407:), may result in an adrenergic storm. This type of tumor is not common to begin with, and furthermore, the subtype that can cause massive adrenaline release is rarer still. Patients with pheochromocytoma can unexpectedly fly into a rage or sink into trembling fear, possibly dangerous to themselves and others as their judgment is impaired, their senses and pain threshold are heightened, and the level of the adrenaline in their bloodstream is more than most people ever experience; pheochromocytoma can, very rarely, kill by internal adrenaline overdose. But overall, adrenergic storm is an uncommon but certainly not rare phenomenon associated with the also uncommon condition of pheochromocytoma.
450:. Symptoms caused by excessive adrenergic signalling can occur alongside those of serotonergic signalling. One example would be: overdose of drug(s) influencing multiple targets including serotonin, and adrenergic systems, with concurrent MAOI use). Abnormal echocardiograms, or chest pain are indicative of adrenergic crisis. On the other hand, uncontrollable slow, rhythmic, and/or jerky movements, contractions and tension-often in every part of the body, dangerously high fever, eye rolling, and bruxism are more indicative of serotonin syndrome.
363:, rendering it inactive and effectively destroying it. Irreversible MAOIs are potentially more dangerous, because the body takes about two weeks to regenerate MAO enzymes to functional levels. Two subtypes of MAO exist: MAO-A and MAO-B; this is relevant to adrenergic storms, as there are significant differences between the two types, such as their differential
432:, checked against the possible causes of the adrenergic storm such as those above, should be done, because some adrenergic storms can be caused by serious underlying conditions. If a patient has an adrenergic storm and all or most of the other factors are ruled out, the adrenergic storm could lead to the discovery of a pheochromocytoma, which can become
446:, in which an excess of serotonin in the synapses causes a similar crisis of hypertension and mental confusion, could be confused with an adrenergic storm. Serotonin, being a tryptamine (non-catecholamine) involved in higher brain functions, can cause dangerous hypertension and tachycardia from its effects on the
374:
is an extremely serious condition in which a neural membrane is breached and the brain itself is compromised. The onset is sudden, described as "the worst headache of one's life," and many grave symptoms follow. Adrenergic storm is often present among these symptoms, and is responsible for some of
367:
throughout the body, and range of substrates. While both MAO-A and MAO-B metabolize tyramine, only MAO-A is present in the gastrointestinal tract and singularly metabolizes the majority of consumed tyramine. (The small portion normally passing into circulation is mostly degraded in the liver where
332:
There are several known causes of adrenergic storms; in the United States, cocaine overdose is the leading cause. Any stimulant drug has the capacity to cause this syndrome if taken in sufficient doses, but even non-psychotropic drugs can very rarely provoke a reaction.
203:; however, more recent research performed since 2019 has revealed that this and other severe side effects are rare and their occurrence does not warrant banning antipsychotics from the treatment of adrenergic crises for which they can be extremely useful.
358:
of the enzyme MAO is tyramine. MAOIs inhibit the enzyme either reversibly, in which MAO is inhibited only until the drug is cleared from the system, or irreversibly, in which the substrate binds permanently to the
649:
Connors, Nicholas J.; Alsakha, Ahmed; Larocque, Alexandre; Hoffman, Robert S.; Landry, Tara; Gosselin, Sophie (October 2019). "Antipsychotics for the treatment of sympathomimetic toxicity: A systematic review".
375:
the dangers, both long-term and short, of subarachnoid hemorrhage adrenergic storm, through a complex cascade of processes starting with the movement of subarachnoid blood into the brain. Apparently, as the
473:
and a non-selective beta blocker; other antihypertensive drugs may also be used. It is important to note that not all benzodiazepines and beta blockers are safe to use in an adrenergic storm; for instance,
890:
511:
Adrenergic storms are often idiopathic in nature; however if there is an underlying condition, then that must be addressed after bringing the heart rate and blood pressure down.
440:, sometimes a patient has a single one, or perhaps a few, and then does not for the rest of their life. The mechanisms of idiopathic adrenergic storm are very poorly understood.
482:; alprazolam weakly agonizes dopamine receptors and causes catecholamine release while propranolol mildly promotes some catecholamine release - each worsening the condition.
