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and also reduces osteoblast activity resulting in decreased bone formation&#46; In addition&#44; acidosis stimulates parathyroid hormone &#40;PTH&#41; secretion&#44; another factor involved in bone resorption&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">6&#8211;9</span></a> Finally&#44; it has been shown that chronic acidosis exerts an antianabolic effect on bone growth by generating resistance to the effect of growth hormone and insulin-like growth factor-1 &#40;IGF-1&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">10&#44;11</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In a retrospective study including 96 adult and paediatric patients with dRTA&#44; bone pain or growth failure was observed in 19&#37; of adults and in 52&#37; of the children&#44; respectively&#46; Osteomalacia&#47;rickets were reported in 9&#46;6&#37; of adult patients and 59&#37; of the children&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">12</span></a> In a cohort of 89 patients with dRTA&#44; 58&#37; of the children presented failure to thrive&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">13</span></a> In patients with acquired dRTA due to Sjogren&#39;s syndrome&#44; approximately a 33&#37; presents osteomalacia and&#47;or pseudo-fractures&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">14&#44;15</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Among patients with dRTA&#44; lower blood pH values were observed in patients with bone abnormalities&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">16</span></a> Thus&#44; correction of acidosis should improve growth defects&#44; prevent bone mass loss and maintain a normal bone histology&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">4&#44;17&#44;18</span></a> Correction of acidosis with alkali therapy is achieved when plasma bicarbonate&#44; urinary calcium and citrate excretion levels are restored to normal values&#46; However&#44; these objectives are not satisfactorily attained with current therapies&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">19&#44;20</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">ADV7103 is formulated as prolonged-release alkalizing microgranules&#44; containing potassium citrate and potassium bicarbonate in a proportion 1&#58;2&#44; which allows providing sustained alkali levels throughout day and night with only twice daily administration&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">21</span></a> It has been shown that administration of ADV7103 to patients with dRTA&#44; increases plasma bicarbonate concentration more effectively than the standard of care treatment &#40;SoC&#41;&#44; as demonstrated by morning pre-dose serum bicarbonate concentrations &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41; &#40;mmol&#47;L&#41; 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the Ethics Committee of the Bratislava Children&#39;s Hospital in Slovakia and the Ethics Committee of the Clinical Centre Nis in Serbia&#41; and national regulatory health authorities &#40;<span class="elsevierStyleItalic">i&#46;e&#46;</span> French National Agency for the Safety of Medicines and Health Products &#40;ANSM&#41;&#44; Slovakia State Institute for Drug Control &#40;SUKL&#41; and Medicines and Medical Devices Agency Serbia &#40;ALIMS&#41;&#44; and conducted in accordance with Good Clinical Practice and the Declaration of Helsinki&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">A total of thirty patients &#40;24 paediatric and 6 adults&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; from 12 different centres in France&#44; Serbia and Slovakia were included&#46; They continued treatment with ADV7103 given twice daily at the optimal doses determined during the phase II&#47;III study &#40;the dose was further adapted if required&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Exclusion criteria were hyperkalaemia &#40;plasma potassium<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>5&#46;0<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#41;&#44; kidney function impairment &#40;eGFR &#60;<span class="elsevierStyleHsp" style=""></span>45<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41;&#44; or any other condition that could be negatively affected by the study medication or that could affect the concomitant treatment with potassium-sparing diuretics&#44; angiotensin-converting enzyme inhibitors&#44; angiotensin II receptor antagonists&#44; or tacrolimus&#46; Written informed consent was obtained from all adult patients&#44; and from the parents or legal guardians of all children&#46; Patients were evaluated at baseline &#40;last visit of the phase II&#47;III trial&#41; and at 3&#44; 6&#44; 12&#44; 18 and 24 months of treatment&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Bone mineral density evaluations</span><p id="par0045" class="elsevierStylePara elsevierViewall">Bone mineral density &#40;BMD&#44; g&#47;cm<span class="elsevierStyleSup">2</span>&#41; was measured at baseline and after the 24-month treatment period in three skeletal regions &#40;spine&#44; hip and whole body&#41; using dual-energy X-ray absorptiometry &#40;DXA&#41;&#46; Measurements for each patient were performed with the DXA tools available at their local hospital&#46; Values of <span class="elsevierStyleItalic">z</span>-score<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>&#8722;2&#46;0 were considered below the normal range&#44; according to the International Society for Clinical Densitometry &#40;ISCD&#41; recommendations&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">24</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Anthropometric evaluations</span><p id="par0050" class="elsevierStylePara elsevierViewall">Height &#40;cm&#41;&#44; weight &#40;kg&#41; and BMI were measured at each study visit and <span class="elsevierStyleItalic">z</span>-scores were determined considering age and sex&#44; according to WHO standards for paediatric patients<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>5 years<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">25</span></a> and from 5 to 19 years old&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">26</span></a> Weight standards for paediatric patients 11&#8211;19 years old were obtained from the data provided by the French Auxology Group&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">27</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Stunting and failure to thrive were considered&#44; for height- and for weight-for-age <span class="elsevierStyleItalic">z</span>-scores<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>&#8722;2&#46;0&#46; We determined the number of patients with an increase of height- or weight-for-age <span class="elsevierStyleItalic">z</span>-scores<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;5 units from baseline to the end of the 24-month treatment&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Growth velocity was calculated as the difference between height measurements performed during two consecutive visits and expressed as cm&#47;6 month&#46;<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">28&#44;29</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Genetic target stature &#40;GTS&#41; was calculated according to the American College of Medical Genetics practice guideline&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">30</span></a> The difference between GTS and actual height was estimated in adult patients at baseline and after 24 months&#59; short stature was considered if the difference was<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>cm in men and &#62;9<span class="elsevierStyleHsp" style=""></span>cm in women&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">31</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Blood and urine parameters</span><p id="par0070" class="elsevierStylePara elsevierViewall">During each study visit&#44; blood samples were obtained&#44; before the first morning dose of ADV7103&#46; Serum bicarbonate&#44; phosphate&#44; calcium&#44; and 25-hydroxy-vitamin D were determined by local laboratories&#46; The serum concentration of bone alkaline phosphatases &#40;bALP&#41;&#44; 1&#44;25-dihydroxy-vitamin D&#44; and parathyroid hormone &#40;PTH&#41; were determined by immunoluminometry by a central laboratory&#46; Normal values for bALP were adjusted to age and sex&#46; Urine samples were also collected in the morning&#44; to calculate the ratios calcium&#47;creatinine &#40;UCa&#47;UCr&#41;&#44; citrate&#47;creatinine &#40;UCi&#47;UCr&#41;&#44; calcium&#47;citrate &#40;UCa&#47;UCi&#41; and phosphate&#47;creatinine &#40;UP&#47;UCr&#41;&#46; These measurements were also performed by local laboratories&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">23</span></a> See supplemental document for all normal values&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Adverse events</span><p id="par0075" class="elsevierStylePara elsevierViewall">The occurrence of adverse events &#40;AEs&#41; was recorded throughout the study&#44; including abnormal values of laboratory data&#44; electrocardiogram &#40;ECG&#41; findings &#40;12-lead resting ECG standard including heart rate&#44; PR&#44; QRS&#44; and QT intervals&#41;&#44; vital signs &#40;blood pressure&#44; heart rate&#44; and respiratory rate&#41;&#44; and physical examinations &#40;articular system&#44; bone system&#44; general appearance&#44; and muscular system&#41;&#59; the severity of the adverse events was recorded&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Adherence to treatment</span><p id="par0080" class="elsevierStylePara elsevierViewall">The adherence to the treatment was assessed in all patients based on the returned empty boxes&#46; This was done at each study visit up to the completion of the 24-month period&#46; Four categories of adherence were considered&#58; excellent &#40;&#62;90&#37;&#41;&#44; good &#40;75-90&#37;&#41;&#44; average &#40;50-74&#37;&#41;&#44; and poor &#40;&#60;50&#37;&#41;&#46; In the absence of returned boxes&#44; the investigators classed the patient in one of the four categories on the basis of interviews and laboratory results&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Other exploratory evaluations</span><p id="par0085" class="elsevierStylePara elsevierViewall">Clinical signs&#44; such as diffuse bone and joint pain&#44; myalgia&#44; muscle