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Bandini G, Alunno A, Alcacer-Pitarch B, Ruaro B, Galetti I, El-Aoufy K, Pinheiro F, Campanaro G, Jade J, Donato S, Muir L, Moggi Pignone A, Bellando Randone S, Del Galdo F, McMahan ZH, Matucci-Cerinic M, Hughes M. Patients' unmet needs and treatment preferences concerning digital ulcers in systemic sclerosis. Rheumatology (Oxford) 2024:keae130. [PMID: 38430476 DOI: 10.1093/rheumatology/keae130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/21/2024] [Accepted: 02/07/2024] [Indexed: 03/03/2024] Open
Abstract
INTRODUCTION Digital ulcers (DUs) significantly impact on quality of life and function in patients with systemic sclerosis (SSc). The aim of our survey was to explore patients' perspectives and their unmet needs concerning SSc-DUs. MATERIALS SSc patients were invited through international patient associations and social media to participate in an online survey. RESULTS 358 responses were obtained from 34 countries: US (65.6%), UK (11.5%) and Canada (4.5%). Recurrent DUs are common: >10 DUs (46.1%), 5-10 DUs (21.5%), 1-5 DUs (28.5%), 1 DU (3.9%). Fingertip DUs were most frequent (84.9%), followed by those overlying the interphalangeal joints (50.8%). The impact of DUs in patients is broad, from broad-ranging emotional impacts to impact on activities of daily living, and personal relationships. Half (51.7%) of respondents reported that they received wound/ulcer care, most often provided by non-specialist wound care clinics (63.8%). There was significant variation in local (wound) DU care, in particular the use of debridement and pain management. DU-related education was only provided to one-third of patients. One-quarter (24.6%) were 'very satisfied' or 'satisfied' that the provided DU treatment(s) relieved their DU symptoms. Pain, limited hand function, and ulcer duration/chronicity were the main reasons for patients to consider changing DU treatment. CONCLUSIONS Our data show that there is a large variation in DU treatment between countries. Patient access to specialist wound-care services is limited and only a small proportion of patients had their DU needs met. Moreover, patient education is often neglected. Evidence-based treatment pathways are urgently needed for DU management.
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Affiliation(s)
- Giulia Bandini
- Department of Experimental and Clinical Medicine, Division of Internal Medicine, University of Florence, Italy
| | - Alessia Alunno
- University of L'Aquila, Department of Clinical Medicine, Life Health and Environmental Sciences, Internal Medicine and Nephrology Division, ASL1 Avezzano-Sulmona-L'Aquila, L'Aquila, Italy
| | | | - Barbara Ruaro
- Pulmonology Unit, University of Trieste, Department of Medical Surgical and Health Sciences, Hospital of Cattinara, Trieste, Italy
| | - Ilaria Galetti
- FESCA (Federation of European Scleroderma Associations) Belgium, & GILS (Gruppo Italiano, Lotta alla Sclerodermia), Italy
| | - Khadija El-Aoufy
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Filipe Pinheiro
- Department of Rheumatology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Giulia Campanaro
- Department of Experimental and Clinical Medicine, Division of Internal Medicine, University of Florence, Italy
| | - Judith Jade
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - StefanoDi Donato
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Lindsay Muir
- Department of Hand Surgery, Salford Royal, Salford, UK
| | - Alberto Moggi Pignone
- Department of Experimental and Clinical Medicine, Division of Internal Medicine, University of Florence, Italy
| | - Silvia Bellando Randone
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Italy
| | - Francesco Del Galdo
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Zsuzsanna H McMahan
- Department of Medicine, Division of Rheumatology, University of Texas Health Science Center at Houston, Houston, USA
| | - Marco Matucci-Cerinic
- Vita-Salute San Raffaele University, Milan, Italy
- IRCCS San Raffaele Hospital, Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), Milan, Italy
| | - Michael Hughes
- Department of Rheumatology, Northern Care Alliance NHS Foundation Trust, Salford Care Organisation, Salford, UK