508:; however, newer research has revealed that their careful use does not carry the potential for any significant side effects and today their judicious use is encouraged.
783:
Connors, Nicholas J.; Alsakha, Ahmed; Larocque, Alexandre; Hoffman, Robert S.; Landry, Tara; Gosselin, Sophie (December 2019). "Evidence over dogma and anecdotes".
1369:
765:
466:, or both; this could make the difference between life and death in a close situation. It can however aggravate the patient which should be taken into account.
769:
420:
Because the adrenergic storm overlaps with so many other similar conditions, such as hypertensive crises, stimulant intoxication or overdose, or even
1660:
Jerry, Jason; Collins, Gregory; Streem, David (April 2012). "Synthetic legal intoxicating drugs: The emerging 'incense' and 'bath salt' phenomenon".
1546:
964:
918:
1108:
Mayersohn, Michael; Guentert, Theodor W. (November 1995). "Clinical
Pharmacokinetics of the Monoamine Oxidase-A Inhibitor Moclobemide*".
861:
696:
Richards, John R.; Derlet, Robert W. (December 2019). "Another dogma dispelled? Antipsychotic treatment of sympathomimetic toxicity".
1467:
Manger, William M. (August 2006). "An
Overview of Pheochromocytoma: History, Current Concepts, Vagaries, and Diagnostic Challenges".
1377:
1291:
316:. In all, rhabdomyolysis is especially common in adrenergic storms caused by the use of stimulant drugs, most notably those of the
1706:
906:
597:"Pediatric Methamphetamine Toxicity: Clinical Manifestations and Therapeutic Use of Antipsychotics—One Institution's Experience"
379:
increases, the brain is squeezed and catecholamines are forced out of their vesicles into the synapses and extracellular space.
1617:
Hughes, Joshua D.; Rabinstein, Alejandro A. (June 2014). "Early
Diagnosis of Paroxysmal Sympathetic Hyperactivity in the ICU".
595:
Malashock, Hannah R.; Yeung, Claudia; Roberts, Alexa R.; Snow, Jerry W.; Gerkin, Richard D.; O’Connor, Ayrn D. (April 2021).
1711:
1701:
336:
947:
Finberg, John P.M.; Gillman, Ken (2011). "Selective inhibitors of monoamine oxidase type B and the "cheese effect"".
1073:
von Braun, Amrei; Bühler, Annette; Yuen, Bernd (May 2012). "Severe thyrotoxicosis: a rare cause of acute delirium".
447:
1365:
424:, and because the treatments for these overlapping conditions are largely alike, it is not necessary to obtain a
746:
355:
1432:
Whalen, Raymond K.; Althausen, Alex F.; Daniels, Gilbert H. (January 1992). "Extra-Adrenal
Pheochromocytoma".
1034:"Recovery from Severe Hyperthermia (45 degrees C) and Rhabdomyolysis Induced by Methamphetamine Body-Stuffing"
1550:
371:
227:
78:
51:
1525:
Williams, Robert H.; Erickson, Timothy; Broussard, Larry A. (1 September 2000). Bertholf, Roger L. (ed.).
1233:
Jones, Chris; Owens, Dave (June 1996). "The recreational drug user in the intensive care unit: a review".
425:
259:
1582:
Vizcaychipi, M.P.; Walker, S.; Palazzo, M. (December 2007). "Serotonin syndrome triggered by tramadol".
889:
Roberts, James R. (1 January 2016). Roberts, James R.; Hoffman, Lisa; Nace, Lynn; Gibson, Grace (eds.).
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because of the excessive physical movement, causing the components of the muscle, most notably
293:. Breathing is rapid and shallow while both pulse and blood pressure are dangerously elevated.
1677:
1634:
1599:
1564:
1492:
1449:
1414:
1397:
Tevosian, Sergei G.; Ghayee, Hans K. (December 2019). "Pheochromocytomas and
Paragangliomas".
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O’Connor, Ayrn D.; Padilla-Jones, Angie; Gerkin, Richard D.; Levine, Michael (June 2015).
845:
429:
392:
364:
343:. This enzyme is responsible for breaking down many compounds; basically, anything with a
317:
230:
can also cause an adrenergic storm. A catecholamine storm is part of the normal course of
215:
82:
1268:
Gupta, Anish; Omender, Singh; et al. (Foreword by Fahrad N. Kapadia) (31 May 2019).
