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Legeron R, Bougueon G, Berroneau A, De-Germay S, Bernadou JM, Djabarouti S, Crauste-Manciet S, Xuereb F. Long-term physicochemical stability of acyclovir 5 mg/mL solution stored in polypropylene bags as a simulated hospital stock preparation. Am J Health Syst Pharm 2021; 78:806-812. [PMID: 33630992 DOI: 10.1093/ajhp/zxab071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To investigate the long-term chemical and physical stability of 5-mg/mL acyclovir solution in polypropylene bags stored at 5°C ± 3°C for 2 months in order to determine the feasibility of batch production by a centralized intravenous additive service. METHODS Eight empty 100-mL polypropylene bags (bags A) and 8 empty 250-mL bags (bags B) were respectively filled with 60 mL and 200 mL of 5-mg/mL acyclovir and 0.9% sodium chloride injection (NaCl) under aseptic conditions through a semiautomated manufacturing process and vacuum packed before storage at 5°C ± 3°C. Four bags A and 4 bags B were tested for chemical stability via a stability-indicating high-performance liquid chromatography (HPLC) method immediately after preparation (time 0) and after 7, 14, 21, 28, 35, 42, and 63 days. Samples for microbiological assay were collected on days 0 and 63 from 4 bags A and 4 bags B immediately after breaking the vacuum. Osmolality, pH, and physical stability were assessed by visual examination, Subvisible particle counting was performed on 6 additional bags (3 each of bags A and B). RESULTS Mean percentage loss of acyclovir relative to the mean experimental concentration at time 0 was below 5% over the 63-day study period.. No significant differences of pH, no change in color and no precipitate were observed during the study. Subvisible particle counts were compliant with European Pharmacopoeia requirements. Acyclovir solutions remained sterile over the 63 days of the study. CONCLUSION Extemporaneously prepared acyclovir 5 mg/mL solutions in 0.9% NaCl stored in polypropylene bags were chemically and physically stable over 63 days when stored at 5°C ± 3°C.
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Affiliation(s)
- Rachel Legeron
- CHU de Bordeaux, Pôle Produits de Santé, Service Pharmacie à Usage Intérieur, Pessac, France.,University of Bordeaux, Inserm, UMR1034, Biology of Cardiovascular Diseases, Pessac, France
| | - Guillaume Bougueon
- CHU de Bordeaux, Pôle Produits de Santé, Service Pharmacie à Usage Intérieur, Pessac, France.,University of Bordeaux, Inserm, U1212, UMR CNRS 5320, ARNA (ARN: Régulations Naturelle et Artificielle), ChemBioPharm, Bordeaux, France
| | - Aude Berroneau
- CHU de Bordeaux, Pôle Produits de Santé, Service Pharmacie à Usage Intérieur, Pessac, France
| | - Sybille De-Germay
- CHU de Bordeaux, Pôle Produits de Santé, Service Pharmacie à Usage Intérieur, Pessac, France
| | - Jean-Marc Bernadou
- CHU de Bordeaux, Pôle Produits de Santé, Service Pharmacie à Usage Intérieur, Pessac, France
| | - Sarah Djabarouti
- CHU de Bordeaux, Pôle Produits de Santé, Service Pharmacie à Usage Intérieur, Pessac, France.,University of Bordeaux, Inserm, UMR1034, Biology of Cardiovascular Diseases, Pessac, France
| | - Sylvie Crauste-Manciet
- CHU de Bordeaux, Pôle Produits de Santé, Service Pharmacie à Usage Intérieur, Pessac, France.,University of Bordeaux, Inserm, U1212, UMR CNRS 5320, ARNA (ARN: Régulations Naturelle et Artificielle), ChemBioPharm, Bordeaux, France
| | - Fabien Xuereb
- CHU de Bordeaux, Pôle Produits de Santé, Service Pharmacie à Usage Intérieur, Pessac, France.,University of Bordeaux, Inserm, UMR1034, Biology of Cardiovascular Diseases, Pessac, France
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Sangnier M, Bouguéon G, Berroneau A, Dubois V, Crauste-Manciet S. Removal of bacterial growth inhibition of anticancer drugs by using complexation materials. Pharmaceutical Technology in Hospital Pharmacy 2020. [DOI: 10.1515/pthp-2019-0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractIn the context of batch production of cytotoxic drugs in hospital pharmacies with the need of sterility testing, the objective was to validate the use of Rapid Microbiological Method (RMM), and to develop adequate neutralization method in case of inhibition of bacterial growth. The potential microbiological growth inhibitory effect of three anticancer drugs (5 fluorouracil, irinotecan and oxaliplatin) selected for batch