Journal of Preventive Medicine and Public Health

Volume 32(1); February 1999

Original Articles

Urinary Levels of Arsenic, Cadmium, and Zinc of Children in Ulsan Industrial Area.: Choong Ryeol Lee, Cheol In Ryu, Ji Ho Lee, Sung Ryul Kim, Jin Young Jeong; Korean J Prev Med. 1999;32(1):1-8.

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We conducted this study to obtain basic data of urinary levels of arsenic, cadmium, and zinc in children of Ulsan industrial area and to evaluate the difference in urinary levels of these metals between industrial area and suburban area. METHODS: The study subjects were composed of 348(male 182, female 166) school children residing in industrial area and 100(male 50, female 50) school children of suburban area. We analyzed urinary levels of arsenic, cadmium, and zinc using atomic absorption spectrophotometer. RESULTS: The geometric means of urinary levels of arsenic, cadmium, and zinc of study participants were 3.69, 0.99, 282.49 microgram/L respectively. The adjusted geometric means of urinary levels of arsenic, cadmium, and zinc of study participants were 3.92, 1.05, 299.92 microgram/g creatinine respectively. CONCLUSIONS: The children residing in industrial area had the higher urinary levels of arsenic and cadmium than suburban children with statistical significance(p<0.01).; Summary

Relationship between Adolescent Obesity and Socioeconomic Status of Parents: In Seoul, Yangpyong, and Yanbian Area.: Moran Ki, Bo Youl Choi, Mi Kyoung Kim, Jin Nu Fang, Chun Ying Xu, Dong Hyon Ahn, Yun Ju Kang; Korean J Prev Med. 1999;32(1):9-16.

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Few studies have attempted to explain the association between socioeconomic status (SES) and obesity in Korea. Especially the studies on same race with different SES at same time are good for SES influence estimation. The present study highlights the influence of SES of parents on adolescent obesity. The subjects are the same race, but live in different areas, with different SES, Seoul and Yangpung in Korea, and Yanbian in China. METHODS: The cross-sectional study was conducted in Mar-Jun 1996. We carried out anthropometry, 24 hour-recall diet survey, self-reported questionnaire about sociodemographic characteristics and physical activity. For SES indicators, we used income and education of parents. RESULTS: The relationship between SES of parents, defined as educational status, and obesity in boys in Korea and China is direct, but not significant. The relationship is inverse and non-significant among Korean girls. However, for the Korean girls in severe obesity, the relationship is significant. For the Korean-Chinese girls, there is an inverse relationship between the education level and obesity but a direct relationship between the income level of parents and obesity. For the Korean adolescent, there are a direct association between the SES of parents and the nutrients factors such as energy, protein, and fat intake. The energy expenditure of adolescent has no relationship with SES of parents. CONCLUSION: Among boys, the higher the SES, the greater the risk of obese. Among girls in Korea and Korean-Chinese, on the other hand, the lower the educational status of parents, the greater the risk of obese.; Summary

Basic Study on the Hearing-threshold Levels of Workers with Noise-induced Hearing Loss in Korea.: Yeon Soon Ahn, Young Han Moon, Sang Yeal Lee, Kyung Nam Lee; Korean J Prev Med. 1999;32(1):17-29.

