium-based contrast agents and sedation for MRI ...

Title translation	Sicherheit der Magnetresonanztomographie in der Schwangerschaft.
Abstract	Magnetic resonance imaging is being increasingly used to diagnose and follow up a variety of medical conditions in pregnancy, both for maternal and fetal indications. However, limited data regarding its safe use in pregnancy may be a source of anxiety and avoidance for both patients and their healthcare providers. In this review, we critically discuss the main safety concerns of Magnetic Resonance Imaging (MRI) in pregnancy including energy deposition, acoustic noise, and use of contrast agents, supported by data from animal and human studies. Use of maternal sedatives and concerns related to occupational exposure in pregnant personnel are also addressed. Exposure to gadolinium-based contrast agents and sedation for MRI during pregnancy should be avoided whenever feasible.
MeSH term(s)	Pregnancy ; Female ; Animals ; Humans ; Contrast Media ; Magnetic Resonance Imaging/adverse effects ; Magnetic Resonance Imaging/methods ; Fetus ; Noise
Chemical Substances	Contrast Media
Language	English
Publishing date	2023-09-25
Publishing country	Germany
Document type	Journal Article ; Review
ISSN	2731-7056
ISSN (online)	2731-7056
DOI	10.1007/s00117-023-01207-7
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Article: Gadolinium-Based Contrast Agents in Pregnant Women: A Literature Review of MRI Safety.

Alghamdi, Sami A

Cureus

2023 Volume 15, Issue 5, Page(s) e38493

Abstract: ... pregnancy, concerns have been raised regarding the safety of GBCAs, particularly during the first trimester ... exposure in infants. The safety of GBCAs during pregnancy, particularly during the first trimester, remains ... pregnancy, first trimester, gadolinium contrast agents, foetus, risk, and toxicity. The search criteria were articles ...

Abstract	Gadolinium-based contrast agents (GBCAs) are commonly used in magnetic resonance imaging (MRI) to enhance the visualisation and characterisation of the region of interest/lesion. Internal structures are well seen with MRI with good spatial resolution. Although MRI is generally considered safe during pregnancy, concerns have been raised regarding the safety of GBCAs, particularly during the first trimester. Limited studies have been conducted to assess the safety of GBCAs in pregnant women, with conflicting results. A comprehensive literature search was conducted using PubMed, SpringerLink, Medscape, ResearchGate and Wiley Online Library. The search terms included various combinations of MRI, pregnancy, first trimester, gadolinium contrast agents, foetus, risk, and toxicity. The search criteria were articles published in English in the last 20 years and indexed in the MEDLINE or Embase databases. The majority of studies found no definitive evidence that GBCAs are harmful during pregnancy, particularly during the first trimester. Some studies reported no increased risk of adverse outcomes in infants exposed to GBCAs during the first trimester. However, other studies showed inconsistent results. Retrospective cohort studies provided some reassurance regarding the safety of GBCAs when indicated in pregnant women but did not address potential long-term adverse outcomes in infants exposed to GBCAs during gestation. The literature review also highlights the importance of further evaluating the subacute and chronic effects of GBCA exposure in infants. The safety of GBCAs during pregnancy, particularly during the first trimester, remains uncertain. More large-scale, long-term studies are needed to clarify the safety of GBCAs in pregnant women and their potential effects on foetal and neonatal outcomes. Until conclusive evidence is available, healthcare providers should carefully weigh the benefits and risks of using GBCAs during pregnancy and consider alternative imaging modalities, such as non-contrast MRI or ultrasound, when necessary.
Language	English
Publishing date	2023-05-03
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.38493
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Article ; Online: MRI safety considerations during pregnancy.

Lum, Mark / Tsiouris, A John

Clinical imaging

2020 Volume 62, Page(s) 69–75

Abstract: ... on a single, large cohort study. Understanding the available evidence regarding MRI safety during pregnancy ... profile, theoretically concerns regarding the safety of MRI and gadolinium-based contrast agent (GBCA ... The use of magnetic resonance imaging (MRI) during pregnancy is on the rise due its ability ...

