The following doses have been studied in scientific research: A type of inflammatory bowel disease (Crohn disease). J Chemother 1996;8:207-9. WebMD does not provide medical advice, diagnosis or treatment. Some people apply mastic directly to the skin for cuts and as an insect repellent. That said, there is some evidence to suggest that it may help with issues such as stomach upset and dental cavities. It is especially known to the Arab cuisine, but recently mastic is also increasingly used in Japanese cuisine. For professional medical information on natural medicines, see Natural Medicines Comprehensive Database Professional Version.© Therapeutic Research Faculty . Mastic Gum in Ancient History J Periodontol. J Dent. Papada E, Gioxari A, Brieudes V, et al. Infection may even lead to gastric cancer. Modern research supports these attributes of mastic gum. Vitamins and Supplements to Avoid with Hepatitis C. Quiz: What Do You Know About Vitamin B12 Deficiency? However, due to the limited research, children, pregnant women, and those who are breastfeeding may wish to avoid it. Dabos, K. J., Sfika, E., Vlatta, L. J., and Giannikopoulos, G. The effect of mastic gum on Helicobacter pylori: a randomized pilot study. Mastic resin, or gum, from the mastic tree (Pistacia lentiscus), is well known for its antioxidant and anti-inflammatory effects, as well as bactericidal effect against Helicobacter pylori. People use mastic gum for a variety of health reasons. Also, the Food and Drug Administration (FDA) do not regulate mastic gum supplements for safety or effectiveness. Mastic gum is a resin, or sap-like substance, that comes from the mastic tree. In dentistry, mastic resin is used as a material for fillings. A serious gum infection (periodontitis). This copyrighted material is provided by Natural Medicines Comprehensive Database Consumer Version. Early research suggests that taking mastic by mouth for 4 weeks improves symptoms in people with Crohn disease. Mastic Gum Supplement - Natural Antiseptic for Gastrointestinal Health . If you buy through links on this page, we may earn a small commission. Pop a mastic crystal (or two or three) into your mouth and start chewing. Other tilers say that tile mastic should be confined to dry areas. An infection with H. pylori bacteria is a major risk factor for stomach ulcers. It is commonly used for baking and cooking, adding its aroma to foodstuffs such as brioches, ice-cream and other desserts. Mastic gum is a resin that comes from the mastic tree, or sap-like substance. Although studies have not proven that it can treat or cure any health conditions, it seems to have a low risk of toxicity and side effects. Magkouta, S., Stathopoulos, G. T., Psallidas, I., Papapetropoulos, A., Kolisis, F. N., Roussos, C., and Loutrari, H. Protective effects of mastic oil from Pistacia lentiscus variation chia against experimental growth of lewis lung carcinoma. Acacia gum and other gums/fibers like xanthan gum, locust bean gum and guar gum are common ingredients in foods like candies, baked goods and confections. It prevents yeast infection in the body Older studies have found that mastic gum has antibacterial abilities against H. pylori. Mastic gum is an ancient remedy that may have some medicinal properties. Some also commonly use mastic essential oil to treat skin conditions of a certain type. Here’s our process. Some research shows that taking mastic doesn't help with quality of life in people with IBD. CONDITIONS OF USE AND IMPORTANT INFORMATION: chia inhibits growth and survival of human K562 leukemia cells and attenuates angiogenesis. The mastic tree is an evergreen shrub growing on Chios, the Greek island. View abstract. Those who took 1 gram (g) of mastic per day reported a reduction in ulcer symptoms after 2 weeks. The people in the study took 2.8 g of mastic per day. The mastic tree is an evergreen shrub that grows on the Greek island of Chios. Used ground and mixed with sugar or salt, mastiha is great for adding flavor to savory or sugary preparations. Mastic gum is also used to treat heartburn, gastroesophageal reflux disease (GERD), Crohn’s disease, chronic sore throat, herpes simplex, and to improve cholesterol levels. Today mastic gum is used as a food ingredient in Mediterranean cuisine (to flavour spirits and liqueurs (such as Chios’s native drink Mastiha, chewing gum, and a number of cakes, pastries, spoon sweets, and desserts. Clin Exp Pharmacol.Physiol 1984;11(5):541-544. Sterer, N., Nuas, S., Mizrahi, B., Goldenberg, C., Weiss, E. I., Domb, A., and Davidi, M. P. Oral malodor reduction by a palatal mucoadhesive tablet containing herbal formulation. Some evidence suggests that mastic gum is an antioxidant with anti-inflammatory and antimicrobial qualities. 