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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">gnck</journal-id><journal-title-group><journal-title xml:lang="ru">Колопроктология</journal-title><trans-title-group xml:lang="en"><trans-title>Koloproktologia</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">2073-7556</issn><issn pub-type="epub">2686-7303</issn><publisher><publisher-name>Russian Association of Coloproctology</publisher-name></publisher></journal-meta><article-meta><article-id custom-type="elpub" pub-id-type="custom">gnck-1740</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>Статьи</subject></subj-group></article-categories><title-group><article-title>Применение эндоскопической резекции слизистой оболочки с циркулярным разрезом при удалении новообразований толстой кишки (промежуточные результаты)</article-title><trans-title-group xml:lang="en"><trans-title>The first experience of use of endoscopic mucosal resection with a circumferential incision in the removal of colon neoplasms</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Абдулжалиева</surname><given-names>Эльмира У.</given-names></name><name name-style="western" xml:lang="en"><surname>Abdulzhaliyeva</surname><given-names>Elmira U.</given-names></name></name-alternatives><email xlink:type="simple">polikarpova-e@yandex.ru</email><xref ref-type="aff" rid="aff-1"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>ФГБУ "НМИЦ колопроктологии имени А.Н.Рыжих" Минздрава России</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Ryzhikh National Medical Research Center of Coloproctology (Salyama Adilya str., 2, Moscow, 123423, Russia)</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2022</year></pub-date><pub-date pub-type="epub"><day>21</day><month>12</month><year>2022</year></pub-date><volume>21</volume><issue>4</issue><elocation-id>1740</elocation-id><permissions><copyright-statement>Copyright &amp;#x00A9; Абдулжалиева Э.У., 2022</copyright-statement><copyright-year>2022</copyright-year><copyright-holder xml:lang="ru">Абдулжалиева Э.У.</copyright-holder><copyright-holder xml:lang="en">Abdulzhaliyeva E.U.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.ruproctology.com/jour/article/view/1740">https://www.ruproctology.com/jour/article/view/1740</self-uri><abstract><sec><title>ЦЕЛЬ</title><p>ЦЕЛЬ: изучить непосредственные результаты лечения больных с доброкачественными эпителиальными новообразованиями ободочной кишки методом эндоскопической резекции слизистой с циркулярным разрезом (C-EMR).</p></sec><sec><title>ПАЦИЕНТЫ И МЕТОДЫ</title><p>ПАЦИЕНТЫ И МЕТОДЫ: с ноября 2020 г. по январь 2022 г. в проспективное рандомизированное сравнительное исследование включено 50 пациентов, которым было выполнено эндоскопическое удаление доброкачественных эпителиальных новообразований ободочной кишки размерами от 20 до 30 мм. В основную группу, где применялась эндоскопическая резекция слизистой оболочки с циркулярным разрезом включено 26 пациентов, а в контрольную, где новообразование ободочной кишки удалялось методом эндоскопической диссекции в подслизистом слое (ESD) - 24 пациента. РЕЗУЛЬТАТЫ: послеоперационные осложнения развились в группе C-EMR в 5(19,2%), а в группе ESD - в 7(29,2%) наблюдениях (p=0,51). Время, затраченное на удаление новообразования методом C-EMR, было статистически значимо в два раза меньше, чем при использовании методики ESD – 30 и 60 мин, соответственно (p&lt;0,001). Во всех наблюдениях в обеих группах опухоли были удалены единым блоком. Статистически значимых различий между группами в частоте достижения R0 границы резекции не было - 22(84,6%) и 23(95,8%) случая в основной и контрольной группах, соответственно (p=0,3). У 2(8,3%) больных в контрольной группе была выполнена конверсия в методику C-EMR.