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1. NMR Metabolomics of Primary Ovarian Cancer Cells in Comparison to Established Cisplatin-Resistant and -Sensitive Cell Lines

Author

Veronica Ghini, Flavia Sorbi, Massimiliano Fambrini, and Francesca Magherini

Subjects
ovarian cancer, cell lines, NMR, metabolomics, primary cells, Cytology, QH573-671
Abstract

Cancer cell lines are frequently used in metabolomics, such as in vitro tumor models. In particular, A2780 cells are commonly used as a model for ovarian cancer to evaluate the effects of drug treatment. Here, we compare the NMR metabolomics profiles of A2780 and cisplatin-resistant A2780 cells with those of cells derived from 10 patients with high-grade serous ovarian carcinoma (collected during primary cytoreduction before any chemotherapeutic treatment). Our analysis reveals a substantial similarity among all primary cells but significant differences between them and both A2780 and cisplatin-resistant A2780 cells. Notably, the patient-derived cells are closer to the resistant A2780 cells when considering the exo-metabolome, whereas they are essentially equidistant from A2780 and A2780-resistant cells in terms of the endo-metabolome. This behavior results from dissimilarities in the levels of several metabolites attributable to the differential modulation of underlying biochemical pathways. The patient-derived cells are those with the most pronounced glycolytic phenotype, whereas A2780-resistant cells mainly diverge from the others due to alterations in a few specific metabolites already known as markers of resistance.

Published
2024
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2. Therapy-Induced Stromal Senescence Promoting Aggressiveness of Prostate and Ovarian Cancer

Author

Elisa Pardella, Erica Pranzini, Ilaria Nesi, Matteo Parri, Pietro Spatafora, Eugenio Torre, Angela Muccilli, Francesca Castiglione, Massimiliano Fambrini, Flavia Sorbi, Paolo Cirri, Anna Caselli, Martin Puhr, Helmut Klocker, Sergio Serni, Giovanni Raugei, Francesca Magherini, and Maria Letizia Taddei

Subjects
prostate cancer, ovarian cancer, therapy induced senescence, tumor microenvironment, docetaxel, cisplatin, Cytology, QH573-671
Abstract

Cancer progression is supported by the cross-talk between tumor cells and the surrounding stroma. In this context, senescent cells in the tumor microenvironment contribute to the development of a pro-inflammatory milieu and the acquisition of aggressive traits by cancer cells. Anticancer treatments induce cellular senescence (therapy-induced senescence, TIS) in both tumor and non-cancerous cells, contributing to many detrimental side effects of therapies. Thus, we focused on the effects of chemotherapy on the stromal compartment of prostate and ovarian cancer. We demonstrated that anticancer chemotherapeutics, regardless of their specific mechanism of action, promote a senescent phenotype in stromal fibroblasts, resulting in metabolic alterations and secretion of paracrine factors, sustaining the invasive and clonogenic potential of both prostate and ovarian cancer cells. The clearance of senescent stromal cells, through senolytic drug treatment, reverts the malignant phenotype of tumor cells. The clinical relevance of TIS was validated in ovarian and prostate cancer patients, highlighting increased accumulation of lipofuscin aggregates, a marker of the senescent phenotype, in the stromal compartment of tissues from chemotherapy-treated patients. These data provide new insights into the potential efficacy of combining traditional anticancer strategies with innovative senotherapy to potentiate anticancer treatments and overcome the adverse effects of chemotherapy.

Published
2022
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3. SHBG as a Marker of NAFLD and Metabolic Impairments in Women Referred for Oligomenorrhea and/or Hirsutism and in Women With Sexual Dysfunction

Author

Vincenza Di Stasi, Elisa Maseroli, Giulia Rastrelli, Irene Scavello, Sarah Cipriani, Tommaso Todisco, Sara Marchiani, Flavia Sorbi, Massimiliano Fambrini, Felice Petraglia, Mario Maggi, and Linda Vignozzi

Subjects
sex hormone binding globulin (SHBG), non-alcoholic fatty liver disease (NAFLD), polycystic ovary syndrome (PCOS), metabolic syndrome, female sexual dysfunction, Diseases of the endocrine glands. Clinical endocrinology, RC648-665
Abstract

PCOS is one of the most common endocrine disorders and NAFLD is one of its most dangerous metabolic consequences. The diagnosis of NAFLD is not a practical task and the condition is at risk of being overlooked. The use of simpler but still reliable surrogate markers is necessary to identify women with a high likelihood of NAFLD. The aim of this study was to evaluate the clinical correlates of NAFLD Liver Fat Score (NAFLD-LFS) in women with oligomenorrhea and/or hirsutism. Furthermore, the study aimed to evaluate whether, among the hormonal parameters evaluated in such women, possible hallmarks of NAFLD may be identified. To this purpose, 66 women who attended our Outpatient Clinic for oligomenorrhea and/or hyperandrogenism were included in the study. In order to validate the results obtained in the first cohort, a second independent sample of 233 women evaluated for female sexual dysfunction (FSD) was analyzed. In cohort 1, NAFLD-LFS positively correlated with metabolic and inflammatory parameters. Among the hormone parameters, NAFLD-LFS showed no significant relationships with androgens but a significant negative correlation with SHBG (p

Published
2021
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4. Cervicoisthmic choriocarcinoma mimicking cesarean section scar ectopic pregnancy

Author

Flavia Sorbi, Giovanni Sisti, Annalisa Pieralli, Mariarosaria Di Tommaso, Lorenzo Livi, Anna Maria Buccoliero, and Massimiliano Fambrini

Subjects
c0 esarean section scar, choriocarcinoma, ectopic pregnancy, Medicine
Abstract

Primary choriocarcinoma of the uterine cervix is an extremely rare disease. The clinical diagnosis of cervical choriocarcinoma is difficult, because of its rarity and being non-specific abnormal vaginal bleeding the most common symptom. In the present report, the authors present a case of cervical choriocarcinoma, which was initially misdiagnosed as a cesarean section scar ectopic pregnancy. Remission of cervical choriocarcinoma was accomplished with the combination of hysterectomy and chemotherapy.

Published
2013

5. LH/hCG-receptor expression may have a negative prognostic value in low-risk endometrial cancer.

Author

Ivo Noci, Flavia Sorbi, Luca Mannini, Elisabetta Projetto, Serena Pillozzi, Viola Ghizzoni, Tiziano Lottini, Daniela Moncini, Gianna Baroni, Francesco Mungai, Annarosa Arcangeli, and Massimiliano Fambrini

Subjects
Recurrence, biomarker, endometrial cancer, molecular analysis, Immunohistochemical analysis, LH/hCG receptor, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Introduction: A 51 years-old woman was diagnosed with endometrial cancer and underwent surgical staging. Pathologic evaluation showed a 2x1 cm G2 endometrioid endometrial cancer with a 30% myometrial deep invasion (FIGO stage 1A). The patient was classified as low-risk of recurrence and no adjuvant treatment was offered. Six months after surgery, the patient developed an early vescico-vaginal recurrence and chemotherapy treatment was started. Few months later a subsequent involvement of vaginal wall, ileum and omentum was detected and the patient underwent second surgery. Background: LH/hCG-receptor (LH/hCG-R) expression has been previously reported to be associated with an invasive phenotype in endometrial cancer cells. Moreover, in a preclinical mouse model of EC behaves as a pro metastatic molecular device. Discussion: We analysed the expression level of LH/hCG-R in cancer specimens collected during surgeries. Molecular and immunohistochemical analysis showed a strong expression of both mRNA and protein for LH/hCG-R in all specimens. Conclusion: LH/hCG-R expression may be assessed together with other clinicopathological parameters in order to better predict the risk of recurrence in low-risk endometrial cancer patients. Further clinical trials are warranted in order to validate LH/hCG-R as biomarker in endometrial cancer.

Published
2016
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6. Ovarian Vein Thrombosis Presenting as Acute Abdomen in Puerperium

Author

Flavia Sorbi, Luca Mannini, Martina Aldinucci, Viola Ghizzoni, and Massimiliano Fambrini

Subjects
deep vein thrombosis, postpartum, right ovarian vein, Medicine
Abstract

Postpartum Ovarian Vein Thrombosis (POVT) is a rare, but serious condition that causes slow quadrant pain in the postpartum period. POVT must be considered in the differential diagnosis of postpartum acute abdomen. We hereby report a case on a 36-year-old Italian woman who developed an acute abdomen a week after spontaneous vaginal delivery. She had persistent fever and constipation. Diagnosis of POVT was made with an abdominal Computed Tomography (CT) and treatment with heparin and broad-spectrum antibiotics were started. After 72 hours, the patient was switched from low molecular weight heparin to oral anticoagulant treatment. After 5 months a complete recanalization was demonstrated by abdomen CT and the treatment was stopped 6 months after diagnosis. POVT is a diagnosis of exclusion in the puerperium. This case illustrated that POVT may also occur in low risk patient.

Published
2016
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9. Urinary Tract Endometriosis: How to Predict and Prevent Recurrence after Primary Surgical Excision

Author

Fabrizio Di Maida, Luca Lambertini, Antonio Andrea Grosso, Andrea Mari, Silvia Vannuccini, Tommaso Capezzuoli, Massimiliano Fambrini, Felice Petraglia, and Andrea Minervini

Subjects
Adult, Treatment Outcome, Recurrence, Endometriosis, Humans, Ureteral Diseases, Obstetrics and Gynecology, Female, Laparoscopy, Urinary Tract, Retrospective Studies
Abstract

To investigate the clinical and surgical predictors of urinary tract endometriosis (UTE) relapse.Retrospective single institutional study.Italian multidisciplinary referral center for endometriosis.Consecutive patients affected by UTE and surgically treated between January 2016 and March 2020.Surgical excision for UTE. Uni- and multivariate logistic regression analyses were fitted to evaluate clinical and surgical predictors of recurrence.A total of 105 female age-reproductive patients were enrolled. Median age was 32 years (interquartile range, 24-37). Ureteral involvement was recorded in 53 patients (50.5%), being unilateral and bilateral in 46 patients (43.8%) and 7 patients (6.7%), respectively. Bladder involvement occurred in 52 patients (49.5%). Open surgical approach was performed in 24 cases (22.9%), whereas 30 patients (28.5%) and 51 patients (48.6%) were treated with laparoscopic and robot-assisted approach, respectively. Overall, 53 patients (50.5%) received adjuvant hormonal therapy. At a median follow-up of 39 months (interquartile range, 22-51), 30 patients (28.6%) experienced disease relapse, with 14 recurrences (13.3%) recorded at the level of the urinary tract. At multivariable analysis, age at first surgery25 years (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.10-1.84; p = .02) and the presence of a concomitant autoimmune disease (OR, 1.45; 95% CI, 1.24-2.17; p = .02) were found as predictors of deep infiltrating endometriosis recurrence, whereas adjuvant postsurgical therapy showed a protective role (OR, 0.83; 95% CI, 0.53-0.98; p = .01).Young age (25 years) and the presence of autoimmune diseases were significant predictors for the development of disease recurrence, whereas adjuvant hormonal therapy showed a protective role.

Published
2022
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10. Mechanisms and Pathogenesis of Adenomyosis

Author

Margherita Rossi, Silvia Vannuccini, Tommaso Capezzuoli, Massimiliano Fambrini, Valentina Vannuzzi, Chiara Donati, and Felice Petraglia

Subjects
General Medicine
Abstract

Purpose of the Review The purpose of this review is to provide a synopsis of all the mechanisms involved in the pathogenesis of adenomyosis. It will summarize recent advances in the field, discussing current controversies, and considering potential future directions. Recent Findings Adenomyosis pathogenesis is still a topic under investigation, however advancements in the understanding of disease development and mechanisms have been made. New data coming from new next generation sequencing-based studies and more-in-depth acquisitions on sex hormones imbalance, neuroangiogenesis, inflammation, fibrosis and cell proliferation have been obtained. Summary Adenomyosis is a uterine disorder that affects women of reproductive age, characterized by a benign invasion of the endometrium basalis (glands and stroma) within the myometrium. So far, three theories for the pathophysiology of adenomyosis have been proposed: An invagination of the endometrial basalis into the myometrium by tissue injury and repair. The development from adult stem cells or displaced embryonic müllerian remnants. An “invasion from outside to inside”. In order to invade and develop, endometrial cells require a series of pathogenetic mechanisms which drive to adenomyosis. Altered sex steroids hormones receptors may be the primary event which causes increased endometrial cell proliferations and differentiation from epithelial to mesenchymal cells. Once invaded the myometrium, an inflammatory reaction is displayed, probably driven by local immune changes. The processes of neuroangiogenesis and fibrosis are also involved in the adenomyosis development and may explain some of the associated clinical symptoms (dysmenorrhea, abnormal uterine bleeding, and infertility).

Published
2022
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12. Cardiometabolic risk is unraveled by color Doppler ultrasound of the clitoral and uterine arteries in women consulting for sexual symptoms

Author

D. Menafra, Flavia Sorbi, E. Maseroli, Sara Marchiani, V. Di Stasi, Nunzia Verde, Felice Petraglia, Irene Scavello, Mario Maggi, Sarah Cipriani, Valdo Ricca, Massimiliano Fambrini, Linda Vignozzi, Giulia Rastrelli, and S. Scannerini

Subjects
Adult, medicine.medical_specialty, Waist, Science, Female sexual dysfunction, Context (language use), Clitoris, Body Mass Index, Surveys and Questionnaires, medicine.artery, Body Image, medicine, Humans, Sexual Dysfunctions, Psychological, Ultrasonography, Doppler, Color, Uterine artery, Metabolic Syndrome, Multidisciplinary, Obstetrics, business.industry, Cardiometabolic Risk Factors, Middle Aged, medicine.disease, Uterine Artery, Female, Vascular Resistance, Population study, Medicine, Metabolic syndrome, business, Body mass index, Blood sampling
Abstract

Female sexual dysfunction (FSD) may be a mirror of a poor cardiometabolic state. In a small pilot study enrolling 71 women with FSD, we previously demonstrated that clitoral Pulsatility Index (PI) evaluated by using color Doppler ultrasound (CDU), reflecting vascular resistance, was associated with cardiometabolic risk factors. Data on uterine CDU in this context are lacking. First, to confirm previously reported data on the direct association between clitoral PI and cardiometabolic risk factors on a larger study population of women consulting for sexual symptoms; second, to investigate eventual similar correlations between cardiometabolic risk factors and CDU parameters of the uterine artery. We also ascertained whether uterine artery PI, similarly to what had previously been observed for clitoral artery PI, was directly related to body image uneasiness and psychopathological symptoms, assessed by validated questionnaires. N = 230 women consulting our clinic for sexual symptoms were examined with clitoral CDU and blood sampling and were asked to fill out the Female Sexual Function Index, the Middlesex Hospital Questionnaire (MHQ) and the Body Uneasiness Test (BUT). In a subgroup of women (n = 164), we also performed transvaginal CDU with measurement of uterine artery parameters. At multivariate analysis, we found a direct association between clitoral PI and body mass index (BMI) (p = 0.004), waist circumference (WC) (p = 0.004), triglycerides (p = 0.006), insulin (p = 0.029) and HOMA-IR (p = 0.009). Furthermore, a correlation between obesity and Metabolic Syndrome (MetS) and a higher clitoral PI was observed (p = 0.003 and p = 0.012, respectively). Clitoral PI was also correlated with MHQ-S (p = 0.010), a scale exploring somatized anxiety symptoms, and BUT-B Positive Symptom Distress Index (p = 0.010), a measure of body image concerns. Similarly, when investigating the uterine artery, we were able to demonstrate an association between its PI and BMI (p p = 0.001), insulin (p = 0.006), glycated haemoglobin (p = p = 0.009). Women diagnosed with obesity and MetS showed significantly higher uterine PI values vs. those without obesity or MetS (p = 0.001 and p = 0.004, respectively). Finally, uterine PI was associated with BUT-A Global Severity Index (p

Published
2021

13. Accelerated Partial-Breast Irradiation Compared With Whole-Breast Irradiation for Early Breast Cancer: Long-Term Results of the Randomized Phase III APBI-IMRT-Florence Trial

Author

Luis A. Sanchez, Stefania Pallotta, S. Lucidi, Calogero Saieva, Marco Bernini, Livia Marrazzo, Vieri Scotti, Icro Meattini, Lorenzo Livi, Monica Mangoni, Simonetta Bianchi, Massimiliano Fambrini, Gabriele Simontacchi, Jacopo Nori, Silvia Scoccianti, Lorenzo Orzalesi, L. Paoletti, Daniela Greto, Pierluigi Bonomo, and Isacco Desideri

Subjects
Cancer Research, medicine.medical_treatment, Breast Neoplasms, Kaplan-Meier Estimate, 030218 nuclear medicine & medical imaging, law.invention, 03 medical and health sciences, 0302 clinical medicine, Breast cancer, Whole Breast Irradiation, Randomized controlled trial, law, medicine, Humans, Survival rate, Aged, Early breast cancer, business.industry, Radiotherapy Planning, Computer-Assisted, Partial Breast Irradiation, Middle Aged, medicine.disease, Survival Rate, Radiation therapy, Clinical trial, Oncology, Patient Satisfaction, 030220 oncology & carcinogenesis, Female, Radiotherapy, Intensity-Modulated, business, Nuclear medicine, Follow-Up Studies
Abstract

PURPOSE To report the long-term results of external-beam accelerated partial-breast irradiation (APBI) intensity-modulated radiation therapy (IMRT) Florence phase III trial comparing whole-breast irradiation (WBI) to APBI in early-stage breast cancer. PATIENTS AND METHODS The primary end point was to determine the 5-year difference in ipsilateral breast tumor recurrence (IBTR) between 30 Gy in 5 once-daily fractions (APBI arm) and 50 Gy in 25 fractions with a tumor bed boost (WBI arm) after breast-conserving surgery. RESULTS Five hundred twenty patients, more than 90% of whom had characteristics associated with low recurrence risk, were randomly assigned (WBI, n = 260; APBI, n = 260) between 2005 and 2013. Median follow-up was 10.7 years. The 10-year cumulative incidence of IBTR was 2.5% (n = 6) in the WBI and 3.7% (n = 9) in the APBI arm (hazard ratio [HR], 1.56; 95% CI, 0.55 to 4.37; P = .40). Overall survival at 10 years was 91.9% in both arms (HR, 0.95; 95% CI, 0.50 to 1.79; P = .86). Breast cancer–specific survival at 10 years was 96.7% in the WBI and 97.8% in the APBI arm (HR, 0.65; 95% CI, 0.21 to 1.99; P = .45). The APBI arm showed significantly less acute toxicity ( P = .0001) and late toxicity ( P = .0001) and improved cosmetic outcome as evaluated by both physician ( P = .0001) and patient ( P = .0001). CONCLUSION The 10-year cumulative IBTR incidence in early breast cancer treated with external APBI using IMRT technique in 5 once-daily fractions is low and not different from that after WBI. Acute and late treatment-related toxicity and cosmesis outcomes were significantly in favor of APBI.

Published
2020
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14. Detection of PIK3CA E545A mutation in circulating tumor DNA of a patient affected by uterine carcinosarcoma

Author

Irene Turrini, Serena Pillozzi, Carlo Ammatuna, Francesca Castiglione, Ivo Noci, Giulia Fantappiè, Francesca Malentacchi, Flavia Sorbi, Massimiliano Fambrini, Lorenzo Antonuzzo, and Federica Vergoni

Subjects
0301 basic medicine, Cancer Research, Class I Phosphatidylinositol 3-Kinases, medicine.drug_class, medicine.medical_treatment, medicine.disease_cause, Circulating Tumor DNA, Targeted therapy, 03 medical and health sciences, 0302 clinical medicine, Carcinosarcoma, medicine, Humans, Pharmacology (medical), Molecular Targeted Therapy, Liquid biopsy, Aged, 80 and over, Pharmacology, Chemotherapy, Mutation, business.industry, Prognosis, Radiation therapy, 030104 developmental biology, Real-time polymerase chain reaction, Oncology, Estrogen, 030220 oncology & carcinogenesis, Uterine Neoplasms, Cancer cell, Cancer research, Female, business
Abstract

Uterine carcinosarcomas are biphasic neoplasms consisting of mixed epithelial and mesenchymal elements, representing less than 5% of all uterine malignancies. Carcinosarcomas are rare, although the most common cause of uterine cancer-specific death. Few information is available on the pathogenesis, and molecular characterization is poorly investigated. Consequently, the treatment has not changed over the last years and is far too being tailored, consisting of surgery and traditional chemotherapy and radiotherapy. Molecular characterization of liquid biopsy by circulating tumor DNA (ctDNA)/circulating cell-free DNA (ccfDNA) evaluation in a patient with uterine carcinosarcoma. Here, we describe a case report of an 83-year-old woman with carcinosarcomas, stage T3aN0M0. Cancer cells did not express estrogen nor progesterone receptors, while p53 and p16 were positive. Molecular characterization of ccfDNA and of ctDNA was performed by quantitative PCR, amplification-refractory mutation system technology. The presence of phosphatidylInositol-4,5-bisphosphate 3-Kinase catalytic subunit alpha p.E545A mutation was detected in plasma. This approach may suggest the use of liquid biopsy and the development of specific targeted therapy for precision personalized medicine even in rare carcinosarcomas.

Published
2020
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15. Epigenetics of Estrogen and Progesterone Receptors in Endometriosis

Author

Abdel Halim Harrath, Massimiliano Fambrini, Hefeng Huang, Francesca Malentacchi, Felice Petraglia, and Huixi Chen

Subjects
0301 basic medicine, medicine.drug_class, Receptor expression, Endometriosis, Estrogen receptor, Epigenesis, Genetic, 03 medical and health sciences, 0302 clinical medicine, Progesterone receptor, Humans, Medicine, Epigenetics, Receptor, 030219 obstetrics & reproductive medicine, business.industry, Obstetrics and Gynecology, DNA Methylation, medicine.disease, MicroRNAs, 030104 developmental biology, Gene Expression Regulation, Receptors, Estrogen, Nuclear receptor, Estrogen, Cancer research, Female, RNA, Long Noncoding, Receptors, Progesterone, business
Abstract

Endometriosis is an estrogen-dependent inflammatory gynecological disease. Increased estrogen activity and progesterone resistance are the main hormonal substrate of this disease and are associated with inflammatory response and debilitating symptoms, including pain and infertility. Estrogens and progesterone act via their specific nuclear receptors. The regulation of receptor expression by epigenetics maybe a critical factor for endometriosis. The present review aims to discuss the epigenetic mechanisms related to the expression of estrogen receptors (ERs) and progesterone receptors (PRs) in patients with endometriosis, including two classic epigenetic mechanisms: DNA methylation and histone modification, and, other non-classic mechanisms: miRNAs and lncRNA. Several in vitro and in vivo studies support the key role of epigenetics in the regulation of the expression of ERs and PRs, which may provide new molecules and targets for the diagnosis and treatment of endometriosis.

Published
2020
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16. Mutational profile in circulating tumor DNA in a patient affected by low-risk endometrial cancer: predictable tool of relapse?

Author

Francesca Zepponi, Lorenzo Antonuzzo, Ivo Noci, Massimiliano Fambrini, Serena Pillozzi, Giulia Fantappiè, Irene Turrini, Francesca Malentacchi, and Flavia Sorbi

Subjects
0301 basic medicine, Oncology, Cancer Research, medicine.medical_specialty, medicine.medical_treatment, Clone (cell biology), medicine.disease_cause, Circulating Tumor DNA, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Adjuvant therapy, Humans, Pharmacology (medical), Liquid biopsy, Stage (cooking), Aged, Pharmacology, Mutation, business.industry, Endometrial cancer, High-Throughput Nucleotide Sequencing, medicine.disease, Primary tumor, Endometrial Neoplasms, 030104 developmental biology, 030220 oncology & carcinogenesis, Female, Neoplasm Recurrence, Local, business, Adjuvant
Abstract

Endometrial cancer is the commonest gynecological cancer, the majority is endometrioid type, diagnosed at an early stage with 69-88% 5-year survival. Low-grade endometrial cancers have low recurrence rates and often do not receive adjuvant therapy; however, a subset of these patients will have poor outcomes and would benefit from adjuvant treatment has been challenging. We evaluate the circulating cell-free DNA (ccfDNA) in a patient with low-risk endometrial cancer in order to identify the presence of molecular markers associated with risk of recurrence. The evaluation of mutation profile was performed by next-generation sequencing (NGS) in primary tumor formalin-fixed paraffin-embedded (FFPE) tissue and in circulating tumor DNA (ctDNA). We identified a specific mutational profile in ctDNA, different from primary tumor tissue suggesting that the clone involved in the relapse may be different in comparison to the most represented in the primary tumor. These findings open new prospective and new wonderings. The molecular characterization of tissue may be useful for setting new target personalized therapy even in the treatment of endometrial cancer, moreover, endometrial cancer at low risk should be not underestimated for the incidence of relapse, and for this evaluation the molecular characterization may be useful. Moreover, these results suggest that the single analysis of primary tumors may be not sufficient for setting a specific personalized therapy targeted to avoid the relapse but may be necessary to join the molecular characterization of liquid biopsy to primary tissue.

Published
2020
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17. Physical activity and female sexual dysfunction: a lot helps, but not too much

Author

Tommaso Todisco, Linda Vignozzi, Sarah Cipriani, Flavia Sorbi, Veronica Gironi, Valdo Ricca, Giovanni Castellini, Felice Petraglia, Giulia Rastrelli, Elisa Maseroli, Vincenza Di Stasi, Massimiliano Fambrini, Mario Maggi, and Irene Scavello

Subjects
Sexual Behavior, Urology, Endocrinology, Diabetes and Metabolism, Female sexual dysfunction, 030232 urology & nephrology, Human sexuality, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Surveys and Questionnaires, Medicine, Humans, Sexual Dysfunctions, Psychological, Exercise, Sedentary lifestyle, Retrospective Studies, 030219 obstetrics & reproductive medicine, business.industry, Hypoactive sexual desire disorder, medicine.disease, Distress, Psychiatry and Mental health, Cross-Sectional Studies, Reproductive Medicine, Psychosexual development, Female, business, Sexual function, Psychopathology, Clinical psychology
Abstract

Background Research on the relationship between physical activity (PA) and female sexual dysfunction (FSD) is lacking. Aim To investigate the clinical, psychological, and sexual correlates of PA in women with FSD. Methods A non-selected series of n = 322 pre- and post-menopausal patients consulting for FSD was retrospectively studied. Regular involvement in PA and its frequency (6 hours/week: extremely active) were investigated with a specific question. Outcomes FSDs, including HSDD (Hypoactive sexual desire disorder) and FGAD (Female genital arousal disorder), were diagnosed according to a structured and clinical interview. Participants underwent a physical examination and a clitoral Doppler ultrasound, and were asked to complete the Female Sexual Function Index, Female Sexual Distress Scale-Revised, Body Uneasiness Test, and Middlesex Hospital Questionnaire. RESULTS At multivariate analysis, women engaging in PA (67.4%, n = 217) scored significantly higher in several Female Sexual Function Index domains - including desire, arousal and lubrication - and showed lower sexual distress and lower resistance of clitoral arteries, as compared to sedentary women. A significant, inverse association between PA and HSDD was observed. Mediation analysis demonstrated that the negative association between PA and HSDD was partly mediated by body image concerns (Body Uneasiness Test Global severity index), psychopathological symptoms (Middlesex Hospital Questionnaire total score) and sexual distress (Female Sexual Distress Scale-Revised score). These latter 2 factors also partly mediated the association between PA and a reduced risk of FGAD, whilst a lower BMI was a full mediator in the relationship between PA and FGAD. Finally, extreme PA was associated with significantly worse scores in several psychosexual parameters (i,e, sexual satisfaction and histrionic/hysterical symptoms), even compared to a sedentary lifestyle. Clinical Implications Women consulting for FSD may gain benefits on desire, arousal, lubrication and sex-related distress from regular PA; however, physicians should remain alert to the downsides of excessive exercise. Strengths & Limitations The main strength lies in the novelty of the findings. The main limitations are the cross-sectional nature, the clinical setting, the small sample size of the different PA groups, and the use of self-reported instruments for the evaluation of PA. CONCLUSION In women with FSD, PA was associated with better sexual function and clitoral vascularization, lower sexual distress and reduced odds of HSDD and FGAD; the benefits of PA on sexuality were mediated by both psychological and organic determinants; excessive PA was related with a poor overall sexual function and with a low sexual satisfaction.

