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Toppino F, Martini M, Longo P, Caldas I, Delsedime N, Lavalle R, Raimondi F, Abbate-Daga G, Panero M. Inpatient treatments for adults with anorexia nervosa: a systematic review of literature. Eat Weight Disord 2024; 29:38. [PMID: 38767754 PMCID: PMC11106202 DOI: 10.1007/s40519-024-01665-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/29/2024] [Indexed: 05/22/2024] Open
Abstract
PURPOSE Anorexia nervosa (AN) is a mental disorder for which hospitalization is frequently needed in case of severe medical and psychiatric consequences. We aim to describe the state-of-the-art inpatient treatment of AN in real-world reports. METHODS A systematic review of the literature on the major medical databases, spanning from January 2011 to October 2023, was performed, using the keywords: "inpatient", "hospitalization" and "anorexia nervosa". Studies on pediatric populations and inpatients in residential facilities were excluded. RESULTS Twenty-seven studies (3501 subjects) were included, and nine themes related to the primary challenges faced in hospitalization settings were selected. About 81.48% of the studies detailed the clinical team, 51.85% cited the use of a psychotherapeutic model, 25.93% addressed motivation, 100% specified the treatment setting, 66.67% detailed nutrition and refeeding, 22.22% cited pharmacological therapy, 40.74% described admission or discharge criteria and 14.81% follow-up, and 51.85% used tests for assessment of the AN or psychopathology. Despite the factors defined by international guidelines, the data were not homogeneous and not adequately defined on admission/discharge criteria, pharmacological therapy, and motivation, while more comprehensive details were available for treatment settings, refeeding protocols, and psychometric assessments. CONCLUSION Though the heterogeneity among the included studies was considered, the existence of sparse criteria, objectives, and treatment modalities emerged, outlining a sometimes ambiguous report of hospitalization practices. Future studies must aim for a more comprehensive description of treatment approaches. This will enable uniform depictions of inpatient treatment, facilitating comparisons across different studies and establishing guidelines more grounded in scientific evidence. LEVEL OF EVIDENCE Level I, systematic review.
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Affiliation(s)
- Federica Toppino
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Matteo Martini
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Paola Longo
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Inês Caldas
- Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal
| | - Nadia Delsedime
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Raffaele Lavalle
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Francesco Raimondi
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Giovanni Abbate-Daga
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Matteo Panero
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Via Cherasco 11, 10126, Turin, Italy.
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Salter F, Singh U, Kerr D, Zhao Y, Jeffery E. A prospective observational study examining weight and psychosocial change in adolescent and adult eating disorder inpatients admitted for nutritional rehabilitation using a high-energy re-feeding protocol. J Eat Disord 2024; 12:58. [PMID: 38745266 PMCID: PMC11094855 DOI: 10.1186/s40337-024-01015-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 05/02/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND High-energy re-feeding protocols are increasingly utilised for nutritional rehabilitation in adolescents with anorexia nervosa (AN), however, concern persists that adults with AN may be at greater risk of developing complications. In addition, research on psychological outcomes of eating disorder (ED) inpatient treatment programs, and outcomes of high-energy protocols in avoidant restrictive food intake disorder (ARFID) and bulimia nervosa (BN), is limited. This study of an ED inpatient program using a high-energy protocol, compared changes in weight and psychosocial outcomes between adolescents and adults, and identified medical risk factors associated with deviation from the protocol. METHOD This prospective observational study took place in a voluntary ED treatment program in a private hospital. Weight, height, and psychosocial questionnaires (ED Examination-Questionnaire, Depression Anxiety Stress Score, Clinical Impairment Assessment and AN/BN Stage of Change) were collected from consenting adolescents (16-20 years) and adults (> 20 years) on admission and discharge. Medical tolerance to the high-energy protocol was assessed daily. Independent samples t-tests and paired samples t-tests were applied to normally distributed data, and Mann-Whitney U tests and Wilcoxon signed-rank tests to skewed data. P-values < 0.05 were considered significant statistically. RESULTS Ninety-seven participants were recruited. The majority (n = 91, 94%) were female and most (n = 80, 83%) had AN. Forty-two (43%) were adolescents and 55 (57%) were adults. In participants with AN, weight change (Δ) was significant [median Δ 8.0 (interquartile range (IQR) 4.3) kg]. There was no difference in rate of weight change between adolescents and adults with AN [mean Δ 1.8 (standard deviation (SD) 0.5) kg/week vs. Δ 1.8 (SD 0.6) kg/week; p = 0.841, respectively]. One (1%) participant with AN did not tolerate the high-energy protocol due to oedema. Participants achieved positive change in psychosocial questionnaire scores (p < 0.001) after the the specialist ED program, with no difference between adolescents and adults (p > 0.05). CONCLUSIONS This voluntary ED treatment program using a high energy re-feeding protocol was effective in achieving positive weight and psychological change for adolescents and adults with minimal adverse events. This indicates that the specialist ED program has both nutritional and psychological benefits.
