Managing Urolithiasis with Thulium Fiber Laser: Updated Real-Life Results-A Systematic Review

Olivier Traxer, Mariela Corrales, Olivier Traxer, Mariela Corrales

Abstract

Thirty-three years ago, pulsed lasers marked the beginning of a new era in endoscopic lithotripsy, and the one that was highlighted because of its potential was the Holmium: YAG laser, which became and still is the gold standard in endourology. Recently, a new laser technology has been accepted for clinical use in lithotripsy: the thulium fiber laser (TFL), showing appealing characteristics not seen before in several preclinical studies. A review of the literature was performed and all relevant in vitro studies and clinical trials until April 2021 were selected. The search came back with 27 clinical experiences (7 full-text clinical trials and 20 peer-reviewed abstracts) and 33 laboratory studies (18 full-text articles and 15 peer-reviewed abstracts). The clinical experiences confirmed the clinical safety of using the wide parameter range of the TFL. This technology demonstrated the performance at a higher ablation speed, the higher ablation efficiency, and the better dust quality of the TFL, as well as reduced stone retropulsion, thus helping to maintain an optimal visibility. No thermal or radiation damage was found. Given the current evidence, we may be facing the future gold standard laser in endoscopic lithotripsy.

Keywords: endourology; holmium laser; kidney stones; laser; lithotripsy; thulium fiber laser; ureteral stones.

Conflict of interest statement

Olivier Traxer is a consultant for Coloplast, Rocamed, Olympus, EMS, Boston Scientific, and IPG Medical. Mariela Corrales has no conflict of interest to declare.

Figures

Figure 1
Figure 1
Flow chart of the literature review.

