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Trial registered on ANZCTR
Registration number
ACTRN12616000952448
Ethics application status
Approved
Date submitted
10/07/2016
Date registered
19/07/2016
Date last updated
3/12/2019
Date data sharing statement initially provided
27/11/2018
Type of registration
Retrospectively registered
Titles & IDs
Public title
Wear assessment of highly crossed linked (X3) acetabular liners by Radio stereometric analysis (RSA). An analysis of patients with osteoarthritis treatment hip replacement surgery.
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Scientific title
Wear assessment of highly cross-linked (X3) polyethylene liners with Radio stereometric analysis (RSA). A double cohort study of osteoarthritis patients with hip replacements of 32 mm head size compared to 36 to 40mm head sizes.
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Secondary ID [1]
289646
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none
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Universal Trial Number (UTN)
U1111-1185-2074
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Osteoarthritis
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Condition category
Condition code
Surgery
299423
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0
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Surgical techniques
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Patients with advanced osteoarthritis will be treated with a hip replacement that is the standard practice of the senior author. The migration of femoral head into the polyethylene liner over time will be measured by Radio stereometric analysis (RSA).
The Trident acetabular system comprises a metallic hemispherical acetabular shell, used in association with a highly cross-linked polyethylene liner (X3).. The surgery is performed by a specialist hip arthroplasty surgeon, through a posterior approach and according to normal standards at the clinic.
During surgery six one-mm tantalum markers are inserted in the plastic liner to facilitate migration measurements. This will add about 5 minutes to the 60 minute surgical procedure. Tantalum is the most biocompatible metal known. In 25 years of use no problems have ever been identified with the use of this technique.
Outcomes will be measured by radiological examination and general outcome survey. The general outcome surveys will be compled at the standard follow up visits. These surveys will include the Harris hip a disease specific survey form and SF12 a general outcome survey. The forms will take approximately 20mins to fill out and the patients will be deidentified to protect their privacy
The study is an interventional trial of two groups of patients. The first study cohort will include patients implanted with a standard sized 32 mm femoral head articulating with an X3 polyethylene liner. The first group of patients will have a preliminary analysis to ensure safety and efficacy of the X3 polyethylene. Once initial safety requirements have been met a second group of patients will be recruited with the largest femoral head size that permits a minimum 6mm polyethylene thickness, a 36-40 mm Cobalt Chrome (CoCr) femoral head articulating with a highly cross linked (X3) polyethylene liner.
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Intervention code [1]
295263
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Treatment: Devices
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Intervention code [2]
295272
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Treatment: Surgery
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Intervention code [3]
295273
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Early detection / Screening
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Comparator / control treatment
The study consists of two cohorts and both are compared to historical clinical and migration values. There are limited RSA wear studies on conventional and cross-linked polyethylene. Nivbradt et al (Rohl, Nivbrandt, Minuggo, Hewitt, In Vivo Wear and Migration of Highly Cross-linked Polyethylene cups. J Arthroplasty, vol 20 (2), 2005) report RSA derived wear rates for traditional and second-generation cross-linked polyethylene. Campbell et al (Campbell D, et al., Eur J Orthop Surg Traumatol. 2009; 20(1):23-27) report RSA derived wear of an intermediate cross-linked (5Gy) polyethylene and these two studies form an historical control group .
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Control group
Historical
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Outcomes
Primary outcome [1]
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RSA assessed femoral head migration as a measure of polyethylene wear.
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Assessment method [1]
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Timepoint [1]
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Two years, five years, and 10 years post surgery.
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Secondary outcome [1]
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Oxford hip scores
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Assessment method [1]
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Timepoint [1]
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One year and five years post surgery
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Secondary outcome [2]
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SF-12 scores
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Assessment method [2]
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Timepoint [2]
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One and five years post surgery
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Secondary outcome [3]
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Harris hip scores.
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Assessment method [3]
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Timepoint [3]
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One and five years post surgery
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Eligibility
Key inclusion criteria
Patients between 50 and 80 years of age, planned for Total Hip Arthroplasty (THA) due to osteoarthritis
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Minimum age
50
Years
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Maximum age
80
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Residence outside Adelaide metropolitan area, abnormal gross anatomy of hip, age above 80 years, inflammatory arthritis or severe osteoporosis
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Non-randomised trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
nil
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
nil
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Other
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Other design features
Consecutive cohort interventional trial
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Phase
Not Applicable
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Type of endpoint/s
Safety/efficacy
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Statistical methods / analysis
Migration and wear is calculated with UMRSA software (RSA Biomedical). Statistic analyses of the material will be done with the SPSS 10 package. Migration and wear differences between patients analyzed with Mann Whitney U-test and repeated measurement ANOVA and correlations to other parameters with linear regression. Probability values of less than 0.05 will be considered significant. An earlier study of the same cup showed a SD of 0.17 mm. Difference in migration between the patients is anticipated to be at least 0.15 mm. To accommodate these facts a power analyses suggests a sample size of 27 patients when comparing two implant types. Again, this number is based on a head-to-head assessment of two different prostheses and is included to indicate our appreciation of what is actually required to meet statistical validity. We believe that the numbers cited (20) with be more than adequate to evaluate the performance of a single system.
