stimwave cpt code

All 7 patients were successfully trialed with DRGS utilizing leads placed over the bilateral L1 and S2 DRG's -- to the authors knowledge, no publications describing either this particular lead configuration, or utilizing DRS on CPP, exist. The implanted leads were then connected to the novel external stimulation device and patients were trialed for an additional 4 days. The main adverse events were infection of sites of implantation, cerebrospinal fluid (CSF) leakage, pain at the sites of electrodes, dislodgement of the electrodes and system failure, however, the incidence in patients with cancer could not be calculated. One case showing improvement in sleep despite pain palliation may suggest that SCS might have independently affected the sleep system, although further studies are needed. Aetna considers the use of cervicaldorsal columnstimulation experimental and investigationalfor the treatment of members with cervical trauma,disc herniation,essential tremor, failed cervical spine surgery syndrome presenting with arm pain, neck pain, cervicogenic headache, gliomas, migraine, radiation-induced brain injury,stroke, trigeminal neuropathy,or any other indication (other than CRPS)because its effectiveness for these indications has not been established. Spine. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. } Neuromodulation. Not Otherwise Classified (NOC) codes are used when there is no existing true code for the service, procedure, drug or biological being provided. The authors concluded that treatments proposed for disorders of consciousness have not yet gained the level of "evidence-based treatments"; moreover, the studies to date have led to inconclusiveness. Neurosurgery. These investigators concluded that in severe cases of RSD and idiopathic Raynaud's disease, SCS is an alternative treatment that can be used as primary therapy or as secondary therapy after unsuccessful sympathectomy or sympathetic blocks. At least moderate certainty with small net benefit). For the cross-over group, mean baseline lower limb pain VAS was 7.2 cm (95 % CI: 6.8 to 7.6) with no change at 6 months but improvement after cross-over, similar to the originally assigned 10-kHz SCS group: mean 70.3 % pain relief (95 % CI: 63.4 to 77.1, p < 0.001), lower limb pain VAS score of 2.0 cm (95 % CI: 1.6 to 2.4), and 84 % responders (49 of 58). mike.vallie@westwicke.com, Internet Explorer presents a security risk. The SCS electrode was implanted in the thoracic epidural space. Tiede J, Brown L, Gekht G, et al. The patient had a history of cholecystectomy and had suffered from chronic right upper quadrant abdominal pain. "JavaScript" disabled. Two subjects had a myocardial infarction which was associated with typical pain, and not concealed by DCS. 2019;6(11):2223-2229. presented in the material do not necessarily represent the views of the AHA. Long-term back pain relief with anatomically guided neural targeted SCS. Member has angiographically documented significant coronary artery disease and is not a suitable candidate for revascularization procedures such as coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA). Hunter CW, Yang A. Dorsal root ganglion stimulation for chronic pelvic pain: A case series and technical report on a novel lead configuration. It may not display this or other websites correctly. HF10 therapy subjects did not experience paresthesias. 2013;16(4):363-369; discussion 369. In a retrospective, multi-center, real-world review, Chen et al (2021) evaluated pain relief and functional improvements for consecutive patients with diabetic neuropathy aged greater than or equal to 18 years of age who were permanently implanted with a high-frequency (10-kHz) SCS device. If at least a 50% reduction in pain is reported, the patient returns for permanent electrodes and a generator device. Prospective, randomized blind effect-on-outcome study of conventional vs high-frequency spinal cord stimulation in patients with pain and disability due to failed back surgery syndrome. McHugh and associates (2021) noted that epidural SCS (ESCS) emerged as a technology for eliciting motor function in the 1990's and was subsequently employed therapeutically in patients with SCI. Kumar K, Wyant GM, Ekong CEU. These benefits persisted in some patients for over 2 years without any apparent adverse sequelae. PTHs can contribute to disability, lost productivity, and health care costs. By scrutinizing titles and abstracts, these investigators found 412 articles irrelevant to the analytical purpose of this systematic review due to different scopes of diseases or different methods of intervention (intra-thecal infusion system; oral medication) or aims other than pain control (spinal cord function monitoring, bladder function restoration or amelioration of organ metabolism). descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work J Diabetes Sci Technol. ul.ur li{ BMJ Case Rep. 2018;2018. Neuromodulation. Stereotact Funct Neurosurg. Acta Neurochir Suppl (Wien). Strand and Burkey (2021) carried out a review to examine the evidence for SCS from published RCTs as well as prospective studies exploring the safety and effectiveness of treating PDN with neuromodulation. CNS Drugs. 