scholarly journals Endovascular Treatment of Ruptured Very Small Intracranial Aneurysms: Complications, Recurrence Rate, and Clinical Outcomes

2022 ◽  
Vol 12 ◽  
Author(s):  
Feiyun Qin ◽  
Jiaqiang Liu ◽  
Xintong Zhao ◽  
Degang Wu ◽  
Niansheng Lai ◽  
...  
Keyword(s):  
Risk Factor ◽  
Endovascular Treatment ◽  
Clinical Outcomes ◽  
Recurrence Rate ◽  
Coil Embolization ◽  
Perioperative Complications ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Fisher Grade

Objective: The aim of this study was to evaluate the safety and efficacy of endovascular treatment for ruptured very small (≤3 mm) intracranial aneurysms (VSIAs).Methods: The clinical data and imaging results for 152 patients with VSIAs treated with coil embolization from August 2014 to June 2020 were retrospectively reviewed. The influential factors related to the preoperative complications, aneurysm recurrence, and clinical outcomes for these patients were analyzed.Results: Among 152 patients with ruptured VSIAs, 90 were treated with coil embolization alone, while 62 were treated with stent-assisted coil embolization. Eighteen patients experienced intra and/or postoperative complications (overall incidence = 11.8%). One person died of intraoperative aneurysm re-rupture and postoperative rebleeding (mortality rate = 0.65%). Twenty patients had various degrees of neurological dysfunction (morbidity rate = 13.1%). Statistical analysis showed that there was no independent risk factor associated with perioperative complications. The rate of complete aneurysm occlusion at discharge and follow-up was 76.3 and 86.2%, respectively. A total of 105 patients underwent digital subtraction angiography during follow-up, and 18 of them experienced postoperative recurrence (recurrence rate = 17.1%). Seven patients were retreated (retreatment rate = 6.7%). The use of stents was the only factor that affected the postoperative recurrence of aneurysm. The incidence of favorable clinical outcomes (Glasgow Outcome Scale score ≥ 4) at discharge and follow-up was 86.2 and 97.1%, respectively. Univariate analysis showed that the preoperative Hunt-Hess grade, CT Fisher grade, and perioperative complications were risk factors for poor clinical outcomes. Multiple logistic regression analysis showed that perioperative complication was the most significant risk factor for the clinical prognosis of patients with ruptured VSIAs.Conclusion: Endovascular treatment is a safe and efficient approach for ruptured VSIAs. Stent-assisted coiling reduced the recurrence rate of aneurysm without increasing the incidence of perioperative complications. The Hunt-Hess grade, CT Fisher grade, and perioperative complications were independent factors associated with the clinical outcomes of patients with ruptured VSIAs, and perioperative complication was the most significant risk factor for poor prognosis in patients.

scholarly journals Risk Factors and Outcomes of Revision Arthroscopic Posterior Shoulder Capsulolabral Repair in Contact Athletes

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0031
Author(s):  
Justin W. Arner ◽  
Sachidhanand Jayakumar ◽  
Dharmesh Vyas ◽  
James P. Bradley
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Revision Surgery ◽  
Significant Risk ◽  
Return To Sport ◽  
Significant Risk Factor ◽  
Return To Play ◽  
Bone Width ◽  
Posterior Shoulder

