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1. Neoadjuvant chemotherapy does not increase peri-operative morbidity following radical cystectomy

Author

Arora, Amandeep, Zugail, Ahmed S., Pugliesi, Felipe, Cathelineau, Xavier, Macek, Petr, Barbé, Yann, Karnes, R. Jeffrey, Ahmed, Mohamed, Di Trapani, Ettore, Soria, Francesco, Alvarez-Maestro, Mario, Montorsi, Francesco, Briganti, Alberto, Necchi, Andrea, Pradere, Benjamin, D’Andrea, David, Krajewski, Wojciech, Roumiguié, Mathieu, Bajeot, Anne Sophie, Hurle, Rodolfo, Contieri, Roberto, Carando, Roberto, Teoh, Jeremy Yuen-Chun, Roupret, Morgan, Benamran, Daniel, Ploussard, Guillaume, Mir, M. Carmen, Sanchez-Salas, Rafael, and Moschini, Marco

Published
2022
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3. Survival Outcomes After Immediate Radical Cystectomy Versus Conservative Management with Bacillus Calmette-Guérin Among T1 High-grade Micropapillary Bladder Cancer Patients: Results from a Multicentre Collaboration

Author

Lonati, Chiara, Baumeister, Philipp, Afferi, Luca, Mari, Andrea, Minervini, Andrea, Krajewski, Wojciech, Azizi, Sosan, Hendricksen, Kees, Martini, Alberto, Necchi, Andrea, Montorsi, Francesco, Briganti, Alberto, Colombo, Renzo, Tafuri, Alessandro, Antonelli, Alessandro, Cerruto, Maria Angela, Rouprêt, Morgan, Masson-Lecomte, Alexandra, Laukhtina, Ekaterina, D’Andrea, David, Shariat, Shahrokh F., Soria, Francesco, Marra, Giancarlo, Gontero, Paolo, Contieri, Roberto, Hurle, Rodolfo, Valiquette, Anne Sophie, Mir, M. Carmen, Zamboni, Stefania, Simeone, Claudio, Klatte, Tobias, Teoh, Jeremy Yuen-Chun, Yoshida, Soichiro, Fujii, Yasuhisa, Carando, Roberto, Schulz, Gerald B., Mordasini, Livio, Mattei, Agostino, and Moschini, Marco

Published
2022
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4. Carboplatin-based adjuvant chemotherapy versus observation after radical cystectomy in patients with pN1-3 urothelial bladder cancer

Author

Afferi, Luca, Lonati, Chiara, Montorsi, Francesco, Briganti, Alberto, Necchi, Andrea, Mari, Andrea, Minervini, Andrea, Campi, Riccardo, di Trapani, Ettore, de Cobelli, Ottavio, Karnes, R. Jeffrey, Ahmed, Mohamed, Mir, M. Carmen, Algarra, Maria Asuncion, Rink, Michael, Zamboni, Stefania, Simeone, Claudio, Krajewski, Wojciech, Xylinas, Evanguelos, Soria, Francesco, Hendricksen, Kees, Einerhand, Sarah, Mattei, Agostino, Carando, Roberto, Roumiguié, Mathieu, Bajeot, Anne Sophie, Black, Peter C., Shariat, Shahrokh F., and Moschini, Marco

Published
2022
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5. Immediate radical cystectomy versus BCG immunotherapy for T1 high-grade non-muscle-invasive squamous bladder cancer: an international multi-centre collaboration

Author

Lonati , Chiara, Afferi, Luca, Mari, Andrea, Minervini, Andrea, Krajewski, Wojciech, Borghesi, Marco, Schulz, Gerald B., Rink, Michael, Montorsi, Francesco, Briganti, Alberto, Colombo, Renzo, Martini, Alberto, Necchi, Andrea, Contieri, Roberto, Hurle, Rodolfo, Umari, Paolo, Zamboni, Stefania, Simeone, Claudio, Soria, Francesco, Marra, Giancarlo, Gontero, Paolo, Teoh, Jeremy Yuen-Chun, Klatte, Tobias, Bajeot, Anne-Sophie, Roumiguié, Mathieu, Rouprêt, Morgan, Masson-Lecomte, Alexandra, Laukhtina, Ekaterina, Valiquette, Anne Sophie, Mir, M. Carmen, Antonelli, Alessandro, Einerhand, Sarah M. H., Hendricksen, Kees, Carando, Roberto, Fankhauser, Christian D., Baumeister, Philipp, Mattei, Agostino, Shariat, Shahrokh F., and Moschini, Marco

