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Niwińska A, Kunkiel M. Type of Recurrence, Cause of Death and Second Neoplasms among 737 Patients with Ductal Carcinoma In Situ of the Breast—15-Year Follow-Up. Cancers (Basel) 2022; 14:cancers14030669. [PMID: 35158936 PMCID: PMC8833655 DOI: 10.3390/cancers14030669] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/10/2022] [Accepted: 01/15/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary A retrospective analysis of 737 consecutive DCIS patients with a 15-year follow-up was carried out. Sixty-six recurrences (42% DCIS, 58% invasive) were reported: 61 in the breast and 5 outside the breast. 79% of local recurrences were true recurrences. The highest number of recurrences was reported in patients after local excision without radiotherapy despite the fact that it was the lowest-risk group. Deaths due to DCIS progression were reported in 0.5% of all patients and in 10.5% of patients with invasive recurrences. The majority of deaths were linked to the age of the patients or other diseases, including other neoplasms. Abstract Aim: To assess the outcomes of 737 consecutive patients with DCIS, with particular attention to the type of recurrences, other malignancies and causes of deaths. Material and Methods: A retrospective analysis of 737 consecutive DCIS patients treated in one institution in the years 1996–2011 was carried out. The cumulative recurrence risk, DFS, OS depending on the method of treatment (mastectomy, breast-conserving treatment (BCT), breast-conserving surgery (BCS)) and cause of death were assessed. Results: Sixty-six recurrences (42% DCIS, 58% invasive) were reported: 61 in the breast and 5 outside the breast. The cumulative recurrence risk after a 15-year observation after mastectomy, BCT and BCS was 3.2%, 19.5% and 31.2%, respectively (p < 0.001). The 15-year DFS after mastectomy, BCT and BCS was 72%, 65% and 48%, respectively (p < 0.001). The 15-year OS after mastectomy, BCT and BCS was 75%, 83% and 70%, respectively (p = 0.329). Deaths due to DCIS progression were reported in four (0.5%) of the overall patients and in 10.5% of patients with invasive recurrences. The majority of deaths were linked to the age of the patients or other diseases, including other neoplasms, but not DCIS. Conclusions: The highest number of recurrences was reported in patients after BCS, despite the fact that it was the lowest-risk group. In total, 79% of local recurrences were true recurrences and 58% were invasive recurrences. Local recurrences were effectively treated without an influence on the OS. The percentage of deaths due to DCIS was low and mainly concerned patients with locoregional and distant failure.
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Strell C, Folkvaljon D, Holmberg E, Schiza A, Thurfjell V, Karlsson P, Bergh J, Bremer T, Akslen LA, Wärnberg F, Östman A. High PDGFRb Expression Predicts Resistance to Radiotherapy in DCIS within the SweDCIS Randomized Trial. Clin Cancer Res 2021; 27:3469-3477. [PMID: 33952629 DOI: 10.1158/1078-0432.ccr-20-4300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/15/2021] [Accepted: 03/29/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE This study analyzes the potential of stromal platelet-derived growth factor receptor-beta (PDGFRb) expression as biomarker for radiotherapy (RT) benefit on ipsilateral breast events (IBE) in ductal carcinoma in situ (DCIS). Improved identification of DCIS patients refractory to adjuvant whole-breast RT is needed. Predictive biomarker studies in DCIS have focused on tumor cell features rather than the tumor-associated stroma, despite growing evidence of its influence on therapy efficiency. EXPERIMENTAL DESIGN Samples from the Swedish randomized radiotherapy DCIS trial (SweDCIS) were subjected to IHC analysis for stromal PDGFRb expression. IBE incidence at 10 years after breast-conserving surgery was the primary endpoint. Interactions between marker and treatment were analyzed. RESULTS PDGFRb score was predictive for RT benefit with regard to IBE (P interaction = 0.002 and P interaction = 0.008 adjusted multivariably). Patients of the PDGFRblow group had a strong benefit from RT regarding IBE risk [HR, 0.23; 95% confidence interval (CI), 0.12-0.45; P < 0.001] with an absolute risk reduction of 21% (cumulative risk 7% vs. 28%) at 10 years. No significant risk reduction by RT was observed for patients of the PDGFRbhigh group (HR, 0.83; 0.51-1.34; P = 0.444; cumulative risk 22% vs. 25%). The RT response-predictive effect of stromal PDGFRb was equally strong in analyses for in situ and invasive IBE when analyzed separately (in situ IBE: P = 0.029; invasive IBE: P = 0.044). CONCLUSIONS Results suggest high stromal PDGFRb expression as a novel biomarker identifying DCIS patients who are refractory to standard whole-breast adjuvant RT. The data imply previously unrecognized fibroblast-mediated modulation of radiosensitivity of DCIS, which should be further explored from mechanistic and targeting perspectives.
