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Sandgruber F, Höger AL, Kunze J, Schenz B, Griehl C, Kiehntopf M, Kipp K, Kühn J, Stangl GI, Lorkowski S, Dawczynski C. Impact of Regular Intake of Microalgae on Nutrient Supply and Cardiovascular Risk Factors: Results from the NovAL Intervention Study. Nutrients 2023; 15:nu15071645. [PMID: 37049486 PMCID: PMC10097350 DOI: 10.3390/nu15071645] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/25/2023] [Accepted: 03/26/2023] [Indexed: 03/30/2023] Open
Abstract
A 14-day randomized controlled study with a parallel design was conducted with 80 healthy participants. Intervention groups I (IG1) and II (IG2) received a defined background diet and consumed a smoothie enriched with either 15 g of Chlorella dry weight (d.w.) or 15 g of Microchloropsis d.w. daily. Control group II (CG2) received a defined background diet without the smoothie. Control group I (CG1) received neither. Blood samples and 24-h urine were collected at the beginning and the end of the study. Serum concentrations of 25-hydroxyvitamin D3, vitamin D3, selenium, iron, ferritin, transferrin saturation, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, non-HDL cholesterol and the LDL-cholesterol/HDL cholesterol ratio decreased in IG1 (p < 0.05), while 25-hydroxyvitamin D2 increased (p < 0.05). In IG2, vitamin D3, 25-hydroxyvitamins D2 and D3 decreased (p < 0.05), while concentrations of fatty acids C20:5n3 and C22:5n3 increased. Serum and urine uric acid increased in IG1 and IG2 (p < 0.05). Microchloropsis is a valuable source of n3 fatty acids, as is Chlorella of vitamin D2. Regular consumption of Chlorella may affect the iron and selenium status negatively but may impact blood lipids positively. An elevated uric acid concentration in blood and urine following the regular consumption of microalgae poses potential risks for human health.
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Affiliation(s)
- Fabian Sandgruber
- Junior Research Group Nutritional Concepts, Institute of Nutritional Sciences, Friedrich Schiller University Jena, Dornburger Str. 29, 07743 Jena, Germany; (F.S.); (J.K.); (B.S.)
- Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, Dornburger Str. 25, 07743 Jena, Germany; (J.K.); (G.I.S.); (S.L.)
| | - Anna-Lena Höger
- Competence Center Algal Biotechnology, Anhalt University of Applied Science, Bernburger Str. 55, 06366 Köthen, Germany; (A.-L.H.); (C.G.)
| | - Julia Kunze
- Junior Research Group Nutritional Concepts, Institute of Nutritional Sciences, Friedrich Schiller University Jena, Dornburger Str. 29, 07743 Jena, Germany; (F.S.); (J.K.); (B.S.)
- Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, Dornburger Str. 25, 07743 Jena, Germany; (J.K.); (G.I.S.); (S.L.)
| | - Benjamin Schenz
- Junior Research Group Nutritional Concepts, Institute of Nutritional Sciences, Friedrich Schiller University Jena, Dornburger Str. 29, 07743 Jena, Germany; (F.S.); (J.K.); (B.S.)
- Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, Dornburger Str. 25, 07743 Jena, Germany; (J.K.); (G.I.S.); (S.L.)
| | - Carola Griehl
- Competence Center Algal Biotechnology, Anhalt University of Applied Science, Bernburger Str. 55, 06366 Köthen, Germany; (A.-L.H.); (C.G.)
| | - Michael Kiehntopf
- Institute of Clinical Chemistry and Laboratory Diagnostics, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany;
| | - Kristin Kipp
- Department of Pediatrics and Adolescent Medicine, Sophien- and Hufeland Hospital, Henry-Van-De-Velde-Str. 1, 99425 Weimar, Germany;
| | - Julia Kühn
- Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, Dornburger Str. 25, 07743 Jena, Germany; (J.K.); (G.I.S.); (S.L.)
- Institute of Agricultural and Nutritional Science, Martin Luther University Halle-Wittenberg, Von-Danckelmann-Platz 2, 06120 Halle, Germany
| | - Gabriele I. Stangl
- Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, Dornburger Str. 25, 07743 Jena, Germany; (J.K.); (G.I.S.); (S.L.)