References

    1. Coptcoat M.J., Ison K.T., Watson G., Wickham J.E.A. Lasertripsy for Ureteric Stones in 120 Cases: Lessons Learned. Br. J. Urol. 1988;61:487–489. doi: 10.1111/j.1464-410X.1988.tb05085.x.
    1. Panthier F., Doizi S., Corrales M., Traxer O. Pulsed Lasers and Endocorporeal Laser Lithotripsy. Prog. Urol. 2021;31:451–457. doi: 10.1016/j.purol.2020.11.008.
    1. Denstedt J.D., Razvi H.A., Sales J.L., Eberwein P.M. Preliminary Experience with Holmium: YAG Laser Lithotripsy. J. Endourol. 1995;9:255–258. doi: 10.1089/end.1995.9.255.
    1. Terry R.S., Whelan P.S., Lipkin M.E. Current Opinion in Urology. Lippincott Williams and Wilkins; Pennsylvania, PA, USA: 2020. New Devices for Kidney Stone Management; pp. 144–148.
    1. Fried N.M., Irby P.B. Nature Reviews Urology. Nature Publishing Group; Pennsylvania, PA, USA: 2018. Advances in Laser Technology and Fibre-Optic Delivery Systems in Lithotripsy; pp. 563–573.
    1. Olympus Olympus Launches the Soltive SuperPulsed Thulium Fiber Laser System for Urology. Launched. Jun 17, 2020. [(accessed on 1 April 2021)]. Available online: .
    1. Hall L.A., Gonzalez D.A., Fried N.M. Thulium Fiber Laser Ablation of Kidney Stones Using an Automated, Vibrating Fiber. J. Biomed. Opt. 2019;24:1–10. doi: 10.1117/1.JBO.24.3.038001.
    1. Andreeva V., Vinarov A., Yaroslavsky I., Kovalenko A., Vybornov A., Rapoport L., Enikeev D., Sorokin N., Dymov A., Tsarichenko D., et al. Preclinical Comparison of Superpulse Thulium Fiber Laser and a Holmium:YAG Laser for Lithotripsy. World J. Urol. 2020;38:497–503. doi: 10.1007/s00345-019-02785-9.
    1. Traxer O., Rapoport L., Tsarichenko D., Dymov A., Enikeev D., Sorokin N., Ali S., Akopyan G., Korolev D., Proskura A., et al. V03-02 First Clinical Study on Superpulse Thulium Fiber Laser for Lithotripsy. J. Urol. 2018;199:e321–e322. doi: 10.1016/j.juro.2018.02.827.
    1. Moher D., Liberati A., Tetzlaff J., Altman D.G. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. Int. J. Surg. 2010;8:336–341. doi: 10.1016/j.ijsu.2010.02.007.
    1. Traxer O., Keller E.X. Thulium Fiber Laser: The New Player for Kidney Stone Treatment? A Comparison with Holmium: YAG Laser. World J. Urol. 2020;38:1883–1894. doi: 10.1007/s00345-019-02654-5.
    1. Kronenberg P., Traxer O. The Laser of the Future: Reality and Expectations about the New Thulium Fiber Laser-a Systematic Review. Transl. Androl. Urol. 2019;8:S398–S417. doi: 10.21037/tau.2019.08.01.
    1. Olympus Superpulsed Laser System SOLTIVE Premium: Sell Sheet; S00316EN. 10/20 OEKG. [(accessed on 25 October 2020)];2020 Available online: .
    1. Hardy L.A., Kennedy J.D., Wilson C.R., Irby P.B., Fried N.M. Analysis of Thulium Fiber Laser Induced Bubble Dynamics for Ablation of Kidney Stones. J. Biophotonics. 2017;10:1240–1249. doi: 10.1002/jbio.201600010.
    1. Moses Laser: Holmium Laser Lithotripsy & Enucleation Machine. [(accessed on 7 May 2021)]; Available online: .
    1. Ibrahim A., Elhilali M.M., Fahmy N., Carrier S., Andonian S. Double-Blinded Prospective Randomized Clinical Trial Comparing Regular and Moses Modes of Holmium Laser Lithotripsy. J. Endourol. 2020;34:624–628. doi: 10.1089/end.2019.0695.
    1. Ventimiglia E., Doizi S., Kovalenko A., Andreeva V., Traxer O. Effect of Temporal Pulse Shape on Urinary Stone Phantom Retropulsion Rate and Ablation Efficiency Using Holmium:YAG and Super-Pulse Thulium Fibre Lasers. BJU Int. 2020;126:159–167. doi: 10.1111/bju.15079.
    1. Hardy L.A., Wilson C.R., Irby P.B., Fried N.M. Thulium Fiber Laser Lithotripsy in an in Vitro Ureter Model. J. Biomed. Opt. 2014;19:128001. doi: 10.1117/1.JBO.19.12.128001.
