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Ampadiotaki MM, Vlachos C, Papagrigorakis E, Galanis A, Mitsikostas P, Vasiliadis ES, Giannoulis F. Thumb Distal Phalanx Giant Enchondroma. A Case Presentation and Literature Review. MAEDICA 2024; 19:177-181. [PMID: 38736932 PMCID: PMC11079749 DOI: 10.26574/maedica.2024.19.11.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Background: Enchordoma of the distal phalange of the thumb is extremely rare. Case presentation: We report a case of 31-year-old man who presented with a pathological fracture of the left thumb. Imaging evaluation revealed a lytic lesion and surgical curettage with bone graft was performed after fracture healing. Histological examination confirmed the diagnosis of enchordoma. The postoperative period was uncomplicated without signs of recurrence. Conclusion:Lytic lesions in the thumb are uncommon occurrences and necessitate a comprehensive examination to determine their potential causes. Given the significant functional role of the thumb compared to other fingers, it is crucial to undergo radiological assessment and further investigation of these lytic lesions.
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Affiliation(s)
| | - Christos Vlachos
- 3rd Department of Orthopaedic Surgery, KAT Hospital, University of Athens, 14561 Athens, Greece
| | | | - Athanasios Galanis
- 3rd Department of Orthopaedic Surgery, KAT Hospital, University of Athens, 14561 Athens, Greece
| | - Pantelis Mitsikostas
- Hand, Upper Extremity and Microsurgery Department, KAT Hospital, 14561 Athens, Greece
| | - Elias S Vasiliadis
- 3rd Department of Orthopaedic Surgery, KAT Hospital, University of Athens, 14561 Athens, Greece
| | - Filippos Giannoulis
- Hand, Upper Extremity and Microsurgery Department, KAT Hospital, 14561 Athens, Greece
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Dallas JN, Marchessault JA. Kirschner Wires and Bone Allograft Salvage Finger Motion in Pathologic Fracture of Middle Phalanx Enchondroma: A Case Report. J Orthop Case Rep 2024; 14:151-154. [PMID: 38292105 PMCID: PMC10823805 DOI: 10.13107/jocr.2024.v14.i01.4182] [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: 10/28/2023] [Revised: 11/07/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Pathologic phalangeal fracture is a common initial presentation of solitary enchondroma of the finger. Enchondromas of the middle phalanx are most frequently associated with post-operative range of motion deficits. This report describes a case in which the use of Kirschner wires (K-wires) and allograft bone were used to salvage finger motion following surgical fixation of pathologic fracture of a middle phalanx enchondroma with extensor tendon injury. Case Report A 37-year-old right hand dominant woman presents with pathologic fracture of the left index finger middle phalanx. The patient elected for surgical intervention to stabilize fracture and enable early motion at the proximal interphalangeal joint (PIP). Surgical fixation involved tumor curettage, fracture stabilization and length preservation with longitudinal K-wires, allograft bone with hardening properties to fill the bony defect, and dorsal K-wires for securing the extensor tendon. At follow-up 11 months postoperatively, the allograft had almost completely resolved, and the patient had regained PIP flexion of 90° and full extension. Conclusion Pathologic fracture of middle phalanx enchondroma is prone to complication by extensor tendon injury and associated post-operative loss of motion. Bone grafting and Kirschner wire fixation allowed for early mobilization of finger motion and thus may be a useful technique for use in treatment of other pathologic fractures.
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Affiliation(s)
- Jamie N Dallas
- Department of Orthopaedic Surgery, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee
| | - Jeffrey A Marchessault
- Department of Orthopaedic Surgery, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee
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Smolle MA, Roessl V, Leithner A. Effect of Local Adjuvants Following Curettage of Benign and Intermediate Tumours of Bone: A Systematic Review of the Literature. Cancers (Basel) 2023; 15:4258. [PMID: 37686534 PMCID: PMC10487159 DOI: 10.3390/cancers15174258] [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: 07/14/2023] [Revised: 08/24/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
Local adjuvants are used upon intralesional resection of benign/intermediate bone tumours, aiming at reducing the local recurrence (LR) rate. However, it is under debate whether, when and which local adjuvants should be used. This PRISMA-guideline based systematic review aimed to analyse studies reporting on the role of adjuvants in benign/intermediate bone tumours. All original articles published between January 1995 and April 2020 were potentially eligible. Of 344 studies identified, 58 met the final inclusion criteria and were further analysed. Articles were screened for adjuvant and tumour type, follow-up period, surgical treatment, and development of LR. Differences in LR rates were analysed using chi-squared tests. Altogether, 3316 cases (10 different tumour entities) were analysed. Overall, 32 different therapeutic approaches were identified. The most common were curettage combined with high-speed burr (n = 774; 23.3%) and high-speed burr only (n = 620; 18.7%). The LR rate for studies with a minimum follow-up of 24 months (n = 30; 51.7%) was 12.5% (185/1483), with the highest rate found in GCT (16.7%; 144/861). In comparison to a combination of curettage, any adjuvant and PMMA, the sole application of curettage and high-speed burr (p = 0.015) reduced the LR rate in GCT. The overall complication rate was 9.6% (263/2732), which was most commonly attributable to postoperative fracture (n = 68) and osteoarthritis of an adjacent joint during follow-up (n = 62). A variety of adjuvants treatment options are reported in the literature. However, the most important step remains to be thorough curettage, ideally combined with high-speed burring.
