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Wanhainen, Anders
Alternative names
Publications (10 of 143) Show all publications
Karthikesalingam, A., Grima, M. J., Holt, P. J., Vidal-Diez, A., Thompson, M. M., Wanhainen, A., . . . Mani, K. (2018). Comparative analysis of the outcomes of elective abdominal aortic aneurysm repair in England and Sweden. Paper presented at Annual Meeting of the British-Society-for-Endovascular-Therapy, JUN, 2017, Wotton under Edge, ENGLAND. British Journal of Surgery, 105(5), 520-528
Open this publication in new window or tab >>Comparative analysis of the outcomes of elective abdominal aortic aneurysm repair in England and Sweden
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2018 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 105, no 5, p. 520-528Article in journal (Refereed) Published
Abstract [en]

Background

There is substantial international variation in mortality after abdominal aortic aneurysm (AAA) repair; many non-operative factors influence risk-adjusted outcomes. This study compared 90-day and 5-year mortality for patients undergoing elective AAA repair in England and Sweden.

Methods

Patients were identified from English Hospital Episode Statistics and the Swedish Vascular Registry between 2003 and 2012. Ninety-day mortality and 5-year survival were compared after adjustment for age and sex. Separate within-country analyses were performed to examine the impact of co-morbidity, hospital teaching status and hospital annual caseload.

Results

The study included 36 249 patients who had AAA treatment in England, with a median age of 74 (i.q.r. 69–79) years, of whom 87·2 per cent were men. There were 7806 patients treated for AAA in Sweden, with a median of age 73 (68–78) years, of whom 82·9 per cent were men. Ninety‐day mortality rates were poorer in England than in Sweden (5·0 versus 3·9 per cent respectively; P < 0·001), but were not significantly different after 2007. Five‐year survival was poorer in England (70·5 versus 72·8 per cent; P < 0·001). Use of EVAR was initially lower in England, but surpassed that in Sweden after 2010. In both countries, poor outcome was associated with increased age. In England, institutions with higher operative annual volume had lower mortality rates.

Conclusion

Mortality for elective AAA repair was initially poorer in England than Sweden, but improved over time alongside greater uptake of EVAR, and now there is no difference. Centres performing a greater proportion of EVAR procedures achieved better results in England. Improving in England

National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-354237 (URN)10.1002/bjs.10749 (DOI)000428846100009 ()29468657 (PubMedID)
Conference
Annual Meeting of the British-Society-for-Endovascular-Therapy, JUN, 2017, Wotton under Edge, ENGLAND
Available from: 2018-06-29 Created: 2018-06-29 Last updated: 2018-06-29Bibliographically approved
Baderkhan, H., Haller, O., Wanhainen, A., Björck, M. & Mani, K. (2018). Follow-up after endovascular aortic aneurysm repair can be stratified based on first postoperative imaging. British Journal of Surgery, 05(6), 709-718
Open this publication in new window or tab >>Follow-up after endovascular aortic aneurysm repair can be stratified based on first postoperative imaging
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2018 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 05, no 6, p. 709-718Article in journal (Refereed) Published
Abstract [en]

Background

Lifelong postoperative surveillance is recommended following endovascular aneurysm repair (EVAR). Although the purpose is to prevent and/or identify complications early, it also results in increased cost and workload. This study was designed to examine whether it may be possible to identify patients at low risk of complications based on their first postoperative CT angiogram (CTA).

Methods

All patients undergoing EVAR in two Swedish centres between 2001 and 2012 were identified retrospectively and categorized based on the first postoperative CTA as at low risk (proximal and distal sealing zone at least 10 mm and no endoleak) or high risk (sealing zone less than 10 mm and/or presence of any endoleak) of complications.

