Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “ANTACIDS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 127 records · Page 7Linked to original sources
PubMed1998

An interesting case of osteomalacia due to antacid use associated with stainable bone aluminum in a patient with normal renal function.

Antacids containing aluminum and magnesium hydroxide are widely used nonprescription agents for treatment of gastritis and peptic ulcer disease. One of the side effects of these antacids is that they bind phosphate in the gut, resulting in its malabsorption. Short-term use, consistent with the directions on the manufacturer's label, is safe and effective for most patients. Heavy chronic use, even when within label, can cause serious skeletal impairment. This report concerns the case of a 39-year-old pharmacist who self-mediated for peptic ulcer disease with high doses of a potent antacid containing aluminum and magnesium hydroxide. The patient consumed over 18 kg of elemental aluminum and 15 kg of elemental magnesium over 8 years of antacid use. This treatment resulted in the clinical syndrome of severe osteomalacia due to profound phosphate depletion. Bone biopsy revealed stainable aluminum deposits along 27.6% of the total bone surface, which is a unique observation in a patient with normal renal function. Treatment included withdrawing the antacid and supplementation with phosphate, calcium, and vitamin D. She experienced marked subjective and objective improvement with this regimen. This included a striking increase in her bone mineral density occurring over the 2-year follow-up period. This case documents that long-term antacid therapy, even when used by patients with normal renal function and within the manufacturer's label recommendations, can lead to severe phosphate depletion, osteomalacia, and toxic accumulation of aluminum and magnesium. This clinical syndrome was readily treated by withdrawal of the antacid and with calcium and phosphate supplementation. Physicians recommending treatment with these compounds or learning of their patient's self-medication with them should inform the patient of the potential serious side effects these agents can cause when used chronically at maximally recommended doses.

Adult↗
PubMed1981

Effect of antacids on the bioavailability of diflunisal in the fasting and postprandial states.

Diflunisal is long-acting salicylate derivative. We examined the effect of single concomitant doses of three antacids on diflunisal bioavailability under fasting or fed conditions (30 min after finishing a standard meal). With the use of an open, randomized, and balanced design, one 250-mg diflunisal tablet was given to each of 12 healthy men under six conditions: fasted, no antacid; fed, no antacid; fasted, 15 ml of aluminum hydroxide gel; fed, 15 ml of aluminum hydroxide gel; fasted, 10 ml magnesium hydroxide suspension; and fed, 15 ml of an aluminum hydroxide/magnesium hydroxide mixture. Diflunisal plasma 0- to 48-hr area uiven to each of 12 healthy men under six conditions: fasted, no antacid; fed, no antacid; fasted, 15 ml of aluminum hydroxide gel; fed, 15 ml of aluminum hydroxide gel; fasted, 10 ml magnesium hydroxide suspension; and fed, 15 ml of an aluminum hydroxide/magnesium hydroxide mixture. Diflunisal plasma 0- to 48-hr area uiven to each of 12 healthy men under six conditions: fasted, no antacid; fed, no antacid; fasted, 15 ml of aluminum hydroxide gel; fed, 15 ml of aluminum hydroxide gel; fasted, 10 ml magnesium hydroxide suspension; and fed, 15 ml of an aluminum hydroxide/magnesium hydroxide mixture. Diflunisal plasma 0- to 48-hr area under the time curve (AUC), peak plasma concentrations, and 0-to 96-hr urinary excretion were determined. Food (alone) decreased peak plasma concentrations by 16% (P less than 0.05) but did not affect AUC or urinary excretion. Under fasting conditions, aluminum hydroxide reduced AUC by 26% (P less than 0.01), peak plasma concentrations by 46% (P less than 0.01), and urinary excretion by 14% (P less than 0.05). Magenisuum hydroxide suspension (in the fasting state) increased the early plasma concentrations (by 130% at 0.5 hr and 64% at 1 hr, P less than 0.05) and increased AUC by 10% (P less than 0.05) but had no effect on urinary excretion. In the fed state neither aluminum hydroxide nor the aluminum hydroxide/magnesium hydroxide mixture had any detectable effect.

Adult↗
PubMedDate not supplied

[Antacids for postoperative prevention of stress ulcer in infants: a dose finding study].

