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Dinwoodie OM, Tucker AS, Fons JM. Tracking cell layer contribution during repair of the tympanic membrane. Dis Model Mech 2024; 17:dmm050466. [PMID: 38390727 PMCID: PMC10985735 DOI: 10.1242/dmm.050466] [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: 08/17/2023] [Accepted: 02/17/2024] [Indexed: 02/24/2024] Open
Abstract
The tympanic membrane (i.e. eardrum) sits at the interface between the middle and external ear. The tympanic membrane is composed of three layers: an outer ectoderm-derived layer, a middle neural crest-derived fibroblast layer with contribution from the mesoderm-derived vasculature, and an inner endoderm-derived mucosal layer. These layers form a thin sandwich that is often perforated following trauma, pressure changes or middle ear inflammation. During healing, cells need to bridge the perforation in the absence of an initial scaffold. Here, we assessed the contribution, timing and interaction of the different layers during membrane repair by using markers and reporter mice. We showed that the ectodermal layer is retracted after perforation, before proliferating away from the wound edge, with keratin 5 basal cells migrating over the hole to bridge the gap. The mesenchymal and mucosal layers then used this scaffold to complete the repair, followed by advancement of the vasculature. Finally, differentiation of the epithelium led to formation of a scab. Our results reveal the dynamics and interconnections between the embryonic germ layers during repair and highlight how defects might occur.
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Affiliation(s)
- Olivia M. Dinwoodie
- Centre for Craniofacial and Regenerative Biology, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London SE1 9RT, UK
| | - Abigail S. Tucker
- Centre for Craniofacial and Regenerative Biology, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London SE1 9RT, UK
| | - Juan M. Fons
- Centre for Craniofacial and Regenerative Biology, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London SE1 9RT, UK
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von Witzleben M, Stoppe T, Zeinalova A, Chen Z, Ahlfeld T, Bornitz M, Bernhardt A, Neudert M, Gelinsky M. Multimodal additive manufacturing of biomimetic tympanic membrane replacements with near tissue-like acousto-mechanical and biological properties. Acta Biomater 2023; 170:124-141. [PMID: 37696412 DOI: 10.1016/j.actbio.2023.09.005] [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: 04/04/2023] [Revised: 08/08/2023] [Accepted: 09/05/2023] [Indexed: 09/13/2023]
Abstract
The three additive manufacturing techniques fused deposition modeling, gel plotting and melt electrowriting were combined to develop a mimicry of the tympanic membrane (TM) to tackle large TM perforations caused by chronic otitis media. The mimicry of the collagen fiber orientation of the TM was accompanied by a study of multiple funnel-shaped mimics of the TM morphology, resulting in mechanical and acoustic properties similar to those of the eardrum. For the different 3D printing techniques used, the process parameters were optimized to allow reasonable microfiber arrangements within the melt electrowriting setup. Interestingly, the fiber pattern was less important for the acousto-mechanical properties than the overall morphology. Furthermore, the behavior of keratinocytes and fibroblasts is crucial for the repair of the TM, and an in vitro study showed a high biocompatibility of both primary cell types while mimicking the respective cell layers of the TM. A simulation of the in vivo ingrowth of both cell types resulted in a cell growth orientation similar to the original collagen fiber orientation of the TM. Overall, the combined approach showed all the necessary parameters to support the growth of a neo-epithelial layer with a similar structure and morphology to the original membrane. It therefore offers a suitable alternative to autologous materials for the treatment of chronic otitis media. STATEMENT OF SIGNIFICANCE: Millions of people worldwide suffer from chronic middle ear infections. Although the tympanic membrane (TM) can be reconstructed with autologous materials, the grafts used for this purpose require extensive manual preparation during surgery. This affects not only the hearing ability but also the stability of the reconstructed TM, especially in the case of full TM reconstruction. The synthetic alternative presented here mimicked not only the fibrous structure of the TM but also its morphology, resulting in similar acousto-mechanical properties. Furthermore, its high biocompatibility supported the migration of keratinocytes and fibroblasts to form a neo-epithelial layer. Overall, this completely new TM replacement was achieved by combining three different additive manufacturing processes.
