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<meta name="DC.Title" content="An In-Depth Analysis of Brain and Spine Neuroimaging in Children with Abusive Head Trauma: Beyond the Classic Imaging Findings" />
<meta name="DC.Identifier" content="10.3174/ajnr.A7492" />
<meta name="DC.Date" content="2022-04-07" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Abusive head trauma is the leading cause of morbidity and mortality in young children. Radiology provides valuable information for this challenging diagnosis, but no single neuroimaging finding is independently diagnostic of abusive head trauma. Our purposes were to describe the prevalence of brain and spine neuroimaging findings and to analyze the association of neuroimaging findings with clinical factors to determine which neuroimaging findings may be used as prognostic indicators.

MATERIALS AND METHODS: Children with a confirmed abusive head trauma diagnosis between January 2018 to February 2021 were included in this single-center retrospective study. Patient demographics, survival, Glasgow Coma Scale score on admission, length of hospital stay, and intensive care unit stay were examined. Brain neuroimaging findings were categorized as classic and nonclassic findings. Spine MRIs were also assessed for spinal ligamentous injury, compression fracture, and hemorrhage. The χ2 test or the Wilcoxon rank-sum test was used for the analysis.

RESULTS: One hundred two children (male/female ratio: 75:27; average age, 9.49; range, 0.27–53.8 months) were included. Subdural hematoma was the most common (83.3%) classic neuroimaging finding. Bridging vein thrombosis was the most common (30.4%) nonclassic neuroimaging finding. Spinal ligamentous injury was seen in 23/49 patients. Hypoxic-ischemic injury was significantly higher in deceased children ( P  = .0001). The Glasgow Coma Scale score was lower if hypoxic-ischemic injury ( P  &lt; .0001) or spinal ligamentous injury were present ( P  = .017). The length of hospital stay was longer if intraventricular hemorrhage ( P  = .04), diffuse axonal injury ( P  = .017), hypoxic-ischemic injury ( P  = .001), or arterial stroke ( P  = .0003) was present. The intensive care unit stay was longer if intraventricular hemorrhage ( P  = .02), diffuse axonal injury ( P  = .01), hypoxic-ischemic injury ( P  &lt; .0001), or spinal ligamentous injury ( P  = .03) was present.

CONCLUSIONS: Our results may suggest that a combination of intraventricular hemorrhage, diffuse axonal injury, hypoxic-ischemic injury, arterial stroke, and/or spinal ligamentous injury on neuroimaging at presentation may be used as potential poor prognostic indicators in children with abusive head trauma.

AHT
:   abusive head trauma
AS
:   arterial stroke
BVT
:   bridging vein thrombosis
DAI
:   diffuse axonal injury
EDH
:   epidural hematoma
GCS
:   Glasgow Coma Scale
HII
:   hypoxic-ischemic injury
ICU
:   intensive care unit
IVH
:   intraventricular hemorrhage
LOS
:   length of hospital stay
PL
:   parenchymal laceration
SDH
:   subdural hematoma
SPH
:   subpial hemorrhage
VS
:   venous stroke" />
<meta name="DC.Contributor" content="G. Orman" />
<meta name="DC.Contributor" content="S.F. Kralik" />
<meta name="DC.Contributor" content="N.K. Desai" />
<meta name="DC.Contributor" content="T.G. Singer" />
<meta name="DC.Contributor" content="S. Kwabena" />
<meta name="DC.Contributor" content="S. Risen" />
<meta name="DC.Contributor" content="T.A.G.M. Huisman" />
<meta name="article:published_time" content="2022-04-07" />
<meta name="article:section" content="PEDIATRICS" />
<meta name="citation_title" content="An In-Depth Analysis of Brain and Spine Neuroimaging in Children with Abusive Head Trauma: Beyond the Classic Imaging Findings" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Abusive head trauma is the leading cause of morbidity and mortality in young children. Radiology provides valuable information for this challenging diagnosis, but no single neuroimaging finding is independently diagnostic of abusive head trauma. Our purposes were to describe the prevalence of brain and spine neuroimaging findings and to analyze the association of neuroimaging findings with clinical factors to determine which neuroimaging findings may be used as prognostic indicators.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Children with a confirmed abusive head trauma diagnosis between January 2018 to February 2021 were included in this single-center retrospective study. Patient demographics, survival, Glasgow Coma Scale score on admission, length of hospital stay, and intensive care unit stay were examined. Brain neuroimaging findings were categorized as classic and nonclassic findings. Spine MRIs were also assessed for spinal ligamentous injury, compression fracture, and hemorrhage. The χ&lt;sup&gt;2&lt;/sup&gt; test or the Wilcoxon rank-sum test was used for the analysis.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;One hundred two children (male/female ratio: 75:27; average age, 9.49; range, 0.27–53.8 months) were included. Subdural hematoma was the most common (83.3%) classic neuroimaging finding. Bridging vein thrombosis was the most common (30.4%) nonclassic neuroimaging finding. Spinal ligamentous injury was seen in 23/49 patients. Hypoxic-ischemic injury was significantly higher in deceased children (&lt;i&gt;P &lt;/i&gt;= .0001). The Glasgow Coma Scale score was lower if hypoxic-ischemic injury (&lt;i&gt;P &lt;/i&gt;&amp;lt; .0001) or spinal ligamentous injury were present (&lt;i&gt;P &lt;/i&gt;= .017). The length of hospital stay was longer if intraventricular hemorrhage (&lt;i&gt;P &lt;/i&gt;= .04), diffuse axonal injury (&lt;i&gt;P &lt;/i&gt;= .017), hypoxic-ischemic injury (&lt;i&gt;P &lt;/i&gt;= .001), or arterial stroke (&lt;i&gt;P &lt;/i&gt;= .0003) was present. The intensive care unit stay was longer if intraventricular hemorrhage (&lt;i&gt;P &lt;/i&gt;= .02), diffuse axonal injury (&lt;i&gt;P &lt;/i&gt;= .01), hypoxic-ischemic injury (&lt;i&gt;P &lt;/i&gt;&amp;lt; .0001), or spinal ligamentous injury (&lt;i&gt;P &lt;/i&gt;= .03) was present.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Our results may suggest that a combination of intraventricular hemorrhage, diffuse axonal injury, hypoxic-ischemic injury, arterial stroke, and/or spinal ligamentous injury on neuroimaging at presentation may be used as potential poor prognostic indicators in children with abusive head trauma.&lt;/p&gt;" />
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<meta name="twitter:title" content="An In-Depth Analysis of Brain and Spine Neuroimaging in Children with Abusive Head Trauma: Beyond the Classic Imaging Findings" />
<meta name="twitter:card" content="summary" />
<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Abusive head trauma is the leading cause of morbidity and mortality in young children. Radiology provides valuable information for this challenging diagnosis, but no single neuroimaging finding is independently diagnostic of abusive head trauma. Our purposes were to describe the prevalence of brain and spine neuroimaging findings and to analyze the association of neuroimaging findings with clinical factors to determine which neuroimaging findings may be used as prognostic indicators.

