Head and Neck Diseases by Alexandros G.Sfakianakis: 01/22/16

Παρασκευή 22 Ιανουαρίου 2016

Polydioxanone Absorbable Plate for Cartilaginous Grafting

Polydioxanone Absorbable Plate for Cartilaginous Grafting: This randomized clinical trial examines the use of a polydioxanone absorbable plate for stabilization and positioning of caudal septal extension grafts in a population of patients undergoing surgical nasal correction.

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It is Time to Let in Pediatric Palliative Care

(Source: Pediatric Blood and Cancer)

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Erratum

(Source: Pediatric Blood and Cancer)

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Tramadol-Paracetamol Combination for Postoperative Pain Relief in Elective Single-level Microdisectomy Surgery.

Background: The tramadol and paracetamol combination is used frequently for postoperative pain management. The literature on the use of this combination for vertebral surgery is limited. Our objective was to compare a combination of paracetamol 1 g and a lower dose of tramadol (1 mg/kg: group 1T) with a combination of paracetamol 1 g and a higher dose of tramadol (1.5 mg/kg: group 1.5T) for postoperative pain after microdisectomy surgery. Our main outcome measure was Visual Analogue Scale pain scores for 4 hours postoperatively. Methods: This prospective randomized triple-blind clinical trial was conducted at Aga Khan University Hospital, Karachi. Ninety-four patients aged between 18 and 50 years scheduled for elective single-level microdisectomy were allocated randomly into 1 of 2 groups. Twenty minutes before the end of the surgery, patients received the study drugs. Results: There was no significant demographic difference between groups. None of the patients experienced severe pain (VAS>6). There was no significant difference in the mean pain score between groups. The mean score at 4 hours was 2.17 (1.38) in group 1.5T and 1.74 (1.37) in group 1T. The difference was not statistically significant (P=0.14). In group 1.5T, 13 patients reported having nausea and vomiting compared with 2 patients in group 1T. This was a statistically significant difference (P=0.004). The sedation score was similar between groups. Conclusions: The combination of low-dose tramadol (1 mg/kg) and paracetamol has comparable analgesia and a decreased incidence of nausea and vomiting compared with the higher dose of tramadol (1.5 mg/kg) and paracetamol combination. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved

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Classification and Algorithmic Management of Constricted Ears: A 22-Year Experience.

Background: The term 'constricted ear' was coined by Tanzer. The classification and corrective methods for these malformations, however, continue to be controversial. To clarify them, we have reviewed and analyzed cases operated at our Center from January 1992 to January 2014. Methods: A total of 164 ear cases (involving 139 patients), showing features of lidded helix, compression of scapha and fossa triangularis, and/or cup-like protrusions were included in our study (constricted ear-featured microtias were excluded) and reviewed through medical records, photographs, analysis of surgical methods, and postoperative outcomes. Results: The deformed ears were classified into four graded types by antihelical tubing test and scapha-helix push test: Type I (n=21), Type II (n=63), Type III (n=38), and Type IV (n=42). Throughout our series, we've continued the improvement and performance of consistent operative techniques. Antihelical tubing, concha cartilage grafting, tumbling concha-cartilage flap, antihelical wrapping, or helical expansion were the preferred techniques. A total of 144 ear cases (88%) were followed up between 1 month and 14 years (an average of 13.2 months). The average score of aesthetic outcomes, rated on a 4-point Likert scale (1=poor, 2=fair, 3=good, 4=excellent) was 3.3 points. Corrective methods and aesthetic outcomes for patients with each graded type of deformity were described. Conclusion: Constricted ears were effectively corrected by a graded surgical approach. All corrections were performed in one stage, without removal of deformed auricular cartilage (though some of them were made with the addition of conchal or costal cartilage). (C)2016American Society of Plastic Surgeons

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Hydroxyurea use in Children with Sickle Cell Disease: Do Severely Affected Patients Use It and Does It Impact Hospitalization Outcomes?