UNLABELLED: In the prophylaxis of stress ulcers with antacids in young infants there are no recommendations of dosages that consider the physiologic maturation of gastric acid secretion. During the first six month of life the amount of gastric acid secretion in relation to body weight and body surface area increases exponentially. Therefore adult dosages of antacids cannot be transferred to infants. METHODS: In a cross over study 12 infants aged between 4 and 174 days, who had been undergoing a cardiosurgical intervention with the heart lung machine, were treated during 48 hours with 2 different antacid regimens over a period of 24 hours each, monitoring the gastric pH continuously. The used antacid consisted of an aluminium-magnesium complex (Al(OH)3, 90 mg/ml and Mg(OH)2, 60 mg/ml): Regimen A: 6 x 0.5 ml per kg body weight. Regimen B: 0.25 ml per kg body weight at a gastric pH less than 3, with the pH read every 30 minutes. RESULTS: Compared to 28 applications under regimen B, 72 single doses were given under regimen A, 58 of them at a gastric pH of higher than 3. Thus, the mean administered dose was significant lower under regimen B (2.2 ml) than under regimen A (12.0 ml). Consequently, the mean level of gastric pH was higher under regimen A (median: 5.96 +/- 1.31 versus 4.94 +/- 1.16). pH-values lower than 3 were more often measured under regimen B, whereas the phases at this pH-level were longer under regimen A. CONCLUSION: The usual body weight related dosage of antacids seems to be to high for early infancy. In the face of the discrepancy of the administered antacid quantity comparing regimen A with regimen B, it seems to be reasonable for the studied age group to reduce the single antacid dose to 0.25 ml/kg body weight while adhering to a high application frequency of 6 times a day.

Antacids↗
PubMed1995

Pharmacokinetics of tenidap sodium administered with food or antacid in healthy volunteers.

1. The effects of food and antacid on the pharmacokinetics of tenidap were investigated in this randomised, 3-way cross-over study. 2. Twenty-one healthy young men, mean age 27.4 years, received single oral doses of tenidap sodium 120 mg at weekly intervals after either an overnight fast, with food or with 20 ml of the antacid Maalox (aluminum hydroxide 1.8 g and magnesium hydroxide 1.2 g). Plasma samples collected immediately before and up to 96 h after each tenidap dose were assayed for tenidap using a validated h.p.l.c. method. The assay data were used to determine the pharmacokinetic parameters of tenidap in each group. 3. Co-administration of tenidap with food produced a statistically significant delay in the rate of absorption (tmax, 4.4 h) (P < 0.001). There was no statistically significant change in Cmax. However, co-administration with the antacid significantly decreased both the mean rate and extent of absorption of tenidap compared with the fasting state: AUC, 420.93 micrograms ml-1 h (antacid), 476.31 micrograms ml-1 h (fasting) (P = 0.026); Cmax 14.3 micrograms ml-1 (antacid), 18.0 micrograms ml-1 (fasting) (P = 0.001); tmax 4.5 h (antacid), 2.9 h (fasting) (P < 0.001). Neither food nor the antacid had any effect on the elimination of tenidap. These changes in tmax are unlikely to be of any clinical significance owing to the long half-life of tenidap. 4. Treatment was well tolerated. Only two adverse events were reported that were considered by the investigator to be related to tenidap. There were no reports of laboratory or cardiovascular abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Gastrointestinal absorption of aluminium from single doses of aluminium containing antacids in man.

Ten subjects with normal renal function were given different single doses of aluminium containing antacids (1, 4, or 8 tablets). The antacid tablets (aluminium content 244 mg tablet-1) were chewed and swallowed either with water, with orange juice, or with citric acid solution. There was a marked increase in serum concentration of aluminium when the antacids was ingested with citric acid (P less than 0.001) or with orange juice (P less than 0.05). When antacids were taken with water, a slight, but significant increase in serum aluminium concentration was seen with 4, but not with 1 or with 8 tablets. Following all doses of antacid, a significant increase in 24 h urinary excretion of aluminium was seen. The estimated absorption of aluminium was 8 and 50 times higher when antacids were taken with orange juice or with citric acid, respectively, than when taken with water. Thus, measurable quantities of aluminium are absorbed from single oral doses of antacids. The absorption is substantially enhanced by concomitant ingestion of citric acid.

