Publications by authors named "Elisabeth Codsi"

18 Publications

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Perinatal and cardiac outcomes of women with hypertrophic cardiomyopathy.

J Matern Fetal Neonatal Med 2021 Oct 15:1-6. Epub 2021 Oct 15.

Department of Obstetrics and Gynecology, Maternal Fetal Medicine Division, University Hospital Centre Sainte-Justine, Montreal, Canada.

Rationale: Pregnancy causes important physiologic stress for women with hypertrophic cardiomyopathy. Data regarding the impact of this condition on obstetrical outcomes is missing.

Objectives: Our objective was to report obstetrical and cardiac outcomes in pregnant women with hypertrophic cardiomyopathy and to assess the possible adverse effects of left ventricular outflow tract obstruction in pregnancy.

Study Design: This was a retrospective cohort study of pregnant women diagnosed with HCM and followed at single tertiary center between 1995 and 2019. Demographic, medical and surgical data, echocardiographic parameters, and pregnancy outcomes were abstracted through extensive chart review. Patients were divided into 2 groups: obstructive (maximal left ventricular outflow tract gradient over 30 mmHg) versus non-obstructive hypertrophic cardiomyopathy. Outcomes between groups were compared with -test, Mann-Whitney and Fisher's exact tests when appropriate.

Results: Eighteen women with 27 pregnancies were included. The study population was formed of 18 women with a total of 27 pregnancies that reached at least 20 weeks of gestation: 12 pregnancies in women with obstructive hypertrophic cardiomyopathy and 15 pregnancies in women with non-obstructive hypertrophic cardiomyopathy. Among the non-obstructive hypertrophic cardiomyopathy, 5 of them had been treated for their obstruction. One patient with obstructive hypertrophic cardiomyopathy had a medical termination of pregnancy for uncontrolled arrhythmia at 21 weeks. There were no maternal deaths. Left ventricular outflow tract obstruction was associated with increased cardiac events including arrhythmias and heart failure (5/12 versus 0/15;  = .006). Preterm birth occurred in more than 50% of cases, resulting from induced delivery for a maternal (40%) or fetal reason (60%). Most deliveries were late preterm between 34 and 36 6/7 weeks. In both groups, birthweight was mainly distributed below the 50th percentile (89%) and 35% of neonates were born small for gestational age defined as a birthweight below the 10th percentile. Most severe cases of small for gestational age (birthweight under the 5th percentile) were found in patients with treated obstructive hypertrophic cardiomyopathy.

Conclusion: Hypertrophic cardiomyopathy is associated with prematurity and small for gestational age. Left ventricular outflow tract obstruction is associated with adverse cardiac events including arrythmias or heart failure. Treated obstructive cardiomyopathy constitutes a sub-group of patients at high risk of severe small for gestational age and deserves a close surveillance. Therefore, fetal growth surveillance with ultrasound, early in the third trimester and doppler studies to assess the utero-placental perfusion in the second and third trimesters are warranted in all patients with hypertrophic cardiomyopathy regardless of the severity of their condition.
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http://dx.doi.org/10.1080/14767058.2021.1990883DOI Listing
October 2021

Management of Complicated Monochorionic Twin Gestations: An Evidence-Based Protocol.

Obstet Gynecol Surv 2021 Sep;76(9):541-549

Full Professor, Consultant, and Chair, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN.

Importance: Monochorionic (MC) twins are hemodynamically connected by vascular anastomoses within the single shared placenta. The transfer of fluid or blood from one fetus to the other may result in development of pathologic complications, such as twin-twin transfusion syndrome, twin anemia polycythemia sequence, selective intrauterine growth restriction, and twin reversed arterial perfusion sequence. Monoamniotic gestations, which comprise a small fraction of MC pregnancies, can also present with unique challenges, particularly antepartum umbilical cord entanglement. All these complications carry a high risk of fetal morbidity and mortality if not recognized and managed in a timely fashion.

Objective: The purpose of this article is to review evidence-based management of complicated MC twin gestations and propose a standardized approach to surveillance.

Evidence Acquisition: Monochorionic gestations account for the majority of complications that occur in twin pregnancies; however, there is unclear evidence on the appropriate surveillance for and management of specific complications associated with these pregnancies.

Results: This article summarizes management for each specific type of MC complication in a structured and clear manner.

