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© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
From the Division of Cardiac Surgery (S.V., C.-H.W., S.-H.L., P.W.M.F., M.V.B., B.D., R.D.W., R.-K.L., D.A.G.M.), Toronto General Hospital, University of Toronto, Toronto, Canada; Division of Neurosurgery (A.S.D), University of Virginia, Charlottesville; and the Division of Cardiology (D.J.S.), St Michaels Hospital, University of Toronto, Toronto, Canada.
Correspondence to Subodh Verma, MD, PhD, Division of Cardiac Surgery, 14 EN-215, 200 Elizabeth St, Toronto General Hospital, Toronto, ON, Canada M5G 2C4. (e-mail subodh.verma{at}sympatico.ca); or Donald A.G. Mickle, MD, University of Toronto, Toronto, Canada.
| Abstract |
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Methods and Results Endothelial cells (ECs) were incubated with recombinant CRP (0 to 100 µg/mL, 24 hours), and NO and cyclic guanosine monophosphate (cGMP) production was assessed. The effects of CRP on endothelial NO synthase (eNOS) protein, mRNA expression, and mRNA stability were also examined. In a separate study, the effects of CRP (25 µg/mL) on EC cell survival, apoptosis, and in vitro angiogenesis were evaluated. Incubation of ECs with CRP resulted in a significant inhibition of basal and stimulated NO release, with concomitant reductions in cGMP production. CRP caused a marked downregulation of eNOS mRNA and protein expression. Actinomycin D studies suggested that eNOS downregulation was related to decreased mRNA stability. In conjunction with a decrease in NO production, CRP inhibited both basal and vascular endothelial growth factorstimulated angiogenesis as assessed by EC migration and capillary-like tube formation. CRP did not induce EC survival but did, however, promote apoptosis in a NO-dependent fashion.
Conclusions CRP, at concentrations known to predict adverse vascular events, directly quenches the production of the NO, in part, through posttranscriptional effect on eNOS mRNA stability. Diminished NO bioactivity, in turn, inhibits angiogenesis, an important compensatory mechanism in chronic ischemia. Through decreasing NO synthesis, CRP may facilitate the development of diverse cardiovascular diseases. Risk reduction strategies designed to lower plasma CRP may be effective by improving NO bioavailability.
Key Words: angiogenesis nitric oxide interleukins protein, C-reactive cells
| Introduction |
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| Methods |
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Assessment of NO Release and cGMP Production
ECs (n=10 wells per group) were incubated with human recombinant CRP (1, 3, 5, 25, 50, and 100 µg/mL, 24 hours) and NO production was detected spectrophotometrically by measuring its final stable equimolar degradation products, nitrite and nitrate. Total nitrite was quantified after the reduction of all nitrates with nitrate reductase (Boehringer Mannheim). After the conversion of nitrate to nitrite, total nitrite was determined spectrophotometrically at 540 µm by employing the Griess reaction. The measurement of nitrite was performed in a total of 5.0 mL of Tris-buffered saline (Tris 25 mmol/L, NaCl 138 mmol/L, MgCl2 0.49 mmol/L, CaCl2 0.68 mmol/L, glucose 3.0 mmol/L, and pH 7.4) to avoid phosphate interference with the assay procedure. Extracellular fluid was collected and concentrated by freeze-drying and reconstituted in glass-distilled water. Total nitrite concentration was calculated from a standard curve constructed over the linear range of the assay and expressed as µmol/L per milligram protein. Because we have previously demonstrated the ability of CRP to augment endothelin-1 (ET-1) and interleukin-6 (IL-6) production,15 we evaluated the effects of CRP on NO production in the presence and absence of bosentan (ETA/B receptor antagonist, 10 µmol/L, Actelion Pharmaceuticals Inc) and antihuman IL-6 antibody (5 µg/mL, RandD Systems) for 2 hours before being incubated with CRP as above. The concentration of the IL-6 monoclonal antibody was sufficient to neutralize >95% of cytokine activity in vitro. In a separate experiment, the effects of CRP (25 µg/mL, 24 hours) on bradykinin-stimulated NO release were evaluated. In these experiments, ECs incubated with CRP were exposed to 10-6 mol/L bradykinin or vehicle for 30 minutes. The supernatant was then harvested for NO measurement. To evaluate the effects of CRP on the bioactivity of NO, we assessed intracellular cyclic guanosine monophosphate (cGMP) concentrations in ECs incubated with and without CRP. cGMP was determined by a commercial enzyme immunoassay (Amersham). After treatment, the confluent cell culture plates were subjected to ice-cold ethanol (65%). The cells were scraped and then centrifuged at 2000 rpm for 15 minutes at 4°C. The supernatant was transferred to fresh tubes and freeze-dried. The extracts were dissolved in 100 µL of manufacturers assay buffer before analysis. The extracted intracellular cGMP was assayed by the enzyme-immunoassay kit and expressed as fmol/µg protein. The cross-reactivity of the assay kit was <0.0.00008 for adenosine-3', 5'-cyclic monophosphate (cAMP) and <0.0000004 for GMP, where the reactivity was 100 for cGMP.