Administration, Oral↗
PubMed1990

Acute effects of antacids on gastric juice components in duodenal ulcer patients.

In 10 duodenal ulcer patients gastric juice was aspirated every 10 min for 20 min before and 200 min after sham feeding. One antacid tablet or placebo was given 80 min after the sham feeding. Analyses of the aspirates showed that antacids reduced mean hydrogen ion activity and pepsin concentration significantly for 40 and 60 min, respectively, and increased phospholipid concentration for 30 min, compared with placebo. Highest mean pH was 2.52. The percentage of pH readings at or above pH levels of 2, 3, and 4 during the 2 h period following antacid administration was 29, 10, and 2%, respectively. No significant differences between antacid and placebo were found regarding intragastric concentrations of bile acids and prostaglandin E2. When one antacid tablet was administered 80 min after a real meal, the effect on intragastric pH was similarly weak, but lasted slightly longer. Acid neutralization' alone can hardly explain the ulcer-healing effect of low-dose antacids. Antacid-induced increase in intragastric concentration of phospholipids is a new and potentially important observation.

Adult↗
PubMed1989

Influence of an antacid containing aluminum and magnesium on the pharmacokinetics of cefixime.

Interaction studies in dogs have indicated that antacids significantly decrease the oral bioavailability of cefixime. Twelve healthy adult male volunteers participated in a randomized, four-way crossover trial to evaluate the influence of an aluminum-magnesium antacid (Maalox; 20 ml) on the pharmacokinetics of cefixime (400 mg). Regimens were (i) cefixime alone; (ii) cefixime simultaneous with antacid; (iii) cefixime 2 h before antacid; and (iv) cefixime 2 h after antacid. Serial blood and urine samples were collected over a 24-h period following each dose of cefixime. There was a 1-week washout interval between regimens. Cefixime concentrations in serum and urine were analyzed by high-performance liquid chromatography. Maximum cefixime concentrations in serum for regimens i through iv were (mean +/- standard deviation) 4.9 +/- 1.4, 5.7 +/- 1.3, 5.1 +/- 1.0, and 5.5 +/- 1.5 micrograms/ml, respectively. Corresponding values for area under the serum concentration-time curve extrapolated to infinity were 38.3 +/- 14.5, 42.8 +/- 13.9, 38.5 +/- 9.8, and 41.6 +/- 16.7 micrograms.h/ml. There was a trend toward increased concentrations in serum and area under the curve of cefixime when it was administered concomitantly with antacid; however, these differences were not statistically significant (P greater than 0.05; analysis of variance). We conclude that single-dose administration of an aluminum-magnesium antacid does not significantly decrease the oral bioavailability of cefixime.

Adult↗
PubMed2001

Evaluation of the influence of antacids and H2 antagonists on the absorption of moxifloxacin after oral administration of a 400mg dose to healthy volunteers.