</p></sec><sec><title>ЗАКЛЮЧЕНИЕ</title><p>ЗАКЛЮЧЕНИЕ: эндоскопическая резекция слизистой с циркулярным разрезом является эффективным и безопасным методом удаления доброкачественных эпителиальных новообразований размерами от 20 до 30 мм, как и подслизистая диссекция. При этом удаление опухоли методом C-EMR требует в два раза меньше времени, чем метод ESD.</p></sec></abstract><trans-abstract xml:lang="en"><sec><title>OBJECTIVE</title><p>OBJECTIVE: to study the immediate results of the treatment of patients with benign epithelial neoplasms of the colon by endoscopic mucosal resection with a circular incision (C-EMR).</p></sec><sec><title>PATIENTS AND METHODS</title><p>PATIENTS AND METHODS: from November 2020 to January 2022, a prospective randomized comparative study was recruted 50 patients who underwent endoscopic removal of benign epithelial neoplasms of the colon with sizes from 20 to 30 mm. In the main group the endoscopic resection of the mucous with a circular incision technique was used (26 patients). The neoplasms of the colon in the control group were removed by endoscopic dissection in the submucosal layer (ESD) – 24 patients.</p></sec><sec><title>RESULTS</title><p>RESULTS: postoperative complications developed in the C-EMR group in 5 (19.2%), and in the ESD group - in 7 (29.2%) cases (p=0.51). The operative time in the C-EMR group was significantly less comparative with the ESD group – 30 and 60 min., respectively (p&lt;0.001). In all cases in both groups, tumors were removed en bloc. There R0 resection were performed in 22 (84.6%) and in 23 (95.8%) cases in the main and control groups, respectively (p=0.3). Two (8.3%) operation in the control group were converted to the C-EMR procedure.</p></sec><sec><title>CONCLUSION</title><p>CONCLUSION: endoscopic resection of the mucosa with a circular incision is an effective and safe method for removing benign epithelial neoplasms ranging in size from 20 to 30 mm, as well as submucosal dissection. The removal of the tumor by the C-EMR method requires two times less time than the ESD method.</p></sec></trans-abstract><kwd-group xml:lang="ru"><kwd>циркулярный разрез</kwd><kwd>эпителиальные новообразования</kwd><kwd>EMR</kwd><kwd>ESD</kwd><kwd>C-EMR</kwd></kwd-group><kwd-group xml:lang="en"><kwd>circular incision</kwd><kwd>epithelial neoplasms</kwd><kwd>EMR</kwd><kwd>ESD</kwd><kwd>C-EMR</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Ваганов Ю.Е., Хомяков Е.А., Серебрий А.Б., Абдулжалиева Э.У. Мукозэктомия и традиционная полипэктомия в лечении аденом ободочной кишки. Колопроктология. 2021; 20(2): 29–34. DOI: 10.33878/2073-7556-2021-20-2-29-34</mixed-citation><mixed-citation xml:lang="en">Vaganov Yu.E., Khomyakov E.A., Serebry A.B., Abdulzhalieva E.U. Endoscopic mucosal resection and conventional polypectomy in colon adenomas. Koloproktologia. 