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Dawood AS, Dawood AS, Shazly SA, Assar TM, Soliman AS. Retracted: A randomized controlled study comparing two uterine sparing techniques in conservative management of placenta accreta spectrum. Int J Gynaecol Obstet 2024; 165:1-8. [PMID: 35986615 DOI: 10.1002/ijgo.14419] [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: 11/02/2021] [Revised: 07/30/2022] [Accepted: 08/10/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To compare the efficacy and safety of two uterine sparing techniques in conservative management of placenta accreta spectrum (PAS). METHODS This multicenter randomized controlled study was conducted from January 1, 2017 to December 31, 2020 at two university hospitals. Patients were randomly allocated into two groups; Group 1 was managed by Assar's technique and Group 2 was managed by Shehata's technique. Operative time, blood loss, operative complications (organ or vessel injury), and postoperative complications (early and late) were reported. Success of the technique, units of blood transfusion, and intensive care unit admissions were recorded. RESULTS Demographic data in both groups were not significantly different. The mean gestational age at the delivery time was 36 weeks in both groups. Operative time was 120 (100-140) minutes and 75 (60-100) minutes in Assar's and Shehata's techniques, respectively (P < 0.001). Blood loss was higher in Shehata's technique than in Assar's (P < 0.001). Intensive care unit admissions were minimal in both groups. Operative complications were comparable in both groups. The success of Assar's and Shehata's techniques in uterine preservation was 85% and 95%, respectively. CONCLUSION Both techniques were safe and successful in uterine sparing. Therefore, we recommend these techniques for conservative management of PAS. CLINICAL TRIAL REGISTRATION The trial was registered on UMIN-CTR and had the unique ID: UMIN000025315 on the following link: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000029120.
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Tinari S, Buca D, Cali G, Timor-Tritsch I, Palacios-Jaraquemada J, Rizzo G, Lucidi A, Di Mascio D, Liberati M, D'Antonio F. Risk factors, histopathology and diagnostic accuracy in posterior placenta accreta spectrum disorders: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:903-909. [PMID: 32840934 DOI: 10.1002/uog.22183] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/30/2020] [Accepted: 07/22/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To elucidate the risk factors, histopathological correlations and diagnostic accuracy of prenatal imaging in pregnancies complicated by posterior placenta accreta spectrum (PAS) disorders. METHODS MEDLINE, EMBASE and CINAHL were searched for studies reporting on women with posterior PAS. Inclusion criteria were women with posterior PAS confirmed either at surgery or on histopathological analysis. The outcomes explored were risk factors for posterior PAS, histopathological correlation and the diagnostic accuracy of ultrasound and magnetic resonance imaging (MRI) in detecting posterior PAS. Random-effects meta-analysis of proportions was used to analyze the data. RESULTS Twenty studies were included. Placenta previa was present in 92.8% (107/114; 17 studies) of pregnancies complicated by posterior PAS, while 76.1% (53/88; 11 studies) of women had had prior uterine surgery, mainly a Cesarean section (CS) or curettage and 82.5% (66/77; 10 studies) were multiparous. When considering histopathological analysis in women affected by posterior PAS, 77.5% (34/44; 11 studies) had placenta accreta, 19.5% (8/44; 11 studies) had placenta increta and 9.3% (2/44; 11 studies) had placenta percreta. Of the cases of posterior PAS disorder, 52.4% (31/63; 12 studies) were detected prenatally on ultrasound, while 46.7% (32/63; 12 studies) were diagnosed only at birth. When exploring the distribution of the classic ultrasound signs of PAS, placental lacunae were present in 39.0% (12/30; seven studies), loss of the clear zone in 41.1% (13/30; seven studies) and bladder-wall interruption in 16.6% (4/30; seven studies) of women, while none of the included cases showed hypervascularization at the bladder-wall interface. When assessing the role of MRI in detecting posterior PAS, 73.5% (26/32; 11 studies) of cases were detected on prenatal MRI, while 26.5% (6/32; 11 studies) were discovered only at the time of CS. CONCLUSIONS Placenta previa, prior uterine surgery and multiparity represent the most commonly reported risk factors for posterior PAS. Ultrasound had a very low diagnostic accuracy in detecting these disorders prenatally. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S Tinari
- Centre for High Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - D Buca
- Centre for High Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - G Cali
