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  1. Article ; Online: Sport-related concussion in 8- to 12-year-olds: an understudied population.

    Zargari, Michael / Jo, Jacob / Williams, Kristen / Yengo-Kahn, Aaron M / Vance, E Haley / Bonfield, Christopher M / Terry, Douglas P / Zuckerman, Scott L

    Journal of neurosurgery. Pediatrics

    2024  Volume 33, Issue 4, Page(s) 390–397

    Abstract: Objective: Most studies regarding sport-related concussion (SRC) focus on high school and collegiate athletes; however, little has been published on children younger than 12 years of age. In a cohort of children aged 8-12 years with SRC, the authors ... ...

    Abstract Objective: Most studies regarding sport-related concussion (SRC) focus on high school and collegiate athletes; however, little has been published on children younger than 12 years of age. In a cohort of children aged 8-12 years with SRC, the authors sought to describe demographics, initial presentation, and recovery in this understudied population.
    Methods: A retrospective cohort study of children aged 8-12 years who sustained an SRC between November 2017 and April 2022 and were treated at a regional sports concussion center was conducted. Demographic information, injury characteristics, traditional Sport Concussion Assessment Tool 5 (SCAT5) and Child/Parent SCAT5 scores, and outcomes, defined as days to return to learn (RTL), symptom resolution, and return to play (RTP), were reported. Outcomes in boys and girls were compared using effect size analyses given sample size constraints.
    Results: Forty-seven athletes were included. The mean age was 11.0 ± 0.8 years, and the majority were male (34, 72.3%). A sizable proportion of patients visited an emergency department (19, 40.4%), and many received head imaging (16, 34.0%), mostly via CT (n = 13). The most common sport for boys was football (15, 44.1%), and the most common sports for girls were soccer (4, 30.8%) and cheerleading (4, 30.8%). These athletes reported a variety of symptoms on presentation. It took a mean of 8.8 ± 10.8 days to RTL, 27.3 ± 38.3 days to reach symptom resolution, and 35.4 ± 41.9 days to RTP. When comparing boys versus girls, there appeared to be moderate differences in symptom severity scores (Cohen's d = 0.44 for SCAT5, 0.13 for Child SCAT5, and 0.38 for Parent SCAT5) and minimal differences in recovery (Cohen's d = 0.11 for RTL, n = 35; 0.22 for symptom resolution, n = 22; and 0.12 for RTP, n = 21).
    Conclusions: In this cohort of concussed athletes aged 8-12 years, a little less than half of the athletes initially presented to the emergency department, and approximately one-third received acute head imaging. Across all athletes, the mean RTL was slightly more than a week and the mean symptom resolution and RTP were both approximately 1 month; however, much of the cohort is missing recovery outcome measures. This study demonstrated a strong positive correlation between Child SCAT5 and Parent SCAT5 symptom reporting. Future efforts are needed to evaluate differences in clinical presentation and outcomes following SRC between children and older populations.
    MeSH term(s) Child ; Humans ; Male ; Female ; Athletic Injuries/diagnostic imaging ; Athletic Injuries/epidemiology ; Retrospective Studies ; Neuropsychological Tests ; Brain Concussion/diagnostic imaging ; Brain Concussion/epidemiology ; Athletes ; Soccer/injuries
    Language English
    Publishing date 2024-02-02
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2403985-8
    ISSN 1933-0715 ; 1933-0707
    ISSN (online) 1933-0715
    ISSN 1933-0707
    DOI 10.3171/2023.10.PEDS23410
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Tumor-related hydrocephalus in infants: a narrative review.

    Yengo-Kahn, Aaron M / Dewan, Michael C

    Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery

    2021  Volume 37, Issue 11, Page(s) 3365–3373

    Abstract: Primary brain tumors diagnosed during infancy present several challenges for the pediatric neurosurgeon including the management of tumor-related hydrocephalus. Infant tumor-related hydrocephalus (iTRH) is present in over 70% of new diagnoses overall and ...