Published
2022
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6. Novel Classification for Upper Tract Urothelial Carcinoma to Better Risk-stratify Patients Eligible for Kidney-sparing Strategies: An International Collaborative Study

Author

Marcq, Gautier, Foerster, Beat, Abufaraj, Mohammad, Matin, Surena F., Azizi, Mounsif, Gupta, Mohit, Li, Wei-Ming, Seisen, Thomas, Clinton, Timothy, Xylinas, Evanguelos, Mir, M. Carmen, Schweitzer, Donald, Mari, Andrea, Kimura, Shoji, Bandini, Marco, Mathieu, Romain, Ku, Ja H., Guruli, Georgi, Grabbert, Markus, Czech, Anna K., Muilwijk, Tim, Pycha, Armin, D’Andrea, David, Petros, Firas G., Spiess, Philippe E., Bivalacqua, Trinity, Wu, Wen-Jeng, Rouprêt, Morgan, Krabbe, Laura-Maria, Hendricksen, Kees, Egawa, Shin, Briganti, Alberto, Moschini, Marco, Graffeille, Vivien, Autorino, Riccardo, John, Patricia, Heidenreich, Axel, Chlosta, Piotr, Joniau, Steven, Soria, Francesco, Pierorazio, Phillip M., Shariat, Shahrokh F., and Kassouf, Wassim

Published
2022
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7. Multi-Center Assessment of Lymph-Node Density and Nodal-Stage to Predict Disease-Specific Survival in Patients with Bladder Cancer Treated by Radical Cystectomy

Author

van Gennep, Erik J., primary, Claps, Francesco, additional, Bostrom, Peter J., additional, Shariat, Shahrokh F., additional, Neuzillet, Yann, additional, Zlotta, Alexandre R., additional, Trombetta, Carlo, additional, Eckstein, Markus, additional, Mertens, Laura S., additional, Bussani, Rossana, additional, Burger, Maximilian, additional, Boormans, Joost L., additional, Wullich, Bernd, additional, Hartmann, Arndt, additional, Mayr, Roman, additional, Pavan, Nicola, additional, Bartoletti, Riccardo, additional, Mir, M. Carmen, additional, Pouessel, Damien, additional, van der Hoeven, John, additional, van der Kwast, Theo H., additional, Allory, Yves, additional, Zuiverloon, Tahlita C.M., additional, Lotan, Yair, additional, and van Rhijn, Bas W.G., additional

Published
2024
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8. Risk factors associated with positive surgical margins’ location at radical cystectomy and their impact on bladder cancer survival

Author

Claps, Francesco, van de Kamp, Maaike W., Mayr, Roman, Bostrom, Peter J., Boormans, Joost L., Eckstein, Markus, Mertens, Laura S., Boevé, Egbert R., Neuzillet, Yann, Burger, Maximilian, Pouessel, Damien, Trombetta, Carlo, Wullich, Bernd, van der Kwast, Theo H., Hartmann, Arndt, Allory, Yves, Lotan, Yair, Shariat, Shahrokh F., Zuiverloon, Tahlita C. M., Mir, M. Carmen, and van Rhijn, Bas W. G.

Published
2021
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9. Upfront versus deferred cytoreductive nephrectomy following targeted or immunotherapy: a population-based propensity score-matched analysis of perioperative complications.

Author

Ditonno, Francesco, Bologna, Eugenio, Licari, Leslie Claire, Franco, Antonio, Pettenuzzo, Greta, Leonardo, Costantino, Proietti, Flavia, Carbonara, Umberto, Mir, M. Carmen, Crivellaro, Simone, Veccia, Alessandro, Bertolo, Riccardo, Antonelli, Alessandro, and Autorino, Riccardo

Subjects
SURGICAL complications, IMMUNOTHERAPY, NEPHRECTOMY, RENAL cell carcinoma, PROTEIN-tyrosine kinase inhibitors, IMMUNE checkpoint inhibitors
Abstract