Objectives: Risk factors and outcomes of revision arthroscopic posterior capsulolabral repairare currently not well defined in contact athletes.Evaluation of risk factors for contact athletes who require revision arthroscopic posterior unidirectional capsulolabral repair is needed. Methods: A total of 186 contact athletes’ shoulders that underwent arthroscopic posterior capsulolabral repair at minimum 2 year follow-up were reviewed. Those who required revision surgery were compared with those who did not. Parameters assessed included age, gender, labral and/or capsular injury, level of sport, and return to sport. Glenoid bone width, bone version, labral width, and labral version were also compared. Results: Eleven shoulders required revision surgery (5.9%) at mean 12.0 year follow-up. The only significant risk factor was glenoid bone width (revision=26.4 mm vs. non-revision=29.1 mm, p=0.005). Cartilage version (p=0.676), labral version (p=0.539), and bone version (p=0.791) were not significantly different between groups, nor was labral width (p=0.751). Gender (p=0.326), labral injury (p=0.349), capsule injury (p=0.683), and level of sport (p=0.381) were not significant factors for requiring revision surgery. Both return to sport at the same level (revision=16.7% vs. non-revision=72.1%, p<0.001) and overall return to sport (revision=50% vs. non-revision=93.7%, p<0.001) was significantly worse in the revision group. Of those who had revision surgery, 33.3% stated their original surgery was not worthwhile, which was significantly higher than the 4.5% in the non-revision group (p=0.041). Conclusion: Contact athletes underwent revision arthroscopic posterior capsulolabral repair at an incidence of 5.9% at 12 year follow-up. The only significant risk factor for requiring revision surgery was smaller glenoid bone width. Return to play was significantly worse in those who required revision surgery. This data is essential for patient selection, optimal treatment techniques, and patient education as posterior shoulder capsulolabral repair in contact athletes that require revision has not previously been evaluated.

Predictors, clinical characteristics, and outcome of conduct disorder in girls with attention-deficit/hyperactivity disorder: a longitudinal study

2007 ◽  
Vol 37 (12) ◽  
pp. 1731-1741 ◽  
Author(s):  
MICHAEL C. MONUTEAUX ◽  
STEPHEN V. FARAONE ◽  
LARA MICHELLE GROSS ◽  
JOSEPH BIEDERMAN
Keyword(s):  
Sexual Behavior ◽  
Risk Factor ◽  
Longitudinal Study ◽  
Clinical Characteristics ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Sexual Behavior Problems ◽  
Hyperactivity Disorder ◽  
Girls With Adhd

ABSTRACTBackgroundResearch on the overlap between attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) in males has provided useful information on the etiology, correlates, course, and nosology of this co-morbid condition. However, it is unclear how these results extend to females. Our aim was to examine the predictors, clinical characteristics, and functional outcome of CD in a sample of female youth with and without ADHD.MethodWe conducted a blind, 5-year prospective longitudinal study of girls with (n=140) and without (n=122) ADHD, aged 6–18 years at baseline. At the 5-year follow-up, 123 (88%) and 112 (92%) of the ADHD and control children respectively were reassessed at a mean age of 16·7 years. Psychiatric disorders were assessed using blind structured diagnostic interviews.ResultsBaseline ADHD was a significant risk factor for lifetime CD throughout childhood and adolescence [hazard ratio (HR) 5·8, 95% confidence interval (CI) 2·9–11·5, p<0·001]. Among ADHD girls, childhood-onset (<12 years) CD was predicted by paternal antisocial personality disorder (ASPD), while adolescent-onset CD (⩾12 years) was predicted by family conflict. In addition, lifetime CD significantly predicted academic, psychiatric and sexual behavior problems in girls with ADHD at follow-up.ConclusionsADHD is a significant risk factor for CD in girls. CD is associated with increased risk for academic, psychiatric and sexual behavior problems compared to ADHD girls without CD. Given that the therapeutic approaches indicated by ADHD and CD differ, these findings highlight the importance of improved efforts aimed at early identification and treatment of CD in girls with ADHD.

scholarly journals Definitions and Risk Factors for Drug-Resistant Epilepsy in an Adult Cohort

2021 ◽  
Vol 12 ◽  
Author(s):  
Alyssa Denton ◽  
Lilian Thorpe ◽  
Alexandra Carter ◽  
Adriana Angarita-Fonseca ◽  
Karen Waterhouse ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Risk Factor ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Drug Resistant ◽  
Age Group ◽  
Drug Resistant Epilepsy ◽  
New Diagnosis