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Bandini G, Cometi L, Accogli E, Domanico A, Tofani L, Bruni C, Bellando-Randone S, Lepri G, Orlandi M, Guiducci S, El-Aoufy K, Ciuti G, Fabbri A, Matucci-Cerinic M, Moggi-Pignone A. Ultrasound evaluation of bowel vasculopathy in systemic sclerosis. Eur J Intern Med 2022; 100:62-68. [PMID: 35058148 DOI: 10.1016/j.ejim.2022.01.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/05/2022] [Accepted: 01/13/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gastrointestinal (GI) manifestations are frequent in systemic sclerosis (SSc) with an impact on quality of life and morbidity. Bowel vasculopathy is a key pathogenetic factor responsible for GI involvement. OBJECTIVES To compare abdominal ultrasound (US) and Color Doppler Ultrasonography (CDU) features of splanchnic vessels of SSc patients with healthy controls. METHODS The charts of SSc patients who underwent an abdominal US and CDU study were retrospectively analyzed. For Superior Mesenteric Artery (SMA) and Inferior Mesenteric Artery (IMA) caliber, Peak Systolic Velocity (PSV), Reverse Velocity (RV), End-Diastolic Velocity (EDV), Mean Velocity (mV), Blood-flow, Resistive Index (RI) and Pulsatility Index (PI) were recorded. RESULTS 28 SSc patients and 28 controls were enrolled. In SSc, caliber of SMA was significantly smaller than in controls (5.75 ± 0.62 mm vs. 6.45 ± 0.60 mm, p < 0.0001 - p adj =0.0002). The flow study of SMA and IMA showed a significant reduction of RV (SMA: 7.25 ± 6.37 cm/s vs. 18.52 ± 6.16 cm/s, p < 0.0001 - p adj <0.0001; IMA: 2.69 ± 6.10 cm/s vs. 17.06 ± 5.75 cm/s, p < 0.0001 - p adj <0.0001) and PI (SMA: 3.33 ± 0.75 vs. 4.53 ± 1.03, p < 0.0001 - p adj =0.0002; IMA: 3.54 ± 0.95 vs. 6.08 ± 1.53, p < 0.0001 - p adj <0.0001) in SSc patients than controls. CONCLUSION involvement of splanchnic vessels in SSc may be non-invasively investigated with abdominal US and CDU. Morphological and functional changes of Doppler parameters observed in SMA and IMA clearly demonstrate that these vessels are affected by SSc vasculopathy.
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Affiliation(s)
- Giulia Bandini
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Internal Medicine AOUC, Viale San Luca, Florence 50134, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy.
| | - Laura Cometi
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Esterita Accogli
- Department of Internal Medicine, Centre of Research and Learning in Ultrasound, Maggiore Hospital, Bologna, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Andrea Domanico
- Department of Internal Medicine, Centre of Research and Learning in Ultrasound, Maggiore Hospital, Bologna, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Lorenzo Tofani
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Gemma Lepri
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Martina Orlandi
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Khadija El-Aoufy
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Gabriele Ciuti
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Internal Medicine AOUC, Viale San Luca, Florence 50134, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Alessia Fabbri
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Internal Medicine AOUC, Viale San Luca, Florence 50134, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Alberto Moggi-Pignone
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Internal Medicine AOUC, Viale San Luca, Florence 50134, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
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Gargani L, Romei C, Bruni C, Lepri G, El-Aoufy K, Orlandi M, D'Errico L, Bandini G, D'Angelo G, Guiducci S, Dagna L, Falaschi F, Matucci-Cerinic M, Moggi-Pignone A. Lung ultrasound B-lines in systemic sclerosis: cut-off values and methodological indications for interstitial lung disease screening. Rheumatology (Oxford) 2021; 61:SI56-SI64. [PMID: 34698807 DOI: 10.1093/rheumatology/keab801] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/21/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Lung ultrasound (LUS), through assessment of B-lines and pleural line alterations, is able to evaluate interstitial lung disease (ILD), a frequent complication of systemic sclerosis (SSc). Different scanning schemes and counting methods have been proposed, but no clear cut-off values have been indicated for screening. We aimed to evaluate the accuracy of different LUS methodological approaches to detect ILD, compared with high resolution computed tomography (HRCT) as gold standard. METHODS Sixty-nine SSc patients underwent LUS and chest HRCT on the same day. Both exams were scored by expert readers. The accuracy of different scanning schemes and counting methods was assessed, and clinical and functional data were compared with imaging findings. RESULTS B-lines were more numerous in patients with the diffuse skin subset and Scl70 autoantibody positivity. The number of B-lines correlated with the Scleroderma Lung Study (SLS) I HRCT score (R = 0.754, p< 0.0001). A total number >10 B-lines on the whole chest or > 1 B-line on the postero-basal chest showed 97% sensitivity for detecting even very early ILD signs (corresponding to SLS I score =1). Sensitivity increased to 100% when pleural line alterations were included in the analysis. CONCLUSIONS LUS has a very high sensitivity in detecting SSc-related ILD. A cut-off value of > 10 B-lines on the whole chest or > 1 B-line on the postero-basal chest can be used for the screening of SSc-ILD. Assessing only the postero-basal chest seems mostly effective to combine high sensitivity with a less time-consuming approach.
