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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Patients with chronic kidney disease on dialysis&#44; and particularly those with kidney transplant&#44; have a higher incidence of cancer than the general population&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Chemotherapy for these patients poses special challenges&#44; primarily in relation to adjusting the dose according to renal function&#44; drug interactions and increased side effects&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In recent years&#44; great advances have been achieved in the treatment of various cancers based on immunotherapy&#46; Specifically&#44; <span class="elsevierStyleItalic">check-point</span> inhibitor drugs have been developed which&#44; by negatively inhibiting co-stimulation signals from T lymphocytes&#44; enable them to remain reactive against cancer cells&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> These drugs inhibit the CTLA-4&#44; PD-1 or PD-L1 protein&#44; and many of their side effects are related to the persistent activation of T lymphocytes&#44; thereby leading to a higher incidence of acute tubulointerstitial nephropathy&#44; acute tubular necrosis and minimal change disease&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Pembrolizumab is a monoclonal antibody which selectively binds to PD-1&#44; blocking the negative impact of this receptor on T lymphocyte function&#46; It is indicated in the treatment of a number of different types of cancer&#44; including melanoma&#44; renal carcinoma and lung cancer&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">There is very little experience of such treatment in patients on renal replacement therapy with dialysis or kidney transplantation&#46; We report the case of a patient on haemodialysis with lung cancer who received treatment with pembrolizumab and probably developed immune intolerance of the non-functioning graft&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">This was a 58-year-old male&#44; former smoker&#44; having smoked for 24 years &#40;24 pack years&#41;&#44; diagnosed with IgA mesangial glomerulonephritis&#44; who began haemodialysis for the first time in 1996&#46; He received a cadaveric kidney transplant a few months later&#46; He developed chronic graft nephropathy and returned to haemodialysis in 2000 with subsequent transplantectomy&#46; He received a second cadaveric kidney transplant in 2006&#46; In 2015&#44; he started on a peritoneal dialysis programme as a result of deteriorating kidney function due to global glomerulosclerosis and interstitial fibrosis with tubular atrophy of probable pyelonephritic origin&#44; subsequently being switched to haemodialysis in March 2019 after peritoneal leakage into the right hemithorax with pleural effusion&#46; At that point the patient was anuric&#46; In May 2019&#44; he developed pain in the right superior costal margins&#44; with chest X-ray showing a lytic lesion in the posterior region of the 2nd right costal cartilage&#46; He was diagnosed with stage IV-A undifferentiated clear cell carcinoma of probable pulmonary origin &#40;cT1a N2 M1b&#41;&#44; the molecular study for EGFR&#47;ALK&#47;ROS1 mutations was negative&#44; with PDL-1 expression in 90&#37; of the cells&#46; He was started on treatment with pembrolizumab in July 2019&#46; After 4 weeks of treatment&#44; the patient experienced low-grade fever&#44; graft discomfort and macroscopic haematuria&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Blood tests showed constant elevation of CRP&#44; without leucocytosis&#44; neutrophilia or eosinophilia&#59; from the outset&#44; all cultures&#44; including urine&#44; pleural fluid and blood were negative&#46; Findings of the Doppler ultrasound of the graft were nonspecific&#44; with increased echogenicity of the sinus&#44; thinning of the cortex and pyramid hypertrophy&#44; and persistent intrarenal flow&#46; With suspected immune intolerance of the graft&#44; it was decided to start treatment with low doses of corticosteroids&#44; with some improvement&#44; although the scant haematuria continued&#46; Treatment was continued with 200&#8239;mg of pembrolizumab every 3 weeks &#40;after the last weekly session&#41; and low doses of prednisone&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">There is very little experience in treating haemodialysis patients with immunotherapy&#46; Reported predisposing factors to developing toxicity include the previous use of corticosteroids&#44; being female&#44; previous history of autoimmune disease&#44; and abnormal kidney function&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Although they are well-tolerated drugs&#44; their side effects are related to the activation of T lymphocytes and are relatively common&#44; most notably skin&#44; gastrointestinal&#44; thyroid&#44; pulmonary and renal disorders&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> From the renal point of view&#44; the main complications are acute tubular necrosis&#44; acute tubulointerstitial nephropathy&#44; and some forms of glomerulonephritis&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Nevertheless&#44; these drugs have been used safely in haemodialysis patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">There is also limited experience with these treatments in kidney transplant