International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - 14(13), July, 2022

Pages: 26-29

Date of Publication: 05-Jul-2022

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An Evaluation on the use of Photon-Induced Photoacoustic Streaming in Root Canal Treatment

Author: Khalifa A. Amina, Hwisa A. Sara

Category: Healthcare

Abstract:Introduction: The main purpose of endodontic treatment is to retain the involved teeth in the oral cavity for as long as possible by the prevention and elimination of infection in the root canal system. Irrigation of the root canal after instrumentation is a fundamental component of endodontic treatment success. It is mainly aimed to achieve debridement, smear layer removal, and disinfection of the entire root canal system. Recently, Photon Induced Photoacoustic Streaming (PIPS), which is an activation technique based on the using of Er:YAG (2.940nm) laser equipped with PIPS tip at sub-ablative energy levels, has been used to achieve this goal. Objective: Evaluate the ability of PIPS technique in removing smear layer and remnants. Material and Method: Review and summarize studies evaluated the effect of PIPS in root canal treatment. Results: Several in-vitro studies has been evaluated the evidence to support the benefit of PIPS technique over the traditional and other laser agitation techniques as an efficient method regarding removal of smear layer, remnants disinfection of root canal system and its benefits in other procedures. Conclusion: Photon-induced photoacoustic streaming in in-vitro studies seems to show better smear layer removal at coronal and middle thirds of root canal but not at the apical third, it has no superior effects compared with the other activation technique of endodontic solution.

Keywords: Endodontics, Erbium: YAG, Lasers, PIPS, Smear layer

Full Text:


Removal of tissue remnant and smear layer produced by root canal preparation, in addition to the disinfection of the root canal system, represents a key role of successful endodontic treatment. 1

Traditionally, this goal is achieved by a sequence of procedures aimed at the treatment of the infected root canal and its three-dimensional tubular network, starting with a good, effective diagnosis and evaluation of the case, followed by traditional mechanical root canal enlargement by means of rotary instruments, removal of infected pulp tissue, smear layer (SL), disinfecting of the root canal by chemical disinfection agents and filling with biocompatible materials. 2, 3

Since the invention of the laser and the first research on using CO2 in endodontics by Weichman and Johnson in 1971,4 a considerable number of studies and experiments have been conducted to evaluate and investigate the benefit of lasers as an adjunct to root canal treatment.5, 6 The clinical use of lasers in root canal treatment was introduced by the development of the new delivery systems of lasers including thin and flexible fibers and endodontic tips in the late 1990s.7 This adjunctive application is primarily aimed to eradicate bacteria and their toxins and remove the pulpal tissue remnant and SL from the root canal.8

Photon-induced photoacoustic streaming, specific Laser-activated irrigation (LAI) technique, is based on the radial firing stripped tip with a laser of sublative evaporated at very low energies of 20 mJ at 15 Hz for an average power of 0.3 W at 50 μs impulses of the Er: YAG 2940nm.9 The impulses create an interaction of water molecules with peak powers of 400 W.10 This creates an expansion and successive shock waves lead to the formation of very powerful streaming of the fluid located inside the root canal, with no rising of temperature.11 The authors also stated that the energy conversion efficacy is larger when a conical fiber tip is used, with higher pulse energy and lower pulse duration.12

The newly designed radical quartz tip of 400µm diameter and 12mm long PIPS tip, stripped 3mm at its distal end, is not required to be placed inside the canal system itself but rather in the pulp chamber only. This reduces the need for using larger files and rotary instruments to create larger canal shapes to open the system Divito et al. 2012.13

The objective of this study was to evaluate the ability of the PIPS (Photon-Induced Photoacoustic Streaming) technique in removing smear layers and remnants from root canals.

Materials and method

Methods and Study Design; A literature search was conducted for the electronic database for the articles that addressed the effectiveness of use of PIPS technique in root canal treatment.

The search keywords were; Endodontics, Er: YAG laser, Photon-induced photoacoustic streaming (PIPS), and the combination of PIPS with the other keywords.

Primarily, titles and abstracts resulting from the electronic searches were screened. Thereafter, full-text articles were examined and selected according to the inclusion criteria. The reference lists of potentially included articles were also searched.

Results and discussion

Several studies were evaluated to define the benefit of using Photon-induced photoacoustic streaming (PIPS) in root canal treatment were these studies compared this technique to the traditional methods (Table 1).

The PIPS technique was introduced by Olivi et al.13 as a revolutionary technology that eliminates the need of over enlarging the root canal size as the tip is not introduced into the canals according to the treatment protocol. Later in 2011 and 2012, Divito et al.14,15 conducted two in-vitro studies considering an apical root canal enlargement of ISO 20/0.06. They have studied the effect of different repetition rates of 10Hz and 15Hz. Their results showed that using of PIPs technique with these parameters to activate 17% EDTA for 20s and 40s has significantly removed SL. Furthermore, SEM magnification at 20,000X exposed higher opened dentinal tubules. One of the most significant findings of their work is the measurement of the temperature rise during irradiation. Thermocouples were utilized to conduct the temperature measurements which were found to be 1.2?C and 1.5?Cfor irradiation times of 20s and 40s, respectively.