    Abstract Primary brain tumors diagnosed during infancy present several challenges for the pediatric neurosurgeon including the management of tumor-related hydrocephalus. Infant tumor-related hydrocephalus (iTRH) is present in over 70% of new diagnoses overall and in over 90% of infants with infratentorial neoplasms. iTRH may be related to direct obstruction of cerebrospinal fluid (CSF) pathways, shedding of protein and/or cells leading to dysfunctional subarachnoid, tumor-related CSF production, or, most frequently, a combination of these mechanisms. Treatment plans must consider the acuity of presentation, the mechanism of iTRH, and the additional neoadjuvant or adjuvant therapies required to treat the neoplasm. This narrative review provides a broad reference on the epidemiology, pathophysiology, and treatment of iTRH.
    MeSH term(s) Brain Neoplasms/complications ; Brain Neoplasms/therapy ; Child ; Humans ; Hydrocephalus/etiology ; Infant ; Infratentorial Neoplasms ; Subarachnoid Space
    Language English
    Publishing date 2021-03-26
    Publishing country Germany
    Document type Journal Article ; Review
    ZDB-ID 605988-0
    ISSN 1433-0350 ; 0302-2803 ; 0256-7040
    ISSN (online) 1433-0350
    ISSN 0302-2803 ; 0256-7040
    DOI 10.1007/s00381-021-05142-7
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Mild Traumatic Brain Injury in Children.

    Yengo-Kahn, Aaron M / Reynolds, Rebecca A / Bonfield, Christopher M

    Pediatric clinics of North America

    2021  Volume 68, Issue 4, Page(s) 857–874

    Abstract: Mild traumatic brain injury accounts for an estimated 4.8 million cases of pediatric traumatic brain injuries worldwide every year. In the United States, 70% of mild traumatic brain injury cases are due to sports and recreational injuries. Early ... ...

    Abstract Mild traumatic brain injury accounts for an estimated 4.8 million cases of pediatric traumatic brain injuries worldwide every year. In the United States, 70% of mild traumatic brain injury cases are due to sports and recreational injuries. Early diagnosis, especially in active children, is critical to preventing recurrent injuries. Management is guided by graded protocols for returning to school and activity. Ninety percent of children recover within 1 month of injury. Promising research has shown that early referral to specialty concussion care and multidisciplinary treatment with physical and occupational therapy may shorten recovery time and improve neurologic outcomes.
    MeSH term(s) Athletic Injuries/rehabilitation ; Brain Concussion/rehabilitation ; Child ; Disease Management ; Evidence-Based Medicine ; Family Practice/standards ; Humans ; Recovery of Function ; Referral and Consultation/statistics & numerical data ; Students/statistics & numerical data
    Language English
    Publishing date 2021-07-10
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 215711-1
    ISSN 1557-8240 ; 0031-3955
    ISSN (online) 1557-8240
    ISSN 0031-3955
    DOI 10.1016/j.pcl.2021.04.011
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: The survival of reimplanted shunts following externalization: a single-institution cohort study.

    Kelly, Patrick D / Yengo-Kahn, Aaron M / Naftel, Robert P

    Journal of neurosurgery. Pediatrics

    2021  Volume 27, Issue 4, Page(s) 382–390

    Abstract: Objective: The failure-free survival of ventriculoperitoneal shunts (VPSs) following externalization for distal catheter infection or malfunction has not been adequately explored. Conversion to a ventriculoatrial shunt (VAS) may allow earlier ... ...