Abstract	The use of magnetic resonance imaging (MRI) during pregnancy is on the rise due its ability to provide detailed cross-sectional anatomy without ionizing radiation. Despite the favorable radiation profile, theoretically concerns regarding the safety of MRI and gadolinium-based contrast agent (GBCA) administration have been raised. Currently there are no studies that have shown any attributable harms of MRI during any trimester of pregnancy although prospective and longitudinal studies are lacking. GBCA administration may be associated with a slightly higher rate of neonatal death, although this is based on a single, large cohort study. Understanding the available evidence regarding MRI safety during pregnancy in the context of current society guidelines will help the radiologist serve as a valuable resource to patients and referring providers.
MeSH term(s)	Adult ; Cohort Studies ; Contrast Media ; Cross-Sectional Studies ; Female ; Humans ; Magnetic Resonance Imaging/methods ; Male ; Pregnancy ; Prospective Studies
Chemical Substances	Contrast Media
Language	English
Publishing date	2020-02-20
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1028123-x
ISSN	1873-4499 ; 0899-7071
ISSN (online)	1873-4499
ISSN	0899-7071
DOI	10.1016/j.clinimag.2020.02.007
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Article ; Online: Neuroimaging safety during pregnancy and lactation: a review.

Proença, F / Guerreiro, C / Sá, G / Reimão, S

Neuroradiology

2021 Volume 63, Issue 6, Page(s) 837–845

Abstract: ... the latest evidence and guidelines regarding neuroimaging safety during pregnancy and lactation, proposing ... some usage safety concerns regarding the magnetic field strength and gadolinium-based contrast use ... of imaging studies during pregnancy and lactation. Ultimately the decision should be based on the risk ...

Abstract	Purpose: Imaging studies are crucial adjuncts when studying acute and chronic diseases, so pregnant and lactating women are as likely to be evaluated with one of the available imaging modalities. Due to the specific condition of the mother and child in this time period it is crucial to make an appropriate selection of imaging studies. Methods: We review the existing literature and analyse the latest evidence and guidelines regarding neuroimaging safety during pregnancy and lactation, proposing an algorithm of action based on risk/benefits assessment. Results: Choosing the most appropriate neuroimaging modality implicates assessing the pretest pertinence of the study-the possibility of a serious treatable neurologic disease, pondering what is the most useful imaging modality for the diagnosis and evaluating the associated risks. Among physicians (and patients), however, the risk component is perhaps the least well understood, with misperceptions regarding safety and potential hazards. Computed tomography (CT) risks are principally related to ionizing radiation and intravenous (IV) administration of iodinated contrast. However, as very low risks for the mother and foetus have been reported and CT remains the most available tool for initial rapid diagnosis of acute neurological conditions, it should not be withheld in urgent situations. Magnetic resonance imaging (MRI), unlike CT, does not use ionizing radiation or iodinated contrast mediums, having the best anatomical detail possible. However, there are some usage safety concerns regarding the magnetic field strength and gadolinium-based contrast use. Conclusion: There are lacking longitudinal and prospective studies to sustain evidence based choices of imaging studies during pregnancy and lactation. Ultimately the decision should be based on the risk/benefit, taking into account the patient's safety, care and outcomes. However, using a specific algorithm can guide decisions in daily clinical practice.
MeSH term(s)	Child ; Contrast Media/adverse effects ; Female ; Humans ; Lactation ; Neuroimaging ; Pregnancy ; Pregnancy Complications ; Prospective Studies
Chemical Substances	Contrast Media
Language	English
Publishing date	2021-03-11
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	123305-1
ISSN	1432-1920 ; 0028-3940
ISSN (online)	1432-1920
ISSN	0028-3940
DOI	10.1007/s00234-021-02675-1
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Article ; Online: Exposure to natalizumab throughout pregnancy: effectiveness and safety in an Italian cohort of women with multiple sclerosis.

Landi, Doriana / Bovis, Francesca / Grimaldi, Alfonso / Annovazzi, Pietro Osvaldo / Bertolotto, Antonio / Bianchi, Alessia / Borriello, Giovanna / Brescia Morra, Vincenzo / Bucello, Sebastiano / Buscarinu, Maria Chiara / Caleri, Francesca / Capobianco, Marco / Capra, Ruggero / Cellerino, Maria / Centonze, Diego / Cerqua, Raffaella / Chisari, Clara Grazia / Clerico, Marinella / Cocco, Eleonora /