ConclusionsHU use is high among hospitalized children with SCD. However, HU is not utilized by many children with clinically severe SCD. These results support that HU be considered in children with SCD to prevent hospitalization rather than as a treatment to improve hospitalization outcomes. (Source: Pediatric Blood and Cancer)

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Issue Information

(Source: Pediatric Blood and Cancer)

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Pharmacogenetics driving personalized medicine: analysis of genetic polymorphisms related to breast cancer medications in Italian isolated populations

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Background: Breast cancer is the most common cancer in women characterized by a high variable clinical outcome among individuals treated with equivalent regimens and novel targeted therapies. In this study, we performed a population based approach intersecting high-throughput genotype data from Friuli Venezia Giulia (FVG) isolated populations with publically available pharmacogenomics information to estimate the frequency of genotypes correlated with responsiveness to breast cancer treatment thus improving the clinical management of this disease in an efficient and cost effective way. Methods: A list of 80 variants reported to be related to the efficacy or toxicity of breast cancer drugs was obtained from PharmGKB database. Fourty-one were present in FVG, 1000G European (EUR) and ExAC (Non Finnish European) databases. Their frequency was extracted using PLINK software and the differences tested by Fisher's exact test. Results: Statistical analyses revealed that 13 out of the 41 (32 %) variants were significantly different in frequency in our sample as compared to the EUR/ExAC cohorts. For nine variants the available level of evidence (LOE) included polymorphisms related to cyclophosphamide, tamoxifen, doxorubicin, fluorpyrimidine and paclitaxel. In particular, for trastuzumab two variants were detected: (1) rs1801274-G within FCGR2A and associated with decreased efficacy (LOE 2B); (2) rs1136201-G located within ERBB2 and associated with increased toxicity (LOE 3). Both these two variants were underrepresented in the FVG population compared to EUR/ExAC population thus suggesting a high therapeutic index of this drug in our population. Moreover, as regards fluoropyrimidines, the frequency of two polymorphisms within the DPYD gene associated with drug toxicity (e.g., rs2297595-C allele and rs3918290-T allele, LOE 2A and 1, respectively) was extremely low in FVG population thus suggesting that a larger number of FVG patients could benefit from full dosage of fluoropyrimidine therapy. Conclusions: All these findings increase the overall knowledge on the prevalence of specific variants related with breast cancer treatment responsiveness in FVG population and highlight the importance of assessing gene polymorphisms related with cancer medications in isolated communities.

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Supernumerary Kidneys Do Exist!

American Journal of Roentgenology, Volume 206, Issue 2, Page W48-W48, February 2016.

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Chemosensors, Vol. 4, Pages 2: Acknowledgement to Reviewers of Chemosensors in 2015

The editors of Chemosensors would like to express their sincere gratitude to the following reviewers for assessing manuscripts in 2015. […]

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Classification and Algorithmic Management of Constricted Ears: A 22-Year Experience.

Primary versus Flap Closure of Perineal Defects Following Oncologic Resection: A Systematic Review and Meta Analysis.

No abstract available

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Eliciting cytotoxic T lymphocytes against human laryngeal cancer-derived antigens: evaluation of dendritic cells pulsed with a heat-treated tumor lysate and other antigen-loading strategies for dendritic-cell-based vaccination

Dendritic cells (DCs) have been used successfully in clinical pilot studies. However, tumor-specific immunity and clinical responses were only induced in certain cancer patients. It has been well documented th...

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3D Topographical Surface Changes in Response to Compartmental Volumization of the Medial Cheek; Defining a Malar "Augmentation Zone".

Background: Given the widespread use of facial fillers and recent identification of distinct facial fat compartments, a better understanding of 3D surface changes in response to volume augmentation is needed. Advances in 3D imaging technology now afford an opportunity to elucidate these morphological changes for the first time. Methods: A cadaver study was undertaken in which volumization of the deep medial cheek (DMC) compartment was performed at intervals up to 4cc (n=4). 3D photographs were taken following each injection in order to analyze the topographical surface changes which we define as the 'zone of augmentation' (ZOA). Perimeter, diameter, and projection were studied. The arcus marginalis of the inferior orbit consistently represented a fixed boundary of the ZOA, and additional cadavers underwent similar volumization following surgical release of this portion of the arcus marginalis (n=4). Repeat 3D computer analysis was performed comparing the ZOA with and without arcus marginalis release. Results: Volumization of the DMC led to unique topographical changes of the malar region defined by distinct boundaries. Interestingly, the cephalic border of the ZOA was consistently noted to be at the level of the arcus marginalis in all specimens. When surgical release of the arcus marginalis was performed, the cephalic border of the ZOA was no longer restricted. Conclusions: Utilizing advances in 3D photography and computer analysis, we demonstrate characteristic surface anatomy changes in response to volume augmentation of facial compartments. This novel concept of the "zone of augmentation" can be applied to volumization of other distinct facial regions. (C)2016American Society of Plastic Surgeons

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Integrated analysis of microRNA regulatory network in nasopharyngeal carcinoma with deep sequencing

MicroRNAs (miRNAs) have been shown to play a critical role in the development and progression of nasopharyngeal carcinoma (NPC). Although accumulating studies have been performed on the molecular mechanisms of...