Background: Less than one-third of people with epilepsy will develop drug-resistant epilepsy (DRE). Establishing the prognosis of each unique epilepsy case is an important part of evaluation and treatment.Most studies on DRE prognosis have been based on a pooled, heterogeneous group, including children, adults, and older adults, in the absence of clear recognition and control of important confounders, such as age group. Furthermore, previous studies were done before the 2010 definition of DRE by the International League Against Epilepsy (ILAE), so data based on the current definitions have not been entirely elucidated. This study aimed to explore the difference between 3 definitions of DRE and clinical predictors of DRE in adults and older adults.Methods: Patients with a new diagnosis of epilepsy ascertained at a Single Seizure Clinic (SSC) in Saskatchewan, Canada were included if they had at least 1 year of follow-up. The first study outcome was the diagnosis of DRE epilepsy at follow-up using the 2010 ILAE definition. This was compared with 2 alternative definitions of DRE by Kwan and Brodie and Camfield and Camfield. Finally, risk factors were analyzed using the ILAE definition.Results: In total, 95 patients with a new diagnosis of epilepsy and a median follow-up of 24 months were included. The median age of patients at the diagnosis of epilepsy was 33 years, and 51% were men. In the cohort, 32% of patients were diagnosed with DRE by the Kwan and Brodie definition, 10% by Camfield and Camfield definition, and 15% by the ILAE definition by the end of follow-up. The only statistically significant risk factor for DRE development was the failure to respond to the first anti-seizure medication (ASM).Conclusion: There were important differences in the percentage of patients diagnosed with DRE when using 3 concurrent definitions. However, the use of the ILAE definition appeared to be the most consistent through an extended follow-up. Finally, failure to respond to the first ASM was the sole significant risk factor for DRE in the cohort after considering the age group.

scholarly journals Post-Anticoagulation Cessation D-Dimer Testing and VTE Recurrence in Real-World Australian Audit

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 1227-1227
Author(s):  
Julie Wang ◽  
Rowena Brook ◽  
Alison Slocombe ◽  
Lisa Hong ◽  
Prahlad Ho
Keyword(s):  
Risk Factor ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Risk Of Recurrence ◽  
Increased Risk ◽  
Recurrent Vte ◽  
Residual Thrombus ◽  
Repeat Imaging ◽  
D Dimer

Abstract Aim Elevated D-dimer post-anticoagulation cessation is a recognised risk factor for recurrent venous thromboembolic events (VTE). In particular, raised D-dimer post cessation has been associated with increased risk of recurrence in unprovoked major VTE. Currently in Australia, D-dimer has not been widely used in practice to stratify the risk of VTE recurrence. This study aims to retrospectively analyse the effect of routine D-dimer testing and it's association with VTE recurrence. Methods A retrospective evaluation was performed on 1024 patients with a diagnosis of VTE at a tertiary hospital in Australia between January 2013 and December 2016. Data collected included demographics, results and timing of D-dimer testing and serial imaging results. Results 1024 patients were reviewed with a total median follow up of 12 months (range 0-59 months). D-dimer was tested in 189 patients (18.5%) within 90 days after cessation of anticoagulation. Of these patients, median age was 58 (18-92) and 55.3% (n=105) were female. 33.3% (n=63) had isolated distal deep vein thrombosis (IDDVT), 66.3% (n=126) had above knee DVT (AKDVT)/pulmonary embolus (PE), 54.5% (n=103) of VTE were provoked. Abnormal post cessation D-dimer (>500) was found in 72 patients (37.9%). Of these, 25 patients were restarted on anticoagulation; one had recurrent VTE whilst on low dose apixaban 2.5mg BD and one had recurrence after cessation of anticoagulation at a later date. Patients with elevated D-dimer post cessation had a higher rate of recurrence with the highest risk in patients with D-dimer >1000 (RR 7.38, p=<0.01) outlined in Table 1. Of the 164 patients with post cessation D-dimer testing who remained off anticoagulation there were a total of 24 (12.6%) episodes of recurrent VTE. Elevated D-dimer post anticoagulation cessation was a significant risk factor for recurrence in both provoked VTE (RR 4.21, p=0.01) and unprovoked VTE cohorts (RR 4.55, p=0.008) outlined in Table 2. When provoked VTE were sub-categorised, raised D-dimer demonstrated the most statistical significance in VTE provoked by travel (RR 13.5 p=0.06). Of the patients with post anticoagulation cessation D-dimer testing 170 patients (89.9%) had repeat imaging to assess for residual thrombus. In the subgroup of patients with no residual thrombus, elevated D-dimer was a significant risk factor for VTE recurrence (RR 6.4, p=<0.01). Patients with normal D-dimer and no residual thrombus had the lowest rate of recurrence 5.4% (n=4) see Table 3. When stratified by type of VTE, elevated D-dimer post anticoagulation cessation was significantly related to risk for recurrence in the overall IDDVT sub-cohort (RR 4.09, p=0.007). This was not significant for the AKDVT/PE sub cohort (RR 3.24, p=0.079). However, for patients with unprovoked AKDVT or PE, having D-dimer tested post anticoagulation, regardless of result, was associated with lower rates of VTE recurrence RR 0.30 (p=0.02) compared to those who had no D-dimer testing as part of follow-up. Conclusion Post treatment D-dimer testing may have a clinical role in stratifying the risk of VTE recurrence along with repeat imaging to detect residual thrombus. Elevated D-dimer post anticoagulation cessation is associated with increased risk of VTE recurrence for both provoked and unprovoked VTE with highest risk in patients with D-dimer >1000. Patients with no residual thrombus and a negative D-dimer post anticoagulation cessation had the lowest rate of recurrence. In the subgroup of patients with provoked VTE and IDDVT a positive D-dimer post cessation was associated with 4.21 and 4.09 relative risk of recurrence respectively, suggesting that the role of D-dimer testing can be extended to these subpopulations. Interestingly, in patients with unprovoked AKDVT or PE, having post-cessation D-dimer testing performed, regardless of result, was associated with a significantly lower rate of VTE recurrence compared to patients without D-dimer testing, which may be related to specialist review and recommencement of anticoagulation in high-risk patients. Disclosures No relevant conflicts of interest to declare.

