Beloica, Sofija

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Mehanističko modelovanje i mogućnost predviđanja brzine rastvaranja lekovite supstance iz tableta in vitro i in vivo

Beloica, Sofija

(Универзитет у Београду, Фармацеутски факултет, 2022)

TY  - THES
AU  - Beloica, Sofija
PY  - 2022
UR  - https://eteze.bg.ac.rs/application/showtheses?thesesId=9136
UR  - https://fedorabg.bg.ac.rs/fedora/get/o:29734/bdef:Content/download
UR  - https://plus.cobiss.net/cobiss/sr/sr/bib/107150089
UR  - https://nardus.mpn.gov.rs/handle/123456789/21488
UR  - https://farfar.pharmacy.bg.ac.rs/handle/123456789/4972
AB  - Ispitivanje brzine rastvaranja lekovite supstance iz preparata prepoznato je kao najznačajnija invitro metoda u biofarmaceutskoj karakterizaciji lekova. Adekvatno osmišljenim in vitro testom moguće jesimulirati ponašanje lekovite supstance in vivo, te na taj način uočiti eventualne probleme vezane za njenubiološku raspoloživost. Dobijeni profili mogu se koristiti kao ulazni parametri za in silico simulacije, aovakav integrisani pristup ima za cilj da ubrza razvoj efikasnih i bezbednih lekova u skladu sa potrebamai očekivanjima pacijenata. Osnovni cilj ovog rada je procena mogućnosti primene mehanističkog in vitro-in vivo-in silico modelovanja u razvoju in vitro metode za ispitivanje brzine rastvaranja lekovitesupstance iz preparata koja omogućava predviđanje in vivo ponašanja leka i identifikaciju kliničkiznačajnih specifikacija za lekovite supstance koje pokazuju različite biofarmaceutske karakteristike ipripadaju različitim klasama Biofarmaceutskog sistema klasifikacije.U istraživanju je ispitivan uticaj fiziološki zasnovanih medijuma i dinamičkih uređaja na brzinurastvaranja lekovitih susptanci iz ispitivanih preparata. Kod najvećeg broja ispitivanih preparata nijezabeležen značajan uticaj fizioloških surfaktanata na brzinu rastvaranja. Takođe, u slučaju preparata satrenutnim oslobađanjem, primena dinamičkih uređaja za ispitivanje brzine rastvaranja nije pokazalaprednost u odnosu na aparaturu sa lopaticom. Dobijeni rezultati ukazuju da se za najveći broj ispitivanihpreparata ispitivanje brzine rastvaranja u aparaturi sa lopaticom uz korišćenje medijuma koji simulirasadržaj tankog creva na gladno bez dodatka fizioloških surfaktanata može usvojiti kao bioprediktivnametoda za ispitivanje brzine rastvaranja. Ovakav zaključak podržan je i visokim stepenom in vitro-in vivokorelacije između ispitivanih profila.Fiziološki zasnovano biofarmaceutsko modelovanje uz primenu Simcyp® i GastroPlusTMprogramskih paketa omogućilo je uspešno predviđanje apsorpcije ispitivanih model supstanci na osnovuodgovarajućeg seta ulaznih podataka. Ipak, u najvećem broju slučajeva, bilo je neophodno primenitioptimizaciju parametara kako bi se postiglo slaganje simuliranog i in vivo profila koncentracije lekovitesupstance u plazmi (tzv. „middle out“ pristup). Analiza osteljivosti parametara pokazala se vrlo korisnomalatkom koja može ukazati na kritične parametre koji značajno utiču na obim i brzinu apsorpcije. Naprimeru model supstance ibuprofena dokazana je i generalizaciona sposobnost razvijenog modela zapredviđanje apsorpcije lekovite supstance iz različitih farmaceutskih oblika. Iako su prisutne izvesnerazlike, pre svega u pogledu obima apsorpcije, profili dobijeni Simcyp® i GastroPlusTM simulacijama su,generalno, bili međusobno slični. Pokazano je da se gastrointestinalna simulacija može koristiti kaometoda izbora za predviđanje apsorpcije lekovitih supstanci, kao i za mehanističko proučavanje procesaapsorpcije u slučajevima kada primena konvencionalnih farmakokinetičkih metoda nije moguća (lekovitesupstance klase 2 i 4 BCS koje se zbog niske rastvorljivosti ne mogu primeniti u obliku rastvora zaintravensku primenu i/ili u slučajevima kada lekovita supstanca pokazuje nelinearnu kinetiku usledizraženog presistemskog metabolizma, uticaja transportera i td.). Rezultati dobijeni primenomgastrointestinalne simulacije bili su, generalno, u saglasnosti sa rezultatima dobijenim primenomkonvencionalne farmakokinetičke analize.