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Affiliation(s)
- Luna Gargani
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Chiara Romei
- Second Radiology Unit, University Hospital of Pisa, Italy
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, University of Florence, & Division of Rheumatology & Scleroderma Unit AOUC, Florence, Italy
| | - Gemma Lepri
- Department of Experimental and Clinical Medicine, University of Florence, & Division of Rheumatology & Scleroderma Unit AOUC, Florence, Italy
| | - Khadija El-Aoufy
- Department of Experimental and Clinical Medicine, University of Florence, & Division of Rheumatology & Scleroderma Unit AOUC, Florence, Italy
| | - Martina Orlandi
- Department of Experimental and Clinical Medicine, University of Florence, & Division of Rheumatology & Scleroderma Unit AOUC, Florence, Italy
| | | | - Giulia Bandini
- Department of Experimental and Clinical Medicine, University of Florence, & Division of Medicine AOUC, Florence, Italy
| | - Gennaro D'Angelo
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, University of Florence, & Division of Rheumatology & Scleroderma Unit AOUC, Florence, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy & Rare Diseases, IRCCS San Raffaele Hospital, Milano, Italy
| | - Fabio Falaschi
- Second Radiology Unit, University Hospital of Pisa, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, & Division of Rheumatology & Scleroderma Unit AOUC, Florence, Italy.,Royal Papworth Hospital NHS Foundation Trust
| | - Alberto Moggi-Pignone
- Department of Experimental and Clinical Medicine, University of Florence, & Division of Medicine AOUC, Florence, Italy
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Melchiorre D, Ceccherini MT, Romano E, Cometi L, El-Aoufy K, Bellando-Randone S, Roccotelli A, Bruni C, Moggi-Pignone A, Carboni D, Guiducci S, Lepri G, Tofani L, Pietramellara G, Matucci-Cerinic M. Oral Lactobacillus Species in Systemic Sclerosis. Microorganisms 2021; 9:1298. [PMID: 34203626 PMCID: PMC8232208 DOI: 10.3390/microorganisms9061298] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/07/2021] [Accepted: 06/11/2021] [Indexed: 11/16/2022] Open
Abstract
In systemic sclerosis (SSc), the gastrointestinal tract (GIT) plays a central role in the patient's quality of life. The microbiome populates the GIT, where a relationship between the Lactobacillus and gastrointestinal motility has been suggested. In this study, the analysis of oral Lactobacillus species in SSc patients and healthy subjects using culture-independent molecular techniques, together with a review of the literature on microbiota and lactobacilli in SSc, has been carried out. Twenty-nine SSc female patients (mean age 62) and twenty-three female healthy subjects (HS, mean age 57.6) were enrolled and underwent tongue and gum swab sampling. Quantitative PCR was conducted in triplicate using Lactobacillus specific primers rpoB1, rpoB1o and rpoB2 for the RNA-polymerase β subunit gene. Our data show significantly (p = 0.0211) lower LactobacillusspprpoB sequences on the tongue of patients with SSc compared to HS. The mean value of the amount of Lactobacillus ssprpoB gene on the gumsofSSc patients was minor compared to HS. A significant difference between tongue and gums (p = 0.0421) was found in HS but not in SSc patients. In conclusion, our results show a lower presence of Lactobacillus in the oral cavity of SSc patients. This strengthens the hypothesis that Lactobacillus may have both a protective and therapeutic role in SSc patients.
