Treatment Response of Cystic Echinococcosis to Benzimidazoles: A Systematic Review
Publication Date
September 29, 2009
Journal
PLOS Neglected Tropical Diseases
Authors
Marija Stojkovic, Marcel Zwahlen, Antonella Teggi, Kamenna Vutova, et al
Volume
3
Issue
9
Pages
e524
DOI
https://dx.plos.org/10.1371/journal.pntd.0000524
Publisher URL
http://journals.plos.org/plosntds/article?id=10.1371%2Fjournal.pntd.0000524
PubMed
http://www.ncbi.nlm.nih.gov/pubmed/19787039
PubMed Central
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2745697
Europe PMC
http://europepmc.org/abstract/MED/19787039
Web of Science
000270818900020
Scopus
70449507442
Mendeley
http://www.mendeley.com/research/treatment-response-cystic-echinococcosis-benzimidazoles-systematic-review
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Mendeley | Further Information

{"title"=>"Treatment response of cystic echinococcosis to benzimidazoles: A systematic review", "type"=>"journal", "authors"=>[{"first_name"=>"Marija", "last_name"=>"Stojkovic", "scopus_author_id"=>"36906587800"}, {"first_name"=>"Marcel", "last_name"=>"Zwahlen", "scopus_author_id"=>"7004748418"}, {"first_name"=>"Antonella", "last_name"=>"Teggi", "scopus_author_id"=>"7003689944"}, {"first_name"=>"Kamenna", "last_name"=>"Vutova", "scopus_author_id"=>"7004199578"}, {"first_name"=>"Carmen M.", "last_name"=>"Cretu", "scopus_author_id"=>"6602397199"}, {"first_name"=>"Roberto", "last_name"=>"Virdone", "scopus_author_id"=>"6602450785"}, {"first_name"=>"Polyxeni", "last_name"=>"Nicolaidou", "scopus_author_id"=>"56265868600"}, {"first_name"=>"Nazan", "last_name"=>"Cobanoglu", "scopus_author_id"=>"9742101400"}, {"first_name"=>"Thomas", "last_name"=>"Junghanss", "scopus_author_id"=>"7003586905"}], "year"=>2009, "source"=>"PLoS Neglected Tropical Diseases", "identifiers"=>{"issn"=>"1935-2735", "scopus"=>"2-s2.0-70449507442", "sgr"=>"70449507442", "pui"=>"355629310", "isbn"=>"1935-2735", "pmid"=>"19787039", "doi"=>"10.1371/journal.pntd.0000524"}, "id"=>"5d0bf851-03b5-3032-b61b-773a7c692fd1", "abstract"=>"Over the past 30 years, benzimidazoles have increasingly been used to treat cystic echinococcosis (CE). The efficacy of benzimidazoles, however, remains unclear. We systematically searched MEDLINE, EMBASE, SIGLE, and CCTR to identify studies on benzimidazole treatment outcome. A large heterogeneity of methods in 23 reports precluded a meta-analysis of published results. Specialist centres were contacted to provide individual patient data. We conducted survival analyses for cyst response defined as inactive (CE4 or CE5 by the ultrasound-based World Health Organisation [WHO] classification scheme) or as disappeared. We collected data from 711 treated patients with 1,308 cysts from six centres (five countries). Analysis was restricted to 1,159 liver and peritoneal cysts. Overall, 1-2 y after initiation of benzimidazole treatment 50%-75% of active C1 cysts were classified as inactive/disappeared compared to 30%-55% of CE2 and CE3 cysts. Further in analyzing the rate of inactivation/disappearance with regard to cyst size, 50%-60% of cysts <6 cm responded to treatment after 1-2 y compared to 25%-50% of cysts >6 cm. However, 25% of cysts reverted to active status within 1.5 to 2 y after having initially responded and multiple relapses were observed; after the second and third treatment 60% of cysts relapsed within 2 y. We estimated that 2 y after treatment initiation 40% of cysts are still active or become active again. The overall efficacy of benzimidazoles has been overstated in the past. There is an urgent need for a pragmatic randomised controlled trial that compares standardized benzimidazole therapy