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Garg HK, Shashi KK, Fisher P, Winant AJ, Hull NC, Lee EY. Pediatric Upper Abdominal Masses: Current Practical Imaging Assessment. Semin Roentgenol 2024; 59:299-311. [PMID: 38997183 DOI: 10.1053/j.ro.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 07/14/2024]
Affiliation(s)
- Harsha K Garg
- Department of Diagnostic, Molecular and Interventional Radiology and Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at The Mount Sinai Hospital, New York, NY.
| | - Kumar K Shashi
- Department of Radiology, Arkansas Children's Hospital, Little Rock, AR
| | - Paul Fisher
- Department of Diagnostic, Molecular and Interventional Radiology and Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at The Mount Sinai Hospital, New York, NY
| | - Abbey J Winant
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Nathan C Hull
- Department of Radiology, Division of Pediatric Radiology, Mayo Clinic, Rochester, MN
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA
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2
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Krivonosov AA, Minnullin MM, Akhaladze DG, Grachev NS. [Surgery for abdominal neuroblastoma in children]. Khirurgiia (Mosk) 2024:152-160. [PMID: 38785252 DOI: 10.17116/hirurgia2024051152] [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] [Indexed: 05/25/2024]
Abstract
This review is devoted to surgical approach for neurogenic tumors in children. The authors discuss epidemiological data, history of surgical approaches, preoperative imaging and risk factors. A special attention is paid to the influence of surgical interventions for various neuroblastomas on overall and event-free survival in pediatric population, as well as the most common surgical complications and modern approaches to their treatment.
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Affiliation(s)
- A A Krivonosov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - M M Minnullin
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - D G Akhaladze
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - N S Grachev
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
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3
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Pio L, Melero Pardo AL, Zaghloul T, Murphy AJ, Talbot L, Mothi SS, Davidoff AM, Abdelhafeez AH. Retroperitoneoscopic or Transperitoneal Approach for Neurogenic and Adrenal Tumors in Children? A Comparison on the Way to Enhanced Recovery in Pediatric Surgical Oncology. J Pediatr Surg 2023; 58:2135-2140. [PMID: 37385908 DOI: 10.1016/j.jpedsurg.2023.06.003] [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: 03/15/2023] [Revised: 04/20/2023] [Accepted: 06/05/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Minimally invasive surgery is increasingly utilized for resection of neurogenic tumors in children. The minimally invasive retroperitoneoscopic approach was recently reported in children, but transperitoneal laparoscopy still remains the most common technique. The aim of this study is to compare a novel single-port retroperitoneoscopy (SPR) approach for pediatric neurogenic tumor resection with transperitoneal laparoscopic (TPL). METHODS Patients undergoing minimally invasive resection of abdominal neurogenic tumors over 5 years at a single institution (from 2018 to 2022) were retrospectively reviewed. Tumor volume, stage, presence of image-defined risk factors (IDRFs), neoadjuvant chemotherapy, operative time, estimated blood loss (EBL), length of stay (LOS), complications, oral morphine equivalents per kilogram (OME/Kg), and time to chemotherapy were assessed and compared with SPR and TPL approaches. RESULTS Eighteen and fifteen patients underwent TPL and SPR, respectively. No significant differences were found between the TPL and SPR approaches in terms of tumor characteristics and IDRFs. Patients who underwent SPR had a significantly faster recovery (p = 0.008) and less postoperative opioid use compared to those in TPL (p = 0.02), thus allowing an enhanced recovery after surgery (ERAS) protocol application. TPL and SPR approaches were performed in presence of IDRFs, respectively in 2 (11%) and 4 patients (27%), with a IDRFs-related conversion in one TPL procedure. Both approaches had one < Grade 3 Clavien Dindo complication, but not requiring further surgery. DISCUSSION SPR approach can be considered as a safe and feasible minimally invasive approach for the resection of pediatric primary adrenal and neurogenic tumors. The retroperitoneoscopic approach performed using a single port technique represents a promising new frontier of ERAS application in pediatric surgical oncology. CONCLUSION SPR is a viable surgical alternative in selected neurogenic abdominal tumors with limited IDRFs, thus allowing for the application of ERAS protocols in these patients. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Luca Pio
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Ana L Melero Pardo
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Tarek Zaghloul
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA; Department of Surgery, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Andrew J Murphy
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA; Department of Surgery, University of Tennessee Health Science Center, 800 Madison Ave, Memphis, TN, 38163, USA
| | - Lindsay Talbot
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA; Department of Surgery, University of Tennessee Health Science Center, 800 Madison Ave, Memphis, TN, 38163, USA
| | - Suraj Sarvode Mothi
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, 38163, USA
| | - Andrew M Davidoff
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA; Department of Surgery, University of Tennessee Health Science Center, 800 Madison Ave, Memphis, TN, 38163, USA
| | - Abdelhafeez H Abdelhafeez
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA; Department of Surgery, University of Tennessee Health Science Center, 800 Madison Ave, Memphis, TN, 38163, USA.