OBJECTIVE: To determine the effect of concomitant administration of the antacid Maalox 70 or the histamine H2 receptor antagonist ranitidine on the bioavailability of moxifloxacin. DESIGN: These were nonblinded, randomised, crossover studies performed in healthy volunteers. PARTICIPANTS: 24 healthy males aged 22 to 39 years (study 1; n = 12) and 24 to 43 years (study 2; n = 12) were included in these studies. METHODS: In study 1, 12 participants received ranitidine 150mg twice daily during a 3-day pretreatment phase and 1 tablet of ranitidine together with a single 400mg dose of moxifloxacin on the profile day. In study 2, 12 participants received a single 400mg dose of moxifloxacin alone (treatment A), simultaneously with Maalox 70 10ml (treatment B), or with Maalox 70 10ml given 4 hours before (treatment C) or 2 hours after (treatment D) the fluoroquinolone. In treatments B, C and D, administration of the antacid (10ml, 1 hour after each meal) was continued for 2 days. Plasma and urine samples were obtained for determination of the pharmacokinetic parameters of moxifloxacin. RESULTS: Coadministration of moxifloxacin with ranitidine showed lack of interaction for area under the plasma concentration-time curve extrapolated to infinity (AUCinfinity) [35.5 versus 34.3 mg/L x h with versus without ranitidine; relative bioavailability 103%, 90% confidence interval (CI) 97.7 to 109.3%] and maximum plasma concentration (Cmax) [2.98 versus 2.76 mg/L with versus without ranitidine; ratio 107.9%, 90% CI 90.5 to 128.6%]. When moxifloxacin was given simultaneously with Maalox 70, AUCinfinity ( 14.7 mg/L x h) and Cmax (1.00 mg/L) were reduced by approximately 60%. When the antacid was given 4 hours before or 2 hours after the fluoroquinolone, AUCinfinity values (28.0 and 26.7 versus 34.3 mg/L x h) were moderately reduced (by <27%), terminal elimination half-life values declined by approximately 24% (9.4 and 9.3 versus 12.3 hours) compared with moxifloxacin alone and Cmax values were almost unchanged (2.55 and 2.38 versus 2.57 mg/L). The mean bioavailabilities corrected for the elimination rate constants (lambdaz) were 101% (antacid given 4 hours before moxifloxacin) and 98% (antacid given 2 hours after moxifloxacin), indicating that Maalox 70 may interfere with the gastrointestinal recirculation of moxifloxacin. CONCLUSIONS: The bioavailability of moxifloxacin is not affected by concurrent administration of ranitidine. Absorption of moxifloxacin is impaired by concomitant administration of aluminium- and magnesium-containing antacids and administration of these agents should be staggered. An interval of 2 hours before or 4 hours after taking the antacid ensures that the effect of the interaction is not clinically relevant.

Administration, Oral↗
PubMed1989

A critical look at the clinical use of antacids in acid-peptic disease and gastric acid rebound.

Ancient man found that he could relieve dyspepsia by ingesting minerals that had antacid properties. Calcium carbonate was one of the first of these, as it occurred in relatively pure form in coral and limestone. Antacids were the keystone of medical management until the modern era of ulcer treatment. There has been a renewal of interest in antacids in recent years. Calcium as a component of the diet has come under scrutiny. Antacids have been found to be as effective in promoting healing of ulcer as H2 antagonists, sulcrafate, and colloidal bismuth. With regard to optimal dose in ulcer treatment, doses of antacids from 120 to 1008 mmol/day have been effective. A dose of 120 mmol/day given qid is effective. Low-dose antacids may increase mucosal resistance. The evidence for a specific gastric acid rebound with CaCO3 is based upon flawed assumptions and studies. Stimulation of gastric secretion occurs with all buffers, and this effect is compensated by the remaining buffer. When used properly, CaCO3 is an efficient, inexpensive, and safe antacid.

Animals↗
PubMed1989

[Influence of pH in the adsorption capacity of bile salts and lysolecithins in vitro by antacids containing clay and/or aluminum].

In vitro binding properties of eight clay and/or aluminium-containing antacids for bile salts and lysolecithin were measured in comparison with cholestyramine binding capacity, taking into account the final medium pH. Dihydroxy-bile salt adsorption was greater when the initial pH was 1.8 and the intensity varied according to the drugs. Trihydroxybile salts were less bound and the binding was less related to the medium pH. Lysolecithins were bound by clay-containing antacids with the same intensity as cholestyramine, while the binding capacity of aluminium-containing antacids was weaker and related to the final pH. There were close relationships between binding capacities and the final pH so that bile salts are bound by antacids with a great intensity in acid medium and released by alkalinisation in contrary to the binding capacity of cholestyramine. Lysolecithins should be also bound more intensively in acid medium by aluminium-containing antacids. Binding capacities of the antacids were related to their composition, their antacid effect and to the final pH.

Adsorption↗
PubMed1988

Evaluation of antacid tablets and liquid in fasting and fed men and women.