on responsive cyst stages with the other treatment modalities.", "link"=>"http://www.mendeley.com/research/treatment-response-cystic-echinococcosis-benzimidazoles-systematic-review", "reader_count"=>34, "reader_count_by_academic_status"=>{"Librarian"=>1, "Researcher"=>6, "Student > Doctoral Student"=>5, "Student > Ph. D. Student"=>3, "Student > Postgraduate"=>5, "Student > Master"=>5, "Other"=>2, "Student > Bachelor"=>1, "Lecturer"=>1, "Professor"=>5}, "reader_count_by_user_role"=>{"Librarian"=>1, "Researcher"=>6, "Student > Doctoral Student"=>5, "Student > Ph. D. Student"=>3, "Student > Postgraduate"=>5, "Student > Master"=>5, "Other"=>2, "Student > Bachelor"=>1, "Lecturer"=>1, "Professor"=>5}, "reader_count_by_subject_area"=>{"Engineering"=>1, "Unspecified"=>1, "Biochemistry, Genetics and Molecular Biology"=>2, "Materials Science"=>1, "Medicine and Dentistry"=>20, "Agricultural and Biological Sciences"=>5, "Veterinary Science and Veterinary Medicine"=>1, "Chemistry"=>1, "Psychology"=>1, "Computer Science"=>1}, "reader_count_by_subdiscipline"=>{"Engineering"=>{"Engineering"=>1}, "Materials Science"=>{"Materials Science"=>1}, "Medicine and Dentistry"=>{"Medicine and Dentistry"=>20}, "Chemistry"=>{"Chemistry"=>1}, "Psychology"=>{"Psychology"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>5}, "Computer Science"=>{"Computer Science"=>1}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>2}, "Unspecified"=>{"Unspecified"=>1}, "Veterinary Science and Veterinary Medicine"=>{"Veterinary Science and Veterinary Medicine"=>1}}, "reader_count_by_country"=>{"Ecuador"=>1, "Spain"=>1}, "group_count"=>1}

CrossRef

Scopus | Further Information

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/882184"], "description"=>"<p>Abbreviations: CS, case series; PCS, prospective case series.</p>", "links"=>[], "tags"=>["groups"], "article_id"=>552640, "categories"=>["Computational Biology"], "users"=>["Marija Stojkovic", "Marcel Zwahlen", "Antonella Teggi", "Kamenna Vutova", "Carmen M. Cretu", "Roberto Virdone", "Polyxeni Nicolaidou", "Nazan Cobanoglu", "Thomas Junghanss"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0000524.t002", "stats"=>{"downloads"=>2, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Characteristics_of_study_groups_identified_by_the_literature_search_where_data_were_available_/552640", "title"=>"Characteristics of study groups identified by the literature search where data were available.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2009-09-29 00:44:00"}
  • {"files"=>["https://ndownloader.figshare.com/files/437277"], "description"=>"<div><p>Over the past 30 years, benzimidazoles have increasingly been used to treat cystic echinococcosis (CE). The efficacy of benzimidazoles, however, remains unclear. We systematically searched MEDLINE, EMBASE, SIGLE, and CCTR to identify studies on benzimidazole treatment outcome. A large heterogeneity of methods in 23 reports precluded a meta-analysis of published results. Specialist centres were contacted to provide individual patient data. We conducted survival analyses for cyst response defined as inactive (CE4 or CE5 by the ultrasound-based World Health Organisation [WHO] classification scheme) or as disappeared. We collected data from 711 treated patients with 1,308 cysts from six centres (five countries). Analysis was restricted to 1,159 liver and peritoneal cysts. Overall, 1–2 y after initiation of benzimidazole treatment 50%–75% of active C1 cysts were classified as inactive/disappeared compared to 30%–55% of CE2 and CE3 cysts. Further in analyzing the rate of inactivation/disappearance with regard to cyst size, 50%–60% of cysts <6 cm