Early Veno-venous Hemofiltration for Severe Acute Pancreatitis: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

JIANG Kun ¹ , CHEN Xinzu ² ,  XIA Qing ¹ , TANG Wenfu ¹ , WANG Lei ¹

1. Traditional Chinese and Western Medicine Integrated Department, West China Hospital, Sichuan University, Chengdu 610041, China; 2. Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

XIA Qing, Email: xiaqing@medmail.com.cn

Keywords：

Veno-venous hemofiltration; Severe acute pancreatitis; Systematic review

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Objective 　To evaluate the effectiveness and safety of early veno-venous hemofiltration in patients with severe acute pancreatitis (SAP).
Methods 　We searched Cochrane Central Register of Controlled Trials (Issue 4, 2005), MEDLINE (1990 to 2006) and CBMdisc (1990 to 2006). We also handsearched the references of relevant articles. We included randomized controlled trials (RCTs) and non-randomized clinical controlled trials (CCTs) comparing early veno-venous hemofiltration versus conventional therapy only, which reported either mortality rate, cure rate, or both. Two reviewers assessed the quality of each trial and extracted data independently. Trials were graded methodologically. The Cochrane Collaboration’s RevMan 4.2.8 software was used for statistical analysis.
Results 　Ten RCTs and 6 CCTs involving 891 patients were included, all of which were China-based. The Jadad scores of all included RCTs were less than 3. Five trials were incorrectly described as having used random allocation. The baseline data of each trial were comparable. Meta-analyses showed that hemofiltration significantly increased the overall cure rate (OR 3.01, 95%CI 1.28 to 7.09) and decreased the overall mortality rate (OR 0.43, 95%CI 0.27 to 0.70). Moreover, APACHE-II score, conversion to operation rate and incidence of complications of SAP were reduced significantly., The duration of abdominal pain or distension and hospitalization stay were shortened compared with non-hemofiltration. However, continuous veno-venous hemofiltration (CVVH) did not improve overall prognosis, with greater possibility of adverse events. Repeated or intermittent short veno-venous hemfiltration (RSVVH/ISVVH) either with or without peritoneal dialysis, could improve the overall prognosis without any adverse events reported.
Conclusions 　Based on these findings, early RSVVH/ISVVH was effective and safe for SAP, but the efficacy of CVVH could not be proven. Current studies were only available from China and were poor in methodological quality. Further, high-quality, large-scale, randomized controlled trials are required to identify reliably the effectiveness and safety of early veno-venous hemofiltration for SAP.

Citation： JIANG Kun,CHEN Xinzu,XIA Qing,TANG Wenfu,WANG Lei. Early Veno-venous Hemofiltration for Severe Acute Pancreatitis: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2007, 07(2): 121-134. doi: Copy

