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Endocrine disorders associated with hepatitis C virus chronic infection

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Abstract

The term “HCV syndrome” encompasses several organ- and systemic pathophysiological states, which often recognize autoimmunity or neoplastic evolution in their pathophysiology, as well as chronic HCV infection as trigger. The clinical features of HCV patients are heterogenous, and may include endocrine or metabolic disorders, namely autoimmune thyroiditis, type 2 diabetes mellitus, and erectile/sexual dysfunctions. In this review, we summarize current knowledge on the endocrine/metabolic diseases associated with chronic HCV infection, focusing on the main concepts emerged in the recent literature in this field. The application of this knowledge in everyday clinical practice may be relevant, in order to reinforce a holistic vision of the patient with chronic HCV infection, stimulating in turn a multi-disciplinary approach, thus increasing the probability of early diagnosis, more effective treatments, and a better prognostic outcome.

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References

  1. Ferri C, Antonelli A, Mascia MT, Sebastiani M, Fallahi P, Ferrari D, et al. HCV-related autoimmune and neoplastic disorders: the HCV syndrome. Dig Liver Dis. 2007;39(Suppl 1):S13–21.

    Article  PubMed  Google Scholar 

  2. Ferri C, Sebastiani M, Giuggioli D, Colaci M, Fallahi P, Piluso A, et al. Hepatitis C virus syndrome: a constellation of organ- and non-organ specific autoimmune disorders, B-cell non-Hodgkin's lymphoma, and cancer. World J Hepatol. 2015 Mar 27;7(3):327–43.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Ferrari SM, Fallahi P, Mancusi C, Colaci M, Manfredi A, Ferri C, et al. HCV-related autoimmune disorders in HCV chronic infection. Clin Ter. 2013;164(4):e305–12.

    CAS  PubMed  Google Scholar 

  4. Antonelli A, Ferri C, Ferrari SM, Colaci M, Sansonno D, Fallahi P. Endocrine manifestations of hepatitis C virus infection. Nat Clin Pract Endocrinol Metab. 2009;5:26–34.

    Article  CAS  PubMed  Google Scholar 

  5. Shen Y, Wang XL, Xie JP, Shao JG, Lu YH, Zhang S, et al. Thyroid disturbance in patients with chronic hepatitis C infection: a systematic review and meta-analysis. J Gastrointestin Liver Dis. 2016;25:227–34.

    PubMed  Google Scholar 

  6. Desbois AC, Cacoub P. Diabetes mellitus, insulin resistance and hepatitis C virus infection: a contemporary review. World J Gastroenterol. 2017 Mar 7;23(9):1697–711.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Gentile I, Fusco F, Buonomo AR, Scotto R, Zappulo E, Pinchera B, et al. Prevalence and risk factors of erectile dysfunction in patients with hepatitis B virus or hepatitis C virus or chronic liver disease: results from a prospective study. Sex Health 2018;in press.

  8. Ferri C, Monti M, La Civita L, Longombardo G, Greco F, Pasero G, et al. Infection of peripheral blood mononuclear cells by hepatitis C virus in mixed cryoglobulinemia. Blood. 1993 Dec 15;82(12):3701–4.

    CAS  PubMed  Google Scholar 

  9. Antonelli A, Ferrari SM, Corrado A, Di Domenicantonio A, Fallahi P. Autoimmune thyroid disorders. Autoimmun Rev. 2015;14:174–80.

    Article  CAS  PubMed  Google Scholar 

  10. Di Domenicantonio A, Politti U, Marchi S, De Bortoli N, Giuggioli D, Antonelli A, et al. A review on thyroid autoimmune disorders and HCV chronic infection. Clin Ter. 2014;165:e376–81.

    PubMed  Google Scholar 

  11. Antonelli A, Ferri C, Pampana A, Fallahi P, Nesti C, Pasquini M, et al. Thyroid disorders in chronic hepatitis C. Am J Med. 2004;117:10–3.

