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Mazzaracchio V, Rios Maciel M, Porto Santos T, Toda-Peters K, Shen AQ. Duplex Electrochemical Microfluidic Sensor for COVID-19 Antibody Detection: Natural versus Vaccine-Induced Humoral Response. Small 2023; 19:e2207731. [PMID: 36916701 DOI: 10.1002/smll.202207731] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/03/2023] [Indexed: 06/18/2023]
Abstract
The rapid transmission and resilience of coronavirus disease 2019 (COVID-19) have led to urgent demands in monitoring humoral response for effective vaccine development, thus a multiplex co-detection platform to discriminate infection-induced from vaccine-induced antibodies is needed. Here a duplex electrochemical immunosensor for co-detection of anti-nucleocapsid IgG (N-IgG) and anti-spike IgG (S-IgG) is developed by using a two-working electrode system, via an indirect immunoassay, with antibody quantification obtained by differential pulse voltammetry. The screen-printed electrodes (SPEs) are modified by carbon black and electrodeposited gold nanoflowers for maximized surface areas, enabling the construction of an immunological chain for S-IgG and N-IgG electrochemical detection with enhanced performance. Using an optimized immunoassay protocol, a wide linear range between 30-750 and 20-1000 ng mL-1 , and a limit of detection of 28 and 15 ng mL-1 are achieved to detect N-IgG and S-IgG simultaneously in serum samples. This duplex immunosensor is then integrated in a microfluidic device to obtain significantly reduced detection time (≤ 7 min) while maintaining its analytical performance. The duplex microfluidic immunosensor can be easily expanded into multiplex format to achieve high throughput screening for the sero-surveillance of COVID-19 and other infectious diseases.
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Affiliation(s)
- Vincenzo Mazzaracchio
- Micro/Bio/Nanofluidics Unit, Okinawa Institute of Science and Technology Graduate University, Onna-son, Okinawa, 904-0495, Japan
- Department of Chemical Science and Technologies, University of Rome "Tor Vergata,", Via della Ricerca Scientifica, 00133, Rome, Italy
| | - Mauricio Rios Maciel
- Micro/Bio/Nanofluidics Unit, Okinawa Institute of Science and Technology Graduate University, Onna-son, Okinawa, 904-0495, Japan
| | - Tatiana Porto Santos
- Micro/Bio/Nanofluidics Unit, Okinawa Institute of Science and Technology Graduate University, Onna-son, Okinawa, 904-0495, Japan
| | - Kazumi Toda-Peters
- Micro/Bio/Nanofluidics Unit, Okinawa Institute of Science and Technology Graduate University, Onna-son, Okinawa, 904-0495, Japan
| | - Amy Q Shen
- Micro/Bio/Nanofluidics Unit, Okinawa Institute of Science and Technology Graduate University, Onna-son, Okinawa, 904-0495, Japan
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Detert M, Santos TP, Shen AQ, Calabrese V. Alignment-Rheology Relationship of Biosourced Rod-Like Colloids and Polymers under Flow. Biomacromolecules 2023. [PMID: 37364888 DOI: 10.1021/acs.biomac.3c00347] [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: 06/28/2023]
Abstract
Fluids composed of biosourced rod-like colloids (RC) and rod-like polymers (RP) have been extensively studied due to various promising applications relying on their flow-induced orientation (e.g., fiber spinning). However, the relationship between RC and RP alignment and the resulting rheological properties is unclear due to experimental challenges. We investigate the alignment-rheology relationship for a variety of biosourced RC and RP, including cellulose-based particles, filamentous viruses, and xanthan gum, by simultaneous measurements of the shear viscosity and fluid anisotropy under rheometric shear flows. For each system, the RC and RP contribution to the fluid viscosity, captured by the specific viscosity ηsp, follows a universal trend with the extent of the RC and RP alignment independent of concentration. We further exploit this unique rheological-structural link to retrieve a dimensionless parameter (β) directly proportional to ηsp at zero shear rate (η0,sp), a parameter often difficult to access from experimental rheometry for RC and RP with relatively long contour lengths. Our results highlight the unique link between the flow-induced structural and rheological changes occurring in RC and RP fluids. We envision that our findings will be relevant in building and testing microstructural constitutive models to predict the flow-induced structural and rheological evolution of fluids containing RC and RP.
