2025
Percutaneous Cryoablation of Non-small Cell Lung Cancer in Patients with Recurrence After Stereotactic Body Radiation Therapy
Fish A, Park H, Knight E, Knowlton C, Madoff D. Percutaneous Cryoablation of Non-small Cell Lung Cancer in Patients with Recurrence After Stereotactic Body Radiation Therapy. CardioVascular And Interventional Radiology 2025, 48: 626-632. PMID: 40069339, DOI: 10.1007/s00270-025-04002-0.Peer-Reviewed Original ResearchConceptsStereotactic body radiation therapyNon-small cell lung cancerCell lung cancerProgression-free survivalLung cancerPercutaneous cryoablationRadiation therapyOverall survivalTechnical successLocal controlNon-small cell lung cancer recurrenceHome oxygen requirementPost-procedure hospitalizationHistory of smokingWorsening pulmonary functionPost-procedural pneumothoraxEffective treatment alternativeConclusionPercutaneous cryoablationCryoablation protocolResults29 patientsTarget tumorsAdverse eventsCryoablationPulmonary functionLesion size
2024
Cross-shift changes in pulmonary function and occupational exposure to particulate matter among e-waste workers in Ghana
Laskaris Z, O'Neill M, Batterman S, Mukherjee B, Fobil J, Robins T. Cross-shift changes in pulmonary function and occupational exposure to particulate matter among e-waste workers in Ghana. Frontiers In Public Health 2024, 12: 1368112. PMID: 38784567, PMCID: PMC11111984, DOI: 10.3389/fpubh.2024.1368112.Peer-Reviewed Original ResearchConceptsE-waste workersExposure to particulate matterE-wasteParticulate matterAgbogbloshie e-waste siteInhalation exposure to particulate matterE-waste sitesBurning e-wasteConcentrations of PMHealth-based guidelinesExposure to airborne pollutantsExposure to PMOccupational exposure to particulate matterCross-shift changesElectronic-wasteForced Vital CapacityPersonal PMPM exposureAirborne pollutantsLinear mixed modelsBreathing zone concentrationsPulmonary functionComparison populationRecovery workersMixed modelsDeployment-related Cigarette Smoking Behaviors and Pulmonary Function Among U.S. Veterans
Maccarone J, Sterns O, Timmons A, Korpak A, Smith N, Nakayama K, Baird C, Ciminera P, Kheradmand F, Fan V, Hart J, Koutrakis P, Jerrett M, Kuschner W, Ioachimescu O, Montgrain P, Proctor S, Redlich C, Wendt C, Blanc P, Garshick E, Wan E. Deployment-related Cigarette Smoking Behaviors and Pulmonary Function Among U.S. Veterans. Military Medicine 2024, 189: 2030-2038. PMID: 38536226, DOI: 10.1093/milmed/usae049.Peer-Reviewed Original ResearchPack-yearsEver-smokersMultivariable linear regression models assessed associationsLinear regression models assessed associationsRegression models assessed associationsVeterans Affairs sitesModels assessed associationsPost-9/11 veteransLand-based deploymentsPack-years smokingEffects of smokingPulmonary functionCigarette smoking behaviorDeployed veteransInverse associationSmoking intensityLevels of ambient particulate matterSmoking behaviorU.S. veteransVeteransSmokingCigarette smokingAmbient particulate matterMultiple deploymentsFEV1%-predictedMycophenolate and azathioprine efficacy in interstitial lung disease: a systematic review and meta-analysis
Lombardi F, Stewart I, Fabbri L, Adams W, Kawano-Dourado L, Ryerson C, Jenkins G, Consortium R, Cavalcanti A, Mojibian A, Bravery A, Goodwin A, Etges A, Boshoff A, Guenther A, Briggs A, Palmer A, Wilson A, Crawshaw A, Anna-MariaHoffmann-Vold A, Holland A, Gordon A, Prasse A, Tzouvelekis A, Trachalaki A, Wells A, Nair A, Wendelberger B, Hope-Gill B, Gooptu B, Baldi B, Crestani B, Polanczyk C, Vancheri C, Robalo C, Summers C, Grainge C, Ryerson C, von Garnier C, Huntley C, Ravaglia C, Valenzuela C, Hayton C, McCarthy C, Chambers D, Wang D, Bablis D, Thicket D, Turner D, Talwar D, Adegunsoye D, Anand D, Dhasmana D, Parek D, Griffiths D, Richards D, Santucci E, Bendstrup E, Balestro E, Tsitoura E, Falaschetti E, Karlsen E, Gupta E, Farrand E, Khan F, Chua F, Martinez F, Bonella F, Lombardi F, Hunninghake G, Saini G, Chalmers