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Affiliation(s)
- Carina Strell
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Dick Folkvaljon
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Erik Holmberg
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Aglaia Schiza
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Viktoria Thurfjell
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Per Karlsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jonas Bergh
- Karolinska Institutet and Breast Cancer Section, Cancer Theme, Karolinska University Hospital, Department of Oncology and Pathology, Stockholm, Sweden.,Department of Public Health, Oxford University, Oxford, United Kingdom
| | | | - Lars A Akslen
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Fredrik Wärnberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Arne Östman
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden. .,Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Arenas M, Selek U, Kaidar-Person O, Perrucci E, Montero Luis A, Boersma L, Coles C, Offersen B, Meattini I, Bölükbaşı Y, Leonardi MC, Pfeffer R, Cutuli B, Vidali C, Franco P, Kouloulias V, Masiello V, Rivera S, Bourgier C, Ciabattoni A, Lancellotta V, Trigo L, Valentini V, Poortmans P, Aristei C. The 2018 assisi think tank meeting on breast cancer: International expert panel white paper. Crit Rev Oncol Hematol 2020; 151:102967. [PMID: 32450277 DOI: 10.1016/j.critrevonc.2020.102967] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/27/2020] [Accepted: 04/15/2020] [Indexed: 01/13/2023] Open
Abstract
We report on the second Assisi Think Tank Meeting (ATTM) on breast cancer which was held under the auspices of the European Society for RadioTherapy & Oncology (ESTRO). In discussing in-depth current evidence and practice it was designed to identify grey areas in diverse forms of the disease. It aimed at addressing uncertainties and proposing future trials to improve patient care. Before the meeting, three key topics were selected: 1) primary systemic therapy, mastectomy, breast reconstruction and post-mastectomy radiation therapy, 2) therapeutic options in ductal carcinoma in situ, and 3) therapy de-escalation in early stage breast cancer. Clinical practice in these areas was investigated by means of an online questionnaire. The time lapse period between the survey and the meeting was used to review the literature and on-going clinical trials. At the ATTM both were discussed in depth and research protocols were proposed.
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Affiliation(s)
| | - Ugur Selek
- Radiation Oncology, Koc University School of Medicine, Istambul, Turkey
| | - Orit Kaidar-Person
- Radiation Oncology, Oncology Institute, Rambam Medical Center, Haifa, Israel
| | | | | | - Liesbeth Boersma
- Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Charlotte Coles
- Radiation Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Icro Meattini
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi (AOUC), Florence, Italy
| | - Yasemin Bölükbaşı
- Radiation Oncology, Koc University School of Medicine, Istambul, Turkey
| | | | - Raphael Pfeffer
- Radiation Oncology, Assuta Medical Centres, Tel Aviv, Israel
| | - Bruno Cutuli
- Radiation Oncology, Institut du Cancer Courlancy, Reims, France
| | - Cristiana Vidali
- Radiation Oncology, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy
| | - Pierfrancesco Franco
- Radiation Oncology, Department of Oncology, University of Turin School of Medicine, Turin, Italy
| | - Vassilis Kouloulias
- Radiation Oncology, National and Kapodistrian University of Athens, Medical School, Attikon University Hospital, Athens, Greece
| | - Valeria Masiello
- Radiation Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Sofia Rivera
- Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Céline Bourgier
- Radiation Oncology, ICM-Val d'Aurelle, University Montpellier, Montpellier, France
| | | | - Valentina Lancellotta
- Radiation Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Lurdes Trigo
- Radiation Oncology, Instituto Portugues de Oncologia Francisco Martins Porto E.P.E, Porto, Portugal
| | - Vincenzo Valentini
- Radiation Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Philip Poortmans
- Radiation Oncology, Iridium Kankernetwerk, Wilrijk-Antwerp - University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk-Antwerp, Belgium
| | - Cynthia Aristei
- Radiation Oncology, University of Perugia and Perugia General Hospital, Perugia, Italy.
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Breast Ductal Carcinoma in Situ: Precursor to Invasive Breast Cancer. THE AMERICAN JOURNAL OF PATHOLOGY 2020; 189:942-945. [PMID: 31029232 DOI: 10.1016/j.ajpath.2019.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 03/12/2019] [Accepted: 03/12/2019] [Indexed: 02/06/2023]
Abstract
This Editorial introduces this month's special Breast Ductal Carcinoma in Situ Theme Issue, a series of reviews intended to highlight the relationship of ductal carcinoma in situ as a precursor to breast cancer and emphasize the need for appropriate treatment in hopes of minimizing the progression to invasive disease.