Western Blot Analysis
The effects of CRP on endothelial nitric oxide synthase (eNOS) protein expression were determined by Western blotting with the use of an anti-eNOS monoclonal antibody. Briefly, EC lysates were fractionated through a 4% stacking and 10% running SDS-PAGE gel and the fractionated proteins were transferred to PVDF membranes. Blots were blocked for 1 hour at room temperature with blocking buffer (5% nonfat milk in 10 mmol/L Tris pH 7.5, 100 mmol/L NaCl, 0.1% Tween 20). Anti-eNOS monoclonal IgG (Transduction Laboratories, Lexington, Ky), at a dilution of 1:2500, was reacted with the blots overnight at 4°C. After washing (2x for 15 minutes in 1x TTBS), the blots were incubated with the secondary antibody (horseradish peroxidaseconjugated goat antimouse immunoglobulin antibody (BioRad, Hercules, Calif) at 1:3000 dilution for 1 hour at room temperature. Visualization was performed with the use of enhanced chemiluminescence. Densitometric analysis of Western blots was performed with the use of PDI Imageware System. Western blotting of the structural protein
-tubulin was also performed to confirm equal loading.
Northern Blot Analysis and mRNA Stability
Total cellular RNA was isolated by lysis of cells in guanidinium isothiocyanate followed by phenol extraction. Northern blot analysis was conducted by subjecting 10 µg of RNA sample to electrophoresis in 1% agarose gel containing formaldehyde; then the RNA was transferred to a nylon membrane and UV-cross-linked. The eNOS cDNA probes were labeled with [32P]dCTP by a random primer kit (Amersham), and hybridized with the membranes in the presence of 50% formaldehyde and 10% dextran sulfate at 42151 C (12 hours). The hybridized blots were washed and exposed to an x-ray film (Amersham) for 48 hours, and autoradiographic results quantified with the use of densitometry and ImageMaster software. The eNOS mRNA signal was normalized for the corresponding ribosomal 28S band. The effects of CRP (25 µg/mL) on mRNA stability were also evaluated. For this purpose, confluent ECs were incubated with CRP in media containing 2.5 µg/mL actinomycin D. Culture media was removed at 0, 8, and 24 hours after actinomycin D treatment and RNA extracted for Northern blot analysis.
Cell Injury and Apoptosis
For the assessment of cellular injury, cells were stained with trypan blue. Injured cells were unable to exclude the large-molecular-weight dye and were subsequently stained blue. For detection of apoptosis, ECs were washed with PBS and fixed in 4% formaldehyde, after which they were stained with 4',6-diamidino-phenylidole (DAPI; 0.2 µg/mL in 10 mmol/L Tris/HCl, 10 mmol/L EDTA and 100 mmol/L NaCl) for 30 minutes. Cells were washed with PBS and DAPI-positive cells were evaluated by fluorescence microscopy.
In Vitro Angiogenesis: Scratch Wound Assay and Capillary-Like Tube Formation
A wounding migration assay was performed to ascertain the effects of CRP on angiogenesis. EC migration was determined with the use of 2x105 cells seeded on 60-mm culture dishes with the use of MCDB131 complete medium. After incubation for 24 hours, the cells were washed twice with PBS after wounding with a sterile disposable rubber policeman. The wounded cells were then incubated in 20% FBS EC basal medium-2 (Clonetics) in the presence of various interventions (control, CRP 25 µg/mL, vascular endothelial growth factor (VEGF) 100 µg/mL and VEGF+CRP, and L-NAME 1 mmol/L, 24 hours incubation). At the end of the incubation period, cells migrating from the wound edge were counted at 100x magnification under a phase contrast microscope. Results were expressed as the mean number of migrating cells per field.
A Matrigel tube formation assay was also performed to assess in vitro angiogenesis. Growth factorreduced Matrigel (Becton Dickinson) was placed in 24-well tissue culture plates (150 µL/well) and allowed to set at 37°C for 30 minutes. Then 5 x104 ECs were added to each well and incubated in 20% FBS EC basal medium-2 (Clonetics) basic medium with the presence or absence of CRP (25 µg/mL) and interventions as mentioned above at 37°C for 24 hours under a 5% CO2 atmosphere. The morphological changes were observed and photographed with the use of a phase contrast microscope. Each well was photographed 4 times at random. The length of the tube was measured at 40x magnification with Scion image (Scion Corp, NIH, Beta 4.0.2), and expressed as mm/mm2.
Statistical Analysis
All values are presented as mean±SEM. Comparisons between multiple treatment groups were done with the use of a 1-way ANOVA followed by a Newman-Keuls test. Unpaired data were analyzed by a 2-tailed Students t test. Differences were considered significant at P<0.05.
| Results |
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5 µg/mL (P<0.001). Increases in CRP concentrations beyond 5 µg/mL did not further attenuate NO release, demonstrating a potent NO quenching effect of low concentrations of CRP. In addition to inhibiting basal NO production, CRP (25 µg/mL) inhibited bradykinin-stimulated NO production (Figure 1B) in human umbilical vein ECs (P<0.01). The majority of the vascular actions of NO are mediated via the second messenger cGMP. Therefore, measuring cGMP levels is a surrogate marker of bioactivity of eNOS-derived NO. Figure 1C depicts the effects of human recombinant CRP on cGMP production. cGMP levels, determined by enzyme immunoassay, were markedly lower in cells treated with CRP (P<0.01). We have previously demonstrated that CRP increases EC production of ET-1 and IL-6. To examine the contribution of ET-1 and IL-6 toward CRPs effects on NO production, we studied the effects of coincubation with bosentan and antiIL-6 antibodies. The ability of CRP (25 µg/mL) to attenuate basal NO production was unaffected during either ET receptor blockade or IL-6 inhibition (Figure 2).