AB  - Dissolution test for solid oral dosage forms has been recognized as the most important invitro method in biopharmaceutical drug characterization. With the right choice of experimentalconditions, it is possible to simulate the in vivo drug behavior, and in that way to identifypossible problems related to its bioavailability. Experimentally obtained in vitro drug dissolutionprofiles can be used as input parameters for in silico simulations, and this integrated approachaims to accelerate development of effective and safe drugs in accordance with patients needs andexpectations. The main objective of this work was to assess the possibility of applyingmechanistic in vitro-in vivo-in silico modeling in the development of an in vitro drug dissolutionmethod, that enables prediction of in vivo behavior of the drug and identification of clinicallysignificant specifications for drug substances that show different biopharmaceutical propertiesand belong to different classes of the Biopharmaceutical Classification System.In this research we examined the influence of physiologically based dissolution media anddynamic dissolution devices on the dissolution rate of drug substances from selectedpreparations. No significant influence of physiological surfactants on the dissolution rate wasrecorded for the majority of tested preparations. Also, in the case of immediate releasepreparations, the dynamic dissolution devices did not show an adventage over the compandialpaddle apparatus. The obtained results indicate that, for the majority of tested preparations,paddle apparatus using fasted state simulated intestinal fluid without addition of physiologicalsurfactants can be adopted as biopredictive dissolution method. This conclusion is also supportedby the high level of in vitro-in vivo correlation between the examined profiles.Physiologically based biopharmaceutics modeling using Simcyp® and GastroPlusTMsoftware packages enabled to successfully predict absorption of selected drugs based on theappropriate set of input data. However, in the majority of cases, it was necessary to applyparameter optimization in order to achieve agreement between the simulated and the in vivo drugsubstance plasma profile (the so-called „middle out“ approach). Parameter sensitivity analysisproved to be a very useful tool that can indicate critical parameters that significantly affect theextent and rate of absorption. Using the example of model substance ibuprofen, thegeneralization ability of the developed model for predicting drug absorption from differentdosage forms was proven. Although there are some differences, primarly regarding the extent ofabsorption, the profiles obtained by Simcyp® and GastroPlusTM simulations were, in general,similar to each other. It has been shown that gastrointestinal simulations can be used as methodof choice for predicting drug absorption, as well as for mechanistic study of drug absorptionprocess in cases where application of conventional pharmacokinetic methods is not possible(drug substances of BCS class 2 and 4 which due to low solubility cannot be administered in theform of intravenous solution and/or in cases when drug substance shows non-linear kinetics dueto pronounced pre-systemic metabolism, influence of transporteres, etc.). The results obtainedusing gastrointestinal simulation were, in general, in agreement with the results obtained usingconventional pharmacokinetic analysis.
PB  - Универзитет у Београду, Фармацеутски факултет
T2  - Универзитет у Београду
T1  - Mehanističko modelovanje i mogućnost predviđanja brzine rastvaranja lekovite supstance iz tableta in vitro i in vivo
UR  - https://hdl.handle.net/21.15107/rcub_nardus_21488
ER  - 
@phdthesis{
author = "Beloica, Sofija",
year = "2022",