    Article  CAS  PubMed  Google Scholar 

  12. Giordano TP, Henderson L, Landgren O, Chiao EY, Kramer JR, El-Serag H, et al. Risk of non-Hodgkin lymphoma and lymphoproliferative precursor diseases in US veterans with hepatitis C virus. JAMA. 2007;297:2010–7.

    Article  CAS  PubMed  Google Scholar 

  13. Antonelli A, Ferri C, Fallahi P, Giuggioli D, Nesti C, Longombardo G, et al. Thyroid involvement in patients with overt HCV-related mixed cryoglobulinemia. QJM. 2004;97:499–506.

    Article  CAS  PubMed  Google Scholar 

  14. Ferri C, Colaci M, Fallahi P, Ferrari SM, Antonelli A, Giuggioli D. Thyroid involvement in hepatitis C virus-infected patients with/without mixed cryoglobulinemia. Front Endocrinol. 2017;8:159.

    Article  Google Scholar 

  15. Wang P, Jing Z, Liu C, Xu M, Wang P, Wang X, et al. Hepatitis C virus infection and risk of thyroid cancer: a systematic review and meta-analysis. Arab J Gastroenterol. 2017;18:1–5.

    Article  PubMed  Google Scholar 

  16. Akeno N, Blackard JT, Tomer Y. HCV E2 protein binds directly to thyroid cells and induces IL-8 production: a new mechanism for HCV induced thyroid autoimmunity. J Autoimmun. 2008;31:339–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Zignego AL, Gragnani L, Piluso A, Sebastiani M, Giuggioli D, Fallahi P, et al. Virus-driven autoimmunity and lymphoproliferation: the example of HCV infection. Expert Rev Clin Immunol. 2015;11:15–31.

    Article  CAS  PubMed  Google Scholar 

  18. Blackard JT, Kong L, Huber AK, Tomer Y. Hepatitis C virus infection of a thyroid cell line: implications for pathogenesis of HCV and thyroiditis. Thyroid. 2012;23:863–70.

    Article  CAS  Google Scholar 

  19. Fallahi P, Ferrari SM, Giuggioli D, Sebastiani M, Colaci M, Ferri C, et al. Chemokines in the pathogenesis and as Therapeutical markers and targets of HCV chronic infection and HCV extrahepatic manifestations. Curr Drug Targets. 2017;18(7):786–93.

    Article  CAS  PubMed  Google Scholar 

  20. Fallahi P, Ferri C, Ferrari SM, Corrado A, Sansonno D, Antonelli A. Cytokines and HCV-related disorders. Clin Dev Immunol. 2012;2012:468107.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Antonelli A, Ferri C, Ferrari SM, De Marco S, Di Domenicantonio A, Centanni M, et al. Interleukin-1β, C-x-C motif ligand 10, and interferon-gamma serum levels in mixed cryoglobulinemia with or without autoimmune thyroiditis. J Interf Cytokine Res. 2010;30:835–42.

    Article  CAS  Google Scholar 

  22. Antonelli A, Fallahi P, Ferrari SM, Colaci M, Giuggioli D, Saraceno G, et al. Increased CXCL9 serum levels in hepatitis C-related mixed cryoglobulinemia, with autoimmune thyroiditis, associated with high levels of CXCL10. J Interf Cytokine Res. 2013;33:739–45.10.

    Article  CAS  Google Scholar 

  23. Antonelli A, Fallahi P, Ferrari SM, Sebastiani M, Manfredi A, Mazzi V, et al. Circulating CXCL11 and CXCL10 are increased in hepatitis C-associated cryoglobulinemia in the presence of autoimmune thyroiditis. Mod Rheumatol. 2012;22:659–67.

    Article  CAS  PubMed  Google Scholar 

  24. Antonelli A, Ferri C, Ferrari SM, Di Domenicantonio A, Ferrari P, Pupilli C, et al. The presence of autoimmune thyroiditis in mixed cryoglobulinemia patients is associated with high levels of circulating interleukin-6, but not of tumor necrosis factor-alpha. Clin Exp Rheumatol. 2011;29(1 Suppl 64):S17–22.

