Abstract 2887: Peri-Operative Beta-Blockers in Patients Undergoing Non-cardiac Surgery: A Meta-Analysis of 12,306 Patients from Randomized Trials

Background: The 2007 ACC/AHA guideline on perioperative evaluation recommends perioperative β-blockers for non-cardiac surgery. However, some clinical trials seem to be at odds with these recommendations. Methods: PUBMED/EMBASE/CENTRAL search for randomized trials (RCTs) evaluating β-blockers for non-cardiac surgery. Efficacy outcomes of all-cause mortality, cardiovascular (CV) mortality, nonfatal MI, nonfatal stroke, heart failure, and myocardial ischemia (30 days), and safety outcomes of perioperative bradycardia, hypotension, and bronchospasm. Results: Among 33 RCTs which evaluated 12,306 patients, β-blockers were not associated with any significant reduction in the risk of all-cause mortality, CV mortality, or heart failure, but were associated with a 35% decrease in nonfatal MI, 64% decrease in myocardial ischemia at the expense of a 101% increase (Figure ) in nonfatal strokes. The beneficial effects were driven mainly by trials with high-bias risk, while analyses of low-biased trials showed a 28% and 101% increase in all-cause mortality and stroke with only a 29% and 59% reduction in nonfatal MI and 59%myocardial ischemia. For the safety outcomes, β-blockers were associated with a significantly increased risk of peri-op bradycardia and peri-op hypotension. Conclusions: In patients undergoing non-cardiac surgery, we estimate that treatment of 1000 patients with β-blockers results in 16 fewer nonfatal MI, but at the expense of 3 disabling strokes and 45 and 59 patients with clinically significant perioperative bradycardia and hypotension respectively, and suggests an increase in all-cause mortality.

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Prediction of all-cause mortality with malnutrition assessed by controlling nutritional status score in patients with heart failure: a systematic review and meta-analysis

Public Health Nutrition ◽

10.1017/s1368980021002470 ◽

2021 ◽

pp. 1-8

Author(s):

Huiyang Li ◽

Peng Zhou ◽

Yikai Zhao ◽

Huaichun Ni ◽

Xinping Luo ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Nutritional Status ◽

Meta Analysis ◽

Predictive Values ◽

Increased Risk ◽

Patients With Heart Failure ◽

All Cause Mortality ◽

Conut Score

Abstract Objective: The aim of this meta-analysis was to investigate the association between malnutrition assessed by the controlling nutritional status (CONUT) score and all-cause mortality in patients with heart failure. Design: Systematic review and meta-analysis. Settings: A comprehensively literature search of PubMed and Embase databases was performed until 30 November 2020. Studies reporting the utility of CONUT score in prediction of all-cause mortality among patients with heart failure were eligible. Patients with a CONUT score ≥2 are grouped as malnourished. Predictive values of the CONUT score were summarized by pooling the multivariable-adjusted risk ratios (RR) with 95 % CI for the malnourished v. normal nutritional status or per point CONUT score increase. Participants: Ten studies involving 5196 patients with heart failure. Results: Malnourished patients with heart failure conferred a higher risk of all-cause mortality (RR 1·92; 95 % CI 1·58, 2·34) compared with the normal nutritional status. Subgroup analysis showed the malnourished patients with heart failure had an increased risk of in-hospital mortality (RR 1·78; 95 % CI 1·29, 2·46) and follow-up mortality (RR 2·01; 95 % CI 1·58, 2·57). Moreover, per point increase in CONUT score significantly increased 16% risk of all-cause mortality during the follow-up. Conclusions: Malnutrition defined by the CONUT score is an independent predictor of all-cause mortality in patients with heart failure. Assessment of nutritional status using CONUT score would be helpful for improving risk stratification of heart failure.