responded to treatment after 1–2 y compared to 25%–50% of cysts >6 cm. However, 25% of cysts reverted to active status within 1.5 to 2 y after having initially responded and multiple relapses were observed; after the second and third treatment 60% of cysts relapsed within 2 y. We estimated that 2 y after treatment initiation 40% of cysts are still active or become active again. The overall efficacy of benzimidazoles has been overstated in the past. There is an urgent need for a pragmatic randomised controlled trial that compares standardized benzimidazole therapy on responsive cyst stages with the other treatment modalities.</p></div>", "links"=>[], "tags"=>["cystic", "echinococcosis", "systematic"], "article_id"=>146209, "categories"=>["Biological Sciences"], "users"=>["Marija Stojkovic", "Marcel Zwahlen", "Antonella Teggi", "Kamenna Vutova", "Carmen M. Cretu", "Roberto Virdone", "Polyxeni Nicolaidou", "Nazan Cobanoglu", "Thomas Junghanss"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0000524", "stats"=>{"downloads"=>1, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Treatment_Response_of_Cystic_Echinococcosis_to_Benzimidazoles_A_Systematic_Review/146209", "title"=>"Treatment Response of Cystic Echinococcosis to Benzimidazoles: A Systematic Review", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2009-09-29 01:43:29"}
  • {"files"=>["https://ndownloader.figshare.com/files/881861"], "description"=>"<p>First time a cyst was staged as inactive or disappeared by centre.</p>", "links"=>[], "tags"=>["cyst", "was", "staged", "inactive", "disappeared"], "article_id"=>552310, "categories"=>["Computational Biology"], "users"=>["Marija Stojkovic", "Marcel Zwahlen", "Antonella Teggi", "Kamenna Vutova", "Carmen M. Cretu", "Roberto Virdone", "Polyxeni Nicolaidou", "Nazan Cobanoglu", "Thomas Junghanss"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0000524.g005", "stats"=>{"downloads"=>1, "page_views"=>10, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_First_time_a_cyst_was_staged_as_inactive_or_disappeared_by_centre_/552310", "title"=>"First time a cyst was staged as inactive or disappeared by centre.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2009-09-29 00:38:30"}
  • {"files"=>["https://ndownloader.figshare.com/files/882296"], "description"=>"<p>Abbreviations: F, female; M, male; SD, standard deviation; WBC, white blood count.</p>", "links"=>[], "tags"=>["characteristics", "restricted", "patients", "peritoneal"], "article_id"=>552746, "categories"=>["Computational Biology"], "users"=>["Marija Stojkovic", "Marcel Zwahlen", "Antonella Teggi", "Kamenna Vutova", "Carmen M. Cretu", "Roberto Virdone", "Polyxeni Nicolaidou", "Nazan Cobanoglu", "Thomas Junghanss"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0000524.t004", "stats"=>{"downloads"=>0, "page_views"=>3, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Patient_and_treatment_characteristics_by_centre_restricted_to_patients_with_liver_and_peritoneal_cysts_/552746", "title"=>"Patient and treatment characteristics by centre: restricted to patients with liver and peritoneal cysts.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2009-09-29 00:45:46"}
  • {"files"=>["https://ndownloader.figshare.com/files/881372"], "description"=>"<p>Flow diagram of searches, study selection, and specialist centre identification.</p>", "links"=>[], "tags"=>["diagram", "centre"], "article_id"=>551821, "categories"=>["Computational Biology"], "users"=>["Marija Stojkovic", "Marcel Zwahlen", "Antonella Teggi", "Kamenna Vutova", "Carmen M. Cretu", "Roberto Virdone", "Polyxeni Nicolaidou", "Nazan Cobanoglu", "Thomas Junghanss"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0000524.g001", "stats"=>{"downloads"=>1, "page_views"=>3, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Flow_diagram_of_searches_study_selection_and_specialist_centre_identification_/551821", "title"=>"Flow diagram of searches, study selection, and specialist centre identification.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2009-09-29 00:30:21"}
