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Kleeven A, Jonis YMJ, Tielemans H, van Kuijk S, Kimman M, van der Hulst R, Vasilic D, Hummelink S, Qiu SS. The N-LVA Study: effectiveness and cost-effectiveness of lymphaticovenous anastomosis (LVA) for patients with cancer who suffer from chronic peripheral lymphoedema - study protocol of a multicentre, randomised sham-controlled trial. BMJ Open 2024; 14:e086226. [PMID: 38626967 PMCID: PMC11029230 DOI: 10.1136/bmjopen-2024-086226] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Cancer-related lymphoedema is one of the most debilitating side-effects of cancer treatment with an overall incidence of 15.5%. Patients may suffer from a variety of symptoms, possibly resulting in a diminished health-related quality of life (HRQoL). A microsurgical technique known as lymphaticovenous anastomosis (LVA) might be a promising treatment option. The objective of this study is to evaluate whether LVA is effective and cost-effective compared with sham surgery in improving the HRQoL. METHODS AND ANALYSIS A multicentre, double-blind, randomised sham-controlled trial conducted in three university hospitals in the Netherlands. The study population comprises 110 patients over the age of 18 years with unilateral, peripheral cancer-related lymphoedema, including 70 patients with upper limb lymphoedema and 40 patients with lower limb lymphoedema. A total of 55 patients will undergo the LVA operation, while the remaining 55 will undergo sham surgery. The follow-up will be at least 24 months. Patients are encouraged to complete the follow-up by explaining the importance of the study. Furthermore, patients may benefit from regular monitoring moments for their lymphoedema. The primary outcome is the HRQoL. The secondary outcomes are the limb circumference, excess limb volume, changes in conservative therapy, postoperative complications, patency of the LVA and incremental cost-effectiveness. ETHICS AND DISSEMINATION The study was approved by the Medical Ethical Committee of Maastricht University Medical Center on 20 September 2023 (NL84169.068.23). The results will be presented at scientific conferences and published in peer-reviewed medical journals. TRIAL REGISTRATION NUMBER NCT06082349.
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Affiliation(s)
- Alieske Kleeven
- Department of Plastic and Reconstructive Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Yasmine M J Jonis
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hanneke Tielemans
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sander van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Merel Kimman
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - René van der Hulst
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Dalibor Vasilic
- Department of Plastic and Reconstructive Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Stefan Hummelink
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Shan Shan Qiu
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Kaur MN, Cornacchi SD, Klassen AF, Haykal S, Hircock C, Mehrara BJ, Dayan JH, Vasilic D, Pusic AL. Ensuring patient centeredness in upper extremity lymphedema research: Identifying patient-prioritized agenda and preferences. J Plast Reconstr Aesthet Surg 2023; 83:326-333. [PMID: 37302238 DOI: 10.1016/j.bjps.2023.04.036] [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: 09/23/2022] [Revised: 03/28/2023] [Accepted: 04/08/2023] [Indexed: 06/13/2023]
Abstract
PURPOSE To elicit a patient-prioritized agenda and preferences for upper extremity lymphedema (LE) research. METHODS Focus group sessions (FGs) were conducted with English-speaking, adult women (18 years and older) with breast cancer-related LE (BCRL) seeking conservative or surgical care at two tertiary cancer centers in Ontario, Canada. An interview guide was used; women were asked to describe health-related quality of life (HRQL) outcomes that mattered the most to them, followed by their preferences for research study design and for providing patient-reported outcomes measure (PROM) data. Inductive content analysis was used to identify themes and subthemes. RESULTS A total of 16 women participated in 4 FG sessions (55 ± 9.5 years) and described the impact of LE on their appearance, physical, psychosocial, and sexual well-being. Women emphasized that psychosocial well-being was often not discussed in clinical care and that they were poorly informed of LE risk and care options. Most women said that they would not be willing to be randomized to surgical versus conservative management of LE. They also expressed a preference to complete PROM data electronically. All women emphasized the value of having an open text option alongside PROMs to expand on their concerns. CONCLUSION Patient centeredness is key to generating meaningful data and ensuring ongoing engagement in clinical research. In LE, comprehensive PROMs that measure a range of HRQL concerns, especially psychosocial well-being, should be considered. Women with BCRL are reluctant to be randomized to conservative care when a surgical option is available, resulting in implications for planning trial sample size and recruitment.
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Affiliation(s)
- Manraj N Kaur
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States.
| | - Sylvie D Cornacchi
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, 3N27, 1280 Main Street W, Hamilton, ON L8N 3Z5, Canada
| | - Anne F Klassen
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, 3N27, 1280 Main Street W, Hamilton, ON L8N 3Z5, Canada
| | - Siba Haykal
- Division of Plastic, Reconstructive and Aesthetic Surgery, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Caroline Hircock
- Michael G. DeGroote School of Medicine, McMaster University, MDCL, 3104, 1280 Main Street W, Hamilton, ON L8S 4K1, Canada
| | - Babak J Mehrara
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Joseph H Dayan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Dalibor Vasilic
- Department of Plastic, Reconstructive and Hand Surgery Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Andrea L Pusic
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
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Clarijs ME, van Egdom LSE, Verhoef C, Vasilic D, Koppert LB. Bilateral prophylactic mastectomy: should we preserve the pectoral fascia? Protocol of a Dutch double blinded, prospective, randomised controlled pilot study with a within-subject design (PROFAS). BMJ Open 2023; 13:e066728. [PMID: 36806067 PMCID: PMC9944307 DOI: 10.1136/bmjopen-2022-066728] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
INTRODUCTION Bilateral prophylactic mastectomy (BPM) in women with a high risk of developing breast cancer has shown to provide the greatest risk reduction. Many surgical guidelines recommend the removal of the pectoral fascia (PF) in mastectomies; however, there is no evidence to support this statement. Reported wound-related complications following mastectomy include seroma, flap necrosis, infection and haematoma. Seroma causes discomfort and may delay the reconstructive procedures. Whether removal or preservation of the PF influences drain volume, seroma formation and other postoperative complications following BPM remains unclear. The aim of this study is to assess the impact of removal versus preservation of the PF on drain policy and seroma after BPM. METHODS AND ANALYSIS This is a double blinded, prospective, randomised controlled pilot study with a within-subject design. The inclusion criteria are women >18 years, presenting in the Academic Breast Cancer Centre Rotterdam, who are opting for BPM. Patients with a history or diagnosis of breast cancer are excluded. According to the sample size calculation based on the difference in total drain volume, a number of 21 eligible patients will be included. Randomisation will occur within the patient, which means PF preservation in one breast and PF removal in the contralateral breast. The primary study endpoint is total drainage volume. Secondary study outcomes include time to drain removal, number of needle aspirations, postoperative complications and length of hospital stay. ETHICS AND DISSEMINATION The study is approved by the Erasmus Medical Center Review Board (REC 2020-0431). Results will be presented during international conferences and published in a peer-reviewed academic journal. TRIAL REGISTRATION NUMBER NCT05391763; clinicaltrials.gov.
