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Koukourakis IM, Xanthopoulou E, Sgouras TI, Kouroupi M, Giatromanolaki A, Kouloulias V, Tiniakos D, Zygogianni A. Preoperative chemoradiotherapy induces multiple pathways related to anti-tumour immunity in rectal cancer. Br J Cancer 2023; 129:1852-1862. [PMID: 37838813 PMCID: PMC10667544 DOI: 10.1038/s41416-023-02459-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 09/19/2023] [Accepted: 09/29/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND Rectal cancer treated with preoperative radiotherapy (RT) provides an interesting model to study changes induced on cancer cell immuno-phenotype that could be exploited by immunotherapy interventions to improve prognosis. MATERIALS AND METHODS We assessed the expression of HLA-class-I, β2-microglobulin, TAP1, PD-L1 and STING/IFNβ in preoperative biopsies and respective post-RT surgical specimens from patients with rectal cancer (n = 27). The effect of radiation was further investigated in colorectal adenocarcinoma cell lines HT-29 and Caco-2. RESULTS Rectal carcinomas exhibited extensive loss of expression of HLA-Class-I related molecules, which was restored in post-irradiation surgical specimens (P < 0.0001). RT induced the expression of IFNβ and STING in cancer cells and tumour-infiltrating lymphocytes (P < 0.0001). In in vitro experiments, irradiation with 4 Gy or 10 Gy induced the expression of HLA-class-I protein (P < 0.001). PD-L1 levels were transiently induced for two days (P < 0.001). cGAS, STING, IFNβ and the downstream genes (MX1, MX2, UBE2L6v2, IFI6v2 and IFI44) mRNA levels significantly increased after 3 × 8 Gy or 1 × 20 Gy irradiation (P < 0.001). TREX1 mRNA levels remained unaltered. CONCLUSIONS RT induces the IFN-type-I pathway and the expression of HLA-class-I molecules on rectal carcinoma. The transient induction of PD-L1 expression suggests that long-course daily RT may sustain increased PD-L1 levels. Anti-PD-L1/PD-1 immunotherapy could block this immunosuppressive pathway.
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Affiliation(s)
- Ioannis M Koukourakis
- Radiation Oncology Unit, 1st Department of Radiology, Aretaieion University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - Erasmia Xanthopoulou
- Department of Radiotherapy/Oncology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Theologos I Sgouras
- Department of Radiotherapy/Oncology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Maria Kouroupi
- Department of Pathology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Alexandra Giatromanolaki
- Department of Pathology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Vassilios Kouloulias
- Radiation Oncology Unit, 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dina Tiniakos
- Department of Pathology, Aretaieion University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Anna Zygogianni
- Radiation Oncology Unit, 1st Department of Radiology, Aretaieion University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Bekiaridou K, Kambouri K, Giatromanolaki A, Foutzitzi S, Kouroupi M, Aggelidou M, Deftereos S. Predicting Complicated Appendicitis in Children: Pros and Cons of a New Score Combining Clinical Signs, Laboratory Values, and Ultrasound Images (CLU Score). Diagnostics (Basel) 2023; 13:2275. [PMID: 37443669 DOI: 10.3390/diagnostics13132275] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/29/2023] [Revised: 06/22/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND This retrospective study aimed to combine the clinical signs, laboratory values, and ultrasound images of 199 children with acute appendicitis in order to create a new predictive score for complicated appendicitis in children. METHODS The study included children who had clinical examination of abdominal pain (description of pain, anorexia, body temperature, nausea or vomiting, duration of symptoms), laboratory findings on admission (white blood cell, platelets, neutrophils, C-reactive protein), preoperative abdominal ultrasound, and histopathological report after an operation for appendicitis in their records during the period from January 2016 to February 2022. RESULTS According to the statistical analysis of the values using multivariate logistic regression models, the patients with appendiceal diameter ≥ 8.45 mm, no target sign appearance, appendicolith, abscess, peritonitis, neutrophils ≥ 78.95%, C-reactive protein ≥ 1.99 mg/dL, body temperature ≥ 38 °C, pain migration to right lower quadrant, and duration of symptoms < 24 h were more likely to suffer from complicated appendicitis. The new score was comprised of the 10 variables that were found statistically significant in the multivariate logistic model. Each of these variables was assigned a score of 1 due to the values that were associated with complicated appendicitis. CONCLUSIONS A cutoff value of ≥4 has been a good indicator of the final score. The sensitivity with the usage of this score is 81.1%, the specificity 82.4%, the PPV 73.2%, the NPV approaches 88% and finally the accuracy is 81.9%. Also, the pros and cons of this score are discussed in this study.