G, Jenkins G, Gudmundsson G, Collard H, Parfrey H, Prosch H, Fainberg H, Adamali H, Stewart I, Forrest I, Glaspole I, Bauer-Ventura I, Noth I, Cox I, Strambu I, Sellares J, Eaden J, Johnston J, Swigris J, Blaikley J, Kim J, Chung J, Lasky J, Jacob J, Lee J, Behr J, Storrer K, Negrelli K, Lewandowska K, Johnson K, Antoniou K, Hostettler K, Johannson K, Hurley K, Hett K, Schwarzkopf L, Fabbri L, Price L, Pearmain L, Kawano-Dourado L, Galvin L, Spencer L, Watson L, Crowley L, Richeldi L, Piccari L, Chambour M, Molina-Molina M, Jones M, Spears M, Toshner M, Wijsenbeek-Lourens M, Brutsche M, Vasakova M, Quintana M, Gibbons M, Henry M, Keane M, Kreuter M, Hatieganu M, Sadatsafavi M, Kaminski N, Chaudhuri N, Weatherley N, Hirani N, Babes O, Spagnolo P, Beirne P, Bryce P, George P, Molyneaux P, Ortega P, Crisan-Dabija R, Maida R, Borie R, Lewis R, Rolo R, Guler S, Paganoni S, Singh S, Freitas S, Piciucchi S, Malik S, Barratt S, Hart S, Dal Corso S, Fletcher S, Stanel S, Bianchi S, Jones S, Adams W. Mycophenolate and azathioprine efficacy in interstitial lung disease: a systematic review and meta-analysis. BMJ Open Respiratory Research 2024, 11: e002163. PMID: 38413120, PMCID: PMC10973691, DOI: 10.1136/bmjresp-2023-002163.Peer-Reviewed Original ResearchConceptsInterstitial lung diseaseMycophenolate mofetilRandomised controlled trialsPrimary endpointLung diseasePulmonary functionEfficacy of mycophenolate mofetilPreservation of pulmonary functionInterstitial lung disease diagnosisMMF efficacyPrimary endpoint analysisProspective observational studySystematic reviewNo language restrictionsGrading of RecommendationsAzathioprine efficacyConcomitant steroidsAzathioprine treatmentImmunomodulatory treatmentRandomised controlled trial designSecondary endpointsPlacebo comparatorRetrospective studyAzathioprineSubgroup analysisPreservation of Pulmonary Function Following Hematopoietic Cell Transplant for Sickle Cell Disease: A STAR Study
Horan F, Bendiak G, Abraham A, Liu K, Gillespie S, Chellapandian D, Shah R, Bhatia M, Chaudhury S, Eckrich M, Jaroscak J, Kasow K, Krajewski J, Ngwube A, Horan J, Krishnamurti L, Shenoy S, Guilcher G, Stenger E. Preservation of Pulmonary Function Following Hematopoietic Cell Transplant for Sickle Cell Disease: A STAR Study. Transplantation And Cellular Therapy 2024, 30: s45-s46. DOI: 10.1016/j.jtct.2023.12.079.Peer-Reviewed Original ResearchHematopoietic cell transplantationPulmonary function testsPost-HCTYears post-HCTSickle cell diseaseAmerican Thoracic SocietyCell transplantationPulmonary dysfunctionPulmonary functionCurative hematopoietic cell transplantationPreservation of pulmonary functionCell diseaseGroup of SCD patientsPulmonary function test dataPost-HCT patientsProgressive pulmonary dysfunctionLung volume valuesSevere clinical phenotypeMyeloablative conditioningMedian followHLA matchingMedian ageNo significant differencePFT resultsPre-HCT
2023
Pulmonary Function and Quality of Life in Aging Men With and Without HIV from the Multicenter AIDS Cohort Study
Abdo M, Kunisaki K, Morris A, Stosor V, Chang D, D'Souza G, Crothers K, Abdel-Maksoud M, DiGuiseppi C, Brown T, Erlandson K, MaWhinney S. Pulmonary Function and Quality of Life in Aging Men With and Without HIV from the Multicenter AIDS Cohort Study. AIDS Research And Human Retroviruses 2023, 39: 621-632. PMID: 37276144, PMCID: PMC10712368, DOI: 10.1089/aid.2023.0001.Peer-Reviewed Original ResearchConceptsPulmonary impairmentPulmonary functionOdds ratioMedian age 57 yearsMulticenter AIDS Cohort StudyGreater respiratory impairmentPulmonary function impairmentImpaired pulmonary functionAge 57 yearsHealth-related qualityLower physical HRQoLRespiratory health statusAIDS Cohort StudyCohort study dataQuality of lifeHRQoL scoresCohort studyLower HRQoLPhysical HRQoLHIV serostatusAdjusted analysisFunction impairmentRespiratory impairmentMmHg decreaseRespiratory healthLow CC16 mRNA Expression Levels in Bronchial Epithelial Cells Are Associated with Asthma Severity.