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CRP Attenuates eNOS Protein, mRNA Expression, and Stability
To examine whether the effects of CRP on NO release were secondary to decreased eNOS, we studied eNOS protein expression by Western blotting in saphenous vein ECs incubated with and without CRP (25 µg/mL, 24 hours). In the presence of CRP, basal eNOS protein expression was markedly downregulated (P<0.001) (Figure 3, E and F). A similar effect was noted at concentrations of 5 µg/mL (not shown). Northern blot analysis revealed that CRP caused a significant decrease in mRNA levels (Figure 3, A and B). eNOS mRNA half-life was assessed in actinomycin Dtreated ECs incubated with CRP (25 µg/mL, 24 hours). CRP caused a significant reduction in eNOS mRNA stability (half-life
14 hours in CRP-treated cells versus >24 hours in control ECs) (Figure 3, C and D).
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Effects of CRP on Cell Injury and Apoptosis
Figure 4 depicts the effects of CRP on cell injury and apoptosis. Cell injury, assessed by trypan blue exclusion, was similar in CRP-treated versus untreated cells (Figure 4A). Evaluation of apoptosis by DAPI staining revealed greater proportion of apoptotic cells in the CRP-treated versus untreated group (Figure 4B). This effect appeared to be NO dependent because it was reversed during coincubation with sodium nitroprusside.
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CRP Inhibits Angiogenesis In Vitro
Because CRP decreased the release of NO, we hypothesized that a key NO-mediated event, ie, angiogenesis, would also be attenuated under both basal and VEGF-stimulated conditions. Angiogenesis was evaluated in vitro by capillary-like tube formation and EC migration assays, respectively. The effects of CRP and VEGF on capillary-like tube formation are depicted in Figure 5. CRP markedly reduced tube length under both basal and VEGF-stimulated conditions (P<0.01). Further evidence for an antiangiogenic effect of CRP was derived from the wounding migration assay. CRP inhibited both basal and VEGF-stimulated EC migration (P<0.01, Figure 6). Taken together, these data suggest that the ability of CRP to directly quench NO production is associated with diminished angiogenesis, a key compensatory mechanism to chronic ischemia.
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| Discussion |
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Given the central importance of NO in the development and manifestations of cardiovascular diseases, we sought to determine whether the powerful predictive value of CRP might be explained through a direct effect on decreasing NO production. We found, that human recombinant CRP, at concentrations known to predict adverse cardiovascular events, caused a marked, sustained, and dose-dependent decrease in NO production in venous ECs. To confirm the functional significance of these data, we assessed the effects of human recombinant CRP on the production of cGMP, the second messenger for NO. As expected, CRP caused a marked reduction in endothelial production of cGMP, suggesting that reduction in NO release was associated with decreased second messenger bioactivity. To determine the mechanism, we examined the effects of CRP on the expression of eNOS, the rate-limiting enzyme in the production of NO. We show that CRP caused a marked downregulation of eNOS protein and transcript expression, in part via an effect of CRP to attenuate eNOS mRNA stability. mRNA levels represent the net balance between gene transcription and mRNA degradation, the latter being dependent on nucleotide sequence motifs, usually located in the 3' untranslated region of the gene.22 The ability of CRP to attenuate eNOS mRNA half-life is analogous to the effects of cytokines (tumor necrosis factor-
),23 lipopolysachccharides,24 hypoxia,25 and oxidized LDL.26 In this regard, it is important to note that CRP has been shown to augment the EC production of IL-6, an important inflammatory cytokine.15 It is plausible, therefore, that the effects of CRP on eNOS may be secondary to an increase in cytokine production. However, in our studies, preincubation with an antiIL-6 antibody did not prevent CRP-mediated decreases in NO release (Figure 2). Whether CRP increases the production of tumor necrosis factor-
, a potent destabilizer of eNOS mRNA, is an important question that remains to be determined. The effects of CRP on eNOS mRNA expression could also be due to a diminished transcription rate. Because nuclear run-on assays were not performed, this mechanism cannot be excluded.
A growing body of evidence supports the notion that NO is a key modulator of angiogenesis.27 Angiogenesis is a key compensatory mechanism in response to chronic ischemia and has emerged as an important therapeutic target for ischemic heart disease. NO donors promote EC proliferation and migration, whereas NOS inhibitors block VEGF-induced EC proliferation and capillary-like tube formation. VEGF-induced angiogenesis is critically dependent on NO release. Our data suggest that the ability of CRP to attenuate NO production is associated with a marked reduction in in vitro angiogenesis; both wound cell migration and capillary-like tube formation were inhibited by CRP, at concentrations known to predict adverse cardiovascular outcomes.
In addition to promoting angiogenesis, NO has been suggested to augment cell survival and inhibit apoptosis induced by a variety of stimuli.28 Although a number of NO-mediated antiapoptotic effects have been described, one important mechanism involves nitrosylation of caspases.29 In states of decreased NO bioavailability, ECs are unable to produce enough NO required for S-nitrosylation and inactivation of caspases, in turn facilitating apoptotic cell death. Because CRP reduced the production of NO, we hypothesized that EC apoptosis would be augmented in CRP-treated cells. Indeed, results from the present study suggest that CRP promotes apoptosis, and that this occurs in a NO-dependent fashion because it is inhibited by the exogenous NO donor sodium nitroprusside.
