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1帕博利珠单抗单用或与放疗联用治疗转移性非小细胞肺癌:两个随机试验的汇总分析显示文摘背景放疗可以提高整个机体对免疫治疗的应答。在Ⅱ期PEMBRO-RT研究和Ⅰ/Ⅱ期MDACC研究中,患有转移性非小细胞肺癌(NSCLC)的患者被随机分配入组,接受免疫治疗(帕博利珠单抗)+放疗联合疗法,或免疫治疗单一疗法。当上述2个研究单独分析时,联合疗法组显示出潜在获益。由于每个研究的样本量较小,缓解率和结局并未显示出统计学意义,然而却有显著的临床获益。因此,本研究进行汇总分析,来判断放疗是否会改善转移性NSCLC患者的免疫治疗应答。方法PEMBRO-RT和MDACC研究纳入标准:患者年龄≥18岁,患有转移性NSCLC,且有≥1处未经放疗照射的病灶,以便进行射野外应答监测。PEMBRO-RT研究纳入曾接受过化疗患者,MDACC研究纳入曾接受过治疗或新诊断患者。2个研究中的患者均未接受过免疫治疗。在PEMBRO-RT研究中患者被等比例随机分配入组,并根据吸烟状态进行分层(分为<10年组和≥10年组)。MDACC研究的患者根据放疗计划可行性被等比例随机分配入2个受试组。由于联合治疗组的干预本质,每个研究中的放疗均不适用盲法。在2个研究中,不论是否进行放疗,均静脉滴入帕博利珠单抗(每3周200 mg)。在PEMBRO-RT研究中,在放疗(24 Gy 3次分割照射)结束后1周给予第1剂帕博利珠单抗。在MDACC研究中,在第1次放疗(50 Gy 4次分割照射或45 Gy 15次分割照射)同时给予帕博利珠单抗。仅检测未经照射病灶的应答。本研究的终点为最佳射野外(远隔)应答率(ARR)、最佳射野外疾病控制率(ACR)、12周时ARR、12周时ACR、无进展生存期(PFS)和总生存期(OS)。2个研究的意向治疗(ITT)人群均纳入分析。PEMBRO-RT研究(NCT02492568)和MDACC研究(NCT02444741)均在ClinicalTrials.gov上注册。发现纳入148例患者,76例接受帕博利珠单抗治疗,72例接受帕博利珠单抗+放疗治疗。所有患者随访时间中位数为33个月[四分位距(IQR):32.4~33.6]。148例患者中124例(84%)组织学特征为非鳞癌,111例(75%)患者曾经接受过化疗。组间没有基线特征差异,包括PD-L1表达状态和转移灶体积。最常见的照射部位为肺转移灶(39%,28/72)、胸腔内淋巴结(21%,15/72)和非原发灶(17%,12/72)。帕博利珠单抗组和联合治疗组的最佳ARR分别为19.7%(15/76)和41.7%(30/72),OR=2.96,95%CI:1.42~6.20,P=0.0039;最佳ACR分别为43.4%(33/76)和65.3%(47/72),OR=2.51,95%CI:1.28~4.91,P=0.0071;PFS中位数分别为4.4(IQR:2.9~5.9)和9.0个月(IQR:6.8~11.2),HR=0.67,95%CI:0.45~0.99,P=0.045;OS中位数分别为8.7(IQR:6.4~11.0)和19.2个月(IQR:14.6~23.8),OR=0.67,95%CI:0.54~0.84,P=0.0004。在汇总分析中没有发现新的安全问题。解读帕博利珠单抗免疫疗法+放疗显著提高转移性NSCLC患者的应答和改善治疗结局。这些结果需要在三期临床试验中进行验证。陈大卫(翻译) 于金明(校对) Willemijn S M E Theelen Vivek Verma Brian P Hobbs Heike M U Peulen Joachim G J V Aerts Idris Bahce Anna Larissa N Niemeijer Joe Y Chang Patricia M de Groot Quynh-Nhu Nguyen Nathan I Comeaux George R Simon Ferdinandos Skoulidis Steven H Lin Kewen He Roshal Patel John Heymach Paul Baas James W Welsh 2021中华肿瘤防治杂志2021,28,24:49
2成人、儿童及孕妇特发性血小板减少性紫癜诊治指南显示文摘特发性血小板减少性紫癜(ITP)是一种自体免疫性疾病,以持续性血小板减少为特征(血小板<150×109/L).其发病机理是自身抗体与血小板抗原结合导致它们在未成熟时即被网状内皮系统,特别是在脾脏中被破坏引起血小板减少.Provan D Newland A Norfolk D Bolton-Maggs P Lilleyman J Greer I May A Murphy M Ouwehand W Watson S 李振宇 徐开林 2004国外医学(输血及血液学分册)2004,27,4:25
32018加拿大心境障碍与焦虑障碍治疗协作组/国际双相障碍学会指南:双相障碍的管理显示文摘加拿大心境障碍与焦虑障碍治疗协作组(Canadian Network for Mood and Anxiety Treatments,CANMAT)曾于2005年发布了第1版双相障碍管理指南,并分别于2007、2009和2013年对该指南进行了更新,其中最近的2次更新是与国际双相障碍学会(International Society for Bipolar Disorders,ISBD)合作完成。2018版CANMAT/ISBD双相障碍治疗指南(以下简称指南)反映了自2005年首版指南发表以来本领域取得的重大进展,包括疾病诊断与疾病管理的更新以及药物治疗与心理治疗的近期研究进展。这些前沿进展中综合考虑了循证证据的级别,并基于治疗疗效、临床实践经验、安全性、耐受性和药物导致的转相风险等,对一线、二线及三线治疗方案进行了简明而清晰的推荐。本指南中新增内容涵盖了双相Ⅰ型障碍(BD-Ⅰ)的躁狂发作急性期、抑郁发作急性期和双相障碍维持期的一线及二线治疗推荐等级划分。这种对治疗推荐等级的划分综合考虑了治疗方法对双相障碍不同时相的影响,将进一步帮助临床医生做出基于循证证据的治疗决策。