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Differential effect of neonatal thymectomy on systemic and organ-specific autoimmune disease.

Thymectomy on day 3 after birth (d3tx) depletes CD4+CD25+ regulatory T cells leading to multiple independent organ-specific autoimmune diseases. However, systemic autoimmune disease such as systemic lupus erythematosus has not been reported in d3tx mice. Herein, we investigate the effect of d3tx on spontaneous autoantibody response and immune complex glomerulonephritis (GN) in the lupus-prone (SWR x NZB)F1 (SNF1) mice. The d3tx SNF1 mice developed accelerated antibody responses to double-stranded DNA and DNA-histone complexes, and an increased frequency of activated CD4+ T cells. Unexpectedly, the renal histopathology and mortality from GN were significantly ameliorated in d3tx SNF1 mice, which concomitantly exhibited a Th2-biased antibody response. By 16 weeks, the d3tx mice had higher levels of total and autoantigen-specific IgG1, and at 12 months, the autoantigen-specific IgG2a was significantly below that of the sham thymectomized mice. These differences corresponded with reduction in total and autoantigen-specific IgG2a in the renal eluates of the d3tx mice. In addition, while all the mice had immune complex deposition in the mesangium and peripheral capillary loops of the glomeruli, IgG2a and C3 deposits restricted to the mesangial regions alone were more frequent in d3tx mice. D3tx SNF1 mice, protected from lupus-like GN, developed organ-specific autoimmune responses and diseases including prostatitis, orchitis and oophoritis, and antibodies to prostate, cardiac and skeletal muscle antigens. Therefore, d3tx paradoxically protects SNF1 mice from genetically prone lupus-like GN, yet promotes de novo organ-specific autoimmunity.

Animals↗

Comparison of three different regimens in the treatment of acute brucellosis: a multicenter multinational study.

The present study was undertaken to evaluate efficacy, safety and patient acceptability of three antibiotic regimens for the treatment of acute brucellosis. Six different centres were involved: three in France, one in Greece and two in Spain. The regimens were: oral rifampicin 900 mg/day plus oral doxycycline 200 mg/day for 45 days (A), oral doxycycline 200 mg/day for 45 days plus im streptomycin 1 g/day for 21 days (regimen B) [corrected] and the WHO regimen (C) combining oral tetracycline 2 g/day for 21 days plus im streptomycin, 1 g/day, for 14 days. Regimens A and B were randomly allocated in all centres, while regimen C was allocated only in two centres. All patients were suffering from acute brucellosis clinically and biologically proven. 143 patients were allocated for treatment and analysed. Their mean age was 41 years (range 13-70), 49 were female and 94 male, and their mean weight was 64 kg (range 35-98). Among these patients, 14% had localized disease (nine orchitis, eight osteo-articular involvement and one pleural effusion), but there was no statistical difference between the three regimens in regard to this localized disease. Forty-five per cent of the patients had positive blood cultures. The cure rate with regimen A was 95%, 96% with regimen B and 59% with regimen C. Thus regimen A presented the same efficacy rate as regimen B, but regimen C cannot be regarded as the treatment of choice for acute brucellosis.

Acute Disease↗

Disposition of roxithromycin in the epididymis after repeated oral administration.

The epididymal penetration of roxithromycin was studied in order to evaluate the drug for use in the treatment of epididymo-orchitis. Seventeen patients hospitalized for surgery as part of treatment for prostatic adenoma or prostatic cancer were premedicated orally with roxithromycin 150 mg bd for three days followed by 150 mg pre-operatively (3 h before surgical incision). Roxithromycin concentrations in serum and epididymis were determined by microbiological assay. The mean epididymal concentrations were 6.48 +/- 4.88 and 5.98 +/- 3.92 mg/kg for left and right epididymis respectively and the corresponding mean tissue/serum ratios 0.88 +/- 0.57 and 0.84 +/- 0.53. The wide intersubject variation in the concentration of roxithromycin found in serum and tissue is commonly seen with other macrolide antibiotics. The concentrations observed in this study in serum and tissue were greater than the MIC90s for Chlamydia trachomatis (0.25 to 1 mg/L), and Ureaplasma urealyticum (0.5 mg/L).

Adenoma↗

Breast cancer in men: risk factors with hormonal implications.

