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Pambet M, Delabaere A, Figuier C, Lambert C, Comptour A, Rouzaire M, Gallot D. Factors of Non-Compliance with a Protocol for Oral Administration of Misoprostol (Angusta ®) 25 Micrograms to Induce Labor: An Observational Study. J Clin Med 2023; 12:jcm12041521. [PMID: 36836056 PMCID: PMC9964196 DOI: 10.3390/jcm12041521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/09/2023] [Accepted: 02/12/2023] [Indexed: 02/17/2023] Open
Abstract
We set out to identify factors of non-compliance with a protocol for the oral administration of misoprostol 25 µg (Angusta®) every 2 h (up to eight tablets), for the induction of labor (IOL). We conducted a retrospective study on IOL at term, on singleton pregnancies from 2019 to 2021, in a university hospital. The study included 195 patients, comprising 144 compliant protocols. Pain was statistically more frequent in the non-compliance group (92.2% vs. 62.5%, p < 0.001), and when a midwife was unavailable (15.7% vs. 0.7%, p < 0.001). A multivariable analysis found factors of good response (defined as going into labor before the administration of the median number of tablets, i.e., six) to be an indication for PROM (OR: 12.03, 95% CI: 5.42-26.71), and gestational age at induction (OR: 1.54, 95% CI: 1.19-2.01), independently of BMI, initial Bishop score, and parity. Patients with pain who were able to follow the protocol delivered 9 h earlier than patients with pain who interrupted the protocol and 16 h earlier than patients who experienced no pain. We identified two key elements that favored compliance: (i) providing the next tablet in advance; and (ii) offering patients early epidural analgesia when in pain in order to continue the protocol and go into labor promptly.
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Affiliation(s)
- Mathilde Pambet
- Obstetrics and Gynaecology Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Amélie Delabaere
- Obstetrics and Gynaecology Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Claire Figuier
- Obstetrics and Gynaecology Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Céline Lambert
- Biostatistics Unit, DRCI, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Aurélie Comptour
- CIC 1405 CRECHE Unit, INSERM, Obstetrics and Gynaecology Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Marion Rouzaire
- CIC 1405 CRECHE Unit, INSERM, Obstetrics and Gynaecology Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Denis Gallot
- Obstetrics and Gynaecology Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
- “Translational Approach to Epithelial Injury and Repair” Team, CNRS 6293, Inserm 1103, GReD, Auvergne University, 63000 Clermont-Ferrand, France
- Correspondence:
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Chow R, Li A, Wu N, Martin M, Wessels JM, Foster WG. Quality appraisal of systematic reviews on methods of labour induction: a systematic review. Arch Gynecol Obstet 2021; 304:1417-1426. [PMID: 34495378 DOI: 10.1007/s00404-021-06228-y] [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: 06/29/2021] [Accepted: 08/31/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Induction of labour has become more common over the last decade, together with an increase in the number of systematic reviews of the subject. However, with multiple systematic reviews it is necessary to evaluate the methodological rigor to ensure the reliability of conclusions and recommendations for clinical practice. Therefore, the aim of this study was to appraise the quality of systematic reviews that examined the efficacy and/or safety of labour induction methods. METHODS An electronic search of MEDLINE, Embase, and the Cochrane Library from 2000 to 2020 was conducted. Study selection, data extraction and quality assessment were conducted using A Measurement Tool to Assess Systematic Reviews (AMSTAR) by two independent reviewers, in duplicate. RESULTS The search identified 387 publications, of which 48 studies (13%) met the a priori inclusion criteria. No significant relationships were found between study quality and number of citations, journal impact factor, or publication year. CONCLUSION Methodological quality for systematic reviews on the induction of labour were ranked as moderate with no significant changes in quality over the past 2 decades. Publication characteristics are not significantly associated with methodological quality, indicating that healthcare professionals should critically appraise studies before applying them to practice.
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Affiliation(s)
- Ryan Chow
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1N 6N5, Canada.,Department of Obstetrics and Gynecology, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Allen Li
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1N 6N5, Canada
| | - Nicole Wu
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Morgan Martin
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Jocelyn M Wessels
- Department of Obstetrics and Gynecology, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Warren G Foster
- Department of Obstetrics and Gynecology, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.