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This study was carried out to analyze the hearing-threshold levels and relating factors of 1,048 workers with noise-induced hearing loss(D1). METHODS: We analyzed the hearing-threshold levels and relating factors of 1,048 workers with noise-induced hearing loss(D1) examined by the summary reports of specific health examination results of industries and personal reports of specific health examination results reported by 58 specific health examination institutes and 8 secondary pneumoconiosis examination institutes in 1996. RESULTS: Among 1,048 workers at 510 workplaces, male workers were 1,009 (96.3%) and female workers were 39 (3.7%). The mean ages of workers initially exposed to noise and at present were 28.7 and 47.2, respectively. The duration of total exposure was 16.5 years. Average hearing-threshold levels analyzed by three-divided classification of the study subjects were 43.7dB(Lt) and 42.6dB(Rt). Those analyzed by six-divided classification were 50.5dB(Lt) and 48.6dB(Rt). Among workers with noise-induced shearing loss(D1), 16.3% was unilateral hearing loss and 84.6% was classified to compensation case. 8.8%(Rt) and 10.2%(Lt) of them were suspected to be conductive hearing loss by differences of air-bone hearing-threshold levels. Hearing-threshold levels of workers in manufacturing industry were significantly increased during the short exposure compared with the levels in mining industry. Among manufacturing industries, hearing-threshold levels of workers in trailer and other transportation equipment manufacturing industry were significantly increased. Age and duration of total noise exposure were not significantly related to the average hearing-threshold levels analyzed by three-divided classification. Hearing-threshold levels of female workers were significantly increased during the short exposure compared with those of male workers. Hearing-threshold levels of workers at the high risk group, ages of 20s, 30s and total exposure duration of less than 10 years, were not significantly increased compared with those of the other groups. However, they were exposed at young ages. The 3 leading industries of workers at high risk group were trailer and other transportation equipment manufacturing, automobile manufacturing and assemble-metal manufacturing industries. CONCLUSIONS: This study was the first nationwide analysis of the hearing-threshold levels and relating factors of workers with noise-induced hearing loss(D1). We found the differences of the real number by the statistics of the department of labour and the expected number of worker's compensations for occupationally-induced hearing loss estimated by this study. According to the results of this study, we should carefully examine the methods to narrow this difference.; Summary

Evaluation of Puretone Threshold Using Periodic Health Examination Data on Noise-exposed Workers in Korea .: Kyoo Sang Kim, Yangho Kim, Jung Keun Choi, Jung Sun Park, Young Han Moon; Korean J Prev Med. 1999;32(1):30-39.

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This study was carried out to evaluate hearing impairment judgement and to investigate the differences in various diagnostic criteria for noise-induced hearing loss (NIHL) among workers who required for close observation (C). METHODS: Out of 731,029 workers who had taken the specific periodic health examination in 1994, we used the audiometric data on 37,999 workers (C) eliminating the employees who had previous otologic problems. Many investigators have being using different criteria for the evaluation of hearing impairment. In this study, we used the criteria of early (1989-1994), current, compensation for NIHL in Korea, 2-, 3-, 4-divided classification and hearing loss at 4,000 Hz and compared the evaluation results. RESULTS: The prevalences of C and workers who had occupational disease (D1) diagnosed for NIHL were 11.1 % and 0.44 %. There were significant difference in the prevalences of C and D1 depending on different province of Korea. Pure tone averages (PTAs) were not appropriately applied in their evaluation. 97% of workers whom we studied on were below the level of mild hearing loss judged by ISO standard. However, there were wide variations in the prevalence rate of mild hearing loss by diagnostic criteria. Thus, there were different judgements in determining the degree of NIHL depending on which diagnostic criteria were utilized. PTAs were found 20.54 (Rt) and 20.74 (Lt) when the method of 3-divided classification was applied for audiometric data. The degree of hearing impairment of the left ear was more severe than that of right ear. The prevalence of normal hearing threshold below 20 dB was 75.4% and the range of difference in both ear was below 10 dB. Right sided hearing threshold levels were 21.08 dB (500 Hz), 18.44 dB (1,000 Hz), 22.09 (2,000 Hz) and 52.36 dB (4,000 Hz). There was typical high frequency loss (C5-dip at 4,000 Hz) above 30 - 40 dB in normal hearing level. The increasing trend in hearing threshold level was gradually decreased by the increase of PTAs. The difference between PTAs and threshold at 4,000 Hz was about 10 dB. CONCLUSIONS: We could found that PTAs in the previous examination were not appropriately evaluated. This study revealed that they did not use unique criteria for managing the workers of NIHL. For the prevention of NIHL, it was found that the quality control on diagnosis and comprehensive management program were required, especially for those of hearing loss (C).; Summary

Prevalence Estimation of Several Chronic Diseases through Community Based Health Examination Survey.: Soon Young Lee, Geun Shik Han, Young Ok Kim, Hae Kyung Kim, Byoung Hyun Min; Korean J Prev Med. 1999;32(1):40-47.

