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Takeda H, Michikawa T, Nagai S, Akaike Y, Imai T, Kawabata S, Ito K, Ikeda D, Kaneko S, Fujita N. Relationship between frailty and locomotive syndrome in older patients with degenerative cervical myelopathy: A retrospective longitudinal study. J Orthop Sci 2024:S0949-2658(24)00143-X. [PMID: 39013755 DOI: 10.1016/j.jos.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/13/2024] [Accepted: 07/04/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND The management of degenerative cervical myelopathy (DCM), which often impairs lower extremity function and increases the risk of falls, is gaining recognition for its importance in an aging society. Despite the significant overlap between frailty and locomotive syndrome (LS) in older adults, their interaction in older DCM patients remains unclear. We aimed to determine the characteristics of older DCM patients with frailty, focusing on the association between frailty and LS. METHODS We retrospectively examined the clinical records and imaging data of consecutive patients aged 65 years and above who underwent surgery for DCM at a single facility. Frailty and LS stage were diagnosed using the modified frailty index-11 and the 25-question Geriatric Locomotive Function Scale (GLFS-25), respectively. RESULTS A total of 114 subjects were analyzed, among whom approximately 30% were diagnosed with frailty. DCM patients with frailty had significantly worse Japanese Orthopaedic Association Cervical Myelopathy Assessment Questionnaire (JOACMEQ) and GLFS-25 scores at baseline than did those without frailty. Moreover, DCM patients with frailty had significantly more advanced LS stage at baseline than did those without frailty. Meanwhile, no significant difference in the improvement in JOACMEQ and GLFS-25 scores were observed between those with and without frailty after surgery. More precisely, DCM patients with frailty experienced better improvement in lower extremity function based on the JOACMEQ than did those without frailty. CONCLUSIONS Our results demonstrated that older DCM patients had favorable outcomes following surgery regardless of frailty. Despite the significant association between frailty and LS in DCM patients, frailty did not negatively impact the improvement in LS in older DCM patients. These findings provide valuable information for both older DCM patients and their attending physicians that would help guide decisions about cervical spine surgery for DCM.
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Affiliation(s)
- Hiroki Takeda
- Department of Spine and Spinal Cord Surgery, School of Medicine, Fujita Health University, Aichi, Japan
| | - Takehiro Michikawa
- Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan
| | - Sota Nagai
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Aichi, Japan
| | - Yuki Akaike
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Aichi, Japan; Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takaya Imai
- Department of Spine and Spinal Cord Surgery, School of Medicine, Fujita Health University, Aichi, Japan
| | - Soya Kawabata
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Aichi, Japan
| | - Kei Ito
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Aichi, Japan
| | - Daiki Ikeda
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Aichi, Japan
| | - Shinjiro Kaneko
- Department of Spine and Spinal Cord Surgery, School of Medicine, Fujita Health University, Aichi, Japan
| | - Nobuyuki Fujita
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Aichi, Japan.
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Lodge M, Aitken R, Chong YH, Thillainadesan J. Development of a minimum clinical dataset for preoperative comprehensive geriatric assessment using a modified Delphi technique. Australas J Ageing 2024. [PMID: 38754868 DOI: 10.1111/ajag.13334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/24/2024] [Accepted: 04/29/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE To construct a standardised, consensus-guided minimum clinical dataset (MCDS) for preoperative comprehensive geriatric assessment and optimisation (CGA) in Australia and Aotearoa New Zealand. METHODS We conducted a review of the international perioperative literature to identify CGA domains and tools for potential inclusion in the MCDS. We invited members of the Australian and New Zealand Society for Geriatric Medicine to participate in a Delphi study to obtain consensus on MCDS tools. Participants were asked to rate proposed tools using Likert scales (when >2 tools) or make a binary choice between two proposed tools. Consensus was considered to be achieved when there was at least 75% concordance between the two rounds amongst the participants, and at least one variable attaining over 50% of participants' votes. Domains that did not achieve consensus in Round 1 were carried over to Round 2. RESULTS There were 73 participants in Round 1 of the Delphi study and 47 participants in Round 2. Consensus was achieved on tool/s recommended for every MCDS domain: Clinical Frailty Scale (frailty); sMMSE, RUDAS, MoCA (cognition); 4AT (delirium); timed-up-and-go (physical function); GDS-15 (mood); Barthel Index (functional status); and MUST (malnutrition). CONCLUSIONS We recommend clinicians delivering preoperative CGA consider the use of the MCDS we have constructed when assessing older people contemplating surgery, as part of a multicomponent and multidisciplinary approach to optimising perioperative outcomes.