锂盐、喹硫平、双丙戊酸盐、阿塞那平、阿立哌唑、帕利哌酮、利培酮和卡利拉嗪单药或联合使用被推荐为躁狂发作急性期的一线治疗选择。BD-Ⅰ抑郁期的一线治疗选择包括喹硫平、鲁拉西酮、锂盐、拉莫三嗪单药,鲁拉西酮联合锂盐或双丙戊酸盐或拉莫三嗪辅助治疗。尽管急性期治疗有效的药物通常应继续用于BD-Ⅰ的维持期治疗,但也存在一些特殊情况(例如抗抑郁药)。现有数据表明,锂盐、喹硫平、双丙戊酸盐、拉莫三嗪、阿塞那平和阿立哌唑单药或联合治疗应被视为维持治疗的初始或更换治疗方案时的一线选择。除了探讨BD-Ⅰ的相关问题外,本指南中还对双相Ⅱ型障碍(BD-Ⅱ)的临床管理进行了系统回顾并给予治疗推荐,同时针对特殊人群也有相关推荐,如处于各个生殖周期的女性、儿童、青少年和老年人。此外,本指南中还讨论了特定精神疾病及共病(如物质滥用、焦虑障碍和代谢性疾病)的影响。最后,本指南中概述了安全性和药物监测的相关问题。CANMAT/ISBD工作组希望本指南能够成为全球临床医生的实用工具。Lakshmi N Yatham Sidney H Kennedy Sagar V Parikh Ayal Sehaffer David J Bond Benicio N Frey Verinder Sharma Benjamin I Goldstein Soham Rej Serge Beaulieu Martin Alda Glenda MaeQueen Roumen V Milev Arun Ravindran Claire O'Donovan Diane Mclntosh Raymond W Lam Gustavo Vazquez Flavio Kapczinski Roger S Melntyre Jan Kozicky Shigenobu Kanba Beny Lafer Trisha Suppes Joseph R Calabrese Eduard Vieta Gin Malhi Robert M Post Michael Berk 胡晨(译) 王刚(译) 2019中华精神科杂志2019,52,1:25
4非胰岛素依赖型糖尿病冠状动脉疾病的危险因素:英国糖尿病前瞻性研究(UKPDS:23)显示文摘目的:评价2型糖尿病患者冠状动脉疾病的基线危险因素。设计:对2 693例资料完整的患者进行年龄和性别调整的逐步选择过程分析,以确定哪些冠状动脉疾病的危险因素应纳入 Cox 比例风险模型。对象:3 055例白人患者,平均年龄52岁,均新近诊断为2型糖尿病,且无动脉粥样硬化相关疾病的证据。平均随访期7.9年。335例患者于10年内出现冠状动脉疾病。结局评定:具有明确异常心电图的心绞痛、致死或非致死性心肌梗塞。结果:冠状动脉疾病与低密度脂蛋白胆固醇浓度升高、高密度脂蛋白胆固醇浓度降低、甘油三酯浓度升高、高血红蛋白 A_(1c)、高收缩压、高空腹血糖以及吸烟史密切相关。低密度脂蛋白胆固醇较高1/3对较低1/3区间的估计风险比为2.26(95%可信区间为1.70~3.00),高密度脂蛋白胆固醇为0.55(0.41~0.73),血红蛋白 A_(1c)为1.52(1.15~2.01),收缩压为1.82(1.34~2.47)。吸烟者的估计风险比为1.41(1.06~1.88)。结论:2型糖尿病患者中,存在冠状动脉疾病潜在的、可变的5种危险因素的交叉重叠影响。它们是低密度脂蛋白胆固醇浓度升高、高密度脂蛋白胆固醇浓度降低、高血压、高血糖和吸烟。R C Turner H Millns H A W Neil I M Stratton S E Manley D R Matthews R R Holman 赵维纲 1998英国医学杂志中文版1998,0,3:11
5Viral hepatitis prevalence in patients with active and latent tuberculosis显示文摘AIM: To assess the prevalence of hepatitis B virus(HBV) and hepatitis C virus(HCV) infection and association with drug induced liver injury(DILI) in patients undergoing anti-tuberculosis(TB) therapy.METHODS: Four hundred and twenty nine patients with newly diagnosed TB- either active disease or latent infection- who were due to commence antiTB therapy between September 2008 and May 2011 were included. These patients were prospectively tested for serological markers of HBV, HCV and human immunodeficiency virus(HIV) infections- hepatitis B core antigen(HBc Ag), hepatitis B surface antigen(HBs Ag), hepatitis B e antigen, Ig G and Ig M antibody to HBc Ag(anti-HBc), HCV Ig G antibody and HIV antibody using a combination of enzyme-linked immunosorbent assay, Western blot assay and polymerase chain reaction techniques. Patients were reviewed at least monthly during the TB treatment initiation phase. Liver function tests were measured prior