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Effects of Beta-Blockers on Cardiovascular Events and Mortality in Dialysis Patients: A Systematic Review and Meta-Analysis

Blood Purification ◽

10.1159/000496083 ◽

2019 ◽

Vol 48 (1) ◽

pp. 51-59 ◽

Cited By ~ 3

Author(s):

Jingjing Jin ◽

Xiaoyang Guo ◽

Qiyao Yu

Keyword(s):

Cardiovascular Mortality ◽

Cardiovascular Events ◽

Observational Studies ◽

Beta Blockers ◽

Meta Analysis ◽

Cochrane Library ◽

Dialysis Patients ◽

Statistical Heterogeneity ◽

All Cause Mortality ◽

Β Blockers

Background: The effects of beta-blockers are uncertain in dialysis patients. Except antihypertension, β-blockers may play a unique cardiovascular protective role in the population. This meta-analysis aimed to explore the effects of β-blockers therapy in adult patients treated with dialysis. Methods: We searched MEDLINE, EMBASE, and the Cochrane library from inception to May 2018 for randomized controlled trials (RCTs) and observational studies about the role of β-blockers on all-cause mortality, cardiovascular mortality, cardiovascular events, or hospitalizations in dialysis population. Results: Three RCTs and 9 observational studies met the predefined inclusion criteria. The RCTs showed significant association between β-blockers and reduced all-cause mortality (n = 363; risk ratio [RR] 0.73; 95% CI 0.54–0.97), cardiovascular mortality (n = 314; RR 0.44; 95% CI 0.29–0.68), cardiovascular events (n = 363; RR 0.52; 95% CI 0.31–0.88), or hospitalizations (n = 314; RR 0.61; 95% CI 0.48–0.78) in dialysis patients. The observational studies showed significant difference in all-cause mortality (n = 35,233; hazard ratio [HR] 0.86; 95% CI 0.80–0.92) between β-blockers and no β-blockers therapy in patients with dialysis, while the studies showed no difference in cardiovascular mortality (n = 19,413; HR 0.79; 95% CI 0.57–1.11), or cardiovascular events (n = 87,060; HR 0.79; 95% CI 0.50–1.26). Conclusions: β-blockers seem to be associated with reduced mortality in patients on dialysis. Both the statistical heterogeneity in observational studies and the small number of participants and studies in RCTs limit the strength of these findings. Video Journal Club “Cappuccino with Claudio Ronco” at https://www.karger.com/Journal/ArticleNews/496083?sponsor=52

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Abstract 118: Right Bundle Branch Block and Clinical Outcomes in Patients with Heart Failure: A Systematic Review and Meta-analysis

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.7.suppl_1.118 ◽

2014 ◽

Vol 7 (suppl_1) ◽

Author(s):

Ahmad Hazem ◽

Sunita Sharma ◽

Amit Sharma ◽

Cameron Leitch ◽

Roopalakshmi Sharadanant ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Clinical Outcomes ◽

Cardiovascular Mortality ◽

Observational Studies ◽

Meta Analysis ◽

Bundle Branch Block ◽

Increased Risk ◽

Patients With Heart Failure ◽

All Cause Mortality

Importance: Right bundle branch block (RBBB) is observed in approximately 5-14% of patients with heart failure (HF). Multiple observational studies have reported the association of RBBB with clinical outcomes in patients with HF. We performed a systematic review and meta-analysis to determine the prognostic significance of RBBB for patients with HF. Data Sources: We have systematically searched MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science and Scopus through January 2014. Study Selection: Reviewers working independently and in duplicate screened all eligible abstracts that described all cause or cardiovascular mortality in patients with RBBB and HF. We excluded studies that reported unadjusted outcome, i.e.: unadjusted event rates. Knowledge synthesis: We pooled reported risk ratio and hazard ratio. Main Outcomes: All-cause mortality and cardiovascular mortality (death). Results: We found 12 relevant observational studies enrolling over 38,000 patients. Risk of bias was assessed using the Newcastle-Ottawa Scale. Included studies had at least a moderate quality. Seven of those evaluated prognosis of patients with RBBB and heart failure. After a mean follow up period of 2.5 years (range: 1-5 years), RBBB was associated with a statistically significant increased risk of all-cause mortality compared to patients with heart failure but no BBB, RR 1.27, 95% CI (1.08-1.50), Figure 1. The other 5 studies evaluated CHF patients receiving cardiac resynchronization therapy (CRT), comparing outcomes of patients with RBBB to those with LBBB. After a mean f/u period of 3 years, patients with RBBB were once again found to have an increased risk of all-cause mortality, RR 1.45, 95% CI 1.12-1.89. Conclusion and Relevance: RBBB in patients with HF is associated with higher all-cause mortality in comparison to patients without inter-ventricular conduction defects, as well as LBBB patients in patients undergoing CRT setting.