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The health examination survey was conducted in order to estimate the prevalence of major chronic diseases in a community. METHODS: A multi-stage stratified probability sample of 1,656 persons, aged from 20 to 69 years, was drawn out from Kuri City. All sampled persons were personally informed of the purpose, content and procedures of the survey and mobile examination center was run between 6 AM and 9 PM for the convenience of the participants. RESULTS: 854 persons (339 males and 515 females) completed this survey with a response rate of 53.4%. Prevalent diseases in male were hypertension(19.0%), HBs Ag carrier(9.8%), impaired glucose tolerance(8.7%), diabetes mellitus(6.3%), hypercholesterolemia(3.4%), anemia(2.7%) and degenerative arthritis(2.6%) in order of prevalence rate. Prevalent diseases in female were osteoporosis(22.5%), impaired glucose tolerance(17.3%), anemia(12.8%), hypertension(12.4%), degenerative arthritis (6.6%), HBs Ag carrier(5.8%), diabetes mellitus(5.4%) and hypercholesterolemia(3.5%) in order of prevalence rate. CONCLUSIONS: This results suggest that hypertension was most prevalent in adult male whereas diabetes mellitus including IGT, osteoporosis were most prevalent in adult female, in Kuri City.; Summary

The Relation Between Work-Related Musculoskeletal Symptoms and Rapid Upper Limb Assessment(RULA) among Vehicle Assembly Workers.: Jae young Kim, Jae wook Choi, Hae joon Kim; Korean J Prev Med. 1999;32(1):48-59.

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This study was conducted to evaluate the association between upper extremity musculoskeletal symptoms and Rapid Upper Limb Assessment(RULA) in vehicle assembly line workers. The goal of this study is to show the feasibility of RULA as a checklist for work related musculoskeletal symptoms (WMSDs) in Korean workers. METHODS: The total number of 199 people from the department of assembly and 115 people from the department of Quality Control(QC) in automotive plant were subjects for this cross sectional study. A standard symptom questionnaire survey has been used for the individual characteristics, work history, musculosketal symptoms and non-occupational covariates. The data were obtained by applying one-on-one interview for the all subjects. RULA has been applied for ergonomic work posture analysis and the primary ergonomic risk score was computed by RULA method. Association between upper extremity musculoskeletal symptoms and RULA were assessed by multiple logistic regression analysis. RESULTS: A total of 314 workers was examined. The prevalence of musculoskeletal symptoms by NIOSH case definition was 62.4%. The distribution of musculoskeletal symptoms by the part of the body turned out to be following; back:41.4%, neck: 32.8%, shoulder: 26.4%, arm: 10.5% and hand:29.3%. The relationship of the individual RULA scores were statistically significant for the prevalence of musculoskeletal symptoms. As the result of the multiple logistic regressioin analysis, grand final score (OR=2.250 95% CI: 1.402-3.612) was associated with musculoskeletal symptoms in any part of the body.; upper arm score(OR=1.786 95% CI: 1.036-3.079) and posture score A(OR=1.634 95% CI: 1.016-2.626) in neck; muscel use score(OR=3.076 95% CI:1.782-5.310) and posture score A(OR=1.798 95% CI: 1.072-3.017) in shoulder; upper arm score(OR=1.715 95% CI: 1.083-2.715) and muscel use score(OR=2.057 95% CI:1.303-3.248) in neck & shoulder; muscle use score(OR=10.662 95% CI: 3.180-35.742) in arm; writst/twist score(OR=2.068 95% CI: 1.130-3.786) and muscle use score(OR=2.215 95% CI: 1.284-3.819) in hand & wrist.; muscle use score of trunk (OR=2.601 95% CI: 1.147-5.901) in back. CONCLUSIONS: Musculoskeletal symptoms of the upper extremities were strongly associated with individual RULA body score. These results show that RULA can be used as a useful assessment tool for the evaluation of musculoskeletal loading which is known to contribute to work-related musculoskeletal disorders. RULA also can be used as a screening tool or incorporated into a wider ergonomic assessment of epidemiological, physical, mental, environmental and organizational factors. As shown in this study, complement of the analysis system for the other risk factors and characterizing between the upper limb and back part will be needed for future work.; Summary

Prediction Equations for FVC and FEV1 among Korean Children Aged 12 Years.: Jong Won Kang, Yeong Su Ju, Joohon Sung, Soo Hun Cho; Korean J Prev Med. 1999;32(1):60-64.

