1
|
Wu S, Li H, Yu M, Hu X, Chao S, Yang F, Qin S. Metabolic profiling of the Chinese population with extreme longevity identifies Lysophospholipid species as potential biomarkers for the human lifespan. Maturitas 2025; 198:108379. [PMID: 40315554 DOI: 10.1016/j.maturitas.2025.108379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Revised: 04/06/2025] [Accepted: 04/24/2025] [Indexed: 05/04/2025]
Abstract
BACKGROUND Metabolic regulation plays a crucial role in extending the healthspan and lifespan across multiple organisms, including humans. Although numerous studies have identified the characteristics of the metabolome and potential biomarkers in long-lived populations worldwide, the metabolome landscape of Chinese centenarians remains largely unknown. This study characterised the plasma metabolic profiles of Chinese centenarians and nonagenarians and identified potential biomarkers of longevity. METHODS A global untargeted metabolomics approach was used to analyze plasma samples from 65 centenarians (average age 101.72 ± 1.46 years), 53 nonagenarians (average age 98.92 ± 0.27 years), 47 older individuals (average age 64.66 ± 3.31 years), and 35 middle-aged participants (average age 33.91 ± 3.53 years) recruited from the Lishui region, an area of China well known for the longevity of its population. RESULTS The plasma metabolic profiles of centenarians and nonagenarians differed significantly from those of the two younger populations. Specifically, 211 and 114 differentially abundant metabolites (DAMs) were identified in the centenarian and nonagenarian groups, respectively. The majority of these DAMs were glycerophosphoethanolamines, glycerophosphocholines, fatty esters, fatty alcohols, fatty acyls, and fatty acids and conjugates. For example, the circulating levels of LysoPA (20:2), LysoPA (20:3), LysoPC (16:0), LysoPC (18:2), and LysoPE (20:4) were significantly lower in centenarians than in the older and middle-aged groups. A similar pattern was also observed in the nonagenarian population. Notably, the plasma levels of five DAMs - LysoPA (20:3), LysoPC (18:2), LysoPE (20:4), PG (18:0/18:1), and PG (18:1/18:2) - were significantly and continuously reduced with the ageing process. Pearson correlation analysis revealed that the reduced abundance of LysoPA (20:3), LysoPC (18:2), LysoPE (20:4), LysoPE (24:0), PG (18:0/18:1), and PG (18:1/18:2) was significantly and negatively associated with lifespan, from middle-age to centenarian. ROC analysis indicated that LysoPA (20:3), LysoPC (18:2), LysoPE (20:4), LysoPE (24:0), PG (18:0/18:1), and PG (18:1/18:2), as well as the combination of these six DAMs (AUC = 0.9074), had high predictive power for the human longevity phenotype. CONCLUSION This study elucidated the plasma metabolic landscape of centenarians and nonagenarians in China and identified several potential biomarkers for predicting human lifespan. Our findings will aid in understanding the metabolic regulation of longevity and may promote the clinical practice of gerontology in the future.
Collapse
Affiliation(s)
- Shaochang Wu
- Department of Geriatrics, Lishui Key Laboratory of Brain Health and Severe Brain Disorders, Lishui Second People's Hospital, Lishui, China
| | - He Li
- Department of Geriatrics, Lishui Key Laboratory of Brain Health and Severe Brain Disorders, Lishui Second People's Hospital, Lishui, China
| | - Maoqiang Yu
- Department of Geriatrics, Lishui Key Laboratory of Brain Health and Severe Brain Disorders, Lishui Second People's Hospital, Lishui, China
| | - Xiaogang Hu
- Department of Geriatrics, Lishui Key Laboratory of Brain Health and Severe Brain Disorders, Lishui Second People's Hospital, Lishui, China
| | - Shan Chao
- Research Center for Lin He Academician New Medicine, Institutes for Shanghai Pudong Decoding Life, Shanghai, China
| | - Fan Yang
- Department of Geriatrics, Lishui Key Laboratory of Brain Health and Severe Brain Disorders, Lishui Second People's Hospital, Lishui, China; Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University, Shanghai, China.
| | - Shengying Qin
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University, Shanghai, China.