  • {"files"=>["https://ndownloader.figshare.com/files/881712"], "description"=>"<p>First time a cyst was staged as inactive or disappeared by size of cyst.</p>", "links"=>[], "tags"=>["cyst", "was", "staged", "inactive", "disappeared"], "article_id"=>552159, "categories"=>["Computational Biology"], "users"=>["Marija Stojkovic", "Marcel Zwahlen", "Antonella Teggi", "Kamenna Vutova", "Carmen M. Cretu", "Roberto Virdone", "Polyxeni Nicolaidou", "Nazan Cobanoglu", "Thomas Junghanss"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0000524.g004", "stats"=>{"downloads"=>0, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_First_time_a_cyst_was_staged_as_inactive_or_disappeared_by_size_of_cyst_/552159", "title"=>"First time a cyst was staged as inactive or disappeared by size of cyst.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2009-09-29 00:35:59"}
  • {"files"=>["https://ndownloader.figshare.com/files/881537"], "description"=>"<p>First time a cyst was staged as CE4, CE5, or disappeared by stage at baseline (only centres using the WHO CE classification).</p>", "links"=>[], "tags"=>["cyst", "was", "staged", "disappeared", "baseline", "centres", "ce"], "article_id"=>551985, "categories"=>["Computational Biology"], "users"=>["Marija Stojkovic", "Marcel Zwahlen", "Antonella Teggi", "Kamenna Vutova", "Carmen M. Cretu", "Roberto Virdone", "Polyxeni Nicolaidou", "Nazan Cobanoglu", "Thomas Junghanss"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0000524.g003", "stats"=>{"downloads"=>0, "page_views"=>10, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_First_time_a_cyst_was_staged_as_CE4_CE5_or_disappeared_by_stage_at_baseline_only_centres_using_the_WHO_CE_classification_/551985", "title"=>"First time a cyst was staged as CE4, CE5, or disappeared by stage at baseline (only centres using the WHO CE classification).", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2009-09-29 00:33:05"}
  • {"files"=>["https://ndownloader.figshare.com/files/882094"], "description"=>"<p>Time an inactive or disappeared stage was reached for the next time, stratified by the number of times an active or transitional stage had been reached previously.</p>", "links"=>[], "tags"=>["inactive", "disappeared", "was", "reached", "stratified", "times", "transitional", "had", "been"], "article_id"=>552534, "categories"=>["Computational Biology"], "users"=>["Marija Stojkovic", "Marcel Zwahlen", "Antonella Teggi", "Kamenna Vutova", "Carmen M. Cretu", "Roberto Virdone", "Polyxeni Nicolaidou", "Nazan Cobanoglu", "Thomas Junghanss"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0000524.g007", "stats"=>{"downloads"=>1, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Time_an_inactive_or_disappeared_stage_was_reached_for_the_next_time_stratified_by_the_number_of_times_an_active_or_transitional_stage_had_been_reached_previously_/552534", "title"=>"Time an inactive or disappeared stage was reached for the next time, stratified by the number of times an active or transitional stage had been reached previously.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2009-09-29 00:42:14"}
