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Bücker P, Richter H, Radbruch A, Sperling M, Brand M, Holling M, Van Marck V, Paulus W, Jeibmann A, Karst U. Deposition patterns of iatrogenic lanthanum and gadolinium in the human body depend on delivered chemical binding forms. J Trace Elem Med Biol 2021; 63:126665. [PMID: 33152670 DOI: 10.1016/j.jtemb.2020.126665] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Recently, gadolinium from linear GBCAs has been reported to deposit in various regions of the body. Besides gadolinium, other lanthanides are used in medical care. In the current study, we investigated deposition of lanthanum in two patients who received lanthanum carbonate as a phosphate binder due to chronic kidney injury and compared it to additionally found Gd deposition. METHODS Tissue specimens of two patients with long-term application of lanthanum carbonate as well as possible GBCA application were investigated. Spatial distribution of gadolinium and lanthanum was determined by quantitative laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS) imaging of tissue sections. The deposition of gadolinium and lanthanum in different organs was compared, and the ratio of Gd concentration to La concentration (Gd-to-La-ratio) was investigated on an individual pixel base within the images. RESULTS Deposition of Gd and La was found in all investigated tissues of both patients. Gd and La exhibited high spatial correlation for all samples, with the main deposition being located in the middle coat (tunica media) of blood vessels. The Gd-to-La-ratio was similar in the tissues investigated (between 8 ± 4 (mean ± standard deviation) and 10 ± 2), except for the thyroid vasculature and surrounding tissue (90 ± 17) as well as the cerebellum (270 ± 18). Here, the ratio was significantly increased towards higher Gd concentration. CONCLUSION The results of this study demonstrate long-term deposition of La and comparable localization of additionally found Gd in various tissues of the body. La deposition was relatively low, considering the total administered amount of lanthanum carbonate of up to 11.5 kg, indicating a low absorption and/or high excretion of lanthanum. However, the total amount of deposited La is significant and raises questions about possible adverse side effects. The ratio-approach allows for the usage of the additionally generated Gd data, without detailed knowledge about possible GBCA applications. The significantly decreased Gd-to-La-ratio in the brain might be explained by the lanthanum being released and taken up as free La3+ ion in the stomach that impedes a crossing of the blood-brain-barrier while the intravenously injected GBCAs might dechelate first when they have already crossed the blood-brain-barrier.
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Affiliation(s)
- Patrick Bücker
- Institute of Inorganic and Analytical Chemistry, University of Münster, 48149 Münster, Germany
| | - Henning Richter
- Diagnostic Imaging Research Unit (DIRU), Clinic for Diagnostic Imaging, University of Zurich, CH-8057 Zurich, Switzerland
| | - Alexander Radbruch
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Clinic Essen, University Duisburg-Essen, 45147 Essen, Germany; Department of Diagnostic and Interventional Neuroradiology, University Clinic Bonn, 53127 Bonn, Germany
| | - Michael Sperling
- Institute of Inorganic and Analytical Chemistry, University of Münster, 48149 Münster, Germany; European Virtual Institute for Speciation Analysis (EVISA), 48149 Münster, Germany
| | - Marcus Brand
- Department of Medicine D, University Hospital Münster, Division of General Internal Medicine, Nephrology and Rheumatology, 48149 Münster, Germany
| | - Markus Holling
- Department of Neurosurgery, University Hospital Münster, 48149 Münster, Germany
| | - Veerle Van Marck
- Department of Pathology, University Hospital Münster, 48149 Münster, Germany
| | - Werner Paulus
- Department of Neuropathology, University Hospital Münster, 48149 Münster, Germany
| | - Astrid Jeibmann
- Department of Neuropathology, University Hospital Münster, 48149 Münster, Germany
| | - Uwe Karst
- Institute of Inorganic and Analytical Chemistry, University of Münster, 48149 Münster, Germany.