- Institute of Agricultural and Nutritional Science, Martin Luther University Halle-Wittenberg, Von-Danckelmann-Platz 2, 06120 Halle, Germany
| | - Stefan Lorkowski
- Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, Dornburger Str. 25, 07743 Jena, Germany; (J.K.); (G.I.S.); (S.L.)
- Institute of Nutritional Sciences, Friedrich Schiller University Jena, Dornburger Str. 25, 07743 Jena, Germany
| | - Christine Dawczynski
- Junior Research Group Nutritional Concepts, Institute of Nutritional Sciences, Friedrich Schiller University Jena, Dornburger Str. 29, 07743 Jena, Germany; (F.S.); (J.K.); (B.S.)
- Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, Dornburger Str. 25, 07743 Jena, Germany; (J.K.); (G.I.S.); (S.L.)
- Correspondence:
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Żymańczyk-Duda E, Samson SO, Brzezińska-Rodak M, Klimek-Ochab M. Versatile Applications of Cyanobacteria in Biotechnology. Microorganisms 2022; 10:microorganisms10122318. [PMID: 36557571 PMCID: PMC9785398 DOI: 10.3390/microorganisms10122318] [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: 10/24/2022] [Revised: 11/09/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022] Open
Abstract
Cyanobacteria are blue-green Gram-negative and photosynthetic bacteria which are seen as one of the most morphologically numerous groups of prokaryotes. Because of their ability to fix gaseous nitrogen and carbon dioxide to organic materials, they are known to play important roles in the universal nutrient cycle. Cyanobacteria has emerged as one of the promising resources to combat the issues of global warming, disease outbreaks, nutrition insecurity, energy crises as well as persistent daily human population increases. Cyanobacteria possess significant levels of macro and micronutrient substances which facilitate the versatile popularity to be utilized as human food and protein supplements in many countries such as Asia. Cyanobacteria has been employed as a complementary dietary constituent of feed for poultry and as vitamin and protein supplement in aquatic lives. They are effectively used to deal with numerous tasks in various fields of biotechnology, such as agricultural (including aquaculture), industrial (food and dairy products), environmental (pollution control), biofuel (bioenergy) and pharmaceutical biotechnology (such as antimicrobial, anti-inflammatory, immunosuppressant, anticoagulant and antitumor); recently, the growing interest of applying them as biocatalysts has been observed as well. Cyanobacteria are known to generate a numerous variety of bioactive compounds. However, the versatile potential applications of cyanobacteria in biotechnology could be their significant growth rate and survival in severe environmental conditions due to their distinct and unique metabolic pathways as well as active defensive mechanisms. In this review, we elaborated on the versatile cyanobacteria applications in different areas of biotechnology. We also emphasized the factors that could impede the implementation to cyanobacteria applications in biotechnology and the execution of strategies to enhance their effective applications.
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[Association between diet of the vegan population and self-perception of periodontal state in Metropolitan Lima]. NUTR HOSP 2021; 39:147-156. [PMID: 34779213 DOI: 10.20960/nh.03757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVE to determine the association between vegan diet and self-perceived periodontal status in a vegan population of Metropolitan Lima, Peru. MATERIALS AND METHODS a total of 240 people (120 vegans and 120 non-vegans) were surveyed in this study during the months of August to December 2020 in a virtual way. To evaluate self-perception of periodontal status and oral hygiene habits, the self-report of periodontal disease was used, which is validated with a Cronbach's alpha of 0.77. In addition, other variables such as age, sex, socioeconomic level, educational level, and tobacco consumption were registered. A Poisson regression with robust variance estimator was used both for the association of variables, and prevalence ratios were reported in a crude and adjusted model. The confidence level was 95 % and the significance level was p < 0.05. RESULT a statistically significant association was found between the appearance of reddish and/or swollen gums (PR = 0.67; 95 % CI: 0.25-0.54) and poor perception of the state of the gums (PR = 0.43; 95 % CI: 0.33-0.56) with the vegan diet. Finally, for the gum bleeding dimension during brushing, no statistically significant differences were observed between vegans and non-vegans.