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The association of beta-blocker use with mortality in elderly patients with congestive heart failure and advanced chronic kidney disease

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfz167 ◽

2019 ◽

Vol 35 (5) ◽

pp. 782-789 ◽

Cited By ~ 6

Author(s):

Amber O Molnar ◽

William Petrcich ◽

Matthew A Weir ◽

Amit X Garg ◽

Michael Walsh ◽

...

Keyword(s):

Heart Failure ◽

Chronic Kidney Disease ◽

Congestive Heart Failure ◽

Kidney Disease ◽

Elderly Patients ◽

Randomized Trials ◽

Advanced Chronic Kidney Disease ◽

All Cause Mortality ◽

Β Blocker ◽

Β Blockers

Abstract Background Whether the survival benefit of β-blockers in congestive heart failure (CHF) from randomized trials extends to patients with advanced chronic kidney disease (CKD) [estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2 but not receiving dialysis] is uncertain. Methods This was a retrospective cohort study using administrative datasets. Older adults from Ontario, Canada, with incident CHF (median age 79 years) from April 2002 to March 2014 were included. We matched new users of β-blockers to nonusers on age, sex, eGFR categories (>60, 30–60, <30), CHF diagnosis date and a high-dimensional propensity score. Using Cox proportional hazards models, we examined the association of β-blocker use versus nonuse with all-cause mortality. Results We matched 5862 incident β-blocker users (eGFR >60, n = 3136; eGFR 30–60, n = 2368; eGFR <30, n = 358). There were 2361 mortality events during follow-up. β-Blocker use was associated with reduced all-cause mortality [adjusted hazard ratio (HR) 0.58, 95% confidence interval (CI) 0.54–0.64]. This result was consistent across all eGFR categories (>60: adjusted HR 0.55, 95% CI 0.49–0.62; 30–60: adjusted HR 0.63, 95% CI 0.55–0.71; <30: adjusted HR 0.55, 95% CI 0.41–0.73; interaction term, P = 0.30). The results were consistent in an intention-to-treat analysis and with β-blocker use treated as a time-varying exposure. Conclusions β-Blocker use is associated with reduced all-cause mortality in elderly patients with CHF and CKD, including those with an eGFR <30. Randomized trials that examine β-blockers in patients with CHF and advanced CKD are needed.

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Digoxin Use to Control Ventricular Rate in Patients with Atrial Fibrillation and Heart Failure Is Not Associated with Increased Mortality

Cardiology Research and Practice ◽

10.1155/2015/314041 ◽

2015 ◽

Vol 2015 ◽

pp. 1-10 ◽

Cited By ~ 6

Author(s):

Surbhi Chamaria ◽

Anand M. Desai ◽

Pratap C. Reddy ◽

Brian Olshansky ◽

Paari Dominic

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Meta Analysis ◽

Ventricular Rate ◽

Point Estimate ◽

Hazard Ratios ◽

Inverse Variance ◽

Increased Risk ◽

All Cause Mortality ◽

Meta Analyses

Introduction.Digoxin is used to control ventricular rate in atrial fibrillation (AF). There is conflicting evidence regarding safety of digoxin. We aimed to evaluate the risk of mortality with digoxin use in patients with AF using meta-analyses.Methods.PubMed was searched for studies comparing outcomes of patients with AF taking digoxin versus no digoxin, with or without heart failure (HF). Studies were excluded if they reported only a point estimate of mortality, duplicated patient populations, and/or did not report adjusted hazard ratios (HR). The primary endpoint was all-cause mortality. Adjusted HRs were combined using generic inverse variance and log hazard ratios. A multivariate metaregression model was used to explore heterogeneity in studies.Results.Twelve studies with 321,944 patients were included in the meta-analysis. In all AF patients, irrespective of heart failure status, digoxin is associated with increased all-cause mortality (HR [1.23], 95% confidence interval [CI] 1.16–1.31). However, digoxin is not associated with increased mortality in patients with AF and HF (HR [1.08], 95% CI 0.99–1.18). In AF patients without HF digoxin is associated with increased all-cause mortality (HR [1.38], 95% CI 1.12–1.71).Conclusion.In patients with AF and HF, digoxin use is not associated with an increased risk of all-cause mortality when used for rate control.