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Pan X, Li J, He X, Deng J, Dong F, Wang K, Yu S. Gadolinium chloride promotes proliferation of HEK293 human embryonic kidney cells by activating EGFR/PI3K/Akt and MAPK pathways. Biometals 2019; 32:683-693. [PMID: 31286331 DOI: 10.1007/s10534-019-00205-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 07/01/2019] [Indexed: 11/30/2022]
Abstract
Prolonged exposure to gadolinium-based contrast agents has been reported to trigger nephrogenic systemic fibrosis in end stage renal disease patients. However, the exact molecular mechanisms are not fully understood, and no effective therapy is available to date. In the present study, we report that gadolinium chloride (Gd3+) concentration- and time-dependently promoted the proliferation of HEK293 human embryonic kidney cells by increasing DNA synthesis. Gd3+ treatment increased the protein levels of phosphorylated Akt and MAPKs. Inhibition of Akt and ERK by pharmacological inhibitors abolished the increased proliferation and cell cycle progression. Furthermore, Gd3+ activated EGFR signaling possibly by enhancing EGFR clustering on the cell membrane. Inhibition of EGFR by gefitinib blocked Gd3+-induced proliferation. Gd3+ exposure also upregulated the mRNA levels of TGFβ-1, TGFβR1, TNFα, TIMP-1 and integrin αV, β1 which could also be attenuated by the inhibition of Akt and ERK signaling. Our study provides new clues for the etiological role of Gd3+ in the pathogenesis of nephrogenic systemic fibrosis, and suggests the inhibition of EGFR/Akt/ERK signaling as a potential treatment strategy.
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Affiliation(s)
- Xin Pan
- State Key Laboratory of Natural and Biomimetic Drugs, Peking University School of Pharmaceutical Sciences, Beijing, 100191, People's Republic of China
| | - Jinxia Li
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, Institute of High Energy Physics, Chinese Academy of Sciences (CAS), Beijing, 100049, People's Republic of China
| | - Xia He
- State Key Laboratory of Natural and Biomimetic Drugs, Peking University School of Pharmaceutical Sciences, Beijing, 100191, People's Republic of China
| | - Jianjun Deng
- Key Lab of Solid Waste Treatment and Resource, Ministry of Education/School of Environment and Resource, Southwest University of Science and Technology, Mianyang, 621010, Sichuan, People's Republic of China
| | - Faqin Dong
- Key Lab of Solid Waste Treatment and Resource, Ministry of Education/School of Environment and Resource, Southwest University of Science and Technology, Mianyang, 621010, Sichuan, People's Republic of China
| | - Kui Wang
- State Key Laboratory of Natural and Biomimetic Drugs, Peking University School of Pharmaceutical Sciences, Beijing, 100191, People's Republic of China
| | - Siwang Yu
- State Key Laboratory of Natural and Biomimetic Drugs, Peking University School of Pharmaceutical Sciences, Beijing, 100191, People's Republic of China.
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Pai AB, Jang SM, Wegrzyn N. Iron-based phosphate binders--a new element in management of hyperphosphatemia. Expert Opin Drug Metab Toxicol 2015; 12:115-27. [PMID: 26572591 DOI: 10.1517/17425255.2016.1110573] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Management of serum phosphorus in patients with chronic kidney disease remains a significant clinical challenge. A pivotal component of the clinical approach to maintaining serum phosphorus concentrations towards the normal range is the use of phosphate binding agents in addition to comprehensive dietary counseling. The available agents work similarly by capitalizing on a cation within the agent to bind negatively charged phosphorus, forming an insoluble complex and reducing ingested phosphorus absorption. Despite several effective options for phosphate binder therapies, patient adherence remains an issue, mainly due to adverse effect profiles and large daily pill burdens. AREAS COVERED Two new iron-based phosphate binder therapies have recently become available in the United States, sucroferric oxyhydroxide and ferric citrate. These agents have both been shown to effectively reduce serum phosphorus comparably to widely used calcium-based binders and sevelamer salts. EXPERT OPINION The two new iron-based binders differ substantially with regard to phosphate binding chemistry and iron absorption profiles. Their place in therapy is still evolving and the impact of pill burden, gastrointestinal adverse effect profiles, potential cost reduction of anemia therapies and physiologic effects of long-term iron exposure need to be further evaluated.