Published
2022
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18. Practice patterns and 90-day treatment-related morbidity in early-stage cervical cancer

Author

Giorgio Bogani, Violante Di Donato, Giovanni Scambia, Fabio Landoni, Fabio Ghezzi, Ludovico Muzii, Pierluigi Benedetti Panici, Francesco Raspagliesi, Jvan Casarin, Giampaolo Di Martino, Tommaso Grassi, Anna Myriam Perrone, Pierandrea De Iaco, Francesco Multinu, Roberto Berretta, Vito A. Capozzi, Errico Zupi, Gabriele Centini, Antonio Pellegrino, Silvia Corso, Guido Stevenazzi, Anna Chiara Boschi, Giuseppe Comerci, Pantaleo Greco, Gennaro Scutiero, Francesco Sopracordevole, Giorgio Giorda, Mariasole Fichera, Tommaso Simoncini, Marta Caretto, Enrico Sartori, Federico Ferrari, Antonio Cianci, Giuseppe Sarpietro, Maria Grazia Matarazzo, Pierluigi Giampaolino, Giuseppe Bifulco, Michele Morelli, Michele Di Dio, Annamaria Ferrero, Nicoletta Biglia, Fabio Barra, Simone Ferrero, Stefano Cianci, Vito Chiantera, Giulio Sozzi, Alfredo Ercoli, Sergio Schettini, Teresa Orlando, Francesco G. Cannone, Giuseppe Ettore, Andrea Puppo, Elena Olearo, Umberto Leone Roberti Maggiore, Valeria Artuso, Innocenza Palaia, Giorgia Perniola, Rossana Tripodi, Tullio Golia D'Augè, Ilaria Cuccu, Margherita Fischetti, Giusi Santangelo, Assunta Casorelli, Andrea Giannini, Ottavia D’Oria, Giuseppe Vizzielli, Stefano Restaino, Alice Bergamini, Luca Bocciolone, Francesco Plotti, Roberto Angioli, Giulia Mantovani, Marcello Ceccaroni, Chiara Cassini, Mattia Dominoni, Laura Giambanco, Silvia Amodeo, Livio Leo, Raphaël Thommaset, Diego Raimondo, Renato Seracchioli, Mario Malzoni, Francesca Falcone, Franco Gorlero, Martina Di Luca, Enrico Busato, Sami Kilzie, Andrea Dell'Acqua, Giovanna Scarfone, Paolo Vercellini, Marco Petrillo, Giampiero Capobianco, Andrea Ciavattini, Liliana Mereu, Paolo Scollo, Flavia Sorbi, Massimiliano Fambrini, Federico Romano, Giuseppe Ricci, Giuseppe Trojano, Gianluca Raffaello Damiani, Roberto Consonni, Nadia Di Lorenzo, Antonio Lippolis, Raffaele Tinelli, Lorenzo Aguzzoli, Vincenzo D. Mandato, Stefano Palomba, Marcello Tripodi, Davide Calandra, Franco Pellegrini, Fulvio Zullo, Daniela Surico, Valentino Remorgida, Francesco Ruscitto, Paolo Beretta, Enrico Vizza, Bogani, Giorgio, Donato, Violante Di, Scambia, Giovanni, Landoni, Fabio, Ghezzi, Fabio, Muzii, Ludovico, Panici, Pierluigi Benedetti, Raspagliesi, Francesco, Giampaolino, Pierluigi, Bogani, G, Donato, V, Scambia, G, Landoni, F, Ghezzi, F, Muzii, L, Panici, P, Raspagliesi, F, Casarin, J, Di Martino, G, Grassi, T, Perrone, A, De Iaco, P, Multinu, F, Berretta, R, Capozzi, V, Zupi, E, Centini, G, Pellegrino, A, Corso, S, Stevenazzi, G, Boschi, A, Comerci, G, Greco, P, Scutiero, G, Sopracordevole, F, Giorda, G, Fichera, M, Simoncini, T, Caretto, M, Sartori, E, Ferrari, F, Cianci, A, Sarpietro, G, Matarazzo, M, Giampaolino, P, Bifulco, G, Morelli, M, Dio, M, Ferrero, A, Biglia, N, Barra, F, Ferrero, S, Cianci, S, Chiantera, V, Sozzi, G, Ercoli, A, Schettini, S, Orlando, T, Cannone, F, Ettore, G, Puppo, A, Olearo, E, Leone Roberti Maggiore, U, Artuso, V, Palaia, I, Perniola, G, Tripodi, R, D'Auge, T, Cuccu, I, Fischetti, M, Santangelo, G, Casorelli, A, Giannini, A, D'Oria, O, Vizzielli, G, Restaino, S, Bergamini, A, Bocciolone, L, Plotti, F, Angioli, R, Mantovani, G, Ceccaroni, M, Cassini, C, Dominoni, M, Giambanco, L, Amodeo, S, Leo, L, Thommaset, R, Raimondo, D, Seracchioli, R, Malzoni, M, Falcone, F, Gorlero, F, Di Luca, M, Busato, E, Kilzie, S, Dell'Acqua, A, Scarfone, G, Vercellini, P, Petrillo, M, Capobianco, G, Ciavattini, A, Mereu, L, Scollo, P, Sorbi, F, Fambrini, M, Romano, F, Ricci, G, Trojano, G, Damiani, G, Consonni, R, Di Lorenzo, N, Lippolis, A, Tinelli, R, Aguzzoli, L, Mandato, V, Palomba, S, Tripodi, M, Calandra, D, Pellegrini, F, Zullo, F, Surico, D, Remorgida, V, Ruscitto, F, Beretta, P, Vizza, E, Casarin, Jvan, Di Martino, Giampaolo, Grassi, Tommaso, Perrone, Anna Myriam, De Iaco, Pierandrea, Multinu, Francesco, Berretta, Roberto, Capozzi, Vito A., Zupi, Errico, Centini, Gabriele, Pellegrino, Antonio, Corso, Silvia, Stevenazzi, Guido, Boschi, Anna Chiara, Comerci, Giuseppe, Greco, Pantaleo, Scutiero, Gennaro, Sopracordevole, Francesco, Giorda, Giorgio, Fichera, Mariasole, Simoncini, Tommaso, Caretto, Marta, Sartori, Enrico, Ferrari, Federico, Cianci, Antonio, Sarpietro, Giuseppe, Matarazzo, Maria Grazia, Bifulco, Giuseppe, Morelli, Michele, Dio, Michele Di, Ferrero, Annamaria, Biglia, Nicoletta, Barra, Fabio, Ferrero, Simone, Cianci, Stefanoa, Chiantera, Vitoa, Ercoli, Alfredo, Schettini, Sergio, Orlando, Teresa, Cannone, Francesco G., Ettore, Giuseppe, Puppo, Andrea, Olearo, Elena, Maggiore, Umberto Leone Roberti, Artuso, Valeria, Palaia, Innocenza, Perniola, Giorgia, Tripodi, Rosanna, D'Augè, Tullio Golia, Cuccu, Ilaria, Fischetti, Margherita, Santangelo, Giusi, Casorelli, Assunta, Giannini, Andrea, D’Oria, Ottvaio, Vizzielli, Giuseppe, Restaino, Stefano, Bergamini, Alice, Bocciolone, Luca, Plotti, Francesco, Angioli, Roberto, Mantovani, Giulia, Ceccaroni, Marcello, Cassini, Chiara, Dominoni, Mattia, Giambanco, Laura, Amodeo, Silvia, Leo, Livio, Thommaset, Raphaël, Raimondo, Diego, Seracchioli, Renato, Malzoni, Mario, Falcone, Francesca, Gorlero, Franco, Di Luca, Martina, Busato, Enrico, Kilzie, Sami, Dell'Acqua, Andrea, Scarfone, Giovanna, Vercellini, Paolo, Petrillo, Marco, Capobianco, Giampiero, Ciavattini, Andrea, Mereu, Liliana, Scollo, Paolo, Sorbi, Flavia, Fambrini, Massimiliano, Romano, Federico, Ricci, Giuseppe, Trojano, Giuseppe, Damiani, Gianluca Raffaello, Consonni, Roberto, Di Lorenzo, Nadia, Lippolis, Antonio, Tinelli, Raffaele, Aguzzoli, Lorenzo, Mandato, Vincenzo D., Palomba, Stefano, Tripodi, Marcello, Calandra, Davide, Pellegrini, Franco, Zullo, Fulvio, Surico, Daniela, Remorgida, Valentino, Ruscitto, Francesco, Beretta, Paolo, and Vizza, Enrico.

Subjects
Complications, Obstetrics and Gynecology, Uterine Cervical Neoplasms, Hysterectomy, Settore MED/40 - GINECOLOGIA E OSTETRICIA, Oncology, Retrospective Studie, Laparoscopy, Morbidity, Radical hysterectomy, Female, Humans, Neoplasm Staging, Retrospective Studies, Complication, Human
Abstract

Background. To evaluate the impact of the Laparoscopic Approach to Cervical Cancer (LACC) Trial on patterns of care and surgery-related morbidity in early-stage cervical cancer. Methods. This is a retrospective, a multi-institutional study evaluating 90-day surgery-related outcomes of patients undergoing treatment for early-stage cervical cancer before (period I: 01/01/2016-06/01/2018) and after (period II: 01/01/2019-06/01/2021) the publication of the results of the LACC trial. Results. Charts of 1295 patients were evaluated: 581 (44.9%) and 714 (55.1%) before and after the publication of the LACC trial, respectively. After the publication of the LACC trial, the number of patients treated with minimally invasive radical hysterectomy decreased from 64.9% to 30.4% (p < 0.001). Overall, 90-day complications occurred in 110 (18.9%) and 119 (16.6%) patients in the period I and period II, respectively (p = 0.795). Similarly, the number of severe (grade 3 or worse) complications did not differ between the two periods (38 (6.5%) vs. 37 (5.1%); p = 0.297). Overall and severe 90-day complications were consistent between periods even evaluating stage IA (p = 0.471), IB1 (p = 0.929), and IB2 (p = 0.074), separately. Conclusions. The present investigation highlighted that in referral centers the shift from minimally invasive to open radical hysterectomy does not influence 90-day surgery-related morbidity. (c) 2022 Elsevier Inc. All rights reserved.

Published
2022

19. Characteristics and patterns of care of endometrial cancer before and during COVID-19 pandemic

Author

Giorgio Bogani, Giovanni Scambia, Chiara Cimmino, Francesco Fanfani, Barbara Costantini, Matteo Loverro, Gabriella Ferrandina, Fabio Landoni, Luca Bazzurini, Tommaso Grassi, Domenico Vitobello, Gabriele Siesto, Anna Myriam Perrone, Vanna Zanagnolo, Pierandrea De Iaco, Francesco Multinu, Fabio Ghezzi, Jvan Casarin, Roberto Berretta, Vito A Capozzi, Errico Zupi, Gabriele Centini, Antonio Pellegrino, Silvia Corso, Guido Stevenazzi, Serena Montoli, Anna Chiara Boschi, Giuseppe Comerci, Pantaleo Greco, Ruby Martinello, Francesco Sopracordevole, Giorgio Giorda, Tommaso Simoncini, Marta Caretto, Enrico Sartori, Federico Ferrari, Antonio Cianci, Giuseppe Sarpietro, Maria Grazia Matarazzo, Fulvio Zullo, Giuseppe Bifulco, Michele Morelli, Annamaria Ferrero, Nicoletta Biglia, Fabio Barra, Simone Ferrero, Umberto Leone Roberti Maggiore, Stefano Cianci, Vito Chiantera, Alfredo Ercoli, Giulio Sozzi, Angela Martoccia, Sergio Schettini, Teresa Orlando, Francesco G Cannone, Giuseppe Ettore, Andrea Puppo, Martina Borghese, Canio Martinelli, Ludovico Muzii, Violante Di Donato, Lorenza Driul, Stefano Restaino, Alice Bergamini, Giorgio Candotti, Luca Bocciolone, Francesco Plotti, Roberto Angioli, Giulia Mantovani, Marcello Ceccaroni, Chiara Cassani, Mattia Dominoni, Laura Giambanco, Silvia Amodeo, Livio Leo, Raphael Thomasset, Diego Raimondo, Renato Seracchioli, Mario Malzoni, Franco Gorlero, Martina Di Luca, Enrico Busato, Sami Kilzie, Andrea Dell'Acqua, Giovanna Scarfone, Paolo Vercellini, Marco Petrillo, Salvatore Dessole, Giampiero Capobianco, Andrea Ciavattini, Giovanni Delli Carpini, Luca Giannella, Liliana Mereu, Saverio Tateo, Flavia Sorbi, Massimiliano Fambrini, Stefania Cicogna, Federico Romano, Giuseppe Ricci, Giuseppe Trojano, Roberto Consonni, Simona Cantaluppi, Antonio Lippolis, Raffaele Tinelli, Giovanni D'Ippolito, Lorenzo Aguzzoli, Vincenzo D Mandato, Stefano Palomba, Davide Calandra, Maurizio Rosati, Cinzia Gallo, Daniela Surico, Valentino Remorgida, Francesco Ruscitto, Paolo Beretta, Pierluigi Benedetti Panici, Francesco Raspagliesi, Bogani G., Scambia G., Cimmino C., Fanfani F., Costantini B., Loverro M., Ferrandina G., Landoni F., Bazzurini L., Grassi T., Vitobello D., Siesto G., Perrone A.M., Zanagnolo V., De Iaco P., Multinu F., Ghezzi F., Casarin J., Berretta R., Capozzi V.A., Zupi E., Centini G., Pellegrino A., Corso S., Stevenazzi G., Montoli S., Boschi A.C., Comerci G., Greco P., Martinello R., Sopracordevole F., Giorda G., Simoncini T., Caretto M., Sartori E., Ferrari F., Cianci A., Sarpietro G., Matarazzo M.G., Zullo F., Bifulco G., Morelli M., Ferrero A., Biglia N., Barra F., Ferrero S., Maggiore U.L.R., Cianci S., Chiantera V., Ercoli A., Sozzi G., Martoccia A., Schettini S., Orlando T., Cannone F.G., Ettore G., Puppo A., Borghese M., Martinelli C., Muzii L., Di Donato V., Driul L., Restaino S., Bergamini A., Candotti G., Bocciolone L., Plotti F., Angioli R., Mantovani G., Ceccaroni M., Cassani C., Dominoni M., Giambanco L., Amodeo S., Leo L., Thomasset R., Raimondo D., Seracchioli R., Malzoni M., Gorlero F., Di Luca M., Busato E., Kilzie S., Dell'acqua A., Scarfone G., Vercellini P., Petrillo M., Dessole S., Capobianco G., Ciavattini A., Delli Carpini G., Giannella L., Mereu L., Tateo S., Sorbi F., Fambrini M., Cicogna S., Romano F., Ricci G., Trojano G., Consonni R., Cantaluppi S., Lippolis A., Tinelli R., D'ippolito G., Aguzzoli L., Mandato V.D., Palomba S., Calandra D., Rosati M., Gallo C., Surico D., Remorgida V., Ruscitto F., Beretta P., Panici P.B., Raspagliesi F., Bogani, Giorgio, Scambia, Giovanni, Cimmino, Chiara, Fanfani, Francesco, Costantini, Barbara, Loverro, Matteo, Ferrandina, Gabriella, Landoni, Fabio, Bazzurini, Luca, Grassi, Tommaso, Vitobello, Domenico, Siesto, Gabriele, Perrone, Anna Myriam, Zanagnolo, Vanna, De Iaco, Pierandrea, Multinu, Francesco, Ghezzi, Fabio, Casarin, Jvan, Berretta, Roberto, Capozzi, Vito A, Zupi, Errico, Centini, Gabriele, Pellegrino, Antonio, Corso, Silvia, Stevenazzi, Guido, Montoli, Serena, Boschi, Anna Chiara, Comerci, Giuseppe, Greco, Pantaleo, Martinello, Ruby, Sopracordevole, Francesco, Giorda, Giorgio, Simoncini, Tommaso, Caretto, Marta, Sartori, Enrico, Ferrari, Federico, Cianci, Antonio, Sarpietro, Giuseppe, Matarazzo, Maria Grazia, Zullo, Fulvio, Bifulco, Giuseppe, Morelli, Michele, Ferrero, Annamaria, Biglia, Nicoletta, Barra, Fabio, Ferrero, Simone, Leone Roberti Maggiore, Umberto, Cianci, Stefano, Chiantera, Vito, Ercoli, Alfredo, Sozzi, Giulio, Martoccia, Angela, Schettini, Sergio, Orlando, Teresa, Cannone, Francesco G, Ettore, Giuseppe, Puppo, Andrea, Borghese, Martina, Martinelli, Canio, Muzii, Ludovico, Di Donato, Violante, Driul, Lorenza, Restaino, Stefano, Bergamini, Alice, Candotti, Giorgio, Bocciolone, Luca, Plotti, Francesco, Angioli, Roberto, Mantovani, Giulia, Ceccaroni, Marcello, Cassani, Chiara, Dominoni, Mattia, Giambanco, Laura, Amodeo, Silvia, Leo, Livio, Thomasset, Raphael, Raimondo, Diego, Seracchioli, Renato, Malzoni, Mario, Gorlero, Franco, Di Luca, Martina, Busato, Enrico, Kilzie, Sami, Dell'Acqua, Andrea, Scarfone, Giovanna, Vercellini, Paolo, Petrillo, Marco, Dessole, Salvatore, Capobianco, Giampiero, Ciavattini, Andrea, Delli Carpini, Giovanni, Giannella, Luca, Mereu, Liliana, Tateo, Saverio, Sorbi, Flavia, Fambrini, Massimiliano, Cicogna, Stefania, Romano, Federico, Ricci, Giuseppe, Trojano, Giuseppe, Consonni, Roberto, Cantaluppi, Simona, Lippolis, Antonio, Tinelli, Raffaele, D'Ippolito, Giovanni, Aguzzoli, Lorenzo, Mandato, Vincenzo D, Palomba, Stefano, Calandra, Davide, Rosati, Maurizio, Gallo, Cinzia, Surico, Daniela, Remorgida, Valentino, Ruscitto, Francesco, Beretta, Paolo, Benedetti Panici, Pierluigi, Raspagliesi, Francesco, Bogani, G., Scambia, G., Cimmino, C., Fanfani, F., Costantini, B., Loverro, M., Ferrandina, G., Landoni, F., Bazzurini, L., Grassi, T., Vitobello, D., Siesto, G., Perrone, A. M., Zanagnolo, V., De Iaco, P., Multinu, F., Ghezzi, F., Casarin, J., Berretta, R., Capozzi, V. A., Zupi, E., Centini, G., Pellegrino, A., Corso, S., Stevenazzi, G., Montoli, S., Boschi, A. C., Comerci, G., Greco, P., Martinello, R., Sopracordevole, F., Giorda, G., Simoncini, T., Caretto, M., Sartori, E., Ferrari, F., Cianci, A., Sarpietro, G., Matarazzo, M. G., Zullo, F., Bifulco, G., Morelli, M., Ferrero, A., Biglia, N., Barra, F., Ferrero, S., Leone Roberti Maggiore, U., Cianci, S., Chiantera, V., Ercoli, A., Sozzi, G., Martoccia, A., Schettini, S., Orlando, T., Cannone, F. G., Ettore, G., Puppo, A., Borghese, M., Martinelli, C., Muzii, L., Di Donato, V., Driul, L., Restaino, S., Bergamini, A., Candotti, G., Bocciolone, L., Plotti, F., Angioli, R., Mantovani, G., Ceccaroni, M., Cassani, C., Dominoni, M., Giambanco, L., Amodeo, S., Leo, L., Thomasset, R., Raimondo, D., Seracchioli, R., Malzoni, M., Gorlero, F., Di Luca, M., Busato, E., Kilzie, S., Dell'Acqua, A., Scarfone, G., Vercellini, P., Petrillo, M., Dessole, S., Capobianco, G., Ciavattini, A., Delli Carpini, G., Giannella, L., Mereu, L., Tateo, S., Sorbi, F., Fambrini, M., Cicogna, S., Romano, F., Ricci, G., Trojano, G., Consonni, R., Cantaluppi, S., Lippolis, A., Tinelli, R., D'Ippolito, G., Aguzzoli, L., Mandato, V. D., Palomba, S., Calandra, D., Rosati, M., Gallo, C., Surico, D., Remorgida, V., Ruscitto, F., Beretta, P., Benedetti Panici, P., Raspagliesi, F., Bogani, G, Scambia, G, Cimmino, C, Fanfani, F, Costantini, B, Loverro, M, Ferrandina, G, Landoni, F, Bazzurini, L, Grassi, T, Vitobello, D, Siesto, G, Perrone, A, Zanagnolo, V, De Iaco, P, Multinu, F, Ghezzi, F, Casarin, J, Berretta, R, Capozzi, V, Zupi, E, Centini, G, Pellegrino, A, Corso, S, Stevenazzi, G, Montoli, S, Boschi, A, Comerci, G, Greco, P, Martinello, R, Sopracordevole, F, Giorda, G, Simoncini, T, Caretto, M, Sartori, E, Ferrari, F, Cianci, A, Sarpietro, G, Matarazzo, M, Zullo, F, Bifulco, G, Morelli, M, Ferrero, A, Biglia, N, Barra, F, Ferrero, S, Leone Roberti Maggiore, U, Cianci, S, Chiantera, V, Ercoli, A, Sozzi, G, Martoccia, A, Schettini, S, Orlando, T, Cannone, F, Ettore, G, Puppo, A, Borghese, M, Martinelli, C, Muzii, L, Di Donato, V, Driul, L, Restaino, S, Bergamini, A, Candotti, G, Bocciolone, L, Plotti, F, Angioli, R, Mantovani, G, Ceccaroni, M, Cassani, C, Dominoni, M, Giambanco, L, Amodeo, S, Leo, L, Thomasset, R, Raimondo, D, Seracchioli, R, Malzoni, M, Gorlero, F, Di Luca, M, Busato, E, Kilzie, S, Dell'Acqua, A, Scarfone, G, Vercellini, P, Petrillo, M, Dessole, S, Capobianco, G, Ciavattini, A, Delli Carpini, G, Giannella, L, Mereu, L, Tateo, S, Sorbi, F, Fambrini, M, Cicogna, S, Romano, F, Ricci, G, Trojano, G, Consonni, R, Cantaluppi, S, Lippolis, A, Tinelli, R, D'Ippolito, G, Aguzzoli, L, Mandato, V, Palomba, S, Calandra, D, Rosati, M, Gallo, C, Surico, D, Remorgida, V, Ruscitto, F, Beretta, P, Benedetti Panici, P, Raspagliesi, F, Maggiore, U. L. R., and Panici, P. B.

Subjects
medicine.medical_specialty, endometrial neoplasms, Coronavirus disease 2019 (COVID-19), Endometrial Cancer, COVID-19, Uterine cancer, SARS-CoV-2, covid-19, endometrial cancer, sars-cov-2, uterine cancer, female, humans, pandemics, retrospective studies, NO, Retrospective Studie, Pandemic, medicine, Patterns of care, Obstetrics, business.industry, Endometrial cancer, Obstetrics and Gynecology, General Medicine, medicine.disease, Endometrial Neoplasms, Settore MED/40 - GINECOLOGIA E OSTETRICIA, Oncology, Original Article, Female, business, Human
Abstract

Objective Coronavirus disease 2019 (COVID-19) outbreak has correlated with the disruption of screening activities and diagnostic assessments. Endometrial cancer (EC) is one of the most common gynecological malignancies and it is often detected at an early stage, because it frequently produces symptoms. Here, we aim to investigate the impact of COVID-19 outbreak on patterns of presentation and treatment of EC patients. Methods This is a retrospective study involving 54 centers in Italy. We evaluated patterns of presentation and treatment of EC patients before (period 1: March 1, 2019 to February 29, 2020) and during (period 2: April 1, 2020 to March 31, 2021) the COVID-19 outbreak. Results Medical records of 5,164 EC patients have been retrieved: 2,718 and 2,446 women treated in period 1 and period 2, respectively. Surgery was the mainstay of treatment in both periods (p=0.356). Nodal assessment was omitted in 689 (27.3%) and 484 (21.2%) patients treated in period 1 and 2, respectively (p, Synopsis The prevalence of patients with early-stage endometrial cancer (EC) has been lower during coronavirus disease 2019 (COVID-19) pandemic than before its onset. Further evidence is needed to assess the impact of COVID-19 pandemic on survival outcomes of EC patients.

Published
2022

20. Enhanced recovery after gynecological surgery: comparison between intrathecal and intravenous morphine multimodal analgesia

Author

Marta Mazzella, Giuseppe Cariti, Gretha Orlandi, Alessandro Di Filippo, Tommaso Capezzuoli, Tommaso Borracci, Massimiliano Fambrini, Luciana Di Nardo, Felice Petraglia, and Giulia Vannucci

Subjects
business.industry, Nausea, medicine.medical_treatment, Obstetrics and Gynecology, Intrathecal, Group B, Opioid, Anesthesia, medicine, Morphine, Clinical endpoint, Observational study, medicine.symptom, business, Gynecological surgery, medicine.drug
Abstract

BACKGROUND The purpose of the present study was to compare the effectiveness of intrathecal injection of morphine, inserted in the protocols of multimodal analgesia, versus intravenous morphine in the control of postoperative pain and course in women undergoing gynecological surgery. METHODS An observational, single-center, retrospective and case-controlled study was performed. Data were collected in a group of women (n=80) who underwent to gynecological surgery. Women were divided into two groups: Group A (40 patients) laparoscopic hysterectomy and Group B (n=40) performing laparotomic myomectomy. In both Groups 20 patients underwent administration of intrathecal morphine (125 mcg in 5 ml) and 20 patients underwent to intravenous morphine (1 mg maximum every 10 minutes). The primary endpoint collected was the mean VAS Score during the first 3 days after surgery, while secondary endpoints were opioid consumed during the same period, nausea, vomitis and pruritus. Among the exploratory objectives, length of hospital stay, canalization and feeding time were collected. RESULTS In Group A, patients performing intrathecal morphine presented a significantly lowest VAS on postoperative day 1 and 3 compared to patients performing intravenous morhpine while in Group B mean VAS was statistically significant lower only on the first day. The emergence of pruritus was significantly higher in patients performing intrathecal morphine. The day of complete canalization was different in Group A patients in favor of intratechal morhpine as well as the length of stay. CONCLUSIONS Our present study showed that intrathecal morphine allows to achieve important management goals with minimal side effects and complications, in particular in case of laparoscopic hysterectomy.

Published
2021

21. O004/#393 Does intensive follow-up improve overall survivalin endometrial cancer patients? Results from the totem randomized controlled trial

Author

D Di Cuonzo, G Comerci, Marco Adorni, R Angioli, Annamaria Ferrero, Stefano Greggi, S Loda, Luca Fuso, Vincenzo Dario Mandato, Anna Myriam Perrone, E Busato, Roberto Berretta, L. Zavallone, C Terranova, Massimiliano Fambrini, G. Ciccone, Paolo Zola, E Peirano, Elisa Piovano, and Francesca Chiudinelli

Subjects
Oncology, medicine.medical_specialty, Randomized controlled trial, law, business.industry, Endometrial cancer, Internal medicine, Totem, medicine, medicine.disease, business, law.invention
Published
2021
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22. Identification of a Gene Panel for Endometrioid Endometrial Cancer: a Possible Prognostic Value?

Author

Ivo Noci, Gianni Amunni, Francesca Malentacchi, Serena Pillozzi, Flavia Sorbi, Francesca Castiglione, Elisabetta Projetto, Felice Petraglia, Irene Turrini, Massimiliano Fambrini, and Federica Vergoni

Subjects
Oncology, medicine.medical_specialty, endocrine system diseases, ARID1A, Pilot Projects, medicine.disease_cause, Polymorphism, Single Nucleotide, symbols.namesake, Exon, Internal medicine, Biomarkers, Tumor, medicine, Humans, PTEN, neoplasms, Gene, PI3K/AKT/mTOR pathway, Sanger sequencing, biology, business.industry, Endometrial cancer, Obstetrics and Gynecology, Prognosis, medicine.disease, Endometrial Neoplasms, Mutation, biology.protein, symbols, Female, KRAS, business, Carcinoma, Endometrioid
Abstract

The incidence of endometrial cancer (EC) is increasing in developed countries. The most frequent is the endometrioid subtype with usually good prognosis; nevertheless, some cases escape this paradigm and may have recurrence. A recent study from The Cancer Genome Atlas suggested to implement the EC analysis by molecular profile for improving diagnosis, prognosis, and therapeutic treatment. The present preliminary study was performed on 15 G3 endometrioid endometrial cancers (G3 EEC) for the identification of somatic mutations in a panel of specific exons in selected genes as ARID1A, CTNNB1, KRAS, PIK3CA, POLE, PTEN, and TP53. The combined procedure, based on the Sanger sequencing and PCR-high-resolution melting analysis, allowed the identification of variations of the selected gene panel in most of patients (93%) of our cohort. The overall evaluation of mutational load exhibited that the most frequent mutated genes were PTEN (93%), followed by PIK3CA (47%) suggesting a deep involvement of PI3K pathway alteration in G3 EEC. Mutations in TP53 (27%), ARID1A (27%), POLE (13%), and at the lower level in KRAS and CTNNB1 (7%) were also observed (exclusively in FIGO III stage patients). The evaluation of the mutations of our proposed panel (ARID1A, CTNNB1, KRAS, PIK3CA, POLE, PTEN, TP53) is suitable to improve the characterization of G3 EEC and could suggest targetable pathways for development of personalized treatments.

Published
2020
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23. The relation between endometrioma and ovarian cancer

Author

Massimiliano Fambrini, Flavia Sorbi, Tommaso Capezzuoli, Giulia Fantappiè, Srdjan Saso, Martina Corda, and Felice Petraglia

Subjects
Oncology, Infertility, endocrine system, medicine.medical_specialty, endocrine system diseases, Endometriosis, Disease, Carcinoma, Ovarian Epithelial, Endometrium, Internal medicine, medicine, Humans, Risk factor, Stage (cooking), Ovarian Neoplasms, business.industry, Obstetrics and Gynecology, medicine.disease, female genital diseases and pregnancy complications, Ovarian Endometriosis, Quality of Life, Female, Population Risk, Ovarian cancer, business
Abstract

Introduction The relationship between endometrioma and ovarian cancer is a topic of discussion in the field of endometriosis and to date it is still debated whether ovarian endometriosis may represent a risk factor for ovarian cancers. Evidence acquisition A literature search was carried out using Cochrane Library, EMBASE, Medline and Google Scholar up to October 2020. Primary outcome of interest was ovarian cancer incidence in patients with endometriosis. Secondary outcome was ovarian cancer prognosis in patients with endometriosis compared to patient without endometriosis. Evidence synthesis Patients with ovarian endometriosis has a slight increase risk of developing ovarian cancer (merely 1.8%), being the general population risk for ovarian cancer 1.31%. In patient at postmenopausal age, long-lasting endometriosis, early-age diagnosis, infertility and/or infertility treatment the risk of developing ovarian cancer is higher. Endometriosis-related ovarian cancers are generally clear cell and endometrioid and are diagnosed at early stage compared to non-endometriosis related ovarian cancer. Conclusions The lifetime risk for ovarian cancer is low in endometriosis patients in general and higher in subgroups of patients allowing a tailored management based on patient characteristics. Endometriosis is a chronic disease negatively affecting the quality of life, nonetheless, concerns on ovarian cancer should be avoided in order to reduce the burden of the disease on women's health.