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Affiliation(s)
- Konstantina Bekiaridou
- Department of Pediatric Surgery, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Katerina Kambouri
- Department of Pediatric Surgery, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | | | - Soultana Foutzitzi
- Department of Radiology, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Maria Kouroupi
- Department of Pathology, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Maria Aggelidou
- Department of Pediatric Surgery, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Savas Deftereos
- Department of Pathology, Democritus University of Thrace, 68100 Alexandroupolis, Greece
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Giovannopoulou E, Karakasi MV, Kouroupi M, Giatromanolaki A, Tsikouras P, Pavlidis P. Safety and efficacy of ovarian tissue autotransplantation: A systematic literature review. Folia Med (Plovdiv) 2023; 65:362-370. [PMID: 38351810 DOI: 10.3897/folmed.65.e89198] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/30/2022] [Indexed: 02/16/2024] Open
Abstract
Ovarian tissue autotransplantation is an innovative fertility preservation technique that has provoked ongoing investigations. The purpose of the present study was to assess the safety and reproductive performance of ovarian tissue autotransplantation. This review is conducted according to PRISMA guidelines. Seven studies met the inclusion criteria. A total of 3427 patients underwent ovarian tissue cryopreservation and 205 received an autotransplantation. Tissue retrieval was mainly performed by laparoscopy and only one major complication occurred. Transplantations were predominantly performed by open procedures and data on safety were insufficient. A total of 295 autotransplantations were analyzed, resulting in 104 pregnancies. Sixty-five pregnancies led to live births, while nine were ongoing at that time. A pregnancy rate (PR) of 50.7% and a live-birth rate (LBR) of 32.7% were observed. Natural conception accounted for 46.3% of live births. No birth deficits were recorded. Ovarian tissue autotransplantation seems to be a safe procedure with acceptable pregnancy rates.
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Affiliation(s)
| | | | - Maria Kouroupi
- General University Hospital of Alexandroupolis, Alexandroupolis, Greece
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4
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Bekiaridou K, Kambouri K, Giatromanolaki A, Foutzitzi S, Kouroupi M, Chrysafis I, Deftereos S. The Prognostic Value of Ultrasound Findings in Preoperatively Distinguishing between Uncomplicated and Complicated Types of Pediatric Acute Appendicitis Based on Correlation with Intraoperative and Histopathological Findings. Diagnostics (Basel) 2022; 12:2315. [PMID: 36292004 PMCID: PMC9600393 DOI: 10.3390/diagnostics12102315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/01/2022] [Revised: 09/11/2022] [Accepted: 09/23/2022] [Indexed: 08/30/2023] Open
Abstract
OBJECTIVE This study compares the preoperative ultrasound findings of all children with a clinical picture of acute appendicitis on the basis of intraoperative and histopathological findings to assess the feasibility of this approach in preoperatively distinguishing between uncomplicated and complicated cases. METHODS This retrospective study includes 224 pediatric patients who underwent ultrasound prior to appendectomy at our institution between January 2016 and February 2022. Logistic regression analysis was used to investigate the association between sonographic and intraoperative histopathological findings. RESULTS Of the 224 participants, 61.1% were intraoperatively diagnosed with uncomplicated appendicitis (59.8% male). Multivariate logistic regression analysis revealed that patients with a higher appendiceal diameter, presence of appendicolith, and peritonitis were more likely to suffer from complicated appendicitis. Finally, the common anatomical position of the appendix and an appendiceal diameter greater than 6 mm had the highest sensitivity (94.6% and 94.5%, respectively) for predicting complicated appendicitis, with the most specific (99.3%) sonographic finding being the existence of an abscess. CONCLUSIONS Preoperative abdominal ultrasound in children with a clinical diagnosis of acute appendicitis can distinguish between uncomplicated and complicated appendicitis in most cases of pediatric appendicitis. A higher appendiceal diameter, the presence of appendicolith, and peritonitis are parameters noted by ultrasound that strongly predict complicated appendicitis.