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Affiliation(s)
- Max von Witzleben
- Technische Universität Dresden, Faculty of Medicine Carl Gustav Dresden, Centre for Translational Bone, Joint and Soft Tissue Research, Fetscherstr. 74, 01307 Dresden, Germany
| | - Thomas Stoppe
- Technische Universität Dresden, Faculty of Medicine Carl Gustav Carus, Department of Otorhinolaryngology, Head and Neck Surgery, Ear Research Center Dresden (ERCD), Fetscherstr. 74, 01307 Dresden, Germany
| | - Alina Zeinalova
- Technische Universität Dresden, Faculty of Medicine Carl Gustav Dresden, Centre for Translational Bone, Joint and Soft Tissue Research, Fetscherstr. 74, 01307 Dresden, Germany
| | - Zhaoyu Chen
- Technische Universität Dresden, Faculty of Medicine Carl Gustav Carus, Department of Otorhinolaryngology, Head and Neck Surgery, Ear Research Center Dresden (ERCD), Fetscherstr. 74, 01307 Dresden, Germany
| | - Tilman Ahlfeld
- Technische Universität Dresden, Faculty of Medicine Carl Gustav Dresden, Centre for Translational Bone, Joint and Soft Tissue Research, Fetscherstr. 74, 01307 Dresden, Germany
| | - Matthias Bornitz
- Technische Universität Dresden, Faculty of Medicine Carl Gustav Carus, Department of Otorhinolaryngology, Head and Neck Surgery, Ear Research Center Dresden (ERCD), Fetscherstr. 74, 01307 Dresden, Germany
| | - Anne Bernhardt
- Technische Universität Dresden, Faculty of Medicine Carl Gustav Dresden, Centre for Translational Bone, Joint and Soft Tissue Research, Fetscherstr. 74, 01307 Dresden, Germany
| | - Marcus Neudert
- Technische Universität Dresden, Faculty of Medicine Carl Gustav Carus, Department of Otorhinolaryngology, Head and Neck Surgery, Ear Research Center Dresden (ERCD), Fetscherstr. 74, 01307 Dresden, Germany
| | - Michael Gelinsky
- Technische Universität Dresden, Faculty of Medicine Carl Gustav Dresden, Centre for Translational Bone, Joint and Soft Tissue Research, Fetscherstr. 74, 01307 Dresden, Germany.
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Ji C, Zhang X, Yan X, Cao S, Fu T. Cholesteatoma in chronic otitis media secondary to pars tensa perforation. Acta Otolaryngol 2023; 143:376-381. [PMID: 37082904 DOI: 10.1080/00016489.2023.2200437] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
BACKGROUND Acquired cholesteatoma secondary to pars tensa perforation was rare in clinic. OBJECTIVES In this study, we explored factors related to acquired cholesteatoma in chronic otitis media patients with pars tensa perforation. MATERIAL AND METHODS 262 adults (296 ears) with pars tensa perforation were divided into four groups: anterior perforation group, posterior perforation group, central perforation group, and marginal perforation group. Analysis was carried out in terms of cholesteatoma formation, adhesion of perforation edges, mastoid pneumatization, and the function of eustachian tube. RESULTS Cholesteatoma was found in 34% (18 in 53 ears) in posterior perforation group, 14.3% (14 in 98 ears) in marginal perforation group, and 2.5% (2 in 80 ears) in anterior perforation group. For subjects with adhesion in perforation edges, cholesteatoma was approved in 94% of posterior perforation, 42% of marginal perforation and 25% of anterior perforation groups. The adhesion in perforation edges and function of eustachian tube instead of mastoid pneumatization were statistically significant for cholesteatoma formation. CONCLUSIONS AND SIGNIFICANCE Acquired cholesteatoma was mostly found in patients with posterior and marginal perforation, followed by anterior perforation. Adhesion of perforation edges was another risk factor for cholesteatoma formation. Eustachian tube also functioned by influencing the ventilation of middle ear.
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Affiliation(s)
- Caili Ji
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaowen Zhang
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xudong Yan
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Songli Cao
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Tao Fu
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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A design-thinking approach to therapeutic translation: tympanic regeneration. Curr Opin Otolaryngol Head Neck Surg 2021; 28:274-280. [PMID: 32833885 DOI: 10.1097/moo.0000000000000650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Clinician researchers face the pressures of meeting academic benchmarks combined with advancing new therapies to patients. The vast majority of drug discoveries fail in translation. A new method of meeting the challenges of preclinical therapeutic translation is presented using the example of tympanic regeneration. RECENT FINDINGS The key to a design-thinking approach to therapeutic translation is to 'begin with the end in mind' by widening the scope of the problem, with multiple points of view, to not only understand the disease but the context for the patient and the health system in which it occurs. Idea for therapeutics should be tested in relevant models early and once proof of efficacy is established, translational milestones that represent the greatest risk, such as safety and toxicity should be addressed first. It is important to seek the feedback of industry early to understand what milestones should be best addressed next with limited academic resources. Whenever proceeding, guidelines for maintaining scientific reproducibility should be followed to minimize risk of failure during transfer into industry. SUMMARY A Design-thinking approach addresses the potential failures in drug discovery and preclinical translation.
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Abstract
PURPOSE OF REVIEW One of the most common diseases of the tympanic membrane is a perforation, and tympanoplasty is one of the more common procedures in otolaryngology. Tympanic membrane regeneration and bioengineering aim to improve the success rate of the procedure, increase the availability of different scaffolds and provide innovative tools that will simplify the surgical technique and make it accessible for surgeons with varying expertise level. This review aims to raise awareness of current tissue engineering developments in tympanic membrane regeneration and how they may augment current clinical practices. We focus here on achievements in tympanic membrane cell cultures and on innovations in development of new scaffolds and growth factors that enhance regeneration of patient's native tympanic membranes. RECENT FINDINGS In recent years, great achievements were reached in the field of tympanic membrane regeneration in the three hallmarks of bioengineering: cells, scaffolds and bioactive molecules. New techniques for modeling normal tympanic membrane proliferation were developed, as well as for isolation and expansion of normal tympanic membrane keratinocytes from miniature samples of scarred tissue. Ongoing clinical trials aim to seal the perforation by applying different scaffolds infiltrated by growth factors on the tympanic membrane. SUMMARY Research efforts in tympanic membrane regeneration continue to seek the ideal single tissue-engineered substitute. Recent advances in tympanic membrane bioengineering include new types of scaffolds that may augment and provide a safe and effective alternative to the current gold-standard autograft. New bioactive molecules may simplify the surgical procedure and reduce surgical time by augmenting the native tympanic membrane regeneration. Several groups of bioengineering scientists and neurotologists are continuing to move forward and develop new strategies, seeking to create a fully functional tissue-engineered tympanic membrane.
