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Arora K, Gaudioso G, Solovyev P, Tuohy K, Di Cagno R, Gobbetti M, Fava F. In vitro faecal fermentation of Tritordeum breads and its effect on the human gut health. Curr Res Microb Sci 2023; 6:100214. [PMID: 38116184 PMCID: PMC10727946 DOI: 10.1016/j.crmicr.2023.100214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
Spontaneous fermentation of Tritordeum flour enhances the nutritional potential of this hybrid cereal. However, the effect of consumption of Tritordeum sourdough bread (SDB) on gut health remains to be elucidated. This study investigated the effect of in vitro digestion and faecal fermentation of SDB compared to that of traditional baker's yeast (BYB) Tritordeum bread. After 24-h anaerobic faecal fermentation, both SDB and BYB (1% w/v) induced an increase in the relative abundances of Bifidobacterium, Megasphaera, Mitsuokella, and Phascolarctobacterium genera compared to baseline, while concentrations of acetate and butyrate were significantly higher at 24 h for SDB compared to those for BYB. Integrity of intestinal epithelium, as assessed through in vitro trans-epithelial electrical resistance (TEER) assay, was slightly increased after incubation with SDB fermentation supernatants, but not after incubation with BYB fermentation supernatants. The SDB stimulated in vitro mucosal immune response by inducing early secretion of inflammatory cytokines, IL-6 and TNF-α, followed by downregulation of the inflammatory trigger through induction of anti-inflammatory IL-10 expression. Overall, our findings suggest that Tritordeum sourdough can modulate gut microbiota fermentation activity and positively impact the gut health.
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Affiliation(s)
- Kashika Arora
- Faculty of Agricultural, Environmental and Food Sciences, Libera Università di Bolzano, Piazza Università, 5, Bolzano 39100, Italy
| | - Giulia Gaudioso
- Nutrition and Nutrigenomics Unit, Fondazione Edmund Mach di San Michele all'Adige Via E. Mach, 1 38098 S. Michele all'Adige, Italy
| | - Pavel Solovyev
- Traceability Unit, Fondazione Edmund Mach di San Michele all'Adige Via E. Mach, 1 38098 S. Michele all'Adige, Italy
| | - Kieran Tuohy
- Nutrition and Nutrigenomics Unit, Fondazione Edmund Mach di San Michele all'Adige Via E. Mach, 1 38098 S. Michele all'Adige, Italy
- School of Food Science & Nutrition, University of Leeds, Leeds LS2 9JT, UK
| | - Raffaella Di Cagno
- Faculty of Agricultural, Environmental and Food Sciences, Libera Università di Bolzano, Piazza Università, 5, Bolzano 39100, Italy
| | - Marco Gobbetti
- Faculty of Agricultural, Environmental and Food Sciences, Libera Università di Bolzano, Piazza Università, 5, Bolzano 39100, Italy
| | - Francesca Fava
- Nutrition and Nutrigenomics Unit, Fondazione Edmund Mach di San Michele all'Adige Via E. Mach, 1 38098 S. Michele all'Adige, Italy
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Menghi L, Cliceri D, Fava F, Pindo M, Gaudioso G, Giacalone D, Gasperi F. Salivary microbial profiles associate with responsiveness to warning oral sensations and dietary intakes. Food Res Int 2023; 171:113072. [PMID: 37330830 DOI: 10.1016/j.foodres.2023.113072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/19/2023]
Abstract
Oral microbiota-host interactions are gaining recognition as potential factors contributing to interindividual variations in taste perception. However, whether such possible links imply specific bacterial co-occurrence networks remains unknown. To address this issue, we used 16 s rRNA gene sequencing to profile the salivary microbiota of 100 healthy individuals (52 % women; 18-30 y/o), who provided hedonic and psychophysical responses to 5 liquid and 5 solid commercially-available foods, each chosen to elicit a target sensation (sweet, sour, bitter, salty, pungent). The same cohort also completed several psychometric measures and a 4-day food diary. Unsupervised data-driven clustering of genus-level Aitchison distances supported the existence of two salivary microbial profiles (CL-1, CL-2). While CL-1 (n = 57; 49.1 % women) exhibited higher α-diversity metrics and was enriched in microbial genera assigned to the class Clostridia (e.g., Lachnospiraceae_[G-3]), CL-2 (n = 43; 55.8 % women) harbored greater amounts of taxa with potential cariogenic effects (e.g., genus Lactobacillus) and significantly lower abundances of inferred MetaCyc pathways related to the metabolic fate of acetate. Intriguingly, CL-2 showed enhanced responsiveness to warning oral sensations (bitter, sour, astringent) and a higher propensity to crave sweet foods or engage in prosocial behaviors. Further, the same cluster reported habitually consuming more simple carbohydrates and fewer beneficial nutrients (vegetable proteins, monounsaturated fatty acids). In summary, while the mediating role of participants' baseline diet on findings can not be definitively excluded, this work provides evidence suggesting that microbe-microbe and microbe-taste interactions may exert an influence on dietary habits and motivates further research to uncover a potential "core" taste-related salivary microbiota.