abstract = "Ispitivanje brzine rastvaranja lekovite supstance iz preparata prepoznato je kao najznačajnija invitro metoda u biofarmaceutskoj karakterizaciji lekova. Adekvatno osmišljenim in vitro testom moguće jesimulirati ponašanje lekovite supstance in vivo, te na taj način uočiti eventualne probleme vezane za njenubiološku raspoloživost. Dobijeni profili mogu se koristiti kao ulazni parametri za in silico simulacije, aovakav integrisani pristup ima za cilj da ubrza razvoj efikasnih i bezbednih lekova u skladu sa potrebamai očekivanjima pacijenata. Osnovni cilj ovog rada je procena mogućnosti primene mehanističkog in vitro-in vivo-in silico modelovanja u razvoju in vitro metode za ispitivanje brzine rastvaranja lekovitesupstance iz preparata koja omogućava predviđanje in vivo ponašanja leka i identifikaciju kliničkiznačajnih specifikacija za lekovite supstance koje pokazuju različite biofarmaceutske karakteristike ipripadaju različitim klasama Biofarmaceutskog sistema klasifikacije.U istraživanju je ispitivan uticaj fiziološki zasnovanih medijuma i dinamičkih uređaja na brzinurastvaranja lekovitih susptanci iz ispitivanih preparata. Kod najvećeg broja ispitivanih preparata nijezabeležen značajan uticaj fizioloških surfaktanata na brzinu rastvaranja. Takođe, u slučaju preparata satrenutnim oslobađanjem, primena dinamičkih uređaja za ispitivanje brzine rastvaranja nije pokazalaprednost u odnosu na aparaturu sa lopaticom. Dobijeni rezultati ukazuju da se za najveći broj ispitivanihpreparata ispitivanje brzine rastvaranja u aparaturi sa lopaticom uz korišćenje medijuma koji simulirasadržaj tankog creva na gladno bez dodatka fizioloških surfaktanata može usvojiti kao bioprediktivnametoda za ispitivanje brzine rastvaranja. Ovakav zaključak podržan je i visokim stepenom in vitro-in vivokorelacije između ispitivanih profila.Fiziološki zasnovano biofarmaceutsko modelovanje uz primenu Simcyp® i GastroPlusTMprogramskih paketa omogućilo je uspešno predviđanje apsorpcije ispitivanih model supstanci na osnovuodgovarajućeg seta ulaznih podataka. Ipak, u najvećem broju slučajeva, bilo je neophodno primenitioptimizaciju parametara kako bi se postiglo slaganje simuliranog i in vivo profila koncentracije lekovitesupstance u plazmi (tzv. „middle out“ pristup). Analiza osteljivosti parametara pokazala se vrlo korisnomalatkom koja može ukazati na kritične parametre koji značajno utiču na obim i brzinu apsorpcije. Naprimeru model supstance ibuprofena dokazana je i generalizaciona sposobnost razvijenog modela zapredviđanje apsorpcije lekovite supstance iz različitih farmaceutskih oblika. Iako su prisutne izvesnerazlike, pre svega u pogledu obima apsorpcije, profili dobijeni Simcyp® i GastroPlusTM simulacijama su,generalno, bili međusobno slični. Pokazano je da se gastrointestinalna simulacija može koristiti kaometoda izbora za predviđanje apsorpcije lekovitih supstanci, kao i za mehanističko proučavanje procesaapsorpcije u slučajevima kada primena konvencionalnih farmakokinetičkih metoda nije moguća (lekovitesupstance klase 2 i 4 BCS koje se zbog niske rastvorljivosti ne mogu primeniti u obliku rastvora zaintravensku primenu i/ili u slučajevima kada lekovita supstanca pokazuje nelinearnu kinetiku usledizraženog presistemskog metabolizma, uticaja transportera i td.). Rezultati dobijeni primenomgastrointestinalne simulacije bili su, generalno, u saglasnosti sa rezultatima dobijenim primenomkonvencionalne farmakokinetičke analize., Dissolution test for solid oral dosage forms has been recognized as the most important invitro method in biopharmaceutical drug characterization. With the right choice of experimentalconditions, it is possible to simulate the in vivo drug behavior, and in that way to identifypossible problems related to its bioavailability. Experimentally obtained in vitro drug dissolutionprofiles can be used as input parameters for in silico simulations, and this integrated approachaims to accelerate