Cola, Gaia / Cordioli, Cinzia / Curti, Erica / d'Ambrosio, Alessandro / D'Amico, Emanuele / De Luca, Giovanna / Di Filippo, Massimiliano / Di Lemme, Sonia / Fantozzi, Roberta / Ferraro, Diana / Ferraro, Elisabetta / Gallo, Antonio / Gasperini, Claudio / Granella, Franco / Inglese, Matilde / Lanzillo, Roberta / Lorefice, Lorena / Lus, Giacomo / Malucchi, Simona / Margoni, Monica / Mataluni, Giorgia / Mirabella, Massimiliano / Moiola, Lucia / Nicoletti, Carolina Gabri / Nociti, Viviana / Patti, Francesco / Pinardi, Federica / Portaccio, Emilio / Pozzilli, Carlo / Ragonese, Paolo / Rasia, Sarah / Salemi, Giuseppe / Signoriello, Elisabetta / Vitetta, Francesca / Totaro, Rocco / Sormani, Maria Pia / Amato, Maria Pia / Marfia, Girolama Alessandra

Journal of neurology, neurosurgery, and psychiatry

2022

Abstract: Objective: Assessing the risk of clinical and radiological reactivation during pregnancy and ... 0.30-0.66), p=0.0004) during pregnancy, and in LONG_EXP (0.12 (0.05-0.24)) compared with SHORT_EXP ... 0.30 (0.17-0.50), p=0.008) during post partum. Gadolinium-enhancing (Gd+) lesions were less frequent ...

Abstract	Objective: Assessing the risk of clinical and radiological reactivation during pregnancy and post partum in women with multiple sclerosis (MS) treated with natalizumab (NTZ) throughout pregnancy (LONG_EXP) compared with women interrupting treatment before (NO_EXP) and within >-30 days and ≤90 days from conception (SHORT_EXP), and describing newborns' outcomes. Methods: Maternal clinical and radiological outcomes and obstetric and fetal outcomes were retrospectively collected and compared among groups (NO_EXP, SHORT_EXP, LONG_EXP). Predictors of clinical and radiological reactivation were investigated through univariable and multivariable analysis. Results: 170 eligible pregnancies from 163 women referring to 29 Italian MS centres were included. Annualised relapse rate (ARR) was significantly lower in LONG_EXP (n=66, 0.02 (0.001-0.09)) compared with NO_EXP (n=31, 0.43 (0.21-0.75), p=0.002) and SHORT_EXP (n=73, 0.46 (0.30-0.66), p=0.0004) during pregnancy, and in LONG_EXP (0.12 (0.05-0.24)) compared with SHORT_EXP (0.30 (0.17-0.50), p=0.008) during post partum. Gadolinium-enhancing (Gd+) lesions were less frequent in LONG_EXP (n=6/50, 2.00%) compared with NO_EXP (n=9/21, 42.86%) and SHORT_EXP after delivery (n=17/49, 34.69%, p=0.010).Delaying NTZ resumption after delivery significantly increased the risk of relapses (OR=1.29 (95% CI 1.07 to 1.57), p=0.009) and Gd+ lesions (OR=1.49 (95% CI 1.17 to 1.89, p=0.001). Newborns' weight, length, head circumference and gestational age did not differ among groups after adjusting for confounders. Anaemia was tracked in 4/69 LONG_EXP newborns. Congenital anomaly rate was within the expected range for the untreated MS population. Conclusions: Our findings indicate that in women with MS treated with NTZ before conception, continuation of NTZ throughout pregnancy and its early resumption after delivery mitigate the risk of clinical and radiological reactivation. This approach has no major impact on newborns' outcomes.
Language	English
Publishing date	2022-09-30
Publishing country	England
Document type	Journal Article
ZDB-ID	3087-9
ISSN	1468-330X ; 0022-3050
ISSN (online)	1468-330X
ISSN	0022-3050
DOI	10.1136/jnnp-2022-329657
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Article ; Online: Safety of Contrast Material Use During Pregnancy and Lactation.

Puac, Paulo / Rodríguez, Andrés / Vallejo, Carina / Zamora, Carlos A / Castillo, Mauricio

Magnetic resonance imaging clinics of North America

2017 Volume 25, Issue 4, Page(s) 787–797

Abstract: The use of contrast media to image patients who are pregnant has increased during the past decades ... worldwide. Their use in pregnancy and in patients who are lactating remains a challenging issue ... used in such patients according to the imaging modality (iodinated contrast media, barium, gadolinium ...

