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Chloroquine phosphate has shown apparent efficacy in treating Covid-19
- weekay 7y agoChloroquine phosphate, an old drug for treatment of malaria, is shown to have apparent efficacy and acceptable safety against COVID-19 associated pneumonia in multicenter clinical trials conducted in China. The drug is recommended to be included in the next version of the Guidelines for the Prevention, Diagnosis, and Treatment of Pneumonia Caused by COVID-19 issued by the National Health Commission of the People's Republic of China for treatment of COVID-19 infection in larger populations in the future.
- ascorbic 7y agoYes, that's the abstract
- hackeerTwo 7y agoOr is it?
- Sylamore 7y agoI've been watching the videos in this youtube channel today, where the last couple of videos have talked about this finding : https://youtu.be/U7F1cnWup9M https://youtu.be/U7F1cnWup9M and https://youtu.be/vE4_LsftNKM https://youtu.be/vE4_LsftNKM Basically the goal is to allow zinc to get into a cell, it needs a helper to get inside the cell (a Zinc Ionophore). Apparently based on the 2nd video, Hydroxychloroquine is even more effective than Chloroquine. It's really important to note however that these are lab based findings, not from studies on patients.
- biolurker1 7y agoyes they tried it on ICU patients with better outcomes
- jbourne007 7y agoDo you have a reference or source for this? Thx.
- jbourne007 7y agoOne would think there would be easier ways to get Zinc into a cell. Does one really have to go for a drug for this? There have to be alternatives?
- jbourne007 7y agoI looked around and found naturally occurring zinc ionophores: https://pubs.acs.org/doi/abs/10.1021/jf5014633 https://pubs.acs.org/doi/abs/10.1021/jf5014633 Quercetin is present in Red Onions and Epigallocatechin-gallate in green tea. Don't know if they are as effective etc but there's got to be alternatives to Chloroquine....
- robocat 7y agoI read some links implying that Quercetin was potentially useful against coronavirus, although they sounded a bit like PR/sales, and site that had links is down (bad sign?) so I can't find the links now. Edit: https://www.macleans.ca/news/canada/a-made-in-canada-solution-to-the-coronavirus-outbreak/ https://www.macleans.ca/news/canada/a-made-in-canada-solutio...
- Parrot_Bay 7y agoWhat about zinc lozenges dissolved in the mouth, followed by a can or two of tonic water infused with green tea or matcha and a few drops of bay leaf essential oil. Essential oils have been evaluated for their inhibitory activity against SARS-CoV and HSV-1 replication in vitro by visually scoring of the virus-induced cytopathogenic effect post-infection. Laurus nobilis oil exerted an interesting activity against SARS-CoV with an IC(50) value of 120 microg/ml and a selectivity index (SI) of 4.16. This oil was characterized by the presence of beta-ocimene, 1,8-cineole, alpha-pinene, and beta-pinene as the main constituents. https://onlinelibrary.wiley.com/doi/epdf/10.1002/cbdv.200890045 https://onlinelibrary.wiley.com/doi/epdf/10.1002/cbdv.200890...
- easytiger 7y agohttps://factcheck.afp.com/chloroquine-has-not-been-approved-treatment-covid-19 https://factcheck.afp.com/chloroquine-has-not-been-approved-... Some enterprising Nigerian has apparently been trying to illegally sell it in the UK at least.
- shoyer 7y agoFor a slightly more balanced perspective, try this paper: https://www.sciencedirect.com/science/article/pii/S0166354220301145 https://www.sciencedirect.com/science/article/pii/S016635422...: Highlights from that paper (all of which look quite reasonable to me, as a non-expert): • In vitro data suggest that chloroquine inhibits SARS Cov-2 replication. • In past research, chloroquine has shown in vitro activity against many different viruses, but no benefit in animal models. • Chloroquine has been proposed several times for the treatment of acute viral diseases in humans without success. • The outcomes of some current clinical trials of chloroquine in China have been announced, without access to the data. • Peer review of the results and an independent assessment of the potential benefit for patients are essential.