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Affiliation(s)
- Marloes E Clarijs
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, Zuid-Holland, The Netherlands
| | - Laurentine S E van Egdom
- Department of Plastic and Reconstructive Surgery, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, Zuid-Holland, The Netherlands
| | - Dalibor Vasilic
- Department of Plastic and Reconstructive Surgery, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Linetta B Koppert
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, Zuid-Holland, The Netherlands
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Van Heumen S, Riksen JJ, Singh MKA, Van Soest G, Vasilic D. LED-based photoacoustic imaging for preoperative visualization of lymphatic vessels in patients with secondary limb lymphedema. Photoacoustics 2023; 29:100446. [PMID: 36632606 PMCID: PMC9826814 DOI: 10.1016/j.pacs.2022.100446] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/16/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
Lymphedema is the accumulation of protein-rich fluid in the interstitium (i.e., dermal backflow (DBF)). Preoperative imaging of the lymphatic vessels is a prerequisite for lymphovenous bypass surgical planning. We investigated the visualization of lymphatic vessels and veins using light-emitting diode (LED)-based photoacoustic imaging (PAI). Indocyanine-green mediated near-infrared fluorescence lymphography (NIRF-L) was done in fifteen patients with secondary limb lymphedema. Photoacoustic images were acquired in locations where lymphatic vessels and DBF were observed with NIRF-L. We demonstrated that LED-based PAI can visualize and differentiate lymphatic vessels and veins even in the presence of DBF. We observed lymphatic and blood vessels up to depths of 8.3 and 8.6 mm, respectively. Superficial lymphatic vessels and veins can be visualized using LED-based PAI even in the presence of DBF showing the potential for pre-operative assessment. Further development of the technique is needed to improve its usability in clinical settings.
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Affiliation(s)
- Saskia Van Heumen
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Jonas J.M. Riksen
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | | | - Gijs Van Soest
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Dalibor Vasilic
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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5
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van Heumen S, Riksen JJM, Bramer WM, van Soest G, Vasilic D. Imaging of the Lymphatic Vessels for Surgical Planning: A Systematic Review. Ann Surg Oncol 2023; 30:462-479. [PMID: 36171528 PMCID: PMC9726677 DOI: 10.1245/s10434-022-12552-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/02/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Secondary lymphedema is a common complication after surgical or radiotherapeutic cancer treatment. (Micro) surgical intervention such as lymphovenous bypass and vascularized lymph node transfer is a possible solution in patients who are refractory to conventional treatment. Adequate imaging is needed to identify functional lymphatic vessels and nearby veins for surgical planning. METHODS A systematic literature search of the Embase, MEDLINE ALL via Ovid, Web of Science Core Collection and Cochrane CENTRAL Register of Trials databases was conducted in February 2022. Studies reporting on lymphatic vessel detection in healthy subjects or secondary lymphedema of the limbs or head and neck were analyzed. RESULTS Overall, 129 lymphatic vessel imaging studies were included, and six imaging modalities were identified. The aim of the studies was diagnosis, severity staging, and/or surgical planning. CONCLUSION Due to its utility in surgical planning, near-infrared fluorescence lymphangiography (NIRF-L) has gained prominence in recent years relative to lymphoscintigraphy, the current gold standard for diagnosis and severity staging. Magnetic resonance lymphography (MRL) gives three-dimensional detailed information on the location of both lymphatic vessels and veins and the extent of fat hypertrophy; however, MRL is less practical for routine presurgical implementation due to its limited availability and high cost. High frequency ultrasound imaging can provide high resolution imaging of lymphatic vessels but is highly operator-dependent and accurate identification of lymphatic vessels is difficult. Finally, photoacoustic imaging (PAI) is a novel technique for visualization of functional lymphatic vessels and veins. More evidence is needed to evaluate the utility of PAI in surgical planning.