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Affiliation(s)
- Fiona Salter
- School of Population Health, Curtin University, Kent Street, GPO Box U1987, Perth, WA, 6845, Australia
- Ramsay Clinic Hollywood, Hollywood Private Hospital, 95 Monash Avenue, Nedlands, WA, 6009, Australia
- Esus Centre, Centre of Excellence in the Treatment of Eating Disorders, 588, Hay Street, Subiaco, WA, 6008, Australia
| | - Urvashnee Singh
- School of Population Health, Curtin University, Kent Street, GPO Box U1987, Perth, WA, 6845, Australia
- Esus Centre, Centre of Excellence in the Treatment of Eating Disorders, 588, Hay Street, Subiaco, WA, 6008, Australia
| | - Deborah Kerr
- Ramsay Clinic Hollywood, Hollywood Private Hospital, 95 Monash Avenue, Nedlands, WA, 6009, Australia
- Curtin Health Innovation Research Institute, Curtin University, Kent Street, GPO Box U1987, Perth, WA, 6845, Australia
| | - Yun Zhao
- Ramsay Clinic Hollywood, Hollywood Private Hospital, 95 Monash Avenue, Nedlands, WA, 6009, Australia
| | - Emily Jeffery
- Ramsay Clinic Hollywood, Hollywood Private Hospital, 95 Monash Avenue, Nedlands, WA, 6009, Australia.
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Cheung VHI, Christie LJ, Maister T, Higgins D, Williams D, Woods N, Armstrong M, Hart S. Identifying potential cases of eating disorders in an acute medical hospital. Int J Eat Disord 2024. [PMID: 38647421 DOI: 10.1002/eat.24203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To identify patients presenting to an acute medical hospital with common signs and symptoms that occur in people with eating disorders (EDs), and determine by retrospective file audit if these are diagnosed cases of an ED. METHOD The investigators screened electronic medical records of people 16 years and older for common signs and symptoms of an ED such as hypokalemia, in patients presenting to an acute hospital in Sydney, Australia from 2018 to 2020. Cases where the clinical finding was unexplained had their file audited. Cases with a known ED diagnosis or coded with an ED were also retrieved to audit. RESULTS Investigators identified 192 definite ED cases with a total of 598 episodes of care from 2018 to 2020 presenting to the hospital. Eighty-three cases were identified as possible EDs due to unexplained clinical signs consistent with an ED, but were not confirmed cases due to lack of clinical history in the file. Only 19.1% of presentations were diagnostically coded with an ED in the electronic medical record. DISCUSSION Our study revealed a large number of definite ED cases presenting to an acute medical hospital via the emergency department, who were not recognized as having an ED. Greater awareness of clinical signs and symptoms of an ED, such as unexplained low body mass index and hypokalemia, is necessary among acute care clinicians. Correctly identifying EDs in those seeking somatic care should be a public health priority, to facilitate timely and equitable access to diagnostic assessment and evidence based treatment. PUBLIC SIGNIFICANCE People with eating disorders (EDs) present to acute care settings and have a relatively high utilization of generalist health services with nonspecific problems such as abdominal pain. An enhanced understanding of healthcare utilization by people with EDs, who may not disclose their symptoms, is crucial for improving access to treatment.