Cases included in a population-based case-control study of breast cancer in men were recruited from 10 geographic areas of the United States from 1983 to 1986. Controls, matched to cases on age and geographic area, were selected by random digit dialing for men under age 65 years and from Health Care Financing Administration files for older men. Results are based on responses from 227 cases and 300 controls to questions asked in a standardized personal interview. An increased risk of breast cancer was most strongly associated with undescended testes and was also related to orchiectomy, orchitis, testicular injury, late puberty, and infertility; and a decreasing trend in risk was observed with an increasing number of children. Relative risk estimates were also elevated in relation to a history of high blood cholesterol, rapid weight gain, benign breast conditions, and possibly obesity. These findings suggest that breast cancer in men develops in response to androgen deficiency associated with testicular dysfunction and under conditions associated with excess estrogen. Risk was also found to be elevated in men with a history of amphetamine use, diabetes, and cigar smoking and reduced in men with prior head trauma.

Adult↗

Immunobiology of male infertility.

Experimental and clinical data reported in the literature emphasize the important role that immune factors may play in the genesis of male infertility even if many problems still remain to be solved. Auto or homo-sensitization in animals (and in male volunteers) can be obtained with testicular homogenate or epididymal spermatozoa and complete Freund's adjuvant. Immune orchitis in spontaneous human pathology has also been reported. Vasectomy for the voluntary control of male fertility may be considered a particular form of experimental autoimmunization; and many vasectomized individuals develop antisperm antibodies in blood serum and/or in seminal plasma. In spontaneous male infertility antisperm antibodies can: (i) be a mere epiphenomenon; (ii) be a factor aggravating a pathologic situation already able to cause infertility; (iii) play a pathogenetic role in some forms of so-called idiopathic infertility and so could be defined as infertility due to antisperm antibodies. If the antisperm autoimmune reaction represents the casual factor of infertility, corticosteroid therapy seems to give the most satisfactory results, administered either in high doses for a very short time period or in low doses over a prolonged period, or even after transient pharmacologically induced azoospermia.

Autoantibodies↗

Inflammatory changes in the epididymis after vasectomy in the Lewis rat.

The epididymides of Lewis rats were studied at intervals up to 7 months after vasectomy, vasectomy followed 3 months later by vasovasostomy, or sham operations. Epididymal histology was related to testicular alterations and to serum antisperm antibodies as determined with an enzyme-linked immunosorbent assay. In vasectomy and vasovasostomy groups. 13 of 33 rats had testicular alterations, which consisted mainly of pronounced depletion of germ cells. Over half of the rats with testicular alterations also had severe epididymal lesions that included interstitial changes characteristic of an inflammatory response. These consisted of aggregates of mononuclear cells, including lymphocytes, plasma cells, and macrophages. The lumina of epididymides with interstitial changes contained polymorphonuclear leukocytes and/or macrophages. All animals with altered testes had greatly decreased numbers of epididymal sperm. In many instances, the lumen of the proximal cauda epididymidis was collapsed, and columnar cells of the epididymal epithelium contained many very large lysosomes. The distal cauda epididymidis was distended with sperm and debris. None of the rats that lacked testicular alterations showed epididymal changes. Mean serum antisperm antibody levels were significantly higher for rats with epididymal interstitial changes than for animals without such epididymal alterations. Infiltrations of inflammatory cells into the epididymal interstitium and lumen are part of the constellation of changes that occurs after immunization with testicular homogenates to produce experimental allergic orchitis. The observations reported here support the hypothesis that reproductive tract alterations after vasectomy in this model have an immune basis.

Animals↗

Potential contraceptive use of epididymal proteins: immunization of male rats with epididymal protein DE inhibits sperm fusion ability.

