Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
  • A61L27/14—Macromolecular materials
  • A61L27/18—Macromolecular materials obtained otherwise than by reactions only involving carbon-to-carbon unsaturated bonds
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
  • A61L27/40—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material
  • A61L27/44—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material having a macromolecular matrix
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
  • A61L27/40—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material
  • A61L27/44—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material having a macromolecular matrix
  • A61L27/446—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material having a macromolecular matrix with other specific inorganic fillers other than those covered by A61L27/443 or A61L27/46
• • C—CHEMISTRY; METALLURGY
  • C08—ORGANIC MACROMOLECULAR COMPOUNDS; THEIR PREPARATION OR CHEMICAL WORKING-UP; COMPOSITIONS BASED THEREON
  • C08G—MACROMOLECULAR COMPOUNDS OBTAINED OTHERWISE THAN BY REACTIONS ONLY INVOLVING UNSATURATED CARBON-TO-CARBON BONDS
  • C08G65/00—Macromolecular compounds obtained by reactions forming an ether link in the main chain of the macromolecule
• • C—CHEMISTRY; METALLURGY
  • C08—ORGANIC MACROMOLECULAR COMPOUNDS; THEIR PREPARATION OR CHEMICAL WORKING-UP; COMPOSITIONS BASED THEREON
  • C08K—Use of inorganic or non-macromolecular organic substances as compounding ingredients
  • C08K3/00—Use of inorganic substances as compounding ingredients
  • C08K3/10—Metal compounds
• • C—CHEMISTRY; METALLURGY
  • C08—ORGANIC MACROMOLECULAR COMPOUNDS; THEIR PREPARATION OR CHEMICAL WORKING-UP; COMPOSITIONS BASED THEREON
  • C08K—Use of inorganic or non-macromolecular organic substances as compounding ingredients
  • C08K3/00—Use of inorganic substances as compounding ingredients
  • C08K3/30—Sulfur-, selenium- or tellurium-containing compounds
• • C—CHEMISTRY; METALLURGY
  • C08—ORGANIC MACROMOLECULAR COMPOUNDS; THEIR PREPARATION OR CHEMICAL WORKING-UP; COMPOSITIONS BASED THEREON
  • C08L—COMPOSITIONS OF MACROMOLECULAR COMPOUNDS
  • C08L71/00—Compositions of polyethers obtained by reactions forming an ether link in the main chain; Compositions of derivatives of such polymers
  • C08L71/08—Polyethers derived from hydroxy compounds or from their metallic derivatives
  • C08L71/10—Polyethers derived from hydroxy compounds or from their metallic derivatives from phenols
• • C—CHEMISTRY; METALLURGY
  • C08—ORGANIC MACROMOLECULAR COMPOUNDS; THEIR PREPARATION OR CHEMICAL WORKING-UP; COMPOSITIONS BASED THEREON
  • C08L—COMPOSITIONS OF MACROMOLECULAR COMPOUNDS
  • C08L71/00—Compositions of polyethers obtained by reactions forming an ether link in the main chain; Compositions of derivatives of such polymers
  • C08L71/08—Polyethers derived from hydroxy compounds or from their metallic derivatives
  • C08L71/10—Polyethers derived from hydroxy compounds or from their metallic derivatives from phenols
  • C08L71/12—Polyphenylene oxides

Definitions

• This invention relates to polymeric materials and particularly, although not exclusively, relates to polymeric materials with improved Notched Izod Impact Strength.
• Notched Izod Impact Strength may be assessed in accordance with ISO180 wherein a specimen 2 as shown in figure 1 is held as a vertical cantilevered beam and is broken by a pendulum. Impact occurs on the notched side of the specimen.
• the NIIS test may be of use in assessing the strength of parts made from polymeric materials which have a notch (or a shape similar to a notch) as part of the design or may be of use in assessing the impact on the strength of a part by damage which may produce a notch (or a shape similar to a notch) in the part.