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Strandberg M, Wallstrom T, Wiberg-Itzel E. Women's expectations and experiences of labor induction - a questionnaire-based analysis of a randomized controlled trial. BMC Pregnancy Childbirth 2021; 21:355. [PMID: 33947349 PMCID: PMC8097967 DOI: 10.1186/s12884-021-03786-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 04/09/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Although labor induction is a commonly used procedure in obstetrical care, there are limited data on its psycho-emotional effects on the woman. This study analysed the expectations and experiences of women in different routes of labor induction. The study's primary aim was to compare women's delivery experience if induced by orally administrated misoprostol (OMS) compared with misoprostol vaginal insert (MVI). Secondly, an evaluation of women's general satisfaction with induced labor was made, and factors associated with a negative experience. METHODS Primiparous women (n = 196) with a singleton fetus in cephalic presentation, ≥ 37 weeks of gestation, with a Bishop's score ≤ 4 planning labor induction were randomly allocated to receive either OMS (Cytotec®) or MVI (Misodel®). Data were collected by validated questionnaires, the Wijma Delivery Expectation/Experience Questionnaire (A + B). The pre-labor part of the survey (W-DEQ version A) was given to participants to complete within 1 hour before the start of induction, and the post-labor part of the questionnaire (W-DEQ version B) was administered after birth and collected before the women were discharged from hospital. RESULTS It was found that 11.8% (17/143) reported a severe fear of childbirth (W-DEQ A score ≥ 85). Before the induction, women with extreme fear had 3.7 times increased risk of experiencing labor induction negatively (OR 3.7 [95% CI, 1.04-13.41]). CONCLUSION No difference was identified between OMS and MVI when delivery experience among women induced to labor was analysed. Severe fear of childbirth before labor was a risk factor for a negative experience of labor induction. TRIAL REGISTRATION Clinical trial register number NCT02918110 . Date of registration on May 31, 2016.
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Affiliation(s)
- Moa Strandberg
- Department of Clinical Science and Education Karolinska Institute, Sodersjukhuset, 118 83, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Sodersjukhuset, 118 83, Stockholm, Sweden
| | - Tove Wallstrom
- Department of Clinical Science and Education Karolinska Institute, Sodersjukhuset, 118 83, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Sodersjukhuset, 118 83, Stockholm, Sweden
| | - Eva Wiberg-Itzel
- Department of Clinical Science and Education Karolinska Institute, Sodersjukhuset, 118 83, Stockholm, Sweden.
- Department of Obstetrics and Gynecology, Sodersjukhuset, 118 83, Stockholm, Sweden.
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Kashanian M, Bahasadri S, Nejat Dehkordy A, Sheikhansari N, Eshraghi N. A comparison between induction of labor with 3 methods of titrated oral misoprostol, constant dose of oral misoprostol and Foley catheter with extra amniotic saline infusion (EASI), in women with unfavorable cervix. Med J Islam Repub Iran 2019; 33:115. [PMID: 31934574 PMCID: PMC6946922 DOI: 10.34171/mjiri.33.115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Indexed: 11/24/2022] Open
Abstract
Background: Different methods of cervical ripening and induction of labor have been used in the cases of unfavorable cervix with different levels of success, but no method has been found to be the best option. The purpose of the present study was to find the effects and side effects of three different methods of cervical ripening and induction of labor. These three methods were oral titrated misoprostol, constant dose of oral misoprostol and Foley catheter with extra-amniotic saline infusion. Methods: This clinical trial was performed on women with unfavorable cervix who had been admitted in Akbarabadi Teaching Hospital for induction of labor and had bishop score of less than six; between March 2014- March 2015. The eligible women were assigned into three groups. In titrated oral misoprostol group (n=33), titrated solution of misoprostol, and in oral misoprostol group (n=33), 50µg oral misoprostol every four hours and in Foley catheter group (n=50), Foley catheter with extra-amniotic saline infusion were administered. The main outcome was the number of vaginal deliveries during the first 24 hours. In addition, number of cesarean deliveries and adverse effects were compared between the three groups. The obtained data were analyzed using SPSS 18 software. Data analysis was performed according to the intention to treat principle. Chi-square test, Fisher Exact test, Student ttest, and Mann-Whitney U test, were used for comparing data. P-value≤0.05 was considered