2007;14(4):263-272. All information will be used in a manner consistent with the WebMD, Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, Coronavirus in Context: Interviews With Experts. Antiinflammatory and antioxidant activities of gum mastic. Also, early research suggests that taking mastic powder by mouth for 4 weeks improves these outcomes in people with stomach ulcers. Early research suggests that brushing with mastic essential oil-containing toothpaste using a sonic toothbrush for 12 weeks reduces plaque buildup, as well as swelling, redness, and bleeding of the gums, in people with gum disease better than using a sonic toothbrush alone. One review notes that mastic gum improved some markers of Crohn’s disease in people who had active disease. Sign Up to Receive Our Free Coroanvirus Newsletter. Toxicol.Appl.Pharmacol. People should therefore exercise caution when purchasing mastic supplements, and they should only use those from a reputable source. People have used mastic gum for its medicinal properties for centuries. View abstract. Al Habbal, M. J., Al Habbal, Z., and Huwez, F. U. ), in the production of chewing gum, in perfumery and in dentistry. Huwez, F. U. and Al Habbal, M. J. Mastic in treatment of benign gastric ulcers. View abstract. It is also used to improve blood circulation.. Mastic gum is traditionally used as chewing gum. No studies have proven that mastic gum can treat any conditions. Studies show that people who took these amounts did not have serious side effects. For those who wish to try mastic gum as a supplement, some research suggests that a dosage of 330 mg, three times per day, may be effective. Manufacturer dosage guidelines recommend 4 capsules orally before bed for 2 weeks, followed by a maintenance dosage of 2 capsules daily.Mastic 2000 Historically, mastic gum has had many commercial uses, dating as far back as the Greek Empire where it was used as a form of chewing gum. Its use was described by ancient Greek physicians such as Hippocrates. People who took a placebo did not report this benefit. View abstract. Nutrients. View abstract. The volunteers who saw an improvement in cholesterol and blood sugar took 330 mg of crude mastic gum three times per day. A person should speak with their doctor if they wish to try mastic gum alongside their other treatments. People use the sap (resin) from the trunk to make medicine. However, taking mastic gum seems to be less effective at eliminating H. pylori infections compared to taking a combination of the drugs pantoprazole, amoxicillin, and clarithromycin. Research suggests that taking 1 g of mastic per day, divided into three doses, may soothe symptoms related to stomach ulcers. Nutr Cancer 2009;61(5):640-648. Mastic gum should never replace prescribed cancer treatments. Last medically reviewed on February 20, 2020, The bacteria H. pylori can cause a range of gastrointestinal issues, including gastritis. Mastic definition, a small Mediterranean tree, Pistacia lentiscus, of the cashew family, that is the source of an aromatic resin used in making varnish and adhesives. 2008;36(7):535-539. It can even be used as a natural chewing gum (mastic gum). Traditionally, mastic gum has been used for thousands of years in the Mediterranean as a natural remedy for wound healing, pain relief, and various gut disorders. Mastic gum may help with certain digestive problems. 2010;17(3-4):296-299. Ali-Shtayeh, M. S. and Abu Ghdeib, S. I. Antifungal activity of plant extracts against dermatophytes. Some evidence suggests that mastic gum could also help with inflammatory bowel diseases (IBD) such as Crohn’s disease. pii: E1779. Mastic Gum Benefits. The penalty for stealing mastic was execution, by order of the sultan. 