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Charton E, Baldini C, Fayet Y, Schultz E, Auroy L, Vallier E, Italiano A, Robert M, Coquan E, Isambert N, Moreau P, Touzeau C, Le Tourneau C, Ghrieb Z, Kiladjian JJ, Delord JP, Gomez Roca C, Vey N, Barlesi F, Lesimple T, Penel N, Soria JC, Massard C, Besle S. Inequality factors in access to early-phase clinical trials in oncology in France: results of the EGALICAN-2 study. ESMO Open 2023; 8:101610. [PMID: 37536254 PMCID: PMC10415590 DOI: 10.1016/j.esmoop.2023.101610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Investigation of the disparities in the access to experimental treatment in early-phase clinical trials is lacking. The objective of the EGALICAN-2 study was to identify the factors underpinning such inequalities. METHODS A national prospective survey was conducted in 11 early-phase clinical trial centers (CLIP2) certified by the French National Cancer Institute. Sociodemographic, socioeconomic and medical data were collected. Univariate logistic regression models were carried out to estimate odds ratios and 90% confidence intervals associated with the effect of each study variable. A multivariate logistic regression model was built to explore the independent factors associated with the administration of the experimental treatment (C1D1). A post hoc analysis was carried out excluding female cancer patients. RESULTS Between 2015 and 2016, 1355 patients referred from 11 CLIP2 centers in France were included in the study. Eight hundred and forty-eight patients received C1D1 (73%) and 320 patients (27%) were screening failure. Median age was 58 years (range 17-97 years) and 667 patients (54%) were female. Most patients had a metastatic disease (n = 751, 87%). In the multivariate logistic regression analysis, the significant independent factors associated with C1D1 were male sex, initial care received in a hospital with an early-phase unit and living in wealthy metropolitan areas (P values <0.05). In the post hoc analysis, the sex factor was no longer significant [odds ratio = 1.21 (95% confidence interval 0.86-1.70), P value = 0.271]. CONCLUSIONS This study investigated the factors producing social inequalities in the context of early-phase clinical trials in oncology. Our research highlights factors of sex, care pathway and geographic location. Gynecological cancer was found to impact C1D1 significantly, unlike breast cancer. The results of this study should contribute to improve patient access to early-phase clinical trials.
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Affiliation(s)
- E Charton
- Human and Social Sciences Department, Centre Léon Bérard, Lyon.
| | - C Baldini
- Drug Development Department (DITEP), Gustave Roussy, Paris-Saclay University, Villejuif
| | - Y Fayet
- Human and Social Sciences Department, Centre Léon Bérard, Lyon; Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon
| | - E Schultz
- CEPED (UMR 196), University of Paris, IRD, Paris; SESSTIM, CANBIOS Team, Aix-Marseille University, INSERM, IRD, Marseille
| | - L Auroy
- University of Grenoble Alpes, CNRS, Sciences Po Grenoble, Grenoble
| | - E Vallier
- Human and Social Sciences Department, Centre Léon Bérard, Lyon; Drug Development Department (DITEP), Gustave Roussy, Paris-Saclay University, Villejuif
| | | | - M Robert
- Medical Oncology Department, Institut de Cancérologie de l'Ouest, Saint-Herblain
| | - E Coquan
- Medical Oncology Department, Centre François Baclesse, Caen
| | - N Isambert
- Medical Oncology Department, University Hospital of Poitiers, Poitiers
| | - P Moreau
- Medical Oncology Department, Centre Georges-François Leclerc, Dijon
| | - C Touzeau
- Department of Hematology, University Hospital of Nantes, Nantes
| | - C Le Tourneau
- Department of Drug Development and Innovation, Institut Curie, Paris
| | - Z Ghrieb
