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The Effect of Prolactinoma on Tear Film Function
10.4274/tjo.galenos.2022.98752
Cezmi Doğan
Ümit Yaşar Güleser
Oğuzhan Kılıçarslan
Burak Mergen
Özer Açbay
Güzin İskeleli
Received Date: 24.08.2021 Accepted Date: 22.01.2022 Turk J Ophthalmol 2022;52(6):374-378 PMID: 36578179
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To compare dry eye parameters in prolactinoma patients and healthy controls and evaluate their correlation with prolactin (PRL) levels and the duration of hyperprolactinemia.
Consecutive patients with prolactinoma and healthy controls were included in the study. Schirmer, tear break-up time (TBUT), tear osmolarity values, and ocular surface disease index (OSDI) scores were evaluated for each patient. Follow-up time and total duration of hyperprolactinemia were recorded for prolactinoma patients.
The study included 39 eyes of 39 patients with prolactinoma and 39 eyes of 39 age- and gender-matched healthy controls. Prolactinoma patients showed lower Schirmer (14.1±8.4 vs. 24.8±8.9 mm; p<0.001) and TBUT values (7.0±3.2 vs. 11.6±2.6 s; p<0.001) and higher OSDI scores (20.6±16.6 vs. 5.8±2.4; p<0.001) compared to the healthy controls. While the mean osmolarity of the prolactinoma patients was 301.6±8.3 mOsm/L, it was 297.7±12.5 mOsm/L for the healthy controls (p=0.07). The duration of hyperprolactinemia in prolactinoma patients showed a negative correlation with Schirmer (r=-0.395; p=0.013) and TBUT values (r=-0.377; p=0.018) and a positive correlation with OSDI scores (r=0.337; p=0.036).
Prolactinoma patients had significantly lower Schirmer and TBUT levels and higher OSDI scores compared to the healthy controls, but no significant difference in tear osmolarity. The effect of high PRL levels on tear film function was duration-dependent.
Keywords: Prolactinoma, dry eye, Schirmer, tear osmolarity, tear break-up time
Prolactinoma is a pituitary adenoma which originates from prolactin (PRL)-producing cells of the pituitary gland. It occurs more frequently in middle-aged women, especially between the second and fifth decades. The female-to-male ratio of the disease was reported to be 10:1, and its prevalence is 100 per million cases.1,2 With its benign nature, adenoma does not spread to local tissues or distant organs. Prolactinoma shows its effects in the body via hormonal differences or local pressure on the adjacent structures. Hyperprolactinemia disrupts reproductive hormone production and causes different signs and symptoms in both male and female patients. Amenorrhea, oligomenorrhea, galactorrhea, and hirsutism are among the most commonly observed symptoms in female patients. Erectile dysfunction, loss of libido, and gynecomastia are commonly observed in male patients. If prolactinoma remains undiagnosed, it can cause pressure signs such as headache, diplopia, and visual field loss.1,2,3
Dry eye disease (DED) is one of the most common causes of ocular irritation in adults.4 Rheumatologic pathologies such as rheumatoid arthritis, systemic lupus erythematosus, and Sjögren's syndrome may accompany DED or it may present as a primary ocular problem without any accompanying disease. The most frequent symptoms are common ocular irritation symptoms like burning, stinging, lacrimation, and red eyes. Schirmer's test, tear break-up time (TBUT), tear osmolarity, slit-lamp examination, and ocular surface disease index (OSDI) scores can be utilized in the diagnosis and grading of DED.4,5
DED is observed more frequently with older age, possibly due to a decrease in gonadal hormone levels during menopause.6 Hyperprolactinemia inhibits gonadotropin-releasing hormone (GnRH) and follicle stimulating hormone (FSH), which in turn may cause a decrease in gonadal hormone levels. Androgen hormones are strong stimulating factors for meibomian gland function and important in the regulation of ocular surface inflammation.7 Recent studies have suggested that androgen deficiency is a potential contributor to dry eye.7,8 Previous in vivo studies showed the presence of prolactin-like molecules and PRL receptors in acinar cells and some interstitial cells of the lacrimal gland.9 In one study, drug-induced hyperprolactinemia was related to a change in the collagenous structures of the lacrimal gland in rats.10 Additionally, serum PRL levels have been shown to have strong negative correlations with tear film function in women undergoing hormone replacement therapy.11 This growing body of evidence may indicate a possible role of hyperprolactinemia in tear film functions.