    1. Martov A., Ergakov D., Guseynov M., Coninck V., Keller E., Traxer O. VS1-2 SuperPulse Thulium Fiber Laser for UreteroscopicLithotripsy: 1 Year Experience. J. Endourol. 2018;32:A495.
    1. Dymov A., Tsarichenko D., Akopyan G., Chinenov D., Ali S., Klimov R., Lekarev V., Korolev D., Rapoport L. MP30-05 RIRS with SuperPulse Thulium Fiber Laser for Kidney Stones Larger than 2 Cm. J. Endourol. 2019;33:A315.
    1. Korolev D., Klimov R., Tsarichenko D., Enikeev M., Dymov A., Ali S., Lekarev V., Akopyan G., Taratkin M., Rapoport L., et al. RIRS for Lower Pole Small Renal Stones: Novel SuperPulse Thulium (Tm) Fiber Laser Lithotripsy. First Clinical Results. Eur. Urol. Open Sci. 2020;19:e13. doi: 10.1016/S2666-1683(20)30012-4.
    1. Ergakov D., Martov A.G., Guseynov M. The Comparative Clinical Study of Ho: YAG and SuperPulse Tm Fiber Laser Lithotripters. Eur. Urol. Suppl. 2018;17:e1391. doi: 10.1016/S1569-9056(18)31816-5.
    1. Garcia-Gil M., Chew B.H., Humphreys M.R., Molina W., Carrera R.V. PD07-12 thulium fiber laser lithotripsy is safe, efficient and effective in minipcnl: The initial north american experience. J. Urol. 2020;203:e166. doi: 10.1097/JU.0000000000000834.012.
    1. Traxer O., Martov A., Ergakov D., Guseynov M. V01-01 prospective transurethral lithotripsy study with superpulse TM fiber laser. J. Urol. 2019;201(Suppl. 4):e85. doi: 10.1097/01.JU.0000555073.09285.09.
    1. Carrera R., Randall J., Kansas City K., Garcia-Gil M., Knudsen B., Columbus O., Chew B., Vancouver C., Thompson J., Kansas City K., et al. PD34-04 ureteroscopic performance of thulium fiber laser (soltive premium super pulsed lasertm) for the treatment of urolithiasis: Results of the first case series in the united states. J. Urol. 2020;203:e712–e713.
    1. Traxer O., Dymov A., Rapoport L., Tsarichenko D., Enikeev D., Sorokin N., Akopyan G., Proskura A., Ali S., Klimov R., et al. V01-02 Comprehensive Clinical Study of Super Pulse Tm Fiber Laser for Treatment of Stone Disease. J. Urol. 2019;201(Suppl. 4):e85–e86. doi: 10.1097/01.JU.0000555074.09285.c7.
    1. Keller E.X., De Coninck V., Vinnichenko V., Chiron P., Doizi S., Guseynov M., Ergakov D., Martov A., Traxer O. V01-09 Superpulse Thulium Fiber Laser for Lithotripsy Of Large Renal Stones: Initial Experience. J. Urol. 2019;201(Suppl. 4):e88. doi: 10.1097/01.JU.0000555081.47403.44.
    1. Martov A., Ergakov D., Baykov N., Guseynov M., Andronov A., Moscow S.D. V04-11 the superpulse thulium fiber laser in the management of giant distal ureter stone. J. Urol. 2020;203(Suppl. 4):e390. doi: 10.1097/JU.0000000000000863.011.
    1. Ali S., Rapoport L., Tsarichenko D., Enikeev D., Sorokin N., Akopyan G., Dimov A., Klimov R., Lekarev V. VS1-3 Clinical Study on Superpulse Thulium Fiber Laser for Lithotripsy. J. Endourol. 2018;32:A496.
    1. Martov A., Ergakov D., Andronov A., Guseynov M., Coninck V., Keller E., Traxer O. MP12-3 First Ultra-Mini-Percutaneous Nephrolithotripsy(UM-PCNL) with the New Thulium SuperPulse Fiber Laser(TSPFL) J. Endourol. 2018;32:111.
    1. Dymov A., Rapoport L., Tsarichenko D., Enikeev D., Sorokin N., Akopyan G., Proskura A., Ali S., Klimov R., Lekarev V., et al. PD01-06 prospective clinical study on superpulse thulium fiber laser: Initial analysis of optimal laser settings. J. Urol. 2019;201(Suppl. 4):e58. doi: 10.1097/01.JU.0000555018.13063.41.
    1. Mistry T., Pahwa M., Tyagi V. MP22-05 efficacy of super-pulse thulium fiber laser in endoscopic management of lower ureteric stones in indian population. J. Urol. 2020;203:e329. doi: 10.1097/JU.0000000000000855.05.