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Affiliation(s)
- Maria Anna Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria; (V.R.); (A.L.)
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Capitanio JF, Mortini P. Brain and/or Spinal Cord Tumors Accompanied with Other Diseases or Syndromes. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:645-672. [PMID: 37452957 DOI: 10.1007/978-3-031-23705-8_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Several medical conditions that interest both the brain and the spinal cord have been described throughout the history of medicine. Formerly grouped under the term Phacomatosis because lesions of the eye were frequently encountered or genodermatosis when typical skin lesions were present, these terms have been progressively discarded. Although originally reported centuries ago, they still represent a challenge for their complexity of cure. Nowadays, with the introduction of advanced genetics and the consequent opportunity of whole-genome sequencing, new single cancer susceptibility genes have been identified or better characterized; although there is evidence that the predisposition to a few specific tumor syndromes should be accounted to a group of mutations in different genes while certain syndromes appeared to be manifestations of different mutations in the same gene adding supplementary problems in their characterization and establishing the diagnosis. Noteworthy, many syndromes have been genetically determined and well-characterized, accordingly in the near future, we expect that new targeted therapies will be available for the definitive cure of these syndromes and other gliomas (Pour-Rashidi et al. in World Neurosurgery, 2021). The most common CNS syndromes that will be discussed in this chapter include neurofibromatosis (NF) types 1 and 2, von Hippel-Lindau (VHL) disease, and tuberous sclerosis complex (TSC), as well as syndromes having mostly extra-neural manifestations such as Cowden, Li-Fraumeni, Turcot, and Gorlin syndromes.
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Affiliation(s)
- Jody Filippo Capitanio
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy.
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
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5
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European Board of Hand Surgery (EBHS) Examination Questions. J Hand Surg Eur Vol 2023; 48:71-74. [PMID: 36408557 DOI: 10.1177/17531934221137763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Karaytuğ K, Alpan B, Bayram S, Valiyev N, Bilgiç B, Özger H. Long-term results of different surgical options in the management of solitary enchondroma. ANZ J Surg 2022; 92:1809-1813. [PMID: 35621280 DOI: 10.1111/ans.17796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/05/2022] [Accepted: 05/06/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUNDS We aimed to compare the average 10-year results of patients treated with three different surgical methods, that is, extended curettage, extended curettage with grafting and extended curettage with cementation for the management of solitary enchondromas. METHODS Two hundreds and three patients with a solitary enchondroma who underwent surgery at our department between 1990 and 2015 were evaluated retrospectively. Only extended curettage was performed in Group A (n: 75), extended curettage with grafting with autologous bone graft from the iliac crest in Group B (n: 58), and extended curettage with bone cement in Group C (n: 70). Surgical complications and recurrence were analysed and compared between these groups. RESULTS No significant differences were noted among the groups in terms of gender (P = 0.654), age (P = 0.264) and follow-up duration (P = 0.919). The mean follow-up period in all groups was 122.9 ± 39 (range: 60-271) months. In addition to curettage and cementation, three patients received mechanical support with plate screws because of fracture risk. One patient in the extended curettage with grafting group had surgical site infection that was treated with simple debridement and antibiotherapy. One patient in the extended curettage group had lost motions of the proximal interphalangeal joint, which was treated with aggressive physiotherapy. CONCLUSION We compared the average 10-year results of patients treated with three surgical options, namely, extended curettage, extended curettage with grafting, and extended curettage with cementation and no difference was found among the groups in local control of solitary enchondromas.