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Changes in lung function are frequently used as biological markers to assess the health effects of criteria air pollutants. We tried to formulate the prediction models of pulmonary functions based on height, weight, age and gender, especially for children aged 12 years who are commonly selected for the study of health effects of the air pollution. METHODS: The target pulmonary function parameters were forced vital capacity(FVC) and forced expiratory volume in one second(FEV1). Two hundreds and fifity-eight male and 301 female 12-year old children were included in the analysis after excluding unsatisfactory tests to the criteria recommended by American Thoracic Sosiety and excluding more or less than 20% predicted value by previous prediction equations. The weight prediction equation using height as a independent variable was calculated, and then the difference of observed weight and predicted weight (i.e. residual) was used as the independent variable of pulmonary function prediction equations with height. RESULTS: The prediction equations of FVC and FEV1 for male are FVC(ml) = 50.84 x height(cm) + 7.06 x weight residual - 4838.86, FEV1(ml) = 43.57 x height(cm) + 3.16 x weight residual - 4156.66, respectively. The prediction equations of FVC and FEV1 for female are FVC(ml) = 42.57 x height(cm) + 12.50 x weight residual - 3862.39, FEV1(ml) = 36.29 x height(cm) + 7.74 x weight residual - 3200.94, respectively.; Summary

Association between Cognitive Impairment and ADL of the Elderly in Rural Area.: Sang Kyu Kim, Seok Beom Kim, Pock Soo Kang; Korean J Prev Med. 1999;32(1):65-71.

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The purpose of this investigation was to study the correlation between cognitive impairment and activities of daily living(ADL) in the elderly of rural area. METHODS: The study population consisted of 210 elderly people aged 65 years and older, living in a district of Kyongju City. The cognitive impairment was measured with the Korean version of mini-mental state examination(MMSE-K) and newly constructed the Korean version of mini-mental state examination (K-MMSE). Bristol activities of daily living scale developed specifically to be used with people with dementia was used to measure ADL. RESULTS: The mean scores of both MMSE-K and K-MMSE were significantly different by sex groups and by age groups, respectively(p<0.05). The mean scores of ADL were significantly different by age groups(p<0.01) not by sex groups. Among the 4 components of ADL(instrumental activities of daily living(IADL), self care, orientation, and mobility), the mean score of the orientation was significantly higher in men(p<0.01); and IADL, orientation and mobility components were significantly different by age groups(p<0.01). ADL correlated well with MMSE-K (r=0.54) and K-MMSE(r=0.52) and showed higher correlation in female (r=0.73, 0.71) than male(r=0.27, 0.29). IADL and orientation showed significant correlation with MMSE-K(r=0.52, 0.62) and K-MMSE(r=0.50, 0.63), respectively(p<0.01). CONCLUSIONS: In developing and establishing a care model for people with dementia in the community, both cognitive impairment and the activities of daily living(ADL) need to be considered.; Summary

Quality Assessment of the Abstracts of the Original Articles (1997) in the Korean Journal of Preventive Medicine.: Jong Ku Park, Chun Bae Kim, Desmond Hannibal; Korean J Prev Med. 1999;32(1):72-79.