weakness&#44; abnormal posture&#44; and abnormal height were registered throughout the follow up&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Statistical analysis</span><p id="par0090" class="elsevierStylePara elsevierViewall">Descriptive statistics were performed to obtain the mean and standard deviation &#40;SD&#41; or median &#40;range&#41;&#44; as well as changes from baseline and 95&#37; confidence intervals&#44; at the different time points in all patients and in groups separated by age&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Comparison of mean values of the parameters evaluated at the different time points and between age groups was performed by non-parametric methods &#40;Kruskal&#8211;Wallis and Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> tests&#41;&#46; Comparison of the densitometric parameters was performed using Student&#39;s <span class="elsevierStyleItalic">t</span>-test&#46; The groups have been considered as random samples to avoid the missing data effect&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Pearson&#39;s correlation coefficient or the Spearman&#39;s Rho coefficient were used to assess the potential correlations between age&#44; growth velocity and other parameters&#44; including densitometry&#44; including data from the evaluations at baseline and at the 24-month visit&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">All the tests were two-sided&#44; considering the differences as statistically significant when <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46; Statistical analyses were performed using IBM SPSS Statistics&#44; version 27&#46;0&#46;0&#46;0&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Results</span><p id="par0110" class="elsevierStylePara elsevierViewall">Information relative to the 30 dRTA patients included in the study is shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; A female adult patient discontinued the study after 12 months for personal reasons&#59; thus 29 completed the 24-month study&#46; At the end of the study a total of 79&#37; of patients presented adherence rates<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>75&#37; after two years of treatment&#46; The mean dose<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD at this time was 2&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;3<span class="elsevierStyleHsp" style=""></span>mEq&#47;kg&#47;day in adults&#44; while it was 2&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;7<span class="elsevierStyleHsp" style=""></span>mEq&#47;kg&#47;day in adolescents&#44; 3&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;3<span class="elsevierStyleHsp" style=""></span>mEq&#47;kg&#47;day in children&#44; and 4&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;0<span class="elsevierStyleHsp" style=""></span>mEq&#47;kg&#47;day in toddlers&#44; with two daily administrations&#44; in the morning and in the evening&#46;</p><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Bone mineral density</span><p id="par0115" class="elsevierStylePara elsevierViewall">Changes in BMD <span class="elsevierStyleItalic">z</span>-scores after 24 months of treatment are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; The overall mean spine <span class="elsevierStyleItalic">z</span>-score significantly increased from -1&#46;1<span class="elsevierStyleHsp" style=""></span>at baseline to &#8722;0&#46;8 at 24 months &#40;Student&#39;s <span class="elsevierStyleItalic">t</span>-test&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;024&#41;&#44; while no significant change was observed in hip and whole-body <span class="elsevierStyleItalic">z</span>-scores&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">Correlations were found when evaluating the relationship between BMD <span class="elsevierStyleItalic">z</span>-scores and blood and urine parameters&#44; including all data available from the evaluations at baseline and at the 24-month visit&#46; In children&#44; whole-body BMD <span class="elsevierStyleItalic">z</span>-scores &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#41; showed a statistically significant direct &#40;positive&#41; correlation with the UCi&#47;UCr ratio &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;745&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;013&#41;&#46; In adolescents&#44; the whole-body densitometry <span class="elsevierStyleItalic">z</span>-scores &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41; showed a statistically significant indirect &#40;negative&#41; correlation with UCa&#47;UCr ratio &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;585&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;046&#41;&#46; In the case of adults &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; spine &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#41; and whole-body &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#41; BMD <span class="elsevierStyleItalic">z</span>-scores&#44; showed statistically significant direct correlation with plasma bicarbonate levels &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;817&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;004 and <span class="elsevierStyleItalic">r</span><span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;971&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#44; respectively&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Growth in paediatric patients and young adults</span><p id="par0125" class="elsevierStylePara elsevierViewall">Between the first and the third month of the study&#44; 5&#47;24 &#40;21&#37;&#41; children presented height velocity values below the 3rd centile and by the end of the study all patients were above the 3rd centile and 18 of them &#40;75&#37;&#41; were above the 25th centile&#46; The mean growth velocity in the overall paediatric population &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41; did not show statistically significant changes throughout the study &#40;ANOVA <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;522&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">At baseline most children presented <span class="elsevierStyleItalic">z</span>-scores within the &#177;2SD range for weight&#44; height and BMI&#46; After completion of 24 months of study&#44; the change in <span class="elsevierStyleItalic">z</span>-score for height was 0&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;5&#59; for weight the change was also 0&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;5 &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46; Among children with available data height and weight-for-age <span class="elsevierStyleItalic">z</span>-scores increased<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;5 units in 4 &#40;18&#37;&#41; and 8 &#40;36&#37;&#41;&#44; respectively&#46; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> shows the evolution of mean height and weight <span class="elsevierStyleItalic">z</span>-scores throughout the study&#46; Particularly interesting was the positive evolution of growth of a girl &#40;4&#46;5 years old at study entry&#41;&#44; who presented stunting and failure to thrive &#40;<span class="elsevierStyleItalic">z</span>-scores<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#8722;2&#41; at baseline&#46; Her height and weight-to-age <span class="elsevierStyleItalic">z</span>-scores were both<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>&#8722;2 by the end of the study &#40;they increased by 1&#46;8 and 0&#46;8 units&#44; respectively&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">Considering the 5 adults with available data &#40;19&#8211;21 years old&#41; mean height increased by 1&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;8<span class="elsevierStyleHsp" style=""></span>cm after the 2 years of treatment &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46; While at baseline their mean height was 0&#46;9<span class="elsevierStyleHsp" style=""></span>cm below the GTS&#44; they caught up and exceeded GTS by 1&#46;1<span class="elsevierStyleHsp" style=""></span>cm at the end of the treatment&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Metabolic control</span><p id="par0140" class="elsevierStylePara elsevierViewall">After the phase II&#47;III the serum bicarbonate was normal in 63&#37; of patients and it remained normal in most patients &#40;69 to 86&#37;&#41; throughout the 24 months of treatment&#46; At 24 months&#44; overall mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD plasma bicarbonate levels were 22&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;9<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#46; Clinically significant metabolic acidosis was reported in one adult patient presenting bicarbonate levels of 19&#46;0<span class="elsevierStyleHsp" style=""></span>mmol&#47;L at the two last visits&#46; With the exception of two cases of occasional hypercalciuria&#44; the UCa&#47;UCr ratios were normal throughout the study&#44; while 9 to 17 patients presented low UCi&#47;UCr levels at the different visits&#46; Approximately half of the patients presented UCa&#47;UCi excretion ratios below the threshold considered for an increased risk of lithogenesis throughout the study&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">PTH and bALP levels</span><p id="par0145" class="elsevierStylePara elsevierViewall">PTH and bALP plasma levels were available in 15 patients at baseline and in 24 at the end of the study&#46; Mean &#40;95&#37; CI&#41; PTH was 15&#46;6 &#40;11&#46;1&#44; 20&#46;2&#41; ng&#47;L at baseline and 22&#46;6 &#40;17&#46;4&#44; 27&#46;8&#41; ng&#47;L after 24 months of treatment&#46; There were no significant changes in PTH throughout the study &#40;Kruskal&#8211;Wallis <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;267&#41;&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Mean &#40;95&#37; CI&#41; bALP was 57&#46;5 &#40;41&#46;4&#44; 73&#46;6&#41; &#956;g&#47;L at baseline and 53&#46;5 &#40;40&#46;0&#44; 67&#46;0&#41; &#956;g&#47;L after 24 months of treatment without significant modifications observed throughout the study &#40;Kruskal-Wallis <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;786&#41;&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Vitamin D levels</span><p id="par0155" class="elsevierStylePara elsevierViewall">No significant changes in 25-hydroxyvitamin D and 1&#46;25-dihydroxyvitamin