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Virulence genes in Escherichia coli isolates from commercialized saltwater mussels Mytella guyanensis (Lamarck, 1819)

Presença de genes de virulência em isolados de Escherichia coli provenientes de sururu Mytella guyanensis (Lamarck, 1819) comercializado

Abstract

The isolation of Escherichia coli from food is a major concern. Pathogenic strains of these bacteria cause diseases which range from diarrhea to hemolytic-uremic syndrome. Therefore the virulence genes in E. coli isolates from the mussel ( Mytella guyanensis) commercialized in Cachoeira, Bahia, Brazil were investigated. Samples were purchased from four vendors: two from supermarkets and two from fair outlets. They were conditioned into isothermal boxes with reusable ice and transported to the laboratory for analysis. E. coli strains were isolated in eosin methylene blue agar, preserved in brain-heart infusion medium with 15% glycerol and stored at -20 °C, after microbiological analysis. Virulence genes in the isolated strains were identified by specific primers, with Polymerase Chain Reaction. Twenty-four isolates were obtained, with a prevalence of elt gene, typical from enterotoxigenic infection, in 75% of the isolates. The stx and bfpA genes, prevalent in enterohemorragic and enteropathogenic E. coli, respectively, were not detected. The occurrence of elt virulence-related gene in the E. coli isolates of Mytella guyanensis reveals urgent improvement in food processing, including good handling practices, adequate storage and cooking before consumption, to ensure consumer’s health.

Keywords:
bivalve mollusk; thermotolerant coliform; PCR; elt gene

Resumo

O isolamento de Escherichia coli a partir de alimentos é uma grande preocupação, pois cepas patogênicas desta bactéria podem causar desde diarreia até síndrome hemolítico-urêmica. Diante do exposto, o objetivo do trabalho foi pesquisar genes de virulência em isolados de Escherichia coli provenientes do sururu Mytella guyanensis comercializado na cidade de Cachoeira, Bahia, Brasil. As amostras foram adquiridas de quatro comerciantes, sendo duas de mercados e duas em pontos de venda na feira livre da cidade de Cachoeira, acondicionadas em caixas isotérmicas com gelo reutilizável e transportadas até o laboratório para a análise. Após a análise microbiológica, as cepas de Escherichia coli foram isoladas em ágar Eosina Azul de Metileno e preservadas em caldo Brian Heart Infusion e glicerol a 15% e mantidas a - 20° C. A identificação dos genes de virulência nas cepas isoladas foi realizada utilizando primers específicos, por meio da Reação em Cadeia da Polimerase. Foram obtidos 24 isolados de Escherichia coli, destes a prevalência do gene elt , característico de Escherichia coli enterotoxigênica, foi de 75% dos isolados. Não houve a detecção dos genes stx e bfpA nos isolados, os quais são prevalentes nas cepas de Escherichia coli enterohemorrágica e Escherichia coli enteropatogênica, respectivamente. A presença do gene elt relacionado à virulência de Escherichia coli nos isolados de Mytella guyanensis revela a necessidade da melhoria no processamento, incluindo boas práticas de manipulação, armazenamento adequado e cocção previa ao consumo, visando a garantia da saúde do consumidor.

Palavras-chave:
molusco bivalve; coliforme termotolerante; PCR; Gene elt

1. Introduction

Escherichia coli may be a commensal bacterium or it may cause several infections in humans and animals ( Backer, 2015 BACKER, K.S., 2015. Demystifying Escherichia coli pathovars. Nature Reviews. Microbiology, vol. 13, no. 1, pp. 5. http://dx.doi.org/10.1038/nrmicro3411. PMId: 25482288.
http://dx.doi.org/10.1038/nrmicro3411 ...
). E. coli strains which cause intestine infections are called diarrheagenic, with six pathotypes: enterohemorrhagic E. coli (EHEC); enteropathogenic E. coli (EPEC); enterotoxigenic E. coli (ETEC); enteroinvasive E. coli (EIEC); enteroaggregative E. coli (EAEC); diffused adherence E. coli (DAEC) ( Croxen and Finlay, 2010 CROXEN, M.A. and FINLAY, B.B., 2010. Molecular mechanisms of Escherichia coli pathogenicity. Nature Reviews. Microbiology, vol. 8, no. 1, pp. 26-38. http://dx.doi.org/10.1038/nrmicro2265. PMid:19966814.
http://dx.doi.org/10.1038/nrmicro2265 ...
).