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Affiliation(s)
- Leonardo Menghi
- Center Agriculture Food Environment, University of Trento, Via Mach 1, San Michele all'Adige, 38098, Italy; Department of Technology and Innovation, University of Southern Denmark, Campusvej 55, Odense 5230, Denmark; Research and Innovation Centre, Fondazione Edmund Mach, Via Mach 1, San Michele all'Adige, 38098, Italy
| | - Danny Cliceri
- Center Agriculture Food Environment, University of Trento, Via Mach 1, San Michele all'Adige, 38098, Italy
| | - Francesca Fava
- Research and Innovation Centre, Fondazione Edmund Mach, Via Mach 1, San Michele all'Adige, 38098, Italy
| | - Massimo Pindo
- Research and Innovation Centre, Fondazione Edmund Mach, Via Mach 1, San Michele all'Adige, 38098, Italy
| | - Giulia Gaudioso
- Research and Innovation Centre, Fondazione Edmund Mach, Via Mach 1, San Michele all'Adige, 38098, Italy
| | - Davide Giacalone
- Department of Technology and Innovation, University of Southern Denmark, Campusvej 55, Odense 5230, Denmark.
| | - Flavia Gasperi
- Center Agriculture Food Environment, University of Trento, Via Mach 1, San Michele all'Adige, 38098, Italy; Research and Innovation Centre, Fondazione Edmund Mach, Via Mach 1, San Michele all'Adige, 38098, Italy.
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Gaudioso G, Weil T, Marzorati G, Solovyev P, Bontempo L, Franciosi E, Bertoldi L, Pedrolli C, Tuohy KM, Fava F. Microbial and metabolic characterization of organic artisanal sauerkraut fermentation and study of gut health-promoting properties of sauerkraut brine. Front Microbiol 2022; 13:929738. [PMID: 36312966 PMCID: PMC9606823 DOI: 10.3389/fmicb.2022.929738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/09/2022] [Indexed: 12/03/2022] Open
Abstract
Sauerkraut is a traditionally fermented cabbage, and recent evidence suggests that it has beneficial properties for human health. In this work, a multi-disciplinary approach was employed to characterize the fermentation process and gut health-promoting properties of locally produced, organic sauerkraut from two distinct producers, SK1 and SK2. 16S rRNA metataxonomics showed that bacterial diversity gradually decreased as fermentation progressed. Differences in sauerkraut microbiota composition were observed between the two producers, especially at the start of fermentation. Lactic acid bacteria (LAB) dominated the microbiota after 35 days, with Lactiplantibacillus being the dominant genus in both sauerkraut products, together with Leuconostoc and Paucilactobacillus in SK1, and with Pediococcus, Levilactibacillus, and Leuconostoc in SK2. LAB reached between 7 and 8 Log CFU/mL brine at the end of fermentation (35 days), while pH lowering happened within the first week of fermentation. A total of 220 LAB strains, corresponding to 133 RAPD-PCR biotypes, were successfully isolated. Lactiplantibacillus plantarum and Lactiplantibacillus pentosus accounted for 67% of all SK1 isolates, and Lactiplantibacillus plantarum/paraplantarum and Leuconostoc mesenteroides represented 72% of all the isolates from SK2. 1H-NMR analysis revealed significant changes in microbial metabolite profiles during the fermentation process, with lactic and acetic acids, as well as amino acids, amines, and uracil, being the dominant metabolites quantified. Sauerkraut brine did not affect trans-epithelial electrical resistance through a Caco-2 cell monolayer as a measure of gut barrier function. However, significant modulation of inflammatory response after LPS stimulation was observed in PBMCs-Caco-2 co-culture. Sauerkraut brine supported a robust inflammatory response to endotoxin, by increasing TNF-α and IL-6 production while also stimulating the anti-inflammatory IL-10, therefore suggesting positive resolution of inflammation after 24 h and supporting the potential of sauerkraut brine to regulate intestinal immune function.