MATERIALS AND METHODS: Children with a confirmed abusive head trauma diagnosis between January 2018 to February 2021 were included in this single-center retrospective study. Patient demographics, survival, Glasgow Coma Scale score on admission, length of hospital stay, and intensive care unit stay were examined. Brain neuroimaging findings were categorized as classic and nonclassic findings. Spine MRIs were also assessed for spinal ligamentous injury, compression fracture, and hemorrhage. The χ2 test or the Wilcoxon rank-sum test was used for the analysis.

RESULTS: One hundred two children (male/female ratio: 75:27; average age, 9.49; range, 0.27–53.8 months) were included. Subdural hematoma was the most common (83.3%) classic neuroimaging finding. Bridging vein thrombosis was the most common (30.4%) nonclassic neuroimaging finding. Spinal ligamentous injury was seen in 23/49 patients. Hypoxic-ischemic injury was significantly higher in deceased children ( P  = .0001). The Glasgow Coma Scale score was lower if hypoxic-ischemic injury ( P  &lt; .0001) or spinal ligamentous injury were present ( P  = .017). The length of hospital stay was longer if intraventricular hemorrhage ( P  = .04), diffuse axonal injury ( P  = .017), hypoxic-ischemic injury ( P  = .001), or arterial stroke ( P  = .0003) was present. The intensive care unit stay was longer if intraventricular hemorrhage ( P  = .02), diffuse axonal injury ( P  = .01), hypoxic-ischemic injury ( P  &lt; .0001), or spinal ligamentous injury ( P  = .03) was present.

CONCLUSIONS: Our results may suggest that a combination of intraventricular hemorrhage, diffuse axonal injury, hypoxic-ischemic injury, arterial stroke, and/or spinal ligamentous injury on neuroimaging at presentation may be used as potential poor prognostic indicators in children with abusive head trauma.

AHT
:   abusive head trauma
AS
:   arterial stroke
BVT
:   bridging vein thrombosis
DAI
:   diffuse axonal injury
EDH
:   epidural hematoma
GCS
:   Glasgow Coma Scale
HII
:   hypoxic-ischemic injury
ICU
:   intensive care unit
IVH
:   intraventricular hemorrhage
LOS
:   length of hospital stay
PL
:   parenchymal laceration
SDH
:   subdural hematoma
SPH
:   subpial hemorrhage
VS
:   venous stroke" />
<meta name="og-title" property="og:title" content="An In-Depth Analysis of Brain and Spine Neuroimaging in Children with Abusive Head Trauma: Beyond the Classic Imaging Findings" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2022/04/07/ajnr.A7492" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Abusive head trauma is the leading cause of morbidity and mortality in young children. Radiology provides valuable information for this challenging diagnosis, but no single neuroimaging finding is independently diagnostic of abusive head trauma. Our purposes were to describe the prevalence of brain and spine neuroimaging findings and to analyze the association of neuroimaging findings with clinical factors to determine which neuroimaging findings may be used as prognostic indicators.

