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Evaluation of Toxic Properties of New Glycopeptide Flavancin on Rats. Pharmaceuticals (Basel) 2022; 15:ph15060661. [PMID: 35745578 PMCID: PMC9228439 DOI: 10.3390/ph15060661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/12/2022] [Accepted: 05/23/2022] [Indexed: 12/10/2022] Open
Abstract
Glycopeptide antibiotics have side effects that limit their clinical use. In view of this, the development of glycopeptides with improved chemotherapeutic properties remains the main direction in the search for new antibacterial drugs. The objective of this study was to evaluate the toxicological characteristics of new semi-synthetic glycopeptide flavancin. Acute and chronic toxicity of antibiotic was evaluated in Wistar rats. The medium lethal dose (LD50) and the maximum tolerated doses (MTD) were calculated by the method of Litchfield and Wilcoxon. In the chronic toxicity study, the treatment regimen consisted of 15 daily intraperitoneal injections using two dosage levels: 6 and 10 mg/kg/day. Total doses were equivalent to MTD or LD50 of flavancin, respectively. The study included assessment of the body weight, hematological parameters, blood biochemical parameters, urinalysis, and pathomorphological evaluation of the internal organs. The results of the study demonstrated that no clinical-laboratory signs of toxicity were found after 15 daily injections of flavancin at a total dose close to the MTD or LD50. The pathomorphological study did not reveal any lesions on the organ structure of animals after low-dose administration of flavancin. Thus, flavancin favorably differs in terms of toxicological properties from the glycopeptides currently used in the clinic.
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Hsu CK, Chen CY, Chen WC, Chao CM, Lai CC. Clinical efficacy and safety of novel lipoglycopeptides in the treatment of acute bacterial skin and skin structure infections: a systematic review and meta-analysis of randomized controlled trials. Expert Rev Anti Infect Ther 2021; 20:435-444. [PMID: 34550853 DOI: 10.1080/14787210.2022.1984880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND This systematic review and meta-analysis aimed to investigate the clinical efficacy and safety of novel lipoglycopeptides in treating acute bacterial skin and skin structure infections (ABSSSIs). RESEARCH DESIGN AND METHODS PubMed, Embase, Cochrane Central Register of Controlled Trials, Turning Research into Practice, and ClinicalTrials.gov were searched from inception to 20 May 2021. Randomized controlled trials (RCTs) comparing the clinical efficacy and safety of lipoglycopeptides with other comparators in treating adult patients with ABSSSIs were included. The primary outcome was clinical response. RESULTS Eight RCTs (6416 patients; lipoglycopeptides: 3359, comparators: 3057) were enrolled. Clinical response rate was not significantly different between lipoglycopeptides and comparators at early-clinical-evaluation (odds ratio [95% confidence interval]: 1.01 [0.85-1.20], I2 = 34%), end-of-treatment (0.94 [0.80-1.11], I2 = 0%), and test-of-cure (1.05 [0.85-1.30], I2 = 0%). Lipoglycopeptides showed a similar overall microbiological eradication rate (1.12 [0.90-1.38], I2 = 21%) but a borderline higher microbiological eradication rate for methicillin-resistant Staphylococcus aureus (1.37 [1.00-1.86], I2 = 0%) than the comparators. Lipoglycopeptides were not associated with a higher risk than comparators. CONCLUSIONS Lipoglycopeptides can achieve similar clinical and microbiological responses to other comparators in treating ABSSSIs. In addition, lipoglycopeptides are as tolerable as their comparators.