Greek Registry Of Essential Thrombocythemia: Baseline Characteristics and Therapeutic Strategy

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4084-4084
Author(s):  
Damianos Sotiropoulos ◽  
Argiris Symeonidis ◽  
Vassilios K Papadopoulos ◽  
Panagiotis Tsirigotis ◽  
Maria Pagoni ◽  
...  
Keyword(s):  
Risk Factor ◽  
Significant Risk ◽  
Jak2 V617f ◽  
Significant Risk Factor ◽  
First Line ◽  
Platelet Counts ◽  
First Line Therapy ◽  
Line Therapy ◽  
History Of

Abstract The Greek Registry of Essential Thrombocythemia (ET) is implemented under the auspices of the Acute Leukemias and Myeloproliferative Neoplasms Study Group of the Hellenic Society of Haematology. Hereby, we present results after four years of retrospective data collection. The total number of patients included is 1078, from 14 Greek sites; ET was diagnosed between 1982 and 2012. The male to female ratio is 1:1.19. Median age at diagnosis is 63 years, median platelet counts (PLT) 826x109/L, hemoglobin (Hb) 13.6 g/dL, white blood cell counts (WBC) 9.4x109/L. The presenting symptoms were a thrombotic event in 6.8%, a hemorrhagic event in 1.5% of patients. In 79.8% of the patients the diagnosis was made after incidental finding of elevated platelet counts on routine laboratory investigation. Molecular studies were performed in 677 patients and 42.8% of them were positive for the JAK2-V617F mutation. The presence of JAK2-V617F mutation (mutant vs wild type allele) was associated with baseline platelet counts (757.5 vs 882 x109/L) and hemoglobin levels (14.4 vs 13.4 g/dL), p<0.001 (Mann-Whitney U-test). A history of thrombosis or hemorrhage was present in 18.6% and 6.6% of patients respectively. Chi-square test was performed to assess whether platelet counts at diagnosis (<600, 600-800, >800 x109/L), Hb<13.8g/dL, WBC>9.5x109/L, or splenomegaly are associated with thrombotic or hemorrhagic events in the past medical history or during the follow-up of ET patients. The only statistically significant difference was observed in the occurrence of thrombosis during the follow up: 10.1% of those with PLT between 600-800 x109/L, 4.5% in PLT<600 and 5.6% in PLT>800 x109/L. To assess for possible confounders the multivariable logistic regression model was used, with independent variables the PLT at diagnosis, age >60 years, history of thrombosis and first line therapy. The history of thrombosis was the only statistically significant risk factor with odds ratio (OR) 3.9 (p=0.0005), while PLT was not a statistically significant risk factor (OR=2.5, p=0.074). Antiplatelet therapy was offered in 80% of patients (aspirin in 59.1%, clopidogrel in 4.7%, and combination therapy in 6.5%); anticoagulants (low molecular weight heparin or warfarin) were given in 2.3%, while the remaining 17.8% of patients did not receive any antithrombotic therapy. During the first six months post diagnosis, 31.6% of patients did not need any cytoreductive therapy. The rest 68.4% of the patients received first line therapy (hydroxyurea 80.6%, anagrelide 11.4% and interferon 5.4%). The response rates were 89.9%, 82.1% and 85.7%, respectively. Second-line therapy was received by 25.8% of the patients (hydroxyurea 23%, anagrelide 44.6%, interferon 9.5%), while the off-label combination of hydroxyurea and anagrelide was administered to 21.2% of the patients. Of the 852 patients treated with hydroxyurea