- Service de Pharmacologie et Investigations Cliniques, Hôpital Saint-Louis, AP-HP, Paris
| | - J-J Kiladjian
- Service de Pharmacologie et Investigations Cliniques, Hôpital Saint-Louis, AP-HP, Paris
| | - J-P Delord
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse
| | - C Gomez Roca
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse
| | - N Vey
- Department of Hematology, Institut Paoli-Calmettes, Marseille
| | - F Barlesi
- CRCM, INSERM, CNRS, APHM, Aix-Marseille University, Marseille; Gustave Roussy, Villejuif
| | - T Lesimple
- Department of Oncology, Eugene Marquis Center, Rennes
| | - N Penel
- Centre Oscar Lambret, Lille University, Lille
| | - J-C Soria
- Drug Development Department (DITEP), Gustave Roussy, Paris-Saclay University, Villejuif
| | - C Massard
- Drug Development Department (DITEP), Gustave Roussy, Paris-Saclay University, Villejuif
| | - S Besle
- Human and Social Sciences Department, Centre Léon Bérard, Lyon; Drug Development Department (DITEP), Gustave Roussy, Paris-Saclay University, Villejuif; Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon, Institut Convergence PLAsCAN, Lyon, France
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Guerin M, Miran C, Colomba E, Cabart M, Herrmann T, Pericart S, Maillet D, Neuzillet Y, Deleuze A, Coquan E, Laramas M, Thibault C, Abbar B, Mesnard B, Borchiellini D, Dumont C, Boughalem E, Deville JL, Cancel M, Saldana C, Khalil A, Baciarello G, Flechon A, Walz J, Gravis G. Urachal carcinoma: a large retrospective multicentric study from the French Genito-Urinary Tumor Group. Front Oncol 2023; 13:1110003. [PMID: 36741023 PMCID: PMC9892758 DOI: 10.3389/fonc.2023.1110003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/06/2023] [Indexed: 01/20/2023] Open
Abstract
Introduction Urachal cancer (UrC) is a rare, non-urothelial malignancy. Its natural history and management are poorly understood. Although localized to the bladder dome, the most common histological subtype of UrC is adenocarcinoma. UrC develops from an embryonic remnant, and is frequently diagnosed in advanced stage with poor prognosis. The treatment is not standardized, and based only on case reports and small series. This large retrospective multicentric study was conducted by the French Genito-Urinary Tumor Group to gain a better understanding of UrC. Material and Methods data has been collected retrospectively on 97 patients treated at 22 French Cancer Centers between 1996 and 2020. Results The median follow-up was 59 months (range 44-96). The median age at diagnosis was 53 years (range 20-86), 45% were females and 23% had tobacco exposure. For patients with localized disease (Mayo I-II, n=46) and with lymph-node invasion (Mayo III, n=13) median progression-free-survival (mPFS) was 31 months (95% CI: 20-67) and 7 months (95% CI: 6-not reached (NR)), and median overall survival (mOS) was 73 months (95% CI: 57-NR) and 22 months (95% CI: 21-NR) respectively. For 45 patients with Mayo I-III had secondary metastatic progression, and 20 patients were metastatic at diagnosis. Metastatic localization was peritoneal for 54% of patients. Most patients with localized tumor were treated with partial cystectomy, with mPFS of 20 months (95% CI: 14-49), and only 12 patients received adjuvant therapy. Metastatic patients (Mayo IV) had a mOS of 23 months (95% CI: 19-33) and 69% received a platin-fluorouracil combination treatment. Conclusion UrC is a rare tumor of the bladder where patients are younger with a higher number of females, and a lower tobacco exposure than in standard urothelial carcinoma. For localized tumor, partial cystectomy is recommended. The mOS and mPFS were low, notably for patients with lymph node invasion. For metastatic patients the prognosis is poor and standard therapy is not well-defined. Further clinical and biological knowledge are needed.