Bacteria have different virulence factors to trigger infection, such as toxins and cell-adhesive mechanisms ( Croxen and Finlay, 2010 CROXEN, M.A. and FINLAY, B.B., 2010. Molecular mechanisms of Escherichia coli pathogenicity. Nature Reviews. Microbiology, vol. 8, no. 1, pp. 26-38. http://dx.doi.org/10.1038/nrmicro2265. PMid:19966814.
http://dx.doi.org/10.1038/nrmicro2265 ...
; Chandra et al., 2013 CHANDRA, M., CHENG, P., RONDEAU, G., PORWOLLIK, S. and MCCLELLAND, M., 2013. A single step multiplex PCR for identification of six diarrheagenic E. coli pathotypes and Salmonella. International Journal of Medical Microbiology , vol. 303, no. 4, pp. 210-216. http://dx.doi.org/10.1016/j.ijmm.2013.02.013. PMid:23562277.
http://dx.doi.org/10.1016/j.ijmm.2013.0...
). Highlighted toxins comprise Shiga (STX), produced by EHEC ( Obrig, 2010 OBRIG, T.G., 2010. Escherichia coli Shiga Toxin Mechanisms of Action in Renal Disease. Toxins, vol. 2, no. 12, pp. 2769-2794. http://dx.doi.org/10.3390/toxins2122769. PMid:21297888.
http://dx.doi.org/10.3390/toxins2122769...
) and codified by gene stx ( Mauro and Koudelka, 2011 MAURO, S.A. and KOUDELKA, G.B., 2011. Shiga Toxin: Expression, Distribution, and Its Role in the Environment. Toxins, vol. 3, no. 6, pp. 608-625. http://dx.doi.org/10.3390/toxins3060608. PMid:22069728.
http://dx.doi.org/10.3390/toxins3060608...
); thermo-labile (LT) and thermo-stable (ST) toxins, produced by ETEC ( Begum et al., 2014 BEGUM, Y.A., BABY, N.I., FARUQUE, A.S., JAHAN, N., CRAVIOTO, A., SVENNERHOLM, A.M. and QADRI, F., 2014. Shift in Phenotypic Characteristics of Enterotoxigenic Escherichia coli (ETEC) Isolated from Diarrheal Patients in Bangladesh. PLoS Neglected Tropical Diseases, vol. 8, no. 7, pp. e3031. http://dx.doi.org/10.1371/journal.pntd.0003031. PMid:25032802.
http://dx.doi.org/10.1371/journal.pntd....
) and codified respectively by genes elt and est ( Manzoor et al., 2015 MANZOOR, R., SHAH, M.I., UL-HUSNA, A., WANI, S.A., PANDIT, F., DAR, P.A. and MIR, M.I., 2015. Prevalence, serodiversity and antibiogram of enterotoxigenic Escherichia coli (ETEC) in diarrhoeic calves and lambs of Kashmir valley (J&K), India. Journal of Applied and Natural Science, vol. 7, no. 1, pp. 477-481. http://dx.doi.org/10.31018/jans.v7i1.635.
http://dx.doi.org/10.31018/jans.v7i1.63...
); and bacteria´s cell-adherence mechanisms associated with EPEC ( Mainil and Daube, 2005 MAINIL, J.G. and DAUBE, G., 2005. Escherichia coli from animals, humans and foods: who’s who? Journal of Applied Microbiology, vol. 98, no. 6, pp. 1332-1344. http://dx.doi.org/10.1111/j.1365-2672.2005.02653.x. PMid:15916647.
http://dx.doi.org/10.1111/j.1365-2672.2...
), such as bundle-forming pilus (BFP), type IV, with main structural subunit codified by gene bfpA ( Contreras et al., 2010 CONTRERAS, C.A., OCHOA, T.J., LACHER, D.W., DEBROY, C., NAVARRO, A., TALLEDO, M., DONNENBERG, M.S., ECKER, L., GIL, A.I., LANATA, C.F. and CLEARY, T.G., 2010. Allelic variability of critical virulence genes (eae, bfpA and perA) in typical and atypical enteropathogenic Escherichia coli in Peruvian children. Journal of Medical Microbiology, vol. 59, no. 1, pp. 25-31. http://dx.doi.org/10.1099/jmm.0.013706-0. PMid:19797469.
http://dx.doi.org/10.1099/jmm.0.013706-...
; Teixeira et al., 2015 TEIXEIRA, N.B., ROJAS, T.C., SILVEIRA, W.D., MATHEUS-GUIMARÃES, C., SILVA, N.P. and SCALETSKY, I.C., 2015. Genetic analysis of enteropathogenic Escherichia coli (EPEC) adherence factor (EAF) plasmid reveals a new deletion within the EAF probe sequence among O119 typical EPEC strains. BMC Microbiology, vol. 15, no. 1, pp. 200. http://dx.doi.org/10.1186/s12866-015-0539-9. PMid:26438110.
http://dx.doi.org/10.1186/s12866-015-05...
).