Purpose: To evaluate the incidence of postoperative complications after cytoreductive nephrectomy (CN) following first-line treatment for metastatic renal cell carcinoma (mRCC), and to compare it with postoperative complications of upfront CN. Methods: For this population-based retrospective study, the PearlDiver Mariner database (PearlDiver Technologies, Colorado Springs, CO), a database of insurance billing records was analyzed. Using relevant ICD-9/10 and CPT codes, patients diagnosed with mRCC between 2011 and 2021, who received first-line systemic molecular therapy (SMT), either tyrosine kinase inhibitors (TKI) or immune-checkpoint inhibitors (ICI), were identified. The selected population was stratified into two cohorts according to the timing of CN (deferred: after SMT vs. upfront: before SMT). Propensity-score matching (PSM) was performed as per baseline patients' characteristics to control for potential confounders between the two cohorts. The primary outcome was to compare 30-day postoperative complications rate between patients undergoing upfront vs. deferred CN. Results: After PSM, 162 patients who received upfront CN were compared with 162 patients who underwent deferred CN. The overall rate of 30-day postoperative complications was statistically significantly higher in patients undergoing deferred CN (33.9%), compared to patients treated with upfront CN (21%, p < 0.01). In addition, the rate of both medical (26.5% vs. 14.2%, p < 0.01) and surgical (14.8 vs. 7.4%, p = 0.03) complication rate was statistically significantly higher in deferred vs. upfront CN. Multivariable logistic regression analysis revealed that none of the treatment regimens significantly predicted the occurrence of postoperative complications. Conclusion: Patients undergoing deferred CN experience a higher rates of overall, medical, and surgical 30-day postoperative complications compared to those receiving upfront surgery. Findings from this study should be interpreted within the limitations of this type of analysis. [ABSTRACT FROM AUTHOR]

Published
2024
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10. PD09-04 PREDICTION OF 90-DAY MORTALITY AFTER RADICAL CYSTECTOMY FOR BLADDER CANCER IN LARGE-SCALE MULTICENTER COLLABORATION STUDY

Author

Laukhtina, Ekaterina, primary, Maier, Elisabeth, additional, Schuettfort, Victor M., additional, Lonati, Chiara, additional, Soria, Francesco, additional, Albisinni, Simone, additional, Krajewski, Wojciech, additional, Basile, Giuseppe, additional, Ploussard, Guillaume, additional, Yuen-Chun Teoh, Jeremy, additional, Pradere, Benjamin, additional, D`Andrea, David, additional, Mori, Keiichiro, additional, Salas, Rafael Sanchez, additional, Mir, M. Carmen, additional, Simeone, Claudio, additional, Zamboni, Stefania, additional, Mattei, Agostino, additional, Carando, Roberto, additional, Fisch, Margit, additional, Xylinas, Evanguelos, additional, May, Matthias, additional, Roghmann, Florian, additional, Enikeev, Dmitry, additional, Briganti, Alberto, additional, Montorsi, Francesco, additional, Shariat, Shahrokh F., additional, Moschini, Marco, additional, and Aziz, Atiqullah, additional

Published
2023
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11. A systematic review and meta-analysis to evaluate the diagnostic accuracy of PSMA PET/CT in the initial staging of prostate cancer

Author

Mari, Andrea, Cadenar, Anna, Giudici, Sofia, Cianchi, Gemma, Albisinni, Simone, Autorino, Riccardo, Di Maida, Fabrizio, Gandaglia, Giorgio, Mir, M. Carmen, Valerio, Massimo, Marra, Giancarlo, Zattoni, Fabio, Bianchi, Lorenzo, Lombardo, Riccardo, Shariat, Shahrokh F., Roupret, Morgan, Bauckneht, Matteo, Vaggelli, Luca, De Nunzio, Cosimo, and Minervini, Andrea