An Integrated Perspective
The mechanistic basis of the CRPatherosclerosis connection may lie in the ability of CRP to directly modulate the production of endothelium-derived vasoactive factors. To the best of our knowledge, this is the first evidence that CRP can profoundly downregulate the production of NO, the central "controller" of cardiovascular homeostasis. This effect appears to occur in part via an effect of CRP on eNOS mRNA stability. In a synchronous fashion, CRP augments the production of the potent endothelium-derived constrictor, ET-1, and a key inflammatory cytokine, IL-6 (Figure 7). 15 These events in turn facilitate the expression of early atherosclerotic processes, including adhesion molecule expression, chemokine production, and macrophage LDL-uptake, and uncover a prothrombotic and proinflammatory phenotype.15,3033 Through decreasing NO production, CRP may also facilitate EC apoptosis and attenuate important compensatory mechanisms to ischemia-like angiogenesis. Thus, CRP may not just be a marker of atherosclerosis and coronary events, but also a mediator of this disease because it contributes to the substrate underlying lesion formation, plaque rupture, and coronary thrombosis. In the same context, strategies designed to lower plasma CRP may be effective in reducing risk of cardiovascular events by virtue of directly improving NO bioavailability and endothelial function.34 In this way, the ability of CRP to attenuate NO release is nothing short of a self-fulfilling prophecy.
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| Acknowledgments |
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| Footnotes |
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Received May 13, 2002; accepted July 3, 2002.
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A. Momin, N. Melikian, S. B. Wheatcroft, D. Grieve, L. C. John, A. El Gamel, M. T. Marrinan, J. B. Desai, C. Driver, R. Sherwood, et al. The association between saphenous vein endothelial function, systemic inflammation, and statin therapy in patients undergoing coronary artery bypass surgery J. Thorac. Cardiovasc. Surg., August 1, 2007; 134(2): 335 - 341. [Abstract] [Full Text] [PDF] |
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E. Grad, M. Golomb, I. Mor-Yosef, N. Koroukhov, C. Lotan, E. R. Edelman, and H. D. Danenberg Transgenic expression of human C-reactive protein suppresses endothelial nitric oxide synthase expression and bioactivity after vascular injury Am J Physiol Heart Circ Physiol, July 1, 2007; 293(1): H489 - H495. [Abstract] [Full Text] [PDF] |
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P. E. Szmitko and S. Verma C-Reactive Protein and Reendothelialization: NO Involvement Circ. Res., May 25, 2007; 100(10): 1405 - 1407. [Full Text] [PDF] |
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R. Schwartz, S. Osborne-Lawrence, L. Hahner, L. L. Gibson, A. K. Gormley, W. Vongpatanasin, W. Zhu, R. A. Word, D. Seetharam, S. Black, et al. C-Reactive Protein Downregulates Endothelial NO Synthase and Attenuates Reendothelialization In Vivo in Mice Circ. Res., May 25, 2007; 100(10): 1452 - 1459. [Abstract] [Full Text] [PDF] |
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D. Ramzy, V. Rao, L. C. Tumiati, N. Xu, R. Sheshgiri, J. Jackman, D. H. Delgado, and H. J. Ross Endothelin-1 accentuates the proatherosclerotic effects associated with C-reactive protein J. Thorac. Cardiovasc. Surg., May 1, 2007; 133(5): 1137 - 1146. [Abstract] [Full Text] [PDF] |
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R. J. Bisoendial, J. J. P. Kastelein, S. L. M. Peters, J. H. M. Levels, R. Birjmohun, J. I. Rotmans, D. Hartman, J. C. M. Meijers, M. Levi, and E. S. G. Stroes Effects of CRP infusion on endothelial function and coagulation in normocholesterolemic and hypercholesterolemic subjects J. Lipid Res., April 1, 2007; 48(4): 952 - 960. [Abstract] [Full Text] [PDF] |
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O. Schlager, M. Exner, W. Mlekusch, S. Sabeti, J. Amighi, P. Dick, O. Wagner, R. Koppensteiner, E. Minar, and M. Schillinger C-Reactive Protein Predicts Future Cardiovascular Events in Patients With Carotid Stenosis Stroke, April 1, 2007; 38(4): 1263 - 1268. [Abstract] [Full Text] [PDF] |
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T. J. Wang, P. Gona, M. G. Larson, D. Levy, E. J. Benjamin, G. H. Tofler, P. F. Jacques, J. B. Meigs, N. Rifai, J. Selhub, et al. Multiple Biomarkers and the Risk of Incident Hypertension Hypertension, March 1, 2007; 49(3): 432 - 438. [Abstract] [Full Text] [PDF] |
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H. D. Sesso, L. Wang, J. E. Buring, P. M Ridker, and J. M. Gaziano Comparison of Interleukin-6 and C-Reactive Protein for the Risk of Developing Hypertension in Women Hypertension, February 1, 2007; 49(2): 304 - 310. [Abstract] [Full Text] [PDF] |
