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González-Domínguez Á, Domínguez-Riscart J, Savolainen O, Lechuga-Sancho A, Landberg R, González-Domínguez R. Identifying metabotypes of insulin resistance severity in children with metabolic syndrome. Cardiovasc Diabetol 2024; 23:315. [PMID: 39192263 DOI: 10.1186/s12933-024-02412-x] [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] [Received: 04/24/2024] [Accepted: 08/19/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Insulin resistance is a frequent precursor of typical obesity and metabolic syndrome complications. However, accurate diagnosis remains elusive because of its pathophysiological complexity and heterogeneity. Herein, we have explored the utility of insulin secretion dynamics in response to an oral glucose tolerance test as a surrogate marker to identify distinct metabotypes of disease severity. METHODS The study population consisted of children with obesity and insulin resistance, stratified according to the post-challenge insulin peak timing (i.e., early, middle, and late peak), from whom fasting and postprandial plasma and erythrocytes were collected for metabolomics analysis. RESULTS Children with late insulin peak manifested worse cardiometabolic health (i.e., higher blood pressure, glycemia, and HOMA-IR scores) than early responders. These subjects also showed more pronounced changes in metabolites mirroring failures in energy homeostasis, oxidative stress, metabolism of cholesterol and phospholipids, and adherence to unhealthy dietary habits. Furthermore, delayed insulin peak was associated with impaired metabolic flexibility, as reflected in compromised capacity to regulate mitochondrial energy pathways and the antioxidant defense in response to glucose overload. CONCLUSIONS Altogether, these findings suggest that insulin resistance could encompass several phenotypic subtypes characterized by graded disturbances in distinctive metabolic derangements occurring in childhood obesity, which serve as severity predictive markers.
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Affiliation(s)
- Álvaro González-Domínguez
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Hospital Universitario Puerta del Mar, Universidad de Cádiz, Cádiz, 11009, Spain
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, 10029, USA
| | - Jesús Domínguez-Riscart
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Hospital Universitario Puerta del Mar, Universidad de Cádiz, Cádiz, 11009, Spain
- Unidad de Endocrinología Pediátrica y Diabetes, Servicio de Pediatría, Hospital Universitario Puerta del Mar, Cádiz, 11009, Spain
| | - Otto Savolainen
- Division of Food and Nutrition Science, Department of Life Sciences, Chalmers University of Technology, Gothenburg, SE-412 96, Sweden
| | - Alfonso Lechuga-Sancho
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Hospital Universitario Puerta del Mar, Universidad de Cádiz, Cádiz, 11009, Spain
- Unidad de Endocrinología Pediátrica y Diabetes, Servicio de Pediatría, Hospital Universitario Puerta del Mar, Cádiz, 11009, Spain
- Departamento Materno Infantil y Radiología, Facultad de Medicina, Universidad de Cádiz, Cádiz, 11009, Spain
| | - Rikard Landberg
- Division of Food and Nutrition Science, Department of Life Sciences, Chalmers University of Technology, Gothenburg, SE-412 96, Sweden
| | - Raúl González-Domínguez
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Hospital Universitario Puerta del Mar, Universidad de Cádiz, Cádiz, 11009, Spain.
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Agbaje AO, Saner C, Zhang J, Henderson M, Tuomainen TP. DXA-based Fat Mass With Risk of Worsening Insulin Resistance in Adolescents: A 9-Year Temporal and Mediation Study. J Clin Endocrinol Metab 2024; 109:e1708-e1719. [PMID: 38173399 PMCID: PMC11319001 DOI: 10.1210/clinem/dgae004] [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: 10/12/2023] [Revised: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 01/05/2024]
Abstract
CONTEXT Surrogate measures of childhood and adolescent obesity have impaired the understanding of the relationship of body composition with insulin resistance in the young population. OBJECTIVE We aim to examine the longitudinal associations of directly measured total fat mass, trunk fat mass, and lean mass with the risk of hyperglycemia, hyperinsulinemia, and insulin resistance from ages 15 to 24 years, the mediation path through which lipids and inflammation influence insulin resistance, and whether increased fat mass temporally precede insulin resistance. METHODS We studied 3160 adolescents from the Avon Longitudinal Study of Parents and Children (ALSPAC), UK birth cohort, who had complete dual-energy x-ray absorptiometry measure and fasting blood samples at age 15 years and repeated measures at ages 17- and 24-years clinic visit. Fasting glucose greater than 6.1 mmol/L, insulin greater than 11.78 mU/L, and homeostatic model assessment for insulin resistance (HOMA-IR) greater than or equal to the 75th percentile were categorized as hyperglycemia, hyperinsulinemia, and high insulin resistance, respectively. Longitudinal associations were examined with generalized logit-mixed-effect models, while mediation and temporal path analyses were examined using structural equation models, adjusting for cardiometabolic and lifestyle factors. RESULTS Among 3160 participants (51% female), fat mass and lean mass increased linearly both in males and females, while glucose, insulin, and HOMA-IR had a U-shaped course from age 15 through 24 years. After full adjustment, each 1-kg cumulative increase in total fat mass (odds ratio 1.12 [95% CI, 1.11-1.13]) and trunk fat mass (1.21 [1.19-1.23]) from ages 15 through 24 years were associated with a progressively worsening risk of high insulin resistance as well as hyperglycemia and hyperinsulinemia. The association of increased total fat mass with increased insulin resistance was partly mediated by triglycerides (9% mediation). In the temporal path analysis, higher total fat mass at age 15 years was associated with higher insulin resistance at age 17 years, but not vice versa. Higher total fat mass at age 17 years was bidirectionally associated with higher insulin resistance at 24 years. CONCLUSION Mid-adolescence may be an optimal time for interrupting the worsening fat mass-insulin resistance pathologic cycle and attenuating the risk of progressively worsening metabolic dysfunction before young adulthood.