Rat epididymal protein DE associates with the sperm surface during maturation and participates in sperm-egg fusion. Immunization of male rats with DE raised specific antibodies and produced a significant reduction in the animals' fertility. The present study focused on determining the in vivo mechanism involved in fertility inhibition. Wistar males were injected with DE, and antibody levels and animal fertility were evaluated. Results revealed an association between the two parameters, since animals with absorbance values lower than 0.5 in ELISA presented high fertility rates (66%, 100%) while those with absorbance values higher than 0.5 exhibited the lowest fertility rates (0%, 33%). Histological studies showed no evidence of orchitis, epididymitis, or vasitis in DE-immunized animals. ELISA results revealed the presence of anti-DE antibodies in epididymal and vas deferential fluids. Indirect immunofluorescence and ELISA experiments indicated that these antibodies would not interfere with the synthesis or secretion of DE or with its association with the sperm surface. Finally, while epididymal sperm recovered from DE-immunized animals presented no changes in motility, viability, or ability to undergo capacitation and acrosome reaction, they exhibited a significant decrease in their ability to fuse with zona-free eggs, with no effect on their ability to bind to the oolemma. Together these results indicate that immunization of male rats with epididymal protein DE specifically interferes with the sperm fertilizing ability, supporting the use of epididymal proteins for contraceptive vaccine development.

Animals↗

Corticotropin-releasing factor: an antireproductive hormone of the testis.

Corticotropin-releasing factor (CRF), the key neuropeptide in the stress cascade, has major inhibitory actions on testicular function in addition to its known antireproductive effects at the central level (inhibition of sexual behavior and LH secretion). CRF is secreted by the Leydig cells of the testis and acts through high-affinity receptors at the Leydig cell membrane as a potent negative regulator of LH action, inhibiting gonadotropin-induced cAMP generation and androgen production. CRF is also a primary stimulus of beta-endorphin secretion by the Leydig cells, which in turn exerts paracrine inhibition of FSH action in the tubular compartment of the testis through high-affinity receptors in the Sertoli cells. CRF action in the Leydig cells involves a pertussis toxin-insensitive guanyl nucleotide regulatory unit. In contrast to CRF receptors in the brain, pituitary, and other peripheral tissues, those in the Leydig cell are not coupled to Gs. The inhibitory action of CRF in the Leydig cell is exerted through protein kinase C, at the level of the catalytic subunit of adenylate cyclase. The secretion of CRF by the Leydig cell is stimulated by LH, acting via release of serotonin (5HT) and autocrine activation of 5HT2 receptors. Serotonin acts on 5HT2 receptors in the Leydig cell to stimulate CRF secretion via a pertussis toxin insensitive G-protein and presumably through activation of phosphoinositide hydrolysis. The diversity of the biochemical responses to CRF and 5HT2 receptor activation (i.e., inhibition of adenylate cyclase at the cytoplasmic aspect of the cell membrane vs. stimulation of CRF release from secretion granules) may reflect the stimulation of different protein kinase C isoenzymes. The LH-->5HT-->CRF inhibitory loop serves to continuously buffer the stimulation of androgen production by gonadotropin. 5HT, the immediate stimulus of testicular CRF secretion, is released during stress and is locally increased in the testis in pathological conditions associated with impaired testicular function (i.e., orchitis, varicocele). Also, propranolol, the beta-adrenergic antagonist frequently used in the control of blood pressure in patients with hypertension and often associated with impotence, acts via a serotonergic mechanism to stimulate CRF secretion and causes marked inhibition of LH-induced cAMP production and steroidogenesis in cultured Leydig cells. These basic studies of 5HT and CRF are relevant to the pathogenesis of testicular dysfunction and for the development of antagonist therapies to block CRF production and its local antireproductive effects.

Animals↗

Characterization of signaling pathways leading to Fas expression induced by TNF-alpha: pivotal role of NF-kappaB.

TNF-alpha is known to induce a strong up-regulation of Fas expression in mouse Sertoli cell cultures, leading to their apoptosis triggered by effector FasL-bearing cells. These data suggest that increased Fas expression on the cell surface might be a key event in the pathogenesis of autoimmune orchitis, by inducing a leakage of the blood-tubular barrier as a consequence of Sertoli cell apoptosis. In the present paper, we have investigated the signal transduction mechanisms involved in the regulation of Fas expression induced by TNF-alpha in mouse Sertoli cells. We studied the role of the transcription factor NF-kappaB and of MAPKs in regulating Fas expression. By using Sertoli cells transfected with a NF-kappaB Luc reporter gene, we proved that TNF-alpha activates the IkappaB/NF-kappaB system. Moreover, the use of the proteasome inhibitor lactacystin led us to demonstrate that NF-kappaB is required for TNF-alpha mediated Fas expression. By using specific inhibitors for each MAPK, we confirmed the pivotal role of the IkappaB/NF-kappaB system by demonstrating that ERKs, p38, and JNK are not involved in Fas up-regulation by TNF-alpha. The comprehension of these pathways could be relevant to the knowledge of the pathogenesis of autoimmune disorders in immune privileged districts of the body.

