Management of pediatric primary spontaneous pneumothorax in a tertiary hospital
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Branco-Salvador, J. Jardim, C. Ferraz, T. Nunes, L.G. Vaz, I. Azevedo, T. Henriques-Coelho" "autores" => array:8 [ 0 => array:4 [ "Iniciales" => "R." "apellidos" => "Lamas-Pinheiro" "email" => array:1 [ 0 => "rubenlms@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "Iniciales" => "J." "apellidos" => "Branco-Salvador" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 2 => array:3 [ "Iniciales" => "J." "apellidos" => "Jardim" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 3 => array:3 [ "Iniciales" => "C." "apellidos" => "Ferraz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 4 => array:3 [ "Iniciales" => "T." "apellidos" => "Nunes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 5 => array:3 [ "Iniciales" => "L.G." "apellidos" => "Vaz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 6 => array:3 [ "Iniciales" => "I." "apellidos" => "Azevedo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 7 => array:3 [ "Iniciales" => "T." "apellidos" => "Henriques-Coelho" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Pediatric Surgery, Hospital São João, Faculty of Medicine, Porto, Portugal" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Department of Pediatric Pulmonology, Hospital São João, Faculty of Medicine, Porto, Portugal" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "<span class="elsevierStyleSup">*</span>" "correspondencia" => "Corresponding author. rubenlms@hotmail.com" ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "320v21n06-90445976fig1.jpg" "Alto" => 2063 "Ancho" => 3087 "Tamanyo" => 407408 ] ] "descripcion" => array:1 [ "en" => "Therapeutic algorithm in the first and recurrent episodes of primary spontaneous pneumothorax." ] ] ] "textoCompleto" => "<p class="elsevierStylePara">Management of pediatric primary spontaneous pneumothorax (PSP) is based on adult literature and the best therapeutic algorithm for PSP is still debatable.<a href="#bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> The aim of this work was to review the approach to pediatric PSP in a tertiary care hospital.</p><p class="elsevierStylePara">Clinical charts of patients admitted with first episode of PSP at Hospital São João (Porto, Portugal) between January 2006 and January 2012 were reviewed and analyzed for demographic, diagnosis, treatment and follow-up.</p><p class="elsevierStylePara">The management of PSP followed the institution protocol: small (<20%) pneumothoraxes are treated with high output oxygen therapy; moderate to large pneumothoraxes (>20–25%) are treated with chest tube drainage or needle aspiration. Surgical indications are: second ipsilateral pneumothorax; first contralateral pneumothorax; bilateral pneumothorax or persistent air leakage (>4 days). All patients proposed for elective surgery had a computerized tomography scan (CT).</p><p class="elsevierStylePara">Twenty-five patients with a first episode of PSP were included, with a male predominance (80%) as described in the literature. Chest pain was the most frequent presentation (>80%) followed by dyspnea and cough. Five patients had asthma, three were active smokers and one had a family history of PSP. With a follow-up range from one to six years, there were seven recurrences.</p><p class="elsevierStylePara">The results of the therapeutic algorithm are summarized in <a href="#f0005" class="elsevierStyleCrossRefs">Figure 1</a>. Eight of the initial episodes and 1 recurrence were successfully treated with oxygen therapy; success rate was 43% for first episodes. Chest tube was the next step and was used in 12 initial episodes with a success rate of 75%; however, chest tubes failed in all recurrent episodes. A total of 11 patients underwent thoracoscopy: 5 during the first episode and 6 during recurrence. Thoracoscopy proved to be successful in all cases, with no recurrences. In the presence of blebs, mechanical pleurodesis with bleb resection was performed, whereas in absence of blebs a mechanical pleurodesis was performed.</p><a name="f0005" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"><img src="320v21n06-90445976fig1.jpg" alt="Therapeutic algorithm in the first and recurrent episodes of primary spontaneous pneumothorax."