    PubMed  Google Scholar 

  25. Antonelli A, Ferrari SM, Frascerra S, Galetta F, Franzoni F, Corrado A, et al. Circulating chemokine (CXC motif) ligand (CXCL)9 is increased in aggressive chronic autoimmune thyroiditis, in association with CXCL10. Cytokine. 2011 Aug;55(2):288–93.

    Article  CAS  PubMed  Google Scholar 

  26. Fallahi P, Ferrari SM, Politti U, Giuggioli D, Ferri C, Antonelli A. Autoimmune and neoplastic thyroid diseases associated with hepatitis C chronic infection. Int J Endocrinol. 2014;2014:935131.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Antonelli A, Ferri C, Ferrari SM, Colaci M, Fallahi P. Immunopathogenesis of HCV-related endocrine manifestations in chronic hepatitis and mixed cryoglobulinemia. Autoimmun Rev. 2008;8:18–23.

    Article  CAS  PubMed  Google Scholar 

  28. Antonelli A, Ferri C, Fallahi P. Thyroid cancer in patients with hepatitis C infection. JAMA. 1999 May 5;281(17):1588.

    Article  CAS  PubMed  Google Scholar 

  29. Montella M, Crispo A, de Bellis G, Izzo F, Frigeri F, Ronga D, et al. HCV and cancer: a case-control study in a high-endemic area. Liver. 2001 Oct;21(5):335–41.

    Article  CAS  PubMed  Google Scholar 

  30. Fiore E, Rago T, Latrofa F, Provenzale MA, Piaggi P, Delitala A, et al. Hashimoto’s thyroiditis is associated with papillary thyroid carcinoma: role of TSH and treatment with L-thyroxine. Endocr Relat Cancer. 2011;18:429–37.

    Article  CAS  PubMed  Google Scholar 

  31. Ferri C, Ramos-Casals M, Zignego AL, Arcaini L, Roccatello D, Antonelli A, et al. ISG-EHCV coauthors. International diagnostic guidelines for patients with HCV-related extrahepatic manifestations. A multidisciplinary expert statement. Autoimmun Rev. 2016 Dec;15(12):1145–60.

    Article  PubMed  Google Scholar 

  32. White DL, Ratziu V, El-Serag HB. Hepatitis C infection and risk of diabetes: a systematic review and meta-analysis. J Hepatol. 2008;49(5):831–44.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Fabiani S, Fallahi P, Ferrari SM, Miccoli M, Antonelli A. Hepatitis C virus infection and development of type 2 diabetes mellitus: Systematic review and meta-analysis of the literature. Rev Endocr Metab Disord. 2018;in press.

  34. Liang J, Lv C, Chen M, Xu M, Zhao C, Yang Y, Wang J, Zhu D, Gao J, Rong R, Zhu T, Yu M. Effects of preoperative hepatitis B virus infection, hepatitis C virus infection, and co-infection on the development of new-onset diabetes after kidney transplantation. J Diabetes. 2018;in press.

  35. Choi HY, Kim Y, Cho H, Kim BH, Ki M. Risk of diabetes in viral hepatitis B or C patients compared to that in noninfected individuals in Korea, 2002-2013: a population-based cohort study. J Viral Hepat. 2018 Mar;25(3):272–80.

    Article  CAS  PubMed  Google Scholar 

  36. Subramaniam S, Wong VW, Tse YK, Yip TC, Chan HL, Wong GL. Impact of diabetes mellitus and hepatitis B virus coinfection on patients with chronic hepatitis C: a territory-wide cohort study. J Gastroenterol Hepatol. 2018 Apr;33(4):934–41.

    Article  PubMed  Google Scholar 

  37. Farshadpour F, Taherkhani R, Ravanbod MR, Eghbali SS. Prevalence and genotype distribution of hepatitis C virus infection among patients with type 2 diabetes mellitus. Med Princ Pract. 2018;27(4):308–16.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Soverini V, Persico M, Bugianesi E, Forlani G, Salamone F, Masarone M, et al. HBV and HCV infection in type 2 diabetes mellitus: a survey in three diabetes units in different Italian areas. Acta Diabetol. 2011;48:337–43.

