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Davitt CC, Zhang Y, Costales AB. Thinking Twice about the Cervical Mass: A Case Report of Primary Vaginal Leiomyosarcoma and Review of the Literature. Case Rep Obstet Gynecol 2024; 2024:1829000. [PMID: 38591061 PMCID: PMC11001473 DOI: 10.1155/2024/1829000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 04/10/2024] Open
Abstract
Primary vaginal leiomyosarcoma (LMS) is an unusual cause of aggressive gynecologic cancer which requires prompt surgical treatment for favorable outcomes. Definitive diagnosis and treatment render unique challenges to clinicians based on vague presentation and limited evidence for management. Here, we describe a case of vaginal LMS in a middle-aged woman with a history of cervical dysplasia found to have a proximal vaginal mass after presenting with vaginal discharge and cramping pain. The patient was diagnosed on pathologic surgical specimen and subsequently underwent definitive surgical treatment. She remains with no evidence of disease 20 months later. In our report, we emphasize the nuances of surgical management including localized source control in those desiring future fertility. Ultimately, we make recommendations for surgical treatment and surveillance based on the available published literature.
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Affiliation(s)
- Caroline C. Davitt
- Baylor College of Medicine, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Dan L Duncan Comprehensive Cancer Center, 7200 Cambridge St., Houston, TX 77030, USA
| | - Yingao Zhang
- Baylor College of Medicine, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Dan L Duncan Comprehensive Cancer Center, 7200 Cambridge St., Houston, TX 77030, USA
| | - Anthony B. Costales
- Baylor College of Medicine, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Dan L Duncan Comprehensive Cancer Center, 7200 Cambridge St., Houston, TX 77030, USA
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Trétarre B, Dantony E, Coureau G, Defossez G, Guizard AV, Delafosse P, Daubisse L, Velten M, Karima Hammas, Barra S, Lapotre B, Plouvier S, d'Almeida T, Molinié F, Woronoff AS. Trends in incidence of invasive vaginal cancer in France from 1990 to 2018 and survival of recently diagnosed women - A population-based study. Eur J Obstet Gynecol Reprod Biol 2023; 283:125-129. [PMID: 36842246 DOI: 10.1016/j.ejogrb.2023.02.003] [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: 10/28/2022] [Revised: 01/26/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVE The aim of this study was to analyze trends in the incidence of vaginal cancer in France over a 28-year period and to present survival for recently-diagnosed women. METHODS French cancer registries provided data on invasive vaginal cancers diagnosed from 1990 to 2015 and followed up through June 2018. Trends in incidence were analyzed using a Poisson model with a bidimensional penalized spline of age and year at diagnosis. Net survival analysis was restricted to recently-diagnosed cases (2010-2015) and used a novel approach based on a bidimensional penalized spline of age and time-since-diagnosis to model excess mortality hazard. RESULTS With 162 new cases estimated in France in 2018, vaginal cancer represented 0.9 % of genital cancers in French women. In 2018, the world population age-standardized incidence rate was 0.2 per 100,000 person-years, median age at diagnosis was 75 years. The standardized incidence rate decreased significantly by 3 % per year (95 % CI, -3.8; -2.2) between 1990 and 2018 (0.4 cases per 100,000 person-year in 1990, vs 0.2 in 2018). Age-standardized net survival at 1 and 5 years after diagnosis was respectively 74 % and 45 %. CONCLUSIONS This study confirms that vaginal cancer is still a rare malignancy in France with 5-year net survival that remains low. We observed a consistent decrease in the incidence rate between 1990 and 2018. It may be too early to attribute these trends to a positive impact of vaccination campaigns against hrHPV infection, since vaginal cancer mainly affects older women and HPV vaccination has only been available since the early 2000s, and only targets young girls.
