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Shigeeda W, Yosihimura R, Fujita Y, Saiki H, Deguchi H, Tomoyasu M, Kudo S, Kaneko Y, Kanno H, Inoue Y, Saito H. Utility of mass spectrometry and artificial intelligence for differentiating primary lung adenocarcinoma and colorectal metastatic pulmonary tumor. Thorac Cancer 2021; 13:202-209. [PMID: 34812577 PMCID: PMC8758431 DOI: 10.1111/1759-7714.14246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/07/2021] [Accepted: 11/08/2021] [Indexed: 11/27/2022] Open
Abstract
Background Rapid intraoperative diagnosis for unconfirmed pulmonary tumor is extremely important for determining the optimal surgical procedure (lobectomy or sublobar resection). Attempts to diagnose malignant tumors using mass spectrometry (MS) have recently been described. This study evaluated the usefulness of MS and artificial intelligence (AI) for differentiating primary lung adenocarcinoma (PLAC) and colorectal metastatic pulmonary tumor. Methods Pulmonary samples from 40 patients who underwent pulmonary resection for PLAC (20 tumors, 20 normal lungs) or pulmonary metastases originating from colorectal metastatic pulmonary tumor (CRMPT) (20 tumors, 20 normal lungs) were collected and analyzed retrospectively by probe electrospray ionization‐MS. AI using random forest (RF) algorithms was employed to evaluate the accuracy of each combination. Results The accuracy of the machine learning algorithm applied using RF to distinguish malignant tumor (PLAC or CRMPT) from normal lung was 100%. The algorithms offered 97.2% accuracy in differentiating PLAC and CRMPT. Conclusions MS combined with an AI system demonstrated high accuracy not only for differentiating cancer from normal tissue, but also for differentiating between PLAC and CRMPT with a short working time. This method shows potential for application as a support tool facilitating rapid intraoperative diagnosis to determine the surgical procedure for pulmonary resection.
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Affiliation(s)
- Wataru Shigeeda
- Department of Thoracic Surgery, Iwate Medical University, Iwate, Japan
| | | | - Yuji Fujita
- Division of Critical Care Medicine, Department of Critical Care, Disaster and General Medicine, Iwate Medical University, Iwate, Japan
| | | | - Hiroyuki Deguchi
- Department of Thoracic Surgery, Iwate Medical University, Iwate, Japan
| | - Makoto Tomoyasu
- Department of Thoracic Surgery, Iwate Medical University, Iwate, Japan
| | - Satoshi Kudo
- Department of Thoracic Surgery, Iwate Medical University, Iwate, Japan
| | - Yuka Kaneko
- Department of Thoracic Surgery, Iwate Medical University, Iwate, Japan
| | - Hironaga Kanno
- Department of Thoracic Surgery, Iwate Medical University, Iwate, Japan
| | - Yoshihiro Inoue
- Division of Critical Care Medicine, Department of Critical Care, Disaster and General Medicine, Iwate Medical University, Iwate, Japan
| | - Hajime Saito
- Department of Thoracic Surgery, Iwate Medical University, Iwate, Japan
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Yoshimura R, Deguchi H, Tomoyasu M, Kudo S, Shigeeda W, Kaneko Y, Kanno H, Saito H. Validation of completion lobectomy after wedge resection for ≤20 mm non-small cell lung cancer. J Thorac Dis 2021; 13:4388-4395. [PMID: 34422365 PMCID: PMC8339748 DOI: 10.21037/jtd-21-795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/19/2021] [Indexed: 11/29/2022]
Abstract
Background Completion lobectomy after wedge resection is occasionally performed when final histopathology shows an unexpected primary lung cancer even though the primary lesion has already been resected. The objective of this study was to assess the necessity of completion lobectomy after wedge resection for ≤20 mm non-small cell lung cancer (NSCLC). Methods Between 2006 and 2016, a total of 112 patients with NSCLC underwent wedge resection in our department. After exclusions, 40 patients were analyzed. Of these, 17 patients underwent completion lobectomy and 23 patients underwent wedge resection alone. Age, sex, tumor size, histology, other malignant diseases and final surgical procedure were used as prognostic variables. Survival analyses were confirmed using the Kaplan-Meier method and log-rank test. Results Median follow-up was 70.4 months. No significant difference in 5-year overall survival (OS) and relapse-free survival (RFS) were seen in patients who underwent wedge resection alone compared to the completion lobectomy group (OS: 72.6% vs. 62.5%, P=0.34; RFS: 64.2% vs. 50.0%, P=0.35). Multivariate analysis identified age (>65 years old) and male sex as independent prognostic factors for OS and RFS. Conclusions Completion lobectomy after wedge resection did not impact OS or RFS compared with wedge resection alone in patients with ≤20 mm NSCLC. These findings suggested that selected patients may not require resection of the remaining lobe or lymph node dissection after initial wedge resection.