    Article  CAS  PubMed  Google Scholar 

  39. Li X, Gao Y, Xu H, Hou J, Gao P. Diabetes mellitus is a significant risk factor for the development of liver cirrhosis in chronic hepatitis C patients, particularly for women. Sci Rep. 2017 Aug 22;7(1):9087.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Cao LH, Lu FM, Lu XJ, Zhu LY. Study on the relationship between insulin growth factor 1 and liver fibrosis in patients with chronic hepatitis C with type 2 diabetes mellitus. J Cell Biochem. 2018;in press.

  41. Bakulin IG, Sandler YG, Vinnitskaya EV, Keiyan VA, Rodionova SV, Rotin DL. Diabetes mellitus and nonalcoholic fatty liver disease: the verges of contingency. Ter Arkh. 2017;89:59–65.

    Article  CAS  PubMed  Google Scholar 

  42. Hui JM, Sud A, Farrell GC, Bandara P, Byth K, Kench JG, et al. Insulin resistance is associated with chronic hepatitis C virus infection and fibrosis progression. Gastroenterology. 2003;125:1695–704.

    Article  CAS  PubMed  Google Scholar 

  43. Paradis V, Perlemuter G, Bonvoust F, Dargere D, Parfait B, Vidaud M, et al. High glucose and hyperinsulinemia stimulate connective tissue growth factor expression: a potential mechanism involved in progression to fibrosis in nonalcoholic steatohepatitis. Hepatology (Baltimore, Md.). 2001;34:738–44.

    Article  CAS  Google Scholar 

  44. Kasai D, Adachi T, Deng L, Nagano-Fujii M, Sada K, Ikeda M, et al. HCV replication suppresses cellular glucose uptake through down-regulation of cell surface expression of glucose transporters. J Hepatol. 2009;50:883–94.

    Article  CAS  PubMed  Google Scholar 

  45. Romero-Gómez M. Insulin resistance and hepatitis C. World J Gastroenterol. 2006;12:7075–80.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Banerjee S, Saito K, Ait-Goughoulte M, Meyer K, Ray RB, Ray R. Hepatitis C virus core protein upregulates serine phosphorylation of insulin receptor substrate-1 and impairs the downstream akt/protein kinase B signaling pathway for insulin resistance. J Virol. 2008;82:2606–12.

    Article  CAS  PubMed  Google Scholar 

  47. Knobler H, Zhornicky T, Sandler A, Haran N, Ashur Y, Schattner A. Tumor necrosis factor-alpha-induced insulin resistance may mediate the hepatitis C virus-diabetes association. Am J Gastroenterol. 2003;98(12):2751–6.

    CAS  PubMed  Google Scholar 

  48. Mitsuyoshi H, Itoh Y, Sumida Y, Minami M, Yasui K, Nakashima T. Evidence of oxidative stress as a cofactor in the development of insulin resistance in patients with chronic hepatitis C. Hepatol Res. 2008;38(4):348–53.

    Article  CAS  PubMed  Google Scholar 

  49. Bose SK, Shrivastava S, Meyer K, Ray RB, Ray R. Hepatitis C virus activates the mTOR/S6K1 signaling pathway in inhibiting IRS-1 function for insulin resistance. J Virol. 2012;86(11):6315–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Singhal A, Agrawal A, Ling J. Regulation of insulin resistance and type II diabetes by hepatitis C virus infection: a driver function of circulating miRNAs. J Cell Mol Med. 2018 Apr;22(4):2071–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Huang YW, Yang SS, Fu SC, Wang TC, Hsu CK, Chen DS, et al. Increased risk of cirrhosis and its decompensation in chronic hepatitis C patients with new-onset diabetes: a nationwide cohort study. Hepatology. 2014;60:807–14.

    Article  PubMed  Google Scholar 

  52. Elkrief L, Chouinard P, Bendersky N, Hajage D, Larroque B, Babany G, et al. Diabetes mellitus is an independent prognostic factor for major liver-related outcomes in patients with cirrhosis and chronic hepatitis C. Hepatology. 2014;60:823–31.