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Affiliation(s)
- Brigitte Trétarre
- Registre des Tumeurs de l'Hérault, 208 rue des Apothicaires, Montpellier, France; CERPOP INSERM U1295, Toulouse III University, F-31000, France; FRANCIM Network, Toulouse F-31073, France.
| | - Emmanuelle Dantony
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France; Laboratoire de Biométrie et Biologie Evolutive, UMR 5558, CNRS, Université Lyon 1, Université de Lyon, Villeurbanne, France
| | - Gaëlle Coureau
- FRANCIM Network, Toulouse F-31073, France; Epicene, Centre Inserm U1219/CHU de Bordeaux, Service d'information Médicale, Université Bordeaux, Bordeaux, France
| | - Gautier Defossez
- FRANCIM Network, Toulouse F-31073, France; Registre général des cancers de Poitou-Charentes, Pôle Biologie, Pharmacie et Santé Publique, CHU de Poitiers, Poitiers, France; Université de Poitiers, Poitiers, France; INSERM Centre d'Investigation Clinique CIC1402, Poitiers, France
| | - Anne-Valérie Guizard
- FRANCIM Network, Toulouse F-31073, France; Registre Général des Tumeurs du Calvados, Caen, France
| | - Patricia Delafosse
- FRANCIM Network, Toulouse F-31073, France; Registre Général des Cancers de l'Isère, Meylan, France
| | - Laetitia Daubisse
- CERPOP INSERM U1295, Toulouse III University, F-31000, France; FRANCIM Network, Toulouse F-31073, France; Claudius Regaud Institute, Regional Cancer Center, IUCT-O, Tarn Cancer Registry, Toulouse, F-31059, France
| | - Michel Velten
- FRANCIM Network, Toulouse F-31073, France; Registre des Cancers du Haut-Rhin, Mulhouse, France
| | - Karima Hammas
- FRANCIM Network, Toulouse F-31073, France; Registre des Cancers du Haut-Rhin, ARER68, Groupe Hospitalier de la Région de Mulhouse et Sud-Alsace (GHRMSA), Mulhouse, France
| | - Simona Barra
- FRANCIM Network, Toulouse F-31073, France; Registre des Cancers de la Manche, Cherbourg-Octeville, France
| | - Bénédicte Lapotre
- FRANCIM Network, Toulouse F-31073, France; Registre du cancer de la Somme, hôpital nord CHU Amiens-Picardie, Amiens, France
| | - Sandrine Plouvier
- FRANCIM Network, Toulouse F-31073, France; Registre général des cancers de Lille et de sa région, Lille, France
| | - Tania d'Almeida
- FRANCIM Network, Toulouse F-31073, France; Registre général des cancers de la Haute-Vienne - CHU de Limoges, Limoges, France
| | - Florence Molinié
- CERPOP INSERM U1295, Toulouse III University, F-31000, France; FRANCIM Network, Toulouse F-31073, France; Registre des Cancers de Loire-Atlantique et Vendee, CHU de Nantes, France
| | - Anne-Sophie Woronoff
- FRANCIM Network, Toulouse F-31073, France; Doubs Cancer Registry, Besançon University Hospital, Besançon, France; Research Unit EA3181, Franche-Comté University, Besançon, France
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Gao C, Li H, Wu R, Chen W. Prognostic nomogram and treatment efficacy analysis for vaginal cancer: A SEER database and external validation study. Int J Gynaecol Obstet 2023. [PMID: 36947104 DOI: 10.1002/ijgo.14750] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/16/2023] [Accepted: 03/03/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVES To analyze the prognosis and treatment decisions for patients with vaginal cancer through a large retrospective cohort study, in order to assist clinicians to evaluate the condition and choose treatment methods. METHODS This was a retrospective study analyzed with Cox regression, nomogram, and external validation. The Kaplan-Meier curve was used for comparative analysis of various treatment modalities. RESULTS A total of 6650 cases of vaginal cancer diagnosed between 2000 and 2018 from the Surveillance, Epidemiology, and End Results database and 106 cases diagnosed between 2006 and 2021 from Fujian Cancer Hospital were identified. Young age, early FIGO (the International Federation of Gynecology and Obstetrics) stage, well-differentiated, squamous and adenocarcinoma, first primary malignancy, married, undergoing surgery, and chemoradiotherapy were good independent prognostic factors (P < 0.001). The internal and external validation concordance indices were 0.7102 and 0.7785, respectively. The Kaplan-Meier curves indicated that surgery, radiotherapy, and chemotherapy significantly improved survival in patients with vaginal cancer. Forest plots suggest that radiotherapy combined with surgery was superior to radiotherapy alone (P < 0.001). CONCLUSION We established a specific nomogram to predict vaginal cancer prognosis. Surgery combined with external beam radiation plus brachytherapy may be the most recommended treatment option.