as first line therapy, 12.1% switched to anagrelide and 1.2% to interferon. Of those initially treated with anagrelide, 27.6% switched to hydroxyurea and 8.2% to interferon. During the follow up phase, secondary solid tumor occurred in 4% and hematological malignancy in 2.7% of the patients. The aim of the registry and the subsequent data analysis is to convey the practice of managing the disease. Moreover, useful conclusions can be reached regarding to the patients’ responsiveness to therapy and the minimization of thrombotic and hemorrhagic adverse events. Disclosures: Spanoudakis: Genesis Hellas: Honoraria. Kotsianidis:Genesis Hellas: Honoraria, Research Funding.

scholarly journals Illicit Drug Use Is a Significant Risk Factor for Loss to Follow Up in Patients with HIV-1 Infection at a Large Urban HIV Clinic in Tokyo

PLoS ONE ◽  
2013 ◽  
Vol 8 (8) ◽  
pp. e72310 ◽  
Author(s):  
Takeshi Nishijima ◽  
Hiroyuki Gatanaga ◽  
Hirokazu Komatsu ◽  
Misao Takano ◽  
Miwa Ogane ◽  
...  
Keyword(s):  
Risk Factor ◽  
Drug Use ◽  
Illicit Drug ◽  
Significant Risk ◽  
Illicit Drug Use ◽  
Significant Risk Factor ◽  
Loss To Follow Up ◽  
Hiv 1

scholarly journals Surgical Venous Cutdown for the Insertion of Totally Implantable Venous Access Devices

2018 ◽  
Vol 103 (7-8) ◽  
pp. 415-421
Author(s):  
Naofumi Tsukiyamam ◽  
Manabu Shimomura ◽  
Kazuhiro Toyota ◽  
Nozomi Karakuchi ◽  
Kosuke Ono ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Perioperative Complications ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Venous Access ◽  
Term Treatment ◽  
Intravenous Drip ◽  
Long Term Treatment ◽  
Venous Access Devices

Purpose: Stable insertion of totally implantable venous access devices (TIVADs) is mandatory for the administration of chemotherapy and parenteral nutrition. Subclavian venipuncture is the most popular route; however, perioperative complications occur in up to 12% of patients. We inserted TIVADs by surgical venous cutdown of the cephalic vein at the deltopectoral groove with the intention of a safe and stable implantation. Methods: We implanted TIVADs in 318 consecutive patients (331 cases) from January 2011 to December 2015. We retrospectively analyzed short- and long-term treatment outcomes and risk factors for primary failure of implantation and removal due to catheter-related complications. Results: The aim of implantation was chemotherapy in 198 cases, nutrition in 92 cases, and frequent intravenous drip in 41 case. Surgical venous cutdown was performed in 321 of 331 cases (97%); primary failure occurred in 42 cases (13.1%). Short-term complications occurred in 4 cases (1.2%), and there were no serious complications, such as pneumothorax. In the analysis of risk factors for primary failure, aim of implantation (chemotherapy versus nutrition versus frequent intravenous drip) was the only risk factor (P = 0.02). Removals occurred in 35 cases (11.5%). In the analysis of risk factors for removal due to complications, presence of infectious disease was identified as the only significant risk factor (P &lt; 0.001). Conclusions: We confirmed the safety and efficacy of the cutdown method and clarified the risk factors for primary failure and removal. The cutdown method was safe and was not associated with serious complications; however, selective implantation was needed to achieve a high success rate.