    1. Martov A., Andronov A., Moscow S.D., Traxer O. V01-11 thulium superpulse fiber laser (tspfl) micro-pcnl: How to improve stone-free rate (SFR) J. Urol. 2019;201(Suppl. 4):e89. doi: 10.1097/01.JU.0000555083.32156.03.
    1. Dymov A., Rapoport L., Enikeev D., Tsarichenko D., Sorokin N., Akopyan G., Proskura A., Ali S., Klimov R., Lekarev V., et al. MP17-12 optimizing stone free rate evaluation time point for laser lithotripsy in dusting mode. J. Urol. 2019;201(Suppl. 4):e259–e260. doi: 10.1097/01.JU.0000555437.99672.2f.
    1. Enikeev D., Taratkin M., Alyaev Y., Rapoport L., Korolev D., Ali S., Klimov R., Glybochko P. MP22-04 super-pulse thulium-fiber laser for lithotripsy. J. Urol. 2020;203:e328. doi: 10.1097/JU.0000000000000855.04.
    1. Korolev D., Klimov R., Tsarichenko D., Enikeev M., Dymov A., Ali S., Akopyan G., Lekarev V., Taratkin M., Rapoport L., et al. Rirs for Kidney Stones with Novel Superpulse Thulium (TM) Fiber Laser: First Clinical Experience. Eur. Urol. Open Sci. 2020;19:e14. doi: 10.1016/S2666-1683(20)30013-6.
    1. Shah D., Patil A., Reddy N., Singh A., Ganpule A., Sabnis R., Desai M. A Clinical Experience of Thulium Fibre Laser in Miniperc to Dust with Suction: A New Horizon. World J. Urol. 2020:1–6. doi: 10.1007/s00345-020-03458-8.
    1. Martov A., Ergakov D., Guseynov M., Andronov A., Plekhanova O.A. Clinical Comparison of Super Pulse Thulium Fiber Laser and High-Power Holmium Laser for Ureteral Stone Management. J. Endourol. 2020:795–800. doi: 10.1089/end.2020.0581.
    1. Corrales M., Traxer O. Initial Clinical Experience with the New Thulium Fiber Laser: First 50 Cases. World J. Urol. 2021:1–6. doi: 10.1007/s00345-021-03616-6.
    1. Korolev D., Akopyan G., Tsarichenko D., Shpikina A., Ali S., Chinenov D., Corrales M., Taratkin M., Traxer O., Enikeev D. Minimally Invasive Percutaneous Nephrolithotomy with SuperPulsed Thulium-Fiber Laser. Urolithiasis. 2021:1–7. doi: 10.1007/s00240-021-01258-2.
    1. Enikeev D., Taratkin M., Klimov R., Inoyatov J., Azilgareeva C., Ali S., Korolev D., Corrales M., Traxer O., Glybochko P. Superpulsed Thulium Fiber Laser for Stone Dusting: In Search of a Perfect Ablation Regimen—A Prospective Single-Center Study. J. Endourol. 2020;34:1175–1179. doi: 10.1089/end.2020.0519.
    1. Enikeev D., Taratkin M., Klimov R., Alyaev Y., Rapoport L., Gazimiev M., Korolev D., Ali S., Akopyan G., Tsarichenko D., et al. Thulium-Fiber Laser for Lithotripsy: First Clinical Experience in Percutaneous Nephrolithotomy. World J. Urol. 2020;38:3069–3074. doi: 10.1007/s00345-020-03134-x.
    1. Enikeev D., Grigoryan V., Fokin I., Morozov A., Taratkin M., Klimov R., Kozlov V., Gabdullina S., Glybochko P. Endoscopic Lithotripsy with a SuperPulsed Thulium-Fiber Laser for Ureteral Stones: A Single-Center Experience. Int. J. Urol. 2021;28:261–265. doi: 10.1111/iju.14443.
    1. Chiron P.H.L., Doizi S., De Coninck V., Keller E.X., Berthe L., Traxer O. Impact of SuperPulse Thulium Fiber Laser Settings and Curve Diameter on Optical Fiber Fracture during Intracorporeal Lithotripsy. Eur. Urol. Suppl. 2019;18:e1756. doi: 10.1016/S1569-9056(19)31271-0.
    1. Blackmon R.L., Hutchens T.C., Hardy L.A., Wilson C.R., Irby P.B., Fried N.M. Thulium Fiber Laser Ablation of Kidney Stones Using a 50-Μm-Core Silica Optical Fiber. Opt. Eng. 2014;54:011004. doi: 10.1117/1.OE.54.1.011004.
    1. Panthier F., Doizi S., Gorny C., Berthe L., TRAXER O. Impact of Laser Fiber Diameter and Irrigation Fluids on Induced Bubble Stream Dynamics With Superpulsed Thulium Fiber Laser: An In Vitro Study. J. Endourol. 2020:1–29. doi: 10.1089/end.2020.0766.