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Affiliation(s)
- Chen Gao
- Department of Obstetrics and Gynecology, Ningde Hospital Affiliated to Ningde Normal University, Ningde, China
| | - Hui Li
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Rongrong Wu
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Wenjuan Chen
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
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Yuan H, Wang T. Primary vaginal sarcoma in a single center. Gynecol Oncol Rep 2022; 44:101122. [PMID: 36589507 PMCID: PMC9797610 DOI: 10.1016/j.gore.2022.101122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/26/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022] Open
Abstract
Objectives To investigate the clinical characteristics and prognosis of primary vaginal sarcoma. Methods A retrospective analysis of patients with primary vaginal sarcoma treated at our center from 2000 to 2020 was conducted. Results Fifteen patients were identified, among which 9 (60.0 %) patients had leiomyosarcoma, 2 (13.3 %) patients had Ewing's sarcoma, 2 (13.3 %) patients had rhabdomyosarcoma, 1 (6.7 %) patient had undifferentiated sarcoma, and 1 (6.7 %) patient had malignant peripheral schwannoma. Nine patients presented with vaginal mass that was the most common primary symptoms. Eleven patients received their primary surgery, and 7 of them received postoperative adjuvant chemotherapy or radiation therapy. The remaining 4 patients received initial chemotherapy and/or radiotherapy because of advanced stage. The distribution by stage was as follows: stage I in 10 patients, stage II in 1 patient, stage III in 2 patients and stage IV in 2 patients. The median follow-up was 43.7 months (10.1-137.5 months). Thirteen patients (86.7 %) had disease extent during follow-up, and among them, 11 patients (11/13, 84.6 %) developed local relapse or adjacent organ metastases, 1 patient (1/13, 7.7 %) developed liver metastases, and the remaining 1 patient (1/13, 7.7 %) developed lung metastases and local relapse during follow-up. Ten (10/13, 76.9 %) patients relapsed within 2 years after diagnosis. Eight patients (8/11, 72.7 %) with local recurrence or adjacent organ metastases received a secondary surgery treatment, and only 2 of them relapsed again. Two-year overall survival (OS) and 5-year OS were 80.0 % and 66.7 %, respectively. Patients with leiomyosarcoma had a tendency toward a better 5-year OS than those with other sarcomas (74.1 % vs 66.7 %, P = 0.307). Conclusions Primary vaginal sarcomas are aggressive neoplasms with different presenting characteristics. Surgery is the main treatment for primary vaginal sarcoma and for local relapse vaginal sarcoma.
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Affiliation(s)
- Hua Yuan
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,Corresponding author at: Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
| | - Tonghui Wang
- Clinical Lab, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
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Yuan H, Wang T. Primary vaginal sarcoma in a single center. Gynecol Oncol Rep 2022; 44:101110. [PMID: 36506036 PMCID: PMC9731389 DOI: 10.1016/j.gore.2022.101110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/26/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022] Open
Abstract
Objectives To investigate the clinical characteristics and prognosis of primary vaginal sarcoma. Methods A retrospective analysis of patients with primary vaginal sarcoma treated at our center from 2000 to 2020 was conducted. Results Fifteen patients were identified, among which 9 (60.0 %) patients had leiomyosarcoma, 2 (13.3 %) patients had Ewing's sarcoma, 2 (13.3 %) patients had rhabdomyosarcoma, 1 (6.7 %) patient had undifferentiated sarcoma, and 1 (6.7 %) patient had malignant peripheral schwannoma. Nine patients presented with vaginal mass that was the most common primary symptoms. Eleven patients received their primary surgery, and 7 of them received postoperative adjuvant chemotherapy or radiation therapy. The remaining 4 patients received initial chemotherapy and/or radiotherapy because of advanced stage. The distribution by stage was as follows: stage I in 10 patients, stage II in 1 patient, stage III in 2 patients and stage IV in 2 patients. The median follow-up was 43.7 months (10.1-137.5 months). Thirteen patients (86.7 %) had disease extent during follow-up, and among them, 11 patients (11/13, 84.6 %) developed local relapse or adjacent organ metastases, 1 patient (1/13, 7.7 %) developed liver metastases, and the remaining 1 patient (1/13, 7.7 %) developed lung metastases and local relapse during follow-up. Ten (10/13, 76.9 %) patients relapsed within 2 years after diagnosis. Eight patients (8/11, 72.7 %) with local recurrence or adjacent organ metastases received a secondary surgery treatment, and only 2 of them relapsed again. Two-year overall survival (OS) and 5-year OS were 80.0 % and 66.7 %, respectively. Patients with leiomyosarcoma had a tendency toward a better 5-year OS than those with other sarcomas (74.1 % vs 66.7 %, P = 0.307). Conclusions Primary vaginal sarcomas are aggressive neoplasms with different presenting characteristics. Surgery is the main treatment for primary vaginal sarcoma and for local relapse vaginal sarcoma.