Abstract

Background: Positron Emission Tomography-Computed Tomography using Prostate-Specific Membrane Antigen (PSMA PET/CT) is notable for its superior sensitivity and specificity in detecting recurrent PCa and is under investigation for its potential in pre-treatment staging. Despite its established efficacy in nodal and metastasis staging in trial setting, its role in primary staging awaits fuller validation due to limited evidence on oncologic outcomes. This systematic review and meta-analysis aims to appraise the diagnostic accuracy of PSMA PET/CT compared to CI for comprehensive PCa staging. Methods: Medline, Scopus and Web of science databases were searched till March 2023. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies. Primary outcomes were specificity, sensitivity, positive predictive value (PPV) and negative predictive value (NPV) of PSMA PET/CT for local, nodal and metastatic staging in PCa patients. Due to the unavailability of data, a meta-analysis was feasible only for detection of seminal vesicles invasion (SVI) and LNI. Results: A total of 49 studies, comprising 3876 patients, were included. Of these, 6 investigated accuracy of PSMA PET/CT in detection of SVI. Pooled sensitivity, specificity, PPV and NPV were 42.29% (95%CI: 29.85–55.78%), 87.59% (95%CI: 77.10%–93.67%), 93.39% (95%CI: 74.95%–98.52%) and 86.60% (95%CI: 58.83%–96.69%), respectively. Heterogeneity analysis revealed significant variability for PPV and NPV. 18 studies investigated PSMA PET/CT accuracy in detection of LNI. Aggregate sensitivity, specificity, PPV and NPV were 43.63% (95%CI: 34.19–53.56%), 85.55% (95%CI: 75.95%–91.74%), 67.47% (95%CI: 52.42%–79.6%) and 83.61% (95%CI: 79.19%–87.24%). No significant heterogeneity was found between studies. Conclusions: The present systematic review and meta-analysis highlights PSMA PET-CT effectiveness in detecting SVI and its good accuracy in LNI compared to CI. Nonetheless, it also reveals a lack of high-quality research on its performance in clinical T staging, extraprostatic extension and distant metastasis evaluation, emphasizing the need for further rigorous studies.

Published
2024
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12. Prognostic impact of variant histologies in urothelial bladder cancer treated with radical cystectomy

Author

Claps, Francesco, primary, van de Kamp, Maaike W., additional, Mayr, Roman, additional, Bostrom, Peter J., additional, Shariat, Shahrokh F., additional, Hippe, Katrin, additional, Bertz, Simone, additional, Neuzillet, Yann, additional, Sanders, Joyce, additional, Otto, Wolfgang, additional, van der Heijden, Michiel S., additional, Jewett, Michael A.S., additional, Stöhr, Robert, additional, Zlotta, Alexandre R., additional, Trombetta, Carlo, additional, Eckstein, Markus, additional, Mertens, Laura S., additional, Burger, Maximilian, additional, Soorojebally, Yanish, additional, Wullich, Bernd, additional, Bartoletti, Riccardo, additional, Radvanyi, François, additional, Pavan, Nicola, additional, Sirab, Nanour, additional, Mir, M. Carmen, additional, Pouessel, Damien, additional, van der Kwast, Theo H., additional, Hartmann, Arndt, additional, Lotan, Yair, additional, Bussani, Rossana, additional, Allory, Yves, additional, and van Rhijn, Bas W.G., additional

Published
2023
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14. Selecting the Best Candidates for Cisplatin-based Adjuvant Chemotherapy After Radical Cystectomy Among Patients with pN+ Bladder Cancer

Author

Afferi, Luca, primary, Lonati, Chiara, additional, Montorsi, Francesco, additional, Briganti, Alberto, additional, Necchi, Andrea, additional, Mari, Andrea, additional, Minervini, Andrea, additional, Tellini, Riccardo, additional, Campi, Riccardo, additional, Schulz, Gerald Bastian, additional, Black, Peter C., additional, di Trapani, Ettore, additional, de Cobelli, Ottavio, additional, Karnes, R. Jeffrey, additional, Ahmed, Mohamed, additional, Mir, M. Carmen, additional, Algarra, Maria Asuncion, additional, Rink, Michael, additional, Zamboni, Stefania, additional, Mondini, Francesca, additional, Simeone, Claudio, additional, Antonelli, Alessandro, additional, Tafuri, Alessandro, additional, Krajewski, Wojciech, additional, Małkiewicz, Bartosz, additional, Xylinas, Evanguelos, additional, Soria, Francesco, additional, Sanchez Salas, Rafael, additional, Arora, Amandeep, additional, Cathelineau, Xavier, additional, Hendricksen, Kees, additional, Ammiwala, Maida, additional, Borghesi, Marco, additional, Chierigo, Francesco, additional, Teoh, Jeremy Yuen-Chun, additional, Mattei, Agostino, additional, Albisinni, Simone, additional, Roghmann, Florian, additional, Roumiguié, Mathieu, additional, Bajeot, Anne Sophie, additional, Maier, Elisabeth, additional, Aziz, Atiqullah, additional, Hurle, Rodolfo, additional, Contieri, Roberto, additional, Pradere, Benjamin, additional, Carando, Roberto, additional, Poyet, Cedric, additional, Alvarez-Maestro, Mario, additional, D'Andrea, David, additional, Shariat, Shahrokh F., additional, and Moschini, Marco, additional