1.	Chinese medical association, Society of surgery, Pancreatic disease group. Diagnostic and therapeutic guidelines for acute pancreatitis (Draft). Chinese Journal of Digestion, 2004, 24: 190–192.
2.	Mao EQ, Tang YQ, Zhang SD. Discussion of improve the prognosis of severe acute pancreatitis. Chinese Journal of Practical Surgery, 2003, 23(1): 50–52.
3.	Mao EQ, Tang YQ, Han TQ, et al. Effects of short veno venous hemofiltration on severe acute pancreatitis. Chiese Journal of Surgery, 1999, 37(3): 141–143.
4.	Yang FF, You YW, Lin X, et al. Clinical observation of short-time hemofiltration and peritoneal dialysis on severe acute pancreatitis. Youjiang Medical Journal, 2005, 33(3): 233–234.
5.	Chen ZY, Li Y, Li MZ, et al. Application of blood purification combining cortical sugar hormone to sever acute pancreatitis. Chinese Journal of Primary Medicine Pharmacy, 2005, 12(8): 1070–1071.
6.	Feng GH, Cai Y, Jia PH. Combination of hemofiltration and peritoneal dialysis in the treatment of severe acute pancreatitis. Chinese Journal of Surgery, 2004, 42(5): 272–275.
7.	Sun B, Zhou ZQ, Xu J, et al. Effect of early therapy of hemofiltration on the patients with severe acute pancreatitis. Journal of Clinical Surgery, 2003, 11(5): 306–208.
8.	Sun WJ, Zong WJ, Wu LY, et al. Study on early hemofiltration for treating severe acute pancreatitis. Modern Medicine Health, 2004, 20(18): 1833–1834.
9.	Sun ZX, Sun CY. Combined treatment of abdmninal compartment syndrome complicating with fulminant acute pancreatitis: a report of 40 cases. World Chinese Journal of Digestology, 2005, 13(14): 1797–1799.
10.	Tao J, Wang CY, Yang ZY, et al. Comparative study on the effect of two different hemofiltration methods on severe acute pancreatitis and the indications. Chinese Journal of Experimental Surgery, 2003, 20(10): 937–939.
11.	Tao J, Wang CY, Yang ZY, et al. Effect of hemofiltration on imbalance of pro- and anti-inflammatory cytokines in severe acute pancreatitis patients. Chinese Journal of General Surgery, 2004, 19(4): 233–235.
12.	Wang BJ, Liu WJ. short veno-venous hemofiltration and peritoneal lavage for severe acute pancreatitis patients: a report of 58 cases. Qianwei Journal of Medicine, 2003, 20(9): 649.
13.	Wang XY, Tan JX, Ren GS. Effect of hemofiltration on treatment of severe acute pancreatitis. Chongqing Medical Journal, 2005, 34(12): 1823–1824.
14.	Yang ZH, Yang J, Wang YJ. Protective effect of continuous veno-venous hemofiltration on tissue and organ damage in patients with severe acute pancreatitis. Chinese Critical Care Medicine, 2004, 16(4): 232–234.
15.	Yang ZY, Wang CY, Tao J, et al. Effect of intermittent short veno-venous hemofiltration on immunological function of severe acute pancreatitis. Journal of Clinical Surgery, 2004, 12(11): 667–669.
16.	Zha Y, Zhou L, Liu Q, et al. Effects of RSVVH Therapy on Cytokines in Severe Acute Pancreatitis. Journal of Guiyang Medical College, 2005, 30(1): 36–38.
17.	Zhang T, Zhou L. Chen XQ, et al. Effectiveness evaluation of hemofiltration for severe acute pancreatitis. Chinese Journal of the Practical Chinese With Modern Medicine, 2005, 18(19): 1132–1133.
18.	Zhuang YT, liu LM, Fu JH. hemofiltration for severe acute pancreatitis: a report of 20 cases. Shandong Medical Journal, 2005, 45(25): 76.
19.	Zong WJ, Wu LY, Sun WJ, et al. Clinical evaluation of continuous veno-venous hemofiltration for severe acute pancreatitis. Chinese Journal of Blood Purification, 2004, 3(10): 562–564.
20.	Shen Q, Gan H, Du XG, et al. Continuous veno-venous hemofiltration for severe acute pancreatitis. Chongqing Medical Journal, 2002, 31(12): 1222–1224.
21.	.Lowenfels AB, Sullivan T, Fiorianti J, et al. The epidemiology and impact of pancreatic diseases in the United States. Curr Gastroenterol Rep, 2005, 7(2): 90–95.