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Affiliation(s)
- Amy Barton Pai
- a Department of Pharmacy Practice , Albany College of Pharmacy and Health Sciences , Albany , NY 12208 , USA
| | - Soo Min Jang
- a Department of Pharmacy Practice , Albany College of Pharmacy and Health Sciences , Albany , NY 12208 , USA
| | - Nicole Wegrzyn
- a Department of Pharmacy Practice , Albany College of Pharmacy and Health Sciences , Albany , NY 12208 , USA
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Abstract
Urolithiasis affects around 10% of the US population with an increasing rate of prevalence, recurrence and penetrance. The causes for the formation of most urinary calculi remain poorly understood, but obtaining the chemical composition of these stones might help identify key aspects of this process and new targets for treatment. The majority of urinary stones are composed of calcium that is complexed in a crystalline matrix with organic and inorganic components. Surprisingly, mitigation of urolithiasis risk by altering calcium homeostasis has not been very effective. Thus, studies to identify other therapeutic stone-specific targets, using proteomics, metabolomics and microscopy techniques, have been conducted, revealing a high level of complexity. The data suggest that numerous metals other than calcium and many nonmetals are present within calculi at measurable levels and several have distinct distribution patterns. Manipulation of the levels of some of these elemental components of calcium-based stones has resulted in clinically beneficial changes in stone chemistry and rate of stone formation. The elementome--the full spectrum of elemental content--of calcium-based urinary calculi is emerging as a new concept in stone research that continues to provide important insights for improved understanding and prevention of urinary stone disease.
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Yang Y, Mohammad A, Berendt RT, Carlin A, Khan MA, Faustino PJ. Evaluation of the In Vitro Efficacy of Sevelamer Hydrochloride and Sevelamer Carbonate. J Pharm Sci 2015. [PMID: 26219932 DOI: 10.1002/jps.24572] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The objective of this project is to develop an in vitro approach that can be used to determine the phosphate binding capacity of sevelamer hydrochloride and carbonate for both drug products and active pharmaceutical ingredients (APIs). A simple and efficient inductively coupled plasma spectrometer method for analysis of phosphate at physiologically relevant pH conditions has been developed and validated. The method addresses each of the analytical validation characteristics such as linearity, accuracy, precision, stability, and selectivity, and meets the acceptance criteria defined in the United States Food and Drug Administration guidance (Food and Drug Administration, Center for Drug Evaluation and Research. 2001. Guidance for industry-Bioanalytical method validation, May). The in vitro phosphate binding efficacies were systematically evaluated and compared for two drug products and two APIs. The phosphate binding profiles appeared similar between the drug products. Under all conditions, the sevelamer-phosphate binding reached equilibrium at 6 h. The 90% confidence interval for the k2 ratio (sevelamer carbonate vs. sevelamer hydrochloride) was well within 80%-125% under all pH conditions. However, the k1 ratio varied, indicating that there exists difference in the binding affinity. Our findings will be useful in assisting with "in vivo" biowaiver for the approval of generic sevelamer drug products.
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Affiliation(s)
- Yongsheng Yang
- Division of Product Quality Research, Office of Pharmaceutical Quality, Food and Drug Administration, Life Science Building 64, Silver Spring, Maryland 20993.