    Abstract Objective: The failure-free survival of ventriculoperitoneal shunts (VPSs) following externalization for distal catheter infection or malfunction has not been adequately explored. Conversion to a ventriculoatrial shunt (VAS) may allow earlier reinternalization in lieu of waiting for the peritoneum to be suitable for reimplantation. This option is tempered by historical concerns regarding high rates of VAS failure, and the risks of rare complications are rampant.
    Methods: In this retrospective cohort study, all patients undergoing externalization of a VPS at a single institution between 2005 and 2020 were grouped according to the new distal catheter terminus location at the time of reinternalization (VPS vs VAS). The primary outcomes were failure-free shunt survival and duration of shunt externalization. Secondary outcomes included early (< 6 months) shunt failure.
    Results: Among 36 patients, 43 shunt externalization procedures were performed. Shunts were reinternalized as VPSs in 25 cases and VASs in 18 cases. The median failure-free survival was 1002 (interquartile range [IQR] 161-3449) days for VPSs and 1163 (IQR 360-2927) days for VASs. There was no significant difference in shunt survival according to the new distal catheter terminus (log-rank, p = 0.73). Conversion to a VAS was not associated with shorter duration of shunt externalization (Wilcoxon rank-sum, p = 0.64); the median duration was 7 (IQR 5-11) days for VPSs and 8 (IQR 6-15) days for VASs. No rare complications occurred in the VAS group.
    Conclusions: Shunt failure-free survival rates following externalization are similar to published survival rates for nonexternalized shunts. There was no significant difference in survival between reinternalized VPSs and VASs. Although the VAS was not associated with a shortened duration of externalization, this finding is confounded by strong institutional preference for the VPS over the VAS. Early conversion to the VAS may be a viable treatment option in light of reassuring modern VAS survival data.
    MeSH term(s) Adolescent ; Cerebrospinal Fluid Shunts/adverse effects ; Cerebrospinal Fluid Shunts/methods ; Child ; Child, Preschool ; Cohort Studies ; Female ; Humans ; Infant ; Male ; Reoperation/methods ; Retrospective Studies ; Ventriculoperitoneal Shunt/adverse effects ; Ventriculoperitoneal Shunt/methods
    Language English
    Publishing date 2021-02-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2403985-8
    ISSN 1933-0715 ; 1933-0707
    ISSN (online) 1933-0715
    ISSN 1933-0707
    DOI 10.3171/2020.8.PEDS20533
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Positive Head Computed Tomography Findings in the Setting of Sport Head Injuries: Can These Athletes Return-to-Play?

    Jo, Jacob / Williams, Kristen L / Jonzzon, Soren / Yengo-Kahn, Aaron M / Terry, Douglas P / Zuckerman, Scott L

    Neurosurgery

    2023  Volume 93, Issue 4, Page(s) 773–781

    Abstract: Background: The literature on athletes with positive head computed tomography (HCT) findings in the setting of sport head injuries remains sparse.: Objective: To report the proportions of athletes with a positive HCT and compare acute injury ... ...

    Abstract Background: The literature on athletes with positive head computed tomography (HCT) findings in the setting of sport head injuries remains sparse.
    Objective: To report the proportions of athletes with a positive HCT and compare acute injury characteristics and recovery between those with and without a positive HCT.
    Methods: A retrospective, single-institution, cohort study was performed with all athletes aged 12 to 23 years seen at a regional concussion center from 11/2017 to 04/2022. The cohort was dichotomized into positive vs negative HCT (controls). Acute injury characteristics (ie, loss of consciousness and amnesia) and recovery, as measured by days to return-to-learn (RTL), symptom resolution, and return-to-play (RTP) were compared. χ 2 and Mann-Whitney U tests were performed.
    Results: Of 2061 athletes, 226 (11.0%) received an HCT and 9 (4.0%) had positive findings. HCT findings included 4 (44.4%) subdural hematomas, 1 (11.1%) epidural hematoma, 2 (22.2%) facial fractures, 1 (11.1%) soft tissue contusion, and 1 (11.1%) cavernous malformation. All 9 (100.0%) athletes were treated nonoperatively and successfully returned-to-play at a median (IQR) of 73.0 (55.0-82.0) days. No differences in loss of consciousness or amnesia were seen between positive HCT group and controls. The Mann-Whitney U test showed differences in RTL (17.0 vs 4.0 days; U = 45.0, P = .016) and RTP (73.0 vs 27.0 days; U = 47.5, P = .007) but not in symptom resolution. Our subanalysis showed no differences across all recovery metrics between acute hemorrhages and controls.
    Conclusion: Among athletes seen at a regional concussion center who underwent an acute HCT, positive findings were seen in 4%. Although athletes with a positive HCT had longer RTL and RTP, symptom resolution was similar between those with a positive and negative HCT. All athletes with a positive HCT successfully returned to play. Despite a more conservative approach to athletes with a positive HCT, clinical outcomes are similar between those with and without a positive HCT.
    MeSH term(s) Humans ; Athletic Injuries/diagnostic imaging ; Athletic Injuries/therapy ; Return to Sport ; Cohort Studies ; Retrospective Studies ; Brain Concussion/diagnostic imaging ; Athletes ; Amnesia ; Unconsciousness ; Tomography
    Language English
    Publishing date 2023-05-11
    Publishing country United States
    Document type Journal Article
    ZDB-ID 135446-2
    ISSN 1524-4040 ; 0148-396X
    ISSN (online) 1524-4040
    ISSN 0148-396X
    DOI 10.1227/neu.0000000000002520
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Risk of Two Sport-Related Concussions in the Same Year: Is the Second Concussion Worse?