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Affiliation(s)
- Hua Yuan
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,Corresponding author at: Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
| | - Tonghui Wang
- Clinical Lab, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
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Bakirarar B, Namli Kalem M, Kalem Z. Factors that affect survival in vaginal cancer: a seer analysis. J OBSTET GYNAECOL 2022; 42:2307-2313. [PMID: 35543117 DOI: 10.1080/01443615.2022.2049717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study aimed to investigate the factors that affect survival in vaginal cancer by means of a large population-based database that had been monitored over a 42 year period (1975-2017). It was investigated which factors were most predictive in survival. This study evaluated the factors that affect survival in primary vaginal cancer as one of the rarest gynaecological cancers. Relationships were explored between survival and age and race of patient, in situ/invasive behaviour of tumour, histological type, stage, grade, surgical treatment, and year of diagnosis. Survival rate was found to be higher at younger ages and earlier stages, in in situ and squamous cell carcinomas, in the presence of previous surgery, and diagnosis from 2000 onward. It was shown that other causes were more predictive of mortality in older patients and that mortality due to other causes decreased in patients diagnosed from 2000 onward. Mortalities due to cancer were found to be lower in the patients who had underwent surgery.At the end of this study, an estimation model was developed for 10-year survival in vaginal cancer and software was created for the model. Impact StatementWhat is already known on this subject? Primary vaginal cancer is very rare, accounting for 2% of female genital tract malignancies. Due to its low incidence and difficulty of its final diagnosis, vaginal cancer has the least amount of data among all female genital tract malignancies. It is difficult for clinicians to estimate the survival with already limited data on vaginal cancer in the literature.What do the results of this study add? Survival rate was found to be higher at younger ages and earlier stages, in in situ and squamous cell carcinomas, in the presence of previous surgery, and diagnosis from 2000 onward. It was shown that other causes were more effective in mortality with older age and that mortality due to other causes decreased in patients diagnosed from 2000 onward. Mortalities due to cancer were found to be lower in the patients who had underwent surgery.What are the implications of these findings for clinical practice and/or further research? It is anticipated that such studies will contribute to the transformation of societal data collection methods into a prospective nature and lead the way for stronger survival estimation models to be developed in days to come.
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Affiliation(s)
- Batuhan Bakirarar
- Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey
| | - Muberra Namli Kalem
- Department of Obstetrics and Gynecology, Istinye University School of Medicine, Istanbul, Turkey
| | - Ziya Kalem
- Department of Obstetrics and Gynecology, Istinye University School of Medicine, Istanbul, Turkey
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Ranhem C, Larsson GL, Lindqvist D, Sorbe B, Karlsson MG, Farnebo M, Hellman K, Kovaleska L, Kashuba E, Andersson S. Evaluation of dyskerin expression and the Cajal body protein WRAP53β as potential prognostic markers for patients with primary vaginal carcinoma. Oncol Lett 2021; 23:30. [PMID: 34868367 PMCID: PMC8630817 DOI: 10.3892/ol.2021.13148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/30/2021] [Indexed: 11/06/2022] Open
Abstract
Primary vaginal cancer (PVC) is a rare gynaecological malignancy, which, at present, lacks appropriate biomarkers for prognosis. The proteins dyskerin and WD repeat containing antisense to TP53 (WRAP53β), both of which exert their functions in the telomerase holoenzyme complex, have been shown to be upregulated in different cancer types. These proteins have also been proposed as prognostic markers in some types of cancer. The aim of the present study was to examine the expression patterns of dyskerin and WRAP53β in patients with PVC. Moreover, as part of a search for effective biomarkers to evaluate prognosis in PVC, the expression of these two proteins and their potential association with clinical variables and survival were also evaluated. The expression of dyskerin and WRAP53β was assessed in PVC tumour samples from 68 patients using immunohistochemistry. The majority of tumour samples showed low and moderate expression levels of dyskerin. Upregulation of dyskerin in tumour samples was significantly associated with a shorter survival time and a poorer cancer-specific survival rate. WRAP53β was also expressed in most of the cells but was not significantly associated with clinical variables or survival. This study demonstrates that upregulation of dyskerin is significantly associated with poor prognosis. Thus, dyskerin may serve as a promising prognostic marker and a potential putative therapeutic target in PVC.