| |
Collapse
|
2
|
Zeng X, Chen R, Shi D, Zhang X, Su T, Wang Y, Hu Y, He M, Yu H, Shang X. Association of metabolomic aging acceleration and body mass index phenotypes with mortality and obesity-related morbidities. Aging Cell 2025; 24:e14435. [PMID: 39663904 PMCID: PMC11984667 DOI: 10.1111/acel.14435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Revised: 11/13/2024] [Accepted: 11/17/2024] [Indexed: 12/13/2024] Open
Abstract
This study aims to investigate the association between metabolomic aging acceleration and body mass index (BMI) phenotypes with mortality and obesity-related morbidities (ORMs). 85,458 participants were included from the UK Biobank. Metabolomic age was determined using 168 metabolites. The Chronological Age-Adjusted Gap was used to define metabolomically younger (MY) or older (MO) status. BMI categories were defined as normal weight, overweight, and obese. Participants were categorized into MY normal weight (MY-NW, reference), MY overweight (MY-OW), MY obesity (MY-OB), MO normal weight (MO-NW), MO overweight (MO-OW), and MO obesity (MO-OB). Mortality and 43 ORMs were identified through death registries and hospitalization records. Compared with MY-NW phenotype, MO-OB phenotype yielded increased risk of mortality and 32 ORMs, followed by MO-OW with mortality and 27 ORMs, MY-OB with mortality and 26 ORMs, MY-OW with 21 ORMs, and MO-NW with mortality and 14 ORMs. Consistently, MO-OB phenotype showed the highest risk of developing obesity-related multimorbidities, followed by MY-OB phenotype, MO-OW phenotype, MY-OW phenotype, and MO-NW phenotype. Additive interactions were found between metabolomic aging acceleration and obesity on CVD-specific mortality and 10 ORMs. Additionally, individuals with metabolomic aging acceleration had higher mortality and cardiovascular risk, even within the same BMI category. These findings suggest that metabolomic aging acceleration could help stratify mortality and ORMs risk across different BMI categories. Weight management should also be extended to individuals with overweight or obesity even in the absence of accelerated metabolomic aging, as they face increased healthy risk compared with MY-NW individuals. Additionally, delaying metabolic aging acceleration is needed for all metabolomically older groups, including those with normal weight.
Collapse
Affiliation(s)
- Xiaomin Zeng
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
| | - Ruiye Chen
- The Ophthalmic Epidemiology DepartmentCentre for Eye Research AustraliaMelbourneVictoriaAustralia
- Department of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
| | - Danli Shi
- School of OptometryThe Hong Kong Polytechnic UniversityKowloonHong Kong
- Research Centre for SHARP Vision (RCSV)The Hong Kong Polytechnic UniversityKowloonHong Kong
| | - Xiayin Zhang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
| | - Ting Su
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
| | - Yaxin Wang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
| | - Yijun Hu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
| | - Mingguang He
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
- The Ophthalmic Epidemiology DepartmentCentre for Eye Research AustraliaMelbourneVictoriaAustralia
- Department of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
- School of OptometryThe Hong Kong Polytechnic UniversityKowloonHong Kong
- Research Centre for SHARP Vision (RCSV)The Hong Kong Polytechnic UniversityKowloonHong Kong
- Centre for Eye and Vision Research (CEVR)Hong KongHong Kong
| | - Honghua Yu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and ApplicationGuangzhouChina
| | - Xianwen Shang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
- The Ophthalmic Epidemiology DepartmentCentre for Eye Research AustraliaMelbourneVictoriaAustralia
- Department of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
- School of OptometryThe Hong Kong Polytechnic UniversityKowloonHong Kong
- Research Centre for SHARP Vision (RCSV)The Hong Kong Polytechnic UniversityKowloonHong Kong
| |
Collapse
|
3
|
Huang SY, Yang YX, Chen SD, Li HQ, Zhang XQ, Kuo K, Tan L, Feng L, Dong Q, Zhang C, Yu JT. Investigating causal relationships between exposome and human longevity: a Mendelian randomization analysis. BMC Med 2021; 19:150. [PMID: 34281550 PMCID: PMC8290559 DOI: 10.1186/s12916-021-02030-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 06/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Environmental factors are associated with human longevity, but their specificity and causality remain mostly unclear. By integrating the innovative "exposome" concept developed in the field of environmental epidemiology, this study aims to determine the components of exposome causally linked to longevity using Mendelian randomization (MR) approach. METHODS A total of 4587 environmental exposures extracting from 361,194 individuals from the UK biobank, in exogenous and endogenous domains of exposome were