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Affiliation(s)
- Saskia van Heumen
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,MSc Educational Program Technical Medicine, Leiden University Medical Center, Delft University of Technology and Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jonas J M Riksen
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Wichor M Bramer
- Medical Library, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Gijs van Soest
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Dalibor Vasilic
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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van Heumen S, Riksen JJM, Bramer WM, van Soest G, Vasilic D. Correction: Imaging of the Lymphatic Vessels for Surgical Planning: A Systematic Review. Ann Surg Oncol 2022; 29:628. [PMID: 36245057 PMCID: PMC9675688 DOI: 10.1245/s10434-022-12660-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Affiliation(s)
- Saskia van Heumen
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- MSc Educational Program Technical Medicine, Leiden University Medical Center, Delft University of Technology and Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jonas J M Riksen
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Wichor M Bramer
- Medical Library, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Gijs van Soest
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Dalibor Vasilic
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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7
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Klassen AF, Tsangaris E, Kaur MN, Poulsen L, Beelen LM, Jacobsen AL, Jørgensen MG, Sørensen JA, Vasilic D, Dayan J, Mehrara B, Pusic AL. Development and Psychometric Validation of a Patient-Reported Outcome Measure for Arm Lymphedema: The LYMPH-Q Upper Extremity Module. Ann Surg Oncol 2021; 28:5166-5182. [PMID: 34224044 PMCID: PMC8349351 DOI: 10.1245/s10434-021-09887-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/15/2021] [Indexed: 11/20/2022]
Abstract
Background A multiphased mixed-methods study was performed to develop and validate a comprehensive patient-reported outcome measure (PROM) for arm lymphedema in women with breast cancer (i.e., the LYMPH-Q Upper Extremity Module). Methods Qualitative interviews (January 2017 and June 2018) were performed with 15 women to elicit concepts specific to arm lymphedema after breast cancer treatment. Data were audio-recorded, transcribed, and coded. Scales were refined through cognitive interviews (October and Decemeber 2018) with 16 patients and input from 12 clinical experts. The scales were field-tested (October 2019 and January 2020) with an international sample of 3222 women in the United States and Denmark. Rasch measurement theory (RMT) analysis was used to examine reliability and validity. Results The qualitative phase resulted in six independently functioning scales that measure arm symptoms, function, appearance, psychological function, and satisfaction with information and with arm sleeves. In the RMT analysis, all items in each scale had ordered thresholds and nonsignificant chi-square p values. For all the scales, the reliability statistics with and without extremes for the Person Separation Index were 0.80 or higher, Cronbach’s alpha was 0.89 or higher, and the Intraclass Correlation Coefficients were 0.92 or higher. Lower (worse) scores on the LYMPH-Q Upper Extremity scales were associated with reporting of more severe arm swelling, an arm problem caused by cancer and/or its treatment, and wearing of an arm sleeve in the past 12 months. Conclusions The LYMPH-Q Upper Extremity Module can be used to measure outcomes that matter to women with upper extremity lymphedema. This new PROM was designed using a modern psychometric approach and, as such, can be used in research and in clinical care.
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Affiliation(s)
| | - Elena Tsangaris
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Manraj N Kaur
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lotte Poulsen
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark.,Odense Explorative Patient Network, Odense, Denmark
| | - Louise M Beelen
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Amalie Lind Jacobsen
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark.,Odense Explorative Patient Network, Odense, Denmark
| | - Mads Gustaf Jørgensen
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark
| | - Jens Ahm Sørensen
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark
| | - Dalibor Vasilic
- Department of Plastic, Reconstructive and Hand Surgery, ErasmusMC, Rotterdam, The Netherlands
| | - Joseph Dayan
- Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Babak Mehrara
- Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Andrea L Pusic
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Klassen AF, van Haren ELWG, van Alphen TC, Cano S, Cross KM, van Dishoeck AM, Fan KL, Michael Hoogbergen M, Orgill D, Poulsen L, Ahm Sørensen J, Squitieri L, Tsangaris E, Vasilic D, Pusic AL. International study to develop the WOUND-Q patient-reported outcome measure for all types of chronic wounds. Int Wound J 2021; 18:487-509. [PMID: 33694326 PMCID: PMC8273613 DOI: 10.1111/iwj.13549] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/11/2020] [Accepted: 12/18/2020] [Indexed: 12/13/2022] Open
Abstract
Patient‐reported outcome measures (PROMs) for chronic wounds mainly focus on specific types of wounds. Our team developed the WOUND‐Q for use with all types of wounds in any anatomic location. We conducted 60 concept elicitation interviews with patients in Canada, Denmark, the Netherlands, and the United States. Analysis identified concepts of interest to patients and scales were formed and refined through cognitive interviews with 20 patients and input from 26 wound care experts. Scales were translated into Danish and Dutch. An international field‐test study collected data from 881 patients (1020 assessments) with chronic wounds. Rasch measurement theory (RMT) analysis was used to refine the scales and examine psychometric properties. RMT analysis supported the reliability and validity of 13 WOUND‐Q scales that measure wound characteristics (assessment, discharge, and smell), health‐related quality of life (life impact, psychological, sleep impact, and social), experience of care (information, home care nurses, medical team, and office staff), and wound treatment (dressing and suction device). The WOUND‐Q can be used to measure outcomes in research and clinical practice from the perspective of patients with any type of wound.
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Affiliation(s)
- Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Emiel L W G van Haren
- Department of Plastic and Reconstructive Surgery, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Tert C van Alphen
- Department of Plastic and Reconstructive Surgery, Catharina Ziekenhuis and Da Vinci Kliniek, Geldrop, Eindhoven, The Netherlands
| | | | - Karen M Cross
- Department of Surgery, Division of Plastic Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Anne-Margreet van Dishoeck
- Department of Plastic and Reconstructive and Hand Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Kenneth L Fan
- Department of Plastic Surgery, Georgetown University School of Medicine, Plastic and Reconstructive Surgery, MedStar Health Research Institute, Washington, District of Columbia, USA
| | - Maarten Michael Hoogbergen
- Department of Plastic and Reconstructive Surgery, Catharina Ziekenhuis, Eindhoven, and Da Vinci Kliniek, Geldrop, Eindhoven, The Netherlands
| | - Dennis Orgill
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lotte Poulsen
- Research Unit for Plastic Surgery, Odense University Hospital, University of Southern Denmark, and Odense Explorative Patient Network, Odense, Denmark
| | - Jens Ahm Sørensen
- Research Unit for Plastic Surgery, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Lee Squitieri
- RAND Corporation, Santa Monica, California, USA.,Plastic and Reconstructive Surgery, Adventist Health White Memorial, Los Angeles, California, USA
| | - Elena Tsangaris
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Dalibor Vasilic
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Andrea L Pusic
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Beelen LM, van Dishoeck AM, Tsangaris E, Coriddi M, Dayan JH, Pusic AL, Klassen A, Vasilic D. Patient-Reported Outcome Measures in Lymphedema: A Systematic Review and COSMIN Analysis. Ann Surg Oncol 2021; 28:1656-1668. [PMID: 33249519 PMCID: PMC8693252 DOI: 10.1245/s10434-020-09346-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/25/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Lymphedema is a chronic and debilitating condition that affects many cancer survivors. Patient-reported outcome measures (PROMs) can give valuable insight into the impact of lymphedema on a patient's quality of life and can play an essential role in treatment decisions. This study aims to (1) identify PROMs used to assess health-related quality of life (HRQoL) in patients with lymphedema; and (2) assess the quality of the lymphedema-specific PROMs. METHODS We performed a systematic search to identify articles on lymphedema, quality of life, and PROMs. An overview was created of all PROMs used to assess HRQoL in patients with lymphedema. The methodological quality of the lymphedema-specific PROMs was assessed using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) criteria. RESULTS A total of 235 articles met the inclusion criteria, of which 200 described studies using one or more PROMs as an outcome measure in patients with lymphedema. The other 35 studies described the development and/or validation of a lymphedema-specific PROM. The COSMIN assessment demonstrated that none of these PROMs met all quality standards for development. CONCLUSION The use of PROMs in lymphedema is increasing; however, based on our findings, we cannot fully support the use of any of the existing instruments. A well-developed lymphedema-specific PROM, based on patient input, is needed to gain better insight into the impact of this condition, and can be used to measure the effect of possible medical and surgical treatments.