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H. Fujii, S.-H. Li, P. E. Szmitko, P. W.M. Fedak, and S. Verma C-Reactive Protein Alters Antioxidant Defenses and Promotes Apoptosis in Endothelial Progenitor Cells Arterioscler Thromb Vasc Biol, November 1, 2006; 26(11): 2476 - 2482. [Abstract] [Full Text] [PDF] |
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S. Kapiotis, G. Holzer, G. Schaller, M. Haumer, H. Widhalm, D. Weghuber, B. Jilma, G. Roggla, M. Wolzt, K. Widhalm, et al. A Proinflammatory State Is Detectable in Obese Children and Is Accompanied by Functional and Morphological Vascular Changes Arterioscler Thromb Vasc Biol, November 1, 2006; 26(11): 2541 - 2546. [Abstract] [Full Text] [PDF] |
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P. Libby and P. M. Ridker Inflammation and Atherothrombosis: From Population Biology and Bench Research to Clinical Practice J. Am. Coll. Cardiol., October 27, 2006; 48(9_Suppl_A): A33 - A46. [Abstract] [Full Text] [PDF] |
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M. Saura, C. Zaragoza, C. Bao, B. Herranz, M. Rodriguez-Puyol, and C. J. Lowenstein Stat3 Mediates Interelukin-6 Inhibition of Human Endothelial Nitric-oxide Synthase Expression J. Biol. Chem., October 6, 2006; 281(40): 30057 - 30062. [Abstract] [Full Text] [PDF] |
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J. A. Groner, M. Joshi, and J. A. Bauer Pediatric Precursors of Adult Cardiovascular Disease: Noninvasive Assessment of Early Vascular Changes in Children and Adolescents Pediatrics, October 1, 2006; 118(4): 1683 - 1691. [Abstract] [Full Text] [PDF] |
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Y. Zhong, S.-H. Li, S.-M. Liu, P. E. Szmitko, X.-Q. He, P. W.M. Fedak, and S. Verma C-Reactive Protein Upregulates Receptor for Advanced Glycation End Products Expression in Human Endothelial Cells Hypertension, September 1, 2006; 48(3): 504 - 511. [Abstract] [Full Text] [PDF] |
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J. P Casas, T. Shah, J. Cooper, E. Hawe, A. D McMahon, D. Gaffney, C. J Packard, D. S O'Reilly, I. Juhan-Vague, J. S Yudkin, et al. Insight into the nature of the CRP-coronary event association using Mendelian randomization Int. J. Epidemiol., August 1, 2006; 35(4): 922 - 931. [Abstract] [Full Text] [PDF] |
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B. M. Scirica, D. A. Morrow, S. Verma, S. Devaraj, I. Jialal, B. M. Scirica, D. A. Morrow, S. Verma, S. Devaraj, and I. Jialal The Verdict Is Still Out Circulation, May 2, 2006; 113(17): 2128 - 2151. [Full Text] [PDF] |
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M. Hamer, E. Williams, R. Vuonovirta, P. Giacobazzi, E. L. Gibson, and A. Steptoe The Effects of Effort-Reward Imbalance on Inflammatory and Cardiovascular Responses to Mental Stress Psychosom Med, May 1, 2006; 68(3): 408 - 413. [Abstract] [Full Text] [PDF] |
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J. Krupinski, M. M. Turu, J. Martinez-Gonzalez, A. Carvajal, J. O. Juan-Babot, E. Iborra, M. Slevin, F. Rubio, and L. Badimon Endogenous Expression of C-Reactive Protein Is Increased in Active (Ulcerated Noncomplicated) Human Carotid Artery Plaques Stroke, May 1, 2006; 37(5): 1200 - 1204. [Abstract] [Full Text] [PDF] |
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S. Tsimikas, J. T. Willerson, and P. M. Ridker C-reactive protein and other emerging blood biomarkers to optimize risk stratification of vulnerable patients. J. Am. Coll. Cardiol., April 18, 2006; 47(8 Suppl): C19 - C31. [Abstract] [Full Text] [PDF] |
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M. Hermann and F. Ruschitzka Novel anti-inflammatory drugs in hypertension Nephrol. Dial. Transplant., April 1, 2006; 21(4): 859 - 864. [Full Text] [PDF] |
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N. Dhaun, J. Goddard, and DavidJ. Webb The Endothelin System and Its Antagonism in Chronic Kidney Disease J. Am. Soc. Nephrol., April 1, 2006; 17(4): 943 - 955. [Abstract] [Full Text] [PDF] |
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D. M. Mannino, G. Watt, D. Hole, C. Gillis, C. Hart, A. McConnachie, G. Davey Smith, M. Upton, V. Hawthorne, D. D. Sin, et al. The natural history of chronic obstructive pulmonary disease. Eur. Respir. J., March 1, 2006; 27(3): 627 - 643. [Full Text] [PDF] |
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A. Silvestro, V. Schiano, R. Bucur, G. Brevetti, F. Scopacasa, and M. Chiariello Effect of Propionylcarnitine on Changes in Endothelial Function and Plasma Levels of Adhesion Molecules Induced by Acute Exercise in Patients with Intermittent Claudication Angiology, March 1, 2006; 57(2): 145 - 154. [Abstract] [PDF] |
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R. Ullegaddi, H. J. Powers, and S. E. Gariballa Antioxidant Supplementation With or Without B-Group Vitamins After Acute Ischemic Stroke: A Randomized Controlled Trial JPEN J Parenter Enteral Nutr, March 1, 2006; 30(2): 108 - 114. [Abstract] [Full Text] [PDF] |
