Publications by authors named "Claudio Vicini"

123 Publications

Barbed reposition pharyngoplasty (BRP) in obstructive sleep apnea treatment: State of the art.

Am J Otolaryngol 2021 Sep 1;43(1):103197. Epub 2021 Sep 1.

Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy; Department ENT & Audiology, University of Ferrara, Ferrara, Italy.

Purpose: In this paper, we perform a systematic review that discusses the state of the art and evolution on the barbed reposition pharyngoplasty (BRP) in the velo-pharyngeal surgery. Clinical evidence and published outcomes of this surgical technique are reported and discussed.

Materials And Methods: We performed a systematic review of the current literature through the analysis of the last 10 years of literature on barbed palate surgery. Study design, number of patients enrolled, inclusion criteria, pre- and posttreatment outcomes (AHI, ODI), surgical success rate, follow-up time and complication has been collected and reported.

Results: 15 studies for a total of 1531 patients, out of which 1061 underwent barbed reposition pharyngoplasty. Five trials were uncontrolled prospective studies (215 patients, 14% of total), nine were retrospective studies (1266 patients, 82,6% of total), and one randomized prospective clinical trial (RCT) (50 patients, 3,32% of total). All analyzed studies reported good outcomes after BRP surgery. Average preoperative values of AHI and ODI reduced in all studies considered with a significative statistical difference between preoperative and postoperative values (p < 0.05 in all cases). The postoperative surgical success rate ranged between 65.4 and 93% of cases. There were no significant intra-operative or post-operative complications in all studies considered in this systematic review.

Conclusions: Barbed reposition pharyngoplasty has proven to be an easy to learn, quick, safe and effective new palatopharyngeal procedure, that can be used in a single level surgery or as a part of multilevel procedures.
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http://dx.doi.org/10.1016/j.amjoto.2021.103197DOI Listing
September 2021

OSA Upper Airways Surgery: A Targeted Approach.

Medicina (Kaunas) 2021 Jul 6;57(7). Epub 2021 Jul 6.

Ear Nose Throat (ENT) Unit, Head & Neck Department, Morgagni-Pierantoni Hospital, Romagna Health Service, 47121 Forlì, Italy.

Obstructive sleep apnea syndrome (OSA) is a multi-factorial disorder, with quite complex endotypes, consisting of anatomical and non-anatomical pathophysiological factors. Continuous positive airway pressure (CPAP) is recognized as the first-line standard treatment for OSA, whereas upper airway (UA) surgery is often recommended for treating OSA patients who have refused or cannot tolerate CPAP. The main results achievable by the surgery are UA expansion, and/or stabilization, and/or removal of the obstructive tissue to different UA levels. The site and pattern of UA collapse identification is of upmost importance in selecting the customized surgical procedure to perform, as well as the identification of the relation between anatomical and non-anatomical factors in each patient. Medical history, sleep studies, clinical examination, UA endoscopy in awake and drug-induced sedation, and imaging help the otorhinolaryngologist in selecting the surgical candidate, identifying OSA patients with mild UA collapsibility or tissue UA obstruction, which allow achievement of the best surgical outcomes. Literature data reported that the latest palatal surgical procedures, such as expansion sphincter palatoplasty or barbed reposition palatoplasty, which achieve soft palatal and lateral pharyngeal wall remodeling and stiffening, improved the Apnea Hypopnea Index, but the outcome analyses are still limited by methodological bias and the limited number of patients' in each study. Otherwise, the latest literature data have also demonstrated the role of UA surgery in the improvement of non-anatomical factors, confirming that a multidisciplinary and multimodality diagnostic and therapeutical approach to OSA patients could allow the best selection of customized treatment options and outcomes.
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http://dx.doi.org/10.3390/medicina57070690DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8305825PMC
July 2021

Association Between Severity of COVID-19 Respiratory Disease and Risk of Obstructive Sleep Apnea.

Ear Nose Throat J 2021 Jul 28:1455613211029783. Epub 2021 Jul 28.

Intensive Care Unit, Morgagni-Pierantoni Hospital, AUSL of Romagna, Forlì, Italy.

Objectives: The purpose of this observational retrospective study was to evaluate, in patients with a severe acute respiratory syndrome coronavirus 2 infection, the association between the severity of coronavirus disease 2019 (COVID-19) respiratory illness and the risk of infected patients to develop obstructive sleep apnea (OSA).

Methods: Ninety-six patients with confirmed COVID-19 infection were enrolled in the study. The STOP-BANG questionnaire to investigate the risk of the OSA syndrome was filled in by the patients at admission. The enrolled patients were divided into 2 groups according to the respiratory disease: group 1 (72 patients), hospitalized patients undergoing conventional oxygen therapy; group 2 (24 patients), patients requiring enhanced respiratory support. STOP-BANG results of these 2 groups were compared to observe whether patients with high OSA risk more frequently presented a severe form of COVID-19.

Results: 41.6% of the patients in group 2 had a STOP-BANG score between 5 and 8 (high risk of having apnea); in contrast, 20.8% of the patients in group 1 had a STOP-BANG score between 5 and 8, with a statistically significant difference between the 2 groups ( = .05). A complementary trend was observed regarding the proportion of patients in the range 0 to 2, which classifies patients at a low risk of OSA (48.6% vs 20.8% for groups 1 and 2, = .01).

Conclusions: According to our data, the chances of having a severe case of COVID-19 should be considered in patients at high risk of OSA.

Current Knowledge/study Rationale: Emerging research suggests that OSA could represent a potentially important risk factor for the severe forms of COVID-19. The purpose of this observational retrospective study was to evaluate the potential association between OSA and the severity of COVID-19 disease.

