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Copley M, Kozminski B, Gentile N, Geyer R, Friedly J. Postacute Sequelae of SARS-CoV-2: Musculoskeletal Conditions and Pain. Phys Med Rehabil Clin N Am 2023; 34:585-605. [PMID: 37419534 DOI: 10.1016/j.pmr.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
Musculoskeletal and pain sequelae of COVID-19 are common in both the acute infection and patients experiencing longer term symptoms associated with recovery, known as postacute sequelae of COVID-19 (PASC). Patients with PASC may experience multiple manifestations of pain and other concurrent symptoms that complicate their experience of pain. In this review, the authors explore what is currently known about PASC-related pain and its pathophysiology as well as strategies for diagnosis and management.
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Affiliation(s)
- Michelle Copley
- Department of Rehabilitation Medicine, University of Washington, 325 Ninth Avenue, Seattle, WA 98104, USA
| | - Barbara Kozminski
- Department of Rehabilitation Medicine, University of Washington, 325 Ninth Avenue, Seattle, WA 98104, USA
| | - Nicole Gentile
- Department of Family Medicine, University of Washington, 1959 Northeast Pacific Street, Box 356390, Seattle, WA 98195-6390, USA; Department of Laboratory Medicine and Pathology, University of Washington, 1959 Northeast Pacific Street Seattle, WA 98195-6390, USA
| | - Rachel Geyer
- Department of Family Medicine, University of Washington, 1959 Northeast Pacific Street, Box 356390, Seattle, WA 98195-6390, USA
| | - Janna Friedly
- Department of Rehabilitation Medicine, University of Washington, 325 Ninth Avenue, Seattle, WA 98104, USA.
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2
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Poole-Wright K, Guennouni I, Sterry O, Evans RA, Gaughran F, Chalder T. Fatigue outcomes following COVID-19: a systematic review and meta-analysis. BMJ Open 2023; 13:e063969. [PMID: 37185637 PMCID: PMC10151247 DOI: 10.1136/bmjopen-2022-063969] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 03/06/2023] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVES Fatigue is a pervasive clinical symptom in coronaviruses and may continue beyond the acute phase, lasting for several months or years. This systematic review and meta-analysis aimed to incorporate the current evidence for postinfection fatigue among survivors of SARS-CoV-2 and investigate associated factors. METHODS Embase, PsyINFO, Medline, CINAHL, CDSR, Open Grey, BioRxiv and MedRxiv were systematically searched from January 2019 to December 2021. Eligible records included all study designs in English. Outcomes were fatigue or vitality in adults with a confirmed diagnosis of SARS-CoV-2 measured at >30 days post infection. Non-confirmed cases were excluded. JBI risk of bias was assessed by three reviewers. Random effects model was used for the pooled proportion with 95% CIs. A mixed effects meta-regression of 35 prospective articles calculated change in fatigue overtime. Subgroup analyses explored specific group characteristics of study methodology. Heterogeneity was assessed using Cochran's Q and I2 statistic. Egger's tests for publication bias. RESULTS Database searches returned 14 262 records. Following deduplication and screening, 178 records were identified. 147 (n=48 466 participants) were included for the meta-analyses. Pooled prevalence was 41% (95% CI: 37% to 45%, k=147, I2=98%). Fatigue significantly reduced over time (-0.057, 95% CI: -107 to -0.008, k=35, I2=99.3%, p=0.05). A higher proportion of fatigue was found in studies using a valid scale (51%, 95% CI: 43% to 58%, k=36, I2=96.2%, p=0.004). No significant difference was found for fatigue by study design (p=0.272). Egger's test indicated publication bias for all analyses except valid scales. Quality assessments indicated 4% at low risk of bias, 78% at moderate risk and 18% at high risk. Frequently reported associations were female gender, age, physical functioning, breathlessness and psychological distress. CONCLUSION This study revealed that a significant proportion of survivors experienced fatigue following SARS-CoV-2 and their fatigue reduced overtime. Non-modifiable factors and psychological morbidity may contribute to ongoing fatigue and impede recovery. PROSPERO REGISTRATION NUMBER CRD42020201247.