22.	.Sekimoto M, Takada T, Kawarada Y, et al. JPN Guidelines for the management of acute pancreatitis: epidemiology, etiology, natural history, and outcome predictors in acute pancreatitis. J Hepatobiliary Pancreat Surg, 2006, 13(1):10–24.
23.	.Andersson R, Andersson B, Haraldsen P, et al. Incidence, management and recurrence rate of acute pancreatitis. Scand J Gastroenterol, 2004, 39(9): 891–894.
24.	.Goldacre MJ, Roberts SE. Hospital admission for acute pancreatitis in an English population, 1963-98: Database study of incidence and mortality. Br Med J,2004, 328: 1466–1469.
25.	.中华医学会消化病学分会胰腺疾病学组. 中国急性胰腺炎诊治指南(草案). 中华消化杂志, 2004, 24: 190～192.
26.	.Otsuki M, Hirota M, Arata S, et al; The Research Committee of Intractable Diseases of the Pancreas. Consensus of primary care in acute pancreatitis in Japan. World J Gastroenterol, 2006, 12(21): 3314–3323.
27.	.Whitcomb DC. Clinical practice. Acute pancreatitis. N Engl J Med, 2006, 354(20): 2142–2150.
28.	.Hochman D, Louie B, Bailey R. Determination of patient quality of life following severe acute pancreatitis. Can J Surg, 2006, 49(2): 101–106.
29.	.Imamura M. Epidemiology of acute pancreatitis--incidence by etiology, relapse rate, cause of death and long-term prognosis. Nippon Rinsho, 2004, 62: 1993–1997.
30.	.Carnovale A, Rabitti PG, Manes G, et al. Mortality in acute pancreatitis: Is it an early or a late event? J. Pancreas,2005, 6: 438–444.
31.	.Kusske AM, Rongione AJ, Reber HA. Cytokine and acute pancreatitis. Gastroenterology, 1996, 110(2): 639–642.
32.	.毛恩强, 汤耀卿, 张圣道. 进一步改善重症急性胰腺炎预后的探讨. 中国实用外科杂志, 2003, 23(1): 50～52.
33.	.Blinzler L, Hausser J, Bodeker H, et al. Conservative treatment of severe necrotizing pancreatitis using early continuous venovenous hemofiltration. Contrib Nephrol, 1991, 93: 234–236.
34.	.Jiang HL, Xue WJ, Li DQ, et al. Influence of continuous veno-venous hemofiltration on the course of acute pancreatitis. World J Gastroenterol, 2005, 11(31): 4815–4821.
35.	.Yekebas EF, Treede H, Knoefel WT, et al. Influence of zero-balanced hemofiltration on the course of severe experimental pancreatitis in pigs. Ann Surg, 1999, 229(4): 514–522.
36.	.毛恩强, 汤耀卿, 韩天权, 等. 短时血滤对重症急性胰腺炎治疗的影响. 中华外科杂志, 1999, 37(3): 141～143.
37.	.杨发奋, 尤燕舞, 林栩, 等. 腹膜透析联合短时血液滤过治疗急性重症胰腺炎的临床观察. 右江医学, 2005, 33(3): 233～234.
38.	.Aldeson P, Green S, Higgins JPT. Cochrane Reviews’ Handbook 4.2.2 [Updated December 2003]. In: The Cochrane Library, Issue 1, 2004. Chichester, UK: John Wiley & Sons, Ltd.
39.	.陈仲悦, 李毅, 李媚珍, 等. 大剂量地塞米松联合血液滤过在重症急性胰腺炎中的应用. 中国基层医药, 2005, 12(8): 1070～1071.
40.	.封光华, 蔡阳, 贾鹏辉. 联合血液滤过和腹膜透析治疗急性重症胰腺炎. 中华外科杂志, 2004, 42(5): 272～275.
41.	.孙备, 周尊强, 许军, 等. 早期血液滤过在治疗重症急性胰腺炎中的应用. 临床外科杂志, 2003, 11(5): 306～208.
42.	.孙文军, 宗伟钧, 吴丽颖, 等. 早期血液滤过治疗重症急性胰腺炎的探讨. 现代医药卫生, 2004, 20(18): 1833～1834.
43.	.孙早喜, 孙诚谊. 暴发性胰腺炎时腹腔室隔综合征的联合治疗40例. 世界华人消化杂志, 2005, 13(14): 1797～1799.
44.	.陶京, 王春友, 杨智勇, 等. 不同血滤方法治疗重症急性胰腺炎疗效比较及适应证探讨. 中华实验外科杂志, 2003, 20(10): 937～939.
45.	.陶京, 王春友, 杨智勇, 等. 血液滤过治疗对重症急性胰腺炎患者血浆炎性细胞因子水平的影响. 中华普通外科杂志, 2004, 19(4): 233～235.
46.	.王炳军, 刘文举. 短时血滤及腹腔灌洗治疗重症急性胰腺炎58例. 实用医药杂志, 2003, 20(9): 649.
47.	.王小毅, 谭金祥, 任国胜. 血液滤过治疗重症急性胰腺炎的疗效观察. 重庆医学, 2005, 34(12): 1823～1824.
48.	.杨朝晖, 杨军, 汪勇俊. 连续性血液滤过对重症急性胰腺炎诱发组织器官损害的保护作用. 中国危重病急救医学, 2004, 16(4): 232～234.
49.	.杨智勇, 王春友, 陶京, 等. 间断短时血滤对重症急性胰腺炎患者免疫功能的影响及意义. 临床外科杂志, 2004, 12(11): 667～669.
50.	.查艳, 周力, 刘琦, 等. 反复短时血滤疗法对重症急性胰腺炎细胞因子的影响. 贵阳医学院学报, 2005, 30(1): 36～38.
51.	.张涛, 周力, 陈晓琴, 等. 血液滤过治疗对重症急性胰腺炎疗效的评价. 中华实用中西医杂志, 2005, 18(19): 1132～1133.
52.	.庄育田, 刘兰梅, 傅金华. 血液滤过治疗重型急性胰腺炎20例体会. 山东医药. 2005, 45(25):76.
53.	.Wang H, Li WQ, Zhou W, et al. Clinical effects of continuous high volume hemofiltration on severe acute pancreatitis complicated with multiple organ dysfunction syndrome. World J Gastroenterol, 2003, 9(9): 2096–2099.
54.	.宗伟钧, 吴丽颖, 孙文军, 等. 连续性静脉-静脉血液滤过对重症急性胰腺炎治疗的临床评估. 中国血液净化, 2004, 3(10): 562～564.
55.	.沈清, 甘华, 杜晓刚, 等. 应用连续性血液滤过治疗急性重症胰腺炎. 重庆医学, 2002, 31(12): 1222～1224.