Published
2021

24. SHBG as a Q1 marker of NAFLD and metabolic impairments in women referred for oligomenorrhea and/or hirsutism and in women with sexual dysfunction

Author

Felice Petraglia, Flavia Sorbi, Sarah Cipriani, Linda Vignozzi, Elisa Maseroli, Sara Marchiani, Irene Scavello, Giulia Rastrelli, Massimiliano Fambrini, Mario Maggi, Stasi Vincenza Di, and Tommaso Todisco

Subjects
Sex hormone-binding globulin, Sexual dysfunction, biology, business.industry, biology.protein, Medicine, Physiology, medicine.symptom, business, medicine.disease, hirsutism
Published
2021
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25. Physical activity and female sexual dysfunction: too much of a good thing?

Author

Elisa Maseroli, Linda Vignozzi, Flavia Sorbi, Massimiliano Fambrini, Veronica Gironi, Irene Scavello, Stasi Vincenza Di, Giulia Rastrelli, Mario Maggi, Sarah Cipriani, Valdo Ricca, Tommaso Todisco, Giovanni Castellini, and Felice Petraglia

Subjects
business.industry, Female sexual dysfunction, Physical activity, Medicine, business, medicine.disease, Clinical psychology
Published
2021
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26. CO2 laser colposcopic guided surgery for the see and treat management of VHSIL: a preliminary experience

Author

A. De Magnis, Annalisa Pieralli, N. Auzzi, M. G. Fallani, Claudia Bianchi, Irene Turrini, and Massimiliano Fambrini

Subjects
medicine.medical_specialty, Co2 laser, Vulvar Neoplasms, business.industry, medicine.medical_treatment, Uterine Cervical Neoplasms, Therapeutic Procedure, Dermatology, Ablation, Surgery, Exact test, Colposcopy, Pregnancy, Risk Factors, See and treat, Relative risk, medicine, Lasers, Gas, Humans, Statistical analysis, Female, Laser Therapy, Risk factor, business
Abstract

The purpose of this study is to evaluate the efficiency of CO2 laser colposcopic guided surgery performed in an outpatient see and treat setting in the management of VHSIL. Women with a suspected diagnosis of VHSIL and no vulvoscopic suspicion of vSCC were enrolled. An electronic register of CO2 laser treatment was created where description of performing parameters (excision or ablation) was specified and personal history was recorded. Statistical analysis was performed by Fisher’s exact test. Relative risks (RR) of risk factor were calculated and expressed in odds. From September 2014 to September 2018, we enrolled a total of 63 patients who underwent CO2 laser procedure and had a minimum follow-up time of 2 years at Careggi University Hospital in Florence. Forty-eight (76.2%) patients underwent laser excision and 15 (23.8%) patients underwent ablative treatment without histological results. Undertreatment was performed in 3 cases (6.3%) with definitive histology of vSCC. Therapeutical appropriateness of CO2 laser excision was reached in 85.4% of the cases (41/48). No volunteer loss to follow-up was registered; thus, fidelity to treatment was assess at 100%. Recurrence rate within 2 years attested in 8/60 followed patients (13.3%). No personal factor was found to influence the VHSIL course. CO2 laser excision may represent an excellent therapeutic option to VHSIL because it provides adequate oncological purpose with good cosmetic and functional results and high patients’ loyalty to treatment. An expert team could allow to undergo patients with VHSIL suspicion to unique diagnostic and therapeutic procedure with significant benefits.

Published
2021

27. Effects of testosterone treatment on clitoral haemodynamics in women with sexual dysfunction

Author

Emmanuele A. Jannini, Flavia Sorbi, V. Di Stasi, Irene Scavello, Giulia Rastrelli, Linda Vignozzi, Felice Petraglia, Mario Maggi, Tommaso Todisco, Sarah Cipriani, Elisa Maseroli, and Massimiliano Fambrini

Subjects
Adult, 0301 basic medicine, medicine.medical_specialty, Clitoris, Female sexual dysfunction, Genital blood flow, Testosterone treatment in women, Treatment for female sexual dysfunction, Ultrasound, Administration, Topical, Endocrinology, Diabetes and Metabolism, media_common.quotation_subject, Urology, Orgasm, Administration, Cutaneous, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Endocrinology, Outcome Assessment, Health Care, medicine, Humans, Testosterone, Sex organ, Ultrasonography, Doppler, Color, media_common, 030219 obstetrics & reproductive medicine, business.industry, Hemodynamics, Estrogens, Testosterone (patch), medicine.disease, Sexual Dysfunction, Physiological, Treatment Outcome, 030104 developmental biology, medicine.anatomical_structure, Sexual dysfunction, chemistry, Original Article, Female, Glycated hemoglobin, medicine.symptom, Sexual function, business, Gonadal Hormones
Abstract

Purpose To explore the effects of 6-month systemic testosterone (T) administration on clitoral color Doppler ultrasound (CDU) parameters in women with female sexual dysfunction (FSD). Methods 81 women with FSD were retrospectively recruited. Data on CDU parameters at baseline and after 6 months with four different treatments were available and thus further longitudinally analyzed: local non-hormonal moisturizers (NH group), n = 37; transdermal 2% T gel 300 mcg/day (T group), n = 23; local estrogens (E group), n = 12; combined therapy (T + E group), n = 9. Patients underwent physical, laboratory, and genital CDU examinations at both visits and completed different validated questionnaires, including the Female Sexual Function Index (FSFI). Results At 6-month visit, T therapy significantly increased clitoral artery peak systolic velocity (PSV) when compared to both NH (p p p = 0.039 vs. E). In addition, T treatment was associated with significantly higher FSFI desire, pain, arousal, lubrication, orgasm, and total scores at 6-month visit vs. baseline. Similar findings were observed in the T + E group. No significant differences in the variations of total and high-density lipoprotein-cholesterol, triglycerides, fasting glycemia, insulin and glycated hemoglobin levels were found among the four groups. No adverse events were observed. Conclusion In women complaining for FSD, systemic T administration, either alone or combined with local estrogens, was associated with a positive effect on clitoral blood flow and a clinical improvement in sexual function, showing a good safety profile. Trial registration number NCT04336891; date of registration: April 7, 2020.

Published
2021

28. High grade cervical intraepithelial neoplasia positive biopsy: the importance of accurate pre-operative workup

Author

Valeria Dubini, Flavia Sorbi, Dora Pavone, Irene Turrini, Felice Petraglia, Francesca Malentacchi, Cecilia Bussani, Massimiliano Fambrini, Giulia Fantappiè, Karin L. Andersson, and Chiara Coco

Subjects
Adult, medicine.medical_specialty, Genotype, Biopsy, Conization, Uterine Cervical Neoplasms, Cervix Uteri, Alphapapillomavirus, Gastroenterology, Preoperative care, Young Adult, Internal medicine, Preoperative Care, Humans, Medicine, Young adult, Aged, Colposcopy, Human papillomavirus 16, medicine.diagnostic_test, business.industry, Incidence (epidemiology), Age Factors, virus diseases, Obstetrics and Gynecology, Middle Aged, Uterine Cervical Dysplasia, female genital diseases and pregnancy complications, High Grade Cervical Intraepithelial Neoplasia, Cohort, Female, business
Abstract

BACKGROUND In cervical cancer screening programs, women with abnormal cytology and confirmation by biopsy are referred for colposcopy for histological evaluation. METHODS We characterized the presence and the genotype of HPV by Linear Array HPV genotyping assay in cytological samples collected from about 400 women undergoing conization, with reported high CIN grade after biopsy. RESULTS The most prevalent genotype was HPV 16, with an increasing presence depending on the severity of the CIN and with the highest incidence in the 26-35 age range. In the group of younger women (

Published
2021
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29. Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study