- weekay 7y ago>The outcomes of some current clinical trials of chloroquine in China have been announced, without access to the data. This seems to be the link to the details of clinical trials in China that are made available http://www.chictr.org.cn/searchproj.aspx?title=氯喹&officialname=&subjectid=&secondaryid=&applier=&studyleader=ðicalcommitteesanction=&sponsor=&studyailment=&studyailmentcode=&studytype=0&studystage=0&studydesign=0&minstudyexecutetime=&maxstudyexecutetime=&recruitmentstatus=0&gender=0&agreetosign=&secsponsor=®no=®status=0&country=&province=&city=&institution=&institutionlevel=&measure=&intercode=&sourceofspends=&createyear=0&isuploadrf=&whetherpublic=&btngo=btn&verifycode=&page=1 http://www.chictr.org.cn/searchproj.aspx?title=氯喹&officialna...
- yorwba 7y agoI checked the most recent result from that search: http://www.chictr.org.cn/showproj.aspx?proj=50843 http://www.chictr.org.cn/showproj.aspx?proj=50843 At the very bottom, it says "original data will be published on web-based public database in 6 months after the research" which is a bit disappointing.
- _-___________-_ 7y agoWhat would be the motivation for that 6 month delay? Cynically it only seems like a way to grab headlines without any possibility of informed criticism, but I really want to believe that there are other possible motivations!
- allovernow 7y agoHonestly this is a perfect example of a time when laws are excessively restrictive. I should have the right to purchase this drug and use it as a last resort in the case that I or my family are infected. It's not fair to responsible people who are capable of researching safety and dosages to have to pay for the ignorance of others. Especially when this drug is OTC in most of the world. You don't need a medical degree to safely administer most drugs - and you should have the right to take that risk, even if that means ignorant people getting hurt or dying.
- saagarjha 7y agoWhat if the drug causes humans to die two weeks after taking it?
- scarejunba 7y agoThen you'll know because I volunteered for it. And I know I won't die because it's already safe enough to fight malaria. But maybe you don't know that. That's fine. I do. Let me arbitrage my knowledge.
- saagarjha 7y ago> Then you'll know because I volunteered for it. Clinical trials are already fast-tracked during epidemics; if you're really interested you may even be selected for one. But going out and randomly buying medicine because it seems like it might work (even though it might not, but you're cured without it, which means you're going to go out and tell everyone else to go buy it too) might not necessarily be the best way to deal with this. > But maybe you don't know that. I am aware of chloroquine's use in malaria treatment.
- scarejunba 7y ago> But going out and randomly buying medicine because it seems like it might work (even though it might not, but you're cured without it, which means you're going to go out and tell everyone else to go buy it too) might not necessarily be the best way to deal with this. Hey, that's okay, let me live or die on my own terms. It's my body. Stop trying to rule it. I'm not making you take it. How about you don't make me not take it.
- deleted 7y ago[deleted]
- Cantbekhan 7y agoThis is old news by this time. As I commented on previous threads. https://news.ycombinator.com/item?id=22534339 https://news.ycombinator.com/item?id=22534339 Yes chloroquine has been shown effective in vitro (https://www.nature.com/articles/s41422-020-0282-0 https://www.nature.com/articles/s41422-020-0282-0). Yes hydroxichloroquine has been shown effective in vitro very recently as well (https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa237/5801998 https://academic.oup.com/cid/advance-article/doi/10.1093/cid...). Yes both compounds are already actively being used and approved for use by Asian and EU countries against Covid19: Here are the Netherlands treatment guidelines (in Dutch): https://lci.rivm.nl/covid-19/bijlage/medicamenteuze-behandelopties https://lci.rivm.nl/covid-19/bijlage/medicamenteuze-behandel... Here are the Italy treatment guidelines (in Italian): http://www.simit.org/medias/1555-covid19-linee-guida-trattamento-01mar.pdf http://www.simit.org/medias/1555-covid19-linee-guida-trattam... How they found out about it: https://www.jqknews.com/news/388543-The_novel_coronavirus_pneumonia_has_short_term_curative_effect_on_the_treatment_of_new_crown_pneumonia.html https://www.jqknews.com/news/388543-The_novel_coronavirus_pn... Approval and recommendation of the chinese: https://pubmed.ncbi.nlm.nih.gov/32075365-expert-consensus-on-chloroquine-phosphate-for-the-treatment-of-novel-coronavirus-pneumonia/ https://pubmed.ncbi.nlm.nih.gov/32075365-expert-consensus-on... https://pubmed.ncbi.nlm.nih.gov/32074550-breakthrough-chloroquine-phosphate-has-shown-apparent-efficacy-in-treatment-of-covid-19-associated-pneumonia-in-clinical-studies/ https://pubmed.ncbi.nlm.nih.gov/32074550-breakthrough-chloro... I don't think there is much doubt left about it's efficiency at this stage. Hydroxichloroquine is much safer than chloroquine and it's just a 5 day course at pretty low dosage (2x400mg on day1 as a charge dose, then 2x200mg for 4 days). More importantly, the drug is readily available, mass producded and doesn't cost 300$+/box like lopinavir/ritonavir. This drug isn't also 100% experimental and probably in the 3 digits rangs like remdesivir. The only real issue is that with a lot of doctors using it, the temporary shortage of the drug could be troublesome for many Lupus patients around the world who depend on Plaquenil for their management.