Due to the harm done by pathogenic strains of E. coli, there is great concern with regard to strains of the microorganism in food, such as fish ( Costa, 2013 COSTA, R.A., 2013. Escherichia coli in seafood: A brief overview. Advances in Bioscience and Biotechnology, vol. 4, no. 3A, pp. 450-454. http://dx.doi.org/10.4236/abb.2013.43A060.
http://dx.doi.org/10.4236/abb.2013.43A0...
). According to Zhao et al. (2014) ZHAO, X., LIN, C.W., WANG, J. and OH, D.H., 2014. Advances in Rapid Detection Methods for Foodborne Pathogens. Journal of Microbiology and Biotechnology, vol. 24, no. 3, pp. 297-312. http://dx.doi.org/10.4014/jmb.1310.10013. PMid:24375418.
http://dx.doi.org/10.4014/jmb.1310.1001...
, there is a high occurrence of diseases in developing countries caused by the consumption of contaminated food. The detection of contaminating agents is an important step for the development of prophylactic strategies. Polymerase Chain Reaction (PCR) is a commonly used method to detect human pathogens transmitted by the consumption of contaminated food. This highly sensitive technique is based on the amplification of specific regions of the DNA by specific primers.

Studies on the genotype characterization of bacterial isolates in commercialized mussels Mytella guyanensis are scarce, so this work aims to investigate virulence genes in E. coli isolates from the mussel (M. guyanensis ) commercialized in the town of Cachoeira, Bahia, Brazil.

2. Material and Methods

2.1. Sampling

Samples of M. guyanensis were obtained from four sellers in the town of Cachoeira, Bahia, Brazil: two kilos of mussels were bought from two open stall outlets (1k each) and two kilos from supermarkets (1k each), between December 2015 and January 2016. Samples were conditioned in new plastic bags, identified and transported under refrigeration to the laboratory of the Research Nucleus in Food Safety and Nutrition of the Center of Health Sciences of the Federal University of Recôncavo of Bahia, in the town of Santo Antônio de Jesus, and immediately analyzed.

2.2. Isolation and purification of strains

E. coli populations were estimated by PetrifilmTM (3M) rapid counting method, with EC plates (AOAC 998.08). An amount of each sample (25 g) were added to a 225 mL of 0.9% NaCl saline solution homogenized in a stomacher for 30 seconds and diluted in series (10-2 and 10-3). About 1 mL of the samples were placed on plates and incubated at 35 ± 1 °C for 24 ± 2h ( Silva et al., 2007 SILVA, N., JUNQUEIRA, V.C.A., SILVEIRA, N.F.A., TANIWAKI, M.H., SANTOS, R.F.S. and GOMES, R.A.R., 2007. Manual de métodos de análise microbiológica de alimentos e água. 3. ed. São Paulo: Varela, 544 p. ). Characteristical E. coli colonies (blue with gas bubbles) were removed by a platinum spatula, sprinkled with Eosin Methylene Blue agar (EMB) Kasvi® and incubated at 35±1° C for 24±2 h. A characteristic colony (black with brilliant metallic blue), isolated from each plate, was transferred to Brain Heart Infusion (BHI) broth Kasvi® and incubated at 35 ± 1 °C for 24 ± 2 h ( Silva et al., 2007 SILVA, N., JUNQUEIRA, V.C.A., SILVEIRA, N.F.A., TANIWAKI, M.H., SANTOS, R.F.S. and GOMES, R.A.R., 2007. Manual de métodos de análise microbiológica de alimentos e água. 3. ed. São Paulo: Varela, 544 p. ). Twenty-four isolates were kept by adding glycerol 15% and stored at -20° C ( Silva et al., 2011 SILVA, I.M.M., EVÊNCIO-NETO, J., SILVA, R.M., LUCENA-SILVA, N., MAGALHÃES, J. and BALIZA, M., 2011. Caracterização genotípica dos isolados de Escherichia coli provenientes de frangos de corte. Arquivo Brasileiro de Medicina Veterinária e Zootecnia, vol. 63, no. 2, pp. 333-339. http://dx.doi.org/10.1590/S0102-09352011000200010.
http://dx.doi.org/10.1590/S0102-0935201...
).