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Liew LJ, Chen LQ, Wang AY, von Unge M, Atlas MD, Dilley RJ. Tympanic Membrane Derived Stem Cell-Like Cultures for Tissue Regeneration. Stem Cells Dev 2018; 27:649-657. [DOI: 10.1089/scd.2018.0021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lawrence J. Liew
- Ear Sciences Centre, School of Medicine, University of Western Australia, Perth, Australia
- Ear Science Institute Australia, Perth, Australia
| | - Linda Q. Chen
- Ear Science Institute Australia, Perth, Australia
- School of Veterinary and Life Sciences, Murdoch University, Perth, Australia
| | - Allen Y. Wang
- Ear Sciences Centre, School of Medicine, University of Western Australia, Perth, Australia
- Ear Science Institute Australia, Perth, Australia
- Department of Otolaryngology, Head and Neck, Skull Base Surgery, Sir Charles Gairdner Hospital, Perth, Australia
| | - Magnus von Unge
- Akershus University Hospital and University of Oslo, Oslo, Norway
- Centre for Clinical Research Västerås, University of Uppsala, Uppsala, Sweden
| | - Marcus D. Atlas
- Ear Sciences Centre, School of Medicine, University of Western Australia, Perth, Australia
- Ear Science Institute Australia, Perth, Australia
| | - Rodney J. Dilley
- Ear Sciences Centre, School of Medicine, University of Western Australia, Perth, Australia
- Ear Science Institute Australia, Perth, Australia
- The Centre for Cell Therapy and Regenerative Medicine, School of Medicine, University of Western Australia, Perth, Australia
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Ong HT, Redmond SL, Marano RJ, Atlas MD, von Unge M, Aabel P, Dilley RJ. Paracrine Activity from Adipose-Derived Stem Cells on In Vitro Wound Healing in Human Tympanic Membrane Keratinocytes. Stem Cells Dev 2017; 26:405-418. [DOI: 10.1089/scd.2016.0204] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Huan Ting Ong
- Ear Science Institute Australia, Nedlands, Australia
- School of Veterinary and Life Sciences, Murdoch University, Murdoch, Australia
| | - Sharon L. Redmond
- Ear Science Institute Australia, Nedlands, Australia
- Ear Sciences Centre, University of Western Australia, Perth, Australia
| | - Robert J. Marano
- Ear Science Institute Australia, Nedlands, Australia
- Ear Sciences Centre, University of Western Australia, Perth, Australia
| | - Marcus D. Atlas
- Ear Science Institute Australia, Nedlands, Australia
- Ear Sciences Centre, University of Western Australia, Perth, Australia
| | - Magnus von Unge
- Division of Surgery, Akershus University Hospital and University of Oslo, Oslo, Norway
- Centre for Clinical Research Västerås, University of Uppsala, Uppsala, Sweden
| | - Peder Aabel
- Division of Surgery, Akershus University Hospital and University of Oslo, Oslo, Norway
| | - Rodney J. Dilley
- Ear Science Institute Australia, Nedlands, Australia
- Ear Sciences Centre, University of Western Australia, Perth, Australia
- Centre for Cell Therapy and Regenerative Medicine, University of Western Australia, Perth, Australia
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Wang AY, Liew LJ, Shen Y, Wang JT, von Unge M, Atlas MD, Dilley RJ. Rat model of chronic tympanic membrane perforation: A longitudinal histological evaluation of underlying mechanisms. Int J Pediatr Otorhinolaryngol 2017; 93:88-96. [PMID: 28109506 DOI: 10.1016/j.ijporl.2016.12.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 12/15/2016] [Accepted: 12/18/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate histologically the progressive development and underlying mechanisms of chronic tympanic membrane perforation (TMP) in a rat model using a two-weeks ventilation tube (VT) treatment combined with topical application of mitomycin C/dexamethasone (VT-M/D), compared with normal tympanic membrane and acute TMPs. METHODS Fifty male Sprague-Dawley rats were divided into three experimental groups: a normal control group (n = 5), an acute TMP group (n = 5) (i.e. 3 days post-myringotomy) and a VT-M/D group (n = 40). The TMs were regularly assessed by otoscopy. The normal control animals were sacrificed on day 0 and the acute TMP group was sacrificed 3 days post-myringotomy for histological and immunohistochemical evaluations. The VT-M/D group was sacrificed at various time points - 14 and 17 days, 3, 4, 6, 8 and 10 weeks. RESULTS On longitudinal histological examination, compared with normal TM and acute TMP, the perforation edges at the later time points illustrated thickened stratified squamous epithelium rimming around the edges, significant increase in keratin and collagen deposition, increased macrophage infiltration as well as reduced cellular proliferation. Three phases of TMP healing process were identified - the acute healing phase (3-17 days), the transition phase (3-4 weeks) and the chronic phase (6-10 weeks). CONCLUSION Based on the histological results of this study, the progressive development of chronic TMPs appeared to be associated with increased epidermal thickening, collagen and keratin deposition, macrophage infiltration and reduced cellular proliferation. After the 3-4 weeks of transition phase, the TMPs seemed to have transformed into a non-healing chronic TMP between 6 and 10 weeks.