Li X, Guerra S, Ledford JG, Kraft M, Li H, Hastie AT, Castro M, Denlinger LC, Erzurum SC, Fahy JV, Gaston B, Israel E, Jarjour NN, Levy BD, Mauger DT, Moore WC, Zein J, Kaminski N, Wenzel SE, Woodruff PG, Meyers DA, Bleecker ER. Low CC16 mRNA Expression Levels in Bronchial Epithelial Cells Are Associated with Asthma Severity. American Journal Of Respiratory And Critical Care Medicine 2023, 207: 438-451. PMID: 36066606, PMCID: PMC9940145, DOI: 10.1164/rccm.202206-1230oc.Peer-Reviewed Original ResearchConceptsBronchial epithelial cellsMRNA expression levelsAsthma severityT2 biomarkersAsthma susceptibilityT2 inflammationExpression levelsSevere Asthma Research ProgramSystemic corticosteroid useLower pulmonary functionEpithelial cellsAsthma-related phenotypesCorticosteroid useAsthma exacerbationsPulmonary functionAsthma developmentAsthma endotypesAsthma progressionInflammation biomarkersInflammation genesHost defenseCC16Th2 genesSeverityBiomarkersEffects of physical rehabilitation interventions in COVID-19 patients following discharge from hospital: A systematic review
Rahmati M, Molanouri Shamsi M, Woo W, Koyanagi A, Won Lee S, Keon Yon D, Shin J, Smith L. Effects of physical rehabilitation interventions in COVID-19 patients following discharge from hospital: A systematic review. Journal Of Integrative Medicine 2023, 21: 149-158. PMID: 36717302, PMCID: PMC9851951, DOI: 10.1016/j.joim.2023.01.003.Peer-Reviewed Original ResearchConceptsPhysical rehabilitation interventionsRehabilitation interventionsMental health statusQuality of lifeSystematic reviewFunctional capacityHealth statusOutpatient rehabilitation programMethodological quality assessmentRandomized Controlled TrialsPhysical activityRehabilitation programRestore functional capacityPhysical rehabilitationPulmonary functionMental healthClinically relevant outcomesBreathing trainingCohort studyData extractionCOVID-19Systematic searchControlled TrialsReview authorsCOVID-19 patients
2022
A review and guide to nutritional care of the infant with established bronchopulmonary dysplasia
Miller A, Curtiss J, Taylor S, Backes C, Kielt M. A review and guide to nutritional care of the infant with established bronchopulmonary dysplasia. Journal Of Perinatology 2022, 43: 402-410. PMID: 36494567, DOI: 10.1038/s41372-022-01578-0.Peer-Reviewed Original ResearchConceptsBronchopulmonary dysplasiaNutritional careCommon long-term morbidityIncidence of BPDLong-term pulmonary functionEnteral nutrition managementLong-term morbidityExcess weight gainPostnatal growth failureBPD preventionPreterm nutritionPulmonary functionNeurodevelopmental outcomesPremature birthChronic diseasesFavorable outcomeLung growthGrowth failureHigh riskClinical experienceComprehensive centerInfantsWeight gainNutrition managementDysplasiaPulmonary and physical function limitations in aging men with and without HIV from the Multicenter AIDS Cohort Study (MACS)
Abdo M, Kunisaki K, Morris A, Stosor V, Chang D, D'Souza G, Crothers K, Abdel-Maksoud M, DiGuiseppi C, Brown T, MaWhinney S, Erlandson K. Pulmonary and physical function limitations in aging men with and without HIV from the Multicenter AIDS Cohort Study (MACS). Annals Of Epidemiology 2022, 76: 50-60. PMID: 36244514, PMCID: PMC9881119, DOI: 10.1016/j.annepidem.2022.10.005.Peer-Reviewed Original ResearchConceptsMulticenter AIDS Cohort StudyWeak grip strengthGait speedGrip strengthPhysical functionPulmonary impairmentPulmonary functionGreater oddsSimilar gait speedSlow gait speedPhysical function limitationsAIDS Cohort StudyCohort study dataNormal FEVCohort studyMedian ageHIV serostatusHIVFunction limitationsFEVDlPhysical outcomesAgeFrailtyMenCirculating CTRP9 Is Associated With Severity of Systemic Sclerosis–Associated Interstitial Lung Disease