Our study aimed to compare dry eye parameters (Schirmer's test, TBUT, tear osmolarity, and OSDI scores) in prolactinoma patients to those of healthy controls and evaluate their correlation with PRL levels and duration of hyperprolactinemia.
The study included consecutive patients diagnosed with prolactinoma and healthy controls. All patients underwent a complete ophthalmological examination to exclude any coexisting ocular pathology other than DED that might affect the results of the tests. Only the right eyes of the patients were included in the study. Age, gender, and the follow-up duration since the diagnosis of prolactinoma were recorded. Patients who had any systemic diseases other than prolactinoma or were using any systemic or topical medication that might affect tear functions were excluded. Smokers and individuals with prolonged screen exposure (more than one hour per day) were excluded from the study. The study was conducted according to the Declaration of Helsinki and was approved by the local ethics committee. Informed consent was obtained from the patients before the examination.
Prolactinoma patients were included in the study regardless of their serum PRL levels on their screening day for the study. Therefore, both controlled and uncontrolled prolactinoma patients were included. Patients who had normal serum PRL levels during follow-up were considered controlled prolactinoma patients, whereas patients who had hyperprolactinemia on the day of screening and for at least 6 months in total during follow-up despite oral cabergoline therapy were regarded as uncontrolled prolactinoma patients. Hyperprolactinemia was defined as a PRL level >25 ng/mL in female patients and >20 ng/mL in male patients. The total duration of previous hyperprolactinemia (in months) was calculated from the patients' medical records.
Schirmer's test, TBUT values, and OSDI scores were recorded for each patient. Schirmer's test was performed without topical anesthesia at the same hour of the day for all patients. TBUT was performed after staining with a fluorescein strip at least 30 minutes after Schirmer's test. OSDI scores were calculated according to the patients' responses to the questionnaire. Tear osmolarity was measured with the TearLab Osmolarity System (TearLab, San Diego, CA, USA). The mean value of two measurements obtained at the same time was accepted as the tear osmolarity value. Tears were collected from the inferior lateral meniscus without any contact with the conjunctiva.
Data distributions were evaluated for normality using the Shapiro-Wilk test. Student's t-test was used to compare the means of the groups with normally distributed data and the Mann-Whitney U test was used to compare those without normal distribution. For the correlation analysis, Spearman's correlation test was used. P values below 0.05 were accepted as statistically significant. SPSS version 21.0 (IBM Corp, Armonk, NY, USA) was used for all statistical analyses.
Thirty-nine eyes of 39 patients with prolactinoma and 39 eyes of 39 healthy controls were included in the study. The mean age was 39.6±13.5 years for the prolactinoma patients and 35.2±6.5 years for the control group (p=0.08). The female-to-male ratios of the groups were 24:15 and 23:16, respectively (p=0.817). Twelve patients (31%) had controlled and 27 patients (69%) had uncontrolled PRL levels. Twenty-six patients received oral cabergoline throughout follow-up.
The mean Schirmer value was 14.1±8.4 mm in the prolactinoma group and 24.8±8.9 mm in the control group (p<0.001). The prolactinoma and control groups' mean TBUT values were 7.0±3.2 s and 11.6±2.6 s (p<0.001) and their mean OSDI scores were 20.6±16.6 and 5.8±2.4, respectively (p<0.001). The results are shown in Table 1.
The patients' mean duration of hyperprolactinemia was 24.6±27.5 months (range: 3-117) and the mean serum PRL level was 28±32.4 ng/mL (range: 0.86-150) at the time of examination.
The correlation analysis results of the prolactinoma patients are shown in Table 2. The duration of hyperprolactinemia in prolactinoma patients showed a negative correlation with Schirmer (r=-0.395; p=0.013) and TBUT values (r=-0.377; p=0.018) and a positive correlation with OSDI scores (r=0.337; p=0.036).
