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de Baat EC, Feijen EAM, van Niekerk JB, Mavinkurve-Groothuis AMC, Kapusta L, Loonen J, Kok WEM, Kremer LCM, van Dalen EC, van der Pal HJH. Electrocardiographic abnormalities in childhood cancer survivors treated with cardiotoxic therapy: a systematic review. Pediatr Blood Cancer 2022; 69:e29720. [PMID: 35482534 DOI: 10.1002/pbc.29720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/09/2022] [Accepted: 03/22/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE The purpose of this study is to assess the available literature on the prevalence and risk factors of electrocardiographic (ECG) abnormalities after cardiotoxic treatment in childhood cancer survivors (CCS). METHODS A literature search was performed within MEDLINE, EMBASE, and CENTRAL (1966-11/2020) and reference lists of relevant studies. Studies were eligible for inclusion if they reported ECG abnormalities ≥2 years after cancer diagnosis in ≥50 CCS treated with anthracyclines, RT involving the heart region and/or mitoxantrone. Information about population, treatment, outcome, and risk factors were extracted and risk of bias was assessed. RESULTS Of 934 identified publications, 10 studies were included. Outcome definitions, treatment regimens, follow-up period, and risk of bias varied. These ECG abnormalities and prevalences were reported: major (5%-23%) and minor (12%) abnormalities according to the Minnesota Code, rhythm abnormalities (0%-12%), conduction abnormalities (0.3%-7.1%), depolarization abnormalities (0%), and repolarization abnormalities (0%-65%). The reported risk factors of ECG abnormalities (two studies) are male sex, anthracyclines, RT involving the heart region, and hypertension, although results were not univocal between studies and abnormalities. CONCLUSIONS Multiple ECG abnormalities have been described in CCS ≥2 years from diagnosis, some of which can have important implications. Future research is needed to evaluate the exact long-term incidence and risk factors, and to investigate their clinical relevance and relation with cardiac dysfunction or future cardiac events. This could improve cardiac surveillance for CCS.
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Affiliation(s)
- Esmée C de Baat
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Jorrit B van Niekerk
- Department of General Practice/Family Medicine, Amsterdam University Medical Center, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
| | | | - Livia Kapusta
- Department of Pediatric Cardiology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Pediatrics, Pediatric Cardiology Unit, Tel Aviv Sourasky Medical Centre, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacqueline Loonen
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wouter E M Kok
- Amsterdam UMC, University of Amsterdam, Heart Center; department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands.,Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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2
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van Dalen EC, Mulder RL, Suh E, Ehrhardt MJ, Aune GJ, Bardi E, Benson BJ, Bergler-Klein J, Chen MH, Frey E, Hennewig U, Lockwood L, Martinsson U, Muraca M, van der Pal H, Plummer C, Scheinemann K, Schindera C, Tonorezos ES, Wallace WH, Constine LS, Skinner R, Hudson MM, Kremer LCM, Levitt G, Mulrooney DA. Coronary artery disease surveillance among childhood, adolescent and young adult cancer survivors: A systematic review and recommendations from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Eur J Cancer 2021; 156:127-137. [PMID: 34450551 DOI: 10.1016/j.ejca.2021.06.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/28/2021] [Accepted: 06/14/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Coronary artery disease (CAD) is a concerning late outcome for cancer survivors. However, uniform surveillance guidelines are lacking. AIM To harmonise international recommendations for CAD surveillance for survivors of childhood, adolescent and young adult (CAYA) cancers. METHODS A systematic literature review was performed and evidence graded using the Grading of Recommendations, Assessment, Development and Evaluation criteria. Eligibility included English language studies, a minimum of 20 off-therapy cancer survivors assessed for CAD, and 75% diagnosed prior to age 35 years. All study designs were included, and a multidisciplinary guideline panel formulated and graded recommendations. RESULTS 32 of 522 identified articles met eligibility criteria. The prevalence of CAD ranged from 0 to 72% and was significantly increased compared to control populations. The risk of CAD was increased among survivors who received radiotherapy exposing the heart, especially at doses ≥15 Gy (moderate-quality evidence). The guideline panel agreed that healthcare providers and CAYA cancer survivors treated with radiotherapy exposing the heart should be counselled about the increased risk for premature CAD. While the evidence is insufficient to support primary screening, monitoring and early management of modifiable cardiovascular risk factors are recommended. Initiation and frequency of surveillance should be based on the intensity of treatment exposures, family history, and presence of co-morbidities but at least by age 40 years and at a minimum of every 5 years. All were strong recommendations. CONCLUSION These systematically assessed and harmonised recommendations for CAD surveillance will inform care and guide research concerning this critical outcome for CAYA cancer survivors.