2007;51(2):551-559. Historically, trunk exudates of Pistacia lentiscus (mastic gum) have been used for the treatment of stomach ulcers. Kaliora, A. C., Stathopoulou, M. G., Triantafillidis, J. K., Dedoussis, G. V., and Andrikopoulos, N. K. Alterations in the function of circulating mononuclear cells derived from patients with Crohn's disease treated with mastic. View abstract. This resin is extensively used in Eastern Mediterranean and Arab cuisine in desserts, pastries, pudding, candy, fruit preserves, and to flavor beverages like tea or coffee. However, people should always ask a doctor before using mastic or any other natural supplements. Food Chem Toxicol. Mastic Gum is a natural antiseptic remedy that inhibits or eliminates H.Pyori, improving gastrointestinal problems. Moulos, P., Papadodima, O., Chatziioannou, A., Loutrari, H., Roussos, C., and Kolisis, F. N. A transcriptomic computational analysis of mastic oil-treated Lewis lung carcinomas reveals molecular mechanisms targeting tumor cell growth and survival. Bioavailability of terpenes and postprandial effect on human antioxidant potential. Nutr Cancer 2006;55(1):86-93. Some natural supplements can interfere with certain medications, or they may be unsafe for people with certain health conditions. Keynan N, Tamir R, Waisel Y, et al. Yakuri to chiryo 2010;38(10):915-925. Allergenicity of the pollen of Pistacia. View abstract. 20 min 1 ora 40 min substitute for mastic … Al-Said MS, Ageel AM, Parmar NS, Tariq M. Evaluation of mastic, a crude drug obtained from Pistacia lentiscus for gastric and duodenal anti-ulcer activity. J Med Food 2006;9(2):290-292. Dimas, K., Hatziantoniou, S., Wyche, J. H., and Pantazis, P. A mastic gum extract induces suppression of growth of human colorectal tumor xenografts in immunodeficient mice. (check all that apply), What factors are most important to you? A person can chew mastic gum like normal chewing gum, or they can ingest it in capsule or powder form. Mastic gum has a low risk of serious side effects. Takahashi, K., Fukazawa, M., Motohira, H., Ochiai, K., Nishikawa, H., and Miyata, T. A pilot study on antiplaque effects of mastic chewing gum in the oral cavity. Mahmoudi, M., Ebrahimzadeh, M. A., Nabavi, S. F., Hafezi, S., Nabavi, S. M., and Eslami, Sh. View abstract. Loutrari, H., Magkouta, S., Pyriochou, A., Koika, V., Kolisis, F. N., Papapetropoulos, A., and Roussos, C. Mastic oil from Pistacia lentiscus var. Those who took a placebo or polymer-free mastic and mastic powder did not have any improvement. 2007;45(3):494-501. An older study in 38 people found that mastic gum could improve the symptoms of stomach ulcers. Mastic gum is used for a variety of benefits. It is traditionally derived from the resin of the mastic tree, which is where it gets its name, though it is commonly manufactured synthetically as well. © 2005 - 2019 WebMD LLC. CHIOS Mastic Gum Greek Large Pebble Tears Superb Quality Fast Ship 15 grams 8.9 8.4 9.0 5: Solaray Mastic Gum Extract 500 mg | 45 Count 8.6 8.1 8.7 6: Mastic Gum 120 Vegetable capsules Arch Oral Biol 12-15-2005; View abstract. Mastic is a tree. View abstract. Mastic has been used in medicine since ancient times and is still used today because of the amazing health benefits it provides. Dabos, K. J., Sfika, E., Vlatta, L. J., Frantzi, D., Amygdalos, G. I., and Giannikopoulos, G. Is Chios mastic gum effective in the treatment of functional dyspepsia? Sometimes it is even used in making cheese. Sterer, N. Antimicrobial effect of mastic gum methanolic extract against Porphyromonas gingivalis. Mastic gum is a harmless resin obtained from the wounded trunks of the mastic bush (Pistacia lentiscus). These ingredients are used in food manufacturing, baking and cooking to create gels and manipulate how spongy, brittle or … Mycoses 1999;42(11-12):665-672. Tile mastic is not known for its high resistance to moisture. As a spice, it continues to be used in Greece to flavour spirits and liqueurs (such as Chios's native drink Mastiha), chewing gum, and a number of cakes, pastries, spoon sweets, and desserts. Mastic has been used as a breath freshener for thousands of years. H.pylori infection is associated with gastritis, dyspepsia and peptic ulcers - in fact, it is now recognized as the cause of the latter. Balan, K. V., Prince, J., Han, Z., Dimas, K., Cladaras, M., Wyche, J. H., Sitaras, N. M., and Pantazis, P. Antiproliferative activity and induction of apoptosis in human colon cancer cells treated in vitro with constituents of a product derived from Pistacia lentiscus L. var. It may have a number of…, Many home remedies can prevent cavities or stop them at a very early stage. These translucent-opaque granules of mastic gum are cleaned, segregated, and processed further. Mastic gum is principally used either as a flavouring or for its gum properties, as in mastic chewing gum. Some tilers claim that tile mastic