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Affiliation(s)
- Konstantina Bekiaridou
- Department of Pediatric Surgery, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Katerina Kambouri
- Department of Pediatric Surgery, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | | | - Soultana Foutzitzi
- Department of Radiology, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Maria Kouroupi
- Department of Pathology, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Ioannis Chrysafis
- Department of Radiology, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Savas Deftereos
- Department of Radiology, Democritus University of Thrace, 68100 Alexandroupolis, Greece
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Tsatsaris G, Fasoulakis Z, Koutras A, Ntounis T, Samara AA, Syllaios A, Diamantis A, Kouroupi M, Stamos C, Kontomanolis EN. Primary Cervical Carcinosarcoma: Report of a Rare Case. Surg J (N Y) 2022; 8:e174-e178. [PMID: 35928548 PMCID: PMC9345680 DOI: 10.1055/s-0042-1744152] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 01/31/2022] [Indexed: 11/04/2022] Open
Abstract
Background
Carcinosarcomas are malignant mixed Müllerian tumors (MMMT), containing both epithelial and mesenchymal components. Carcinosarcomas of the uterine cervix comprise an extremely rare histopathological entity, with less than 150 cases reported in the literature to date.
Materials and Methods
A 79-year-old postmenopausal female patient was referred to our gynecological department due to a pelvic mass and vaginal bleeding. A cervical curettage was performed and the histological report revealed a malignant neoplasm with high cellularity consisting of two components; the first was a chondrosarcoma and the latter a adenocarcinoma. A diagnosis of MMMT was confirmed through immunohistochemical (IHC) staining. Neoadjuvant chemotherapy and radiotherapy were implemented, and a year later the patient underwent a radical hysterectomy and oncological pelvic lymph node dissection. She remains disease-free 12 months postoperatively.
Conclusion
Primary cervical carcinosarcomas are extremely rare tumors demonstrating a bipartite profile. Preoperative diagnosis with appropriate immunochemistry testing of this rare entity is crucial to decision making.
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Affiliation(s)
- Georgios Tsatsaris
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Dragana, Alexandroupolis, Greece
| | - Zacharias Fasoulakis
- Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, General Hospital of Athens “ALEXANDRA,” Athens, Greece
| | - Antonios Koutras
- Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, General Hospital of Athens “ALEXANDRA,” Athens, Greece
| | - Thomas Ntounis
- Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, General Hospital of Athens “ALEXANDRA,” Athens, Greece
| | - Athina A. Samara
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | - Athanasios Syllaios
- Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | | | - Maria Kouroupi
- Department of Pathology, Democritus University of Thrace, Dragana, Alexandroupolis, Greece
| | - Charilaos Stamos
- Department of Pathology, Democritus University of Thrace, Dragana, Alexandroupolis, Greece
| | - Emmanuel N. Kontomanolis
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Dragana, Alexandroupolis, Greece
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Giatromanolaki A, Kouroupi M, Balaska K, Koukourakis MI. A Novel Lipofuscin-detecting Marker of Senescence Relates With Hypoxia, Dysregulated Autophagy and With Poor Prognosis in Non-small-cell-lung Cancer. In Vivo 2021; 34:3187-3193. [PMID: 33144423 DOI: 10.21873/invivo.12154] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/17/2020] [Revised: 08/03/2020] [Accepted: 08/07/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND/AIM The role of senescence in defining tumor aggressiveness at a clinical level remains obscure. A novel mixed histochemical/immunohistochemical method (SenTraGor™, STG) detecting lipofuscin accumulation allows the assessment of senescent cells in paraffin-embedded tissue material. MATERIALS AND METHODS STG expression was quantified in 98 surgically resected primary non-small-cell-lung carcinomas (NSCLC). Data were analyzed in parallel with other immunohistochemical markers related to hypoxia and autophagy. RESULTS Strong STG staining was noted in 36/98 cases (36.7%). High STG expression was significantly associated with high HIF1α expression and high expression of glucose (GLUT1) and monocarboxylate (MCT2) transporters, pointing to a link between senescence, hypoxia and glycolysis. High STG expression was also linked with high cytoplasmic accumulation of MAP1-LC3B, TFEB and LAMP2a, suggestive of a blockage of autophagy flux in tumors with intense senescence. Survival analysis showed a direct association with poor survival, independently of stage. CONCLUSION SenTraGor™ provides a reliable methodology to detect lipofuscin accumulation in cancer cells in paraffin-embedded tissues, opening a new field for translational studies focused on senescence.