| | - Adil Mohammad
- Division of Product Quality Research, Office of Pharmaceutical Quality, Food and Drug Administration, Life Science Building 64, Silver Spring, Maryland 20993
| | - Robert T Berendt
- Office of Lifecycle Drug Products, Office of Pharmaceutical Quality, Food and Drug Administration, Life Science Building 75, Silver Spring, Maryland 20993
| | - Alan Carlin
- Division of Product Quality Research, Office of Pharmaceutical Quality, Food and Drug Administration, Life Science Building 64, Silver Spring, Maryland 20993
| | - Mansoor A Khan
- Division of Product Quality Research, Office of Pharmaceutical Quality, Food and Drug Administration, Life Science Building 64, Silver Spring, Maryland 20993
| | - Patrick J Faustino
- Division of Product Quality Research, Office of Pharmaceutical Quality, Food and Drug Administration, Life Science Building 64, Silver Spring, Maryland 20993
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Idée JM, Fretellier N, Robic C, Corot C. The role of gadolinium chelates in the mechanism of nephrogenic systemic fibrosis: A critical update. Crit Rev Toxicol 2014; 44:895-913. [PMID: 25257840 DOI: 10.3109/10408444.2014.955568] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Jean-Marc Idée
- Guerbet, Research & Innovation Division , Aulnay-sous-Bois , France
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Bioequivalence for Drug Products Acting Locally Within Gastrointestinal Tract. FDA BIOEQUIVALENCE STANDARDS 2014. [DOI: 10.1007/978-1-4939-1252-0_12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Yang Y, Bykadi S, Carlin AS, Shah RB, Yu LX, khan MA. Comparative Evaluation of the In Vitro Efficacy of Lanthanum Carbonate Chewable Tablets. J Pharm Sci 2013; 102:1370-81. [DOI: 10.1002/jps.23454] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 12/19/2012] [Accepted: 01/03/2013] [Indexed: 11/11/2022]
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Yang Y, Shah RB, Yu LX, Khan MA. In Vitro Bioequivalence Approach for a Locally Acting Gastrointestinal Drug: Lanthanum Carbonate. Mol Pharm 2013; 10:544-50. [DOI: 10.1021/mp300517p] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yongsheng Yang
- Division of
Product Quality
Research, Office of Pharmaceutical Science, Food and Drug Administration,
Life Science Building 64, 10903 New Hampshire Avenue, Silver Spring,
Maryland 20993, United States
| | - Rakhi B. Shah
- Division of
Product Quality
Research, Office of Pharmaceutical Science, Food and Drug Administration,
Life Science Building 64, 10903 New Hampshire Avenue, Silver Spring,
Maryland 20993, United States
| | - Lawrence X. Yu
- Office of Generic Drugs, Food
and Drug Administration, 7519 Standish Place, Rockville, Maryland
20855, United States
| | - Mansoor A. Khan
- Division of
Product Quality
Research, Office of Pharmaceutical Science, Food and Drug Administration,
Life Science Building 64, 10903 New Hampshire Avenue, Silver Spring,
Maryland 20993, United States
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Park H, Rascati KL, Keith MS, Hodgkins P, Smyth M, Goldsmith D, Akehurst R. Cost-effectiveness of lanthanum carbonate versus sevelamer hydrochloride for the treatment of hyperphosphatemia in patients with end-stage renal disease: a US payer perspective. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2011; 14:1002-9. [PMID: 22152168 DOI: 10.1016/j.jval.2011.05.043] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 03/09/2011] [Accepted: 05/21/2011] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To assess the cost-effectiveness of lanthanum carbonate (LC) versus sevelamer hydrochloride (SH) as a treatment for hyperphosphatemia in end-stage renal disease (ESRD) patients. METHODS A Markov model was developed to estimate health outcomes; quality-adjusted life years (QALYs) and life-years saved (LYS), as well as associated costs. The model incorporated patient-level data from a randomized head-to-head crossover study that compared the reduction of serum phosphorus using LC and SH for 4 weeks each. The model included patients previously treated with calcium-based binders. Both the intent-to-treat (ITT) population and the cohort of patients who completed treatment in both periods of the study (i.e., completer population) were assessed. The baseline risks of cardiovascular disease (CVD), all-cause mortalities for CVD, and non-CVD patients were derived from a large US renal database. Patient outcomes were modeled for 10 years, and incremental cost-effectiveness ratios (ICERs) were calculated for LC relative to SH. Deterministic and probabilistic sensitivity analyses (PSA) were performed to test the robustness of the base-case model. RESULTS For the ITT population, the ICERs of LC versus SH were $24,724/QALY and $15,053/LYS, respectively (in US dollars). When the completer population was considered, the ICERs of LC versus SH were $15,285/QALY and $9,337/LYS (Table 2), respectively. The PSA indicated 61.9% and 85.8% probabilities for ITT and completer populations of LC being cost-effective at the $50,000/QALY willingness-to-pay threshold, respectively. CONCLUSION LC is a cost-effective strategy compared with SH in the treatment of ESRD patients with hyperphosphatemia who were previously treated with calcium-based binders. Sensitivity analyses demonstrated the robustness of the pharmacoeconomic model.