Results

Some 326 patients (273 men) with a CTA performed less than 1 year after EVAR were included (low risk 212, 65·0 per cent; high risk 114, 35·0 per cent). There was no difference between the groups in terms of sex, age, co‐morbidities, abdominal aortic aneurysm (AAA) diameter, preoperative AAA neck anatomy, stent‐graft type or duration of follow‐up (mean(s.d.) 4·8(3·2) years). Five‐year freedom from AAA‐related adverse events was 97·1 and 47·7 per cent in the low‐ and high‐risk groups respectively (P < 0·001). The corresponding freedom from AAA‐related reintervention was 96·2 and 54·1 per cent (P < 0·001). The method had a sensitivity of 88·3 per cent, specificity of 77·0 per cent and negative predictive value of 96·6 per cent to detect AAA‐related adverse events. The number of surveillance imaging per AAA‐related adverse event was 168 versus 11 for the low‐risk versus high‐risk group.

Conclusion

Two‐thirds of patients undergoing EVAR have an adequate seal and no endoleak on the first postoperative CTA, and a very low risk of AAA‐related events up to 5 years. Less vigilant follow‐up after EVAR may be considered for these patients.

National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-334332 (URN)10.1002/bjs.10766 (DOI)000430058000014 ()
Available from: 2017-11-22 Created: 2017-11-22 Last updated: 2018-08-08Bibliographically approved
Liungman, K., Mani, K., Wanhainen, A., Bosaeus, L. & Lachat, M. (2018). Safety and Functionality of a Guidewire Fixator: Clinical Investigation of a New Endovascular Tool. Innovations (Philadelphia): technology and techniques in cardiothoracic and vascular surgery, 13(1), 51-53
Open this publication in new window or tab >>Safety and Functionality of a Guidewire Fixator: Clinical Investigation of a New Endovascular Tool
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2018 (English)In: Innovations (Philadelphia): technology and techniques in cardiothoracic and vascular surgery, ISSN 1556-9845, E-ISSN 1559-0879, Vol. 13, no 1, p. 51-53Article in journal (Refereed) Published
Abstract [en]

Objective: A new endovascular tool, the Liungman Guidewire Fixator, has been developed to simplify endovascular treatment in complex aortic aneurysms. The device has been extensively tested in bench models and animal trials. To verify the safety and functionality demonstrated in the porcine model, the device was tested in ten patients undergoing endovascular aortic repair (EVAR) or fenestrated endovascular aortic repair (f-EVAR) treatment for abdominal aortic aneurysm.

Methods: The Liungman Guidewire Fixator consists of a braided stent-like, cylindrical structure with conical ends and a central channel for a 0.035 '' guidewire. When in use, it is slid along the guidewire and positioned in the target artery, where the Liungman Guidewire Fixator interacts with the arterial wall by anchoring the guidewire to the wall through a radial force. The Liungman Guidewire Fixator allows for uninterrupted blood flow passed the point of fixation. In this study, the Liungman Guidewire Fixator was tested in ten patients undergoing EVAR or f-EVAR treatment for abdominal aortic aneurysm. The device was deployed and retrieved crossover into the hypogastric artery, and the occurrence of thrombotic occlusion, arterial dissection, and vascular rupture or trauma was studied using angiography, as well as device ability to withstand guidewire tension.

Results: There were no instances of occlusion, dissection, or vascular trauma detected using angiography. In all cases, deployment and retrieval were successful, and the devices could withstand an applied tension of 3 N. In one instance, retrieval was challenging because of significant tortuosity, which was resolved by a coaxial catheterization.