Conclusions: Early pregnancy ultrasound, ideally between 10 and 13 weeks' gestation, is critical for the diagnosis and characterization of twin pregnancies. To improve outcomes for MC twins, appropriate fetal surveillance should be initiated at 16 weeks' gestation and continued until delivery.
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http://dx.doi.org/10.1097/OGX.0000000000000917DOI Listing
September 2021

Prenatal presentation of glutaric aciduria type II: A case report with radiologic, clinical, biochemical, molecular, and pathological phenotyping.

Clin Case Rep 2021 Mar 12;9(3):1101-1103. Epub 2021 Jan 12.

Department of Obstetrics and Gynecology CHU Ste-Justine Montreal QC Canada.

We know that glutaric aciduria type II is an inborn metabolism. This case report highlights that polycystic kidneys with hepatomegaly in prenatal ultrasound are suggestive of glutaric aciduria type II and it identifies a new variant as pathogenic.
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http://dx.doi.org/10.1002/ccr3.3663DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7981664PMC
March 2021

Expectant Management of Monochorionic-Triamniotic Triplets Complicated by Selective In Utero Growth Restriction: Report of 2 Cases.

Case Rep Obstet Gynecol 2020 3;2020:2979261. Epub 2020 Oct 3.

Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Sainte-Justine Mother and Child University Hospital, 3175 Chemin de la Côte Sainte Catherine, Montreal, QC, Canada H3T 1C5.

The optimal management of monochorionic-triamniotic (MCTA) triplet pregnancies is not clearly established, and there is no literature to guide management of MCTA complicated with selective intrauterine growth restriction (sIUGR). This gap in knowledge and the concern for higher risk of severe complications have led some medical societies to recommend selective termination of nontrichorionic triplet pregnancies. We sought to report the favourable outcomes of two MCTA complicated by sIUGR expectantly managed at Sainte-Justine Hospital, Montreal, Canada. The first case is of a 42-year-old woman with spontaneous MCTA triplets diagnosed at 18 weeks with type II sIUGR who opted for expectant management. The second patient was a 22-year-old woman with a spontaneous MCTA triplet pregnancy diagnosed at 18 weeks with type III sIUGR. Our experience shows that close serial ultrasounds could potentially allow physicians to foresee fetal deterioration. In our opinion, expectant management should be considered as a management option for MCTA complicated by sIUGR.
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http://dx.doi.org/10.1155/2020/2979261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7548933PMC
October 2020

Chirurgie fœtale : le passé, le présent et l'avenir.

J Obstet Gynaecol Can 2019 Dec;41 Suppl 2:S290-S292

Division de médecine foeto-maternelle, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Qc.

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http://dx.doi.org/10.1016/j.jogc.2019.10.014DOI Listing
December 2019

Fetal Surgery: Past, Present, and Future Perspectives.

J Obstet Gynaecol Can 2019 Dec;41 Suppl 2:S287-S289

Division of Maternal and Fetal Medicine, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, QC.

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http://dx.doi.org/10.1016/j.jogc.2019.08.039DOI Listing
December 2019

Electronic Algorithm Is Superior to Hospital Discharge Codes for Diagnoses of Hypertensive Disorders of Pregnancy in Historical Cohorts.

Mayo Clin Proc 2018 12;93(12):1707-1719

Division of Nephrology and Hypertension, University of Belgrade, Belgrade, Serbia; Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN. Electronic address:

Objectives: To develop and validate criteria for the retrospective diagnoses of hypertensive disorders of pregnancy that would be amenable to the development of an electronic algorithm, and to compare the accuracy of diagnoses based on both the algorithm and diagnostic codes with the gold standard, of physician-made diagnoses based on a detailed review of medical records using accepted clinical criteria.

Patients And Methods: An algorithm for hypertensive disorders of pregnancy was developed by first defining a set of criteria for retrospective diagnoses, which included relevant clinical variables and diagnosis of hypertension that required blood pressure elevations in greater than 50% of readings ("the 50% rule"). The algorithm was validated using the Rochester Epidemiology Project (Rochester, Minnesota). A stratified random sample of pregnancies and deliveries between January 1, 1976, and December 31, 1982, with the algorithm-based diagnoses was generated for review and physician-made diagnoses (normotensive, gestational hypertension, and preeclampsia), which served as the gold standard; the targeted cohort size for analysis was 25 per diagnosis category according to the gold standard. Agreements between (1) algorithm-based diagnoses and (2) diagnostic codes and the gold standard were analyzed.

Results: Sensitivities of the algorithm for 25 normotensive pregnancies, 25 with gestational hypertension, and 25 with preeclampsia were 100%, 88%, and 100%, respectively, and specificities were 94%, 100%, and 100%, respectively. Diagnostic code sensitivities were 96% for normotensive pregnancies, 32% for gestational hypertension, and 96% for preeclampsia, and specificities were 78%, 96%, and 88%, respectively.