production was assessed on BacT/ALERT® system. Among cytotoxic drugs, only 5FU exhibited inhibitory effect on microbiological growth using rapid microbiological method. To counteract this effect our purpose was to use neutralizing agents complexing the drug i. e. activated carbon or ion exchange resins. The microbiological bactericidal concentration of 5FU was very low (1.10–4 mg/mL) indicating the absolute need to neutralize the whole drug before sterility test. The complexation was validated by High Performance Liquid Chromatography control of the residual 5FU concentration in solution after the use of neutralizing agents. Only activated carbon was able to fully capture 5FU when previously diluted at 5 mg/mL. Conversely, the resins, in the condition of the study, were not able to fully capture 5FU whatever the dilution. The microbiological growth on BacT/ALERT® system after active carbon treatment was successfully confirmed with Staphylococcus aureus. Based on this validation results a method was then developed to routinely be able to perform sterility test of the batches produced and was confirmed on five microbiological species (i. e. S. aureus, Pseudomonas aeruginosa, Bacillus subtilis, Candida albicans, Aspergillus brasiliensis). Our work gives a new insight for considering sterility testing by rapid microbiological method even for drugs exhibiting inhibitory effect on microbiological growth.
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Affiliation(s)
- Maïté Sangnier
- Pharmaceutical Technology Department, Bordeaux University Hospital, Avenue de Magellan, Pessac, France
| | - Guillaume Bouguéon
- Pharmaceutical Technology Department, Bordeaux University Hospital, Avenue de Magellan, Pessac, France
- ARNA Laboratory-ChemBioPharm U1212 INSERM – UMR5320, CNRS – University of Bordeaux, 146 rue Léo Saignat, Bordeaux, France
| | - Aude Berroneau
- Pharmaceutical Technology Department, Bordeaux University Hospital, Avenue de Magellan, Pessac, France
| | - Véronique Dubois
- Fundamental Microbiology and Pathogenicity Laboratory UMR-CNRS 5234 – University of Bordeaux, 146 rue Léo Saignat, Bordeaux, France
- Microbiology Department, Bordeaux University Hospital, Place Amélie Rabat Léon, Bordeaux Cedex, France
| | - Sylvie Crauste-Manciet
- Pharmaceutical Technology Department, Bordeaux University Hospital, Avenue de Magellan, Pessac, France
- ARNA Laboratory-ChemBioPharm U1212 INSERM – UMR5320, CNRS – University of Bordeaux, 146 rue Léo Saignat, Bordeaux, France
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Poullenot F, Ollivier J, Rivière P, Sauvaget L, Berroneau A, Djabarouti S, Xuereb F, Zerbib F, Breilh D, Laharie D. Implementation of infliximab standardized doses after pharmacokinetic modelization in a cohort of patients with Crohn's disease. Dig Liver Dis 2020; 52:408-413. [PMID: 31874834 DOI: 10.1016/j.dld.2019.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/22/2019] [Accepted: 11/27/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND According to infliximab (IFX) license in Crohn's disease (CD), infusion doses are based on patient's body-weight. Dose banding providing standardized doses (SD) has been implemented in parenteral chemotherapy in order to optimize aseptic unit capacity and reduce drug expenditure, duration of hospital stay and costs without decreasing efficacy. MATERIAL AND METHOD The first part was a single-center retrospective analysis of consecutive CD patients receiving IFX maintenance therapy to determine standardized doses covering more than 50% of infusions. The second part was a prospective cohort study assessing the impact of SD compared to body-weight doses (BWD) on admission duration and costs. RESULTS Six IFX SD covering more than 90% of infusion doses were implemented for dose banding. According to the Monte-Carlo simulation, there was no significant difference between IFX SD and BWD maintenance regimens. When assessed prospectively in 116 patients (75 patients treated with SD and 41 with BWD) corresponding to 128 infusions, hospitalization duration was shortened by 70 min per patient (p < 0.001). CONCLUSION According to a pharmacokinetic model, IFX SD has a pharmacokinetic profile close to BWD and is associated with reduced length of hospitalization in a cohort of patients with CD. IFX SD implementation could optimize infusion units functioning and, save time and costs without decreasing efficacy.