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Affiliation(s)
- M. Guerin
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France,*Correspondence: M. Guerin,
| | - C. Miran
- Department of Medical Oncology, Centre Leon-Berard, Lyon, France
| | - E. Colomba
- Department of Cancer Medicine, Institut Gustave-Roussy, University of Paris Saclay, Villejuif, France
| | - M. Cabart
- Department of Medical Oncology, Institut Bergonie, Bordeaux, France
| | - T. Herrmann
- Department of Medical Oncology, Centre Jean-Perrin, Clermont-Ferrand, France
| | - S. Pericart
- Department of Anatomo-pathology, Institut Universitaire du Cancer, Centre Hospital-Universitaire de Toulouse, Toulouse, France
| | - D. Maillet
- Department of Medical Oncology, Centre hospitalo-Universitaire Hospices civils, Lyon, France
| | - Y. Neuzillet
- Department of Urology, Hopital Foch, Paris, France
| | - A. Deleuze
- Department of Medical Oncology, Centre Eugene Marquis, Rennes, France
| | - E. Coquan
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | - M. Laramas
- Department of Medical Oncology, Centre Hospitalo-Universitaire, Grenoble, France
| | - C. Thibault
- Department of Medical Oncology, Hopital Europeen Georges Pompidou, Paris, France
| | - B. Abbar
- Department of Medical Oncology, Hopital Pitié-Salpetriere, Paris, France
| | - B. Mesnard
- Department of Urology, Centre Hospitalo-Universitaire, Nantes, France
| | - D. Borchiellini
- Department of Medical Oncology, Centre Lacassagne, Nice, France
| | - C. Dumont
- Department of Medical Oncology, Hopital Saint-Louis, Paris, France
| | - E. Boughalem
- Department of Medical Oncology, Centre Paul Papin, Angers, France
| | - JL. Deville
- Department of Medical Oncology, Centre Hospitalo-Universitaire Timone, Marseille, France
| | - M. Cancel
- Department of Medical Oncology, Centre Hospitalo-Universitaire Bretonneau, Tours, France
| | - C. Saldana
- Department of Medical Oncology, Hopital Henri Mondor, Paris, France
| | - A. Khalil
- Department of Medical Oncology, Hopital tenon, Paris, France
| | - G. Baciarello
- Department of Cancer Medicine, Institut Gustave-Roussy, University of Paris Saclay, Villejuif, France
| | - A. Flechon
- Department of Medical Oncology, Centre Leon-Berard, Lyon, France
| | - J. Walz
- Department of Urology, Institut Paoli-Calmettes, Marseille, France
| | - G. Gravis
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
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Baldini C, Charton E, Schultz E, Auroy L, Italiano A, Robert M, Coquan E, Isambert N, Moreau P, Le Gouill S, Le Tourneau C, Ghrieb Z, Kiladjian J, Delord J, Roca CG, Vey N, Barlesi F, Lesimple T, Penel N, Soria J, Massard C, Besle S. Access to early-phase clinical trials in older patients with cancer in France: the EGALICAN-2 study. ESMO Open 2022; 7:100468. [PMID: 35533427 PMCID: PMC9271476 DOI: 10.1016/j.esmoop.2022.100468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/15/2022] [Accepted: 03/04/2022] [Indexed: 11/26/2022] Open
Abstract
Background Patients and methods Results Conclusions Older patients are underrepresented in early-phase clinical trials (17.7%) compared with the number of new cases (50%). The rate of signed informed consent was similar across age groups (92.7% in younger patients versus 90.6% in older patients). The rate of screening failure was consistent across all age groups (28.5% in younger patients versus 24.3% in older patients). In older patients the initial care received in the center having a phase I unit was associated with study drug administration.