statistically significant. Results: The three groups did not have any significant difference according to maternal age, gestational age at the time of admission, gravidity, parity, and primary Bishop Score. There was no significant difference between the three groups for the main outcome, which was vaginal delivery during the first 24 hours (p=0.887). There was no significant difference between the three groups according to hypertonicity, uterine hyperstimulation, meconium passage, non-reassuring fetal heart rate, neonatal Apgar score in minutes one and 5, and mean duration of beginning the intervention up to delivery. However, uterine tachysystole and NICU admission were more in the group to whom the titrated solution of misoprostol was administered (p=0.002 and p=0.037 respectively). The number of cesarean deliveries due to failure to progress was higher in the EASI group. However, EASI group showed the least number of none-reassuring fetal heart rate between the three groups. Meconium passage was more in the titrated misoprostol group, but the difference was not significant. Conclusion: All three methods are appropriate methods for induction of labor in the cases of unfavorable cervix; and choosing each method depends on the expertise of labor staff, accessibility to the medications, cost, and taking care for monitoring the patients and adverse effects.
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Affiliation(s)
- Maryam Kashanian
- Department of Obstetrics & Gynecology, Iran University of Medical Sciences, Akbarabadi Teaching Hospital, Tehran, Iran.,National Association of Iranian Obstetricians & Gynecologists (NAIGO), Tehran, Iran
| | - Shohreh Bahasadri
- Department of Obstetrics & Gynecology, Iran University of Medical Sciences, Akbarabadi Teaching Hospital, Tehran, Iran
| | - Ashraf Nejat Dehkordy
- Department of Obstetrics & Gynecology, Iran University of Medical Sciences, Akbarabadi Teaching Hospital, Tehran, Iran
| | | | - Noushin Eshraghi
- Department of Obstetrics & Gynecology, Iran University of Medical Sciences, Akbarabadi Teaching Hospital, Tehran, Iran.,National Association of Iranian Obstetricians & Gynecologists (NAIGO), Tehran, Iran
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Kashanian M, Eshraghi N, Rahimi M, Sheikhansari N, Javanmanesh F. Efficacy comparison of titrated oral solution of misoprostol and intravenous oxytocin on labour induction in women with full-term pregnancy. J OBSTET GYNAECOL 2019; 40:20-24. [PMID: 31195867 DOI: 10.1080/01443615.2019.1587598] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A double-blind randomised trial was conducted on women with gestational age of 40-42 weeks of pregnancy and Bishop score of more than 5. The first group received oxytocin infusion and the second group received a titrated oral solution of misoprostol. Then, the two groups were compared by the primary outcome (the number of deliveries in the first 24 hours of intervention). The two groups did not have any significant difference in maternal and gestational age at the time of intervention, primary Bishop score, parity and neonatal weight. The number of deliveries in the first 24 hours was greater in the misoprostol group. Duration of onset of intervention to proper contractions was longer in the misoprostol group. However, the number of deliveries between 6-12 hours, 12-18 hours and 18-24 hours after induction was greater in the misoprostol group. The incidence of tachysystole and meconium was greater in the misoprostol group.Impact statementWhat is already known on this subject? Labour induction is widely used where the continuation of pregnancy might be dangerous for the mother or the baby. Of the various methods used for induction, misoprostol which is a prostaglandin E1 analogue has been reviewed more in recent years. Misoprostol has various routes of administration but in most studies only vaginal administration has been evaluated, leaving us with limited data about oral administration.What do the results of this study add? Oral misoprostol is a suitable method for labour induction and can be used as an alternative to oxytocin.What are the implications of these findings for clinical practice and/or further research? Misoprostol is not expensive, has a long shelf life, accessible in underdeveloped countries and rural areas and has several routes of administrations such as oral, sublingual and vaginal. Despite the fact that the oral route of misoprostol has a fast absorption and easier administration, there are relatively few studies assessing the the use of the oral route of misoprostol. Misoprostol is a suitable method for Labour induction and it has the potentials of being used as an alternative for oxytocin, however, the optimum dosages, the preferred route of administration, the maximum dose, the maximum time for administration, and maternal and neonatal safety should be studied more.