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Affiliation(s)
- Florian Poullenot
- CHU De Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie, CMC Magellan, Bordeaux, Pessac, France.
| | - Julien Ollivier
- Pharmacie, Groupe Hospitalier Sud Haut-Lévêque, CHU De Bordeaux, Pessac, France
| | - Pauline Rivière
- CHU De Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie, CMC Magellan, Bordeaux, Pessac, France
| | - Lucie Sauvaget
- Pharmacie, Groupe Hospitalier Sud Haut-Lévêque, CHU De Bordeaux, Pessac, France
| | - Aude Berroneau
- Pharmacie, Groupe Hospitalier Sud Haut-Lévêque, CHU De Bordeaux, Pessac, France; Laboratoire De Pharmacocinétique Et De Pharmacie Clinique, Université Victor Segalen, Bordeaux Cedex, France; INSERM U1034 Cardiovascular Adaptation to Ischemia, Pessac, France
| | - Sarah Djabarouti
- Pharmacie, Groupe Hospitalier Sud Haut-Lévêque, CHU De Bordeaux, Pessac, France; Laboratoire De Pharmacocinétique Et De Pharmacie Clinique, Université Victor Segalen, Bordeaux Cedex, France; INSERM U1034 Cardiovascular Adaptation to Ischemia, Pessac, France
| | - Fabien Xuereb
- Pharmacie, Groupe Hospitalier Sud Haut-Lévêque, CHU De Bordeaux, Pessac, France; Laboratoire De Pharmacocinétique Et De Pharmacie Clinique, Université Victor Segalen, Bordeaux Cedex, France; INSERM U1034 Cardiovascular Adaptation to Ischemia, Pessac, France
| | - Frank Zerbib
- CHU De Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie, CMC Magellan, Bordeaux, Pessac, France
| | - Dominique Breilh
- Pharmacie, Groupe Hospitalier Sud Haut-Lévêque, CHU De Bordeaux, Pessac, France; Laboratoire De Pharmacocinétique Et De Pharmacie Clinique, Université Victor Segalen, Bordeaux Cedex, France; INSERM U1034 Cardiovascular Adaptation to Ischemia, Pessac, France
| | - David Laharie
- CHU De Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie, CMC Magellan, Bordeaux, Pessac, France
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Perino J, Mottal N, Bohbot Y, Servant V, Berroneau A, Poustis P, Fenaux P, Laribi K, Charbonnier A, Bilion E, Calmettes C, Bégaud B, Pigneux A, Milpied N, Miremont-Salamé G, Théophile H, Dimicoli-Salazar S. Cardiac failure in patients treated with azacitidine, a pyrimidine analogue: Case reports and disproportionality analyses in Vigibase. Br J Clin Pharmacol 2020; 86:991-998. [PMID: 31912911 DOI: 10.1111/bcp.14211] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/25/2019] [Accepted: 12/09/2019] [Indexed: 01/09/2023] Open
Abstract
AIMS Azacitidine (AZA), a pyrimidine analogue, is validated for high-risk myelodysplastic syndrome or low-blast acute myeloid leukaemia in unfit patients for more intensive treatment. This study assessed the putative link between cardiac failure (CF) and AZA exposure. METHODS Cases of CF in patients treated with AZA were retrospectively collected and described from several centres of the Groupe Francophone des Myélodysplasies. A description analysis and a disproportionality analysis using Vigibase, the WHO Global Individual Case Safety Reports (ICSRs) database, were conducted on ICSRs by the Standardized MedDRA Queries (SMQ broad) cardiac failure and by preferred terms cardiac failure and cardiac failure acute. The reported odds ratio (ROR) and its 95% 2-sided confidence interval was computed by comparing the proportion of CF reports with the suspected drug (AZA) and the proportion of reports of the same adverse drug reaction with all other suspected drugs in the database during the same period. RESULTS In the 4 case reports, all patients presented a cardiovascular history. In 1 patient, CF recurred after AZA re-challenge. The pharmacovigilance analysis in Vigibase retrieved 307 ICSRs of CF (SMQ) with AZA. Significant disproportionality signals associated with AZA were identified by using the SMQ cardiac failure (ROR 1.3) and the preferred terms cardiac failure (ROR 5.1) and cardiac failure acute (ROR 23.2). CONCLUSION This study points to the potential role of AZA in the occurrence of CF. Cardiac evaluation before AZA initiation and regular monitoring of cardiac function during AZA treatment should be performed in patients with a history of cardiovascular disease.