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Abstract
OBJECTIVE Ductal carcinoma in situ (DCIS) has the potential to progress to invasive carcinoma. The optimal management of DCIS and methods for individualizing treatment of DCIS are still being determined. This evidence map depicts the robustness and topical span of research on DCIS management choice on patient-centered and clinical outcomes. METHODS We searched PubMed, EMBASE, PsycINFO, PubMed Health, PROSPERO, and clinical practice guideline sites to identify systematic reviews of DCIS management options and consulted with topic experts. A bubble plot visualizes the literature volume and research content for patient-centered outcomes. An online decision tree facilitates discussions with patients and guides through the available evidence. RESULTS In total, 40 systematic reviews met inclusion criteria. The research syntheses addressed DCIS management options, including the role of magnetic resonance imaging, axillary surgery/sentinel lymph node biopsy, and excisional biopsy. The map shows existing evidence for mutually exclusive treatment options including active surveillance, breast-conserving surgery, nipple sparing mastectomy, and simple mastectomy. Research findings for intraoperative radiation, adjuvant radiation therapy, adjuvant hormone therapy, hypofractionation radiotherapy, accelerated partial breast irradiation, radiation therapy plus boost, and combined radiation and hormone therapy, as well as for breast reconstruction after mastectomy and surveillance mammography postsurgery are also displayed. The evidence map highlights a scarcity of robust evidence on patient-centered outcomes. CONCLUSIONS The evidence map provides an overview of DCIS research showing the range of management options and remaining decisional dilemmas that follow a diagnosis of DCIS. It maps the evidence in accessible tools to guide practice and future research. : Video Summary:http://links.lww.com/MENO/A448.
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Kim BH, Ko BK, Bae JW, Nam S, Park MH, Jeong J, Lee HJ, Chang JH, Kim S, Hwang KT. Survival benefit of postoperative radiotherapy for ductal carcinoma in situ after breast-conserving surgery: a Korean population-based cohort study. Breast Cancer Res Treat 2019; 178:105-113. [DOI: 10.1007/s10549-019-05372-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 07/20/2019] [Indexed: 12/15/2022]
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Montero-Luis A, Aristei C, Meattini I, Arenas M, Boersma L, Bourgier C, Coles C, Cutuli B, Falcinelli L, Kaidar-Person O, Leonardi MC, Offersen B, Marazzi F, Rivera S, Tagliaferri L, Tombolini V, Vidali C, Valentini V, Poortmans P. The Assisi Think Tank Meeting Survey of post-mastectomy radiation therapy in ductal carcinoma in situ: Suggestions for routine practice. Crit Rev Oncol Hematol 2019; 138:207-213. [PMID: 31092377 DOI: 10.1016/j.critrevonc.2019.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/11/2019] [Accepted: 04/13/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Risk factors for local recurrence after mastectomy in ductal carcinoma in situ (DCIS) emerged as a grey area during the second "Assisi Think Tank Meeting" (ATTM) on Breast Cancer. AIM To review practice patterns of post-mastectomy radiation therapy (PMRT) in DCIS, identify risk factors for recurrence and select suitable candidates for PMRT. METHODS A questionnaire concerning DCIS management, focusing on PMRT, was distributed online via SurveyMonkey. RESULTS 142 responses were received from 15 countries. The majority worked in academic institutions, had 5-20 years work-experience and irradiated <5 DCIS patients/year. PMRT was more given if: surgical margins <1 mm, high-grade, multicentricity, young age, tumour size >5 cm, skin- or nipple- sparing mastectomy. Moderate hypofractionation was the most common schedule, except after immediate breast reconstruction (57% conventional fractionation). CONCLUSIONS The present survey highlighted risk factors for PMRT administration, which should be further evaluated.
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Affiliation(s)
- A Montero-Luis
- Radiation Oncology, University Hospital HM Sanchinarro, Madrid, Spain.