    Article  CAS  PubMed  Google Scholar 

  53. Lai SW, Chen PC, Liao KF, Muo CH, Lin CC, Sung FC. Risk of hepatocellular carcinoma in diabetic patients and risk reduction associated with anti-diabetic therapy: a population-based cohort study. Am J Gastroenterol. 2012;107:46–52.

    Article  CAS  PubMed  Google Scholar 

  54. Nkontchou G, Cosson E, Aout M, Mahmoudi A, Bourcier V, Charif I, et al. Impact of metformin on the prognosis of cirrhosis induced by viral hepatitis C in diabetic patients. J Clin Endocrinol Metab. 2011;96:2601–8.

    Article  CAS  PubMed  Google Scholar 

  55. Delgado-Borrego A, Jordan SH, Negre B, Healey D, Lin W, Kamegaya Y. Reduction of insulin resistance with effective clearance of hepatitis C infection: results from the HALT-C trial. Clin Gastroenterol Hepatol. 2010;8(5):458–62.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Aghemo A, Prati GM, Rumi MG, Soffredini R, D’Ambrosio R, Orsi E. Sustained virological response prevents the development of insulin resistance in patients with chronic hepatitis C. Hepatology. 2012;56(5):1681–7.

    Article  CAS  PubMed  Google Scholar 

  57. Pavone P, Tieghi T, d’Ettorre G, Lichtner M, Marocco R, Mezzaroma I. Rapid decline of fasting glucose in HCV diabetic patients treated with direct-acting antiviral agents. Clin Microbiol Infect. 2016;22(5):462 e1–3.

    Article  CAS  Google Scholar 

  58. Fabrizio C, Procopio A, Scudeller L, Dell’Acqua R, Bruno G, Milano E. HCV and diabetes: towards a ‘sustained’ glycaemic improvement after treatment with DAAs? Clin Microbiol Infect. 2017;23(5):342–3.

    Article  CAS  PubMed  Google Scholar 

  59. Ciancio A, Bosio R, Bo S, Pellegrini M, Sacco M, Vogliotti E, et al. Significant improvement of glycemic control in diabetic patients with HCV infection responding to direct-acting antiviral agents. J Med Virol. 2018 Feb;90(2):320–7.

    Article  CAS  PubMed  Google Scholar 

  60. Drazilova S, Gazda J, Janicko M, Jarcuska P. Chronic hepatitis C association with diabetes mellitus and cardiovascular risk in the era of DAA therapy. Can J Gastroenterol Hepatol. 2018 Aug 13;2018:6150861.

    PubMed  PubMed Central  Google Scholar 

  61. Gastaldi G, Goossens N, Clément S, Negro F. Current level of evidence on causal association between hepatitis C virus and type 2 diabetes: a review. J Adv Res. 2017 Mar;8(2):149–59.

    Article  CAS  PubMed  Google Scholar 

  62. Cacoub P, Desbois AC, Comarmond C, Saadoun D. Impact of sustained virological response on the extrahepatic manifestations of chronic hepatitis C: a meta-analysis. Gut. 2018;67(11):2025–34.

  63. Akbar DH, Siddique AM, Ahmed MM. Prevalence of Type-2 diabetes in patients with hepatitis C and B virus infection in Jeddah, Saudi Arabia. Med Princ Pract. 2002 Apr-Jun;11(2):82–5.

    Article  PubMed  Google Scholar 

  64. Kabbaj N, Errabih I, Guédira M, El Atmani H, Benabed K, Al Hamany Z, et al. Hepatitis C and diabetes mellitus: effect of diabetes on the course of the liver disease. Ann Endocrinol. 2006 Jun;67(3):233–7.

    Article  CAS  Google Scholar 

  65. Antonelli A, Ferri C, Fallahi P, Sebastiani M, Nesti C, Barani L, et al. Type 2 diabetes in hepatitis C-related mixed cryoglobulinaemia patients. Rheumatology (Oxford). 2004 Feb;43(2):238–40.