Acetylcysteine↗

Cystic transformation of the rete testis.

In a review of the testicular and epididymal specimens obtained from autopsies (1,798 men) or surgery (518 men), cystic transformation of the rete testis (CTRT) was found in 20 autopsies and 18 surgical specimens. When both testes were studied (autopsies), the lesion was bilateral. Ultrasonography revealed a widened mediastinum testis showing small hypoechoic areas. Arteriography showed thin or irregularly outlined testicular arteries, and the epididymal artery was lacking or appeared stenosed. Simple CTRT (without epithelial alteration) was found in both testes of 17 autopsied patients (all were elderly men) and in eight surgically removed testes from patients with sarcoma, tuberculous orchidoepididymitis, or hematocele. The most frequent epididymal lesion was bilateral efferent duct atrophy. In three patients, the rete testis presented nodular proliferation of calcifying connective tissue. CTRT with columnar transformation of the rete testis epithelium was observed in both testes from three patients with alcoholic cirrhosis, and in 10 surgically removed testes from patients with testicular tumor, cryptorchidism, or nonspecific orchitis. In cirrhotic patients, the efferent ducts appeared atrophied. In patients with testicular tumors, the efferent ducts were infiltrated by carcinoma in situ cells (CISs) and often contained granular material, cell debris, or hyaline globules. In both kinds of CTRT (without or with epithelial metaplasia), the most frequent seminiferous tubule lesions were tubular ectasia, hypospermatogenesis, tubular sclerosis, spermatogonium arrest, and sloughing of immature germ cells (spermatids and spermatocytes). The mechanism leading to CTRT might be mechanic (compression of the epididymis by an epididymal tumor or a spermatic cord tumor, or the result of a long-standing epididymitis or traumatic hemocele); ischemic (autopsied elderly men); hormonal (cirrhotic patients); malformative (cryptorchidism); or unknown (the remaining cases).

Adolescent↗

Anterior tension-free repair of recurrent inguinal hernia under local anesthesia: a 7-year experience in a teaching hospital.

OBJECTIVE: To describe a 7-year experience with recurrent inguinal hernia repair performed mainly with tension-free mesh or plug technique under local anesthesia through the anterior approach, and to evaluate the safety and effectiveness of this method of treatment. METHODS: One hundred forty-five elective and 1 emergency herniorrhaphies for recurrent groin hernia were performed in 141 subjects (134 men and 7 women) with a mean age of 65 years (range 30-89). Concomitant medical and surgical problems were present in 73% and 8% of subjects, respectively. In 28 instances, the relapsed hernia had already been operated on once or twice for recurrence. A traditional hernioplasty had been previously performed in the vast majority of cases (136). Tension-free mesh or plug techniques through an anterior approach under local anesthesia were performed in 144 reoperations. Preperitoneal mesh repair and general or spinal anesthesia were used in all but one case when herniorrhaphy was performed during simultaneous operations. RESULTS: Mean hospital stay after surgery was 1.5 days (range 3 hours-14 days). No perioperative deaths occurred in this series. General complications were one case of acute intestinal bleeding and two cases of urinary retention. Local complications consisted of eight (5.5%) minor complications and one case of orchitis (0.7%) followed by testicular atrophy. In no instance was postoperative neuralgia or chronic pain reported. Two re-recurrences occurred. CONCLUSIONS: Given the low complication rate in this and other reported series and the absence of surgical or general complications described after preperitoneal open or laparoscopic repair and after general and spinal anesthesia, anterior mesh repair under local anesthesia seems to be a low-cost surgical technique that can be safely and effectively used even in a teaching hospital for the treatment of the majority of patients with recurrent groin hernias.

Adult↗

Early diagnosis of testicular tumor using Tc-99m pertechnetate scrotal imaging.

Two patients who originally presented with clinical symptoms of epididymo-orchitis, with compatible findings on the Tc-99m pertechnetate scrotal images, had temporary remission of their symptoms with antibiotic therapy. After two months, both patients had repeat scrotal images, because of persistent testicular enlargement. Both now demonstrated a "cold spot" in the otherwise increased activity on the affected side. Both patients underwent orchiectomy; patient 1 had a tissue diagnosis of malignant mixed germ cell tumor and patient 2 showed teratocarcinoma.