| | - C Aristei
- Radiation Oncology, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - I Meattini
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi (AOUC), Florence, Italy
| | - M Arenas
- Radiation Oncology, University Hospital Sant Joan, Reus, Spain
| | - L Boersma
- Radiation Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhøek Huis, Amsterdam, Netherlands
| | - C Bourgier
- Radiation Oncology, ICM-Val d'Aurelle, Univ Montpellier, Montpellier, France
| | - C Coles
- Radiation Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - B Cutuli
- Radiation Oncology, Institut du Cancer Courlancy, Reims, France
| | - L Falcinelli
- Radiation Oncology, Perugia General Hospital, Italy
| | - O Kaidar-Person
- Radiation Oncology Unit, Oncology Institute, Rambam Medical Center, Haifa, Israel
| | - M C Leonardi
- Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - B Offersen
- Radiation Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - F Marazzi
- Radiation Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - S Rivera
- Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - L Tagliaferri
- Radiation Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - V Tombolini
- Radiation Oncology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - C Vidali
- Radiation Oncology, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy
| | - V Valentini
- Radiation Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - P Poortmans
- Radiation Oncology, Institut Curie, Department of Radiation Oncology; Paris Sciences & Lettres - PSL University; Paris, France
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Koh VCY, Lim JCT, Thike AA, Cheok PY, Thu MMM, Li H, Tan VKM, Ong KW, Tan BKT, Ho GH, Thilagaratnam S, Wong JSL, Wong FY, Ellis IO, Tan PH. Behaviour and characteristics of low‐grade ductal carcinomain situof the breast: literature review and single‐centre retrospective series. Histopathology 2019; 74:970-987. [DOI: 10.1111/his.13837] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
| | | | - Aye Aye Thike
- Division of Pathology Singapore General Hospital Singapore
- Duke‐NUS Medical School Singapore
| | - Poh Yian Cheok
- Division of Pathology Singapore General Hospital Singapore
| | | | - Huihua Li
- Health Services Research Unit Singapore General Hospital Singapore
| | | | - Kong Wee Ong
- Division of Surgical Oncology National Cancer Centre Singapore Singapore
| | | | - Gay Hui Ho
- Division of Surgical Oncology National Cancer Centre Singapore Singapore
| | - Shyamala Thilagaratnam
- Regional Health and Community Outreach Division Singapore
- Saw Swee Hock School of Public Health Singapore
| | - Jill Su Lin Wong
- Division of Oncologic Imaging National Cancer Centre Singapore Singapore
| | - Fuh Yong Wong
- Division of Radiation Oncology National Cancer Centre Singapore Singapore
| | | | - Puay Hoon Tan
- Division of Pathology Singapore General Hospital Singapore
- Duke‐NUS Medical School Singapore
- Department of Anatomy Yong Loo Lin School of Medicine Singapore
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Park J, Thomas S, Zhong AY, Wolfe AR, Krings G, Terranova-Barberio M, Pawlowska N, Benet LZ, Munster PN. Local delivery of hormonal therapy with silastic tubing for prevention and treatment of breast cancer. Sci Rep 2018; 8:92. [PMID: 29311658 PMCID: PMC5758798 DOI: 10.1038/s41598-017-18436-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 12/08/2017] [Indexed: 01/22/2023] Open
Abstract
Broad use of germline testing has identified an increasing number of women at risk for breast cancer with a need for effective chemoprevention. We report a novel method to selectively deliver various anti-estrogens at high drug levels to the breast tissue by implanting a device comprised of silastic tubing. Optimized tubing properties allow elution of otherwise poorly bioavailable anti-estrogens, such as fulvestrant, into mammary tissue in vitro and in vivo with levels sufficient to inhibit estrogen receptor activation and tumor cell proliferation. Implantable silastic tubing delivers fulvestrant selectively to mouse mammary fat tissue for one year with anti-tumor effects similar to those achieved with systemic fulvestrant exposure. Furthermore, local delivery of fulvestrant significantly decreases cell proliferation, as assessed by Ki67 expression, most effectively in tumor sections adjacent to tubing. This approach may thereby introduce a potential paradigm shift and offer a promising alternative to systemic therapy for prevention and early interception of breast cancer.
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Affiliation(s)
- Jeenah Park
- Division of Hematology and Oncology, University of California, San Francisco, USA
| | - Scott Thomas
- Division of Hematology and Oncology, University of California, San Francisco, USA
| | - Allison Y Zhong
- Department of Molecular and Cell Biology, University of California, Berkeley, USA
| | - Alan R Wolfe
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, USA
| | - Gregor Krings
- Department of Pathology, University of California, San Francisco, USA
| | | | - Nela Pawlowska
- Division of Hematology and Oncology, University of California, San Francisco, USA
| | - Leslie Z Benet
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, USA
| | - Pamela N Munster
- Division of Hematology and Oncology, University of California, San Francisco, USA.
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Toss M, Miligy I, Thompson A, Khout H, Green A, Ellis I, Rakha E. Current trials to reduce surgical intervention in ductal carcinoma in situ of the breast: Critical review. Breast 2017; 35:151-156. [DOI: 10.1016/j.breast.2017.07.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 07/13/2017] [Indexed: 12/12/2022] Open
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