MATERIALS AND METHODS: Children with a confirmed abusive head trauma diagnosis between January 2018 to February 2021 were included in this single-center retrospective study. Patient demographics, survival, Glasgow Coma Scale score on admission, length of hospital stay, and intensive care unit stay were examined. Brain neuroimaging findings were categorized as classic and nonclassic findings. Spine MRIs were also assessed for spinal ligamentous injury, compression fracture, and hemorrhage. The χ2 test or the Wilcoxon rank-sum test was used for the analysis.

RESULTS: One hundred two children (male/female ratio: 75:27; average age, 9.49; range, 0.27–53.8 months) were included. Subdural hematoma was the most common (83.3%) classic neuroimaging finding. Bridging vein thrombosis was the most common (30.4%) nonclassic neuroimaging finding. Spinal ligamentous injury was seen in 23/49 patients. Hypoxic-ischemic injury was significantly higher in deceased children ( P  = .0001). The Glasgow Coma Scale score was lower if hypoxic-ischemic injury ( P  &lt; .0001) or spinal ligamentous injury were present ( P  = .017). The length of hospital stay was longer if intraventricular hemorrhage ( P  = .04), diffuse axonal injury ( P  = .017), hypoxic-ischemic injury ( P  = .001), or arterial stroke ( P  = .0003) was present. The intensive care unit stay was longer if intraventricular hemorrhage ( P  = .02), diffuse axonal injury ( P  = .01), hypoxic-ischemic injury ( P  &lt; .0001), or spinal ligamentous injury ( P  = .03) was present.

CONCLUSIONS: Our results may suggest that a combination of intraventricular hemorrhage, diffuse axonal injury, hypoxic-ischemic injury, arterial stroke, and/or spinal ligamentous injury on neuroimaging at presentation may be used as potential poor prognostic indicators in children with abusive head trauma.

AHT
:   abusive head trauma
AS
:   arterial stroke
BVT
:   bridging vein thrombosis
DAI
:   diffuse axonal injury
EDH
:   epidural hematoma
GCS
:   Glasgow Coma Scale
HII
:   hypoxic-ischemic injury
ICU
:   intensive care unit
IVH
:   intraventricular hemorrhage
LOS
:   length of hospital stay
PL
:   parenchymal laceration
SDH
:   subdural hematoma
SPH
:   subpial hemorrhage
VS
:   venous stroke" />
<meta name="og-type" property="og:type" content="article" />
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    <title>An In-Depth Analysis of Brain and Spine Neuroimaging in Children with Abusive Head Trauma: Beyond the Classic Imaging Findings | American Journal of Neuroradiology</title>  
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      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">PEDIATRICS</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">An In-Depth Analysis of Brain and Spine Neuroimaging in Children with Abusive Head Trauma: Beyond the Classic Imaging Findings</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">G. Orman</span>, <span class="highwire-citation-author" data-delta="1">S.F. Kralik</span>, <span class="highwire-citation-author" data-delta="2">N.K. Desai</span>, <span class="highwire-citation-author" data-delta="3">T.G. Singer</span>, <span class="highwire-citation-author" data-delta="4">S. Kwabena</span>, <span class="highwire-citation-author" data-delta="5">S. Risen</span> and <span class="highwire-citation-author" data-delta="6">T.A.G.M. Huisman</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">April 2022,  </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A7492 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-96685--81147199190" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">G. Orman </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Edward B. Singleton Department of Radiology (G.O., S.F.K., N.K.D., T.A.G.M.H.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=G.%2BOrman%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Orman%20G&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AG.%2BOrman%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-2684-3957" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for G. Orman</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">S.F. Kralik </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Edward B. Singleton Department of Radiology (G.O., S.F.K., N.K.D., T.A.G.M.H.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.F.%2BKralik%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kralik%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AS.F.%2BKralik%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-7213-1761" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S.F. Kralik</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">N.K. Desai </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Edward B. Singleton Department of Radiology (G.O., S.F.K., N.K.D., T.A.G.M.H.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=N.K.%2BDesai%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Desai%20N&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AN.K.%2BDesai%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-9663-8655" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for N.K. Desai</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">T.G. Singer </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Global Child Health Residency (T.G.S.)</div><div class='author-affiliation'><span class='nlm-sup'>e</span>Division of General Surgery (T.G.S.), Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=T.G.%2BSinger%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Singer%20T&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AT.G.%2BSinger%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-8641-958X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for T.G. Singer</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">S. Kwabena </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Department of Pediatrics (S.K.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.%2BKwabena%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kwabena%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AS.%2BKwabena%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-0189-2533" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S. Kwabena</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">S. Risen </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Division of Public Health Pediatrics, and Department of Pediatrics (S.R.), Division of Child Neurology and Developmental Neuroscience, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.%2BRisen%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Risen%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AS.%2BRisen%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-3345-1839" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S. Risen</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">T.A.G.M. Huisman </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Edward B. Singleton Department of Radiology (G.O., S.F.K., N.K.D., T.A.G.M.H.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=T.A.G.M.%2BHuisman%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Huisman%20T&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AT.A.G.M.%2BHuisman%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-2302-6724" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for T.A.G.M. 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