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Affiliation(s)
- Alexandra Giatromanolaki
- Department of Pathology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Maria Kouroupi
- Department of Pathology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Konstantina Balaska
- Department of Pathology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Michael I Koukourakis
- Department of Radiotherapy/Oncology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Koukourakis IM, Giakzidis AG, Kouroupi M, Giatromanolaki A, Abatzoglou I, Karpouzis A, Koukourakis MI. Cutaneous squamous-cell carcinoma of the head-neck area refractory to chemo-radiotherapy: benefit from anti-PD-1 immunotherapy. BJR Case Rep 2021; 7:20200170. [PMID: 34131497 PMCID: PMC8171141 DOI: 10.1259/bjrcr.20200170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/25/2020] [Accepted: 01/21/2021] [Indexed: 11/26/2022] Open
Abstract
Objective: Radiotherapy provides excellent results in locally advanced cutaneous squamous-cell carcinoma of the head and neck area (cSCC-HN), with a 2-year local progression-free interval obtained for about 80% of patients. Overexpression of immune checkpoint co-inhibitory molecules, like PD-L1 (programmed death ligand 1), by cancer cells may define local immunosuppression, tumour escape from immune surveillance and reduced radiotherapy efficacy. Methods: A 65-year-old female, with a large exophytic cSCC-HN invading adjacent soft tissues, was treated with hypofractionated accelerated chemo-radiotherapy. The patient received four bi-weekly cycles of chemotherapy concurrently with eight fractions of 5.5 Gy (two fractions per week). Two months after the end of chemo-radiotherapy, the tumour was stable in dimensions, without any signs of symptomatic relief. The patient was, after that, treated with anti-PD-1 immunotherapy (nivolumab). The tumour gradually regressed, reaching partial response after four cycles and complete response after 16 cycles of nivolumab. No side-effects related to immunotherapy were recorded. The patient is alive and without evidence of disease 28 months after radiotherapy. Conclusions: Treatment of patients with chemo- and radio-resistant cSCC-HN with immunotherapy may optimize the efficacy of radiotherapy by stimulating immunological tumour rejection mechanisms. cSCC-HN patients who fail to respond to chemo-radiotherapy completely are expected to benefit the most from immunotherapy because of the radio-vaccination effect expected from the preceded radiotherapy.
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Affiliation(s)
- Ioannis M Koukourakis
- Department of Radiotherapy - Oncology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Axiotis G Giakzidis
- Department of Radiotherapy - Oncology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Maria Kouroupi
- Department of Pathology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Alexandra Giatromanolaki
- Department of Pathology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Ioannis Abatzoglou
- Department of Radiotherapy - Oncology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Antonios Karpouzis
- Department of Dermatology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Michael I Koukourakis
- Department of Radiotherapy - Oncology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Giatromanolaki A, Koukourakis IM, Chatzipantelis P, Kouroupi M, Balaska K, Koukourakis MI. Rectal cancer induces a regulatory lymphocytic phenotype in the tumor-draining lymph nodes to promote cancer cell installation. Immunol Res 2020; 68:363-372. [PMID: 33150567 DOI: 10.1007/s12026-020-09161-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 07/29/2020] [Accepted: 10/30/2020] [Indexed: 01/07/2023]
Abstract
Tumor-draining lymph nodes (TDLNs) are critical organs, where activation of B cells and T cells is orchestrated. Effector or regulatory anti-tumor immune responses are reflected by the composition of the lymphocytic and monocytic cell population of the node. Aside from the migratory cancer cell abilities, immune cell phenotypic changes in the TDLNs may define nodal invasion by cancer. We assessed the qualitative and quantitative differences between lymphocytic phenotypes in regional TDLNs, in 20 node-negative and 20 node-positive patients (involved and uninvolved nodes) with rectal adenocarcinomas. Benign reactive nodes were also analyzed. CD8+ cells, the main source of cytotoxic T cells, were increased in all TDLNs and, even stronger, in the involved nodes. The percentage of CD4+ cells were significantly increased in negative and uninvolved nodes, while the CD4/CD8 ratio was significantly lower in involved TDLNs. CD25+ and FOXP3+ regulatory lymphocytes, however, prevailed in involved nodes, while uninvolved and negative nodes had a low presence of these regulatory cells. CD20+ B cells were also more abundant in involved nodes. PD-1+ lymphocytes were localized in the germinal centers. A significantly lower percentage of PD-1+ lymphocytes were noted in involved nodes. The development of a regulatory lymphocytic phenotype in the TDLNs appears as an important mechanism that allows cancer cell installation into the nodal environment. As negative/uninvolved TDLNs had a less severe immunosuppression, it is postulated that secreted molecules by cancer cells gradually attenuate the anti-tumor defenses of the TDLNs allowing the subsequent intra-nodal growth of cancer.