Abstract	The use of contrast media to image patients who are pregnant has increased during the past decades worldwide. Their use in pregnancy and in patients who are lactating remains a challenging issue for radiologists and other physicians. This article addresses the different types of contrast media that may be used in such patients according to the imaging modality (iodinated contrast media, barium, gadolinium-based, and ultrasound contrast agents), focusing on their adverse effects, potential teratogenic effects, strategies to minimize risks, and current clinical recommendation.
Language	English
Publishing date	2017-11
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1196851-5
ISSN	1557-9786 ; 1064-9689
ISSN (online)	1557-9786
ISSN	1064-9689
DOI	10.1016/j.mric.2017.06.010
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Article ; Online: Gadolinium Chelate Safety in Pregnancy: Barely Detectable Gadolinium Levels in the Juvenile Nonhuman Primate after in Utero Exposure.

Prola-Netto, Joao / Woods, Mark / Roberts, Victoria H J / Sullivan, Elinor L / Miller, Christina Ann / Frias, Antonio E / Oh, Karen Y

Radiology

2017 Volume 286, Issue 1, Page(s) 122–128

Abstract: ... maternal exposure to intravenous gadoteridol during pregnancy. Materials and Methods Gravid rhesus macaques and ... Purpose To determine whether gadolinium remains in juvenile nonhuman primate tissue after ... harvested from each juvenile macaque. Gadolinium levels were measured by using inductively coupled plasma ...

Abstract	Purpose To determine whether gadolinium remains in juvenile nonhuman primate tissue after maternal exposure to intravenous gadoteridol during pregnancy. Materials and Methods Gravid rhesus macaques and their offspring (n = 10) were maintained, as approved by the institutional animal care and utilization committee. They were prospectively studied as part of a pre-existing ongoing research protocol to evaluate the effects of maternal malnutrition on placental and fetal development. On gestational days 85 and 135, they underwent placental magnetic resonance imaging after intravenous gadoteridol administration. Amniocentesis was performed on day 135 prior to administration of the second dose of gadoteridol. After delivery, the offspring were followed for 7 months. Tissue samples from eight different organs and from blood were harvested from each juvenile macaque. Gadolinium levels were measured by using inductively coupled plasma mass spectrometry. Results Gadolinium concentration in the amniotic fluid was 0.028 × 10
MeSH term(s)	Amniotic Fluid/chemistry ; Animals ; Contrast Media/adverse effects ; Contrast Media/pharmacokinetics ; Female ; Gadolinium/adverse effects ; Gadolinium/pharmacokinetics ; Heterocyclic Compounds/adverse effects ; Heterocyclic Compounds/pharmacokinetics ; Macaca mulatta ; Magnetic Resonance Imaging/methods ; Maternal Exposure ; Organometallic Compounds/adverse effects ; Organometallic Compounds/pharmacokinetics ; Pregnancy ; Tissue Distribution
Chemical Substances	Contrast Media ; Heterocyclic Compounds ; Organometallic Compounds ; gadoteridol (0199MV609F) ; Gadolinium (AU0V1LM3JT)
Language	English
Publishing date	2017-09-04
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	80324-8
ISSN	1527-1315 ; 0033-8419
ISSN (online)	1527-1315
ISSN	0033-8419
DOI	10.1148/radiol.2017162534
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Article ; Online: Single-Center Study: Evaluating the Diagnostic Performance and Safety of Contrast-Enhanced Ultrasound (CEUS) in Pregnant Women to Assess Hepatic Lesions.

Schwarze, Vincent / Marschner, Constantin / Negrão de Figueiredo, Giovanna / Rübenthaler, Johannes / Clevert, Dirk-André

Ultraschall in der Medizin (Stuttgart, Germany : 1980)

2019 Volume 41, Issue 1, Page(s) 29–35

Abstract: ... performance and safety of CEUS during pregnancy to evaluate hepatic lesions of unknown entity.: Methods: 6 ... of CEUS during pregnancy. CEUS has already been safely applied for assessing uteroplacental blood flow ... fetal or maternal conditions during pregnancy. Published data is limited with respect to the application ...

