Browsing by Author "Gana Ansaldo, Juan Cristóbal"

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    Achieving the best bowel preparation for colonoscopy
    (2014) Parra Blanco, Adolfo; Ruiz, A.; Álvarez Lobos, Manuel; Amoros, A.; Gana Ansaldo, Juan Cristóbal; Ibáñez Lazo, Patricio Fernando; Ono, A.; Fujii, T.
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    Adaptación a la realidad de Latinoamérica de la Guía Clínica NASPGHAN/ESPGHAN 2016 sobre Diagnóstico, Prevención y Tratamiento de Infección por Helicobacter pylori en Pediatría
    (2020) Harris D., Paul R.; Calderon-Guerrero, O. G.; Vera Chamorro, J. F.; Lucero, Y.; Vasquez, M.; Ogata, S. K.; Angulo, D.; Madrazo, A.; Gonzales, J.; Gana Ansaldo, Juan Cristóbal; Rivero, A.
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    Adaptation to the reality of Latin America of the NASPGHAN/ESPGHAN 2016 Guidelines on the Diagnosis, Prevention and Treatment of Helicobacter pylori Infection in Pediatrics
    (Sociedad Chilena de Pediatría, 2020) Harris Diez Paul Richard; Calderón Guerrero, Otto Gerardo; Vera Chamorro, José Fernando; Lucero, Yalda; Vásquez, Margarita; Kazuo Ogata, Silvio; Angulo, Diana; Madrazo, Armando; Gonzales, José; Rivero, Anelsy; Gana Ansaldo, Juan Cristóbal; Sociedad Latinoamericana Gastroenterología
    Introduction: The latest joint H. pylon NASPGHAN and ESPGHAN clinical guidelines published in 2016, contain 20 statements that have been questioned in practice regarding their applicability in Latin America (LA); in particular in relation to gastric cancer prevention. Methods: We conducted a critical analysis of the literature, with special emphasis on LA data and established the level of evidence and level of recommendation of the most controversial claims in the Joint Guidelines. Two rounds of voting were conducted according to the Delphi consensus technique and a Likert scale (from 0 to 4) was used to establish the "degree of agreement" among a panel of SLACHNP experts. Results: There are few studies regarding diagnosis, treatment effectiveness and susceptibility to antibiotics of H. pylon in pediatric patients of LA. Based on these studies, extrapolations from adult studies, and the clinical experience of the participating expert panel, the following recommendations are made. We recommend taking biopsies for rapid urease and histology testing (and samples for culture or molecular techniques, when available) during upper endoscopy only if in case of confirmed H. pylon infection, eradication treatment will be indicated. We recommend that selected regional centers conduct antimicrobial sensitivity/resistance studies for H. pylori and thus act as reference centers for all LA. In case of failure to eradicate H. pylori with first-line treatment, we recommend empirical treatment with quadruple therapy with proton pump inhibitor, amoxicillin, metronidazole, and bismuth for 14 days. In case of eradication failure with the second line scheme, it is recommended to indicate an individualized treatment considering the age of the patient, the previously indicated scheme and the antibiotic sensitivity of the strain, which implies performing a new endoscopy with sample extraction for culture and antibiogram or molecular resistance study. In symptomatic children referred to endoscopy who have a history of first or second degree family members with gastric cancer, it is recommended to consider the search for H. pylori by direct technique during endoscopy (and eradicate it when detected). Conclusions: The evidence supports most of the general concepts of the NASPGHAN/ESPGHAN 2016 Guidelines, but it is necessary to adapt them to the reality of LA, with emphasis on the development of regional centers for the study of antibiotic sensitivity and to improve the correct selection of the eradication treatment. In symptomatic children with a family history of first or second degree gastric cancer, the search for and eradication of H. pylori should be considered.
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    Angiogenesis and portal-systemic collaterals in portal hypertension
    (2016) Gana Ansaldo, Juan Cristóbal; Serrano Berríos, Carolina Lourdes; Ling, S.
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    Asociación entre componentes del síndrome metabólico durante la infancia y grosor de la íntima-media carotidea en la adolescencia.