Even though they used an irrigant of 17% EDTA in the experiments, they compared their finding against conventional needle irrigation with saline. This is an obvious omission, and consequently, their results are questionable.

The same great results were also achieved by using a combination of NaOCl and 17% EDTA as compared to using SNI technique.16 That is, the volume increase of canals treated with PIPS was found to be 2.6 times greater than that treated with SNI.

The activation of 17% EDTA with PIPS, as compared to other activating techniques, showed 0% remaining Ca(HO)2 in canals of PIPS group, with significant superior effectiveness to SI (p<0.001), UI (p=0.046) and NI (p<0.001).17 Similarly, the activation of 3% NaOCl revealed the same greater removal efficacy of Ca(HO)2 from the main canal and isthmus of both PIPS and USI groups.18

A significantly greater amount of filling material was removed at coronal and middle thirds (p<0.05) but no significant difference was observed at apical thirds (p>0.05) when PIPS was used to activate 3%NaOCl compared to USI group.19 PIPS with 1% NaOCl removed antibiotic paste with significantly different (p<0.006) than that of other irrigation methods.

However, utilizing PIPs for debridement (SL, filling materials, and medication removal) has been reported to show less effectiveness compared to LAI using Er:YAG laser utilized by flat endodontic fiber.19,20 The authors found out that the use of Er: YAG with flat fiber positioned 3mm short working length (WL) (activating 5% NaOCl followed by 17% EDTA for 60s cycle of each irrigant) removed 13% filling material versus 4% with PIPS and 3% with Nd:YAG laser.18 Flat endodontic fiber also displayed the least SL scores at the middle thirds of root canals when tip was placed 1mm short WL. PIPS in the same study showed the least SL scores at coronal third, while the least SL scores at apical thirds were recorded in groups of ANP method.21 Comparable results were achieved by using of QMix as an irrigant, as well.22

Considering the tissue dissolution ability, the 5.25% NaOCl activated using Er:YAG laser with flat tip showed the best results (p<0.05).17 The lack of effectiveness of PIPS technique as compared to LAI using Er:YAG can be attributed to the effect of the position of laser tip. The results of Meire et al.23 supported this conclusion where they found that the greater debris removal from artificially created groove was achieved when the tip was held next to the groove rather than the pulp chamber as well as when using shorter pulse length and lower frequencies. Also, no significant effect observed neither with different fiber diameters (300, 400 or 600µm) nor with tip shapes (conical or flat end). To conclude, it should be addressed that no treatment group used in the articles has successfully removed the SL at apical thirds of the root canal. Even though PIPS groups eliminate the need for enlargement of the root canal, they showed less effectiveness regarding the cleaning of the apical third.


A comprehensive review of using of photon-induced photoacoustic streaming in endodontics has been conducted. A number of 36 research articles have been included in the review. The articles were classified according to the Smear Layer (SL) removal and retreatment properties, root canal system disinfection, and other treatment properties. Regarding SL removal, PIPS showed greater SL removal at the coronal thirds of a root canal, while it produced fewer results at the apical thirds. On the other hand, the examination of its of disinfection ability revealed that it will sterilize the main canal with the tendency to disinfect deep dentine layers at 500µm when high energies are used. Some articles assessed the PIPS effect on bond strength of filling materials and sealers to canal dentine walls. The results were inconsistent, and consequently, a conclusion cannot be drawn.


 Authors acknowledge the immense help received from the scholars whose articles are cited and included in the references of this manuscript. The authors are also grateful to the authors/editors/publishers of all those articles, journals and books from which the literature for this article has been reviewed and discussed.

 Conflict of interest: NIL

 Financial support: NIL


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2. Gutknecht N. Lasers in endodontics. J LA&HA. 2008; 4(1): 1-5.

3. Pari A, Rao AP, Thayumanavan, Vijay C. Antimicrobial efficacy of different root canal preparation techniques using k- files and k- niti flex – an in vitro study. IJCRR. 2012; 4(5): 69-79.

4. Violich D R,Chandler N P. The smear layer in endodontics – a review. Int Endod J. 2010; 43(1): 2-15.

5. Pineda F, Kuttler Y. Mesiodistal and buccolingualroentgenographic investigation of 7,275 root canals. Oral Surg Oral Med Oral Pathol. 1972; 33(1): 101-110.

6. Sriram T, Mythili R, Gokul K, Kumar SS, Anuradha B. Efficacy of co2 laser on removal of smear layer – an in-vitro study. IJCRR. 2012; 4(10): 101-110.

7. Zmener O, Pameijer C. H, Banegas G. Effectiveness in cleaning oval-shaped root canals using Anatomic Endodontic Technology, ProFile and manual instrumentation: a scanning electron microscopic study. Int Endod J. 2005; 38(6), 356-363.