1. Chinese medical association, Society of surgery, Pancreatic disease group. Diagnostic and therapeutic guidelines for acute pancreatitis (Draft). Chinese Journal of Digestion, 2004, 24: 190–192.
2. Mao EQ, Tang YQ, Zhang SD. Discussion of improve the prognosis of severe acute pancreatitis. Chinese Journal of Practical Surgery, 2003, 23(1): 50–52.
3. Mao EQ, Tang YQ, Han TQ, et al. Effects of short veno venous hemofiltration on severe acute pancreatitis. Chiese Journal of Surgery, 1999, 37(3): 141–143.
4. Yang FF, You YW, Lin X, et al. Clinical observation of short-time hemofiltration and peritoneal dialysis on severe acute pancreatitis. Youjiang Medical Journal, 2005, 33(3): 233–234.
5. Chen ZY, Li Y, Li MZ, et al. Application of blood purification combining cortical sugar hormone to sever acute pancreatitis. Chinese Journal of Primary Medicine Pharmacy, 2005, 12(8): 1070–1071.
6. Feng GH, Cai Y, Jia PH. Combination of hemofiltration and peritoneal dialysis in the treatment of severe acute pancreatitis. Chinese Journal of Surgery, 2004, 42(5): 272–275.
7. Sun B, Zhou ZQ, Xu J, et al. Effect of early therapy of hemofiltration on the patients with severe acute pancreatitis. Journal of Clinical Surgery, 2003, 11(5): 306–208.
8. Sun WJ, Zong WJ, Wu LY, et al. Study on early hemofiltration for treating severe acute pancreatitis. Modern Medicine Health, 2004, 20(18): 1833–1834.
9. Sun ZX, Sun CY. Combined treatment of abdmninal compartment syndrome complicating with fulminant acute pancreatitis: a report of 40 cases. World Chinese Journal of Digestology, 2005, 13(14): 1797–1799.
10. Tao J, Wang CY, Yang ZY, et al. Comparative study on the effect of two different hemofiltration methods on severe acute pancreatitis and the indications. Chinese Journal of Experimental Surgery, 2003, 20(10): 937–939.
11. Tao J, Wang CY, Yang ZY, et al. Effect of hemofiltration on imbalance of pro- and anti-inflammatory cytokines in severe acute pancreatitis patients. Chinese Journal of General Surgery, 2004, 19(4): 233–235.
12. Wang BJ, Liu WJ. short veno-venous hemofiltration and peritoneal lavage for severe acute pancreatitis patients: a report of 58 cases. Qianwei Journal of Medicine, 2003, 20(9): 649.
13. Wang XY, Tan JX, Ren GS. Effect of hemofiltration on treatment of severe acute pancreatitis. Chongqing Medical Journal, 2005, 34(12): 1823–1824.
14. Yang ZH, Yang J, Wang YJ. Protective effect of continuous veno-venous hemofiltration on tissue and organ damage in patients with severe acute pancreatitis. Chinese Critical Care Medicine, 2004, 16(4): 232–234.