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Guerin M, Colomba-Blameble E, Miran C, Herrmann T, Pericart S, Maillet D, Neuzillet Y, Deleuze A, Thibault C, Coquan E, Dumont C, Boughalem E, Borchiellini D, Mesnard B, Khalil A, Baciarello G, Fléchon A, Walz J, Gravis G. 788P Urachal carcinoma: Large retrospective multicentric GETUG-AFU study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Blay JY, Chevret S, Penel N, Bertucci F, Bompas E, Saada-Bouzid E, Eymard JC, Lotz JP, Coquan E, Schott R, Soulié P, Linassier C, Le Cesne A, Brahmi M, Hoog-Labouret N, Legrand F, Simon C, Lamrani-Ghaouti A, Ray-Coquard I, Massard C. 1619O High clinical benefit rates of single agent pembrolizumab in selected rare sarcoma histotypes: First results of the AcSé Pembrolizumab study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1845] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Blay JY, Penel N, Ray-Coquard I, Schott R, Saada-Bouzid E, Bertucci F, Chevreau C, Bompas E, Coquan E, Cousin S, Soulié P, Le Cesne A, Mir O, Ryckewaert T, Brahmi M, Hoog-Labouret N, Couch D, Chevret S, Soria JC, Massard C. High clinical benefit rates of pembrolizumab in very rare sarcoma histotypes: First results of the AcSé pembrolizumab study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz253.096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Stefan D, Lesueur P, Lequesne J, Coquan E, Brachet P, Castera L, Goardon N, Lacroix J, Lange M, Capel A, Andre B, Grellard JM, Clarisse B. Phase I/IIa study of concomitant radiotherapy with olaparib and temozolomide in unresectable high-grade gliomas patients: OLA-TMZ-RTE-01. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy273.394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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8
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Brédart A, Bodson S, Le Tourneau C, Flahault C, Bonnetain F, Beaudeau A, Coquan E, Dolbeault S, Paoletti X. Patients' perceived tolerance of side effects in phase I cancer clinical trials: A qualitative study. Eur J Cancer Care (Engl) 2016; 26. [PMID: 27734561 DOI: 10.1111/ecc.12596] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2016] [Indexed: 12/18/2022]
Abstract
This qualitative study aimed to explore cancer patients' perceived tolerance of side effects in phase I drug trials. Patients with solid tumours receiving molecularly targeted agents with/without chemotherapy were eligible for inclusion. In-depth semi-structured interviews were carried out with 17 patients with a median [range] age of 63 [41-72] years. Treatment was discontinued in seven patients. Verbatim transcripts of the audio-taped interviews were analysed using a constructivist grounded theory approach. Four conceptual categories emerged from data analysis, labelled "suffering from side effects" comprising a range of symptoms, psychosocial or role disturbances; "striving to cope with side effects" reflecting psychological strategies for managing side effects; "hoping" reflecting expectations about treatment efficacy and relief from side effects; and "appraisal of care." Among patients remaining in the trial, treatment was currently perceived as fairly tolerable. For most respondents, whether still in a trial or not, treatment discontinuation could not be justified by the non-tolerance of treatment side effects. These results question the adequacy of patient-perceived tolerance reports to determine an optimal drug dose for phase II trials. Confronted with patients' hopes and inappropriate beliefs, communication is challenging in phase I trials and could benefit from facilitating psychosocial interventions.
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Affiliation(s)
- A Brédart
- Psycho-Oncology Unit, Institut Curie, Paris, France.,Psychopathology and Health Process Laboratory (EA 4057), Psychology Institute, University Paris Descartes, Boulogne-Billancourt, France
| | - S Bodson
- Psychopathology and Health Process Laboratory (EA 4057), Psychology Institute, University Paris Descartes, Boulogne-Billancourt, France
| | - C Le Tourneau
- Department of Medical Oncology, Institut Curie, Paris & Saint-Cloud, France.,EA7285, Versailles-Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux, France
| | - C Flahault
- Psycho-Oncology Unit, Institut Curie, Paris, France.,Psychopathology and Health Process Laboratory (EA 4057), Psychology Institute, University Paris Descartes, Boulogne-Billancourt, France
| | - F Bonnetain
- Methodology and Quality of Life in Oncology Unit (EA 3181) & Quality of Life and Cancer Clinical Research Platform, CHU Besançon, France
| | - A Beaudeau
- Psycho-Oncology Unit, Institut Curie, Paris, France
| | - E Coquan
- Department of Medical Oncology, Institut Curie, Paris & Saint-Cloud, France.,EA7285, Versailles-Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux, France
| | - S Dolbeault
- Psycho-Oncology Unit, Institut Curie, Paris, France.,Inserm, U 669, Paris, France
| | - X Paoletti
- Gustave Roussy Cancer Campus, Villejuif, France
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Coquan E, Guizard AV, Heutte N, Bor C, Allouache D, Delcambre C, Switsers O, Guilloit JM, Leiber N, Delier T, Levy C. P3-14-20: Concomitant Taxane-Anthracyclin Regimen for Neoadjuvant Chemotherapy of Primary Breast Cancer: Experience from a Cohort of 223 Patients Treated in a Single Institution. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p3-14-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Neoadjuvant chemotherapy (NAC) may be an alternative to mastectomy for localized breast cancer ineligible for breast conservation. The optimal schedule (sequential versus concomitant) remains controversial. Based on encouraging results of a phase 2 study (Luporsi E. et al, ASCO 2000) a concomitant docetaxel (D) and epirubicin (E) neoadjuvant combination is applied in neoadjuvant setting in our institution since 2001 for HER2−negative patients (pts). The results of this combination are presented, with a particular focus on pathological complete response (pCR) and conservation rate.