Study Impact: According to our data, the likelihood of contracting a severe form of COVID-19 disease should be considered in patients at high risk of OSA.
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http://dx.doi.org/10.1177/01455613211029783DOI Listing
July 2021

Impact of COVID-19 pandemic on the incidence of otitis media with effusion in adults and children: a multicenter study.

Eur Arch Otorhinolaryngol 2021 Jul 4. Epub 2021 Jul 4.

Otolaryngology, Head-Neck and Oral Surgery Unit, Department of Head-Neck Surgery, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121, Forli, Italy.

Purpose: To compare and analyze the incidence of otitis media with effusion (OME), before and during the COVID-19-related pandemic period, to evaluate the effects of the social changes (lockdown, continuous use of facial masks, social distancing, reduction of social activities) in the OME incidence in children and adults.

Methods: The number of diagnosed OME in e five referral centers, between 1 March 2018 and 1 March 2021, has been reviewed and collected. To estimate the reduction of OME incidence in children and adults during the COVID-19 pandemic period the OME incidence in three period of time were evaluated and compared: group 1-patients with OME diagnosis achieved between 1/03/2018 and 01/03/2019 (not pandemic period). Group 2-patients with OME diagnosis achieved between 1/03/2019 and 1/03/2020 (not pandemic period). Group 3-patients with OME diagnosis achieved between 1/03/2020 and 1/03/2021 (COVID-19 pandemic period).

Results: In the non-pandemic periods (group 1 and 2), the incidence of OME in the five referral centers considered was similar, with 482 and 555 diagnosed cases, respectively. In contrast, the OME incidence in the same centers, during the pandemic period (group 3) was clearly reduced with a lower total number of 177 cases of OME estimated. Percentage variation in OME incidence between the first non-pandemic year considered (group 1) and the pandemic period (group 3) was-63, 3%, with an absolute value decrease value of-305 cases. Similarly, comparing the second non-pandemic year (group 2) and the pandemic year (group 3) the percentage variation of OME incidence was-68, 1% with an absolute value of-305 cases decreased.

Conclusions: Our findings showed a lower incidence of OME during the pandemic period compared with 2 previous non pandemic years. The drastic restrictive anti-contagion measures taken by the Italian government to contain the spread of COVID-19 could have had a positive impact on the lower OME incidence during the last pandemic year.
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http://dx.doi.org/10.1007/s00405-021-06958-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8255053PMC
July 2021

Conventional approaches versus laser CO2 surgery in stapes surgery: a multicentre retrospective study.

Eur Arch Otorhinolaryngol 2021 Jun 11. Epub 2021 Jun 11.

Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy.

Purpose: To analyze and compare surgical and audiological outcomes of conventional approaches versus laser CO2 surgery in stapes surgery.

Methods: 333 patients who underwent stapes surgery were enrolled in the study; the patient population was divided into three groups: group 1: 170 patients treated with conventional stapedotomy with manual microdrill (average age 49.13 years); group 2: 119 patients treated with conventional stapedotomy with electrical microdrill (average age 51.06 years); group 3: 44 patients (average age 50.4 years) who underwent CO2 laser stapedotomy. Intra-operative, postoperative outcomes and audiological results were investigated.

Results: The average surgical time of laser CO2 surgery was longer than for other surgical procedures. No statistical differences emerged in post-operative abnormal taste sensation. There was also no difference in postoperative dizziness. Air-bone gap (ABG) went down from 29.7 ± 10 dB (group 1) and 27.32 ± 9.20 (group 2) to 10 ± 6.9 dB (group 1) and 10.7 ± 6.03 dB (group 2). In group 3 the preoperative ABG was lowered from 28.3 ± 10.1 to 11.8 ± 10.9, with a statistical difference in auditory recovery (p = 0.0001); The group of patients treated with laser CO2 showed a percentage of patients with an ABG closure of between 0 and 10 dB higher than in the group treated with manual microdrills (77.2% vs. 60%, respectively; p = 0.03).

Conclusion: Overall surgical results of CO2 laser and conventional stapedotomy are comparable without any significant difference; however, the group treated with CO2 laser appears to have a percentage of patients with an ABG closure 0-10 dB higher than the group treated using the conventional technique.
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http://dx.doi.org/10.1007/s00405-021-06926-yDOI Listing
June 2021

Neck dissection and trans oral robotic surgery for oropharyngeal squamous cell carcinoma.

Auris Nasus Larynx 2021 Jun 3. Epub 2021 Jun 3.

Otolaryngology and Head-Neck Surgery Unit, Department of Head-Neck Surgeries, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy.

Objective: Trans Oral Robotic Surgery (TORS) is a modality in the management of oropharyngeal squamous cell carcinoma(OPSCC). This study was planned to determine whether Selective Neck Dissection (SND) is oncological safe procedure even in patients with lymph node metastases.

Methods: OPSCC patients were divided into Modified Radical Neck Dissection (MRND) and SND groups. The outcome measures were overall survival (OS), disease-free survival (DFS) and regional recurrence free survival (RRFS).

Results: Thirty-seven SNDs and 18 MRNDs were performed. Regional relapse rate was 6.1% in SND group whilst 18.8% in MRND group(p=0.19). The 5-year OS, DFS and RRFS rates' differences were not statistically significant between SND and MRND groups (p=0.40, p=0.42 and p=0.18, respectively). At multivariate analysis, advanced stage impacted the 5-year OS and DFS(HR=9.39, p<0.01 and HR=11.03, p=0.04).

Conclusions: The SND seems to be effective in a TORS framework. The indication should be accurately discussed by the multidisciplinary tumor board.
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http://dx.doi.org/10.1016/j.anl.2021.05.007DOI Listing
June 2021

Correction to: Endoscopic surgical treatment for rhinogenic contact point headache: systematic review and meta-analysis.