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4
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Feng L, Zhang S, Lu X, Yang X, Kan Y, Wang C, Zhang H, Wang W, Yang J. An Optimal Radiomics Nomogram Based on 18F-FDG PET/CT for Identifying Event-Free Survival in Pediatric Neuroblastoma. Acad Radiol 2023; 30:2309-2320. [PMID: 37393177 DOI: 10.1016/j.acra.2023.06.004] [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: 04/18/2023] [Revised: 05/13/2023] [Accepted: 06/02/2023] [Indexed: 07/03/2023]
Abstract
RATIONALE AND OBJECTIVES To investigate whether the 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) radiomics features that combine tumor and bone marrow can more accurately identify event-free survival (EFS) in pediatric neuroblastoma. MATERIALS AND METHODS A total of 126 patients with neuroblastoma were retrospectively included and randomly divided into the training and validation cohorts (7:3 ratio). Radiomics features were extracted to develop a tumor- and bone marrow-based radiomics risk score (RRS). The Kaplan-Meier method was used to evaluate the effectiveness of RRS in EFS risk stratification. Univariate and multivariate Cox regression analyses were used to determine independent clinical risk factors and construct the clinical models. The conventional PET model was constructed based on conventional PET parameters, and the noninvasive combined model integrated the RRS and the noninvasive independent clinical risk factors. The performance of the models was evaluated using C-index, calibration curves, and decision curve analysis (DCA). RESULTS A total of 15 radiomics features were selected to build the RRS. According to Kaplan-Meier analysis, there was a significant difference in EFS between the low-risk and high-risk groups as defined by the value of RRS (P < .05). The noninvasive combined model combining RRS and the International Neuroblastoma Risk Group stage achieved the best prognostic prediction of EFS, with a C-index of 0.810 and 0.783 in the training and validation cohorts, respectively. The calibration curves and DCA indicated that the noninvasive combined model had good consistency and clinical utility. CONCLUSION The 18F-FDG PET/CT-based radiomics of neuroblastoma allows a reliable evaluation of EFS. The performance of the noninvasive combined model was superior to the clinical and conventional PET models.
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Affiliation(s)
- Lijuan Feng
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, 95 Yong An Road, Xi Cheng District, Beijing 100050, China (L.F., S.Z., X.L., X.Y., Y.K., W.W., J.Y.)
| | - Shuxin Zhang
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, 95 Yong An Road, Xi Cheng District, Beijing 100050, China (L.F., S.Z., X.L., X.Y., Y.K., W.W., J.Y.)
| | - Xia Lu
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, 95 Yong An Road, Xi Cheng District, Beijing 100050, China (L.F., S.Z., X.L., X.Y., Y.K., W.W., J.Y.)
| | - Xu Yang
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, 95 Yong An Road, Xi Cheng District, Beijing 100050, China (L.F., S.Z., X.L., X.Y., Y.K., W.W., J.Y.)
| | - Ying Kan
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, 95 Yong An Road, Xi Cheng District, Beijing 100050, China (L.F., S.Z., X.L., X.Y., Y.K., W.W., J.Y.)
| | - Chao Wang
- SinoUnion Healthcare Inc., Beijing, China (C.W.)
| | - Hui Zhang
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China (H,Z,)
| | - Wei Wang
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, 95 Yong An Road, Xi Cheng District, Beijing 100050, China (L.F., S.Z., X.L., X.Y., Y.K., W.W., J.Y.)
| | - Jigang Yang
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, 95 Yong An Road, Xi Cheng District, Beijing 100050, China (L.F., S.Z., X.L., X.Y., Y.K., W.W., J.Y.).
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Karray A, Cherifi W, Sassi F, Boussetta A, Haouet S, Gargah T. Adrenal neuroblastoma in three year old boy, mistaken for pancreatic tumor: A case report. Urol Case Rep 2023; 49:102429. [PMID: 37275563 PMCID: PMC10238441 DOI: 10.1016/j.eucr.2023.102429] [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: 04/27/2023] [Revised: 05/12/2023] [Accepted: 05/13/2023] [Indexed: 06/07/2023] Open
Abstract
Neuroblastoma is the most common extracranial solid tumor in children, often manifests in the retroperitoneal region. We present a case of a 3-year-old boy with no previous medical history, presented for abdominal distension. Physical examination revealed a distinct, mobile, solid mass situated in the left lumbar region. Abdominal magnetic resonance imaging displayed a well delimited, well-encapsulated mass attached to the tail of the pancreas. Urinary catecholamine metabolite levels were negative. Surgical exploration revealed that the tumor was primitively related to the left adrenal gland, and a complete resection was performed. The postoperative recovery was uncomplicated. NMYC oncogene was non-amplified.