• the notch sensitivity is, in some cases, a potential cause of failure of an implant.
• dynamic stabilization rods may be pre-notched during manufacture or may be notched during the surgical procedure. The notched areas have been identified as possible failure points.
• notch sensitivity may be important in sports medicine applications (e.g. for suture anchors and screws), in trauma (e.g. for plates, nails and screws) and in orthopaedics (e.g. for acetabular cups, femoral heads and humeral heads).
• NIIS is important, particularly if there is a risk that a part may become damaged so that a notch is defined.
• m,r,s,t,v,w and z independently represent zero or a positive integer
• E and E' independently represent an oxygen or a sulphur atom or a direct link
• G represents an oxygen or sulphur atom, a direct link or a -O-Ph-0- moiety
• Ph represents a phenyl group and Ar is selected from one of the following moieties (i)**, (i) to (iv) which is bonded via one or more of its phenyl moieties to adjacent moieties
• a phenyl moiety has 1 ,4-, linkages to moieties to which it is bonded.
• the middle phenyl may be 1 ,4- or 1 ,3-substituted. It is preferably 1 ,4-substituted.
• Said polymeric material may include more than one different type of repeat unit of formula I; and more than one different type of repeat unit of formula II; and more than one different type of repeat unit of formula III. Preferably, however, only one type of repeat unit of formula I, Il and/or III is provided.
• Said moieties I, Il and III are suitably repeat units.
• units I, Il and/or III are suitably bonded to one another - that is, with no other atoms or groups being bonded between units I, Il and III.
• Phenyl moieties in units I, Il and III are preferably not substituted. Said phenyl moieties are preferably not cross-linked.
• the respective phenylene moieties may independently have 1 ,4- or 1 ,3-linkages to the other moieties in the repeat units of formulae Il and/or III.
• said phenylene moieties have 1 ,4- linkages.
• the polymeric chain of the polymeric material does not include a -S- moiety.
• G represents a direct link.
• "a” represents the mole % of units of formula I in said polymeric material, suitably wherein each unit I is the same;
• "b” represents the mole % of units of formula Il in said polymeric material, suitably wherein each unit Il is the same;
• "c” represents the mole % of units of formula III in said polymeric material, suitably wherein each unit III is the same.
• a is in the range 45-100, more preferably in the range 45-55, especially in the range 48-52.
• the sum of b and c is in the range 0-55, more preferably in the range 45-55, especially in the range 48-52.
• the ratio of a to the sum of b and c is in the range 0.9 to 1.1 and, more preferably, is about 1.
• the sum of a, b and c is at least 90, preferably at least 95, more preferably at least 99, especially about 100.
• said polymeric material consists essentially of moieties I, Il and/or III.
• Said polymeric material may be a homopolymer having a repeat unit of general formula
• A, B, C and D independently represent 0 or 1 and E,E',G,Ar,m,r,s,t,v,w and z are as described in any statement herein.
• m is in the range 0-3, more preferably 0-2, especially 0-1.
• r is in the range 0-3, more preferably 0-2, especially 0-1.
• t is in the range 0-3, more preferably 0-2, especially 0-1.
• s is 0 or 1.
• v is 0 or 1.
• w is 0 or 1.
• z is 0 or 1.
• said polymeric material is a homopolymer having a repeat unit of general formula IV.
• Ar is selected from the following moieties (xi)** and (vii) to (x)
• the middle phenyl may be 1 ,4- or 1 ,3-substituted. It is preferably 1 ,4-substituted.
• Suitable moieties Ar are moieties (i), (ii), (iii) and (iv) and, of these, moieties (i), (ii) and (iv) are preferred.
• Other preferred moieties Ar are moieties (vii), (viii), (ix) and (x) and, of these, moieties (vii), (viii) and (x) are especially preferred.
• polymeric materials are polymers (or copolymers) which consist essentially of phenyl moieties in conjunction with ketone and/or ether moieties. That is, in the preferred class, said polymeric material does not include repeat units which include -S-, -SO 2 - or aromatic groups other than phenyl.