- vijayr02 7y agoI just posted a story about a vaccine being found. Would be great to know from the experts in this area if the approach they describe in the article makes sense https://news.ycombinator.com/item?id=22565460 https://news.ycombinator.com/item?id=22565460
- mirekrusin 7y agoCrypto is great, you can see from price charts when they found potential cure. Bit like twitter, but faster.
- deleted 7y ago[deleted]
- newsbinator 7y agoI can't seem to find information on whether Chloroquine would be taken prophylactically to be effective, or only after diagnosis and symptoms appear.
- 9nGQluzmnq3M 7y agoThis will be a moot point for the foreseeable future, since if this actually works, limited supplies will be redirected to people who are actually infected.
- sudosysgen 7y agoChloroquine is relatively easy to make. I think if prophylactic usage is recommended thousands of tons of the stuff will be produced in very short order.
- Cantbekhan 7y agoSome GPs in some EU countries did decide do take it prophylactically due to lack of PPE. But most around me agree this is a risky and probably bad advice. The current publicly available guidelines do not recommend taking it before you develop symptoms and do not recommend taking it at all if you are asymptomatic and/or very young. And also certainly they do not recommend any self medication without doctor's approval as there can be serious adverse effects with chloroquine (less with hydroxichloroquine). Also this would have a terrible effect and indeed cause supply shortages as another commenter pointed out.
- tim333 7y agoProbably works as a prophylactic. Unproven. I'm actually taking it at the malarial prophylactic dose (500mg/wk). There is some info here from a doctor https://www.reddit.com/r/medicine/comments/fbfj0r/covid19_prophylaxis_in_healthcare_workers/ https://www.reddit.com/r/medicine/comments/fbfj0r/covid19_pr... There is some evidence that hydroxychloroquine may be better as a prophylactic. Here's medcram talking about it from in vitro results https://youtu.be/vE4_LsftNKM?t=192 https://youtu.be/vE4_LsftNKM?t=192 Re real patients I thought this interesting on lupus patients using hydroxychloroquine at a hospital in Wuhan: >In the early stage of the study group, through the clinical analysis of 178 patients with new coronavirus received by the hospital from December 2019, it was found that none of them was systemic lupus erythematosus. After that, in the consultation of 80 patients with systemic lupus erythematosus treated by dermatology department of the hospital, it was found that they were not infected with new coronavirus pneumonia. https://www.jqknews.com/news/388543-The_novel_coronavirus_pneumonia_has_short_term_curative_effect_on_the_treatment_of_new_crown_pneumonia.html https://www.jqknews.com/news/388543-The_novel_coronavirus_pn... Which suggests it may work in real life. Lupus patient get a pretty high dose but looking at the in vitro stuff it looks like a low dose say 400mg/wk might work. There may be a possibility here to save millions of lives - if this does go full pandemic with 60% global infection, taking say weekly hydroxychloroquine might reduce the effects to something mild flu rather than ICU death. It seems to me enough upside to make it worth doing a serious research effort which I don't think is being done.
- baybal2 7y ago> • The outcomes of some current clinical trials of chloroquine in China have been announced, without access to the data. Shameless tangent, China has just booted its most competent respiratory disease epidemiologist from heading epidemic control committee for not backing Xi Jinping's "herbal remedies" https://www.taiwannews.com.tw/en/news/3895540 https://www.taiwannews.com.tw/en/news/3895540
- dakom 7y agowhy does a search lead me to an article with the exact opposite story? http://www.china.org.cn/china/2020-02/19/content_75720773.htm http://www.china.org.cn/china/2020-02/19/content_75720773.ht...