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Effects of sodium‐glucose cotransporter type 2 inhibitors on cardiovascular, renal, and safety outcomes in patients with cardiovascular disease: a meta‐analysis of randomized controlled trials

Cardiovascular Diabetology ◽

10.1186/s12933-021-01272-z ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Caiyun Zheng ◽

Meimei Lin ◽

Yan Chen ◽

Haiting Xu ◽

Lingqun Yan ◽

...

Keyword(s):

Heart Failure ◽

Cardiovascular Disease ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Controlled Trials ◽

Sodium Glucose Cotransporter ◽

All Cause Mortality ◽

Safety Outcomes ◽

Randomised Controlled

Abstract Background Controlled studies and observational studies have shown that sodium-glucose cotransporter type 2 inhibitors (SGLT-2i) are beneficial for the survival of patients with heart failure (HF). However, it is unclear whether SGLT-2i can provide benefit in patients with other cardiovascular diseases. Here, we conducted a systematic review and meta-analysis to determine the outcomes of cardiovascular, renal, and safety outcomes of SGLT-2i administration in patients with cardiovascular diseases. Methods We searched PubMed, EMBASE, Cochrane Library, Web of Science databases, and ClinicalTrials.gov databases for randomised controlled trials written in English from inception until November 1, 2020. Two reviewers independently identified randomised controlled trials comparing the effects of SGLT-2i in patients with cardiovascular disease with or without diabetes. Primary outcomes were cardiovascular outcomes and renal outcomes. Secondary outcomes were safety outcomes, including adverse endocrine outcomes and adverse infection outcomes. The effects of SGLT-2i were evaluated using RevMan5.3 software. The Cochrane risk of bias tool was used to assess study quality. Results We identified 10 randomised controlled trials (25,108 patients in the SGLT-2i group and 18,574 patients in the placebo group). Meta-analysis revealed that SGLT-2i treatment significantly reduced all-cause mortality, cardiovascular mortality, and hospitalisation for heart failure (HHF) in patients with cardiovascular disease (all-cause mortality relative risk [RR]: 0.86; 95% confidence interval [CI] 0.81–0.91; P < 0.00001; I2 = 0%; cardiovascular mortality RR: 0.85; 95% CI 0.79–0.92; P < 0.0001; I2 = 26%; HHF RR: 0.69; 95% CI 0.64–0.81; P < 0.00001; I2 = 0%). In patients with HF, mortality and HHF after SGLT-2i treatment for HF with reduced ejection fraction were significantly reduced, whereas HF with preserved ejection fraction did not differ compared with placebo treatment. Moreover, SGLT-2i induced a lower incidence of renal damage and myocardial infarction than the placebo group; however, the risk of infection, amputation, volume depletion, and diabetic ketoacidosis was higher. Conclusions SGLT-2i had significant clinical effects on cardiovascular outcomes and significantly influenced acute kidney injury. The effects of SGLT-2i on cardiovascular disease were independent of diabetic status. Sotagliflozin could have advantages over other SGLT-2i in lowering HHF.

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Nintedanib, Pirfenidone and Pirfenidone Versus Nintedanib: A Systematic Review And Meta-Analysis

10.21203/rs.3.rs-589439/v1 ◽

2021 ◽

Author(s):

Tyler Pitre ◽

Renata Husnudinov ◽

Muhammad Faran Khalid ◽

Melanie C. Zhang ◽

Sonya Cui ◽

...