In view of in vitro tests suggesting good performance of an experimental tablet formulation of an aluminum hydroxide-magnesium hydroxide antacid, a study was conducted to evaluate the efficacy in vivo. Twenty-three healthy men and women were enrolled in the study, which was carried out in two parts: fasting and postprandial. Eight of the volunteers failed to qualify because of repeated baseline pH greater than 2.5. In the 15 participants who qualified, the intragastric pH was monitored for up to 240 minutes after the administration of one or two experimental tablets, 5 or 10 ml of a commercially available liquid antacid, or placebo. In the fasting subjects (n = 10), the antacids rapidly increased the mean pH. One antacid tablet and 5 ml of liquid antacid yielded similar results, with mean peak pH values of 5.2 and 4.8 and durations above pH 3.5 of 25 and 40 minutes, respectively. When the doses were doubled, 10 ml of liquid produced a peak pH of 6.7 and maintained the pH above 3.5 for 40 minutes, whereas two tablets produced a peak pH of 4.8 and maintained pH above 3.5 for 15 minutes. In the fed subjects (n = 10), neither antacid formulation at either dose significantly raised intragastric pH. Further studies are needed to establish the optimal time for postprandial administration of antacids.

Adult↗
PubMed1987

[Value of antacids in ulcer therapy. Continuing the tradition or scientific progress?].

For many centuries antacids have been the mainstay of treatment of peptic disorders. After the introduction of histamine H2-receptor antagonists, many clinicians anticipated the end of the antacid era. The opposite happened. Antacids have undergone a "renaissance". Controlled clinical trials have verified their therapeutic efficacy. New antacids with greater acid-binding capacity have been introduced. They have also been used for other indications, such as the prevention of bleeding or reflux esophagitis. More has also been learned about their mode of action and their side effects. The increase of our knowledge about antacids has led to their safer use in gastrointestinal disorders. The aim of the present review was to summarize what we know about antacids today, and to establish what place they have in the therapy, and, last but not least, to find out whether antacids belong to our drug arsenal in the future, as well.

Antacids↗
PubMed1985

Effect of antacids on salicylate kinetics.

The effect of an antacid on the absorption of aspirin can vary depending on certain physical characteristics of the brand of aspirin chosen. In a study carried out to test the effect of a commonly used antacid on the absorption of a brand of aspirin, no differences were seen in the area under the curve (AUC) of plasma concentrations of salicylic acid versus time, Cmax and Ka of salicylic acid without or with antacid. However, the antacid was seen to alter the pH of urine in four of the six subjects investigated. The study, when extended to examine the effect of antacid on steady-state kinetics of salicylic acid, showed that when the Cmin plasma concentrations of salicylic acid were in the region of 15 mg%, the antacid reduced the plasma concentrations and half-life of salicylic acid. It therefore follows that 15 mg% is the minimum plasma concentration at which an antacid that alters the pH of urine brings about a reduction in the steady-state plasma concentrations and an increase in the elimination of salicylic acid from plasma.

Adult↗
PubMed1979

Effect of an antacid on gastrointestinal absorption of theophylline.

The effect of a magnesium-aluminum hydroxide antacid (Maalox) on the oral absorption of aminophylline tablets was studied. Twelve healthy adults were administered 200 mg of aminophylline alone or with 30 ml of antacid in a complete crossover study. Blood samples were drawn at 0.33, 0.67, 1, 2, 4, 8, 12, and 24 hours following theophylline (as aminophylline) administration. Theophylline plasma levels were measured by high-performance liquid chromatography. The plasma theophylline concentrations of the group receiving theophylline only were significantly greater than those of the group receiving theophylline plus antacid at the 0.67- and 1-hour sample times only (p less than 0.05). The extent of theophylline absorption and the eliminated rate constant were not significantly affected by the antacid. Antacid significantly decreased theophylline's absorption rate constant (p less than 0.05), indicating a slower absorption of theophylline with antacid. Concurrent administration of the antacid Maalox should not significantly change theophylline's clinical effect.

Adult↗
PubMed1984

Radiotelemetric comparison of two antacids using the Heidelberg capsule.

The acid neutralizing capacity of a new antacid, almagate (hydrated aluminium-magnesium hydroxycarbonate, Al2Mg6(OH)14(CO3)2 X 4 H2O, Almax) has been compared with that of a popular mixture of aluminium-magnesium hydroxide codried gel, aluminium hydroxide and calcium carbonate (antacid A) using a transistorized telemetric technique (Heidelberg capsule) in 10 healthy volunteers following a double-blind crossover design. After placement of the radio transmitter capsule in the stomach a standard bicarbonate alkali test was made followed by the antacid under study. From the pH versus time curves obtained it was clearly shown that both antacid A and Almax produced a rapid (less than 1 min) neutralization of gastric acid (greater than pH 3) and that there were no significant differences between the two in terms of duration of effect (mean values of 48.35 and 54.65 min, respectively) and area under the pH versus time curves (mean values of 166.9 and 197.2 mm2, respectively). The maximum pH reached with Almax (mean 8.3) was, however, significantly (p less than 0.05) higher than that reached with antacid A (mean 7.6) although these maximum values were only transient. A calculation of antacid capacity relative to the bicarbonate alkali test control in each subject showed that Almax (5.75) had an apparently greater capacity than antacid A (3.33) but the individual variations were too great to allow statistical confirmation of this difference.