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Affiliation(s)
- Louise Marie Beelen
- Department of Surgery, Patient-Reported Outcome, Value and Experience (PROVE) Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
- Department of Plastic and Reconstructive Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - Anne-Margreet van Dishoeck
- Department of Plastic and Reconstructive Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Elena Tsangaris
- Department of Surgery, Patient-Reported Outcome, Value and Experience (PROVE) Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Joseph H Dayan
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea L Pusic
- Department of Surgery, Patient-Reported Outcome, Value and Experience (PROVE) Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Dalibor Vasilic
- Department of Plastic and Reconstructive Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Beslic J, Herbel R, Puchala A, Heckel S, Stavrou S, Plomer B, Kubanek S, Dierkes H, Vasilic D, Garcia Ocana GE, Rath JM, Schott M, Ebner F. Maligne transformiertes Teratom. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- J Beslic
- Helios Amper-Klinikum Dachau, Gynäkologie und Geburtshilfe
| | - R Herbel
- Helios Amper-Klinikum Dachau, Gynäkologie und Geburtshilfe
| | - A Puchala
- Helios Amper-Klinikum Dachau, Gynäkologie und Geburtshilfe
| | - S Heckel
- Helios Amper-Klinikum Dachau, Gynäkologie und Geburtshilfe
| | - S Stavrou
- Helios Amper-Klinikum Dachau, Gynäkologie und Geburtshilfe
| | - B Plomer
- Helios Amper-Klinikum Dachau, Gynäkologie und Geburtshilfe
| | - S Kubanek
- Helios Amper-Klinikum Dachau, Gynäkologie und Geburtshilfe
| | - H Dierkes
- Helios Amper-Klinikum Dachau, Gynäkologie und Geburtshilfe
| | - D Vasilic
- Helios Amper-Klinikum Dachau, Gynäkologie und Geburtshilfe
| | | | - JM Rath
- Helios Amper-Klinikum Dachau, Gynäkologie und Geburtshilfe
| | - M Schott
- Helios Amper-Klinikum Dachau, Gynäkologie und Geburtshilfe
| | - F Ebner
- Helios Amper-Klinikum Dachau, Gynäkologie und Geburtshilfe
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11
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Etra JW, Fidder SAJ, Frost CM, Messner F, Guo Y, Vasilic D, Beck SE, Bonawitz S, Brandacher G, Cooney DS. Latissimus Dorsi Myocutaneous Flap Procedure in a Swine Model. J INVEST SURG 2020; 34:1289-1296. [PMID: 32752901 DOI: 10.1080/08941939.2020.1795952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND As surgical research expands in both breadth and scope, translational models become increasingly important. The accessibility, reproducibility, and clinical applicability of translational models is of vital importance to ensure adequate and accurate research. Though different flap models have been described, the literature lacks an in-depth, technical description of an easy large-animal preclinical model. We here describe the procedure for elevation of a latissimus dorsi flap in a swine. This flap contains muscle and skin that can be isolated on a vascular pedicle, transferred as a free flap, perfused, or innervated/denervated as dictated by the needs of the experiment. METHODS Five different latissimus dorsi flaps were elevated in miniature swine. Careful attention was paid to anatomical landmarks and optimal placement of incision, dissection, and retraction. Temporary ischemia with vascular clamping was performed along with serial digital and infrared imaging both intra- and postoperatively. In three of the flaps with induced ischemia, the animal was observed for a 30-day follow up with daily photodocumentation and intermittent biopsy. RESULTS A reproducible latissimus flap model was designed with optimized conditions. In the animals in which flaps were followed postoperatively, complete healing was seen within 30 days without evidence of procedure-related ischemia or loss of motor function. CONCLUSION We have identified and described a pre-clinical large animal flap model that can be easily reproduced for translational studies of multiple scientific areas including flap-based repair, ischemia, ischemia reperfusion, and operative technique. This provides an important model for ready replication in preclinical studies of many varieties.
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Affiliation(s)
- Joanna W Etra
- Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Samuel A J Fidder
- Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Plastic and Reconstructive Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Christopher M Frost
- Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Franka Messner
- Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yinan Guo
- Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Hand and Microsurgery, Xiangya Hospital, Central South University, Hunan, China
| | - Dalibor Vasilic
- Department of Plastic and Reconstructive Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sarah E Beck
- Department of Molecular and Comparative Pathobiology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Steven Bonawitz
- Department of Surgery, Cooper Medical School, Rowan University, Camden, New Jersey, USA
| | - Gerald Brandacher
- Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Damon S Cooney
- Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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12
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Paulus VAA, Winters H, Hummelink S, Schulten S, Ulrich DJO, Vasilic D. Submental flap for vascularized lymph node transfer; a CTA-based study on lymph node distribution. J Surg Oncol 2020; 122:1226-1231. [PMID: 32668040 PMCID: PMC7689706 DOI: 10.1002/jso.26117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 06/27/2020] [Indexed: 01/03/2023]
Abstract
Background Amongst various options of vascularized lymph node transfers, the submental flap has the lowest risk for iatrogenic lymphedema. The aim of this study was to gain insight into distribution, number, and size of lymph nodes along the mandible using computed tomography angiography (CTA). Methods A total of 52 CTA scans of head/neck region were evaluated retrospectively. Lymph nodes in the submental and submandibular region, related to the origin of the submental artery, were recorded using a three‐dimensional coordinate system, and standardized using an iterative closest point algorithm. Results were analyzed for gender, location, size, and number. Results The mean number and size of lymph nodes were 5.30 ± 2.00 and 5.28 ± 1.29 mm, respectively. The mean distance of the lymph nodes to the origin of the submental artery was 25.53 ± 15.27 mm. There was no significant difference between both sides when comparing size (left: 5.39 ± 1.28; right: 5.17 ± 1.34; P = .19), number (left: 5.46 ± 2.10; right: 5.17 ± 1.96; P = .49), and distance (left: 24.78 ± 12.23; right: 26.32 ± 14.73; P = .19). No significance was found between males and females concerning number (P = .60), size (P = .50), and distance (P = .06). Conclusion The variance of lymph node distribution along the mandible may warrant conducting a CTA scan to maximize the number of transferred lymph nodes and aid in flap design.