2021;20(2):29–34. (in Russ.). https://doi.org/10.33878/2073-7556-2021-20-2-29-34</mixed-citation></citation-alternatives></ref><ref id="cit2"><label>2</label><citation-alternatives><mixed-citation xml:lang="ru">Ваганов Ю.Е., Веселов В.В., Ликутов А.А., Хомяков Е.А. и соавт. Факторы риска рецидива аденом ободочной кишки после их удаления методом мукозэктомии. Колопроктология. 2021; 20(1): 10-16. DOI: 10.33878/2073-7556-2021-20-1-10-16</mixed-citation><mixed-citation xml:lang="en">Vaganov Yu.E., Veselov V.V., Likutov A.A., Khomyakov E.A., et al. Risk factors for</mixed-citation></citation-alternatives></ref><ref id="cit3"><label>3</label><citation-alternatives><mixed-citation xml:lang="ru">Ликутов А.А., Мтвралашвили Д.А., Нагудов М.А., Югай О.М. и соавт. Факторы, лимитирующие выполнение подслизистой диссекции в толстой кишке. Колопроктология. 2021; 20(2): 50–56. DOI:10.33878/2073-7556-2021-20-2-50-56</mixed-citation><mixed-citation xml:lang="en">colon adenomas recurrence after endoscopic mucosal resection. Koloproktologia. 2021;20(1):10-16. (in Russ.). https://doi.org/10.33878/2073-7556-2021-20-1-10-16</mixed-citation></citation-alternatives></ref><ref id="cit4"><label>4</label><citation-alternatives><mixed-citation xml:lang="ru">Williams AM, Hourigan SJ, Brown LF, et al (2015). Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian Colonic EMR (ACE) study. Gut. 2015 Jan; 64(1), 57–65. DOI:10.1136/gutjnl-2013-305516</mixed-citation><mixed-citation xml:lang="en">Likutov A.A., Mtvralashvili D.A., Nagudov M.A., Yugai O.M., Vaganov Yu.E., et al. Factors limiting the endoscopic submucosal dissection in colorectal tumors. Koloproktologia. 2021;20(2):50–56. (in Russ.). https://doi.org/10.33878/2073-7556-2021-20-2-50-56</mixed-citation></citation-alternatives></ref><ref id="cit5"><label>5</label><citation-alternatives><mixed-citation xml:lang="ru">Gotoda Takuji, Yamamoto Hironori, Soetikno RM. Endoscopic submucosal dissection of early gastric cancer. Gastroenterol. 2006; 41(10), 929–942. DOI:10.1007/s00535-006-1954-3</mixed-citation><mixed-citation xml:lang="en">Williams AM, Hourigan SJ, Brown LF, et al (2015). Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian Colonic EMR (ACE) study. Gut. 2015 Jan; 64(1), 57–65. DOI:10.1136/gutjnl-2013-305516</mixed-citation></citation-alternatives></ref><ref id="cit6"><label>6</label><citation-alternatives><mixed-citation xml:lang="ru">Jung, Yunho; Kim, Jong Wook; Byeon, Jeong-Sik; Koo, Hoon Sup; et al. Factors Predictive of Complete Excision of Large Colorectal Neoplasia Using Hybrid Endoscopic Submucosal Dissection: A KASID Multicenter Study. Digestive Diseases and Sciences. 2018 Oct; 63(10): 2773-2779. DOI:10.1007/s10620-018-5140-2</mixed-citation><mixed-citation xml:lang="en">Gotoda Takuji, Yamamoto Hironori, Soetikno RM. Endoscopic submucosal dissection of early gastric cancer. Gastroenterol. 2006; 41(10), 929–942. DOI:10.1007/s00535-006-1954-3</mixed-citation></citation-alternatives></ref><ref id="cit7"><label>7</label><citation-alternatives><mixed-citation xml:lang="ru">Masanori Hirao, Kazuhiko Masuda, Takeki Asanuma, Hiroji Naka, et al. Endoscopic resection of early gastric cancer and other tumors with local injection of hypertonic saline-epinephrine. Gastrointestinal Endoscopy. 