    1. Knudsen B., Molina W., City K., Chew B. PD30-01 comparison of small core diameter laser fibers used for lithotripsy with a 120w ho: Yag laser and the soltive superpulsed thulium fiber laser. J. Urol. 2020;203:e624. doi: 10.1097/JU.0000000000000894.01.
    1. Knudsen B., Chew B., Molina W. MP79-16 SUPER PULSE THULIUM FIBER LASER COMPARED TO 120W HOLMIUM: YAG LASER: IMPACT ON RETROPULSION AND LASER FIBER BURN BACK. J. Urol. 2019;201(Suppl. 4):e1157–e1158.
    1. Glybochko P., Altshuler G., Vinarov A., Rapoport L., Enikeev M., Grigoriev N., Enikeev D., Sorokin N., Dymov A., Sukhanov R., et al. Comparison between the Possibilities of Holmium and Thulium Laser in Lithotripsy in Vitro. Eur. Urol. Suppl. 2017;16:e391–e392. doi: 10.1016/S1569-9056(17)30292-0.
    1. Hardy L.A., Vinnichenko V., Fried N.M. High Power Holmium:YAG versus Thulium Fiber Laser Treatment of Kidney Stones in Dusting Mode: Ablation Rate and Fragment Size Studies. Lasers Surg. Med. 2019;51:522–530. doi: 10.1002/lsm.23057.
    1. Panthier F., Doizi S., Berthe L., Traxer O. PD04-12 in vitro comparison of ablation rates between superpulsed thulium fiber laser and ho: Yag laser for endocorporeal lithotripsy. J. Urol. 2020;203(Suppl. 4):e83.
    1. Chiron P., Berthe L., Haddad M., Doizi S., Traxer O. PD59-06 IN vitro comparison of efficiency between superpulsed thulium fiber laser and ho: Yag laser for endocorporeal lithotripsy. J. Urol. 2019;201(Suppl. 4):e1093.
    1. Dymov A., Glybochko P., Alyaev Y., Vinarov A., Altshuler G., Zamyatina V., Sorokin N., Enikeev D., Lekarev V., Proskura A., et al. V11-11 thulium lithotripsy: From experiment to clinical practice. J. Urol. 2017;197:e1285. doi: 10.1016/j.juro.2017.02.3000.
    1. Molina W., Knudsen B., Chew B. MP5-19 Comparison of Rapid-Pulse Tm Fiber LASER (RPFL) vs. High Power 120W Holmium-YAG LASER (Ho:YAG): Stone Ablation Efficiency at the Same Average Power Settings. J. Endourol. 2018;32:A49.
    1. Chew B.H., Knudsen B.E., Molina W.R. MP79-19 comparison of dusting and fragmenting using the new super pulse thulium fiber laser to a 120w holmium: Yag laser. J. Urol. 2019;201(Suppl. 4):e1159–e1160.
    1. Ventimiglia E., Pauchard F., Gorgen A.R.H., Panthier F., Doizi S., Traxer O. How Do We Assess the Efficacy of Ho:YAG Low-Power Laser Lithotripsy for the Treatment of Upper Tract Urinary Stones? Introducing the Joules/Mm3 and Laser Activity Concepts. World J. Urol. 2020;39:891–896. doi: 10.1007/s00345-020-03241-9.
    1. Fried N.M. Thulium Fiber Laser Lithotripsy: An in Vitro Analysis of Stone Fragmentation Using a Modulated 110-Watt Thulium Fiber Laser at 1.94 Μm. Lasers Surg. Med. 2005;37:53–58. doi: 10.1002/lsm.20196.
    1. Keller E.X., De Coninck V., Doizi S., Daudon M., Traxer O. Thulium Fiber Laser: Ready to Dust All Urinary Stone Composition Types? World J. Urol. 2020:1–6. doi: 10.1007/s00345-020-03217-9.
    1. Blackmon R.L., Irby P.B., Fried N.M. Holmium: YAG (λ = 2120 Nm) versus Thulium Fiber (λ = 1908 Nm) Laser Lithotripsy. Lasers Surg. Med. 2010;42:232–236. doi: 10.1002/lsm.20893.
    1. Dragos L., Somani B.K., Keller Etienne X., De Coninck Vincent M.J., Steeve D., Cumpanas Alin A., Martis Sandra M., Daminescu L.C., Wiseman Oliver J., Olivier T. PD01-05 high power holmim moses technology versus super-pulse thulium fibre laser. which is more efficient on stones? J. Urol. 2019;201(Suppl. 4):e58. doi: 10.1097/01.JU.0000555017.05439.f5.
    1. Wieliczka D.M., Weng S., Querry M.R. Wedge Shaped Cell for Highly Absorbent Liquids: Infrared Optical Constants of Water. Appl. Opt. 1989;28:1714. doi: 10.1364/AO.28.001714.