428:
and definitive diagnosis before initiating treatment. However, analysis of the patient's
17:
1480:
1324:
1311:
Yamada, M (January 2004). "Clinical
Pharmacology of MAO Inhibitors: Safety and Future".
1210:
1185:
1161:
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176:
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144:
129:
104:
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1332:
1246:
1186:"Prevalence of Rhabdomyolysis in Sympathomimetic Toxicity: a Comparison of Stimulants"
266:
movement and unpredictable mental status including mania, rage and suicidal behavior;
159:, and is especially dire for those with prior heart problems. If treatment is prompt,
1695:
1121:
871:
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725:
344:
313:
188:
172:
136:
125:
108:
1504:
679:
1646:
1383:
1297:
875:
578:
545:"Sympathomimetic Toxidromes and Other Pharmacological Causes of Acute Hypertension"
500:. Originally, the use of antipsychotics was discouraged because of their potential
421:
267:
263:
235:
156:
60:
195:
or terror, after their use was formerly discouraged because of their potential to
1359:
1273:
831:
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If there is evidence of overdose or it is suspected, the patient should be given
1559:
1526:
841:
505:
479:
436:. However, not all cases of adrenergic storm have an identifiable cause. Like a
247:
234:
infection, and is responsible for the severe feelings of agitation, terror, and
200:
191:
are also used to treat the most severe psychiatric reactions such as psychosis,
152:
140:
56:
796:
740:
739:
Goldstein, Scott; Richards, John R. (1 January 2020). Richards, John R. (ed.).
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are also used to treat the psychiatric symptoms such as aggression, agitation,
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1410:
1201:
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853:
561:
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475:
433:
321:
132:
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1488:
1279:
1145:"Acute renal failure due to rhabdomyolysis associated with cocaine toxicity"
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184:
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74:
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570:
1453:
1254:
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Holstege, Christopher P.; Borek, Heather A. (October 2012). "Toxidromes".
1595:
1542:
951:. International Review of Neurobiology. Vol. 100. pp. 169–190.
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100:
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70:
404:
360:
286:
231:
90:
828:"8. Management of Sympathomimetic Overdose Including Designer Drugs"
151:
transmission. It is a life-threatening condition because of extreme
1283:
351:
1527:"Evaluating sympathomimetic intoxication in an emergency setting"
1358:. In Awad, Isam A.; Barrow, Daniel L.; Miller, Linda S. (eds.).
223:
543:
King, Andrew; Dimovska, Mirjana; Bisoski, Luke (January 2018).
27:
Sudden increase in adrenaline and noradrenaline in the blood
1368:, United States of America: AANS Publications Committee (
308:, to be released into the bloodstream and then clog the
1399:
Endocrinology and
Metabolism Clinics of North America
339:(MAOIs) are a class of drugs that inhibit the enzyme
277:
Physical symptoms are more serious and include heart
206:
Adrenergic storms are usually caused by overdoses of
1370:
766:
1275:
Principles and
Practice of Critical Care Toxicology
833:
Evidence-Based Critical Care: A Case Study Approach
749:, United States of America: StatPearls Publishing.
246:The behavioral symptoms are similar to those of an
147:respectively), with a less significant increase in
96:
66:
50:
40:
35:
1286:: Jaypee Brothers Medical Publishers. p. 84.
1143:Lombard, J.; Wong, B.; Young, J. H. (April 1988).
770:NLM (United States National Library of Medicine)
830:. In Hyzy, Robert C.; McSparron, Jakob (eds.).
1547:American Society for Clinical Pathology (ASCP)
238:present in the pre-coma stage of the disease.
8:
891:"InFocus: Treating Sympathomimetic Toxicity"
1272:. In Singh, Omender; Juneja, Deven (eds.).
992:
990:
988:
986:
984:
590:
588:
1469:Annals of the New York Academy of Sciences
785:The American Journal of Emergency Medicine
698:The American Journal of Emergency Medicine
691:
689:
652:The American Journal of Emergency Medicine
32:
1558:
1361:Cuerrent Management of Cerebral Aneurysms
1354:Rodman, Karen A.; Awad, Issam A. (1993).