1998;87(6):1242-1244. In a RCT with a 1-year follow-up (n = 22), de Jongste and Staal (1993) found that DCS improved both the quality of life and cardiac parameters of patients with refractory angina pectoris. Two months after the implantation, she continued to have 100 % pain relief, worked full-time, was physically active, and no longer required any pain medication including opioids. CPP has been presented neuromodulators attempting to utilize conventional SCS, with constant frustration and high explant rates. All patients reported an improvement in pain. The investigators stated thata multimodal stimulation device has advantages. Data from a multi-center, prospective clinical trial showed that the therapy provided substantial back and leg pain relief. Mean age at implantation was 53.5 years and all patients were insulin-treated with stage 3 severe disabling CPDN of at least 1 year's duration. J Pain Symptom Mgmt. Mailis A, Taenzer P. Evidence-based guideline for neuropathic pain interventional treatments: Spinal cord stimulation, intravenous infusions, epidural injections and nerve blocks. 2017;20(7):703-707. After successful implantation of another SCS system, the patient was able to reduce her medications and is now able to ambulate with the use of a left elbow crutch. Patients' pain ratings, disability, sleep disturbances, pioid use, satisfaction, and adverse events were assessed for 24 months. Taylor RS, Van Buyten JP, Buchser E. Spinal cord stimulation for complex regional pain syndrome: A systematic review of the clinical and cost-effectiveness literature and assessment of prognostic factors. damages arising out of the use of such information, product, or process. Importantly, excellent pain-paresthesia overlap was reported, remaining stable through 12 months. Applications are available at the American Dental Association web site. Stocks RA, Williams CT. Spinal cord stimulation for chronic pain. Device-related and serious AEs were not different between the 2 groups; DRG stimulation also demonstrated greater improvements in quality of life and psychological disposition. Aetna considers replacement of a cervical, lumbar or thoracic dorsal column stimulator or battery/generatormedically necessary for individuals who have had a positive pain relief response from the existing DCS and the existing stimulator or battery/generator are no longer under warranty and cannot be repaired. J Pain Symptom Mgmt. While every effort has been made to provide accurate and Each subject was implanted with 2 epidural leads spanning C2 to C6 vertebral bodies. .arrowPurpleSmall, a:hover.arrowPurpleSmall { The 6-month mean total healthcare cost in the DCS group (CAN$19,486; 12,653 Euros) was significantly higher than in the CMM group (CAN$3,994; 2,594 Euros), with a mean adjusted difference of CAN$15,395 (9,997 Euros) (p < 0.001). Obuchi M, Sumitani M, Shin M, et al. Sensitivity analyses were performed varying the costs of CMM, device longevity and average device cost, showing that ICERs for CRPS were higher. 2005;8(3):315-318. Since all trials were non-RCTs, they carried risk of all types of bias. A total of 11 subjects with chronic intractable neuropathic trunk and/or lower limbs pain were included. Van Buyten JP. 2008;63(4):762-770; discussion 770. Patients provided data on pain, quality of life, function, pain medication use, treatment satisfaction, and employment status. The authors concluded that SCS reduced the pain intensity and improves health status in the majority of the CRPS I patients in this study. Unfortunately, pharmacotherapy is often partially effective or accompanied by unacceptable side effects; thus, new treatments are urgently needed. The present study investigated the long-term effects of cervical and lumbar SCS in patients with CRPS type I (CRPS I). CPT is a trademark of the American Medical Association (AMA). After a mean follow-up of 14 months, 2 patients were pain-free, 1 had partial relief and required analgesics, and in 3 patients there was no effect. There were2 further cardiovascular deaths (these patients had continued pain relief) and the4 surviving patients were re-assessed at 7.5 (range of7 to 8.5) years: background pain [73 (65 to 77) mm versus 33 (28 to 36) mm, median (inter-quartile range)], peak pain [86 (81 to 94) mm versus 42 (31 to 53) mm]. Resource consumption was costed using UK and Canadian 2005 to 2006 national figures. These researchers included 19 