Published
2022
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15. Active Surveillance for Small Renal Masses

Author

Kauffman, Eric C., primary, Ball, Mark W., additional, Barod, Ravi, additional, Capitanio, Umberto, additional, Finelli, Antonio, additional, Mir, M. Carmen, additional, Schuch, Brian, additional, Smaldone, Mark C., additional, Tran, Maxine G.B., additional, and Pierorazio, Phillip M., additional

Published
2022
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20. MP54-16 IMMEDIATE RADICAL CYSTECTOMY VS. BCG IMMUNOTHERAPY FOR T1 HIGH GRADE NON-MUSCLE-INVASIVE BLADDER CANCER: AN INTERNATIONAL MULTICENTRE COLLABORATION

Author

Lonati, Chiara, primary, Afferi, Luca, additional, Mari, Andrea, additional, Minervini, Andrea, additional, Krajewski, Wojciech, additional, Borghesi, Marco, additional, Schulz, Gerald B., additional, Rink, Michael, additional, Montorsi, Francesco, additional, Briganti, Alberto, additional, Martini, Alberto, additional, Zamboni, Stefania, additional, Simeone, Claudio, additional, Soria, Francesco, additional, Teoh, Jeremy Y. C., additional, Roumiguié, Mathieu, additional, Roupret, Morgan, additional, Mir, M. Carmen, additional, Antonelli, Alessandro, additional, Hendricksen, Kees, additional, Carando, Roberto, additional, Fankhauser, Christian D., additional, Baumeister, Philipp, additional, Mattei, Agostino, additional, Shariat, Shahrokh F., additional, and Moschini, Marco, additional

Published
2022
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21. MP23-11 PERIOPERATIVE COMPLICATIONS AFTER RADICAL CYSTECTOMY FOR BLADDER CANCER: AN INTERNATIONAL MULTICENTER COLLABORATION

Author

Lonati, Chiara, primary, Afferi, Luca, additional, Di Trapani, Ettore, additional, Zamboni, Stefania, additional, Simeone, Claudio, additional, Briganti, Alberto, additional, Montorsi, Francesco, additional, Simone, Giuseppe, additional, Soria, Francesco, additional, Mir, M. Carmen, additional, Sanchez-Salas, Rafael, additional, Roumiguié, Mathieu, additional, Antonelli, Alessandro, additional, Hendricksen, Kees, additional, Mattei, Agostino, additional, Fankhauser, Christian D., additional, Carando, Roberto, additional, Teoh, Jeremy Y.C., additional, Shariat, Shahrokh F., additional, Albisinni, Simone, additional, Hurle, Rodolfo, additional, Peroni, Angelo, additional, Xylinas, Evanguelos, additional, Krajewski, Wojciech, additional, Roupret, Morgan, additional, and Moschini, Marco, additional

Published
2022
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24. Risk factors associated with positive surgical margins’ location at radical cystectomy and their impact on bladder cancer survival

Author

Yair Lotan, Markus Eckstein, Maaike W. van de Kamp, Tahlita C.M. Zuiverloon, Bernd Wullich, Yann Neuzillet, Shahrokh F. Shariat, Joost L. Boormans, Egbert R. Boevé, Bas W.G. van Rhijn, Francesco Claps, Theo van der Kwast, M. Carmen Mir, Carlo Trombetta, Peter J. Boström, Yves Allory, Roman Mayr, Laura S. Mertens, Damien Pouessel, Arndt Hartmann, Maximilian Burger, Urology, Claps, Francesco, van de Kamp, Maaike W, Mayr, Roman, Bostrom, Peter J, Boormans, Joost L, Eckstein, Marku, Mertens, Laura S, Boevé, Egbert R, Neuzillet, Yann, Burger, Maximilian, Pouessel, Damien, Trombetta, Carlo, Wullich, Bernd, van der Kwast, Theo H, Hartmann, Arndt, Allory, Yve, Lotan, Yair, Shariat, Shahrokh F, Zuiverloon, Tahlita C M, Mir, M Carmen, and van Rhijn, Bas W G