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Affiliation(s)
| | - Renée L Mulder
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Eugene Suh
- Loyola University Chicago Health Sciences Division, Maywood, USA
| | | | - Gregory J Aune
- Greehey Children's Cancer Research Institute, University of Texas Health Science Center San Antonio, San Antonio, USA
| | - Edit Bardi
- Kepler University Clinic, Department of Pediatrics, Division of Pediatric Hemato-Oncology, Linz, Austria; St. Anna Children's Hospital, Medical University Vienna, Vienna, Austria
| | | | | | - Ming H Chen
- Boston Children's Hospital/Dana Farber Cancer Institute, Department of Cardiology, Harvard Medical School, Boston, USA
| | - Eva Frey
- St. Anna Children's Hospital, Medical University Vienna, Vienna, Austria
| | - Ulrike Hennewig
- University Hospital of Giessen and Marburg, Pediatric Hematology and Oncology, Giessen, Germany
| | - Liane Lockwood
- Children's Health Queensland Hospital and Health Service, South Brisbane, Australia
| | - Ulla Martinsson
- Department of Genetics, Immunology and Pathology, Section of Experimental and Clinical Oncology, Uppsala University, Uppsala, Sweden
| | | | | | - Chris Plummer
- Department of Cardiology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Katrin Scheinemann
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Kantonsspital Aarau, Aarau, Switzerland; University of Basel, Basel, Switzerland; McMaster Children's Hospital and McMaster University, Hamilton, Canada
| | - Christina Schindera
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Pediatric Hematology and Oncology, University Children's Hospital Basel, Basel, Switzerland
| | | | - W Hamish Wallace
- Department of Paediatric Haematology and Oncology & University of Edinburgh, Royal Hospital for Sick Children, Edinburgh, UK
| | | | - Roderick Skinner
- Great North Children's Hospital, and Newcastle University Centre for Cancer, Newcastle Upon Tyne, UK
| | | | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Gill Levitt
- Department of Haematology/Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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3
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Lo AC, Chen B, Samuel V, Savage KJ, Freeman C, Goddard K. Late effects in survivors treated for lymphoma as adolescents and young adults: a population-based analysis. J Cancer Surviv 2021; 15:837-846. [PMID: 33453004 DOI: 10.1007/s11764-020-00976-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/25/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The study objective is to describe and quantify the incidence of treatment-induced late effects in AYA lymphoma patients. METHODS Consecutive patients diagnosed with Hodgkin lymphoma (HL) or non-Hodgkin lymphoma (NHL) at 15-24 years of age were identified. All patients in British Columbia who received radiation therapy (RT) from 1974 to 2014 with ≥ 5-year survival post-RT were included. Late effects' analyses included only survivors who received RT to the relevant anatomical site(s) and/or relevant chemotherapy, and were reported as cumulative incidence (CI) ± standard error. RESULTS Three hundred and five patients were identified (74% HL). Median age of diagnosis was 21 years. Median follow-up was 19.1 years for secondary malignancy and 7.2 years for other endpoints. Hypothyroidism was the most prevalent late effect, with a CI of 22.4 ± 2.8% and 35.1 ± 4% at 5 and 10 years, respectively. CI of in-field secondary malignancy was 0.4 ± 0.4% at 10 years and 2.8 ± 1.2% at 20 years. CI of symptomatic pulmonary toxicity was 4.6 ± 1.5% and 6.8 ± 2.0% at 5 and 10 years, respectively, and was higher in patients receiving multiple RT courses (p = 0.009). Esophageal complications occurred at a CI of 1.4 ± 0.8% at 5 years and 2.2 ± 1.1% at 10 years. CI of xerostomia/dental decay was 2.6 ± 1.3% at 5 years and 4.9 ± 2.1% at 10 years. CI of cardiac disease was at 2.3 ± 0.9% at 5 years and 4.4 ± 1.5% at 10 years. CI of infertility was 6.5 ± 1.6% at 5 years and 9.4 ± 2.1% at 10 years. CONCLUSION Survivors of AYA lymphoma have a high incidence and diverse presentation of late effects. IMPLICATIONS FOR CANCER SURVIVORS AYA lymphoma survivors should be educated about their risks of late effects and offered screening and follow-up when appropriate.
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Affiliation(s)
- Andrea C Lo
- Department of Radiation Oncology, British Columbia (BC) Cancer, 600 West 10th Avenue, Vancouver, BC, V5Z 4E6, Canada.