Prolactinoma is a pituitary adenoma that causes high serum PRL levels. Although the effect of androgen hormones on the lacrimal gland and tear function has been investigated extensively, the effect of elevated serum PRL on tear function in humans has not been evaluated yet. In this study, we showed that prolactinoma patients had significantly lower Schirmer and TBUT values and higher OSDI scores in comparison to the healthy controls. While the duration of hyperprolactinemia in these patients showed a negative correlation with Schirmer and TBUT values, it was positively correlated with OSDI scores.
High PRL levels cause a decrease in the levels of GnRH and FSH, which in turn might cause a decrease in the estrogen and androgen levels. Although androgens have been shown to increase the synthesis and secretion of lipids from the meibomian glands, estrogens have been shown to decrease lipid production.12 The effect of sex steroids seems more complex. Azcarate et al.7 showed that patients with decreased androgen levels after the development of andropause had high dry eye syndrome scores and lower TBUT values. Antiandrogen therapy was also linked to meibomian gland dysfunction and lipid tear deficiency.8 Additionally, topical androgen therapies were also suggested for dry eye patients to provide symptomatic relief.13 In addition to androgens, estrogens have been suggested to play an important role in the regulation of tear film function because of evidence that the frequency of dry eye syndrome increases dramatically in the postmenopausal period and estrogen replacement therapy improves tear film function.14,15,16,17 Despite the conflicting results regarding the effect of estrogen replacement therapy on tear film function, a recent meta-analysis of 7 different studies showed that estrogen replacement therapy significantly improved Schirmer test results without any significant effect on TBUT.14 However, the studies included in the meta-analysis had small sample sizes and even the treatment approach was heterogeneous. Thus, further randomized controlled clinical trials are needed to clarify the effect of hormone replacement therapy on tear film function. All of these supporting findings may explain why prolactinoma caused dry eye syndrome.
Numerous studies showed the presence of PRL receptors on the acinar cells of the lacrimal gland and one study also showed the presence of PRL in the tear film.9,18 A study on a PRL receptor knockout model showed that hyperprolactinemia caused a hyperfemale morphology, suggesting a role of PRL in dry eye syndromes.19 Hyperprolactinemia in a mouse model was also shown to cause alterations in acinar cells (cellular disorganization, changes in their volume, and altered spacing between the acini) and the amount of collagen in the lacrimal gland in female mice.10 Mathers et al.11 showed that serum PRL levels had strong negative correlations with tear film functions in women under hormone replacement therapy. All of these findings support that PRL might have a direct regulatory negative effect on tear film function in the pathogenesis of dry eye syndrome in the prolactinoma patients in our study. Increased levels of serum PRL might have a negative effect on the production of the aqueous part of the tear film, while decreased sex steroids might have a negative effect on meibomian gland function, leading to a decrease in the Schirmer and TBUT values. However, the presence of PRL receptors in the human lacrimal gland and the presence of PRL in the human tear film should be studied extensively to support this hypothesis.
Although we showed decreased TBUT and Schirmer values and increased OSDI scores in prolactinoma patients, we observed no change in tear osmolarity levels in prolactinoma patients. This interesting finding might be explained as the effect of PRL not being related to the inflammatory status of the tear film. Instead, PRL might adversely impact only the production of the aqueous and lipid layers of the tear film, thereby affecting Schirmer and TBUT values without any effect on tear osmolarity, because tear osmolarity is related mostly to the release of the inflammatory cytokines, especially in patients with Sjögren's syndrome.20
After observing lower Schirmer and TBUT values and higher OSDI scores in prolactinoma patients, we further analyzed the duration of high serum PRL levels to evaluate its correlation with dry eye status. Our findings showed that the duration of hyperprolactinemia correlated negatively with Schirmer and TBUT values and positively with OSDI scores. Therefore, we concluded that the effect of high PRL levels was duration-dependent. Thus, patients with prolactinoma should be monitored for dry eye-related symptoms.
Study Limitations
Limitations of our study include the absence of serum estrogen and androgen levels of the patients, because the complex effect of prolactinoma on tear film function can be better analyzed with the consideration of sex steroid levels. Another limitation of the study is the exclusion of the patients' fellow eyes. We included only one eye to avoid the double organ bias. However, examination of both eyes for tear osmolarity difference between two eyes might have given important data related to the dry eye status of the patients. Future studies may also examine the tear osmolarity difference in prolactinoma patients.