is fine in wet areas, as long as the grout is properly sealed--and kept sealed. J Ethnopharmacol. Mastic adhesive is a very strong bonding agent used in many commercial and industrial settings, but is perhaps most popular for setting tiles and sealing windows, walls, and ceilings in building construction. View abstract. Depending on your personal need, mastic gum can be chewed as a substitute for gum or used in powders, capsules, etc. These bacteria may also be a risk factor for stomach cancer. J Ethnopharmacol 1986;15:271-8. Mastic gum is not an approved cancer treatment, but studies suggest that it may have potential as a cancer-fighting supplement. Long-term swelling (inflammation) in the digestive tract (inflammatory bowel disease or IBD). They had less stomach pain in general and less stomach pain from anxiety. Huwez, F. U., Thirlwell, D., Cockayne, A., and Ala'Aldeen, D. A. Mastic gum kills Helicobacter pylori. When the gum is turned into a liquid, it is used in a variety of ways, from bread to dessert. Kaliora, A. C., Stathopoulou, M. G., Triantafillidis, J. K., Dedoussis, G. V., and Andrikopoulos, N. K. Chios mastic treatment of patients with active Crohn's disease. Papada E, Gioxari A, Amerikanou C, et al. Papada E, Forbes A, Amerikanou C, et al. In the Eastern Mediterranean, Chios mastic is considered a spice for food. Watanabe, H., Hagiwara, S., Fukuda, M., Yuichi, I., Tamura, N., Suzuki, M., and Kawasaki, D. Double blind randomized control test for the usefulness of mastic compound dentifrice against periodontitis under using sonic toothbrush 2010. When chewed, the bitter taste will gradually soften as the resin becomes more pliable and turns from a translucent yellow to an opaque white. A person should speak with a doctor before using mastic gum or essential oil. Some early research suggests that mastic oil could help fight certain types of cancer. We include products we think are useful for our readers. Mastic gum is a resinous extract from the Pistacia lentiscus tree, indigenous to the Mediterranean islands. Taking mastic powder by mouth for 2 weeks seems to reduce symptoms and improve healing in people with intestinal ulcers. chia. Characterization of the volatile constituents in the essential oil of Pistacia lentiscus L. from different origins and its antifungal and antioxidant activity. Having high cholesterol and high blood sugar levels can increase the risk of heart disease and type 2 diabetes, according to the Centers for Disease Control and Prevention (CDC). Antioxidative efficacy of a Pistacia lentiscus supplement and its effect on the plasma amino acid profile in inflammatory bowel disease: A randomised, double-blind, placebo-controlled trial. View abstract. Never delay or disregard seeking professional medical advice from your doctor or other qualified health care provider because of something you have read on WebMD. Another study in 20 dental students found that those who chewed mastic gum had lower levels of certain bacteria in their mouths. The following are some possible uses and health benefits of mastic gum: One 2007 study found that chewing mastic gum may help prevent cavities. Early research suggests that taking mastic gum for 2 weeks helps eliminate H. pylori infections in some, but not all, people 5 weeks after finishing treatment. Gastroenterol.Jpn. Mastic gum is a resin, or sap-like substance, that comes from the mastic tree. Correct brushing and flossing, knowing which foods and drinks to eat and to avoid, and attending regular…, © 2004-2020 Healthline Media UK Ltd, Brighton, UK, a Red Ventures Company. Studies of mastic gum have not noted any significant or dangerous side effects. It is created from bacteria that is taken from plants. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional, Centers for Disease Control and Prevention (CDC), Complementary Medicine / Alternative Medicine, Drought may increase females' HIV risk in developing nations, New model more effective in predicting Alzheimer's, US election result: Impact on healthcare for undocumented communities, Link between air pollution and COVID-19 spikes identified. The aromatic flavor is best described as a mix between pine and eucalyptus. Barra, A., Coroneo, V., Dessi, S., Cabras, P., and Angioni, A. What factors influenced or will influence your purchase? This supplement poses a risk for side effects in some patients. Phytother Res. Phytomedicine. The anti-ulcer activity of this resin is