Yang MM, Balmert LC, Marangoni RG, Carns M, Hinchcliff M, Korman BD, Varga J. Circulating CTRP9 Is Associated With Severity of Systemic Sclerosis–Associated Interstitial Lung Disease. Arthritis Care & Research 2022, 75: 152-157. PMID: 34251759, PMCID: PMC9233895, DOI: 10.1002/acr.24749.Peer-Reviewed Original ResearchConceptsC1q/tumor necrosis factor-related protein 9Interstitial lung diseaseSystemic sclerosisLung diseaseLung functionSystemic sclerosis-associated interstitial lung diseaseSSc-associated interstitial lung diseasePulmonary function test dataLatent trajectory analysisVital capacity percentWorse lung functionPrimary outcome measureWorse pulmonary functionCause of morbidityRetrospective longitudinal studyAdipose tissue metabolismCross-sectional analysisAdipokine homeostasisDisease stabilityPulmonary functionSSc patientsSerum levelsPatient RegistryPredictive markerCapacity percentResting Energy Expenditure of Patients on Venovenous Extracorporeal Membrane Oxygenation for Adult Respiratory Distress Syndrome: A Pilot Study
Ong CS, Brown P, Shou BL, Wilcox C, Cho SM, Mendez-Tellez PA, Kim BS, Whitman GJR, Whitman G, Cho S, Acton M, Rando H, Alejo D, Calligy K, Anderson S, Sussman M, Wilcox C. Resting Energy Expenditure of Patients on Venovenous Extracorporeal Membrane Oxygenation for Adult Respiratory Distress Syndrome: A Pilot Study. Critical Care Explorations 2022, 4: e0730. PMID: 35923588, PMCID: PMC9296180, DOI: 10.1097/cce.0000000000000730.Peer-Reviewed Original ResearchAcute respiratory distress syndrome patientsAdult respiratory distress syndromeRespiratory distress syndrome patientsVenovenous extracorporeal membrane oxygenationAdult ARDS patientsExtracorporeal membrane oxygenationML/Respiratory distress syndromeRetrospective observational studyEnergy expenditureCarbon dioxide eliminationPatient's paralysisVenovenous ECMOECMO flowARDS patientsDistress syndromePulmonary functionMembrane oxygenationMean REEBlood gasesObservational studySyndrome patientsTidal volumePatientsBody weightChronic lung lesions in COVID-19 survivors: predictive clinical model
Carvalho C, Chate R, Sawamura M, Garcia M, Lamas C, Cardenas D, Lima D, Scudeller P, Salge J, Nomura C, Gutierrez M, Araújo A, Segurado A, Montal A, Miethke-Morais A, Levin A, Perondi B, Guedes B, Carmo C, Lázari C, Antonio C, Tanaka C, Leite C, Gomes C, Utiyama E, Burdmann E, Bonfá E, Kallas E, Sabino E, Miguel E, Pinna F, Kawano F, Busatto G, Cerri G, Fonseca G, Souza H, Marcilio I, Rios I, Hallak J, Krieger J, Ferreira J, Marchini J, Oliveira L, Harima L, Batisttella L, Yu L, Castro L, Rocha M, Magri M, Mancini M, de Jesus M, Corrêa M, Francisco M, Rossi M, Silva M, Imamura M, Oliveira M, Gouveia N, Forlenza O, Lotufo P, Bento R, Nitrini R, Damiano R, Chammas R, Francisco R, Fusco S, Barros-Filho T, Mauad T, Guimarães T, Avelino-Silva T, Filho W. Chronic lung lesions in COVID-19 survivors: predictive clinical model. BMJ Open 2022, 12: e059110. PMID: 35697456, PMCID: PMC9195157, DOI: 10.1136/bmjopen-2021-059110.Peer-Reviewed Original ResearchConceptsChest