    (2020) Villarreal H., Grisell E.; Alberti R., Gigliola; Gana Ansaldo, Juan Cristóbal; Pontificia Universidad Católica de Chile. Facultad de Medicina
    La enfermedad cardiovascular es la principal causa de muerte a nivel mundial y el reconocimiento del impacto de los factores predisponentes en etapas tempranas es fundamental para su prevención. El aumento del grosor de la íntima-media carotidea (GIMc) es un marcador del proceso aterosclerótico en un estadio temprano, subclínico y potencialmente reversible. Objetivo: Evaluar la asociación entre los componentes del síndrome metabólico (SM) durante la infancia y el GIMc medido en la adolescencia. Métodos: Estudio de cohorte que incluye 700 niños sanos, seguidos en forma seriada desde los 3-5 años, a quienes se les realizó medición ecográfica del GIMc a los 13-17 años de edad. La variable dependiente fue el GIMc y las independientes fueron índice de masa corporal (IMC) y circunferencia abdominal (CA), presión arterial, trigliceridemia, colesterolemia HDL, glicemia, HOMA-IR y la agrupación de componentes del SM durante la infancia. Los resultados fueron analizados mediante X2o T-student y Riesgo Relativo (RR) para medir fuerza de asociación, con significancia del 5%. Resultados: Se encontró asociación entre el GIMc aumentado en la adolescencia y el sobrepeso (RR 1.67, 1.14-2.46) y la obesidad (RR 2.39, 1.51-3.78) desde los 1-2 años, la CA desde los 5-6 años (RR 1.68, 1.01-2.79), el HOMA-IR alto desde los 7-8 años (RR 2.23, 1.15-4.32) y la agrupación de 2 componentes del SM desde los 11-12 años (RR 2.76, 1.57-4.84). Conclusión: El exceso de peso, la resistencia insulínica y la agrupación de componentes del SM durante la infancia se asocian con un inicio precoz del proceso aterosclerótico.
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    Asociación entre niveles séricos de bilirrubina, variantes genéticas en UGT1A1 e hígado graso no-alcohólico en adolescentes de la cohorte chilena “Estudio de crecimiento y obesidad”
    (2023) Galindo Muñoz, Karen Melissa; Santos Martín, José Luis; Gana Ansaldo, Juan Cristóbal; Pontificia Universidad Católica de Chile. Escuela de Medicina
    Introducción: La bilirrubina es una molécula resultante de la degradación del grupo hemo, y que es conjugada en el hígado con ácido glucurónico por la enzima UGT1A1 (uridina difosfato glucuroniltransferasa 1A1) dando lugar a bilirrubina conjugada. Junto al incremento de la prevalencia de obesidad a lo largo de la vida, se ha observado un avance en la frecuencia de acumulación de grasa intrahepática que progresa a enfermedad de hígado graso no alcohólico (HGNA), siendo ésta la primera causa de trasplante hepático en Chile en población adulta. Se ha observado que las personas con síndrome de Gilbert, caracterizado por mutaciones en UGT1A1 y niveles séricos de bilirrubina ligeramente elevados, podría mostrar una menor incidencia de hígado graso, en relación con personas con niveles de bilirrubina normales. Objetivo: Evaluar la asociación entre bilirrubina sérica y presencia de hígado graso no alcohólico en participantes del estudio chileno de crecimiento y obesidad (ECO), con un enfoque de randomización mendeliana usando genotipos UGT1A1 como variable instrumental. Metodología: Se analizaron 750 adolescentes participantes de la cohorte chilena ECO, con edad promedio de 15.4 ± 0.98 años, 51.6% mujeres. Un 9.6% de la muestra presenta diagnóstico de hígado graso evaluado mediante ultrasonografía. Además, se cuenta con mediciones antropométricas (IMC, presión arterial) y metabólicas (pruebas hepáticas). Se determinaron niveles séricos de bilirrubina total y directa. El genotipo UGT1A1 (rs6742078) se determinó mediante uso selectivo de información procedente del microarreglo genómico MEGA-Illumina. La asociación entre variables se evaluó mediante regresión lineal y regresión logística múltiple. Resultados: La asociación entre bilirrubina plasmática total e hígado graso resultó en una odds ratio significativo de 0.70 (IC 95%; 0.51 – 0.97; p=0.03). Sin embargo, la asociación entre genotipos rs6742078 de UGT1A1 e hígado graso resultó en una odds ratio no significativa de 1.41 para el genotipo GT (IC 95%: 0.77 – 2.59; P = 0.27) y 0.80 para el genotipo TT (IC 95%: 0.29 – 2.18; P = 0.66) (referencia: genotipo GG), tras ajuste por edad, sexo, índice de masa corporal y tres componentes principales de etnia. Conclusión: Existe una asociación significativa entre niveles de bilirrubina plasmáticos y presencia de hígado graso en adolescentes. Sin embargo, al análisis de randomización mendeliana con genotipos UGT1A1 no ha podido demostrar inequívocamente que esta asociación sea de tipo causal.
