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Ottander, Ulrika
Publications (10 of 36) Show all publications
Rutegård, M., Moshtaghi-Svensson, J., Weibull, C. E., Ottander, U., Nordenvall, C. & Sund, M. (2023). Exposure to oestrogen and risk of anastomotic leakage after colorectal cancer surgery - A clue to the different leak rates in men and women.. Colorectal Disease, 25(1), 9-15
Open this publication in new window or tab >>Exposure to oestrogen and risk of anastomotic leakage after colorectal cancer surgery - A clue to the different leak rates in men and women.
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2023 (English)In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 25, no 1, p. 9-15Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Colorectal anastomotic leakage is consistently more common in men, regardless of tumour location. This fact is largely unexplained but might be a consequence of biological differences including hormonal exposure and not only related to anatomy.

METHODS: This was a retrospective, nationwide registry-based observational study of post-menopausal women operated for colorectal cancer with an anastomosis between 2007 and 2016. Hormonal exposure before surgery, as defined by prescribed drugs affecting oestrogen levels, was related to postoperative anastomotic leakage, using mixed-effects logistic regression models with adjustment for confounding. Odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were derived. In addition, separate estimates according to tumour location were computed, and a sensitivity analysis excluding topical oestrogen hormone exposure was conducted.

RESULTS: Some 16,535 post-menopausal women were included, of which 16.2% were exposed to drugs increasing oestrogen levels before surgery. In this exposed group compared to the unexposed, leak rates were 3.1 and 3.8%, respectively. After adjustment, a reduction of anastomotic leakage in the exposed group was detected (OR: 0.77; 95% CI: 0.59-0.99). This finding was largely attributed to the rectal cancer subgroup (OR: 0.55; 95% CI: 0.36-0.85), while the exclusion of topical oestrogen drugs further reduced the estimates of the main analysis (OR: 0.63; 95% CI: 0.38-1.02).

CONCLUSIONS: Anastomotic leakage rates are lower in women exposed to hormone replacement therapy before surgery for colorectal cancer, which might explain some of the difference in leak rates between men and women, especially regarding rectal cancer.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
anastomotic insufficiency, gender, hormones, sex
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-199794 (URN)10.1111/codi.16300 (DOI)000853430300001 ()36007883 (PubMedID)2-s2.0-85137874282 (Scopus ID)
Funder
Cancerforskningsfonden i NorrlandThe Cancer Society in StockholmKnut and Alice Wallenberg FoundationSwedish Society of Medicine
Available from: 2022-09-28 Created: 2022-09-28 Last updated: 2024-02-01Bibliographically approved
Gideonsson, I., Israelsson, P., Strandberg, S. & Ottander, U. (2023). Long-term follow-up of tamoxifen treatment and the use of imaging in psammocarcinoma: a case report, review of the literature and discussion of diagnostic and therapeutic challenges. Current Oncology, 30(12), 10260-10271
Open this publication in new window or tab >>Long-term follow-up of tamoxifen treatment and the use of imaging in psammocarcinoma: a case report, review of the literature and discussion of diagnostic and therapeutic challenges
2023 (English)In: Current Oncology, ISSN 1198-0052, E-ISSN 1718-7729, Vol. 30, no 12, p. 10260-10271Article in journal (Refereed) Published
Abstract [en]

Psammocarcinoma (PsC) represents a rare form of low-grade serous tumor of the ovary or peritoneum. Although ovarian cancer generally has a poor prognosis in its late stages, PsC seems to have a more indolent course. We present a patient with a history of unspecific abdominal pain for more than a year, with sudden acute onset of severe inguinal pain. On admission to the hospital, a computed tomography (CT) revealed a pelvic mass of suspected ovarian origin. Radical surgery was attempted but not achieved due to widespread tumor growth. Histopathological evaluation revealed estrogen receptor-positive stage III PsC. Tamoxifen treatment was thus initiated, still maintaining stable disease 10 years later. The patient has undergone extensive radiological work-up, including CT, chest X-ray, 18F-fluoro-deoxy-glucose positron emission tomography (PET)/CT, 99mTc- hydroxymethylene diphosphonate (HDP) bone scintigraphy, 18F-fluoro-thymidine (FLT) PET/CT, Tc-99m depreotide scintigraphy and magnetic resonance imaging. In conclusion, we demonstrate that PsC has characteristic radiological features and different imaging modalities can be suitable in different clinical situations. In contrast to most other ovarian cancers, PsC does not always warrant adjuvant chemotherapy, even in advanced stages. This emphasizes the need for a deeper knowledge of the biological behavior of this rare tumor, to select the optimal treatment strategy.