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Affiliation(s)
- Haesuk Park
- University of Texas at Austin College of Pharmacy, Austin, TX, USA
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Shigematsu T, Tokumoto A, Nakaoka A, Arisaka H. Effect of Lanthanum Carbonate Treatment on Bone in Japanese Dialysis Patients With Hyperphosphatemia. Ther Apher Dial 2011; 15:176-84. [DOI: 10.1111/j.1744-9987.2010.00898.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Handley SA, Raja KB, Sharpe C, Flanagan RJ. Measurement of serum lanthanum in patients treated with lanthanum carbonate by inductively coupled plasma-mass spectrometry. Ann Clin Biochem 2011; 48:178-82. [DOI: 10.1258/acb.2010.010162] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Lanthanum carbonate is used as a phosphate binder in patients with stage V chronic kidney disease (CKD). While well tolerated in clinical trials, with no toxicity reported as regards bone and liver metabolism, and cognitive function, concerns remain over possible toxicity. Published methods for the measurement of lanthanum ion in biological samples include aggressive and complicated sample preparation steps that are unsuitable for routine use. A simple method has been developed and validated for the measurement of serum lanthanum. Method A ThermoFisher Scientific XSERIES-II inductively coupled plasma-mass spectrometer was used to monitor 139La. Validation was undertaken using internal quality control solutions containing lanthanum ion (0.20, 0.70 and 4.00 μg/L). Lanthanum was measured in patients (number = 20) with CKD prescribed lanthanum carbonate (500–1500 mg/d) and patients undergoing haemodialysis not prescribed lanthanum carbonate (number = 20). Results Accuracy and imprecision were >95% and <5%, respectively. Calibration was linear (range 0.1–5 μg/L, R2 = 0.99). The lower limit of quantification (LLoQ) was 0.1 μg/L lanthanum ion. In patients with CKD not prescribed lanthanum carbonate, serum lanthanum was below the LLoQ. Out of 20 CKD patients prescribed lanthanum carbonate, serum lanthanum was measurable in only 12 (range 0.11–0.60 μg/L lanthanum ion). There was no apparent relationship between dose and serum lanthanum in these patients. Conclusions A lack of relationship between the dose of lanthanum carbonate and the serum lanthanum concentration may have been due to poor adherence to the treatment regimen. However the concentrations measured were close to the LLoQ.
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Affiliation(s)
- S A Handley
- Trace Elements and Toxicology Laboratories, Department of Clinical Biochemistry
| | - K B Raja
- Trace Elements and Toxicology Laboratories, Department of Clinical Biochemistry
| | - C Sharpe
- Department of Renal Medicine, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - R J Flanagan
- Trace Elements and Toxicology Laboratories, Department of Clinical Biochemistry
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Wang LH, Jiang N, Zhao B, Li XD, Lu TH, Ding XL, Huang XH. Structural basis for the decrease in the outward potassium channel current induced by lanthanum. J Biol Inorg Chem 2010; 15:989-93. [DOI: 10.1007/s00775-010-0688-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Accepted: 07/09/2010] [Indexed: 10/19/2022]
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Samy R, Faustino PJ, Adams W, Yu L, Khan MA, Yang Y. Development and validation of an ion chromatography method for the determination of phosphate-binding of lanthanum carbonate. J Pharm Biomed Anal 2010; 51:1108-12. [DOI: 10.1016/j.jpba.2009.11.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 11/18/2009] [Accepted: 11/19/2009] [Indexed: 10/20/2022]
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