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Affiliation(s)
| | - Lauren J Christie
- Allied Health Research Unit, St Vincent's Health Network Sydney, Australia
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, North Sydney, Australia
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Australia
| | - Terri Maister
- Nutrition and Dietetic Services, St Vincent's Health Network Sydney, Australia
| | - Devlin Higgins
- The O'Brien Centre Mental Health Services, St Vincent's Health Network Sydney, Australia
| | - David Williams
- Gastroenterology and Hepatology, St Vincent's Health Network Sydney, Australia
| | - Nikki Woods
- Emergency Department, St Vincent's Health Network Sydney, Australia
| | - Melissa Armstrong
- Nutrition and Dietetic Services, St Vincent's Health Network Sydney, Australia
| | - Susan Hart
- Nutrition and Dietetic Services, St Vincent's Health Network Sydney, Australia
- Eating Disorders and Nutrition Research Group, Western Sydney University, Australia
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O'Donnell SL, Meloncelli NJL. Implementing evidence-based eating disorder guidelines at a small metro hospital: current practice and staff perceptions of caring for eating disorder patients. J Eat Disord 2023; 11:64. [PMID: 37081565 PMCID: PMC10120213 DOI: 10.1186/s40337-023-00787-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/12/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND The aim of this study was to understand current clinical practice, adherence to evidence-based guidelines, and the perceptions, knowledge and attitudes of the multidisciplinary team caring for inpatients with an eating disorder at a small metro hospital. METHODS This mixed methods study involved a retrospective audit of eating disorder patient care and a semi-qualitative staff survey. The audit was undertaken at a small metro hospital from 2018 to 2019. Documented practices were compared to state-wide best-practice guidelines. A staff survey was designed to understand health care professional's knowledge and use of evidence-based practice guidelines, as well their perception of caring for this patient population and areas for improvement. RESULTS Twenty-three discrete admissions (18 individuals) were included in the audit. Findings highlighted several evidence-practice gaps including delayed nutrition initiation and inconsistent medical refeeding and management of refeeding risk. Survey themes (from 60 hospital staff) included: lack of confidence with providing eating disorder care; uncertainty about professional roles/responsibilities; and lack of clear processes/guidelines to inform clinical care. CONCLUSIONS Gaps exist between evidence-based practice and eating disorder patient care. Staff lack confidence providing care to this patient group. These findings will allow for targeted implementation strategies to improve patient care and the uptake of research into practice.
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Affiliation(s)
- Stacey L O'Donnell
- Department of Nutrition and Dietetics, Caboolture Hospital, Caboolture, QLD, Australia.
| | - Nina J L Meloncelli
- Metro North Health, Office of the Chief Allied Health Practitioner, Brisbane, QLD, Australia
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A network approach can improve eating disorder conceptualization and treatment. NATURE REVIEWS PSYCHOLOGY 2022; 1:419-430. [PMID: 36330080 PMCID: PMC9624475 DOI: 10.1038/s44159-022-00062-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Eating disorders are severe mental illnesses with the second highest mortality rate of all psychiatric illnesses. Eating disorders are exceedingly deadly because of their complexity. Specifically, eating disorders are highly comorbid with other psychiatric illnesses (up to 95% of individuals with an eating disorder have at least one additional psychiatric illness), have extremely heterogeneous presentations, and individuals often migrate from one specific eating disorder diagnosis to another. In this Perspective, we propose that understanding eating disorder comorbidity and heterogeneity via a network theory approach offers substantial benefits for both conceptualization and treatment. Such a conceptualization, strongly based on theory, can identify specific pathways that maintain psychiatric comorbidity, how diagnoses vary across individuals, and how specific symptoms and comorbidities maintain illness for one individual, thereby paving the way for personalized treatment.