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Affiliation(s)
- Chi-Kuei Hsu
- Division of Pulmonary Disease, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan.,Department of Critical Care Medicine, E-Da Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Ching-Yi Chen
- Division of Pulmonary Disease, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Wang-Chun Chen
- Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan.,Department of Pharmacy, E-Da Hospital, Kaohsiung, Taiwan
| | - Chien-Ming Chao
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Taiwan
| | - Chih-Cheng Lai
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan, Taiwan
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3
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Congedi S, Minotti C, Giaquinto C, Da Dalt L, Donà D. Acute infectious osteomyelitis in children: new treatment strategies for an old enemy. World J Pediatr 2020; 16:446-455. [PMID: 32394145 DOI: 10.1007/s12519-020-00359-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 03/17/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Acute osteomyelitis still represents a significant clinical challenge, with an increasing incidence in paediatric population. A careful assessment and a rapid diagnosis with proper timing and choice of empirical antimicrobial therapy are necessary to avoid sequelae. The initial treatment should consist of empirical antibiotic therapy, to cover the major responsible pathogens in each age group. DATA SOURCES We made a literature search with PubMed and Cochrane database from 2000 to 2019 in English, French, and Spanish languages using the key words "osteomyelitis, children, clinical, diagnosis, and treatment". RESULTS The child's clinical features, age, and the microbiological profile of the geographic area should be evaluated for diagnosis and in the choice of antibiotic treatment. Latest data suggest the administration of intravenous antibiotics for a short period, with subsequent oral therapy, according to the improvement of clinical status and inflammatory markers. For children older than 3 months, the shift to oral medications is already possible after a short course of intravenous therapy, until recovery. The timing for the shift from cefazolin to cephalexin or cefuroxime, intravenous clindamycin to oral clindamycin, and intravenous ceftriaxone + oxacillin to oral equivalents will be decided according to the improvement of clinical status and inflammatory markers. We also present the approach to osteomyelitis due to difficult pathogens, such as Methicillin-resistant Staphylococcus aureus (MRSA) and Panton-Valentine leukocidin (PVL)-positive S. aureus infections. CONCLUSION In this review, we present the current approach to the clinical diagnosis and management of osteomyelitis in childhood, with an update on recent recommendations, as a useful instrument to understand the rationale of antibiotic therapy.
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Affiliation(s)
- Sabrina Congedi
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Chiara Minotti
- Department of Women's and Children's Health, University of Padua, Padua, Italy.
| | - Carlo Giaquinto
- Division of Paediatric Infectious Diseases, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Liviana Da Dalt
- Paediatric Emergency Department, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department of Women's and Children's Health, University of Padua, Padua, Italy
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Endocarditis Caused by Highly Penicillin-Resistant Viridans Group Streptococci: Still Room for Vancomycin-Based Regimens. Antimicrob Agents Chemother 2019; 63:AAC.00516-19. [PMID: 31182540 DOI: 10.1128/aac.00516-19] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/04/2019] [Indexed: 01/04/2023] Open
Abstract
Optimal treatment options remain unknown for infective endocarditis (IE) caused by penicillin-resistant (PEN-R) viridans group streptococcal (VGS) strains. The aims of this study were to report two cases of highly PEN-R VGS IE, perform a literature review, and evaluate various antibiotic combinations in vitro and in vivo The following combinations were tested by time-kill studies and in the rabbit experimental endocarditis (EE) model: PEN-gentamicin, ceftriaxone-gentamicin, vancomycin-gentamicin, daptomycin-gentamicin, and daptomycin-ampicillin. Case 1 was caused by Streptococcus parasanguinis (PEN MIC, 4 μg/ml) and was treated with vancomycin plus cardiac surgery. Case 2 was caused by Streptococcus mitis (PEN MIC, 8 μg/ml) and was treated with 4 weeks of vancomycin plus gentamicin, followed by 2 weeks of vancomycin alone. Both patients were alive and relapse-free after ≥6 months follow-up. For the in vitro studies, except for daptomycin-ampicillin, all combinations demonstrated both synergy and bactericidal activity against the S. parasanguinis isolate. Only PEN-gentamicin, daptomycin-gentamicin, and daptomycin-ampicillin demonstrated both synergy and bactericidal activity against the S. mitis strain. Both strains developed high-level daptomycin resistance (HLDR) during daptomycin in vitro passage. In the EE studies, PEN alone failed to clear S. mitis from vegetations, while ceftriaxone and vancomycin were significantly more effective (P < 0.001). The combination of gentamicin with PEN or vancomycin increased bacterial eradication compared to that with the respective monotherapies. In summary, two patients with highly PEN-R VGS IE were cured using vancomycin-based therapy. In vivo, regimens of gentamicin plus either β-lactams or vancomycin were more active than their respective monotherapies. Further clinical studies are needed to confirm the role of vancomycin-based regimens for highly PEN-R VGS IE. The emergence of HLDR among these strains warrants caution in the use of daptomycin therapy for VGS IE.