Place, publisher, year, edition, pages
MDPI, 2023
Keywords
case report, CT, FDG PET, imaging, MRI, ovarian cancer, psammocarcinoma, psammoma bodies, serous carcinoma, tamoxifen
National Category
Radiology, Nuclear Medicine and Medical Imaging Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-219099 (URN)10.3390/curroncol30120747 (DOI)38132381 (PubMedID)2-s2.0-85180702524 (Scopus ID)
Funder
Umeå University
Available from: 2024-01-10 Created: 2024-01-10 Last updated: 2024-01-10Bibliographically approved
Israelsson, P., Björk, E., Nagaev, I., Nagaeva, O., Lundin, E., Mincheva-Nilsson, L. & Ottander, U. (2023). NKG2D-mediated cytotoxicity improves after primary surgery for high-grade serous ovarian cancer. American Journal of Reproductive Immunology, 89(1), Article ID e13647.
Open this publication in new window or tab >>NKG2D-mediated cytotoxicity improves after primary surgery for high-grade serous ovarian cancer
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2023 (English)In: American Journal of Reproductive Immunology, ISSN 1046-7408, E-ISSN 1600-0897, Vol. 89, no 1, article id e13647Article in journal (Refereed) Published
Abstract [en]

Problem: Tumors compromise the patients’ immune system to promote their own survival. We have previously reported that HGSC exosomes play a central role, downregulating NKG2D cytotoxicity. Primary surgery's effect on tumor exosomes and NKG2D cytotoxicity in HGSC patients has not been studied before. The overall objective of this study was to explore the effect of surgery on the exosome-induced impairment of NKG2D cytotoxicity in HGSC.

Method of study: Paired pre- and post-operative blood samples were subjected to cell and exosome analyses regarding the NKG2D receptor and ligands, and NKG2D-mediated cytotoxicity. Lymphocytes were phenotyped by immunoflow cytometry. Exosomes, isolated by ultracentrifugation, and characterized by nanoparticle tracking analysis, transmission and immune electron microscopy and western blot were used in functional cytotoxic experiments. HGSC explant culture-derived exosomes, previously studied by us, were used for comparison.

Results: HGSC exosomes from patients’ sera downregulated NKG2D-mediated cytotoxicity in NK cells of healthy donors. In a subgroup of subjects, NKG2D expression on CTLs and NK cells was upregulated after surgery, correlating to a decrease in the concentration of exosomes in postoperative sera. An overall significantly improved NKG2D-mediated cytotoxic response of the HGSC patients’ own NK cells in postoperative compared to preoperative samples was noted.