D were observed throughout the study &#40;Kruskal&#8211;Wallis <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;349 and 0&#46;131&#44; respectively&#41;&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD 25-hydroxyvitamin D was 51&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>33&#46;7<span class="elsevierStyleHsp" style=""></span>nmol&#47;L at baseline &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#41; and 58&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#46;8<span class="elsevierStyleHsp" style=""></span>nmol&#47;L at the 24-month visit &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>21&#41;&#46; The mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD serum level of 1&#44;25-dihydroxyvitamin D was 153<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>48<span class="elsevierStyleHsp" style=""></span>pmol&#47;L at baseline &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41; and 135<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>pmol&#47;L at the end of the study &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&#41;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Blood levels of 25-hydroxyvitamin D and 1&#44;25-dihydroxyvitamin D were normal in 60&#37; and 80&#37; of the patients at baseline and in 43&#37; and 100&#37; of the patients after 24 months&#44; respectively&#46; Clinically significant low levels of 25-hydroxyvitamin D were measured at different time points in six paediatric patients&#46; Occasional vitamin D supplementation was given to 60&#37; of patients&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Safety and tolerability</span><p id="par0170" class="elsevierStylePara elsevierViewall">A total of 104 adverse events in 27 patients were reported&#44; among which only 9 in 5 patients were confirmed treatment related&#58; three cases of diarrhoea affecting one patient&#44; two cases of abdominal pain in two children and single events of dyspepsia&#44; upper abdominal pain&#44; gastrointestinal disorder and gastrointestinal pain&#46; They were all of mild or moderate severity and no discontinuation of treatment was needed&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">22</span></a></p></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Discussion</span><p id="par0175" class="elsevierStylePara elsevierViewall">Among the long-term effects of dRTA in children are failure to thrive&#44; stunted growth&#44; osteopenia and rickets<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">4&#44;32</span></a>&#59; osteopenia and osteomalacia are observed mainly in adults&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">5</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">In these patients&#44; alkaline therapy is believed to increase bone mass through the restoration of bone mineral balance and the improvement of osteoblast function&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">33</span></a> In general&#44; the prognosis of dRTA is favourable in most patients on alkali therapy&#46; Treatment has been shown to improve radiological abnormalities of rickets&#44;<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">32&#44;34</span></a> increase growth&#44;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">4&#44;17&#44;35&#44;36</span></a> and improve bone structure and bone metabolism&#46;<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">33&#44;37</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">Adherence to treatment is shown to be key to correct bone abnormalities&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">38</span></a> Reduced growth rates in dRTA children have been associated with sporadic parental noncompliance in administering alkali therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">4</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">Additionally&#44; current treatments are not effective in all cases&#46; In a UK cohort of 24 patients with inherited dRTA&#44; growth retardation &#40;height-for-age <span class="elsevierStyleItalic">z</span>-score<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#8722;2&#41; was found in 10 patients at presentation &#40;42&#37;&#41; and persisted in 3 &#40;13&#37;&#41; once treated&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">39</span></a> Similarly&#44; in a cohort of 31 dRTA patients with a median follow up of 77 months&#44; severe growth retardation at the time of diagnosis was observed in 14 &#40;45&#37;&#41; patients and at their last visit catchup growth was not achieved in six &#40;19&#37;&#41; of them&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">19</span></a> As illustrated by observations in recent cohorts of paediatric patients&#44; significantly improved height-for-age <span class="elsevierStyleItalic">z</span>-scores are obtained with adequate metabolic control&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">19&#44;20</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">As our cohort was previously treated with alkali therapy &#40;in most cases potassium citrate&#44; sodium bicarbonate or a combination of both&#41;&#44; most patients were already within the<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2SDs range for height and weight before starting ADV7103&#46; However&#44; a positive effect of ADV7103 treatment on the height and weight of patients who were below that range at baseline was shown&#46; Additionally&#44; several paediatric patients presenting growth <span class="elsevierStyleItalic">z</span>-scores within the<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2SDs range&#44; but most frequently<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44; benefited from increases<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;5 units in their <span class="elsevierStyleItalic">z</span>-scores&#46; In young adults&#44; mean GTS was exceeded&#44; showing a potential benefit on growth also in this population&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Similarly&#44; BMD scores were normal in most patients throughout the study but a significant improvement in mean spine <span class="elsevierStyleItalic">z</span>-scores of the cohort was observed&#46; Additionally&#44; there was a positive correlation between adequate control of metabolic acidosis and bone parameters in some age groups&#44; although this was difficult to observe with our product because most parameters were near or within the normal range&#44; and information describing the effect of acidosis was scarce&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Despite treatment&#44; low citrate&#47;creatinine urine ratios were observed in one third of the patients or more at the different visits&#46; A potential remaining intracellular acidosis could suggest that alkali amounts for these patients should be increased for an optimal adaptation to their needs as they grow&#46; In children there was a positive correlation between citrate&#47;creatinine ratio in urine and whole-body densitometry&#44; suggesting that normal citraturia&#44; an indicator of good metabolic control&#44; is linked to a higher body BMD&#46; In adolescents&#44; there was a negative correlation between calciuria and body densitometry&#44; indicating that patients losing more calcium in urine are those with worst body densitometry&#44; as expected&#46; In adults&#44; there was a strong positive correlation between both spine and whole-body densitometry and plasma bicarbonate levels&#44; again substantiating that adequate metabolic control in patients with dRTA has a positive impact on BMD&#46; These results corroborate those published in a cohort of 10 naive adult patients with dRTA showing increased plasma bicarbonate levels and BMD after treatment with potassium citrate for one year&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">18</span></a> As demonstrated&#44; there is an improvement of BMD in patients with dRTA that had been previously treated with other alkalizing agents&#46; Although we have reported an increase in spine BMD <span class="elsevierStyleItalic">z</span>-score&#44; which can be explained by a sustained metabolic control of plasma bicarbonate levels achieved with ADV7103&#44; a final conclusion with the highest level of evidence cannot be provided due to the absence of a control arm&#46; However&#44; it is remarkable that such an improvement is achieved in patients that were considered adequately treated before switching to ADV7103&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">In conclusion&#44; ADV7103 was well tolerated and provided a sustained control of metabolic acidosis in patients with dRTA&#44; which could explain the improvement of growth and spine BMD after 2 years of treatment&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Authors&#8217; contributions</span><p id="par0215" class="elsevierStylePara elsevierViewall">Aur&#233;lia Bertholet-Thomas has been involved in Investigation and Writing &#8211; review &#38; editing&#46; Maria A&#46; Manso-Silv&#225;n has been involved in Writing &#8211; original draft Writing &#8211; review &#38; editing&#46; Victor Navas-Serrano has been involved in Writing &#8211; original draft Writing &#8211; review &#38; editing&#46; Catherine Guittet&#44; has been involved in Conceptualization Methodology Writing &#8211; review &#38; editing&#46; Sophie Joukoff&#44; has been involved in Project administration Supervision Writing &#8211; review &#38; editing&#46; Justine Bacchetta has been involved in Writing &#8211; review &#38; editing&#46; Olivia Boyer has been involved in Investigation and Writing &#8211; review &#38; editing&#46; Mariano Rodriguez has been involved in Conceptualization Writing &#8211; original draft Writing &#8211; review &#38; editing&#46; Luc-Andr&#233; Granier has been involved in Conceptualization Methodology Writing &#8211; review &#38; editing&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Ethics approval</span><p id="par0220" class="elsevierStylePara elsevierViewall">This study was approved by regional independent ethics committees and national regulatory health authorities&#44; and conducted in accordance with Good Clinical Practice and the Declaration of Helsinki&#46;</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Consent to participate</span><p id="par0225" class="elsevierStylePara elsevierViewall">Written consent was obtained from all adult patients&#44; and from the parents or legal guardians of all children&#46; When possible&#44; the assent from paediatric patients themselves was also obtained&#46;</p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Consent for publication</span><p id="par0230" class="elsevierStylePara elsevierViewall">Not applicable&#46;</p></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Funding</span><p id="par0235" class="elsevierStylePara elsevierViewall">This study was funded by <span class="elsevierStyleGrantSponsor" id="gs1">Advicenne</span>&#46;</p></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Conflicts of interest</span><p id="par0240" class="elsevierStylePara elsevierViewall">A&#46; Bertholet perceived support from Advicenne for traveling to meetings and&#47;or funding for lectures&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">C&#46; Guittet&#44; M&#46;A&#46; Manso-Silv&#225;n and L&#46;A&#46; Granier are employees of Advicenne and hold stock options or shares in the company&#46; S&#46; Joukoff and V&#46; Navas-Serrano are also employees of Advicenne&#46;</p></span></span>"