Eur Arch Otorhinolaryngol 2021 May 7. Epub 2021 May 7.

Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section, ENT Department of University of Catania, Via Santa Sofia, 95100, Catania, Italy.

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http://dx.doi.org/10.1007/s00405-021-06844-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8102839PMC
May 2021

Surgical, clinical, and functional outcomes of transoral robotic surgery used in sleep surgery for obstructive sleep apnea syndrome: A systematic review and meta-analysis.

Head Neck 2021 07 16;43(7):2216-2239. Epub 2021 Apr 16.

Research Committee, Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.

We investigated safety and efficacy of transoral robotic surgery (TORS) for base of tongue (BOT) reduction in obstructive sleep apnea syndrome (OSAS) patients. PubMed, Cochrane Library, and Scopus were searched. A meta-analysis was performed. Random effects models were used. Thirty-one cohorts met our criteria (1693 patients). The analysis was based mostly on retrospective studies. The summary estimate of the reduction of Apnea-Hypoxia Index (AHI) was 24.25 abnormal events per hour (95% CI: 21.69-26.81) and reduction of Epworth Sleepiness Scale (ESS) was 7.92 (95% CI: 6.50-9.34). The summary estimate of increase in lowest O saturation was 6.04% (95% CI: 3.05-9.03). The success rate of TORS BOT reduction, either alone or combined with other procedures, was 69% (95% CI: 64-79). The majority of studies reported low level of evidence but suggested that TORS BOT reduction may be a safe procedure associated with improvement of AHI, ESS, and lowest O saturation.
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http://dx.doi.org/10.1002/hed.26702DOI Listing
July 2021

Dysphagia in multiple system atrophy consensus statement on diagnosis, prognosis and treatment.

Parkinsonism Relat Disord 2021 05 30;86:124-132. Epub 2021 Mar 30.

Department of Neurology, New York University School of Medicine, New York, NY, USA. Electronic address:

Multiple system atrophy (MSA) is a neurodegenerative disorder characterized by a combination of autonomic failure plus cerebellar syndrome and/or parkinsonism. Dysphagia is a frequent and disabling symptom in MSA and its occurrence within 5 years of motor onset is an additional diagnostic feature. Dysphagia can lead to aspiration pneumonia, a recognized cause of death in MSA. Guidelines for diagnosis and management of dysphagia in MSA are lacking. An International Consensus Conference among experts with methodological support was convened in Bologna to reach consensus statements for the diagnosis, prognosis, and treatment of dysphagia in MSA. Abnormalities of the oral and pharyngeal phases of swallowing, esophageal dysfunction and aspiration occur in MSA and worsen as the disease progresses. According to the consensus, dysphagia should be investigated through available screening questionnaires and clinical and instrumental assessment (videofluoroscopic study or fiberoptic endoscopic evaluation of swallowing and manometry) at the time of MSA diagnosis and periodically thereafter. There is evidence that dysphagia is associated with poor survival in MSA, however effective treatments for dysphagia are lacking. Compensatory strategies like diet modification, swallowing maneuvers and head postures should be applied and botulinum toxin injection may be effective in specific conditions. Percutaneous endoscopic gastrostomy may be performed when there is a severe risk of malnutrition and pulmonary complications, but its impact on survival is undetermined. Several research gaps and unmet needs for research involving diagnosis, prognosis, and treatment were identified.
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http://dx.doi.org/10.1016/j.parkreldis.2021.03.027DOI Listing
May 2021

Postoperative amyloidosis of tongue base: Extremely rare complication after multilevel sleep surgery.

Clin Case Rep 2021 Mar 24;9(3):1504-1506. Epub 2021 Jan 24.

Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit Morgagni Pierantoni Hospital Azienda USL della Romagna Forlì Italy.

Amyloidosis is to be considered in the differential diagnosis of postoperative edema of tongue base after its ablation. It might be triggered by surgical trauma. After establishment of diagnosis, cause of secondary amyloidosis should be excluded.
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http://dx.doi.org/10.1002/ccr3.3812DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7981647PMC
March 2021

Endoscopic surgical treatment for rhinogenic contact point headache: systematic review and meta-analysis.

Eur Arch Otorhinolaryngol 2021 Jun 6;278(6):1743-1753. Epub 2021 Mar 6.

Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section, ENT Department of University of Catania, Via Santa Sofia, 95100, Catania, Italy.

Purpose: This meta-analysis study was designed to analyze endoscopic surgery's role in treating rhinogenic contact point headache.

Methods: We performed a comprehensive review of the last 20 years' English language regarding Rhinogenic contact point headache and endoscopic surgery. We included the analysis papers reporting post-operative outcomes through the Visual Analogue Scale or the Migraine Disability Assessment scale.

Results: We provided 18 articles for a total of 978 RCPH patients. While 777 (81.1%) subjects underwent functional nasal surgery for RCPH, 201 patients (20.9%) were medically treated. A significant decrease from the VAS score of 7.3 ± 1.5 to 2.7 ± 1.8 was recorded (p < 0.0001). At quantitative analysis on 660 patients (11 papers), surgical treatment demonstrated significantly better post-operative scores than medical (p < 0.0001).

Conclusion: At comparison, surgical treatment in patients with rhinogenic contact points exhibited significantly better values at short-term, medium-term, and long term follow up. Endoscopic surgery should be proposed as the choice method in approaching the symptomatic patient.
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http://dx.doi.org/10.1007/s00405-021-06724-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7936872PMC
June 2021

Barbed suture Extrusion and Exposure in palatoplasty for OSA: What does it mean?