studies that enrolled 2,779 patients. treatment (implantation within 2 weeks, n = 8), and. 2006;31(4 Suppl):S25-S29. Therefore, if a drug is self-administered by more than 50 percent of Medicare beneficiaries, the drug is excluded from coverage" and the MAC will make no payment for the drug. Effective January 2015, the edits are broadly defined and may include any HCPCS II device code with any CPT procedure code used in earlier Clavo and colleagues (2008) stated that syndromes resulting from decreased cerebral blood flow and metabolic activity have significant clinical and social repercussion. Bell GK, Kidd D, North RB. In addition, they may avoid undesired stimulation-induced paresthesia, particularly in non-painful areas of the body. The mean VAS score before implantation (8.7) compared to VAS 12 months after implantation (4.0) was significantly lower (95 % CI: 3.9 to 5.4], p < 0.001). While the SCS device was de-activated, each patient underwent an initial FDG-PET study to evaluate the clinical status. Carter ML. Organizations who contract with CMS acknowledge that they may have a commercial CDT license with the ADA, and that use of CDT codes as permitted herein for the administration of CMS programs does not extend to any other programs or services the organization may administer and royalties dues for the use of the CDT codes are governed by their commercial license. Neurosurg Rev. Moreover, they stated that prospective controlled studies are needed to confirm the effectiveness of this treatment as an option for the afore-mentioned condition. color:#eee; To ensure the most secure and best overall experience on our website we recommend the latest versions of, Internet Explorer is no longer supported. The views and/or positions presented in the material do not necessarily represent the views of the AHA. Puylaert M. Pelvic pain: Mechanistically enigmatic, therapeutically challenging. Aetna considers dorsal column stimulation experimental and investigational for all other indications not mentioned abovebecause its effectiveness for other indications has not been established. Working capacity was not significantly improved. CPT codes, descriptions and other data only are copyright 2022 American Medical Association. These materials contain Current Dental Terminology (CDTTM), copyright© 2022 American Dental Association (ADA). Neuromodulation in the treatment of painful diabetic neuropathy: A review of evidence for spinal cord stimulation. It is associated with an entrapment mononeuropathy of the lateral femoral cutaneous nerve. }. 10-kHz high-frequency SCS therapy: A clinical summary. These investigators also appraised risk and potential adverse events associated with the use of SCS. For ischemic pain, there may need to be selection criteria developed for CLI, and SCS may have clinical benefit for refractory angina short-term. Analgesic use was largely reduced. The patient reported an immediate improvement in pain because of the introduction of the DRG-SCS. The average time of follow-up was 21.8 months (range of 4.3 to 46.3 months); and a majority of patients reported improvements in sleep and overall function relative to their baseline. Stimwave Technologies Freedom Systems, the SCS and PNS products, provide a unique and innovative technology with an HF-EMC wireless energy transfer from an external transmitter and antenna to the implanted electrode array and separate receiver. Mannheimer C, Eliasson T, Augustinsson LE, et al. Neurodegenerative cerebellar ataxias are considerably uncommon, and this group of patients was relatively small (n = 20) and heterogeneous, so clear-cut associations need to be made with caution. The median number of days with migraine decreased from 28 (range of 12 to 28) to 9.0 (range of 0 to 28) days (p = 0.0313). Epidural spinal electrical stimulation for severe angina: A study of its effects on symptoms, exercise tolerance and degree of ischaemia. Draft articles have document IDs that begin with "DA" (e.g., DA12345). Hence, as Miles and colleagues wrote nearly 20 years ago, At this stage it seems sensible to concentrate effort on evaluating the method rather than on encouraging widespread and possibly indiscriminate use of what is an expensive use and relatively unproven technique.". In addition, 28 % of all subjects at last follow-up used opioid medications, compared to 40 % of all subjects before implantation of the DCS. Diabetes Care. The authors concluded that from this clinical case, SCS is an effective and alternative treatment option for SOD. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or To-date no explants or instances of loss of efficacy have occurred (greater than 1 year since implant). Dorsal column stimulationis a therapy for chronic pain with organic origins and has not been shown to benefit problems which are largely behavioral or psychiatric. Neurosurgery. Accepted revision of codes 63685, 63688, 64590, 64595 Addition of Category I codes 64XX2, 64XX3, 64XX4 Addition of Category III codes 0X43T, 0X44T, X004T, 0X46T, CMS has defined "not usually self-administered" according to how the Medicare population as a whole uses the drug, not how an individual patient or physician may choose to use a particular drug. Hunter et al (2013) stated that chronic pelvic pain (CPP) is complex and often resistant to treatment. Neuromodulation. Durability of high-frequency 10-kHz spinal cord stimulation for patients with painful diabetic neuropathy refractory to conventional treatments: 12-month results from a randomized controlled trial. North RB, Kidd DH, Olin J, et al. Three patients experienced a diminution of pain relief, despite good initial outcomes. These researchers presented a case of intractable meralgia paresthetica in which conservative therapeutic options failed but which was successfully treated with a spinal cord stimulator (SCS). Patients underwent trial therapy where specifically designed leads were implanted at the target DRGs between T12 and L4. The procedure was performed after Institutional Review Board approval. The initial management of chronic pelvic pain. Responders (the primary outcome) were defined as having 50 % or greater back pain reduction with no stimulation-related neurological deficit. At the last assessment, 79.5 % (58/73) of patients were treatment-responders, defined as having at least 50 % patient-reported pain relief from baseline. of the Medicare program. Neurology. The electrical characteristics were collated to establish the dosage range across stimulation trials. de Andrade et al (2016) stated that axial symptoms are a late-developing phenomenon in the course of Parkinson's disease (PD) and represent a therapeutic challenge given their poor response to levodopa therapy and deep brain stimulation. The use of a SCS was discussed with the patient. list-style-type: lower-roman; Please review and accept the agreements in order to view Medicare Coverage documents, which may include licensed information and codes. Novel 10-kHz high-frequency therapy (HF10 Therapy) is superior to traditional low-frequency spinal cord stimulation for the treatment of chronic back and leg pain: The SENZA-RCT Randomized Controlled Trial. The calculated success rate was contingent upon subjects not only achieving 50 % pain relief but also continuing in the study (drop-outs were counted as failures). Lee and colleagues (2015) noted that sphincter of Oddi dysfunction (SOD) is a syndrome of chronic biliary pain or recurrent pancreatitis due to the functional obstruction of the pancreaticobiliary flow. Aetna considers the use of cervical dorsal column stimulation for the treatment of members with complex regional pain syndrome medically necessary when criteria in section I are met and the member has experienced significant pain reduction (50 % or more) with a 3- to 7-day trial of percutaneous spinal stimulation. An electrical impulse generated by the device travels to the electrodes where it creates a "tingling" sensation (paresthesia) which is thought to alter the perception of pain by the patient. Mannheimer et al (1993) examined the effects of DCS on myocardial ischemia, coronary blood flow, and myocardial oxygen consumption in angina pectoris induced by atrial pacing (n = 20). Individual cases showed improvement with a variety of etiologies and pain distributions; a subanalysis of post-herniorrhaphy cohort also showed significant improvement. Thomson S. Spinal cord stimulation for neuropathic pain. article does not apply to that Bill Type. However, the gain in HRQoL with DCS over the same period of time was markedly greater in the DCS group, with a mean EQ-5D score difference of 0.25 [p < 0.001] and 0.21 [p < 0.001], respectively at 3- and 6-months after adjusting for baseline variables. Finally, analyses included in the study were limited to available data that were not collected uniformly for all patients. Janfaza DR, Michna E, Pisini JV, Ross EL. The authors concluded that the clinical experience reported in this article supported the effectiveness and pain relief provided by HF10 SCS therapy. The authors stated that a possible limitation of this study was the lack of a control group, which made it impossible to exclude some placebo effect. The authors concluded that these preliminary results of HF10 cSCS in reducing neck and upper limb pain were encouraging. Findings from the studiesby Daousi et al (2005) as well as de Vos et al (2009) need to be validated by well-designed RCTs. Successful treatment of central pain and spasticity in patient with multiple sclerosis with dorsal column, paresthesia-free spinal cord stimulator: A case report. Neurosurgery. The following outcomes were collected as part of an institutional review board (IRB)-approved, prospective, multi-center, international registry: pain relief, Pain Disability Index (PDI) score, QOL, and satisfaction at 3, 6, and 12 months post-implantation. The Restore Sensor SureScan is an example of the first DCS that is approved by the US Food and Drug Administration (FDA) for use in a magnetic resonance imaging (MRI). Maino P, Koetsier E, Kaelin-Lang A, et al. The SCS leads were typically placed at the level of T6 to T8 in the epidural space. 