Author

Dmitri, Nepogodiev, Joana Ff Simoes, Elizabeth, Li, Maria, Picciochi, James, C Glasbey, Glauco, Baiocchi, Ruth, Blanco-Colino, Daoud, Chaudhry, Ehab, Alameer, Kariem, El-Boghdadly, Funmilola, Wuraola, Dhruva, Ghosh, Rohan, R Gujjuri, Ewen, M Harrison, Herman, Lule, Haytham, Kaafarani, Mohammad, Khosravi, Irmgard, Kronberger, Sezai, Leventoğlu, Harvinder, Mann, Kenneth, A Mclean, Mengistu Gebreyohanes Mengesha, Maria Marta Modolo, Faustin, Ntirenganya, Lisa, Norman, Oumaima, Outani, Riinu, Pius, Peter, Pockney, Ahmad Uzair Qureshi, April Camilla Roslani, Sohei, Satoi, Catherine, Shaw, Aneel, Bhangu, Omar, M Omar, Waheed-Ul-Rahman, Ahmed, Leah, Argus, Alasdair, Ball, Edward, P Bywater, Amanpreet, Brar, Brett, E Dawson, Irani, Duran, Muhammed, Elhadi, Conor, S Jones, Sivesh, K Kamarajah, James, M Keatley, Samuel, Lawday, Ella, J Marson, Riinu, Ots, Irène, Santos, Elliott, H Taylor, Isobel, M Trout, Chris, Varghese, Mary, L Venn, William, Xu, Irida, Dajti, Arben, Gjata, Salah Eddine Oussama Kacimi, Luis, Boccalatte, Daniel, Cox, Philip, Townend, Felix, Aigner, Irmgard Elisabeth Kronberger, Elgun, Samadov, Amer, Alderazi, Kamral, Hossain, Greg, Padmore, Gabrielle van Ramshorst, Ismaïl, Lawani, Anis, Cerovac, Samir, Delibegovic, Gustavo Mendonça Ataíde Gomes, Igor Lima Buarque, Muhammad, Gohar, Mihail, Slavchev, Chukwuemeka, Nwegbu, Arnav, Agarwal, Janet, Martin, Joshua, Ng-Kamstra, Maricarmen, Olivos, Wenhui, Lou, Dong-Lin, Ren, Jose Andres Calvache, Carlos, J Perez Rivera, Ana Danic Hadzibegovic, Tomislav, Kopjar, Jakov, Mihanovic, Pablo Mijahil Avilés Jiménez, Nikolaos, Gouvas, Jaroslav, Klat, René, Novysedlák, Nicolas, Amisi, Peter, Christensen, Alaa, El-Hussuna, Sylvia, Batista, Eddy, Lincango-Naranjo, Sameh, Emile, Danilo Alfonso Arévalo Sandoval, Hailu, Dhufera, Samuel, Hailu, Mengistu, G Mengesha, Joonas, H Kauppila, Alexis, P Arnaud, Zaza, Demetrashvili, Markus, Albertsmeier, Hans, Lederhuber, Markus, W Löffler, Daniel Kwesi Acquah, Bernard, Ofori, Stephen, Tabiri, Symeon, Metallidis, Georgios, Tsoulfas, Maria-Lorena, Aguilera-Arevalo, Gustavo, Recinos, Tamás, Mersich, Dániel, Wettstein, Gabriele, Kembuan, Peiman Brouki Milan, Mohammad Hossein Khosravi, Masoud, Mozafari, Ahmed, Hilmi, Helen, Mohan, Oded, Zmora, Gaetano, Gallo, Francesco, Pata, Gianluca, Pellino, Yuki, Fujimoto, Naoto, Kuroda, Mohamad, K Abou Chaar, Faris, Ayasra, Ildar, Fakhradiyev, Intisar Hisham Said Hamdun, Jang, Jin-Young, Mohammad, Jamal, Lina, Karout, Aiste, Gulla, Fanjandrainy, Rasoaherinomenjanahary, Luc Hervé Samison, Iran Irani Durán Sánchez, Diana Samantha Gonzalez, Laura, Martinez, María José Martínez, Alejandra, Nayen, Antonio Ramos-De la Medina, Jade, Nunez, Pueya Rashid Nashidengo, Rakesh, Shah, Ashish Lal Shrestha, Pascal, Jonker, Schelto, Kruijff, Milou, Noltes, Pieter, Steinkamp, Deborah, Wright, Lukman, Abdur-Rahman, Adesoji, Ademuyiwa, Adewale, Adisa, Babatunde, Osinaike, Justina, Seyi-Olajide, Omolara, Williams, Emmanuel, Williams, Sofija, Pejkova, Zainab Al Balushi, Raza, Sayyed, Mustafa Abo Mohsen, Sadi, A Abukhalaf, Moises, Cukier, Hugo, Gomez-Fernandez, Sebastian Shu Yip, Ximena Paola Vasquez Ojeda, Marie Dione Sacdalan, Piotr, Major, José, Azevedo, Miguel, F Cunha, Ahmad, Zarour, Eduard-Alexandru, Bonci, Ionut, Negoi, Sergey, Efetov, Viktor, Kochetkov, Andrey, Litvin, Jc Allen Ingabire, Georges, Bucyibaruta, Ntirenganya, Faustin, Sosthene, Habumuremyi, Alphonsine, Imanishimwe, Haragirimana Jean de Dieu, Emmanuel, Munyaneza, Isaie, Ncogoza, Abdourahmane, Ndong, Dejan, Radenkovic, Min Hoe Chew, Frederick, Koh, James, Ngu, Arpád, Panyko, Uros, Bele, Jurij Aleš Košir, Hassan, Daoud, Ana Maria Minaya Bravo, Umesh, Jayarajah, Dakshitha, Wickramasinghe, Mohammed Elmujtba Adam Essa Adam, Martin, Rutegård, Malin, Sund, Michel, Adamina, Eleftherios, Gialamas, Karoline, Horisberger, Muhammad, Alshaar, Abel, Huang, Varut, Lohsiriwat, Shane, Charles, Haithem, Jlassi, Arda, Isik, Hervé Monka Lekuya, Slava, Kopetskyi, Hayder, Alsaadi, Sattar, Alshryda, Osaid, Alser, Brittany, Bankhead-Kendall, Kerry, Breen, Hassan, Mashbari, Fernando Bonilla Cal, Hamza, Al-Naggar, Mayaba, Maimbo, Dennis, Mazingi, Tom, Abbott, Melika, Akhbari, Ruth, Benson, Shivam, Bhanderi, Bruce, Biccard, Edward, Caruana, Sohini, Chakrabortee, Reema, Chapatwala, Ainhoa, Costas-Chavarri, Andreas, K Demetriades, Anant, Desai, Salomone Di Saverio, Thomas, Drake, John, Edwards, Jonathan, Evans, Marco, Fiore, Samuel, Ford, Christina, Fotopoulou, Alexander, Fowler, Kaori, Futaba, Ian, Ganly, Harelimana Grace James, Ewen, Griffiths, Alessandro, Gronchi, Peter, Hutchinson, Gabriella Yael Hyman, Joseph, Incorvia, Ritu, Jain, Michael, Jenkinson, Tabassum, Khan, Stephen Richard Knight, Angelos, Kolias, Søren, Kudsk-Iversen, Tsun Yu Kwan, Elaine, Leung, Julio, Mayol, Siobhan, Mckay, John, G Meara, Emily, Mills, Susan, Moug, Akshay, Patel, Roberto, Perinotti, Henry, E Rice, Keith, Roberts, Andrew, Schache, Richard, Shaw, Neil, Smart, Matthew, Stephens, Grant, D Stewart, Ella, Teasdale, Peter, Vaughan-Shaw, Raghavan, Vidya, Naomi, Wright, Natalie, Zimmelman, Ervis, Agastra, Dariel, Thereska, Sergio Martin Lucchini, Veronica, Laudani, Carina, Chwat, Ivana Ines Pedraza Salazar, Diana Alejandra Pantoja Pachajoa, Agustin, Duro, José Alfredo Calderón Arancibia, Giuliana, D'Aulerio, Nagendra, Dudi-Venkata, Natasha, Egoroff, Shebani, Farik, Natalie, Lott, Jana-Lee, Moss, Sarah, Rennie, Lorwai, Tan, Uyen Giao Vo, David, Watson, David, Watters, Tim, Bright, Paul, Hollington, Xuanyu, Zhou, Hidde, M Kroon, Anthony, Farfus, John, Barker, Eleanor, Watson, Sean, Stevens, Haider, Latif, Amanda Caroline Dawson, Alwin, Chuan, Vijayaragavan, Muralidharan, Enoch, Wong, Travis, Ackermann, Maurizio, Pacilli, Russell, Hodgson, Alexander, Heriot, Peter, Choong, Wendy, Brown, Surjit, Lidder, Justin, Yeung, Luke, Traeger, Guillermo, Regalo, Ralph, Gourlay, Sarit, Badiani, Cherry, Koh, Soni, Putnis, Fayza, Haider, Ashrarur Rahman Mitul, Niels, Komen, Bert, Dhondt, Serge, Cappeliez, Manon, Pigeolet, Martijn, Schoneveld, Jasper, Stijns, Wouter, Oosterlinck, Nicolas, Flamey, Cyrille, Kpangon, Mouhamed, Agbadebo, Sèmèvo Romaric Tobome, Aldo Vieira Barros, Samuel Aguiar Júnior, Heloisa Galvão do Amaral Campos, Jefferson, Gross, Felipe José Fernandez Coimbra, Luiz Paulo Kowalski, Fabiana, Makdissi, Suely, Nakagawa, Joao Pedreira Duprat Neto, Jose Guilherme Vartanian, Guilherme, Yazbek, Stenio, C Zequi, Ronald, Flumignan, Natalia, Jaworska, Angela, Dell, Harsha, Shanthanna, Abdollah, Behzadi, Carolyn, Nessim, Michelle, Mozel, Pascal, St-Germain, Crispin, Russell, Gary, Groot, Najib, Safieddine, Duminda, Wijeysundera, Antoine, Eskander, Sami, Chadi, Shawn, Mackenzie, Alana, Flexman, Fernando, Heredia, Julio, Villanueva, Sofia, Waissbluth, Roberto, Macchiavello, Mario, I Escudero, Tyare, Fuentes, Ximena, Mimica, Dinimo Bolivar Saenz, Lina, Caicedo, Juan Pablo Alzate, Joaquin, Luna, Nestor Fabian Pedraza Alonso, Camilo Ortiz Silva, Juliana, Rodriguez, Liliana, Silva-Igua, Martha Luz Torres, Lina María Trujillo, Albaro José Nieto Calvache, Julián, Balanta-Melo, Rafael, Figueroa-Casanova, Oscar-Julián, García-Montoya, Carlos Andres Marulanda Toro, Marcela Velez Botero, Maria Clara Mendoza Arango, Eneida Diaz Martinez, Valentina Gutiérrez Perdomo, Emileth, Montenegro, Julia, Rodriguez-Abreu, Dolores, Mejía, Galal, Abouelnagah, Sameh, Shehata, Ahmed Hossam Eldin Fouad Rida, Ramy, A Hassan, Mahmoud, M Saad, Mohamed Reda Loaloa, Badr, Mostafa, Mohamed, Qassem, Mohamed, Fahmy, Hesham, Abozied, Ahmed, Y Azzam, Sherief, Ghozy, Asser, Sallam, Ahmed, Shehta, Mohamed, Abdelkhalek, Rehab, Samaka, Amr, Morsy, Ahmed Elshawadfy Sherif, Abraham, Negussie, Tigist, Fisseha, Kibruyisfaw, Shumbash, Metasebia, Abebe, Seid Mohammed Yasin, Yemisirach Bizuneh Akililu, Abebe, Megersa, Teshome, Tefera, Melatework, Assefa, Bahru, Atnafu, Bereket, Tsegaye, Yoseph Solomon Bezabih, Silamlak, Sisay, Kebebe, Bekele, Moa, Jira, Habtamu, Derilo, Eyueal, Degefa, Anteneh, Tadesse, Melkamu, Nidaw, Elise, Sarjanoja, Sylvie, Testelin, Sophie, Boucher, Lionel, Jouffret, Zaher, Lakkis, Alban Zarzavadjian Le Bian, Luke, Harper, Marc Danguy des Déserts, Benoît, André, Karem, Slim, Romain, Verhaeghe, Andrea, Police, Edouard, Girard, Alexandre, Chebaro, Armande Subayi Nkembi, Laurent, Arnalsteen, Quentin, Ballouhey, Diane, Mege, Clement, Jeandel, Emilie, Duchalais, Pierre-Alban, Bouche, Gilles, Manceau, Célia, Crétolle, Erik, Hervieux, Noémie, Girard, Agathe, Seguin-Givelet, Sebastien, Gaujoux, Belinda De Simone, Matthieu, Boisson, Damien, Bergeat, Fabien, Fredon, Francesco, Nappi, Radwan, Kassir, Aurélien, Scalabre, Federico, Migliorelli, Anne-Cecile, Ezanno, Barbara, Seeliger, Charlotte, Vaysse, Helene, Charbonneau, Vincent, Misrai, Olivier, Abbo, Martina Aida Angeles, Laurent, Brunaud, Ali, Modabber, Sebastian, Wolf, Carsten, Kamphues, Philipp, Höhn, Tim, R Glowka, Alexander Christopher Rokohl, Ulrich, Bork, Georg, Fluegen, Raymund, E Horch, Andrea, Schmedding, Andreas, Schnitzbauer, Helge, Eberbach, Daniel, Schlager, Fritz, Spelsberg, Lena, Keppler, Andreas, Hecker, Susanne, Wolfer, Ulrich, Ronellenfitsch, Christine, Nitschke, Christian, Peiper, Ibrahim, Hakami, Stefan, Welter, Karine, Nikolaieva, Andreas, Roth, Judith, Lindert, Konstantinos, Gousias, Anke, Rissmann, Valerie Catherine Linz, Nuh, Rahbari, Marie-Claire, Rassweiler-Seyfried, Anna Eleonora Gut, Jens, Gempt, Daniel, Reim, Arthur, Wagner, Alexander, M Keppler, Mircea Gabriel Stoleriu, Tim, Saier, Josef, Stadler, Julia Christina Kaiser, Stefan, M Brunner, Karin, Pfister, Jonas, Herzberg, Kai, Nowak, Tobias, Reinhard, Gregor, A Stavrou, Alfred, Königsrainer, Christian, Konrads, Markus, Quante, Simon, Laban, Silke von Pusch, Markus, Hirschburger, Johannes, Doerner, Armin, Wiegering, Ekaterini Christina Tampaki, Alitza Gutiérrez Ruiz, Alejandra, Rodas, Ana Lucía Portilla, Jacqueline, Carrera, Amalia Barrios Duarte, Megan, Lowey, Sabrina, Barillas, Atul, Suroy, Dhaivat, Vaishnav, Raghunandan Gorantlu Chowdappa, Irappa, Madabhavi, Dhananjaya, Bhat, Sunil Kumar Venkatappa, Sumit, Thakar, Kavitha, Jain, Aruna, Kumar, Manoj, Nagar, Tushar, Mishra, Arunkumar, Sekar, Anand, Gupta, Lileswar, Kaman, Madhivanan, Karthigeyan, Manjul, Tripathi, Ashwin, Rammohan, Sudheer Othiyil Vayoth, Anupama, Rajanbabu, Anbukkani, Subbian, Rahul, Gupta, Monish, Raut, Nissi, Evelyn, R Lavanya Kannaiyan, Anil, Matai, Sanjeev, Misra, Vishal, Bhende, Sathish, Muthu, Indranil, Ghosh, Abhishek, Sharma, Ankur, Bajaj, Shiv, Rajan, Gaurav, Agarwal, Pranay, Pawar, Philip, Alexander, M Vijayakumar Vijayakumar, Zeeshan, Hameed, Badareesh, L, Navneet Kumar Chaudhry, Lipika, Baliarsing, Satish, Dharap, Amruta, Kulkarni, Yuvaraja, Thyavihally, Rahul Deo Sharma, S Pramesh, C, Rajesh, Soni, Surya Kumar Dube, Shilpa, Sharma, Harvinder, Singh, Lovenish, Bains, Rahul, Ghodke, Ashwani, Kumar, Vivek, Sodhai, Suvendu, Maji, Somprakas, Basu, Chandrashekhar, Mahakalkar, Ravi, Kannan, Asif, Mehraj, Ranganath, N, Ashish, Phadnis, Yadev, I, Alfie, Kavalakat, Rohin, Mittal, Karthik Chandra Vallam, Hamed, Akhavizadegan, Esmaeil Rezghi Maleki, Naser Yousefzadeh Kandevani, Hilary, Ikele, Catherine, Mcnestry, Christina, Fleming, Stephen, O'Brien, Sami Abd Elwahab, Niall, Davis, Mohsen, Javadpour, Brendan, Mcdonnell, Clare, O Connor, Jarlath, Bolger, Cillian, Clancy, Stefanie, M Croghan, Noel, Donlon, Carolyn, Cullinane, Ben, Creavin, Muheilan, Muheilan, Helen, Earley, Syed Mohammad Umar Kabir, Muhammad, Fahadullah, Éanna, Ryan, Tara, Connelly, Daisuke, Hashimoto, Majdi Ali Alqudah, Amer, Alajalen, Rand, Y Omari, Abdulrahman, Qasem, Yazan, Alawneh, Amer, Ahmad, Omar, Aladawi, Bourhan, Alrayes, Hanan, Haidar, Shatha, Husain, Faisal, Qassem, Adnan, Sumadi, Ala'a Abu Salhiyeh, Balqees Mahmoud Al-Manaseer, Zaid, Alsunna, Hazim, Ra'Ed, Faten Reyad Bani Hamad, Amro, Abuleil, Elmi Ahmed Mohamed Jimaale, Marah, Abu-Mehsen, Noor, Olaywah, Omar, Wafi, Hazim, Ababneh, Luai, Abu-Ismail, Almu'Atasim, Khamees, Ahmad, Alkhatib, Raikhan, Bolatbekova, Mukhtar, Kulimbet, Talgat, Nurgozhin, Timur, Saliev, Baurzhan, Zhussupov, Ydyrys, Almabayev, Dilyara, Kaidarova, Khalil, Tamoos, Ahmed, Aqeelah, Alsnosy Abdullah Khalefa Mohammed, Faraj Al Maadany, Ghadah, Alkadeeki, Milad, Gahwagi, Wafa, Aldressi, Mohamed, Amnaina, Arowa Hassan Abdulrahman Alansari, Akram, Alkaseek, Ghozlan, Yagoub, Anass Ben Amer, Marwa, Salem, Ayman, Almugaddami, Dania, Burgan, Mohammed, Abdelkabir, Khayriyah, Alshareef, Rayet Al Islam Ben Jouira, Ayman, Meelad, Ahmad, Bouhuwaish, Sumayya Essayah Dwaga, Houda, Khalifa, Bushray, Almiqlash, Taha, Suliaman, Mohammed, Alawami, Fras, Elhajdawe, Hajir, Aboazamazem, Ibrahim, Ellojli, Ahmed, Msherghi, Ismail Ali Saleh, Mohammed, Alayan, Marcel Didier Ndayishyigikiye, Akutu, Munyika, Philipp, Plarre, David, W Borowski, Cameron, Wells, Rebecca, Teague, Brodie, Elliott, David, Kieser, Omar, Mohyieldin, Nick, Mcintosh, Cheyaanthan, Haran, Jasmin, King, Jeong, Ha, Matthew James McGuinness, Opeoluwa, Adesanya, Julius, Olaogun, Akinola, Akinmade, Kefas, Bwala, Peter, Agbonrofo, Akinwale, Afolabi, Usang, Usang, Sebastian, Ekenze, Samson, Olori, Taiwo Akeem Lawal, Abiodun, Okunlola, Stephen, Kache, Danjuma, Sale, Lofty-John, Anyanwu, Chukwuma, Okereke, Musliu Adetola Tolani, Venko, Filipce, Lazar, Todorovic, Sotir, Stavridis, John George Massoud, Sareyah, Alsibai, Rizwan, Sultan, Humera Naz Altaf, Abu Bakar Hafeez Bhatti, Shahzad Hussain Waqar, Aliya, Aziz, Asad Ali Kerawala, Lajpat, Rai, Mariyah, Anwer, Aiman, Tariq, Bushra, Ayub, Sami Ullah Niazi, Muhammad Yasir Naseem, Muhammad Zeeshan Sarwar, Muhammad Imran Khokhar, Imdad Ahmad Zahid, Haroon Javaid Majid, Nabila, Talat, Muhammad, Asif, Muhammad Hamid Chaudhary, Umer, Farooq, Siddique, Ahmad, Waleed, Mabood, Syed Imran Bukhari, Muhammad, Tariq, Eesha, Yaqoob, Saad, Javed, Muhammad Usman Malik, Hassan Nawaz Yaqoob, Glenda Marina Falcon Pacheco, Robinson Mas Melendez, Arazzelly Del Pilar Paucar Urbina, Jose Rios 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Michael, Grechenig, Ricarda, Gruber, Jörg, Hutter, Tarkan, Jäger, Oliver, Koch, Michael, Lechner, Lisa, Manzenreiter, Franz, Mayer, Iris, Muehlbacher, Jaroslav, Presl, Daniel, Rezaie, Philipp, Schredl, Martin, Varga, Michael, Weitzendorfer, Angela, Wimmer, Eberhard, Brunner, Michael de Cillia, Michaela, Gruber, Martin, Grünbart, Elmar, Heinrich, Hannes, Hoi, Vanessa, Kemmetinger, Christof, Mittermair, Victoria, Mosshammer, Christian, Obrist, Peter, Paal, Judith, Roesch, Elisabeth, Russe, Tobias, Schaetz, Jan, Schirnhofer, Karl, Schwaiger, Gottfried, Wechselberger, Helmut, Weiss, Maximilian, Lanner, Alf-Dorian, Binder, Thomas, Gürtler, Marcus, Fink, Daniel, Reichhold, Radoslava, Stoyanova, Klara, Beitl, Martin, H Bernardi, Philip, Datler, Christopher, Dawoud, Alex, Farr, Philipp, Foessleitner, Christoph, Grimm, Felix, Harpain, Mir Alireza Hoda, Simone, Holawe, Marlene, Kranawetter, Johannes, Ott, Alexandra, Perricos, Maximilian, Pesta, Robert, Pillerstorff, Christian, Reiterer, Stefan, 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Mohammed Shadrul Alam, Akm Khairul Basher, Shahnoor, Islam, M Nazmul Islam, S, Sabbir, Karim, Muntasir, Faisel, Sadia, Khan, Iftekhar Ibne Mannan, Nawshin, Nazia, Malissa, Bentham, Sasha, Corbin, Alex, Doyle, Asha, Eastmond, Amelia, Haynes, Margaret, O'Shea, Emil, Phillips, Keisha, Walkes, Evgeniy, L Artyushkov, Mark, L Kaplan, Vladislav, Straltsov, Yauheniya, Litvina, Alexei, Lyzikov, Victor, E Tihmanovich, Mafalda, Borges, Tim, Brits, Nicolas De Hous, Stefan De Wachter, Tomas, Menovsky, Xavier, Mortiers, Dorien, Vermeulen, Nils, Vleminckx, Dirk, Ysebaert, Julie, Bontinck, Danny, Bulthé, Ricky, Rasschaert, Anne-Sophie Van Haver, Koen Van Belle, Laurence, Verstraeten, Manon, Vounckx, Sébastien, D'Ulisse, Yasmine De Bruyne, Badih El Nakadi, Tessely, Heloise, Matteo, Luisetto, Sotirios, Marinakis, Maxime, Maton, Claire, Viste, Elke Van Daele, Mathieu, Vandeputte, Marc, Duinslaeger, Daniel, Jacobs-Tulleneers-Thevissen, Yanina, Jansen, Ward, Janssens, Rastislav, Kunda, Nouredin, Messaoudi, Michael, Ruyssers, Ellen Van Eetvelde, Marian, Vanhoeij, Jef Van den Eynde, Raf Van den Eynde, Ahmed, M Chaoui, Marcellin, Akpla, Souliath, Lawani, Hermann, Agossou, Hulrich Aouagbe Behanzin, Covalic, Bokossa, Hubert, Dewanon, Hugues, Yome, Alassan, Boukari, Oswald, Gbehade, Labissi Francois Amossou, Francis, Dossou, Tatjana, Barišić, Miran, Boras, Zdrinko, Brekalo, Ivana Čuljak Blagojević, Ana, Damjanović, Vedran, Dragisic, Ana Dugandžić Šimić, Filip, Gunaric, Martin, Kajic, Darko, Knežević, Tanja, Krešić, Valentina, Lasić, Ludvig, Letica, Vlatka, Martinovic, Iva, Mikulic, Josip, Miskovic, Hrvoje, Pehar, Pejana, Rastović, Irena, Sesar, Violeta, Šetka-Čuljak, Martina, Soljic, Dejan, Tiric, Vajdana, Tomić, Anja, Vasilj, Igor, Hudic, Renato Aguera Oliver, Felipe Azenha Lamonica, Jorge De Medeiros, Henrique Donizetti Bianchi Florindo, Rodolfo Jose Favaretto Filho, Fernanda Costa Pereira, Rodrigo, Rodrigues, Antonio Antunes Rodrigues Junior, Fernanda Ruiz de Andrade, Maisa, Salvetti, Débora Schalge Campioto, Mayra Tuboi Lamonica, Gustavo, Urbano, Ricardo Villela Prado, Nivaldo, Alonso, Carlos Ferreira Dos Santos, Cristiano, Tonello, Robinson Esteves Pires, Ricardo Fernandes Rezende, Igor, Reis, Fernando Augusto Lima Marson, Erick Pires Ferreira, Camila Vantini Capasso Palamim, Marcelo, Brandao, Tiago Henrique de Souza, Rebecca, Maunsell, Alfeu Accorsi Neto, Guilherme, Accorsi, Murilo Francisco Fernandes, Camila, Machareth, Barbara Viegas Moura, Vanessa, Dias, Luciano, Guarienti, Lia Regina de Sampaio, Cristiano, Vendrame, Tatiane Amorim Coelho, Karin, Becker, Andre, Dias, Camila Girardi Fachin, Monica Maria Gomes-da-Silva, Isabela, Moraes, Amanda, Pinto, Adriano Seikiti Stychnicki, Nathalia Siqueira Julio, José Mauro Dos Santos, Humberto Fenner Lyra Junior, João Carlos Costa de Oliveira, Tiago Rafael Onzi, Marlus Tavares Gerber, Filipe Osni Coelho, Janaína Carla da Silva, Carolina, Panis, Daniel, Rech, Melissa, Avelino, Lais, Botacin, Mateus Capuzzo Gonçalves, Amanda Lira Dos Santos Leite, Laercio, Pol-Fachin, Tainá Santos Bezerra, Alcimar Lavareda Dos Santos Junior Alcimar, Robson, Amorim, Maria Eduarda Bellotti Leão, João José Corrêa Bergamasco, Cintia Cardoso Pinheiro, Rubem Alves Da Silva Neto, Elaine Francisca De Araújo, Lilian, Guimaraes, Tatiana, Liborio-Kimura, Isabelle Melo da Camara, Victor Ripardo Siqueira, Juan, Rodriguez, Jeancarllo, Silva, Rubem Alves Silva Junior, Cláudio, Cardoso, Andre, Guimaraes, Wislene Sarajane Moreira Alves, Agna Soares Da Silva Menezes, Marcelo, Araujo, Kattiucy, Brito, Josie Marcelle Lira Albuquerque, Jairo Alberto Dussan-Sarria, Andressa, Souza, Andre Ricardo Stüker, Tiago, Bresciani, Luciana Cadore Stefani, Leandro Totti Cavazzola, Tainá, Costa, Matheus, Dasqueve, Gustavo De Bacco Marangon, Otávio Ritter Silveira Martins, Josy, Rodrigues, Guilherme Roloff Cardoso, Brasil Silva Neto, Tilaê, Soares, Aline, Zanella, Lucas Torelly Filippi, Enilde Eloena Guerra, Ricardo Pedrini Cruz, Antonio Nocchi Kalil, Gustavo, Laporte, Moacyr, Salem, Murilo de Lima Brazan, Caio Antonio de Campos Prado, Elaine Christine Dantas Moises, Hilda Satie Suto, Alice Gadotti Yasuda, Ana Carolina Tagliatti Zani, Roberto Cardoso Cardoso Dos Santos, Geraldo, Duarte, Edwaldo Edner Joviliano, Carolina Lourenço Gomes Dos Santos, Silvana Maria Quintana, Edwin, Tamashiro, Fabiana Cardoso Pereira Valera, Marília Veccechi Bijos Zaccaro, Isis, Andreotti, Leonardo, Lima, Wilson Salgado Jr, Alonço da Cunha Viana Júnior, Lana, Moutinho, Cora Pichler de Oliveira, Isabela Trindade Martins, Isabela Vieira Toledo, Marco Antonio Correa Guimaraes-Filho, Rodrigo, Arrivabeno, Claudio Bovolenta Murta, Danniel Frade Said, Jose Pontes Junior, Felipe Guimarães Pugliesi, Paulo, Gregorio, Alessandro, Mariani, Fabio, Minamoto, Juliana Lourenço da Silva, Bruno, Muller, Caio, Zanon, Vladimir, C Carvalho, Ana Lucia Munhoz Lima, Priscila, R Oliveira, Jorge Dos Santos Silva, Mariana Faccini Teixeira, Marco, Kulcsar, Leandro, Matos, Kamilla Schmitz Nunes, Joel Abdala Junior, Emne, Abdallah, Genival Barbosa Carvalho, Igor Correia de Farias, Cassia da Silva, Fabio Fernando Eloi Pinto, Luciana, Facure, André, Godoy, Bruna, Kupper, Fernanda, Leite, Matheus de Melo Lôbo, Henrique, Mantoan, Narimã, Marques, Tomas, Marques, João Paulo Medici, Silvio Melo Torres, Katheryne Merlos Garcia, Rafael Ribeiro Meduna, Ana Carolina Scintini Herbst, Silvana Soares Dos Santos, Bruna Tirapelli Gonçalves, Marcelo, Antonini, Carolina, Brienze, José Francisco Farah, Rodrigo, Gonçalves, Vinicius, Machado, Luis Roberto Nadal, Danilo Nadal Rodrigues, Adrieli, Pansani, Maria Luiza Rocha, Marcelo, Simonsen, Daniela, Tsuchiya, Rafaela, Vasques, Jorge, Amorim, Ana Alyra Carvalho, Rebeca, Correia, Brena Costa Dos Santos, Henrique Jorge Guedes Neto, Luis, Nakano, Mariana, Pereda, Vladimir, Vasconcelos, Jamile Barakat Awada, Guilherme, Gava, Tiago Riuji Ijichi, Nam Jin Kim, Rafael, Nunes, Fabio, Pinto, Thiago Henrique Sigoli Pereira, Gustavo Jardim Volpe, Arthur, Gatti, Caroline, Nardi, Ramon, Oliva, Layze Braz de Oliveira, Herica Emilia Félix de Carvalho, Ivonizete Pires Ribeiro, Gabriel Renan Soares Rodrigues, Álvaro Francisco Lopes de Sousa, Michel, Chebel, Paulo Henrique de Sousa Fernandes, Marcelo Augusto Faria Freitas, Juliano Rodrigues da Cunha, Zeenia, Ather, Dobromir, Dimitrov, Emil, Filipov, Elitsa, Gyokova, Ivelina, Ilieva, Tsvetomir, Ivanov, Martin, Karamanliev, Vasil, Neykov, Boyko, Atanasov, Nikolay, Belev, Paolina, Kamenova, Kaloyan, Tonev, Tsanko, Yotsov, Evguenia, Hristova, Kolyo, Spassov, Tsanko, Tsankov, Dragomir, Dardanov, Petar, Gribnev, Manol, Sokolov, James, Brown, John, Tanyi, Heather, Hurdle, Anthony, Maclean, Michael, Sander, Salim Al Riyami, Krittika, Bali, David, Bigam, Khaled, Dajani, Mehran, Anvari, Rafik, Bolis, David, Choi, Susan, Ellis, Michael, Gupta, Wael, Hanna, Dennis, Hong, Cynthia, Horner, Lea, Luketic, Peter, Moisiuk, Yaron, Shargall, Hilda, Alfaro, Nawar, Alkhamesi, Laura, Allen, Muriel, Brackstone, Eunice, Chan, Davy, Cheng, Jason, Chui, Nelson, Gonzalez, Brent, Lanting, S Danielle MacNeil, Robert, Mayer, Jacob, Mcgee, Mahesh, Nagappa, Nicholas, Power, Agya, Prempeh, Mehdi, Qiabi, Hassan, Razvi, Emil, Schemitsch, Herman, Sehmbi, Ushma, Shah, Yamini, Subramani, Edward, Vasarhelyi, Kelly, Vogt, Homer, Yang, Ali Ghorbani Abdehgah, Saba, Balvardi, Liane, Feldman, Julio Flavio Fiore Jr, Melissa, Hanson, Brent, Hopkins, Pepa, Kaneva, Lawrence, Lee, Julia, Leonard, Jad, Abou-Khalil, Andre, Martel, James, Stevenson, Susan, Lee, Richard, Merchant, Samuel, Avoine, Laurence, Belanger, Mathieu, Belanger, Etienne, Belzile, Anne-Sophie, Blais, Sofia, Boucher-Kovalik, Cindy, Boulanger-Gobeil, Etienne, Cardinal, Pierre-Olivier, Champagne, Jonathan, Cloutier, Simon, Corriveau-Durand, Mathieu, Cote, Maxime, Cote, Mathilde, Côté, Valérie, Courval, Suzanne, Demers, Christine, Desbiens, Mehdi El Ouazzani, Karine, Girard, Ève-Marie, Girard, Karo, Gosselin, Helene, Khuong, Nathalie, Labrecque, Eve-Lyne, Langlais, Audrey, Larouche, Andréane, Lavallée, Madeleine, Lemyre, Sarah, Maheux-Lacroix, Melissa, Marien, Patrick, Marin, Julie, Mauger, Genevieve, Milot, Sylvie, Nadeau, Sebastien, Nguyen, Mélinda, Paris, Stéphane, Pelet, Marie, Plante, Carole, Plante, Frederic, Pouliot, Marie Claude Renaud, Mathilde, Sarlabous, Isabelle, Schmit, Raphaël, St-Germain, Brian, Johnston, Nicole, Labine, Amit, Persad, Hong, Pham, Melissa, Wood, Riordan, Azam, Amit, Atrey, Andrew, Beckett, Daniel, Cohen, Sunit, Das, Julian, Daza, Cheryl, Dunkerton, Yosef, Ellenbogen, Ciara, Hanley, Sorcha, Kellett, Amir, Khoshbin, Karim, Ladha, Amanda, Mcfarlan, Spencer, Montgomery, Janneth, Pazmino-Canizares, Hrishikesh, Suresh, Ravleen, Vasdev, Maira, Ahmed, Fred, Gentili, Aristotelis, Kalyvas, Matthias, Millesi, Can, Sarica, Taariq, Shaikh, Leslie, St, Jacques, Raha, Tabasinejad, Gelareh, Zadeh, Marvin, Hsiao, Nicole, Jedrzejko, Peter, Black, Claire, Broe, Charlotte, Dandurand, Rebecca, Grey, Philemon, Leung, Andrew, Lindberg, Juan Mata Gutierrez, Kelly, Mayson, Adam, Meneghetti, Drew, Phillips, John, Street, Carolina Carvajal Calderón, Daniel Alejandro Donoso Pizarro, Esteban, Fernández, Ángela, Molero, Nastassja, Mutarello, Jorge Núñez Lucic, Katherine Ochoa Gaete, Catalina Ruiz Lopez, Rina, Sepúlveda, Camila, Ulloa, Mauricio, Barreda, Matias, Dallaserra, Matías Günther Wood, Mauricio Sandoval Tobar, Francisco, Garcia-Huidobro, Jimena, Dona, Carolina Soto Diez, Daniel, Igor, Javier, Mena, José Tomás Reyes, Catalina Arredondo Soto, Jose, Campos, Javier, Gonzalez, Barbara, Rivera, Jaime, Altamirano-Villarroel, David, Cohn, Luis Marin de Amesti, Pedro, Recabal, Camilo, Sandoval, Bruno Catoia Fonseca, Monica, Contador, Andres, Hodali, Camila, Pincheira, Andrea Ramos Mantilla, Claudio Salas Garrido, Janina, Torres, Marco, Valenzuela, Zehua, Chen, Jiankun, Hu, Jin, Tao, Kun, Yang, Yuexin, Zhang, Yuan, Chen, Wang, Cunchuan, Wah, Yang, Xueli, Bai, Tingbo, Liang, Tao, Ma, Ning, Pu, Hanlin, Yin, Camilo, Caicedo, Diego Felipe Tellez Beltran, Alejandro, Escobar, Carolina Perez Granados, Lisbeth Alexandra Urueña Pinzon, Carlos, Bonilla, Diana, Santana, Oscar, Serrano, Andrea, Garcia, Fernando Giron Luque, Nasly, G Patino-Jaramillo, Laura Giselle Contreras Baquero, Nestor Augusto Muñoz Botero, Jhoana Andrea Murillo Castellanos, Andrea Juliana Vega Calvera, Lina, M Acosta Buitrago, Maria Paz Bohórquez-Tarazona, Paulo Andrés Cabrera Rivera, J Felipe Casas, Valeria Cormane Alfaro, Julian, Corso, Bayron, Guerra, Albert Franz Guerrero-Becerra, Akram Kadamani Abiyomaa, Felix Ramon Montes, Manuel Santiago Mosquera Paz, Camilo Andrés Polanía Sandoval, Natalia, Quintana, Carlos Fernando Roman Ortega, Carlos, Santacruz, Manuela, Téllez, Camilo Alejandro Velandia Sánchez, Fernando, Arias-Amézquita, Luis Felipe Cabrera Vargas, Natalia Cortes Murgueitio, Elkin, Escorcia, Kemel Ahmed Ghotme Ghotme, Jorge Luis Gomez-Mayorga, Alvaro Felipe Guerrero Vergel, Gabriel, Herrera-Almario, Eduardo, Londono-Schimmer, Juan, A Mejia, Guillermo, Monsalve, Camilo, Rodriguez, Juan Nicolas Rodriguez Niño, Luis Martín Rodríguez Ortegón, Daniel, Sanabria, Andres, Alvarez, Arnulfo, Andrade, Javier, Ardila-Montealegre, David, Baquero, Edgar Mauricio Barrios Vidales, María Alejandra Caicedo Giraldo, María Camila Carvajal, Maria, Castillo, Maria Carolina Castillo Florez, María Angelica Cendales, Danny Conde Monroy, Henry, Cortes, Mario, Daniel, Jairo De la Peña, Elena Leonor Delgado-Nieto, Hernando, Espitia, Carlos Figueroa Avendaño, Edgar Oswaldo Hernandez Burgos, Andres, Isaza-Restrepo, German, Londono, Margarita Maria Maldonado, Andrea, Montenegro, Juan Carlos Navarro, Jorge, Navarro-Alean, Katherine Parra Abaunza, Eliana, Pulido, Erika, M Ramírez Amaya, Carlos Eduardo Rey Chaves, Natalia Andrea Rivera Rincón, William Mauricio Riveros Castillo, Lizeth Rodriguez Sanchez, Wilson, Rubiano, Maria, Russi, Juan Carlos Sabogal Olarte, Javier Mauricio Salgado Tovar, Maria Juliana Sanchez, David Mauricio Solano Varela, Paula Torres Gomez, Marcial, Trillos, Ana María Vargas Patiño, Felipe, Vargas-Barato, Juan Pablo Villate Leon, María Alejandra Wagner Useche, Jesus, Acosta, Adriana, Almeciga, Luis Becerra Mendez, Rafael Jose Beltran, Ana, Bonilla, Miguel, Buitrago, Marino, Cabrera, Pedro Hernando Calderon Quiroz, Diego, Camacho-Nieto, Carlos Andrés Carvajal Fierro, Sergio Cervera Bonilla, Sandra, Diaz, Helena, Facundo, Jorge, Forero, Mauricio Garcia Mora, Karena Victoria Garcia Tirado, German Fabian Godoy Perez, Felipe, Gonzalez, Oscar, Guevara, Jairo Alonso Hernandez, David Ricardo Herrera Mora, Juan David Lalinde, Carlos, Lehmann, Eduardo Leon Llanos, Byron Eduardo Lopez De Mesa Lopez, Ivan, Mariño, Monica, Medina, Raúl Eduardo Pinilla Morales, Angela, Puerto, Andrea, Quintero-Ortíz, Juliana Rendón Hernández, Elio Fabio Sánchez Cortés, Alvaro Eduardo Sánchez Hernández, Raul, Suarez, Oscar, Suescun, Marco, Vanegas, Rodolfo, Varela, Jorge Luis Velez Bernal, David, Viveros-Carreño, Daniela Camargo Gómez, Angelica, Fletcher, Abel, Merchan, Euler Javier Burbano Luna, Indira, Cujiño, Mauricio Velasquez Galvis, Lina Maria Vergara Galliadi, Orlando Abonia Gonzalez Abonia Gonzalez, Maria Fernanda Acuna Saravia, Roberto, Arroyave, Jose Maria Barreto Angulo, Francisco Javier Bonilla-Escobar, Uriel, Cardona, Ivan Castañeda Giacometto, José Luis Castillo, Diego Fernando Castillo-Cobaleda, Diego Jose Caycedo Garcia, Brenda Marcela Coll Tello, Juan Carlos Dueñas-Ramirez, Oscar Andres Escobar Vidarte, Luis, Figueroa, Herney, Garcia-Perdomo, Alden, Gomez, Laura, Gomez, Alejandro, Gomez, Ana María Grande-Gil, David, Guarin, Natalia, Guzman, Enrique Herrera Castañeda, Marisol, Hinaoui, Anuar Armando Idrobo Escobar, Christian Kammerer Kammerer, Sergio, Leon, Carlos Antonio Llanos Lucero, Angie, López, Alexander Maximiliano Martinez-Blanco, Antonio José Montoya Casella, Ricardo Andres Niño Corredor, Sebastian, Ordoñez, Diego Alfredo Palta Uribe, 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Baelum, Mark Bremholm Ellebaek, Signe Bremholm Ellebaek, Anders, Hogh, Maria, Acosta, Yancy, Acosta, Pedro, Baez, Luis Alfredo Betances, Luis Rodolfo Bonilla, Daniel, Cabreja, Wilton Cabrera Cruz, María Mabel Collado Expósito, Aldo, Crespo, Octavio, Cruz-Pineda, Claudio Samuel D'óleo García, Pedro, Díaz, Remberto, Escoto, Jatnna, Figueroa, Luis, Garcia, U Garcia-Dubus Rodriguez, Humberto, Gomez, Adrian, Grullon, Fatherin, Guerrero, Lillian, Guzman, Thelma Rocío Jiménez Mosquea, Engels, Lazala, Ariela, Lopez, Leeany Maletta Francisco, Jhomayri, Mercado, Herisardy, Munoz, Jeffrey, Paulino, Maricely Ambar Perez Fernandez, Rudeily, Reyes, Lilia Rosa Reyes Guilamo, Ruben, Rivas, Claudia Alejandra Rivas Torres, Ada, Rodríguez, Madelin Tamar Rosario Villa, Eleazar, Santana, Joel, Soto, Nassin, Tactuk, Cristina Kristel Tonos Sardiñas, Raul, Ubinas, Jose, Victoria, Aaron, Villegas, Ricardo, Acra-Tolari, Larissa, Beltran, Luis Fernand Betances, Alejandro, Blaubach, Denisse Idalia Campos Mejía, Nathalia, Capellan, María Fernanda Cedeño Bruzual, Saray Cordero Spencer, Gabriella Cuevas Lantigua, Luis De Jesus, Gabriela, Díaz, Pedro Pablo Díaz Vásquez, Karla, Disla, Jesús Antonio Echavarría Uceta, Paola Irina Eusebio Jimenez, Damaris, Fernandez, Marlin Fernandez Camilo, Jiomar Manuel Figueroa Germosen, Maruel, Fortunato, Leyla Gabriel Fernández, Alicia German Dihmes, Héctor, Herrera, Elizabeth Leon Cuevas, Jose Alejandro Mata, Mirian Mateo De La Cruz, Dolores Mejia De la Cruz, Marcos, Mirambeaux, Fabio Ortiz De La Cruz, Henry, Paulino, Gabriela, Pelletier, Merycarla, Pichardo, Rodriguez Pumarol Próspero Enrique, Julio, Rivas, Ann Stephany Sanchez Marmolejos, Roman Santana Santana, Irina Suero Almanzar, María Magdalena Vásquez Sánchez, Nicolás, Campuzano, José Ricardo Negrete Ocampo, Maria, Armas, Alvaro Santiago LeMarie Guerra, Gustavo León Vizcaya, Omar Ahmed Abdelwahab, Ahmed, O Elmehrath, Mohammed Ezzat Mostafa, Gamal, Amira, Ibrahim, Sallam, Mohamed, Sherief, Ahmed, Abdelmajeed, Mostafa, Abdou, Ahmed Abo Shanab, Aya, Abodeeb, Roger, Aboelkhel, Nour Eldin Abosamak, Amna Abou Bakr, Samar, Aboubakr, Yossof, Abouelnagah, Omar, Aboumadawy, Dina, Adel, Nermeen, Afifi, Sara, Ahmed, Abedelrahman, Ahmed, Mohamed Al Sayed, Abdelrahman, Alberkamy, Mohamed, Aldahma, Ahmed, Ali, Mostafa, Ali, Mohamed Amin Bakr, Alaa, Anter, Doaa, Asal, Fouad, Ashoush, Olfat, Ashraf, Abdel Rahman Ashraf, Rewan, Atta, Salma, Badr, Mohamed, Bahaaeldin, Mostafa, Bastawesy, Sara, Darwish, Rasha El Kharashy, Ziad, Elassar, Seifeldin, Elbadawy, Dina, Elkhity, Alromisaa, Elsaka, Manal, Elsayed, Mostafa Elsayed Elsayed Hewalla, Mohamed, Elshafey, Youssof, Eshac, Fares, Eshac, Amr, Essameldin, Moataz, Ewedah, Yara, Ezz, Mohamed, Farag, Inas, Gadelkarim, Ziyad, Gadelrab, Dina, Gamal, Mira, Ghaly, Nathalie, Girgis, Omar, Gouda, Nancy, H El Goweini, Nour, Hafez, Youssef, Hafez, Abdelkader Hamed Abdin, Rodina, Hanno, Aliaa, Hassanin, Mohamed, Hassanin, Hanan, M Hemead, Abdelrahman, Hemida, Maher, Hosain, Ahmed, Hossam, Hamza Hussein Aly Salama Aly, Mohamed, Ibrahim, Abdelrahman, Ibrahim, Nourhan, Ibrahim, Noha Mohamed Salah Ibrahim Moussa Hamouda, Monica, Iskander, Islam, Khalifa, Mostafa, Kotb, Nada, Mahmoud, Alaa Mahmoud Abo Shabana, Nora, Mamdouh, Maram, Metwalli, Khaled, Metwally, Mahmoud, Moghazy, Moustafa, Mohamed, Mohamed, Mourad, Esraa, Moustafa, Kamilia, Mubarek, Nour Eldin Nader, Ahmed, Nasser, Samaa, Omar, Mostafa Shehata Qatora, Mohamed, Ragab, Marawan, Ragal, Dina, Ramadan, Rana, Ramadan, Sara, Ramadan, John, Romany, Ahmed, Sabry, Yasmeen, Said, Sara, Salamah, Ahmed Mostafa Saleh, Mona Saleh Mesbah Mohamed Elkaffas, Alaa, Salem, Hashem, Salim, Ahmed, Samih, Ahmed Samir Abdelaal, Ahmed, Shaheen, Yassmeen Sharafeldin Mohammed, Abdelrahman, Shehata, Mohamed, Shemeis, Karim, Shenit, Mennatallah, Sheta, Asmaa, Soffar, Yousef, Tanas, Ahmed, Tarek, Nermin, Yehia, Omar Khaled Mohamed Eid, Ammar Yasser Abdulfattah, Ahmed, Elsaghir, Mohamed Fouad Elganainy, Omar Ibrahim Elsayed, Omar, Elmandouh, Omar, Hamam, Mostafa Ahmed Shehata, Areej, A Abdelaziz, Ahmed, M Abbas, Wael Abd El-Ghani, Hossam Aldein, S Abd Elazeem, Mustafa Abd Elsayed, Ahmed Yassien Abd-Elkariem, Shimaa, Abdalla, Mahmoud, Abdel-Aleem, Khaled, Abdelazeem, Mahmoud, Abdelfattah, Mohammed, Abdelhafez, Mohamed, M Abdelkarem, Ali, Abdelraouf, Lamess, Abdullaha, Hossam, Abubeih, Moaiad Eldin Ahmed, Nagm Eldin Abu Elnga Ahmed, Ahmed, Ahmed, Sarah Ahmed Saad, Sherif, Alaa, Ali, Alhussaini, Abdelrahman Ahmed Abdelrahman Ali, Ibrahim, Ali, Wagdi, Ali, Mohamed Ali Mohamed, Mohamed, Ashraf, Muhammad, Bassiouni, Mohamed, G El-Adawy, Mohammad, El-Sharkawi, Hussein, Elkhayat, Khaled, Elmaghraby, Shady, Elsdfy, Mohamed, Elsharkawy, Almoutaz, Eltayeb, Mohamed Esmat Mohamed, Esraa, Essam, Mahmoud, Fahd, Osama, Farouk, Rabea, Gadelkareem, Ahmed, Ghoneim, Mohammed Hamada Takrouney, Ahmed, Hamdan, Abd El-Rahman Hamed, Ahmad, Hasan, Mohamed Abdelghafor Hassanin, Islam, Hawal, Kerollos, Henes, Mohamed Omar Herdan, Helal, F Hetta, Omar, Ibrahem, Mostafa, Ibrahim, Islam, H Ibrahim, Mahmoud, Kamel, Mohamed, Khallaf, Shrouk, M Elghazaly, Abobakr, Mahfouz, Osman, Mahmoud, Wesam, Mahran, Doha, Mahrous, Abadeer, Marsis, Ayman, Mohamed, Aliae Mohamed Hussein, Amr Mohamed Sayed, Mahmoud, M Mohammed, Ahmed, Mokhtar, Fatma, A Monib, Ahmed, Nageeb, Mariam Albatoul Nageh, Mohammed, Nageh, Nehal Gamal Omar, Abdelrahman, Ragab, Abdelrahman, Ramadan, Abdallah Rashad Temerik, Aya, Sabry, Hadeer, Safwat, Omar, Salah, Ahmed Elhussiny Salah Mahmoud, Ahmed, Saleh, Mahmoud, Sallam, Ahmed, Samir, Reem, Sayad, Esraa, Sayed, Ahmed, S Sedik, Mohammed, Shahine, Antonios, Soliman, Wael, Soliman, Mohamed Gamal Taher, Randa, Wanees, Ebrahim Ahmed Yousof, Ahmed, Youssef, Omar Zein Elabedeen, Ahmed Emad Sayed Hassan, Shrouk Abdel Fattah, Ahmed, Abostate, Samar, Ali, Saad Ali Saad Salama, Mohamed, Allam, Ahmed, Alsadek, Ebrahim, Arafa, Ahmed, Barakat, Mohammed El Sherpiny, Gehad, Elbehairy, Mahmoud, Eleisawy, 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Krause, Frank, Meyer, Salmai, Turial, Bilal, Al-Nawas, Marco Johannes Battista, Jan, Goedeke, Annette, Hasenburg, Julia, Heider, Lena Katharina Mueller, Simon, Zeller, Sina Louisa Patrizia Jentschura, Karl-Friedrich, Kowalewski, Maximilian, Kriegmair, David, Männle, Christoph, Reissfelder, Nicole, Rotter, Claudia, Scherl, Steffen, Seyfried, Andreas, Kirschniak, Jens, Rolinger, Peter, Wilhelm, Franz, G Bader, Stephanie, Ottl, Alexandra Viktoria Behr, Alexandros, Diamantis, Andreas, Fichter, Florian, Grill, Matthias, Heck, Daniel, Jira, Michael, Kallmayer, Florestan, Koll, Stefan, Luhne, Bernhard, Meyer, Robert, Patachia, Ilaria, Pergolini, Seyer, Safi, Christoph, Schäffer, Moritz, Schirren, Helmut, Wegmann, Markus, Wirth, Zhaojun, Zhu, Ughur, Aghamaliyev, Mahmoud, Almaghrabi, Wolfgang, Böcker, Jan, Bruder, Konstantin, Frank, Viktoria, Herterich, Verena, Huber, Matthias, Ilmer, Christian, Kammerlander, Carl, Neuerburg, Viktor, H von Ehrlich-Treuenstätt, Jens, Werner, Nikolaus, Börner, 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Enrico, Gelarda, Giorgio, Giraudo, Maria Carmela Giuffrida, Alessandra, Marano, Elena, Olearo, Vincenzo Pruiti Ciarello, Andrea, Puppo, Valentina, Testa, Marco, Giacometti, Sandro, Zonta, Eleonora, Monti, Andrea, Porta, Daniele, Sambucci, Arianna, Birindelli, Barbara, Carrara, Bruno, Compagnoni, Roberto Del Giudice, Sara Elisabetta Dester, Daniele, Lomiento, Silvia, Ruggiero, Lucio, Taglietti, Fabio, Viotti, Domenico, Lacavalla, Savino, Occhionorelli, Michele, Rubbini, Massimiliano, Bernabei, Nicolò, Fabbri, Marta, Fazzin, Carlo, V Feo, Marco, Torchiaro, Renato, Costi, Edoardo, Virgilio, Lorenzo, Arlia, Giuseppe, Barbato, Ilenia, Bartolini, Andrea, Bottari, Chiara, Bruno, Alessandro, Bruscino, Carlotta, Checcucci, Fabio, Cianchi, Francesco, Coratti, Rosita De Vincenti, Annamaria Di Bella, Massimiliano, Fambrini, Laura, Fortuna, Oreste, Gallo, Giacomo, Gigliucci, Luca Giovanni Locatello, Gherardo, Maltinti, Jacopo, Martellucci, Paolo, Prosperi, Maria Novella Ringressi, Flavia, Sorbi, 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Massimiliano, Gennaro, Lorenzo, Giannini, Marcello, Guaglio, Marco, Guzzo, Andrea, Leva, Alberto, Macchi, Elena, Manzo, Fabio, Martinelli, Ilaria, Mattavelli, Vincenzo Maria Mazzaferro, Francesco, Raspagliesi, Luigi, Rolli, Laura, Sala, Roberto, Salvioni, Mario, Santinami, Silvia, Segattini, Luca, Sorrentino, Carlotta, Zaborra, Alexandre, Anesi, Gianmaria Casoni Pattacini, Mattia Di Bartolomeo, Francesca, Pecchini, Arrigo, Pellacani, Micaela, Piccoli, Federico, Fusini, Andrea, Gattolin, Marco, Migliore, Roberto, Rimonda, Diego, Sasia, Elisabetta, Travaglio, Federica, Brunetti, Marco, Cereda, Marco, Ceresoli, Luca, Cigagna, Cristina, Dell'Oro, Alessandro, Fogliati, Robert, Fruscio, Tommaso, Grassi, Maini Marzia Isabella, Luca Carlo Nespoli, Massimo, Oldani, Sara, Ornaghi, Nicolò, Tamini, Carmine, Antropoli, Antonio, Castaldi, Alessio, Palumbo, Gaia, Altieri, Umberto, Bracale, Francesco, Corcione, Marcello De Luca, Giovanni Domenico De Palma, Maria Michela Di Nuzzo, Ruggero, Lionetti, 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Matteo, Filardo, Marika Sharmayne Milani, Franco, Ragni, Andrea de Manzoni Garberini, Edoardo, Baldini, Diana, Carpaneto, Michele, Cauteruccio, Corrado, Ciatti, Luigi, Conti, Serena, Gattoni, Pietro, Maniscalco, Gerardo, Palmieri, Calogero Puma Pagliarello, Giuseppe, Caristo, Raffaele, Galleano, Michele, Malerba, Marcello, Calabrò, Francesca, Farnesi, Elia Giuseppe Lunghi, Andrea, Muratore, Nicoletta Sveva Pipitone Federico, Joel Reuben Abel, Lorenzo, Andreani, Darienzo, Antonio, Vittorio, Aprile, Riccardo, Balestri, Giacomo, Benettini, Stefano, Berrettini, Luca, Bruschini, Massimo, Chiarugi, Federico, Coccolini, Simone, Colangeli, Camilla, Cremonini, Lodovica Cristofani Mencacci, Iacopo, Dallan, Silvia De Santi, Gregorio Di Franco, Lorena Di Girolami, Giacomo, Fiacchini, Niccolò, Furbetta, Stylianos, Korasidis, Marco, Lucchi, Andrea, Morandi, Luca, Morelli, Serena, Musetti, Carlo Maria Neri, Matteo, Palmeri, Miriana, Picariello, Francesco, Porcelli, Marco, Puccini, Nicolo, Roffi, 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Bianchi, Giuseppe, Bianco, Alberto, Biondi, Paola, Campennì, Valerio, Cozza, Sabatino, D'Archi, Domenico, D'Ugo, Veronica De Simone, Marta Di Grezia, Sofia Di Lorenzo, Federica, Ferracci, Valeria, Fico, Gianluca, Franceschini, Pietro, Fransvea, Giulio, Gasparini, Luca, Gordini, Antonio La Greca, Francesco, Litta, Celestino Pio Lombardi, Angelo Alessandro Marra, Angelo, Parello, Marco Maria Pascale, Romeo, Patini, Gilda, Pepe, Roberto, Persiani, Caterina, Puccioni, Carlo, Ratto, Fausto, Rosa, Gianmarco, Saponaro, Lorenzo, Scardina, Tedesco, Silvia, Giuseppe, Tropeano, Maria, Benevolo, Daniele, Bugada, Flaminia, Campo, Maria Gabriella Dona, Valentina, Manciocco, Paolo, Marchesi, Riccardo, Mastroianni, Francesco, Mazzola, Silvia, Moretto, Raul, Pellini, Gerardo, Petruzzi, Barbara, Pichi, Giuseppe, Simone, Gabriele, Tuderti, Jacopo, Zocchi, Luigi Marino Cosentino, Andrea, Sagnotta, Roberta, Angelico, Vittoria, Bellato, Michela, Campanelli, Marzia, Franceschilli, Michele, Grande, Giorgio, Lisi, Tommaso Maria Manzia, Lorenzo, Petagna, Bruno, Sensi, Giuseppe, Sica, Leandro, Siragusa, Giuseppe, Tisone, Marco, Assenza, Barbara, Binda, Massimo, Biondi, Gioia, Brachini, Placido, Bruzzaniti, Mauro, Casagrande, Flavia, Ciccarone, Pierfranco Maria Cicerchia, Bruno, Cirillo, Daniele, Crocetti, Giancarlo, D'Ambrosio, Vito, D'Andrea, Francesca De Felice, Giorgio De Toma, Carlo Della Rocca, Giulia, Duranti, Pietro, Familiari, Enrico, Fiori, Giovanni Battista Fonsi, Alessandro, Frati, Stefania La Rocca, Filippo La Torre, Pierfrancesco, Lapolla, Giovanni, Marruzzo, Simona, Meneghini, Andrea, Mingoli, Andrea, Picchetto, Antonella, Polimeni, Diego, Ribuffo, Maurizio, Salvati, Antonio, Santoro, Paolo, Sapienza, Luigi, Simonelli, Valentino, Valentini, Martina, Zambon, Giuseppa, Zancana, Emma, Zuppi, Simone, D'Annunzio, Cosimo De Nunzio, Silvia, Fiorelli, Mohsen, Ibrahim, Chiara, Loffredo, Domenico, Massullo, Cecilia, Menna, Rocco, Monica, Massimiliano, Pelli, Erino Angelo Rendina, Leonardo, Teodonio, Andrea, Tubaro, Giulio, Argenio, Giulio, Accarino, Accarino, Giancarlo, Antonio Nicola Giordano, Luca, Cardinali, Elisa, Sebastiani, Grazia, Travaglini, Erika, Andreatta, Emanuele Luigi Giuseppe Asti, Daniele, Bernardi, Luigi, Bonavina, Caterina, Froiio, Andrea, Lovece, Chiara, Copelli, Alfonso, Manfuso, Pasquale Di Maio, Marco, Giudice, Oreste, Iocca, Rosario, Cennamo, Tommaso, Cornali, Francesco Di Marzo, Cristian, Altana, Francesco, Bussu, Giampiero, Capobianco, Anna Giacomina Carta, Sandro, Ciccarello, Maria Laura Cossu, Pietrina, Cottu, Giacomo De Riu, Salvatore, Dessole, Francesco, Dessole, Salvatora, Dettori, Carlo, Doria, Alessandro, Fancellu, Claudio, F Feo, Giorgio Carlo Ginesu, Giuliana, Giuliani, Marco Giuseppe Iannuccelli, Massimo, Madonia, Roberto, Mancino, Olindo, Massarelli, Gianfranco, Meloni, Fabio, Milia, Andrea, Mulliri, Teresa, Perra, Marco, Petrillo, Antonio, Piras, Franco, Piredda, Francesco, Pisanu, Alberto, Porcu, Davide, Rizzo, Angelino, Sanna, Antonio