  • {"files"=>["https://ndownloader.figshare.com/files/881966"], "description"=>"<p>Time an active or transitional stage was reached stratified by the number of times an inactive stage had been reached previously (only centres that recorded recurrences are included).</p>", "links"=>[], "tags"=>["transitional", "was", "reached", "stratified", "times", "inactive", "had", "been", "centres", "recorded", "recurrences"], "article_id"=>552407, "categories"=>["Computational Biology"], "users"=>["Marija Stojkovic", "Marcel Zwahlen", "Antonella Teggi", "Kamenna Vutova", "Carmen M. Cretu", "Roberto Virdone", "Polyxeni Nicolaidou", "Nazan Cobanoglu", "Thomas Junghanss"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0000524.g006", "stats"=>{"downloads"=>1, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Time_an_active_or_transitional_stage_was_reached_stratified_by_the_number_of_times_an_inactive_stage_had_been_reached_previously_only_centres_that_recorded_recurrences_are_included_/552407", "title"=>"Time an active or transitional stage was reached stratified by the number of times an inactive stage had been reached previously (only centres that recorded recurrences are included).", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2009-09-29 00:40:07"}
  • {"files"=>["https://ndownloader.figshare.com/files/881439"], "description"=>"<p>Length of follow-up per centre.</p>", "links"=>[], "tags"=>["follow-up"], "article_id"=>551894, "categories"=>["Computational Biology"], "users"=>["Marija Stojkovic", "Marcel Zwahlen", "Antonella Teggi", "Kamenna Vutova", "Carmen M. Cretu", "Roberto Virdone", "Polyxeni Nicolaidou", "Nazan Cobanoglu", "Thomas Junghanss"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0000524.g002", "stats"=>{"downloads"=>0, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Length_of_follow_up_per_centre_/551894", "title"=>"Length of follow-up per centre.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2009-09-29 00:31:34"}
  • {"files"=>["https://ndownloader.figshare.com/files/882147"], "description"=>"<p>Abbreviations: CS, case series; PCS, prospective case series; RCT, randomised controlled trial.</p>", "links"=>[], "tags"=>["groups"], "article_id"=>552601, "categories"=>["Computational Biology"], "users"=>["Marija Stojkovic", "Marcel Zwahlen", "Antonella Teggi", "Kamenna Vutova", "Carmen M. Cretu", "Roberto Virdone", "Polyxeni Nicolaidou", "Nazan Cobanoglu", "Thomas Junghanss"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0000524.t003", "stats"=>{"downloads"=>1, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Characteristics_of_study_groups_identified_by_the_literature_search_where_no_data_were_available_or_no_contact_could_be_established_/552601", "title"=>"Characteristics of study groups identified by the literature search where no data were available or no contact could be established.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2009-09-29 00:43:21"}
  • {"files"=>["https://ndownloader.figshare.com/files/882218"], "description"=>"<p>Ultrasound classification systems of CE cysts.</p>", "links"=>[], "tags"=>["classification", "systems", "ce"], "article_id"=>552671, "categories"=>["Computational Biology"], "users"=>["Marija Stojkovic", "Marcel Zwahlen", "Antonella Teggi", "Kamenna Vutova", "Carmen M. Cretu", "Roberto Virdone", "Polyxeni Nicolaidou", "Nazan Cobanoglu", "Thomas Junghanss"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0000524.t001", "stats"=>{"downloads"=>1, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Ultrasound_classification_systems_of_CE_cysts_/552671", "title"=>"Ultrasound classification systems of CE cysts.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2009-09-29 00:44:31"}