Conclusions: Deployment was uneventful in all ten patients. Retrieval according to the intended instruction for use was performed in nine of the patients. In one patient, a coaxial catheterization was necessary. All devices withstood a retention force of 3 N.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS, 2018
Keywords
Guidewire fixator, Guidewire tension, Aortic aneurysm, Stent graft, Fenestration
National Category
Surgery Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-351769 (URN)10.1097/IMI.0000000000000468 (DOI)000429101200009 ()29465630 (PubMedID)
Funder
VINNOVA, 2012-00374
Available from: 2018-05-31 Created: 2018-05-31 Last updated: 2018-05-31Bibliographically approved
Budtz-Lilly, J., Wanhainen, A., Eriksson, J. & Mani, K. (2017). Adapting to a total endovascular approach for complex aortic aneurysm repair: Outcomes after fenestrated and branched endovascular aortic repair. Journal of Vascular Surgery, 66(5), 1349-1356, Article ID S0741-5214(17)31065-0.
Open this publication in new window or tab >>Adapting to a total endovascular approach for complex aortic aneurysm repair: Outcomes after fenestrated and branched endovascular aortic repair
2017 (English)In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 66, no 5, p. 1349-1356, article id S0741-5214(17)31065-0Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: This study reports the feasibility of adopting a total endovascular approach for the treatment of complex abdominal aortic aneurysms (AAAs) at a European aortic center and compares the short- and midterm results against those from large and multicenter studies.

METHODS: All patients treated endovascular aortic repair (EVAR) for juxta/pararenal AAAs or thoracoabdominal aortic aneurysms (TAAAs), both elective and acute, as well as reoperations, from 2010 to 2015 were included. Treatment was fenestrated (FEVAR) or branched (BEVAR), and outcomes were analyzed for technical success and mortality at 30 and 90 days and by Kaplan-Meier curve estimates at 3 years. Outcomes on target vessels were reported as freedom from branch instability in the follow-up period. Reinterventions, endoleaks and perioperative and postoperative morbidities were analyzed.

RESULTS: A total of 71 patients were treated for juxta/pararenal AAA (n = 40) or TAAA (n = 31): 14 type II, 4 type III, and 13 type IV. There were 47 FEVAR (including 2 physician-modified fenestrated grafts) and 24 BEVAR procedures performed. Four TAAAs were ruptured. No open repairs were performed for these pathologies in this period. Mortality was 2.8% (n = 2) at 30 days and 9.9% at 90 days (n = 7). One late rupture occurred in a patient whose treatment was a technical failure. Survival at 3 years was 77.9% ± 5.6% overall, 90.9% ± 5.2% for juxta/pararenal AAAs, and 60.7% ± 10.3% for TAAAs. Graft deployment was successful in 69 of 71 patients. Revascularization was successful in 205 of 208 target vessels (98.6%): 51 of 51 superior mesenteric arteries, 27 of 27 celiac arteries, and 127 of 130 renal arteries. There were 131 fenestrated bridging stent grafts and 74 branched bridging stent grafts. Technical success was 68 of 71 (95.7%). There were nine cases of branch instability (5 BEVARs, 4 FEVARs) in five patients (7.0%). Seven vessels (5 renal arteries and 2 superior mesenteric arteries) underwent reintervention: 5 for stenoses, 1 for occlusion, and 1 for stent migration. Freedom from branch instability at 3 years was 92.7% ± 2.5% overall, 88.6% ± 6.4% for BEVAR, and 94.6% for FEVAR.

CONCLUSIONS: The short- and midterm results obtained here indicate that the benefits of a total endovascular treatment for complex aortic aneurysms, as demonstrated by large and multicenter studies, can be adapted and replicated at other centers with a dedicated aortic service. This may help guide future considerations of how to refer or treat this complex patient group.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-336068 (URN)10.1016/j.jvs.2017.03.422 (DOI)000415129100006 ()28647195 (PubMedID)
Available from: 2017-12-12 Created: 2017-12-12 Last updated: 2018-02-21Bibliographically approved
Lilja, F., Wanhainen, A. & Mani, K. (2017). Changes in abdominal aortic aneurysm epidemiology. Journal of Cardiovascular Surgery, 58(6), 848-853
Open this publication in new window or tab >>Changes in abdominal aortic aneurysm epidemiology
2017 (English)In: Journal of Cardiovascular Surgery, ISSN 0021-9509, E-ISSN 1827-191X, Vol. 58, no 6, p. 848-853Article, review/survey (Refereed) Published
Abstract [en]