Mario Scanu, Fabrizio, Scognamillo, Damiano, Soma, Anna Rita Tanca, Alessandro, Tedde, Matteo, Tedde, Luigi Angelo Vaira, Andrea Bartalini Cinughi de Pazzi, Osvaldo Carpineto Samorani, Daniele, Fusario, Luigi, Marano, Gaia, Oldrà, Anna Lisa Pesce, Stefania Angela Piccioni, Luca, Resca, Vincenzo, Ricchiuti, Franco, Roviello, Vinno, Savelli, Alberto, Abrate, Pierpaolo, Bordoni, Lorenzo, Bosio, Guglielmo, Clarizia, Francesco, Fleres, Marco, Franzini, Antonio, Fratto, Pierluigi, Giumelli, Alessandro, Grechi, Alessandro, Longhini, Fabrizio, Lorusso, Elisa, Scarnecchia, Federica, Scolari, Alessandro, Spolini, Vincenzo, Maiuri, Matteo, Papandrea, Arturo, Roncone, Lorenzo, Conti, Andrea, Rizzi, Marco, Rovagnati, Alberto, Brolese, Tommaso, Cai, Francesco Antonio Ciarleglio, Francesca, Dalprà, Gianni, Malossini, Liliana, Mereu, Irene, Tamanini, Saverio, Tateo, Giovanni, Viel, Enrico, Battistella, Paolo Boscolo Rizzo, Cristoforo, Fabbris, Marco, Massani, Giacomo, Spinato, Roberta, Tutino, Ugo, Grossi, Alessandro, Iacomino, Simone, Novello, Maurizio, Romano, Serena, Rossi, Giulio, Santoro, Giacomo, Zanus, Sokol, Trungu, Giada, Aizza, Gabriele, Bellio, Selene, Bogoni, Marina, Bortul, Biagio, Casagranda, Sara, Cortinovis, Nicolò de Manzini, Davide, Drigo, Paola, Germani, Manuela, Mastronardi, Lucia, Paiano, Silvia, Palmisano, Pier Luigi Filosso, Francesco, Guerrera, Matteo, Marro, Mauro, Rinaldi, Enrico, Ruffini, Stefano, Salizzoni, Laura, Bardelli, Mattia, Berselli, Giacomo, Borroni, Eugenio, Cocozza, Matteo, Desio, Bottazzoli, Elisa, Giuseppe, Ietto, Valentina, Iori, Domenico, Iovino, Lorenzo, Livraghi, Valentina, Marchionini, Stefano, Megna, Emma Amal Nahal, Mara, Palumbo, Valeria, Quintodei, Alessandra, Zullo, Lucrezia, D'Alimonte, Giovanni, Pirozzolo, Chiara, Vignotto, Tommaso, Campagnaro, Andrea, Caravati, Simone, Conci, Carlotta De Cristofaro, Gabriele, Gecchele, Tommaso, Giuliani, Jacopo, Graziosi, Alfredo, Guglielmi, Salvatore, Paiella, Corrado, 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Mubaydeen, Husam, Sarayrah, Mohammad Abdel Elah, A Tarawneh, Mohammad Yousef Karasneh, Amany, Zurgan, Mohammad, Alassaf, Sayel, H Alzraikat, Justin, Z Amarin, Ahmed, Hijjawi, Haya, H Suradi, Louay, Y Zaghlol, Ahmad, Abdalah, Ghaida, Abdallah, Ammar Abu Tarieh, Tareq, Abu-Libdeh, Faisal, Abualteen, Murad Al Abdallah, Zakaria Al Bdour, Seif Al Dahabrh, Farah, Al-Kasaji, Zaid Al-Sheikh Ali, Mohammad, Al-Thaher, Tareq, Alnajjar, Mohannad, Alqedrh, Mohammad, Alsaleh, Mohammad, Alzaatreh, Ghandi, Amayreh, Yazeed, Ayasra, Ahmad, Eid, Ibrahim, Ghayada, Khaled Moh'd Ahmed Hasanein, Anas, Hassouneh, Raid, Hijazeen, Majedah, Hmeidan, Ahmed, Khaled, Barihan, Khasawneh, Omar, Kifayeh, Yasser, Lafi, Jasem, Seba, Qusai, Semrin, Fda, Sma, Mohammad, Theab, Haitham, Tumeh, Muna Aba Zaid, Alaa, Abazeed, Bader, Abbad, Osaid, Abbadi, Nizar, Abu-Ishkerih, Malk, Al-Osta, Reham, Al-Zyadat, Bashar Omar Falah Alawneh, Majd, Alhattab, Mohd Mujahed Alkurdieh, Ziad, Awwad, Mohammad, Hammouri, Hamzeh, Hussein, 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Mohammedali, Claude, Mwaria, Ralph, Obure, Sayed Shah Nur Hussein Shah, Chetan, Hirani, Muthoni, Kibunyi, Claire, Mailu, Victor, Mwangi, Roy, Ogenya, Lydia, Osea, Davies, Cheruiyot, Omar, Hirsi, Carolyne, Muiru, Samuel, Wanjara, Chang Woo Kim, Suk Hwan Lee, Ahmad, Almulla, Mustafa, Dashti, Omar, Elghany, Abdullah, Sultan, Husain, Al-Mahmeed, Jasim, Alabbad, Ibtisam, Albader, Shuaib, Aldalal, Mahdi, Baba, Fareed, Abdulsalam, Naser, Alhajri, Athari, Alwael, Brook, Ayele, Hatem, Marie, Ahmed, Zaitoun, Ahmad, M AlAli, Ahmed, Alkhamis, Ous, Alozairi, Sulaiman, Almazeedi, Salman, Alsabah, Mostafa, Abdelkarim, Asmaa Al Rashed, Saud Al Subaie, Tariq, Al-Shaiji, Abdullatif, Al-Terki, Omar, Alhunaidi, Ali, Aljewaied, Khaled, Alzamel, Ahmed, Farag, Hussein, Hayati, Salah, Termos, Sarah, Wood, Maha, Al-Gilani, Mutlaq, Al-Sihan, Haifa, Alotaibi, Dmitrijs, Lobovs, Andrejs, Pcolkins, Armands, Sivins, Ingus Arnolds Apse, Annija Evelīna Berga, Anna, Ivanova, Jevgenijs, Demicevs, Igors, Ivanovs, 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Alameen, Rehab, Alarabi, Alarabi, Alarabi, Aisha, Alelwany, Abdulkarim, Alesmail, Noran, Algadi, Khuloud, Almaqrahi, Hadel, Alosta, Mohamed, Alsharedi, Rasha, Bashir, Mahmoud Ben Ghrema, Sari Bin Nour, Sofian, Elbarouni, Ahmed, Elhadi, Abdulmohimen, A Elkhadar, Esraa, Elkouba, Nabiha, Elmsherghi, Abdulmohimen, Gammoudi, Abdulraouf, Ghariba, Fatima Zayed Gjam, Arwa, Haidar, Hala, Helal, Mohammed, Huwaysh, Ahmed Khalid Alhadheeri, Eslam, Kriem, Halim, Osman, Mohamed Ali Ossman, Marwah, Shilfeet, Laila, Turshani, Nouran, Albishty, Abdulmueti, Alhadi, Salem, Ali, Manal Ahmed Altoumi, Sumayyah Ghayth Bahroun, Eman, Younes, Hana, Atarabulsi, Mohamed, Elshaibi, Abdullmujeeb, Othman, Hayat Ben Hasan, Najat Shaban Ben Hasan, Rabab Shaban Ben Hasan, Vidmantas, Barauskas, Edvinas, Dainius, Zilvinas, Dambrauskas, Albertas, Dauksa, Inga, Dekeryte, Rita, Gudaityte, Kristijonas, Jasaitis, Akvilė, Koženiauskaitė, Virgilijus, Krasauskas, Ausra, Lukosiute-Urboniene, Almantas, Maleckas, Romualdas, Riauka, Vygintas, Šlenfuktas, Saulius, Svagzdys, Kestutis, Urbonas, Tomas, Vanagas, Linas, Venclauskas, Donatas, Venskutonis, Justas, Zilinskas, Marijus, Ambrazevicius, Vilius, Syminas, Oleg, Aliosin, Agne, Cizauskaite, Vitalijus, Eismontas, Jonas, Jurgaitis, Vytenis, Mikutaitis, Donatas, Petrauskas, Narimantas Evaldas Samalavicius, Dainius, Simcikas, Algirdas, Slepavicius, Albinas, Tamosiunas, Vaidotas, Turskis, Bernardas, Vasiliauskas, Laura, Aniukstyte, Audrius, Dulskas, Gediminas, Januška, Justas, Kuliavas, Margarita, Montrimaite, Albertas, Cekauskas, Azuolas Algimantas Kaminskas, Sarunas, Kozenevskis, Tomas, Poskus, Kestutis, Strupas, Arunas, Zelvys, Georges, Decker, Audrey, Noël, Maheriandrianina Fanambinana Voahary Rajaonarivony, Randimbinirina Zakarimanana Lucas, Herimampionona, E Andriantsoa, Mamisoa, B Rasamoelina, Rakotonarivo Aina Andrianina Vatosoa, Liantsoa, Andriamanana, Casimir Fp Rahantasoa Finaritra, Aristide Romain Raherison, Tsirimalala, Rajaobelison, Haritiana, Rakotoarisoa, Maharo, Ramifehiarivo, Solonirina Harinarindra Ranaivoson, Hajamihamina Marina Parfaite Randriantsoa, Narindra Njarasoa Mihaja Razafimanjato, Jeannie Ba Razafindrahita, Solofoarimanana, Solofoarimanana, Guillaume Odilon Tsiambanizafy, Rakotonaivo Mamisoa Judicaël, Corinne Eulalie Solo, Tojomamy Herinjaka Ralaizafindraibe, Fanonjomahasoa Safiry Andofenohasina, Hanta, Rasataharifetra, Vanona Barijaona Razafindraibe, Angelin Sablon Herinirina, Andre, Das, Thanga, Ganapathy, Yohesuwary, Gunarasa, Kalyani, Mariapan, Maathichsudhaar, Muniandy, Mohd Firdauss Osman, Mohd Azem Fathi Mohammad Azmi, Jien Yen Soh, Wan Zainira Wan Zain, Andee Dzulkarnaen Zakaria, Zaidi, Zakaria, Kheng Hooi Chan, Firdaus, Hayati, Syamim, Johan, Jin Jiun Mah, Ratha Krishnan Sriram, Sentilnathan, Subramaniam, Nur Shahirah Binti Muhammad Shahimi, Khairul Hazim Hamdan, Mohd Razali Ibrahim, Guhan, Muthkumaran, Ju Ann Tan, Mohana Raj Thanapal, Dayang Anita Abdul Aziz, Mae-Lynn, Bastion, Mohd Hairul Nizam Harun, Farrah-Hani, Imran, Norshamsiah Md Din, Ayesha Mohd Zain, Mushawiahti, Mustapha, Syed, Nabil, Ainal Adlin Naffi, Abd Jabar Nazimi, Roszalina, Ramli, Bee Hong Soon, Pavin, Bal, Joo Qing Cheng, Mohd Rusdi Draman, Ahmad Nazran Fadzli, Sakina, Ghauth, Weipin, Hung, Suniza, Jamaris, Peng Soon Koh, Sivakumar, Krishnasamy, Yeong Sing Lee, Yew Toong Liew, Jeffery Zk Lim, Raymond Chung Siang Lim, Hiong Chin Lim, Siti Farhan Moh Pauzi, Shireen Anne Nah, Ashvin Krishna Nair, Doris Sin Wen Ng, Yuki Julius Ng We Yong, Kamarajan, Ramayah, Rahmah, Saaid, Anand, Sanmugam, Mee Hoong See, Kanesh Kumaran Seevalingam, Neha, Sethi, Srihari, Singaravel, Syeda Nureena Syed Jafer Hussain Zaidi, Chu Yik Tang, Li Ying Teoh, Kian Boon Wong, Ruben, Xavier, Ahmad Shuib Yahaya, Norhafiza, Ab, Rahman, Islah Munjih Ab, Rashid, Mohd Fahmi Abd Aziz, Mohd Norhisham Azmi Abdul Rahman, Nasser Muhammad Amjad, Shahidah Che Alhadi, Faisal, Elagili, Mohd Nazli Kamarulzaman, Azmi Md Nor, Ahmad Faidzal Othman, Mohd Yusof Sainal, Mat Salleh Sarif, Richelle, Chua, Aini Fahriza Ibrahim, Abdul Rauf Bin Ahmad, Yii Ling Lau, Ka Yee Liew, Kandasami, Palayan, Hui Yu Wong, Jasiah, Zakaria, Nor Azimah Abd Aziz, Norazila Abdul Rahim, Noorneza Abdul Rahman, Bahiyah, Abdullah, Mohamed Faizal Bin Sikkandar, Fatin, Firman, Nik Mohd Hazleigh, Intan Kartika Kamarudin, Shahril, Khalid, Mohd Fairudz Mohd Miswan, Akmal Zulayla Mohd Zahid, Norasyikin, Mustafa, Kadhim, Obaid, Mohd Yusoff Bin Yahaya Yahaya, Ahmad Ramzi Yusoff, Predrag, Andrejevic, Jeremy Borg Myatt, Svetlana, Brincat, Clifford, Caruana, Kurt Lee Chircop, Francesca, Chircop, Daniel Mario Chircop, Charles, Cini, Viktoria, Czok, Melanie, Farrugia, Gabriella, Grima, Fatimah Mj Hassan Almukhariq, Esther, Muscat, Darryl, Pisani, Mohsin Hassan Khan Roshan, Nicholas, Schembri, Mohamed, Shoukry, Neville, Spiteri, Gilbert, Tanti, Ziad Aboharp Hasan, Alberto Bazan Soto, Cedillo Rodrìguez Jonathan Rubén, Gustavo Esteban Lugo Zamudio, David Gerardo Miranda Gómez, José Alfredo Pérez Meave, Victor Pinto Angulo, Antonio Rojas Aguilar, Erik Efrain Sosa Duran, Alejandro Vàzquez Perez, Diego, Arroyo, Jose, Corona-Cruz, Hector, Martinez-Said, Heriberto, Medina-Franco, Manuel, Mendez, Teresa Moreno, Y Suárez Ma, Dolores Orta Díaz, Martha Patricia Pérez de León Vázquez, Angélica Azucena Soto Carvajal, Fidel Soto Hernández, Juan Ignacio Stenner, Adriana Valenzuela López, Mauricio Rene Hernandez, Rey Jesus Romero, Aldo Bernal Hernandez, Ana Olivia Cortes-Flores, Carlos Jose Zuloaga Fernandez Del Valle, Carlos Andres Colunga Tinajero, Jaime, Orozco-Perez, Laura Gabriela Peña Balboa, Guillermo, Yanowsky-Reyes, Víctor Hugo Alcalá Torres, Francisco José Barbosa Camacho, Irma Valeria Brancaccio Perez, Miguel Angel Calderon-Llamas, Aldo Camacho Gomez, Edgar-Joaquin, Cortes-Torres, Esteban, Cueva-Martinez, Oscar Durán Anguiano, Isaac Esparza Estrada, Roberto, Fierro-Rizo, Paola Flores Becerril, Clotilde Fuentes Orozco, Miguel García Castillo, Alejandro Gonzalez Ojeda, Ana Sofia Gonzalez Rubio, Erick Alonso González-García de Rojas, Luis Humberto Govea-Camacho, Jose Aldo Guzman Barba, Juan Carlos Ibarrola Peña, César Íñiguez Martínez, Francisco Javier Llamas-Macias, Ruben Eduardo Morán Galaviz, Cesar, Nuño-Escobar, Oscar-Everardo, Olvera-Flores, Jaqueline, Osuna-Rubio, Jose Victor Pérez-Navarro, Rodrigo, Prieto-Aldape, Luis Ricardo Ramirez Gonzalez, Marco Vinicio Ramírez Sánchez, Emilio, Reyes, Olaya Moramay Romero-Limón, Carlos Beas Ruiz-Velasco, José Antonio Sánchez Martínez, Guillermo, Sanchez-Villaseñor, Ismael, Sedano-Portillo, Gabriela Ambriz Gonzalez, Pedro Berrones Moreno Berrones Moreno, Ana Beatriz Calderon Alvarado, José de Jesús Cárdenas Barón, Araceli, Hernández, Francisco Javier León Frutos, Edgard Efren Lozada Hernandez, Eduardo Morales Valencia, Karla Daniela Pérez, Francina, Bolanos-Morales, Julio, Herrera-Zamora, Patricio, Santillan-Doherty, David Omar Arriaga Zavala, Salvador Francisco Campos Campos, Lizette, Carmona, Antonio Galindo Nava, Blanca, Santos, Juan Roberto Torres Cisneros, Katya, Bozada-Gutiérrez, Jose Jesus Herrera, Mucio Moreno Portillo, Francisco Pérez López, Mario, Trejo-Avila, Carlos Valenzuela Salazar, Maria Regina Alvarez, Fernando, Cordera, Marco Antonio de la Rosa Abaroa, Antonio, Gómez-Pedraza, Roberto, Hernandez, Antonio, Maffuz-Aziz, José Antonio Posada, Carlos Robles Vidal, Jose-Luis, Beristain-Hernandez, Blas Eduardo Quintero Sada, Nicolás Uxmal Soruco Heredia, Ernesto, Anaya, Ricardo, Arceo-Olaiz, Bernardo Gutiérrez Sougarret, Sonia Lopez Flores, Francisco, J Ochoa Carrillo, Raymundo Alfredo Pérez Uribe, Ludwigvan Adriano Bustamante Silva, Arianne, I Lupián-Angulo, Christian Enrique Soulé Martínez, Francisco César Becerra García, Ernesto Javier Guerrero Casillas, Edgar, Uribe, Nereida Esparza Arias, J Mindy Hernández-Nava, David, Isla-Ortiz, Javier, Melchor-Ruan, Esmeralda Romero Bañuelos, Rosa, Salcedo-Hernández, Diana, Vilar-Compte, Paola Zinser Peniche, Jorge, L Aguilar 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Sanchez Barrueco, Maria Dieguez López, Isabel López García, Pilar López-Toribio López, Marina, Bosch, Carolina Curtis Martínez, Alba Fernández Candela, Sandra Lario Pérez, Cristina Lillo García, Clara López de Lerma Martínez de Carneros, Francisco López Rodríguez-Arias, Inmaculada, Oller, Saray, Quinto, Luis, Sánchez-Guillén, Antonio Sanchís López, Álvaro, Soler-Silva, Daniel Triguero Cánovas, Victoria Garcia Peces, Estefania, Hernández-García, Guillermo, Plaza, Rafael Abad Alonso, Francisca Aranda Lozano, Marta Calvo Fernández, Eneko Del Pozo Andres, Josune Etxabe Gurrutxaga, Francisco Javier Fernández Pablos, Francisco Javier Ibáñez-Aguirre, Begoña Ochoa Villalabeitia, Natalia, Ortega, Amaia Sanz Larrainzar, Irune Vicente Rodriguez, Javier Jimenez Miramón, Jose, M Jover, Tamara, Llamero, Jose Luis Ramos Rodriguez, Ainhoa Valle Rubio, Maria Teresa Albiol, Codina, Antonio, Clara, Codony, Ramon Farres Coll, Cristina Farrés Pla, Nuria Gomez Romeu, Santiago, Lopez-Ben, Marcel, Pujadas, 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Marqueta De Salas, Paula Martinez Pascual, Almudena Ortiz Simón, Laura, Osuna, Marta Perez Gonzalez, Antonio Ramos Bonilla, Lorena Rodríguez Gómez, Jose Luis Uquillas, Miguel Angel Alonso Prieto, Marta, Ballesteros-Pomar, Sara Busto Suarez, Mario, Castaño, Laura Castillo Pardo, Mario De Arriba Alonso, Fernando Diez Burón, Anna Farrés Rabanal, Diego Fernández-Samos Fernández, David, Garcia, Cristina García Pérez, Miguel García Sanz, Cesar, Gracia, Javier, Gualis, Gonzalo Gutiérrez Carrillo, Mateo, Hevia, Eva Higuera Miguélez, Gregorio, Laguna, Cristina Lombardia Gonzalez de Lera, Pablo López Martínez, Pasquale, Maiorano, Sergio Marcos Contreras, Elio Martín Gutiérrez, Marta, Molina, Irene, Perez, Teresa Renedo Villar, Luis Angel Suarez Gonzalez, Eva Alvarez Torres, Luz Bueno Rey, Zulay Adriana Calderon Barajas, Ana, M Castaño-Leon, Aida, Fernández, Pablo Garcia Pimentel, Luis, Jimenez-Roldan, Meta, Levstek, Rosalia Navarro Casado, Claudia Olea Vielba, Ana Maria Parada Rodriguez, Igor, Paredes, Patricia, Pascual-Cambero, Miguel Saiz Sánchez-Buitrago, Claudia Sarrais Polo, Victor Zarza Fernandez de Alegria, Mireya, Bonet, Alberto Encinas Vicente, Jose Miguel Villacampa Auba, Maria Dolores Burgueño, Patricia Serrano Méndez, Thomas, W Jorgensen, Mercedes, Martin, Mónica, Huecas, Felipe, Velasco, Verónica Alen Villamayor, Santiago Alonso Bartolomé, Miguel Alonso Juarranz, Luis Felipe Ávila-Ramírez, Javier Buendia Pérez, Barbara, Burgos-Blasco, Enrique Camarero Rodríguez, Paula Campelos Fernández, Claudia, Celotti, Marco Ciappara Paniagua, Ignacio, Cristobal, Alejandro Encinas Bascones, Elena, Fernandez-Martin, Inés Gil Prados, Jesus Gimeno Hernandez, Maria Alejandra Giraldo, Manuel Gomez Cervantes, Noemi Guemes Villahoz, Araceli Hernández Ramos, Maria Cruz Iglesias Moreno, Bibiana Lasses Martínez, Francisco Leyva Rodríguez, Leyre López Antoñanzas, Javier Martín Monterrubio, Jose Maria Martinez-de-la-Casa, Lourdes Montero Cruces, Jesús Moreno Sierra, Jose Maria Muguerza, Alexia Victoria Paluso Montero, Natalia Pérez Romero, Adriana, Poch, Jaime Rodríguez de Alarcón, Adriana Ruano Campos, Rebeca Ruiz Roman, Patricia Saez Carlin, Cristina Sánchez Del Pueblo, Lidia Sotillo Valenzuela, Armando, Galvan, Miguel Ángel García Ureña, Enrique, González, Manuel Medina Pedrique, Alvaro Robin Valle de Lersundi, Carlos San Miguel, Juan, Aragón-Chamizo, Monica, Ballon, Jose, M Barrio, Beatriz Castro Catalan, Laura Cebolla Rojas, Renan Carlo Colombari, Miguel Cuende Diez, Paula Dujovne Lindenbaum, Oscar, Gil-de-Sagredo, Silvia Kayser Mata, Pablo Lozano Lominchar, Yeniffer Tatiana Moreno Salazar, Angela, Moreno-Gutierrez, Melanie, Morote, Uxue, Murgoitio, Nikolas Palma Caucig, Lucía Polanco Pujol, Alejandro, Prosperi, María Belén Ramírez Senent, Diego Fernando Ruiz Chiriboga, Mercedes, Sanz, Maria, Tudela, María Adrien Lara, Raquel, Alarza, Isabel Alonso Sebastian, Mariano Artés Caselles, Laura, Calles-Sastre, Marcos Casas Sánchez, Aritz Equisoain Azcona, Lucía, Fuentes, Lucia Gil Cidoncha, Sofía Herrero Gámiz, Eva Iglesias Garcia, Jose Luis Lucena De La Poza, Mª Eugenia Marín Martínez, Pilar Martín Rodrigo, Joaquin Manuel Muñoz Rodríguez, Verónica, Polaino, Alberto Pueyo Rabanal, Xabier Remirez Arriaga, Xiana, Rial, Miguel Sánchez Suárez, Maria Eugenia Torguet Muñoz, Borja Bazán Inostroza, Lara Blanco Terés, Alba Correa Bonito, Angela de la Hoz, Gustavo, Eisenberg, Javier Garcia Septiem, Jose Maria Lopesino, Rocio, Maqueda, Elena, Martin-Perez, Jose Luis Muñoz de Nova, Julia Revuelta Ramírez, Ana Rodríguez Sánchez, Álvaro Valdés de Anca, Laura Colao García, David Díaz Pérez, Enrique Esteban Agustí, Pablo Galindo Jara, Ana Belén Gallardo, Cesar, Garcia, Maria Gutierrez Samaniego, Miguel Angel Hernandez Bartolome, Lorenzo, Rabadan, Barriga Sánchez Raquel, Beatriz, Diéguez, Miguel, Hernández-García, Carolina Alfonso Carrillo, María Belén Alonso Bartolomé, Estibaliz, Alvarez, Mario, Alvarez-Gallego, Paula, Aragón-Ramos, Pablo Cesar Arteaga Asensio, Luis Asensio Gomez, Diego, Carrion, Nuria, Chavarrias, Alvaro de Arriba, Jose Antonio Gazo Martínez Gazo, Alberto Gegúndez Simón, Juan Gómez Rivas, Natalia Gonzalez Alcolea, Carolina, Gonzalez-Gomez, Sara Gortázar de Las Casas, María Alexandra Heras Garceau, Alicia Hernández Gutierrez, Luis, Lassaletta, Fuad Samir Lopez Fernández, Marta, Mancheño, Blanca, Mateos-Serrano, Isabel Pascual Miguelañez, Maria Fernanda Pedrero Escalas, Julio, Peñarrocha, Yolanda, Perez, Maria Isabel Prieto-Nieto, Teresa Rivera Schmitz, Laura, Rodrigáñez, Ines, Rubio-Perez, Isabel Sanchez Cuadrado, José Ignacio Sánchez Méndez, Jorge Fernando Tone, Carlos Toribio Vazquez, Aitor, Urbieta, Diego Córdova García, Francisca Garcia-Moreno Nisa, Laura, Jiménez, Inmaculada, Lasa, Belen, Matías-García, Fernando, Mendoza-Moreno, Marina Pérez González, Ana Sánchez Gollarte, Alejandro Sanchez Pellejero, Cristina Vera Mansilla, Rafael, Barberá, Lourdes, Montes-Jovellar, Sara Fra Fernández, Nicolas Moreno Mata, Barbara, Algar-Yañez, Gutiérrez, Bérénice, Olga De La Varga-Martínez, Paula, Fernandez-Valdes-Bango, Sandra Maria Gadin-Lopez, José María Martínez-Gómiz, Elena, Nieto-Moreno, Ana, Nieto-Moreno, Montserrat Ocampos Hernandez, Maria Laura Pelegrina-Lopez, Alicia Ruiz Escobar, Elena, Sáez-Ruiz, Beatriz, Vazquez-Rivero, Antonio, Lara, Belén Vielva Del Campo, Fernando Alcaide Matas, Simbad, Costas-Ochoa, José María García Pérez, Elizabeth, Marmol, Paula Troncoso Pereira, Maria Del Pilar Concejo Cutoli, Juan Ramón Gómez López, Juan Carlos Martín Del Olmo, Paloma Guillamot Ruano, Javier Páramo Zunzunegui, Antonio Albarracín Marín Blázquez, Alfonso, Aliaga-Sanchez, Marta María Arroyo Domingo, Miriam Artés Artés, Ana Isabel Avellaneda Camarena, Aida, Blaya, Emny Rochell Bobadilla Romero, Pedro Vicente Fernández-Fernández, Lorena Galindo Iñiguez, Víctor Javier García Porcel, Clara Giménez Francés, Antonio Javier Gomez Poveda, Rebeca Gonzalez Celdran, Francisco Miguel González Valverde, Laura Guillamon Vivancos, Elena, Gurrea-Almela, Alejandra Jara Maquilón, Jose David Jimenez Parra, Abd Al Aziz Lanagrán Torres, Raquel Lax Perez, Carmen Maria Lopez Lopez, Francisco, Machado, Alfonso Marco Garrido, Florencio Manuel Marin Martinez, Victoria Martínez Muñoz, Esther, Medina, Olimpia, Molina, José Manuel Muñoz Camarena, Julian, Onate, Pedro Antonio Parra Baños, Emilio Peña Ros, Enrique, Rubio, Marina Sánchez Robles, Carlos Sanchez Rodriguez, María Valero Soriano, María Teresa Yepes García, Felipe, Alconchel, Andrés Balaguer Román, Valentín, Cayuela, Ana, Conesa, Ana Delegido García, Pedro José Gil Vázquez, Paula Gómez Valles, Francisco, Gómez-Bosch, Vicente, J León-Muñoz, Francisco, Martínez, Alvaro, Navarro-Barrios, Tatiana, Nicolás-López, Pablo Ramirez Romero, Emiliano, Cano-Trigueros, María Concepcion Alonso González, Leticia Gómez Viana, Ana Pastor Zapata, Elisa Contreras Saiz, Tamara Díaz Vico, Maria, Fernandez-Hevia, Luis Joaquín García Flórez, Raquel, Rodríguez-Uria, Sandra, Sanz, Lorena, Solar-Garcia, Aida Suárez Sánchez, Jaume, Gelonch, Dietmar, Reinaldo, Miriam Abdulkarim Polo, Asier, Aguirre, Marta Alomar Bofill, Santiago, Baena, Ashish, Bartakke, Carmen Cabeza Oliver, Marta Castro Suárez, José Andrés Cifuentes Rodenas, Olga Claramonte Bellmunt, Ant Onia Crespí Mir, Anabel De La Llave Serralvo, Mar, Escales, Isabel Rosa Fernández Burgos, Pablo Gandia Gonzalez, Juan Lliteras Jorge, María Cristina Martínez Canto, Javier, Mata, Andreu, Morell, Naila, Pagès, Sara Pérez Palao, Cristian Plaza Valiente, Catalina Ramon Barcelo, Carmen Reyero Fernández, Albert Reyes Claret, Leticia Rodriguez Vaquero, Maialen Saez de Vicuña Salinas, Pilar Santos Cidon, Concepcion, Segura, Aina, Serra, Maria Serra Guivernau, Maria Soler Pedrola, Marta, Tasende, Marta Torrent Lluch, María Inmaculada Valldeperas Hernández, Rosa-Maria, Yañez-Lpez, Andrea, Craus-Miguel, Laura Fernández Vega, Natalia Pujol Cano, Juan José Segura-Sampedro, Laura Colet Oliver, Ivan Dot Pascuet, Mireia, Duart, Isabel Tello Galindo, Eduardo Arrea Salto, Jaume Cámara Cabrera, Marta Camats Terré, Juan Gabriel Castro Ríos, Marta de la Rosa-Estadella, Anna, Fernandez-Colorado, Anna, Gasulla-Rodriguez, Antonio, Gimenez-Gaibar, Elena, Gonzalez, Yeray Maldonado Sotoca, Matilde, Molina-Corbacho, Montserrat Monfort Mira, Josep, Rodoreda, Marta Santos Espí, Arnau Verdaguer Figuerola, Elisa Angela Diego-Alonso, Jaime, López-Sánchez, Luis, Muñoz-Bellvis, Jacobo, Trebol, Borja, Aguinagalde, Cristina Gabriela Alzate Arsuaga, Ainhoa Andres Imaz, Iñigo, Arana, Coro Aranzabal Urrutia, Mikel, Armendariz, Lorena, Arrabal, Iñigo, Augusto, Adolfo, Beguiristain, Laura, Busto, Ainhoa, Cuevas, Itziar De Ariño, Alejandro, Elúa, Leticia, Fernandez, Arantza, Fernandez-Monge, Lander, Gallego, Alba, Garcia, Amaia Garcia Dominguez, Gregorio, Garmendia, Carmen, Grañén, Pelayo Hevia Rodríguez, Maria, Iraola, José Miguel Izquierdo, Aintzane, Lizarazu, Jon Ander Lizarbe, Claudia Cristina Lopes Moreira, Iker, López, Ruth Marquina González, Tania, Pastor, Adrián Recio Ayesa, Ana Paula Riverola Aso, Carballo, Rodríguez, Araceli, Rodrìguez, Maria Inmaculada Ruiz Montesinos, Patricia, Torres, Jose, Undabeitia, Ainara, Villafruela, Maria Barrionuevo Ramos, David, Blanco, Marta, Calderón, Eva Corral Rubio, Angel, Cuadrado-García, Daniela, Cubek, Ignacio, Fariña, Maria Fernandez LLorente, Natalia Flores Amador, Mariana García Virosta, Luis Garcia-Sancho Tellez, Adelina Gonzalez Martinez, María, Hernandez, Rubén Herreros Ruiz-Valdepeñas, Carmen Jimenez Sanchez, Eduardo Llamazares Cobo, María, López, Javier, López-Martin, Teresa Martínez Marivela, Luis Miguel Martinez Parra, Paloma Maté Mate, Paloma, Medrano, Manuel Moriche Carretero, Sara Núñez O'Sullivan, Manuel Ortega Oria de Rueda, María Begoña Pastor Nieto, Clara, Pérez, Antonio, L Picardo, Remedios Revilla Amores, Carmen Rodríguez Haro, Jose Alberto Rojo López, Fatima Sanchez Cabezudo Noguera, Cristina, Sanz, Daniel Serralta de Colsa, Cristina Valor Garcia, Marta Velasco Martinez, Iván Andújar Lara, Aranzazu, Calero-Lillo, Enrique, López-Ruiz, Alberto Díaz García, Alejandro Menéndez Moreno, Luis Eduardo Pérez-Sánchez, Ángela, Pascual, Miguel Adeba García, Marta Alonso Fernández, Javier Alvarez Gama, Roberto, Ballestero, Loreto Berjon De La Vega, Paola Calleja Hermosa, Mariana, Carrillo-Rivas, Alfonso, Casado, Andrea, Cerveró, Bonifacio Cimadevilla Calvo, Patricia Corriols Noval, Paloma de la Dehesa Cueto-Felgueroso, Miren Jasone Diez Zapirain, José Estevez Tesouro, José Antonio Fernández-Dívar Sánchez, Lucia Garcia Alcalde, Juan García Cardo, Tito García Moreno, Daniel, García-López, Belen Garcia-Montesinos Perea, Miren Gonzalez Benito, Rocio, Gonzalez-Aguado, Miguel Ángel Gordo Vega Gordo-Vega, Jose, Gutierrez-Banos, Jaime Jimeno Fraile, Yolanda Jubete Castañeda, Patricia Lopez Gomez, Antonia Jesús López López, David Mato Mañas, Carmelo, Morales-Angulo, Dieter, Morales-Garcia, Sara, Naranjo, Jose Luis Rabago, Jose Manuel Rabanal, Rocio Revuelta Zorrilla, Adriana Reyes Echeverría, Juan Carlos Rodríguez-Sanjuán, Juan Ramón Sanz, Isabel Simal Badiola, Guillermo, Tejón, Enrique Toledo Martínez, Raquel Varea Malo, Begoña, Fadrique, Tania, Funes, Elena González Revilla, Isaias, Alarcón, Daniel Aparicio Sánchez, Pablo Beltran Miranda, Carmen, Cepeda-Franco, María Josefa Cuevas López, Sandra, Dios-Barbeito, Virginia María Durán Muñoz-Cruzado, Carlos Gonzalez De Pedro, Rosa, M Jimenez-Rodriguez, Francisco, Manresa-Manresa, Gabriel, Marin, Cristobalina, Martin-Garcia, Sara, Martínez-Núñez, Juan Manuel Martos Martinez, Lucas, Mengíbar, Felipe Pareja Ciuro, Eduardo Perea Del Pozo, Veronica Pino Diaz, José, Pintor-Tortolero, Claudia, Quintero-Pérez, Maria Luisa Reyes Diaz, Mercedes Rubio Manzanares Dorado, Alejandro Sanchez Arteaga, Ana, Senent-Boza, Luis, Tallon-Aguilar, Jose, Tinoco-Gonzalez, Luis-Cristobal, Capitan-Morales, Juan Cintas Catena, Javier, Valdes-Hernandez, María Del Campo Lavilla, Alina López De Fernández, Miriam Abellan Lucas, Alba Diaz Padillo, Maria Gómez Romero, Linda Grace Puerto Tamayo, El Mostafa El Yaqine Er Raoudi, Melody García Domínguez, María Ángeles Gascón Domínguez, Marta González Pérez, Alba Hernáez Arzoz, Joana San Anton, Cristian, Ruminot, Hander Guillermo Acosta Diaz, Daniella, Laguado, Kristina, Aghababyan, Alba, Jr, Enrique, Artigues, Rocío, Belda, Miguel, Beltran, Jose Ignacio Blanes, Elena Campos Carot, Miriam, Cantos, Laura, Costa, Carolina Ferrer Gomez, José María Gallego Sánchez, Oscar, Gil-Albarova, Juan, Gilabert-Estellés, Emilio Lopez Alcina, Isabel López Sánchez, Severiano Marin Bertolin, Carolina, Martinez-Perez, Antonio Melero Abellán, Claudia Mulas Fernández, Beatriz, Novoa, Ruth, Nuñez, Pablo Renovell Ferrer, Guijarro-Jorge, Ricardo, Carolina Soledad Romero Garcia, Miguel Sanfeliu Giner, Silvia, M West, Enrique, Zapater, Ignacio, Miranda, Ana, Monís, Alejandro Roselló Añón, María José Sangüesa, Jorge Sanz Romera, Marcos, Adrianzén, Maria Barrios Carvajal, Mireia, Bauzá, Ana Benítez Riesco, Jose Antonio Carbonell Lopez, María-Carmen, Fernández-Moreno, Ricardo Gadea Mateo, Francisco, Garcia, Maris Luisa García-Pérez, Luisa Paola Garzon, Ana, Izquierdo, Maria Lapeña Rodríguez, Carlos, León-Espinoza, Fernando, Lopez, Rosa Martí Fernández, Sara Martínez Castro, Berta Monleón López, Isabel Mora Oliver, David, Moro-Valdezate, Ernesto Muñoz Sornosa, Sara Palomares Casasús, Leticia Pérez Santiago, Mara Albert Fort, Reyes, Balanzá, Lorena Bermell Marco, Carla Carratalá Pérez, Claudia Pilar Clemente Tomas, Marta, Córcoles, Jose Ángel Diez Ares, Carlos Domingo Del Pozo, Nuria Estellés Vidagany, Gonzalo, Garrigos, Mar Gimeno Gimeno Vicente, Blanca Alastrue Giner, Segundo, Gomez-Abril, Paloma, Gonzalez, Paula Gonzálvez Guardiola, Guillermo Sebastian Martínez Fernández, Charo Martínez García, Lucía, Martínez-Costa, Luz María Moratalla Charcos, Sergio Navarro Martínez, Carmen, Payá-Llorente, Álvaro Pérez Rubio, Nuria, Peris, Eduardo Picazo Pineda, Jordi Planelles Gómez, Francisco Ripoll Vidal, Andrea, Roca, Enrique, Salmerón-González, Raquel Segura Roselló, Ramon Trullenque Juan, Cristina Verdejo Gimeno, Jose Miguel Zaragozá García, Gema Zomeño Bravo, Marcos Bruna Esteban, Hanna, Cholewa, Milton de Jesus, Matteo, Frasson, Luis Oliver García, Héctor, J Aguado, Antonio Jose Alonso Villalba, Francisco, Ardura, Carmen Elena Badillo Bercebal, María Bedate Núnez, Alvarez-Ramos Begoña Aranzazu, Juan Beltrán de Heredia, Hugo, Bermejo, Juan Berrocal Cuadrado, Maria Bragado González, Juan, Bustamante-Munguira, Raul Calvo Gonzalez, Yolanda, Carrascal, Ana Belén Casas Marcos, María Carmen Cervera, Sergio Chávez Valladares, Ángel Cilleruelo Ramos, Susana, Cortes, Jesús, Crespo-Sanjuán, María, Cuaresma, Luis Antonio Cuellar Martin, Carlos Ferreras García, Alvaro, Fuentes-Martín, Abel, Ganso, Elena García García, Luis, Garcia-Florez, Virginia, Garcia-Virto, Juan, Gatón, Julio Alberto Gobernado Tejedor, Tania Gómez Sanz, Jose Ignacio González Martín, María Begoña Gregorio Crespo, Ana Herranz Arriero, Jose, Herreros, Marta Ibáñez Nieto, César, Infante, Carlos, Jezieniecki, Moises, Juarez, Gregorio de Jesus Labrador Hernandez, Ana Patricia Legido Morán, Ricardo León Fernández, Alejandro, Leon-Andrino, Almudena, Llorente, Maria Lopez Pais, Mauricio Loucel Bellino, Sergio, Martin, Miguel Angel Martin-Ferrero, Gonzalo Martinez Municio, Elvira Mateos Alvarez, José María Matilla, Luis María Merino Peñacoba, Mario, Montes-Manrique, Fernando Natal Álvarez, David, C Noriega, Henar Nuñez Del Barrio, Francisco Javier Ortiz de Solórzano Aurusa, Lucía, Pañeda, Victoria Pascual Escudero, Miguel Pascual Samaniego, Adela, Pereda, Marta Pérez Febles, Laura, Pesquera, Maria, Plata, Emma Puertas Ruiz, Mario, Rodriguez-Lopez, Alejandro Romero de Diego, Ana, Ruano, María Ruiz Soriano, Cristina Sánchez Torralvo, Silvia Santiago Maniega, Bárbara, Segura-Méndez, Clarisa Simon Perez, José, Soro-García, Paula Suárez Mansilla Suárez-Mansilla, Jeancarlos Trujillo Díaz, Mª Esther Valsero Herguedas, Andrea Vazquez Fernandez, Eduardo Velasco García, Ana, Zabalza, Álvaro Zamora Horcajada, Fernando Acebes García, Enrique Asensio Díaz, Martín, Bailón, Alejandro David Bueno Cañones, Alvaro Centeno Velasco, Ekta Choolani Bhojwani, Fernando Labarga Rodríguez, Sara, Mambrilla, Pablo, Marcos-Santos, Toledano, Miguel, David Pacheco Sánchez, Baltasar, Pérez-Saborido, Pilar, Pinto, Katherine, Plua, Javier Sanchez Gonzalez, Vicente, Simo, Rosalía Velasco López, Sandra Veleda Belanche, Fabiola Eugenia Michel Campos, Iciar Muñoz Lindez, Maria, Balluerca, Maite, Camuera, Pablo, Helguera, Imanol, Herrero, Patricia Paunero Vazquez, María, Sánchez-Rubio, Isami, Soeda, María Dolores Arribas Del Amo, Vicente Manuel Borrego Estella, Estefania, Casas, Néstor Castán Villanueva, Daniel Delfau Lafuente, Elena Delgado Blanco, María, Domingo, Ismael Gil Romea, Azucena, Gonzalo, Emilio Lagunas Lostao, Noelia Lete Aguirre, Yaiza Martinez Lahoz, Jesús Víctor Pérez-Tierra Ruiz, Maria Del Mar Soriano, Isabel Valero Lázaro, Esmeralda Carnicer Escusol, Guillermo Pola Bandres, Juan Luis Blas Laina, Beatriz, Cros, Patricio Andrés Freile Pazmiño, David, Garcia-Aguilera, Ana Mejía Casado, Ana, Nogués, Issa Talal El-Abur, Carlos, Yánez, Isabel Gascon Ferrer, Carlos, Gracia-Roche, Ursula María Jariod Ferrer, María Victoria Simón Sanz, Tomas, Uson, Waseem, Ahamed, Sumudu, Jayasinghe, Eranda, Karunadasa, Prathibha, Nelihela, Sujeewa Priyantha Bandara Thalgaspitiya, Dickson, Wickramarathna, Nagenthiram, Harivallavan, Pirashanthan, Nagarasa, Eranga, Perera, Kanapathipillai, Piratheep, Vithranage Srimantha Dewsiri Rodrigo, Meera, Thayalan, Rajendram, Thayaparren, Arulprashanth, Arulanantham, Kanishka De Silva, Gagana, Ganga, Anuja Nadeeshan Kumarasinghe, Mahanada, Udukala, Koculen, Vimaleswaran, Prashanthan, Yogarajah, Ravindri, Jayasinghe, Probhodana, Ranaweera, Mohamed, Rishard, Dharmabandhu, N Samarasekera, Sanjeewa, Seneviratne, Sivasuriya, Sivaganesh, Chamal, Fernando, Nishantha, Mendis, Balasingam, Balagobi, Balasupramaniam, Sathesan, Lanka, Dasanayake, Malitha, Patabendige, Wickramasooriya, Dj, Kugarajh, Ganeshapillai, Sathyamoorthy, Prasanna, Dileepa, Ediriweera, Sumudu, Kumarage, Asanka, Jayawardane, Athula, Kaluarachchi, Pituwala Liyanage Adithya Sirisena, Abubakr, Abubakr, Hozifa, Mohamed, Ismail, Mustafa, Mogahid, Sharfeldein, Samir, Ismail, Reem, Musa, Monira, Sarih, Mussab, Abaker, Eman Adam Abdalla, Mohamad, Abdelbagi, Alsafe, Adlan, Ahmed, Alnaeem, Safa, Atyah, Yasir, Awad, Rsheeda, Dawelbait, Mohamed El Hag, Ibrahim, Elbashir, Sami, Eldirdiri, Samwal, Eldirdiri, Mohammed Eltahier Abdalla Omer, Lana Abdalgadir Ahmed Mohamed, Hiba Hassan Rehmtallah Ahmed, Mohammed Balla Yousif Balla, Abdulmoiz, Aljafari, Abdulmalek, Aljafari, Elsagad, Mohamed, Abdulkader, Mohammad, Abdulkader, Shaar, Mohamed Nafea Shaar, Maab Hussein Yousif Elhafiz, Mohammed Husien Yosif Elhafiz, Abubakr Ali Mohammed Alhassan Humidan, Almigdad, Ali, Hisham, Eljack, Mohamedyasin, Elrashid, Manhal, Ahmed, Albrra, Alhag, Douaa, Ali, Mohammed Ahmed Babikir, Imad, Bakheit, Hytham K, S Hamid, Sami, Mohamed, Walid, Shaban, Nidhal, Siddig, Mohamed, Suliman, Rihab Yasir Abdelmagid, Abubaker, Yassin, Omer, Abbas, Eltahir, Abdelrahim, Muhammed, Ahmed, Mohamed, Elobaid, Adil, Hashim, Ali, Mohamed, Omer, Mohamed, Khalid, Osman, Abdallah, Yousif, Safaa, Abdulaal, Marwa, Elsadig, Mohammed, Hussain, Malaz Amir Ataalmanan, Doha Amir AtaAlmanan, Tebyan Amir AtaAlmanan, Alaa, Elgaili, Maria, Mohamed, Usra, Omara, Alkhansa, Osman, Amna, Osman, Safaa, Saad, Abdelkareem, Ahmed, Ali Adil Ali Karar, Aya, Alhassan, Mohanad, Alsidig, Mohamed, Eljack, Mohammed Ibrahim Mohammed Ali, Awad Kamal Awad Osman, Liena, Mohamed, Samah Ibrahim Omer Mohamed Osman Mohamed Osman, Altayeb, Mohammed, Ayman, Mohammed, Khadija, Muhmmed, Eltahir, Musa, Egbal Sahal Abdelmajed, Khalid Z M, Y Hamid, Omnia M, M Yousif, Mahmoud, Saleh, Osman, Bashir, Yassein, Elhussein, Omar, Madani, Eva, Angenete, Jennifer, Park, Lars, Gillberg, Monir, Jawad, Linas, Pieteris, Yousif, Saeed, Sergej, Safonov, Martin, Spångfors, Henrik, Andersson, Hans, Bahlmann, Karin Björnström Karlsson, Michelle, Chew, Lara, Daham, Lina De Geer, Helen, Didriksson, Gunilla, Gagnö, Carina, Jonsson, Anna, Oscarsson, Pamela, Buchwald, Mathilde, Delorme, Marie-Louise, Lydrup, Shahin, Mohseni, Arvid, Pourlotfi, Souheil, Reda, Kajsa, Anderin, Nina, Blomme, Josefin, Segelman, Malin, Simlund, Anders, Thorell, Fredrik, Wogensen, Daniel, Danielsson, Peter, Elbe, Rebecka, Hultgren, Boel, Hynning, Fredrik, Klevebro, Karin, Lind, Ebba, K Lindqvist, Carl, Montan, Ernesto, Sparrelid, Clara Svenberg Lind, Jeremy, Wales, Andreas, Älgå, Martin, Nordberg, Emil, Pieniowski, Ioannis, Gkekas, Niklas, Löfgren, Karolina, Niska, Robert, Zürner, Silvio, Däster, Otto, Kollmar, Savas, Soysal, Stephanie, Taha-Mehlitz, Athanasios, Tampakis, Dominik Valentin Flury, Marie, Heyne-Pietschmann, 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Travis, Grotz, James, Jakub, Rahul, Kanade, David, Larson, Sherief, Shawki, Dennis, Wigle, Haradeen, Dhillon, Avni, Suri, Leonardo Weber Graeff, Ahmed, Elshabrawy, Grace Ihsiu Todd, Mark, Davies, Yan, Qi, Walter, Biffl, Kathryn, Schaffer, Sarah, Averbach, Terry, Curry, Alexandra, Schwartz, Mary Kathryn Abel, Veronica, Andaya, Kristina, Benirschke, Katherine, Bigay, Marissa, Boeck, Lee-Lynn, Chen, Lee-May, Chen, Huey-Lan, Chern, Amanda, Compadre, Patricia, Conroy, Alexa, Glencer, Patrick, Ha, Barbara Cs Hamilton, Johannes, R Kratz, Rondall, Lane, Rex, H Lee, Brenda, Nunez-Garcia, Richard, O'Donnell, Doruk, Ozgediz, Paul, Park, Ankit, Sarin, Ipsit, Shah, Bonnie, Sheu, Madhulika, Varma, Katherine, Wai, Rosanna, Wustrack, Mary Jue Xu, Melissa, Zimel, Pedro, Escobar, Meredid Maldonado Santiago, Mohammad, Azam, Asad, Choudhry, Eric, Hammond, William, Marx, Jihad, Abbas, Somya, Al-Embideen, Carol, Angel, Bailea, Bobich, Raul, Bosio, Gregory, Georgiadis, Tahir, Jamil, Maria, Kenner, Meghan, Lark, Tamara, Maghathe, Sonia, Masih, Gabriel, Naimy, Kristin, O'Mara-Gardner, Emily, Rady, Roberta, Redfern, Jack, Sample, Joseph, Sferra, Kaitlyn, Sharp, Jessica, Shoemaker, Stephen, Stanek, John, Stengle, Hibba, Sumra, Jeffrey, M Sutton, Faris, Azar, Anne, Fischer, Jaymie, Henry, Lawrence, Lottenberg, Mario, Rueda, Sasha, Thiel, Adel, Bozorgzadeh, John, Kelly, Armando Salim Munoz Abraham, Erin, Scott, Camila, Haro, Andrés, Pouy, Gastón, Acuña, Sofia, Álvarez, Ana Carmen Carbajal, Fabiola, Castedo, Diego, Pereiranuñez, Helena, Sobrero, Josefina, Tarigo, Rafat, Al-Saban, Fatima, Al-Eryani, Siham Al Maqtari, Sahar, Al-Maqtari, Mahmmoud, Abdualqader, Majed, Aeed, Ghadeer Al Sanany, Anwaar Al Dhafif, Buthina Al Jarmozi, Saba, Al-Ameri, Awsan, Al-Dhaheri, Dhyia Alhuq Al-Surimi, Amira, Alakhdury, Sabreen, Alashmali, Zainab, Alattas, Manar, Alduba'Ai, Hamdan, Aldumaini, Wafa, Alhaddad, Abdelrahman, Alharazi, Nawal, Alhemyari, Adnan, Alhumaida, Maniee, Aljabri, Hassan, Almarashi, Zuhoor, Almohanady, Marwa, Alodine, Nooraldin, Alqasemi, Basma, Alqudaimi, Ansam Mohammed Ghaleb Alrobaiee, Mohammed, Alsabri, Radfan, Alsalal, Ramzi, Alsayadi, Musaed, Alsayadi, Reem, Alshaipani, Ebrahim, Alsharabi, Nora, Atiah, Hadeel, Bajjah, Muhib, Esmael, Asma, Ghallab, Rana, Ghannam, Adwa'A, Hamid, Lina, Hashem, Sara, Saif, Shaima, Sayad, Nawras, Shaban, Amatallah Hadi Shamsan, Sarah, Shream, Amal, Shukri, Shahd, Zeid, Nabila, Abdullah, Abdulrahman Faisal Al-Garadi, Ahmed, M Ali Al-Radhi, Norhan, Naji, Shaima'A, Nasser, Areej Taha Al Anaib, Ebrahim, Abdurab, Fadhl Al Muhtadi, Amer, Al-Hebbah, Ahmed, Al-Madhrahi, Shehab, Al-Mahdi, Sakhr Abdulhakeem Al-Maswari, Ayman, Al-Oqabi, Zakarya Abdullah Al-Zaazaai, Karim, Al-Zazay, Ali, Alafif, Asem, Albzzaz, Lina, Alqalisi, Mohammed, Alrezami, Haneen, Alshargabi, Mokhtar, Alshargabi, Hossam, Ghanem, Kareem, Saeed, Rasheed, Shalabi, Fareed, Showqi, Miriam, Maimbo, Catherine, Mkandawire, Mulaya, Mubambe, Theresa, Nkole, Vanessa, Savopoulos, Patricia, Shinondo, Chabwera, Shumba, Penias, Tembo, Shelton, Chivanga, Ngqabutho, Dube, Handsome, Dube, Daniel, Dzinotyiwei, Ronald, Makanda, Moses, Mangena, Partson, Maphosa, Derek, Matsika, Proud, Mawere, Nkosikhona, Moyo, Assel, Moyo, Arnold, Muguwu, Simbarashe, Mungazi, Garikai, Mwale, Gamuchirai, Ndabvonga, Mambote Crispin Olivier Ntoto, Hardlife, Ranganai, Ernesto Sánchez Castillo, Oltah, Tshuma, Grace, Gwini, Vimbai Moyana Muguto, Gilbert, Moyo, Trust, Mushawarima, Tinashe, Shoko, Rorisang, Jamela, Marvellous, Machiri, Eric, Shumba, Antony, Chengahomwe, Yemurai, Bikwa, Maxwell, Chimhina, Jeremy, Marume, Kudzayi, Munanzvi, Precious G, T Mutambanengwe, Federico, Ferrari, Marco, Fontanella, Franco, Odicino, Romano, Vito, Nepogodiev D, Emanuele Cammarata, Sofia Campanella, Daniela Canzonieri, Adriana Cordova, Federico De Michele, Ettore Dinoto, Mara Franza, Leo Licari, Daniele Matta, Domenico Mirabella, Felice Pecoraro, Roberto Pirrello, Pierfrancesco Pugliese, Fernando Rosatti, Giuseppe Salamone, Francesca Toia, Massimiliano Tripoli, Nepogodiev, D, Rosati, R, Surgery, Medicine and Pharmacy academic/administration, Basic (bio-) Medical Sciences, Surgical clinical sciences, Faculty of Medicine and Pharmacy, Gastroenterology, Medical Oncology, Clinical sciences, Breda, João, ARD - Amsterdam Reproduction and Development, Paediatric Surgery, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, AGEM - Endocrinology, metabolism and nutrition, Graduate School, Tytgat Institute for Liver and Intestinal Research, Laura Alberici, Filippo Antonacci, Alessandro Arena, Angela Belvedere, Fabio Bernagozzi, Paolo Bernante, Pietro Bertoglio, Lorenzo Bianchi, Maria Bisulli, Barbara Bonfanti, Safia Boussedra, Jury Brandolini, Crescenzo Cacciapuoti, Stefano Cardelli, Riccardo Casadei, Matteo Cescon, Alessandro Cipolli, Riccardo Cipriani, Alfredo Conti, Luca Contu, Francesco Costa, Niccolo’ Daddi, Eugenia De Crescenzo, Pierandrea De Iaco, Alessandra De Palma, Massimo Del Gaudio, Anna Nunzia Della Gatta, Giampiero Dolci, Giulia Dondi, Matteo Droghetti, Sergio Nicola Forti Parri, Elena Garelli, Chiara Gelati, Giuliana Germinario, Federico A. Giorgini, Carlo Ingaldi, Elio Jovine, Kenji Kawamukai, Antonio Lanci Lanci, Raffaele Lombardi, Maria Elisa Lozano Miralles, Claudio Marchetti, Michele Masetti, Francesco Minni, Daniele Morezzi, Daniele Parlanti, Alice Pellegrini, Anna Myriam Perrone, Anna paola Pezzuto, Marco Pignatti, Gianluigi Pilu, Valentina Pinto, Gilberto Poggioli, Silvana Bernadetta Puglisi, Diego Raimondo, Matteo Ravaioli, Claudio Ricci, Sara Ricciardi, Francesco Ricotta, Roberta Rizzo, Angela Romano, Matteo Rottoli, Riccardo Schiavina, Renato Seracchioli, Matteo Serenari, Margherita Serra, Piergiorgio Solli, Gioia Sorbi, Mario Taffurelli, Marta Tanzanu, Achille Tarsitano, Marco Tesei, Gabriele Vago, Tommaso Violante, Simone Zanotti, Tommaso Frisoni, leonardo solaini, giorgio ercolani, Fruscio, R, Ornaghi, S, Collaborative, Covidsurg, Collaborative, Globalsurg, Palmisano, Silvia, de Manzini, Nicolo', Žundienė, Laura, Dulskas, Audrius, Kuliavas, Justas, Čekauskas, Albertas, Kielaitė-Gulla, Aistė, Poškus, Tomas, Strupas, Kęstutis, Želvys, Arūnas, COVIDSurg Collaborative, GlobalSurg Collaborative, Department of Surgery, HUS Abdominal Center, Simoes, Jff, Li, E, Picciochi, M, Glasbey, Jc, Baiocchi, G, Blanco-Colino, R, Chaudhry, D, Alameer, E, El-Boghdadly, K, Wuraola, F, Ghosh, D, Gujjuri, Rr, Harrison, Em, Lule, H, Kaafarani, H, Khosravi, M, Kronberger, I, Leventoglu, S, Mann, H, Mclean, Ka, Mengistu, Gm, Modolo, Mm, Ntirenganya, F, Norman, L, Outani, O, Pius, R, Pockney, P, Qureshi, Au, Roslani, Ac, Satoi, S, Shaw, C, Bhangu, A, Omar, Om, Ahmed, Wur, Argus, L, Ball, A, Bywater, Ep, Brar, A, Dawson, Be, Duran, I, Elhadi, M, Jones, C, Kamarajah, Sk, Keatley, Jm, Lawday, S, Marson, Ej, Ots, R, Santos, I, Taylor, Eh, Trout, Im, Varghese, C, Venn, Ml, Xu, W, Dajti, I, Gjata, A, Kacimi, Seo, Boccalatte, L, Cox, D, Townend, P, Aigner, F, Kronberger, Ie, Samadov, E, Alderazi, A, Hossain, K, Padmore, G, van Ramshorst, G, Lawani, I, Cerovac, A, Delibegovic, S, Gomes, Gma, Buarque, Il, Gohar, M, Slavchev, M, Nwegbu, C, Agarwal, A, Martin, J, Ng-Kamstra, J, Olivos, M, Lou, Wh, Ren, Dl, Calvache, Ja, Rivera, Cjp, Hadzibegovic, Ad, Kopjar, T, Mihanovic, J, Jimenez, Pma, Gouvas, N, Klat, J, Novysedlak, R, Amisi, N, Christensen, P, El-Hussuna, A, Batista, S, Lincango-Naranjo, E, Emile, S, Sandoval, Daa, Dhufera, H, Hailu, S, Mengesha, Mg, Kauppila, Jh, Arnaud, Ap, Demetrashvili, Z, Albertsmeier, M, Lederhuber, H, Loffler, Mw, Acquah, Dk, Ofori, B, Tabiri, S, Metallidis, S, Tsoulfas, G, Aguilera-Arevalo, Ml, Recinos, G, Mersich, T, Wettstein, D, Kembuan, G, Milan, Pb, Khosravi, Mh, Mozafari, M, Hilmi, A, Mohan, H, Zmora, O, Gallo, G, Pata, F, Pellino, G, Fujimoto, Y, Kuroda, N, Abou Chaar, Mk, Ayasra, F, Fakhradiyev, I, Hamdun, Ih, Jin-Young, J, Jamal, M, Karout, L, Gulla, A, Rasoaherinomenjanahary, F, Samison, Lh, Sanchez, Iid, Gonzalez, D, Martinez, L, Martinez, Mj, Nayen, A, and Ramos-De la Medina, A