Conclusion: The electronic diagnostic algorithm was highly sensitive and specific in identifying and classifying hypertensive disorders of pregnancy and was superior to diagnostic codes.
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http://dx.doi.org/10.1016/j.mayocp.2018.08.031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6353636PMC
December 2018

The Current State of Ultrasound Training in Obstetrics and Gynecology Residency Programs.

J Ultrasound Med 2018 Sep 21;37(9):2201-2207. Epub 2018 Feb 21.

Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.

Objectives: We evaluated the current state of ultrasound training in obstetrics and gynecology (OB-GYN) residency programs across the United States.

Methods: An electronic survey was sent to OB-GYN residency program directors and OB-GYN residents. Responses were obtained in September 2016. Program directors and residents were asked to reflect on their current ultrasound curriculum.

Results: A total of 93 program directors and 437 residents responded. Respondents were mostly from university programs located in tertiary centers. Ultrasound curricula varied: 11% of program directors and 23% of residents did not have any ultrasound-related didactics; of those who did, 27% of program directors and 40% of residents had it yearly or less. Three-quarters had mandatory ultrasound rotations, and few offered ultrasound electives (program directors, 52%; residents, 28%). Most residents were required to perform ultrasound examinations daily or weekly (98%). Most stated that the main focus of the rotation was OB only. Skill was evaluated mainly subjectively by direct observation. Although most program directors stated that residents were satisfactory/excellent in ultrasound, 22% would not treat patients on the basis of ultrasound examinations performed by their senior residents. Similarly, of all postgraduate year 4 respondents (n = 86), 76% stated that they will require additional training to be able to perform or read ultrasound examinations independently, and 43% would not treat a patient on the basis of their own ultrasound examinations without further confirmation. Residents believed that the biggest obstacle in ultrasound training is lack of dedicated faculty time (41%).

Conclusions: Recognizing the lack of clearly defined milestones in ultrasound training in OB-GYN residency, this study confirms the substantial heterogeneity in curricula between programs, highlighting a need for a standardized ultrasound curriculum.
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http://dx.doi.org/10.1002/jum.14570DOI Listing
September 2018

Subsequent Pregnancy Outcomes in Patients With Peripartum Cardiomyopathy.

Obstet Gynecol 2018 02;131(2):322-327

Division of Maternal and Fetal Medicine and the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.

Objective: To describe cardiac and obstetric outcomes in subsequent pregnancies of patients with peripartum cardiomyopathy and to report demographic and clinical characteristics of index pregnancies.

Methods: We conducted a retrospective cohort study of all pregnant patients with prior peripartum cardiomyopathy seen at the Mayo Clinic from January 2000 through March 2017. Maternal and neonatal outcome data of index and all subsequent pregnancies were abstracted, and all echocardiography examinations were individually reviewed.

Results: Twenty-five patients with prior peripartum cardiomyopathy were included; all except one had recovered left ventricular (LV) function (LV ejection fraction 50% or greater) before the subsequent pregnancy. Forty-three subsequent pregnancies were identified: six (14.0%) miscarriages, four (9.3%) terminations, and 33 (76.7%) live births. The rate of peripartum cardiomyopathy relapse was 20.9%; median LV ejection fraction nadir in patients with relapse was 43% (range 35-45%). None had LV ejection fraction decline to the level of their index pregnancy. No cardiac arrests or deaths were observed, and all patients with relapse recovered LV function. Median gestational age at delivery for all live births in subsequent pregnancies was 39.0 weeks (range 36 6/7-41 3/7 weeks).

Conclusion: Patients with a history of peripartum cardiomyopathy who recover LV function are at risk for a transient minor decrease in LV ejection fraction during future pregnancies, but obstetric and neonatal outcomes are often favorable.
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http://dx.doi.org/10.1097/AOG.0000000000002439DOI Listing
February 2018

Use of Genetic Testing after Abnormal Screening Ultrasound: A Descriptive Cohort Study.

Gynecol Obstet Invest 2018 20;83(5):466-470. Epub 2017 Nov 20.

Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA.

Background/aims: The study aimed to characterize the use of genetic testing after abnormal screening ultrasound.

Methods: We performed a retrospective review of patients undergoing genetic testing after abnormal ultrasound. Genetic evaluation consisted of noninvasive prenatal screening (NIPS) or amniocentesis. Classification of ultrasound findings, type of genetic testing, and results were collected.