    Williams, Kristen / Zeoli, Tyler / Allen, Jackson H / Jo, Jacob / Yengo-Kahn, Aaron M / Terry, Douglas P / Zuckerman, Scott L

    Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine

    2023  Volume 34, Issue 1, Page(s) 38–43

    Abstract: Objectives: 1) Evaluate the frequency of same-year, repeat concussions; (2) assess predictors of sustaining a repeat concussion; and (3) compare outcomes of athletes with repeat concussions with athletes with single concussion.: Design: A ... ...

    Abstract Objectives: 1) Evaluate the frequency of same-year, repeat concussions; (2) assess predictors of sustaining a repeat concussion; and (3) compare outcomes of athletes with repeat concussions with athletes with single concussion.
    Design: A retrospective, case-control study.
    Setting: Regional sports concussion center.
    Patients: Adolescents sustaining a sport-related concussions (SRC) from November 2017 to October 2020.
    Independent variables: Participants were dichotomized into 2 groups: (1) athletes with a single concussion; and (2) athletes with repeat concussions.
    Main outcome measures: Between group and within group analyses were completed to look for differences in demographics, personal and family history, concussion history, and recovery metrics between the 2 groups.
    Results: Of 834 athletes with an SRC, 56 (6.7%) sustained a repeat concussion and 778 (93.3%) had a single concussion. Between group: Personal history of migraines (19.6% vs 9.5%, χ 2 = 5.795, P = 0.02), family history of migraines (37.5% vs 24.5%, χ 2 = 4.621, P = 0.03), and family history of psychiatric disorders (25% vs 13.1%, χ 2 = 6.224, P = 0.01) were significant predictors of sustaining a repeat concussion. Within group: Among those with a repeat concussion, initial symptom severity was greater (Z = -2.422; P = 0.02) during the repeat concussion and amnesia was more common (χ 2 = 4.775, P = 0.03) after the initial concussion.
    Conclusions: In a single-center study of 834 athletes, 6.7% suffered a same-year, repeat concussion. Risk factors included personal/family migraine history and family psychiatric history. For athletes with repeat concussions, initial symptom score was higher after the second concussion, yet amnesia was more common after the initial concussion.
    MeSH term(s) Adolescent ; Humans ; Athletic Injuries/diagnosis ; Retrospective Studies ; Case-Control Studies ; Brain Concussion/complications ; Brain Concussion/epidemiology ; Brain Concussion/diagnosis ; Amnesia/etiology ; Athletes ; Migraine Disorders/complications
    Language English
    Publishing date 2023-04-14
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1062530-6
    ISSN 1536-3724 ; 1050-642X
    ISSN (online) 1536-3724
    ISSN 1050-642X
    DOI 10.1097/JSM.0000000000001156
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Symptom resolution following a repeat concussion within the same athlete.