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Affiliation(s)
- Giulia Gaudioso
- Nutrition and Nutrigenomics Unit, Research and Innovation Center, Fondazione Edmund Mach, San Michele all'Adige, Italy
- Centre for Integrative Biology (CIBIO) – Department of Cellular, Computational and Integrative Biology, University of Trento, Trento, Italy
| | - Tobias Weil
- Nutrition and Nutrigenomics Unit, Research and Innovation Center, Fondazione Edmund Mach, San Michele all'Adige, Italy
| | - Giulia Marzorati
- Nutrition and Nutrigenomics Unit, Research and Innovation Center, Fondazione Edmund Mach, San Michele all'Adige, Italy
| | - Pavel Solovyev
- Traceability Unit, Research and Innovation Center, Fondazione Edmund Mach, San Michele all'Adige, Italy
| | - Luana Bontempo
- Traceability Unit, Research and Innovation Center, Fondazione Edmund Mach, San Michele all'Adige, Italy
| | - Elena Franciosi
- Nutrition and Nutrigenomics Unit, Research and Innovation Center, Fondazione Edmund Mach, San Michele all'Adige, Italy
| | - Luigi Bertoldi
- Organic Agriculture Unit, Environmental Department, Technology Transfer Center, Fondazione Edmund Mach, San Michele all'Adige, Italy
| | - Carlo Pedrolli
- Dietetics and Clinical Nutrition, Nutrition Department, S. Chiara Hospital, Azienda Provinciale per I Servizi Sanitari, Trento, Italy
| | - Kieran Michael Tuohy
- Nutrition and Nutrigenomics Unit, Research and Innovation Center, Fondazione Edmund Mach, San Michele all'Adige, Italy
- School of Food Science and Nutrition, University of Leeds, Leeds, United Kingdom
| | - Francesca Fava
- Nutrition and Nutrigenomics Unit, Research and Innovation Center, Fondazione Edmund Mach, San Michele all'Adige, Italy
- *Correspondence: Francesca Fava
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Diotallevi C, Gaudioso G, Fava F, Angeli A, Lotti C, Vrhovsek U, Rinott E, Shai I, Gobbetti M, Tuohy K. Measuring the effect of Mankai® (Wolffia globosa) on the gut microbiota and its metabolic output using an in vitro colon model. J Funct Foods 2021. [DOI: 10.1016/j.jff.2021.104597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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Mastrocola R, Collotta D, Gaudioso G, Le Berre M, Cento AS, Ferreira Alves G, Chiazza F, Verta R, Bertocchi I, Manig F, Hellwig M, Fava F, Cifani C, Aragno M, Henle T, Joshi L, Tuohy K, Collino M. Effects of Exogenous Dietary Advanced Glycation End Products on the Cross-Talk Mechanisms Linking Microbiota to Metabolic Inflammation. Nutrients 2020; 12:nu12092497. [PMID: 32824970 PMCID: PMC7551182 DOI: 10.3390/nu12092497] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/15/2020] [Accepted: 08/17/2020] [Indexed: 12/12/2022] Open
Abstract
Heat-processed diets contain high amounts of advanced glycation end products (AGEs). Here we explore the impact of an AGE-enriched diet on markers of metabolic and inflammatory disorders as well as on gut microbiota composition and plasma proteins glycosylation pattern. C57BL/6 mice were allocated into control diet (CD, n = 15) and AGE-enriched diet (AGE-D, n = 15) for 22 weeks. AGE-D was prepared replacing casein by methylglyoxal hydroimidazolone-modified casein. AGE-D evoked increased insulin and a significant reduction of GIP/GLP-1 incretins and ghrelin plasma levels, altered glucose tolerance, and impaired insulin signaling transduction in the skeletal muscle. Moreover, AGE-D modified the systemic glycosylation profile, as analyzed by lectin microarray, and increased Nε-carboxymethyllysine immunoreactivity and AGEs receptor levels in ileum and submandibular glands. These effects were associated to increased systemic levels of cytokines and impaired gut microbial composition and homeostasis. Significant correlations were recorded between changes in bacterial population and in incretins and inflammatory markers levels. Overall, our data indicates that chronic exposure to dietary AGEs lead to a significant unbalance in incretins axis, markers of metabolic inflammation, and a reshape of both the intestinal microbiota and plasma protein glycosylation profile, suggesting intriguing pathological mechanisms underlying AGEs-induced metabolic derangements.