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    Band ligation versus sham or no intervention for primary prophylaxis of oesophageal variceal bleeding in children and adolescents with chronic liver disease or portal vein thrombosis
    (John Wiley and Sons Ltd., 2021) Cifuentes Aguila, Lorena Isabel; Gattini Valdes, Daniela Cecilia; Torres Robles, Romina Del Pilar; Gana Ansaldo, Juan Cristóbal
    Background: Portal hypertension commonly accompanies advanced liver disease and often gives rise to life-threatening complications, including bleeding (haemorrhage) from oesophageal and gastrointestinal varices. Variceal bleeding commonly occurs in children and adolescents with chronic liver disease or portal vein thrombosis. Prevention is, therefore, important. Randomised clinical trials have shown that non-selective beta-blockers and endoscopic variceal band ligation decrease the incidence of variceal bleeding in adults. In children and adolescents, band ligation, beta-blockers, and sclerotherapy have been proposed as primary prophylaxis alternatives for oesophageal variceal bleeding. However, it is unknown whether these interventions are of benefit or harm when used for primary prophylaxis in children and adolescents. Objectives: To assess the benefits and harms of band ligation compared with sham or no intervention for primary prophylaxis of oesophageal variceal bleeding in children and adolescents with chronic liver disease or portal vein thrombosis. Search methods: We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, CENTRAL, PubMed, Embase, and two other databases (April 2020). We scrutinised the reference lists of the retrieved publications, and we also handsearched abstract books of the two main paediatric gastroenterology and hepatology conferences from January 2008 to December 2019. We also searched clinicaltrials.gov, the United States Food and Drug Administration (FDA), the European Medicines Agency (EMA), and the World Health Organization (WHO) for ongoing clinical trials. We imposed no language or document type restrictions on our search. Selection criteria: We aimed to include randomised clinical trials irrespective of blinding, language, or publication status, to assess the benefits and harms of band ligation versus sham or no intervention for primary prophylaxis of oesophageal variceal bleeding in children with chronic liver disease or portal vein thrombosis. If the search for randomised clinical trials retrieved quasi-randomised and other observational studies, then we read them through to extract information on harm. Data collection and analysis: We used standard Cochrane methodology to perform this systematic review. We used GRADE to assess the certainty of evidence for each outcome. Our primary outcomes were all-cause mortality, serious adverse events and liver-related morbidity, and quality of life. Our secondary outcomes were oesophageal variceal bleeding and adverse events not considered serious. We used the intention-to-treat principle. We analysed data using Review Manager 5. Main results: One conference abstract, describing a feasibility multi-centre randomised clinical trial, fulfilled our review inclusion criteria. We judged the trial at overall high risk of bias. This trial was conducted in three hospital centres in the United Kingdom. The aim of the trial was to determine the feasibility and safety of further larger randomised clinical trials of prophylactic band ligation versus no active treatment in children with portal hypertension and large oesophageal varices. Twelve children received prophylactic band ligation and 10 children received no active treatment. There was no information on the age of the children included, or about the diagnosis of any child included. All children were followed up for at least six months. Mortality was 8% (1/12) in the band ligation group versus 0% (0/10) in the no active intervention group (risk ratio (RR) 2.54, 95% confidence interval (CI) 0.11 to 56.25; very low certainty of evidence). The abstract did not report when the death occurred, but we assume it happened between the six-month follow-up and one year. No child (0%) in the band ligation group developed adverse events (RR 0.28, 95% CI 0.01 to 6.25; very low certainty of evidence) but