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Affiliation(s)
- Vera A A Paulus
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Harm Winters
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stefan Hummelink
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sascha Schulten
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dietmar J O Ulrich
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dalibor Vasilic
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Plastic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
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13
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Ebner F, Götz SC, Herbel R, Beslic J, Vasilic D, Hempel D, Milani V. Reduktion der chemotherapieinduzierten Alopezie durch Verwendung von Kühlhauben bei Patientinnen mit primärem und fortgeschrittenem Mammakarzinom: Auswertung von 57 Fällen. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1713984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- F Ebner
- Universität Ulm, Frauenklinik, Ulm
- Helios Amper Klinikum, Frauenklinik, Dachau
| | - S-C Götz
- Universität Ulm, Frauenklinik, Ulm
| | - R Herbel
- Universität Ulm, Frauenklinik, Ulm
| | - J Beslic
- Universität Ulm, Frauenklinik, Ulm
| | - D Vasilic
- Helios Amper Klinikum, Frauenklinik, Dachau
| | - D Hempel
- Onkologisches Zentrum, Donauwörth
| | - V Milani
- Onkologisches Zentrum, Donauwörth
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14
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Götz SC, Herbel R, Beslic J, Vasilic D, Ebner F. Ergebnisse einer Umfrage unter Senologen zum Thema ‚Sport nach Brustaufbau‘. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1714023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- S-C Götz
- Frauenklinik mit zertifiziertem Brustzentrum, Helios Amperklinikum, Dachau
| | - R Herbel
- Frauenklinik mit zertifiziertem Brustzentrum, Helios Amperklinikum, Dachau
| | - J Beslic
- Frauenklinik mit zertifiziertem Brustzentrum, Helios Amperklinikum, Dachau
| | - D Vasilic
- Frauenklinik mit zertifiziertem Brustzentrum, Helios Amperklinikum, Dachau
| | - F Ebner
- Frauenklinik mit zertifiziertem Brustzentrum, Helios Amperklinikum, Dachau
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15
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Fidder SAJ, Furtmüller GJ, Matoso A, Etra JW, Lombardo K, Chicco M, Oh BC, Vasilic D, Lee WPA, Redett RJ, Cooney DS, Brandacher G. A novel rat microsurgical model to study the immunological characteristics of male genital tissue in the context of penile transplantation. Transpl Int 2020; 33:796-805. [PMID: 32145119 DOI: 10.1111/tri.13603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/08/2019] [Accepted: 03/02/2020] [Indexed: 11/28/2022]
Abstract
Penis transplantation represents an exciting new avenue for restoration of male genitalia and function after devastating tissue loss. This animal model is designed to fill a critical void to study immunologic aspects related to reconstructive transplantation of male genitalia. A rat penile graft dissection was designed based on the internal pudendal arteries and dorsal penile vein and includes the skin of the prepuce. A nonsuture cuff technique was used to anastomose the graft vessels to the recipient superficial epigastric and femoral vessels. Seventy-seven penile transplantations were performed. Graft design yields suitable caliber and length of vessels at the radix of the penis. Anastomosis of the dorsal penile vein and the internal pudendal arteries insures optimal graft perfusion. The nonsuture cuff technique allows for successful microvascular anastomosis by a single surgeon with an average overall operative time of 2.5 h. Long-term graft survival (>30 days) was observed in syngeneic transplants. We have established a robust murine model with ideal vascular perfusion of penile tissue to study the unique immunobiology of male genitourinary allotransplantation. Heterotopic inset further allows for visual monitoring of graft viability, while the native penis serves as an optimal control.
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Affiliation(s)
- Samuel A J Fidder
- Vascularized Composite Allotransplantation (VCA) Laboratory, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Plastic and Reconstructive Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Georg J Furtmüller
- Vascularized Composite Allotransplantation (VCA) Laboratory, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andres Matoso
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joanna W Etra
- Vascularized Composite Allotransplantation (VCA) Laboratory, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kara Lombardo
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Maria Chicco
- Vascularized Composite Allotransplantation (VCA) Laboratory, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Byoung Chol Oh
- Vascularized Composite Allotransplantation (VCA) Laboratory, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dalibor Vasilic
- Department of Plastic and Reconstructive Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Wei P A Lee
- Vascularized Composite Allotransplantation (VCA) Laboratory, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard J Redett
- Vascularized Composite Allotransplantation (VCA) Laboratory, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Damon S Cooney
- Vascularized Composite Allotransplantation (VCA) Laboratory, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gerald Brandacher
- Vascularized Composite Allotransplantation (VCA) Laboratory, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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16
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Mohammad Zadeh M, Lingsma H, van Neck JW, Vasilic D, van Dishoeck AM. Outcome predictors for wound healing in patients with a diabetic foot ulcer. Int Wound J 2019; 16:1339-1346. [PMID: 31418528 DOI: 10.1111/iwj.13194] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 12/11/2022] Open
Abstract
The aim of this study was to identify diabetic foot ulcer (DFU) patients at risk for the development of a hard-to-heal wound. This is a post-hoc analysis of a prospective cohort study including a total of 208 patients with a DFU. The primary endpoints were time to healing and the development of a hard-to-heal-wound. Univariable and multivariable logistic and Cox regression analysis were used to study the associations of patient characteristics with the primary endpoints. The number of previous DFUs [odds ratio (OR): 1.42, 95% confidence interval (CI): 1.01-1.99, P = .04], University of Texas (UT) classification grade 2 (OR: 2.93, 95% CI: 1.27-6.72, P = .01), UT classification grade 3 (OR: 2.80, 95% CI: 1.17-6.71, P = .02), and a diagnosis of foot stand deformation (OR: 1.54, 95% CI: 0.77-3.08, P = .05) were significantly associated with the development of a hard-to-heal wound. Only UT classification grade 3 (HR: 0.61, 95% CI: 0.41-0.90, P = .01) was associated with time to healing. The number of previous DFUs, UT classification grade, and a diagnosis of foot deformation are significantly associated with development of a hard-to-heal wound in patients with a DFU. The only predictor significantly associated with time to healing was UT classification grade 3. These patient characteristics can be used to identify patients at risk for the development of hard-to-heal wounds, who might need an early intervention to prevent wound problems.