experimentally proven too (2). We currently have no information for MASTIC Interactions. View abstract. The gum has anti-bacteria properties to eliminate Helicobacter pylori bacterium that causes ulcers. Acta Pharmacol.Sin. In vitro antimicrobial activity of Pistacia lentiscus L. extracts: preliminary report. What are the best natural H. pylori treatments? Fortunately…, A look at xanthan gum, a food thickener with numerous health benefits. It has been known for its use as an anti-inflammatory, antioxidant, anti-ulcerative, and digestive aid in ancient medicine. The study cited results from laboratory tests, but researchers have not yet tested these benefits in humans. Another study of 60 people with IBD found that those who took mastic gum had significant improvements in their IBD markers after 3 months. The elimination of this bacterium can help relieve patients of the symptoms of ulcers. View abstract. Paraschos, S., Magiatis, P., Mitakou, S., Petraki, K., Kalliaropoulos, A., Maragkoudakis, P., Mentis, A., Sgouras, D., and Skaltsounis, A. L. In vitro and in vivo activities of Chios mastic gum extracts and constituents against Helicobacter pylori. Doi, K., Wei, M., Kitano, M., Uematsu, N., Inoue, M., and Wanibuchi, H. Enhancement of preneoplastic lesion yield by Chios Mastic Gum in a rat liver medium-term carcinogenesis bioassay. Arabic Gum, Arbre à Mastic, Arbre au Mastic, Chios Mastic, Lentisco, Lentisk, Mastic Gum, Mastich, Mastiha, Mastika, Mastix, Mata Charneca, Pistacia lentiscus, Pistachier Lentisque. 4-20-2007;111(1):43-49. The first known reference to the mastic gum … The oil had antibacterial effects against certain strains of H. pylori that are resistant to antibiotics. 1986;21(3):273-274. Researchers found these effects in a laboratory, however — not in humans. In this article, we…, What is the secret to teeth and gum care? An open-label study in healthy subjects. Where did you or where do you plan to purchase this product? In a 2006 study published in Archives of Oral Biology, for instance, researchers found that mastic gum may help prevent cavities. Find out more about causes, preventive strategies, and when to see a…, Upset stomach, or indigestion, is usually no cause for concern. Taking mastic gum by mouth for 3 weeks seems to improve symptoms of indigestion, including stomach pain, upper abdominal pain, and heartburn. The people in the study took 350 milligrams (mg) of mastic gum three times per day. Those who wish to use mastic gum for dental health reasons can chew it for at least 15 minutes, several times per day. World J Gastroenterol. 2007;28(4):567-572. Allergy 1997;52:323-30. Below are a few of the main benefits mastic gum provides: Contains antioxidants; Is anti-inflammatory; Has antibacterial properties; Has antifungal properties; Can help digestion; Can help kill H Pylori bacteria View abstract. Those who took the mastic powder and exercised three times per week had the biggest improvement. A study in mice found that mastic oil had an antitumor effect on colon cancer. View abstract. View abstract. These bacteria can lead to plaque and gum disease. It is often possible to treat the symptoms using home remedies. View abstract. Eur.Rev.Med Pharmacol.Sci 2010;14(9):765-769. If you want to take mastic gum for dental health, then chew the gum. View abstract. Mastic gum is a viscous light-green liquid obtained from the bark of Pistacia lentiscus Var. It traditionally has been used as a treatment for dyspepsia and other disorders of the digestive tract. Mastic is used in cooking for the consistency it gives to Greek slow-cooked lamb, it is used in ice cream and in The Spice & Herb Bible there is a recipe for an Asparagus and Mastic Summer Soup. Essential oil from mastic gum is also available. Koutsoudaki, C., Krsek, M., and Rodger, A. People who wish to use mastic gum to help with the symptoms of ulcers may try taking 350 mg three times per day. View abstract. For centuries, the resin was used to improve digestion, oral health, and liver health.Mastic gum comes from the mastic tree, an evergreen shrub that grows on the Greek island of Chios. Stomach ulcers. The Greeks believed it could treat gastralgia, peptic ulcers, and dyspepsia. World J Gastroenterol. Another mouse study found that mastic oil could help with a type of lung cancer. BY MOUTH: Did you or will you purchase this product in-store or online? A range of mastic gum products are available for purchase online. For example, one