- Department of Obstetrics and Gynaecology, Arnas Civico Hospital, Palermo, Italy
| | - I Timor-Tritsch
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, New York University SOM, New York, NY, USA
| | - J Palacios-Jaraquemada
- Centre for Medical Education and Clinical Research (CEMIC), University Hospital, Buenos Aires, Argentina
| | - G Rizzo
- Università di Roma Tor Vergata, Division of Maternal-Fetal Medicine, Ospedale Cristo Re, Rome, Italy
- The First I.M. Sechenov Moscow State Medical University, Department of Obstetrics and Gynecology, Moscow, Russia
| | - A Lucidi
- Centre for High Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - D Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - M Liberati
- Centre for High Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - F D'Antonio
- Centre for High Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
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Li P, Tang Y, Jiang Y, Li D. Analysis of clinical features of 231 cases with pernicious placenta previa: A retrospective cohort study. Medicine (Baltimore) 2021; 100:e25023. [PMID: 33725977 PMCID: PMC7982193 DOI: 10.1097/md.0000000000025023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 02/10/2021] [Indexed: 01/05/2023] Open
Abstract
Pernicious placenta previa (PEPP) is a severe complication of late pregnancy, which might result in adverse maternal-fetal outcome. To explore the application value of placenta accreta score (PAS) for PEPP and its association with maternal-fetal outcome.In this retrospective cohort study, the clinical data of PEPP patients were analyzed. According to the ultrasonic PAS, patients were grouped into 3 groups: scores ≤5, a scores between 6 and 9, and scores ≥10. The clinical data, intraoperative and postoperative outcomes were collected. Receiver operating characteristic (ROC) curves were used to evaluate the performance of PAS in disease severity evaluation. Multivariate logistic and linear regression analysis were performed to assess associations of PAS with intraoperative and postoperative outcomes.A total of 231 patients were enrolled. There were significant differences in intraoperative, postoperative and neonatal outcomes, such as operation time, bladder repair, ICU admission, postoperative hospitalization days, operation complications, Apgar score of newborns in 1 minute and premature delivery among the 3 groups (all P < .05), while the worst outcomes were found in those with a score ≥ 10 (all P < .05). According to ROC curves, scores <5.5, between 5.5 and 7.5, and >7.5 indicated placenta accreta, placenta increta and placenta percreta, respectively. PAS was independently associated with longer time of operation, surgical complications, intraoperative bleeding volume, and postoperative hospitalization days (all P < .05).Placenta accreta score might help with PEPP subtype diagnosis and predict the maternal-fetal outcome of PEPP patients.
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Abd Elazeem HAS, Saad MM, Ahmed IA, Sayed EG, AlMahdy AM, Atef F, Elassall GM, Ashraf Salah M, Ali AK, Ragab EY, Shazly SA. High-intensity focused ultrasound in management of placenta accreta spectrum: A systematic review. Int J Gynaecol Obstet 2020; 151:325-332. [PMID: 32976627 DOI: 10.1002/ijgo.13391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/07/2020] [Accepted: 09/21/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND High-intensity focused ultrasound (HIFU) is a non-invasive procedure that has been studied in the management of placenta accreta spectrum (PAS). OBJECTIVE To appraise HIFU in the management of PAS and highlight the restrictions on converting uterus-preserving studies into evidence-based practice. SEARCH STRATEGY A search on Scopus, Cochrane, PubMed and Web of Science was conducted from date of inception to January 2020. SELECTION CRITERIA Studies on using HIFU in the management of PAS were eligible. Review articles, conference papers, and case reports were excluded. DATA COLLECTION A standardized sheet was used to abstract data from eligible studies. CON-PAS registry was used to include studies on other conservative modalities. RESULTS Four studies were eligible (399 patients). Average residual placental volume was 61.74 cm3 (6.01-339 cm3 ). Treatment was successful in all patients. Normal menstruation recovered after 48.8 days (15-150 days). No major complications were encountered. Sixty-one studies were retrieved from the CON-PAS registry; uterine artery embolization (23 studies), balloon placement (15 studies), compression sutures (10 studies), placenta in situ (7 studies), and uterine resection (6 studies) were successful in 83.7%, 92.9%, 87.9%, 85.2%, and 79.3% of cases, respectively. CONCLUSIONS HIFU may fit certain clinical situations in the management of PAS. A global research strategy is recommended to incorporate conservative approaches within a comprehensive management protocol.