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Zugravu CA, Macri A, Belc N, Bohiltea R. Efficacy of supplementation with methylcobalamin and cyancobalamin in maintaining the level of serum holotranscobalamin in a group of plant-based diet (vegan) adults. Exp Ther Med 2021; 22:993. [PMID: 34345275 DOI: 10.3892/etm.2021.10425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 05/31/2021] [Indexed: 01/15/2023] Open
Abstract
Plant-based nutrition has become extremely popular in the contemporary era. Its positive effects are sustained by many studies, but one of its risks is that it is almost completely devoid of vitamin B12. In the present study, we analyzed the effects of two types of vitamin B12 supplements, cyancobalamin and methylcobalamin on the level of active serum vitamin (holotranscobalamin) in a group of Romanian individuals (n=42) following a (vegan) plant-based diet. The results revealed that cyancobalamin gives better results in maintaining B12, as quantified by the holotranscobalamin value (median=150 pcg/l) when compared with methylcobalamin (median=78.5 pcg/l). The frequency of administration, regardless of the quantity in one dose, is another important factor in maintaining the holotranscobalamin level within suitable limits. More frequent intakes give more optimal results. Vegans trying to supplement with alternative products (algae, kombucha, other fermented products), had the lowest levels of holotranscobalamin, always bellow the recommended level of 35 pcg/l (median=29 pcg/l). Vegans must be educated on B12 supplementation, about the pharmaceutical forms on the market and their performances and on choosing the optimal plan in order to avoid the onset of B12 deficiency.
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Affiliation(s)
- Corina-Aurelia Zugravu
- Department of Hygiene and Ecology, Faculty of Nursing and Midwifery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Adriana Macri
- Department of Biotechnology, National Institute of Research and Development for Food Bioresources, 014192 Bucharest, Romania
| | - Nastasia Belc
- Department of Biotechnology, National Institute of Research and Development for Food Bioresources, 014192 Bucharest, Romania
| | - Roxana Bohiltea
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
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Atazadegan MA, Bagherniya M, Askari G, Tasbandi A, Sahebkar A. The Effects of Medicinal Plants and Bioactive Natural Compounds on Homocysteine. Molecules 2021; 26:3081. [PMID: 34064073 PMCID: PMC8196702 DOI: 10.3390/molecules26113081] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/11/2021] [Accepted: 05/18/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Among non-communicable diseases, cardiovascular diseases (CVDs) are the leading cause of mortality and morbidity in global communities. By 2030, CVD-related deaths are projected to reach a global rise of 25 million. Obesity, smoking, alcohol, hyperlipidemia, hypertension, and hyperhomocysteinemia are several known risk factors for CVDs. Elevated homocysteine is tightly related to CVDs through multiple mechanisms, including inflammation of the vascular endothelium. The strategies for appropriate management of CVDs are constantly evolving; medicinal plants have received remarkable attention in recent researches, since these natural products have promising effects on the prevention and treatment of various chronic diseases. The effects of nutraceuticals and herbal products on CVD/dyslipidemia have been previously studied. However, to our knowledge, the association between herbal bioactive compounds and homocysteine has not been reviewed in details. Thus, the main objective of this study is to review the efficacy of bioactive natural compounds on homocysteine levels according to clinical trials and animal studies. RESULTS Based on animal studies, black and green tea, cinnamon, resveratrol, curcumin, garlic extract, ginger, and soy significantly reduced the homocysteine levels. According to the clinical trials, curcumin and resveratrol showed favorable effects on serum homocysteine. In conclusion, this review highlighted the beneficial effects of medicinal plants as natural, inexpensive, and accessible agents on homocysteine levels based on animal studies. Nevertheless, the results of the clinical trials were not uniform, suggesting that more well-designed trials are warranted.