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Affiliation(s)
- Kim Poole-Wright
- Psychological Medicine, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | | | - Olivia Sterry
- Psychological Medicine, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Rachael A Evans
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Fiona Gaughran
- Psychosis Studies, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Trudie Chalder
- Psychological Medicine, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
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Cohen AB, McAvay GJ, Geda M, Chattopadhyay S, Lee S, Acampora D, Araujo K, Charpentier P, Gill TM, Hajduk AM, Ferrante LE. Rationale, Design, and Characteristics of the VALIANT (COVID-19 in Older Adults: A Longitudinal Assessment) Cohort. J Am Geriatr Soc 2023; 71:832-844. [PMID: 36544250 PMCID: PMC9877652 DOI: 10.1111/jgs.18146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 10/08/2022] [Accepted: 10/29/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Most older adults hospitalized with COVID-19 survive their acute illness. The impact of COVID-19 hospitalization on patient-centered outcomes, including physical function, cognition, and symptoms, is not well understood. To address this knowledge gap, we collected longitudinal data about these issues from a cohort of older survivors of COVID-19 hospitalization. METHODS We undertook a prospective study of community-living persons age ≥ 60 years who were hospitalized with COVID-19 from June 2020-June 2021. A baseline interview was conducted during or up to 2 weeks after hospitalization. Follow-up interviews occurred at one, three, and six months post-discharge. Participants completed comprehensive assessments of physical and cognitive function, symptoms, and psychosocial factors. An abbreviated assessment could be performed with a proxy. Additional information was collected from the electronic health record. RESULTS Among 341 participants, the mean age was 71.4 (SD 8.4) years, 51% were women, and 37% were of Black race or Hispanic ethnicity. Median length of hospitalization was 8 (IQR 6-12) days. All but 4% of participants required supplemental oxygen, and 20% required care in an intensive care unit or stepdown unit. At enrollment, nearly half (47%) reported at least one preexisting disability in physical function, 45% demonstrated cognitive impairment, and 67% were pre-frail or frail. Participants reported a mean of 9 of 14 (SD 3) COVID-19-related symptoms. At the six-month follow-up interview, more than a third of participants experienced a decline from their pre-hospitalization function, nearly 20% had cognitive impairment, and burdensome symptoms remained highly prevalent. CONCLUSIONS We enrolled a diverse cohort of older adults hospitalized with COVID-19 and followed them after discharge. Functional decline was common, and there were high rates of persistent cognitive impairment and symptoms. Future analyses of these data will advance our understanding of patient-centered outcomes among older COVID-19 survivors.
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Affiliation(s)
- Andrew B. Cohen
- Department of MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Gail J. McAvay
- Department of MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Mary Geda
- Department of MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Sumon Chattopadhyay
- Clinical and Translational Science InstituteUniversity of UtahSalt Lake CityUtahUSA
| | - Seohyuk Lee
- Department of MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Denise Acampora
- Department of MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Katy Araujo
- Department of MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Peter Charpentier
- Department of MedicineYale School of MedicineNew HavenConnecticutUSA
- CRI Web ToolsDurhamConnecticutUSA
| | - Thomas M. Gill
- Department of MedicineYale School of MedicineNew HavenConnecticutUSA
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Ochiai GS, de Godoy CG, Silva ÉCGE, de Oliveira DB, da Silva EM, Viana BDOC, da Silva JM, de Souza ROB, dos Santos MD, de Campos CM, Schmitt ACB, de Carvalho CRF, Fu C, Tanaka C, Toufen C, de Carvalho CRR, Pompeu JE. Functional impact on adults and older people after hospitalization by Covid‐19. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2022; 28:e1983. [PMID: 36377222 DOI: 10.1002/pri.1983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/14/2022] [Accepted: 11/05/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Hospitalization by Covid-19 can cause persistent functional consequences after hospital discharge due to direct and indirect effects of SARS-COV-2 in several organs and systems of the body added to post-intensive care syndrome and prolonged bed rest. These impacts can lead to dependency in activities of daily living, mainly in older people due to aging process and functional decline. This study aimed to compare the effects of hospitalization by Covid-19 on functional capacity of adults and older people and to identify its associated factors. METHODS Cross-sectional observational study of 159 survivors of hospitalization by Covid-19 after 1 month from discharge at Hospital das Clínicas of the University of São Paulo, divided into groups: adults (aged < 60 years) and older people (aged ≥ 60 years). Those who did not accept to participate, without availability or without ability to understand the questionnaires were excluded. Functional capacity was assessed by the Barthel Index and patients were classified according to their scores. Data analysis was performed in JASP Statistics program and the sample was compared between the age groups. Wilcoxon test was applied to compare before and after periods, Mann-Whitney test was used for between groups comparison. We adopted alpha = 0.05. RESULTS The total Barthel Index median score was lower 1 month after hospital discharge than in the pre-Covid-19 period. Older people had worse functional status than adults before and also showed greater impairment after hospital discharge. Both groups showed lower Barthel Index classification than before, and older people presented more functional dependence than adults in both periods. Age, sarcopenia and frailty were associated factors. DISCUSSION Hospitalization by Covid-19 impacts functional capacity after 1 month from discharge, especially in older people. Age, sarcopenia and frailty are associated factors. These results suggest need for care and rehabilitation of Covid-19 survivors.