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Affiliation(s)
- Margot Lodge
- Alfred Health, Melbourne, Victoria, Australia
- National Centre for Healthy Ageing, Melbourne, Victoria, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Rachel Aitken
- Department of Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Yih Harng Chong
- Te Whatu Ora (Waitemata District), Auckland, New Zealand
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Janani Thillainadesan
- Department of Geriatric Medicine, Centre for Education and Research on Ageing, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Ishii N, Hatakeyama S, Miura H, Tanaka R, Oishi T, Horiguchi H, Hosogoe S, Fujita N, Iwamura H, Okamoto T, Yamamoto H, Yoneyama T, Hashimoto Y, Ohyama C. Trends in the age of hospitalized patients with urological cancers: A 17-year experience. Int J Urol 2023; 30:572-578. [PMID: 36941076 DOI: 10.1111/iju.15180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/28/2023] [Indexed: 03/22/2023]
Abstract
OBJECTIVES To investigate the impact of global aging on the trends in the age of hospitalized patients with a urological cancer diagnosis. METHODS We retrospectively evaluated a cumulative total of 10 652 cases of referred patients (n = 6637) with a urological disease who were hospitalized in our institution between January 2005 and December 2021. We compared age and the proportion of patients aged ≥80 years among patients who were hospitalized in the urological ward between the period of 2005-2013 and that of 2014-2021. RESULTS We identified 8168 hospitalized patients with urological cancer. The median age was significantly increased in patients with urological cancer between the periods of 2005-2013 and 2014-2021. The proportion of hospitalized patients with urological cancer aged ≥80 years was significantly increased between the periods of 2005-2013 (9.3%) and 2014-2021 (13.8%). The median ages of the patients with urothelial cancer (UC) and renal cell carcinoma (RCC), but not the median age of those with prostate cancer (PC), were significantly increased between the study periods. The proportion of hospitalized patients with UC, but not the proportions of those with PC and RCC, aged ≥80 years was significantly increased between the study periods. CONCLUSIONS The age of patients with urological cancer who were hospitalized in the urological ward and the proportion of patients with UC aged ≥80 years significantly increased over the entire study period.
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Affiliation(s)
- Noritaka Ishii
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Shingo Hatakeyama
- Department of Advanced Blood Purification Therapy, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Hikari Miura
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Ryuma Tanaka
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Takuya Oishi
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Hirotaka Horiguchi
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Shogo Hosogoe
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Naoki Fujita
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Hiromichi Iwamura
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Teppei Okamoto
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Hayato Yamamoto
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Takahiro Yoneyama
- Department of Advanced Regenerative Medicine, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Yasuhiro Hashimoto
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
- Department of Advanced Blood Purification Therapy, Hirosaki University School of Medicine, Hirosaki, Japan
- Department of Advanced Regenerative Medicine, Hirosaki University School of Medicine, Hirosaki, Japan
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Dzhioeva O, Tadic M, Belyavskiy E. Preoperative Stress Testing before Non-Cardiac Surgery. Rev Cardiovasc Med 2023; 24:98. [PMID: 39076260 PMCID: PMC11273002 DOI: 10.31083/j.rcm2404098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 07/31/2024] Open
Abstract
The current guidelines from various medical societies provide a good summary of data regarding various preoperative exercise tests in patients prior to non-cardiac surgical interventions. However, there is no consensus among experts on the appropriateness of these methods for identifying risk groups for potential perioperative complications. A large volume of published studies describes the role of preoperative exercise stress testing impact in improving the prediction of potential cardiovascular (CV) risk in patients after non-cardiac surgery. Numerous stress tests are available in clinical practice, and the methods used and the best choice depends on the purpose of the study and the availability of equipment in the hospital. Traditionally, the value of exercise electrocardiography (ECG), or ECG stress test, has been based on the belief that it is beneficial for perioperative cardiac risk prediction. However, in the past two decades, the key role of this method has lost its importance due to the growing trend toward the use of imaging techniques. Moreover, in light of current trends, the six-minute walk test (6MWT) is a helpful tool in preoperative assessment and plays an important role in postoperative rehabilitation. Interestingly, the recent finding showed how 6MWT affects the risk of postoperative complications. Cardiopulmonary testing, as a dynamic clinical tool, determines the cardiorespiratory status of a patient. Various clinical indications for cardiopulmonary exercise testing include evaluation of therapy, stratification of risk factors, diagnosis of disease, and control of physical activity. Stress testing is one of the most practical ways of predicting perioperative risk and managing patients. This test is based on ischemia provoked by pharmacological agents or exercise. There is no established evidence of a significant advantage of pharmacological stress over exercise stress imaging in subjects who are capable enough to be physically active. All of these studies examined a stress test for induced myocardial ischemia. Currently, there are no data on the use of ischaemic stress tests, especially diastolic stress tests, in the assessment of perioperative risk before non-cardiac surgical interventions. We consider it promising and essential to continue research in this direction in patients with coronary heart disease and other categories of cardiac patients, in particular, comorbid and low-symptomatic individuals, before elective high-risk surgical interventions.
