Bio

Clinical Focus


  • Psychiatry
  • Geriatric Psychiatry

Academic Appointments


Administrative Appointments


  • Member, Stanford Hospital Well Being of Physicians Committee (2001 - Present)
  • Member, Stanford Hospital Care Review Committee (1997 - 2006)

Professional Education


  • Board Certification: Geriatric Psychiatry, American Board of Psychiatry and Neurology (1991)
  • Board Certification: Psychiatry, American Board of Psychiatry and Neurology (1985)
  • Fellowship:Massachusetts General Hospital and McLean Hospital - OCD Department (1985) MA
  • Residency:Tufts-New England Medical Center (1984) MA
  • Internship:Baystate Medical Center (1980) MA
  • Medical Education:New York Medical College (1979) NY
  • MD, New York Medical College, Medicine (1979)

Research & Scholarship

Current Research and Scholarly Interests


My academic interest is in intellectual function and its adaptability over the course of a person’s lifetime despite the stressors placed upon it. Researchers have learned about a few risk factors for dementia, such as prolonged loss of consciousness, head injury, and old age. It is likely that there are also risk factors for non-Alzheimer’s cognitive loss causing the changes often attributed to normal aging. With a better knowledge of these risk factors, better protection against them at an earlier age and perhaps much of the lost cognition now attributed to normal aging might be spared.

My papers have focused on the evaluation of ways in which co-morbid factors such as folic acid deficiency or its administration, or anticholinergic drugs prior to ECT affect cognitive function. Anticholinergic medications deplete brain stores of the acetylcholine, known to be a key neurotransmitter in language acquisition and memory storage and retrieval. These drugs not only worsen symptoms of Alzheimer’s disease, but are known to cause delirium when given in high doses. I have been interested in the long-term effects of these drugs and whether cognitive impairment is prolonged.

Clinical Trials


  • Desflurane or Propofol Anesthesia in Elderly Obese Patients Undergoing Total Knee Replacement Recruiting

    You are invited to participate in a research study assessing your mental status in the first days after your surgery and how you will be doing in the 2 years following the surgery. The investigators hope to learn more about the incidence of postoperative confusion and a possible relation with 2 anesthesia techniques that are routinely used. The first one is an anesthesia technique that uses the inhaled anesthetic gas desflurane and the second one is an anesthesia technique that uses the anesthetic propofol administered by infusion in a vein. The investigators are also looking to see if there is a relationship between anesthesia technique and cardiovascular outcomes. You were selected as a possible participant in this study because at your age this phenomenon appears to have a greater incidence.

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Teaching

2013-14 Courses


Publications

Journal Articles


  • Topiramate: Effects on cognition in patients with epilepsy, migraine headache and obesity. Therapeutic advances in neurological disorders Sommer, B. R., Mitchell, E. L., Wroolie, T. E. 2013; 6 (4): 211-227

    Abstract

    This paper reviews the clinical implications of topiramate (TPM)-induced cognitive deficits in patients with epilepsy, migraine headache, obesity, and in normal populations, followed by reviews of the literature describing the reversal of such deficits upon medication discontinuation. It also discusses animal investigations of TPM's role of neuroprotection in brain injury. TPM's most intolerable adverse effects (AEs) are on verbal fluency and reaction time, resulting in high discontinuation rates in patients taking it for epilepsy and migraine headache. However, because TPM is so effective in the treatment of epilepsy and migraine headache, its use is expected to continue. There appears to be greater tolerance of TPM's cognitive AEs when it is used in the treatment of obesity, perhaps because of the lower doses required. Research attempting to predict the populations most vulnerable to the cognitive effects caused by TPM is ongoing. Studies suggest that one such population may include patients with a past psychiatric history. Slow titration and administration of the lowest possible doses may decrease risk of cognitive deficits.