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              "titulo" => "Anthropometric evaluations"
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              "titulo" => "Blood and urine parameters"
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              "titulo" => "Growth in paediatric patients and young adults"
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              "identificador" => "sec0070"
              "titulo" => "Metabolic control"
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              "identificador" => "sec0075"
              "titulo" => "PTH and bALP levels"
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              "identificador" => "sec0080"
              "titulo" => "Vitamin D levels"
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    "fechaRecibido" => "2021-09-09"
    "fechaAceptado" => "2022-02-27"
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          "clase" => "keyword"
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            0 => "dRTA"
            1 => "Plasma bicarbonate"
            2 => "Calciuria"
            3 => "Citraturia"
            4 => "Growth"
            5 => "Bone mineral density"
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            0 => "ATRd"
            1 => "Bicarbonato plasm&#225;tico"
            2 => "Calciuria"
            3 => "Citraturia"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">ADV7103 is a new prolonged-release treatment for distal renal tubular acidosis &#40;dRTA&#41;&#44; containing potassium citrate and potassium bicarbonate&#46; Since acidosis may affect bone mineral contents&#44; the effects of ADV7103 on bone mineral density &#40;BMD&#41; and growth in patients with dRTA over 24 months were evaluated&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Thirty patients &#40;24 paediatric patients and 6 adults&#41; were included in an open-label extension study after a phase II&#47;III trial&#46; BMD&#44; measured by densitometry&#44; was assessed at baseline and at 24 months&#46; Growth was evaluated throughout the study&#46; Plasma bicarbonate&#44; parathyroid hormone&#44; 25-hydroxy vitamin D&#44; 1&#44;25-dihydroxy vitamin D&#44; bone alkaline phosphatase&#44; calciuria and citraturia&#44; were also determined&#46; Safety and treatment compliance were evaluated as well&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">After 24 months of treatment with ADV7103&#44; mean spine BMD <span class="elsevierStyleItalic">z</span>-score values significantly increased as compared with baseline &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;024&#41;&#46; In adults&#44; spine and whole-body densitometry <span class="elsevierStyleItalic">z</span>-scores showed a significant correlation with plasma bicarbonate levels &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;82 and <span class="elsevierStyleItalic">r</span><span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;97&#44; respectively&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#41;&#46; There was an increase<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;5 units in <span class="elsevierStyleItalic">z</span>-scores for height and weight in 18&#37; and 36&#37; of the paediatric patients&#44; respectively&#46; With treatment&#44; plasma bicarbonate concentration and calciuria at the different visits were normal in 69&#8211;86&#37; and 93&#8211;96&#37; patients&#44; respectively&#46; Only nine treatment-related gastrointestinal AEs of mild&#47;moderate severity&#44; were reported in five patients&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Two years of ADV7103 treatment improved growth and increased spine BMD&#46; These results suggest that control of acidosis by ADV7103 treatment improves bone parameters&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background and objectives"
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          1 => array:2 [
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            "titulo" => "Patients and methods"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El ADV7103 es un nuevo tratamiento de liberaci&#243;n prolongada para la acidosis tubular renal distal &#40;ATRd&#41;&#44; que contiene citrato pot&#225;sico y bicarbonato pot&#225;sico&#46; Dado que la acidosis puede afectar al contenido mineral &#243;seo&#44; se ha evaluado el efecto de dicho medicamento a lo largo de 24 meses sobre la densidad mineral &#243;sea &#40;DMO&#41; y el crecimiento en pacientes con ATRd&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron treinta pacientes &#40;24 pedi&#225;tricos y seis adultos&#41; en un estudio abierto de extensi&#243;n tras un ensayo cl&#237;nico de fase II&#47;III&#46; La DMO medida por densitometr&#237;a se midi&#243; al inicio del estudio y los 24 meses&#46; El crecimiento se evalu&#243; a lo largo del estudio&#46; Adicionalmente&#44; se determinaron el bicarbonato plasm&#225;tico&#44; la parathormona&#44; 25 hidroxivitamina D&#44; 1&#44;25 dihidroxivitamina D&#44; fosfatasa alcalina &#243;sea&#44; calciuria y citraturia&#46; La seguridad y el cumplimento terap&#233;utico tambi&#233;n fueron evaluados&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Tras 24 meses de tratamiento con ADV7103 la media del z-<span class="elsevierStyleItalic">score</span> de DMO de columna aument&#243; significativamente frente al valor basal &#40;p &#61; 0&#44;024&#41;&#46; En los adultos el z-<span class="elsevierStyleItalic">score</span> de la densitometr&#237;a de columna y corporal total mostr&#243; una correlaci&#243;n significativa con los valores de bicarbonato plasm&#225;tico &#40;r<span class="elsevierStyleInf">S</span> &#61; 0&#44;82 y r<span class="elsevierStyleInf">S</span> &#61; 0&#44;97&#44; respectivamente&#44; p &#60; 0&#44;005&#41;&#46; Se registr&#243; un incremento &#62; 0&#44;5 unidades de z-<span class="elsevierStyleItalic">score</span> para altura y peso en el 18 y 36&#37;&#44; respectivamente&#44; de los pacientes pedi&#225;tricos&#46; Con el tratamiento&#44; la concentraci&#243;n plasm&#225;tica de bicarbonato y la calciuria fueron normales en las diferentes visitas en un 69-86&#37; y un 93-96&#37; de los pacientes&#44; respectivamente&#46; Solamente se notificaron nueve eventos adversos gastrointestinales relacionados con el tratamiento&#44; todos de intensidad leve&#47;moderada en cinco pacientes&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Dos a&#241;os de tratamiento con ADV7103 mejoraron el crecimiento y la DMO de columna&#46; Estos resultados sugieren que el control de la acidosis con dicho tratamiento provoca una mejora de par&#225;metros &#243;seos&#46;</p></span>"
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            "etiqueta" => "Appendix A"
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                  \t\t\t\t" scope="col">Adults&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col">Infants and toddlers&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">Overall&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#40;&#8805;18 Y&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#40;12&#8211;17 Y&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#40;4&#8211;11 Y&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#40;6M&#8211;3Y&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;54&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t">0&#46;3<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Baseline&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">127&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">139&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Change&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3478793.png"
              ]
            ]
            1 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col"><span class="elsevierStyleItalic">z</span>-Scores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Height-for-age <span class="elsevierStyleItalic">z</span>-score</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Weight-for-age <span class="elsevierStyleItalic">z</span>-score</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">BMI-for-age <span class="elsevierStyleItalic">z</span>-score</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Baseline&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Change&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#46;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#8722;0&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Adults&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="3" align="center" valign="\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">159&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">163&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Change&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#8722;1&#46;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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Original article
Bone mineral density and growth changes in patients with distal renal tubular acidosis after two-years treatment with a new alkalizing drug (ADV7103)
Cambios en la densidad mineral ósea y en el crecimiento en pacientes con acidosis tubular renal distal tras dos años de tratamiento con un nuevo fármaco alcalinizante (ADV7103)
Aurélia Bertholet-Thomasa, Maria A. Manso-Silvánb, Victor Navas-Serranob,
Corresponding author
vnavas2007@hotmail.com

Corresponding author.