15. Yang ZY, Wang CY, Tao J, et al. Effect of intermittent short veno-venous hemofiltration on immunological function of severe acute pancreatitis. Journal of Clinical Surgery, 2004, 12(11): 667–669.
16. Zha Y, Zhou L, Liu Q, et al. Effects of RSVVH Therapy on Cytokines in Severe Acute Pancreatitis. Journal of Guiyang Medical College, 2005, 30(1): 36–38.
17. Zhang T, Zhou L. Chen XQ, et al. Effectiveness evaluation of hemofiltration for severe acute pancreatitis. Chinese Journal of the Practical Chinese With Modern Medicine, 2005, 18(19): 1132–1133.
18. Zhuang YT, liu LM, Fu JH. hemofiltration for severe acute pancreatitis: a report of 20 cases. Shandong Medical Journal, 2005, 45(25): 76.
19. Zong WJ, Wu LY, Sun WJ, et al. Clinical evaluation of continuous veno-venous hemofiltration for severe acute pancreatitis. Chinese Journal of Blood Purification, 2004, 3(10): 562–564.
20. Shen Q, Gan H, Du XG, et al. Continuous veno-venous hemofiltration for severe acute pancreatitis. Chongqing Medical Journal, 2002, 31(12): 1222–1224.
21. .Lowenfels AB, Sullivan T, Fiorianti J, et al. The epidemiology and impact of pancreatic diseases in the United States. Curr Gastroenterol Rep, 2005, 7(2): 90–95.
22. .Sekimoto M, Takada T, Kawarada Y, et al. JPN Guidelines for the management of acute pancreatitis: epidemiology, etiology, natural history, and outcome predictors in acute pancreatitis. J Hepatobiliary Pancreat Surg, 2006, 13(1):10–24.
23. .Andersson R, Andersson B, Haraldsen P, et al. Incidence, management and recurrence rate of acute pancreatitis. Scand J Gastroenterol, 2004, 39(9): 891–894.
24. .Goldacre MJ, Roberts SE. Hospital admission for acute pancreatitis in an English population, 1963-98: Database study of incidence and mortality. Br Med J,2004, 328: 1466–1469.
25. .中华医学会消化病学分会胰腺疾病学组. 中国急性胰腺炎诊治指南(草案). 中华消化杂志, 2004, 24: 190～192.
26. .Otsuki M, Hirota M, Arata S, et al; The Research Committee of Intractable Diseases of the Pancreas. Consensus of primary care in acute pancreatitis in Japan. World J Gastroenterol, 2006, 12(21): 3314–3323.
27. .Whitcomb DC. Clinical practice. Acute pancreatitis. N Engl J Med, 2006, 354(20): 2142–2150.
28. .Hochman D, Louie B, Bailey R. Determination of patient quality of life following severe acute pancreatitis. Can J Surg, 2006, 49(2): 101–106.
29. .Imamura M. Epidemiology of acute pancreatitis--incidence by etiology, relapse rate, cause of death and long-term prognosis. Nippon Rinsho, 2004, 62: 1993–1997.
30. .Carnovale A, Rabitti PG, Manes G, et al. Mortality in acute pancreatitis: Is it an early or a late event? J. Pancreas,2005, 6: 438–444.