1209:
1160:
1049:
1038:The Western Journal of Emergency Medicine
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642:
640:
620:
560:
826:Lam, Vivian; Shaffer, Robert W. (2017).
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1518:
1516:
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1364:. Neurosurgical Topics. Vol. 15.
949:Monoamine Oxidase and their Inhibitors
538:
536:
124:is a sudden and dramatic increase in
7:
1662:Cleveland Clinic Journal of Medicine
942:
940:
938:
936:
163:is good; typically large amounts of
1235:Intensive and Critical Care Nursing
1032:Suchard, Jeffrey R. (August 2007).
354:by monoamine oxidase. An important
1356:"CHAPTER 2: Clinical Presentation"
1270:"Chapter 8: Sympathomimetic Drugs"
957:10.1016/B978-0-12-386467-3.00009-1
915:10.1097/01.EEM.0000476273.56614.28
296:Other complications would include
25:
907:Lippincott Williams & Wilkins
258:overdose. Overstimulation of the
1122:10.2165/00003088-199529050-00002
274:can also be present but rarely.
1149:The Western Journal of Medicine
1075:Internal and Emergency Medicine
1584:British Journal of Anaesthesia
469:The first line treatments are
1:
1446:10.1016/s0022-5347(17)37119-7
1333:10.1016/S0161-813X(03)00097-4
1247:10.1016/s0964-3397(96)80418-6
1190:Journal of Medical Toxicology
601:Journal of Medical Toxicology
289:in people who are at risk of
270:is also prominently present.
1545:, United States of America:
549:Current Hypertension Reports
337:Monoamine oxidase inhibitors
224:monoamine oxidase inhibitors
1560:10.1309/WVX1-6FPV-E2LC-B6YG
903:Wolters Kluwer Health, Inc.
179:in some patients, so other
171:are administered alongside
1728:
797:10.1016/j.ajem.2019.05.014
710:10.1016/j.ajem.2019.05.013
664:10.1016/j.ajem.2019.01.001
613:10.1007/s13181-020-00821-4
448:sympathetic nervous system
218:, or eating foods high in
1631:10.1007/s12028-013-9877-3
1411:10.1016/j.ecl.2019.08.006
1366:Rolling Meadows, Illinois
1202:10.1007/s13181-014-0451-y
1110:Clinical Pharmacokinetics
1087:10.1007/s11739-011-0572-0
1011:10.1016/j.ccc.2012.07.008
854:10.1007/978-3-030-26710-0
562:10.1007/s11906-018-0807-9
46:Sympathomimetic toxidrome
18:Sympathomimetic toxidrome
747:Treasure Island, Florida
742:Sympathomimetic Toxicity
44:Sympathomimetic toxicity
1707:Cardiovascular diseases
1551:Oxford University Press
1489:10.1196/annals.1353.001
895:Emergency Medicine News
372:Subarachnoid hemorrhage
228:subarachnoid hemorrhage
79:subarachnoid hemorrhage
1674:10.3949/ccjm.79a.11147
416:Differential diagnosis
262:results in a state of
260:central nervous system
999:Critical Care Clinics
377:intracranial pressure
368:both MAO types act.)
300:, a breakdown of the
521:Sympathomimetic drug
399:, which are located
281:as well as outright
175:. Beta blockers are
1712:Medical emergencies
1702:Medical terminology
1531:Laboratory Medicine
1481:2006NYASA1073....1M
1372:). pp. 21–43.
1325:2004NeuTx..25..215Y
183:medication such as
1619:Neurocritical Care
1596:10.1093/bja/aem325
1434:Journal of Urology
921:on 10 January 2016
464:activated charcoal
444:Serotonin syndrome
242:Signs and symptoms
113:anti-hypertensives
966:978-0-12-386467-3
704:(12): 2256–2257.
658:(10): 1880–1890.
341:monoamine oxidase
324:or amphetamines.
302:voluntary muscles
181:anti-hypertensive
118:
117:
30:Medical condition
16:(Redirected from
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1319:(1–2): 215–221.
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917:. Archived from
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836:(2nd ed.).
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389:pheochromocytoma
350:is likely to be
291:coronary disease
122:adrenergic storm
85:, foods high in
36:Adrenergic storm
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430:medical history
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318:phenethylamines
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216:methamphetamine
177:contraindicated
169:benzodiazepines
139:(also known as
105:benzodiazepines
83:methamphetamine
45:
31:
28:
23:
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5:
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1668:(4): 258–264.