scholarly journals Resistin is a risk factor for all-cause mortality in elderly Finnish population: A prospective study in the OPERA cohort

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248015
Author(s):  
Karri Parkkila ◽  
Antti Kiviniemi ◽  
Mikko Tulppo ◽  
Juha Perkiömäki ◽  
Y. Antero Kesäniemi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Risk Factor ◽  
Prospective Study ◽  
Mononuclear Cells ◽  
Leisure Time Physical Activity ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Lipid Lowering ◽  
All Cause Mortality

Objective Resistin is a small, cysteine-rich proinflammatory molecule that is primarily secreted by peripheral blood mononuclear cells and macrophages in humans. Previous studies have shown resistin to participate in various pathological processes including atherosclerosis and cancer progression but not many studies have assessed the role of resistin as a risk factor for all-cause mortality. The objective of this prospective study was to evaluate whether resistin predicts mortality among elderly Finnish people. Methods The study population consisted of 599 elderly (71.7 ± 5.4 years) patients and the follow-up was approximately six years. A thorough clinical examination including anthropometric and other clinical measurements such as blood pressure as well as various laboratory parameters (including resistin) was conducted at baseline. Results After the follow-up, 65 (11%) of the patients died. Resistin was a significant risk factor for all-cause mortality (HR 3.02, 95% CI: 1.64–5.56, p<0.001) when the highest tertile was compared to the lowest. Resistin remained as a significant risk factor even after adjusting for various covariates such as age, sex, systolic blood pressure, smoking habits, alcohol consumption, medications (antihypertensive, lipid-lowering, glucose-lowering), hsCRP and leisure time physical activity. Receiver operating characteristic (ROC) curve analysis for resistin demonstrated area under the curve (AUC) of 0.656 (95% CI: 0.577–0.734), p<0.001 and an optimal cutoff value of 12.88 ng/ml. Conclusions Our results indicate that resistin is a significant risk factor for all-cause mortality among elderly Finnish subjects, independent from traditional cardiovascular risk factors.

scholarly journals Bedtime Salivary Cortisol and Depressive Symptoms in Older Adults Living With Dementia

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 437-437
Author(s):  
Miranda McPhillips ◽  
Darina Petrovsky ◽  
Liming Huang ◽  
Adriana Adriana ◽  
Nancy Hodgson ◽  
...  
Keyword(s):  
Older Adults ◽  
Risk Factor ◽  
Depressive Symptoms ◽  
Salivary Cortisol ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Quadratic Term ◽  
Baseline Cortisol ◽  
Prospective Longitudinal

Abstract The dysregulation of cortisol has been associated with depressive symptoms in older adults. To date, no prospective longitudinal studies have examined whether salivary cortisol is a risk factor for depressive symptoms in persons living with dementia (PLWD). With a sample of 123 PLWD, baseline salivary cortisol was collected at awaking, 30 minutes after awaking, and bedtime. Depressive symptoms were assessed at baseline and the four-week follow-up. Cortisol indicator were centered. Baseline bedtime cortisol level was significantly associated with depressive symptoms in a curvature style while controlling age, gender, and baseline depressive symptoms (𝛽=3.76 for linear term and 𝛽=-1.57 for quadratic term, both ps&lt;0.04). No other baseline cortisol measures were significant prospective predictors. Our results suggest the bedtime cortisol was a significant risk factor for depressive symptoms in PLWD. These findings suggest that bedtime cortisol may play a role in the etiology of depressive symptoms in PLWD.

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