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Affiliation(s)
- Maryam Mohammad Zadeh
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hester Lingsma
- Department of Public Health, Center for Clinical Decision Making, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Johan W van Neck
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Dalibor Vasilic
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Anne-Margreet van Dishoeck
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
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17
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Weesie F, Naus NC, Vasilic D, Hollestein LM, van den Bos RR, Wakkee M. Recurrence of periocular basal cell carcinoma and squamous cell carcinoma after Mohs micrographic surgery: a retrospective cohort study. Br J Dermatol 2019; 180:1176-1182. [PMID: 30536656 PMCID: PMC6849866 DOI: 10.1111/bjd.17516] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2018] [Indexed: 12/02/2022]
Abstract
Background Despite the widespread use of Mohs micrographic surgery (MMS) for periocular basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) – together called keratinocyte carcinoma (KC) – follow‐up data regarding recurrences are limited. Objectives To investigate the recurrence rate for periocular KCs after MMS and to describe our experience with interdisciplinary collaborations. Methods Patients with periocular KCs treated with MMS between 2006 and 2016 in a tertiary MMS referral hospital were included in this retrospective cohort study. Descriptive statistics were used to describe the MMS procedure‐related characteristics. Using follow‐up data from the electronic patient records and linkage with the Dutch nationwide network and registry of histopathology and cytopathology on 30 June 2017, the recurrence rate was evaluated and calculated using a cumulative incidence curve. Results In total, 683 (93·7%) periocular BCCs and 46 (6·3%) SCCs were treated with MMS. Three‐quarters (n = 549) were primary tumours and the majority were located at the medial canthus or lower eyelid (n = 649, 89·0%). In 505 MMS procedures (69·3%) an oculoplastic surgeon participated, and in 63 patients (8·6%) a plastic surgeon performed the reconstruction. After a median follow‐up of 46 months the recurrence rate was 3·0%, based on 22 recurrences (20 BCCs and two SCCs). Conclusions MMS is an excellent treatment option for periocular KCs, with a low recurrence rate. Due to this specific anatomical location an interdisciplinary approach should pre‐eminently be considered. What's already known about this topic? Mohs micrographic surgery (MMS) is a widespread treatment for periocular basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) because of the expected high cure rate, while preserving healthy tissue. Follow‐up data on the risk of recurrence after periocular MMS are limited.
What does this study add? This retrospective cohort study demonstrates that with a recurrence rate of 3·0% after almost 4 years, MMS has proven to be an excellent surgical treatment option for periocular BCC and SCC. We advise a low threshold for interdisciplinary collaborations, especially in case of recurrent BCCs, BCCs localized in the medial canthus and aggressive BCCs.
Linked Comment: https://doi.org/10.1111/bjd.17736. https://www.bjdonline.com/article/
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Affiliation(s)
- F Weesie
- Department of Dermatology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - N C Naus
- Department of Ophthalmology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - D Vasilic
- Department of Plastic Surgery, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - L M Hollestein
- Department of Dermatology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - R R van den Bos
- Department of Dermatology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - M Wakkee
- Department of Dermatology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
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18
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van 't Hart W, Jansen AJG, Lam KH, Lugtenburg PJ, Vasilic D. Swelling of the breast after cosmetic augmentation. Neth J Med 2018; 76:345. [PMID: 30220663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- W van 't Hart
- Departmentsof Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
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19
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Kloeters O, Vasilic D, Hupkens P, Ulrich D. Markers of blood coagulation and fibrinolysis in patients with early and delayed microsurgical reconstructions in the lower extremities. J Plast Surg Hand Surg 2017; 51:420-426. [PMID: 28319440 DOI: 10.1080/2000656x.2017.1303499] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND In this study, markers of coagulation and fibrinolysis were assessed during early and delayed microsurgical reconstruction in patients with traumatic defects of their lower legs to analyse whether an imbalance of the hemostasis after trauma might predispose the development of vascular complications. METHODS The prospective study included 70 patients. In 35 patients, surgery was performed within 72 hours after injury. In 35 other patients, delayed free flap transfer was performed between 14-21 days after trauma. In each group, reconstruction was performed with a fasciocutaneous anterior-lateral thigh flap (ALT, n = 18) or a myocutaneous flap (latissimus dorsi flap; n = 17). Blood samples were collected preoperatively, intraoperatively, and 3, 6, 12, 24, 36, 48, 72, 96 and 120 hours after the operation. Analysed parameters included markers of coagulation such as prothrombin fragment 1 + 2 (F1 + 2), thrombin-antithrombin III-complex (TAT), and antithrombin, as well as fibrinolysis markers such as plasminogenactivator inhibitor-I (PAI-1), tissue-plasminogenactivator (t-PA), and plasminogen. RESULTS Preoperatively, levels of F1 + 2, TAT, and PAI-1 were significantly higher in patients with delayed reconstruction (p < .05). Patients with later vascular complications in this group (n = 5) presented a significant higher concentration of TAT, F1 + 2, and PAI-1 (p < .05). Twelve and 24 hours after free flap surgery, patients with vascular complications presented significant elevated levels of these markers (p < .05). CONCLUSIONS Patients with delayed free flap surgery after lower leg trauma present a hypercoagulable state in their blood due to activation of the coagulation system and hypofibrinolysis. Early reconstruction might minimise the risk of flap failure caused by hypercoagulability.