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Azrad M, Baum M, Rokney A, Levi Y, Peretz A. In vitro activity of Tedizolid and Dalbavancin against MRSA strains is dependent on infection source. Int J Infect Dis 2019; 78:107-112. [DOI: 10.1016/j.ijid.2018.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/07/2018] [Accepted: 11/15/2018] [Indexed: 01/18/2023] Open
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Olsufyeva EN, Shchekotikhin AE, Bychkova EN, Pereverzeva ER, Treshalin ID, Mirchink EP, Isakova EB, Chernobrovkin MG, Kozlov RS, Dekhnich AV, Preobrazhenskaya MN. Eremomycin pyrrolidide: a novel semisynthetic glycopeptide with improved chemotherapeutic properties. Drug Des Devel Ther 2018; 12:2875-2885. [PMID: 30237697 PMCID: PMC6137948 DOI: 10.2147/dddt.s173923] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Development of new semisynthetic glycopeptides with improved antibacterial efficacy and reduced pseudoallergic reactions. METHODS Semisynthetic glycopeptides 3-6 were synthesized from vancomycin (1) or eremomycin (2) by the condensation with pyrrolidine or piperidine. The minimum inhibitory concentration (MIC) for the new derivatives was measured by the broth micro-dilution method on a panel of clinical isolates of Staphylococcus and Enterococcus. Acute toxicity (50% lethal dose, maximum tolerated doses), antibacterial efficacy on model of systemic bacterial infection with S. aureus and pseudoallergic inflammatory reaction (on concanavalin A) of eremomycin pyrrolidide (5) were evaluated in mice according to standard procedures. RESULTS The eremomycin pyrrolidide (5) was the most active compound and showed a high activity against Gram-positive bacteria: vancomycin-susceptible staphylococci and enterococci (minimum inhibitory concentrations [MICs] 0.13-0.25 mg/L), as well as vancomycin-intermediate resistant Staphylococcus aureus (MICs 1 mg/L). Antimicrobial susceptibility tested on a panel of 676 isolates showed that 5 had similar activity for the genera Staphylococcus and Enterococcus with MIC90=0.5 mg/L, while vancomycin had MIC90=1-2 mg/L. The number of resistant strains of Enterococcus faecium (vancomycin-resistant enterococci) (MIC =64 mg/L) with this value was 7 (8%) for vancomycin (1) and 0 for the compound 5. In vivo comparative studies in a mouse model of systemic bacterial infection with S. aureus demonstrated that the efficacy of 5 was notably higher than that of the original antibiotics 1 and 2. In contrast to 1, compound 5 did not induce pseudoallergic inflammatory reaction (on concanavalin A). CONCLUSION The new semisynthetic derivative eremomycin pyrrolidide (5) has high activity against staphylococci and enterococci including vancomycin-resistant strains. Compound 5 has a higher efficacy in a model of staphylococcal sepsis than vancomycin (1) or eremomycin (2). In striking contrast to natural antibiotics, the novel derivative 5 does not induce a pseudoallergic inflammatory reaction to concanavalin A and therefore has no histamine release activity. These results indicate the advantages of a new semisynthetic glycopeptide antibiotic eremomycin pyrrolidide (5) which may be a prospective antimicrobial agent for further pre-clinical and clinical evaluations.