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Affiliation(s)
- Marvin Detert
- Physics of Fluids, Max Planck Center Twente for Complex Fluid Dynamics, and J. M. Burgers Centre for Fluid Dynamics, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
- Physics of Interfaces and Nanomaterials, MESA+ Institute, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
| | | | - Amy Q Shen
- Okinawa Institute of Science and Technology, Onna-son, Okinawa 904-0495, Japan
| | - Vincenzo Calabrese
- Okinawa Institute of Science and Technology, Onna-son, Okinawa 904-0495, Japan
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Francisco CRL, Santos TP, Cunha RL. Nano and micro lupin protein-grape seed extract conjugates stabilizing oil-in-water emulsions. Food Hydrocoll 2023. [DOI: 10.1016/j.foodhyd.2022.108117] [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: 11/28/2022]
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Abstract
Microfluidic technology enables judicious control of the process parameters on a small length scale, which in turn allows speeding up the destabilization of emulsion droplets interface in microfluidic devices. In this light, microfluidic channels can be used as an efficient tool to assess emulsion stability and to observe the behavior of the droplets immediately after their formation, enabling to determine whether or not they are prone to re-coalescence. Observation of the droplets after emulsifier adsorption also allows the investigation of emulsion stability over time. Both evaluations would contribute to determine emulsion stability aiming at specific applications in food and pharmaceutical industries. Furthermore, emulsion coalescence can also be performed under extremely controlled conditions within the microfluidic devices in order to explore emulsion droplets as micro-reactors (for regulated biological and chemical assays). Such microfluidic procedures can be performed either in confined environments or under dynamic flow conditions. Under confined environments, droplets are observed in fixed positions simulating different environmental conditions. On the other hand, with the scrutiny of emulsions under dynamic flow processes, it is possible to determine the behavior of the droplets when subjected to shear forces, comparable to those experienced in conventional emulsification techniques or even in pumping operations. Given the above, this paper reviews different microfluidic techniques (such as changing channel geometry or wettability) hitherto used to destabilize emulsions, mainly focusing on the specificities of each study, whether the droplets are destabilized in confined or dynamic flow processes. Thereby, by going deeper into this review, readers will be able to identify different strategies for emulsion destabilization (in order to understand stabilizing mechanisms or even to apply these droplets as micro-reactors), as this paper shows the particularities of the most recent studies and elucidates the current state-of-the-art of this microfluidic-related application.
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Affiliation(s)
- Tatiana Porto Santos
- Department of Food Engineering, Faculty of Food Engineering, University of Campinas, Rua Monteiro Lobato, 80-CEP 13083-862 Campinas, Brazil.
| | - Cesare M Cejas
- Microfluidics, MEMS, Nanostructures Laboratory, CNRS Chimie Biologie Innovation (CBI) UMR 8231, Institut Pierre Gilles de Gennes (IPGG), ESPCI Paris, PSL Research University, 6 rue Jean Calvin 75005, Paris, France.
| | - Rosiane Lopes Cunha
- Department of Food Engineering, Faculty of Food Engineering, University of Campinas, Rua Monteiro Lobato, 80-CEP 13083-862 Campinas, Brazil.
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Fonseca LR, Santos TP, Czaikoski A, Cunha RL. Microfluidics-based production of chitosan-gellan nanocomplexes encapsulating caffeine. Food Res Int 2022; 151:110885. [PMID: 34980412 DOI: 10.1016/j.foodres.2021.110885] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 08/22/2021] [Revised: 11/16/2021] [Accepted: 12/07/2021] [Indexed: 11/04/2022]
Abstract
Electrostatic complexes produced by interactions between polysaccharides have promising applications in the medical, pharmaceutical and food fields. In this light, for the development of such particles, microfluidics emerges as a promising technique in which processes occur at a strict laminar flow regime, allowing diffusion-dominated transport and particle formation in highly-controlled conditions. As a proof of concept, we compared bulk versus microfluidic (different devices simulating a range of residence times) processes for the production of electrostatic complexes of gellan with either chitosan (molecular weight ∼ 28 kDa) or hydrolyzed chitosan (molecular weight ∼ 3 kDa). Regardless of the process, polysaccharide solutions (pH 4.5) were mixed in pre-defined concentrations (polysaccharide ratios) to form electrostatic complexes that were used to encapsulate caffeine. These complexes were characterized by zeta potential measurements and particle size distribution. Overall, microfluidics produced complexes with improved characteristics such as lower polydispersity index (PDI ∼ 0.1) and mean size (∼200 nm) when compared to the conventional bulk process (PDI ∼ 0.3 and mean size ∼ 400 nm). Moreover, hydrolyzed chitosan (HC) contributed to an even smaller size and PDI value of the complexes. Such outcome is associated with the lower molecular weight and higher solubility of HC when comparing to conventional chitosan, which in turn improves electrostatic complexation. Caffeine could also be encapsulated in all complexes, but the highest encapsulation efficiency was achieved using microfluidics (70%) and with the geometry that provided a longer residence time. Therefore, we were able to demonstrate that microfluidics is clearly an effective strategy for generating electrostatic complexes with improved properties. Ultimately, this technique demonstrated a high potential for the production of vehicles of bioactive compounds.