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Affiliation(s)
- Maryam Kashanian
- Department of Obstetrics and Gynecology, Iran University of Medical Sciences, Akbarabadi Teaching Hospital, Tehran, Iran
| | - Noushin Eshraghi
- Department of Obstetrics and Gynecology, Iran University of Medical Sciences, Akbarabadi Teaching Hospital, Tehran, Iran
| | - Maryam Rahimi
- Department of Obstetrics and Gynecology, Iran University of Medical Sciences, Akbarabadi Teaching Hospital, Tehran, Iran
| | | | - Forough Javanmanesh
- Department of Obstetrics and Gynecology, Iran University of Medical Sciences, Akbarabadi Teaching Hospital, Tehran, Iran
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Labor Induction with Orally Administrated Misoprostol: A Retrospective Cohort Study. BIOMED RESEARCH INTERNATIONAL 2017; 2017:6840592. [PMID: 29124067 PMCID: PMC5624161 DOI: 10.1155/2017/6840592] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/11/2017] [Accepted: 07/25/2017] [Indexed: 11/20/2022]
Abstract
Introduction One great challenge in obstetric care is labor inductions. Misoprostol has advantages in being cheap and stable at room temperature and available in resource-poor settings. Material and Methods Retrospective cohort study of 4002 singleton pregnancies with a gestational age ≥34 w at Sodersjukhuset, Stockholm, during 2009-2010 and 2012-2013. Previously used methods of labor induction were compared with misoprostol given as a solution to drink, every second hour. Main outcome is as follows: Cesarean Section (CS) rate, acid-base status in cord blood, Apgar score < 7,5′, active time of labor, and blood loss > 1500 ml (PPH). Results The proportion of CS decreased from 26% to 17% when orally given solution of misoprostol was introduced at the clinic (p < 0.001). No significant difference in the frequency of low Apgar score (p = 0.3), low aPh in cord blood (p = 0.1), or PPH (p = 0.4) between the different methods of induction was studied. After adjustment for different risk factor for CS the only method of induction which was associated with CS was dinoproston⁎⁎ (Propess®) (aor = 2.9 (1.6–5.2)). Conclusion Induction of labor with misoprostol, given as an oral solution to drink every second hour, gives a low rate of CS, without affecting maternal or fetal outcome.
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Wang X, Yang A, Ma Q, Li X, Qin L, He T. Comparative study of titrated oral misoprostol solution and vaginal dinoprostone for labor induction at term pregnancy. Arch Gynecol Obstet 2016; 294:495-503. [PMID: 26746850 PMCID: PMC4981622 DOI: 10.1007/s00404-015-4000-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 12/18/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate effectiveness and safety of titrated oral misoprostol solution (OMS) in comparison with vaginal dinoprostone for cervix ripening and labor induction in term pregnant women. METHODS A multicenter randomized controlled trial of women with term singleton pregnancy with indications for labor induction; 481 participants were allocated to receive titrated OMS with different doses by hourly administration according to the procedure or insert vaginal dinoprostone for cervix ripening and labor induction to compare maternal outcomes including indication of labor induction, mode of outcome of delivery, maternal morbidity, and neonatal outcomes between two groups for evaluating the efficacy and safety of titrated oral misoprostol induction. RESULT Proportion of delivery within 12 h of titrated oral misoprostol is significantly less than vaginal dinoprostone (p = 0.03), but no difference of total vaginal delivery rate (p = 0.93); the mean time of first treatment to vaginal delivery was longer in OMS group (21.3 ± 14.5 h) compared with the vaginal dinoprostone group (15.7 ± 9.6 h). Although the proportion of cesarean section between the two groups showed no statistically significant difference, OMS group showed significantly lower frequency of uterine hyperstimulation, hypertonus, partus precipitatus and non-reassuring fetal heart rate than dinoprostone group. Neonatal outcomes were similar evaluating from Apgar score and NICU admission. Our study also showed that labor induction of women with cervix Bishop score ≤3 needed increased dosage of misoprostol solution. CONCLUSION Titrated OMS is as effective as vaginal dinoprostone in labor induction for term pregnant women, with safer effect for its lower rate of adverse effect for women.
