Endoscopically assisted versus open repair of sagittal craniosynostosis: the St. Louis Children's Hospital experience

Object This study investigated the differences in effectiveness and morbidity between endoscopically assisted wide-vertex strip craniectomy with barrel-stave osteotomies and postoperative helmet therapy versus open calvarial vault reconstruction without helmet therapy for sagittal craniosynostosis. Methods Between 2003 and 2010, the authors prospectively observed 89 children less than 12 months old who were surgically treated for a diagnosis of isolated sagittal synostosis. The endoscopic procedure was offered starting in 2006. The data associated with length of stay, blood loss, transfusion rates, operating times, and cephalic indices were reviewed. Results There were 47 endoscopically treated patients with a mean age at surgery of 3.6 months and 42 patients with open-vault reconstruction whose mean age at surgery was 6.8 months. The mean follow-up time was 13 months for endoscopic versus 25 months for open procedures. The mean operating time for the endoscopic procedure was 88 minutes, versus 179 minutes for the open surgery. The mean blood loss was 29 ml for endoscopic versus 218 ml for open procedures. Three endoscopically treated cases (6.4%) underwent transfusion, whereas all patients with open procedures underwent transfusion, with a mean of 1.6 transfusions per patient. The mean length of stay was 1.2 days for endoscopic and 3.9 days for open procedures. Of endoscopically treated patients completing helmet therapy, the mean duration for helmet therapy was 8.7 months. The mean pre- and postoperative cephalic indices for endoscopic procedures were 68% and 76% at 13 months postoperatively, versus 68% and 77% at 25 months postoperatively for open surgery. Conclusions Endoscopically assisted strip craniectomy offers a safe and effective treatment for sagittal craniosynostosis that is comparable in outcome to calvarial vault reconstruction, with no increase in morbidity and a shorter length of stay.

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One hundred consecutive endoscopic repairs of sagittal craniosynostosis: an evolution in care

Journal of Neurosurgery Pediatrics ◽

10.3171/2017.5.peds16674 ◽

2017 ◽

Vol 20 (5) ◽

pp. 410-418 ◽

Cited By ~ 12

Author(s):

Dennis C. Nguyen ◽

Scott J. Farber ◽

Gary B. Skolnick ◽

Sybill D. Naidoo ◽

Matthew D. Smyth ◽

...

Keyword(s):

Blood Loss ◽

Patient Care ◽

Length Of Hospital Stay ◽

Successful Outcome ◽

Emissary Vein ◽

Sagittal Craniosynostosis ◽

Care Protocol ◽

Estimated Blood Loss ◽

Helmet Therapy ◽

The Mean

OBJECTIVEEndoscope-assisted repair of sagittal craniosynostosis was adopted at St. Louis Children’s Hospital in 2006. This study examines the first 100 cases and reviews the outcomes and evolution of patient care protocols at our institution.METHODSThe authors performed a retrospective chart review of the first 100 consecutive endoscopic repairs of sagittal craniosynostosis between 2006 and 2014. The data associated with length of hospital stay, blood loss, transfusion rates, operative times, cephalic indices (CIs), complications, and cranial remolding orthosis were reviewed. Measurements were taken from available preoperative and 1-year postoperative 3D reconstructed CT scans.RESULTSThe patients’ mean age at surgery was 3.3 ± 1.1 months. Of the 100 patients, 30 were female and 70 were male. The following perioperative data were noted. The mean operative time (± SD) was 77.1 ± 22.2 minutes, the mean estimated blood loss was 34.0 ± 34.8 ml, and the mean length of stay was 1.1 ± 0.4 days; 9% of patients required transfusions; and the mean pre- and postoperative CI values were 69.1 ± 3.8 and 77.7 ± 4.2, respectively. Conversion to open technique was required in 1 case due to presence of a large emissary vein that was difficult to control endoscopically. The mean duration of helmet therapy was 8.0 ± 2.9 months. Parietal osteotomies were eventually excluded from the procedure.CONCLUSIONSThe clinical outcomes and improvements in CI seen in our population are similar to those seen at other high-volume centers. Since the inception of endoscope-assisted repair at our institution, the patient care protocol has undergone several significant changes. We have been able to remove less cranium using our “narrow-vertex” suturectomy technique without affecting patient safety or outcome. Patient compliance with helmet therapy and collaborative care with the orthotists remain the most essential aspects of a successful outcome.