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The purpose of this study was to evaluate the quality of abstracts of original articles. METHODS: This subjects selected total 63 abstracts of the original articles of the Korean Journal of Preventive Medicine in 1997. The quality of abstracts was measured against a checklist of evaluation criteria, which were divided into eight categories and the numbers of inappropriate words (including grammar) according to criterion-based survey. A score for each abstract was obtained by dividing the number of criteria presented by the number applicable. The overall mean score was also determined. RESULTS: The overall mean score of abstract quality was 0.55 out of 1. Of the abstracts subject selection 83% didn't include specific technical descriptors. Of those that gave conclusions 92% didn't address study limitations and 78% made no recommendations for future study. The overall mean number of inappropriate usage of words (including grammar) per abstract was 14.1. The overall mean number of English words was 283. In the multiple regression analyses, the research career of the first author and the number of English words to the number of inappropriate usage of words were statistically significant. Also, in the secondary regression model, the number of English words to the quality score of abstract was only statistically significant. CONCLUSIONS: Most of the abstracts provided some information pertaining to each evaluation criterion. However, they did not provide sufficient details to enhance the reader's understanding of the article. On the basis of the study the abstracts need improvement in its description of the reported subject selection, statements of limitations and recommendations, etc. The Korean Society for Preventive Medicine will recommend a proposal for more informative abstracts in Korean J Prev Med and will take into consideration the introduction of foreign review of abstracts. Future studies should address these issues and compare the quality of abstracts between different journals and their time of publication.; Summary

A study on the Statistical Distribution and Testing of Variation Indicies at the Small Area Variation Analysis .: Jungmo Nam, Sunhee Lee, Woohyun Cho; Korean J Prev Med. 1999;32(1):80-87.

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The Study of Small Area Variation(SAV) is most interesting issue in the health care researches. Most studies of SAV have been concluded the existences of variation on the basis of the magnitude of variation without statistical testing. But it is difficult to explain the existence of variation with this way because variation indicies are easily influenced by several parameters and also their distribution are skewed. So, it needs for the study to investigate the distribution of these indices and develop the statistical testing model. METHODS: This study was planned to analyze on the distribution of variation indices such as Extremal Quotient(EQ), Coefficient of Variation(CV), Systematic Component of Variation(SCV) and compare the statistical power among indicies. The simulations was performed on the basis of several assumptions and compared to the empirical data. RESULTS: Main findings can be summarized as follows. 1. If other conditions are constant, the more number of regions, the larger 95 percentile of EQ. But under same situation, 95 percentile of CV and SCV were slightly decreased. 2. If the size of regional population or utilization rate were increased, 95 percentile of all statistics were decreased. Also in the cases of small population size and low utilization rate, 95 percentiles of EQ showed various change contrast to the little change of CV. 3. If the difference at the size of regional population were increased, 95 percentiles of EQ and SCV were increased contrast to the little difference of CV 4. If the utilization rate were increased, 95 percentiles of all indicies were increased. But under the same difference of utilization rate, the power of CV and SCV were increased comparing to no change of the power of EQ. 5. Usually the power of EQ were lower than that of CV or SCV and it is similar between CV and SCV. CONCLUSIONS: Therefore, we suggest that in selecting the variation indicies at the SAV, CV or SCV are superior than EQ in terms of significance level and power.; Summary

Induction of Hepatic Microsomal Cytochrome P450 by N,N-dimethylformamide in Sprague-Dawley Rats.: Sang Baek Koh, Bong Suk Cha, Ki Joon Kim, Seung Kyu Kang, Hyo Seok Joung; Korean J Prev Med. 1999;32(1):88-94.

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In order to gain a better understanding of the mechanism of DMF toxicity, recent studies have focused on hepatic drug metabolizing enzymes. In this study, we investigated the effects of DMF on the induction of P450 and the activities of other related enzymes in rat liver microsomes. METHODS: DMF was administered to male Sprague Daweley rats by intraperitoneal injection at 0(control), 450(D1), 900(D2), 1,800(D3) mg DMF/kg body weight in olive oil once a day for three days. Hepatic P450 was measured by method of Omura and Sato. We evaluated selective assays for the three drug metabolizing cytochrome P450 isoenzymes 1A1, 2B1 and 2E1. RESULTS: The content of microsomal protein, P450 and b5 were tended to be decreased in DMF treated group, but they were not statistically significant. The activity of NADPH-cytochrome P450 reductase was significantly increased dose dependently(p<0.01), but the activity of NADH-b5 reductase was decreased in the treated group(p<0.01). The activities of PROD and EROD were not significant between control and treated group. The activities of pNPH in the DMF treated groups were higher than that of the control group(p<0.01). When Western immunoblottings were carried out utilizing three monoclonal antibodies which were specific against P4501A1/1, P4502B1/2 and P4502E1, the strong density band corresponding to P4502E1 was observed with the microsomes obtained from the rats treated with DMF. But there were no significant increased in the P4501A1/2 and P4502B1/2 band densities in immunoblotting. CONCLUSIONS: These result suggested that P4502E1 was inducible by DMF and P4502E1 isozyme might be responsible for the hydroxylation of DMF to HMMF.; Summary