X-rayPredictive clinical modelCOVID-19 survivorsLung lesionsClinical modelLung lesion detectionMMRC scaleChest CTMedical Research Council dyspnoea scaleSARS-CoV-2-infected patientsSARS-CoV-2 infectionCOVID-19 sequelaeSignificant pulmonary abnormalitiesProspective cohort studyGround-glass opacitiesCOVID-19 infectionChronic lung lesionsLesion detectionDyspnoea scalePulmonary involvementTraction bronchiectasisCohort studyCXR findingsHospital dischargePulmonary functionA guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation—part 3: systematic review of evidence regarding surgery in compromised patients or specific tumors
Bade BC, Blasberg JD, Mase VJ, Kumbasar U, Li AX, Park HS, Decker RH, Madoff DC, Brandt WS, Woodard GA, Detterbeck FC. A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation—part 3: systematic review of evidence regarding surgery in compromised patients or specific tumors. Journal Of Thoracic Disease 2022, 0: 0-0. PMID: 35813753, PMCID: PMC9264070, DOI: 10.21037/jtd-21-1825.Peer-Reviewed Original ResearchLimited pulmonary reserveLong-term outcomesResection extentNon-randomized comparisonPulmonary reserveOlder patientsIndividual patientsFavorable tumorsSystematic reviewStage I lung cancerFavorable long-term outcomeI lung cancerScreen-detected tumorsStage I NSCLCCharacteristics of patientsShort-term outcomesLesser resectionsPerioperative mortalityPulmonary functionSublobar resectionWedge resectionPatient selectionRandomized trialsLung cancerResidual confoundingA guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation—part 4: systematic review of evidence involving SBRT and ablation
Park HS, Detterbeck FC, Madoff DC, Bade BC, Kumbasar U, Mase VJ, Li AX, Blasberg JD, Woodard GA, Brandt WS, Decker RH. A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation—part 4: systematic review of evidence involving SBRT and ablation. Journal Of Thoracic Disease 2022, 0: 0-0. PMID: 35813762, PMCID: PMC9264060, DOI: 10.21037/jtd-21-1826.Peer-Reviewed Original ResearchLong-term outcomesNon-randomized comparisonIndividual patientsSystematic reviewStage I lung cancerI lung cancerCharacteristics of patientsStage I NSCLCPulmonary function testsMinority of patientsShort-term outcomesStereotactic body radiotherapyThermal ablationLate toxicityPulmonary functionRandomized trialsFunction testsAdjusted comparisonsBody radiotherapyLung cancerResidual confoundingEffect modifiersShort-term benefitsPatientsPubMed systematic reviewChange in plasma α-tocopherol associations with attenuated pulmonary function decline and with CYP4F2 missense variation
Xu J, Guertin K, Gaddis N, Agler A, Parker R, Feldman J, Kristal A, Arnold K, Goodman P, Tangen C, Hancock D, Cassano P. Change in plasma α-tocopherol associations with attenuated pulmonary function decline and with CYP4F2 missense variation. American Journal Of Clinical Nutrition 2022, 115: 1205-1216. PMID: 35040869, PMCID: PMC8970985, DOI: 10.1093/ajcn/nqac013.Peer-Reviewed Original ResearchConceptsMulti-Ethnic Genotyping ArrayFunctional declineMixed-effects linear regressionAttenuate age-related declinePulmonary function declineFEV1 declineNever smokersFormer smokersAdherent participantsEuropean ancestryDietary intakeHigh dietary intakeEffect sizeCytochrome P450 family 4 subfamily F member 2SmokersGenotyping arraysAge-related declineLinear regressionAssociationC alleleMissense variantsT alleleMissense variationsPulmonary functionBaseline