Conclusions: Surgical removal of the primary tumor has a beneficial effect, relieving the exosome-mediated suppression of NKG2D cytotoxicity in HGSC patients, thus boostering their ability to combat cancer.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
cytotoxicity, EOC/HGSC, epithelial ovarian cancer, exosomes, immune suppression, NKG2D, NKG2D ligands, surgery
National Category
Immunology in the medical area
Identifiers
urn:nbn:se:umu:diva-201334 (URN)10.1111/aji.13647 (DOI)000888859600001 ()36335434 (PubMedID)2-s2.0-85142285991 (Scopus ID)
Funder
Swedish Research Council, 18-20–345240311Swedish Cancer Society, CAN 2018/350; no. 18 07 17
Available from: 2022-12-15 Created: 2022-12-15 Last updated: 2022-12-30Bibliographically approved
Ottander, U. & Dahlstrand, H. (2023). Äggstockscancer (1:1ed.). In: Mikael Johansson; Roger Henriksson; Mef Nilbert (Ed.), Cancersjukdomar: (pp. 369-377). Lund: Studentlitteratur AB
Open this publication in new window or tab >>Äggstockscancer
2023 (Swedish)In: Cancersjukdomar / [ed] Mikael Johansson; Roger Henriksson; Mef Nilbert, Lund: Studentlitteratur AB, 2023, 1:1, p. 369-377Chapter in book (Other academic)
Place, publisher, year, edition, pages
Lund: Studentlitteratur AB, 2023 Edition: 1:1
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-216317 (URN)9789144161693 (ISBN)
Available from: 2023-11-08 Created: 2023-11-08 Last updated: 2023-11-13Bibliographically approved
Ottander, U. (2021). Gynekologi (4ed.). In: Pontus Karling (Ed.), Kliniska färdigheter: mötet mellan patient och läkare (pp. 145-157). Lund: Studentlitteratur AB
Open this publication in new window or tab >>Gynekologi
2021 (Swedish)In: Kliniska färdigheter: mötet mellan patient och läkare / [ed] Pontus Karling, Lund: Studentlitteratur AB, 2021, 4, p. 145-157Chapter in book (Other academic)
Place, publisher, year, edition, pages
Lund: Studentlitteratur AB, 2021 Edition: 4
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-194241 (URN)978-91-44-13588-5 (ISBN)
Available from: 2022-04-28 Created: 2022-04-28 Last updated: 2022-05-06Bibliographically approved
Danielsson, J., Hadding, C., Martin, F., Ottander, U. & Lindquist, D. (2021). Medical students’ experiences in learning to perform pelvic examinations: a mixed-methods study. International Journal of Medical Education, 12, 233-242
Open this publication in new window or tab >>Medical students’ experiences in learning to perform pelvic examinations: a mixed-methods study
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2021 (English)In: International Journal of Medical Education, E-ISSN 2042-6372, Vol. 12, p. 233-242Article in journal (Refereed) Published
Abstract [en]

Objectives: We aimed to explore learning experiences among medical students learning to perform pelvic examinations and to identify factors that facilitate their training.

Methods: A mixed-methods study including a web-based survey and focus group discussions (FGDs) was conducted among medical students who had completed their obstetrics and gynaecology (ObGyn) clerkship. The FGDs were recorded, transcribed and analysed using qualitative content analysis with systematic text condensation. Survey factors were compared using the χ2 test or Fisher's exact test.

Results: 160 students (97 female, 61 male, two other) at six universities in Sweden responded to the survey. Two mixed FGDs were conducted. The majority (87%) of the students experienced confidence in performing pelvic examinations, stating that sufficient, repeated training opportunities and support from a clinical tutor were crucial components of the learning experience. Prior to the ObGyn clerkship, negative expectations were more common among male students. The male participants experienced having a disadvantage because of their gender, while female students considered their gender an advantage (p<0.001, N=121, Fisher's Exact Test). The clinical tutor and the use of professional patients (PPs) had a fundamental role in providing learning opportunities by including the student in patient care activities.

Conclusions: The importance of the clinical tutor, as well as the use of PPs, are important factors when planning education in pelvic examinations, and this knowledge could be used when educating other intimate examinations during medical school. In addition, similar investigations on students' experience in training other intimate examinations could be considered.