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Affiliation(s)
- Olga Dzhioeva
- Department of Therapy and Preventive Medicine, Moscow State University of Medicine and Dentistry named after A.I. Evdokimov, 127473 Moscow, Russia
| | - Marijana Tadic
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, 89081 Ulm, Germany
| | - Evgeny Belyavskiy
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), 13353 Berlin, Germany
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Yap EN, Dusendang JR, Ng KP, Keny HV, Webb CA, Weyker PD, Thoma MS, Solomon MD, Herrinton LJ. Risk of cardiac events after elective versus urgent or emergent noncardiac surgery: Implications for quality measurement and improvement. J Clin Anesth 2023; 84:110994. [PMID: 36356394 DOI: 10.1016/j.jclinane.2022.110994] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/10/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Patient populations differ for elective vs urgent and emergent surgery. The effect of this difference on surgical outcome is not well understood and may be important for improving surgical safety. Our primary hypothesis was that there is an association of surgical acuity with risk of postoperative cardiac events. Secondarily, we examined elective vs urgent and emergent patients separately to understand patient characteristics that are associated with postoperative cardiac events. METHODS We performed a retrospective cohort study of patients ≥65 years undergoing noncardiac elective or urgent/emergent surgery. Logistic regression estimated the association of surgical acuity with a postoperative cardiac event, which was defined as myocardial infarction or cardiac arrest within 30 days of surgery. For the secondary analysis, we modeled the outcome after stratifying by acuity. RESULTS The study included 161,177 patients with 1014 cardiac events. The unadjusted risk of a postoperative cardiac event was 3.2 per 1000 among elective patients and 28.7 per 1000 among urgent and emergent patients (adjusted odds ratio 4.10, 95% confidence interval 3.56-4.72). After adjustment, increased age, higher baseline cardiac risk, peripheral vascular disease, hypertension, worse American Society of Anesthesiologist (ASA) physical classification, and longer operative time were associated with a postoperative cardiac event. Higher baseline cardiac risk was more strongly associated with postoperative cardiac events in elective patients. In contrast, worse ASA physical classification was more strongly associated with postoperative cardiac events in urgent and emergent patients. Black patients had higher odds of a postoperative cardiac event only in urgent and emergent patients compared to White patients. CONCLUSIONS Quality measurement and improvement to address postoperative cardiac risk should consider patients based on surgical acuity.
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Affiliation(s)
- Edward N Yap
- Department of Anesthesia, The Permanente Medical Group, USA; Department of Anesthesia and Perioperative Care, University of California, San Francisco, USA.
| | - Jennifer R Dusendang
- Division of Research, Kaiser Permanente Northern California, The Permanente Medical Group, USA
| | - Kevin P Ng
- Department of Anesthesia, The Permanente Medical Group, USA
| | - Hemant V Keny
- Department of Surgery, The Permanente Medical Group, USA
| | - Christopher A Webb
- Department of Anesthesia, The Permanente Medical Group, USA; Department of Anesthesia and Perioperative Care, University of California, San Francisco, USA
| | - Paul D Weyker
- Department of Anesthesia, The Permanente Medical Group, USA
| | - Mark S Thoma
- Department of Anesthesia, The Permanente Medical Group, USA; Department of Anesthesia and Perioperative Care, University of California, San Francisco, USA
| | - Matthew D Solomon
- Division of Research, Kaiser Permanente Northern California, The Permanente Medical Group, USA; Department of Cardiology, The Permanente Medical Group, USA
| | - Lisa J Herrinton
- Division of Research, Kaiser Permanente Northern California, The Permanente Medical Group, USA
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Utility of the Age Discrepancy between Frailty-Based Biological Age and Expected Life Age in Patients with Urological Cancers. Cancers (Basel) 2022; 14:cancers14246229. [PMID: 36551713 PMCID: PMC9776733 DOI: 10.3390/cancers14246229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/14/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Background: The estimation of biological age is challenging in patients with cancers. We aimed to investigate frailty-based biological ages using frailty-discriminant scores (FDS) and examined the effect of biological-expected life age discrepancy on the prognosis of patients with urological cancers. Methods: We retrospectively evaluated frailty in 1035 patients having urological cancers. Their frailty-based biological age was then defined by the FDS, which is a comprehensive frailty assessment tool, using 1790 noncancer individuals as controls. An expected life age (=chronological age + life expectancy) was subsequently calculated using the 2019 life expectancy table. The primary outcome was the estimation of the biological-expected life age discrepancy between the frailty-based biological age and expected life age in patients with urological cancers. Secondary outcomes were the evaluation of the effect of the biological-expected life age discrepancy on overall survival. Results: We included 405, 466, and 164 patients diagnosed with prostate cancer, urothelial carcinoma, and renal cell carcinoma, respectively. The median chronological age, life expectancy, and estimated frailty-based biological age were 71, 17, and 83 years, respectively. The biological-expected life age discrepancy in any urological cancers, localized diseases, and metastatic diseases was −4.8, −6.3, and +0.15 years, respectively. The biological-expected life age discrepancy of >5 years was significantly associated with poor overall survival. Conclusions: The biological-expected life age discrepancy between frailty-based biological age and expected life age may be helpful in understanding the role of frailty and patient/doctor conversation.