1988; 34(3): 264–269. DOI:10.1016/S0016-5107(88)71327-9</mixed-citation><mixed-citation xml:lang="en">Jung, Yunho; Kim, Jong Wook; Byeon, Jeong-Sik; Koo, Hoon Sup; et al. Factors Predictive of Complete Excision of Large Colorectal Neoplasia Using Hybrid Endoscopic Submucosal Dissection: A KASID Multicenter Study. Digestive Diseases and Sciences. 2018 Oct; 63(10): 2773-2779. DOI:10.1007/s10620-018-5140-2</mixed-citation></citation-alternatives></ref><ref id="cit8"><label>8</label><citation-alternatives><mixed-citation xml:lang="ru">Jae Ho Cho, Cheol Min Shin, Hyuk Yoon, Young Soo Park, et al Comparison of endoscopic treatments for small gastric adenomas. Surgical Endoscopy. 2022; 36(6): 3920–3931. DOI: 10.1007/s00464-021-08710-9</mixed-citation><mixed-citation xml:lang="en">Masanori Hirao, Kazuhiko Masuda, Takeki Asanuma, Hiroji Naka, et al. Endoscopic resection of early gastric cancer and other tumors with local injection of hypertonic saline-epinephrine. Gastrointestinal Endoscopy. 1988; 34(3): 264–269. DOI:10.1016/S0016-5107(88)71327-9</mixed-citation></citation-alternatives></ref><ref id="cit9"><label>9</label><citation-alternatives><mixed-citation xml:lang="ru">Min BH, Lee JH, Kim JJ, Shim SG, et al. Clinical outcomes of endoscopic submucosal dissection (ESD) for treating early gastric cancer: Comparison with endoscopic mucosal resection after circumferential precutting (EMR-P). Digestive and Liver Disease. 2009; 41(3): 201-209. DOI:10.1016/j.dld.2008.05.006</mixed-citation><mixed-citation xml:lang="en">Jae Ho Cho, Cheol Min Shin, Hyuk Yoon, Young Soo Park, et al Comparison of endoscopic treatments for small gastric adenomas. Surgical Endoscopy. 2022; 36(6): 3920–3931. DOI: 10.1007/s00464-021-08710-9</mixed-citation></citation-alternatives></ref><ref id="cit10"><label>10</label><citation-alternatives><mixed-citation xml:lang="ru">Dong-Hoon Yang, Min-Seob Kwak, Sang Hyoung Park, Byong Duk Ye, et al. Endoscopic Mucosal Resection with Circumferential Mucosal Incision for Colorectal Neoplasms: Comparison with Endoscopic Submucosal Dissection and between Two Endoscopists with Different Experiences. Clin Endosc. 2017 Jul; 50(4): 379-387. DOI:10.5946/ce.2016.058</mixed-citation><mixed-citation xml:lang="en">Min BH, Lee JH, Kim JJ, Shim SG, et al. Clinical outcomes of endoscopic submucosal dissection (ESD) for treating early gastric cancer: Comparison with endoscopic mucosal resection after circumferential precutting (EMR-P). Digestive and Liver Disease. 2009; 41(3): 201-209. DOI:10.1016/j.dld.2008.05.006</mixed-citation></citation-alternatives></ref><ref id="cit11"><label>11</label><citation-alternatives><mixed-citation xml:lang="ru">Takashi Toyonaga, Mariko Man-I, Yoshinori Morita, Takeshi Azuma. Endoscopic Submucosal Dissection (ESD) Versus Simplified/Hybrid ESD. Gastrointestinal Endoscopy Clinics of North America. 2014; 24(2): 191–199. DOI:10.1016/j.giec.2013.11.004</mixed-citation><mixed-citation xml:lang="en">Dong-Hoon Yang, Min-Seob Kwak, Sang Hyoung Park, Byong Duk Ye, et al. Endoscopic Mucosal Resection with Circumferential Mucosal Incision for Colorectal Neoplasms: Comparison with Endoscopic Submucosal Dissection and between Two Endoscopists with Different Experiences. Clin Endosc. 