patients&#46; In fact&#44; there have been reports of some cases in which immunotherapy&#44; by preserving the activation of T lymphocytes&#44; has led to graft rejection and its use is therefore not safe in patients with a functioning transplant&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In our patient&#44; the association of treatment with pembrolizumab and the development of fever&#44; local symptoms and haematuria posed a significant challenge in terms of diagnosis&#46; Furthermore&#44; it was possible that he had developed acute tubulointerstitial nephropathy&#44; and although the blood test showed absence of eosinophilia&#44; we could not exclude this diagnosis&#46; However&#44; we believe it more likely that the patient had developed an immunological intolerance on the non-functioning graft&#44; which until then had been well tolerated&#46; Unfortunately&#44; we were unable to perform a graft biopsy given the patient&#39;s situation and the fact that the lesion would presumably have had severe chronic damage&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The differential diagnosis between the two processes was very important&#44; since in the case of patients with a functioning kidney graft&#44; withdrawal of treatment would be indicated&#44; as well as performing the biopsy for an accurate diagnosis and the taking of decisions accordingly&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> In the case of immunological intolerance to the non-functioning graft&#44; which was the most likely case in our patient&#44; treatment with low doses of corticosteroids is recommended&#44; in order not to inhibit the therapeutic effect of pembrolizumab&#59; in fact&#44; the symptoms in our patient improved&#44; and for the moment it has been possible to continue treatment&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Finally&#44; to the best of our knowledge&#44; we have described the first haemodialysis patient treated with pembrolizumab to have likely suffered from treatment-related non-functioning graft immune intolerance&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0050" class="elsevierStylePara elsevierViewall">This work has not required funding from any entity&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">Los autores declaran que no tienen conflictos de inter&#233;s&#46;</p></span></span>"
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                    ]
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                        "paginaFinal" => "88"
                        "link" => array:1 [
                          0 => array:2 [
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                          0 => array:2 [
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                    ]
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                ]
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Letter to the Editor
Pembrolizumab in hemodialysis patients. Is it safe?
Pembrolizumab en pacientes en hemodiálisis ¿es seguro?
Melisa Guzmán Vasqueza,
Corresponding author
mel.g.v315@gmail.com

Corresponding author.
, Andrea Patricia Zapata Balcázara, Daniel Germán Gaitán Tocoraa, Concepción Álamo Caballeroa, José Ramón Rodríguez Palomaresa,b, Marta Sánchez Herasa,b, Gabriel de Arriba de La Fuentea,b
a Servicio de Nefrología, Hospital Universitario de Guadalajara, Guadalajara, Spain
b Departamento de Medicina y Especialidades Médicas. Universidad de Alcalá (UAH), Alcalá de Henares, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Patients with chronic kidney disease on dialysis&#44; and particularly those with kidney transplant&#44; have a higher incidence of cancer than the general population&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Chemotherapy for these patients poses special challenges&#44; primarily in relation to adjusting the dose according to renal function&#44; drug interactions and increased side effects&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In recent years&#44; great advances have been achieved in the treatment of various cancers based on immunotherapy&#46; Specifically&#44; <span class="elsevierStyleItalic">check-point</span> inhibitor drugs have been developed which&#44; by negatively inhibiting co-stimulation signals from T lymphocytes&#44; enable them to remain reactive against cancer cells&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> These drugs inhibit the CTLA-4&#44; PD-1 or PD-L1 protein&#44; and many of their side effects are related to the persistent activation of T lymphocytes&#44; thereby leading to a higher incidence of acute tubulointerstitial nephropathy&#44; acute tubular necrosis and minimal change disease&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Pembrolizumab is a monoclonal antibody which selectively binds to PD-1&#44; blocking the negative impact of this receptor on T lymphocyte function&#46; It is indicated in the treatment of a number of different types of cancer&#44; including melanoma&#44; renal carcinoma and lung cancer&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">There is very little experience of such treatment in patients on renal replacement therapy with dialysis or kidney transplantation&#46; We report the case of a patient on haemodialysis with lung cancer who received treatment with pembrolizumab and probably developed immune intolerance of the non-functioning