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Affiliation(s)
- Gabriela Sayuri Ochiai
- School of Medicine Department of Physical Therapy, Speech Therapy and Occupational Therapy University of São Paulo São Paulo Brazil
| | - Caroline Gil de Godoy
- School of Medicine Department of Physical Therapy, Speech Therapy and Occupational Therapy University of São Paulo São Paulo Brazil
| | - Érika Christina Gouveia e Silva
- School of Medicine Department of Physical Therapy, Speech Therapy and Occupational Therapy University of São Paulo São Paulo Brazil
| | - Danielle Brancolini de Oliveira
- School of Medicine Department of Physical Therapy, Speech Therapy and Occupational Therapy University of São Paulo São Paulo Brazil
| | - Elizabeth Mendes da Silva
- School of Medicine Department of Physical Therapy, Speech Therapy and Occupational Therapy University of São Paulo São Paulo Brazil
| | - Bianca de Oliveira Candido Viana
- School of Medicine Department of Physical Therapy, Speech Therapy and Occupational Therapy University of São Paulo São Paulo Brazil
| | - Juliana Magalhães da Silva
- School of Medicine Department of Physical Therapy, Speech Therapy and Occupational Therapy University of São Paulo São Paulo Brazil
| | - Roberta Oliveira Bueno de Souza
- School of Medicine Department of Physical Therapy, Speech Therapy and Occupational Therapy University of São Paulo São Paulo Brazil
| | - Michelle Didone dos Santos
- School of Medicine Department of Physical Therapy, Speech Therapy and Occupational Therapy University of São Paulo São Paulo Brazil
| | - Camila Machado de Campos
- School of Medicine Department of Physical Therapy, Speech Therapy and Occupational Therapy University of São Paulo São Paulo Brazil
| | - Ana Carolina Basso Schmitt
- School of Medicine Department of Physical Therapy, Speech Therapy and Occupational Therapy University of São Paulo São Paulo Brazil
| | | | - Carolina Fu
- School of Medicine Department of Physical Therapy, Speech Therapy and Occupational Therapy University of São Paulo São Paulo Brazil
| | - Clarice Tanaka
- School of Medicine Department of Physical Therapy, Speech Therapy and Occupational Therapy University of São Paulo São Paulo Brazil
| | - Carlos Toufen
- Instituto do Coração of Hospital das Clínicas of the School of Medicine of the University of São Paulo São Paulo Brazil
| | | | - José Eduardo Pompeu
- School of Medicine Department of Physical Therapy, Speech Therapy and Occupational Therapy University of São Paulo São Paulo Brazil
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Case KR, Wang CP, Hosek MG, Lill SF, Howell AB, Taylor BS, Bridges J, MacCarthy DJ, Winkler P, Tsevat J. Health-related quality of life and social determinants of health following COVID-19 infection in a predominantly Latino population. J Patient Rep Outcomes 2022; 6:72. [PMID: 35737279 PMCID: PMC9219362 DOI: 10.1186/s41687-022-00473-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/01/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND As the COVID-19 pandemic evolves, more information is needed on its long-term impacts on health-related quality of life (HRQoL) and social determinants of health (SDoH). The aim of the study was to assess HRQoL and SDoH among a predominantly Latino population of COVID-19 survivors and to compare effects in Latinos versus non-Latinos. METHODS This cross-sectional study consisted of a survey (in English and Spanish) of COVID-19 survivors from December 2020 to July 2021. The study assessed sociodemographic data, clinical characteristics, and SDoH, consisting of 10 COVID-19-related concerns. The PROMIS-29 + 2 (PROPr) measure, which captures 8 HRQoL domains and a preference-based health utility, was used to assess HRQoL. Bivariate analyses included chi-square tests and t-tests. Generalized linear models were conducted for multivariable analyses. RESULTS Of 230 respondents (6.3% response rate), the mean [SD] age was 43.1 [14.3] years; 83.0% were Latino; the mean [SD] time since diagnosis was 8.1 [3.2] months; and 12.6% had a history of hospitalization with COVID-19. HRQoL scores were slightly worse than population norms on all domains, especially anxiety; the mean [SD] PROPr health utility was 0.36 [0.25]. Domain scores were similar by ethnicity except for cognitive function-abilities, where scores were lower in Latinos. Multivariable analyses revealed that: (1) financial concerns were associated with worse health utility, as well as worse scores on all 8 PROMIS domains; (2) interpersonal conflict was associated with worse health utility and worse scores on 6 of the 8 PROMIS domains (anxiety, depression, fatigue, sleep disturbance, social function, and pain interference); and (3) Latino ethnicity was only associated with 1 PROMIS domain (cognitive function-abilities) after controlling for covariates. CONCLUSION COVID-19 infection is associated with HRQoL decrements long after the acute infection, and financial concerns and interpersonal conflict are particularly associated with worse HRQoL.