2.3. DNA extraction and PCR technique

DNA extraction and PCR technique were performed according to a methodology adapted from Silva et al. (2011) SILVA, I.M.M., EVÊNCIO-NETO, J., SILVA, R.M., LUCENA-SILVA, N., MAGALHÃES, J. and BALIZA, M., 2011. Caracterização genotípica dos isolados de Escherichia coli provenientes de frangos de corte. Arquivo Brasileiro de Medicina Veterinária e Zootecnia, vol. 63, no. 2, pp. 333-339. http://dx.doi.org/10.1590/S0102-09352011000200010.
http://dx.doi.org/10.1590/S0102-0935201...
. Positive controls were used as standards: strain ATCC 11105 for elt gene, strain CDC EDL 933 for stx gene and strain CDC 086:H35 for bfpA gene. The standardization of the PCR tests for the genes under study was performed regarding to the amount of DNA in the reaction (data not shown) and the components used for the stx and elt genes were: milli-Q sterile water (15.2 uL), 10XPCR buffer (5 uL) in final concentration 2 X, 10 mM dNTP mix (0.5 uL) in final concentration 0.2 mM, 50 mM MgCl2 (1.5 uL) in final concentration 3 mM, direct initiator (0.8 uL) in final concentration 0.8 pmol, reverse initiator (0.8 uL) in final concentration 0.8 pmol, Taq DNA polymerase (0.2 uL) in final concentration 2 U, DNA mold (1uL). For the bfpA gene the following components were used: milli-Q sterile water (16.5 uL), 10XPCR buffer (2.5 uL) in final concentration 1 X, 10 mM dNTP mix (0.5 uL) in final concentration 0.2 mM, 50 mM MgCl2 (0.75 uL) in final concentration 1.5 mM, direct initiator (1 uL) in final concentration 1 pmol, reverse initiator (1 uL) in final concentration 1 pmol, Taq DNA polymerase (0.2 uL) in final concentration 2 U, DNA mold (3 uL). The total volume of components for the amplification of each gene was 25 uL. Amplification reactions were performed in thermal cycler Amplitherm® TX96 Plus, according to conditions in Table 1 . PCR amplified products were loaded in a 2% agarose gel and placed in a horizontal electrophoresis system to visualize bands by employing 50 bp molecular weight as size marker. Electrophoresis run was performed in a digital source GSR® 200STD with parameters: 80 v, 80 min, 200 mA for genes stx and elt and 70 v, 100 min, 200 mA for gene bfpA. Loading Dye 6X Promega® plus SYBR Green Life Technologies® were used to visualize PCR products in ultraviolet Loccus L-PIX.

Table 1
Sequence of primers, size of amplified fragment and PCR conditions.

3. Results

The results revealed amplification of elt gene, typical of ETEC, in 75% of E. coli isolates, of which 50% were originating from mussel samples collected in supermarkets and 50% were originating from mussel samples collected in open fair stalls. No amplification of stx and bfpA gene, respectively typical of EHEC and EPEC, were observed.