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Affiliation(s)
- Ryuichi Yoshimura
- Department of Thoracic Surgery, Iwate Medical University, Iwate, Japan
| | - Hiroyuki Deguchi
- Department of Thoracic Surgery, Iwate Medical University, Iwate, Japan
| | - Makoto Tomoyasu
- Department of Thoracic Surgery, Iwate Medical University, Iwate, Japan
| | - Satoshi Kudo
- Department of Thoracic Surgery, Iwate Medical University, Iwate, Japan
| | - Wataru Shigeeda
- Department of Thoracic Surgery, Iwate Medical University, Iwate, Japan
| | - Yuka Kaneko
- Department of Thoracic Surgery, Iwate Medical University, Iwate, Japan
| | - Hironaga Kanno
- Department of Thoracic Surgery, Iwate Medical University, Iwate, Japan
| | - Hajime Saito
- Department of Thoracic Surgery, Iwate Medical University, Iwate, Japan
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Wu L, Zhao W, Chen T, Yang Y. Surgical choice for patients with stage I non-small-cell lung cancer ≤2 cm: an analysis from surveillance, epidemiology, and end results database. J Cardiothorac Surg 2021; 16:191. [PMID: 34233699 PMCID: PMC8265100 DOI: 10.1186/s13019-021-01568-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/27/2021] [Indexed: 11/18/2022] Open
Abstract
Background No consensus was reached on the surgical procedure for patients with stage I non-small-cell lung cancer (NSCLC) ≤ 2 cm. The aim of this study is to investigate the appropriate surgical procedure for stage I NSCLC ≤2 cm. Methods Patients with stage I NSCLC ≤2 cm received wedge resection, segmentectomy, lobectomy between January 2004 and December 2015 were identified using the Surveillance, Epidemiology, and End Results (SEER) database. Data were stratified by age, gender, race, side, location, grade, histology, extent of lymphadenectomy. Overall survival (OS) and lung cancer-specific survival (LCSS) were compared among patients received wedge resection, segmentectomy, lobectomy. Univariate analysis and multivariable Cox regression were performed to identify the prognostic factors of OS and LCSS. Results A total of 16,511 patients with stage I NSCLC ≤2 cm were included in this study, of whom 2945 patients were classified as stage I NSCLC ≤1 cm. Lobectomy had better OS and LCSS when compared with wedge resection in patients with NSCLC ≤2 cm. Only OS favored lobectomy compared with segmentectomy in stage I NSCLC>1 to 2 cm. Multivariable analysis showed that segmentectomy had similar OS and LCSS compared with lobectomy in patients with stage I NSCLC ≤2 cm. Lymph node dissection (LND) was associated with better OS in patients with NSCLC ≤2 cm and better LCSS in patients with stage I NSCLC>1 to 2 cm. Conclusions Segmentectomy showed comparable survival compared with lobectomy in patients with stage I NSCLC ≤2 cm. LND can provide more accurate pathological stage, may affect survival, and should be recommended for above patients.
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Affiliation(s)
- Liang Wu
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Weigang Zhao
- Department of Thoracic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Tangbing Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Yi Yang
- Department of Thoracic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200030, China.
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Sagawa M, Oizumi H, Suzuki H, Uramoto H, Usuda K, Sakurada A, Chida M, Shiono S, Abe J, Hasumi T, Sato M, Sato N, Shibuya J, Deguchi H, Okada Y. A prospective 5-year follow-up study after limited resection for lung cancer with ground-glass opacity. Eur J Cardiothorac Surg 2019; 53:849-856. [PMID: 29236995 DOI: 10.1093/ejcts/ezx418] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 10/31/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The incidence of small-sized pulmonary adenocarcinomas with ground-glass opacity (GGO) has recently increased, with excellent postoperative prognosis. The limited resection of such cancers has been deemed to be acceptable based on retrospective studies. We conducted a prospective multi-institutional study evaluating the validity of limited resection for small-sized pulmonary adenocarcinoma with GGO. METHODS The inclusion criteria were 25-80 years of age, no prior treatment, a maximum tumour diameter of 8-20 mm, a GGO ratio of ≥ 80%, clinical T1N0M0, lower 18F-fluorodeoxyglucose accumulation than the mediastinum, resectable by sublobar resection, pulmonary lobectomy tolerable and an intraoperative pathological diagnosis of bronchiloalveolar carcinoma. Wedge resection was preferred, but segmentectomy was permitted. Disease-specific survival and overall survival were analysed. RESULTS From November 2006 to April 2012, 73 patients were enrolled from 13 institutions. One patient was ineligible, and the remaining 72 patients were preregistered. The tumours of 3 and 14 patients were intraoperatively diagnosed as benign lesions and adenocarcinomas with mixed subtype, respectively. Intraoperative cytological/histological examination of surgical margin was not performed in 2 patients, and the remaining 53 patients were ultimately eligible for this study. The mean tumour size was 14.0 mm and the mean GGO ratio was 95.9%. Thirty-nine and 14 patients underwent wedge resection and segmentectomy, respectively. Although all tumours were intraoperatively diagnosed as bronchioloalveolar carcinomas, 6 were ultimately diagnosed as adenocarcinoma with a mixed subtype. No completion lobectomy was performed. As of 1 May 2017, no recurrence of the original lung cancer was observed during 60.0-126.3 months after surgery. Two patients died from other diseases. The 5-year disease-specific and overall survival rates were 100% and 98.1%, respectively. The reduction in the pulmonary function after limited resection was minimal. CONCLUSIONS With these criteria, limited resection was performed safely without any recurrence, and the postoperative pulmonary function was well preserved. The outcomes of limited resection for small-sized lung cancer with GGOs that met the criteria of this study were satisfactory.