2017 Jul; 50(4): 379-387. DOI:10.5946/ce.2016.058</mixed-citation></citation-alternatives></ref><ref id="cit12"><label>12</label><citation-alternatives><mixed-citation xml:lang="ru">Yun Jung Kim, EunSoo Kim, Kwang Bum Cho, Kyung Sik Park, et al. Comparison of Clinical Outcomes Among Different Endoscopic Resection Methods for Treating Colorectal Neoplasia. Dig Dis Sci. 2013 Jun;58(6):1727-36. DOI: 10.1007/s10620-013-2560-x</mixed-citation><mixed-citation xml:lang="en">Takashi Toyonaga, Mariko Man-I, Yoshinori Morita, Takeshi Azuma. Endoscopic Submucosal Dissection (ESD) Versus Simplified/Hybrid ESD. Gastrointestinal Endoscopy Clinics of North America. 2014; 24(2): 191–199. DOI:10.1016/j.giec.2013.11.004</mixed-citation></citation-alternatives></ref><ref id="cit13"><label>13</label><citation-alternatives><mixed-citation xml:lang="ru">Lee, Eun-Jung; Lee, Jae Bum; Lee, Suk Hee; Youk, Eui Gon. Endoscopic treatment of large colorectal tumors: comparison of endoscopic mucosal resection, endoscopic mucosal resection–precutting, and endoscopic submucosal dissection. Surgical Endoscopy. 2012; 26(8), 2220–2230. DOI:10.1007/s00464-012-2164-0</mixed-citation><mixed-citation xml:lang="en">Yun Jung Kim, EunSoo Kim, Kwang Bum Cho, Kyung Sik Park, et al. Comparison of Clinical Outcomes Among Different Endoscopic Resection Methods for Treating Colorectal Neoplasia. Dig Dis Sci. 2013 Jun;58(6):1727-36. DOI: 10.1007/s10620-013-2560-x</mixed-citation></citation-alternatives></ref><ref id="cit14"><label>14</label><citation-alternatives><mixed-citation xml:lang="ru">Lambert R, eiKudo Sh, Vieth M, Allen JI, et al. Pragmatic classification of superficial neoplastic colorectal lesions. Gastrointest Endosc. 2009;70(6), 1182–1199. DOI:10.1016/j.gie.2009.09.015</mixed-citation><mixed-citation xml:lang="en">Lee, Eun-Jung; Lee, Jae Bum; Lee, Suk Hee; Youk, Eui Gon. Endoscopic treatment of large colorectal tumors: comparison of endoscopic mucosal resection, endoscopic mucosal resection–precutting, and endoscopic submucosal dissection. Surgical Endoscopy. 2012; 26(8), 2220–2230. DOI:10.1007/s00464-012-2164-0</mixed-citation></citation-alternatives></ref><ref id="cit15"><label>15</label><citation-alternatives><mixed-citation xml:lang="ru">Lambert R, et al. Update on the Paris Classification of Superficial Neoplastic Lesions in the Digestive Tract. Endoscopy. 2005;37(6), 570–578. DOI:10.1055/s-2005-861352</mixed-citation><mixed-citation xml:lang="en">Lambert R, eiKudo Sh, Vieth M, Allen JI, et al. Pragmatic classification of superficial neoplastic colorectal lesions. Gastrointest Endosc. 2009;70(6), 1182–1199. DOI:10.1016/j.gie.2009.09.015</mixed-citation></citation-alternatives></ref><ref id="cit16"><label>16</label><citation-alternatives><mixed-citation xml:lang="ru">Kudo S, Rubio CA, Teixeira CR, et al. Pit pattern in colorectal neoplasia: endoscopic magnifying view. Endoscopy. 2001; 33(4):367– 373. DOI: 10.1055/s-2004-826104</mixed-citation><mixed-citation xml:lang="en">Lambert R, et al. Update on the Paris Classification of Superficial Neoplastic Lesions in the Digestive Tract. Endoscopy. 2005;37(6), 570–578. DOI:10.1055/s-2005-861352</mixed-citation></citation-alternatives></ref><ref id="cit17"><label>17</label><citation-alternatives><mixed-citation xml:lang="ru">Sano Y, Ikematsu H, Fu KI, et al. Meshed capillary vessels by use of narrow-band imaging for differential diagnosis of small colorectal polyps. Gastrointestinal Endosc. 