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Affiliation(s)
- Raffaella Mastrocola
- Department of Clinical and Biological Sciences, University of Turin, 10125 Turin, Italy; (A.S.C.); (M.A.)
- Correspondence: (R.M.); (M.C.); Tel.: +39-011-6707758 (R.M.); +39-011-6706861 (M.C.)
| | - Debora Collotta
- Department of Drug Science and Technology, University of Turin, 10125 Turin, Italy; (D.C.); (G.F.A.); (F.C.); (R.V.)
| | - Giulia Gaudioso
- Fondazione Edmund Mach, 38010 San Michele all’Adige, Italy; (G.G.); (F.F.); (K.T.)
| | - Marie Le Berre
- Biomedical Sciences, National University of Ireland, H91 TK33 Galway, Ireland; (M.L.B.); (L.J.)
| | - Alessia Sofia Cento
- Department of Clinical and Biological Sciences, University of Turin, 10125 Turin, Italy; (A.S.C.); (M.A.)
| | - Gustavo Ferreira Alves
- Department of Drug Science and Technology, University of Turin, 10125 Turin, Italy; (D.C.); (G.F.A.); (F.C.); (R.V.)
| | - Fausto Chiazza
- Department of Drug Science and Technology, University of Turin, 10125 Turin, Italy; (D.C.); (G.F.A.); (F.C.); (R.V.)
| | - Roberta Verta
- Department of Drug Science and Technology, University of Turin, 10125 Turin, Italy; (D.C.); (G.F.A.); (F.C.); (R.V.)
| | - Ilaria Bertocchi
- Department of Neuroscience, University of Turin, 10124 Turin, Italy;
| | - Friederike Manig
- Chair of Food Chemistry, Technische Universität Dresden, 01062 Dresden, Germany; (F.M.); (M.H.); (T.H.)
| | - Michael Hellwig
- Chair of Food Chemistry, Technische Universität Dresden, 01062 Dresden, Germany; (F.M.); (M.H.); (T.H.)
| | - Francesca Fava
- Fondazione Edmund Mach, 38010 San Michele all’Adige, Italy; (G.G.); (F.F.); (K.T.)
| | - Carlo Cifani
- Pharmacology Unit, School of Pharmacy, University of Camerino, 62032 Camerino, Italy;
| | - Manuela Aragno
- Department of Clinical and Biological Sciences, University of Turin, 10125 Turin, Italy; (A.S.C.); (M.A.)
| | - Thomas Henle
- Chair of Food Chemistry, Technische Universität Dresden, 01062 Dresden, Germany; (F.M.); (M.H.); (T.H.)
| | - Lokesh Joshi
- Biomedical Sciences, National University of Ireland, H91 TK33 Galway, Ireland; (M.L.B.); (L.J.)
| | - Kieran Tuohy
- Fondazione Edmund Mach, 38010 San Michele all’Adige, Italy; (G.G.); (F.F.); (K.T.)
| | - Massimo Collino
- Department of Drug Science and Technology, University of Turin, 10125 Turin, Italy; (D.C.); (G.F.A.); (F.C.); (R.V.)