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D. Sander, C. Schulze-Horn, H. Bickel, H. Gnahn, E. Bartels, and B. Conrad Combined Effects of Hemoglobin A1c and C-Reactive Protein on the Progression of Subclinical Carotid Atherosclerosis: The INVADE Study Stroke, February 1, 2006; 37(2): 351 - 357. [Abstract] [Full Text] [PDF] |
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A. Khera, J. A. de Lemos, R. M. Peshock, H. S. Lo, H. G. Stanek, S. A. Murphy, F. H. Wians Jr, S. M. Grundy, and D. K. McGuire Relationship Between C-Reactive Protein and Subclinical Atherosclerosis: The Dallas Heart Study Circulation, January 3, 2006; 113(1): 38 - 43. [Abstract] [Full Text] [PDF] |
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N. Sattar High sensitivity C-reactive protein in cardiovascular disease and type 2 diabetes: evidence for a clinical role? The British Journal of Diabetes & Vascular Disease, January 1, 2006; 6(1): 5 - 8. [PDF] |
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L. G. Futterman and L. Lemberg Regular Physical Exercise Reduces Cardiovascular Risks Am. J. Crit. Care., January 1, 2006; 15(1): 99 - 102. [Full Text] [PDF] |
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D.-H. Kang, S.-K. Park, I.-K. Lee, and R. J. Johnson Uric Acid-Induced C-Reactive Protein Expression: Implication on Cell Proliferation and Nitric Oxide Production of Human Vascular Cells J. Am. Soc. Nephrol., December 1, 2005; 16(12): 3553 - 3562. [Abstract] [Full Text] [PDF] |
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C. Mineo, A. K. Gormley, I. S. Yuhanna, S. Osborne-Lawrence, L. L. Gibson, L. Hahner, R. V. Shohet, S. Black, J. E. Salmon, D. Samols, et al. Fc{gamma}RIIB Mediates C-Reactive Protein Inhibition of Endothelial NO Synthase Circ. Res., November 25, 2005; 97(11): 1124 - 1131. [Abstract] [Full Text] [PDF] |
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S. De Servi, M. Mariani, G. Mariani, and A. Mazzone C-Reactive Protein Increase in Unstable Coronary Disease: Cause or Effect? J. Am. Coll. Cardiol., October 18, 2005; 46(8): 1496 - 1502. [Abstract] [Full Text] [PDF] |
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A. G. Herman and S. Moncada Therapeutic potential of nitric oxide donors in the prevention and treatment of atherosclerosis Eur. Heart J., October 1, 2005; 26(19): 1945 - 1955. [Abstract] [Full Text] [PDF] |
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H. Sun, T. Koike, T. Ichikawa, K. Hatakeyama, M. Shiomi, B. Zhang, S. Kitajima, M. Morimoto, T. Watanabe, Y. Asada, et al. C-Reactive Protein in Atherosclerotic Lesions: Its Origin and Pathophysiological Significance Am. J. Pathol., October 1, 2005; 167(4): 1139 - 1148. [Abstract] [Full Text] [PDF] |
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P. Cirillo, P. Golino, P. Calabro, G. Cali, M. Ragni, S. De Rosa, G. Cimmino, M. Pacileo, R. De Palma, L. Forte, et al. C-reactive protein induces tissue factor expression and promotes smooth muscle and endothelial cell proliferation Cardiovasc Res, October 1, 2005; 68(1): 47 - 55. [Abstract] [Full Text] [PDF] |
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U. Singh, S. Devaraj, and I. Jialal C-Reactive Protein Decreases Tissue Plasminogen Activator Activity in Human Aortic Endothelial Cells: Evidence that C-Reactive Protein Is a Procoagulant Arterioscler Thromb Vasc Biol, October 1, 2005; 25(10): 2216 - 2221. [Abstract] [Full Text] [PDF] |
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T. Nakakuki, M. Ito, H. Iwasaki, Y. Kureishi, R. Okamoto, N. Moriki, M. Kongo, S. Kato, N. Yamada, N. Isaka, et al. Rho/Rho-Kinase Pathway Contributes to C-Reactive Protein-Induced Plasminogen Activator Inhibitor-1 Expression in Endothelial Cells Arterioscler Thromb Vasc Biol, October 1, 2005; 25(10): 2088 - 2093. [Abstract] [Full Text] [PDF] |
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F. Mittermayer, J. Pleiner, G. Schaller, S. Zorn, K. Namiranian, S. Kapiotis, G. Bartel, M. Wolfrum, M. Brugel, J. Thiery, et al. Tetrahydrobiopterin corrects Escherichia coli endotoxin-induced endothelial dysfunction Am J Physiol Heart Circ Physiol, October 1, 2005; 289(4): H1752 - H1757. [Abstract] [Full Text] [PDF] |
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I. S. Anand, R. Latini, V. G. Florea, M. A. Kuskowski, T. Rector, S. Masson, S. Signorini, P. Mocarelli, A. Hester, R. Glazer, et al. C-Reactive Protein in Heart Failure: Prognostic Value and the Effect of Valsartan Circulation, September 6, 2005; 112(10): 1428 - 1434. [Abstract] [Full Text] [PDF] |
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Z. T. Bloomgarden Inflammation, Atherosclerosis, and Aspects of Insulin Action Diabetes Care, September 1, 2005; 28(9): 2312 - 2319. [Full Text] [PDF] |