Am J Otolaryngol 2021 Jul-Aug;42(4):102994. Epub 2021 Feb 20.

Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34-47121 Forlì, Italy; Ear-Nose-Throat & Audiology Unit, University of Ferrara, 44121 Ferrara, Italy. Electronic address:

Purpose: Analyze Extrusion&Exposion (E&E), its implications in the functional, anatomical results and subjective discomfort in OSA patients treated with Barbed Reposition Pharyngoplasty (BRP).

Materials And Methods: 488 patients treated with BRP or multilevel TORS. Stratafix wire was used in 230 patients, V-Loc in 258. E&E, timing and localization evaluated at follow-up. Polygraphy used to assess the impact of E&E on functional results, PPOPS questionnaire used for subjective discomfort.

Results: E&E in the entire group was 18,4%, with significant difference between Stratafix and V-Loc wire (p = 0,002), but not between BRP alone and multilevel surgery (p = 0,68). 28,9% of extrusion happened within the first seven days, 76,7% between seven days and two months, 5,5% after two months. Symptomatic clinical profile has been seen in 62,2%, asymptomatic one in 37,8% of patients. 35,5% of E&E were localized in tonsillar bed, 46,7% in soft palate and 20% in other sites. Mean delta-AHI of E&E patients was -15,87 ± 16.82 compared with one of those who did not have E&E was -16.34 ± 22,77 (p = 0,38). Mean PPOPS of 183 patients analyzed was 12,32 ± 4,96. Mean PPOPS of extruded group was 12,94 ± 4,68 and 11,92 ± 5,11 in not extruded one (p = 0,166).

Conclusions: E&E are suture-type sensitive (V-Loc > Stratafix), reported more frequent when BRP is performed alone than BRP-TORS with no statistical significance. 76,7% of the E&E occur after patient discharge and within 2 months. About half of the E&E were localized in soft palate. There is no need to fear Extrusion&Exposition because it does not affect in a negative way subjective and PSG outcome.
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http://dx.doi.org/10.1016/j.amjoto.2021.102994DOI Listing
February 2021

Oxidative Stress and Inflammation Biomarker Expression in Obstructive Sleep Apnea Patients.

J Clin Med 2021 Jan 13;10(2). Epub 2021 Jan 13.

Department of Sensory Organs, "Sapienza" University of Rome, 00100 Rome, Italy.

Obstructive Sleep Apnea Syndrome (OSAS) is a respiratory sleep disorder characterised by repeated episodes of partial or complete obstruction of the upper airway during the night. This obstruction usually occurs with a reduction (hypopnea) or complete cessation (apnea) of the airflow in the upper airways with the persistence of thoracic-diaphragmatic respiratory movements. During the hypopnea/apnea events, poor alveolar ventilation reduces the oxygen saturation in the arterial blood (SaO) and a gradual increase in the partial arterial pressure of carbon dioxide (PaCO). The direct consequence of the intermittent hypoxia is an oxidative imbalance, with reactive oxygen species production and the inflammatory cascade's activation with pro and anti-inflammatory cytokines growth. Tumour necrosis factors, inflammatory cytokines (IL2, IL4, IL6), lipid peroxidation, and cell-free DNA have been found to increase in OSAS patients. However, even though different risk-related markers have been described and analysed in the literature, it has not yet been clarified whether specified inflammatory bio-markers better correlates with OSAS diagnosis and its clinical evolution/comorbidities. We perform a scientific literature review to discuss inflammatory and oxidative stress biomarkers currently tested in OSAS patients and their correlation with the disease's severity and treatment.
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http://dx.doi.org/10.3390/jcm10020277DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7828672PMC
January 2021

Does nasal surgery improve multilevel surgical outcome in obstructive sleep apnea: A multicenter study on 735 patients.

Laryngoscope Investig Otolaryngol 2020 Dec 8;5(6):1233-1239. Epub 2020 Oct 8.

Otolaryngology Western University London Ontario Canada.

Objective: Does nasal surgery affect multilevel surgical success outcome.

Methods: Prospective eight country nonrandomized trial of 735 obstructive sleep apnea (OSA) patients, who had multilevel palate and/or tongue surgery, divided into two groups, with or without nose surgery.

Results: There were 575 patients in nose group, 160 patients in no nose group. The mean age for nose group 44.6 ± 11.4, no nose group 44.2 ± 11.8. Mean preoperative BMI for nose group 27.5 ± 3.6, no nose group 27.5 ± 4.1, mean postoperative BMI nose group 26.3 ± 3.7, no nose group 27.1 ± 3.8 ( = .006). Mean preoperative AHI nose group 32.7 ± 19.4, no nose group 34.3 ± 25.0 ( = .377); and mean postoperative AHI nose group 13.5 ± 10.2, no nose group 17.1 ± 16.0 ( = .001). Mean preoperative ESS nose group was 11.3 ± 4.7, no nose group was 10.4 ± 5.4 ( = .051); and mean postoperative ESS nose group was 5.3 ± 3.2, no nose group was 6.7 ± 2.8 ( = .001). The nose group had higher percentage change (adjusted for age, gender, BMI) in AHI (33.7%, 95% CI 14% to 53.5%) compared to the no nose group ( = .001); the nose group also had more percentage change in ESS (37%, 95% CI 23.6% to 50.3%) compared to the no nose group ( < .001). Change in BMI did not affect AHI nor ESS change (Cohen effect 0.03 and 0.14, respectively). AHI change in both groups were also statistically significant in the mild OSA ( = .008) and the severe OSA ( = .01). Success rate of surgery for the nose group 68.2%, while the no nose group 55.0% ( = .002).

Conclusion: Combining nose surgery in multilevel surgery improves surgical success.