to commencement of antiTB therapy and 2-4 wk later. Liver function tests were also performed at any time the patient had significant nausea, vomiting, rash, or felt non-specifically unwell. Fisher's exact test was used to measure significance in comparisons of proportions between groups. A P value of less than 0.05 was considered statistically significant.RESULTS: Of the 429 patients, 270(62.9%) had active TB disease and 159(37.1%) had latent TB infection. 61(14.2%) patients had isolated anti-HBc positivity, 11(2.6%) were also HBs Ag positive and 7(1.6%) were HCV-antibody positive. 16/270 patients with active TB disease compared to 2/159 patients with latent TB infection had markers of chronic viral hepatitis(HBs Ag or HCV antibody positive; P = 0.023). Similarly the proportion of HBs Ag positive patients were significantly greater in the active vs latent TB infection group(10/43 vs 1/29, P = 0.04). The prevalence of chronic HBV or HCV was significantly higher than the estimated United Kingdom prevalence of 0.3% for each. We found no association between DILI and presence of serological markers of HBV or HCV. Three(5.3%) patients with serological markers of HBV or HCV infection had DILI compared to 25(9.5%) patients without; P = 0.04.CONCLUSION: Viral hepatitis screening should be considered in TB patients. DILI risk was not increased in patients with HBV/HCV.Hesam Ahmadi Nooredinvand David W Connell Mahmoud Asgheddi Mohammed Abdullah Marie O'Donoghue Louise Campbell Melissa I Wickremasinghe Ajit Lalvani Onn Min Kon Shahid A Khan 2015World Journal of Gastroenterology2015,21,29:7
6三种胰岛素在反相色谱上的保留行为与热力学性质显示文摘以C8 柱为固定相 ,5 4%~ 5 9%甲醇为流动相 ,在一个广泛的温度 10~ 6 5℃范围内 ,研究了人、牛、猪 3种生物的胰岛素在高效反相色谱上的保留行为和热力学性质。研究结果表明 3种胰岛素在结构上的细微差别 ,能在反相色谱行为上明显地显示出来。同时还测定了 3种胰岛素与C8 柱结合时的焓ΔHo 和熵ΔSo 变化情况 ,这些热力学参数 ,对多肽和疏水界面相互作用机制的研究具有重要的参考价值。实验结果证明 ,通过色谱热力学参数的测定 ,将为蛋白质折叠机制以及生物大分子相互作用机制的研究 。郭敏亮 Milton T W Hearn Reinhard I Boysen 2000生物化学与生物物理学报2000,32,3:6
7Patterns of in-hospital mortality and bleeding complications following PCI for very elderly patients: insights from the Dartmouth Dynamic Registry显示文摘BackgroundVery 老病人(年龄 85 年) 是人口的一个很快增加的片断。作为一个组,他们经历跟随经皮的冠的干预(一种总线标准) 的在里面医院死亡和流血复杂并发症的高率。然而,在流血和死亡在之间的关系老 unknown.MethodsRetrospective 评论在 Dartmouth-Hitchcock 从 2000 ~ 2015 在 17,378 连续一种总线标准过程上被执行医学中心。在索引一种总线标准承认期间流血的发生(流血要求的输送,存取地点 hematoma > 5 厘米, pseudoaneurysm,和 retroperitoneal 流血)? 并且在里面医院死亡为四个年龄组被报导(< 65 年, 65-74 年, 75-84 年,和 85 年) 。承受了谁的流血复杂并发症和那些的病人的死亡被计算, multivariate 分析为在里面医院被执行死亡。最后,知道流血的预言者在病人年龄之间被比较 < 85 年和年龄 17,378 个病人学习了的 85 years.ResultsOf,(5.9%) 1019 经历了流血,(2.1%) 369 死了在里面医院追随者一种总线标准。