Keyword(s):

Systematic Review ◽

Randomized Trials ◽

Meta Analysis ◽

Drug Effects ◽

Mean Difference ◽

Drug Discontinuation ◽

Inverse Variance ◽

Increased Risk ◽

Acute Exacerbations ◽

All Cause Mortality

Abstract Background: Patients with idiopathic pulmonary fibrosis have a poor overall prognosis. Only nintedanib and pirfenidone have been shown to reduce mortality. Objective: This systematic review and meta-analysis aims to assess the efficacy of nintedanib, pirfenidone, and pirfenidone vs nintedanib on patient important outcomes. Methods: Randomized trials were retrieved from MEDLINE, Cochrane, and EMBASE. The primary outcome was mortality. The secondary outcomes included change in FVC, acute exacerbations and hospitalizations and adverse drug effects leading to discontinuation. We used an inverse variance random effects meta-analysis method to calculate pooled relative risk (RR), standardized mean difference (SMD) and mean difference (MD).Results: A total of 13 studies were included. Both nintedanib [RR 0.63 (0.47,0.85); moderate certainty] and pirfenidone [RR 0.68 (0.47,0.99); moderate certainty] probably reduce all-cause mortality when compared to placebo, but only nintedanib [SMD 0.47 (0.34, 0.60); high certainty] reduces change in FVC. Nintedanib [RR 0.69 (0.48,0.99); moderate certainty],but not pirfenidone probably reduces acute exacerbations or hospitalizations compared to placebo. Compared with placebo, neither nintedanib nor pirfenidone increased risk of drug discontinuation due to adverse effect but there is probably risk of patient drug discontinuation with pirfenidone compared to nintedanib [RR 4.34 (1.72 to 10.98); moderate certainty].Conclusion: Both nintedanib and pirfenidone probably reduce all-cause mortality. Nintedanib is probably more tolerable to pirfenidone in regard to compliance and may be more effective than pirfenidone in reducing mortality rate and in slowing disease progression. Larger head to head randomized trials are needed.

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Albuminuria and Dipstick Proteinuria for Predicting Mortality in Heart Failure: A Systematic Review and Meta-Analysis

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.665831 ◽

2021 ◽

Vol 8 ◽

Author(s):

Wei Liang ◽

Qian Liu ◽

Qiong-ying Wang ◽

Heng Yu ◽

Jing Yu

Keyword(s):

Heart Failure ◽

Cardiovascular Mortality ◽

Meta Analysis ◽

Prognostic Indicator ◽

Adverse Outcomes ◽

Rapid Screening ◽

Dipstick Test ◽

Heart Failure Patients ◽

Increased Risk ◽

All Cause Mortality

Background: Research suggest that albuminuria is not only an independent risk factor for the development of heart failure but may also act as a biomarker for predicting adverse outcomes. To date, no study has synthesized evidence on its role as a prognostic indicator. Thus, the current study aimed to quantitatively assess the prognostic utility of albuminuria as well as dipstick proteinuria in predicting mortality in heart failure patients.Methods: PubMed, Embase, ScienceDirect, CENTRAL, and Google Scholar databases were searched up to October 10, 2020. All studies reporting multivariable-adjusted hazard ratios (HR) for albuminuria or dipstick proteinuria for mortality and/or hospitalization in heart failure patients were included.Results: Eleven studies were included. Seven assessed albuminuria and five assessed dipstick proteinuria. Our analysis revealed a statistically significant increased risk of all-cause mortality with microalbuminuria (HR: 1.54; 95% CI, 1.23–1.93; I2 = 79%; p = 0.0002) and macroalbuminuria (HR: 1.76; 95% CI, 1.21–2.56; I2 = 88%; p = 0.003) in heart failure patients. The risk of all-cause mortality and hospitalization was also significantly increased with macroalbuminuria. Microalbuminuria was associated with significantly increased cardiovascular mortality and combined cardiovascular mortality and hospitalization. Positive dipstick test for proteinuria was significantly associated with mortality in heart failure (HR: 1.54; 95% CI, 1.28–1.84; I2 = 67%; p < 0.00001).Conclusion: Both microalbuminuria and macroalbuminuria are predictors of mortality in patients with heart failure. Dipstick proteinuria may be used as a rapid screening test to predict mortality in these patients.