Level Of Evidence: IIC.
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http://dx.doi.org/10.1002/lio2.452DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7752065PMC
December 2020

TUSC (TUrbinate Surgery Classification): A Novel Classification Proposal for Turbinate Surgery.

Ear Nose Throat J 2020 Dec 11:145561320981448. Epub 2020 Dec 11.

ENT & Audiology Unit, Department of Neuroscience and Rehabilitation, University Hospital of Ferrara, Ferrara, Italy.

Aim of this manuscript is to propose a clear and easily applicable classification for turbinate surgery, based on the use of a numerical model, which could be introduced in the practice of Otolaryngologists and Maxillo-Facial surgeons.Applying this classification, it will be possible to offer an easy format when describing which turbinates are involved in a procedure, and to offer a quick method to record and analyse clinical data, also for scientific purpose.
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http://dx.doi.org/10.1177/0145561320981448DOI Listing
December 2020

Sleep medicine in otolaryngology units: an international survey.

Sleep Breath 2020 Nov 20. Epub 2020 Nov 20.

Unit of Otolaryngology, Hospital Morgagni Pierantoni, Via Carlo Forlanini 2, 47100, Forlì, Italy.

Purpose: No study to date has described the overall landscape of sleep disorders management and training in otolaryngology departments of different countries. The aim of our study was to investigate and compare settings, diagnostic and therapeutic approaches and training programmes.

Methods: An international online survey was developed with the collaboration of the YO-IFOS (Young Otolaryngologists-International Federation of Otorhinolaryngological Societies) to assess the current practice of otolaryngologists in the management of sleep disorders. The survey also included a session dedicated to training.

Results: A total of 126 otolaryngologists completed the survey. The larger part of responses was collected from Central/South America and Europe. The majority of responders from South/Central America (97%) declared to be certified as sleep specialist while 49% of Europeans stated the opposite. Of responders 83% perform a drug-induced sleep endoscopy (DISE) before planning a possible surgical intervention. Soft palate and base of tongue interventions were the most common procedure, respectively performed in 94% and 79% of the cases. Residents were allowed to perform soft palate surgery in 77% of the cases. Upper airway stimulation (26% vs 10%), trans-oral robotic surgery (36% vs 11%) and radiofrequency of the base of the tongue (58% vs 25%) were preferred more frequently by European responders. The highest caseloads of soft palate surgery and bi-maxillary advancement were registered in the academic institutions.

Conclusion: Significant concordance and few interesting divergences in diagnosis and treatment of sleep disorders were observed between nationalities and types of institution. Economic resources might have played a significant role in the therapeutic choice. Trainees' lack of exposure to certain interventions and to a sufficient caseload appeared to be the main burden to overcome.
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http://dx.doi.org/10.1007/s11325-020-02243-6DOI Listing
November 2020

Overview of different modified full-face snorkelling masks for intraoperative protection.

Acta Otorhinolaryngol Ital 2020 Oct 24;40(5):317-324. Epub 2020 Sep 24.

IRCCS Ospedale Policlinico San Martino, Unit of Otorhinolaryngology Head and Neck Surgery, Genoa, Italy.

Objective: The COVID-19 pandemic has caused significant impact on healthcare systems worldwide. The rate of infected healthcare workers is > 10% in Italy. Within this dramatic scenario, the development of new personal protective equipment (PPE) devices is mandatory. This study focuses on validation of modified full-face snorkel masks (MFFSM) as safe and protective equipment against SARS-CoV-2 infection during diagnostic and therapeutic procedures on the upper aerodigestive tract.

Methods: Five different MFFSM were tested during otolaryngological surgery and in anaesthesia procedures. Data were collected through an online survey to assess the feedback of operators. pO and pCO monitoring values during procedures were recorded in selected cases.

Results: All five MFFSM tested were easy to use and gave all operators a sound "feeling" of protection. All clinicians involved had common agreement regarding safety and the user-friendly format.

Conclusions: In the future, specific development of different type of masks for protection in the operating room, intensive care units and/or office will be possible as a joint venture between clinicians and developers. Goals for clinicians include better definition of needs and priorities, while developers can devote their expertise to produce devices that meet medical requirements.
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http://dx.doi.org/10.14639/0392-100X-N0841DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7726642PMC
October 2020

Olfactory function in patients with obstructive sleep apnea: a meta-analysis study.

Eur Arch Otorhinolaryngol 2021 Mar 10;278(3):883-891. Epub 2020 Sep 10.

Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185, Rome, Italy.

Purpose: This meta-analysis study was designed to analyze the olfactory function in obstructive sleep apnea patients (OSA).

Methods: A comprehensive review of the English language literature regarding OSA patients and olfactory function/dysfunction was performed. The papers assessing olfactory dysfunction with Sniffin' Sticks test were taken into consideration.

Results: A total of 420 OSA patients were judged eligible for the study. The average TDI score was found to be 24.3 ± 5.6. The olfactory identification (OD), the olfactory discrimination (OD), and the olfactory threshold (OT) average values were calculated resulting 9.9 ± 2.1, 9.8 ± 1.5, and 5.3 ± 2, respectively. There were 161 healthy control subjects in this meta-analysis. The average TDI of the control group was 30.7 ± 6.0 showing a statistical difference with the group of OSA patients (p = 0.03). A linear correlation between Apnea-Hypopnea Index (AHI) increase and TDI decrease (R = 0.1, p = 0.05) was detected. Finally, the average values of TDI of 151 patients classified as mild-moderate OSA and 159 patients considered as severe OSA were calculated. The difference between these two groups resulted not statistically significant (p = 0.3).