流血和在里面医院死亡的发生与增加年龄 monotonically 增加了(死亡:0.94% , 2.27% , 4.24% 和 4.58% ;流血:3.96% , 6.62% , 10.68% 和 13.99% 好久 < 65, 65-74, 75-84 和 85 年,分别地) 。除了病人年龄 85 年,在 multivariate 分析上,流血为所有年龄组与增加的死亡被联系[机会比率(95% CI ) :变老 < 65 年, 3.65 (1.99-6.74 ) ;年龄 65-74 年, 2.83 (1.62-4.94 ) ;年龄 75-84 年, 3.86 (2.56-5.82 ) ,年龄 85 年:1.39 (0.49-3.95 )] 有增加的 .ConclusionsBleeding 和死亡追随者一种总线标准增加变老。为老尽管有流血的高率,流血在里面医院死亡追随者一种总线标准不再是预兆的。Shawn X Li Hannah I Chaudry Jiyong Lee Theodore B Curran Vishesh Kumar Kendrew K Wong Bruce W Andrus James T DeVries 2018Journal of Geriatric Cardiology2018,15,2:6
8座椅热舒适性客观评价温度模型构建显示文摘本文建立了人体—座椅接触面的温度模型,利用实测温度数据验证了模型的精度。从接触面温度特性模型中提取出了三个评价指标:接触面最终温度,接触面温度的最大变化率以及接触面的平均温度,据此建立了座椅舒适度客观评价体系。利用评价体系对三种材料座椅(泡沫、压模和木质座椅)进行评估,结果表明:泡沫座椅的舒适度得分为8.96±2.58,压模座椅的舒适度得分为6.15±1.96,木质座椅的舒适度得分为4.91±1.88。主观测评法得到的座椅舒适度得分为:泡沫座椅的舒适度得分为8.36±1.21,压模座椅的舒适度得分为7.27±1.42,木质座椅的舒适度得分为5.36±3.14。结论,利用人体—座椅接触面温度特性来衡量座椅舒适度的客观评价体系具有一定的实用性和可靠性。刘卓夫 李恩会 李峻夫 Cascioli Vincenzo Heusch I Andrew McCarthy W Peter 2012人类工效学2012,18,1:5
9Correlation of serum insulin like growth factor-I with retinopathy in Malaysian pregnant diabetics显示文摘AIM:To study the association of serum insulin-like growth factor-I(IGF-I) with diabetic retinopathy.· METHODS:Serum IGF-1 levels were measured in 25 pregnant diabetic patients and 25 pregnant non-diabetic patients who were matched for age,ethnicity,parity and period of gestation.Fundus examination was performed in both groups at 28,32 and 36 weeks of gestation.RESULTS:The serum IGF-I level was significantly elevated in pregnant diabetics compared to pregnant non-diabetics(366±199μg/L vs 184±89μg/L,(P=0.0001) at 24 weeks,535±251μg/L vs 356±89μg/L,(P=0.007) at 32 weeks and 404±166μg/L vs 264±113μg/L,(P=0.003) at 36 weeks of gestation).The pregnant diabetics with established diabetes had significantly higher IGF-1 level than gestational diabetes at 28,32 and 36 weeks of gestation.The serum IGF-I level in pregnant diabetics with retinopathy was significantly higher than in those without retinopathy at all periods of gestation.· CONCLUSION:Increased serum IGF-1 in pregnancy may increase the risks for retinopathy.S Adzura M Muhaya M Normalina A M Zaleha W P Sharifa Ezat I Tajunisah 2011International Journal of Ophthalmology(English edition)2011,4,1:4
10高危心血管病老年人血压变异性的相关因素显示文摘诊问血压变异性是心血管病的独立预测因素。该研究探讨老年人血压变异的相关因素。方法:在普伐他汀干预高危老年人的前瞻性研究( pravastatin inelderly individuals at risk of vascular disease, PROS-PER)中,分析70~82岁有心血管病史或危险因素的男性和女性者3794人。Poortvliet RK Lloyd SM Ford I Sattar N de Craen AJ Wijsman LW Mooijaart SP Westendorp G Jukema JW de Ruijter W Gussekloo J Stott DJ 2015中华高血压杂志2015,23,10:3