development of effective and safe drugs in accordance with patients needs andexpectations. The main objective of this work was to assess the possibility of applyingmechanistic in vitro-in vivo-in silico modeling in the development of an in vitro drug dissolutionmethod, that enables prediction of in vivo behavior of the drug and identification of clinicallysignificant specifications for drug substances that show different biopharmaceutical propertiesand belong to different classes of the Biopharmaceutical Classification System.In this research we examined the influence of physiologically based dissolution media anddynamic dissolution devices on the dissolution rate of drug substances from selectedpreparations. No significant influence of physiological surfactants on the dissolution rate wasrecorded for the majority of tested preparations. Also, in the case of immediate releasepreparations, the dynamic dissolution devices did not show an adventage over the compandialpaddle apparatus. The obtained results indicate that, for the majority of tested preparations,paddle apparatus using fasted state simulated intestinal fluid without addition of physiologicalsurfactants can be adopted as biopredictive dissolution method. This conclusion is also supportedby the high level of in vitro-in vivo correlation between the examined profiles.Physiologically based biopharmaceutics modeling using Simcyp® and GastroPlusTMsoftware packages enabled to successfully predict absorption of selected drugs based on theappropriate set of input data. However, in the majority of cases, it was necessary to applyparameter optimization in order to achieve agreement between the simulated and the in vivo drugsubstance plasma profile (the so-called „middle out“ approach). Parameter sensitivity analysisproved to be a very useful tool that can indicate critical parameters that significantly affect theextent and rate of absorption. Using the example of model substance ibuprofen, thegeneralization ability of the developed model for predicting drug absorption from differentdosage forms was proven. Although there are some differences, primarly regarding the extent ofabsorption, the profiles obtained by Simcyp® and GastroPlusTM simulations were, in general,similar to each other. It has been shown that gastrointestinal simulations can be used as methodof choice for predicting drug absorption, as well as for mechanistic study of drug absorptionprocess in cases where application of conventional pharmacokinetic methods is not possible(drug substances of BCS class 2 and 4 which due to low solubility cannot be administered in theform of intravenous solution and/or in cases when drug substance shows non-linear kinetics dueto pronounced pre-systemic metabolism, influence of transporteres, etc.). The results obtainedusing gastrointestinal simulation were, in general, in agreement with the results obtained usingconventional pharmacokinetic analysis.",
publisher = "Универзитет у Београду, Фармацеутски факултет",
journal = "Универзитет у Београду",
title = "Mehanističko modelovanje i mogućnost predviđanja brzine rastvaranja lekovite supstance iz tableta in vitro i in vivo",
url = "https://hdl.handle.net/21.15107/rcub_nardus_21488"
}
Beloica, S.. (2022). Mehanističko modelovanje i mogućnost predviđanja brzine rastvaranja lekovite supstance iz tableta in vitro i in vivo. in Универзитет у Београду
Универзитет у Београду, Фармацеутски факултет..
https://hdl.handle.net/21.15107/rcub_nardus_21488
Beloica S. Mehanističko modelovanje i mogućnost predviđanja brzine rastvaranja lekovite supstance iz tableta in vitro i in vivo. in Универзитет у Београду. 2022;.
https://hdl.handle.net/21.15107/rcub_nardus_21488 .
Beloica, Sofija, "Mehanističko modelovanje i mogućnost predviđanja brzine rastvaranja lekovite supstance iz tableta in vitro i in vivo" in Универзитет у Београду (2022),
https://hdl.handle.net/21.15107/rcub_nardus_21488 .