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Santos DCD, Ataide CDG, Mota da Costa N, Oliveira Junior VPD, Egea MB. Blenderized formulations in home enteral nutrition: a narrative review about challenges in nutritional security and food safety. Nutr Rev 2022; 80:1580-1598. [PMID: 35026011 DOI: 10.1093/nutrit/nuab121] [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: 11/14/2022] Open
Abstract
Blenderized formulations (BFs) are prepared by homogenization of food that is normally used in oral nutrition. BFs are mainly used in home enteral nutrition (HEN), although their use has also been reported by hospitals when commercial enteral formulas are not available. HEN is applied when the patient has been discharged from the hospital. This nutritional therapy promotes the patient's reintegration into the family nucleus and promotes humanized care, and decreases treatment costs. However, the patient should continue to receive health and nutritional care, ranging from periodic nutritional re-evaluation to adaptation of the dietary plan. HEN provides the patient a greater contact with the family, whereas BFs promote the adaptation of the diet with food, respecting the food diversity and culture, lower cost, and easier access to food. Disadvantages of BFs include more time spent by the professional to calculate the dietary plan, greater difficulty in adjusting daily needs, and less microbiological and chemical stability. In this review, the nutritional, food security, and safety aspects of BF used in HEN are discussed. Technological quality aspects that are essential knowledge in the preparation of the patient's dietary plan also are presented.
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Affiliation(s)
- Daiane Costa Dos Santos
- D.C.d. Santos is with the Goiás Federal University (UFG), Institute of Tropical Pathology and Public Health, IPTSP-UFG, Goiânia, Goiás, Brazil. C.D.G. Ataide is with the Hospital DF Star, Asa Sul, Brasília, Brazil. N.M. da Costa, V.P. de Oliveira Junior, and M.B. Egea are with the Federal Institute of Education, Science, and Technology Goiano, Rio Verde, Goiás, Brazil
| | - Carla Daniela Gomes Ataide
- D.C.d. Santos is with the Goiás Federal University (UFG), Institute of Tropical Pathology and Public Health, IPTSP-UFG, Goiânia, Goiás, Brazil. C.D.G. Ataide is with the Hospital DF Star, Asa Sul, Brasília, Brazil. N.M. da Costa, V.P. de Oliveira Junior, and M.B. Egea are with the Federal Institute of Education, Science, and Technology Goiano, Rio Verde, Goiás, Brazil
| | - Nair Mota da Costa
- D.C.d. Santos is with the Goiás Federal University (UFG), Institute of Tropical Pathology and Public Health, IPTSP-UFG, Goiânia, Goiás, Brazil. C.D.G. Ataide is with the Hospital DF Star, Asa Sul, Brasília, Brazil. N.M. da Costa, V.P. de Oliveira Junior, and M.B. Egea are with the Federal Institute of Education, Science, and Technology Goiano, Rio Verde, Goiás, Brazil
| | - Valtemir Paula de Oliveira Junior
- D.C.d. Santos is with the Goiás Federal University (UFG), Institute of Tropical Pathology and Public Health, IPTSP-UFG, Goiânia, Goiás, Brazil. C.D.G. Ataide is with the Hospital DF Star, Asa Sul, Brasília, Brazil. N.M. da Costa, V.P. de Oliveira Junior, and M.B. Egea are with the Federal Institute of Education, Science, and Technology Goiano, Rio Verde, Goiás, Brazil
| | - Mariana Buranelo Egea
- D.C.d. Santos is with the Goiás Federal University (UFG), Institute of Tropical Pathology and Public Health, IPTSP-UFG, Goiânia, Goiás, Brazil. C.D.G. Ataide is with the Hospital DF Star, Asa Sul, Brasília, Brazil. N.M. da Costa, V.P. de Oliveira Junior, and M.B. Egea are with the Federal Institute of Education, Science, and Technology Goiano, Rio Verde, Goiás, Brazil
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Why Do Women with Eating Disorders Decline Treatment? A Qualitative Study of Barriers to Specialized Eating Disorder Treatment. Nutrients 2021; 13:nu13114033. [PMID: 34836288 PMCID: PMC8623214 DOI: 10.3390/nu13114033] [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: 10/07/2021] [Revised: 10/29/2021] [Accepted: 11/09/2021] [Indexed: 12/02/2022] Open
Abstract
Despite the fact that eating disorders (EDs) are conditions that are potentially life-threatening, many people decline treatment. The aim of this study was to investigate why women decline specialized ED treatment, including their viewpoints on treatment services. Eighteen semi-structured qualitative interviews were conducted with women who had declined inpatient or outpatient specialized ED treatment. A thematic analysis revealed five main themes: (1) Disagreement on treatment needs, (2) rigid standard procedures, (3) failure to listen, (4) deprivation of identity, and (5) mistrust and fear. The women had declined ED treatment because they believed that treatment was only focused on nutritional rehabilitation and that it failed to address their self-identified needs. From their perspectives treatment was characterized by rigid standard procedures that could not be adapted to their individual situations and preferences. They felt that the therapists failed to listen to them, and they felt deprived of identity and reduced to an ED instead of a real person. This investigation is one of the first of its kind to provide clues as to how treatment could be moderated to better meet the needs of women who decline specialized ED treatment.