graft&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">This was a 58-year-old male&#44; former smoker&#44; having smoked for 24 years &#40;24 pack years&#41;&#44; diagnosed with IgA mesangial glomerulonephritis&#44; who began haemodialysis for the first time in 1996&#46; He received a cadaveric kidney transplant a few months later&#46; He developed chronic graft nephropathy and returned to haemodialysis in 2000 with subsequent transplantectomy&#46; He received a second cadaveric kidney transplant in 2006&#46; In 2015&#44; he started on a peritoneal dialysis programme as a result of deteriorating kidney function due to global glomerulosclerosis and interstitial fibrosis with tubular atrophy of probable pyelonephritic origin&#44; subsequently being switched to haemodialysis in March 2019 after peritoneal leakage into the right hemithorax with pleural effusion&#46; At that point the patient was anuric&#46; In May 2019&#44; he developed pain in the right superior costal margins&#44; with chest X-ray showing a lytic lesion in the posterior region of the 2nd right costal cartilage&#46; He was diagnosed with stage IV-A undifferentiated clear cell carcinoma of probable pulmonary origin &#40;cT1a N2 M1b&#41;&#44; the molecular study for EGFR&#47;ALK&#47;ROS1 mutations was negative&#44; with PDL-1 expression in 90&#37; of the cells&#46; He was started on treatment with pembrolizumab in July 2019&#46; After 4 weeks of treatment&#44; the patient experienced low-grade fever&#44; graft discomfort and macroscopic haematuria&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Blood tests showed constant elevation of CRP&#44; without leucocytosis&#44; neutrophilia or eosinophilia&#59; from the outset&#44; all cultures&#44; including urine&#44; pleural fluid and blood were negative&#46; Findings of the Doppler ultrasound of the graft were nonspecific&#44; with increased echogenicity of the sinus&#44; thinning of the cortex and pyramid hypertrophy&#44; and persistent intrarenal flow&#46; With suspected immune intolerance of the graft&#44; it was decided to start treatment with low doses of corticosteroids&#44; with some improvement&#44; although the scant haematuria continued&#46; Treatment was continued with 200&#8239;mg of pembrolizumab every 3 weeks &#40;after the last weekly session&#41; and low doses of prednisone&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">There is very little experience in treating haemodialysis patients with immunotherapy&#46; Reported predisposing factors to developing toxicity include the previous use of corticosteroids&#44; being female&#44; previous history of autoimmune disease&#44; and abnormal kidney function&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Although they are well-tolerated drugs&#44; their side effects are related to the activation of T lymphocytes and are relatively common&#44; most notably skin&#44; gastrointestinal&#44; thyroid&#44; pulmonary and renal disorders&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> From the renal point of view&#44; the main complications are acute tubular necrosis&#44; acute tubulointerstitial nephropathy&#44; and some forms of glomerulonephritis&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Nevertheless&#44; these drugs have been used safely in haemodialysis patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">There is also limited experience with these treatments in kidney transplant patients&#46; In fact&#44; there have been reports of some cases in which immunotherapy&#44; by preserving the activation of T lymphocytes&#44; has led to graft rejection and its use is therefore not safe in patients with a functioning transplant&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In our patient&#44; the association of treatment with pembrolizumab and the development of fever&#44; local symptoms and haematuria posed a significant challenge in terms of diagnosis&#46; Furthermore&#44; it was possible that he had developed acute tubulointerstitial nephropathy&#44; and although the blood test showed absence of eosinophilia&#44; we could not exclude this diagnosis&#46; However&#44; we believe it more likely that the patient had developed an immunological intolerance on the non-functioning graft&#44; which until then had been well tolerated&#46; Unfortunately&#44; we were unable to perform a graft biopsy given the patient&#39;s situation and the fact that the lesion would presumably have had severe chronic damage&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The differential diagnosis between the two processes was very important&#44; since in the case of patients with a functioning kidney graft&#44; withdrawal of treatment would be indicated&#44; as well as performing the biopsy for an accurate diagnosis and the taking of decisions accordingly&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> In the case of immunological intolerance to the non-functioning graft&#44; which was the most likely case in our patient&#44; treatment with low doses of corticosteroids is recommended&#44; in order not to inhibit the therapeutic effect of pembrolizumab&#59; in fact&#44; the symptoms in our patient improved&#44; and for the moment it has been possible to continue treatment&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Finally&#44; to the best of our knowledge&#44; we have described the first haemodialysis patient