, Catherine Guittetb, Sophie Joukoffb, Justine Bacchettaa, Olivia Boyerc, Mariano Rodriguez Portillod, Luc-André Granierb
a Centre de Référence des Maladies Rénales Rares – Néphrogones – Hôpital Femme Mère Enfant, Hospices Civils de Lyon – Filière ORKiD, Bron, France
b Advicenne, Nîmes, France
c Service de Néphrologie Pédiatrique, Centre de Référence des Maladies Rénales Héréditaires de l’Enfant et de l’Adulte (MARHEA), Institut Imagine, Hôpital Necker-Enfants Malades, Université de Paris, France
d Servicio de Nefrología, Hospital Universitario Reina Sofía, IMIBIC-UCO, Córdoba, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Distal renal tubular acidosis &#40;dRTA&#41; is a rare disease characterized by an impaired net acid excretion at the distal tubule causing hyperchloremic metabolic acidosis&#46; It is often associated with hypokalaemia&#44; due to renal potassium wasting&#46; Additionally&#44; hypercalciuria occurs as excess of calcium is released from bone in an attempt to compensate metabolic acidosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">1&#44;2</span></a> Low intracellular pH also affects calcium channel TRPV5 function&#44; causing a reduction of calcium reabsorption in the distal tubule&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">3</span></a> Sustained metabolic acidosis impairs growth in children and causes a reduction in bone mass&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">4&#44;5</span></a> Prolonged acidosis directly stimulates osteoclasts activity which increases bone resorption&#44; and also reduces osteoblast activity resulting in decreased bone formation&#46; In addition&#44; acidosis stimulates parathyroid hormone &#40;PTH&#41; secretion&#44; another factor involved in bone resorption&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">6&#8211;9</span></a> Finally&#44; it has been shown that chronic acidosis exerts an antianabolic effect on bone growth by generating resistance to the effect of growth hormone and insulin-like growth factor-1 &#40;IGF-1&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">10&#44;11</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In a retrospective study including 96 adult and paediatric patients with dRTA&#44; bone pain or growth failure was observed in 19&#37; of adults and in 52&#37; of the children&#44; respectively&#46; Osteomalacia&#47;rickets were reported in 9&#46;6&#37; of adult patients and 59&#37; of the children&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">12</span></a> In a cohort of 89 patients with dRTA&#44; 58&#37; of the children presented failure to thrive&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">13</span></a> In patients with acquired dRTA due to Sjogren&#39;s syndrome&#44; approximately a 33&#37; presents osteomalacia and&#47;or pseudo-fractures&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">14&#44;15</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Among patients with dRTA&#44; lower blood pH values were observed in patients with bone abnormalities&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">16</span></a> Thus&#44; correction of acidosis should improve growth defects&#44; prevent bone mass loss and maintain a normal bone histology&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">4&#44;17&#44;18</span></a> Correction of acidosis with alkali therapy is achieved when plasma bicarbonate&#44; urinary calcium and citrate excretion levels are restored to normal values&#46; However&#44; these objectives are not satisfactorily attained with current therapies&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">19&#44;20</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">ADV7103 is formulated as prolonged-release alkalizing microgranules&#44; containing potassium citrate and potassium bicarbonate in a proportion 1&#58;2&#44; which allows providing sustained alkali levels throughout day and night with only twice daily administration&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">21</span></a> It has been shown that administration of ADV7103 to patients with dRTA&#44; increases plasma bicarbonate concentration more effectively than the standard of care treatment &#40;SoC&#41;&#44; as demonstrated by morning pre-dose serum bicarbonate concentrations &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41; &#40;mmol&#47;L&#41; of 21&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;1 and 23&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;6 after treatment with SoC and ADV7103&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">22</span></a> This effect was maintained in most patients during at least 24 months of treatment when they were treated with ADV7103&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">23</span></a> Other oral alkalizing products&#44; such as oral bicarbonate salts are not sustained-release forms&#44; require several administrations during the day and are not as well tolerated as ADV7103&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">23</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Thus&#44; our hypothesis was that treatment with ADV7103 would produce significant improvement in bone in dRTA patients&#46; The objective of the present study was to evaluate the bone effects of 2-year treatment with ADV7103&#44; assessing bone mineral density &#40;BMD&#41; variations from baseline&#44; and measuring growth changes&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patients and study design</span><p id="par0030" class="elsevierStylePara elsevierViewall">Patients with dRTA that completed a previous phase II&#47;III study<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">22</span></a> with ADV7103 were included in a 2-year extension study&#46; It was a multicenter&#44; single-arm&#44; open-label trial &#40;EudraCT 2013-003828-36&#44; registered in September 2013&#41;&#44; aiming to assess efficacy&#44; safety&#44; and tolerability&#44; of treatment with ADV7103 in paediatric and adult patients&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">23</span></a> The study was approved by regional independent ethics committees &#40;<span class="elsevierStyleItalic">i&#46;e&#46;</span> the Ethics Committee CPP Sud Est II in France&#44; the Ethics Committee of the Bratislava Children&#39;s Hospital in Slovakia and the Ethics Committee of the Clinical Centre Nis in Serbia&#41; and national regulatory health authorities &#40;<span class="elsevierStyleItalic">i&#46;e&#46;</span> French National Agency for the Safety of Medicines and Health Products &#40;ANSM&#41;&#44; Slovakia State Institute for Drug Control &#40;SUKL&#41; and Medicines and Medical Devices Agency Serbia &#40;ALIMS&#41;&#44; and conducted in accordance with Good Clinical Practice and the Declaration of Helsinki&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">A total of thirty patients &#40;24 paediatric and 6 adults&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; from 12 different centres in France&#44; Serbia and Slovakia were included&#46; They continued treatment with ADV7103 given twice daily at the optimal doses determined during the phase II&#47;III study &#40;the dose was further adapted if required&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Exclusion criteria were hyperkalaemia &#40;plasma potassium<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>5&#46;0<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#41;&#44; kidney function impairment &#40;eGFR &#60;<span class="elsevierStyleHsp" style=""></span>45<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41;&#44; or any other condition that could be negatively affected by the study medication or that could affect the concomitant treatment with potassium-sparing diuretics&#44; angiotensin-converting enzyme inhibitors&#44; angiotensin II receptor antagonists&#44; or tacrolimus&#46; Written informed consent was obtained from all adult patients&#44; and from the parents or legal guardians of all children&#46; Patients were evaluated at baseline &#40;last visit of the phase II&#47;III trial&#41; and at 3&#44; 6&#44; 12&#44; 18 and 24 months of treatment&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Bone mineral density evaluations</span><p id="par0045" class="elsevierStylePara elsevierViewall">Bone mineral density &#40;BMD&#44; g&#47;cm<span class="elsevierStyleSup">2</span>&#41; was measured at baseline and after the 24-month treatment period in three skeletal regions &#40;spine&#44; hip and whole body&#41; using dual-energy X-ray absorptiometry &#40;DXA&#41;&#46; Measurements for each patient were performed with the DXA tools available at their local hospital&#46; Values of <span class="elsevierStyleItalic">z</span>-score<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>&#8722;2&#46;0 were considered below the normal range&#44; according to the International Society for Clinical Densitometry &#40;ISCD&#41; recommendations&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">24</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Anthropometric evaluations</span><p id="par0050" class="elsevierStylePara elsevierViewall">Height &#40;cm&#41;&#44; weight &#40;kg&#41; and BMI were measured at each study visit and <span class="elsevierStyleItalic">z</span>-scores were determined considering age and sex&#44; according to WHO standards for paediatric patients<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>5 years<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">25</span></a> and from 5 to 19 years old&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">26</span></a> Weight standards for paediatric patients 11&#8211;19 years old were obtained from the data provided by the French Auxology Group&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">27</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Stunting and failure to thrive were considered&#44; for height- and for weight-for-age <span class="elsevierStyleItalic">z</span>-scores<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>&#8722;2&#46;0&#46; We determined the number of patients with an increase of height- or weight-for-age <span class="elsevierStyleItalic">z</span>-scores<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;5 units from baseline to the end of the 24-month treatment&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Growth velocity was calculated as the difference between height measurements performed during two consecutive visits and expressed as cm&#47;6 month&#46;<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">28&#44;29</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Genetic target stature &#40;GTS&#41; was calculated according to the American College of Medical Genetics practice guideline&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">30</span></a> The difference between GTS and actual height was estimated in adult patients at baseline and after 24 months&#59; short stature was considered if the difference was<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>cm in men and &#62;9<span class="elsevierStyleHsp" style=""></span>cm in women&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">31</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Blood and urine parameters</span><p id="par0070" class="elsevierStylePara elsevierViewall">During each study visit&#44; blood samples were obtained&#44; before the first morning dose of ADV7103&#46; Serum bicarbonate&#44; phosphate&#44; calcium&#44; and 25-hydroxy-vitamin D were determined by local laboratories&#46; The serum concentration of bone alkaline phosphatases &#40;bALP&#41;&#44; 1&#44;25-dihydroxy-vitamin D&#44; and parathyroid hormone &#40;PTH&#41; were determined by immunoluminometry by a central laboratory&#46; Normal values for bALP were adjusted to age and sex&#46; Urine samples were also collected in the