    View details for DOI 10.1177/1756285613481257

    View details for PubMedID 23858325

  • Treatment-resistant major depression and the capacity to terminate care Journal of Ethics in Mental Health Sommer BR 2010; 5 (1): 1-4
  • Review of topiramate for the treatment of epilepsy in elderly patients CLINICAL INTERVENTIONS IN AGING Sommer, B. R., FENN, H. H. 2010; 5: 89-99

    Abstract

    Individuals over 65 years of age experience the new onset of seizures at a prevalence rate of roughly twice that of younger adults. Differences in physiology, need of concomitant medications, and liability for cognitive deficits in this population, make the choice of anticonvulsant drugs especially important. This paper reviews topiramate (TPM), a treatment for many types of seizures, with the above risks in mind. In particular, we discuss efficacy and pharmacokinetics with emphasis on the older patient, and adverse events in both the younger and older adult. With most studies of TPM-induced cognitive deficits having been performed in younger adults and volunteers, we discuss the implications for the older adult. Even in studies of younger individuals, up to 50% discontinue TPM because of intolerable cognitive deficits. Most studies find specific declines in working memory and verbal fluency. In conclusion, we give recommendations for use of this antiepileptic drug in this population.

    View details for Web of Science ID 000208239100010

    View details for PubMedID 20458347

  • The efficacy, safety, and tolerability of donepezil for the treatment of young adults with Down syndrome Am J Med Genetics Kishnani PS, Sommer BS, Handen BL, Seltzer B, Capone GT, et al 2009; 149A (8): 1641-1654
  • Slower speed-of-processing of cognitive tasks is associated with presence of the apolipoprotein epsilon 4 allele JOURNAL OF PSYCHIATRIC RESEARCH O'Hara, R., Sommer, B., Way, N., Kraemer, H. C., Taylor, J., Murphy, G. 2008; 42 (3): 199-204

    Abstract

    Detection of preclinical cognitive deficits is important for identifying those at greatest risk for such disorders as Alzheimer's disease. However, available neuropsychological measures may not be sufficiently sensitive to preclinical cognitive impairment, particularly in high functioning or younger older adults. This study utilizes a battery of computerized cognitive tests (Cognometer) designed to provide a more sensitive measure of age-related cognitive performance by incorporating speed-of-processing components. Fifty-one community-dwelling older adults were administered the Cognometer battery, which incorporates speed-of-processing components into measures of verbal, spatial and working memory, attention, and visuo-spatial ability. Performance of 18 subjects with the epsilon4 allele was compared to that of 33 subjects without the epsilon4 allele. A brief battery of standard neuropsychological measures was also administered. No significant differences were observed between the two groups with respect to performance on any of the neuropsychological measures. However, with respect to the Cognometer battery, individuals with the epsilon4 allele were significantly slower in performing all the cognitive tasks, with the exception of the visuo-spatial task. With respect to performance, the two genotype groups did not differ significantly except on immediate memory, with the epsilon4 group exhibiting increased errors. Overall, the epsilon4 group was significantly slower in performing all of the Cognometer memory tasks. These findings provide continued support for the negative impact of the epsilon4 allele on cognition and further suggest that speed-of-processing during memory tasks may have the potential to detect subtle cognitive deficits.

    View details for DOI 10.1016/j.jpsychires.2006.12.001

    View details for Web of Science ID 000253397900004

    View details for PubMedID 17250852

  • Safety and efficacy of anticonvulsants in elderly patients with psychiatric disorders: oxcarbazepine, topiramate and gabapentin EXPERT OPINION ON DRUG SAFETY Sommer, B. R., Fenn, H. H., Ketter, T. A. 2007; 6 (2): 133-145

    Abstract

    Few controlled studies are available to guide the clinician in treating potentially assaultive elderly individuals with psychiatric disorders. Safety concerns limit the use of benzodiazepines and antipsychotic medications in the elderly individual, making anticonvulsants an attractive alternative. This paper reviews three specific anticonvulsants for this purpose: gabapentin, oxcarbazepine and topiramate, describing safety and efficacy in elderly patients with severe agitation from psychosis or dementia. Gabapentin, renally excreted, with a half-life of 6.5-10.5 h, may cause ataxia. Oxcarbazapine, hepatically reduced, may cause hyponatremia, and topiramate may cause significant cognitive impairment. Nonetheless, these are important medications to consider in the treatment of agitation.