4. Discussion

Species for biomonitoring are generally good coliform accumulators ( Farrapeira et al., 2010 FARRAPEIRA, C.M.R., MENDES, E.S., DOURADO, J. and GUIMARÃES, J., 2010. Coliform accumulation in Amphibalanus amphitrite (Darwin, 1854) (Cirripedia) and its use as an organic pollution bioindicator in the estuarine area of Recife, Pernambuco, Brazil. Brazilian Journal of Biology = Revista Brasileira de Biologia , vol. 70, no. 2, pp. 301-309. http://dx.doi.org/10.1590/S1519-69842010000200011. PMid:20549061.
http://dx.doi.org/10.1590/S1519-6984201...
). This indicates the importance of these microorganisms as indicators of contamination, which also extends to food. The presence of E. coli, a thermotolerant coliform in fish, is related to their hygienic-sanitary quality, since this bacteria indicates fecal contamination ( Dutta et al., 2015 DUTTA, C., PANIGRAHI, A.K. and SENGUPTA, C., 2015. Prevalence of Pathogenic Bacteria in Finfish and Shellfish Obtained from Domestic Markets of West Bengal, India. Frontiers in Environmental Microbiology, vol. 1, no. 2, pp. 14-18. http://dx.doi.org/10.11648/j.fem.20150102.11.
http://dx.doi.org/10.11648/j.fem.201501...
). Pathogenic strains of this bacteria may occur in food, as demonstrated with gene elt in this work.

Kambire et al. (2017) KAMBIRE, M.A., ADINGRA, A.A., YAO, K.M. and KOFFI-NEVRY, R., 2017. Prevalence of Virulence Genes Associated with Diarrheagenic Pathotypes of Escherichia coli Isolates from Water, Sediment, Fish, and Crab in Aby Lagoon, Côte d’Ivoire. International Journal of Microbiology, vol. 2017, no. 2017, pp. 9532170. https://doi.org/10.1155/2017/9532170. PMId: 28676828.
https://doi.org/10.1155/2017/9532170 ...
conducted studies to detect E. coli pathotypes in samples of water, sediment, fish and crabs, and pinpointed ETEC as the most prevalent pathotype in water, sediment and crab samples. According to Anand et al. (2016) ANAND, S., MANDAL, S., PATIL, P. and TOMAR, S.K., 2016. Pathogen-induced secretory diarrhea and its prevention. European Journal of Clinical Microbiology & Infectious Diseases, vol. 35, no. 11, pp. 1721-1739. http://dx.doi.org/10.1007/s10096-016-2726-5. PMid:27473379.
http://dx.doi.org/10.1007/s10096-016-27...
, ETEC is the pathotype that causes diarrhea due to the release of potent enterotoxins, one of which is codified by gene elt. Shahrokhi et al. (2011) SHAHROKHI, N., BOUZARI, S. and JAFARI, A., 2011. Comparison of virulence markers and antibiotic resistance in enterotoxigenic Escherichia coli isolated ten years apart in Tehran. Journal of Infection in Developing Countries , vol. 5, no. 4, pp. 248-254. PMid:21537065. demonstrated that the production of LT and ST in ETEC strains is similar, although some strains may produce only a single enterotoxin, that result may explain the absence of amplifications of the stx gene.

The production of LT helps in the colonization of the host’s cells and also LT uses cell components to produce its toxic effect. LT interactions with the host cell produce the constitutive activation of adenylate cyclase and the production of cyclic monophosphate adenosine (AMPc). The component´s intracellular elevation activates the AMPc-dependent protein cinase A. The phosphoryl chloride is dominium R of the regular of the transmembrane conductance of cytic fibrose. The admission of chloride and water efflux in the intestinal lumen causes aqueous diarrhea ( Johnson et al., 2009 JOHNSON, A.M., KAUSHIK, R.S., FRANCIS, D.H., FLECKENSTEIN, J.M. and HARDWIDGE, P.R., 2009. Heat-Labile Enterotoxin Promotes Escherichia coli Adherence to Intestinal Epithelial Cells. Journal of Bacteriology, vol. 191, no. 1, pp. 178-186. http://dx.doi.org/10.1128/JB.00822-08. PMid:18978047.
http://dx.doi.org/10.1128/JB.00822-08 ...
; Dubreuil et al., 2016 DUBREUIL, J.D., ISAACSON, R.E. and SCHIFFERLI, D.M., 2016. Animal Enterotoxigenic Escherichia coli. EcoSal Plus, vol. 7, no. 1, pp. 1-47. http://dx.doi.org/10.1128/ecosalplus.ESP-0006-2016. PMid:27735786.
http://dx.doi.org/10.1128/ecosalplus.ES...
). Therefore the research of this pathotype is extremely important in commercialization of mussels in natura.