  • {"files"=>["https://ndownloader.figshare.com/files/882252"], "description"=>"a<p>Inactive (I) cysts are cysts in patients with multiple cysts. The inactive cysts have not been the indication for treatment and have not been included in the analysis.</p><p>Abbreviation: SD, standard deviation.</p>", "links"=>[], "tags"=>["restricted", "patients", "peritoneal", "cysts", "days"], "article_id"=>552703, "categories"=>["Computational Biology"], "users"=>["Marija Stojkovic", "Marcel Zwahlen", "Antonella Teggi", "Kamenna Vutova", "Carmen M. Cretu", "Roberto Virdone", "Polyxeni Nicolaidou", "Nazan Cobanoglu", "Thomas Junghanss"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0000524.t005", "stats"=>{"downloads"=>1, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Cyst_characteristics_restricted_to_patients_with_liver_and_peritoneal_cysts_and_to_patients_where_total_days_of_treatment_were_available_/552703", "title"=>"Cyst characteristics: restricted to patients with liver and peritoneal cysts and to patients where total days of treatment were available.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2009-09-29 00:45:03"}

PMC Usage Stats | Further Information

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  • {"unique-ip"=>"8", "full-text"=>"9", "pdf"=>"2", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"5"}

Relative Metric

{"start_date"=>"2009-01-01T00:00:00Z", "end_date"=>"2009-12-31T00:00:00Z", "subject_areas"=>[{"subject_area"=>"/Medicine and health sciences/Clinical medicine", "average_usage"=>[392, 582, 702, 793, 902, 1027, 1149, 1287, 1358, 1466, 1542, 1584, 1652, 1730, 1812, 1883, 1957, 2023, 2085, 2130, 2176, 2208, 2254, 2301, 2355, 2391, 2436, 2484, 2526, 2573, 2612, 2666, 2713, 2759, 2815, 2876, 2972, 3022, 3062, 3122, 3173, 3202, 3242, 3265, 3289, 3339, 3381, 3475, 3503, 3552, 3581, 3613, 3664, 3741, 3773, 3809, 3875, 3938, 4035, 4054, 4086, 4115]}, {"subject_area"=>"/Medicine and health sciences/Diagnostic medicine", "average_usage"=>[320, 582, 740, 833, 924, 1044, 1161, 1254, 1351, 1429, 1516, 1596, 1678, 1771, 1862, 1947, 2014, 2085, 2154, 2229, 2307, 2357, 2431, 2489, 2547, 2613, 2668, 2729, 2797, 2843, 2896, 2940, 2983, 3054, 3129, 3184, 3261, 3322, 3380, 3443, 3504, 3545, 3598, 3663, 3737, 3802, 3867, 3912, 3987, 4033, 4079, 4139, 4189, 4239, 4292, 4371, 4462, 4478, 4559, 4625, 4664, 4709]}, {"subject_area"=>"/Medicine and health sciences/Oncology", "average_usage"=>[338, 584, 737, 858, 964, 1086, 1213, 1320, 1412, 1515, 1612, 1699, 1776, 1851, 1931, 1997, 2085, 2165, 2218, 2278, 2340, 2409, 2472, 2541, 2586, 2661, 2713, 2754, 2817, 2889, 2946, 3006, 3064, 3105, 3167, 3234, 3300, 3357, 3420, 3485, 3546, 3609, 3687, 3741, 3790, 3844, 3893, 3957, 4013, 4062, 4105, 4140, 4220, 4268, 4330, 4375, 4438, 4493, 4540, 4573, 4616]}, {"subject_area"=>"/Medicine and health sciences/Surgical and invasive medical procedures", "average_usage"=>[316, 537, 667, 758, 862, 977, 1087, 1194, 1299, 1362, 1454, 1537, 1615, 1714, 1767, 1808, 1890, 1935, 1981, 2047, 2115, 2162, 2211, 2277, 2328, 2400, 2485, 2536, 2582, 2633, 2672, 2701, 2755, 2813, 2858, 2906, 2967, 3042, 3091, 3123, 3210, 3246, 3308, 3341, 3379, 3406, 3442, 3504, 3619, 3667, 3714, 3783, 3841, 3913, 3964, 4045, 4117, 4195, 4258, 4308, 4352, 4410]}, {"subject_area"=>"/Medicine and health sciences/Tropical diseases", "average_usage"=>[262, 539, 658, 749, 834, 916, 1020, 1108, 1196, 1250, 1338, 1408, 1481, 1549, 1611, 1671, 1721, 1786, 1854, 1904, 1968, 2031, 2101, 2158, 2205, 2271, 2326, 2381, 2440, 2488, 2544, 2603, 2658, 2726, 2786, 2839, 2896, 2954, 3019, 3067, 3126, 3181, 3241, 3294, 3367, 3446, 3538, 3634, 3677, 3736, 3785, 3816, 3867, 3946, 4032, 4083, 4121, 4191, 4278, 4344, 4399, 4438]}]}
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