Conclusion: The comparison between OSA patients and healthy subjects using Sniffin' Sticks test showed lower values of the various olfactory parameters. Although a linear correlation between AHI increase and olfactory dysfunction was observed, no statistical difference between mild-moderate and severe OSA patients in terms of the severity of olfactory dysfunction could be proved.
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http://dx.doi.org/10.1007/s00405-020-06316-wDOI Listing
March 2021

A Case of COVID-19 with Late-Onset Rash and Transient Loss of Taste and Smell in a 15-Year-Old Boy.

Am J Case Rep 2020 Aug 20;21:e925813. Epub 2020 Aug 20.

Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section, University of Catania, Catania, Italy.

BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic that spread from China is caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). The head and neck region can be variably affected in adult patients, and taste and smell disorders are typical manifestations. However, pediatric clinical signs are less severe, making the onset diagnosis challenging to interpret. The variability of nasal olfactory symptoms in children and adolescents is intertwined with possible warning signs, including gastrointestinal, ocular, or dermatological symptoms. We present a case involving a 15-year-old boy with clinically confirmed COVID-19 who had late-onset rash and transient taste and smell disorders. CASE REPORT The boy's clinical history revealed that a family member was positive for SARS-CoV-2. In the preceding 3 days, the boy's eating habits had changed; he perceived a metallic taste while eating and had a loss of appetite. He also had erythematous skin lesions on the lower limbs for the 2 previous days. A sore throat, nasal congestion, and a runny nose were reported on head and neck examination. A real-time polymerase chain reaction test was positive, confirming the initial diagnostic hypothesis. CONCLUSIONS SARS-CoV-2 virus infection in children and adolescents can be asymptomatic, but it can also occur with fever, dry cough, fatigue, and gastrointestinal symptoms. Due to the unique immune characteristics of pediatric and adolescent patients, the correct interpretation of the gustatory and skin symptoms associated with specific laboratory tests for SARS-CoV-2 infection can lead to the most appropriate management and supportive care.
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http://dx.doi.org/10.12659/AJCR.925813DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7467634PMC
August 2020

Manipulation of Lateral Pharyngeal Wall Muscles in Sleep Surgery: A Review of the Literature.

Int J Environ Res Public Health 2020 07 23;17(15). Epub 2020 Jul 23.

Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni, L. Pierantoni Hospital, Forlì, FC 47100 ASL of Romagna, Italy.

Background: Obstructive sleep apnea syndrome (OSAS) occurs due to upper airway obstruction resulting from anatomical and functional abnormalities. Upper airway collapsibility, particularly those involving the lateral pharyngeal wall (LPW), is known to be one of the main factors contributing to the pathogenesis of OSAS, leading the authors of the present study to propose different strategies in order to stiffen the pharyngeal walls to try to restore normal airflow.

Methods: An exhaustive review of the English literature on lateral pharyngeal wall surgery for the treatment of OSAS was performed using the PubMed electronic database.

Results: The research was performed in April 2020 and yielded approximately 2000 articles. However, considering the inclusion criteria, only 17 studies were included in the present study.

Conclusions: The analyzed surgical techniques propose different parts of LPW on which to focus and a variable degree of invasivity. Despite the very promising results, no gold standard for the treatment of pharyngeal wall collapsibility has been proposed. However, thanks to progressive technological innovations and increasingly precise data analysis, the role of LPW surgery seems to be crucial in the treatment of OSAS patients.
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http://dx.doi.org/10.3390/ijerph17155315DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432019PMC
July 2020

A structural equation model to examine the clinical features of mild-to-moderate COVID-19: A multicenter Italian study.

J Med Virol 2021 02 2;93(2):983-994. Epub 2020 Aug 2.

COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies, Paris, France.

The purpose of this study was to evaluate the clinical features of mild-to-moderate coronavirus disease 2019 (COVID-19) in a sample of Italian patients and to investigate the occurrence of smell and taste disorders. Infected individuals with suspected (clinical diagnosis) or laboratory-confirmed COVID-19 infection were recruited. Patients completed a survey-based questionnaire with the aim of assessing their epidemiological and clinical characteristics, general otorhinolaryngological symptoms, and smell and taste disorders. A total of 294 patients with mild-to-moderate COVID-19 completed the survey (147 females). The most prevalent general symptoms included fever, myalgia, cough, and headache. A total of 70.4% and 59.2% of patients reported smell and taste disorders, respectively. A significant association between the two above-mentioned disorders was found (rs: 0.412; P < .001). Smell disorders occurred before the other symptoms in 11.6% of patients and was not significantly associated with nasal obstruction or rhinorrhea. Interestingly, our statistical analysis did not show any significant difference, either for general symptoms or otorhinolaryngological features, between the clinical diagnosis group and the laboratory-confirmed diagnosis (polymerase chain reaction) group. The structural equation model confirmed significant standardized paths (P < .05) between general symptoms, comorbidities, and general otorhinolaryngological complaints in the absence of a significant correlation between these elements and smell and taste alterations. The prevalence of smell and taste disorders in mild-to-moderate Italian COVID-19 patients is significant both in suspected and laboratory-confirmed cases and reveals a strong correlation between these clinical signs regardless of the presence of general or otorhinolaryngological symptoms, such as nasal obstruction or rhinorrhea.
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http://dx.doi.org/10.1002/jmv.26354DOI Listing
February 2021

Facial nerve dehiscence and cholesteatoma: Pediatrics vs adults.

Int J Pediatr Otorhinolaryngol 2020 Nov 18;138:110260. Epub 2020 Jul 18.

Department of "Organi di Senso", Sapienza University of Rome, Rome, Italy. Electronic address:

Objectives: the aim of this paper is to study the incidence of facial canal dehiscence (FCD) in pediatric and non-pediatric patients, analyzing eventual differences in frequency, localization, primary or revision surgery and duration of the disease.