In vitro-in vivo-in silico approach in biopharmaceutical characterization of ibuprofen IR and SR tablets

Beloica, Sofija; Cvijić, Sandra; Bogataj, Marija; Parojčić, Jelena

(Elsevier Science BV, Amsterdam, 2015)

TY  - JOUR
AU  - Beloica, Sofija
AU  - Cvijić, Sandra
AU  - Bogataj, Marija
AU  - Parojčić, Jelena
PY  - 2015
UR  - https://farfar.pharmacy.bg.ac.rs/handle/123456789/2464
AB  - Within the last decades, physiologically based pharmacokinetic models have emerged into a biopharmaceutical toolkit that has been proven useful in understanding how physicochemical, formulation and physiological factors affect oral drug absorption. The purpose of this study was to develop a drug specific physiologically based pharmacokinetic model that will allow mechanistic interpretation of oral absorption from dosage forms exhibiting different in vitro and different in vivo performance (i.e. immediate release and sustained release tablets) and identification of bioperformance dissolution testing. Ibuprofen was chosen to be used for the "proof of concept" considering it is well characterised and the necessary physicochemical, biopharmaceutical and pharmacokinetic properties for model development could be found in the literature. Gastrointestinal simulation technology implemented in Simcyp (R) was successful in estimating ibuprofen oral absorption. The developed model exhibited good generalisation ability for the dosage forms studied. The obtained results indicate that the model was sensitive to input kinetics represented by the in vitro drug release profiles obtained under various dissolution conditions. According to the obtained results, reciprocating cylinder apparatus with biorepresentative change in media pH might be considered as bioperformance dissolution in the case of the two ibuprofen SR products studied. These results further justify the use of integrated in vitro-in vivo-in silico approach in estimating bioperformance of oral solid dosage forms.
PB  - Elsevier Science BV, Amsterdam
T2  - European Journal of Pharmaceutical Sciences
T1  - In vitro-in vivo-in silico approach in biopharmaceutical characterization of ibuprofen IR and SR tablets
VL  - 75
SP  - 151
EP  - 159
DO  - 10.1016/j.ejps.2015.03.027
ER  - 
@article{
author = "Beloica, Sofija and Cvijić, Sandra and Bogataj, Marija and Parojčić, Jelena",
year = "2015",
abstract = "Within the last decades, physiologically based pharmacokinetic models have emerged into a biopharmaceutical toolkit that has been proven useful in understanding how physicochemical, formulation and physiological factors affect oral drug absorption. The purpose of this study was to develop a drug specific physiologically based pharmacokinetic model that will allow mechanistic interpretation of oral absorption from dosage forms exhibiting different in vitro and different in vivo performance (i.e. immediate release and sustained release tablets) and identification of bioperformance dissolution testing. Ibuprofen was chosen to be used for the "proof of concept" considering it is well characterised and the necessary physicochemical, biopharmaceutical and pharmacokinetic properties for model development could be found in the literature. Gastrointestinal simulation technology implemented in Simcyp (R) was successful in estimating ibuprofen oral absorption. The developed model exhibited good generalisation ability for the dosage forms studied. The obtained results indicate that the model was sensitive to input kinetics represented by the in vitro drug release profiles obtained under various dissolution conditions. According to the obtained results, reciprocating cylinder apparatus with biorepresentative change in media pH might be considered as bioperformance dissolution in the case of the two ibuprofen SR products studied. These results further justify the use of integrated in vitro-in vivo-in silico approach in estimating bioperformance of oral solid dosage forms.",
publisher = "Elsevier Science BV, Amsterdam",
journal = "European Journal of Pharmaceutical Sciences",
title = "In vitro-in vivo-in silico approach in biopharmaceutical characterization of ibuprofen IR and SR tablets",
volume = "75",
pages = "151-159",
doi = "10.1016/j.ejps.2015.03.027"
}
Beloica, S., Cvijić, S., Bogataj, M.,& Parojčić, J.. (2015). In vitro-in vivo-in silico approach in biopharmaceutical characterization of ibuprofen IR and SR tablets. in European Journal of Pharmaceutical Sciences
Elsevier Science BV, Amsterdam., 75, 151-159.
https://doi.org/10.1016/j.ejps.2015.03.027
Beloica S, Cvijić S, Bogataj M, Parojčić J. In vitro-in vivo-in silico approach in biopharmaceutical characterization of ibuprofen IR and SR tablets. in European Journal of Pharmaceutical Sciences. 2015;75:151-159.
doi:10.1016/j.ejps.2015.03.027 .
Beloica, Sofija, Cvijić, Sandra, Bogataj, Marija, Parojčić, Jelena, "In vitro-in vivo-in silico approach in biopharmaceutical characterization of ibuprofen IR and SR tablets" in European Journal of Pharmaceutical Sciences, 75 (2015):151-159,
https://doi.org/10.1016/j.ejps.2015.03.027 . .
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An in vitro - in silico - in vivo approach in biopharmaceutical drug characterization: metformin hydrochloride IR tablets

Beloica, Sofija; Cvijić, Sandra; Homšek, Irena; Bogataj, M.; Parojčić, Jelena

(Govi-Verlag Pharmazeutischer Verlag Gmbh, Eschborn, 2015)