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Cioffi I, Ponzo V, Pellegrini M, Evangelista A, Bioletto F, Ciccone G, Pasanisi F, Ghigo E, Bo S. The incidence of the refeeding syndrome. A systematic review and meta-analyses of literature. Clin Nutr 2021; 40:3688-3701. [PMID: 34134001 DOI: 10.1016/j.clnu.2021.04.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/25/2021] [Accepted: 04/15/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The refeeding syndrome (RFS) has been recognized as a potentially life-threatening metabolic complication of re-nutrition, but the definition widely varies and, its incidence is unknown. The aim of this systematic review and meta-analyses was to estimate the incidence of RFS in adults by considering the definition used by the authors as well as the recent criteria proposed by the American Society of Parenteral and Enteral Nutrition (ASPEN) consensus. Furthermore, the incidence of refeeding hypophosphatemia (RH) was also assessed. METHODS Four databases were systematically searched until September 2020 for retrieving trials and observational studies. The incidences of RFS and RH were expressed as percentage and reported with 95% confidence intervals (CI). RESULTS Thirty-five observational studies were included in the analysis. The risk of bias was serious in 16 studies and moderate in the remaining 19. The incidence of RFS varied from 0% to 62% across the studies. No substantial change in the originally reported incidence of RFS was found by applying the ASPEN criteria. Similarly, the incidence of RH ranged between 7% and 62%. In the subgroup analyses, inpatients from Intensive Care Units (ICUs) and those initially fed with >20 kcal/kg/day seemed to have a higher incidence of both RFS (pooled incidence = 44%; 95% CI 36%-52%) and RH (pooled incidence = 27%; 95% CI 21%-34%). However, due to the high heterogeneity of data, summary incidence measures are meaningless. CONCLUSION The incidence rate of both RFS and RH greatly varied according to the definition used and the population analyzed, being higher in ICU inpatients and in those with increased initial caloric supply. Therefore, a universally accepted definition for RFS, taking different clinical contexts and groups of patients into account, is still needed to better characterize the syndrome and its approach.
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Affiliation(s)
- Iolanda Cioffi
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Pansini 5, 80131 Naples, Italy.
| | - Valentina Ponzo
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126 Turin, Italy
| | - Marianna Pellegrini
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126 Turin, Italy
| | - Andrea Evangelista
- Unit of Clinical Epidemiology, CPO, "Città della Salute e della Scienza" Hospital of Turin, Turin, Italy
| | - Fabio Bioletto
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126 Turin, Italy
| | - Giovannino Ciccone
- Unit of Clinical Epidemiology, CPO, "Città della Salute e della Scienza" Hospital of Turin, Turin, Italy
| | - Fabrizio Pasanisi
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Pansini 5, 80131 Naples, Italy
| | - Ezio Ghigo
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126 Turin, Italy
| | - Simona Bo
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126 Turin, Italy
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