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Affiliation(s)
- Andrew O Agbaje
- Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, 70211, Finland
- Children’s Health and Exercise Research Centre, Department of Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, EX1 2LU, UK
| | - Christoph Saner
- Division of Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, CH-3010, Switzerland
- Department of Biomedical Research, University of Bern, Bern, CH-3010, Switzerland
| | - Jie Zhang
- Department of Public Health, Aarhus University, DK-8000 Aarhus, Denmark
| | - Mélanie Henderson
- School of Public Health, Faculty of Medicine, Université de Montréal, Montréal, Quebec, H3T 1C5, Canada
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montréal, Quebec, H3T 1C5, Canada
- Research Center of Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, H3T 1C5, Canada
| | - Tomi-Pekka Tuomainen
- Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, 70211, Finland
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Peres M, Moreira-Rosário A, Padeira G, Gaspar Silva P, Correia C, Nunes A, Garcia E, Faria A, Teixeira D, Calhau C, Pereira-da-Silva L, Ferreira AC, Rocha JC. Biochemical and Anthropometric Outcomes in Paediatric Patients with Heterozygous Familial Hypercholesterolemia after COVID-19 Pandemic Lockdowns: An Exploratory Analysis. Nutrients 2024; 16:2170. [PMID: 38999917 PMCID: PMC11242984 DOI: 10.3390/nu16132170] [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: 05/10/2024] [Revised: 07/03/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024] Open
Abstract
The COVID-19 pandemic lockdowns affected the lifestyles of children and adolescents, leading to an increase in childhood obesity. Paediatric patients with familial hypercholesterolemia (FH) may be more susceptible to lockdown effects due to their increased cardiovascular risk. However, data are lacking. We investigated the effect of lockdowns on the metabolic profile of paediatric patients with FH. Blood lipids and anthropometry measured in September 2021-April 2022 were retrospectively compared with pre-pandemic values. Thirty participants were included (1-16 years; 57% female). From baseline to post-pandemic, median [P25, P75] blood LDL-C concentration was 125 [112, 150] mg/dL vs. 125 [100, 147] mg/dL (p = 0.894); HDL-C was 58 [52, 65] mg/dL vs. 56 [51, 61] mg/dL (p = 0.107); triglycerides were 64 [44, 86] mg/dL vs. 59 [42, 86] mg/dL (p = 0.178). The BMI z-score did not change significantly (0.19 [-0.58, 0.89] vs. 0.30 [-0.48, 1.10], p = 0.524). The lack of deterioration in metabolic profiles during lockdowns is positive, as some deterioration was expected. We speculate that patients and caregivers were successfully educated about healthy lifestyle and dietary habits. Our results should be interpreted with caution since the study sample was small and heterogeneous. Multicentre research is needed to better understand the impact of lockdowns on this population.