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Affiliation(s)
| | - Mahmoud M Saad
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Islam A Ahmed
- Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Esraa G Sayed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - AlBatool M AlMahdy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Fatma Atef
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Gena M Elassall
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed Ashraf Salah
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed K Ali
- Department of Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Esraa Y Ragab
- Department of Anesthesia, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Sherif A Shazly
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
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Jauniaux E, Bunce C, Grønbeck L, Langhoff-Roos J. Prevalence and main outcomes of placenta accreta spectrum: a systematic review and meta-analysis. Am J Obstet Gynecol 2019; 221:208-218. [PMID: 30716286 DOI: 10.1016/j.ajog.2019.01.233] [Citation(s) in RCA: 161] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/22/2019] [Accepted: 01/28/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE DATA The objective of this study was to evaluate the prevalence of placenta accreta spectrum in general population studies and the main maternal outcomes at delivery. STUDY We searched PubMed, Google Scholar, clinicalTrials.gov, and MEDLINE between 1982 and 2018. Articles that provided data on the number of cases of placenta accreta spectrum per pregnancies, births, or deliveries in a defined population were used. STUDY APPRAISAL AND SYNTHESIS METHODS Study characteristics were evaluated by 2 independent reviewers who used a predesigned protocol. Primary outcomes were the prevalence of placenta accreta spectrum and clinical diagnostic data at birth; the pathologic criteria were used to confirm the diagnosis. Secondary outcomes included cases that required transfusion, incidence of peripartum hysterectomy, and maternal mortality rates. Heterogeneity between studies was analyzed with the Cochran's Q-test and the I2 statistics. RESULTS Of the 98 full-text studies that were identified, 29 articles met the defined criteria and included 22 retrospective and 7 prospective studies comprising 7001 cases of placenta accreta spectrum of 5,719,992 births. Prevalence rates ranged from 0.01-1.1% with an overall pooled prevalence of 0.17% (95% confidence interval, 0.14-0.19). Only 10 studies provided detailed histopathologic data. The pool prevalence for the adherent vs the invasive grades was 0.5 (95% confidence interval, 0.3-0.36) and 0.3 (95% confidence interval, 0.2-0.4) per 1000 births, respectively. The pooled incidence for peripartum hysterectomy was 52.2% (95% confidence interval, 38.3-66.4; I2=99.8%) and 46.9% (95 % confidence interval, 34-59.9; I2=98.8%) for hemorrhage that required transfusion. The pooled estimate of maternal death was 0.05% (95% confidence interval, 0.06-0.69; I2=73%). We found large amounts of heterogeneity between studies for all parameters and further quantification was limited because of methodologic inconsistencies between studies with regards to clinical criteria that were used for the diagnosis of the condition at birth and the histopathologic confirmation of the diagnosis and differential diagnosis between adherent and invasive accreta placentation. CONCLUSION This meta-analysis indicated wide variation between studies for the prevalence rate of placenta accreta spectrum and for the different grades of accreta placentation that highlighted the need for consistency in definitions that are used to describe placenta accreta spectrum at birth and in the reporting of this increasing common obstetric complication.
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Nieto-Calvache AJ, Zambrano MA, Herrera NA, Usma A, Bryon AM, Benavides Calvache JP, López L, Mejía M, Palacios-Jaraquemada JM. Resective-reconstructive treatment of abnormally invasive placenta: Inter Institutional Collaboration by telemedicine (eHealth). J Matern Fetal Neonatal Med 2019; 34:765-773. [PMID: 31057039 DOI: 10.1080/14767058.2019.1615877] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Resective-reconstructive treatment of an abnormally invasive placenta, also known as conservative surgical management, allows a comprehensive treatment of the pathology in only one surgery; however, this alternative is not generally included in international consensus, as it requires specific training. Here, we report our experience of this type of treatment and its plausibility after training facilitated by interinstitutional collaboration via telemedicine.Materials and methods: A total of 48 women who were diagnosed with abnormally invasive placenta, before and after changes due to the resection-reconstruction protocol were included in the study.Results: In total, 14 conservative reconstructive procedures were performed with outcomes of a lower rate of bleeding, reduced transfusions and complications, and a shorter duration of hospitalization than women with hysterectomy.Conclusion: Conservative surgical management is a safe alternative when implemented at specialized centers by trained groups of professionals. Interinstitutional collaboration, using appropriate telemedicine is a safe and effective alternative to enable training in resective-conservative management of abnormally invasive placenta.