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Affiliation(s)
- Xiu Wang
- Department of Gynecology and Obstetrics, Affiliated Guangren Hospital of Xi’an Jiaotong University, No. 21, Jiefang Road, Xi’an, 710004 Shaanxi China
| | - Aijun Yang
- Department of Gynecology and Obstetrics, Affiliated Guangren Hospital of Xi’an Jiaotong University, No. 21, Jiefang Road, Xi’an, 710004 Shaanxi China
| | - Qingyong Ma
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Medical College, Xi’an Jiaotong University, No. 61, Jiankang Road, Xi’an, 710061 Shaanxi China
| | - Xuelan Li
- Department of Gynecology and Obstetrics, First Affiliated Hospital of Medical College, Xi’an Jiaotong University, No. 61, Jiankang Road, Xi’an, 710061 Shaanxi China
| | - Li Qin
- Obstetric Department of Shannxi Province People Hospital, No. 42, Friendship Road, Xi’an, 710068 Shaanxi China
| | - Tongqiang He
- Obstetric Department of Maternal and Child Care Service Center of Northwest, No. 1616, Yanxiang Road, Xi’an, 710008 Shaanxi China
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Cudaback E, Jorstad NL, Yang Y, Montine TJ, Keene CD. Therapeutic implications of the prostaglandin pathway in Alzheimer's disease. Biochem Pharmacol 2014; 88:565-72. [PMID: 24434190 DOI: 10.1016/j.bcp.2013.12.014] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/18/2013] [Accepted: 12/18/2013] [Indexed: 11/19/2022]
Abstract
An important pathologic hallmark of Alzheimer's disease (AD) is neuroinflammation, a process characterized in AD by disproportionate activation of cells (microglia and astrocytes, primarily) of the non-specific innate immune system within the CNS. While inflammation itself is not intrinsically detrimental, a delicate balance of pro- and anti-inflammatory signals must be maintained to ensure that long-term exaggerated responses do not damage the brain over time. Non-steroidal anti-inflammatory drugs (NSAIDs) represent a broad class of powerful therapeutics that temper inflammation by inhibiting cyclooxygenase-mediated signaling pathways including prostaglandins, which are the principal mediators of CNS neuroinflammation. While historically used to treat discrete or systemic inflammatory conditions, epidemiologic evidence suggests that protracted NSAID use may delay AD onset, as well as decrease disease severity and rate of progression. Unfortunately, clinical trials with NSAIDs have thus far yielded disappointing results, including premature discontinuation of a large-scale prevention trial due to unexpected cardiovascular side effects. Here we review the literature and make the argument that more targeted exploitation of downstream prostaglandin signaling pathways may offer significant therapeutic benefits for AD while minimizing adverse side effects. Directed strategies such as these may ultimately help to delay the deleterious consequences of brain aging and might someday lead to new therapies for AD and other chronic neurodegenerative diseases.
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Affiliation(s)
- Eiron Cudaback
- University of Washington Harborview Medical Center, Department of Pathology, Box 359791, 325 Ninth Ave, Seattle, WA 98104, USA
| | - Nikolas L Jorstad
- University of Washington Harborview Medical Center, Department of Pathology, Box 359791, 325 Ninth Ave, Seattle, WA 98104, USA
| | - Yue Yang
- University of Washington Harborview Medical Center, Department of Pathology, Box 359791, 325 Ninth Ave, Seattle, WA 98104, USA
| | - Thomas J Montine
- University of Washington Harborview Medical Center, Department of Pathology, Box 359791, 325 Ninth Ave, Seattle, WA 98104, USA
| | - C Dirk Keene
- University of Washington Harborview Medical Center, Department of Pathology, Box 359791, 325 Ninth Ave, Seattle, WA 98104, USA.
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