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Optimal duration of postoperative helmet therapy following endoscopic strip craniectomy for sagittal craniosynostosis

Journal of Neurosurgery Pediatrics ◽

10.3171/2018.5.peds184 ◽

2018 ◽

Vol 22 (6) ◽

pp. 610-615 ◽

Cited By ~ 1

Author(s):

Rajiv R. Iyer ◽

Xiaobu Ye ◽

Qiuyu Jin ◽

Yao Lu ◽

Luckmini Liyanage ◽

...

Keyword(s):

Peak Level ◽

Multivariate Regression Analysis ◽

Final Outcome ◽

Sagittal Synostosis ◽

Sagittal Craniosynostosis ◽

Time Period ◽

Helmet Therapy ◽

Age At Surgery ◽

Strip Craniectomy

OBJECTIVEMany infants with sagittal craniosynostosis undergo effective surgical correction with endoscopic strip craniectomy (ESC) and postoperative helmet therapy (PHT). While PHT is essential to achieving optimal cosmesis following ESC, there has been little comprehensive analysis of the ideal PHT duration needed to attain this goal.METHODSThe authors retrospectively reviewed the charts of infants undergoing ESC and PHT for sagittal synostosis at our institution between 2008 and 2015. Data collected included age at surgery, follow-up duration, and PHT duration. Cephalic index (CI) was evaluated preoperatively (CIpre), at its peak level (CImax), at termination of helmet therapy (CIoff), and at last follow-up (CIfinal). A multivariate regression analysis was performed to determine factors influencing CIfinal.RESULTSThirty-one patients (27 male, 4 female) were treated in the studied time period. The median age at surgery was 2.7 months (range 1.6 to 3.2) and the median duration of PHT was 10.4 months (range 8.4 to 14.4). The mean CImax was 0.83 (SD 0.01), which was attained an average of 8.4 months (SD 1.2) following PHT initiation. At last follow-up, there was an average retraction of CIfinal among all patients to 0.78 (SD 0.01). Longer helmet duration after achieving CImax did not correlate with higher CIfinal values. While CImax was a significant predictor of CIfinal, neither age at surgery nor CIpre were found to be predictive of final outcome.CONCLUSIONSPatients undergoing ESC and PHT for sagittal synostosis reach a peak CI around 7 to 9 months after surgery. PHT beyond CImax does not improve final anthropometric outcomes. CIfinal is significantly dependent on CImax, but not on age, nor CIpre. These results imply that helmet removal at CImax may be appropriate for ESC patients, while helmeting beyond the peak does not change final outcome.

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A systematic review and meta-analysis of endoscopic versus open treatment of craniosynostosis. Part 1: the sagittal suture

Journal of Neurosurgery Pediatrics ◽

10.3171/2018.4.peds17729 ◽

2018 ◽

Vol 22 (4) ◽

pp. 352-360 ◽

Cited By ~ 12

Author(s):

Han Yan ◽

Taylor J. Abel ◽

Naif M. Alotaibi ◽

Melanie Anderson ◽

Toba N. Niazi ◽

...

Keyword(s):