    View details for DOI 10.1517/14740338.6.2.133

    View details for Web of Science ID 000244723900005

    View details for PubMedID 17367259

  • Role of psychiatric comorbidity on cognitive function during and after the menopausal transition Expert Rev Neurotherapeutics Alexander JL, Sommer BR 2007; 7 (11): S155
  • Safety and tolerability of mood-stabilising anticonvulsants in the elderly EXPERT OPINION ON DRUG SAFETY Fenn, H. H., Sommer, B. R., Ketter, T. A., Alldredge, B. 2006; 5 (3): 401-416

    Abstract

    The authors review current research on the safety and tolerability of anticonvulsant medications used for individuals over the age of 60 years with affective disorders, agitation and other psychiatric disorders. Three anticonvulsants currently approved in the US for treatment of bipolar affective disorder are reviewed: valproate, lamotrigine and extended-release carbamazepine. The authors discuss the pharmacokinetics, pharmacodynamics, drug-drug interactions and the impact of ageing for each drug. There are few studies of anticonvulsant medications in elderly patients with bipolar disorder or other psychiatric conditions. Therefore, the authors summarise adverse events of greatest prevalence and/or greatest severity based on data derived predominately from studies of geriatric patients with epilepsy and/or other non-psychiatric indications. Guidelines are offered for the safe use of these medications in the elderly, based on research literature.

    View details for DOI 10.1517/14740338.5.3.401

    View details for Web of Science ID 000239097500006

    View details for PubMedID 16610969

  • The effect of oxybutynin treatment on cognition in children with diurnal incontinence JOURNAL OF UROLOGY Sommer, B. R., O'Hara, R., Askari, N., Kraemer, H. C., Kennedy, W. A. 2005; 173 (6): 2125-2127

    Abstract

    Oxybutynin is a powerful anticholinergic drug already known to impair cognition in the elderly. The impact of this drug on cognitive functioning in the pediatric population is unknown. We report the results of a study designed to assess the effect of oxybutynin on cognitive function in children.A total of 25 patients presenting with the primary symptom of daytime enuresis were recruited for this nonrandomized trial. All subjects initially received 4 weeks of behavior modification, followed by an additional 4 weeks of behavior modification either alone or with oxybutynin for continued treatment of enuresis. Neuropsychological testing was performed at baseline (4 weeks) and after additional therapy (8 weeks).Patient demographics included a male-to-female ratio of 11:14 and a mean age of 7.2 +/- 1.8 years. A total of 10 patients were assigned to the control group receiving behavior modification, and 15 patients were assigned to the treatment group receiving behavior modification plus oxybutynin. The oxybutynin treated patients had a lower overall performance at baseline pretreatment testing. However, performance in this group improved following treatment with oxybutynin.Oxybutynin, a commonly used pharmacological agent in pediatric urology, was not associated with cognitive impairment following treatment. However, we observed lower baseline cognitive functioning in patients whose parents chose oxybutynin over behavior modification alone. This finding may represent a selection bias. However, it also supports the need for a multidisciplinary approach to the treatment of patients with dysfunctional voiding, as some may have cognitive difficulties that have not previously been explored.

    View details for Web of Science ID 000229051700055

    View details for PubMedID 15879864

  • Orange juice-induced hyperkalemia in schizophrenia Int J of Psychiatry in Medicine Berk DR, Conti PM, Sommer BR 2004; 34 (1): 79
  • Folic acid supplementation in dementia: A preliminary report JOURNAL OF GERIATRIC PSYCHIATRY AND NEUROLOGY Sommer, B. R., Hoff, A. L., Costa, M. 2003; 16 (3): 156-159

    Abstract

    Recent work on high plasma homocysteine levels in patients at risk for developing Alzheimer's disease has led to the hypothesis that folic acid supplementation might reduce risk in such patients. The authors report on the effects of folic acid 10 mg/day versus placebo on 11 patients (only 7 completers) with dementia and low-normal folic acid levels. This is the first study evaluating folic acid or placebo in patients with dementia. Subjects had low-normal baseline folic acid levels. The magnitude of change between baseline and second testing was not statistically significant between the 2 groups. However, there was a trend for the folate group to perform worse on two specific cognitive measures, suggesting a possible trend toward worsening of some cognitive abilities after the folic acid. The folic acid in very high doses was well tolerated. Larger studies are necessary before empirically administering folic acid to patients already suffering from dementia.