• Preferred polymeric materials of the type described include:
• Said polymeric material may be amorphous or semi-crystalline. Said polymeric material is preferably semi-crystalline.
• the level and extent of crystallinity in a polymer is preferably measured by wide angle X-ray diffraction (also referred to as Wide Angle X-ray Scattering or WAXS), for example as described by Blundell and Osborn (Polymer 24, 953, 1983). Alternatively, crystallinity may be assessed by Differential Scanning Calerimetry (DSC).
• DSC Differential Scanning Calerimetry
• the level of crystallinity in said polymeric material may be at least 1 %, suitably at least 3%, preferably at least 5% and more preferably at least 10%. In especially preferred embodiments, the crystallinity may be greater than 30%, more preferably greater than 40%, especially greater than 45%.
• the main peak of the melting endotherm (Tm) for said polymeric material (if crystalline) may be at least 300 0 C.
• Said polymeric material may consist essentially of one of units (a) to (f) defined above.
• Said polymeric material preferably comprises, more preferably consists essentially of, a repeat unit of formula (XX)
• t1 , and w1 independently represent 0 or 1 and v1 represents 0, 1 or 2.
• said polymeric material is selected from polyetheretherketone, polyetherketone, polyetherketoneetherketoneketone and polyetherketoneketone. In a more preferred embodiment, said polymeric material is selected from polyetherketone and polyetheretherketone. In an especially preferred embodiment, said polymeric material is polyetheretherketone.
• Said polymeric material may have a Notched Izod Impact Strength (specimen 80mm x 10mm x 4mm with a cut 0.25mm notch (Type A), tested at 23 0 C, in accordance with ISO180) (hereinafter referred to as NIIS) of at least 4KJm “2 , preferably at least 5KJm "2 , more preferably at least 6KJm "2 .
• Said Notched Izod Impact Strength measured as aforesaid, may be less than 10KJm "2 , suitably less than 8KJm "2 .
• NIIS hereinafter referred to is measured as aforesaid, unless otherwise stated.
• Said polymeric material suitably has a melt viscosity (MV) of at least 0.06 kNsm " , preferably has a MV of at least 0.085 kNsm “2 , more preferably at least 0.12 kNsm “2 , especially at least 0.14 kNsm “2 .
• MV melt viscosity
• MV is suitably measured using capillary rheometry operating at 400 0 C at a shear rate of 1000s "1 using a tungsten carbide die, 0.5x3.175mm.
• Said polymeric material may have a MV of less than 1.00 kNsm "2 , preferably less than 0.5 kNsm "2 .
• Said polymeric material may have a MV in the range 0.09 to 0.5 kNsm " , preferably in the range 0.14 to 0.5 kNsm -2
• Said polymeric material may have a tensile strength, measured in accordance with ISO527 (specimen type 1 b) tested at 23 0 C at a rate of 50mm/minute of at least 20 MPa, preferably at least 60 MPa, more preferably at least 80 MPa.
• the tensile strength is preferably in the range 80-110 MPa, more preferably in the range 80-100 MPa.
• Said polymeric material may have a flexural strength, measured in accordance with ISO178 (80mm x 10mm x 4mm specimen, tested in three-point-bend at 23 0 C at a rate of 2mm/minute) of at least 50 MPa, preferably at least 100 MPa, more preferably at least 145 MPa.
• the flexural strength is preferably in the range 145-180MPa, more preferably in the range 145-164 MPa.
• Said polymeric material may have a flexural modulus, measured in accordance with ISO178 (80mm x 10mm x 4mm specimen, tested in three-point-bend at 23 0 C at a rate of 2mm/minute) of at least 1 GPa, suitably at least 2 GPa, preferably at least 3 GPa, more preferably at least 3.5 GPa.
• the flexural modulus is preferably in the range 3.5-4.5 GPa, more preferably in the range 3.5-4.1 GPa.