31. .Kusske AM, Rongione AJ, Reber HA. Cytokine and acute pancreatitis. Gastroenterology, 1996, 110(2): 639–642.
32. .毛恩强, 汤耀卿, 张圣道. 进一步改善重症急性胰腺炎预后的探讨. 中国实用外科杂志, 2003, 23(1): 50～52.
33. .Blinzler L, Hausser J, Bodeker H, et al. Conservative treatment of severe necrotizing pancreatitis using early continuous venovenous hemofiltration. Contrib Nephrol, 1991, 93: 234–236.
34. .Jiang HL, Xue WJ, Li DQ, et al. Influence of continuous veno-venous hemofiltration on the course of acute pancreatitis. World J Gastroenterol, 2005, 11(31): 4815–4821.
35. .Yekebas EF, Treede H, Knoefel WT, et al. Influence of zero-balanced hemofiltration on the course of severe experimental pancreatitis in pigs. Ann Surg, 1999, 229(4): 514–522.
36. .毛恩强, 汤耀卿, 韩天权, 等. 短时血滤对重症急性胰腺炎治疗的影响. 中华外科杂志, 1999, 37(3): 141～143.
37. .杨发奋, 尤燕舞, 林栩, 等. 腹膜透析联合短时血液滤过治疗急性重症胰腺炎的临床观察. 右江医学, 2005, 33(3): 233～234.
38. .Aldeson P, Green S, Higgins JPT. Cochrane Reviews’ Handbook 4.2.2 [Updated December 2003]. In: The Cochrane Library, Issue 1, 2004. Chichester, UK: John Wiley & Sons, Ltd.
39. .陈仲悦, 李毅, 李媚珍, 等. 大剂量地塞米松联合血液滤过在重症急性胰腺炎中的应用. 中国基层医药, 2005, 12(8): 1070～1071.
40. .封光华, 蔡阳, 贾鹏辉. 联合血液滤过和腹膜透析治疗急性重症胰腺炎. 中华外科杂志, 2004, 42(5): 272～275.
41. .孙备, 周尊强, 许军, 等. 早期血液滤过在治疗重症急性胰腺炎中的应用. 临床外科杂志, 2003, 11(5): 306～208.
42. .孙文军, 宗伟钧, 吴丽颖, 等. 早期血液滤过治疗重症急性胰腺炎的探讨. 现代医药卫生, 2004, 20(18): 1833～1834.
43. .孙早喜, 孙诚谊. 暴发性胰腺炎时腹腔室隔综合征的联合治疗40例. 世界华人消化杂志, 2005, 13(14): 1797～1799.
44. .陶京, 王春友, 杨智勇, 等. 不同血滤方法治疗重症急性胰腺炎疗效比较及适应证探讨. 中华实验外科杂志, 2003, 20(10): 937～939.
45. .陶京, 王春友, 杨智勇, 等. 血液滤过治疗对重症急性胰腺炎患者血浆炎性细胞因子水平的影响. 中华普通外科杂志, 2004, 19(4): 233～235.
46. .王炳军, 刘文举. 短时血滤及腹腔灌洗治疗重症急性胰腺炎58例. 实用医药杂志, 2003, 20(9): 649.
47. .王小毅, 谭金祥, 任国胜. 血液滤过治疗重症急性胰腺炎的疗效观察. 重庆医学, 2005, 34(12): 1823～1824.
48. .杨朝晖, 杨军, 汪勇俊. 连续性血液滤过对重症急性胰腺炎诱发组织器官损害的保护作用. 中国危重病急救医学, 2004, 16(4): 232～234.
49. .杨智勇, 王春友, 陶京, 等. 间断短时血滤对重症急性胰腺炎患者免疫功能的影响及意义. 临床外科杂志, 2004, 12(11): 667～669.
50. .查艳, 周力, 刘琦, 等. 反复短时血滤疗法对重症急性胰腺炎细胞因子的影响. 贵阳医学院学报, 2005, 30(1): 36～38.
51. .张涛, 周力, 陈晓琴, 等. 血液滤过治疗对重症急性胰腺炎疗效的评价. 中华实用中西医杂志, 2005, 18(19): 1132～1133.
52. .庄育田, 刘兰梅, 傅金华. 血液滤过治疗重型急性胰腺炎20例体会. 山东医药. 2005, 45(25):76.
53. .Wang H, Li WQ, Zhou W, et al. Clinical effects of continuous high volume hemofiltration on severe acute pancreatitis complicated with multiple organ dysfunction syndrome. World J Gastroenterol, 2003, 9(9): 2096–2099.
54. .宗伟钧, 吴丽颖, 孙文军, 等. 连续性静脉-静脉血液滤过对重症急性胰腺炎治疗的临床评估. 中国血液净化, 2004, 3(10): 562～564.
55. .沈清, 甘华, 杜晓刚, 等. 应用连续性血液滤过治疗急性重症胰腺炎. 重庆医学, 2002, 31(12): 1222～1224.

Chinese Journal of Evidence-Based Medicine

Early Veno-venous Hemofiltration for Severe Acute Pancreatitis: A Systematic Review

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