2020;23(1):19-25. Axial LBP also decreased significantly from baseline to 24 months (NRS=4.1, n=70, p<0.0001, on the overall cohort and NRS=5.6, n=38, on the severe subgroup). E EARREYGUE Guru Messages 141 Location Somatic disorders of the spine leading to insurmountable technical problems in treatment with DCS. (2022) examined the long-term impact of 10-kHz SCS for PDN patients with refractory symptoms. Aetna considers the use of intra-operative motor evoked potentials (MEP) and somatosensory evoked potentials (SSEP)experimental and investigational forimplantation of spinal cord stimulators. Arnhem, The Netherlands: European Association of Urology (EAU); February 2012. Moreover, these researchers stated that follow-up of this study population will continue for 24 months and establish potential durability of this treatment beyond 6 months. Four before-and-after case-series studies (a total of 92 participants) met inclusion criteria. As clinical evidence accumulates and technological innovation improves patient outcomes, neuromodulatory techniques will be sought earlier in the treatment continuum to reduce the suffering for the many with otherwise intractable chronic pain. Failed back surgery syndrome: 5-year follow-up after spinal cord stimulator implantation. In another report that examined 5-year follow-up in 102 patients with FBSS undergoing repeated operation, North et al (1991a) found that most of these patients reported no change in their abilities to carry out activities of daily living. Taylor and colleagues (2021) stated that transcutaneous SCS (tSCS) is a non-invasive modality in which electrodes can stimulate spinal circuitries and facilitate a motor response. 2009;13(17):iii, ix-x, 1-154. In most patients, the leads were positioned for the SCS trial with their tips at the level of the T5 vertebral body (n = 26) or T6 vertebral body (n = 15). Federal government websites often end in .gov or .mil. Pain. Eighty percent of subjects receiving a permanent implant had a diagnosis of failed back surgery syndrome. Costs and outcomes were assessed for each patient over their first 6-months of the trial. UpToDate [online serial]. Dorsal root entry zone lesion versus spinal cord stimulation in the management of pain from brachial plexus avulsion. The methodology utilized in this work followed a review process derived from evidence-based systematic review and meta-analysis of randomized trials described in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Therefore, the success rate could be influenced by factors associated with the lack of blinded treatments (e.g., spinal cord stimulation (SCS) subjects were less motivated to stay in the trial, uncontrolled differences in health care provider interactions). 2019;10:109. Below is a summary of the changes, within Tab 11, which will go into effect January 1, 2024. https://www.ama-assn.org/system/files/cpt-summary-panel-actions-feb-2022.pdf, This milestone is the culmination of the collaboration and hard work from our team, industry partners, leading physicians and supporting medical society, said Aure Bruneau, Chief Executive Officer. At the end of the study,8 of9 patients continued to experience significant pain relief and have been able to significantly reduce their pain medication. At 12 months, 84 % of patients with chronic back pain treated with DTM SCS reported at least 50 % pain relief, compared to 51 % of patients treated with conventional SCS (p = 0.0005). A total of 60 patients with PDN in the lower extremities refractory to conventional medical therapy were enrolled and followed for 6 months. 7500 Security Boulevard, Baltimore, MD 21244. 2015;18(4):289-296; discussion 296. Other neuropathic pain syndromes: In patients with other (than the above) neuropathic pain syndromes, there is insufficient evidence to recommend a trial of SCS. At each follow-up visit, the EuroQoL 5D, the short form McGill Pain Questionnaire (SF-MPQ) and a VAS (range of 0 to 100 mm) to measure pain intensity were recorded. A tripolar SCS was implanted at the T8 level using one-eight contact and two-four contact percutaneous leads based on paresthesia reproduction of patient's areas of discomfort. The results for the neuropathic pain model suggested that the cost-effectiveness estimates for SCS in patients with FBSS who had inadequate responses to medical or surgical treatment were below 20,000 pounds per quality-adjusted life-year (QALY) gained. An independent observer conducted a face-to-face interview with each patient to collect data including demography, electrode placement, electrode mapping, and outcomes. This was a small (n = 11) study with short duration ( 45 days). 