- true_religion 7y agoTaiwan isn’t Mainland China. The first source is from Taiwan, the 2nd from China. It’s up to you to choose which news source to believe, knowing that the former can print anything (including wild speculation) and the later will only print government approved information (including blatant obvious propaganda).
- baybal2 7y agoIt's quite tortuously contorted. He said he was proposing to launch proper clinical trials for "herbal remedies," dodging a request to give his blessing.
- dakom 7y agoSo the real story is he proposed doing scientifically valid testing, which could easily disprove their efficacy - and that somehow turned into "the experiments give some hope for the treatment of the novel coronavirus" ... due to a bad English translation?
- chalst 7y agoNo, the story is that he wants yes-men on the panel that assesses their efficacy, not independent scientists.
- rrggrr 7y agoZinc. Chloroquine provides zinc and ionosphere for absorbtion that likely stops replicase.
- jshevek 7y agoYes, I was reading about this recently. Another study compared zinc uptake into the cytosol for various extracellular zinc levels, with and without chloroquine. I noticed when looking at the data, that while chloroquine facilitated a massive uptake a zinc, it was still true that increasing the extracellular zinc concentration (without chloroquine) still increased the cytosol's zinc concentration (by a lesser amount). I promptly ordered zinc supplements. Obviously I'll see a doctor if I have symptoms, but I'll also hedge my bets.
- beagle3 7y agoOne of the side effects of zinc overdose is loss of sense of smell, sometimes permanently. Please research all aspects before use.
- gjs278 7y agoyou'd have to take ridiculous amounts of zinc for long periods of time for that to happen.
- kkarakk 7y agoyou get prepackaged 25mg tablets of zinc for bodybuilding. most people will get those and the recommended dosage is one every night. i don't think anyone except hypochondriacs are in danger of zinc overdose
- beagle3 7y agoI was told by a lady behind me in line in the store yesterday (who had taken 10 packs) that she intends to take 1 per day but if she feels bad she’ll take 4 per day until she overcomes the covid. There is enough stupidity around in normal times, and now is worse.
- babayega2 7y agoIn Africa when you suffer from Malaria they gradually give you Chloroquine, Amodiaquine or even Quinine. From my experience, Quinine is the strongest. I grew up taking those medicines. Man. They knock you out. Your ears are no longer working the first 3 days of taking Quinine. You lose the sense of smell. I guess they slow down the Corona 19 virus. My mom has already sent me Amodiaquine and Quinine here in Italy.
- droopyEyelids 7y agoChloroquine encourages cells to take in zinc, zinc inhibits RdRP, RdRP builds copies of viruses. Thats the mechanism that works in test tubes, but not in humans so far. Pulling Zinc into cells is what determines this hypothetical effect, not to be confused with whatever has the strongest side effects.
- zackmorris 7y agoThere are many papers online giving confidence that 50-80 mg zinc (gluconate) reduces colds by a day or two and 1000-2000+ IU vitamin D3 reduces flu by a day or two. So while I disagree with your conclusion that Chloroquine won't work, I wish I could give you 100 points for making the connection between zinc and RdRP. Edit: just did a search and your insight led to this study on zinc and Coronavirus from 2010: https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1001176 https://journals.plos.org/plospathogens/article?id=10.1371/j... Abstract Increasing the intracellular Zn2+ concentration with zinc-ionophores like pyrithione (PT) can efficiently impair the replication of a variety of RNA viruses, including poliovirus and influenza virus. For some viruses this effect has been attributed to interference with viral polyprotein processing. In this study we demonstrate that the combination of Zn2+ and PT at low concentrations (2 µM Zn2+ and 2 µM PT) inhibits the replication of SARS-coronavirus (SARS-CoV) and equine arteritis virus (EAV) in cell culture. The RNA synthesis of these two distantly related nidoviruses is catalyzed by an RNA-dependent RNA polymerase (RdRp), which is the core enzyme of their multiprotein replication and transcription complex (RTC). Using an activity assay for RTCs isolated from cells infected with SARS-CoV or EAV—thus eliminating the need for PT to transport Zn2+ across the plasma membrane—we show that Zn2+ efficiently inhibits the RNA-synthesizing activity of the RTCs of both viruses. Enzymatic studies using recombinant RdRps (SARS-CoV nsp12 and EAV nsp9) purified from E. coli subsequently revealed that Zn2+ directly inhibited the in vitro activity of both nidovirus polymerases. More specifically, Zn2+ was found to block the initiation step of EAV RNA synthesis, whereas in the case of the SARS-CoV RdRp elongation was inhibited and template binding reduced. By chelating Zn2+ with MgEDTA, the inhibitory effect of the divalent cation could be reversed, which provides a novel experimental tool for in vitro studies of the molecular details of nidovirus replication and transcription.