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Affiliation(s)
- Amina Karray
- Pediatric Department, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis El Manar-Faculty of Medicine of Tunis, Tunis, Tunisia
| | - Walid Cherifi
- University of Tunis El Manar-Faculty of Medicine of Tunis, Tunis, Tunisia
| | - Farah Sassi
- Department of Pathology, Rabta Hospital, Tunis, Tunisia
- University of Tunis El Manar-Faculty of Medicine of Tunis, Tunis, Tunisia
| | - Abir Boussetta
- Pediatric Department, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis El Manar-Faculty of Medicine of Tunis, Tunis, Tunisia
| | - Slim Haouet
- Department of Pathology, Rabta Hospital, Tunis, Tunisia
- University of Tunis El Manar-Faculty of Medicine of Tunis, Tunis, Tunisia
| | - Tahar Gargah
- Pediatric Department, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis El Manar-Faculty of Medicine of Tunis, Tunis, Tunisia
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An 18F-FDG PET/CT radiomics nomogram for differentiation of high-risk and non-high-risk patients of the International Neuroblastoma Risk Group Staging System. Eur J Radiol 2022; 154:110444. [DOI: 10.1016/j.ejrad.2022.110444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/28/2022] [Accepted: 07/18/2022] [Indexed: 11/22/2022]
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Young S, Rettig RL, Hutchinson IV, Sutcliffe MG, Sydorak RM. Surgical approach to pediatric mediastinal masses based on imaging characteristics. Pediatr Surg Int 2022; 38:1297-1302. [PMID: 35794495 DOI: 10.1007/s00383-022-05166-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pediatric mediastinal masses may be resected using an open or video-assisted thoracoscopic surgery (VATS) approach. We sought to define the preoperative imaging findings predicting amenability to VATS. METHODS This multicenter retrospective study of pediatric patients undergoing either VATS or open surgical mediastinal mass resection between 2008 and 2018 evaluated the preoperative imaging descriptors associated with VATS. Postoperative endpoints included length of stay (LOS), 30-day readmission, 90-day mortality and complication rates. RESULTS Mediastinal mass resection was performed in 33 patients. Median tumor size was 6 cm, and 51.5% had anterior mediastinal tumors. The 23 (69.7%) patients who underwent VATS were significantly older (144 months vs 32, P = 0.01) and larger (33.6 kg vs 13.8 P = 0.03). Preoperative imaging characteristics in VATS included "well circumscribed", "smooth margins" and "cystic", while the open surgery group were "heterogeneous" and "coarse calcification". The open group had more germ cell tumors (60.0% vs 13.0%, P = 0.16) but no difference in malignancy. VATS patients had shorter LOS (2 days vs 6.5, P = 0.24). Readmission, complication and mortality rates were similar. CONCLUSIONS Pediatric patients with apparent malignancy frequently underwent open resection compared with the thoracoscopic group, although final malignant pathology was similar. Equivalent outcomes and shorter LOS should favor a minimally invasive approach. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Stephanie Young
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, 4760 Sunset Blvd, 3rdFloor, Los Angeles, CA, 90027, USA
- Department of Surgical Oncology, Providence Saint John's Cancer Institute, Santa Monica, CA, USA
| | - R Luke Rettig
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, 4760 Sunset Blvd, 3rdFloor, Los Angeles, CA, 90027, USA
| | - Ian V Hutchinson
- Clinical Research Services, Providence Health & Services, Santa Monica, CA, USA
| | - Michael G Sutcliffe
- Clinical Research Services, Providence Health & Services, Santa Monica, CA, USA
| | - Roman M Sydorak
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, 4760 Sunset Blvd, 3rdFloor, Los Angeles, CA, 90027, USA.
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8
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Tang L, Wang Y, Yang X, Luo G, Zeng X, Wang R, Song B. Virtual or real: lifelike cinematic rendering of adrenal tumors. Quant Imaging Med Surg 2021; 11:3854-3866. [PMID: 34341754 DOI: 10.21037/qims-20-1282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/26/2021] [Indexed: 02/05/2023]
Abstract
The adrenal gland is small in size and hidden in location. Adrenal tumors are relatively difficult to diagnose due to the wide variety of tumors and partial overlap of image features. Cinematic rendering (CR) is a novel, three-dimensional post-processing technology that simulates how light propagates in the real world, providing high-resolution visualizations that truly present subtle anatomical details. We retrospectively collected a series of pathologically confirmed adrenal tumor cases, raw data was introduced into the post-processing workstation, and different tools and templates of CR software were used for reconstruction and rendering. Compared with traditional black and white two-dimensional images and three-dimensional volume rendering (VR) images, CR images were more colorful, layered, and closer to the truth. CR has potential in diagnosing and preoperative planning of adrenal tumors, allowing vivid and realistic visualization of tumor location, morphology, different components (solid, cystic, fat, calcification, etc.), the pattern of enhancement, and the relationship with surrounding tissues and organs.