    Tang, Alan R / Williams, Kristen L / Davis, Philip J / Grusky, Alan Z / Hou, Brian Q / Hajdu, Katherine S / Yengo-Kahn, Aaron M / Zuckerman, Scott L / Terry, Douglas P

    Brain injury

    2024  Volume 38, Issue 4, Page(s) 295–303

    Abstract: Introduction: Repeat sport-related concussion (SRC) is anecdotally associated with prolonged recovery. Few studies have examined repeat concussion within the same athlete. We sought to explore differences in symptom burden and recovery outcomes in an ... ...

    Abstract Introduction: Repeat sport-related concussion (SRC) is anecdotally associated with prolonged recovery. Few studies have examined repeat concussion within the same athlete. We sought to explore differences in symptom burden and recovery outcomes in an individual athlete's initial and repeat SRC.
    Methods: A retrospective within-subject cohort study of athletes aged 12-23 years diagnosed with two separate SRCs from 11/2017-10/2020 was conducted. Primary outcomes were initial symptom severity and time-to-symptom-resolution. Secondary outcomes included return-to-learn (RTL) and return-to-play (RTP) duration.
    Results: Of 868 athletes seen, 47 athletes presented with repeat concussions. Median time between concussions was 244 days (IQR 136-395). Comparing initial to repeat concussion, no differences were observed in time-to-clinic (4.3 ± 7.3vs.3.7 ± 4.6 days,
    Conclusion: No significant differences in symptom duration and RTP/RTL were seen between initial/repeat concussion.
    MeSH term(s) Humans ; Athletic Injuries/complications ; Athletic Injuries/diagnosis ; Cohort Studies ; Retrospective Studies ; Brain Concussion/diagnosis ; Brain Concussion/complications ; Athletes
    Language English
    Publishing date 2024-02-09
    Publishing country England
    Document type Journal Article
    ZDB-ID 639115-1
    ISSN 1362-301X ; 0269-9052
    ISSN (online) 1362-301X
    ISSN 0269-9052
    DOI 10.1080/02699052.2024.2311341
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Attention-Deficit Hyperactivity Disorder and Learning Disabilities Modify Recovery and Sport Behavior Following Sport-Related Concussion.

    Pullen, Jesse C / Wolfson, Daniel I / Totten, Douglas J / Jeckell, Aaron S / Bonfield, Christopher M / Zuckerman, Scott L / Yengo-Kahn, Aaron M

    Clinical pediatrics

    2022  Volume 62, Issue 2, Page(s) 121–131

    Abstract: Limited evidence exists concerning how a diagnosis of attention-deficit hyperactivity disorder and/or learning disabilities (ADHD/LD) modifies recovery and behavior following sport-related concussion (SRC). To understand how ADHD/LD modifies the post-SRC ...

    Abstract Limited evidence exists concerning how a diagnosis of attention-deficit hyperactivity disorder and/or learning disabilities (ADHD/LD) modifies recovery and behavior following sport-related concussion (SRC). To understand how ADHD/LD modifies the post-SRC experience, we conducted a retrospective cohort study of concussed young athletes through phone interviews with patients and guardians. Outcomes included time until symptom resolution (SR) and return-to-learn (RTL), plus subjective changes in post-SRC activity and sports behavior. Multivariate Cox and logistic regression was performed, adjusting for biopsychosocial characteristics. The ADHD/LD diagnosis was independently associated with worse outcomes, including lower likelihood to achieve SR (hazard ratio [HR] = 0.62, 95% confidence interval [CI] = [0.41-0.94];
    MeSH term(s) Humans ; Attention Deficit Disorder with Hyperactivity/complications ; Athletic Injuries/diagnosis ; Retrospective Studies ; Neuropsychological Tests ; Brain Concussion/diagnosis ; Brain Concussion/complications ; Learning Disabilities/complications ; Athletes
    Language English
    Publishing date 2022-07-26
    Publishing country United States
    Document type Journal Article
    ZDB-ID 207678-0
    ISSN 1938-2707 ; 0009-9228
    ISSN (online) 1938-2707
    ISSN 0009-9228
    DOI 10.1177/00099228221113787
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  9. Article ; Online: In Reply: Recommendation to Create New Neuropathologic Guidelines for the Postmortem Diagnosis of Chronic Traumatic Encephalopathy.