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Affiliation(s)
- Alexandra Giatromanolaki
- Department of Pathology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.
| | - Ioannis M Koukourakis
- Department of Radiotherapy / Oncology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Paschalis Chatzipantelis
- Department of Pathology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Maria Kouroupi
- Department of Pathology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Konstantina Balaska
- Department of Pathology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Michael I Koukourakis
- Department of Radiotherapy / Oncology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
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Giatromanolaki A, Kouroupi M, Pouliliou S, Mitrakas A, Hasan F, Pappa A, Koukourakis MI. Ectonucleotidase CD73 and CD39 expression in non-small cell lung cancer relates to hypoxia and immunosuppressive pathways. Life Sci 2020; 259:118389. [PMID: 32898522 DOI: 10.1016/j.lfs.2020.118389] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/24/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023]
Abstract
AIMS Adenosine triphosphate (ATP) is released at a high concentration in the tumor microenvironment. The overexpression of ectonucleotidases in non-small-cell lung cancer (NSCLC), metabolizing ΑΤP to the immunosuppressive adenosine, is studied. MATERIALS AND METHODS We examined the expression of the ectonucleotidases CD73 and CD39 in NSCLC in parallel with immunological parameters and markers of hypoxia and anaerobic metabolism. In vitro experiments with A549 and H1299 lung cancer cell lines were also conducted. RESULTS CD73 and CD39 were not expressed by normal bronchial and alveolar epithelium. In contrast, these were overexpressed by cancer cells, cancer-associated fibroblasts (CAFs), and tumor-infiltrating lymphocytes (TILs). High CD73 cancer cell expression was directly linked with lactate dehydrogenase LDH5 and with hypoxia-inducible factor HIF1α expression by cancer cells. The expression of CD39 by CAFs was directly linked with PD-L1 expression by cancer cells. A significant abundance of FOXP3+ and PD-1+ TILs was noted in tumors with high CD73 and CD39 stroma expression. In in vitro experiments, hypoxia and acidity induced CD73 mRNA and protein levels in cancer cell lines. Exposure of cancer cell lines to adenosine induced the expression of PD-L1 and LDHA mRNA and protein levels. CONCLUSION Ectonucleotidases are up-regulated in cancer cells, CAFs, and TILs in lung tumors. Such overexpression is linked with regulatory TIL-phenotype and PD-L1 up-regulation by cancer cells. Overexpression of LDH5 is up-regulated by adenosine, creating a vicious cycle, as the high amounts of ATP produced by LDH5-mediated anaerobic glycolysis promote the production of adenosine by a tumor microenvironment rich in ectonucleotidases.
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Affiliation(s)
- Alexandra Giatromanolaki
- Department of Pathology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.
| | - Maria Kouroupi
- Department of Pathology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Stamatia Pouliliou
- Department of Radiotherapy/Oncology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Achilleas Mitrakas
- Department of Radiotherapy/Oncology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Fatma Hasan
- Department of Molecular Biology and Genetics, Democritus University of Thrace, University Campus Dragana, 68100 Alexandroupolis, Greece
| | - Aglaia Pappa
- Department of Molecular Biology and Genetics, Democritus University of Thrace, University Campus Dragana, 68100 Alexandroupolis, Greece
| | - Michael I Koukourakis
- Department of Radiotherapy/Oncology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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10
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Chatzipantelis P, Koukourakis M, Kouroupi M, Giatromanolaki A. P16 detection in benign, precursor epithelial lesions and carcinomas of head and neck. Pathol Res Pract 2020; 216:153035. [PMID: 32703498 DOI: 10.1016/j.prp.2020.153035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/20/2020] [Accepted: 05/25/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) had recently been implicated in the pathogenesis of Head and Neck SCCs. The biological role of HPV in benign and pre-cancerous lesions is far less studied. p16 is a widely accepted marker to detect immonohistochemically the presence of HPV. METHODS We evaluated, immunohistochemically, expression of p16 in 212 specimens: glottis, supraglottis, oropharynx, nasal/paranasal, with various diagnoses: hyperplasia, polyp/nodule, keratosis, papilloma, inverted papilloma, dysplasia, cancer (SCC). Analysis was completed according to location and disease. RESULTS Hyperplasias/polyps were all negative for p16. A small percentage of papillomas was p16+ regardless of their location (12.5 %), the majority of inverted papillomas were p16+ (78.6 %) and statistically significant (p < 0.04). In carcinomas, 18/59 were p16+ (30.5 %): nasal/paranasal SCCs had a significantly higher percentage of p16+ cancer cells compared to glottis (p = 0.009), while tumours of the supraglottis/oropharynx had an intermediate score for p16+ cells (p = 0.07). Dysplasias were p16+ in 9/64 (14 %) regardless of grading (p = 0.03 compared to carcinomas). CONCLUSION p16 was highly detected in inverted papillomas and in certain anatomic sites; however, it failed to be traced in benign lesions and only rarely encountered in dysplasias.