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Affiliation(s)
- Allen Y Wang
- Ear Sciences Centre, School of Surgery, The University of Western Australia, Perth, Western Australia, Australia; Ear Science Institute Australia, Perth, Western Australia, Australia; Department of Otolaryngology, Head and Neck, Skull Base Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
| | - Lawrence J Liew
- Ear Sciences Centre, School of Surgery, The University of Western Australia, Perth, Western Australia, Australia; Ear Science Institute Australia, Perth, Western Australia, Australia
| | - Yi Shen
- Ear Sciences Centre, School of Surgery, The University of Western Australia, Perth, Western Australia, Australia; Ear Science Institute Australia, Perth, Western Australia, Australia; Department of Otolaryngology, Head and Neck Surgery, Ningbo Lihuili Hospital (Ningbo Medical Centre), Ningbo, Zhejiang, China
| | - Jeffrey T Wang
- Ear Sciences Centre, School of Surgery, The University of Western Australia, Perth, Western Australia, Australia
| | - Magnus von Unge
- Akershus University Hospital and University of Oslo, Norway; Center for Clinical Research Västerås, University of Uppsala, Sweden
| | - Marcus D Atlas
- Ear Sciences Centre, School of Surgery, The University of Western Australia, Perth, Western Australia, Australia; Ear Science Institute Australia, Perth, Western Australia, Australia; Department of Otolaryngology, Head and Neck, Skull Base Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Rodney J Dilley
- Ear Sciences Centre, School of Surgery, The University of Western Australia, Perth, Western Australia, Australia; Ear Science Institute Australia, Perth, Western Australia, Australia
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Heparin Binding Epidermal Growth Factor-Like Growth Factor Heals Chronic Tympanic Membrane Perforations With Advantage Over Fibroblast Growth Factor 2 and Epidermal Growth Factor in an Animal Model. Otol Neurotol 2016; 36:1279-83. [PMID: 26075672 DOI: 10.1097/mao.0000000000000795] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HYPOTHESIS That heparin binding epidermal growth factor-like growth factor (HB-EGF) heals chronic tympanic membrane (TM) perforations at higher rates than fibroblast growth factor 2 (FGF2) and epidermal growth factor (EGF) in an animal model. BACKGROUND A nonsurgical treatment for chronic TM perforation would benefit those unable to access surgery or those unable to have surgery, as well as reducing the cost of tympanoplasty. Growth factor (GF) treatments have been reported in the literature with variable success with the lack of a suitable animal providing a major obstacle. METHODS The GFs were tested in a validated mouse model of chronic TM perforation. A bioabsorbable hydrogel polymer was used to deliver the GF at a steady concentration as it dissolved over 4 weeks. A control (polymer only, n = 18) was compared to polymer loaded with HB-EGF (5 μg/ml, n = 18), FGF2 (100 μg/ml, n = 19), and EGF (250 μg/ml, n = 19). Perforations were inspected at 4 weeks. RESULTS The healing rates, as defined as 100% perforation closure, were control (5/18, 27.8%), HB-EGF (15/18, 83.3%), FGF2 (6/19, 31.6%), and EGF (3/19, 15.8%). There were no differences between FGF2 (p = 0.80) and EGF (p = 0.31) with control healing rates. HB-EGF (p = 0.000001) showed a significant difference for healing. The HB-EGF healed TMs showed layers similar to a normal TM, whereas the other groups showed a lack of epithelial migration. CONCLUSION This study confirms the advantage of HB-EGF over two other commonly used growth factors and is a promising nonsurgical treatment of chronic TM perforations.