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S. B. Schwedler, K. Amann, K. Wernicke, A. Krebs, M. Nauck, C. Wanner, L. A. Potempa, and J. Galle Native C-Reactive Protein Increases Whereas Modified C-Reactive Protein Reduces Atherosclerosis in Apolipoprotein E-Knockout Mice Circulation, August 16, 2005; 112(7): 1016 - 1023. [Abstract] [Full Text] [PDF] |
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M. Satoh, M. Nakamura, T. Akatsu, Y. Shimoda, I. Segawa, and K. Hiramori C-reactive protein co-expresses with tumor necrosis factor-{alpha} in the myocardium in human dilated cardiomyopathy Eur J Heart Fail, August 1, 2005; 7(5): 748 - 754. [Abstract] [Full Text] [PDF] |
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P. Thanyasiri, D. S. Celermajer, and M. R. Adams Endothelial dysfunction occurs in peripheral circulation patients with acute and stable coronary artery disease Am J Physiol Heart Circ Physiol, August 1, 2005; 289(2): H513 - H517. [Abstract] [Full Text] [PDF] |
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C. Liu, S. Wang, A. Deb, K. A. Nath, Z. S. Katusic, J. P. McConnell, and N. M. Caplice Proapoptotic, Antimigratory, Antiproliferative, and Antiangiogenic Effects of Commercial C-Reactive Protein on Various Human Endothelial Cell Types In Vitro: Implications of Contaminating Presence of Sodium Azide in Commercial Preparation Circ. Res., July 22, 2005; 97(2): 135 - 143. [Abstract] [Full Text] [PDF] |
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C. D. Buckley, G. E. Rainger, G. B. Nash, and K. Raza Endothelial cells, fibroblasts and vasculitis Rheumatology, July 1, 2005; 44(7): 860 - 863. [Abstract] [Full Text] [PDF] |
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J. Amar, J.-B. Ruidavets, J.-C. Peyrieux, J.-M. Mallion, J. Ferrieres, M. E. Safar, and B. Chamontin C-Reactive Protein Elevation Predicts Pulse Pressure Reduction in Hypertensive Subjects Hypertension, July 1, 2005; 46(1): 151 - 155. [Abstract] [Full Text] [PDF] |
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C. Arnaud, F. Burger, S. Steffens, N. R. Veillard, T. H. Nguyen, D. Trono, and F. Mach Statins Reduce Interleukin-6-Induced C-Reactive Protein in Human Hepatocytes: New Evidence for Direct Antiinflammatory Effects of Statins Arterioscler Thromb Vasc Biol, June 1, 2005; 25(6): 1231 - 1236. [Abstract] [Full Text] [PDF] |
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K. E. Taylor, J. C. Giddings, and C. W. van den Berg C-Reactive Protein-Induced In Vitro Endothelial Cell Activation Is an Artefact Caused by Azide and Lipopolysaccharide Arterioscler Thromb Vasc Biol, June 1, 2005; 25(6): 1225 - 1230. [Abstract] [Full Text] [PDF] |
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C. Kasapis and P. D. Thompson The Effects of Physical Activity on Serum C-Reactive Protein and Inflammatory Markers: A Systematic Review J. Am. Coll. Cardiol., May 17, 2005; 45(10): 1563 - 1569. [Abstract] [Full Text] [PDF] |
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M. Schillinger, M. Exner, W. Mlekusch, S. Sabeti, J. Amighi, R. Nikowitsch, E. Timmel, B. Kickinger, C. Minar, M. Pones, et al. Inflammation and Carotid Artery--Risk for Atherosclerosis Study (ICARAS) Circulation, May 3, 2005; 111(17): 2203 - 2209. [Abstract] [Full Text] [PDF] |
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K. Esposito, F. Giugliano, E. Martedi, G. Feola, R. Marfella, M. D'Armiento, and D. Giugliano High Proportions of Erectile Dysfunction in Men With the Metabolic Syndrome Diabetes Care, May 1, 2005; 28(5): 1201 - 1203. [Full Text] [PDF] |
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The Diabetes Prevention Program Research Group Intensive Lifestyle Intervention or Metformin on Inflammation and Coagulation in Participants With Impaired Glucose Tolerance Diabetes, May 1, 2005; 54(5): 1566 - 1572. [Abstract] [Full Text] [PDF] |
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E. Qamirani, Y. Ren, L. Kuo, and T. W. Hein C-Reactive Protein Inhibits Endothelium-Dependent NO-Mediated Dilation in Coronary Arterioles by Activating p38 Kinase and NAD(P)H Oxidase Arterioscler Thromb Vasc Biol, May 1, 2005; 25(5): 995 - 1001. [Abstract] [Full Text] [PDF] |
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P. E. Szmitko and S. Verma Antiatherogenic potential of red wine: clinician update Am J Physiol Heart Circ Physiol, May 1, 2005; 288(5): H2023 - H2030. [Abstract] [Full Text] [PDF] |
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D. C. W. Lau, B. Dhillon, H. Yan, P. E. Szmitko, and S. Verma Adipokines: molecular links between obesity and atheroslcerosis Am J Physiol Heart Circ Physiol, May 1, 2005; 288(5): H2031 - H2041. [Abstract] [Full Text] [PDF] |
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R. J. Bisoendial, J. J.P. Kastelein, J. H.M. Levels, J. J. Zwaginga, B. van den Bogaard, P. H. Reitsma, J. C.M. Meijers, D. Hartman, M. Levi, and E. S.G. Stroes Activation of Inflammation and Coagulation After Infusion of C-Reactive Protein in Humans Circ. Res., April 15, 2005; 96(7): 714 - 716. [Abstract] [Full Text] [PDF] |