Subjects
Male, medicine.medical_specialty, Urology, medicine.medical_treatment, Bladder, Cystectomy, Cohort Studies, Cancer, Margin, Soft tissue, Ureter, Urethra, Urothelial carcinoma, SDG 3 - Good Health and Well-being, Risk Factors, medicine, Humans, Stage (cooking), Risk factor, Aged, Bladder cancer, business.industry, Margins of Excision, Odds ratio, Middle Aged, medicine.disease, Survival Rate, medicine.anatomical_structure, Urinary Bladder Neoplasms, Concomitant, Cohort, Female, business
Abstract

Purpose: To evaluate the risk factors associated with positive surgical margins' (PSMs) location and their impact on disease-specific survival (DSS) in patients with bladder cancer (BCa) undergoing radical cystectomy (RC). Methods: We analyzed a large multi-institutional cohort of patients treated with upfront RC for non-metastatic (cT1-4aN0M0) BCa. Multivariable binomial logistic regression analyses were used to assess the risk of PSMs at RC for each location after adjusting for clinicopathological covariates. The Kaplan–Meier method was used to estimate DSS stratified by margins’ status and location. Log-rank statistics and Cox’ regression models were used to determine significance. Results: A total of 1058 patients were included and 108 (10.2%) patients had PSMs. PSMs were located at soft-tissue, ureter(s), and urethra in 57 (5.4%), 30 (2.8%) and 21 (2.0%) patients, respectively. At multivariable analysis, soft-tissue PSMs were independently associated with pathological stage T4 (pT4) (Odds ratio (OR) 6.20, p < 0.001) and lymph-node metastases (OR 1.86, p = 0.04). Concomitant carcinoma-in-situ (CIS) was an independent risk factor for ureteric PSMs (OR 6.31, p = 0.003). Finally, urethral PSMs were independently correlated with pT4-stage (OR 5.10, p = 0.01). The estimated 3-years DSS rates were 58.2%, 32.4%, 50.1%, and 40.3% for negative SMs, soft-tissue-, ureteric- and urethral PSMs, respectively (log-rank; p < 0.001). Conclusions: PSMs’ location represents distinct risk factors’ patterns. Concomitant CIS was associated with ureteric PSMs. Urethral and soft-tissue PSM showed worse DSS rates. Our results suggest that clinical decision-making paradigms on adjuvant treatment and surveillance might be adapted based on PSM and their location.

Published
2021

26. 2022 WUOF/SIU International Consultation on Urological Diseases: Active Surveillance for Small Renal Masses.

Author

Kauffman EC, Ball MW, Barod R, Capitanio U, Finelli A, Mir MC, Shuch B, Smaldone MC, Tran MGB, and Pierorazio PM

Abstract

With greater awareness of indolence underlying small renal masses (SRM ≤ 4 cm) and the morbidity of invasive treatment, active surveillance for SRM patients is being increasingly utilized on an international level. This synopsis summarizes the 2022 review and expert opinion recommendations provided to the International Consultation of Urological Diseases (ICUD) by 10 urologists from high-volume active surveillance practices at international centers. Topics reviewed include SRM biology and clinical behavior, current national and international guidelines for active surveillance of SRM patients, active surveillance utilization patterns and barriers to implementation, outcomes and limitations of the active surveillance literature, criteria for active surveillance patient selection, protocols for active surveillance management including frequency/modality of imaging and the role of renal tumor biopsy, triggers for delayed intervention during active surveillance including tumor factors and patient factors, and pathological outcomes of delayed intervention. We conclude that despite limitations of the current literature, active surveillance is a safe initial management strategy for many SRM patients. The slow growth and low metastatic potential of SRMs, combined with no evidence to suggest oncologic compromise with delay to treatment, should provide confidence to both patients and providers who are considering active surveillance. Future research for prioritization should include characterization of long-term active surveillance outcomes including rates of metastasis and delayed intervention, standardization of objective tumor progression criteria for triggering delayed intervention, and further delineation of the role for active surveillance in young and healthy patients., Competing Interests: Competing Interests None declared.

Published
2022
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