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Ben Chen
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Vanessa Samuel
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kerry J Savage
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre of Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
- Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Ciara Freeman
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre of Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
- Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Karen Goddard
- Department of Radiation Oncology, British Columbia (BC) Cancer, 600 West 10th Avenue, Vancouver, BC, V5Z 4E6, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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4
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Feijen EAM, van Dalen EC, van der Pal HJH, Reulen RC, Winter DL, Keuhni CE, Morsellino V, Alessi D, Allodji RS, Byrne J, Bardi E, Jakab Z, Grabow D, Garwicz S, Haddy N, Jankovic M, Kaatsch P, Levitt GA, Ronckers CM, Schindera C, Skinner R, Zalatel L, Hjorth L, Tissing WJE, De Vathaire F, Hawkins MM, Kremer LCM. Increased risk of cardiac ischaemia in a pan-European cohort of 36 205 childhood cancer survivors: a PanCareSurFup study. Heart 2020; 107:33-40. [PMID: 32826285 DOI: 10.1136/heartjnl-2020-316655] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/24/2020] [Accepted: 07/13/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE In this report, we determine the cumulative incidence of symptomatic cardiac ischaemia and its risk factors among European 5-year childhood cancer survivors (CCS) participating in the PanCareSurFup study. METHODS Eight data providers (France, Hungary, Italy (two cohorts), the Netherlands, Slovenia, Switzerland and the UK) participating in PanCareSurFup ascertained and validated symptomatic cardiac events among their 36 205 eligible CCS. Data on symptomatic cardiac ischaemia were graded according to the Criteria for Adverse Events V.3.0 (grade 3-5). We calculated cumulative incidences, both overall and for different subgroups based on treatment and malignancy, and used multivariable Cox regression to analyse risk factors. RESULTS Overall, 302 out of the 36 205 CCS developed symptomatic cardiac ischaemia during follow-up (median follow-up time after primary cancer diagnosis: 23.0 years). The cumulative incidence by age 60 was 5.4% (95% CI 4.6% to 6.2%). Men (7.1% (95% CI 5.8 to 8.4)) had higher rates than women (3.4% (95% CI 2.4 to 4.4)) (p<0.0001). Of importance is that a significant number of patients (41/302) were affected as teens or young adults (14-30 years). Treatment with radiotherapy/chemotherapy conferred twofold risk (95% CI 1.5 to 3.0) and cases in these patients appeared earlier than in CCS without treatment/surgery only (15% vs 3% prior to age 30 years, respectively (p=0.04)). CONCLUSIONS In this very large European childhood cancer cohort, we found that by age 60 years, 1 in 18 CCS will develop a severe, life-threatening or fatal cardiac ischaemia, especially in lymphoma survivors and CCS treated with radiotherapy and chemotherapy increases the risk significantly.
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Affiliation(s)
| | - Elvira C van Dalen
- Pediatric Oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Heleen J H van der Pal
- Pediatric Oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | | | | | | | | | | | | | | | - Zsuzsanna Jakab
- Markusovszky University Teaching Hospital, Szombathely, Vas, Hungary
| | | | | | | | | | | | - Gill A Levitt
- Great Ormond Street Hospital for Children, London, UK
| | - Cecile M Ronckers
- Pediatric Oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | | | - Lorna Zalatel
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Lars Hjorth
- Skåne University Hospital Lund, Lund, Sweden
| | - Wim J E Tissing
- Pediatric Oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Pediatric Oncology, University of Groningen, Groningen, The Netherlands
| | | | | | - Leontien C M Kremer
- Pediatric Oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
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5
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Kreutzer FP, Fiedler J, Thum T. Non-coding RNAs: key players in cardiac disease. J Physiol 2019; 598:2995-3003. [PMID: 31291008 DOI: 10.1113/jp278131] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 05/29/2019] [Indexed: 01/18/2023] Open
Abstract
Molecular mechanisms underlying heart failure (HF) are only partly understood. Non-coding RNAs (ncRNAs) have been reported to control function and signalling routes in the myocardium. As ncRNAs such as microRNAs (miRNAs), long non-coding RNAs (lncRNAs) or circular RNAs (circRNAs) can be selectively targeted via pharmacological approaches, this opens new avenues for diagnostic and therapeutic approaches. Here, we review the main ncRNA classes and how they influence cardiac biology. In addition we provide insight into the role of ncRNAs in chemotherapy-induced cardiac dysfunction. To provide a better understanding of ncRNAs in cardiovascular biology we present an outlook on specialized functions such as chromatin remodelling, biomarker potential and the recently discovered ncRNA-derived micropeptides.