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Affiliation(s)
- Motoyasu Sagawa
- Japan North-East Thoracic Surgical Study Group (JNETS), Sendai, Japan.,Division of Endoscopy, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Hiroyuki Oizumi
- Japan North-East Thoracic Surgical Study Group (JNETS), Sendai, Japan.,Department of Surgery 2, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Hiroyuki Suzuki
- Japan North-East Thoracic Surgical Study Group (JNETS), Sendai, Japan.,Department of Chest Surgery, Fukushima Medical University, Fukushima, Japan
| | - Hidetaka Uramoto
- Japan North-East Thoracic Surgical Study Group (JNETS), Sendai, Japan.,Division of Thoracic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Katsuo Usuda
- Japan North-East Thoracic Surgical Study Group (JNETS), Sendai, Japan.,Division of Thoracic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Akira Sakurada
- Japan North-East Thoracic Surgical Study Group (JNETS), Sendai, Japan.,Department of Thoracic Surgery, Tohoku University Hospital, Sendai, Japan
| | - Masayuki Chida
- Japan North-East Thoracic Surgical Study Group (JNETS), Sendai, Japan.,Department of General Thoracic Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Satoshi Shiono
- Japan North-East Thoracic Surgical Study Group (JNETS), Sendai, Japan.,Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Jiro Abe
- Japan North-East Thoracic Surgical Study Group (JNETS), Sendai, Japan.,Department of Thoracic Surgery, Miyagi Cancer Center, Natori, Miyagi, Japan
| | - Tohru Hasumi
- Japan North-East Thoracic Surgical Study Group (JNETS), Sendai, Japan.,Department of Thoracic Surgery, Sendai Medical Center, Sendai, Japan
| | - Masami Sato
- Japan North-East Thoracic Surgical Study Group (JNETS), Sendai, Japan.,Department of General Thoracic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Nobuyuki Sato
- Japan North-East Thoracic Surgical Study Group (JNETS), Sendai, Japan.,Department of Thoracic Surgery, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Jotaro Shibuya
- Japan North-East Thoracic Surgical Study Group (JNETS), Sendai, Japan.,Department of Thoracic Surgery, Iwate Prefectural Isawa Hospital, Mizusawa, Iwate, Japan
| | - Hiroyuki Deguchi
- Japan North-East Thoracic Surgical Study Group (JNETS), Sendai, Japan.,Department of General Thoracic Surgery, Iwate Medical University, Morioka, Iwate, Japan
| | - Yoshinori Okada
- Japan North-East Thoracic Surgical Study Group (JNETS), Sendai, Japan.,Department of Thoracic Surgery, Tohoku University Hospital, Sendai, Japan
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Lu W, Cham MD, Qi L, Wang J, Tang W, Li X, Zhang J. The impact of chemotherapy on persistent ground-glass nodules in patients with lung adenocarcinoma. J Thorac Dis 2017; 9:4743-4749. [PMID: 29268545 DOI: 10.21037/jtd.2017.10.50] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Backgrounds To evaluate the response of persistent ground glass nodules (GGNs) in patients with lung adenocarcinoma treated with platinum-based chemotherapy on computed tomography (CT). Methods We retrospectively studied patients with GGNs that met the following criteria: (I) GGNs found in patients with lung adenocarcinoma, which persist for more than 3 months; (II) patients treated with platinum-based (cisplatin or carboplatin) chemotherapy for at least 2 cycles; (III) ground glass proportion ¡Ý50%. For each patient, if more than two CTs satisfied the inclusion criteria, then the baseline and last CTs were used for analysis, defined as CT1 and CT2. A total of 91 persistent pulmonary GGNs in 51 patients fulfilled the inclusion criteria. We defined growth as a nodule ¡Ý2 mm increase in diameter or showing up a solid portion. GGN response to therapy was assessed and compared with the baseline CT. Differences in CT findings were analyzed using a paired t-test and Pearson ¦Ö2 test. Results Between 2010 and 2015, 25 of the 51 (49%) were male and 26 of the 51 (51%) were female. The average age at time of detection of a GGN was 63.8 (range, 36-84) years. Mean follow-up duration was 24.1¡À17.9 months. During the follow-up periods, on a per-nodule basis, 94.5% of GGNs (n=86) remained unchanged in size. Only 5.5% GGNs (n=5) in 5 patients increased in size. The nodules CT feature in each lung adenocarcinoma clinical stage show no difference. No significant difference was found in the size, attenuation, volume, and mass of GGN between baseline and post-treatment measurements, regardless of the type of chemotherapy (P>0.05). Conclusions The clinical course of GGNs in patients with lung adenocarcinoma is predominantly indolent, and platinum-based chemotherapy may have no effect on the growth of persistent GGNs.