2021
Associations Between Meal Program Participation and Protein Intake in People Over 65 (NHANES 2013-2018)
Abdo M, Kunisaki K, Stosor V, D'Souza G, Abdel-Maksoud M, Brown T, MaWhinney S, Erlandson K. Associations Between Meal Program Participation and Protein Intake in People Over 65 (NHANES 2013-2018). Innovation In Aging 2021, 5: 613-614. PMCID: PMC8968276, DOI: 10.1093/geroni/igab046.2333.Peer-Reviewed Original ResearchWeak grip strengthGrip strengthHIV serostatusGait speedImpaired DLCONormal DLCOPulmonary functionPhysical functionMulticenter AIDS Cohort StudyPhysical function impairmentPulmonary function testsSlow gait speedAdjusted mixed-effects modelPhysical function limitationsAIDS Cohort StudyCohort study dataNormal FEV1Cohort studyCumulative smokingEffect of ageMedian ageFunction testsFunction impairmentEffect modificationSlow gaitAdolescent and caregiver mental health, pulmonary function, and healthcare utilization in pediatric cystic fibrosis
Vassilopoulos A, Swartz M, Paranjape S, Slifer K. Adolescent and caregiver mental health, pulmonary function, and healthcare utilization in pediatric cystic fibrosis. Children's Health Care 2021, 51: 199-212. DOI: 10.1080/02739615.2021.2002695.Peer-Reviewed Original ResearchHealth care utilizationPulmonary functionDepression symptomsCystic fibrosisPediatric cystic fibrosisNumber of hospitalizationsLength of stayMental health symptomsStandard careHealthcare utilizationPsychosocial screeningCaregiver depressionHealth symptomsSymptomsMental healthYoung adultsAnxiety symptomsFibrosisCaregiversHospitalizationPatientsStayCareCOVID-19 Rehabilitation With Herbal Medicine and Cardiorespiratory Exercise: Protocol for a Clinical Study
Gao Y, Zhong LLD, Quach B, Davies B, Ash GI, Lin ZX, Feng Y, Lau BWM, Wagner PD, Yang X, Guo Y, Jia W, Bian Z, Baker JS. COVID-19 Rehabilitation With Herbal Medicine and Cardiorespiratory Exercise: Protocol for a Clinical Study. JMIR Research Protocols 2021, 10: e25556. PMID: 33970864, PMCID: PMC8158531, DOI: 10.2196/25556.Peer-Reviewed Original ResearchINTERNATIONAL REGISTERED REPORT IDENTIFIERCOVID-19 rehabilitationCardiorespiratory exerciseChinese herbal medicinePulmonary functionLung functionHerbal medicineImmune functionCOVID-19Chinese herbal medicine groupHerbal medicine groupWaiting list groupEffects of rehabilitationDeclaration of HelsinkiBlood oxygen levelEligible patientsSymptoms monthsAdult patientsPrimary outcomeExercise programPulmonary fibrosisClinical trialsAutoimmune deficiencyClinical studiesMedicine group
2020
Pediatric unilobar resection in primary ciliary dyskinesia.
Sendon C, Cowles R, Worhunsky D, Hodson D, Morotti R, Bazzy-Asaad A, Esquibies A. Pediatric unilobar resection in primary ciliary dyskinesia. Minerva Pediatrica 2020, 74: 593-599. PMID: 32731729, DOI: 10.23736/s2724-5276.20.05802-8.Peer-Reviewed Original ResearchConceptsPrimary ciliary dyskinesiaSevere lung diseasePulmonary functionLung diseaseCiliary dyskinesiaAggressive medical managementSelective surgical removalQuality of lifeProgressive bronchiectasisUnilobar diseaseProphylactic antibioticsLung resectionAggressive administrationAirway clearanceMedical managementChronic bronchiectasisTherapy optionsLocalized bronchiectasisSurgical removalChronic infectionBronchiectasisRare caseAlternative treatmentNutritional statusNecrotic areas
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