Methods: 527 patients suffering from chronic otitis media with acquired cholesteatoma, divided into two groups, those aged 18 years or over (470 patients), and those aged below 18 years (57 patients).

Results: Total incidence of FCD in adult population was 25,7% (121/470) and 7% (4/57) in pediatric one. Globally higher values were found in revision surgery, 43,5% (40/92) in adults and 16,7% (1/7) in children. Diseases longer than 5 years have been correlated to higher incidence of FCD in adults, 29,9% (109/364), than in pediatrics, 7,3% (3/41). No statistical significant difference has been found in those with a disease shorter than 5 years: 11,3% in adults (12/106) and 6,2% in children (1/16). The majority of patients, both adults and pediatrics, had a dehiscence in the tympanic tract of facial nerve. No statistical correlation regarding concomitant semicircular canal fistula and FCD has been found due to the absence of data in children.

Conclusions: Incidence of FCD is higher in adult population than in pediatric. Adults have a higher incidence in primary surgery than children. No statistical significant difference has been found in adults and pediatrics with a less than 5 years disease, while diseases longer than 5 years expose adults to higher risk of FCD. Middle tract of tympanic segment is the most involved site of dehiscence in both populations.
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http://dx.doi.org/10.1016/j.ijporl.2020.110260DOI Listing
November 2020

Trans oral robotic surgery versus definitive chemoradiotherapy for oropharyngeal cancer: 10-year institutional experience.

Oral Oncol 2020 11 10;110:104889. Epub 2020 Jul 10.

Otolaryngology and Head-Neck Surgery Unit, Department of Head-Neck Surgeries, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy; Otolaryngology Unit, University of Ferrara, Ferrara, Italy.

Objectives: Trans Oral Robotic Surgery (TORS) is a fascinating new technique that has proved to be a safe and feasible treatment of oropharyngeal squamous cell carcinoma (OPSCC). The aim of this study is to compare oncological outcomes of OPSCC-patients treated with either TORS (with or without adjuvant therapy) or definitive chemoradiation therapy (CRT).

Materials And Methods: This study involved 129 patients with OPSCC, treated with TORS or definitive CRT at our Department between 2008 and 2018. Clinicopathological characteristics, treatment specifications and oncological outcomes were evaluated retrospectively.

Results: Definitive CRT was administered in 69 patients (53,5%), while 60 (46,5%) were surgically treated with TORS alone or in combination with adjuvant therapy. Patients who underwent adjuvant therapy after TORS received a lower dosages of cisplatin and radiation than the CRT group (p < 0.01). There was no statistical difference in 5-year survival rate and in disease free interval between TORS and CRT groups. Albeit 5-year overall survival in the HPV-related tumours was better, the HPV status did not affect the rate of local and regional recurrence. Treatment groups (TORS vs. CRT) were not found affecting survivals on multivariate analysis. Tube feeding dependency rate was low between both groups (1.7% in TORS vs. 4.8% in CRT groups).

Conclusion: The modern management of OPSCC must be tailored to each patient. Although the definitive CRT remains a milestone, TORS is proving to be a valid and safe treatment option. The choice of single therapeutic strategy requires an evaluation by a multidisciplinary team.
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http://dx.doi.org/10.1016/j.oraloncology.2020.104889DOI Listing
November 2020

Voice-Related Quality of Life in Post-Laryngectomy Rehabilitation: Tracheoesophageal Fistula's Wellness.

Int J Environ Res Public Health 2020 06 26;17(12). Epub 2020 Jun 26.

Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section, University of Catania, 95100 Catania, Italy.

(1) Introduction: Laryngeal cancer is one of the most common types of cancer affecting the upper aerodigestive tract. Despite ensuring good oncological outcome in many locoregionally advanced cases, total laryngectomy is associated with relevant physical and psychological sequelae. Treatment through tracheo-esophageal speech, if promising, can lead to very variable outcomes. Not all laryngectomee patients with vocal prosthesis benefit from the same level of rehabilitation mainly due to the development of prosthetic or fistula related problems. The relating sequelae in some cases are even more decisive in the patient quality of life, having a higher impact than communicational or verbal skills. (2) Material and Methods: A retrospective study was conducted on 63 patients initially enrolled with a history of total laryngectomy and voice rehabilitation, treated at the University Hospital of Catania from 1 January 2010 to 31 December 2018. Quality of life (QoL) evaluation through validated self-administrated questionnaires was performed. (3) Results: The Voice-Related Quality of Life questionnaire revealed significantly better outcomes in both socio-emotional and functional domains of the tracheoesophageal patient group compared to the esophageal group ( = 0.01; = 0.01, respectively), whereas in the Voice Handicap Index assessment, statistically significant scores were not achieved ( = 0.33). (4) Discussion: The significant differences reported through the V-RQOL and Voice Handicap Index scales in the presence of fistula related problems and device lifetime reduction when compared to the oesophageal speech group have demonstrated, as supported by the literature, a crucial role in the rehabilitative prognosis. (5) Conclusions: The criteria of low resistance to airflow, optimal tracheoesophageal retention, prolonged device life, simple patient maintenance, and comfortable outpatient surgery are the reference standard for obtaining good QoL results, especially over time. Furthermore, the correct phenotyping of the patient based on the main outcomes achieved at clinical follow-up guarantees the primary objective of the identification of a better quality of life.
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http://dx.doi.org/10.3390/ijerph17124605DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7344397PMC
June 2020

A New Technological Advancement of the Drug-Induced Sleep Endoscopy (DISE) Procedure: The "All in One Glance" Strategy.