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Wang AY, Shen Y, Liew LJ, Wang JT, von Unge M, Atlas MD, Dilley RJ. Rat model of chronic tympanic membrane perforation: Ventilation tube with mitomycin C and dexamethasone. Int J Pediatr Otorhinolaryngol 2016; 80:61-8. [PMID: 26746614 DOI: 10.1016/j.ijporl.2015.11.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 11/12/2015] [Accepted: 11/13/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Chronic tympanic membrane perforation (TMP) in a clinical setting may attract surgical intervention. With the advent of modern biomaterials, new options are available for myringoplasty but safety and efficacy need evaluation in a chronic TMP animal model. The aim of this study was to evaluate the efficacy of ventilation tube (VT) insertion in conjunction with topical application of mitomycin C/dexamethasone (M/D) for the creation of chronic TMP in rats. METHODS Thirty male Sprague-Dawley rats underwent myringotomy of the right tympanic membrane (TM) and were divided into three experimental groups: spontaneous healing (myringotomy control), VT insertion for 2 weeks and VT insertion for 2 weeks in conjunction with topical application of M/D (VT-M/D). All TMs were regularly assessed by otoscopy for 10 weeks and then animals were sacrificed for histological evaluation. RESULTS In the VT-M/D group, seven out of ten (70%) perforations were patent at 10 weeks (mean patency, 57.9 days; P<0.01). The VT group had two out of ten (20%) perforations patent at 10 weeks (mean patency, 26.5 days; P<0.01), while all TMPs from the myringotomy control group were closed by day 9 (mean patency, 7.2 days). Histologically, the TMPs patent at week 10 had a stratified squamous epithelialized rim, keratinocyte layer thickening around the perforation edge as well as increased collagen deposition and macrophage infiltration. CONCLUSION Chronic TMP in a rat model was successfully created by VT insertion and the efficacy was increased in combination with topical application of M/D.
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Affiliation(s)
- Allen Y Wang
- Ear Sciences Centre, School of Surgery, The University of Western Australia, Perth, Western Australia, Australia; Ear Science Institute Australia, Perth, Western Australia, Australia; Department of Otolaryngology, Head and Neck, Skull Base Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
| | - Yi Shen
- Ear Sciences Centre, School of Surgery, The University of Western Australia, Perth, Western Australia, Australia; Ear Science Institute Australia, Perth, Western Australia, Australia; Department of Otolaryngology, Head and Neck Surgery, Ningbo Lihuili Hospital (Ningbo Medical Centre), Ningbo, Zhejiang, China
| | - Lawrence J Liew
- Ear Sciences Centre, School of Surgery, The University of Western Australia, Perth, Western Australia, Australia; Ear Science Institute Australia, Perth, Western Australia, Australia
| | - Jeffrey T Wang
- Ear Sciences Centre, School of Surgery, The University of Western Australia, Perth, Western Australia, Australia
| | - Magnus von Unge
- Akershus University Hospital and University of Oslo, Norway; Center for Clinical Research Västerås, University of Uppsala, Sweden
| | - Marcus D Atlas
- Ear Sciences Centre, School of Surgery, The University of Western Australia, Perth, Western Australia, Australia; Ear Science Institute Australia, Perth, Western Australia, Australia; Department of Otolaryngology, Head and Neck, Skull Base Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Rodney J Dilley
- Ear Sciences Centre, School of Surgery, The University of Western Australia, Perth, Western Australia, Australia; Ear Science Institute Australia, Perth, Western Australia, Australia
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Secreted biofilm factors adversely affect cellular wound healing responses in vitro. Sci Rep 2015; 5:13296. [PMID: 26278131 PMCID: PMC5388174 DOI: 10.1038/srep13296] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 07/16/2015] [Indexed: 12/27/2022] Open
Abstract
Although most chronic wounds possess an underlying pathology, infectious agents also contribute. In many instances, pathogens exist as biofilms forming clusters surrounded by a secreted extracellular substance. We hypothesized that compounds secreted by biofilm bacteria may inhibit normal wound healing events including cell proliferation and migration. Conditioned media from two common bacterial species associated with chronic skin wounds and chronic tympanic membrane perforations, Staphylococcus aureus and Pseudomonas aeruginosa, were evaluated for their capacity to affect keratinocyte proliferation and migration. Additionally, proteomic analysis was performed to identify proteins within the biofilm conditioned media that may contribute to these observed effects. Biofilm conditioned media from both species inhibited proliferation in human tympanic membrane derived keratinocytes, whereas only biofilm conditioned media from S. aureus inhibited migration. Human epidermal keratinocytes were found to be more sensitive to the effects of the conditioned media resulting in high levels of cell death. Heat treatment and microfiltration suggested that S. aureus activity was due to a protein, while P. aeruginosa activity was more likely due to a small molecule. Proteomic analysis identified several proteins with putative links to delayed wound healing. These include alpha hemolysin, alcohol dehydrogenase, fructose-bisphosphate aldolase, lactate dehydrogenase and epidermal cell differentiation inhibitor.