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Editorial Board

Publication date: 1 February 2016
Source:American Journal of Infection Control, Volume 44, Issue 2

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Long term comparison of rib and ear cartilage grafts in autologous and allogenic fascia lata - an experimental study in a white rabbit model.

Background: Diced cartilage in fascia grafts (DCF) have become the material of choice for dorsal grafts in rhinoplasty. Allogenic fascia lata has not yet been investigated as isolated fascial graft or as a combined graft with ear and rib cartilage, especially in comparison to autologous fascia and over a long implantation period. Methods: 10 different grafts were built from either autologous or allogenic fascia lata alone or as DCFs with diced costal or ear cartilage and implanted into the dorsal skin of 15 rabbits. After 3 or 9 months the grafts were explanted and histologically analysed. Chondrocytes and cartilage matrix characteristics, calcification, ossification, formation of bone marrow, fibrosis ingrowth and fibrotic transformation, the presence of immune reactions, vascular ingrowth, regenerative capacity and capsule formation was examined in a semi quantitative manner. Results: All grafts were vital and without inflammatory response. The cartilage showed regular nuclei, a normal matrix and regenerative capacity. A higher grade of calcification and ossification was observed in the fascia/cartilage grafts than in isolated cartilage grafts and more pronounced for costal cartilage. Both types of fascia were shown to be equally stable and without degradation. There were no significant differences in the DCF grafts built with autologous compared to allogenic fascia. Conclusion: This study shows the equivalency of DCFs and isolated fascial grafts using allogenic fascia lata compared to autologous fascia. The type of used cartilage accounts for different long term characteristics of DCF grafts. (C)2016American Society of Plastic Surgeons

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An adenovirus 4 outbreak amongst staff in a pediatric ward manifesting as keratoconjunctivitis—a possible failure of contact and aerosol infection control

Publication date: Available online 21 January 2016
Source:American Journal of Infection Control
Author(s): Elizabeth Hoyle, Joanne C. Erez, Helen R. Kirk-Granger, Elizabeth Collins, Julian W. Tang
An adenovirus serotype 4 outbreak was identified on a pediatric ward involving 4 members of the health care staff. Two inpatients on the ward at the time (1 immunocompromised) were shedding this virus from their respiratory tracts and could have acted as independent index cases for the staff infections. Significantly, upon investigation, it was found that staff members were unaware that adenoviruses are not completely eliminated by alcohol gel handrubs and that soap and water handwashing is also required.

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Neuropilin-1 is associated with clinicopathology of gastric cancer and contributes to cell proliferation and migration as multifunctional co-receptors

Neuropilin-1 (NRP-1) is a transmembrane glycoprotein participating in the growth and metastasis of cancer cells as multifunctional co-receptors by interacting with the signaling pathways. However, its role in ...

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Long-term follow-up of quality of life following DIEP flap breast reconstruction.

Background: Sequelae due to breast cancer are very high and negatively impact patient quality of life (QoL). Although deep inferior epigastric perforator (DIEP) flap has become a standard for autologous breast reconstruction (BR), there are limited data regarding long-term QoL. This study aimed to measure patient QoL more than 5 years after DIEP flap BR and compare the finding with two French reference samples. Methods: A cross-sectionnal study of QoL was performed in women who underwent DIEP flap BR between 1995 and 2007 using the Medical Outcomes Study 36-item short-form health survey s(SF-36). The first reference sample included subjects from the French general population (n=3308) and the second included cancer survivors with mastectomy with (n=70) or without (n=135) BR who took part in a French multi-centric study. Student's t-tests were used for statistical analyses, and differences were considered at a significance level of 0.05. Results: 111 respondents were analyzed among 186 eligible women. The mean follow-up period after reconstruction was 8.6 years (range, 5 to 15). There were no statistically significant differences in the QoL between women who underwent DIEP BR and the French general population from 45 to 64 years old. Five of the eight SF-36 dimensions were significantly better in the DIEP BR group in the 65- to 74-year-old cohort. In addition, QoL of our study population was significantly better than women who underwent mastectomy with or without any kind of BR. (C)2016American Society of Plastic Surgeons

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Investigation of ototoxicity of artesunate as add-on therapy in patients with metastatic or locally advanced breast cancer: new audiological results from a prospective, open, uncontrolled, monocentric phase I study

Abstract

Purpose

Artesunate (ART) has been used for a long time in the treatment of Plasmodium falciparum malaria and has been considered safe. The present phase I study aimed to determine the daily dose of ART that is well tolerated as add-on therapy in patients with breast cancer for 4 weeks of therapy. Ototoxicity could be a potential safety concern in settings different from malaria. Therefore, comprehensive audiological assessment was essential.