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Affiliation(s)
- Kayahan Karaytuğ
- Department of Orthopaedics and Traumatology, Acibadem University School of Medicine, Atasehir, Istanbul, Turkey
| | - Buğra Alpan
- Department of Orthopaedics and Traumatology, Acibadem University School of Medicine, Atasehir, Istanbul, Turkey
| | - Serkan Bayram
- Department of Orthopedics and Traumatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Natig Valiyev
- Department of Orthopaedics and Traumatology, Acibadem Maslak Hospital, Maslak/Sariyer, Istanbul, Turkey
| | - Bilge Bilgiç
- Department of Pathology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Harzem Özger
- Department of Orthopaedics and Traumatology, Acibadem University School of Medicine, Atasehir, Istanbul, Turkey
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De Salvo S, Pavone V, Coco S, Dell’Agli E, Blatti C, Testa G. Benign Bone Tumors: An Overview of What We Know Today. J Clin Med 2022; 11:jcm11030699. [PMID: 35160146 PMCID: PMC8836463 DOI: 10.3390/jcm11030699] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/14/2022] [Accepted: 01/27/2022] [Indexed: 12/14/2022] Open
Abstract
Nonmalignant bone tumors represent a wide variety of different entities but maintain many common features. They usually affect young patients, and most can be diagnosed through imaging exams. Often asymptomatic, they can be discovered incidentally. Due to their similarities, these tumors may be challenging to diagnose and differentiate between each other, thus the need for a complete and clear description of their main characteristics. The aim of this review is to give a picture of the benign bone tumors that clinicians can encounter more frequently in their everyday work.
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Alexander L. An Unusual Case of Finger Fracture. Cureus 2021; 13:e19577. [PMID: 34926049 PMCID: PMC8671062 DOI: 10.7759/cureus.19577] [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] [Accepted: 11/08/2021] [Indexed: 11/18/2022] Open
Abstract
Enchondromas are commonly encountered primary bone tumors in the hand. They can be managed with various treatment options ranging from simple observation to curettage and bone grafting. In this study, the case of a finger enchondroma is reported; it presented as a pathological fracture. It was managed successfully using the delayed approach - initial stabilization of the fracture followed by definitive tumor clearance surgery. Concerning the early versus delayed approach used for fractures associated with enchondromas, there is an ongoing debate in the literature on whether to leave the cavity empty or fill it with bone graft after curettage. This article discusses the relevant literature on these issues and their impact on the refracture and rates of recurrence. Nevertheless, thorough curettage followed by regular monitoring in the follow-up period is important to minimize the morbidity associated with the recurrence of enchondromas.
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Affiliation(s)
- Leon Alexander
- Plastic & Reconstructive Surgery, Sheikh Khalifa Medical City, Abu Dhabi, ARE
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Redgrave N, Nikkhah D, Kang N, Toft N. Surgical Management of Enchondromas of the Hand: A 12-Year Experience. J Hand Microsurg 2021. [DOI: 10.1055/s-0041-1736004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Abstract
Objective Enchondromas are benign tumours of hyaline cartilage most frequently arising in the bones of the hand and the optimum surgical management strategy for these is debated. We present an audit of the surgical management of 57 enchondromas referred to our tertiary hand surgery department over a period of 12 years (2008–2020) and describe our surgical technique for this procedure as well as a comparison with other studies in the literature.
Materials and Methods Retrospective audit of our practice. Data were extracted from our institutional operative database to identify all patients undergoing surgical management of enchondromas during the time period. The individual electronic patient records were then evaluated to extract demographics and outcome data.
Results Our results demonstrate excellent clearance of enchondroma (74% Tordai group 1 radiological resolution) with very low complication rates and no recurrence. Our results also emphasize the importance of surgical management of enchondromas to allow diagnosis of rare chondrosarcoma (3.5% in this study).
Conclusion A larger randomized controlled trial is still required to adequately determine the differences between the surgical options available and determine the best possible surgical approach to these cases. Level of evidence is III.
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Affiliation(s)
- Natalie Redgrave
- Department of Plastic Surgery, Royal Free Hospital, Hampstead, London, United Kingdom
| | - Dariush Nikkhah
- Department of Plastic Surgery, Royal Free Hospital, Hampstead, London, United Kingdom
| | - Norbert Kang
- Department of Plastic Surgery, Royal Free Hospital, Hampstead, London, United Kingdom
| | - Neil Toft
- Department of Plastic Surgery, Royal Free Hospital, Hampstead, London, United Kingdom
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Li Q, Kim J, Kim SY, Baek GH. Early Surgical Treatment of Both Tumor and Fracture in Patients With Enchondroma of the Hand Combined With Pathologic Fracture. Ann Plast Surg 2021; 87:260-264. [PMID: 33661226 DOI: 10.1097/sap.0000000000002776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aims of this study were to evaluate the degree of cortical thinning and the tumor area in simple radiographs in patients with enchondroma of the hand combined with pathologic fracture and to determine the surgical outcome of simultaneous tumor curettage and internal fixation of fracture. METHODS We enrolled 23 bone lesions of 21 patients diagnosed with enchondroma of the hand. Of them, 9 bone lesions of 8 patients had pathologic fracture. We evaluated the degree of cortical thinning and tumor area in simple radiographs and compared them between patients with and without pathologic fracture. For patients with pathologic fracture, we performed curettage of the tumor through the fracture site and fixed the fracture using K-wires. We then evaluated the clinical outcome of these patients using the visual analog scale to measure pain intensity and Takigawa's criteria 1 year after surgery. RESULTS There was a significant difference in the degree of cortical thinning between the 2 groups (P < 0.001); however, there was no significant difference in the percentage of tumor area (P = 0.259). The average time from surgery to bony union was 8.5 weeks in patients with pathologic fracture. The patients reported that they could return to their previous activities of daily living within 12 weeks of surgery. The average visual analog scale score was 0.6 at 1 year after surgery, and 6 patients were graded as excellent and 2 as good according to Takigawa's criteria. CONCLUSIONS Cortical thinning seems to be related to pathologic fracture. Our scoring system for cortical thinning may be helpful in evaluating the risk for pathologic fracture. Early 1-stage surgical treatment for pathologic hand fracture with enchondroma is a very useful method with satisfactory outcomes that could shorten the treatment period.