Place, publisher, year, edition, pages
Nottingham: Medical Education Unit University of Nottingham, 2021
Keywords
gender differences, pelvic examination, learning opportunities, medical students, obstetrics and gynaecology clerkship
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Medicine
Identifiers
urn:nbn:se:umu:diva-190659 (URN)10.5116/ijme.617f.b261 (DOI)000723959800001 ()34842177 (PubMedID)2-s2.0-85122276263 (Scopus ID)
Available from: 2021-12-21 Created: 2021-12-21 Last updated: 2022-09-15Bibliographically approved
Wedin, M., Stalberg, K., Marcickiewicz, J., Ahlner, E., Ottander, U., Åkesson, Å., . . . Kjølhede, P. (2021). Risk factors for lymphedema and method of assessment in endometrial cancer: a prospective longitudinal multicenter study. International Journal of Gynecological Cancer, 31(11), 1416-1427
Open this publication in new window or tab >>Risk factors for lymphedema and method of assessment in endometrial cancer: a prospective longitudinal multicenter study
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2021 (English)In: International Journal of Gynecological Cancer, ISSN 1048-891X, E-ISSN 1525-1438, Vol. 31, no 11, p. 1416-1427Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The aim of the study was to determine risk factors for lymphedema of the lower limbs, assessed by four methods, 1 year after surgery for endometrial cancer.

METHODS: A prospective longitudinal multicenter study was conducted in 14 Swedish hospitals. 235 women with endometrial cancer were included; 116 underwent surgery including lymphadenectomy, and 119 had surgery without lymphadenectomy. Lymphedema was assessed preoperatively and 1 year postoperatively objectively by systematic circumferential measurements of the legs, enabling volume estimation addressed as (1) crude volume and (2) body mass index-standardized volume, or (3) clinical grading, and (4) subjectively by patient-reported perception of leg swelling. In volume estimation, lymphedema was defined as a volume increase ≥10%. Risk factors were analyzed using forward stepwise logistic regression models and presented as adjusted odds ratio (aOR) and 95% confidence interval (95% CI).

RESULTS: Risk factors varied substantially, depending on the method of determining lymphedema. Lymphadenectomy was a risk factor for lymphedema when assessed by body mass index-standardized volume (aOR 14.42, 95% CI 3.49 to 59.62), clinical grading (aOR 2.11, 95% CI 1.04 to 4.29), and patient-perceived swelling (aOR 2.51, 95% CI 1.33 to 4.73), but not when evaluated by crude volume. Adjuvant radiotherapy was only a risk factor for lymphedema when assessed by body mass index-standardized volume (aOR 15.02, 95% CI 2.34 to 96.57). Aging was a risk factor for lymphedema when assessed by body mass index-standardized volume (aOR 1.07, 95% CI 1.00 to 1.15) and patient-perceived swelling (aOR 1.06, 95% CI 1.02 to 1.10), but not when assessed by crude volume or clinical grading. Increase in body mass index was a risk factor for lymphedema when estimated by crude volume (aOR 1.92, 95% CI 1.36 to 2.71) and patient-perceived swelling (aOR 1.36, 95% CI 1.11 to 1.66), but not by body mass index-standardized volume or clinical grading. The extent of lymphadenectomy was strongly predictive for the development of lymphedema when assessed by body mass index-standardized volume and patient-perceived swelling, but not by crude volume or clinical grading.

CONCLUSION: Apparent risk factors for lymphedema differed considerably depending on the method used to determine lymphedema. This highlights the need for a 'gold standard' method when addressing lymphedema for determining risk factors.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2021
Keywords
endometrial neoplasms, sln and lympadenectomy, surgery
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-190872 (URN)10.1136/ijgc-2021-002890 (DOI)000715381200004 ()34610970 (PubMedID)2-s2.0-85121477221 (Scopus ID)
Funder
Swedish Cancer Society, 2013/620
Available from: 2021-12-30 Created: 2021-12-30 Last updated: 2021-12-30Bibliographically approved
Jonsson, S., Lundin, E., Elgh, F., Ottander, U. & Idahl, A. (2020). Chlamydia trachomatis and Anti-MUC1 Serology and Subsequent Risk of High-Grade Serous Ovarian Cancer: A Population-Based Case-Control Study in Northern Sweden. Translational Oncology, 13(1), 86-91
Open this publication in new window or tab >>Chlamydia trachomatis and Anti-MUC1 Serology and Subsequent Risk of High-Grade Serous Ovarian Cancer: A Population-Based Case-Control Study in Northern Sweden
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2020 (English)In: Translational Oncology, ISSN 1944-7124, E-ISSN 1936-5233, Vol. 13, no 1, p. 86-91Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Chlamydia trachomatis salpingitis causes inflammatory damage to the fallopian tube and could potentially cause initiation and progression of high-grade serous ovarian cancer (HGSC). Furthermore, C. trachomatis infection may stimulate mucin 1 (MUC1) protein production, possibly affecting anti-MUC1 antibody levels. The aim of this study was to examine if serology indicating past infection with C. trachomatis as well as anti-MUC1 production was associated with subsequent risk of HGSC.