1991b;28(5):692-699. not endorsed by the AHA or any of its affiliates. For this procedure, epidural electrodes are generally placed at an upper thoracic or lower cervical spinal level. Electrodes are placed through the intraspinal epidural space in contact with thesensory dorsal root ganglia. CPT codes 9597095973 are used to report electronic analysis services. Clin J Pain. A systematic review of the literature. 2015;18(3):191-193; discussion 193. Post-treatment, doses of corticosteroids was significantly decreased (p = 0.026) and performance status significantly improved (p = 0.046). Clinical features, complications, and outcomes were reviewed. 1998;49(2):142-144. 2014;17(4):E537-E541. The authors concluded that despite there being enough evidence to consider upper cervical spinal cord stimulation as an effective treatment for patients with neuropathic trigeminal pain, a RCT is needed to fully evaluate its indications and outcomes and compare it with other therapeutic approaches. The average pain reduction was 71.4 5.6%, and 82.6% (19/23) of patients experienced a > 50% reduction in their pain at the latest follow-up. They reported odds ratios (ORs) and 95 % CIs of the outcomes of interest pooling data across studies using the random effects model. Subjects with chronic, intractable neck and/or upper limb pain of greater than or equal to 5 cm (on a 0 to 10 cm visual analog scale [VAS]) were enrolled in 6 U.S. centers following an investigational device exemption (IDE) from the Food and Drug Administration (FDA) and IRB approval. However, please note that once a group is collapsed, the browser Find function will not find codes in that group. All patients were asked to complete a seven-point Global Perceived Effect (GPE) scale and the Euroqol-5D (EQ-5D) at each post-implant assessment point. Patients completed a percutaneous trial with a commercially available spinal cord stimulator. Eur J Pain. Stimwave Technologies is a medical device company that develops, manufactures and markets, neuromodulation products. The search was constructed around the following key terms: Spinal cord stimulation, SCI and motor response generation. They carried out a literature search through different databases (PubMed, Scopus, and Embase) using the following terms: "multiple sclerosis", "spinal cord stimulation", and "dorsal column stimulation" according to PRISMA guidelines. Neuromodulation. Middleton P, Simpson B, Maddern G. Spinal cord stimulation (neurostimulation): An accelerated systematic review. } Clavo B, Robaina F, Jorge IJ, et al. A total of 78 patients with FBSS diagnosis based on internationally recognized criteria, and refractory to conservative therapy for at least 6 months, were initially recruited, and 60 subjects met the eligibility criteria and were randomized and scheduled for the trial phase. 1998;21(4):286-288. de Jongste MJ, Hautvast RW, Hillege HL, Lie KI. Genes for each activation transcriptome were identified within the authors dataset and gene expression levels were compared with that of healthy animals, nave to injury and interventional procedures. Patients should have had a successful trial of the therapy before a spinal cord stimulator is implanted. From the time of diagnosis of last tumor relapse before re-irradiation, median OS was 39 months (95 % confidence intervals [CI]: 0 to 93) for the overall study group: 39 months (95 % CI: 9 to 69) for those with anaplastic gliomas and 16 months for the patient with glioblastoma. Your MCD session is currently set to expire in 5 minutes due to inactivity. WebView Stimwave (www.stimwavefreedom.com) location in Florida, United States , revenue, industry and description. There are different article types: Articles are often related to an LCD, and the relationship can be seen in the "Associated Documents" section of the Article or the LCD. an effective method to share Articles that Medicare contractors develop. Stimwavespinal cord stimulator has the ability for physicians to utilizea configuration of up to 64 contacts. Investigators documented adverse events. Frey ME, Manchikanti L, Benyamin RM, et al. Use is limited to use in Medicare, Medicaid or other programs administered by the Centers for Medicare and Medicaid Services (CMS). WebRevision Date: May 21, 2014. A second FDG-PET study was performed later the same day while the SCS device was activated in order to evaluate the effect of cervical SCS on glucose metabolism.

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