></img></p><p class="elsevierStylePara">Figure 1. Therapeutic algorithm in the first and recurrent episodes of primary spontaneous pneumothorax.</p><p class="elsevierStylePara">The overall length of stay was longer for patients treated with thoracoscopy compared to patients treated with oxygen therapy or chest tube (respectively 13.4 ± 4.3, 3.8 ± 1.2, 6.2 ± 3 days, <span class="elsevierStyleItalic">p</span> < 0.001). However, patients were hospitalized with a mean of 8 days before surgery and if this is taken into account, there is no significant difference between treatments.</p><p class="elsevierStylePara">In case of oxygen therapy failure, symptomatic or large PSP, American College of Chest Physicians favors chest tube, while British Thoracic Society (BTS) prefers needle aspiration; both have similar efficiency and recurrence rates.<a href="#bib10" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">, </span><a href="#bib11" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a> Robinson et al. have recently reported the implementation of the BTS guidelines in Australia and New Zealand with a large multicenter series, addressing the efficacy of needle aspiration. Although they do not separate the recurrent from the initial episodes of PSP, they report an identical success rate (46%) for expectant treatment independently of oxygen use. As in our study, when intervention was needed, chest tube was still the first-line (used in 79%); needle aspiration was used in only 21% of patients, with a success rate of 52%.<a href="#bib12" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a> In recurrent episodes, the efficiency falls after non-operative treatment, with described success rates as low as 52% in the second episode and 15% in the third.<a href="#bib13" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a> Thoracoscopy may be more aggressive, but it has the lowest reported recurrence rate (5–75%); in our study, thoracoscopy was always successful and there were no recurrences.<a href="#bib12" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">, </span><a href="#bib14" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleSup">, </span><a href="#bib15" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a> In adult population, thoracoscopic surgery is being proposed as an alternative to chest tube even in first episodes, with lower recurrence rate and shorter hospital stay. However, randomized studies in pediatric population still advocate conservative management for initial PSP episodes, since several patients will never need surgical intervention.<a href="#bib14" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleSup">, </span><a href="#bib15" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a></p><p class="elsevierStylePara">Finally, the presence of blebs in the CT scan has been suggested as an independent risk factor for recurrence, but its usefulness remains controversial. Some studies indicate that blebs may not predict recurrence and CT scan findings should not be used as a basis for prophylactic surgery.<a href="#bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">, </span><a href="#bib14" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleSup">, </span><a href="#bib16" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">8</span></a> In our study, more than a half of the patients had no blebs in the CT scan (58%) but blebs were associated with higher recurrence rate (63% versus 18%, <span class="elsevierStyleItalic">p</span> = 0.048).</p><p class="elsevierStylePara">The best treatment for first PSP in pediatrics is probably conservative (oxygen therapy, needle aspiration or chest tube drainage). Nevertheless, thoracoscopy is efficient and seems to be the best option in refractory or recurrent PSP.</p><a name="sec0005" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p class="elsevierStylePara">The authors have no conflicts of interest to declare.</p><p class="elsevierStylePara">Corresponding author. rubenlms@hotmail.com</p>" "pdfFichero" => "320v21n06a90445976pdf001.