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Searching for a rat model of chronic tympanic membrane perforation: Healing delayed by mitomycin C/dexamethasone but not paper implantation or iterative myringotomy. Int J Pediatr Otorhinolaryngol 2015; 79:1240-7. [PMID: 26060147 DOI: 10.1016/j.ijporl.2015.05.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 05/14/2015] [Accepted: 05/16/2015] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Surgical intervention such as myringoplasty or tympanoplasty is an option in the current clinical management of chronic tympanic membrane perforation (TMP). Animal models of chronic TMP are needed for pre-clinical testing of new materials and to improve existing techniques. We evaluated several reported animal model techniques from the literature for the creation of chronic TMPs. The aim of this study was to evaluate production of chronic TMPs in a rat model using topical mitomycin C/dexamethasone, paper insertion into middle ear cavity (MEC) or re-myringotomy. METHODS Forty male Sprague-Dawley rats underwent myringotomy of the right tympanic membrane (TM) and were randomly divided into 3 experimental groups: application of topical mitomycin C/dexamethasone, paper insertion into middle ear cavity, or re-myringotomy. Control perforations were allowed to close spontaneously. TMs were assessed regularly with otoscopy for 8 weeks. At the end of 8 weeks, animals were sacrificed for histology. RESULTS The closure of TMPs was significantly delayed by mitomycin C/dexamethasone (mean patency, 18.9 days; P≤0.01) compared with the control (mean patency, 7 days), but was not significantly delayed in the paper insertion group (mean patency, 9.4 days; P=0.74). Repeated myringotomy of closed perforations (mean number of myringotomies, 8.9 per ear) stimulated acceleration of closure rather than delay. Histologically, the mitomycin C/dexamethasone group had almost normal TM morphology, while the paper insertion group revealed inflammatory and granulomatous responses. The re-myringotomy group had a thickened TM fibrous layer with collagen deposition. CONCLUSIONS Mitomycin C/dexamethasone delayed TMP closure in rats but the effect was not sufficiently long-lasting to be defined as a chronic TMP. Neither paper insertion into middle ear cavity nor re-myringotomy created chronic TMP in rats.
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Makuszewska M, Sokołowska M, Hassmann-Poznańska E, Bialuk I, Skotnicka B, Bonda T, Reszeć J, Winnicka MM. Enhanced expression of hepatocyte growth factor in the healing of experimental acute tympanic membrane perforation. Int J Pediatr Otorhinolaryngol 2015; 79:987-92. [PMID: 25920966 DOI: 10.1016/j.ijporl.2015.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/02/2015] [Accepted: 04/04/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The present study was performed to investigate the expression of hepatocyte (HGF), epidermal (EGF) and vascular endothelial (VEGF) growth factors in the course of healing of experimental tympanic membrane (TM) perforations in rats. The goal was to explain the role of these growth factors in the healing process of TM and to assess the possibility of their future application as healing promoters. METHODS Seventy rats were used, of which 10 served as controls and the others had their TM perforated. The experimental animals were divided into six subgroups on the basis of time points (01, 03, 05, 07, 09, 15 day after injury). Videootoscopy and histology were employed to assess the morphology of the healing process. The expressions of HGF, EGF and VEGF were evaluated using Western blot analysis. Tissue localization of HGF was determined by the immunofluorescence method. RESULTS HGF was hardly detectable in normal TM; however, a significant increase was noted in its expression starting from the third day after injury throughout the follow-up period, with the highest level on day 05. The analysis of HGF tissue localization with immunofluorescence revealed diffuse staining in the cytoplasm of proliferating epithelial cells. The expression of EGF was elevated on the first day after injury, not reaching statistical significance, and then returned to the level observed in the control TM. No significant differences were noted in the expression of VEGF. CONCLUSION High expression of HGF during the healing process of acute TM perforations makes it a promising candidate for further studies oriented towards its possible use in augmentation of TM healing.
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Affiliation(s)
- Maria Makuszewska
- Department of Otolaryngology, J. Śniadecki District Hospital, M. Skłodowskiej-Curie 26, 15-950 Białystok, Poland
| | - Magdalena Sokołowska
- Department of General and Experimental Pathology, Medical University of Białystok, Mickiewicza 2c, 15-222 Białystok, Poland
| | - Elżbieta Hassmann-Poznańska
- Department of Pediatric Otolaryngology, Medical University of Białystok, Waszyngtona 17, 15-274 Białystok, Poland.
| | - Izabela Bialuk
- Department of General and Experimental Pathology, Medical University of Białystok, Mickiewicza 2c, 15-222 Białystok, Poland
| | - Bożena Skotnicka
- Department of Pediatric Otolaryngology, Medical University of Białystok, Waszyngtona 17, 15-274 Białystok, Poland
| | - Tomasz Bonda
- Department of General and Experimental Pathology, Medical University of Białystok, Mickiewicza 2c, 15-222 Białystok, Poland
| | - Joanna Reszeć
- Department of Medical Pathomorphology, Medical University of Białystok, Waszyngtona 13, 15-269 Białystok, Poland
| | - Maria Małgorzata Winnicka
- Department of General and Experimental Pathology, Medical University of Białystok, Mickiewicza 2c, 15-222 Białystok, Poland
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Jackler RK, Santa Maria PL, Varsak YK, Nguyen A, Blevins NH. A new theory on the pathogenesis of acquired cholesteatoma: Mucosal traction. Laryngoscope 2015; 125 Suppl 4:S1-S14. [PMID: 26013635 DOI: 10.1002/lary.25261] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 02/20/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVES/HYPOTHESIS Although the migration of its squamous outer surface of the tympanic membrane has been well characterized, there is a paucity of data available concerning the migratory behavior of its medial mucosal surface. Existing theories of primary acquired cholesteatoma pathogenesis do not adequately explain the observed characteristics of the disease. We propose a new hypothesis, based upon a conjecture that mucosal membrane interactions are the driving force in cholesteatoma. STUDY DESIGN A retrospective chart review and a prospective observational cohort study in rats. METHODS After developing the new theory, it was tested through both clinical and experimental observations. To evaluate whether impairment of middle ear mucociliary migration would influence cholesteatoma formation, a retrospective chart review evaluating cholesteatoma occurrence in a sizable population of patients with either primary ciliary dyskinesia (PCD) or cystic fibrosis (CF) was performed. To study mucosal migration on the medial aspect of the tympanic membrane, ink tattoos were monitored over time in a rat model. RESULTS No cholesteatomas were identified in either PCD patients (470) or in CF patients (1,910). In the rat model, mucosa of the posterior pars tensa migrated toward the posterior superior quadrant, whereas the mucosa of the anterior pars tensa migrated radially toward the annulus. CONCLUSION Mucosal coupling with traction generated by interaction of migrating opposing surfaces provides the first comprehensive theory that explains the observed characteristics of primary acquired cholesteatoma. The somewhat counterintuitive hypothesis that cholesteatoma is fundamentally a mucosal disease has numerous therapeutic implications.