Results: A total of 139 subjects underwent genetic evaluation after abnormal screening ultrasound. Screening via NIPS was pursued by 61 (44%) patients while 78 (56%) proceeded directly to amniocentesis. Patients electing for amniocentesis had more cardiac, neurologic, and gastrointestinal malformations while soft markers for aneuploidy prompted more NIPS screening. Results were negative in 85% of the NIPS group compared to 60% of the amniocentesis group. Only 8% of patients who underwent NIPS proceeded to diagnostic testing.

Conclusion: Patients pursuing NIPS after abnormal ultrasound had more soft markers of aneuploidy. Patients pursuing diagnostic testing were more likely to have major structural malformations and more total abnormalities identified. Patients who proceeded directly to amniocentesis were more likely to have abnormal genetic testing.
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http://dx.doi.org/10.1159/000484242DOI Listing
December 2018

Spontaneous Coronary Artery Dissection Associated With Pregnancy.

J Am Coll Cardiol 2017 Jul;70(4):426-435

Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota.

Background: Spontaneous coronary artery dissection (SCAD) is the most common cause of pregnancy-associated myocardial infarction and remains poorly characterized.

Objectives: This study sought to assess presentation, clinical factors, and outcomes of pregnancy-associated spontaneous coronary artery dissection (P-SCAD) compared with spontaneous coronary artery dissection not associated with pregnancy (NP-SCAD).

Methods: A Mayo Clinic registry was established in 2010 to include comprehensive retrospective and prospective SCAD data. Records were reviewed to identify women who were pregnant or ≤12 weeks postpartum at time of SCAD. Complete records were available for 323 women; 54 women met criteria for P-SCAD (4 during pregnancy) and they were compared with 269 women with NP-SCAD.

Results: Most events occurred within the first month postpartum (35 of 50). Compared with NP-SCAD, P-SCAD patients more frequently presented with ST-segment elevation myocardial infarction (57% vs. 36%; p = 0.009), left main or multivessel SCAD (24% vs. 5%; p < 0.0001; and 33% vs. 14%; p = 0.0027, respectively), and left ventricular function ≤35% (26% vs. 10%; p = 0.0071). Among women with imaging of other vascular territories, P-SCAD was less likely with a diagnosis of fibromuscular dysplasia and extracoronary vascular abnormalities (42% vs. 64%; p = 0.047; and 46% vs. 77%; p = 0.0032, respectively). Compared with U.S. birth data, women with P-SCAD were more often multiparous (p = 0.0167), had a history of infertility therapies (p = 0.0004), and had pre-eclampsia (p = 0.001). On long-term follow-up (median 2.3 years) recurrent SCAD occurred in 51 patients, with no difference in the Kaplan Meier 5-year recurrence rates (10% vs. 23%; p = 0.18).

Conclusions: P-SCAD patients had more acute presentations and high-risk features than women with NP-SCAD did. The highest frequency of P-SCAD occurred during the first postpartum month and P-SCAD patients less often had extracoronary vascular abnormalities. Hormonal, hemodynamic variations, and yet-undefined mechanisms might be significant contributors to P-SCAD. (The "Virtual" Multicenter Spontaneous Coronary Artery Dissection [SCAD] Registry [SCAD]; NCT01429727; Genetic Investigations in Spontaneous Coronary Artery Dissection [SCAD]; NCT01427179).
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http://dx.doi.org/10.1016/j.jacc.2017.05.055DOI Listing
July 2017

Longitudinal characterization of renal proximal tubular markers in normotensive and preeclamptic pregnancies.

Am J Physiol Regul Integr Comp Physiol 2017 05 24;312(5):R773-R778. Epub 2017 Apr 24.

Department of Maternal Fetal Medicine, Mayo Clinic, Rochester, Minnesota.