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Affiliation(s)
- Fabian Philipp Kreutzer
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany
| | - Jan Fiedler
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany.,National Heart and Lung Institute, Imperial College London, London, UK.,Excellence Cluster REBIRTH, Hannover Medical School, Hannover, Germany
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6
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Parkhomenko RA, Shcherbenko OI, Rybakova MK, Zelinskaya NI, Kharchenko NV, Kunda MA, Zapirov GM. Changes of the Heart Valves in the Long Term After Chemoradiotherapy According to Different Protocols for Hodgkin's Lymphoma in Children and Adolescents. J Adolesc Young Adult Oncol 2019; 8:410-416. [PMID: 31017511 DOI: 10.1089/jayao.2018.0142] [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: 10/26/2022] Open
Abstract
Purpose: The purpose of our work was to study late cardiac complications after treatment for Hodgkin's lymphoma (HL) in children and adolescents. Methods: Sixty-seven patients were examined in the long term (>5 years) after chemoradiotherapy for HL according to two different programs of treatment (groups I and II). Mean total doses of radiotherapy (RT) to the mediastinum were 37.2 and 28.9 Gy, respectively. The status of the heart was assessed at the mean age of 22.7 years with electrocardiography (ECG) and echocardiography (EchoCG). Mean terms of follow-up were 16.4 and 9.5 years for group I and group II, respectively. Results: Incidence of ECG changes was equal between the groups (88% and 90%). The prevalence of signs of valvular calcifications and fibrosis was 70.9% after mediastinal doses ≥30 Gy, and 16.6% after lower doses (p = 0.002). Those changes led to considerable valvular dysfunction in four patients. EchoCG signs of pulmonary hypertension were seen in 33.3% patients of group I versus 4.8% in group II (p = 0.047). Pericardial effusion was observed in 7.4% and 5.1%, respectively (p = 1.0). Left ventricular ejection fraction decreased slightly only in two patients (one in each group). Conclusions: The RT mediastinal dose level is the important risk factor of late heart complications. Nevertheless, the differences in the rate and severity of those complications between the groups should be viewed with caution because of differences in the age at baseline and in follow-up terms. The survivors of HL should undergo life-long regular examinations of the heart status.
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Affiliation(s)
- Roman A Parkhomenko
- 1Medical Institute of Russian Peoples Friendship University (RUDN University), Moscow, Russia
| | | | - Marina K Rybakova
- 3Federal State Budgetary Educational Institution of Further Professional Education, "Russian Medical Academy of Continuous Professional Education" of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | | | - Natalya V Kharchenko
- 1Medical Institute of Russian Peoples Friendship University (RUDN University), Moscow, Russia
| | - Mikhail A Kunda
- 1Medical Institute of Russian Peoples Friendship University (RUDN University), Moscow, Russia
| | - Gadjimurad M Zapirov
- 1Medical Institute of Russian Peoples Friendship University (RUDN University), Moscow, Russia
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7
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Williams JP, Newhauser W. Normal tissue damage: its importance, history and challenges for the future. Br J Radiol 2018; 92:20180048. [PMID: 29616836 DOI: 10.1259/bjr.20180048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Sir Oliver Scott, a philanthropist and radiation biologist and, therefore, the epitome of a gentleman and a scholar, was an early Director of the BECC Radiobiology Research Unit at Mount Vernon. His tenure preceded that of Jack Fowler, with both contributing to basic, translational and clinical thought and application in radiation across the globe. With respect to this review, Fowler's name in particular has remained synonymous with the use of models, both animal and mathematical, that assess and quantify the biological mechanisms that underlie radiation-associated normal tissue toxicities. An understanding of these effects is critical to the optimal use of radiation therapy in the clinic; however, the role that basic sciences play in clinical practice has been undergoing considerable change in recent years, particularly in the USA, where there has been a growing emphasis on engineering and imaging to improve radiation delivery, with empirical observations of clinical outcome taking the place of models underpinned by evidence from basic science experiments. In honour of Scott and Fowler's work, we have taken this opportunity to review how our respective fields of radiation biology and radiation physics have intertwined over the years, affecting the clinical use of radiation with respect to normal tissue outcomes. We discuss the past and current achievements, with the hope of encouraging a revived interest in physics and biology as they relate to radiation oncology practice, since, like Scott and Fowler, we share the goal of improving the future outlook for cancer patients.
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Affiliation(s)
- Jacqueline P Williams
- Departments of Environmental Medicine and Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - Wayne Newhauser
- Department of Physics and Astronomy, Louisiana State University, Baton Rouge, LA, USA
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