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Affiliation(s)
- Paschalis Chatzipantelis
- Department of Pathology, Medical Department, Democritus University of Thrace, Alexandroupolis, Greece.
| | - Michail Koukourakis
- Department of Radiotherapy-Oncology, Medical Department, Democritus University of Thrace, Alexandroupolis, Greece
| | - Maria Kouroupi
- Department of Pathology, Medical Department, Democritus University of Thrace, Alexandroupolis, Greece
| | - Alexandra Giatromanolaki
- Department of Pathology, Medical Department, Democritus University of Thrace, Alexandroupolis, Greece
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Giatromanolaki A, Kouroupi M, Balaska K, Koukourakis MI. Immunohistochemical detection of senescence markers in human sarcomas. Pathol Res Pract 2019; 216:152800. [PMID: 31899047 DOI: 10.1016/j.prp.2019.152800] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 12/14/2019] [Accepted: 12/20/2019] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Senescent cells in tumors are not inert cells but exert bystander effects by developing secretory phenotypes affecting the extracellular matrix and interfering the biological behavior of adjacent tumor cells. MATERIALS AND METHODS We assessed putative senescent cell content in a series of human sarcomas, using in parallel markers related to cell proliferation (Ki67), DNA damage (γH2Ax), lipofuscin detection (SenTraGor®) and two cyclin-dependent kinase CDK-inhibitors (p16/INK4a and p21/cip/waf21). RESULTS Necrosis was directly linked with the size of tumors (p = 0.02, r = 0.25), number of mitosis (p = 0.05, r = 0.21) and inversely with the expression of γH2Ax (p = 0.01, r = 0.28). Smaller tumors (less than 3 cm) had a higher p16 expression (p = 0.07); Moreover, in group analysis, tumors with lack of expression of p16 had significantly higher necrosis score (p = 0.03). Linear regression analysis showed that p21 expression was strongly and directly related with MIB1 (p < 0.0001, r = 0.44) and with Lipofuscin expression (p = 0.02, r = 0.26). CONCLUSION Senescence markers are extensively expressed in human sarcomas and correlated with histopathological features. However, p16, p21 and Lipofuscin expression show different patterns, suggesting that these markers may detect different senescence phenotypes. In addition, our data suggest that the novel marker SenTraGor® may detect phenotypes of senescent cells involving p21 activation.
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Affiliation(s)
- Alexandra Giatromanolaki
- Departments of Pathology, Democritus University of Thrace and University General Hospital of Alexandroupolis, Alexandroupolis 68100, Greece.
| | - Maria Kouroupi
- Departments of Pathology, Democritus University of Thrace and University General Hospital of Alexandroupolis, Alexandroupolis 68100, Greece
| | - Konstantina Balaska
- Departments of Pathology, Democritus University of Thrace and University General Hospital of Alexandroupolis, Alexandroupolis 68100, Greece
| | - Michael I Koukourakis
- Radiotherapy/Oncology, Democritus University of Thrace and University General Hospital of Alexandroupolis, Alexandroupolis 68100, Greece
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12
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Aggelidou M, Kambouri K, Kouroupi M, Cassimos D, Foutzitzi S, Deftereos S. Acute eosinophilic appendicitis after generalized skin reaction due to unknown cause in a child: Case report and literature review. Clin Pract 2019; 9:1177. [PMID: 31579497 PMCID: PMC6763710 DOI: 10.4081/cp.2019.1177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Received: 06/03/2019] [Accepted: 08/30/2019] [Indexed: 12/25/2022] Open
Abstract
Acute eosinophilic appendicitis (AEA) is a rare variant of appendix inflammation possibly linked to allergy. Histopathological evidence of eosinophilic infiltration of the muscularis propria and edema separating the muscle fibers is the gold standard for the diagnosis. Here, we report a case of a young boy with AEA following a skin reaction of possible allergic origin. A 6-year-old male was presented to the emergency department with a two-day diffuse abdominal pain and tenderness in the right lower quadrant. A possible allergic reaction had occurred five days before as a pruritic rash. There was no history of allergy and the stool examination was negative for parasites. The initial diagnosis was acute appendicitis, and appendectomy was performed. The histopathological diagnosis was AEA. Further studies on the proper diagnostic and treatment approach of AEA before surgery are required.