Title translation	Single-Center-Studie: Evaluation der diagnostischen Leistung und Sicherheit des kontrastverstärkten Ultraschalls (CEUS) zur Beurteilung von Leberläsionen in der Schwangerschaft.
Abstract	Background: Ultrasound is an essential imaging tool for evaluating physiological and pathological fetal or maternal conditions during pregnancy. Published data is limited with respect to the application of CEUS during pregnancy. CEUS has already been safely applied for assessing uteroplacental blood flow, cesarean scar pregnancy and invasive placenta percreta. CT and MRI scans during pregnancy must be thoroughly evaluated due to harmful ionizing radiation and cerebral gadolinium deposition, respectively. Purpose: The aim of the present retrospective single-center study is to assess the diagnostic performance and safety of CEUS during pregnancy to evaluate hepatic lesions of unknown entity. Methods: 6 pregnant patients who underwent CEUS between 2005 and 2014 (mean age: 32 years; mean weeks of pregnancy: 28 weeks) were included in this study. The applied contrast agent was a second-generation blood-pool agent (SonoVue Results: CEUS was safely performed on all included pregnant women without the occurrence of adverse fetal or maternal events. In the context of the present study, CEUS helped to safely differentiate hepatic metastases, focal nodular hyperplasia, atypical hemangioma, hepatic arteriovenous malformation and cystic echinococcosis. In two patients CEUS determined immediate therapy. Conclusion: Although not clinically approved in obstetrics so far, CEUS is a safe imaging modality which, in addition to B-mode and color Doppler ultrasonography, may be applied during pregnancy for further medical indications and to provide helpful information.
MeSH term(s)	Adult ; Contrast Media ; Female ; Humans ; Liver Neoplasms/diagnostic imaging ; Liver Neoplasms/secondary ; Pregnancy ; Pregnancy Complications, Neoplastic/diagnostic imaging ; Retrospective Studies ; Ultrasonography, Doppler, Color/adverse effects
Chemical Substances	Contrast Media
Language	English
Publishing date	2019-07-30
Publishing country	Germany
Document type	Journal Article
ZDB-ID	801064-x
ISSN	1438-8782 ; 1439-0914 ; 1431-4894 ; 0172-4614
ISSN (online)	1438-8782
ISSN	1439-0914 ; 1431-4894 ; 0172-4614
DOI	10.1055/a-0973-8517
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Article: Single-Center Study: Evaluating the Diagnostic Performance and Safety of Contrast-Enhanced Ultrasound (CEUS) in Pregnant Women to Assess Hepatic Lesions

Schwarze, Vincent / Marschner, Constantin / Negrão de Figueiredo, Giovanna / Rübenthaler, Johannes / Clevert, Dirk-André

Ultraschall in der Medizin - European Journal of Ultrasound

2019 Volume 41, Issue 01, Page(s) 29–35

Abstract: ... and safety of CEUS during pregnancy to evaluate hepatic lesions of unknown entity.: Methods: 6 ... of CEUS during pregnancy. CEUS has already been safely applied for assessing uteroplacental blood flow ... fetal or maternal conditions during pregnancy. Published data is limited with respect to the application ...

Abstract	Background: Ultrasound is an essential imaging tool for evaluating physiological and pathological fetal or maternal conditions during pregnancy. Published data is limited with respect to the application of CEUS during pregnancy. CEUS has already been safely applied for assessing uteroplacental blood flow, cesarean scar pregnancy and invasive placenta percreta. CT and MRI scans during pregnancy must be thoroughly evaluated due to harmful ionizing radiation and cerebral gadolinium deposition, respectively. Purpose: The aim of the present retrospective single-center study is to assess the diagnostic performance and safety of CEUS during pregnancy to evaluate hepatic lesions of unknown entity. Methods: 6 pregnant patients who underwent CEUS between 2005 and 2014 (mean age: 32 years; mean weeks of pregnancy: 28 weeks) were included in this study. The applied contrast agent was a second-generation blood-pool agent (SonoVue, Bracco, Milan, Italy). CEUS examinations were performed and interpreted by a single radiologist with experience since 2000 (EFSUMB Level 3). Results: CEUS was safely performed on all included pregnant women without the occurrence of adverse fetal or maternal events. In the context of the present study, CEUS helped to safely differentiate hepatic metastases, focal nodular hyperplasia, atypical hemangioma, hepatic arteriovenous malformation and cystic echinococcosis. In two patients CEUS determined immediate therapy. Conclusion: Although not clinically approved in obstetrics so far, CEUS is a safe imaging modality which, in addition to B-mode and color Doppler ultrasonography, may be applied during pregnancy for further medical indications and to provide helpful information.
Keywords	pregnancy ; placenta ; fetus ; liver ; CEUS
Language	English
Publishing date	2019-07-30
Publisher	© Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	801064-x
ISSN	1438-8782 ; 0172-4614 ; 1439-0914 ; 1431-4894
ISSN (online)	1438-8782
ISSN	0172-4614 ; 1439-0914 ; 1431-4894
DOI	10.1055/a-0973-8517
Database	Thieme publisher's database

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