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Affiliation(s)
- Qingyuan Li
- From the Department of Orthopaedic Surgery, Seoul National University, College of Medicine, Seoul National University College of Medicine, Seoul, Korea
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Miwa S, Okamoto H, Yamada S, Kawaguchi Y, Endo K, Aiba H, Hayashi K, Kimura H, Sekiya I, Otsuka T, Tsuchiya H. Distribution of Solitary and Multiple Enchondromas of the Hand. In Vivo 2020; 33:2235-2240. [PMID: 31662562 DOI: 10.21873/invivo.11728] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Although some patients with enchondroma have multiple lesions, no study has investigated the distribution of lesions in patients with multiple enchondromas. PATIENTS AND METHODS This retrospective study included 118 patients with enchondroma of the hand. The incidence and characteristic feature of multiple enchondromas of the hand were investigated. RESULTS Four patients (3.4%) had multiple enchondromas. In all the patients with multiple enchondromas, the lesions occurred in the middle phalanx, proximal phalanx, and metacarpal bone in the same digital ray. CONCLUSION The development of the hand rapidly progresses from intrauterine day 33 to day 54. The digital rays are evident on intrauterine day 41, and separation of the distal phalanx, middle phalanx, proximal phalanx, and metacarpal bone is completed until intrauterine day 54. The successive occurrence of multiple enchondroma lesions in the same digital ray in all four cases suggests that the occurrence of lesions preceded the separation of the hand bones and the lesions were divided during the development of these bones.
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Affiliation(s)
- Shinji Miwa
- Department of Orthopedic Surgery, Graduate School of Medical Science, Nagoya City University, Nagoya, Japan.,Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Hideki Okamoto
- Department of Orthopedic Surgery, Graduate School of Medical Science, Nagoya City University, Nagoya, Japan
| | - Satoshi Yamada
- Department of Orthopedic Surgery, Graduate School of Medical Science, Nagoya City University, Nagoya, Japan
| | - Yohei Kawaguchi
- Department of Orthopedic Surgery, Graduate School of Medical Science, Nagoya City University, Nagoya, Japan
| | - Kojiro Endo
- Department of Orthopedic Surgery, Graduate School of Medical Science, Nagoya City University, Nagoya, Japan
| | - Hisaki Aiba
- Department of Orthopedic Surgery, Graduate School of Medical Science, Nagoya City University, Nagoya, Japan
| | - Katsuhiro Hayashi
- Department of Orthopedic Surgery, Graduate School of Medical Science, Nagoya City University, Nagoya, Japan.,Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Hiroaki Kimura
- Department of Orthopedic Surgery, Graduate School of Medical Science, Nagoya City University, Nagoya, Japan.,Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Isato Sekiya
- Department of Orthopaedic Surgery, Kainan Hospital, The Aichi Prefectural Federation of Agricultural Cooperative for Health and Welfare, Yatomi, Japan
| | - Takanobu Otsuka
- Department of Orthopedic Surgery, Graduate School of Medical Science, Nagoya City University, Nagoya, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
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Bickels J, Campanacci DA. Local Adjuvant Substances Following Curettage of Bone Tumors. J Bone Joint Surg Am 2020; 102:164-174. [PMID: 31613863 DOI: 10.2106/jbjs.19.00470] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jacob Bickels
- Unit of Orthopedic Oncology, Orthopedic Division, Hillel-Yaffe Medical Center, Hadera, Rappaport Faculty of Medicine, The Technion, Israel
| | - Domenico A Campanacci
- Unit of Orthopaedic Oncology, Department of Health Sciences, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
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