    1. Keller E.X., De Coninck V., Doizi S., Daudon M., Traxer O. What Is the Exact Definition of Stone Dust? An In Vitro Evaluation. World J. Urol. 2020;39:187–194. doi: 10.1007/s00345-020-03178-z.
    1. Panthier F., Doizi S., Lapouge P., Chaussain C., Kogane N., Berthe L., Traxer O. Comparison of the Ablation Rates, Fissures and Fragments Produced with 150 Μm and 272 Μm Laser Fibers with Superpulsed Thulium Fiber Laser: An In Vitro Study. World J. Urol. 2020;39:1683–1691. doi: 10.1007/s00345-020-03186-z.
    1. De Coninck V., Keller E.X., Kovalenko A., Vinnichenko V., Traxer O. MP03-20 dusting efficiency comparison between moses technology of ho: Yag laser and superpulse thulium fiber laser. J. Urol. 2019;201(Suppl. 4):e28–e29.
    1. Traxer O., De Coninck V., Keller E.X., Doizi S. MP17-03 comparing short, long, and moses regimes of ho: Yag laser vs. super pulse tm fiber laser in vitro: Ablation speed and retropulsion effect. J. Urol. 2019;201(Suppl. 4):e255–e256.
    1. Kronenberg P., Somani B. Advances in Lasers for the Treatment of Stones—A Systematic Review. Curr. Urol. Rep. 2018;19:1–11. doi: 10.1007/s11934-018-0807-y.
    1. Bach T., Muschter R., Sroka R., Gravas S., Skolarikos A., Herrmann T.R.W., Bayer T., Knoll T., Abbou C.C., Janetschek G., et al. Laser Treatment of Benign Prostatic Obstruction: Basics and Physical Differences. Eur. Urol. 2012;61:317–325. doi: 10.1016/j.eururo.2011.10.009.
    1. Liang P., Dong B., Yu X., Yu D., Cheng Z., Su L., Peng J., Nan Q., Wang H. Computer-Aided Dynamic Simulation of Microwave-Induced Thermal Distribution in Coagulation of Liver Cancer. IEEE Trans. Biomed. Eng. 2001;48:821–829. doi: 10.1109/10.930907.
    1. He X., McGee S., Coad J.E., Schmidlin F., Iaizzo P.A., Swanlund D.J., Kluge S., Rudie E., Bischof J.C. Investigation of the Thermal and Tissue Injury Behaviour in Microwave Thermal Therapy Using a Porcine Kidney Model. Int. J. Hyperth. 2004;20:567–593. doi: 10.1080/0265673042000209770.
    1. Taratkin M., Laukhtina E., Singla N., Kozlov V., Abdusalamov A., Ali S., Gabdullina S., Alekseeva T., Enikeev D. Temperature Changes during Laser Lithotripsy with Ho:YAG Laser and Novel Tm-Fiber Laser: A Comparative In-Vitro Study. World J. Urol. 2020;38 doi: 10.1007/s00345-020-03122-1.
    1. Dragoş L.B., Somani B., Keller E., De Coninck V., Doizi S., Wiseman O., Sener E., Martis S., Cumpanas A., Botoca M., et al. Super-Pulse Thulium Fiber versus High Power Holmium Lasers. What about Temperature? Eur. Urol. Suppl. 2019;18:e505–e508. doi: 10.1016/S1569-9056(19)30375-6.
    1. Peng Y., Liu M., Ming S., Yu W., Li L., Lu C., Fang Z., Wang Z., Dong H., Shen R., et al. Safety of a Novel Thulium Fiber Laser for Lithotripsy: An In Vitro Study on the Thermal Effect and Its Impact Factor. J. Endourol. 2020;34:88–92. doi: 10.1089/end.2019.0426.
    1. Chiron P., Mandé S., Doizi S., De Coninck V., Keller E.X., Berthe L., Traxer O. MP17-04 evaluation of heat generation in an in vitro kidney model: Does the superpulsed thulium fiber laser pose a risk? J. Urol. 2019;201(Suppl. 4):e256. doi: 10.1097/01.JU.0000555429.61555.f9.
    1. Molina W.R., Carrera R.V., Chew B.H., Knudsen B.E. Temperature Rise during Ureteral Laser Lithotripsy: Comparison of Super Pulse Thulium Fiber Laser (SPTF) vs. High Power 120 W Holmium-YAG Laser (Ho: YAG) World J. Urol. 2021:1–6. doi: 10.1007/s00345-021-03619-3.
    1. Schembri M., Sahu J., Aboumarzouk O., Pietropaolo A., Somani B.K. Thulium Fiber Laser: The New Kid on the Block. Turk. J. Urol. 2020;46(Suppl. 1):S1–S10. doi: 10.5152/tud.2020.20093.

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