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1625:(3): 454–459.
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1405:(4): 727–750.
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1241:(3): 126–130.
1225:
1196:(2): 195–200.
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1155:(4): 466–468.
1135:
1116:(5): 292–332.
1100:
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1005:(4): 479–498.
980:
965:
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863:978-3030267094
862:
848:. p. 65.
818:
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685:
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607:(2): 168–175.
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486:Antipsychotics
460:gastric lavage
455:
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397:adrenal glands
395:tissue of the
391:(tumor of the
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329:
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298:rhabdomyolysis
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189:Antipsychotics
145:norepinephrine
130:catecholamines
128:levels of the
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1081:(S1): 27–28.
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52:Complications
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1382:– via
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1298:Google Books
1296:– via
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422:panic attack
419:
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283:heart attack
276:
268:hyperthermia
264:hyperkinetic
245:
236:dysautonomia
205:
157:hypertension
121:
119:
61:hypertension
1553:: 497–508.
1475:(1): 1–20.
1440:(1): 1–10.
842:Switzerland
506:QT interval
480:propranolol
383:Rare causes
279:arrhythmias
248:amphetamine
201:QT interval
153:tachycardia
141:epinephrine
57:Tachycardia
41:Other names
1696:Categories
1590:(6): 919.
909:): 10–12.
527:References
502:to prolong
476:alprazolam
387:Rarely, a
365:expression
322:cathinones
312:, causing
208:stimulants
133:adrenaline
1569:423776763
1280:New Delhi
872:202810365
813:167206288
726:155090660
490:psychosis
454:Treatment
434:malignant
411:Diagnosis
356:substrate
306:myoglobin
185:clonidine
167:or other
161:prognosis
97:Treatment
75:stimulant
1682:22473725
1639:23884511
1604:18006535
1543:Illinois
1505:21423113
1497:17102067
1419:31655773
1341:14697896
1220:25468315
1095:21451989
1060:19561691
1019:22998986
975:21971008
805:31128936
755:28613508
718:31088749
680:58631990
672:30639129
631:33442836
571:29478133
555:(1): 8.
515:See also
494:paranoia
471:diazepam
401:anterior
393:medullar
352:oxidized
320:such as
272:Delirium
256:caffeine
220:tyramine
193:paranoia
165:diazepam
149:dopamine
101:diazepam
87:tyramine
1647:6433256
1539:Chicago
1477:Bibcode
1454:1729490
1321:Bibcode
1255:8717812
1211:4469713
1171:3388853
1162:1026152
1130:8582117
1051:2672216
925:28 July
760:28 July
622:8017059
579:3530495
498:anxiety
438:seizure
403:to the
310:kidneys
252:cocaine
212:cocaine
197:prolong
77:abuse,
71:Cocaine
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405:kidney
361:enzyme
348:moiety
328:Causes
287:stroke
232:rabies
91:rabies
67:Causes
1643:S2CID
1537:(9).
1501:S2CID
1284:India
901:(1).
868:S2CID
809:S2CID
722:S2CID
676:S2CID
575:S2CID
126:serum
1678:PMID
1635:PMID
1600:PMID
1565:OCLC
1493:PMID
1473:1073
1450:PMID
1415:PMID
1374:ISBN
1337:PMID
1288:ISBN
1251:PMID
1216:PMID
1167:PMID
1126:PMID
1091:PMID
1056:PMID
1015:PMID
971:PMID
961:ISBN
927:2021
858:ISBN
838:Cham
801:PMID
762:2021
751:PMID
714:PMID
668:PMID
627:PMID
567:PMID
504:the
478:and
226:. A
199:the
155:and
143:and
135:and
1670:doi
1627:doi
1592:doi
1555:doi
1485:doi
1442:doi
1438:147
1407:doi
1329:doi
1243:doi
1206:PMC
1198:doi
1157:PMC
1153:148
1118:doi
1083:doi
1046:PMC
1007:doi
953:doi
911:doi
850:doi
793:doi
706:doi
660:doi
617:PMC
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557:doi
496:or
285:or
254:or
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