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Affiliation(s)
- Wenwen Lu
- Department of Diagnostic Radiology, National cancer center, Cancer Hospital/Institute, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100021, China.,Peking University Eye Center, The Third Hospital of Peking University, Beijing 100191, China
| | - Matthew D Cham
- Department of Radiology Box 1234/Icahn School of Medicine at Mount Sinai, New York, USA
| | - Linlin Qi
- Department of Diagnostic Radiology, National cancer center, Cancer Hospital/Institute, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100021, China
| | - Jianwei Wang
- Department of Diagnostic Radiology, National cancer center, Cancer Hospital/Institute, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100021, China
| | - Wei Tang
- Department of Diagnostic Radiology, National cancer center, Cancer Hospital/Institute, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100021, China
| | - Xiaolu Li
- Department of Diagnostic Radiology, National cancer center, Cancer Hospital/Institute, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100021, China
| | - Jie Zhang
- Radiology Department, Dongzhimen Hospital/Beijing University of Chinese Medicine, Beijing 100700, China
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Wang Y, Wang R, Zheng D, Han B, Zhang J, Zhao H, Luo J, Zheng J, Chen T, Huang Q, Sun Y, Chen H. The indication of completion lobectomy for lung adenocarcinoma ≤3 cm after wedge resection during surgical operation. J Cancer Res Clin Oncol 2017; 143:2095-2104. [PMID: 28616702 DOI: 10.1007/s00432-017-2452-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 06/05/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE This retrospective study was designed to find out the potential indications of completion lobectomy (CL) during wedge resection (WR) operation among patients with lung adenocarcinoma (ADC) ≤3 cm, by the use of Shanghai Chest Hospital Lung Cancer Database. PATIENTS AND METHODS There were totally 1938 patients in this study, including 746 WRs and 1192 CLs. The propensity score matching (PSM) was performed to minimize the effect of confounders. Univariable and multivariable cox regressions were analyzed to discover the independent risk factors of recurrence-free survival (RFS) and overall survival (OS). Subgroup analysis and Kaplan-Meier survival curves were performed if necessary. RESULTS The 5-year RFS (86.1 vs 91.5%, p = 0.001 for unmatched group; 84 v 92%, p < 0.001 for PSM group) and OS (83.6 vs 91.7%, p < 0.001 for unmatched group; 81.6 vs 88.2%, p < 0.001 for PSM group) all indicated a better prognosis when conducting CL. Subgroup analysis suggested that WR was appropriate for non-invasive ADC. Three prognostic factors (sex, surgical approach and pleural invasion) were correlated with RFS and two (sex and surgical approach) corresponded with OS in invasive ADC through multivariable analysis. Non-lepidic-predominant component showed a better RFS and OS when CL was operated after WR in the subgroup of invasive ADC. CONCLUSION CL was an appropriate remediation to WR when the existence of invasive ADC, especially non-lepidic-predominant one. While WR could be applied if non-invasive ADC was confirmed. Whether lepidic-predominant adenocarcinoma was fit for WR needed further study.
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Affiliation(s)
- Yiyang Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Rui Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Difan Zheng
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China
| | - Baohui Han
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jie Zhang
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Heng Zhao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jizhuang Luo
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jiajie Zheng
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Tianxiang Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Qingyuan Huang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yihua Sun
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China. .,Institutes of Biomedical Sciences, Fudan University, Shanghai, China.
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Isaka T, Yokose T, Ito H, Imamura N, Watanabe M, Imai K, Nishii T, Yamada K, Nakayama H, Masuda M. Diagnosis of metachronous multiple lung adenocarcinoma at the cut-end by epidermal growth factor receptor mutation status discordance 4 years after sublobar resection for adenocarcinoma in situ: report of a case. Surg Today 2014; 45:1330-4. [DOI: 10.1007/s00595-014-1077-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 08/21/2014] [Indexed: 10/24/2022]
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