Adult↗

Critical analysis of the clinical presentation of acute scrotum: a 9-year experience at a single institution.

PURPOSE: We assessed the significance of the clinical presentation of boys who underwent surgical exploration for acute scrotum. MATERIALS AND METHODS: We retrospectively analyzed the records of 115 consecutive boys who underwent surgical exploration for acute scrotum between October 1986 and January 1996. We divided the children into group 1-83 with spermatic cord torsion a mean of 14.4 years old, group 2-27 with torsion of a testicular appendage a mean of 9.4 years old and group 3-5 with epididymo-orchitis a mean of 14.1 years old. Particular attention was given to nausea and vomiting, patient age and duration of pain. RESULTS: Nausea and vomiting occurred in 69 and 60% of the boys in group 1, 8 and 4% in group 2 and none in group 3. Nausea and vomiting had positive predictive values of 96 and 98%, respectively, for spermatic cord torsion. Only 6 of the 83 boys (7%) with spermatic cord torsion were younger than 11 years, whereas 15 of the 27 (56%) with torsion of a testicular appendage were younger than 11 years. Of the 83 boys with spermatic cord torsion the testes were salvaged in 51 (61%) and the duration of pain was 40 minutes to 12 hours (mean 4 hours). The testes were not salvaged in any patient with greater than 12 hours of pain. CONCLUSIONS: We believe that any boy 11 years old or older with scrotal pain less than 12 hours in duration that is associated with nausea or vomiting should be considered to have torsion of the spermatic cord. In this day of cost-effective medical management it is not necessary to perform imaging in this subset of boys before surgical exploration.

Adolescent↗

Cell-mediated autoimmune response to testis induced by bilateral testicular injury can be suppressed by cyclosporin A.

PURPOSE: Since the delayed type hypersensitivity (DTH) response to testis antigens plays a key role in the induction and/or maintenance of experimental autoimmune orchitis (EAO), an animal model for human immunological male infertility or aspermatogenesis, we have investigated the immunosuppressive effect of cyclosporin A (CsA) on the DTH response to autologous testicular cells (TC). MATERIALS AND METHODS: A DTH response to autologous TC was induced in C3H/HeN mice by bilateral testicular injury (trauma). CsA was administered intraperitoneally for 10 consecutive days before and after injury. A DTH response was assessed by measuring delayed footpad reaction (DFR) to autologous TC 9 days after injury. RESULTS: When the mice were traumatized alone, 10 mg./kg. or more of CsA suppressed the DTH response to autologous TC significantly. In mice traumatized with 100 mg./kg. of cyclophosphamide (CY)-pretreatment, 30 mg./kg. or more of CsA was needed to suppress the DTH response. In mice traumatized with 200 mg./kg. of CY-pretreatment, 50 mg./kg. of CsA was needed to suppress the autoimmune response. CONCLUSIONS: The DTH response to autologous TC was suppressed significantly by administration of CsA in a dose-dependent manner. We have also shown the direct suppressive effect of CsA on effector cells for DTH by means of local passive transfer of DTH. Administration of CsA had no augmenting or suppressive effect on suppressor cells for DTH. CsA might be a significant drug for the immunosuppression of EAO and possibly for immunological male infertility.

Animals↗

Behçet's disease. Report of 41 cases and a review of the literature.