    Terry, Douglas P / Zuckerman, Scott L / Yengo-Kahn, Aaron M / Kuhn, Andrew W / Brett, Benjamin L / Davis, Gavin A

    Neurosurgery

    2022  Volume 90, Issue 6, Page(s) e206–e207

    MeSH term(s) Chronic Traumatic Encephalopathy/diagnosis ; Chronic Traumatic Encephalopathy/pathology ; Humans ; Nervous System Diseases ; Neuropathology
    Language English
    Publishing date 2022-04-06
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 135446-2
    ISSN 1524-4040 ; 0148-396X
    ISSN (online) 1524-4040
    ISSN 0148-396X
    DOI 10.1227/neu.0000000000001979
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  10. Article ; Online: Decision Support Tool to Judiciously Assign High-Frequency Neurologic Examinations in Traumatic Brain Injury.

    Bryant, Peter / Yengo-Kahn, Aaron / Smith, Candice / Smith, Melissa / Guillamondegui, Oscar

    The Journal of surgical research

    2022  Volume 280, Page(s) 557–566

    Abstract: Introduction: Traumatic brain injury (TBI) management includes serial neurologic examinations to assess for changes dictating neurosurgical interventions. We hypothesized hourly examinations are overassigned. We conducted a decision tree analysis to ... ...

    Abstract Introduction: Traumatic brain injury (TBI) management includes serial neurologic examinations to assess for changes dictating neurosurgical interventions. We hypothesized hourly examinations are overassigned. We conducted a decision tree analysis to determine an algorithm to judiciously assign hourly examinations.
    Methods: A retrospective cohort study of 1022 patients with TBI admitted to a Level 1 trauma center from January 1, 2019, to December 31, 2019, was conducted. Patients with penetrating TBI or immediate or planned interventions and those with nonsurvivable injuries were excluded. Patients were stratified by whether they underwent an unplanned intervention (e.g., craniotomy or invasive intracranial monitoring). Univariate analysis identified factors for inclusion in chi-square automatic interaction detection technique, classifying those at risk for unplanned procedures.
    Results: A total of 830 patients were included, 287 (35%) were assigned hourly (Q1) examinations, and 17 (2%) had unplanned procedures, with 16 of 17 (94%) on Q1 examinations. Patients requiring unplanned procedures were more likely to have mixed intracranial hemorrhage pattern (82% versus 39%; P = 0.001), midline shift (35% versus 14%; P = 0.023), an initial poor neurologic examination (Glasgow Comas Scale ≤8, 77% versus 14%; P < 0.001), and be intubated (88% versus 17%; P < 0.001). Using chi-square automatic interaction detection, the decision tree demonstrated low-risk (2% misclassification) and excellent discrimination (area under the curve = 0.915, 95% confidence interval 0.844-0.986; P < 0.001) of patients at risk of an unplanned procedure. By following the algorithm, 167 fewer patients could have been assigned Q1 examinations, resulting in an estimated 6012 fewer examinations.
    Conclusions: Using a 4-factor algorithm can optimize the assignment of neuro examinations and substantially reduce neuro examination burden without sacrificing patient safety.
    MeSH term(s) Humans ; Retrospective Studies ; Brain Injuries, Traumatic/complications ; Brain Injuries, Traumatic/diagnosis ; Glasgow Coma Scale ; Trauma Centers ; Neurologic Examination
    Language English
    Publishing date 2022-09-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80170-7
    ISSN 1095-8673 ; 0022-4804
    ISSN (online) 1095-8673
    ISSN 0022-4804
    DOI 10.1016/j.jss.2022.07.045
    Database MEDical Literature Analysis and Retrieval System OnLINE

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