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Affiliation(s)
- Larissa Ribas Fonseca
- Department of Food Engineering and Technology, School of Food Engineering, University of Campinas (UNICAMP), 13083-862 Campinas, SP, Brazil
| | - Tatiana Porto Santos
- Department of Food Engineering and Technology, School of Food Engineering, University of Campinas (UNICAMP), 13083-862 Campinas, SP, Brazil
| | - Aline Czaikoski
- Department of Food Engineering and Technology, School of Food Engineering, University of Campinas (UNICAMP), 13083-862 Campinas, SP, Brazil
| | - Rosiane Lopes Cunha
- Department of Food Engineering and Technology, School of Food Engineering, University of Campinas (UNICAMP), 13083-862 Campinas, SP, Brazil.
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Santos TP, Michelon M, Carvalho MS, Cunha RL. Formation and stability of oil-in-water emulsions based on components of bioprocesses: A microfluidic analysis. Colloids Surf A Physicochem Eng Asp 2021. [DOI: 10.1016/j.colsurfa.2021.126994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Porto Santos T, Cejas CM, Cunha RL, Tabeling P. Unraveling driving regimes for destabilizing concentrated emulsions within microchannels. Soft Matter 2021; 17:1821-1833. [PMID: 33399611 DOI: 10.1039/d0sm01674h] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Coalescence is the most widely demonstrated mechanism for destabilizing emulsion droplets in microfluidic chambers. However, we find that depending on the channel wall surface functionalization, surface zeta potential, type of surfactant, characteristics of the oil as a dispersed phase, or even the presence of externally-induced stress, other different destabilization mechanisms can occur in subtle ways. In general, we observe four regimes leading to destabilization of concentrated emulsions: (i) coalescence, (ii) emulsion bursts, (iii) a combination of the two first mechanisms, attributed to the simultaneous occurrence of coalescence and emulsion bursts; and (iv) compaction of the droplet network that eventually destabilizes to fracture-like behavior. We correlate various physico-chemical properties (zeta potential, contact angle, interfacial tension) to understand their respective influence on the destabilization mechanisms. This work provides insights into possible ways to control or inflict emulsion droplet destabilization for different applications.
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Affiliation(s)
- Tatiana Porto Santos
- Department of Food Engineering, Faculty of Food Engineering, University of Campinas, Rua Monteiro Lobato, 80-CEP 13083-862 Campinas, Brazil. and Microfluidics, MEMS, Nanostructures Laboratory, CNRS Chimie Biologie Innovation (CBI) UMR 8231, Institut Pierre Gilles de Gennes (IPGG), ESPCI Paris, PSL Research University, 6 rue Jean Calvin 75005, Paris, France.
| | - Cesare M Cejas
- Microfluidics, MEMS, Nanostructures Laboratory, CNRS Chimie Biologie Innovation (CBI) UMR 8231, Institut Pierre Gilles de Gennes (IPGG), ESPCI Paris, PSL Research University, 6 rue Jean Calvin 75005, Paris, France.
| | - Rosiane Lopes Cunha
- Department of Food Engineering, Faculty of Food Engineering, University of Campinas, Rua Monteiro Lobato, 80-CEP 13083-862 Campinas, Brazil.
| | - Patrick Tabeling
- Microfluidics, MEMS, Nanostructures Laboratory, CNRS Chimie Biologie Innovation (CBI) UMR 8231, Institut Pierre Gilles de Gennes (IPGG), ESPCI Paris, PSL Research University, 6 rue Jean Calvin 75005, Paris, France.