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Affiliation(s)
- Maria Peres
- Nutrition and Metabolism, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
| | - André Moreira-Rosário
- Nutrition and Metabolism, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
- CHRC-Comprehensive Health Research Centre, Nutrition Group, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
- CINTESIS-Center for Health Technology and Services Research, NOVA Medical School, 1169-056 Lisboa, Portugal
| | - Gonçalo Padeira
- Reference Centre of Inherited Metabolic Diseases, Unidade Local de Saúde São José, Centro Clínico Académico de Lisboa, 1169-045 Lisboa, Portugal
| | - Patrícia Gaspar Silva
- Reference Centre of Inherited Metabolic Diseases, Unidade Local de Saúde São José, Centro Clínico Académico de Lisboa, 1169-045 Lisboa, Portugal
| | - Carla Correia
- Reference Centre of Inherited Metabolic Diseases, Unidade Local de Saúde São José, Centro Clínico Académico de Lisboa, 1169-045 Lisboa, Portugal
| | - Andreia Nunes
- Reference Centre of Inherited Metabolic Diseases, Unidade Local de Saúde São José, Centro Clínico Académico de Lisboa, 1169-045 Lisboa, Portugal
| | - Elisabete Garcia
- Reference Centre of Inherited Metabolic Diseases, Unidade Local de Saúde São José, Centro Clínico Académico de Lisboa, 1169-045 Lisboa, Portugal
| | - Ana Faria
- Nutrition and Metabolism, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
- CHRC-Comprehensive Health Research Centre, Nutrition Group, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
| | - Diana Teixeira
- Nutrition and Metabolism, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
- CHRC-Comprehensive Health Research Centre, Nutrition Group, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
| | - Conceição Calhau
- Nutrition and Metabolism, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
- CHRC-Comprehensive Health Research Centre, Nutrition Group, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
- CINTESIS-Center for Health Technology and Services Research, NOVA Medical School, 1169-056 Lisboa, Portugal
| | - Luís Pereira-da-Silva
- CHRC-Comprehensive Health Research Centre, Nutrition Group, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
- Medicine of Woman, Childhood and Adolescence Academic Area, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
| | - Ana Cristina Ferreira
- Reference Centre of Inherited Metabolic Diseases, Unidade Local de Saúde São José, Centro Clínico Académico de Lisboa, 1169-045 Lisboa, Portugal
| | - Júlio César Rocha
- Nutrition and Metabolism, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
- CHRC-Comprehensive Health Research Centre, Nutrition Group, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
- CINTESIS-Center for Health Technology and Services Research, NOVA Medical School, 1169-056 Lisboa, Portugal
- Reference Centre of Inherited Metabolic Diseases, Unidade Local de Saúde São José, Centro Clínico Académico de Lisboa, 1169-045 Lisboa, Portugal
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Ciężki S, Odyjewska E, Bossowski A, Głowińska-Olszewska B. Not Only Metabolic Complications of Childhood Obesity. Nutrients 2024; 16:539. [PMID: 38398863 PMCID: PMC10892374 DOI: 10.3390/nu16040539] [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: 01/09/2024] [Revised: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
The increasing incidence of obesity in the pediatric population requires attention to its serious complications. It turns out that in addition to typical, well-known metabolic complications, obesity as a systemic disease carries the risk of equally serious, although less obvious, non-metabolic complications, such as cardiovascular diseases, polycystic ovary syndrome, chronic kidney disease, asthma, thyroid dysfunction, immunologic and dermatologic conditions, and mental health problems. They can affect almost all systems of the young body and also leave their mark in adulthood. In addition, obesity also contributes to the exacerbation of existing childhood diseases. As a result, children suffering from obesity may have a reduced quality of life, both physically and mentally, and their life expectancy may be shortened. It also turns out that, in the case of obese pregnant girls, the complications of obesity may also affect their unborn children. Therefore, it is extremely important to take all necessary actions to prevent the growing epidemic of obesity in the pediatric population, as well as to treat existing complications of obesity and detect them at an early stage. In summary, physicians treating a child with a systemic disease such as obesity must adopt a holistic approach to treatment.
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Affiliation(s)
- Sebastian Ciężki
- Department of Pediatrics, Endocrinology, and Diabetology with Cardiology Division, Medical University of Bialystok, 15-274 Białystok, Poland
| | - Emilia Odyjewska
- Department of Pediatrics, Endocrinology, and Diabetology with Cardiology Division, Medical University of Bialystok, 15-274 Białystok, Poland
| | - Artur Bossowski
- Department of Pediatrics, Endocrinology, and Diabetology with Cardiology Division, Medical University of Bialystok, 15-274 Białystok, Poland
| | - Barbara Głowińska-Olszewska
- Department of Pediatrics, Endocrinology, and Diabetology with Cardiology Division, Medical University of Bialystok, 15-274 Białystok, Poland
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方 福, 王 宁, 刘 星, 王 薇, 孙 菁, 李 红, 孙 般, 谷 昭, 傅 晓, 闫 双. [Value of C-peptide-based insulin resistance index for evaluating correlation between insulin resistance and serum uric acid level in individuals undergoing health examination]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2023; 43:1509-1514. [PMID: 37814865 PMCID: PMC10563103 DOI: 10.12122/j.issn.1673-4254.2023.09.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Indexed: 10/11/2023]