MATERIALS AND METHODS: In a prospective nested case-control study within the Northern Sweden Health and Disease Study and the Northern Sweden Maternity Cohort, the prevalence of chlamydial and anti-MUC1 antibodies was analyzed in blood samples drawn more than one year before diagnosis from 92 women with HGSC and 359 matched controls. Matching factors were age, date at blood draw, and sampling cohort. Plasma C. trachomatis IgG was analyzed using commercial micro-immunofluorescence test; chlamydial Heat Shock Protein 60 IgG (cHSP60) and anti-MUC1 IgG were analyzed with ELISA technique.

RESULTS: The prevalence of C. trachomatis IgG and cHSP60 IgG antibodies, as well as the level of anti-MUC1 IgG was similar in women with HGSC and controls (16.3% vs. 17.0%, P = 0.87; 27.2% vs. 28.5%, P = 0.80; median 0.24 vs. 0.25, P = 0.70). Anti-MUC1 IgG and cHSP60 IgG levels were correlated (r = 0.169; P < 0.001).

CONCLUSIONS: The findings of this prospective nested case-control study did not support an association between C. trachomatis infection, as measured by chlamydial serology, or anti-MUC1 IgG antibodies, and subsequent risk of HGSC.

Place, publisher, year, edition, pages
Elsevier, 2020
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-174272 (URN)10.1016/j.tranon.2019.09.007 (DOI)000502822300010 ()31805519 (PubMedID)2-s2.0-85075720208 (Scopus ID)
Available from: 2020-08-19 Created: 2020-08-19 Last updated: 2023-05-10Bibliographically approved
Israelsson, P., Dehlin, E., Nagaev, I., Lundin, E., Ottander, U. & Mincheva-Nilsson, L. (2020). Cytokine mRNA and protein expression by cell cultures of epithelial ovarian cancer: Methodological considerations on the choice of analytical method for cytokine analyses. American Journal of Reproductive Immunology, 84(1), Article ID e13249.
Open this publication in new window or tab >>Cytokine mRNA and protein expression by cell cultures of epithelial ovarian cancer: Methodological considerations on the choice of analytical method for cytokine analyses
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2020 (English)In: American Journal of Reproductive Immunology, ISSN 1046-7408, E-ISSN 1600-0897, Vol. 84, no 1, article id e13249Article in journal (Refereed) Published
Abstract [en]

Problem: To get a comprehensive picture of cytokine expression in health and disease is difficult, cytokines are transiently and locally expressed, and protein analyses are burdened by biological modifications, technical issues, and sensitivity to handling of samples. Thus, alternative methods, based on molecular techniques for cytokine mRNA analyses, are often used. We compared cytokine mRNA and protein expression to evaluate whether cytokine mRNA profiles can be used instead of protein analyses.

Method of study: In kinetic experiments, cytokine mRNA and protein expression of IL-1 beta, IL-6, IL-8, TNF-alpha, and TNF-beta/LTA were studied using real-time RT-qPCR and Luminex(R) microarrays in the ovarian cancer cell lines OVCAR-3, SKOV-3 and the T-cell line Jurkat, after activation of transcription by thermal stress. In addition, we analyzed IL-6 and IL-8 mRNA and protein in a small number of ovarian cancer patients.