- ustamills 7y agoIsn't that the "tonic" in "Gin & Tonic" ?
- _-___________-_ 7y agoIt's an analogue of quinine, which tonic water nowadays may contain varying (quite small) amounts of, depending on brand etc. G&Ts almost certainly won't have any effect on your susceptibility to infection nor your prognosis once infected. But they might help with (or make worse?) the anxiety associated with the panic.
- khafra 7y agoTonic water can contain up to 83mg/L actual quinine. Three 2L bottles of tonic water could get you 500mg, a therapeutic dose of quinine. Unfortunately, I have not found any place that manufacturers note how much quinine is in their tonic water.
- _-___________-_ 7y agoYeah, I remember reading something similar years ago. But I suspect with the proliferation of "craft tonic water" there may be some "flavours" that don't contain quinine at all. And 6L of tonic water is... quite a lot.
- auntienomen 7y agoI read somewhere that gin & tonic was invented because they needed the gin to cover up the taste of the quinine, since the tonic needed to have a _lot_ of quinine to be effective. Shudder.
- _-___________-_ 7y agoYeah, I think something related to the British navy?
- 7y ago
- procinct 7y agoHow long would we expect it to take to find out if this is something that can widely be used to combat Covid-19?
- tanilama 7y agoLet us see how CDC will use this drug and do not make our own conclusions. If it helps it helps.
- hkt 7y agoThis seems pretty inconclusive to me; as noted by other posters, we have no data from some of the trials in China and peer review of the potential patient benefits hasn't materialised yet. Not trying to be a downer, but.. As an aside, the number of preppers and conspiracy theorists out on HN under stories like this is awful. Remember, the world has vast infrastructures (CDC, WHO, NHS and equivalents) for working out the right course of action in these situations. They are staffed by professionals who understand how medicine and medical trials work, and how and when to deploy public health measures. I'm not saying their word is law, but hanging out on internet forums and then panic buying random stuff which isn't obviously efficacious off the back of a misunderstanding of the science is not personally or socially productive. At worst, it harms people in genuine need and stymies the ability of society to respond.
- sundbry 7y ago> random stuff which isn't obviously efficacious off the back of a misunderstanding of the science 1) It's not random stuff; there is associated research and a theory of operation how it counteracts the virus 2) Lacking obviousness? By the time the research is settled, you may be very sick already. 3) There is no misunderstanding, there is a risk analysis based on the currently available knowledge. Risk of chloroquine poisoning X probability of effectiveness X risk of acute viral infection. 4) Crowd-sourcing information has shown to be very effective in other times of crisis, a viral outbreak is no different. The internet is not a place for the information police. We share our ideas here.
- blacksqr 7y agoSouth Korea experts recommend anti-HIV, anti-malaria drugs for COVID-19 [1] Mentioned: Kaletra, an anti-HIV medication that includes the drugs lopinavir and ritonavir. Hydroxychloroquine, sold under the brand name Plaquenil. [1] https://www.upi.com/Top_News/World-News/2020/03/12/South-Korea-experts-recommend-anti-HIV-anti-malaria-drugs-for-COVID-19/6961584012321/ https://www.upi.com/Top_News/World-News/2020/03/12/South-Kor...
- jennyyang 7y agoAccording to this verified tweet, Kaletra didn't seem effective (point #5 in the linked images) https://twitter.com/katyw2004/status/1236848300143280128 https://twitter.com/katyw2004/status/1236848300143280128 verification tweet: https://twitter.com/mshah85/status/1237231277251514368 https://twitter.com/mshah85/status/1237231277251514368
- djrogers 7y agoJust lol'd at the concept of a 'verification tweet'... Seriously folks - just because someone on Twitter sounds authoritative, doesn't mean they are spouting facts.