treated with pembrolizumab to have likely suffered from treatment-related non-functioning graft immune intolerance&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0050" class="elsevierStylePara elsevierViewall">This work has not required funding from any entity&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">Los autores declaran que no tienen conflictos de inter&#233;s&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Guzm&#225;n Vasquez M&#44; Zapata Balc&#225;zar AP&#44; Gait&#225;n Tocora DG&#44; &#193;lamo Caballero C&#44; Rodr&#237;guez Palomares JR&#44; S&#225;nchez Heras M&#44; et al&#46; Pembrolizumab en pacientes en hemodi&#225;lisis &#191;es seguro&#63; Nefrologia&#46; 2020&#59;40&#58;678&#8211;679&#46;</p>"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Onco-Nefrolog&#237;a&#58; c&#225;ncer&#44; quimioterapia y ri&#241;&#243;n"
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                  "host" => array:1 [
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                        "fecha" => "2019"
                        "volumen" => "39"
                        "paginaInicial" => "473"
                        "paginaFinal" => "481"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30929891"
                            "web" => "Medline"
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                        ]
                      ]
                    ]
                  ]
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              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of anticancer treatment in patients under chronic dialysis&#58; results of the multicentric CANDY &#40;CANcer and DialYsis&#41; study"
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                        0 => array:2 [
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                            2 => "A&#46; Thyss"
                            3 => "H&#46; Boulanger"
                            4 => "O&#46; Moranne"
                            5 => "M&#46;S&#46; Islam"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/annonc/mds344"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Oncol"
                        "fecha" => "2013"
                        "volumen" => "24"
                        "paginaInicial" => "501"
                        "paginaFinal" => "507"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23038759"
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                      ]
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                ]
              ]
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                        ]
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                    ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.kint.2016.04.008"
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                        "fecha" => "2016"
                        "volumen" => "90"
                        "paginaInicial" => "638"
                        "paginaFinal" => "647"
                        "link" => array:1 [
                          0 => array:2 [
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                ]
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                0 => array:2 [
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                            3 => "T&#46; Baetz"
                            4 => "J&#46;M&#46; Lakoff"
                          ]
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                        "volumen" => "25"
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                        "link" => array:1 [
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                        "tituloSerie" => "Cancer Treat Rev"
                        "fecha" => "2016"
                        "volumen" => "44"
                        "paginaInicial" => "51"
                        "paginaFinal" => "60"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26874776"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
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                            3 => "C&#46; Picard"
                            4 => "C&#46; Mateus"
                            5 => "E&#46; Routier"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ckj/sfy100"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Kidney J"
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                        "volumen" => "12"
                        "paginaInicial" => "81"
                        "paginaFinal" => "88"
                        "link" => array:1 [
                          0 => array:2 [
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              "etiqueta" => "7"
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                0 => array:2 [
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                            4 => "S&#46; Saeki"
                            5 => "K&#46; Nakamura"
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                      ]
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                        "volumen" => "56"
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                        "paginaFinal" => "364"
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Article information
ISSN: 20132514
Original language: English
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