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "320v21n06-90445976fig1.jpg" "Alto" => 2063 "Ancho" => 3087 "Tamanyo" => 407408 ] ] "descripcion" => array:1 [ "en" => "Therapeutic algorithm in the first and recurrent episodes of primary spontaneous pneumothorax." ] ] 1 => array:6 [ "identificador" => "fig2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "descripcion" => array:1 [ "en" => "Therapeutic algorithm in the first and recurrent episodes of primary spontaneous pneumothorax." ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib9" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Evidence-based management of paediatric primary spontaneous pneumothorax. Paediatr Respir Rev. 2009; 10(3):110-7. [quiz 117]" "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Evidence-based management of paediatric primary spontaneous pneumothorax." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Robinson PD" 1 => "Cooper P" 2 => "Ranganathan SC." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.prrv.2008.12.003" "Revista" => array:6 [ "tituloSerie" => "Paediatr Respir Rev. " "fecha" => "2009" "volumen" => "10" "paginaInicial" => "110" "paginaFinal" => "117" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19651381" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib10" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "BTS guidelines for the management of spontaneous pneumothorax. Thorax. 2003; 58(Suppl. 2):ii39-52." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "BTS guidelines for the management of spontaneous pneumothorax." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Henry M" 1 => "Arnold T" 2 => "Harvey J." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Thorax. " "fecha" => "2003" "volumen" => "58" "paginaInicial" => "ii39" "paginaFinal" => "ii52" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12728149" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib11" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement. Chest. 2001; 119(2):590-602." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Baumann MH" 1 => "Strange C" 2 => "Heffner JE" 3 => "Light R" 4 => "Kirby TJ" 5 => "Klein J" 6 => "et-al." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest. " "fecha" => "2001" "volumen" => "119" "paginaInicial" => "590" "paginaFinal" => "602" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11171742" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib12" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Management of paediatric spontaneous pneumothorax: a multicentre retrospective case series. Arch Dis Child. 2015." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Management of paediatric spontaneous pneumothorax: a multicentre retrospective case series." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Robinson PD" 1 => "Blackburn C" 2 => "Babl FE" 3 => "Gamage L" 4 => "Schutz J" 5 => "Nogajski R" 6 => "et-al." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Arch Dis Child. " "fecha" => "2015" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib13" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Spontaneous pneumothorax: determinants of surgical intervention. J Cardiovasc Surg. 1998; 39(1):107-11." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Spontaneous pneumothorax: determinants of surgical intervention." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Jain SK" 1 => "Al-Kattan KM" 2 => "Hamdy MG." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Cardiovasc Surg. " "fecha" => "1998" "volumen" => "39" "paginaInicial" => "107" "paginaFinal" => "111" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib14" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Management of primary spontaneous pneumothorax in children. Clin Pediatr. 2011; 50(9):797-802." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Management of primary spontaneous pneumothorax in children." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Seguier-Lipszyc E" 1 => "Elizur A" 2 => "Klin B" 3 => "Vaiman M" 4 => "Lotan G." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Pediatr. " "fecha" => "2011" "volumen" => "50" "paginaInicial" => "797" "paginaFinal" => "802" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib15" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Spontaneous pneumothorax in children: when is invasive treatment indicated?. Pediatr Pulmonol. 2008; 43(1):41-6." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Spontaneous pneumothorax in children: when is invasive treatment indicated?." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "O’Lone E" 1 => "Elphick HE" 2 => "Robinson PJ." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ppul.20734" "Revista" => array:6 [ "tituloSerie" => "Pediatr Pulmonol. " "fecha" => "2008" "volumen" => "43" "paginaInicial" => "41" "paginaFinal" => "46" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18041754" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib16" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Contralateral recurrence of primary spontaneous pneumothorax. Chest. 2007; 132(4):1146-50." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Contralateral recurrence of primary spontaneous pneumothorax." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Huang TW" 1 => "Lee SC" 2 => "Cheng YL" 3 => "Tzao C" 4 => "Hsu HH" 5 => "Chang H" 6 => "et-al." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.06-2772" "Revista" => array:6 [ "tituloSerie" => "Chest. " "fecha" => "2007" "volumen" => "132" "paginaInicial" => "1146" "paginaFinal" => "1150" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17550937" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08732159/0000002100000006/v0_201604141141/X087321591545976X/v0_201604141142/en/main.assets" "Apartado" => array:4 [ "identificador" => "50815" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/08732159/0000002100000006/v0_201604141141/X087321591545976X/v0_201604141142/en/320v21n06a90445976pdf001.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X087321591545976X?idApp=UINPBA00004E" ]
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| 2022 August | 47 | 42 | 89 |
| 2022 July | 39 | 50 | 89 |
| 2022 June | 34 | 35 | 69 |
| 2022 May | 49 | 39 | 88 |
| 2022 April | 38 | 38 | 76 |
| 2022 March | 47 | 66 | 113 |
| 2022 February | 48 | 34 | 82 |
| 2022 January | 42 | 32 | 74 |
| 2021 December | 35 | 44 | 79 |
| 2021 November | 45 | 36 | 81 |
| 2021 October | 54 | 51 | 105 |
| 2021 September | 37 | 34 | 71 |
| 2021 August | 45 | 26 | 71 |
| 2021 July | 43 | 29 | 72 |
| 2021 June | 56 | 19 | 75 |
| 2021 May | 85 | 53 | 138 |
| 2021 April | 315 | 106 | 421 |
| 2021 March | 217 | 42 | 259 |
| 2021 February | 102 | 30 | 132 |
| 2021 January | 95 | 33 | 128 |
| 2020 December | 70 | 19 | 89 |
| 2020 November | 95 | 24 | 119 |
| 2020 October | 68 | 18 | 86 |
| 2020 September | 106 | 31 | 137 |
| 2020 August | 80 | 31 | 111 |
| 2020 July | 105 | 32 | 137 |
| 2020 June | 82 | 30 | 112 |
| 2020 May | 90 | 16 | 106 |
| 2020 April | 98 | 11 | 109 |
| 2020 March | 86 | 24 | 110 |
| 2020 February | 90 | 87 | 177 |
| 2020 January | 95 | 34 | 129 |
| 2019 December | 85 | 24 | 109 |
| 2019 November | 89 | 37 | 126 |
| 2019 October | 86 | 40 | 126 |
| 2019 September | 96 | 23 | 119 |
| 2019 August | 132 | 29 | 161 |
| 2019 July | 139 | 15 | 154 |
| 2019 June | 145 | 21 | 166 |
| 2019 May | 157 | 28 | 185 |
| 2019 April | 219 | 40 | 259 |
| 2019 March | 214 | 39 | 253 |
| 2019 February | 154 | 10 | 164 |
| 2019 January | 178 | 36 | 214 |
| 2018 December | 103 | 17 | 120 |
| 2018 November | 32 | 1 | 33 |
| 2018 October | 47 | 9 | 56 |
| 2018 September | 23 | 11 | 34 |
| 2018 August | 43 | 46 | 89 |
| 2018 July | 50 | 52 | 102 |
| 2018 June | 64 | 44 | 108 |
| 2018 May | 63 | 70 | 133 |
| 2018 April | 98 | 64 | 162 |
| 2018 March | 102 | 45 | 147 |
| 2018 February | 48 | 39 | 87 |
| 2018 January | 52 | 38 | 90 |
| 2017 December | 72 | 44 | 116 |
| 2017 November | 35 | 41 | 76 |
| 2017 October | 25 | 33 | 58 |
| 2017 September | 17 | 40 | 57 |
| 2017 August | 26 | 66 | 92 |
| 2017 July | 21 | 26 | 47 |
| 2017 June | 13 | 29 | 42 |
| 2017 May | 35 | 51 | 86 |
| 2017 April | 14 | 35 | 49 |
| 2017 March | 17 | 23 | 40 |
| 2017 February | 15 | 19 | 34 |
| 2017 January | 16 | 15 | 31 |
| 2016 December | 25 | 29 | 54 |
| 2016 November | 27 | 33 | 60 |
| 2016 October | 42 | 30 | 72 |
| 2016 September | 39 | 34 | 73 |
| 2016 August | 26 | 24 | 50 |
| 2016 July | 25 | 61 | 86 |
| 2016 June | 0 | 56 | 56 |
| 2016 May | 1 | 12 | 13 |
| 2016 April | 22 | 33 | 55 |
| 2016 March | 18 | 24 | 42 |
| 2016 February | 43 | 37 | 80 |
| 2016 January | 63 | 60 | 123 |
| 2015 December | 57 | 64 | 121 |
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