study found that people who used mastic gum had an improvement in certain types of indigestion and stomach pain. Acta Pharmacol.Sin. Another article states that mastic gum does have the ability to kill H. pylori, but that studies have not shown that it can clear an H. pylori infection completely. Its antioxidant effects may also be beneficial for conditions such as heart disease and cancer. View abstract. This information may not fit your specific health circumstances. A placebo did not provide the same results. J Agric.Food Chem 8-22-2007;55(17):7093-7098. You should always speak with your doctor or health care professional before you start, stop, or change any prescribed part of your health care plan or treatment and to determine what course of therapy is right for you. In Vivo 2009;23(1):63-68. Mastic gum also possesses proven antimicrobial and … BMC.Med Genomics 2009;2:68. The future of the mastic industry was threatened by a Chios forest fire that destroyed mastic groves in August of 2012. Mastic resin at a dosage of 1 g daily has been studied for the treatment of duodenal ulcer.Al-Habbal 1984Various commercial products are available to help eliminate H. pylori bacterium in the stomach (implicated in a number of GI complaints), including Mastika, which contains mastic gum 250 mg in capsule form. A study in 156 healthy volunteers, for example, found that those using mastic gum had lower total cholesterol and blood sugar after 8 weeks. A digestive tract infection that can lead to ulcers (Helicobacter pylori or H. pylori). Mastic Can Be Used for Areas of Light Moisture . J Agric.Food Chem 10-5-2005;53(20):7681-7685. After 15 minutes, people who chewed mastic gum had lower levels of certain bacteria in their mouths. 2-7-2007;13(5):748-753. Gum: Mastic is the original Winterfresh gum. Traditional medicine has used mastic gum as a remedy for several gastrointestinal disorders. In manufacturing, mastic resin is used in the food and drink industries and in the production of chewing gum. Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT, Home and natural remedies for upset stomach. They also reported less heartburn. Though studies on it have generally been small, it does hold promise as a treatment for digestive and oral health conditions. View abstract. All rights reserved. Mastic gum has long been touted as a natural cavity-fighter. Some small studies suggest that mastic gum could help people improve their levels of both. Mastic gum can also be used to treat ulcers. See more. 2019;33(2):360-369. Regulation of faecal biomarkers in inflammatory bowel disease patients treated with oral mastiha (Pistacia lentiscus) supplement: A double-blind and placebo-controlled randomised trial. Aksoy, A., Duran, N., and Koksal, F. In vitro and in vivo antimicrobial effects of mastic chewing gum against Streptococcus mutans and mutans streptococci. 1-1-2009;234(1):135-142. chia. This information is meant to supplement, not replace advice from your doctor or healthcare provider and is not meant to cover all possible uses, precautions, interactions or adverse effects. View abstract. Mastic gum is an extract from Pistacia lentiscus used in herbal medicine to treat gastrointestinal ulcers, breathing conditions, poor circulation, body aches and infections caused by bacteria and fungus. All rights reserved. Traditional medicine has used mastic gum as a remedy for several gastrointestinal disorders. Iauk L, Ragusa S, Rapisarda A, et al. A double-blind controlled clinical trial of mastic and placebo in the treatment of duodenal ulcer. Kang, J. S., Wanibuchi, H., Salim, E. I., Kinoshita, A., and Fukushima, S. Evaluation of the toxicity of mastic gum with 13 weeks dietary administration to F344 rats. This survey is being conducted by the WebMD marketing sciences department. Information from this source is evidence-based and objective, and without commercial influence. The capsule form means that the mastic gum will get into your stomach where it can provide the most benefits. 2003;74(4):501-505. N.Engl.J Med 12-24-1998;339(26):1946. In this article, learn more about the uses and benefits of mastic gum, as well as some potential risks. Mol Nutr Food Res. View abstract. Huang, X. Y., Wang, H. C., Yuan, Z., Li, A., He, M. L., Ai, K. X., Zheng, Q., and Qin, H. L. Gemcitabine combined with gum mastic causes potent growth inhibition and apoptosis of pancreatic cancer cells. Antimicrob.Agents Chemother. 2018;10(11). 2018;62(3).