    Article  CAS  Google Scholar 

  66. Hunter SS, Gadallah A, Azawi MK, Doss W. Erectile dysfunction in patients with chronic hepatitis C virus infection. Arab J Gastroenterol. 2014 Mar;15(1):16–20.

    Article  PubMed  Google Scholar 

  67. Abdelhamid AA, Sherief MH, Nemr NA, Hassoba HM, El-Sakka AI. Homocysteine, insulin-like growth factor one and oestrogen levels in patients with erectile dysfunction-associated chronic hepatitis C virus infection. Andrologia. 2018 Jul;31:e13116.

    Article  CAS  Google Scholar 

  68. Wang FP, Zhang PA, Yang XY. Relationship between sex hormones and RIG-I signaling in peripheral blood mononuclear cells of patients infected with hepatitis C virus. Exp Ther Med. 2017 Sep;14(3):2728–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. White DL, Tavakoli-Tabasi S, Kuzniarek J, Pascua R, Ramsey DJ, EI-Serag HB. Higher serum testosterone is associated with increased risk of advanced hepatitis C-related liver disease in males. Hepatology. 2012;55:759–68.

    Article  CAS  PubMed  Google Scholar 

  70. Magri A, Barbaglia MN, Foglia CZ, Boccato E, Burlone ME, Cole S, et al. 17,β-estradiol inhibits hepatitis C virus mainly by interference with the release phase of its life cycle. Liver Int. 2017 May;37(5):669–77.

    Article  CAS  PubMed  Google Scholar 

  71. Ahmed NH, El-Abaseri TB, El-Sayed HF, El-Serafi TI. Female sex hormones pattern and its relation to disease severity and treatment in pre- and postmenopausal patients with chronic hepatitis C virus (genotype 4) infection. Int J Chronic Dis. 2015;2015:927974.

    PubMed  PubMed Central  Google Scholar 

  72. Soykan A, Boztaş H, Idilman R, Ozel ET, Tüzün AE, Ozden A, et al. Sexual dysfunctions in HCV patients and its correlations with psychological and biological variables. Int J Impot Res. 2005 Mar-Apr;17(2):175–9.

    Article  CAS  PubMed  Google Scholar 

  73. Karaivazoglou K, Tsermpini EE, Assimakopoulos K, Triantos C. Sexual functioning in patients with chronic hepatitis C: a systematic review. Eur J Gastroenterol Hepatol. 2017 Nov;29(11):1197–205.

    Article  PubMed  Google Scholar 

  74. Durazzo M, Premoli A, Di Bisceglie C, Bertagna A, Faga E, Biroli G, et al. Alterations of seminal and hormonal parameters: an extrahepatic manifestation of HCV infection? World J Gastroenterol. 2006 May 21;12(19):3073–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  75. Hofny ER, Ali ME, Taha EA, Nafeh HM, Sayed DS, Abdel-Azeem HG, et al. Semen and hormonal parameters in men with chronic hepatitis C infection. Fertil Steril. 2011 Jun 30;95(8):2557–9.

    Article  CAS  PubMed  Google Scholar 

  76. Hussein TM, Elneily D, Eid AA, Abou-ElKhier H. Assessment of antisperm antibodies in a sample of Egyptian patients with hepatitis C virus infection. Andrologia. 2017 Jun;49(5).

  77. Benvenga S, Guarneri F. Molecular mimicry and autoimmune thyroid disease. Rev Endocr Metab Disord. 2016 Dec;17(4):485–98.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Michele Colaci.

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Michele Colaci, Lorenzo Malatino, Alessandro Antonelli, Poupak Fallahi, Dilia Giuggioli, and Clodoveo Ferri declare no conflict of interests.

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Colaci, M., Malatino, L., Antonelli, A. et al. Endocrine disorders associated with hepatitis C virus chronic infection. Rev Endocr Metab Disord 19, 397–403 (2018). https://doi.org/10.1007/s11154-018-9475-y

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