In conclusion, here we showed that prolactinoma patients had lower Schirmer and TBUT levels and higher OSDI scores compared to the healthy controls, with no significant difference in tear osmolarity. The duration of high serum PRL levels showed a negative correlation with Schirmer and TBUT values and a positive correlation with OSDI scores. Thus, our study suggests that high serum PRL levels might disturb tear film functions in a duration-dependent manner and that patients with prolactinoma should also be questioned about dry eye-related symptoms. However, these findings should be improved with further studies on the effect of PRL on the lacrimal gland and tear film function.
Ethics Committee Approval: İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine Clinical Research Ethics Committee.
Informed Consent: Obtianed.
Peer-review: Externally peer reviewed.
Surgical and Medical Practices: O.K., Concept: C.D., Ü.Y.G., Design: C.D., Ü.Y.G., Data Collection or Processing: O.K., B.M., Analysis or Interpretation: B.M., Literature Search: O.K., B.M., Ü.Y.G., Writing: C.D., Ü.Y.G., O.K., B.M., Ö.A., G.İ.
Conflict of Interest: No conflict of interest was declared by the authors.
Financial Disclosure: The authors declared that this study received no financial support.
Table 1. Comparison of dry eye parameters in pr...
Table 2. Correlation of PRL levels and duration...
Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA, Wass JA; Endocrine Society. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96:273-288.
Ciccarelli A, Daly AF, Beckers A. The epidemiology of prolactinomas. Pituitary. 2005;8:3–6.
Glezer A, Bronstein MD. Prolactinomas. Endocrinol Metab Clin North Am. 2015; 44:71-78.
The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf. 2007;5:75-92.
Lemp MA, Bron AJ, Baudouin C, Benítez Del Castillo JM, Geffen D, Tauber J, Foulks GN, Pepose JS, Sullivan BD. Tear osmolarity in the diagnosis and management of dry eye disease. Am J Ophthalmol. 2011;151:792-798.
de Paiva CS. Effects of Aging in Dry Eye. Int Ophthalmol Clin. 2017;57:47-64.
Azcarate PM, Venincasa VD, Feuer W, Stanczyk F, Schally AV, Galor A. Androgen deficiency and dry eye syndrome in the aging male. Invest Ophthalmol Vis Sci. 2014;55:5046-5053.
Krenzer KL, Dana MR, Ullman MD, Cermak JM, Tolls DB, Evans JE, Sullivan DA. Effect of androgen deficiency on the human meibomian gland and ocular surface. J Clin Endocrinol Metab. 2000;85:4874-4882.
Wood RL, Zhang J, Huang ZM, Gierow JP, Schechter JE, Mircheff AK, Warren DW. Prolactin and prolactin receptors in the lacrimal gland. Exp Eye Res. 1999;69:213-226.
Araujo AS, Simões Mde J, Verna C, Simões RS, Soares Júnior JM, Baracat EC, Gomes RC. Influence of hyperprolactinemia on collagen fibers in the lacrimal gland of female mice. Clinics (Sao Paulo). 2015;70:632-637.
Mathers WD, Stovall D, Lane JA, Zimmerman MB, Johnson S. Menopause and tear function: the influence of prolactin and sex hormones on human tear production. Cornea. 1998;17:353-358.
Suzuki T, Schirra F, Richards SM, Jensen RV, Sullivan DA. Estrogen and progesterone control of gene expression in the mouse meibomian gland. Invest Ophthalmol Vis Sci. 2008;49:1797-1808.
Connor CG. Symptomatic relief of dry eye assessed with the OSDI in patients using 5% testosterone cream. Invest Ophthalmol Vis Sci. 2005;46:2032.
Liu C, Liang K, Jiang Z, Tao L. Sex hormone therapy's effect on dry eye syndrome in postmenopausal women: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2018;97:e12572.
Peck T, Olsakovsky L, Aggarwal S. Dry Eye Syndrome in Menopause and Perimenopausal Age Group. J Midlife Health. 2017;8:51-54.