assessed. We examined the relationship between each environmental factor and two longevity outcomes (i.e., surviving to the 90th or 99th percentile age) from various cohorts of European ancestry. Significant results after false discovery rates correction underwent validation using an independent exposure dataset. RESULTS Out of all the environmental exposures, eight age-related diseases and pathological conditions were causally associated with lower odds of longevity, including coronary atherosclerosis (odds ratio = 0.77, 95% confidence interval [0.70, 0.84], P = 4.2 × 10-8), ischemic heart disease (0.66, [0.51, 0.87], P = 0.0029), angina (0.73, [0.65, 0.83], P = 5.4 × 10-7), Alzheimer's disease (0.80, [0.72, 0.89], P = 3.0 × 10-5), hypertension (0.70, [0.64, 0.77], P = 4.5 × 10-14), type 2 diabetes (0.88 [0.80, 0.96], P = 0.004), high cholesterol (0.81, [0.72, 0.91], P = 0.0003), and venous thromboembolism (0.92, [0.87, 0.97], P = 0.0028). After adjusting for genetic correlation between different types of blood lipids, higher levels of low-density lipoprotein cholesterol (0.72 [0.64, 0.80], P = 2.3 × 10-9) was associated with lower odds of longevity, while high-density lipoprotein cholesterol (1.36 [1.13, 1.62], P = 0.001) showed the opposite. Genetically predicted sitting/standing height was unrelated to longevity, while higher comparative height size at 10 was negatively associated with longevity. Greater body fat, especially the trunk fat mass, and never eat sugar or foods/drinks containing sugar were adversely associated with longevity, while education attainment showed the opposite. CONCLUSIONS The present study supports that some age-related diseases as well as education are causally related to longevity and highlights several new targets for achieving longevity, including management of venous thromboembolism, appropriate intake of sugar, and control of body fat. Our results warrant further studies to elucidate the underlying mechanisms of these reported causal associations.
Collapse
Affiliation(s)
- Shu-Yi Huang
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, 12th Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Yu-Xiang Yang
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, 12th Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Shi-Dong Chen
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, 12th Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Hong-Qi Li
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, 12th Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Xue-Qing Zhang
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, 12th Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Kevin Kuo
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, 12th Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Lei Feng
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Qiang Dong
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, 12th Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Can Zhang
- Genetics and Aging Research Unit, McCance Center for Brain Health, Mass General Institute for Neurodegenerative Diseases (MIND), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, 12th Wulumuqi Zhong Road, Shanghai, 200040, China.
| |
Collapse
|
4
|
Robinson O, Chadeau Hyam M, Karaman I, Climaco Pinto R, Ala-Korpela M, Handakas E, Fiorito G, Gao H, Heard A, Jarvelin M, Lewis M, Pazoki R, Polidoro S, Tzoulaki I, Wielscher M, Elliott P, Vineis P. Determinants of accelerated metabolomic and epigenetic aging in a UK cohort. Aging Cell 2020; 19:e13149. [PMID: 32363781 PMCID: PMC7294785 DOI: 10.1111/acel.13149] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/19/2019] [Accepted: 03/02/2020] [Indexed: 01/08/2023] Open
Abstract
Markers of biological aging have potential utility in primary care and public health. We developed a model of age based on untargeted metabolic profiling across multiple platforms, including nuclear magnetic resonance spectroscopy and liquid chromatography-mass spectrometry in urine and serum, within a large sample (N = 2,239) from the UK Airwave cohort. We validated a subset of model predictors in a Finnish cohort including repeat measurements from 2,144 individuals. We investigated the determinants of accelerated aging, including lifestyle and psychological risk factors for premature mortality. The metabolomic age model was well correlated with chronological age (mean r = .86 across independent test sets). Increased metabolomic age acceleration (mAA) was associated after false discovery rate (FDR) correction with overweight/obesity, diabetes, heavy alcohol use and depression. DNA methylation age acceleration measures were uncorrelated with mAA. Increased DNA methylation phenotypic age acceleration (N = 1,110) was associated after FDR correction with heavy alcohol use, hypertension and low income. In conclusion, metabolomics is a promising approach for the assessment of biological age and appears complementary to established epigenetic clocks.