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Affiliation(s)
- Mohammad Amin Atazadegan
- Department of Clinical Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran;
| | - Mohammad Bagherniya
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran;
- Anesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran
| | - Gholamreza Askari
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran;
- Anesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran
| | - Aida Tasbandi
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad 9177948564, Iran;
| | - Amirhossein Sahebkar
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad 9177948564, Iran;
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad 9177948564, Iran
- School of Pharmacy, Mashhad University of Medical Sciences, Mashhad 9177948954, Iran
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Isolation of Industrial Important Bioactive Compounds from Microalgae. Molecules 2021; 26:molecules26040943. [PMID: 33579001 PMCID: PMC7916812 DOI: 10.3390/molecules26040943] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/24/2020] [Accepted: 01/05/2021] [Indexed: 12/24/2022] Open
Abstract
Microalgae are known as a rich source of bioactive compounds which exhibit different biological activities. Increased demand for sustainable biomass for production of important bioactive components with various potential especially therapeutic applications has resulted in noticeable interest in algae. Utilisation of microalgae in multiple scopes has been growing in various industries ranging from harnessing renewable energy to exploitation of high-value products. The focuses of this review are on production and the use of value-added components obtained from microalgae with current and potential application in the pharmaceutical, nutraceutical, cosmeceutical, energy and agri-food industries, as well as for bioremediation. Moreover, this work discusses the advantage, potential new beneficial strains, applications, limitations, research gaps and future prospect of microalgae in industry.
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Bito T, Okumura E, Fujishima M, Watanabe F. Potential of Chlorella as a Dietary Supplement to Promote Human Health. Nutrients 2020; 12:E2524. [PMID: 32825362 PMCID: PMC7551956 DOI: 10.3390/nu12092524] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/04/2020] [Accepted: 08/17/2020] [Indexed: 12/11/2022] Open
Abstract
Chlorella is a green unicellular alga that is commercially produced and distributed worldwide as a dietary supplement. Chlorella products contain numerous nutrients and vitamins, including D and B12, that are absent in plant-derived food sources. Chlorella contains larger amounts of folate and iron than other plant-derived foods. Chlorella supplementation to mammals, including humans, has been reported to exhibit various pharmacological activities, including immunomodulatory, antioxidant, antidiabetic, antihypertensive, and antihyperlipidemic activities. Meta-analysis on the effects of Chlorella supplementation on cardiovascular risk factors have suggested that it improves total cholesterol levels, low-density lipoprotein cholesterol levels, systolic blood pressure, diastolic blood pressure, and fasting blood glucose levels but not triglycerides and high-density lipoprotein cholesterol levels. These beneficial effects of Chlorella might be due to synergism between multiple nutrient and antioxidant compounds. However, information regarding the bioactive compounds in Chlorella is limited.
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Affiliation(s)
- Tomohiro Bito
- Department of Agricultural, Life and Environmental Sciences, Faculty of Agriculture, Tottori University, Tottori 680-8553, Japan;
| | - Eri Okumura
- Sun Chlorella Corporation, Kyoto 600-8177, Japan; (E.O.); (M.F.)
| | - Masaki Fujishima
- Sun Chlorella Corporation, Kyoto 600-8177, Japan; (E.O.); (M.F.)
| | - Fumio Watanabe
- Department of Agricultural, Life and Environmental Sciences, Faculty of Agriculture, Tottori University, Tottori 680-8553, Japan;
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Rzymski P, Jaśkiewicz M. Microalgal food supplements from the perspective of Polish consumers: patterns of use, adverse events, and beneficial effects. JOURNAL OF APPLIED PHYCOLOGY 2017; 29:1841-1850. [PMID: 28775657 PMCID: PMC5514198 DOI: 10.1007/s10811-017-1079-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 06/07/2023]
Abstract
Microalgal food supplements are becoming increasingly popular due to their promising biological effects and high nutritional value, evidenced in in vitro, in vivo, and human studies. Some products of this kind have, however, raised controversies concerning their safety. At the same time, not much is known about the frequency of adverse events following the use of microalgal supplements, potential factors that may influence them, and general characteristics and behaviours of the consumer group. The present study aimed to fill this gap and surveyed a group of Polish consumers of microalgal products (n = 150) using an online questionnaire. As found, microalgal supplements (Spirulina, Chlorella, and Aphanizomenon) were popular in groups representing lacto-ovo-vegetarianism and veganism and were consumed predominantly for nutritional, immune-boosting, and detoxifying purposes. Their use was rarely discussed with specialists; the Internet constituted the most important source of information regarding these supplements. The most frequently self-reported health-beneficial effects of supplementation included the following: increased immunity, higher vitality, improved hair and skin quality, and better general well-being. Diarrhoea, nausea, abdominal pain, and skin rash were among the most often reported adverse events. Pre-existing medical conditions, namely renal failure and hypothyroidism, but not Hashimoto's thyroiditis, were associated with increased occurrence of side effects. Those individuals who had consulted specialists as to the use of supplements reported adverse events significantly less often. A strikingly high frequency of side effects and very low consumer satisfaction were reported by a group of consumers supplementing Aphanizomenon-based products. In summary, the present study highlights that microalgal consumers may benefit from additional warnings of potential side effects and from consulting a qualified health specialist prior to use.