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Affiliation(s)
- Oliver Kloeters
- a Department of Hand, Plastic and Reconstructive Surgery , Radboud University Hospital , Nijmegen , The Netherlands
| | - Dalibor Vasilic
- a Department of Hand, Plastic and Reconstructive Surgery , Radboud University Hospital , Nijmegen , The Netherlands
| | - Pieter Hupkens
- a Department of Hand, Plastic and Reconstructive Surgery , Radboud University Hospital , Nijmegen , The Netherlands
| | - Dietmar Ulrich
- a Department of Hand, Plastic and Reconstructive Surgery , Radboud University Hospital , Nijmegen , The Netherlands.,b Department of Plastic and Reconstructive Surgery , University Hospital, Aachen University of Technology , Aachen , Germany
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20
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Vasilic D, Kon M. [Facial transplantation: an overview of 8 of the 13 operations]. Ned Tijdschr Geneeskd 2011; 155:A3107. [PMID: 21486511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Composite tissue allotransplantation (CTA) is a new development in reconstructive surgery that makes it possible to use identical tissue to repair large mutilating deformities, to the face for example. Until now, 13 face transplants have been performed worldwide. The functional and aesthetic results are encouraging. However, the lifelong immunosuppressive therapy necessary to prevent rejection has considerable side effects.
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Affiliation(s)
- Dalibor Vasilic
- Universitair Medisch Centrum Utrecht, afd. Plastische, reconstructieve en handchirurgie, Utrecht, the Netherlands
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21
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Brown CS, Gander B, Cunningham M, Furr A, Vasilic D, Wiggins O, Banis JC, Vossen M, Maldonado C, Perez-Abadia G, Barker JH. Ethical considerations in face transplantation. Int J Surg 2007; 5:353-64. [DOI: 10.1016/j.ijsu.2006.06.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2006] [Accepted: 06/21/2006] [Indexed: 11/28/2022]
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22
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Vasilic D, Alloway RR, Barker JH, Furr A, Ashcroft R, Banis JC, Kon M, Woodle ES. Risk Assessment of Immunosuppressive Therapy in Facial Transplantation. Plast Reconstr Surg 2007; 120:657-668. [PMID: 17700117 DOI: 10.1097/01.prs.0000270316.33293.ec] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Immunosuppression-related risks are foremost among ethical concerns regarding facial transplantation. However, previous risk estimates are inaccurate and misleading, because they are based on data from studies using different immunosuppression regimens, health status of the transplant recipients, tissue composition, and antigenicity. This review provides a comprehensive risk assessment for facial transplantation based on comparable data of immunosuppression, recipient health status, and composition and antigenicity of the transplanted tissue. METHODS The risk estimates for face transplantation presented here are based on data reported in clinical kidney (10-year experience) and hand transplantation (5-year experience) studies using tacrolimus/mycophenolate mofetil/corticosteroid therapy. Mitigating factors including ease of rejection diagnosis, rejection reversibility, infection prophylaxis, patient selection, and viral serologic status are taken into account. RESULTS Estimated risks include acute rejection (10 to 70 percent incidence), acute rejection reversibility (approximating 100 percent with corticosteroid therapy alone), chronic rejection (<10 percent over 5 years), cytomegalovirus disease (1 to 15 percent), diabetes (5 to 15 percent), hypertension (5 to 10 percent), and renal failure (<5 percent). CONCLUSIONS A review of these data indicates that previously reported estimates of immunosuppression-related risks are outdated and therefore should no longer be used. These updated risk estimates should be used by facial transplant teams, institutional review boards, and potential recipients when considering the immunologic risks associated with facial transplantation.
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Affiliation(s)
- Dalibor Vasilic
- Louisville, Ky.; Cincinnati, Ohio; and Utrecht, The Netherlands From the Departments of Surgery and Sociology, University of Louisville; Division of Nephrology, Department of Internal Medicine, and Division of Transplantation, Department of Surgery, University of Cincinnati; and Department of Plastic, Reconstructive, and Hand Surgery, University of Utrecht
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23
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Furr LA, Wiggins O, Cunningham M, Vasilic D, Brown CS, Banis JC, Maldonado C, Perez-Abadia G, Barker JH. Psychosocial implications of disfigurement and the future of human face transplantation. Plast Reconstr Surg 2007; 120:559-565. [PMID: 17632364 DOI: 10.1097/01.prs.0000267584.66732.e5] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although the first face transplants have been attempted, the social and psychological debates concerning the ethics and desirability of the procedure continue. Critics contend that these issues have not yet been sufficiently addressed. With this in mind, the present article seeks to elaborate on key psychological and social factors that will be central for addressing the ethical and psychosocial challenges necessary to move face transplantation into mainstream medicine. The goals of this article are to (1) discuss the psychosocial sequelae of facial disfiguration and how face transplantation may relieve those problems, and (2) delineate inclusion and exclusion criteria for the selection of research subjects for face transplantation. The article uses concepts from symbolic interaction theory in sociology to articulate a theoretically coherent scheme for comprehending the psychosocial difficulties of facial disfiguration and the advantages offered by facial transplantation. The authors conclude that the psychosocial implications of disfigurement warrant surgical intervention and that research in the area of face transplantation should continue.