Systematic Review ◽

Length Of Stay ◽

Blood Loss ◽

Open Surgery ◽

Meta Analysis ◽

Operating Time ◽

Transfusion Rate ◽

Endoscopic Procedures ◽

Estimated Blood Loss ◽

Cosmetic Outcomes

OBJECTIVEIn this systematic review and meta-analysis the authors aimed to directly compare open surgical and endoscope-assisted techniques for the treatment of sagittal craniosynostosis, focusing on the outcomes of blood loss, transfusion rate, length of stay, operating time, complication rate, cost, and cosmetic outcome.METHODSA literature search was performed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant articles were identified from 3 electronic databases (MEDLINE, EMBASE, and CENTRAL [Cochrane Central Register of Controlled Trials]) from their inception to August 2017. The quality of methodology and bias risk were assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Effect estimates between groups were calculated as standardized mean differences with 95% CIs. Random and fixed effects models were used to estimate the overall effect.RESULTSOf 316 screened records, 10 met the inclusion criteria, of which 3 were included in the meta-analysis. These studies reported on 303 patients treated endoscopically and 385 patients treated with open surgery. Endoscopic surgery was associated with lower estimated blood loss (p < 0.001), shorter length of stay (p < 0.001), and shorter operating time (p < 0.001). From the literature review of the 10 studies, transfusion rates for endoscopic procedures were consistently lower, with significant differences in 4 of 6 studies; the cost was lower, with differences ranging from $11,603 to $31,744 in 3 of 3 studies; and the cosmetic outcomes were equivocal (p > 0.05) in 3 of 3 studies. Finally, endoscopic techniques demonstrated complication rates similar to or lower than those of open surgery in 8 of 8 studies.CONCLUSIONSEndoscopic procedures are associated with lower estimated blood loss, operating time, and days in hospital. Future long-term prospective registries may establish advantages with respect to complications and cost, with equivalent cosmetic outcomes. Larger studies evaluating patient- or parent-reported satisfaction and optimal timing of intervention as well as heterogeneity in outcomes are indicated.

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EVALUATION OUTCOMES OF THE LAPAROSCOPIC RETROPERITONEAL NEPHRECTOMY FOR BENIGN NONFUNCTIONING KIDNEYS

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2017.5.14 ◽

2017 ◽

pp. 107-112

Author(s):

Duc Minh Hoang ◽

khoa Hung Nguyen ◽

Vinh Quy Truong ◽

Van Binh Nguyen ◽

Hong Duong Nguyen ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Open Surgery ◽

Operating Time ◽

Indications For Surgery ◽

Conversion To Open Surgery ◽

Multicystic Kidney ◽

Post Operation ◽

The Mean ◽

Retroperitoneal Nephrectomy

Purpose: To assess results of retroperitoneoscopy nephrectomy for benign non-function kidneys from June 2013 to June 2017 at Quang Tri General Hospital. Materials and Methods: The study comprised 43 patients who underwent retroperitoneoscopic nephrectomy during a 4 years period beginning from June 2013. Results: Mean age of surgery was 52.6 years (28-72 years). 23 males and 20 females. 25 patients underwent left nephrectomy; 18 underwent right nephrectomy. Retroperitoneoscopic nephrectomy were completed successfully in 38 patients (88.4%). There was 5 patients required conversion to open surgery (11.6%), all cases by poor progression. The mean operating time was 112.7 minutes (range 70 to 210), mean blood loss was 45.7 ml (range 15 to 170 ml), and mean post-operation hospital stay was 4.3 days (range 3 to 9). A total of 21.1% complications (8/38 cases), no severe complications occurred. No re-intervention was needed. No case was mortality. The indications for surgery included hydronephrosis in 19/38 cases (50.0%), atrophic kidney in 13/38 cases (34.2%) and multicystic kidney in 6/38 cases (15.8%). Conclusions: Retroperitoneoscopic nephrectomy can be performed safely and successfully with obvious advantages for benign nonfunctioning kidneys regardless of the etiology or pathogenesis. Key words: nephrectomy, kidney, benign, retroperitoneoscopy

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Microendoscope-Assisted Decompression Surgery With Resection of Bony Fragment for Treating a Separation of Lumbar Posterior Ring Apophysis in Young Athletes

Global Spine Journal ◽

10.1177/2192568220929290 ◽

2020 ◽

pp. 219256822092929 ◽

Cited By ~ 1

Author(s):

Motohiro Okada ◽

Munehito Yoshida ◽

Akihito Minamide ◽

Kazunori Nomura ◽

Kazuhiro Maio ◽

...