Results: Ovarian cancer cells can express cytokines on both mRNA and protein level, with 1-4 hours' time delay between the mRNA and protein peak and a negative Spearman correlation. The mRNA and protein expression in patient samples was poorly correlated, reflecting previous studies.

Conclusion: Cytokine mRNA and protein expression levels show diverging results, depending on the material analyzed and the method used. Considering the high sensitivity and reproducibility of real-time RT-qPCR, we suggest that cytokine mRNA profiles could be used as a proxy for protein expression for some specific purposes, such as comparisons between different patient groups, and in defining mechanistic pathways involved in the pathogenesis of cancer and other pathological conditions.

Place, publisher, year, edition, pages
John Wiley & Sons, 2020
Keywords
cytokine, mRNA, ovarian cancer, protein, protein microarray, real-time polymerase chain reaction
National Category
Immunology in the medical area
Identifiers
urn:nbn:se:umu:diva-171392 (URN)10.1111/aji.13249 (DOI)000530699700001 ()32307767 (PubMedID)2-s2.0-85085074930 (Scopus ID)
Available from: 2020-06-12 Created: 2020-06-12 Last updated: 2023-03-24Bibliographically approved
Björk, E., Vinnars, M.-T., Nagaev, I., Nagaeva, O., Lundin, E., Ottander, U. & Mincheva-Nilsson, L. (2020). Enhanced local and systemic inflammatory cytokine mRNA expression in women with endometriosis evokes compensatory adaptive regulatory mRNA response that mediates immune suppression and impairs cytotoxicity. American Journal of Reproductive Immunology, 84(4), Article ID e13298.
Open this publication in new window or tab >>Enhanced local and systemic inflammatory cytokine mRNA expression in women with endometriosis evokes compensatory adaptive regulatory mRNA response that mediates immune suppression and impairs cytotoxicity
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2020 (English)In: American Journal of Reproductive Immunology, ISSN 1046-7408, E-ISSN 1600-0897, Vol. 84, no 4, article id e13298Article in journal (Refereed) Published
Abstract [en]

Problem: Endometriosis is a disease characterized by ectopic implantation of endometrium and impaired immune responses. To explore its pathogenic mechanisms, we studied the local and systemic cytokine mRNA profiles and their role in the immunity of patients with endometriosis and healthy controls.

Method of Study: mRNA for eleven cytokines defining cytotoxic Th1, humoral Th2, regulatory Tr1/Th3, and inflammatory cytokine profiles was characterized locally in endometriotic tissue and endometrium, and systemically in PBMCs from women with endometriosis and healthy controls, using real‐time qRT‐PCR. In addition, immunohistochemical stainings with monoclonal antibodies were performed looking for T regulatory cells in endometriotic lesions.

Results: We found a downregulation of mRNA for cytokines mediating cytotoxicity and antibody response and an upregulation of inflammatory and T‐regulatory cytokines in the endometriotic tissues and endometrium from the patients with endometriosis, suggesting enhanced local inflammation and priming of an adaptive regulatory response. Consistent with those findings, there was an abundancy of T regulatory cells in the endometriotic lesions.

Conclusions: The ectopic implantation seen in endometriosis could be possible as a consequence of increased inflammation and priming of adaptive T regulatory cells, resulting in impaired cytotoxicity and enhanced immune suppression.

Place, publisher, year, edition, pages
John Wiley & Sons, 2020
Keywords
Cytokines, Cytotoxicity, Endometriosis, Immune suppression, Inflammation, Regulatory T-Lymphocytes
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-173755 (URN)10.1111/aji.13298 (DOI)000548188900001 ()32623813 (PubMedID)2-s2.0-85087896208 (Scopus ID)
Funder
Swedish Research Council, 18-20-345240311Swedish Cancer Society, CAN 2018/350Swedish Cancer Society, 18 07 17
Available from: 2020-07-31 Created: 2020-07-31 Last updated: 2023-03-23Bibliographically approved
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