one child out of 10 (10%) in the no active intervention group developed idiopathic thrombocytopaenic purpura. One child out of 12 (8%) in the band ligation group underwent liver transplantation versus none in the no active intervention group (0%) (RR 2.54, 95% CI 0.11 to 56.25; very low certainty of evidence). The trial reported no other serious adverse events or liver-related morbidity. Quality of life was not reported. Oesophageal variceal bleeding occurred in 8% (1/12) of the children in the band ligation group versus 30% (3/10) of the children in the no active intervention group (RR 0.28, 95% CI 0.03 to 2.27; very low certainty of evidence). No adverse events considered non-serious were reported. Two children were lost to follow-up by one-year. Ten children in total completed the trial at two-year follow-up. There was no information on funding. We found two observational studies on endoscopic variceal ligation when searching for randomised trials. One found no harm, and the other reported E nterobacter cloacae septicaemia in one child and mild, transient, upper oesophageal sphincter stenosis in another. We did not assess these studies for risk of bias. We did not find any ongoing randomised clinical trials of interest to our review. Authors' conclusions: The evidence, obtained from only one feasibility randomised clinical trial at high risk of bias, is very scanty. It is very uncertain about whether prophylactic band ligation versus sham or no (active) intervention may affect mortality, serious adverse events and liver-related morbidity, or oesophageal variceal bleeding in children and adolescents with portal hypertension and large oesophageal varices. We have no data on quality of life. No adverse events considered non-serious were reported. The results presented in the trial need to be interpreted with caution. In addition, the highly limited data cover only part of our research question; namely, children with portal hypertension and large oesophageal varices. Data on children with portal vein thrombosis are lacking. Larger randomised clinical trials assessing the benefits and harms of band ligation compared with sham treatment for primary prophylaxis of oesophageal variceal bleeding in children and adolescents with chronic liver disease or portal vein thrombosis are needed. The trials should include important clinical outcomes such as death, quality of life, failure to control bleeding, and adverse events.
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    Banding ligation versus beta-blockers for primary prophylaxis of oesophageal variceal bleeding in children. Protocol
    (2013) Gana Ansaldo, Juan Cristóbal; Cifuentes, Lorena; Cerda, Jaime; Villarroel del Pino, Luis A.; Rivera Cornejo, Marcela; Peña Villegas, Alfredo Javier
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    Banding ligation versus sclerotherapy for primary prophylaxis of oesophageal varices in children (Protocol)
    (2015) Gana Ansaldo, Juan Cristóbal; Cifuentes, Lorena; Cerda, Jaime; Villarroel del Pino, Luis A.; Peña Villegas, Alfredo Javier; Torres Robles, R.
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    Banding ligation versus sham or no intervention for primary prophylaxis of oesophageal variceal bleeding in children
    (2015) Gana Ansaldo, Juan Cristóbal; Cifuentes, Lorena; Cerda, Jaime; Villarroel del Pino, Luis A.; Peña Villegas, Alfredo Javier; Rivera Cornejo, M.
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    Beta-blockers versus placebo or no intervention for primary prophylaxis of oesophageal varices in children
    (2015) Gana Ansaldo, Juan Cristóbal; Cifuentes, Lorena; Cerda, Jaime; Villarroel del Pino, Luis A.; Peña Villegas, Alfredo Javier; Torres‐Robles, Romina
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    Bile acids for cholelithiasis
    (2018) Gana Ansaldo, Juan Cristóbal; Gattini Valdés, Daniela Cecilia; Villarroel del Pino, Luis A.; Larraín Castellón, Sebastián; Yap, Jason
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    Capsule endoscopy for the diagnosis of oesophageal varices in people with chronic liver disease or portal vein thrombosis
    (2014) Colli, A.; Gana Ansaldo, Juan Cristóbal; Turner, D.; Yap, J.; Adams Webber, T.; Ling, S. C.; Casazza, G.