Int J Environ Res Public Health 2020 06 15;17(12). Epub 2020 Jun 15.

Otolaryngology Head and Neck Surgery, University Hospital of Ferrara, 44124 Cona FE, Italy.

To illustrate a new technological advance in the standard drug-induced sleep endoscopy (DISE) model, a new machine was used, the Experimental 5 Video Stream System (5VsEs), which is capable of simultaneously visualizing all the decisional parameters on a single monitor, and recording and storing them in a single uneditable video. The DISE procedure was performed on 48 obstructive sleep apnea (OSA) or snoring patients. The parameters simultaneously recorded on a single monitor are (1) the pharmacokinetics and pharmacodynamics of propofol (through the target controlled infusion (TCI) pump monitor), (2) the endoscopic upper airway view, (3) the polygraphic pattern, and (4) the level of sedation (through the bispectral index (BIS) value). In parallel to the BIS recording, the middle latency auditory evoked potential (MLAEP) was also recorded and provided. Recorded videos from the 5VsEs machine were re-evaluated six months later by the same clinician and a second clinician to evaluate the concordance of the therapeutic indications between the two. After the six-month period, the same operator confirmed all their clinical decisions for 45 out of 48 videos. Three videos were no longer evaluable for technical reasons, so were excluded from further analysis. The comparison between the two operators showed a complete adherence in 98% of cases. The 5VsEs machine provides a multiparametric evaluation setting, defined as an "all in one glance" strategy, which allows a faster and more effective interpretation of all the simultaneous parameters during the DISE procedure, improving the diagnostic accuracy, and providing a more accurate post-analysis, as well as legal and research advantages.
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http://dx.doi.org/10.3390/ijerph17124261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7345775PMC
June 2020

Minimizing Contagion Risks of COVID-19 During Transoral Robotic Surgery.

Laryngoscope 2020 11 29;130(11):2593-2594. Epub 2020 Jul 29.

Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy.

In this communication, we would like to share our experience in managing TORS patients during COVID-19 pandemic. Laryngoscope, 130:2593-2594, 2020.
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http://dx.doi.org/10.1002/lary.28847DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7283799PMC
November 2020

Transoral robotic submandibular sialadenectomy: how and when.

Gland Surg 2020 Apr;9(2):423-429

Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni-L. Pierantoni Hospital of Forlì, Forlì, Italy.

Traditional removal of the submandibular gland is done through a transcervical approach; new proposals have come into the scientific limelight such as endoscopy-assisted transcervical sialadenectomy or (robot-assisted) submandibular sialadenectomy through a postauricular facelift transcervical approach. Transoral submandibular sialadenectomy has been described in the past, but with the advent of transoral robotic surgery, the proposal of removing the submandibular gland from the oral floor is gaining strength. A transoral robotic submandibular sialadenectomy by the Si Da Vinci Surgical Robot was performed in a 68-years-old female patient under general anaesthesia. The transoral robotic procedure was successful with no major postoperative complications. A mild tingling of the tip of the tongue was described by the patient 3 months after. The surgical time took 110 minutes. No residual gland was observed at ultrasonography. The transoral robotic submandibular sialadenectomy seems to be, with selective indication based on clinical and radiological assessment, a viable and safe alternative to traditional management in patients who refuse a cervical scar and the risk of paralysis of the facial nerve.
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http://dx.doi.org/10.21037/gs.2020.02.04DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7225484PMC
April 2020

Transoral Endoscopic Coblation Tongue Base Surgery in Obstructive Sleep Apnea: Resection versus Ablation.

ORL J Otorhinolaryngol Relat Spec 2020;82(4):201-208. Epub 2020 May 6.

Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy.

Background: A new transoral tongue base surgical procedure for the treatment of snoring and obstructive sleep apnea (OSA) is described. It is named "Robo-Cob" technique because it is similar to transoral robotic surgery (TORS) but it is performed by means of coblation technology in order to resect the tongue base in countries where TORS is not an available option for such benign conditions.

Methods: In this prospective, randomized, controlled trial, the new Robo-Cob technique was carried out in 25 adult OSA patients with confirmed tongue base hypertrophy at preoperative drug-induced sedation endoscopy. The results of this procedure were compared with the coblation endoscopic lingual lightening (CELL) technique used to ablate (or minimally resect) the central part of the tongue base, in another 25 adult OSA patients with similar characteristics (age, sex, preoperative body mass index and Apnea-Hypopnea Index, AHI). The base of tongue surgery was part of multilevel surgery including also septoturbinoplasty and barbed reposition pharyngoplasty (with/without tonsillectomy).

Results: In this study, the Robo-Cob technique is proved to be feasible and effective in all cases either alone or when combined with other procedures in multilevel surgical settings. No/minimal intraoperative or postoperative complications were observed. Postoperative pain as measured by visual analog scale ranged from 3 to 7. No tracheostomy was done in any patient. Objective clinical improvement was confirmed by a level 3 polygraphy performed 6 months after surgery. There was significant difference in operative time at the level of the tongue base between Robo-Cob and CELL techniques, with shorter times observed within the Robo-Cob group. Moreover, the Robo-Cob technique provided tongue base tissue specimens that allowed measurement of the volume that ranged from 5 to 17 cm3 (mean 11.64 ± 3.49 cm3). It was found that resection of at least 10 cm3 of tongue base tissue was associated with better outcomes in terms of postoperative AHI reduction.

Conclusion: In this study, the added values of using coblation for resection and not ablation appear to be the short surgical time, the low postoperative tissue edema, and the possibility of providing tissue specimens to measure resected volumes.
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http://dx.doi.org/10.1159/000506994DOI Listing
March 2021
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