Subjects
Male, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], MULTICENTER, infectious diseases, 0302 clinical medicine, 030202 anesthesiology, Anesthesiology, Cirugía, 80 and over, Prospective Studies, Young adult, Child, Lung, Aged, 80 and over, COVID-19, delay, SARS-CoV-2, surgery, timing, SARS‐CoV‐2 infection, Operative, Child, Preschool, Pneumonia & Influenza, Infection, Cohort study, Human, medicine.medical_specialty, Clinical Sciences, Sars-cov-2, GlobalSurg Collaborative, Settore MED/28 - MALATTIE ODONTOSTOMATOLOGICHE, 03 medical and health sciences, Clinical Research, Biodefense, Correspondence, Humans, PULMONARY COMPLICATIONS, CRIANÇAS EM IDADE PRÉ-ESCOLAR, Aged, Science & Technology, Cirurgia, Prevention, Infant, Odds ratio, Pneumonia, Prospective Studie, Clinical research, Surgery, Human medicine, 610 Medizin und Gesundheit, 1109 Neurosciences, Internationality, Settore MED/29 - CHIRURGIA MAXILLOFACCIALE, Settore MED/18 - CHIRURGIA GENERALE, Adolescent, Adult, Cohort Studies, Female, Middle Aged, Surgical Procedures, Operative, Time, Young Adult, Practice Guidelines as Topic, gastroenterology, Medicine and Health Sciences, 030212 general & internal medicine, Prospective cohort study, Mortality rate, Covid19, Infectious Diseases, Patient Safety, medicine.symptom, 6.4 Surgery, Life Sciences & Biomedicine, 610 Medicine & health, COVID-19, SARS-CoV-2, delay, surgery, timing, Asymptomatic, NO, COVIDSurg Collaborative, Vaccine Related, All institutes and research themes of the Radboud University Medical Center, medicine, Mortalitat, ddc:610, Mortality, Preschool, LS7_4, Surgical Procedures, business.industry, Neurosciences, Evaluation of treatments and therapeutic interventions, 1103 Clinical Sciences, 3126 Surgery, anesthesiology, intensive care, radiology, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], Anesthesiology and Pain Medicine, Emerging Infectious Diseases, Good Health and Well Being, Mortalidad, Cohort Studie, business
Abstract

Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay. ispartof: ANAESTHESIA vol:76 issue:6 pages:748-758 ispartof: location:England status: published

Published
2021
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30. Office hysteroscopy in pre- and post-menopausal women: a predictive model

Author

Flavia Sorbi, Riccardo Cioni, Luigi Piciocchi, Felice Petraglia, Federica Lisi, Srdjan Saso, Ersilia Lucenteforte, and Massimiliano Fambrini

Subjects
Infertility, Adult, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, Population, menopause, 030209 endocrinology & metabolism, Hysteroscopy, endometrium, endoscopic surgery, infertility, Logistic regression, Cohort Studies, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Endocrinology, medicine, Humans, education, Pre and post, Aged, Retrospective Studies, Uterine Diseases, education.field_of_study, 030219 obstetrics & reproductive medicine, Models, Statistical, medicine.diagnostic_test, Obstetrics, business.industry, Area under the curve, Obstetrics and Gynecology, Retrospective cohort study, Middle Aged, medicine.disease, Prognosis, Menopause, Postmenopause, Treatment Outcome, Ambulatory Surgical Procedures, Premenopause, Female, business, Infertility, Female
Abstract

Objectives To assess the variables associated with success of office hysteroscopy (OH) in pre-menopausal and post-menopausal women and to develop a clinical model for predicting the outcome of OH. Methods This is a retrospective cohort study of consecutive patients (n = 3181) referred for an OH to a tertiary care university hospital between January 2018 and March 2020. Multivariate logistic regression analysis was used to investigate the variables for predicting the success of OH in all patients and in pre-menopausal and in post-menopausal patients separately. The logistic regression analysis of each variable was applied to develop a predictive model. Results The overall success rate of the procedure was 92.2%; 95.4% in pre-menopausal women and 87.6% in post-menopausal women. In the general population, independent predictors of procedure success were previous vaginally delivery and hysteroscopy, while previous cervical or uterine surgery were associated with incomplete OH. In the pre-menopausal group, the independent predictors of failure were treatment with GnRH, estroprogestins and infertility. In 89% of cases, our developed model was able to predict whether an OH would be successful in a particular patient. ROC analysis showed an area under the curve of 0.8746 (95% CI: 0.85354-0.89557). Conclusions The present study demonstrates the development of a simple and reliable clinical model for the identification of both pre-menopausal and menopausal patients with a high chance of OH success.

Published
2020

31. SHBG as a Marker of NAFLD and Metabolic Impairments in Women Referred for Oligomenorrhea and/or Hirsutism and in Women With Sexual Dysfunction

Author

Vincenza Di Stasi, Elisa Maseroli, Giulia Rastrelli, Irene Scavello, Sarah Cipriani, Tommaso Todisco, Sara Marchiani, Flavia Sorbi, Massimiliano Fambrini, Felice Petraglia, Mario Maggi, and Linda Vignozzi

Subjects
Hirsutism, Endocrinology, Diabetes and Metabolism, Female sexual dysfunction, lcsh:Diseases of the endocrine glands. Clinical endocrinology, 0302 clinical medicine, Sex hormone-binding globulin, Endocrinology, Non-alcoholic Fatty Liver Disease, Sex Hormone-Binding Globulin, Outpatients, Outpatient clinic, Prospective Studies, polycystic ovary syndrome (PCOS), hirsutism, Original Research, 030219 obstetrics & reproductive medicine, biology, Polycystic ovary syndrome (PCOS), Cohort, 030211 gastroenterology & hepatology, Female, Algorithms, non-alcoholic fatty liver disease (NAFLD), Adult, medicine.medical_specialty, female sexual dysfunction, metabolic syndrome, sex hormone binding globulin (SHBG), Adolescent, Sensitivity and Specificity, 03 medical and health sciences, Young Adult, Metabolic Diseases, Internal medicine, medicine, Humans, Retrospective Studies, Inflammation, lcsh:RC648-665, business.industry, Hyperandrogenism, nutritional and metabolic diseases, Ultrasonography, Doppler, medicine.disease, digestive system diseases, Oligomenorrhea, Sexual Dysfunction, Physiological, Cross-Sectional Studies, ROC Curve, biology.protein, Metabolic syndrome, business
Abstract

PCOS is one of the most common endocrine disorders and NAFLD is one of its most dangerous metabolic consequences. The diagnosis of NAFLD is not a practical task and the condition is at risk of being overlooked. The use of simpler but still reliable surrogate markers is necessary to identify women with a high likelihood of NAFLD. The aim of this study was to evaluate the clinical correlates of NAFLD Liver Fat Score (NAFLD-LFS) in women with oligomenorrhea and/or hirsutism. Furthermore, the study aimed to evaluate whether, among the hormonal parameters evaluated in such women, possible hallmarks of NAFLD may be identified. To this purpose, 66 women who attended our Outpatient Clinic for oligomenorrhea and/or hyperandrogenism were included in the study. In order to validate the results obtained in the first cohort, a second independent sample of 233 women evaluated for female sexual dysfunction (FSD) was analyzed. In cohort 1, NAFLD-LFS positively correlated with metabolic and inflammatory parameters. Among the hormone parameters, NAFLD-LFS showed no significant relationships with androgens but a significant negative correlation with SHBG (p

Published
2020

32. Endometriosis-Induced Pain: The Treatment Strategy

Author

Sara Clemenza, Tommaso Capezzuoli, Huixi Chen, Massimiliano Fambrini, and Felice Petraglia

Subjects
medicine.diagnostic_test, Mechanism (biology), business.industry, Endometriosis, Inflammation, Bioinformatics, medicine.disease, Peripheral, Nociception, medicine, Back pain, Treatment strategy, medicine.symptom, business, Laparoscopy
Abstract

Pain is one of the main symptoms in women with endometriosis. The mechanism of endometriosis-associated pain remains unclear but multiple factors, such as nociception, inflammation, alterations in the peripheral and central nervous systems, psychological aspects, and previous surgery, are involved.

Published
2020
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33. 533 Predictive role of radiomic for post-operative complications of lymphadenectomy in ec patients

Author

Flavia Sorbi, Irene Paternò, Francesco Magni, Felice Petraglia, Silvia Lucarini, Virginia Taddei, Mazzoni Laura, and Massimiliano Fambrini

Subjects
medicine.medical_specialty, Hysterectomy, business.industry, Incidence (epidemiology), Endometrial cancer, medicine.medical_treatment, Cancer, Sentinel node, medicine.disease, Lymphedema, medicine, Lymphadenectomy, Radiology, Risk factor, business
Abstract

Introduction/Background Endometrial cancer (EC) is currently the most frequent cancer affecting the female genital system. The treatment of choice is represented by surgery, which consists of bilateral hysterectomy and adnexectomy with lymphadenectomy (L) according to risk factor for recurrence. The systematic lymphadenectomy procedure is often associated with postoperative complications, such as lymphedema, lymphocysts, lymphorrhoea. Recently, sentinel lymph node mapping have overcome the complications associated with L, though there is limited access to this tecnique. The aim of the study was to evaluate the role of radiomic analysis of pelvic adipose tissue at CT in predicting the incidence of post-oeprative complications of L. Methodology Consecutive patients who underwent surgical treatment of endometrial cancer at Careggi University Hospital between January 2016 and Decemeber 2019 were enrolled. Only patients underwent to pelvic lymphadenectomy were enrolled. Exclusion criteria were bulky nodes at the preoperative imagings. Staging CT images were used fot the radiomic analysis; pelvic adipose tissue was identified and segmented, so the images were imported to the 3D Slicer software. Subsequently, the extractions of the three radiomics features (busyness, flatness, elongation) of the rea of interest were carried out. Results Twenty seven patients were enrolled. Five patients developed post-operative complications. The value of Busyness, Flatness and elongation correlated with postoperative complications (p= 0.04, p= 0.021, p=0.03, respectively). Conclusion Our preliminary study shows that radiomic might be useful to predict whether a patient will develop any complications associated with the lymphadenectomy. Consequently pre-operative imaging might be used also to select which patient benefit the most from sentinel node study instead of L. Disclosures The authors have no conflicts of interest to declare.

Published
2020
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34. 591 The role of hpv genotypes analysis to prevent overtreatment of high-grade CIN

Author

Irene Renda, Massimiliano Fambrini, Milo Giani, Flavia Sorbi, Francesca Malentacchi, Federica Barsanti, and M Alessia Salamina

Subjects
Hpv genotypes, Colposcopy, medicine.medical_specialty, medicine.diagnostic_test, business.industry, Obstetrics, Incidence (epidemiology), HPV infection, virus diseases, Cervical intraepithelial neoplasia, medicine.disease, female genital diseases and pregnancy complications, Biopsy, medicine, Risk factor, business, Prospective cohort study
Abstract

Introduction/Background Invasive Cervical Cancer (ICC) develops from Cervical Intraepithelial Neoplasia (CIN) and persistence of high-risk HPV (HR-HPV) infection represents the main risk factor for evolution of CIN into ICC. Prevention of the disease is based on two screening methods: Papanicolau Smear (Pap-test) and HPV test; the latter with higher sensitivity and lower specificity. HR-HPV positive test detects earlier than Pap-test high-grade CIN (CIN 2–3) at colposcopy-guided biopsy, but the subsequent conization often reveals the absence of an high-grade CIN. The objective of the present study is to assess the incidence of persistency of high-grade CIN at conization after a positive biopsy. Secondly we aimed to investigate the role of HPV genotypes in the evolution of the lesion, in order to better triage women at time of colposcopy. Methodology A prospective study was conducted at Local Health Unit Toscana Centro and Careggi University Hospital (Florence, Italy) between January 2016 and February 2017 involving 308 women undergoing conization for high-grade CIN at cervical biopsy. All recruited patients underwent HPV testing prior conization. Biopsy and cone specimen data were recorded for each patient. Results Only in half of the patients there was a persistency of high-grade CIN. Histology discrepancy between biopsy and cone was observed in 181 out of the 308 recruited patients (58.7%; p Conclusion Approximately a third of patients with high-grade CIN at biopsy detected with Paptest and HPV screening underwent overtreatment with conization. Absent or LR HPV infection at time of conization were identified as predictors of regression. HPV test before conization could triage patients with high-grade CIN at cervical biopsy towards conisation or further follow-up with colposcopy. Disclosures The authors declare that there is no conflict of interest.

Published
2020
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35. Insight on the Intracrinology of Menopause: Androgen Production within the Human Vagina

Author

Sarah Cipriani, Fabio Villanelli, Linda Vignozzi, Mario Maggi, Stasi Vincenza Di, Paolo Comeglio, Flavia Sorbi, Elisa Maseroli, Massimiliano Fambrini, C. Corno, Ilaria Cellai, Felice Petraglia, Erica Sarchielli, Giulia Guarnieri, Sandra Filippi, Tommaso Todisco, Annamaria Morelli, Giulia Rastrelli, Gabriele Acciai, Irene Scavello, and Giovanna Danza

Subjects
Receptors, Steroid, Pediatrics, medicine.medical_specialty, Sulfotransferase, medicine.drug_class, Graves' disease, Myocytes, Smooth Muscle, Primary Cell Culture, Physiology, Gene Expression, Estrogen receptor, Dehydroepiandrosterone, 030209 endocrinology & metabolism, 03 medical and health sciences, Quality of life (healthcare), 0302 clinical medicine, Endocrinology, Internal medicine, medicine, Humans, Testosterone, In patient, Aged, Aged, 80 and over, 030219 obstetrics & reproductive medicine, business.industry, Chemistry, Thyroid, Sex hormone receptor, Middle Aged, Androgen, medicine.disease, Androgen receptor, Menopause, medicine.anatomical_structure, Vagina, Androgens, Female, business
Abstract

In this study, we investigated steroidogenic gene mRNA expression in human vaginas and verified the ability of human vagina smooth muscle cells (hvSMCs) to synthesize androgens from upstream precursor dehydroepiandrosterone (DHEA). As a readout for androgen receptor (AR) activation, we evaluated the mRNA expression of various androgen-dependent markers. hvSMCs were isolated from vagina tissues of women undergoing surgery for benign gynecological diseases. In these cells, we evaluated mRNA expression of several steroidogenic enzymes and sex steroid receptors using real time reverse transcription-polymerase chain reaction. Androgen production was quantified with liquid chromatography tandem-mass spectrometry (LC-MS/MS). In vaginal tissues, AR mRNA was significantly less expressed than estrogen receptor α, whereas in hvSMCs, its mRNA expression was higher than progestin and both estrogen receptors. In hvSMCs and in vaginal tissue, when compared to ovaries, the mRNA expression of proandrogenic steroidogenic enzymes (HSD3β1/β2, HSD17β3/β5), along with 5α-reductase isoforms and sulfotransferase, resulted as being more abundant. In addition, enzymes involved in androgen inactivation were less expressed than in the ovaries. The LC-MS/MS analysis revealed that, in hvSMCs, short-term DHEA supplementation increased Δ4-androstenedione levels in spent medium, while increasing testosterone and DHT secretion after longer incubation. Finally, androgenic signaling activation was evaluated through AR-dependent marker mRNA expression, after DHEA and T stimulation. This study confirmed that the human vagina is an androgen-target organ with the ability to synthesize androgens, thus providing support for the use of androgens for local symptoms of genitourinary syndrome in menopause.

Published
2020
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36. Urethrovaginal space during the third trimester of pregnancy is not related to vaginal orgasm

Author

Giovanni, Sisti, Mauro, Cozzolino, Flavia, Sorbi, Carlo, Maria Oranges, Maria, Isabel Pachon Romero, Riccardo, Landi, Andrea, Sisti, and Massimiliano, Fambrini

Subjects
Adult, Chi-Square Distribution, Pregnancy Trimester, Third, Ultrasonography, Prenatal, Cohort Studies, Young Adult, urethrovaginal space, Italy, Urethra, Pregnancy, Surveys and Questionnaires, Vagina, orgasm, Humans, Original Article, Female, G spot
Abstract

Introduction: Sexologists have described the urethrovaginal space (UVS) as a region of the body involved in the female orgasm. Recently certain authors have described the UVS via ultrasound (US). Pregnancy is associated with a myriad of physiological, anatomical and biochemical changes. To measure the UVS thickness in the third trimester of pregnancy and to investigate the relationship between the UVS thickness and the presence of vaginal orgasm. Material and Methods: Sexually active pregnant patients in the third trimester were included. We measured the UVS via US. Each patient compiled a modified female sexual function index (FSFI) questionnaire and was categorized in group with or without vaginal orgasm. Association between vaginal orgasm and UVS thickness was evaluated via t-test and ROC curve analysis. Results: UVS thickness resulted greater than 15 mm (average) in the third trimester, and was not related to the presence of vaginal orgasm (p>0.05). Conclusion: UVS thickness is high in the third trimester of pregnancy but it is not related to the presence of vaginal orgasm. (www.actabiomedica.it)

Published
2019

37. Spontaneous Resolution of an Acquired Uterine Arteriovenous Malformation in an Elderly Primigravida

Author

Silvia Gabbrielli, Flavia Sorbi, Irene Turrini, Viola Ghizzoni, Dora Pavone, Massimiliano Fambrini, Luca Mannini, Giulia Fantappiè, and Ivo Noci

Subjects
medicine.medical_specialty, medicine.medical_treatment, Remission, Spontaneous, Conservative Treatment, Dilatation and Curettage, 030218 nuclear medicine & medical imaging, Arteriovenous Malformations, Lesion, 03 medical and health sciences, 0302 clinical medicine, Uterine artery embolization, Pregnancy, Humans, Medicine, Vaginal bleeding, Ultrasonography, Doppler, Color, Abortion, Therapeutic, Watchful Waiting, Female, Middle Aged, Uterine Hemorrhage, Uterus, Computed tomography angiography, 030219 obstetrics & reproductive medicine, medicine.diagnostic_test, business.industry, Myometrium, Arteriovenous malformation, Articles, General Medicine, Uterine Artery Embolization, medicine.disease, Curettage, Radiology, medicine.symptom, business
Abstract

Patient: Female, 65 Final Diagnosis: Acquired uterine arteriovenous malformation Symptoms: Vaginal bleeding Medication: — Clinical Procedure: Wait and see Specialty: Obstetrics and Gynecology Objective: Rare disease Background: Uterine arteriovenous malformation (AVM) is an uncommon lesion characterized by an abnormal connection between arterial and venous circulation that can be congenital or acquired. Acquired uterine AVMs are generally traumatic and follow delivery, abortion, curettage, or uterine surgery. Case Report: A 45-year-old female who was gravida 1 para 0 presented to our hospital with severe vaginal bleeding. Two weeks before, the patient underwent therapeutic abortion. At admission, a transvaginal ultrasound showed an unclear intrauterine lesion that spread out to the myometrium. Color Doppler evaluation demonstrated an elevated color score. Beta human chorionic gonadotropin (beta-hCG) levels were measured at admission and daily repeated, with a progressive decrease of values up to a negative level. A pelvic magnetic resonance imaging described an area of tubular and tortuous structures involving the myometrium. A computed tomography angiography confirmed the presence of a lesion infiltrating the endometrium and myometrium containing arteriovenous structures with a highly enhanced effect. Despite these findings, the patient was clinically stable. A diagnosis of uterine AVM was made and, after accurate counselling with the patient, she was discharged and underwent “watch and wait” management. After 35 days, the patient had a follow-up ultrasound that showed a complete resolution of the uterine lesion. Conclusions: AVM should be considered in the presence of heavy and sudden vaginal bleeding in a patient with risk factors for acquired AVM. A color Doppler ultrasound scan should be performed as the first approach and an expectant management should be taken into account especially with a patient of childbearing age and hemodynamic instability.