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K. D. O'Brien, T. O. McDonald, V. Kunjathoor, K. Eng, E. A. Knopp, K. Lewis, R. Lopez, E. A. Kirk, A. Chait, T. N. Wight, et al. Serum Amyloid A and Lipoprotein Retention in Murine Models of Atherosclerosis Arterioscler Thromb Vasc Biol, April 1, 2005; 25(4): 785 - 790. [Abstract] [Full Text] [PDF] |
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A. N. Swafford Jr., I. N. Bratz, J. D. Knudson, P. A. Rogers, J. M. Timmerman, J. D. Tune, and G. M. Dick C-reactive protein does not relax vascular smooth muscle: effects mediated by sodium azide in commercially available preparations Am J Physiol Heart Circ Physiol, April 1, 2005; 288(4): H1786 - H1795. [Abstract] [Full Text] [PDF] |
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B. R. Clapp, G. M. Hirschfield, C. Storry, J. R. Gallimore, R. P. Stidwill, M. Singer, J. E. Deanfield, R. J. MacAllister, M. B. Pepys, P. Vallance, et al. Inflammation and Endothelial Function: Direct Vascular Effects of Human C-Reactive Protein on Nitric Oxide Bioavailability Circulation, March 29, 2005; 111(12): 1530 - 1536. [Abstract] [Full Text] [PDF] |
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S.-J. Lee, K.-M. Kim, S. Namkoong, C.-K. Kim, Y.-C. Kang, H. Lee, K.-S. Ha, J.-A Han, H.-T. Chung, Y.-G. Kwon, et al. Nitric Oxide Inhibition of Homocysteine-induced Human Endothelial Cell Apoptosis by Down-regulation of p53-dependent Noxa Expression through the Formation of S-Nitrosohomocysteine J. Biol. Chem., February 18, 2005; 280(7): 5781 - 5788. [Abstract] [Full Text] [PDF] |
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I. J. Kullo and C. M. Ballantyne Conditional Risk Factors for Atherosclerosis Mayo Clin. Proc., February 1, 2005; 80(2): 219 - 230. [Abstract] [PDF] |
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I. J. Chang and R. C. Harris Are All COX-2 Inhibitors Created Equal? Hypertension, February 1, 2005; 45(2): 178 - 180. [Full Text] [PDF] |
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M. Hermann, S. Shaw, E. Kiss, G. Camici, N. Buhler, R. Chenevard, T. F. Luscher, H. J. Grone, and F. Ruschitzka Selective COX-2 Inhibitors and Renal Injury in Salt-Sensitive Hypertension Hypertension, February 1, 2005; 45(2): 193 - 197. [Abstract] [Full Text] [PDF] |
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S. E. Nissen, E. M. Tuzcu, P. Schoenhagen, T. Crowe, W. J. Sasiela, J. Tsai, J. Orazem, R. D. Magorien, C. O'Shaughnessy, P. Ganz, et al. Statin Therapy, LDL Cholesterol, C-Reactive Protein, and Coronary Artery Disease N. Engl. J. Med., January 6, 2005; 352(1): 29 - 38. [Abstract] [Full Text] [PDF] |
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W. S. Speidl, A. Zeiner, M. Nikfardjam, A. Geppert, N. Jordanova, A. Niessner, G. Zorn, G. Maurer, W. Schreiber, J. Wojta, et al. An increase of C-reactive protein is associated with enhanced activation of endogenous fibrinolysis at baseline but an impaired endothelial fibrinolytic response after venous occlusion J. Am. Coll. Cardiol., January 4, 2005; 45(1): 30 - 34. [Abstract] [Full Text] [PDF] |
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C. K. Roberts and R. J. Barnard Effects of exercise and diet on chronic disease J Appl Physiol, January 1, 2005; 98(1): 3 - 30. [Abstract] [Full Text] [PDF] |
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K. J.E. Sattler, J. E. Woodrum, O. Galili, M. Olson, S. Samee, F. B. Meyer, X.-Y. Zhu, L. O. Lerman, and A. Lerman Concurrent Treatment With Renin-Angiotensin System Blockers and Acetylsalicylic Acid Reduces Nuclear Factor {kappa}B Activation and C-Reactive Protein Expression in Human Carotid Artery Plaques Stroke, January 1, 2005; 36(1): 14 - 20. [Abstract] [Full Text] [PDF] |
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J. A. Vita, J. F. Keaney Jr, M. G. Larson, M. J. Keyes, J. M. Massaro, I. Lipinska, B. T. Lehman, S. Fan, E. Osypiuk, P. W.F. Wilson, et al. Brachial Artery Vasodilator Function and Systemic Inflammation in the Framingham Offspring Study Circulation, December 7, 2004; 110(23): 3604 - 3609. [Abstract] [Full Text] [PDF] |
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L. Li, N. Roumeliotis, T. Sawamura, and G. Renier C-Reactive Protein Enhances LOX-1 Expression in Human Aortic Endothelial Cells: Relevance of LOX-1 to C-Reactive Protein-Induced Endothelial Dysfunction Circ. Res., October 29, 2004; 95(9): 877 - 883. [Abstract] [Full Text] [PDF] |
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S. Fazel, R. D. Weisel, and S. Verma A novel technique to assess flow-mediated vasodilation J. Am. Coll. Cardiol., October 6, 2004; 44(7): 1478 - 1480. [Full Text] [PDF] |
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