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Affiliation(s)
- Piotr Rzymski
- Department of Environmental Medicine, Poznan University of Medical Sciences, Rokietnicka 8, 60-806 Poznań, Poland
| | - Monika Jaśkiewicz
- Department of Environmental Medicine, Poznan University of Medical Sciences, Rokietnicka 8, 60-806 Poznań, Poland
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Rizzo G, Laganà AS, Rapisarda AMC, La Ferrera GMG, Buscema M, Rossetti P, Nigro A, Muscia V, Valenti G, Sapia F, Sarpietro G, Zigarelli M, Vitale SG. Vitamin B12 among Vegetarians: Status, Assessment and Supplementation. Nutrients 2016; 8:E767. [PMID: 27916823 PMCID: PMC5188422 DOI: 10.3390/nu8120767] [Citation(s) in RCA: 177] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 11/23/2016] [Accepted: 11/23/2016] [Indexed: 02/06/2023] Open
Abstract
Cobalamin is an essential molecule for humans. It acts as a cofactor in one-carbon transfers through methylation and molecular rearrangement. These functions take place in fatty acid, amino acid and nucleic acid metabolic pathways. The deficiency of vitamin B12 is clinically manifested in the blood and nervous system where the cobalamin plays a key role in cell replication and in fatty acid metabolism. Hypovitaminosis arises from inadequate absorption, from genetic defects that alter transport through the body, or from inadequate intake as a result of diet. With the growing adoption of vegetarian eating styles in Western countries, there is growing focus on whether diets that exclude animal foods are adequate. Since food availability in these countries is not a problem, and therefore plant foods are sufficiently adequate, the most delicate issue remains the contribution of cobalamin, which is poorly represented in plants. In this review, we will discuss the status of vitamin B12 among vegetarians, the diagnostic markers for the detection of cobalamin deficiency and appropriate sources for sufficient intake, through the description of the features and functions of vitamin B12 and its absorption mechanism.
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Affiliation(s)
| | - Antonio Simone Laganà
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood, "G. Barresi", University of Messina, Via Consolare Valeria 1, Messina 98125, Italy.
| | - Agnese Maria Chiara Rapisarda
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Via S. Sofia 78, Catania 95124, Italy.
| | - Gioacchina Maria Grazia La Ferrera
- Department of Gastroenterology and Digestive Endoscopy Maddalena Raimondi San Cataldo, Via Forlanini 5, San Cataldo, Caltanissetta 93017, Italy.
| | - Massimo Buscema
- Unit of Diabetology and Endocrino-Metabolic Diseases, Hospital for Emergency Cannizzaro, Via Messina 829, Catania 95126, Italy.
| | - Paola Rossetti
- Unit of Diabetology and Endocrino-Metabolic Diseases, Hospital for Emergency Cannizzaro, Via Messina 829, Catania 95126, Italy.
| | - Angela Nigro
- Unit of Diabetology and Endocrino-Metabolic Diseases, Hospital for Emergency Cannizzaro, Via Messina 829, Catania 95126, Italy.
| | - Vincenzo Muscia
- Unit of Diabetology and Endocrino-Metabolic Diseases, Hospital for Emergency Cannizzaro, Via Messina 829, Catania 95126, Italy.
| | - Gaetano Valenti
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Via S. Sofia 78, Catania 95124, Italy.
| | - Fabrizio Sapia
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Via S. Sofia 78, Catania 95124, Italy.
| | - Giuseppe Sarpietro
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Via S. Sofia 78, Catania 95124, Italy.
| | - Micol Zigarelli
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Via S. Sofia 78, Catania 95124, Italy.
| | - Salvatore Giovanni Vitale
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood, "G. Barresi", University of Messina, Via Consolare Valeria 1, Messina 98125, Italy.
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