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    Childhood obesity: a risk factor for non-alcoholic fatty liver disease in adolescence
    (2019) Cuzmar Benítez, Valeria; Gana Ansaldo, Juan Cristóbal; Alberti, Gigliola; Pontificia Universidad Católica de Chile. Facultad de Medicina
    Non-alcoholic fatty liver disease (NAFLD), defined as fat accumulation >5% in hepatocytes, may progress to fibrosis or cirrhosis later in life. NAFLD prevalence in adolescents has increased significantly in direct relation with obesity prevalence. Objective: To identify anthropometric variables during the first 10 years of life associated to the risk of developing NAFLD in adolescence. Methods: Longitudinal cohort study 'Growth and Obesity Chilean Cohort Study' (GOCS) consisting of 513 children born in 2002-2003, with yearly anthropometric data collected over a 10 year period. The presence of intra-hepatic fat in the livers of subjects 14-16 years of age was determined using abdominal ultrasound. In addition, elastography was performed on all participants with ultrasound evidence of NAFLD. Results: 9.7% of the participants presented findings compatible with NAFLD. After 2 years of age, obesity significantly and progressively increased the probability of NAFLD occurrence in adolescence. Obesity at 5 years of age was associated with the highest OR for NAFLD, reaching values of 8.91 (95% CI 3.03-16.11). Among participants with NAFLD, those with altered liver elasticity (≥7 Kpa) had greater weight, BMI z-score, waist and hip circumference and altered liver enzymes (p<0.05). Conclusion: The risk of developing NAFLD in adolescence increases progressively with early obesity starting at age 2 years.
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    Clusters of Autoimmune Diseases in Children and the Role of PTPN22 C1858T Gene Polymorphism in Pediatric Polyautoimmunity
    (2014) Borzutzky Schachter, Arturo; Seiltgens, Cristián; Iruretagoyena B., Mirentxu; Cristi, Francisca; Ponce, María Jesús ; Melendez, Patricia; Martínez Aguayo, Alejandro; Hodgson Bunster, María Isabel; Talesnik Guendelman, Eduardo; Riera Cassorla, Francisca Paz; Méndez, Cecilia; Harris D., Paul R.; García Bruce, Hernán; Gana Ansaldo, Juan Cristóbal; Godoy, Claudia; Cattani Ortega, Andreína
    Background/Purpose:Autoimmune diseases (AIDs) have familial aggregation and frequently share a common genetic background, but few studies have evaluated autoimmune clusters in children with AIDs and their families. Children with more than one AID (pediatric polyautoimmunity) may have a stronger genetic component than children with a single AID. The objectives of this study were to identify clusters of AIDs in children and their first-degree relatives and to evaluate the association of PTPN22 C1858T gene polymorphism with pediatric polyautoimmunity.Methods:A cross-sectional study was performed in subjects with an AID of pediatric onset (<18 years)recruited at Pediatric Rheumatology, Endocrinology and Gastroenterology Clinics at the Health Network of the Pontificia Universidad Católica de Chile School of Medicine. Clusters of AIDs were identified by K-means cluster analysis. The PTPN22 C1858T gene polymorphism was determined by RT-PCR in subjects with pediatric polyautoimmunity and in subjects with three common AIDs: juvenile idiopathic arthritis (JIA), autoimmune thyroid disease (AITD), and type I diabetes (T1D).Results:191 subjects with pediatric AIDs were included, of which 45 (24%) had polyautoimmunity. Mean age was 12.1 years (range 1–19) and 68% were female. Most frequent AIDs were JIA (36%), AITD (25%), T1D (19%), uveitis (8%), celiac disease (6%), and vitiligo (6%). 59% of subjects with pediatric autoimmunity had first-degree relatives with an AID. Five clusters of AID were identified in families of children with autoimmunity (Table 1). Among the 45 subjects with pediatric polyautoimmunity, four clusters of AIDs were identified (Table 2). Genomic DNA from 128 subjects was evaluated for PTPN22 C1858T gene polymorphism revealing common homozygosity (C/C) in 85.2%, heterozygosity (C/T) in 13.3%, and rare homozygosity (T/T) in 1.6 %, in equilibrium with Hardy Weinberg equation (P = 0.4). 26% of polyautoimmune subjects had the T allele in contrast with 11% of monoautoimmune subjects (P = 0.04). No significant difference was found in the age of onset of autoimmunity between mono and polyautoimmune subjects (P = 0.44) or between subjects with C/C genotype vs. C/T and T/T genotypes (P = 0.81).