Several important conclusions may be derived on the basis of our experience with Behcet's disease (B.D.) and a review of the literature, namely: 1. B.D. is a systemic disease characterized by exacerbations and remissions of unpredictable duration, which affects mainly males between the ages of 20 to 30 years. Although its incidence is higher in the eastern hemisphere cases presented in all parts of the world. 2. The common histopathological lesion of all clinical manifestations appears to be a vasculitis. The etiology of B.D. is unknown. A viral etiology has been proposed but not confirmed. The presence of autoantibodies and lymphocyte sensitization to mucosal antigen has been observed but the precise significance of these findings in relation to the pathogenesis of the disease is presently undetermined. 3. The clinical manigestations present in most of the patients and considered diagnostic for B.D. are oral and genital ulcers, uveitis and skin lesions (especially erythema nodosum-like lesions or non-specific skin reactivity to needle pricks). The presence of three of the above manifestations are obligatory for the diagnosis. The other common clinical manifestations occurring in B.D. are: arthritis (44%); thrombophlebitis (24%), and various neurological syndromes (18%). Less frequent complications of the disease include: arterial thrombosis and aneurysm of both the systemic and pulmonary circulation, colitis, epididymitis and orchitis. 4. The serious chronic sequelae of this disease consist of blindness in up to 33% of patients with uveitis, vena caval obstruction and paralysis of limbs. Mortality, usually caused by meningoencephalitis, is rare. 5. The patients may present to different medical specialities, e.g., dermatology, gynecology, ophthalmology, neurology and internal medicine. To facilitate the correct diagnosis the essential criteria should be actively sought as they are not always the cause for medical consultation. 6. The diagnosis of B.D. is based only on clinical grounds as there are no pathognomonic laboratory or histopathological features. 7. Evaluation of treatment in B.D. is difficult, because of the naturally unpredictable course of the disease. Many drugs have been tried in the treatment of B.D. including antibiotics, anti-inflammatory drugs and corticosteroids, all with equivocal effects. Recently several additional treatment schedules have been suggested. Immunosuppressive drugs have been shown to have some beneficial effect, especially on uveitis. Fresh blood or plasma transfusions may prolong remissions. 8. The finding of decreased plasma fibrinolytic activity in patients with active B.D. represents the first observation of a possible disturbance in the blood coagulation mechanism and suggests that the use of fibrinolytic agents may be rewarding.

Adolescent↗

Urogenital manifestations of Wegener granulomatosis.

We report 8 patients with Wegener granulomatosis (WG) who suffered from symptomatic urogenital involvement including acute urinary retention related to prostatitis, orchitis, ureteral stenosis, bladder pseudotumor, and penile ulceration. Urogenital manifestations occurred as an isolated manifestation of WG in 4 patients, at the onset of the disease in 1 patient, and as the only symptom of relapse in 3. Data used to distinguish specific WG involvement from infection or cyclophosphamide urothelial toxicity are discussed. Four patients needed a surgical procedure consisting of suprapubic cystostomy for acute urinary retention, bilateral ureteral double J stents for bilateral ureteral stenosis, and prostate transurethral resection. Urogenital symptoms promptly resolved with medical therapy. High-dose corticosteroids and immunosuppressive drugs should be used as first-line therapy to avoid unnecessary surgery.

Adult↗

Characterization of the humoral immune response of the rabbit to antigens of Treponema pallidum after experimental infection and therapy.

The development of IgM and IgG antibody responses to antigenic molecules of Treponema pallidum was examined in intratesticularly and intradermally infected rabbits by use of immunofluorescence (IF) and Western blotting techniques. IgM antibody was first detectable on day 6 following intratesticular infection and reached maximal IF titers during the period of clinical orchitis (days 10-17). IgG reached peak IF titers in the resolution period following clearance of most organisms from the testes (after day 17). Initial IgM antibody responses on day 6 were directed against the 46-, 43-, and 37-kdalton molecules, with reactivity to the 14- and 12-kdalton molecules appearing on day 10. IgG antibody, which was first apparent in the Western blot on day 6, was directed against the 37-kdalton molecule. IgG antibody to the 46-kdalton molecule was first apparent on day 13, and the full spectrum of 22 molecules was recognized on day 31. Curative therapy of intradermally infected rabbits one week after infection resulted in lower IgG antibody titers but did not abrogate the development of humoral responses to all of the major antigens.

Animals↗

Doppler sonography in testicular and scrotal imaging.

The primary role of Doppler ultrasound of the acute testicle and scrotum is for the diagnosis of spermatic cord torsion or epididymitis. The utility of Doppler in other conditions such as testicular neoplasm is limited, and in general does not increase diagnostic specificity. The application of color Doppler imaging and power Doppler imaging increases sensitivity for the detection of orchitis and testicular neoplasms in which the gray scale findings may be subtle. Power Doppler imaging is more sensitive for the identification of slowly flowing blood than color Doppler imaging. As a result, power Doppler imaging may be particularly helpful for the diagnosis or exclusion of spermatic cord torsion as a cause of acute scrotal pain in the prepubescent male.

Journal Article↗