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Ribas Fonseca L, Porto Santos T, Czaikoski A, Lopes Cunha R. Modulating properties of polysaccharides nanocomplexes from enzymatic hydrolysis of chitosan. Food Res Int 2020; 137:109642. [PMID: 33233221 DOI: 10.1016/j.foodres.2020.109642] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 05/06/2020] [Revised: 08/09/2020] [Accepted: 08/21/2020] [Indexed: 11/16/2022]
Abstract
Synthesis of nanocomplexes is a simple and low-cost technique for the production of encapsulation systems aiming industrial applications, based on the interaction of at least two oppositely charged molecules. Gellan gum (anionic) is a water-soluble biopolymer resistant to stomach pH conditions, therefore an interesting alternative as an encapsulating matrix. Chitosan (cationic) is also widely used due to its biocompatibility and mucoadhesive properties, although its low water solubility is an important step to be overcome for the production of the complexes. To improve this property, many techniques have been employed, but most of them use unsustainable techniques and chemical agents. The enzymatic hydrolysis of chitosan using proteases emerges as an alternative to these drawbacks and, therefore, this study aimed to evaluate the electrostatic nanocomplexation of native (C) or hydrolyzed (HC) chitosan (by porcine pepsin protease) with gellan gum (G). Polysaccharides and nanocomplexes formed with different G:C or G:HC ratio were evaluated by zeta potential measurements, particle size distribution, X-ray diffraction (XRD), Fourier Transform Infrared Spectroscopy (FTIR), Scanning Transmission Electron Microscopy (STEM), intrinsic viscosity and turbidity analyses. Chitosan hydrolysis allowed the formation of a smaller (445.3 nm in pH 4.5) and more soluble structure (3 kDa), which positively influenced the formation of the complexes. The ratios G:HC of 7:3 and 8:2 formed complexes with lower values of zeta potential (13.9 mV and -5.0 mV, respectively), particle size (635.8 nm and 533.6 nm, respectively) and polydispersity (0.28 and 0.23) compared to complexes formed with native chitosan. Overall, our results show that enzymatic hydrolysis of chitosan favored the formation of electrostatic complexes with reduced size and low polydispersity, which can be used as efficient encapsulating matrices for improved targeted delivery and controlled release of bioactive compounds.
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Affiliation(s)
- Larissa Ribas Fonseca
- Department of Food Engineering, Faculty of Food Engineering, University of Campinas (UNICAMP), 13083-862 Campinas, SP, Brazil
| | - Tatiana Porto Santos
- Department of Food Engineering, Faculty of Food Engineering, University of Campinas (UNICAMP), 13083-862 Campinas, SP, Brazil
| | - Aline Czaikoski
- Department of Food Engineering, Faculty of Food Engineering, University of Campinas (UNICAMP), 13083-862 Campinas, SP, Brazil
| | - Rosiane Lopes Cunha
- Department of Food Engineering, Faculty of Food Engineering, University of Campinas (UNICAMP), 13083-862 Campinas, SP, Brazil.
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Santos TP, Costa ALR, Michelon M, Costa LP, Cunha RL. Development of a microfluidic route for the formation of gellan-based microgels incorporating jabuticaba (Myrciaria cauliflora) extract. J FOOD ENG 2020. [DOI: 10.1016/j.jfoodeng.2019.109884] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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10
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Porto Santos T, Cunha RL, Tabeling P, Cejas CM. Colloidal particle deposition on microchannel walls, for attractive and repulsive surface potentials. Phys Chem Chem Phys 2020; 22:17236-17246. [DOI: 10.1039/d0cp01999b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
When both surfaces possess opposite charges, particle deposition increases at low ionic strengths due to van der Waals forces assisted by electrostatic attraction.