Methods

The ARTIC M33/2 study was a prospective, open, uncontrolled, monocentric phase I dose-escalation study to evaluate the safety and tolerability of ART in patients with advanced breast cancer. Patients received either 100, 150 or 200 mg oral ART daily for a test phase of 4 weeks as add-on therapy to their ongoing oncological treatment. For the investigation of the safety of ART for hearing, an audiological assessment was performed with each patient before the intake of ART and after 4 weeks of therapy.

Results

Twenty-three female patients were included in the study. During the test phase, four patients had adverse events (AEs) of the auditory system possibly related to the intake of ART. However, none of these AEs was classified as severe AE (SAE) and did not require treatment interruption. Four patients had AEs concerning the vestibular system (vertigo) during the test phase, one of which was classified as SAE. However, the SAE was fully reversible after discontinuation of ART.

Conclusion

None of the audiological results after 4 weeks of therapy with ART showed any dose-limiting auditory toxicity. However, audiological monitoring in further clinical studies with prolonged use of oral ART in doses up to 200 mg daily is warranted.

The ARTIC M33/2 study is registered at eudract.ema.europa.eu with the Number 2007-004432-23 and at clinicaltrials.gov with the Number NCT00764036.

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APIC Masthead

Publication date: 1 February 2016
Source:American Journal of Infection Control, Volume 44, Issue 2

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Information for Readers

Publication date: 1 February 2016
Source:American Journal of Infection Control, Volume 44, Issue 2

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Three-dimensional computed tomographic angiographic study of the inter-perforator flow of the lower leg.

Background: The area perfused by a single perforator depends on its perforasome and its unique inter-perforator flow pattern. The purpose of this study was to clarify the inter-perforator flow patterns of the peroneal and posterior tibial artery perforators (PA-Ps, PTA-Ps) using three-dimensional computed tomographic angiography (3D-CTA). Methods: Thirteen whole leg skin flaps were harvested in the subfacial plane from fresh cadavers. PA-Ps, PTA-Ps, anterior tibial, and sural artery perforators (ATA-Ps, SA-Ps) with a diameter greater than 0.5 mm were documented. 3D-CTA with an injection of iodinated contrast medium into the PA-P or PTA-P was used to investigate the percentages of the area and the perforators that were perfused. Results: The mean percentage of the total area perfused by a PA-P was 42.0% and by a PTA-P was 38.0% (p = 0.084). The mean percentage of the total perforators perfused by a PA-P was 55.0% and by a PTA-P was 44.2% (p = 0.004). While the mean percentages of same-source artery perforators perfused by a PA-P (73.6%) and by a PTA-P (77.2%) did not differ (p = 0.513), the mean percentages of other-source artery perforators perfused by a PA-P (49.9%) and by a PTA-P (32.3%) were significantly different (p

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Defining quality in healthcare and measuring quality in Surgery.

Quality in healthcare has been sluggish to adapt to the changing landscape, leading to lapses in the successful delivery of care. Consequently, quality of care has come under intense scrutiny in the past decade resulting in the creation of various federally-funded and non-profit org anizations aimed at assessing and implementing systematic quality improvements. In this article, we examine the evolution of quality in healthcare relative to established quality control measures in other sectors, different ways to assess quality, and the current state of our healthcare system. (C)2016American Society of Plastic Surgeons

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Infection surveillance systems in primary health care: A literature review

Publication date: Available online 21 January 2016
Source:American Journal of Infection Control
Author(s): Mary Lou Manning, Monika Pogorzelska-Maziarz
The Patient Protection and Affordable Care Act of 2010 is placing primary care at the epicenter of accountability of US health care delivery. There is a significant body of evidence characterizing the value of acute-care hospital infection surveillance systems. Given the central role primary care is beginning to play, we were interested in examining the use of infection surveillance systems in primary care practice. Our review of the literature found only 2 articles describing the influence of primary care infection surveillance systems, both providing evidence of its benefits. This area is ripe for further research.