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Affiliation(s)
- Justine Perino
- CHU de Bordeaux, Pôle de Santé Publique, Service de pharmacologie médicale, Centre Régional de pharmacovigilance de Bordeaux, Bordeaux, France
| | - Nathan Mottal
- CHU de Bordeaux, Service d'Hématologie Clinique et Thérapie Cellulaire Bordeaux, France
| | - Yohann Bohbot
- CHU d'Amiens, Pôle Cœur-Thorax-Vaisseaux, Département de Cardiologie, Amiens Cedex, France
| | - Vincent Servant
- Pharmacie à Usage Intérieur, CHU de Bordeaux, Pessac, France
| | - Aude Berroneau
- Pharmacie à Usage Intérieur, CHU de Bordeaux, Pessac, France
| | - Pierre Poustis
- Service des soins intensifs cardiologiques Haut-Lévêque (intensive care unit), Pessac, France
| | - Pierre Fenaux
- Service d'Hematologie Seniors, Hôpital Saint Louis, Ass Pub Hôp Paris and Paris 7 Université Paris, France
| | - Kamel Laribi
- Service d'Hematologie, Centre Hospitalier du Mans, Le Mans, France
| | - Aude Charbonnier
- Service d'Hematologie, Institut Paoli Calmettes, Marseille, France
| | - Emilien Bilion
- Service d'Hematologie, Institut Paoli Calmettes, Marseille, France
| | - Claire Calmettes
- CHU de Bordeaux, Service d'Hématologie Clinique et Thérapie Cellulaire Bordeaux, France
| | - Bernard Bégaud
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Centre, team Pharmacoepidemiology, Bordeaux, France
| | - Arnaud Pigneux
- CHU de Bordeaux, Service d'Hématologie Clinique et Thérapie Cellulaire Bordeaux, France
| | - Noël Milpied
- CHU de Bordeaux, Service d'Hématologie Clinique et Thérapie Cellulaire Bordeaux, France
| | - Ghada Miremont-Salamé
- CHU de Bordeaux, Pôle de Santé Publique, Service de pharmacologie médicale, Centre Régional de pharmacovigilance de Bordeaux, Bordeaux, France.,Univ. Bordeaux, Inserm, Bordeaux Population Health Research Centre, team Pharmacoepidemiology, Bordeaux, France
| | - Hélène Théophile
- CHU de Bordeaux, Pôle de Santé Publique, Service de pharmacologie médicale, Centre Régional de pharmacovigilance de Bordeaux, Bordeaux, France
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Heloury J, Bouguéon G, Deljehier T, Jourand A, Berroneau A, Crauste-Manciet S. Automation of Aseptic Sterile Preparation: Risk Analysis and Productivity Comparison with Manual Process. Pharmaceutical Technology in Hospital Pharmacy 2019. [DOI: 10.1515/pthp-2019-0001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Two automation methods for aseptic preparation in hospital pharmacy, robot and peristaltic pump, were compared to manual process both for risk analysis using Failure Modes Effects and Criticality Analysis (FMECA) method and for productivity using time analysis grids built for each process.
The results obtained with the different workflow organizations showed that the worst-case conditions for productivity was production “on demand” of tailor-made preparations. in that case, the manual process was not significantly different from the robotic process (p-value=0.72). For the standardized preparations, the semi-automatic process preparing a batch from bulk solution from “to be reconstituted” drugs was significantly superior to the robotic process preparing repetitive series of doses (p-value<0.01). Productivity of the robot was dramatically increased when the robot performed standardized preparations either from ready to use solutions or mixed cycles due to the robot design. When different processes were FMECA analyzed for risk analysis the robotic process was found as the safer process in comparison to others with a total of Criticality Indexes of 1060, 719, 656 for manual, semi-automatic and robot, respectively. Except for the robotic, semi-automatic and manual processes needed additional IT control systems to limit the risk of failures.