    View details for DOI 10.1177/0891988703256052

    View details for Web of Science ID 000223380400005

    View details for PubMedID 12967058

  • Safety of antidepressants in the elderly. Expert opinion on drug safety Sommer, B. R., Fenn, H., Pompei, P., DeBattista, C., Lembke, A., Wang, P., Flores, B. 2003; 2 (4): 367-383

    Abstract

    Until the 1980s, the two major classes of antidepressants, the tricyclics and the monoamine oxidase inhibitors (MAOIs), were effective but had severe side effects, requiring monitoring by psychiatrists. The past several years have brought new classes of antidepressants that are safer for the patient to take and far easier for the non-psychiatrist to prescribe. Whilst this is of enormous value, it leaves the physician with the dilemma of which one to prescribe. These new antidepressants cannot safely be used interchangeably. This paper will discuss each of the antidepressants presently available, with particular emphasis on safety in the elderly. Drug interactions, side effects and particular challenges to the older patient will be described. The authors will then advise a general strategy for prescribing antidepressants.

    View details for PubMedID 12904093

  • Is dopamine administration possibly a risk factor for delirium? CRITICAL CARE MEDICINE Sommer, B. R., Wise, L. C., Kraemer, H. C. 2002; 30 (7): 1508-1511

    Abstract

    We explored the possibility that the administration of intravenous dopamine increases the risk for delirium as manifested by need for haloperidol.This study was based on a retrospective analysis. To examine the contribution of dopamine in the prediction of need for haloperidol, a multivariate logistic regression model was used.University hospital.All inpatient admissions to Stanford University Hospital over a 1-year period (n = 21,844).None.Dopamine administration was associated with nearly a tripling of the odds of subsequent need of the antipsychotic drug (chi-square = 108, df = 1, p =.0001, odds ratio = 2.89), even after intensive care unit admission and diagnostic related group weight were considered as indicators of severity of illness. Even when analysis was limited to patients seen in the intensive care unit setting (n = 3,308), dopamine administration remained a very strong risk factor for haloperidol and hence possibly for delirium. The increased risk of need for haloperidol in patients administered dopamine is evident in every age group after age 20.The retrospective nature of this study, the inexact method to assess acuity, and, most of all, the use of haloperidol as an indicator of the presence of delirium preclude concluding that dopamine is directly a risk factor for delirium, much less a causal risk factor. However, the association is potent enough to suggest this possibility strongly and thus supports the need for prospective studies to examine the relationship between dopamine and delirium and to consider possible prophylactic treatment against delirium in those given dopamine.

    View details for Web of Science ID 000176841100019

    View details for PubMedID 12130971

  • Gingko biloba and related compounds in Alzheimer?s disease Psychiatric Annals Sommer BR, Schatzberg AF 2002; 32 (1): 13-18
  • Comparison of desipramine and cognitive/behavioral therapy in the treatment of elderly outpatients with mild-to-moderate depression AMERICAN JOURNAL OF GERIATRIC PSYCHIATRY Thompson, L. W., Coon, D. W., Gallagher-Thompson, D., Sommer, B. R., Koin, D. 2001; 9 (3): 225-240

    Abstract

    The authors evaluated the efficacy of desipramine-alone, vs. cognitive/behavioral therapy-alone (CBT) vs. a combination of the two, for the treatment of depression in older adult outpatients. Patients (N=102) meeting criteria for major depressive disorder were randomly assigned to one of these three treatments for 16 to 20 therapy sessions. All treatments resulted in substantial improvement. In general, the CBT-Alone and Combined groups had similar levels of improvement. In most analyses, the Combined group showed greater improvement than the Desipramine-Alone group, whereas the CBT-Alone group showed only marginally better improvement. The combined therapies were most effective in patients who were more severely depressed, particularly when desipramine was at or above recommended stable dosage levels. The results indicate that psychotherapy can be an effective treatment for older adult outpatients with moderate levels of depression.

    View details for Web of Science ID 000170372300005

    View details for PubMedID 11481130

  • Quetiapine-induced extrapyramidal side effects in patients with Parkinson's disease: Case report JOURNAL OF GERIATRIC PSYCHIATRY AND NEUROLOGY Sommer, B. R. 2001; 14 (2): 99-100

    Abstract

    Although quetiapine is the antipsychotic of choice for the psychosis associated with Parkinson's disease (PD) and often is also helpful for sleep, we report two cases of quetiapine-induced extrapyramidal side effects. The patients described were unusual in their frailty and severity of illness and may not represent the majority of patients with PD.