11Physical and Chemical Transformation of Hydroxyapatite Nanoparticles in Aqueous Sol after Preparation and in vitro显示文摘The co-precipitation method followed by ultrasound and heat treatment is a common way to prepare below 100 nm sized hydroxyapatite nanoparticles for biomedical studies and applications. The size and pH value of the obtained calcium phosphate nanoparticles in aqueous sol have a strong impact on the interactions with cells and tissue. The physical and chemical properties of material samples for in vitro and in vivo studies are often assumed to remain constant from the time after fabrication to the actual use. Only little attention is paid to eventual changes of the material over time or due to the different in vitro conditions. In this study, the physical and chemical transformation of calcium phosphate nanoparticles after preparation and in vitro was investigated. As the result showed, dispersed nano sized amorphous calcium phosphate precipitation as well as crystallized hydroxyapatite nanoparticles continue to crystallize even when kept at 4 ℃ leading to declining pH values and particle sizes. Due to the pH buffer in the medium the pH value of the cell culture remained stable after adding 20% nanoparticle sol in vitro. However, hydroxyapatite nanoparticles immediately became unstable in the presents of cell culture medium. The resulting loose agglomerations showed a size of above 500 nm.I W Bauer 李世普 2005Journal of Wuhan University of Technology(Materials Science)2005,20,B12:3
12系统性药物治疗儿童银屑病的安全性显示文摘银屑病是一种常见的慢性炎症性皮肤病。成年人的发病率为2%~3%,其中大约有三分之一的患者在18岁之前发病。在儿童期,该病的发病率呈线性增长。从1970年至2000年,儿童银屑病的发病率增加了一倍多。尽管对许多轻度银屑病患儿而言,局部治疗已足够,但对更多可能影响生活质量的重度或顽固性的银屑病患儿,则往往需要系统性治疗。bronckers imgj seyger mmb west dp lara-corrales i tollefson m tom wl hogeling m belazarian l zachariae c mahé e siegfried e philipp s szalai z vleugels ra holland k murphy r baselga e cordoro k lambert j alexopoulos a mrowietz u kievit w paller as 邓婕(编译) 张锡宝(审校) 2017皮肤性病诊疗学杂志2017,24,5:3
13臂间血压差与脑卒中的关系显示文摘为了检测同时测量的双臂血压差值是否可识别踝臂血压指数〈0.90的受试者,及是否能预测未来心血管事件,Hirofumi等收集来自10个队列的日本受试者13 317人的数据(基于一般人群的队列,既往有心血管事件病史的队列及有心血管病危险因素的队列)进行荟萃分析。刘青 叶鹏 Hirofumi T Toshiaki O Toshiharu N Chisa M Kazuomi K Satoshi H Yoshikuni K Toyoshi I Yasutaka M Katsuhiko K Yasuharu T Motoyuki N Takayoshi O Hirotaka W Masanori M Mitsuru O Norihisa I Michinari N Tetsuo S Charalambos V Akira Y 2018中华高血压杂志2018,26,6:3
14Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial显示文摘Surya SAY Biere Mark I van Berge Henegouwen Kirsten W Maas Luigi Bonavina Camiel Rosman Josep Roig Garcia Suzanne S Gisbertz Jean HG Klinkenbijl Markus W Hollmann Elly SM de Lange H Jaap Bonjer Donald L van der Peet Miguel A Cuesta 2012The Lancet . 2012 (9829)2012,,:3