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Affiliation(s)
- Lei Tang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,Department of Radiology, Guizhou Provincial People's Hospital, Key Laboratory of Intelligent Medical Imaging Analysis and Accurate Diagnosis of Guizhou Province, International Exemplary Cooperation Base of Precision Imaging for Diagnosis and Treatment, Guiyang, China
| | - Yuquan Wang
- Department of Radiology, Guizhou Provincial People's Hospital, Key Laboratory of Intelligent Medical Imaging Analysis and Accurate Diagnosis of Guizhou Province, International Exemplary Cooperation Base of Precision Imaging for Diagnosis and Treatment, Guiyang, China
| | - Xiushu Yang
- Department of Urological Surgery, Guizhou Provincial People's Hospital, Guiyang, China
| | - Guangheng Luo
- Department of Urological Surgery, Guizhou Provincial People's Hospital, Guiyang, China
| | - Xianchun Zeng
- Department of Radiology, Guizhou Provincial People's Hospital, Key Laboratory of Intelligent Medical Imaging Analysis and Accurate Diagnosis of Guizhou Province, International Exemplary Cooperation Base of Precision Imaging for Diagnosis and Treatment, Guiyang, China
| | - Rongpin Wang
- Department of Radiology, Guizhou Provincial People's Hospital, Key Laboratory of Intelligent Medical Imaging Analysis and Accurate Diagnosis of Guizhou Province, International Exemplary Cooperation Base of Precision Imaging for Diagnosis and Treatment, Guiyang, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
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Bhoopathi P, Mannangatti P, Emdad L, Das SK, Fisher PB. The quest to develop an effective therapy for neuroblastoma. J Cell Physiol 2021; 236:7775-7791. [PMID: 33834508 DOI: 10.1002/jcp.30384] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/27/2021] [Accepted: 03/22/2021] [Indexed: 12/18/2022]
Abstract
Neuroblastoma (NB) is a common solid extracranial tumor developing in pediatric populations. NB can spontaneously regress or grow and metastasize displaying resistance to therapy. This tumor is derived from primitive cells, mainly those of the neural crest, in the sympathetic nervous system and usually develops in the adrenal medulla and paraspinal ganglia. Our understanding of the molecular characteristics of human NBs continues to advance documenting abnormalities at the genome, epigenome, and transcriptome levels. The high-risk tumors have MYCN oncogene amplification, and the MYCN transcriptional regulator encoded by the MYCN oncogene is highly expressed in the neural crest. Studies on the biology of NB has enabled a more precise risk stratification strategy and a concomitant reduction in the required treatment in an expanding number of cases worldwide. However, newer treatment strategies are mandated to improve outcomes in pediatric patients who are at high-risk and display relapse. To improve outcomes and survival rates in such high-risk patients, it is necessary to use a multicomponent therapeutic approach. Accuracy in clinical staging of the disease and assessment of the associated risks based on biological, clinical, surgical, and pathological criteria are of paramount importance for prognosis and to effectively plan therapeutic approaches. This review discusses the staging of NB and the biological and genetic features of the disease and several current therapies including targeted delivery of chemotherapy, novel radiation therapy, and immunotherapy for NB.
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Affiliation(s)
- Praveen Bhoopathi
- Department of Human and Molecular Genetics, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.,VCU Institute of Molecular Medicine, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Padmanabhan Mannangatti
- Department of Human and Molecular Genetics, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Luni Emdad
- Department of Human and Molecular Genetics, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.,VCU Institute of Molecular Medicine, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.,VCU Massey Cancer Center, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Swadesh K Das
- Department of Human and Molecular Genetics, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.,VCU Institute of Molecular Medicine, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.,VCU Massey Cancer Center, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Paul B Fisher
- Department of Human and Molecular Genetics, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.,VCU Institute of Molecular Medicine, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.,VCU Massey Cancer Center, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
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10
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Barile A. Multimodality advanced imaging and intervention in gland diseases. Gland Surg 2020; 9:2211-2214. [PMID: 33447573 DOI: 10.21037/gs-20-592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Antonio Barile
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
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