morning&#44; to calculate the ratios calcium&#47;creatinine &#40;UCa&#47;UCr&#41;&#44; citrate&#47;creatinine &#40;UCi&#47;UCr&#41;&#44; calcium&#47;citrate &#40;UCa&#47;UCi&#41; and phosphate&#47;creatinine &#40;UP&#47;UCr&#41;&#46; These measurements were also performed by local laboratories&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">23</span></a> See supplemental document for all normal values&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Adverse events</span><p id="par0075" class="elsevierStylePara elsevierViewall">The occurrence of adverse events &#40;AEs&#41; was recorded throughout the study&#44; including abnormal values of laboratory data&#44; electrocardiogram &#40;ECG&#41; findings &#40;12-lead resting ECG standard including heart rate&#44; PR&#44; QRS&#44; and QT intervals&#41;&#44; vital signs &#40;blood pressure&#44; heart rate&#44; and respiratory rate&#41;&#44; and physical examinations &#40;articular system&#44; bone system&#44; general appearance&#44; and muscular system&#41;&#59; the severity of the adverse events was recorded&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Adherence to treatment</span><p id="par0080" class="elsevierStylePara elsevierViewall">The adherence to the treatment was assessed in all patients based on the returned empty boxes&#46; This was done at each study visit up to the completion of the 24-month period&#46; Four categories of adherence were considered&#58; excellent &#40;&#62;90&#37;&#41;&#44; good &#40;75-90&#37;&#41;&#44; average &#40;50-74&#37;&#41;&#44; and poor &#40;&#60;50&#37;&#41;&#46; In the absence of returned boxes&#44; the investigators classed the patient in one of the four categories on the basis of interviews and laboratory results&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Other exploratory evaluations</span><p id="par0085" class="elsevierStylePara elsevierViewall">Clinical signs&#44; such as diffuse bone and joint pain&#44; myalgia&#44; muscle weakness&#44; abnormal posture&#44; and abnormal height were registered throughout the follow up&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Statistical analysis</span><p id="par0090" class="elsevierStylePara elsevierViewall">Descriptive statistics were performed to obtain the mean and standard deviation &#40;SD&#41; or median &#40;range&#41;&#44; as well as changes from baseline and 95&#37; confidence intervals&#44; at the different time points in all patients and in groups separated by age&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Comparison of mean values of the parameters evaluated at the different time points and between age groups was performed by non-parametric methods &#40;Kruskal&#8211;Wallis and Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> tests&#41;&#46; Comparison of the densitometric parameters was performed using Student&#39;s <span class="elsevierStyleItalic">t</span>-test&#46; The groups have been considered as random samples to avoid the missing data effect&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Pearson&#39;s correlation coefficient or the Spearman&#39;s Rho coefficient were used to assess the potential correlations between age&#44; growth velocity and other parameters&#44; including densitometry&#44; including data from the evaluations at baseline and at the 24-month visit&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">All the tests were two-sided&#44; considering the differences as statistically significant when <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46; Statistical analyses were performed using IBM SPSS Statistics&#44; version 27&#46;0&#46;0&#46;0&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Results</span><p id="par0110" class="elsevierStylePara elsevierViewall">Information relative to the 30 dRTA patients included in the study is shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; A female adult patient discontinued the study after 12 months for personal reasons&#59; thus 29 completed the 24-month study&#46; At the end of the study a total of 79&#37; of patients presented adherence rates<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>75&#37; after two years of treatment&#46; The mean dose<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD at this time was 2&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;3<span class="elsevierStyleHsp" style=""></span>mEq&#47;kg&#47;day in adults&#44; while it was 2&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;7<span class="elsevierStyleHsp" style=""></span>mEq&#47;kg&#47;day in adolescents&#44; 3&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;3<span class="elsevierStyleHsp" style=""></span>mEq&#47;kg&#47;day in children&#44; and 4&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;0<span class="elsevierStyleHsp" style=""></span>mEq&#47;kg&#47;day in toddlers&#44; with two daily administrations&#44; in the morning and in the evening&#46;</p><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Bone mineral density</span><p id="par0115" class="elsevierStylePara elsevierViewall">Changes in BMD <span class="elsevierStyleItalic">z</span>-scores after 24 months of treatment are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; The overall mean spine <span class="elsevierStyleItalic">z</span>-score significantly increased from -1&#46;1<span class="elsevierStyleHsp" style=""></span>at baseline to &#8722;0&#46;8 at 24 months &#40;Student&#39;s <span class="elsevierStyleItalic">t</span>-test&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;024&#41;&#44; while no significant change was observed in hip and whole-body <span class="elsevierStyleItalic">z</span>-scores&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">Correlations were found when evaluating the relationship between BMD <span class="elsevierStyleItalic">z</span>-scores and blood and urine parameters&#44; including all data available from the evaluations at baseline and at the 24-month visit&#46; In children&#44; whole-body BMD <span class="elsevierStyleItalic">z</span>-scores &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#41; showed a statistically significant direct &#40;positive&#41; correlation with the UCi&#47;UCr ratio &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;745&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;013&#41;&#46; In adolescents&#44; the whole-body densitometry <span class="elsevierStyleItalic">z</span>-scores &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41; showed a statistically significant indirect &#40;negative&#41; correlation with UCa&#47;UCr ratio &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;585&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;046&#41;&#46; In the case of adults &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; spine &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#41; and whole-body &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#41; BMD <span class="elsevierStyleItalic">z</span>-scores&#44; showed statistically significant direct correlation with plasma bicarbonate levels &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;817&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;004 and <span class="elsevierStyleItalic">r</span><span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;971&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#44; respectively&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Growth in paediatric patients and young adults</span><p id="par0125" class="elsevierStylePara elsevierViewall">Between the first and the third month of the study&#44; 5&#47;24 &#40;21&#37;&#41; children presented height velocity values below the 3rd centile and by the end of the study all patients were above the 3rd centile and 18 of them &#40;75&#37;&#41; were above the 25th centile&#46; The mean growth velocity in the overall paediatric population &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41; did not show statistically significant changes throughout the study &#40;ANOVA <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;522&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">At baseline most children presented <span class="elsevierStyleItalic">z</span>-scores within the &#177;2SD range for weight&#44; height and BMI&#46; After completion of 24 months of study&#44; the change in <span class="elsevierStyleItalic">z</span>-score for height was 0&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;5&#59; for weight the change was also 0&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;5 &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46; Among children with available data height and weight-for-age <span class="elsevierStyleItalic">z</span>-scores increased<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;5 units in 4 &#40;18&#37;&#41; and 8 &#40;36&#37;&#41;&#44; respectively&#46; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> shows the evolution of mean height and weight <span class="elsevierStyleItalic">z</span>-scores throughout the study&#46; Particularly interesting was the positive evolution of growth of a girl &#40;4&#46;5 years old at study entry&#41;&#44; who presented stunting and failure to thrive &#40;<span class="elsevierStyleItalic">z</span>-scores<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#8722;2&#41; at baseline&#46; Her height and weight-to-age <span class="elsevierStyleItalic">z</span>-scores were both<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>&#8722;2 by the end of the study &#40;they increased by 1&#46;8 and 0&#46;8 units&#44; respectively&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">Considering the 5 adults with available data &#40;19&#8211;21 years old&#41; mean height increased by 1&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;8<span class="elsevierStyleHsp" style=""></span>cm after the 2 years of treatment &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46; While at baseline their mean height was 0&#46;9<span class="elsevierStyleHsp" style=""></span>cm below the GTS&#44; they caught up and exceeded GTS by 1&#46;1<span class="elsevierStyleHsp" style=""></span>cm at the end of the treatment&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Metabolic control</span><p id="par0140" class="elsevierStylePara elsevierViewall">After the phase II&#47;III the serum bicarbonate was normal in 63&#37; of patients and it remained normal in most patients &#40;69 to 86&#37;&#41; throughout the 24 months of treatment&#46; At 24 months&#44; overall mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD plasma bicarbonate levels were 22&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;9<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#46; Clinically significant metabolic acidosis was reported in one adult patient presenting bicarbonate levels of 19&#46;0<span class="elsevierStyleHsp" style=""></span>mmol&#47;L at the two last visits&#46; With the exception of two cases of occasional hypercalciuria&#44; the UCa&#47;UCr ratios were normal throughout the study&#44; while 9 to 17 patients presented low UCi&#47;UCr levels at the different visits&#46; Approximately half of the patients presented UCa&#47;UCi excretion ratios below the threshold considered for an increased risk of lithogenesis throughout the study&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">PTH and bALP levels</span><p id="par0145" class="elsevierStylePara elsevierViewall">PTH and bALP plasma levels were available in 15 patients at baseline and in 24 at the end of the study&#46; Mean &#40;95&#37; CI&#41; PTH was 15&#46;6 &#40;11&#46;1&#44; 20&#46;2&#41; ng&#47;L at baseline and 22&#46;6 &#40;17&#46;4&#44; 27&#46;8&#41; ng&#47;L after 24 months of treatment&#46; There were no significant changes in PTH throughout the study &#40;Kruskal&#8211;Wallis <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;267&#41;&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Mean &#40;95&#37; CI&#41; bALP was 57&#46;5 &#40;41&#46;4&#44; 73&#46;6&#41; &#956;g&#47;L at baseline and 53&#46;5 &#40;40&#46;0&#44; 67&#46;0&#41; &#956;g&#47;L after 24 months of treatment without significant modifications observed throughout the study &#40;Kruskal-Wallis <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;786&#41;&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Vitamin D levels</span><p id="par0155" class="elsevierStylePara elsevierViewall">No significant changes in 25-hydroxyvitamin D and 1&#46;25-dihydroxyvitamin D were observed throughout the study &#40;Kruskal&#8211;Wallis <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;349 and 0&#46;131&#44; respectively&#41;&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD 25-hydroxyvitamin D was 51&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>33&#46;7<span class="elsevierStyleHsp" style=""></span>nmol&#47;L at baseline &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#41; and 58&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#46;8<span class="elsevierStyleHsp" style=""></span>nmol&#47;L at the 24-month visit &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>21&#41;&#46; The mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD serum level of 1&#44;25-dihydroxyvitamin D was 153<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>48<span class="elsevierStyleHsp" style=""></span>pmol&#47;L at baseline &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41; and 135<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>pmol&#47;L at the end of the study &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&#41;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Blood levels of 25-hydroxyvitamin D and 1&#44;25-dihydroxyvitamin D were normal in 60&#37; and 80&#37; of the patients at baseline and in 43&#37; and 100&#37; of the patients after 24 months&#44; respectively&#46; Clinically significant low levels of 25-hydroxyvitamin D were measured at different time points in six paediatric patients&#46; Occasional vitamin D supplementation was given to 60&#37; of patients&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Safety and tolerability</span><p id="par0170" class="elsevierStylePara elsevierViewall">A total of 104 adverse events in 27 patients were reported&#44; among which only 9 in 5 patients were confirmed treatment related&#58; three cases of diarrhoea affecting one patient&#44; two cases of abdominal pain in two children and single events of dyspepsia&#44; upper abdominal pain&#44; gastrointestinal disorder and gastrointestinal pain&#46; They were all of mild or moderate severity and no discontinuation of treatment was needed&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">22</span></a></p></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Discussion</span><p id="par0175" class="elsevierStylePara elsevierViewall">Among the long-term effects of dRTA in children are failure to thrive&#44; stunted growth&#44; osteopenia and rickets<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">4&#44;32</span></a>&#59; osteopenia and osteomalacia are observed mainly in adults&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">5</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">In these patients&#44; alkaline therapy is believed to increase bone mass through the restoration of bone mineral balance and the improvement of osteoblast function&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">33</span></a> In general&#44; the prognosis of dRTA is favourable in most patients on alkali therapy&#46; Treatment has been shown to improve radiological abnormalities of rickets&#44;<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">32&#44;34</span></a> increase growth&#44;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">4&#44;17&#44;35&#44;36</span></a> and improve bone structure and bone metabolism&#46;<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">33&#44;37</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">Adherence to treatment is shown to be key to correct bone abnormalities&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">38</span></a> Reduced growth rates in dRTA children have been associated with sporadic parental noncompliance in administering alkali therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">4</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">Additionally&#44; current treatments are not effective in all cases&#46; In a UK cohort of 24 patients with inherited dRTA&#44; growth retardation &#40;height-for-age <span class="elsevierStyleItalic">z</span>-score<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#8722;2&#41; was found in 10 patients at presentation &#40;42&#37;&#41; and persisted in 3 &#40;13&#37;&#41; once treated&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">39</span></a> Similarly&#44; in a cohort of 31 dRTA patients with a median follow up of 77 months&#44; severe growth retardation at the time of diagnosis was observed in 14 &#40;45&#37;&#41; patients and at their last visit catchup growth was not achieved in six &#40;19&#37;&#41; of them&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">19</span></a> As illustrated by observations in recent cohorts of paediatric patients&#44; significantly improved height-for-age <span class="elsevierStyleItalic">z</span>-scores are obtained with adequate metabolic control&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">19&#44;20</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">As our cohort was previously treated with alkali therapy &#40;in most cases potassium citrate&#44; sodium bicarbonate or a combination of both&#41;&#44; most patients were already within the<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2SDs range for height and weight before starting ADV7103&#46; However&#44; a positive effect of ADV7103 treatment on the height and weight of patients who were below that range at baseline was shown&#46; Additionally&#44; several paediatric patients presenting growth <span class="elsevierStyleItalic">z</span>-scores within the<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2SDs range&#44; but most frequently<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44; benefited from increases<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;5 units in their <span class="elsevierStyleItalic">z</span>-scores&#46; In young adults&#44; mean GTS was exceeded&#44; showing a potential benefit on growth also in this population&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Similarly&#44; BMD scores were normal in most patients throughout the study but a significant improvement in mean spine <span class="elsevierStyleItalic">z</span>-scores of the cohort was observed&#46; Additionally&#44; there was a positive correlation between adequate control of metabolic acidosis and bone parameters in some age groups&#44; although this was difficult to observe with our product because most parameters were near or within the normal range&#44; and information describing the effect of acidosis was scarce&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Despite treatment&#44; low citrate&#47;creatinine urine ratios were observed in one third of the patients or more at the different visits&#46; A potential remaining intracellular acidosis could suggest that alkali amounts for these patients should be increased for an optimal adaptation to their needs as they grow&#46; In children there was a positive correlation between citrate&#47;creatinine ratio in urine and whole-body densitometry&#44; suggesting that normal citraturia&#44; an indicator of good metabolic control&#44; is linked to a higher body BMD&#46; In adolescents&#44; there was a negative correlation between calciuria and body densitometry&#44; indicating that patients losing more calcium in urine are those with worst body densitometry&#44; as expected&#46; In adults&#44; there was a strong positive correlation between both spine and whole-body densitometry and plasma bicarbonate levels&#44; again substantiating that adequate metabolic control in patients with dRTA has a positive impact on BMD&#46; These results corroborate those published in a cohort of 10 naive adult patients with dRTA showing increased plasma bicarbonate levels and BMD after treatment with potassium citrate for one year&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">18</span></a> As demonstrated&#44; there is an improvement of BMD in patients with dRTA that had been previously treated with other alkalizing agents&#46; Although we have reported an increase in spine BMD <span class="elsevierStyleItalic">z</span>-score&#44; which can be explained by a sustained metabolic control of plasma bicarbonate levels achieved with ADV7103&#44; a final conclusion with the highest level of evidence cannot be provided due to the absence of a control arm&#46; However&#44; it is remarkable that such an improvement is achieved in patients that were considered adequately treated before switching to ADV7103&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">In conclusion&#44; ADV7103 was well tolerated and provided a sustained control of metabolic acidosis in patients with dRTA&#44; which could explain the improvement of growth and spine BMD after 2 years of treatment&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Authors&#8217; contributions</span><p id="par0215" class="elsevierStylePara elsevierViewall">Aur&#233;lia Bertholet-Thomas has been involved in Investigation and Writing &#8211; review &#38; editing&#46; Maria A&#46; Manso-Silv&#225;n has been involved in Writing &#8211; original draft Writing &#8211; review &#38; editing&#46; Victor Navas-Serrano has been involved in Writing &#8211; original draft Writing &#8211; review &#38; editing&#46; Catherine Guittet&#44; has been involved in Conceptualization Methodology Writing &#8211; review &#38; editing&#46; Sophie Joukoff&#44; has been involved in Project administration Supervision Writing &#8211; review &#38; editing&#46; Justine Bacchetta has been involved in Writing &#8211; review &#38; editing&#46; Olivia Boyer has been involved in Investigation and Writing &#8211; review &#38; editing&#46; Mariano Rodriguez has been involved in Conceptualization Writing &#8211; original draft Writing &#8211; review &#38; editing&#46; Luc-Andr&#233; Granier has been involved in Conceptualization Methodology Writing &#8211; review &#38; editing&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Ethics approval</span><p id="par0220" class="elsevierStylePara elsevierViewall">This study was approved by regional independent ethics committees and national regulatory health authorities&#44; and conducted in accordance with Good Clinical Practice and the Declaration of Helsinki&#46;</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Consent to participate</span><p id="par0225" class="elsevierStylePara elsevierViewall">Written consent was obtained from all adult patients&#44; and from the parents or legal guardians of all children&#46; When possible&#44; the assent from paediatric patients themselves was also obtained&#46;</p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Consent for publication</span><p id="par0230" class="elsevierStylePara elsevierViewall">Not applicable&#46;</p></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Funding</span><p id="par0235" class="elsevierStylePara elsevierViewall">This study was funded by <span class="elsevierStyleGrantSponsor" id="gs1">Advicenne</span>&#46;</p></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Conflicts of interest</span><p id="par0240" class="elsevierStylePara elsevierViewall">A&#46; Bertholet perceived support from Advicenne for traveling to meetings and&#47;or funding for lectures&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">C&#46; Guittet&#44; M&#46;A&#46; Manso-Silv&#225;n and L&#46;A&#46; Granier are employees of Advicenne and hold stock options or shares in the company&#46; S&#46; Joukoff and V&#46; Navas-Serrano are also employees of Advicenne&#46;</p></span></span>"