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
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Actual
23/09/2005
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Date of last participant enrolment
Anticipated
6/09/2009
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Actual
6/09/2009
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Date of last data collection
Anticipated
6/09/2019
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Actual
6/09/2019
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Sample size
Target
40
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Accrual to date
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Final
40
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Recruitment in Australia
Recruitment state(s)
SA
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Recruitment postcode(s) [1]
13585
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5000 - Adelaide
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Funding & Sponsors
Funding source category [1]
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Commercial sector/Industry
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Name [1]
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Styrker Australia
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Address [1]
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Stryker South Pacific
PO Box 970
Artarmon NSW 1570
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Country [1]
294027
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Australia
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Primary sponsor type
Individual
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Name
David Campbell
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Address
Wakefield Orthopaedic clinic
270 Wakefield Street
Adelaide5000
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
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Address [1]
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Country [1]
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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Calvary Wakefield research and ethics committee
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Ethics committee address [1]
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Calvary wakeful Street Hospital 250 Wakefield Street Adelaide 5000 South Australia
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
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09/06/2004
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Approval date [1]
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21/03/2005
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Ethics approval number [1]
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REC ref: 2007 P1
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Summary
Brief summary
Aseptic loosening, wear and dislocation are complications of primary total hip arthroplasty that have a high cost to society and is unpleasant for the patient to endure. New technology has enabled manufactures to improve the mechanical strength of the bearing surfaces which function well in vitro. Cross-linked polyethylene a second generation polyethylene was introduced into orthopaedic implant designs to address the problems of osteolysis, which is induced by polyethylene wear particles. These implant designs also enable the constructs to accommodate larger femoral heads which create stability and low wear rates which will decrease the amount of osteolysis (Burroughs, Hallstrom et al. 2005) and (Geller, Malchau et al. 2006). X3 'Trademark' represents the third generation of polyethylene, and has been developed in order to address the issues of reduced mechanical properties compared with second generation cross-linked polyethylene, whilst still maintaining the benefits of reduced wear rates. Hip simulator testing shows that the wear rate of X3 polyethylene is significantly less than conventional cross-linked polyethylene (McKellop, Shen et al. 2000). This reduction in wear will result in significantly less wear particles around the joint and therefore less biological reaction, less osteolysis and a lower incidence of osteolysis induced component failure. This Radiostereometry analysis (RSA) study will investigate in vivo wear, migration and performance and the results will be compared to the current standard PE liners study using RSA as the form of analysis (Rohrl, Nivbrant et al. 2005). Hypothesis to be tested Part 1: Annual volumetric wear of the of the highly cross-linked polyethylene (X3 PE) lining used with a 32mm CoCr head is no more than 0.01mm/annum. Part 2: Annual volumetric wear of the of the highly cross-linked polyethylene (X3 PE) lining used with a large (36-40mm) CoCr heads is no more than 0.01mm/annum. Part 3: Annual volumetric wear of the of the highly cross-linked polyethylene (X3 PE) lining used with a Large (36-40mm) CoCr head and thin X3 PE is no more than 0.01mm/annum.
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Trial website
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Trial related presentations / publications
Second-generation Highly Cross-linked X3 ' Trademark' Polyethylene Wear: A Preliminary Radiostereometric Analysis Study David G. Campbell, John R. Field and Stuart A. Callary Clinical Orthopaedics and Related Research. 468 910), 2704-2709 , 2010 DOI: 10.1007/s11999-010-1259-y Low Wear of a Second-generation Highly Cross-linked Polyethylene Liner: A 5-year Radiostereometric Analysis Study Stuart A. Callary, John R. Field, David G. Campbell Clinical Orthopaedics and Related Research. 2013 Nov;471(11):3596-600. doi: 10.1007/s11999-013-3188-z. Epub 2013 Jul 27. Wear of highly crosslinked polyethylene acetabular components. Callary SA1, Solomon LB, Holubowycz OT, Campbell DG, Munn Z, Howie DW. Acta Orthop. 2015 Apr;86(2):159-68. doi: 10.3109/17453674.2014.972890. Epub 2014 Oct 10.
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Public notes
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Contacts
Principal investigator
Name
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A/Prof David Campbell
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Address
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Wakefield Orthopaedic clinic
270 Wakefield Street
Adelaide 5000
South Australia
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Country
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Australia
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Phone
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+61 8 82364196
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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David Campbell
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Address
67319
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Wakefield Orthopaedic clinic
270 Wakefield Street
Adelaide 5000
South Australia
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Country
67319
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Australia
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Phone
67319
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+61 8 82364196
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Name
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David Campbell
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Address
67320
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Wakefield Orthopaedic clinic
270 Wakefield Street
Adelaide 5000
South Australia
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Country
67320
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Australia
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Phone
67320
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+61 8 82364196
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Fax
67320
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Email
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
Source
Title
Year of Publication
DOI
Embase
The rate of wear of second-generation highly crosslinked polyethylene liners five years post-operatively does not increase if large femoral heads are used.
2016
https://dx.doi.org/10.1302/0301-620X.98B12.37682
Dimensions AI
Large articulations do not increase wear rates of thin second-generation highly cross-linked polyethylene liners at ten years
2023
https://doi.org/10.1302/2633-1462.411.bjo-2023-0124.r1
N.B. These documents automatically identified may not have been verified by the study sponsor.
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