The epidemiology and treatment of abdominal aortic aneurysms (AAA) has changed over the past 30 years. This review aims to give the reader an overview of these changes and current trends in AAA epidemiology, management and outcome. In the past decades there have been three changes in AAA management and epidemiology: 1) introduction of endovascular aortic repair (EVAR); 2) population screening; and 3) a markedly reduced prevalence of the disease. These developments have resulted in an increased incidence of intact AAA-repair and reduced incidence of ruptured AAA-repair. Overall, survival after both intact and ruptured AAA repair has improved, much thanks to the broad introduction of EVAR. Additionally, both elective and rupture repair in the elderly population has increased, with octogenarians constituting >20% of intact AAA repairs performed in several countries. International analyses of vascular registries indicate that important variations remain in AAA management and results. The changes in AAA epidemiology and management have led to a situation where most AAAs today are treated with EVAR electively. The incidence of ruptured AAA-repair continues to decrease. These changes are accompanied by improvements in both short- and long-term survival.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-336060 (URN)10.23736/S0021-9509.17.10064-9 (DOI)000413016100006 ()28633519 (PubMedID)
Available from: 2017-12-12 Created: 2017-12-12 Last updated: 2018-03-29Bibliographically approved
Wanhainen, A. (2017). Commentary on "Multi-Centre Study on Cardiovascular Risk Management in Patients Undergoing AAA Surveillance". European Journal of Vascular and Endovascular Surgery, 54(1), 123-123
Open this publication in new window or tab >>Commentary on "Multi-Centre Study on Cardiovascular Risk Management in Patients Undergoing AAA Surveillance"
2017 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 54, no 1, p. 123-123Article in journal, Editorial material (Other academic) Published
National Category
Cardiac and Cardiovascular Systems Surgery
Identifiers
urn:nbn:se:uu:diva-335813 (URN)10.1016/j.ejvs.2017.05.003 (DOI)000405051200026 ()28595779 (PubMedID)
Available from: 2018-01-22 Created: 2018-01-22 Last updated: 2018-01-22Bibliographically approved
Persson, S.-E., Boman, K., Wanhainen, A., Carlberg, B. & Arnerlöv, C. (2017). Decreasing prevalence of abdominal aortic aneurysm and changes in cardiovascular risk factors. Journal of Vascular Surgery, 65(3), 651-658
Open this publication in new window or tab >>Decreasing prevalence of abdominal aortic aneurysm and changes in cardiovascular risk factors
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2017 (English)In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 65, no 3, p. 651-658Article in journal (Refereed) Published
Abstract [en]

Objective: A significant reduction in the incidence of cardiovascular disease, including abdominal aortic aneurysm (AAA), has been observed in the past decades. In this study, a small but geographically well defined and carefully characterized population, previously screened for AAA and risk factors, was re-examined 11 years later. The aim was to study the reduction of AAA prevalence and associated factors. Methods: All men and women aged 65 to 75 years living in the Norsjo municipality in northern Sweden in January 2010 were invited to an ultrasound examination of the abdominal aorta, registration of body parameters and cardiovascular risk factors, and blood sampling. An AAA was defined as an infrarenal aortic diameter >= 30 mm. Results were compared with a corresponding investigation conducted in 1999 in the same region. Results: A total of 602 subjects were invited, of whom 540 (90%) accepted. In 2010, the AAA prevalence was 5.7% (95% confidence interval [CI], 2.8%-8.5%) among men compared with 16.9% (95% CI, 12.3%-21.6%) in 1999 (P < .001). The corresponding figure for women was 1.1% (95% CI, 0.0%-2.4%) vs 3.5% (95% CI, 1.2%-5.8%; P - .080). A low prevalence of smoking was observed in 2010 as well as in 1999, with only 13% and 10% current smokers, respectively (P = .16). Treatment for hypertension was significantly more common in 2010 (58% vs 44%; P < .001). Statins increased in the population (34% in 2010 vs 3% in 1999; P < .001), and the lipid profile in women had improved significantly between 1999 and 2010. Conclusions: A highly significant reduction in AAA prevalence was observed during 11 years in Norsjo. Treatment for hypertension and with statins was more frequent, whereas smoking habits remained low. This indicates that smoking is not the only driver behind AAA occurrence and that lifestyle changes and treatment of cardiovascular risk factors may play an equally important role in the observed recent decline in AAA prevalence.