• the aforesaid characteristics of said polymeric material refer to polymeric material per se (ie unfilled).
• Said polymeric material may be amorphous or semi-crystalline. It is preferably semi-crystalline.
• the level and extent of crystallinity in a polymer is preferably measured by wide angle X-ray diffraction (also referred to as Wide Angle X-ray Scattering or WAXS), for example as described by Blundell and Osborn (Polymer 24, 953, 1983).
• WAXS Wide Angle X-ray Scattering
• crystallinity may be assessed by Differential Scanning Calerimetry (DSC).
• the level of crystallinity of said polymeric material may be at least 1 %, suitably at least 3%, preferably at least 5% and more preferably at least 10%. In especially preferred embodiments, the crystallinity may be greater than 25%.
• the main peak of the melting endotherm (Tm) of said polymeric material (if crystalline) may be at least 300°C.
• Said barium sulphate may have a D 10 particle size in the range 0.1 to 1.O ⁇ m; a D 50 particle size suitably in the range 0.5 ⁇ m to 2 ⁇ m and a D 90 particle size suitably in the range 1.0 ⁇ m to 5 ⁇ m.
• the D 10 may be in the range 0.1 to 0.6 ⁇ m, preferably 0.2 to 0.5 ⁇ m.
• the D 50 may be in the range 0.7 ⁇ m to 1.5 ⁇ m, preferably 0.8 to 1.3 ⁇ m.
• the D 90 may be in the range 1.5 to 3 ⁇ m, preferably in the range 2.0 to 2.5 ⁇ m.
• the ratio of the wt% of barium sulphate to the wt% of said polymeric material may be greater than 0.04, is suitably greater than 0.07, is preferably greater than 0.10, is more preferably greater than 0.13, and is especially greater than 0.16. In some cases, said ratio may be greater than 0.20 or 0.22. The ratio may be less than 0.4, or less than 0.3.
• Said barium sulphate is preferably intimately mixed with the polymeric material, suitably so the barium sulphate and polymeric material define a substantially homogenous mixture.
• the wt% of barium sulphate in a composition which includes barium sulphate and said polymeric material may be at least 5wt%, suitably at least 8wt%, preferably at least 10wt%, more preferably at least 13wt%, especially at least 16wt%. Said wt% of barium sulphate may be less than 30wt% or less than 25wt%.
• the wt% of said polymeric material in a composition which includes barium sulphate (and, optionally water as hereinafter described) may be at least 40wt%, preferably at least 45wt%, more preferably at least 50wt%.
• compositions may consist essentially of barium sulphate and said polymeric material.
• said composition may include one or more other fillers, for example carbon fibre.
• a composition may include up to 35wt% or up to 30wt% carbon fibre. When carbon fibre is included the composition suitably includes 25-35wt% carbon fibre.
• Said barium sulphate may be used to increase the NIIS of said polymeric material by at least 10 KJm “2 , suitably by at least 20KJm “2 , preferably by at least 30 KJm “2 , more preferably by at least 40 KJm “2 , measured in accordance with ISO180. Said NIIS may be increased by less than 60KJm "2 .
• the ratio of the NIIS of a composition which includes barium sulphate as described to the NIIS of an otherwise identical composition which does not include barium sulphate as described may be at least 2, suitably at least 4, preferably at least 6, more preferably at least 8. The ratio may be less than 15 or less than 11.
• the NIIS of a composition comprising said polymeric material and barium sulphate is increased when the composition includes water. Accordingly, the invention extends to the use of barium sulphate and water for increasing the impact strength of a polymeric material as described according to the first aspect.
• the ratio of the wt% of water to barium sulphate may be in the range 0.01 to 0.2, preferably in the range 0.02 to 0.15. The ratio is suitably less than 0.10, preferably less than 0.05, more preferably less than 0.04.
• the wt% of water in a composition which also includes barium sulphate and said polymeric material may be at least 0.10wt%, preferably at least 0.2wt%, more preferably at least 0.30wt%, especially at least 0.40wt%.