Glomerular damage is common in preeclampsia (PE), but the extent and etiology of tubular injury are not well understood. The aim of this study was to evaluate tubular injury in patients with PE and to assess whether it predates clinical disease. We performed a prospective cohort study of 315 pregnant women who provided urine samples at the end of the second trimester and at delivery. This analysis included women who developed PE ( = 15), gestational hypertension (GH; = 14), and normotensive controls (NC; = 44). Urinary markers of tubular injury, α1-microglobulin (A1M), retinol-binding protein (RBP), kidney-injury molecule-1 (KIM1), complement C5b-9, tissue inhibitor metalloproteinase-2 (TIMP-2), and insulin-like growth factor binding protein-7 (IGFBP-7) were measured by enzyme-linked immunosorbent assay (ELISA) and reported in relation to urine creatinine concentration. Second-trimester concentrations of all markers were similar among groups. At delivery, A1M concentrations were higher in the PE group than in the GH and NC groups as an A1M/creatinine ratio >13 (66.7, 8.3, and 35%, respectively, = 0.01). Concentrations of C5b-9 were higher in the PE group than in the GH and NC groups (medians 9.85, 0.05, and 0.28 ng/mg, respectively, = 0.003). KIM1, RBP, TIMP-2, and IGFBP-7 concentrations did not differ among groups at delivery. In conclusion, proximal tubular dysfunction, as assessed by A1M and C5b-9, developed during the interval between the end of the second trimester and delivery in patients with PE. However, this was not matched by abnormalities in markers previously associated with tubular cell injury (KIM-1, IGFBP-7, and TIMP-2).
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http://dx.doi.org/10.1152/ajpregu.00509.2016DOI Listing
May 2017

Peripartum Cardiomyopathy Presenting as Bradycardia.

Case Rep Obstet Gynecol 2017 1;2017:3670520. Epub 2017 Feb 1.

Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.

Peripartum cardiomyopathy (PPCM) is a disease that typically affects young otherwise healthy women. As PPCM is associated with significant mortality, timely diagnosis is necessary to ensure appropriate care. To our knowledge, this represents the first reported case of PPCM presenting as symptomatic bradycardia. We describe the patient's clinical presentation and relevant findings and review the potential etiology and ramifications of bradycardia in patients with PPCM.
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http://dx.doi.org/10.1155/2017/3670520DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5309394PMC
February 2017

Spontaneous Coronary Artery Dissection in Pregnancy: What Every Obstetrician Should Know.

Obstet Gynecol 2016 10;128(4):731-738

Mayo Clinic, and the Departments of Cardiovascular Diseases, Obstetrics and Gynecology, and Anesthesiology, Mayo Clinic, Rochester, Minnesota.

Spontaneous coronary artery dissection is a major cause of myocardial infarction in pregnancy and the postpartum period. It occurs predominantly in young women with few or no conventional risk factors for atherosclerosis and has been clinically underrecognized. Treatment differs from that of myocardial infarction as a result of atherosclerosis and the diagnosis should be considered in all parturient and postpartum patients with acute coronary syndrome. Complications of spontaneous coronary artery dissection include recurrence, congestive heart failure, and death. Thus, specialist obstetrician-gynecologists and maternal-fetal medicine specialists need to gain knowledge of spontaneous coronary artery dissection to improve outcomes.
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http://dx.doi.org/10.1097/AOG.0000000000001630DOI Listing
October 2016

Pregnancy in Desmin-Related Cardiomyopathy.

AJP Rep 2015 Oct 12;5(2):e165-7. Epub 2015 Jun 12.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota.

The course of desmin-related restrictive cardiomyopathy (DRCM) during pregnancy has not been described previously because of the rarity of the condition. Following an episode of heart failure antecedent to conception, a 28-year-old primigravida with DRCM presented to establish prenatal care during the first trimester. Prenatal management consisted of β-blocker and diuretic therapy, with serial echocardiography to monitor cardiac function. Spontaneous labor ensued at 39 weeks' gestation, and vacuum-assisted delivery was performed for fetal indication. Postpartum blood transfusion was required for symptomatic anemia because of uterine atony, and subsequent maternal and neonatal courses were uncomplicated. Cardiac evaluation postpartum demonstrated stable maternal status. Pregnancy in women with controlled DRCM is not contraindicated, however, it requires careful planning and monitoring during the antenatal, intrapartum, and postpartum periods. On the basis of this report, pregnancy does not appear to exert a permanent deleterious effect on cardiac function in women with DRCM.
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http://dx.doi.org/10.1055/s-0035-1555130DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4603864PMC
October 2015

Persistent Notochord in a Fetus with COL2A1 Mutation.

Case Rep Obstet Gynecol 2015 8;2015:935204. Epub 2015 Sep 8.

Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.

Multiple anomalies including micromelia, poor mineralization of the vertebrae, and a persistent notochord were identified on second trimester ultrasound in a fetus with a COL2A1 mutation. To our knowledge, this represents the first case of a persistent notochord associated with a COL2A1 mutation in humans. In this case report, we describe ultrasound and postmortem findings and review the pathogenesis associated with a persistent notochord.
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http://dx.doi.org/10.1155/2015/935204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4578830PMC
October 2015
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