- 0xff00ffee 7y agoChloroquine is a really interesting drug because it is derived from quinine which is one of those "early history medicine man/woman" kinda things (Quechas) that turned out to be effective for two things: antiviral properties and great taste. * It was used for centuries to combat malaria until it recently (~10yrs) became ineffective (I took some in the 80's for a year while working in Central America and had amazing dreams). * It is the basis many awesome aperitifs: Byrrh, Bonal, [tonic water,] and other herbaceous spirits If it can be used as an antiviral for COVID-19, well, that would be a really cool example of an old/ancient medicine still doin' its thing.
- lowdest 7y agoMore gin and tonic == less coronavirus. Got it. That's some specious logic I can get behind.
- herf 7y agoPaper's main source seems to be a news briefing in Chinese. Here's google translate: "We organized more than a dozen hospitals in Beijing, Guangdong and Hunan provinces to jointly evaluate the safety and effectiveness of chloroquine phosphate in the treatment of new coronary pneumonia. In the clinic, we are very sure to see the curative effect, whether it is from the rate of exacerbation, antipyretic phenomenon or the image improvement time of the lungs, the negative time and negative rate of viral nucleic acid, and the shortening of the disease course, and a series of indicators, systematically Based on comprehensive research, the medication group was better than the control group. For example, a patient in Beijing was admitted to the hospital on the 4th day of the onset of disease at the age of 54. One week after taking the medicine, the nucleic acid turned negative, and all the indicators improved, meeting the criteria for release and isolation." "Audio transcript of the news briefing held by the State Council of China on February 17, 2020. The National Health Commission of the People's Republic of China. http://www.nhc.gov.cn/xcs/yqfkdt/202002/f12a62d10c2a48c6895cedf2faea6e1f.shtml http://www.nhc.gov.cn/xcs/yqfkdt/202002/f12a62d10c2a48c6895c... (accessed February 18, 2020). (in Chinese)" Third reference in https://www.jstage.jst.go.jp/article/bst/advpub/0/advpub_2020.01047/_pdf/-char/en https://www.jstage.jst.go.jp/article/bst/advpub/0/advpub_202...
- mnm1 7y agoCan this be used off label now? Or do we have to wait for our incompetent bureaucracy again, like with the testing, while ignoring tools that work?
- tim333 7y agoThat paper is old and a bit vague. A more recent report is from a trial with 120 patients at Sun Shanxian Memorial Hospital. 110 got better with chloroquine, the hospital's coronavirus tests showed negative on average 4.4 days after starting treatment. Report "Expert: Chloroquine Phosphate has a negative time of 4.4 days, faster than other drugs" (google translate) http://news.southcn.com/nfplus/gdjktt/content/2020-03/09/content_190536632.htm http://news.southcn.com/nfplus/gdjktt/content/2020-03/09/con... I posted it on reddit (271 comments) https://www.reddit.com/r/COVID19/comments/ffztou/expert_chloroquine_phosphate_has_a_negative_time/ https://www.reddit.com/r/COVID19/comments/ffztou/expert_chlo...
- retinadoc 7y agoFrom the virologist who recognized Chloroquine as an anti-viral in 2006: https://medium.com/@savesightmd/an-old-drug-for-the-new-virus-a6fd6a0843bc https://medium.com/@savesightmd/an-old-drug-for-the-new-viru...
- known 7y agoChloroquine, a drug mostly used against malaria, was shown in the 2000s to have some effect on SARS-CoV; in cell-culture studies it both reduces the virus’s ability to get into cells and its ability to reproduce once inside them, possibly by altering the acidity of the Golgi apparatus http://archive.vn/yfAWD http://archive.vn/yfAWD
- ocean1 7y agoHas anyone true evidence that drinking Gin reduces the risk of a Corona infection
- mdoval 7y agoOne more reason to love gin and tonic! I had a feeling this old-time, classic drink crafted by the British to make malaria prophylaxis quinine more palatable and fun in colonial times, in India I believe, was a winner. From the bark of "cinchona" trees in Peru, quinine derivatives, are now showing some promise to treat SARS Cov-2. This is quite amazing.
- deleted 7y ago[deleted]
- bschultz 7y agohttps://www.ncbi.nlm.nih.gov/pubmed/23607047 https://www.ncbi.nlm.nih.gov/pubmed/23607047