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Affiliation(s)
- Cecilia Ranhem
- Department of Women's and Children's Health, Karolinska Institutet, 171 77 Stockholm, Sweden.,Centre for Clinical Research Region Västmanland, Uppsala University, Västmanlands Hospital Västerås, 721 89 Västerås, Sweden
| | - Gabriella Lillsunde Larsson
- School of Health and Medical Sciences, Örebro University, Campus USÖ, 701 82 Örebro, Sweden.,Department of Laboratory Medicine, Örebro University Hospital, 701 85 Örebro, Sweden
| | - David Lindqvist
- Department of Radiation Sciences, Umeå Universitet, 901 87 Umeå, Sweden
| | - Bengt Sorbe
- Department of Oncology, Örebro University Hospital, 701 85 Örebro, Sweden
| | - Mats G Karlsson
- School of Medical Sciences, Örebro University, 701 85 Örebro, Sweden
| | - Marianne Farnebo
- Department of Bioscience and Nutrition, Karolinska Institutet, 141 83 Stockholm, Sweden.,Department of Cell and Molecular Biology, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Kristina Hellman
- Department of Oncology-Pathology, Karolinska Institutet, 171 64 Stockholm, Sweden
| | - Larysa Kovaleska
- R.E. Kavetsky Institute of Experimental Pathology, Oncology and Radiobiology of National Academy of Sciences of Ukraine, 03022 Kiev, Ukraine
| | - Elena Kashuba
- R.E. Kavetsky Institute of Experimental Pathology, Oncology and Radiobiology of National Academy of Sciences of Ukraine, 03022 Kiev, Ukraine.,Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, 171 65 Stockholm, Sweden
| | - Sonia Andersson
- Department of Women's and Children's Health, Karolinska Institutet, 171 77 Stockholm, Sweden
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[Interdisciplinary S2k guidelines on the diagnosis and treatment of vaginal carcinoma and its precursors-recommendations on surgical pathology for histopathological workup, diagnostics, and reporting]. DER PATHOLOGE 2021; 42:116-124. [PMID: 33346872 DOI: 10.1007/s00292-020-00876-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Primary vaginal carcinoma is rare. There are two pathogenetic pathways, one associated with HPV high-risk infection and another one with inactivation of p53. Vaginal Paget's disease is rare and mostly associated with vulvar disease or represents intravaginal spread of associated locoregional cancer. Diagnostic vaginal biopsies should be examined by step sections on H&E. Sentinel lymph nodes should be processed completely using ultrastaging. Morphology-based prognostic factors with good clinical evidence are tumour stage and lymph node status. Molecular markers are not currently relevant for treatment decision and prognosis.
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Xiao Y, Liang Y, Yang L, Yang W, Liao G. Long-Term Quality of Life in Patients With Maxillofacial Malignancies Who Have Undergone Craniofacial Resection: A Cross-Sectional Survivorship Study. J Oral Maxillofac Surg 2019; 77:2573-2583. [DOI: 10.1016/j.joms.2019.05.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 03/28/2019] [Accepted: 05/31/2019] [Indexed: 12/19/2022]
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10
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Personalized Therapy in Action: Evolving From a Series of One-Hit Wonders to a Paradigm With Staying Power. Obstet Gynecol 2016; 127:202-3. [PMID: 26942343 DOI: 10.1097/aog.0000000000001278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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