TY  - JOUR
AU  - Beloica, Sofija
AU  - Cvijić, Sandra
AU  - Homšek, Irena
AU  - Bogataj, M.
AU  - Parojčić, Jelena
PY  - 2015
UR  - https://farfar.pharmacy.bg.ac.rs/handle/123456789/2434
AB  - The integrated in vitro - in silico - in vivo approach has emerged into a biopharmaceutical toolkit that could accelerate drug development and improve drug product clinical performance in patients. In the present study, the influence of physiologically based media and dynamic dissolution testing on drug release from two metformin hydrochloride immediate release products with proven bioequivalence was tested. Metformin-specific physiologically based pharmacokinetic (PBPK) model was developed based on a range of literature or in silico predicted data using gastrointestinal simulation technology implemented in the Simcyp (R) software package. Various approaches were employed in order to estimate the human effective permeability which was used as input for metformin plasma profile simulation. Influence of the rate and extent of metformin dissolution on drug absorption was evaluated. Both convolution and deconvolution approaches were used in order to establish a correlation between the in vitro and in vivo data. The results obtained indicate that physiologically based dissolution media and glass bead dissolution device exhibit certain advantages over the compendial dissolution apparatus and simple buffers which tended to be over-discriminative. Gastrointestinal simulation technology implemented in the Simcyp (R) Simulator was successfully used in developing drug-specific PBPK model for metformin. Simulations indicate that in vitro dissolution kinetics has no significant effect on metformin absorption, if more than 65% of drug is released in 1 hour. Level A in vitro-in vivo correlation was obtained using both convolution and deconvolution approaches.
PB  - Govi-Verlag  Pharmazeutischer Verlag Gmbh, Eschborn
T2  - Pharmazie
T1  - An in vitro - in silico - in vivo approach in biopharmaceutical drug characterization: metformin hydrochloride IR tablets
VL  - 70
IS  - 7
SP  - 458
EP  - 465
DO  - 10.1691/ph.2015.4168
ER  - 
@article{
author = "Beloica, Sofija and Cvijić, Sandra and Homšek, Irena and Bogataj, M. and Parojčić, Jelena",
year = "2015",
abstract = "The integrated in vitro - in silico - in vivo approach has emerged into a biopharmaceutical toolkit that could accelerate drug development and improve drug product clinical performance in patients. In the present study, the influence of physiologically based media and dynamic dissolution testing on drug release from two metformin hydrochloride immediate release products with proven bioequivalence was tested. Metformin-specific physiologically based pharmacokinetic (PBPK) model was developed based on a range of literature or in silico predicted data using gastrointestinal simulation technology implemented in the Simcyp (R) software package. Various approaches were employed in order to estimate the human effective permeability which was used as input for metformin plasma profile simulation. Influence of the rate and extent of metformin dissolution on drug absorption was evaluated. Both convolution and deconvolution approaches were used in order to establish a correlation between the in vitro and in vivo data. The results obtained indicate that physiologically based dissolution media and glass bead dissolution device exhibit certain advantages over the compendial dissolution apparatus and simple buffers which tended to be over-discriminative. Gastrointestinal simulation technology implemented in the Simcyp (R) Simulator was successfully used in developing drug-specific PBPK model for metformin. Simulations indicate that in vitro dissolution kinetics has no significant effect on metformin absorption, if more than 65% of drug is released in 1 hour. Level A in vitro-in vivo correlation was obtained using both convolution and deconvolution approaches.",
publisher = "Govi-Verlag  Pharmazeutischer Verlag Gmbh, Eschborn",
journal = "Pharmazie",
title = "An in vitro - in silico - in vivo approach in biopharmaceutical drug characterization: metformin hydrochloride IR tablets",
volume = "70",
number = "7",
pages = "458-465",
doi = "10.1691/ph.2015.4168"
}
Beloica, S., Cvijić, S., Homšek, I., Bogataj, M.,& Parojčić, J.. (2015). An in vitro - in silico - in vivo approach in biopharmaceutical drug characterization: metformin hydrochloride IR tablets. in Pharmazie
Govi-Verlag  Pharmazeutischer Verlag Gmbh, Eschborn., 70(7), 458-465.
https://doi.org/10.1691/ph.2015.4168
Beloica S, Cvijić S, Homšek I, Bogataj M, Parojčić J. An in vitro - in silico - in vivo approach in biopharmaceutical drug characterization: metformin hydrochloride IR tablets. in Pharmazie. 2015;70(7):458-465.
doi:10.1691/ph.2015.4168 .
Beloica, Sofija, Cvijić, Sandra, Homšek, Irena, Bogataj, M., Parojčić, Jelena, "An in vitro - in silico - in vivo approach in biopharmaceutical drug characterization: metformin hydrochloride IR tablets" in Pharmazie, 70, no. 7 (2015):458-465,
https://doi.org/10.1691/ph.2015.4168 . .
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