• the wt% of water may be less than 1wt%, less than 0.8wt%, less than 0.6wt%.
• the wt% of water may be in the range 0.3 to 0.7wt%, suitably 0.4 to 0.6wt%.
• composition comprising polymeric material and barium sulphate may be provided in any desired form, for example as a stock shape, film or fibre.
• the NIIS of said composition comprising polymeric material and barium sulphate has been found to be reversible in dependence upon whether water is present or not.
• a part made from a composition comprising barium sulphate and said polymeric material to be used in a moist and/or wet environment.
• the invention extends to the use of barium sulphate for increasing the impact strength of a polymeric material according to the first aspect used in making a part for use in a moist and/or wet environment.
• Said environment may include water in a liquid state. Water in a liquid state may contact the part in use.
• Said environment may be substantially enclosed and suitably includes a source of water and/or water vapour.
• Said environment may comprise a human or animal body (especially the former) and preferably comprises an internal region of a human body.
• Said part may be an implant.
• a method of increasing the impact strength of a polymeric material as described according to the first aspect comprising forming a composition comprising said polymeric material and barium sulphate.
• composition, polymeric material, barium sulphate, impact strength and any other features of the invention of the first aspect may be applied to the invention of the second aspect mutatis mutandis.
• the method may comprise selecting a said polymeric material and melt compounding it with barium sulphate.
• the method may comprise treating the composition to increase the level of water contained therewithin.
• a method of increasing the impact strength of a part which comprises a polymeric material as described according to the first aspect and barium sulphate, the method comprising treating the part to increase the level of water contained therewithin.
• the part may have any feature of the composition described according to the first and second aspects after said treatment.
• the wt% of water in said part which also includes barium sulphate and said polymeric material may be at least 0.10wt%, preferably at least 0.20wt%, more preferably at least 0.30wt%, especially at least 0.40wt%.
• the wt% of water may be less than 1wt%, less than 0.8wt%, less than 0.6wt%.
• the wt% of water may be in the range 0.3 to 0.7wt%, suitably 0.4 to 0.6wt%.
• the wt% of barium sulphate in said part may be at least 5wt%, suitably at least 8wt%, preferably at least 10wt%, more preferably at least 13wt%, especially at least 16wt%. Said wt% of barium sulphate may be less than 30wt% or less than 25wt%.
• the wt% of said polymeric material in said part may be at least 40wt%. In some cases, greater than 99wt% of said part may consist essentially of barium sulphate and said polymeric material. In other cases, said part may include one or more other fillers, for example carbon fibre.
• a part may include up to 35wt% or up to 30wt% carbon fibre. When carbon fibre is included the part suitably includes 25-35wt% carbon fibre.
• Treatment of said part preferably involves an active treatment. It preferably comprises a treatment at a temperature of greater than 4O 0 C, suitably at greater than 6O 0 C, preferably at greater than 8O 0 C.
• the part may be treated with steam.
• the part may be treated under a pressure of greater than ambient pressure, for example greater than 2 bar or 4 bar. Treatment may involve an autoclave and/or may involve steam sterilisation.
• the invention extends to a part made in a method of the third aspect.
• a part which is made from a composition comprising a polymeric material as described according to the first aspect and barium sulphate.
• said part has been treated to increase its NIIS.
• the part may have been treated in a method of the second or third aspects
• the part is preferably spaced from and/or separated from its position of intended use.
• the part is preferably outside an environment in which it is intended to be used.
• the part may be outside the body but suitably has increased impact strength by virtue of the treatment to which it has been subjected and/or other features of the part described herein.
• Said part is preferably an implantable part, for example an implantable prosthesis, such as an orthopaedic implant, for implantation in a human body. It may be a dynamic stabilisation rod or for use in a prosthetic hip joint.
• Said part may comprise greater than 50wt% of said polymeric material (preferably polyetheretherketone), at least 8wt% (preferably at least 10wt% or at least 13wt%) barium sulphate and at least 0.3wt% (preferably at least 0.45wt%) of water.