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Information for Authors

Publication date: 1 February 2016
Source:American Journal of Infection Control, Volume 44, Issue 2

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Water, Vol. 8, Pages 35: Spatial-Temporal Distribution of Soil Salt Crusts under Saline Drip Irrigation in an Artificial Desert Highway Shelterbelt

Understanding the formation and spatial-temporal distribution of soil salt crusts (SSCs) is important for the sustainable management of the artificial shelterbelt and high-salinity groundwater utility in the Taklimakan Desert in Northwest China. The SSCs in this area were sampled, and their thickness and electrical conductivity (EC) were analyzed to examine the formation mechanism and the spatial-temporal patterns of the SSCs in the shelterbelt, which is drip irrigated with high-salinity groundwater in the Taklimakan Desert. Results demonstrated the following: (1) Soil-moisture depletion and salt accumulation at the soil surface occurred simultaneously. The soil water and salt in the different areas around the drip irrigation emitter showed different temporal dynamics in an irrigation cycle; (2) SSCs EC increased at a logarithmic rate, and SSCs thickness increased linearly with irrigation water salinity; (3) SSCs showed evident spatial distribution around the drip irrigation emitter. The EC initially increased with increasing distance from the emitter but subsequently decreased in different directions around the emitter. The highest EC was recorded at 40 cm from the emitter; (4) Topography had a significant effect on the spatial distribution of SSCs. The EC at the upslope of the emitter was higher than that at the downslope; (5) SSCs thickness showed an initial rapid increase with shelterbelt age, which was followed by a gradual increase. However, EC decreased with shelterbelt age. Our findings can contribute to the shelterbelt design, construction, utility, and sustainable management and the soil and water conservation in shifting desert regions.

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Viruses, Vol. 8, Pages 27: Acknowledgement to Reviewers of Viruses in 2015

The editors of Viruses would like to express their sincere gratitude to the following reviewers for assessing manuscripts in 2015. [...]

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Water, Vol. 8, Pages 34: Improving the Performance of Water Policies: Evidence from Drought in Spain

Water scarcity is a critical environmental issue worldwide, especially in arid and semiarid regions. In those regions, climate change projections suggest further reductions in freshwater supplies and increases of the recurrence, longevity and intensity of drought events. At present, one important question for policy debate is the identification of water policies that could address the mounting water scarcity problems. Suitable policies should improve economic efficiency, achieve environmental sustainability, and meet equity needs. This paper develops and applies an integrated hydro-economic model that links hydrological, economic and environmental elements to such issues. The model is used to conduct a direct comparison of water markets, water pricing and institutional cooperation, based on their economic, environmental and equity outcomes. The analysis is performed in the Jucar Basin of Spain, which is a good natural experiment for studying water scarcity and climate change policies. Results indicate that both institutional and water market policies are high performing instruments to limit the economic damage costs of droughts, achieving almost the same social benefits. However, the environmental effects of water markets are worrying. Another important finding is that water pricing is a poor policy option not only in terms of private and environmental benefits but also in terms of equity.

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Classification and Algorithmic Management of Constricted Ears: A 22-Year Experience.

Primary versus Flap Closure of Perineal Defects Following Oncologic Resection: A Systematic Review and Meta Analysis.

Eliciting cytotoxic T lymphocytes against human laryngeal cancer-derived antigens: evaluation of dendritic cells pulsed with a heat-treated tumor lysate and other antigen-loading strategies for dendritic-cell-based vaccination

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3D Topographical Surface Changes in Response to Compartmental Volumization of the Medial Cheek; Defining a Malar "Augmentation Zone".

Integrated analysis of microRNA regulatory network in nasopharyngeal carcinoma with deep sequencing

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Editorial Board

Publication date: 1 February 2016
Source:American Journal of Infection Control, Volume 44, Issue 2

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Long term comparison of rib and ear cartilage grafts in autologous and allogenic fascia lata - an experimental study in a white rabbit model.

An adenovirus 4 outbreak amongst staff in a pediatric ward manifesting as keratoconjunctivitis—a possible failure of contact and aerosol infection control

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Neuropilin-1 is associated with clinicopathology of gastric cancer and contributes to cell proliferation and migration as multifunctional co-receptors

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Long-term follow-up of quality of life following DIEP flap breast reconstruction.

Investigation of ototoxicity of artesunate as add-on therapy in patients with metastatic or locally advanced breast cancer: new audiological results from a prospective, open, uncontrolled, monocentric phase I study

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The ARTIC M33/2 study is registered at eudract.ema.europa.eu with the Number 2007-004432-23 and at clinicaltrials.gov with the Number NCT00764036.

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Παρασκευή 22 Ιανουαρίου 2016

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