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    Coledococele : Caso diagnosticado por resonancia magnética
    (2020) Calderón H., Miguel; Abarzúa V., Jaime; Quiroga G., Cosme; Gana Ansaldo, Juan Cristóbal; De Barbieri Magnone, Florencia Beatriz
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    Congenital Portosystemic Shunt : Characterization of A Multisystem Disease
    (2013) Sokollik, Christiane; Bandsma, Robert H. J.; Gana Ansaldo, Juan Cristóbal; Van Den Heuvel, Meta; Ling, Simon C.
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    Curvas manométricas rectales en niños. Estudio promano fase I
    (2009) Jaime Méndez, María Francisca; Saavedra Gutierrez, Silvana Jeanette; Gana Ansaldo, Juan Cristóbal; Larraín B., Francisco J.; Harris D., Paul R.
    Propósito del estudio: Evaluar el rol de la manometría rectoanal (MRA) y establecer valores de normalidad en un grupo de niños referidos por desórdenes de defecación. Pacientes y Métodos: Revisión retrospectiva de MRA efectuadas durante un período de 8 años. Resultados: Se analizaron los resultados obtenidos de 789 niños (52,6% hombres). Éstos se clasificaron en cuatro grupos según resultado de la MRA como "Grupo control" (CL), "Grupo con probable megarrecto" (PMG), "Grupo con anormalidades de la inervación intrínseca" (All) y "Grupo con anormalidades de la inervación extrínseca" (ALE). Setenta y nueve porciento de los pacientes fueron referidos para evaluación de constipación crónica y 10% por sospecha de anormalidades de inervación intrínseca; en 94% y 83% de ellos respectivamente, la MRA descartó causas orgánicas. Los niños se distribuyeron en: CL (48,0%), PMG (42,6%), All (7,5%) y AIE (1,5%). El grupo CL y PMG mostraron diferencias edad-dependiente en algunos parámetros manométricos. Además se encontró diferencias en parámetros manométricos entre CL, PMG, All y AIE. Conclusiones: La principal indicación de MRA fue para estudio de constipación crónica, siendo las alteraciones orgánicas confirmadas sólo en un bajo porcentaje. Se describió cuatro patrones diferentes en 789 pacientes referidos para evaluación de dificultades en la defecación.
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    Dietary and Nutritional Interventions in Nonalcoholic Fatty Liver Disease in Pediatrics
    (2023) Farías, Camila; Cisternas, Camila; Gana Ansaldo, Juan Cristóbal; Alberti, Gigliola; Echeverría González, Francisca Cecilia; Videla, Luis A.; Mercado, Lorena; Muñoz, Yasna; Valenzuela, Rodrigo
    Nonalcoholic fatty liver disease (NAFLD) is pediatrics’ most common chronic liver disease. The incidence is high in children and adolescents with obesity, which is associated with an increased risk of disease progression. Currently, there is no effective drug therapy in pediatrics; therefore, lifestyle interventions remain the first line of treatment. This review aims to present an updated compilation of the scientific evidence for treating this pathology, including lifestyle modifications, such as exercise and dietary changes, highlighting specific nutritional strategies. The bibliographic review was carried out in different databases, including studies within the pediatric population where dietary and/or nutritional interventions were used to treat NAFLD. Main interventions include diets low in carbohydrates, free sugars, fructose, and lipids, in addition to healthy eating patterns and possible nutritional interventions with n-3 polyunsaturated fatty acids (EPA and DHA), amino acids (cysteine, L-carnitine), cysteamine, vitamins, and probiotics (one strain or multi-strain). Lifestyle changes remain the main recommendation for children with NAFLD. Nevertheless, more studies are required to elucidate the effectiveness of specific nutrients and bioactive compounds in this population.
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    Early endoscopic, laboratory and clinical predictors of poor disease course in paediatric ulcerative colitis
    (2015) Schechter, A.; Griffiths, C.; Gana Ansaldo, Juan Cristóbal; Shaoul, R.; Shamir, R.; Shteyer, E.; Bdolah, T.; Ledder, O.; Turner, D.