8. Stabholz A, Sahar-Helft S, Moshonov J. Lasers in endodontics. Denl Clin North Am. 2004; 48(4): 809-832.

9. Kokuzawa C, Ebihara A, Watanabe S, Anjo T, Bolortuya G, Saegusa H, Suda H. Shaping of the root canal using Er:YAG laser irradiation. Photomed and laser surg. 2012; 30(7): 367-373.

10. Dostálová T, Jelínková H, Houšová D, Šulc J, Nemec M, Dušková J, Krátky M. Endodontic treatment with application of Er: YAG laser waveguide radiation disinfection. J Clin Laser Med Surg. 2002; 20(3): 135-139.

11. Meire MA, Coenye T, Nelis HJ, De Moor RJG. Evaluation of Nd: YAG and Er: YAG irradiation, antibacterial photodynamic therapy and sodium hypochlorite treatment on Enterococcus faecalis biofilms. Int Endod J. 2012; 45(5): 482-491.

12. Yasuda Y, Kawamorita T, Yamaguchi H, Saito T. Bactericidal effect of Nd: YAG and Er: YAG lasers in experimentally infected curved root canals. Photomed and laser surg. 2010; 28(S2): S-75-8.

13. Olivi G, DiVito E. Photoacoustic endodontics using PIPS™: experimental background and clinical protocol. J LA&HA. 2012; 1: 22-25.

14. DiVito EE, Colonna MP, Olivi G. The photoacoustic efficacy of an Er:YAG laser with radial and stripped tips on root canal dentin walls: an SEM evaluation. J Laser Dent. 2011; 19(1): 156- 161.

15. DiVito E, Peters OA, Olivi G. Effectiveness of the erbium: YAG laser and new design radial and stripped tips in removing the smear layer after root canal instrumentation. Lasers Med Sci. 2012; 27(2): 273-280.

16. Lloyd A, Uhles J. P, Clement D. J, Garcia-Godoy F. Elimination of intracanal tissue and debris through a novel laser-activated system assessed using high-resolution micro-computed tomography: a Pilot Study. J Endod. 2014; 40(4): 584-587.

17. Arslan H, Akcay M, Capar ID, Saygili G, Gok T, Ertas H. An in vitro comparison of irrigation using photon-initiated photoacoustic streaming, ultrasonic, sonic and needle techniques in removing calcium hydroxide. Int Endod J. 2015; 48(3): 246-251.

18. Kele? A, Arslan H, Kamalak A, Akçay M, Sousa-Neto MD, Versiani MA. Removal of Filling Materials from Oval-shaped Canails Using Laser Irradiation: A Micro-computed Tomographic Study. J Endod. 2015; 41(2): 219-224.

19. Guneser MB, Arslan D, Usumez A. Tissue dissolution ability of sodium hypochlorite activated by photon-initiated photoacoustic streaming technique. J Endod. 2015; 41(5): 729-732.

20. Deleu E, Meire M. A, De Moor RJ. Efficacy of laser-based irrigant activation methods in removing debris from simulated root canal irregularities. Lasers Med Sci. 2015; 30(2): 831-835.

21. Akyuz Ekim SN, Erdemir A. Comparison of different irrigation activation techniques on smear layer removal: An in Vitro Study. Microsc Res Tech. 2015; 78(3): 230-239.

22. Arslan D, Guneser MB, Dincer AN, Kustarci A, Er K, SisoSH. Comparison of Smear Layer Removal Ability of QMix with Different Activation Techniques. J Endod. 2016;42(8):1279-1285.

23. MeireMA, HavelaertsS, De Moor RJ. Influence of lasing parameters on the cleaning efficacy of laser-activated irrigation with pulsed erbium lasers. Lasers Med Sci. 2016; 31(4): 653-658.


Dr. Pramod Kumar Manjhi joined Editor-in-Chief since July 2021 onwards

COPE guidelines for Reviewers

SCOPUS indexing: 2014, 2019 to 2021

Awards, Research and Publication incentive Schemes by IJCRR

Best Article Award: 

One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to for more details.

Women Researcher Award:

This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to for more details.

Emerging Researcher Award:

‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to for more details.

Best Article Award

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A study by Alice Alice entitled \"Strengthening of Human Milk Banking across South Asian Countries: A Next Step Forward\" is awarded Best article of Vol 14 issue 20
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A study by Singh R. et al. entitled \"A Prospective Study to Find the Association of Astigmatism in Patients of Vernal Keratoconjunctivitis (VKC) in a Tertiary Health Care Centre in India (Vindhya Region MP)\" is awarded Best Article for Vol 14 issue 15
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A Study by Sarmila G. B. et al. entitled "Study to Compare the Efficacy of Orally Administered Melatonin and Clonidine for Attenuation of Hemodynamic Response During Laryngoscopy and Endotracheal Intubation in Gastrointestinal Surgeries" is awarded Best Article for Vol 13 issue 07
A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award

A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award

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Disclaimer: International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal.


International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal


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