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Affiliation(s)
- Daniela Melchiorre
- Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology, University of Firenze, 50124 Firenze, Italy; (E.R.); (L.C.); (K.E.-A.); (S.B.-R.); (C.B.); (A.M.-P.); (D.C.); (S.G.); (G.L.); (L.T.); (M.M.-C.)
| | - Maria Teresa Ceccherini
- Department of Agriculture, Food, Environment and Forestry (DAGRI)-University ofFirenze, 50144 Firenze, Italy; (M.T.C.); (A.R.); (G.P.)
| | - Eloisa Romano
- Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology, University of Firenze, 50124 Firenze, Italy; (E.R.); (L.C.); (K.E.-A.); (S.B.-R.); (C.B.); (A.M.-P.); (D.C.); (S.G.); (G.L.); (L.T.); (M.M.-C.)
| | - Laura Cometi
- Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology, University of Firenze, 50124 Firenze, Italy; (E.R.); (L.C.); (K.E.-A.); (S.B.-R.); (C.B.); (A.M.-P.); (D.C.); (S.G.); (G.L.); (L.T.); (M.M.-C.)
| | - Khadija El-Aoufy
- Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology, University of Firenze, 50124 Firenze, Italy; (E.R.); (L.C.); (K.E.-A.); (S.B.-R.); (C.B.); (A.M.-P.); (D.C.); (S.G.); (G.L.); (L.T.); (M.M.-C.)
| | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology, University of Firenze, 50124 Firenze, Italy; (E.R.); (L.C.); (K.E.-A.); (S.B.-R.); (C.B.); (A.M.-P.); (D.C.); (S.G.); (G.L.); (L.T.); (M.M.-C.)
| | - Angela Roccotelli
- Department of Agriculture, Food, Environment and Forestry (DAGRI)-University ofFirenze, 50144 Firenze, Italy; (M.T.C.); (A.R.); (G.P.)
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology, University of Firenze, 50124 Firenze, Italy; (E.R.); (L.C.); (K.E.-A.); (S.B.-R.); (C.B.); (A.M.-P.); (D.C.); (S.G.); (G.L.); (L.T.); (M.M.-C.)
| | - Alberto Moggi-Pignone
- Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology, University of Firenze, 50124 Firenze, Italy; (E.R.); (L.C.); (K.E.-A.); (S.B.-R.); (C.B.); (A.M.-P.); (D.C.); (S.G.); (G.L.); (L.T.); (M.M.-C.)
| | - Davide Carboni
- Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology, University of Firenze, 50124 Firenze, Italy; (E.R.); (L.C.); (K.E.-A.); (S.B.-R.); (C.B.); (A.M.-P.); (D.C.); (S.G.); (G.L.); (L.T.); (M.M.-C.)
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology, University of Firenze, 50124 Firenze, Italy; (E.R.); (L.C.); (K.E.-A.); (S.B.-R.); (C.B.); (A.M.-P.); (D.C.); (S.G.); (G.L.); (L.T.); (M.M.-C.)
| | - Gemma Lepri
- Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology, University of Firenze, 50124 Firenze, Italy; (E.R.); (L.C.); (K.E.-A.); (S.B.-R.); (C.B.); (A.M.-P.); (D.C.); (S.G.); (G.L.); (L.T.); (M.M.-C.)
| | - Lorenzo Tofani
- Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology, University of Firenze, 50124 Firenze, Italy; (E.R.); (L.C.); (K.E.-A.); (S.B.-R.); (C.B.); (A.M.-P.); (D.C.); (S.G.); (G.L.); (L.T.); (M.M.-C.)
| | - Giacomo Pietramellara
- Department of Agriculture, Food, Environment and Forestry (DAGRI)-University ofFirenze, 50144 Firenze, Italy; (M.T.C.); (A.R.); (G.P.)
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology, University of Firenze, 50124 Firenze, Italy; (E.R.); (L.C.); (K.E.-A.); (S.B.-R.); (C.B.); (A.M.-P.); (D.C.); (S.G.); (G.L.); (L.T.); (M.M.-C.)
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