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Affiliation(s)
- Maria Aggelidou
- Department of Pediatric Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, Dragana, Alexandroupolis
| | - Katerina Kambouri
- Department of Pediatric Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, Dragana, Alexandroupolis
| | - Maria Kouroupi
- Department of Pathology, Democritus University of Thrace, University Hospital of Alexandroupolis, Dragana, Alexandroupolis
| | - Dimitrios Cassimos
- Department of Pediatrics, Democritus University of Thrace, University Hospital of Alexandroupolis, Dragana, Alexandroupolis
| | - Soultana Foutzitzi
- Department of Radiology, Democritus University of Thrace, University Hospital of Alexandroupolis, Dragana, Alexandroupolis, Greece
| | - Savas Deftereos
- Department of Radiology, Democritus University of Thrace, University Hospital of Alexandroupolis, Dragana, Alexandroupolis, Greece
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13
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Sivridis E, Kouroupi M, Koukourakis MI, Arelaki S, Lyratzopoulos N, Giatromanolaki A. Rheumatoid nodules in thyroid gland parenchyma as an expression of rheumatoid arthritis: a case report. J Med Case Rep 2019; 13:159. [PMID: 31133043 PMCID: PMC6537448 DOI: 10.1186/s13256-019-2113-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Received: 09/24/2018] [Accepted: 05/05/2019] [Indexed: 11/10/2022] Open
Abstract
Background The rheumatoid nodule is the most common extra-articular manifestation of rheumatoid arthritis. When present, it is readily identified in conventional hematoxylin and eosin sections. Case presentation We report a case with several rheumatoid nodules in a thyroid gland of a 33-year-old Greek woman with a 3-year history of rheumatoid arthritis treated with methotrexate, after having total thyroidectomy for hypothyroidism. Conclusion To the best of our knowledge, this is the first time that rheumatoid nodules have been encountered in the thyroid gland.
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Affiliation(s)
- Efthimios Sivridis
- Department of Pathology, Democritus University of Thrace Medical School and University General Hospital of Alexandroupolis, 68100, Alexandroupolis, Greece
| | - Maria Kouroupi
- Department of Pathology, Democritus University of Thrace Medical School and University General Hospital of Alexandroupolis, 68100, Alexandroupolis, Greece.
| | - Michael Ioannis Koukourakis
- Department of Radiotherapy/Oncology, Democritus University of Thrace Medical School and University General Hospital of Alexandroupolis, 68100, Alexandroupolis, Greece
| | - Stella Arelaki
- Department of Pathology, Democritus University of Thrace Medical School and University General Hospital of Alexandroupolis, 68100, Alexandroupolis, Greece
| | - Nikolaos Lyratzopoulos
- Department of Medicine, Democritus University of Thrace Medical School and University General Hospital of Alexandroupolis, 68100, Alexandroupolis, Greece
| | - Alexandra Giatromanolaki
- Department of Pathology, Democritus University of Thrace Medical School and University General Hospital of Alexandroupolis, 68100, Alexandroupolis, Greece
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14
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Kouroupi M, Sivridis E, Papazoglou D, Koukourakis MI, Giatromanolaki A. Hypoxia Inducible Factor Expression and Angiogenesis - Analysis in the Pituitary Gland and Patterns of Death. ACTA ACUST UNITED AC 2018; 32:185-190. [PMID: 29275318 DOI: 10.21873/invivo.11223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 10/01/2017] [Revised: 10/18/2017] [Accepted: 10/19/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND/AIM We investigated the expression of angiogenesis and hypoxia markers in the adenohypophysis and neurohypophysis of patients who died from various acute or chronic diseases. MATERIALS AND METHODS Paraffin-embedded material of pituitary glands (97 patients) was investigated immunohistochemically for vascular density (CD31) and the expression of vascular endothelial growth factor (VEGF) and of hypoxia inducible factors HIF1α and HIF2α. RESULTS Vascular density, and HIF1α/HIF2α reactivity is directly related with VEGF expression in the pituitary gland, suggesting that the HIF pathway may regulate the vascular density and blood flow in the gland under hypoxic conditions. HIF2α appears to be a key regulator in neurohypophysis, whilst in adenohypophysis HIF1α and HIF2α are equally expressed. Chronic conditions, including alcoholism and substance abuse, seem to activate the HIF pathway in both neuro- and adeno-hypophysis. CONCLUSION The HIF pathway has an important role in regulating vascular density and blood flow in the pituitary gland.