Collapse
Affiliation(s)
- Oliver Robinson
- MRC Centre for Environment and HealthDepartment of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUK
| | - Marc Chadeau Hyam
- MRC Centre for Environment and HealthDepartment of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUK
| | - Ibrahim Karaman
- MRC Centre for Environment and HealthDepartment of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUK
| | - Rui Climaco Pinto
- MRC Centre for Environment and HealthDepartment of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUK
| | - Mika Ala-Korpela
- Computational Medicine, Faculty of MedicineUniversity of Oulu and Biocenter OuluOuluFinland
- NMR Metabolomics LaboratorySchool of Pharmacy, University of Eastern FinlandKuopioFinland
| | - Evangelos Handakas
- MRC Centre for Environment and HealthDepartment of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUK
| | - Giovanni Fiorito
- MRC Centre for Environment and HealthDepartment of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUK
- Laboratory of BiostatisticsDepartment of Biomedical SciencesUniversity of SassariSassariItaly
- Italian Institute for Genomic Medicine (IIGM, former HuGeF)CandioloItaly
| | - He Gao
- MRC Centre for Environment and HealthDepartment of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUK
| | - Andy Heard
- MRC Centre for Environment and HealthDepartment of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUK
| | - Marjo‐Riitta Jarvelin
- MRC Centre for Environment and HealthDepartment of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUK
- Center for Life Course Health ResearchFaculty of MedicineUniversity of Oulu and Unit of Primary Health CareOulu University HospitalOuluFinland
- Department of Life SciencesCollege of Health and Life SciencesBrunel University LondonUxbridgeUK
| | - Matthew Lewis
- National Phenome CentreDepartment of MetabolismDigestion and ReproductionImperial College LondonLondonUK
| | - Raha Pazoki
- MRC Centre for Environment and HealthDepartment of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUK
- Department of Life SciencesCollege of Health and Life SciencesBrunel University LondonUxbridgeUK
| | - Silvia Polidoro
- MRC Centre for Environment and HealthDepartment of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUK
- Italian Institute for Genomic Medicine (IIGM, former HuGeF)CandioloItaly
| | - Ioanna Tzoulaki
- MRC Centre for Environment and HealthDepartment of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUK
| | - Matthias Wielscher
- MRC Centre for Environment and HealthDepartment of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUK
| | - Paul Elliott
- MRC Centre for Environment and HealthDepartment of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUK
| | - Paolo Vineis
- MRC Centre for Environment and HealthDepartment of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUK
- Italian Institute for Genomic Medicine (IIGM, former HuGeF)CandioloItaly
| |
Collapse
|
5
|
Fujisawa T, Kagawa K, Hisatomi K, Kubota K, Sato H, Nakajima A, Matsuhashi N. Obesity with abundant subcutaneous adipose tissue increases the risk of post-ERCP pancreatitis. J Gastroenterol 2016; 51:931-8. [PMID: 26792788 DOI: 10.1007/s00535-016-1160-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/24/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND/PURPOSE The risk factors for post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) have been widely investigated. However, studies focusing on the body mass index (BMI) and distribution of adipose tissue have not been reported. Therefore, we examined the correlation between PEP and these factors. METHODS A total of 583 consecutive endoscopic retrograde cholangiopancreatography (ERCP)-naïve patients undergoing therapeutic ERCP were retrospectively analyzed. Subjects were categorized into four groups by BMI: underweight, normal, overweight, and obesity; the PEP rates were compared. In addition, the relationship between PEP and parameters of obesity, visceral and subcutaneous adipose tissue as well as abdominal circumference was investigated. RESULTS PEP rate was significantly higher in obesity (30 %) and lower in normal (3 %, P < 0.001). The PEP rate in underweight (7.3 %) was conversely higher than in normal. As for parameters of obesity, only subcutaneous adipose tissue was correlated with PEP incidence (P = 0.009). The correlation of PEP incidence with BMI and subcutaneous adipose tissue was separately reconfirmed by multivariate analysis including female gender and guidewire placement; these factors showed a tendency toward differences in univariate analysis. CONCLUSIONS Obesity could be a risk factor for PEP. In the obesity group, an excess of subcutaneous adipose tissue might be an especially important factor related to PEP incidence.
Collapse
Affiliation(s)
- Toshio Fujisawa
- Department of Gastroenterology, NTT Medical Centre Tokyo, Tokyo, Japan.
| | - Koichi Kagawa
- Department of Gastroenterology, NTT Medical Centre Tokyo, Tokyo, Japan
| | - Kantaro Hisatomi
- Department of Gastroenterology, NTT Medical Centre Tokyo, Tokyo, Japan
| | - Kensuke Kubota
- Gastroenterology Division, Yokohama City University School of Medicine, Yokohama, Japan
| | - Hajime Sato
- Department of Health Policy and Technology Assessment, National Institute of Public Health, Saitama, Japan
| | - Atsushi Nakajima
- Gastroenterology Division, Yokohama City University School of Medicine, Yokohama, Japan
| | | |
Collapse
|
6
|
Metabolic Control of Longevity. Cell 2016; 166:802-821. [DOI: 10.1016/j.cell.2016.07.031] [Citation(s) in RCA: 524] [Impact Index Per Article: 58.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 05/15/2016] [Accepted: 07/20/2016] [Indexed: 12/19/2022]
|