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Affiliation(s)
| | - Andrey E Shchekotikhin
- Gause Institute of New Antibiotics, Moscow, Russia,
- Mendeleyev University of Chemical Technology, Moscow, Russia
| | | | | | | | | | | | | | - Roman S Kozlov
- Institute of Antimicrobial Chemotherapy, Smolensk State Medical University, Smolensk, Russia
| | - Andrey V Dekhnich
- Institute of Antimicrobial Chemotherapy, Smolensk State Medical University, Smolensk, Russia
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Pfaller MA, Mendes RE, Duncan LR, Flamm RK, Sader HS. Activity of dalbavancin and comparator agents against Gram-positive cocci from clinical infections in the USA and Europe 2015–16. J Antimicrob Chemother 2018; 73:2748-2756. [DOI: 10.1093/jac/dky235] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/23/2018] [Indexed: 01/27/2023] Open
Affiliation(s)
- Michael A Pfaller
- JMI Laboratories, North Liberty, IA, USA
- University of Iowa, Iowa City, IA, USA
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Binyamin D, Nitzan O, Azrad M, Hamo Z, Koren O, Peretz A. In Vitro Activity of Tedizolid, Dalbavancin, and Ceftobiprole Against Clostridium difficile. Front Microbiol 2018; 9:1256. [PMID: 29942295 PMCID: PMC6004428 DOI: 10.3389/fmicb.2018.01256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 05/24/2018] [Indexed: 01/25/2023] Open
Abstract
Background:Clostridium difficile (C. difficile) is a major nosocomial pathogen that colonizes in the human gut. Recently, the U.S. FDA approved three new antimicrobial agents against gram-positive bacteria: Tedizolid, Dalbavancin, and Ceftobiprole. The efficacy of these antibiotics for treatment of C. difficile infection has not been thoroughly examined. The current study aimed to examine the in vitro activity of these antibiotics against C. difficile. In addition, to compare between Dalbavancin and Ceftobiprole to antibiotics from the same class: Vancomycin and Ceftriaxone, respectively. Methods: Eighty-four C. difficile isolates were tested for susceptibility to Tedizolid, Dalbavancin, Ceftobiprole, Vancomycin, and Ceftriaxone by Etest technique in order to determine the minimum inhibitory concentration (MIC). Results: Upon comparison of the novel antibiotic agents, Dalbavancin demonstrated the lowest MIC values and ceftobiprole the highest at MIC50 (0.016, 0.38, and 1.5 μg/mL, for Dalbavancin, Tedizolid, and Ceftobiprole, respectively) and MIC90 (0.03, 0.78, and 3.17 μg/mL, respectively). Dalbavancin demonstrated significantly lower MIC50 and MIC90 values compared to Vancomycin (0.016 vs. 0.38 and 0.03 vs. 3.5, respectively) (p < 0.001) and ceftobiprole had significantly lower MIC values compare to ceftriaxone (1.5 vs. 32 and 3.17 vs. 28.8, respectively) (p < 0.001). Conclusion: Dalbavancin and Tedizolid may play a role as potential therapeutic agents for treatment of C. difficile infection. Examination of antibiotic effect on the intestinal microbiome and clinical trials are needed for more accurate results.
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Affiliation(s)
- Dana Binyamin
- Clinical Microbiology Laboratory, Baruch Padeh Medical Center, Poriya, Azrieli Faculty of Medicine, Bar Ilan University, Galilee, Israel.,The Azrieli Faculty of Medicine, Bar Ilan University, Galilee, Israel
| | - Orna Nitzan
- The Azrieli Faculty of Medicine, Bar Ilan University, Galilee, Israel.,Unit of Infectious Diseases, Baruch Padeh Medical Center, Poriya, Azrieli Faculty of Medicine, Bar Ilan University, Galilee, Israel
| | - Maya Azrad
- Clinical Microbiology Laboratory, Baruch Padeh Medical Center, Poriya, Azrieli Faculty of Medicine, Bar Ilan University, Galilee, Israel
| | - Zohar Hamo
- Clinical Microbiology Laboratory, Baruch Padeh Medical Center, Poriya, Azrieli Faculty of Medicine, Bar Ilan University, Galilee, Israel.,The Azrieli Faculty of Medicine, Bar Ilan University, Galilee, Israel
| | - Omry Koren
- The Azrieli Faculty of Medicine, Bar Ilan University, Galilee, Israel
| | - Avi Peretz
- Clinical Microbiology Laboratory, Baruch Padeh Medical Center, Poriya, Azrieli Faculty of Medicine, Bar Ilan University, Galilee, Israel.,The Azrieli Faculty of Medicine, Bar Ilan University, Galilee, Israel
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Pfaller MA, Flamm RK, Castanheira M, Sader HS, Mendes RE. Dalbavancin in-vitro activity obtained against Gram-positive clinical isolates causing bone and joint infections in US and European hospitals (2011–2016). Int J Antimicrob Agents 2018; 51:608-611. [DOI: 10.1016/j.ijantimicag.2017.12.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 10/13/2017] [Accepted: 12/16/2017] [Indexed: 10/18/2022]
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10
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Abstract
Several new antimicrobial agents-daptomycin, ceftaroline, telavancin, dalbavancin, and-tedizolid have been approved for the treatment of staphylococcal infections, including methicillin-resistant Staphylococcus aureus (MRSA), in adults. Ceftaroline and daptomycin have been approved by the US Food and Drug Administration for use in children. Ceftaroline, a beta-lactam antibiotic with activity against MRSA, has been approved for treatment of community-acquired bacterial pneumonia and complicated skin and skin structure infections. Daptomycin has been approved for treatment of complicated skin and skin structure infections. In this article, we review the pharmacokinetics and pharmacodynamics of these antibiotics and available data on use in children.