• said part includes at least 55wt% polyetheretherketone, at least 10wt% barium sulphate and at least 0.4wt% of water.
• the part may include 0 to 34.6wt% of other fillers, for example carbon fibre.
• a package which is suitably sterile, comprising a part according to the fourth aspect or a part, the impact strength of which has been increased, in accordance with the third aspect.
• Said part may be arranged in a package from which air has been removed.
• it may be vacuum packed for example in a metal (e.g. aluminium) lined receptacle.
• composition comprising a polymeric material according to the first aspect and barium sulphate in the manufacture of an implantable prosthesis for example an orthopaedic implant.
• an implantable prosthesis for example an orthopaedic implant, the method comprising:
• composition comprising a said polymeric material according to the first aspect and barium sulphate;
• melt processing for example extruding or injection moulding, said composition to define the part or a precursor of said part.
• the impact strength of the part may be increased as described according to the second or third aspects.
• PEEK-OPTIMA LT1 (Trade Mark) - an implantable grade of polyetheretherketone having an MV of 0.46 KNsnrf 2 obtained from Invibio Limited, Thornton, Cleveleys, UK.
• Barium sulphate was added to PEEK-OPTIMA via an extrusion compounding process.
• the barium sulphate can be gravimetrically metered and fed through a side feeder into a twin screw extruder, where it is combined with plasticized polymer melt and intimately mixed to provide a uniform dispersion of the filler within the polymer.
• the filler may be added up to 60% by weight of the polymer, depending upon the desired mechanical properties of the compound. Extrusion of this mixture through a die generates strands or laces that cool and solidify before being chopped into small granules in preparation for subsequent processing.
• Example 1 The compound prepared in Example 1 was injection moulded to manufacture test pieces, in accordance with the requirements of ISO 527-2 (sample geometry 1 B), ISO 178, and ISO 180 for tensile strength, flexural strength and notched Izod impact testing respectively.
• Test pieces were prepared as described in Examples 1 and 2 containing PEEK-OPTIMA LT1 and either 4wt% or 20wt% of barium sulphate and subjected to a range of different treatments as described in Table 1.
• Test pieces were prepared as described in Example 2 with different filler loadings, varying between 4 to 20wt% and the Notched Izod Impact Strength assessed in accordance with ISO180 under two different sets of conditions - firstly, after drying in an oven at 12O 0 C for 72 hours; and, secondly, after sterilisation in steam for 20 minutes at 134 0 C, soaking in water for 15 hours followed by further sterilisation in steam for 20 minutes at 134 0 C. Results are provided in Table 3. Table 3
• Respective test pieces comprising 4wt% and 20wt% barium sulphate were prepared and tested in cyclical testing.
• the effect on impact strength of the incorporation of barium sulphate and water into polyaryletherketone may have many industrial applications. It may be of particular utility for making parts which are used in a moist environment so that the optimum amount of water (believed to be about 0.15wt%) may be maintained within a composition which comprises the polyaryletherketone and barium sulphate.
• a suitably moist environment is found in the human body and, consequently, parts made from polyaryletherketone and barium sulphate and, optionally, other fillers, may be pre-conditioned so they contain water, for example 0.15wt%, and then implanted. When implanted, the water level is maintained and so, therefore, is the surprising improvement in impact strength. It is also found that other properties, for example other mechanical properties of the polyaryletherketone are not significantly detrimentally affected by incorporation of barium sulphate and/or water. Furthermore the polyaryletherketone is chemically unchanged.

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• Chemical & Material Sciences (AREA)
• Health & Medical Sciences (AREA)
• Medicinal Chemistry (AREA)
• Chemical Kinetics & Catalysis (AREA)
• Animal Behavior & Ethology (AREA)
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• General Health & Medical Sciences (AREA)
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• Oral & Maxillofacial Surgery (AREA)
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• 2009
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