15Identification and characterization of mutations in hepatitis B virus resistant to Lamivudine显示文摘AllEN M I DESLAURIERS M ANDREWS C W 1998Hepatology1998,27,6:2
16糖尿病孕妇血清胰岛素样生长因子-1与视网膜病变的关系(英文)显示文摘目的:研究血清胰岛素样生长因子-1(IGF-1)与糖尿病性视网膜病变的联系。方法:对25例怀孕的糖尿病患者及按年龄、种族、胎儿期和妊娠期相匹配的25例怀孕的非糖尿病患者的血清IGF-1水平进行测量。结果:怀孕的糖尿病患者血清IGF-1水平与怀孕的非糖尿病患者血清IGF-1水平相比明显升高,24wk分别是366±199μg/L和184±89μg/L(P=0.0001),32wk分别是535±251μg/L和356±89μg/L(P=0.007)。36wk分别是404±166μg/L和264±113μg/L(P=0.003)。在妊娠的28,32,36wk,有明确糖尿病病史的怀孕的糖尿病患者血清IGF-1水平比妊娠期糖尿病患者血清IGF-1水平有明显的升高。在整个妊娠期怀孕的伴有视网膜病变的糖尿病患者血清IGF-1水平比那些不伴有视网膜病的患者血清IGF-1水平明显升高。结论:在妊娠期提高血清IGF-1水平可能增加患糖尿病性视网膜病变的风险。S Adzura M Muhaya M Normalina A M Zaleha W P Sharifa Ezat I Tajunisah 2011国际眼科杂志2011,11,4:2
17Listeria monocytogenes following orthotopic liver transplantation:Central nervous system involvement and review of the literature显示文摘Listeria monocytogene is a well-recognized cause of bacteremia in immunocompromised individuals,including solid organ transplant recipients,but has been rarely reported following orthotopic liver transplantation. We describe a case of listeria meningitis that occurred within a week after liver transplantation. The patient developed a severe headache that mimicked tacrolimus encephalopathy,and was subsequently diagnosed with listeria meningitis by cerebrospinal fluid culture. The infection was successfully treated with three-week course of intravenous ampicillin. Recurrent hepatitis C followed and was successfully treated with interferon alfa and ribavirin. Fourteen cases of listeriosis after orthotopic liver transplantation have been reported in the English literature. Most reported cases were successfully treated with intravenous ampicillin. There were four cases of listeria meningitis,and the mortality of them was 50%. Early detection and treatment of listeria meningitis are the key to obtaining a better prognosis.Shugo Mizuno Ivan R Zendejas Alan I Reed Robin D Kim Richard J Howard Alan W Hemming Denise C Schain Consuelo Soldevila-Pico Roberto J Firpi Shiro Fujita 2007World Journal of Gastroenterology2007,13,32:2
18Does cryotherapy before drainage increase the risk of intraocular hemorrhage and affect outcome? 显示文摘Pearce I A Wang D Ocata W 1997Br J Ophthalmol1997,81,6:2
19Factoring wavelet transforms into lifting steps显示文摘Daubechies I Sweldens W 1998J Fourier Anal Appl1998,4,3:2
20Penetration resistance of lunar soils显示文摘Houston W N Namiq L I 1971Journal of Terramechanics1971,8,1:2
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