Pathogenic strains of E. coli are a great concern for public health authorities due to their high dissemination capacity in different sources. Food is actually an important vector of this microorganism ( Croxen et al., 2013 CROXEN, M.A., LAW, R.J., SCHOLZ, R., KEENEY, K.M., WLODARSKA, M. and FINLAY, B.B., 2013. Recent Advances in Understanding Enteric Pathogenic Escherichia coli. Clinical Microbiology Reviews, vol. 26, no. 4, pp. 822-880. http://dx.doi.org/10.1128/CMR.00022-13. PMid:24092857.
http://dx.doi.org/10.1128/CMR.00022-13 ...
). M. guyanensis is a filtering organism and can accumulate microorganisms and substances harmful to health ( Carvalho et al., 2007 CARVALHO, A.F.U., FARIAS, D.F., BARROSO, C.X., SOMBRA, C.M.L., SILVINO, A.S., MENEZES, M.O.T., SOARES, M.O., FERNANDES, D.A.O. and GOUVEIA, S.T., 2007. Nutritive value of three organisms from mangrove ecosystem: Ucides cordatus (Linnaeus, 1763), Mytella sp. (Soot-Ryen, 1955) and Crassostrea rhizophorae (Guilding, 1828). Brazilian Journal of Biology = Revista Brasileira de Biologia, vol. 67, no. 4, pp. 787-788. http://dx.doi.org/10.1590/S1519-69842007000400031. PMid:18278338.
http://dx.doi.org/10.1590/S1519-6984200...
). This is a major risk for consumption of raw or partially cooked foods as is usually consumed M. guyanensis ( Santiago et al., 2013 SANTIAGO, J.A.S., ARAÚJO, P.F.R., SANTIAGO, A.P., CARVALHO, F.C.T. and VIEIRA, R.H.S.F., 2013. Bactérias patogênicas relacionadas a ingestão de pescados - revisão. Arquivos de Ciências do Mar, vol. 46, no. 2, pp. 92-103. ). Since LT of ETEC is inactivated by heating to 60 °C for 10 min ( Takeda, 2011 TAKEDA, Y., 2011. Vibrio parahaemolyticus, enterotoxigenic Escherichia coli, enterohemorrhagic Escherichia coli and Vibrio cholerae. Proceedings of the Japan Academy. Series B, Physical and Biological Sciences, vol. 87, no. 1, pp. 1-12. http://dx.doi.org/10.2183/pjab.87.1. PMid:21233598.
http://dx.doi.org/10.2183/pjab.87.1 ...
), the consumption of cooked food is highly relevant. According to Santos et al. (2014) SANTOS, T.M.M., SAWAYA, A.L., SILVA, M.C.D., SANTOS, A.F., BARROS-NETO, J.A. and FLORÊNCIO, T.M.M.T., 2014. Avaliação microbiológica e da concentração de vitamina A, ferro e zinco em preparações do molusco sururu (Mytella falcata). Demetra Alimentação. Nutrição & Saúde, vol. 9, no. 3, pp. 811-822. , treatment is a must to warrant sanitary conditions of the final product. Carvalho et al. (2016) CARVALHO, M.C.N., JAYME, M.M., ARENAZIO, G.S., ARAÚJO, F.V., LEITE, S.G.F. and DEL-AGUILA, A.M., 2016. Microbiological Quality Assessment by PCR and Its Antibiotic Susceptibility in Mangrove Crabs (Ucides cordatus) from Guanabara Bay, Rio de Janeiro. Brazililian International Journal of Microbiolology, vol. 2016, pp. 7825031. http://dx.doi.org/10.1155/2016/7825031. PMid:27065187.
http://dx.doi.org/10.1155/2016/7825031 ...
showed that the detection of pathogenic bacteria in fish is crucial for the development of strategies that guarantee their quality for consumers and it may be extended do other marine source of food.

Genes related to E. coli virulence in isolates of M. guyanensis reveal the need of improvement during processing, including good handling practices, proper storage and cooking prior to consumption. These factors guarantee consumer’s health. In fact, cooking maintains the microbiological quality of food and inactivates ETEC thermal labile toxin.

Acknowledgements

The authors would like to thank the Coordination for the Improvement of Higher Education Personnel (CAPES) for grants.

References

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Publication Dates

  • Publication in this collection
    25 Oct 2018
  • Date of issue
    Oct-Dec 2019

History

  • Received
    29 Sept 2017
  • Accepted
    26 Feb 2018
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