Keyword(s):

Blood Loss ◽

Japanese Orthopaedic Association ◽

Operating Time ◽

Case Series ◽

Decompression Surgery ◽

Return To Sports ◽

Intraoperative Blood Loss ◽

Young Athletes ◽

The Mean ◽

Posterior Ring

Study Design: Case series. Objectives: To report the clinical outcomes of the decompression procedure using the microendoscopic discectomy system for the treatment of a separation of lumbar posterior ring apophysis in young active athletes. Methods: We retrospectively reviewed 17 cases that underwent the microendoscopic surgery to treat a symptomatic separated lumbar ring apophysis between 2001 and 2014 at our institute or our associated hospital. The cases consisted of 15 males and 2 females, with their ages ranging from 12 to 19 years. The surgeries were performed at total of 18 lumbar levels, including 15 L4/5 and 3 L5/S1 levels. All patients were young athletes. We evaluated the following: (1) the Japanese Orthopaedic Association (JOA) score for low back pain, (2) recovery rates using Hirabayashi’s method, (3) operating time, (4) intraoperative blood loss, (5) perioperative complications, (6) the status of comeback to sports, and (7) the period taken to return to sports. Results: The JOA score was improved after the surgery in all cases. Recovery rate was 92.0% ± 8.1%. The mean operating time per level was 89.2 ± 33.3 minutes. The mean intraoperative blood loss per level was 95.3 ± 93.1 mL. A pinhole size dural tear occurred in one case as a perioperative complication. All cases returned to sports. The mean period taken to return to sports was 10.9 ± 3.5 weeks. Conclusion: Microendoscopic decompression surgery is useful for treating a separation of lumbar posterior ring apophysis.

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Uterine Isthmus Tourniquet during Abdominal Myomectomy: Support or Hazard? A Randomized Double-Blind Trial

Gynecologic and Obstetric Investigation ◽

10.1159/000510512 ◽

2020 ◽

Vol 85 (5) ◽

pp. 396-404

Author(s):

Abolfazl Mehdizadehkashi ◽

Kobra Tahermanesh ◽

Samaneh Rokhgireh ◽

Vahideh Astaraei ◽

Zahra Najmi ◽

...

Keyword(s):

Blood Loss ◽

Ovarian Reserve ◽

Operating Time ◽

Serum Levels ◽

Massive Hemorrhage ◽

Control Group ◽

Double Blind ◽

Abdominal Myomectomy ◽

Duration Of Surgery ◽

The Mean

Background and Objectives: A tourniquet has been suggested as a useful means of reducing massive hemorrhage during myomectomy. However, it is not clear whether the restricted perfusion affects the ovaries. In the present study, we examined the effect of a tourniquet on ovarian reserve and blood loss during myomectomy. Materials and Methods: In a randomized double-blind clinical trial, fertile nonobese patients scheduled for abdominal myomectomy at Rasool-e-Akram Hospital from February 2018 to June 2019 were randomized to a tourniquet (n = 46) or a non-tourniquet group (n = 35). Serum levels of anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH) were measured before and 3 months after surgery, blood loss was recorded during surgery, and serum levels of hemoglobin (Hb) were recorded before surgery, 6 h and 3 days after surgery. SPSS version 21 was used for statistical analysis. Results: Demographic, obstetric, and myoma characteristics were similar in the 2 groups (p > 0.05). The mean baseline values of AMH and FSH did not differ between groups (p > 0.05). After surgery, only FSH was higher in the control group (p = 0.043). Despite the time taken to fasten and open the tourniquet, the mean operating time was shorter in the tourniquet group (p < 0.001). Blood loss was higher in the control group (p = 0.005). The drop in Hb levels at 6 h after surgery was higher in the non-tourniquet group (p = 0.002). Blood loss was significantly associated with the duration of surgery (r = 0.523, p < 0.001). Conclusion: The use of a tourniquet during abdominal myomectomy significantly reduced the mean volume of blood loss compared to the non-tourniquet group, while it did not prolong the duration of surgery, nor reduced the ovarian reserve. A tourniquet is a safe and efficient measure during abdominal myomectomy.

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Neosuture formation after endoscope-assisted craniosynostosis repair

Journal of Neurosurgery Pediatrics ◽

10.3171/2016.2.peds15231 ◽

2016 ◽

Vol 18 (2) ◽

pp. 196-200 ◽

Cited By ~ 6

Author(s):

Afshin Salehi ◽

Katherine Ott ◽

Gary B. Skolnick ◽

Dennis C. Nguyen ◽

Sybill D. Naidoo ◽

...