Methods: Between 2001 and 2010, 223 pts received NAC for a T2-T3 breast cancer initially ineligible for conservative surgery, but with hope of breast conservation in case of downstaging by pre-operative medical treatment. Six cycles of D (75mg/m2) and E (75mg/m2) were administered every 3 weeks before surgery, with prophylactic support of G-CSF in order to reduce the risk of febrile neutropenia and to maintain the dose-intensity of the NAC. All patients eligible for breast conservation after NAC underwent lumpectomy, the others were treated by mastectomy. In all cases, an axillary dissection was performed. After lumpectomy all patients received radiation therapy, after mastectomy RT was limited to high risk of loco-regional relapse. Patients with positive hormonal receptors (HR+) received hormonal therapy. Results were analyzed in term of breast conservation rate (BCR), pathologic response rate (pCR defined as no residual invasive tumour in breast and axilla, according to Sataloff's classification) and safety.
Results: Mean age of patients was 49,6 years (range: 26–71). Median clinical tumor size was 40mm (range 20–110). Histological subtypes were:78,0 % ductal, 15,3 lobular, 1,8 % ductal/lobular and 4,9 % other types. SBR grading was: grade I: 14,3 %, grade II: 46,2 %, grade III: 33,2 % and 6,3 % unspecified. 77,3 % were HR+, 19,7 % of tumours were triple negative (HER2 unknown for 38 cases). A breast conservation was achievable for 73,5% of patients, the pCR rate was 20,6%. At a median follow up of 48 months, 31 pts relapsed: 9 pts (4%) experienced a local relapse, 5 regional and 28 distant recurrences occured. Additional data about safety and survival will be provided for the meeting.
Conclusions: For HER2−negative tumours, 6 cycles of a concomitant taxane-anthracyclin pre-operative combination allowed a 20,6% pCR rate, slightly lower than obtained with 8 cycles of a sequential regimen in several published trials. However breast conservation rate was similar with a low risk of local recurrence. According to these results, concomitant cytotoxic combination is an acceptable option for neoadjuvant treatment of breast cancer.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-14-20.
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Affiliation(s)
- E Coquan
- 1François Baclesse Cancer Center, Caen, France
| | - A-V Guizard
- 1François Baclesse Cancer Center, Caen, France
| | - N Heutte
- 1François Baclesse Cancer Center, Caen, France
| | - C Bor
- 1François Baclesse Cancer Center, Caen, France
| | - D Allouache
- 1François Baclesse Cancer Center, Caen, France
| | - C Delcambre
- 1François Baclesse Cancer Center, Caen, France
| | - O Switsers
- 1François Baclesse Cancer Center, Caen, France
| | | | - N Leiber
- 1François Baclesse Cancer Center, Caen, France
| | - T Delier
- 1François Baclesse Cancer Center, Caen, France
| | - C Levy
- 1François Baclesse Cancer Center, Caen, France
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Vanbockstael J, Noal S, Brachet PE, Degrendel-Courtecuisse AC, Geffrelot J, Coquan E, Pernin V, Pascal P, Genot JY, Do P, Machavoine JL, Joly F, Lheureux S. Espace de parole en prévention du syndrome de burnout : deux ans d’expérience au sein de l’Association des jeunes oncologues bas-normands (Ajon). PSYCHO-ONCOLOGIE 2011. [DOI: 10.1007/s11839-011-0315-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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