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Maeda K, Kuriyama N, Ito T, Gyoten K, Hayasaki A, Fujii T, Iizawa Y, Murata Y, Tanemura A, Kishiwada M, Mizuno S. Safety and benefits of major hepatectomy with extrahepatic bile duct resection in older perihilar cholangiocarcinoma patients. Langenbecks Arch Surg 2022; 407:2861-2872. [PMID: 35996005 DOI: 10.1007/s00423-022-02654-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 08/13/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE To evaluate the safety and benefits of major hepatectomy with extrahepatic bile duct resection in older perihilar cholangiocarcinoma patients and to identify possible predictors of surgical mortality. METHODS We retrospectively analyzed the data of 102 consecutive patients who underwent major hepatectomy with extrahepatic bile duct resection for perihilar cholangiocarcinoma in our institution between 2004 and 2021. The patients were included and divided into two groups: older patients ≥ 75 years and non-older patients < 75 years. Patient characteristics, preoperative nutritional and operative risk scores, intraoperative details, postoperative outcomes, and long-term prognosis were compared between the groups. Univariate and multivariate analyses were used to identify the predictors of 90-day mortality after major hepatectomy with extrahepatic bile duct resection. RESULTS Significant differences were identified for some preoperative surgical risk scores, but not for nutritional scores. Older patients had a higher morbidity rate of respiratory complications (p = 0.016), but there were no significant differences in overall (p = 0.735) or disease-specific survival (p = 0.858). A high Dasari's score was identified as an independent predictive factor of 90-day mortality. CONCLUSIONS Major hepatectomy with extrahepatic bile duct resection can be performed for optimally selected older and younger patients with perihilar cholangiocarcinoma, resulting in a good prognosis. However, indications for extended surgery should be recognized. Dasari's preoperative risk score may be a good predictor of 90-day mortality.
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Affiliation(s)
- Koki Maeda
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, Japan
- Regional Medical Support Center, Mie University Hospital, Tsu city, Mie, Japan
| | - Naohisa Kuriyama
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, Japan.
| | - Takahiro Ito
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, Japan
| | - Kazuyuki Gyoten
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, Japan
| | - Aoi Hayasaki
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, Japan
| | - Takehiro Fujii
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, Japan
| | - Yusuke Iizawa
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, Japan
| | - Yasuhiro Murata
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, Japan
| | - Akihiro Tanemura
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, Japan
| | - Masashi Kishiwada
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, Japan
| | - Shugo Mizuno
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, Japan
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Covino M, Salini S, Russo A, De Matteis G, Simeoni B, Maccauro G, Sganga G, Landi F, Gasbarrini A, Franceschi F. Frailty Assessment in the Emergency Department for Patients ≥80 Years Undergoing Urgent Major Surgical Procedures. J Am Med Dir Assoc 2022; 23:581-588. [DOI: 10.1016/j.jamda.2021.12.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/13/2021] [Accepted: 12/19/2021] [Indexed: 01/07/2023]
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Rostagno C. Which preoperative screening tool should be applied to older patients undergoing elective surgery to predict short-term postoperative outcomes? Lessons from systematic reviews, meta-analyses and guidelines: heart and non-cardiac surgery need a different approach? Intern Emerg Med 2021; 16:15-17. [PMID: 32944870 DOI: 10.1007/s11739-020-02497-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/04/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Carlo Rostagno
- Dipartimento Medicina Sperimentale e Clinica, Università di Firenze, Viale Morgagni 85, 50134, Firenze, Italy.
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