Aluminum Hydroxide↗
PubMed1983

Effect of pirenzepine and antacids on postprandial intragastric pH.

Peptic ulcer treatment with high dose regimens of antacids may be inconvenient and unpleasant, and the risk of side effects should not be neglected. Anticholinergics are claimed to accentuate and prolong the effect of antacids on intragastric acidity. In the study the effect on postprandial intragastric pH of a moderate dose of antacids in combination with pirenzepine was compared with that of a double dose of antacids in six healthy subjects, to see whether the dose of antacids could be reduced when given in combination with an antimuscarinic compound. Doubling the dose of antacids caused higher pH peaks while adding pirenzepine caused a more sustained pH elevation. The curves showing the percentage of pH readings greater than or equal to each pH level were almost identical up to pH 4. The results support the rationale of using antacids and pirenzepine in combination.

Antacids↗
PubMed1982

Effect of peroral antacid treatment in patients with acute upper gastrointestinal haemorrhage: a randomized controlled trial.

During recent years, it has been reported that antacids have a beneficial prophylactic effect in critically ill patients regarding upper gastrointestinal bleeding. In these trials rather complicated treatment schedules and high doses of antacids were used. The present study was designed to investigate the therapeutic efficacy of a more practical antacid treatment regimen in patients with haematemesis and/or melaena. Ninety patients, hospitalized for haematemesis and/or melaena within the past 24 hours, were included to double-blind treatment with antacids or placebo for 7 days. The dose, 20 ml liquid antacid (Balancid) with a neutralizing capacity of 105 mmol, was administered each second hour during waking hours. The groups were comparable regarding incidence of ulcer disease, age, sex, acid secretion, and usage of aspirin. Continuous bleeding or rebleeding was recorded in 15 of the 43 patients in the antacid group (34.9%), compared to 19 of the 47 patients in the placebo group (40.4%), the difference not being statistically significant. Furthermore, the requirement of blood transfusions was not significantly different in the two groups. In conclusion, the haemostatic effect of the antacid treatment regimen used in the present study was not significantly superior to placebo in patients with endoscopically verified acute upper gastrointestinal haemorrhage.

Adult↗
PubMedDate not supplied

Pharmacokinetic interaction between flurbiprofen and antacids in healthy volunteers.

Gastrointestinal distress resulting from drug intake is often remedied by administering the drug with antacids. However, antacids have been shown to modify the absorption and excretion of many drugs. This study was designed to delineate the effects of aluminium and magnesium hydroxide antacid suspension (Maalox) on the pharmacokinetics of flurbiprofen. Since this drug is often used in the elderly, not only young healthy but also geriatric healthy male volunteers participated in the study. A group of twelve young and a group of seven geriatric volunteers received, in a crossover design, a single oral dose of 100 mg of flurbiprofen with and without Maalox. A non-stereospecific assay was used to determine the total (R + S enantiomers) of flurbiprofen in plasma. The relative pharmacokinetic parameters of total flurbiprofen determined from plasma samples were Cmax, tmax, Kel, t1/2, and AUC infinity. The results indicate that the co-administration of Maalox with flurbiprofen had no effect on the rate and extent of total flurbiprofen absorption in young volunteers. In geriatric volunteers, the results indicate no effect of the antacid on the extent of drug absorption. There was a trend for lower plasma concentrations of total flurbiprofen with antacid in the geriatric group and hence a reduction in rate of flurbiprofen absorption although differences were not significant. The study also included a steady state determination of the influence of antacid administration on flurbiprofen pharmacokinetics. The group of young volunteers received, from Day 3 to Day 8, 100 mg of flurbiprofen every 12 h with and without Maalox.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