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Affiliation(s)
- Jeanne Heloury
- Pharmaceutical Technology Department , Bordeaux University Hospital , Bordeaux , France
| | - Guillaume Bouguéon
- Pharmaceutical Technology Department , Bordeaux University Hospital , Bordeaux , France
- ARNA laboratory ChemBioPharm U1212 INSERM – UMR 5320 CNRS , Bordeaux University , Bordeaux , France
| | - Thomas Deljehier
- Pharmaceutical Technology Department , Bordeaux University Hospital , Bordeaux , France
| | - Audrey Jourand
- Quality department , Bordeaux University Hospital , Bordeaux , France
| | - Aude Berroneau
- Pharmaceutical Technology Department , Bordeaux University Hospital , Bordeaux , France
| | - Sylvie Crauste-Manciet
- Pharmaceutical Technology Department , Bordeaux University Hospital , Bordeaux , France
- ARNA laboratory ChemBioPharm U1212 INSERM – UMR 5320 CNRS , Bordeaux University , Bordeaux , France
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Deljehier T, Bouguéon G, Heloury J, Moreno V, Berroneau A, Crauste-Manciet S. Simulation program of a cytotoxic compounding robot for monoclonal antibodies and anti-infectious sterile drug preparation. J Oncol Pharm Pract 2019; 25:1873-1890. [DOI: 10.1177/1078155218823911] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to develop a specific simulation program for the validation of a cytotoxic compounding robot, KIRO® Oncology, for the preparation of sterile monoclonal antibodies and anti-infectious drugs. The impact of excipient formulations was clearly measured using simulation accuracy tests with worst case excipient (i.e. viscous, foaming) and allowed to correct the robotic settings prior to real production. Corrections brought accuracies within the acceptable range of ±5%. KIRO® Oncology robot has also the capacity of self-cleaning and a simulation combining media fill test, and environmental monitoring was able to validate the aseptic process including simulation of worst case conditions and highlighting the areas not accessible to self-cleaning to be corrected by additional manual cleaning measures. The risk of chemical contamination was simulated by using fluorescent dye of the process with high-risk excipient formulation and overpressure vials. Quality control reliability was simulated by using a model drug, and final concentration was determined by high-performance liquid chromatography-ultraviolet detection. Finally, productivity was simulated using different models of production showing the impact of the type of drug, the number of vials and the poor standardization of the process.
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Affiliation(s)
- Thomas Deljehier
- Pharmaceutical Technology Department, Bordeaux University Hospital, Bordeaux, France
| | - Guillaume Bouguéon
- Pharmaceutical Technology Department, Bordeaux University Hospital, Bordeaux, France
- ARNA Laboratory ChemBioPharm U1212 INSERM, UMR 5320 CNRS Bordeaux University, Bordeaux, France
| | - Jeanne Heloury
- Pharmaceutical Technology Department, Bordeaux University Hospital, Bordeaux, France
| | - Valérie Moreno
- Biomedical Department, Bordeaux University Hospital, Bordeaux, France
| | - Aude Berroneau
- Pharmaceutical Technology Department, Bordeaux University Hospital, Bordeaux, France
| | - Sylvie Crauste-Manciet
- Pharmaceutical Technology Department, Bordeaux University Hospital, Bordeaux, France
- ARNA Laboratory ChemBioPharm U1212 INSERM, UMR 5320 CNRS Bordeaux University, Bordeaux, France
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Ledroit M, Megne Wabo M, Berroneau A, Xuereb F, Breilh D. Conciliation médicamenteuse et lien ville-hôpital. Actualités Pharmaceutiques 2017. [DOI: 10.1016/j.actpha.2017.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ledroit M, Megne Wabo M, Berroneau A, Dromer C, Xuereb F, Breilh D. La greffe pulmonaire et ses traitements. Actualités Pharmaceutiques 2017. [DOI: 10.1016/j.actpha.2017.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ledroit M, Megne Wabo M, Berroneau A, Xuereb F. Place du pharmacien dans l’éducation thérapeutique. Actualités Pharmaceutiques 2017. [DOI: 10.1016/j.actpha.2017.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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