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Affiliation(s)
- L Allen Furr
- Louisville, Ky.; and Utrecht, The Netherlands From the Departments of Sociology, Philosophy, Surgery, and Communication, University of Louisville; Department Physiology and Biophysics, Health Sciences Center, School of Medicine, University of Louisville; and Department of Plastic, Reconstructive, and Hand Surgery, University of Utrecht
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Gander B, Brown CS, Vasilic D, Furr A, Banis JC, Cunningham M, Wiggins O, Maldonado C, Whitaker I, Perez-Abadia G, Frank JM, Barker JH. Composite tissue allotransplantation of the hand and face: a new frontier in transplant and reconstructive surgery. Transpl Int 2007; 19:868-80. [PMID: 17018121 DOI: 10.1111/j.1432-2277.2006.00371.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Each year an estimated 7-million people in the USA need composite tissue reconstruction because of surgical excision of tumors, accidents and congenital malformations. Limb amputees alone comprise over 1.2 million of these. This figure is more than double the number of solid organs needed for transplantation. Composite tissue allotransplantation in the form of hand and facial tissue transplantation are now a clinical reality. The discovery, in the late 1990s, that the same immunotherapy used routinely in kidney transplantation was also effective in preventing skin rejection made this possible. While these new treatments seem like major advancements most of the surgical, immunological and ethical methods used are not new at all and have been around and routinely used in clinical practice for some time. In this review of composite tissue allotransplantation, we: (i) outline the limitations of conventional reconstructive methods for treating severe facial disfigurement, (ii) review the history of composite tissue allotransplantation, (iii) discuss the chronological scientific advances that have made it possible, (iv) focus on the two unique clinical scenarios of hand and face transplantation, and (v) reflect on the critical issues that must be addressed as we move this new frontier toward becoming a treatment in mainstream medicine.
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Affiliation(s)
- Brian Gander
- Department of Surgery, University of Louisville, KY 40202, USA
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Perez‐Abadia G, Arumugam S, Vasilic D, Goga L, Lane AN, Barker JH, Maldonado C. Fusogenic lipid vesicles loaded with adenosine triphosphate (ATP) deliver energy to rat skeletal muscle. FASEB J 2007. [DOI: 10.1096/fasebj.21.6.lb117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Dalibor Vasilic
- SurgeryUniversity of Louisville500 S Preston St, A Room 115LouisvilleKY40292
| | | | | | - John H Barker
- SurgeryUniversity of Louisville500 S Preston St, A Room 115LouisvilleKY40292
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Reynolds CC, Martinez SA, Furr A, Cunningham M, Bumpous JM, Lentsch EJ, Banis JC, Vasilic D, Storey B, Wiggins O, Maldonado C, Perez-Abadia G, Barker JH. Risk Acceptance in Laryngeal Transplantation. Laryngoscope 2006; 116:1770-5. [PMID: 17003736 DOI: 10.1097/01.mlg.0000231309.85984.69] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Advancements in the fields of head and neck surgery and immunology have paved the way for new quality of life-improving procedures such as larynx transplantation. To quantitatively assess the risks versus benefits in larynx transplantation, we used a questionnaire-based survey (Louisville Instrument For Transplantation [LIFT]) to measure the degree of risk individuals are willing to accept to receive different types of transplantation procedures. METHODS The LIFT contains 237 standardized questions incorporating standard gamble and time tradeoff outcome measures as well as questions assessing body image perception, depression, self-esteem, optimism, socially desirable responding, and demographics. Respondents were questioned on the extent to which they would trade off specific numbers of life-years, or sustain other costs, in exchange for receiving seven different types of transplant procedures. For this study, we questioned 243 individuals in three study populations with differing life experiences: healthy individuals, organ transplant recipients, and laryngectomees. RESULTS All populations questioned perceived risks differently based on their varied life experiences and would accept differing degrees of risk for the different transplant procedures. Organ transplant recipients were the most risk-tolerant group, whereas laryngectomees were the least risk-tolerant. CONCLUSIONS By questioning individuals with life experiences directly relevant to the risks and benefits associated with larynx transplantation, this study provides an empiric basis for assessing risk versus benefit in this new quality of life-improving procedure.
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Barker JH, Furr A, Cunningham M, Grossi F, Vasilic D, Storey B, Wiggins O, Majzoub R, Vossen M, Brouha P, Maldonado C, Reynolds CC, Francois C, Perez-Abadia G, Frank JM, Kon M, Banis JC. Investigation of Risk Acceptance in Facial Transplantation. Plast Reconstr Surg 2006; 118:663-70. [PMID: 16932174 DOI: 10.1097/01.prs.0000233202.98336.8c] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The surgical techniques necessary to transplant a human face are well established, and the early success of human hand transplants suggests that the immunological hurdles of transplanting human facial tissues have largely been overcome. Therefore, it is the ethical barriers that pose the greatest challenge to performing facial transplantation. At the center of the ethical debate is the question, "Do the risks posed by the life-long immunosuppression that a recipient would have to take justify the benefits of receiving a face transplant?" In this study, the authors answer this question by assessing the degree of risk individuals would be willing to accept to receive a face transplant. METHODS To quantitatively assess risks versus benefits in facial transplantation, the authors developed the Louisville Instrument for Transplantation, or LIFT, which contains 237 standardized questions. Respondents in three study populations (healthy individuals, n = 150; organ transplant recipients, n = 42; and individuals with facial disfigurement, n = 34) were questioned about the extent to which they would trade off specific numbers of life-years, or sustain other costs, in exchange for receiving seven different transplant procedures. RESULTS The authors found that the three populations would accept differing degrees of risk for the seven transplant procedures. Organ transplant recipients were the most risk-tolerant group, while facially disfigured individuals were the least risk tolerant. All groups questioned would accept the highest degree of risk to receive a face transplant compared with the six other procedures. CONCLUSIONS This study presents an empirical basis for assessing risk versus benefit in facial transplantation. In doing so, it provides a more solid foundation upon which to introduce this exciting new reconstructive modality into the clinical arena.
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Affiliation(s)
- John H Barker
- Department of Surgery, University of Louisville, KY 40202, USA.
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Storey BB, Vasilic D, Cunningham MR, Grossi FV, Reynolds CC, Maldonad C, Perez-Abadia G, Banis JC, Kon M, Barker JH. Investigation of risk acceptance in hand transplantation. J Am Coll Surg 2005. [DOI: 10.1016/j.jamcollsurg.2005.06.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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