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Affiliation(s)
- Robert K Jackler
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Peter L Santa Maria
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Yasin K Varsak
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Anh Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Nikolas H Blevins
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
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Santa Maria PL, Kim S, Varsak YK, Yang YP. Heparin binding-epidermal growth factor-like growth factor for the regeneration of chronic tympanic membrane perforations in mice. Tissue Eng Part A 2015; 21:1483-94. [PMID: 25567607 DOI: 10.1089/ten.tea.2014.0474] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
We aim to explore the role of epidermal growth factor (EGF) ligand shedding in tympanic membrane wound healing and to investigate the translation of its modulation in tissue engineering of chronic tympanic membrane perforations. Chronic suppurative otitis media (CSOM) is an infected chronic tympanic membrane perforation. Up to 200 million suffer from its associated hearing loss and it is the most common cause of pediatric hearing loss in developing countries. There is a need for nonsurgical treatment due to a worldwide lack of resources. In this study, we show that EGF ligand shedding is essential for tympanic membrane healing as it's inhibition, with KB-R7785, leads to chronic perforation in 87.9% (n=58) compared with 0% (n=20) of controls. We then show that heparin binding-EGF-like growth factor (5 μg/mL), which acts to shed EGF ligands, can regenerate chronic perforations in mouse models with 92% (22 of 24) compared with 38% (10 of 26), also with eustachian tube occlusion with 94% (18 of 19) compared with 9% (2 of 23) and with CSOM 100% (16 of 16) compared with 41% (7 of 17). We also show the nonototoxicity of this treatment and its hydrogel delivery vehicle. This provides preliminary data for a clinical trial where it could be delivered by nonspecialist trained healthcare workers and fulfill the clinical need for a nonsurgical treatment for chronic tympanic membrane perforation and CSOM.
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Affiliation(s)
- Peter Luke Santa Maria
- 1 Department of Otolaryngology, Head and Neck Surgery, Stanford University , Stanford, California
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16
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Wang AY, Shen Y, Wang JT, Friedland PL, Atlas MD, Dilley RJ. Animal models of chronic tympanic membrane perforation: a 'time-out' to review evidence and standardize design. Int J Pediatr Otorhinolaryngol 2014; 78:2048-55. [PMID: 25455522 DOI: 10.1016/j.ijporl.2014.10.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 10/01/2014] [Accepted: 10/04/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To review the literature on techniques for creation of chronic tympanic membrane perforations (TMP) in animal models. Establishing such models in a laboratory setting will have value if they replicate many of the properties of the human clinical condition and can thus be used for investigation of novel grafting materials or other interventions. METHODS A literature search of the PubMed database (1950-August 2014) was performed. The search included all English-language literature published attempts on chronic or delayed TMP in animal models. Studies of non English-language or acute TMP were excluded. RESULTS Thirty-seven studies were identified. Various methods to create TMP in animals have been used including infolding technique, thermal injury, re-myringotomy, and topical agents including chemicals and growth factor receptor inhibitors. The most common type of animal utilized was chinchilla, followed by rat and guinea pig. Twenty three of the 37 studies reported success in achieving chronic TMP animal model while 14 studies solely delayed the healing of TMP. Numerous experimental limitations were identified including TMP patency duration of <8 weeks, lack of documentation of total number of animals attempted and absence of proof for chronicity with otoscopic and histologic evidence. CONCLUSION The existing literature demonstrates the need for an ideal chronic TMP animal model to allow the development of new treatments and evaluate the risk of their clinical application. Various identified techniques seem promising, however, a need was identified for standardization of experimental design and evidence to address multiple limitations.