Erdem U, Ozdegirmenci O, Sobaci E, Sobaci G, Göktolga U, Dagli S. Dry eye in post-menopausal women using hormone replacement therapy. Maturitas. 2007;56:257-262.
Golebiowski B, Badarudin N, Eden J, Gerrand L, Robinson J, Liu J, Hampel U, You J, Stapleton F. The effects of transdermal testosterone and oestrogen therapy on dry eye in postmenopausal women: a randomised, placebo-controlled, pilot study. Br J Ophthalmol. 2017;101:926-932.
Mircheff AK, Warren DW, Wood RL, Tortoriello PJ, Kaswan RL. Prolactin localization, binding, and effects on peroxidase release in rat exorbital lacrimal gland. Invest Ophthalmol Vis Sci. 1992;33:641-650.
McClellan KA, Robertson FG, Kindblom J, Wennbo H, Törnell J, Bouchard B, Kelly PA, Ormandy CJ. Investigation of the role of prolactin in the development and function of the lacrimal and harderian glands using genetically modified mice. Invest Ophthalmol Vis Sci. 2001;42:23-30.
Kim M, Kim HS, Na KS. Correlation between Tear Osmolarity and Other Ocular Surface Parameters in Primary Sjögren's Syndrome. Korean J Ophthalmol. 2017;31:25-31.
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Q: How can I simulate UISegmentedControl with custom buttons? I'm just beginning to try out development for the iPhone. My requirement is very similar to thar provided by a UISegmentedControl except I need custom buttons instead of those in a UISegmentedControl.
Here's more detail:
I need one view controller which loads the first view having 3 custom buttons on the top. Below the buttons, I need to load different views (Views?) based on which button is tapped.
Is it possible to use IB to design just the lower part of the view talked about here? I want to use as much of IB I can here.

A: I don't understand why you can't use a UISegmentedControl here?  If you drag a UISegmented control onto a Navigation Controller in IB it will be added as a "custom" button control that looks just like a UISegmentedControl.  It's found in Apps like YouTube etc.  You can then configure it to have three sections and connect up an IBOutlet/IBAction to it easily too.
Edit: Also, if you use a Navigation Controller, you can very easily use IB to design your other views, as that is how Navigation Controllers work - they load their subviews typically from other nibs.  Therefore this would accomplish all you want.

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Home News The Willys Truck
By Keith Nobles
John Willys bought the Overland Automotive Division of Standard Wheel Company in 1908 and in 1912 and renamed it Willys–Overland Motor Company. Willys built many interesting vehicles prior to World War II, but the war changed the very nature of the company. Amid competition from Ford, Willys and Bantum the army in June of 1941 decided that the version of the Jeep that would become the standard version would be the Willys model. The army assigned Willys a contract for 16,000 Jeeps at $739 per vehicle. Willys would go on to produce 363,000 Jeeps and Ford some 280,000 Jeeps during World War II.
When the war ended, Willys took the gamble that there would be a domestic civilian market for the little Jeep that the war had made famous and that gamble paid off. In the summer of 1945 Willys introduced the CJ2A into the civilian market for a retail price of $1090. 214,760 CJ2A's were built from1945 until 1949.
Riding the success of the CJ2A, Willys expanded the concept to a four-wheel drive station wagon and pick-up truck using many of the same components as the CJ2A. Over 300,000 of the station wagons and 200,000 of the pick-up trucks were built from 1946 until 1964.
Willys had discovered a brand-new identity and market as the sole American automobile manufacturer to fully incorporate four-wheel drive vehicles into their line-up. Other manufacturers offered four-wheel as a novelty and, aside from the Dodge Power Wagon, four-wheel drive was an after-market modification.
The Willys pick-up was available in half ton, three-quarter ton and one-ton models, all with different wheelbases. They were also available in pick-up, cab-and-chassis and stake-bed variations.
The Willys truck originally used the same four-cylinder engine, the same T-90 three-speed transmission, the same transfer case and the same Dana 25 front axle as the CJ2A. In 1954 the engine was upgraded to a straight six.