Senior Medical Students' Attitudes toward and Knowledge about Breastfeeding.: Mi Young Lee, Mi Jung Kang, Choong Won Lee, Kyu Bok Jin, Eun Jung Suh, Jae Suk Ahn, Suk Kwon Suh; Korean J Prev Med. 1999;32(1):95-100.

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This study surveyed medical students attending clerkship to assess their attitude toward and knowledge about breastfeeding, and self-confidence to manage common breast-feeding problems. METHODS: A self-report questionnaire was administered to the 323 medical students at four medical colleges in Taegu in May 1997. The response rate was 92.9%, but the respondents used in the final data analysis were 245 (75.8%) due to missing variables. RESULTS: Overall, respondents showed equivocal attitudes toward breastfeeding (mean score 2.9 on a 6-point scale). Knowledge about breastfeeding was substantially low with the median % correct 39.2%. Of nine knowledge areas, weak areas were especially "contraindications and barriers to breastfeeding", "use of breastfeeding aids", "expression and storage of breast milk". Those reported to be confident to manage common breastfeeding problems were only 25.7%. Correlations between knowledge and self-confidence were not statistically significant except in college A (r=0.35, p<0.05). Correlations between knowledge and attitude were not significant. CONCLUSIONS: These results suggest that medical students attending clerkship in Taegu show equivocal attitudes toward breastfeeding, low self-confidence to manage common breastfeeding problems and have substantially limited level of knowledge. There should be more concerted efforts to improve this situation on the part of those involved in breastfeeding education.; Summary

Effects of Exposure to Hexavalent Chromium on the Level of 8-Hydroxydeoxyguanosine and the Activities of Superoxide Dismutase and 8-Hydroxyguanine Endonuclease in Rat Lung .: Heon Kim, Hun Sik Kim, Rosa Kim, Hyeon Yeong Kim, Jae Hwang Jeong; Korean J Prev Med. 1999;32(1):101-107.

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To determine the effects of exposure to hexavalent chromium, 93 male Sprague-Dawley rats were exposed to hexavalent chromium solution. METHODS: Rats were divided into 4 groups and exposed to 0.1 ml of 0 mM, 0.4 mM, 2.0 mM, and 10.0 mM potassium chromate in the first experiment, and to 0.1 ml of 0 mM, 20 mM, 40 mM, and 80 mM in the second for consecutive 3 days by tracheal instillation. Three and 10 rats were the controls for the first and the second experiments, respectively. Lung tissues were then removed to measure the 8-hydroxydeoxyguanosine (8-OH-dG) level using the HPLC-ECD method, superoxide dismutase (SOD) activity using the cytochrome C method, and 8-hydroxyguanine endonuclease activity using the oligonucleotide nicking assay. RESULTS: The results showed no significant linear relationship between chromium exposure level and 8-OH-dG level or 8-hydroxyguanine endonuclease activity. In the first experiment, 8-OH-dG level and 8-hydroxyguanine endonuclease activity increased in 0.4 mM group, and then decreased in 2.0 mM and 10.0 mM groups. The correlation coefficients between 8-OH-dG level and 8-hydroxyguanine endonuclease activity was statistically significant (P<0.01), and total SOD activity was elevated by chromium exposure in a dose-dependent manner (P<0.05). In contrast, there was no significant dose-response pattern or correlation in the second experiment. CONCLUSIONS: Based on the fact that there was no linear relationship between chromium dose and 8-OH-dG level or activity of the repair enzyme, it seems unlikely that 8-OH-dG formation is the major mechanism of chromium carcinogenesis.; Summary

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