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Affiliation(s)
- Albaro J Nieto-Calvache
- Abnormally Invasive Placenta Unit, Department of Obstetrics and Gynecology, Fundación Valle del Lili. Cali, Colombia.,Facultad de Ciencias de la Salud, Universidad Icesi. Cali, Colombia
| | - Maria A Zambrano
- Centro de Investigaciones Clínicas, Fundación Valle del Lili. Cali, Colombia
| | | | - Ana Usma
- Facultad de Ciencias de la Salud, Universidad Icesi. Cali, Colombia
| | - A Messa Bryon
- Abnormally Invasive Placenta Unit, Department of Obstetrics and Gynecology, Fundación Valle del Lili. Cali, Colombia.,Facultad de Ciencias de la Salud, Universidad Icesi. Cali, Colombia
| | - Juan P Benavides Calvache
- Abnormally Invasive Placenta Unit, Department of Obstetrics and Gynecology, Fundación Valle del Lili. Cali, Colombia.,Facultad de Ciencias de la Salud, Universidad Icesi. Cali, Colombia
| | - Leidy López
- Abnormally Invasive Placenta Unit, Department of Obstetrics and Gynecology, Fundación Valle del Lili. Cali, Colombia
| | - Mauricio Mejía
- Abnormally Invasive Placenta Unit, Department of Obstetrics and Gynecology, Fundación Valle del Lili. Cali, Colombia
| | - Jose M Palacios-Jaraquemada
- Centre for Medical Education and Clinical Research (CEMIC), Department of Gynecology and Obstetrics, Buenos Aires, Argentina
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Latif Khan Y, Rahim A, Gardezi J, Iqbal M, Hassan Z, Altaf S, Bhatti S. Conventional and conservative management of placenta accreta is two ends of a single continuum: A report of three cases and literature review. Clin Case Rep 2018; 6:1739-1746. [PMID: 30214754 PMCID: PMC6132159 DOI: 10.1002/ccr3.1717] [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: 03/21/2018] [Accepted: 06/23/2018] [Indexed: 11/11/2022] Open
Abstract
Placenta accreta (PA) is a critical condition that represents a significant source of morbidity and mortality observed in women with multiple prior cesarean sections. Precise prenatal identification of affected pregnancies permits optimal obstetric management. Antenatal diagnosis leads to less blood loss and a requirement for blood transfusion than women diagnose during cesarean section.
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Affiliation(s)
- Yousaf Latif Khan
- Department of Gynecology and ObstetricsHameed Latif Hospital14 – Abu Bakar Block New Garden TownLahorePakistan
- Department of Gynecology and ObstetricsRashid Latif Medical College 35‐KMFerozepur Road LahorePakistan
| | - Arooba Rahim
- Department of Gynecology and ObstetricsHameed Latif Hospital14 – Abu Bakar Block New Garden TownLahorePakistan
- Department of Gynecology and ObstetricsRashid Latif Medical College 35‐KMFerozepur Road LahorePakistan
| | - Javed Gardezi
- Department of Gynecology and ObstetricsHameed Latif Hospital14 – Abu Bakar Block New Garden TownLahorePakistan
| | - Mariam Iqbal
- Department of Gynecology and ObstetricsHameed Latif Hospital14 – Abu Bakar Block New Garden TownLahorePakistan
| | - Zahira Hassan
- Department of Cellular PathologyRoyal Free HospitalLondonUK
| | - Sumbal Altaf
- Department of Gynecology and ObstetricsHameed Latif Hospital14 – Abu Bakar Block New Garden TownLahorePakistan
| | - Shahzad Bhatti
- Department of Medical EducationRashid Latif Medical College 35‐KMFerozepur Road LahorePakistan
- Department of Human Genetics and Molecular BiologyUniversity of Health Sciences LahorePakistan
- Lahore Institute of Fertility and EndocrinologyHameed Latif Hospital Lahore14 – Abu Bakar Block New Garden TownLahorePakistan
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Response to the comments of Dr Shigeki Matsubara. Taiwan J Obstet Gynecol 2017; 56:271. [DOI: 10.1016/j.tjog.2017.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2017] [Indexed: 11/18/2022] Open
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Guarino A, Di Benedetto L, Assorgi C, Rocca A, Caserta D. Conservative and timely treatment in retained products of conception: a case report of placenta accreta ritention. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:13625-13629. [PMID: 26722586 PMCID: PMC4680531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 09/25/2015] [Indexed: 06/05/2023]
Abstract
The term retained products of conception (RPOC) refers to intrauterine tissue that develops after conception and persists after medical and surgical pregnancy termination, miscarriage, and vaginal or cesarean delivery. One of the most important factor risk for RPOC is placenta accreta, defined as "the abnormal adherence, either in whole or in part, of the afterbirth to the underlying uterine wall". We report a case of a 37 years old woman referred to our gynecologic department with irregular vaginal bleeding. On her medical history, she had a cesarean occurred 3 months before. Ultrasonography revealed in the uterine cavity hyperechoic mass, treated with curettage. Two weeks later the curettage, patient complained still vaginal bleeding. On the transvaginal ultrasound, the uterine cavity was occupied again by a hyperechoic mass. She underwent to hysteroscopic resection and histological diagnosis was compatible with placenta accreta residual. In the follow up she had not complications. Early diagnosis, prompt evaluation of bleeding is important for timely treatment and for preventing immediate complications and demolitive approach. A careful follow up is necessary to prevent late consequences. The purpose of this study is to report our experience in timely diagnosis and conservative management.
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Affiliation(s)
- Antonella Guarino
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology University of Rome "Sapienza" Italy
| | - Luisa Di Benedetto
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology University of Rome "Sapienza" Italy
| | - Chiara Assorgi
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology University of Rome "Sapienza" Italy
| | - Alessandra Rocca
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology University of Rome "Sapienza" Italy
| | - Donatella Caserta
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology University of Rome "Sapienza" Italy
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