Abstract
OBJECTIVE To investigate the value of C-peptide-based insulin resistance index in evaluating the correlation between insulin resistance and serum uric acid (Ua) level in subjects undergoing health examination. METHODS The data of 46 017 subjects undergoing health examination were retrospectively collected from the Second Medical Center of PLA General Hospital from January, 2017 to December, 2021. The subjects were divided into Ua≤420 μmol/L group and Ua>420 μmol/L group for comparison of HOMA insulin resistance index (HOMA2-IR) and HOMA insulin resistance-C peptide (HOMA2 IR-CP). The correlations of HOMA2-IR and HOMA2 IR-CP with Ua level were analyzed using Pearson correlation analysis and linear regression analysis. Hierarchical interaction analysis was conducted to assess the differences in the association between insulin resistance index and Ua level in different subgroups. The ROC curve was used to evaluate the predictive ability of insulin resistance index for an increased Ua level. RESULTS The levels of HOMA2-IR and HOMA2 IR-CP were significantly lower in Ua≤420 μmol/L group than in Ua>420 μmol/L group. Univariate Pearson correlation analysis showed a weak correlation of HOMA2-IR with Ua (r=0.262, P<0.001) and moderate correlation of HOMA2 IR-CP with Ua (r=0.409, P<0.001). Multivariate linear regression analysis, after adjustment for confounding factors, demonstrated that HOMA2-IR (R2=0.445, P<0.001) and HOMA2 IR-CP (R2=0.461, P<0.001) were both factors affecting Ua level. Hierarchical interaction analysis showed that the association of insulin resistance index with Ua level varied significantly with gender, age, and glucose metabolism (P<0.001). ROC curve showed that the areas under the curve predicted an increased Ua level by HOMA2-IR and HOMA2 IR-CP were 0.662 and 0.722, respectively. CONCLUSIONS HOMA2 IR-CP is a more accurate indicator for assessing the correlation between insulin resistance and Ua level.
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Affiliation(s)
- 福生 方
- 解放军总医院第二医学中心保健一科,北京 100853Department of Health Care, Second Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - 宁 王
- 解放军总医院第二医学中心健康医学科,北京 100853Department of Health Management, Second Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - 星宇 刘
- 解放军总医院第二医学中心保健一科,北京 100853Department of Health Care, Second Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - 薇 王
- 解放军总医院第二医学中心保健一科,北京 100853Department of Health Care, Second Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - 菁 孙
- 解放军总医院第二医学中心健康医学科,北京 100853Department of Health Management, Second Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - 红 李
- 解放军总医院第二医学中心健康医学科,北京 100853Department of Health Management, Second Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - 般若 孙
- 解放军总医院第二医学中心内分泌科,北京 100853Department of Endocrinology, Second Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - 昭艳 谷
- 解放军总医院第二医学中心内分泌科,北京 100853Department of Endocrinology, Second Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - 晓敏 傅
- 解放军总医院第一医学中心内分泌科,北京 100853Department of Endocrinology, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - 双通 闫
- 解放军总医院第二医学中心内分泌科,北京 100853Department of Endocrinology, Second Medical Center of Chinese PLA General Hospital, Beijing 100853, China
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Dallatana A, Cremonesi L, Trombetta M, Fracasso G, Nocini R, Giacomello L, Innamorati G. G Protein-Coupled Receptors and the Rise of Type 2 Diabetes in Children. Biomedicines 2023; 11:1576. [PMID: 37371671 DOI: 10.3390/biomedicines11061576] [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: 05/11/2023] [Revised: 05/26/2023] [Accepted: 05/27/2023] [Indexed: 06/29/2023] Open
Abstract
The human genome counts hundreds of GPCRs specialized to sense thousands of different extracellular cues, including light, odorants and nutrients in addition to hormones. Primordial GPCRs were likely glucose transporters that became sensors to monitor the abundance of nutrients and direct the cell to switch from aerobic metabolism to fermentation. Human β cells express multiple GPCRs that contribute to regulate glucose homeostasis, cooperating with many others expressed by a variety of cell types and tissues. These GPCRs are intensely studied as pharmacological targets to treat type 2 diabetes in adults. The dramatic rise of type 2 diabetes incidence in pediatric age is likely correlated to the rapidly evolving lifestyle of children and adolescents of the new century. Current pharmacological treatments are based on therapies designed for adults, while youth and puberty are characterized by a different hormonal balance related to glucose metabolism. This review focuses on GPCRs functional traits that are relevant for β cells function, with an emphasis on aspects that could help to differentiate new treatments specifically addressed to young type 2 diabetes patients.
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Affiliation(s)
- Alessia Dallatana
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37134 Verona, Italy
| | - Linda Cremonesi
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37134 Verona, Italy
| | - Maddalena Trombetta
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, 37124 Verona, Italy
| | - Giulio Fracasso
- Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy
| | - Riccardo Nocini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37134 Verona, Italy
| | - Luca Giacomello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37134 Verona, Italy
| | - Giulio Innamorati
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37134 Verona, Italy
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