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Affiliation(s)
- Maria Kouroupi
- Department of Pathology, University General Hospital of Alexandroupolis/Democritus University of Thrace, Alexandroupolis, Greece
| | - Efthimios Sivridis
- Department of Pathology, University General Hospital of Alexandroupolis/Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimitrios Papazoglou
- Department of Internal Medicine, University General Hospital of Alexandroupolis/Democritus University of Thrace, Alexandroupolis, Greece
| | - Michael I Koukourakis
- Department of Radiotherapy/Oncology, University General Hospital of Alexandroupolis/Democritus University of Thrace, Alexandroupolis, Greece
| | - Alexandra Giatromanolaki
- Department of Pathology, University General Hospital of Alexandroupolis/Democritus University of Thrace, Alexandroupolis, Greece
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15
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Koukourakis IM, Perente Memet MS, Kouroupi M, Simopoulos K. Ectopic Pancreatic Tissue Adherent to the External Gallbladder Wall. Case Rep Gastroenterol 2018; 12:170-175. [PMID: 29805362 PMCID: PMC5968295 DOI: 10.1159/000488445] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 03/14/2018] [Indexed: 12/16/2022] Open
Abstract
Heterotopic pancreatic tissue can be found in the gastrointestinal tract, with the stomach and small bowel being the most common sites of localization. The gallbladder is seldom affected. Here, we report 2 cases of ectopic pancreas within the fatty tissue adherent to the organ wall. Both cases concerned young women (31 and 36 years old) who were treated with a laparoscopic cholecystectomy due to persistent abdominal symptoms thought to be related to chronic cholecystitis. Pathological examination revealed the presence of ectopic pancreatic tissue type 1.
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Affiliation(s)
| | | | - Maria Kouroupi
- Department of Pathology, Democritus University of Thrace, Alexandroupolis, Greece
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16
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Koukourakis MI, Giatromanolaki A, Fylaktakidou K, Kouroupi M, Sivridis E, Zois CE, Kalamida D, Mitrakas A, Pouliliou S, Karagounis IV, Simopoulos K, Ferguson DJP, Harris AL. Amifostine Protects Mouse Liver Against Radiation-induced Autophagy Blockage. Anticancer Res 2018; 38:227-238. [PMID: 29277777 DOI: 10.21873/anticanres.12212] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 11/13/2017] [Accepted: 11/14/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Amifostine is the only selective normal tissue cytoprotector, approved for the protection against platinum toxicities and radiotherapy-induced xerostomia. Free radical scavenger and DNA repair activities have been attributed to the drug. MATERIALS AND METHODS We investigated the effect of amifostine on autophagy, lysosomal biogenesis and lipophagy of normal mouse liver exposed to clinically relevant doses of radiation. RESULTS The study provides evidence that ionizing radiation blocks autophagy activity and lysosomal biogenesis in normal mouse liver. Amifostine, protects the liver autophagic machinery and induces lysosomal biogenesis. By suppressing autophagy, ionizing radiation induces lipid droplet accumulation, while pre-treatment with amifostine protects lipophagy and up-regulates the TIP47 protein and mRNA levels, showing a maintenance of lipid metabolism in the liver cells. CONCLUSION It is concluded that amifostine, aside to DNA protection activity, exerts its cytoprotective function by preventing radiation-induced blockage of autophagy, lysosomal biogenesis and lipophagy.
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Affiliation(s)
- Michael I Koukourakis
- Department of Radiotherapy/Oncology, Democritus University of Thrace/University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Alexandra Giatromanolaki
- Department of Pathology, Democritus University of Thrace/University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Konstantina Fylaktakidou
- Department of Molecular Biology and Genetics, Democritus University of Thrace/University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Maria Kouroupi
- Department of Pathology, Democritus University of Thrace/University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Efthimios Sivridis
- Department of Pathology, Democritus University of Thrace/University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Christos E Zois
- CR UK Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, Headington, Oxford, U.K
| | - Dimitra Kalamida
- Department of Radiotherapy/Oncology, Democritus University of Thrace/University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Achilleas Mitrakas
- Department of Radiotherapy/Oncology, Democritus University of Thrace/University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Stamatia Pouliliou
- Department of Radiotherapy/Oncology, Democritus University of Thrace/University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Ilias V Karagounis
- Department of Radiotherapy/Oncology, Democritus University of Thrace/University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Konstantinos Simopoulos
- Department of Experimental Surgery, Democritus University of Thrace/University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - David J P Ferguson
- CR UK Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, Headington, Oxford, U.K
| | - Adrian L Harris
- CR UK Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, Headington, Oxford, U.K
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17
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Sifaki-Pistolla D, Koinis F, Chatzea VE, Lionakis S, Epitropaki K, Vasilaki E, Romanidou T, Kouroupi M, Frouzi E, Georgoulias V, Lionis C, Kyriakidis P, Aggelaki S, Tzanakis N. Towards developing evidence-based GIS-driven infrastructure for cancer surveillance in Greece. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw171.028] [Citation(s) in RCA: 2] [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: 11/15/2022] Open
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