2009;69:278–283. DOI: 10.1016/j. gie.2008.04.066</mixed-citation><mixed-citation xml:lang="en">Kudo S, Rubio CA, Teixeira CR, et al. Pit pattern in colorectal neoplasia: endoscopic magnifying view. Endoscopy. 2001; 33(4):367– 373. DOI: 10.1055/s-2004-826104</mixed-citation></citation-alternatives></ref><ref id="cit18"><label>18</label><citation-alternatives><mixed-citation xml:lang="ru">Kimura T, Yamamoto E, Yamano HO. A novel pit pattern identifies the precursor of colorectal cancer derived from sessile serrated adenoma. Am J Gastroenterol. 2012; 107(3):460–469. DOI: 10.1038/ ajg.2011.457</mixed-citation><mixed-citation xml:lang="en">Sano Y, Ikematsu H, Fu KI, et al. Meshed capillary vessels by use of narrow-band imaging for differential diagnosis of small colorectal polyps. Gastrointestinal Endosc. 2009;69:278–283. DOI: 10.1016/j. gie.2008.04.066</mixed-citation></citation-alternatives></ref><ref id="cit19"><label>19</label><citation-alternatives><mixed-citation xml:lang="ru">Kato H, Haga S, Endo S, Hashimoto M, et al. Lifting of Lesions During Endoscopic Mucosal Resection (EMR) of Early Colorectal Cancer: Implications for the Assessment of Resectability. Endoscopy. 2001 Jul; 33(7):568-73. DOI:10.1055/s-2001-15308</mixed-citation><mixed-citation xml:lang="en">Kimura T, Yamamoto E, Yamano HO. A novel pit pattern identifies the precursor of colorectal cancer derived from sessile serrated adenoma. Am J Gastroenterol. 2012; 107(3):460–469. DOI: 10.1038/ ajg.2011.457</mixed-citation></citation-alternatives></ref><ref id="cit20"><label>20</label><citation-alternatives><mixed-citation xml:lang="ru">Burgess NG, Bassan MS, McLeod D, Williams SJ, et al. Deep mural injury and perforation after colonic endoscopic mucosal resection: a new classification and analysis of risk factors. Gut. 2017 Oct;66(10):1779-1789. DOI:10.1136/gutjnl-2015-309848</mixed-citation><mixed-citation xml:lang="en">Kato H, Haga S, Endo S, Hashimoto M, et al. Lifting of Lesions During Endoscopic Mucosal Resection (EMR) of Early Colorectal Cancer: Implications for the Assessment of Resectability. Endoscopy. 2001 Jul; 33(7):568-73. DOI:10.1055/s-2001-15308</mixed-citation></citation-alternatives></ref><ref id="cit21"><label>21</label><citation-alternatives><mixed-citation xml:lang="ru">Belderbos T, Leenders M, Moons L, Siersema P. Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis. Endoscopy. 2014 May;46(5):388-402. DOI:10.1055/s-0034-1364970</mixed-citation><mixed-citation xml:lang="en">Burgess NG, Bassan MS, McLeod D, Williams SJ, et al. Deep mural injury and perforation after colonic endoscopic mucosal resection: a new classification and analysis of risk factors. Gut. 2017 Oct;66(10):1779-1789. DOI:10.1136/gutjnl-2015-309848</mixed-citation></citation-alternatives></ref><ref id="cit22"><label>22</label><citation-alternatives><mixed-citation xml:lang="ru">Belderbos T, Leenders M, Moons L, Siersema P. Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis. Endoscopy. 2014 May;46(5):388-402. DOI:10.1055/s-0034-1364970</mixed-citation><mixed-citation xml:lang="en">Belderbos T, Leenders M, Moons L, Siersema P. Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis. Endoscopy. 2014 May;46(5):388-402. DOI:10.1055/s-0034-1364970</mixed-citation></citation-alternatives></ref></ref-list><fn-group><fn fn-type="conflict"><p>The authors declare that there are no conflicts of interest present.</p></fn></fn-group></back></article>