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Affiliation(s)
- Tatiana Porto Santos
- Department of Food Engineering, Faculty of Food Engineering, University of Campinas, Rua Monteiro Lobato
- Brazil
- Microfluidics, MEMS
- Nanostructures Laboratory
- CNRS Chimie Biologie Innovation (CBI)
| | - Rosiane Lopes Cunha
- Department of Food Engineering, Faculty of Food Engineering, University of Campinas, Rua Monteiro Lobato
- Brazil
| | - Patrick Tabeling
- Microfluidics, MEMS
- Nanostructures Laboratory
- CNRS Chimie Biologie Innovation (CBI)
- UMR 8231
- Institut Pierre Gilles de Gennes (IPGG)
| | - Cesare M. Cejas
- Microfluidics, MEMS
- Nanostructures Laboratory
- CNRS Chimie Biologie Innovation (CBI)
- UMR 8231
- Institut Pierre Gilles de Gennes (IPGG)
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Santos TP, Cunha RL. In vitro digestibility of gellan gels loaded with jabuticaba extract: Effect of matrix-bioactive interaction. Food Res Int 2019; 125:108638. [DOI: 10.1016/j.foodres.2019.108638] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/19/2019] [Accepted: 08/21/2019] [Indexed: 10/26/2022]
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12
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Santos TP, Cunha RL. Role of process variables on the formation and in vitro digestion of gellan gels. Carbohydr Polym 2018; 192:111-117. [PMID: 29691002 DOI: 10.1016/j.carbpol.2018.03.062] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 11/28/2017] [Revised: 02/26/2018] [Accepted: 03/18/2018] [Indexed: 12/20/2022]
Abstract
Gellan gels were produced using different approaches forming structures with varied potential applications. Gels were characterized from appearance, mechanical properties, water holding capacity (WHC) and microstructure. In addition, in vitro digestibility of these gels was evaluated to understand the effect of gastrointestinal environment on their structure stability. All gels presented high WHC (>80% w/w) but gels were stronger with salt or acid addition, which was associated to the reduction of double helices repulsion of the negatively charged carboxyl groups of gellan. Moreover, low gelation rate induced a more controlled gellan helices aggregation, strengthening even more gels structure. Gellan gels presented resistance to digestion conditions but hardness of these gels during digestion mainly depended on the gelation rate. Based on these findings it would be possible to tune gel properties for a specific application as texture modifier or even as a faecal bulk formation assistant and an "ileal break" inducer.
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Affiliation(s)
- Tatiana Porto Santos
- Department of Food Engineering, Faculty of Food Engineering, University of Campinas (UNICAMP), R. Monteiro Lobato, 80, 13083-862, Campinas, SP, Brazil.
| | - Rosiane Lopes Cunha
- Department of Food Engineering, Faculty of Food Engineering, University of Campinas (UNICAMP), R. Monteiro Lobato, 80, 13083-862, Campinas, SP, Brazil.
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Ribeiro DM, Ribeiro GM, Santos TP, Morrell AC, Chamie L, Serafini P. Totally Robotic Intracorporeal Anastomossis and FireflyTM Fluorescence Imaging with Natural Orifice Specimen Extraction (RNOSE - F) for the Treatment of Bowel Endometriosis, the Technique. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.300] [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: 11/25/2022]
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Ribeiro DM, Ribeiro GM, Santos TP, Morrell AC, Cretella CM. Robotic Transvesical Approach for Vesical-Rectal-Vaginal Fistula, with an Interposition Omental Flap without Intestinal Diversion: A Case of Success. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.299] [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: 11/26/2022]
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Ribeiro DM, Ribeiro GP, Santos TP, Chamie L, Serafini P, Cretella CM. Multifocal Intestinal Endometriosis and Retrocervical Mantle Shape Endometriosis. The Robotic Treatment – State-of-the-Art. J Minim Invasive Gynecol 2015; 22:S118-S119. [DOI: 10.1016/j.jmig.2015.08.330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ribeiro DM, Ribeiro GP, Santos TP, Chamie L, Cretella CM, Serafini P. Incidental Appendectomy in the Surgical Treatment of Deep Endometriosis Infiltrating the Bowel: Anatomopathological Findings in a Series of 109 Patients. J Minim Invasive Gynecol 2015; 22:S30-S31. [PMID: 27679202 DOI: 10.1016/j.jmig.2015.08.084] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- D M Ribeiro
- Clínica Dr. Duarte Miguel Ribeiro, São Paulo, SP, Brazil
| | - G P Ribeiro
- Clínica Dr. Duarte Miguel Ribeiro, São Paulo, SP, Brazil
| | - T P Santos
- Clínica Dr. Duarte Miguel Ribeiro, São Paulo, SP, Brazil
| | - L Chamie
- Chamie Imagem da Mulher, São Paulo, Brazil
| | - C M Cretella
- Clínica Dr. Duarte Miguel Ribeiro, São Paulo, SP, Brazil
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