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Affiliation(s)
- Allen Y Wang
- Ear Sciences Centre, School of Surgery, the University of Western Australia, Perth, Western Australia, Australia; Ear Science Institute Australia, Perth, Western Australia, Australia; Department of Otolaryngology, Head and Neck, Skull Base Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
| | - Yi Shen
- Ear Sciences Centre, School of Surgery, the University of Western Australia, Perth, Western Australia, Australia; Ear Science Institute Australia, Perth, Western Australia, Australia; Department of Otolaryngology, Head and Neck Surgery, Ningbo Lihuili Hospital (Ningbo Medical Centre) , Ningbo, Zhejiang, China
| | - Jeffrey T Wang
- Ear Sciences Centre, School of Surgery, the University of Western Australia, Perth, Western Australia, Australia
| | - Peter L Friedland
- Ear Sciences Centre, School of Surgery, the University of Western Australia, Perth, Western Australia, Australia; Ear Science Institute Australia, Perth, Western Australia, Australia; Department of Otolaryngology, Head and Neck, Skull Base Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Marcus D Atlas
- Ear Sciences Centre, School of Surgery, the University of Western Australia, Perth, Western Australia, Australia; Ear Science Institute Australia, Perth, Western Australia, Australia; Department of Otolaryngology, Head and Neck, Skull Base Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Rodney J Dilley
- Ear Sciences Centre, School of Surgery, the University of Western Australia, Perth, Western Australia, Australia; Ear Science Institute Australia, Perth, Western Australia, Australia
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Hassmann-Poznańska E, Taranta A, Bialuk I, Poznańska M, Zajączkiewicz H, Winnicka MM. Analysis of gene expression profiles in tympanic membrane following perforation using PCR Array in rats--preliminary investigation. Int J Pediatr Otorhinolaryngol 2013; 77:1753-9. [PMID: 24012216 DOI: 10.1016/j.ijporl.2013.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 08/06/2013] [Accepted: 08/09/2013] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The goal of this work was to identify genes, known to be involved in the skin wound healing, that express differentially in the healthy and injured tympanic membrane (TM), and designate the molecules potentially beneficial for treatment of TM perforation. The molecular mechanisms controlling the course of TM regeneration are far from being elucidated. METHODS Twenty rats had their tympanic membranes perforated, while four served as a control. Animals were sacrificed on either days 1, 2, 3, 5 and 10 post injury, and TMs were immediately dissected and frozen in liquid nitrogen. Total TM RNA was isolated and reversely transcribed. qPCR was performed using Rat Wound Healing RT(2) Profiler PCR Array (QIAGEN) containing primers for 84 genes. RESULTS Statistically significant changes in the expression of 42 genes were found in various stages of TM healing. The increased expression of genes taking part in the inflammatory reaction (interleukin 6, granulocyte and macrophage chemotactic proteins) was observed from day 2. The expression of several genes of extracellular matrix components and their remodeling enzymes was also changed. Among growth factor genes: Vegfa, Igf1 and Hbegf showed increased expression at the beginning of the healing process, while Hgf expression was highest on day 3. CONCLUSIONS Several changes in the expression of genes involved in remodeling of extracellular matrix point to important role of connective tissue in TM healing. The molecules accelerating this process, like HbEGF and HGF, seem to be good candidates for further evaluation of their possible use in clinical treatment.
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Affiliation(s)
- Elżbieta Hassmann-Poznańska
- Department of Pediatric Otolaryngology, Medical University of Białystok, Waszyngtona 17, 15-274 Białystok, Poland.
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TGF-α/HA complex promotes tympanic membrane keratinocyte migration and proliferation via ErbB1 receptor. Exp Cell Res 2013; 319:790-9. [DOI: 10.1016/j.yexcr.2013.01.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 12/06/2012] [Accepted: 01/26/2013] [Indexed: 12/31/2022]
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Teh BM, Marano RJ, Shen Y, Friedland PL, Dilley RJ, Atlas MD. Tissue engineering of the tympanic membrane. TISSUE ENGINEERING PART B-REVIEWS 2012; 19:116-32. [PMID: 23031158 DOI: 10.1089/ten.teb.2012.0389] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Tympanic membrane (TM) perforations are common, with current treatments for chronic perforations involving surgery, using various graft materials, from autologous cartilage or fascia through to paper patch. Recent research developments in this field have begun applying the principles of tissue engineering, with appropriate scaffolds, cells, and bioactive molecules (BMs). This has revolutionized the therapeutic approach due to the availability of a wide range of materials with appropriate compatibility and mechanical properties to regenerate the membrane acoustics and may also represent a paradigm shift in the management of TM perforations in an outpatient setting without surgery. However, many factors need to be considered in the fabrication of a bioengineered TM. This review discusses the issues associated with current treatment and examines TM wound healing relevant to the construction of a bioengineered TM. It also describes the tissue-engineering approach to TM regeneration by summarizing currently used scaffolds, BMs, and cells in TM wound healing. Finally, it considers the design of scaffolds, delivery of BMs, and cell engraftment toward potential clinical application.
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Affiliation(s)
- Bing Mei Teh
- Ear Sciences Centre, School of Surgery, The University of Western Australia, Nedlands, Australia.
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Teh BM, Shen Y, Friedland PL, Atlas MD, Marano RJ. A review on the use of hyaluronic acid in tympanic membrane wound healing. Expert Opin Biol Ther 2011; 12:23-36. [DOI: 10.1517/14712598.2012.634792] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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