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Activity of dalbavancin tested against Gram-positive clinical isolates causing skin and skin-structure infections in paediatric patients from US hospitals (2014–2015). J Glob Antimicrob Resist 2017; 11:4-7. [DOI: 10.1016/j.jgar.2017.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/01/2017] [Accepted: 06/02/2017] [Indexed: 01/22/2023] Open
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Ramírez Hidalgo M, Jover-Sáenz A, García-González M, Barcenilla-Gaite F. Dalbavancin treatment of prosthetic knee infection due to oxacillin-resistant Staphylococcus epidermidis. Enferm Infecc Microbiol Clin 2017; 36:142-143. [PMID: 28600171 DOI: 10.1016/j.eimc.2017.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 04/25/2017] [Accepted: 04/26/2017] [Indexed: 12/24/2022]
Affiliation(s)
- María Ramírez Hidalgo
- Unidad Funcional de Infecciones Nosocomiales, Hospital Universitari Arnau de Vilanova, Lleida, España.
| | - Alfredo Jover-Sáenz
- Unidad Funcional de Infecciones Nosocomiales, Hospital Universitari Arnau de Vilanova, Lleida, España
| | - Mercè García-González
- Departamento de Microbiología, Hospital Universitari Arnau de Vilanova, Lleida, España
| | - Fernando Barcenilla-Gaite
- Unidad Funcional de Infecciones Nosocomiales, Hospital Universitari Arnau de Vilanova, Lleida, España
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Abstract
Intravenous dalbavancin (Dalvance®, Xydalba®), first approved as a two-dose regimen for the treatment of acute bacterial skin and skin structure infections (ABSSSI), has now been additionally approved as a single-dose regimen. This narrative review discusses the pharmacological properties of intravenous dalbavancin and its clinical efficacy and tolerability as a single-dose regimen in the treatment of adult patients with ABSSSI. Single-dose dalbavancin is an effective and generally well tolerated treatment option for adults with ABSSSI, with noninferior efficacy to the two-dose dalbavancin regimen with regard to early clinical response (at 48-72 h) and low rates of adverse events. Clinical success rates at days 14 and 28 also did not significantly differ between the single- and two-dose dalbavancin regimens; neither did clinical success rates at day 14 when analysed by baseline pathogen. It has a broad spectrum of activity against common ABSSSI-related pathogens, and a favourable pharmacokinetic profile allowing for the convenience of single-dose administration. Thus, dalbavancin presents a promising alternative to conventional antibacterials for the treatment of ABSSSI in adult patients.
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Dash RP, Babu RJ, Srinivas NR. Review of the pharmacokinetics of dalbavancin, a recently approved lipoglycopeptide antibiotic. Infect Dis (Lond) 2017; 49:483-492. [DOI: 10.1080/23744235.2017.1296968] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Ranjeet Prasad Dash
- Department of Drug Discovery and Development, Harrison School of Pharmacy, Auburn University, AL, USA
| | - R. Jayachandra Babu
- Department of Drug Discovery and Development, Harrison School of Pharmacy, Auburn University, AL, USA
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Sweeney D, Shinabarger DL, Arhin FF, Belley A, Moeck G, Pillar CM. Comparative in vitro activity of oritavancin and other agents against methicillin-susceptible and methicillin-resistant Staphylococcus aureus. Diagn Microbiol Infect Dis 2017; 87:121-128. [DOI: 10.1016/j.diagmicrobio.2016.11.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 10/31/2016] [Accepted: 11/07/2016] [Indexed: 02/07/2023]
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