In the late fifties and early sixties GM, Ford and Dodge started offering their much more modern pick-up trucks with factory four-wheel drive and the dated design of the Willys truck was less attractive. Additionally, Jeep (now owned by Kaiser) had introduced the Jeep Gladiator, their own modern truck, in 1962 for the 1963 model year and that was the practical end of the original Willys truck.
Willys trucks are now highly collectible. Just as with all Jeeps of that era, Willys trucks were highly susceptible to rust and rust doomed many of them to the junk yard. Additionally, many of the Willys trucks and station wagons were the recipient of engine swaps. Chevy V8's were very popular choices to swap into the Willys trucks.
Exceptionally clean, original and rust-free examples are selling for upwards of $30,000.
Kaiser Willys https://www.kaiserwillys.com/about_willys_jeep_truck_history_specs
Willys Jeep Truck https://en.wikipedia.org/wiki/Willys_Jeep_Truck
Jeep World War II
Keith Nobles
Willys Truck

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Park beckons for Wonder Woman and Showman fans
Three fabulous films are on offer in the unique setting of Christchurch Park when the Open Air Cinema returns to Ipswich this summer.
The event, in association with Empire Cinemas, is being held on 30th June – so make a date in your diaries.
Two of the films were announced today by the Borough Council as tickets go on sale from Thursday (19th April) at 10am.
Wonder Woman, the afternoon screening at 1.30pm (gates open at 12.30pm), is a superhero film starring Gal Gadot in the title role, with support from the likes of Chris Pine and Robin Wright. Wonder Woman has scored highly with the critics – and you can see why while you relax in the beautiful surroundings of Christchurch Park.
The Greatest Showman will be the evening offering at 7.30pm (gates open at 6pm). This is a marvellous modern musical movie and stars Hugh Jackman as famous showman PT Barnum.
The children's film in the morning? Details will be released in the next couple of weeks but you won't be disappointed. This will start at 10am and the gates will open at 9am. Keep in touch at www.ipswichentertains.co.uk/events/open-air-cinema/
Mark Whiting, the Council's Commercial Manager, said: "Open Air Cinema in association with Empire Cinemas is sure to be very popular so we recommend you buy your tickets in advance. By doing so you can save money – it's £8.50 per film for adults, £5 for children and £25 for families. You can pay at the gate as well so there is no excuse not to be there! I would like to thank our sponsors, particularly Empire Cinemas but also Fred.Olsen Cruises, Suffolk New College, University of Suffolk, Wagamama, Palmer Group and John Banks Honda. Their support has been crucial in putting this great event together."
Jon Nutton, Marketing Director at Empire Cinemas, added: "We are proud to be the official headline sponsor of this great community event. We've had such a great first year here in Ipswich and we are thrilled to be supporting such a fantastic day."
Open Air Cinema also has some great food and drink on offer – although feel free to bring your own – and parking is also available (via the park's Westerfield Road entrance) at £3 per car. Bring a cushion or a picnic chair and settle down to enjoy the show!


dc.identifier.citation Sboui L, Ghazzai H, Rezki Z, Alouini M-S (2017) Dynamic spectrum management in green cognitive radio cellular networks. 2017 IEEE 28th Annual International Symposium on Personal, Indoor, and Mobile Radio Communications (PIMRC). Available: http://dx.doi.org/10.1109/PIMRC.2017.8292271.
dc.description.abstract In this paper, we propose a new cellular network operation scheme fulfilling the 5G requirements related to spectrum management and green communications. We focus on cognitive radio cellular networks in which both the primary network (PN) and the secondary network (SN) are maximizing their operational profits. The PN and the SN are required to respect a CO emissions threshold by switching off one or more lightly loaded base stations (BSs). In addition, the PN accepts to cooperate with the SN by leasing its spectrum in the cells where the PN is turned off. In return, the corresponding SN BSs host the PN users and impose extra roaming fees to the PN. We propose a low-complexity algorithm that maximizes the profit per CO emissions metric while switching on/off the BSs. In the simulations, we show that our proposed algorithm achieves performances close to the exhaustive search method. In addition, we find that the roaming price is a key parameter that affects both PN and SN profits.


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