- Correspondence: (R.M.); (M.C.); Tel.: +39-011-6707758 (R.M.); +39-011-6706861 (M.C.)
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Vaira V, Musso V, Terrasi A, Gaudioso G, Ferreo S, Rossetti V, Morlacchi L, Tosi D, Palleschi A. miRNAs in Lung Transplantation: Small Things That Make Big Differences. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Fusco N, Lopez G, Corti C, Pesenti C, Colapietro P, Ercoli G, Gaudioso G, Faversani A, Gambini D, Despini L, Blundo C, Vaira V, Miozzo M, Ferrero S, Bosari S. Abstract P2-08-21: Mismatch repair protein loss is a prognostic and predictive biomarker in breast cancers regardless of microsatellite instability. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-08-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Despite the approval of pembrolizumab in all tumors showing mismatch-repair (MMR) deficiency and/or microsatellite instability (MSI), there are currently no companion diagnostics for MMR status assessment in breast cancer. Here, we sought to define the diagnostic and prognostic role of MMR and MSI testing in breast cancer patients.
We subjected 444 breast cancers to MMR immunohistochemistry (IHC) and MSI analysis. Cases were classified as MMR-proficient (pMMR), MMR-deficient (dMMR), and MMR-heterogeneous (hMMR) based on the loss of immunoreactivity; MSI was defined by the instability in the five indicators recommended by the National Cancer Institute for endometrial and colorectal cancers. Correlation of MMR status with patients' survival was assessed using the Kaplan-Meier estimator.
In 75 patients (17%) the loss of MMR proteins was homogeneous, classified as dMMR, while 55 cases (12%) were hMMR. The prevalence of cancers with loss of the MMR proteins was homogeneous across ER+ breast cancers (15-19% for dMMR and 10-18% for hMMR tumors). The level of overlap between IHC and MSI analysis was 9% (p<0.0001). Among ER+/HER2- carcinomas, pMMR and hMMR patients displayed better survival rates (p=0.008). In chemo-treated ER-/HER2- breast cancers, the dMMR status was a marker of good prognosis (p<0.001).
Our study documents the clinical impact of MMR testing in a large series of breast cancers, using the most commonly adopted diagnostic tools and criteria. We show that MMR protein loss is a rather common event in breast cancer and has a remarkable degree of intra-tumor heterogeneity, therefore making the analysis of a small area of the tumor, or a small biopsy, of little clinical value. Our investigation supports the concept that MSI occurs rarely in breast cancer and demonstrate that this condition is restricted to a minority of tumors with MMR protein loss. These data suggest that MMR IHC and MSI analysis should not be considered as interchangeable tests in the diagnostic workup of breast carcinomas. Finally, our observations indicate that the complete loss of at least one of the MMR proteins assessed by IHC is able to identify high-risk ER+/HER2- breast cancers that can potentially benefit from pembrolizumab therapy, whereas first-line chemotherapy shows comparatively good results in dMMR ER-/HER2- breast cancers.
Citation Format: Fusco N, Lopez G, Corti C, Pesenti C, Colapietro P, Ercoli G, Gaudioso G, Faversani A, Gambini D, Despini L, Blundo C, Vaira V, Miozzo M, Ferrero S, Bosari S. Mismatch repair protein loss is a prognostic and predictive biomarker in breast cancers regardless of microsatellite instability [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-08-21.
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Affiliation(s)
- N Fusco
- University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy; Breast Surgery Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - G Lopez
- University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy; Breast Surgery Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - C Corti
- University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy; Breast Surgery Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - C Pesenti
- University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy; Breast Surgery Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - P Colapietro
- University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy; Breast Surgery Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - G Ercoli
- University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy; Breast Surgery Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - G Gaudioso
- University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy; Breast Surgery Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - A Faversani
- University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy; Breast Surgery Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - D Gambini
- University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy; Breast Surgery Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - L Despini
- University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy; Breast Surgery Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - C Blundo
- University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy; Breast Surgery Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - V Vaira
- University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy; Breast Surgery Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - M Miozzo
- University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy; Breast Surgery Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - S Ferrero
- University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy; Breast Surgery Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - S Bosari
- University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy; Breast Surgery Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
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