Keyword(s):

Three Dimensional ◽

Head Width ◽

Long Term Outcomes ◽

Sagittal Synostosis ◽

Helmet Therapy ◽

Age At Surgery ◽

Significant Difference ◽

Ct Data ◽

Strip Craniectomy

OBJECTIVE The goal of this study was to identify the rate of neosuture formation in patients with craniosynostosis treated with endoscope-assisted strip craniectomy and investigate whether neosuture formation in sagittal craniosynostosis has an effect on postoperative calvarial shape. METHODS The authors retrospectively reviewed 166 cases of nonsyndromic craniosynostosis that underwent endoscope-assisted repair between 2006 and 2014. Preoperative and 1-year postoperative head CT scans were evaluated, and the rate of neosuture formation was calculated. Three-dimensional reconstructions of the CT data were used to measure cephalic index (CI) (ratio of head width and length) of patients with sagittal synostosis. Regression analysis was used to calculate significant differences between patients with and without neosuture accounting for age at surgery and preoperative CI. RESULTS Review of 96 patients revealed that some degree of neosuture development occurred in 23 patients (23.9%): 16 sagittal, 2 bilateral coronal, 4 unilateral coronal, and 1 lambdoid synostosis. Complete neosuture formation was seen in 14 of those 23 patients (9 of 16 sagittal, 1 of 2 bilateral coronal, 3 of 4 unilateral coronal, and 1 of 1 lambdoid). Mean pre- and postoperative CI in the complete sagittal neosuture group was 67.4% and 75.5%, respectively, and in the non-neosuture group was 69.8% and 74.4%, respectively. There was no statistically significant difference in the CI between the neosuture and fused suture groups preoperatively or 17 months postoperatively in patients with sagittal synostosis. CONCLUSIONS Neosuture development can occur after endoscope-assisted strip craniectomy and molding helmet therapy for patients with craniosynostosis. Although the authors did not detect a significant difference in calvarial shape postoperatively in the group with sagittal synostosis, the relevance of neosuture formation remains to be determined. Further studies are required to discover long-term outcomes comparing patients with and without neosuture formation.

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Mid-term to long-term clinical and functional outcomes of minimally invasive correction and fusion for adults with scoliosis

Neurosurgical FOCUS ◽

10.3171/2010.1.focus09272 ◽

2010 ◽

Vol 28 (3) ◽

pp. E6 ◽

Cited By ~ 159

Author(s):

Neel Anand ◽

Rebecca Rosemann ◽

Bhavraj Khalsa ◽

Eli M. Baron

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Interbody Fusion ◽

Short Form ◽

Operating Time ◽

Adult Scoliosis ◽

Estimated Blood Loss ◽

The Mean

Object The goal of this study was to assess the operative outcomes of adult patients with scoliosis who were treated surgically with minimally invasive correction and fusion. Methods This was a retrospective study of 28 consecutive patients who underwent minimally invasive correction and fusion over 3 or more levels for adult scoliosis. Hospital and office charts were reviewed for clinical data. Functional outcome data were collected at each visit and at the last follow-up through self-administered questionnaires. All radiological measurements were obtained using standardized computer measuring tools. Results The mean age of the patients in the study was 67.7 years (range 22–81 years), with a mean follow-up time of 22 months (range 13–37 months). Estimated blood loss for anterior procedures (transpsoas discectomy and interbody fusions) was 241 ml (range 20–2000 ml). Estimated blood loss for posterior procedures, including L5–S1 transsacral interbody fusion (and in some cases L4–5 and L5–S1 transsacral interbody fusion) and percutaneous screw fixation, was 231 ml (range 50–400 ml). The mean operating time, which was recorded from incision time to closure, was 232 minutes (range 104–448 minutes) for the anterior procedures, and for posterior procedures it was 248 minutes (range 141–370 minutes). The mean length of hospital stay was 10 days (range 3–20 days). The preoperative Cobb angle was 22° (range 15–62°), which corrected to 7° (range 0–22°). All patients maintained correction of their deformity and were noted to have solid arthrodesis on plain radiographs. This was further confirmed on CT scans in 21 patients. The mean preoperative visual analog scale and treatment intensity scale scores were 7.05 and 53.5; postoperatively these were 3.03 and 25.88, respectively. The mean preoperative 36-Item Short Form Health Survey and Oswestry Disability Index scores were 55.73 and 39.13; postoperatively they were 61.50 and 7, respectively. In terms of major complications, 2 patients had quadriceps palsies from which they recovered within 6 months, 1 sustained a retrocapsular renal hematoma, and 1 patient had an unrelated cerebellar hemorrhage. Conclusions Minimally invasive surgical correction of adult scoliosis results in mid- to long-term outcomes similar to traditional surgical approaches. Whereas operating times are comparable to those achieved with open approaches, blood loss and morbidity appear to be significantly lower in patients undergoing minimally invasive deformity correction. This approach may be particularly useful in the elderly.