    View details for Web of Science ID 000169230800009

    View details for PubMedID 11419575

  • Naturalistic study of antipsychotic medications prescribed to elderly schizophrenic patients Jrnl Prac Psych and Behav Hlth Sommer BR, White L, Parrella M, Harvey PD, Knobler HY, Powchick P, Masiar SJ 1998; 4 (6): 379
  • Risperidone: Clinical outcome predictors and cost-effectiveness in a naturalistic setting Psychopharmacology Bull Finley PR, Sommer BR, Corbitt JL, Brunson GH, Lum BL 1998; 34 (1): 75-81
  • Syndrome of inappropriate antidiuretic hormone (SIADH) in an 80-year-old woman given clomipramine AMERICAN JOURNAL OF GERIATRIC PSYCHIATRY Sommer, B. R. 1997; 5 (3): 268-269

    Abstract

    The author describes the syndrome of inappropriate antidiuretic hormone, with serum sodium decreasing from 137 mEq/L to 122 mEq/L in an 80-year-old woman prescribed clomipramine. The patient's delirium and serum sodium were slow to normalize, prolonging her hospital stay and delaying treatment of her depression.

    View details for Web of Science ID A1997XJ82900012

    View details for PubMedID 9209570

  • Divalproex sodium for treatment of agitation in chronic psychiatric inpatients Jrnl Prac Psych and Behav Hlth Sommer BR, White L, Parrella M, Simon JM, Masiar SJ 1997; 3 (5): 320
  • Changes in tardive dyskinesia symptoms in elderly patients treated with ganglioside GM1 or placebo. Journal of geriatric psychiatry and neurology Sommer, B. R., Cohen, B. M., Satlin, A., Cole, J. O., Jandorf, L., Dorsey, F. 1994; 7 (4): 234-237

    Abstract

    The unique role of ganglioside GM1 in neuronal plasticity led two centers, New York University and McLean Hospital, to study the effect of GM1 or placebo in patients with tardive dyskinesia. Results from the NYU cohort have already been published. We now present data from the entire cohort, allowing us to evaluate the effects of GM1 in the elderly compared to young adults. Subjects with tardive dyskinesia were randomly assigned to single-blind placebo injections for 1 week, followed by 1 month of double-blind intramuscular placebo or GM1 100 mg. The final sample included 29 patients: 12 younger than 55 years of age and 17 older. There was no GM1-versus-placebo difference observed in either age group, or in the total group. However, whether on placebo or GM1, repeated measures analysis of variance (RANOVA) found a significant difference in response between Abnormal Involuntary Movement Scale scores, taken baseline and week 4, in the elderly compared to young adults. Scores for the young adults show initial improvement then deterioration back to baseline, and those for the elderly show continuing improvement during the 4-week trial. The importance of the placebo effect in the elderly and its meaning for studies of GM1 in tardive dyskinesia are discussed.

    View details for PubMedID 7826493

  • A case of baclofen-induced psychotic depression J Clin Psychiatry Sommer BR, Petrides G 1992; 53: 211-212
  • Glycopyrrolate versus atropine in post-ECT amnesia in the elderly. Journal of geriatric psychiatry and neurology Sommer, B. R., Satlin, A., Friedman, L., Cole, J. O. 1989; 2 (1): 18-21

    Abstract

    The neurotransmitter acetylcholine is important in memory function, and low brain concentrations may be associated with cognitive impairment. Our hypothesis was that atropine, a centrally acting anticholinergic drug known to cause amnesia, confusion, and delirium, may further exacerbate the amnesia and/or confusion resulting from electroconvulsive therapy (ECT) when used as a preanesthetic, and that the peripherally acting glycopyrrolate would by comparison decrease these side effects. We randomly administered glycopyrrolate versus atropine in equivalent doses as the preanesthetic agent to 20 consecutively admitted geriatric patients with major depression, for whom ECT was the clinical treatment of choice. Patients were matched for age, Hamilton Scale for Depression, and baseline performance on the Buschke Selective Reminding Task (BSRT). We found no significant difference in outcome between patients treated prior to ECT with atropine versus glycopyrrolate, as assessed by the above measures. We conclude from this study that atropine is no more deleterious to memory than is glycopyrrolate when given before ECT.