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          "titulo" => "Resumen"
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              "titulo" => "Antecedentes y objetivo"
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          "titulo" => "Introduction"
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          "titulo" => "Methods"
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              "identificador" => "sec0015"
              "titulo" => "Patients and study design"
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            1 => array:2 [
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              "titulo" => "Bone mineral density evaluations"
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            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Anthropometric evaluations"
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            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Blood and urine parameters"
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              "titulo" => "Adverse events"
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              "titulo" => "Adherence to treatment"
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              "titulo" => "Bone mineral density"
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              "identificador" => "sec0065"
              "titulo" => "Growth in paediatric patients and young adults"
            ]
            2 => array:2 [
              "identificador" => "sec0070"
              "titulo" => "Metabolic control"
            ]
            3 => array:2 [
              "identificador" => "sec0075"
              "titulo" => "PTH and bALP levels"
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            4 => array:2 [
              "identificador" => "sec0080"
              "titulo" => "Vitamin D levels"
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          "titulo" => "Acknowledgments"
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    "fechaRecibido" => "2021-09-09"
    "fechaAceptado" => "2022-02-27"
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          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1791897"
          "palabras" => array:6 [
            0 => "dRTA"
            1 => "Plasma bicarbonate"
            2 => "Calciuria"
            3 => "Citraturia"
            4 => "Growth"
            5 => "Bone mineral density"
          ]
        ]
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          "titulo" => "Palabras clave"
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          "palabras" => array:6 [
            0 => "ATRd"
            1 => "Bicarbonato plasm&#225;tico"
            2 => "Calciuria"
            3 => "Citraturia"
            4 => "Crecimiento"
            5 => "Densidad mineral &#243;sea"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">ADV7103 is a new prolonged-release treatment for distal renal tubular acidosis &#40;dRTA&#41;&#44; containing potassium citrate and potassium bicarbonate&#46; Since acidosis may affect bone mineral contents&#44; the effects of ADV7103 on bone mineral density &#40;BMD&#41; and growth in patients with dRTA over 24 months were evaluated&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Thirty patients &#40;24 paediatric patients and 6 adults&#41; were included in an open-label extension study after a phase II&#47;III trial&#46; BMD&#44; measured by densitometry&#44; was assessed at baseline and at 24 months&#46; Growth was evaluated throughout the study&#46; Plasma bicarbonate&#44; parathyroid hormone&#44; 25-hydroxy vitamin D&#44; 1&#44;25-dihydroxy vitamin D&#44; bone alkaline phosphatase&#44; calciuria and citraturia&#44; were also determined&#46; Safety and treatment compliance were evaluated as well&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">After 24 months of treatment with ADV7103&#44; mean spine BMD <span class="elsevierStyleItalic">z</span>-score values significantly increased as compared with baseline &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;024&#41;&#46; In adults&#44; spine and whole-body densitometry <span class="elsevierStyleItalic">z</span>-scores showed a significant correlation with plasma bicarbonate levels &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;82 and <span class="elsevierStyleItalic">r</span><span class="elsevierStyleInf">S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;97&#44; respectively&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#41;&#46; There was an increase<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;5 units in <span class="elsevierStyleItalic">z</span>-scores for height and weight in 18&#37; and 36&#37; of the paediatric patients&#44; respectively&#46; With treatment&#44; plasma bicarbonate concentration and calciuria at the different visits were normal in 69&#8211;86&#37; and 93&#8211;96&#37; patients&#44; respectively&#46; Only nine treatment-related gastrointestinal AEs of mild&#47;moderate severity&#44; were reported in five patients&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Two years of ADV7103 treatment improved growth and increased spine BMD&#46; These results suggest that control of acidosis by ADV7103 treatment improves bone parameters&#46;</p></span>"
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            "titulo" => "Patients and methods"
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            "identificador" => "abst0015"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0020"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El ADV7103 es un nuevo tratamiento de liberaci&#243;n prolongada para la acidosis tubular renal distal &#40;ATRd&#41;&#44; que contiene citrato pot&#225;sico y bicarbonato pot&#225;sico&#46; Dado que la acidosis puede afectar al contenido mineral &#243;seo&#44; se ha evaluado el efecto de dicho medicamento a lo largo de 24 meses sobre la densidad mineral &#243;sea &#40;DMO&#41; y el crecimiento en pacientes con ATRd&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron treinta pacientes &#40;24 pedi&#225;tricos y seis adultos&#41; en un estudio abierto de extensi&#243;n tras un ensayo cl&#237;nico de fase II&#47;III&#46; La DMO medida por densitometr&#237;a se midi&#243; al inicio del estudio y los 24 meses&#46; El crecimiento se evalu&#243; a lo largo del estudio&#46; Adicionalmente&#44; se determinaron el bicarbonato plasm&#225;tico&#44; la parathormona&#44; 25 hidroxivitamina D&#44; 1&#44;25 dihidroxivitamina D&#44; fosfatasa alcalina &#243;sea&#44; calciuria y citraturia&#46; La seguridad y el cumplimento terap&#233;utico tambi&#233;n fueron evaluados&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Tras 24 meses de tratamiento con ADV7103 la media del z-<span class="elsevierStyleItalic">score</span> de DMO de columna aument&#243; significativamente frente al valor basal &#40;p &#61; 0&#44;024&#41;&#46; En los adultos el z-<span class="elsevierStyleItalic">score</span> de la densitometr&#237;a de columna y corporal total mostr&#243; una correlaci&#243;n significativa con los valores de bicarbonato plasm&#225;tico &#40;r<span class="elsevierStyleInf">S</span> &#61; 0&#44;82 y r<span class="elsevierStyleInf">S</span> &#61; 0&#44;97&#44; respectivamente&#44; p &#60; 0&#44;005&#41;&#46; Se registr&#243; un incremento &#62; 0&#44;5 unidades de z-<span class="elsevierStyleItalic">score</span> para altura y peso en el 18 y 36&#37;&#44; respectivamente&#44; de los pacientes pedi&#225;tricos&#46; Con el tratamiento&#44; la concentraci&#243;n plasm&#225;tica de bicarbonato y la calciuria fueron normales en las diferentes visitas en un 69-86&#37; y un 93-96&#37; de los pacientes&#44; respectivamente&#46; Solamente se notificaron nueve eventos adversos gastrointestinales relacionados con el tratamiento&#44; todos de intensidad leve&#47;moderada en cinco pacientes&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Dos a&#241;os de tratamiento con ADV7103 mejoraron el crecimiento y la DMO de columna&#46; Estos resultados sugieren que el control de la acidosis con dicho tratamiento provoca una mejora de par&#225;metros &#243;seos&#46;</p></span>"
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Spine</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hip</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Whole body</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Baseline&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Change&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;3<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col"><span class="elsevierStyleItalic">N</span> &#40;months&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col">Median &#40;cm&#47;6-month&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Lower limit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Upper limit&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#8211;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;21&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">4&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#8211;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;07&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#46;47&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">3&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">6&#8211;12&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">2&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#8211;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#8211;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3478792.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Growth velocity &#40;cm&#47;6-month&#41; in paediatric patients throughout the study&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "tablatextoimagen" => array:2 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Measures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Height &#40;cm&#41;</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Weight &#40;kg&#41;</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">BMI &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Baseline&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">127&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">139&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Change&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3478793.png"
              ]
            ]
            1 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col"><span class="elsevierStyleItalic">z</span>-Scores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Height-for-age <span class="elsevierStyleItalic">z</span>-score</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Weight-for-age <span class="elsevierStyleItalic">z</span>-score</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">BMI-for-age <span class="elsevierStyleItalic">z</span>-score</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Baseline&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Change&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Adults&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Height &#40;cm&#41;</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Weight &#40;kg&#41;</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">BMI &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Baseline&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">159&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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Article information
ISSN: 20132514
Original language: English
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