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Affiliation(s)
- Kathleen R Case
- Center for Research to Advance Community Health (ReACH), Joe R. and Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. .,Division of General and Hospital Medicine, Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Chen-Pin Wang
- Department of Population Health Sciences, Joe R. and Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Meredith G Hosek
- Joe R. and Teresa Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,School of Public Health, The University of Texas Health Science Center at Houston, San Antonio Campus, San Antonio, TX, USA
| | - Sarah F Lill
- Center for Research to Advance Community Health (ReACH), Joe R. and Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Alexandra B Howell
- Joe R. and Teresa Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,School of Public Health, The University of Texas Health Science Center at Houston, San Antonio Campus, San Antonio, TX, USA
| | - Barbara S Taylor
- Division of Infectious Diseases, Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - James Bridges
- Center for Research to Advance Community Health (ReACH), Joe R. and Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Division of General and Hospital Medicine, Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Daniel J MacCarthy
- Department of Population Health Sciences, Joe R. and Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Paula Winkler
- Center for Research to Advance Community Health (ReACH), Joe R. and Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,School of Nursing, University of Texas Health Science Center, San Antonio, TX, USA.,South Central Area Health Education Center, University of Texas Health Science Center, San Antonio, TX, USA
| | - Joel Tsevat
- Center for Research to Advance Community Health (ReACH), Joe R. and Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Division of General and Hospital Medicine, Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Pires RE, Reis IGN, Waldolato GS, Pires DD, Bidolegui F, Giordano V. What Do We Need to Know About Musculoskeletal Manifestations of COVID-19?: A Systematic Review. JBJS Rev 2022; 10:01874474-202206000-00001. [PMID: 35658089 DOI: 10.2106/jbjs.rvw.22.00013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
» COVID-19 is a disease that is challenging science, health-care systems, and humanity. An astonishingly wide spectrum of manifestations of multi-organ damage, including musculoskeletal, can be associated with SARS-CoV-2. » In the acute phase of COVID-19, fatigue, myalgia, and arthralgia are the most common musculoskeletal symptoms. » Post-COVID-19 syndrome is a group of signs and symptoms that are present for >12 weeks. The associated musculoskeletal manifestations are fatigue, arthralgia, myalgia, new-onset back pain, muscle weakness, and poor physical performance. » Data on COVID-19 complications are growing due to large absolute numbers of cases and survivors in these 2 years of the pandemic. Additional musculoskeletal manifestations encountered are falls by the elderly, increased mortality after hip fracture, reduced bone mineral density and osteoporosis, acute sarcopenia, rhabdomyolysis, Guillain-Barré syndrome, muscle denervation atrophy, fibromyalgia, rheumatological disease triggering, septic arthritis, adhesive capsulitis, myositis, critical illness myopathy, onset of latent muscular dystrophy, osteonecrosis, soft-tissue abscess, urticarial vasculitis with musculoskeletal manifestations, and necrotizing autoimmune myositis. » A wide range of signs and symptoms involving the musculoskeletal system that affect quality of life and can result in a decrease in disability-adjusted life years. This powerful and unpredictable disease highlights the importance of multimodality imaging, continuing education, and multidisciplinary team care to support preventive measures, diagnosis, and treatment.
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Affiliation(s)
- Robinson E Pires
- Departamento do Aparelho Locomotor, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Serviço de Ortopedia e Traumatologia, Hospital Felicio Rocho, Belo Horizonte, Brazil.,Serviço de Ortopedia e Traumatologia, Instituto Orizonti, Belo Horizonte, Brazil
| | - Igor G N Reis
- Departamento do Aparelho Locomotor, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Gustavo S Waldolato
- Serviço de Ortopedia e Traumatologia, Hospital Felicio Rocho, Belo Horizonte, Brazil.,Serviço de Ortopedia e Traumatologia, Instituto Orizonti, Belo Horizonte, Brazil
| | - Diego D Pires
- Cedimagem Medicina Diagnóstica, Grupo Alliar, Juiz de Fora, Brazil
| | - Fernando Bidolegui
- Servicio de Ortopedia y Traumatologia, Hospital Sirio-Libanes, ECICARO, Buenos Aires, Argentin
| | - Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil
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Andrenelli E, Negrini F, de Sire A, Lazzarini SG, Patrini M, Ceravolo MG. Rehabilitation and COVID-19: update of the rapid living systematic review by Cochrane Rehabilitation Field as of October 31st, 2021. Eur J Phys Rehabil Med 2022; 58:153-156. [PMID: 35229570 PMCID: PMC9980579 DOI: 10.23736/s1973-9087.22.07434-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Elisa Andrenelli
- Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | | | - Alessandro de Sire
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy -
| | | | | | - Maria G Ceravolo
- Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
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