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Abstract 12813: Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta-analysis

Circulation ◽

10.1161/circ.142.suppl_3.12813 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Mohan Satish ◽

Raviteja Guddeti ◽

Florian Wenzl ◽

Ryan Walters ◽

Venkata M Alla

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Systematic Review ◽

Ejection Fraction ◽

Meta Analysis ◽

Excess Risk ◽

Mortality Data ◽

Preserved Ejection Fraction ◽

Increased Risk ◽

All Cause Mortality

Introduction: Due to shared risk factors and pathophysiology, atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) frequently coexist. However, the prognostic implications of AF in HFpEF are unclear with conflicting data. Herein, we conducted a systematic review and meta-analysis to assess the impact of concomitant AF on cardiovascular outcomes in patients with HFpEF. Methods: PubMed, Scopus, and Google Scholar were comprehensively searched through May 7th, 2020 for studies comparing outcomes of HFpEF patients with and without AF. Outcomes assessed were all-cause mortality and a composite of HF hospitalization or cardiovascular (CV) mortality. Data from selected studies were abstracted and pooled using a random-effects meta-analysis to calculate odds ratios (ORs) and 95% confidence intervals [CIs] for each of the outcomes. Results: Our final analysis included 10 studies with 27,440 HFpEF patients (43.2% with AF). AF was associated with significantly increased risk of all-cause mortality (OR 1.37 [1.17-1.61], p < 0.001, Fig. 1A), HF hospitalization or CV mortality (OR 1.66 [1.16-2.36], p = 0.005, Fig. 1B), and HF hospitalization alone (OR 1.34 [1.03-1.76], p = 0.03, Fig. 1C). However, AF was not associated with excess risk of CV mortality alone (OR 1.10 [0.79-1.52], p = 0.57, Fig. 1D). Conclusions: In patients with HFpEF, concomitant AF is associated with an increased risk of all-cause mortality and HF hospitalization. Further research into the mechanisms and interventions to mitigate this excess risk is necessary.

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Carvedilol versus metoprolol succinate in the treatment of patients with heart failure with reduced ejection fraction and patients with acute myocardial infarction

Shidnoevropejskij zurnal vnutrisnoi ta simejnoi medicini ◽

10.15407/internalmed2021.01.036 ◽

2021 ◽

Vol 2021 (1) ◽

pp. 36-39

Author(s):

E.Ya. Nikolenko ◽

◽

K.V. Vovk ◽

O.L. Pavlova ◽

O.O. Salun ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Acute Myocardial Infarction ◽

Ejection Fraction ◽

Randomized Trials ◽

Meta Analysis ◽

Metoprolol Succinate ◽

Reduced Ejection Fraction ◽

Patients With Heart Failure ◽

All Cause Mortality

Choosing the best drug for the treatment of cardiac patients remains one of the most important aspects of medical practice. The purpose of this review is to select the optimal beta-blocker for the treatment of patients with chronic heart failure and patients with acute myocardial infarction by comparing the efficacy of carvedilol and metoprolol succinate, as both drugs significantly reduce mortality rates and reduce hospitalization. The results of meta-analyzes, randomized trials comparing the efficacy of carvedilol and metoprolol succinate in the treatment of patients with heart failure with reduced ejection fraction and patients with acute myocardial infarction were analyzed. Conflicting data received. According to the study “Effect of carvedilol vs metoprolol succinate on mortality in heart failure with reduced ejection fraction”, a meta-analysis published in the American Journal of Cardiology in 2013, carvedilol is significantly more effective than metoprolol succinate in treatment of patients with heart failure with reduced ejection fraction and patients with acute myocardial infarction, while meta-analyzes of 2015 and 2017 showed no preference for carvedilol over metoprolol succinate. Based on the results, concluded that the data obtained is not sufficient to argue that carvedilol is more effective than metoprolol succinate for this category of patients in terms of reducing the risk of all-cause mortality, cardiovascular mortality, and reducing hospitalization. This problem requires further extensive research.

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