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Blood Loss of Pedicle Subtraction Osteotomy for Sagittal Imbalance Spinal Deformity

Revista de Chimie ◽

10.37358/rc.18.12.6818 ◽

2019 ◽

Vol 69 (12) ◽

pp. 3680-3682

Author(s):

Abu Awwad Ahmed ◽

Radu Prejbeanu ◽

Dinu Vermesan ◽

Ioan Branea ◽

Bogdan Deleanu ◽

...

Keyword(s):

Blood Loss ◽

Operating Time ◽

Pedicle Subtraction Osteotomy ◽

Neurological Deficits ◽

Sagittal Imbalance ◽

Female Patients ◽

Fixed Sagittal Imbalance ◽

Male Patients ◽

The Mean ◽

Extensive Surgery

Pedicle subtraction osteotomies (PSO) have been used in the treatment of multiple spinal conditions involving a fixed sagittal imbalance. It is a complex, extensive surgery most often performed in the revision settings. The aim of our study is to review the major complications of this surgical technique with a focus on blood loss. Twenty patients were included, treated using PSO for sagittal imbalance, out of 255 corrective surgeries. Of the 12 female patients included in the study, the mean age was 64.33. Of the 8 male patients included in the study, the mean age was 51.85. For female patients, the mean blood loss was 2122.5 mL in comparison with male patients, with mean blood loss 1737.5 mL. The female patients had an operating time of 357.25 minutes in comparasion with male patients with an 328.5 minute operating time. Eight (5 female and 3 male) had postoperative neurological deficits and 6 (5 female and 1 male) had pseudarthrosis of adjacent levels.

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Study on outcome of laparoscopic donor nephrectomy

International Surgery Journal ◽

10.18203/2349-2902.isj20173424 ◽

2017 ◽

Vol 4 (8) ◽

pp. 2811

Author(s):

Subha Kanesh S. K. ◽

Govindarajan P.

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Operating Time ◽

Donor Nephrectomy ◽

Laparoscopic Donor Nephrectomy ◽

Analgesic Requirement ◽

Ischemic Time ◽

Medical College ◽

Duration Of Hospital Stay ◽

The Mean

Background: Laparoscopic donor nephrectomy is being performed in increasing numbers since 1995. Now laparoscopic donor nephrectomy has been accepted as good alternate to open procedure as seen in various other abdominal surgeries. This was the basis of the present study. So, the present study was designed to analyse and compare the outcome of Laparoscopic donor nephrectomy and Open donor nephrectomies.Methods: The prospective and observational study was conducted at Stanley Medical College in Department of Urology in 61 Patients aged between 25-50 years who underwent left donor nephrectomy The Mean operating time, warm ischemic time, blood loss, analgesic requirement and duration of hospital stay were recorded and analysed statistically.Results: Out of 61 donor nephrectomies, 16 kidneys harvested by laparoscopic method with only 2 (12%) conversion to open due bleeding. Mean operating time was 179.9±47.6 minutes. Present study showed mean blood loss of (163±93 ml). Analgesic requirement of the LDN (mean 1.25 days) was significantly lower when compared to open group (mean 3.75 days). The present study shows duration of hospital stay was lower in LDN (mean 5.1days).Conclusions: Laparoscopic donor nephrectomy is an effective, safe and rewarding though it is time consuming and technically challenging. The analgesic requirement, duration of hospital stay and the blood loss were less with the laparoscopic surgery. Results of graft functioning of kidneys in both procedures were equivalent. So laparoscopic donor nephrectomy can be made as the procedure of choice in future.

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