Place, publisher, year, edition, pages
MOSBY-ELSEVIER, 2017
National Category
Cardiac and Cardiovascular Systems Surgery
Identifiers
urn:nbn:se:uu:diva-320867 (URN)10.1016/j.jvs.2016.08.091 (DOI)000397987900034 ()27793513 (PubMedID)
Available from: 2017-04-26 Created: 2017-04-26 Last updated: 2017-04-26Bibliographically approved
Gavali, H., Mani, K., Tegler, G., Kawati, R., Covaciu, L. & Wanhainen, A. (2017). Editor's Choice - Prolonged ICU Length of Stay after AAA Repair: Analysis of Time Trends and Long-term Outcome. European Journal of Vascular and Endovascular Surgery, 54(2), 157-163
Open this publication in new window or tab >>Editor's Choice - Prolonged ICU Length of Stay after AAA Repair: Analysis of Time Trends and Long-term Outcome
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2017 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 54, no 2, p. 157-163Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of the study was to investigate the frequency and outcome of prolonged intensive care unit (ICU) length of stay (LOS) after abdominal aortic aneurysm (AAA) repair in the endovascular era.

Methods: All patients operated on for AAA between 1999 and 2013 at Uppsala University hospital were identified. Data were retrieved from the Swedish Vascular registry, the Swedish Intensive Care registry, the National Population registry, and case records. Prolonged ICU LOS was defined as >= 48 h during the primary hospital stay. Patients surviving >= 48 h after AAA surgery were included in the analysis.

Results: A total of 725 patients were identified, of whom 707 (97.5%) survived >= 48 h; 563 (79.6%) underwent intact AAA repair and 144 (20.4%) ruptured AAA repair. A total of 548 patients (77.5%) required < 48 h of intensive care, 115 (16.3%) 2-6 days and 44 (6.2%) >= 7 days. The rate of prolonged ICU LOS declined considerably over time, from 41.4% of all AAA repairs in 1999 to 7.3% in 2013 (p < .001) whereas the use of endovascular aortic repair (EVAR) increased from 6.9% in 1999 to 78.0% in 2013 (p < .001). The 30 day survival rate was 98.2% for those with < 48 h ICU stay versus 93.0% for 2-6 days versus 81.8% for >= 7 days (p < .001); the corresponding 90 day survival was 97.1% versus 86.1% versus 63.6% (p < .001) respectively. For patients surviving 90 days after repair, there was no difference in long-term survival between the groups.

Conclusion: During the period of progressively increasing use of EVAR, a simultaneous significant reduction in frequency of prolonged ICU LOS occurred. Although prolonged ICU LOS was associated with a high short-term mortality, long-term outcome among those surviving the initial 90 days was less affected.

Keywords
Abdominal aortic aneurysm, Critical care, Length of stay, Outcome, Time trends
National Category
Surgery Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-334093 (URN)10.1016/j.ejvs.2017.05.014 (DOI)000407536300005 ()28648757 (PubMedID)
Available from: 2017-11-21 Created: 2017-11-21 Last updated: 2017-11-21Bibliographically approved
Lilja, F., Mani, K. & Wanhainen, A. (2017). Editor's Choice – Trend-break in Abdominal Aortic Aneurysm Repair With Decreasing Surgical Workload. European Journal of Vascular and Endovascular Surgery, 53(6), 811-819
Open this publication in new window or tab >>Editor's Choice – Trend-break in Abdominal Aortic Aneurysm Repair With Decreasing Surgical Workload
2017 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 53, no 6, p. 811-819Article in journal (Refereed) Published
Abstract [en]

Background: The epidemiology and management of abdominal aortic aneurysms (AAAs) has changed drastically in the past decades, with implementation of nationwide screening programs, introduction of endovascular repair (EVAR), and reduced prevalence of the disease. This report aims to assess recent trends in AAA repair epidemiology in Sweden in this context.