Published
2018
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39. Severe Fetal Distress and Placental Damage Might Be Associated with High Troponin I (cTnI) Levels in Mothers

Author

Luca Mannini, Alessandro Terreni, Flavia Sorbi, Elisabetta Projetto, Viola Ghizzoni, Massimiliano Fambrini, Irene Turrini, Ivo Noci, and Francesca Castiglione

Subjects
Adult, medicine.medical_specialty, Placenta Diseases, Heart disease, Intrauterine growth restriction, Placental insufficiency, macromolecular substances, Fetal Hypoxia, Ultrasonography, Prenatal, 03 medical and health sciences, 0302 clinical medicine, Rare Diseases, Pregnancy, Internal medicine, Placenta, Troponin I, medicine, Fetal distress, Humans, cardiovascular diseases, Abortion, Therapeutic, Fetus, 030219 obstetrics & reproductive medicine, Fetal Growth Retardation, business.industry, Biopsy, Needle, General Medicine, Articles, medicine.disease, musculoskeletal system, Fetal Blood, Immunohistochemistry, Pregnancy Complications, medicine.anatomical_structure, Italy, Pregnancy Trimester, Second, embryonic structures, Cardiology, cardiovascular system, Disease Progression, Female, business, 030217 neurology & neurosurgery
Abstract

Patient: Female, 40 Final Diagnosis: cTnI elevation of unknown etiology Symptoms: Epigastric pain Medication: — Clinical Procedure: — Specialty: Obstetrics and Gynecology Objective: Unknown ethiology Background: Troponin I is the gold standard for the diagnosis of adult acute coronary syndrome. Although it is known that a hypoxic fetus may produce cTnI, fetal cTnI passage in maternal blood has never been documented. Case Report: We report a case where the rise of cTnI in the blood of a pregnant woman was not related to maternal heart disease. Instead, it might be suggestive of a fetal cardiac origin, as there was a severe placental insufficiency with a fetal intrauterine growth restriction. Conclusions: This study suggests that the rise of cTnI in maternal blood in a cardiovascular healthy pregnant woman might have a fetal origin. After having excluded any maternal causes, cTnI elevation could be explained with the transfer of fetal cTnI through an injured placenta.

Published
2018

40. Psychobiological Correlates of Vaginismus: An Exploratory Analysis

Author

Elisa Maseroli, Sarah Cipriani, Massimiliano Fambrini, Linda Vignozzi, Giovanni Corona, Irene Scavello, Mario Maggi, Edoardo Mannucci, and Manuela Palma

Subjects
Adult, medicine.medical_specialty, Cross-sectional study, Sexual Behavior, Urology, Endocrinology, Diabetes and Metabolism, Female sexual dysfunction, 030232 urology & nephrology, Comorbidity, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Risk Factors, Surveys and Questionnaires, Vaginismus, medicine, Humans, Sexual Dysfunctions, Psychological, Psychiatry, 030219 obstetrics & reproductive medicine, business.industry, Middle Aged, medicine.disease, Psychiatry and Mental health, Distress, Cross-Sectional Studies, Dyspareunia, Logistic Models, Reproductive Medicine, Case-Control Studies, Structured interview, Cohort, Female, business, Psychosocial, Clinical psychology
Abstract

Evidence concerning the determinants of vaginismus (V), in particular medical conditions, is inconclusive.To investigate, in a cohort of subjects consulting for female sexual dysfunction, whether there is a difference in medical and psychosocial parameters between women with V and women with other sexual complaints.A series of 255 women attending our clinic for female sexual dysfunction was consecutively recruited. V was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria. Lifelong and acquired V cases were included.Patients underwent a structured interview and physical, gynecologic, laboratory, and clitoral ultrasound examinations; they completed the Female Sexual Function Index (FSFI), the Middlesex Hospital Questionnaire, the Female Sexual Distress Scale-Revised (FSDS), and the Body Uneasiness Test.V was diagnosed in 20 patients (7.8%). Women with V were significantly younger than the rest of the sample (P.05). No differences were found for traditional risk factors such as a history of sexual abuse, relational parameters, or gynecologic diseases or for newly investigated parameters (ie, neurologic, hormonal, and metabolic alterations). Women with V showed significantly higher histrionic-hysterical symptoms and traits (as detected by MHQ-H score; P.05) compared with subjects with other sexual complaints. When the scores of all MHQ subscales were simultaneously introduced in a logistic model, the association between V and MHQ-H score was confirmed (P = .013). Women with V also showed higher FSFI pain and FSDS total scores, even after adjusting for age (P .05). In an age-adjusted model, FSDS total score increased as a function of the years of duration of V (P = .032) but not as a function of its severity. All observations were confirmed in a case-control study (ratio = 1:3).Our data demonstrate that some novel contributors of V should be investigated, namely histrionic-hysterical traits. This psychological comorbidity could offer valuable insights for intervention and managing complications.This is the first study to assess the role of many metabolic and hormonal parameters as potential determinants of V. The main limitation is its exploratory and cross-sectional nature; our data need to be confirmed in larger, more systematic analyses.V was associated with histrionic-hysterical traits, FSFI pain domain, and sex-related distress. A history of abuse, relational parameters, gynecologic diseases, and hormonal and metabolic alterations do not seem to play a role in the development of V. Maseroli E, Scavello I, Cipriani S, et al. Psychobiological Correlates of Vaginismus: An Exploratory Analysis. J Sex Med 2017;14:1392-1402.

Published
2017
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41. HPV genotype distribution and age correlation in a selected Italian population undergoing conization

Author

Valeria Dubini, Giulia Fantappiè, Flavia Sorbi, Massimiliano Fambrini, Francesca Malentacchi, Dora Pavone, Cecilia Bussani, Chiara Cocco, Felice Petraglia, Annalisa Pieralli, and Karin L Anderson

Subjects
Adult, medicine.medical_specialty, Genotype, Genotyping Techniques, Cross-sectional study, Conization, Cervix Uteri, Cervical intraepithelial neoplasia, Young Adult, Medicine, Humans, Young adult, Genotyping, Papillomaviridae, Aged, Colposcopy, medicine.diagnostic_test, business.industry, Obstetrics, Papillomavirus Infections, HPV infection, Age Factors, virus diseases, Obstetrics and Gynecology, Middle Aged, medicine.disease, Uterine Cervical Dysplasia, female genital diseases and pregnancy complications, Menopause, Cross-Sectional Studies, Italy, Female, Laser Therapy, business
Abstract

Background Detection and genotyping of human papillomavirus (HPV) has gained increasing importance in cervical cancer prevention and treatment of cervical intraepithelial neoplasia (CIN). This study aims to determine the HPV type distribution in cervical specimens obtained from women diagnosed with CIN. We evaluated in a selected Italian population the distribution of HPV genotypes. Methods Cervical samples were collected from women undergoing laser CO2 conization for high grade at Colposcopic Laser Surgery Unit of the Careggi University Hospital and at the Colposcopy Service of Local Health Unit Toscana Centro in Florence, Italy, between September 2014 and February 2017. HPV genotyping was performed using the LINEAR ARRAY® HPV Genotyping Test. Results Three hundred and six patients were enrolled. HPV infection was detected on 244 samples (79.7%). A different rate of mono- and poly-infections was observed, with higher poly-infection rates in younger women. Moreover, depending on different age groups (clustered in 5-years interval from 22 to 69 years old) significant different distribution of HPV was fund as genotype, phylogenetic type and cancer-related risk. Conclusions Our results suggest that some physiological conditions (i.e. menopause), could influence selection and clearance of specific HPV genotypes. The results of this study represent the basis for supporting the HPV genotyping as clinical tool providing benefits in the management of women with high CIN grade.

Published
2020

42. Past, present and future of adjuvant HIPEC in patients at high risk for colorectal peritoneal metastases

Author

Daniele Marrelli, Massimiliano Fambrini, Antonio Macrì, Luca Ansaloni, Marco Vaira, Nicola Cautero, Elena Orsenigo, Luigina Graziosi, Andrea Di Giorgio, Dario Baratti, Piero Vincenzo Lippolis, Anna Fagotti, Franco Decian, C. Sassaroli, F. Roviello, M. Robella, Federico Coccolini, Roberta Gelmini, Pietro Francesco Bagnoli, Massimo Framarini, Paolo Sammartino, Gian Luca Baiocchi, Giammaria Fiorentini, Paolo Delrio, Marcello Guaglio, Lorena Sorrentino, Stefano Scaringi, Matteo Montenovo, Davide Cavaliere, Antonio Sommariva, Alfredo Garofalo, Francesca Cabry, Valentina Bartolini, Shigeki Kusamura, Domenica Lorusso, Orietta Federici, Salvatore Asero, Marcello Deraco, Enrico Maria Pasqual, Roberto Cirocchi, Michele De Simone, and Mario Valle

Subjects
Oncology, medicine.medical_specialty, Colon-cancer, Colorectal cancer, medicine.medical_treatment, Mitomycin, colorectal cancer, peritoneal metastasis, colorectal peritoneal metastases, HIPEC, Anastomotic Leak, Hyperthermic Intraperitoneal Chemotherapy, Peritoneal Neoplasm, Pharmacotherapy, Postoperative Complications, Internal medicine, Antineoplastic Combined Chemotherapy Protocols, Medicine, Humans, In patient, Digestive System Surgical Procedures, Peritoneal Neoplasms, Chemotherapy, business.industry, General Medicine, Acute Kidney Injury, medicine.disease, Oxaliplatin, Colon-cancer, cancercarcinomatosis, Settore MED/40 - GINECOLOGIA E OSTETRICIA, Pancreatitis, Chemotherapy, Adjuvant, Surgery, Hyperthermic intraperitoneal chemotherapy, Cisplatin, cancercarcinomatosis, business, Colorectal Neoplasms, Adjuvant, medicine.drug
Published
2020

43. Intensive versus minimalist follow-up in patients treated for endometrial cancer: A multicentric randomized controlled trial (The TOTEM study—NCT00916708)

Author

Stefano Greggi, Paolo Zola, Luca Fuso, Daniela Di Cuonzo, Enrico Busato, Mario Valenzano Menada, Elena Peirano, Anna Myriam Perrone, L. Zavallone, Elisa Piovano, Annamaria Ferrero, Roberto Berretta, Massimiliano Fambrini, Francesca Chiudinelli, G Comerci, Vincenzo Dario Mandato, Marco Marinaccio, Serena Loda, Marco Adorni, and Giovannino Ciccone

Subjects
Cancer Research, medicine.medical_specialty, business.industry, Endometrial cancer, Cancer, medicine.disease, law.invention, Oncology, Randomized controlled trial, law, Internal medicine, Increased stress, Medicine, In patient, business
Abstract

5506 Background: Intensive follow-up in cancer patients, which absorbs a lot of health system resources and can be a source of increased stress for patients, are often proposed on the assumption that an early recognition of relapse will translate in better outcomes. In endometrial cancer few randomized controlled trials were conducted to assess the role of a reduced number of the scheduled visits and of different settings of the follow-up, but did not investigate the contribution of routine serum, cytological or imaging follow-up investigations in improving overall survival or quality of life. The TOTEM study was planned to compare an intensive (INT) vs minimalist (MIN) 5- year follow-up regimen in endometrial cancer patients in terms of overall survival (OS). Methods: Patients surgically treated for endometrial cancer, in complete clinical remission confirmed by imaging, FIGO stage I-IV, were stratified by center and in low (LoR) or high (HiR) risk of recurrence and then randomized to INT or MIN hospital-based follow-up regimens. The main study hypothesis was to demonstrate an improvement from 75% to 80% (expected hazard ratio, HR = 0.78) of the 5-year OS with the INT regimen. Secondary objectives were to compare relapse free survival (RFS), health-related quality of life (HRQL) assessed at baseline, at 6 and 12 months and then yearly (with the SF-12 Physical and Mental Health Summary Scale) and costs. Results: 1884 patients were randomized in 42 centers between 2008 and 2018, and 1847 patients were available for the final analysis (60% LoR). Compliance with the follow-up scheduled visits was 75.3%, similar between INT (74.7%) and MIN (75.9%) arms, whereas the mean number of recorded exams (laboratory or imaging) was markedly higher in the INT than in the MIN arms (9.7 vs 2.9, p < 0.0001). After a median follow-up of 66 months, the overall 5-year OS was 91.3%, 90.6% in the INT and 91.9% in the MIN arms, respectively (HR = 1.12, 95%CI 0.85-1.48, p = 0.429). Comparing the INT vs MIN arms, the 5-year OS were 94.1% and 96.8% (HR = 1.48, 0.92-2.37, p = 0.104) in the LoR and 85.3% and 84.7% (HR = 0.96, 0.68-1.36, p = 0.814) in the HiR group. No relevant differences emerged in RFS between INT and MIN regimens, (HR = 1.13, 0.87-1.48, p = 0.365). At the time of the relapse most women were asymptomatic (146/228, 64.0%), with a tendency of higher proportions in the INT than in the MIN arm, both in the LoR group (78.8% vs 61.1%, p = 0.070) and in the HiR one (64% vs 60%, p = 0.754). HRQL was available only for a subgroup of patients (50% at baseline) and did not differ between arms. Conclusions: Intensive follow-up in endometrial cancer treated patients showed a weak and uncertain advantage in detecting earlier asymptomatic relapses but did not improve OS, even in HiR patients, nor influenced HRQL. Frequent routine use of imaging and laboratory exams in these patients should be discouraged. Clinical trial information: NCT00916708.

Published
2021
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44. Differential Effects of Testosterone and Estradiol on Clitoral Function: An Experimental Study in Rats

Author

Elisa Maseroli, Massimiliano Fambrini, Paolo Comeglio, Ilaria Cellai, Edoardo Mannucci, Mario Maggi, Elena Maneschi, Sandra Filippi, Annamaria Morelli, Linda Vignozzi, C. Corno, and Francesca Corcetto

Subjects
medicine.medical_specialty, RHOA, Vascular smooth muscle, Pyridines, medicine.drug_class, Ovariectomy, Urology, Endocrinology, Diabetes and Metabolism, Sexual arousal, 030232 urology & nephrology, Clitoris, Nitric Oxide, Real-Time Polymerase Chain Reaction, Rats, Sprague-Dawley, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Endocrinology, Internal medicine, Nitriles, medicine, Animals, Testosterone, Cyclic GMP, Cyclic guanosine monophosphate, rho-Associated Kinases, 030219 obstetrics & reproductive medicine, Estradiol, biology, Muscle, Smooth, Triazoles, Amides, Rats, Psychiatry and Mental health, medicine.anatomical_structure, Reproductive Medicine, chemistry, Estrogen, Letrozole, biology.protein, Ovariectomized rat, Female, rhoA GTP-Binding Protein, Signal Transduction
Abstract

Introduction Female sexual response is a complex phenomenon in which psychological, neurologic, and vascular mechanisms and hormonal factors interact. During the arousal phase, they cooperate to increase genital blood flow, thus inducing engorgement of the clitoris and lubrication of the vagina. Regulation of vascular and non-vascular smooth muscle tone is the crucial event in the erectile process. Preclinical studies have suggested that nitric oxide (NO) is the main vasodilator neurotransmitter modulating, through the second messenger cyclic guanosine monophosphate (cGMP), clitoral flow vessels. Aim To investigate the effects of sexual steroid hormones on pro-erectile and relaxant (mediated by NO and cGMP) and anti-erectile and contractile (mediated by ras homolog gene family member A [RhoA] and Rho-associated protein kinase [ROCK]) mechanisms in the clitoris using a validated animal model of female ovariectomized Sprague-Dawley rats. Methods Subgroups of ovariectomized rats were treated with 17β-estradiol, progesterone, testosterone, or testosterone and letrozole for 6 weeks. The experimental groups were compared with a control group of intact rats. Main Outcome Measures Sex steroids plasma levels were assessed and in vitro contractility studies were carried out in order to investigate the effect of ovariectomy and in vivo treatments on clitoris smooth muscle activity. Smooth muscle cells (SMCs) from rat clitoral biopsies were isolated and characterized. RhoA activity was determined in SMCs cell cultures. RNA from tissues and cells was analyzed by quantitative real-time RT-PCR. Results Using real-time polymerase chain reaction, testosterone treatment upregulated the expression of NO-mediated pathway genes (endothelial and neuronal NO synthase, guanylate cyclase soluble subunit-α3, guanylate cyclase soluble subunit-β3, cGMP-dependent protein kinase 1, and phosphodiesterase type 5). Conversely, estrogen replacement upregulated the expression of calcium-sensitizing RhoA-ROCK pathway genes. In vitro contractility studies were performed on phenylephrine pre-contracted clitoris strips. Ovariectomy resulted in a decreased responsiveness to Y-27632, a ROCK inhibitor, which was fully restored by 17β-estradiol supplementation. To further examine the effect of 17β-estradiol on the RhoA-ROCK pathway, smooth muscle cells were isolated from rat clitoris and their migration capacity was evaluated. Conclusion Collectively, these data demonstrate that testosterone improves the relaxation of vascular smooth muscle cells through the NO-cGMP pathway, and that testosterone and 17β-estradiol are necessary to maintain a functional contractile and relaxant machinery in the clitoris. This new concept might provide support for the concomitant use of estrogen and testosterone during the treatment of sexual arousal disorders related to hormonal imbalance or insufficiency.

Published
2016
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45. Prognostic Significance of Transitional Cell Carcinoma-Like Morphology of High-Grade Serous Ovarian Carcinoma: A Comparative Study

Author

Tomi T. Kanninen, Massimiliano Fambrini, Giovanni Sisti, Dimitrios Nasioudis, and Mariarosaria Di Tommaso

Subjects
Adult, Oncology, medicine.medical_specialty, Adolescent, Serous carcinoma, Population, Cohort Studies, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Ovarian carcinoma, Carcinoma, medicine, Surveillance, Epidemiology, and End Results, Humans, Child, education, Aged, Aged, 80 and over, Ovarian Neoplasms, Carcinoma, Transitional Cell, education.field_of_study, 030219 obstetrics & reproductive medicine, business.industry, Ovary, Obstetrics and Gynecology, Middle Aged, Prognosis, medicine.disease, United States, Cystadenocarcinoma, Serous, Serous fluid, Transitional cell carcinoma, 030220 oncology & carcinogenesis, Female, business, SEER Program, Cohort study
Abstract

ObjectivesThis was a retrospective population-based study investigating the demographic characteristics, clinical characteristics, and prognosis of patients with ovarian high-grade serous carcinoma displaying transitional cell carcinoma-like (TC-like) morphological features.Materials and MethodsA cohort of patients diagnosed with ovarian high-grade serous carcinoma from 1988 to 2012 was drawn from the National Cancer Institute's Surveillance Epidemiology and End Results Database. Patients with transitional cell histology were included in the study group, whereas patients with other serous tumors served as controls. Demographic and clinical characteristics between the study and the control groups were compared using χ2 test. For surgically treated patients, survival was estimated by generation of Kaplan-Meier curves. Multivariate analysis was performed using the Cox regression method.ResultsA total of 29,716 patients met the inclusion criteria. From these, 264 patients (0.9%) were included in the TC-variant group, whereas 29,452 (99.1%) composed the control group. Patients with TC-variant tumors were younger and more likely to present with larger, unilateral tumors at an early disease stage. Surgically treated patients with advanced stage had a median disease-specific survival of 50 months compared with 40 months in the control group (P = 0.013). In that group, multivariate analysis confirmed that TC-like morphological features were an independent predictor of survival.ConclusionsHigh-grade serous carcinoma with TC-like morphological features was associated with unique demographic and clinical characteristics. For patients with advanced stage-disease, the presence of TC-like morphological features was associated with a superior survival.

Published
2016
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46. New adverse obstetrics outcomes associated with endometriosis: a retrospective cohort study

Author

Luca Mannini, Alberto Mattei, Viola Ghizzoni, Flavia Sorbi, Mariarosaria Di Tommaso, Federica Perelli, Ivo Noci, and Massimiliano Fambrini

Subjects
Adult, 0301 basic medicine, medicine.medical_specialty, medicine.medical_treatment, Endometriosis, Cholestasis, Intrahepatic, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Cholestasis, Pregnancy, Spontaneous conception, medicine, Humans, Retrospective Studies, Gynecology, 030219 obstetrics & reproductive medicine, Assisted reproductive technology, Obstetrics, business.industry, Incidence, Incidence (epidemiology), Infant, Newborn, Obstetrics and Gynecology, Retrospective cohort study, General Medicine, medicine.disease, Pregnancy Complications, 030104 developmental biology, Population study, Female, business
Abstract

The main aim of this study was to evaluate the incidence of endometriosis and intrahepatic cholestasis (ICP) and induction of labor in pregnant women with endometriosis compared with women without endometriosis. The secondary aim was to confirm increased incidence of already known endometriosis-related pregnancy complications in these patients. This is a retrospective cohort study performed at a tertiary hospital between January 2009 and December 2014 to compare obstetrics outcome between women with endometriosis and women without endometriosis. Pregnant patients with endometriosis were included in the study group. Patients were divided in the following subgroups: patients with deep infiltrating endometriosis (DIE subgroup) and patients without deep infiltrating endometriosis (non-DIE subgroup); patients with singleton pregnancy and spontaneous conception (subgroup A) and patients with multiple pregnancy and/or patients who underwent assisted reproductive technology (subgroup B). To form a control group, for each patient with endometriosis, two patients without endometriosis were selected as the control group by means of matched sample. The study population included 262 pregnant women with endometriosis and 524 controls. Patients of the study population had significantly increased risks of placenta praevia (p

Published
2016
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47. Which are the male factors associated with female sexual dysfunction (FSD)?

Author

Egidia Fanni, Edoardo Mannucci, Elisa Maseroli, Massimiliano Fambrini, Mario Maggi, Linda Vignozzi, and Emmanuele A. Jannini

Subjects
Adult, Male, medicine.medical_specialty, erectile dysfunction, Libido, Sexual Behavior, Urology, Endocrinology, Diabetes and Metabolism, media_common.quotation_subject, Female sexual dysfunction, 030232 urology & nephrology, relational factor, delayed ejaculation, Orgasm, Settore MED/13 - Endocrinologia, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, male sexual dysfunction, Premature ejaculation, medicine, Humans, Ejaculation, Sexual Dysfunctions, Psychological, media_common, Gynecology, 030219 obstetrics & reproductive medicine, Obstetrics, business.industry, male hypoactive sexual desire, Delayed ejaculation, Middle Aged, female sexual dysfunction, premature ejaculation, medicine.disease, Sexual desire, Sexual Partners, Erectile dysfunction, Reproductive Medicine, Anxiety, Female, medicine.symptom, Sexual function, business
Abstract

It has been generally assumed that partner's erectile dysfunction, premature, and delayed ejaculation play a significant role in determining female sexual dysfunction (FSD). This study aimed to evaluate the role of the male partner's sexual function, as perceived by women, in determining FSD. A consecutive series of 156 heterosexual women consulting our clinic for FSD was retrospectively studied. All patients underwent a structured interview and completed the Female Sexual Function Index (FSFI). FSFI total score decreased as a function of partner's age, conflicts within the couple, relationship without cohabitation and the habit of engaging in intercourse to please the partner; FSFI total score increased as a function of frequency of intercourse, attempts to conceive and fertility-focused intercourse. FSFI total score showed a negative, stepwise correlation with partner's perceived hypoactive sexual desire (HSD) (r = -0.327; p

Published
2016
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48. PS-2-4 Colordoppler Ultrasound in the Evaluation of the Cardiometabolic Profile in Women With Sexual Dysfunction: A Gender Perspective

Author

Felice Petraglia, Elisa Maseroli, Linda Vignozzi, V. Di Stasi, Massimiliano Fambrini, Sarah Cipriani, A. Magini, D. Menafra, Mario Maggi, Irene Scavello, and Nunzia Verde

Subjects
Psychiatry and Mental health, Endocrinology, Sexual dysfunction, Reproductive Medicine, business.industry, Urology, Endocrinology, Diabetes and Metabolism, Perspective (graphical), Ultrasound, medicine, medicine.symptom, business, Clinical psychology
Published
2020
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49. Hormones and Inflammation: An Update on Endometriosis

Author

Flavia Sorbi, Dora Pavone, Silvia Vannuccini, Massimiliano Fambrini, Irene Turrini, Tommaso Capezzuoli, and Felice Petraglia

Subjects
Infertility, medicine.drug_class, business.industry, Endometriosis, Inflammation, Disease, Bioinformatics, medicine.disease, Pathogenesis, Immune system, Estrogen, medicine, medicine.symptom, business, Hormone
Abstract

Endometriosis is a complex inflammatory, hormone-dependent disease that affects up to 10% of women in reproductive age, causing pain and infertility. Although the pathogenesis of this disease remains unknown, in the most recent decades, there has been a substantial progress toward unraveling the enigma associated with this disorder. The present chapter focuses on the influence of hormonal, immunological, and inflammatory pathways in the pathogenesis of endometriosis. The disease is characterized by an increased estrogen activity, which stimulates both eutopic and ectopic endometrial tissue proliferation; in addition, an aberrant response to progesterone, named progesterone resistance, has been shown. Stress hormones are involved in endometriosis pathogenesis. In the present chapter, the relevance of several key points in the inflammatory dysregulation contributing to endometriosis onset and progression, and related symptoms, will also be discussed. Immunological factors (cytokines, chemokines, and prostaglandins) as well as cell-mediated mechanisms play a major role in endometriosis-associated pain. Aberrant hormonal and inflammatory pathways contribute also to inflammatory comorbidities and adverse pregnancy outcome.

Published
2019
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50. Indication of prophylactic vaccines as a tool for secondary prevention in HPV-linked disease

Author

Giuseppe Cariti, Cecilia Bussani, Maria Grazia Fallani, Felice Petraglia, Claudia Bianchi, Alessandro Ghelardi, Massimiliano Fambrini, Gianfranco Scarselli, Annalisa Pieralli, and Noemi Auzzi

Subjects
medicine.medical_specialty, Disease, 03 medical and health sciences, symbols.namesake, 0302 clinical medicine, Cytology, Internal medicine, medicine, Secondary Prevention, Humans, 030212 general & internal medicine, Papillomavirus Vaccines, Prospective Studies, Fisher's exact test, Colposcopy, medicine.diagnostic_test, business.industry, Papillomavirus Infections, Obstetrics and Gynecology, General Medicine, Middle Aged, medicine.disease, Log-rank test, Vaccination, Exact test, Squamous intraepithelial lesion, 030220 oncology & carcinogenesis, symbols, Female, Neoplasm Recurrence, Local, business
Abstract

To determine whether quadrivalent HPV vaccination is effective in reducing recurrent disease in women with a previous history of HPV disease. All women under 45 years of age treated for HPV-linked disease and with negative HPV test, cytology and colposcopy 3 months after treatment were enrolled. Women were randomly assigned into two groups: a group that received HPV vaccine post treatment and a group that was only submitted to follow-up. Follow-up was performed every 6 months for a duration of at least 3 years. Kaplan–Meier curve was used to estimate the overall disease-free survival during the follow-up period. Statistical analysis was performed by Fisher’s exact test. From November 2013 to October 2014, we enrolled a total of 178 women at Careggi University Hospital in Florence and at Azienda USL in Massa Carrara. 12 out of 89 patients in the non-vaccination group recurred (13.5%), while 3 out of 89 patients in the vaccination group recurred (3.4%). The Kaplan–Meier curves showed a statistically difference in the log rank test (p = 0.0147) for the overall disease-free survival in the study groups during follow-up. The rate of recurrence was significantly higher in the non-vaccination group, with a p = 0.0279 by Fisher exact test. The introduction of anti-HPV vaccination during the follow-up post treatment for HPV-linked disease is recommended to reduce the risk of recurrence. The clinical implication of this could be very important to influence post-treatment management of HPV disease.

Published
2018

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