    View details for PubMedID 2663013

  • METABOLISM OF THIORIDAZINE IN THE ELDERLY JOURNAL OF CLINICAL PSYCHOPHARMACOLOGY Cohen, B. M., Sommer, B. R. 1988; 8 (5): 336-339

    Abstract

    Metabolism of drugs may change with age. Yet, there are few studies that provide data to help define appropriate doses of neuroleptic drugs in the treatment of the elderly. To address this issue, we determined serum concentrations of thioridazine and its active metabolites, mesoridazine and sulforidazine, by high performance liquid chromatography in young adult (mean age, 28 +/- 7.6 years) and elderly (mean age, 76 +/- 7.7 years) patients after single 25-mg oral doses of thioridazine. At both times measured, 4 and 8 hours after dosing, the concentrations of parent compound and metabolites in serum were 1.5- to twofold higher, and side effects (especially postural hypotension and dry mouth) were more frequent and severe in the elderly patients. These results, along with those reported in a small number of studies of serum drug levels during extended treatment of the elderly, support the practice of using smaller doses of phenothiazine neuroleptics in older patients.

    View details for Web of Science ID A1988Q410000006

    View details for PubMedID 3183071

  • RBC FOLIC-ACID LEVELS AND COGNITIVE PERFORMANCE IN ELDERLY PATIENTS - A PRELIMINARY-REPORT BIOLOGICAL PSYCHIATRY Sommer, B. R., Wolkowitz, O. M. 1988; 24 (3): 352-354

    View details for Web of Science ID A1988N876700014

    View details for PubMedID 3401527

  • Plasma concentration of neuroleptic and serum prolactin in patients chronically receiving depot fluphenazine: No evidence of tolerance Human Psychopharmacology Cohen BM, Chouinard G, Waternaux C, Schachter H, Jones B, Sommer BR 1987; 2: 171-176
  • PLASMA-LEVELS OF NEUROLEPTIC IN PATIENTS RECEIVING DEPOT FLUPHENAZINE JOURNAL OF CLINICAL PSYCHOPHARMACOLOGY Cohen, B. M., Waternaux, C., Chouinard, G., Sommer, B. R., Jones, B. 1985; 5 (6): 328-332

    Abstract

    Depot forms of fluphenazine are frequently used in the outpatient treatment of psychiatric patients. To gather relevant data on pharmacokinetic characteristics of depot fluphenazines, the authors measured plasma levels of neuroleptic activity in 76 clinic patients on stable dosage regimens of fluphenazine decanoate or fluphenazine enanthate. Dose and plasma neuroleptic activity level were highly correlated for both forms of depot fluphenazine. Furthermore, the slope of the regression of log dose to the log plasma neuroleptic activity was the same for both drug forms. However, doses of enanthate twice those of decanoate were associated with the same mean plasma level of neuroleptic activity. Finally, while blood levels of drug overlapped markedly in cohorts of patients receiving different doses of depot medication, the assumption of recent studies that, on the average, patients in such cohorts have different blood and tissue levels of drug was confirmed.

    View details for Web of Science ID A1985AVF5900004

    View details for PubMedID 4066997

  • CIRCADIAN CHANGES IN THE DISTRIBUTION AND EFFECTS OF HALOPERIDOL IN THE RAT NEUROPHARMACOLOGY Campbell, A., Herschel, M., Sommer, B., Madsen, J. R., Cohen, B. M., BALDESSARINI, R. J. 1982; 21 (7): 663-669

    Abstract

    Striking circadian changes in behavioral sensitivity to haloperidol were found by measurements of cataleptic responses in rats trained in a controlled lighting cycle (lights on, 7:00 a.m.--7:00 p.m.). Thus, catalepsy was maximal at about 4:00 p.m. and minimal at about 4:00 a.m., virtually the opposite of the circadian rhythm of spontaneous behavioral activity in drug-free rats. At a given dose of haloperidol, catalepsy scores differed 2- to 3-fold, and the ED50 shifted left nearly 10-fold from a.m. to p.m. After fixed doses of haloperidol, tissue levels of the drug, as determined by a sensitive and selective radioreceptor assay, differed by 2- to 6-fold through the 24 hr cycle and brain levels closely followed the circadian changes in behavior. These results suggest a pharmacokinetic contribution to the circadian changes in behavioral response, although additional pharmacodynamic factors are also considered.

    View details for Web of Science ID A1982PB21200009

    View details for PubMedID 6889690

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