Methods: Primary AAA repairs registered in the nationwide Swedish Vascular Registry (Swedvasc) 1994-2014 were analyzed regarding patient characteristics, repair incidence, technique, and outcome. Four time periods were compared: 1994-1999, 2000-2004, 2005-2009, and 2010-2014.

Result: The incidence of intact AAA repair increased (18.4/100,000 1994-1999, 27.3/100,000 2010-2014, p < .001) predominantly among octogenarians (12.7/100,000 1994-1999, 36.0/100,000 2010-2014, p < .001). The utilization of EVAR increased (58% of all intact AAA repairs 2010-2014), especially among octogenarians (80% 2010-2014). During the last time period, however, the incidence of intact AAA repair stabilized, despite an increasing number of screening-detected AAAs operated on (19% in 2010-2014). Short-and long-term outcome after intact AAA repair continued to improve, most pronounced among octogenarians (30-day mortality 9% 1994-1999, 2% 2010-2014, p < .001). The incidence of ruptured AAA repair steadily decreased (9.2/100,000 1994-1999, 6.9/100,000 2010-2014, p < .001) and the use of EVAR for ruptures increased (30% in 2010-2014). The previously observed improvement of short-and long-term outcome after ruptured AAA repair (30-day mortality 38% 1994-1999, 28% 2010-2014, p < .001) stalled during the last time period. The overall 30-day mortality after ruptured AAA repair was 22% after EVAR versus 31% after open repair in 2010-2014. The corresponding mortality for octogenarians was 28% versus 42%.

Conclusions: For the first time, a halt in intact AAA repair workload could be identified. This trend-break occurred despite continued increase in treatment of octogenarians and screening-detected aneurysms. Additionally, the ruptured AAA repair incidence continued to decrease. These findings, together with the sustained improvement in survival after AAA repair, may have important impact on planning of vascular surgical services.

Keywords
Abdominal aortic aneurysm, Rupture, Open repair, Endovascular aortic repair, Outcome
National Category
Surgery Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-329712 (URN)10.1016/j.ejvs.2017.02.031 (DOI)000403518800011 ()28392057 (PubMedID)
Available from: 2017-10-03 Created: 2017-10-03 Last updated: 2017-10-03Bibliographically approved
Sörelius, K., Mani, K., Björck, M. & Wanhainen, A. (2017). Endovascular treatment of mycotic aortic aneurysms: a paradigm shift. Journal of Cardiovascular Surgery, 58(6), 870-874
Open this publication in new window or tab >>Endovascular treatment of mycotic aortic aneurysms: a paradigm shift
2017 (English)In: Journal of Cardiovascular Surgery, ISSN 0021-9509, E-ISSN 1827-191X, Vol. 58, no 6, p. 870-874Article, review/survey (Refereed) Published
Abstract [en]

Treatment of mycotic aortic aneurysms (MAAs) composes a particularly difficult challenge. Open repair has been considered the gold standard, despite lack of evidence supporting its superiority compared with the emerging alternative endovascular aortic repair (EVAR). This review discusses the pros and cons of EVAR for MAAs by dissecting the three largest publications on MAAs, and concludes that there has been a paradigm shift in treatment of MAAs for the benefit of EVAR.

National Category
Medical and Health Sciences Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-335156 (URN)10.23736/S0021-9509.17.10069-8 (DOI)000413016100009 ()28627863 (PubMedID)
Available from: 2017-12-01 Created: 2017-12-01 Last updated: 2018-03-29Bibliographically approved
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