Prenatal diagnosis of rhombencephalosynapsis: neuroimaging features and severity of vermian anomaly.


Journal

Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
ISSN: 1469-0705
Titre abrégé: Ultrasound Obstet Gynecol
Pays: England
ID NLM: 9108340

Informations de publication

Date de publication:
Dec 2021
Historique:
revised: 24 03 2021
received: 20 01 2021
accepted: 16 04 2021
pubmed: 5 5 2021
medline: 28 12 2021
entrez: 4 5 2021
Statut: ppublish

Résumé

To describe the prenatal neuroimaging spectrum of rhombencephalosynapsis (RES) and criteria for its classification according to the severity of vermian anomaly. In this multicenter retrospective study of fetuses with RES between 2002 and 2020, the medical records and brain ultrasound and magnetic resonance images were evaluated comprehensively to determine the severity of the vermian anomaly and the presence of associated brain findings. RES was classified, according to the pattern of vermian agenesis and the extent of the fusion of the hemispheres, as complete RES (complete absence of the vermis) or partial RES (further classified according to the part of the vermis that was missing and, consequently, the region of hemispheric fusion, as anterior, posterior, severe or mixed RES). Findings were compared between cases with complete and those with partial RES. Included in the study were 62 fetuses with a gestational age ranging between 12 and 37 weeks. Most had complete absence of the vermis (complete RES, 77.4% of cases), a 'round-shaped' cerebellum on axial views (72.6%) and a transverse cerebellar diameter (TCD) < 3 This study provides prenatal neuroimaging criteria for the diagnosis and classification of RES, and identification of related features, using ultrasound and magnetic resonance imaging. According to our findings, a diagnosis of RES should be considered in fetuses with a small TCD (severe cerebellar hypoplasia) and/or a round-shaped cerebellum on axial views, during the second or third trimester, especially when associated with ventriculomegaly. Partial RES is more common than previously thought, but presents an extreme diagnostic challenge, especially in cases with normal or nearly-normal cerebellar morphobiometric features. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Identifiants

pubmed: 33942916
doi: 10.1002/uog.23660
doi:

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

864-874

Informations de copyright

© 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Références

Utsunomiya H, Takano K, Ogasawara T, Hashimoto T, Fukushima T, Okazaki M. Rhombencephalosynapsis: cerebellar embryogenesis. AJNR Am J Neuroradiol 1998; 19: 547-549.
Rivera-Zengotita M, Yachnis A. Cerebellar Heterotopia and Dysplasia. In Developmental Neuropathology, Adle-Biassette H, Harding B, Golden J (eds). Wiley-Blackwell: Oxford, 2018; 100-104.
Millonig JH, Millen KJ, Hatten ME. The mouse Dreher gene Lmx1a controls formation of the roof plate in the vertebrate CNS. Nature 2000; 403: 764-769.
Pasquier L, Marcorelles P, Loget P, Pelluard F, Carles D, Perez MJ, Bendavid C, de La Rochebrochard C, Ferry M, David V, Odent S, Laquerrière A. Rhombencephalosynapsis and related anomalies: a neuropathological study of 40 fetal cases. Acta Neuropathol 2009; 117: 185-200.
Garfinkle W. Aventriculy: a new entity? AJNR Am J Neuroradiol 1996; 17: 1649-1650.
Ishak GE, Dempsey JC, Shaw DWW, Tully H, Adam M, Sanchez-Lara P, Glass I, Rue TC, Millen KJ, Dobyns WB, Doherty D. Rhombencephalosynapsis: A hindbrain malformation associated with incomplete separation of midbrain and forebrain, hydrocephalus and a broad spectrum of severity. Brain 2012; 135: 1370-1386.
Sener RN. Unusual MRI findings in rhombencephalosynapsis. Comput Med Imaging Graph 2000; 24: 277-282.
Tully HM, Dempsey JC, Ishak GE, Adam MP, Curry CJ, Sanchez-Lara P, Hunter A, Gripp KW, Allanson J, Cunniff C, Glass I, Millen KJ, Doherty D, Dobyns WB. Beyond Gómez-López-Hernández syndrome: Recurring phenotypic themes in rhombencephalosynapsis. Am J Med Genet Part A 2012; 158 A: 2393-2406.
Purvis DJ, Ramirez A, Roberts N, Harper JI. Gomez-Lopez-Hernandez syndrome: another consideration in focal congenital alopecia. Br J Dermatol 2007; 157: 196-198.
Rush E, Adam M, Clark RD, Curry C, Hartmann JE, Dobyns WB, Olney AH. Four new patients with Gomez-Lopez-Hernandez syndrome and proposed diagnostic criteria. Am J Med Genet A 2013; 161A: 320-326.
McAuliffe F, Chitayat D, Halliday W, Keating S, Shah V, Fink M, Nevo O, Ryan G, Shannon P, Blaser S. Rhombencephalosynapsis: Prenatal imaging and autopsy findings. Ultrasound Obstet Gynecol 2008; 31: 542-548.
Arisoy R, Erdogdu E, Pekin O, Tugrul S, Aydin H, Yorganci C. A rare case of rhombencephalosynapsis and prenatal diagnosis. J Obstet Gynaecol (Lahore) 2016; 36: 839-841.
Bekiesińska-Figatowska M, Jurkiewicz E, Szkudlińska-Pawlak S, Malczyk K, Nowak K. Rhombencephalosynapsis - Isolated anomaly or complex malformation? Polish J Radiol 2012; 77: 35-38.
Izzo G, Conte G, Cesaretti C, Parazzini C, Bulfamante G, Righini A. Prenatal Magnetic Resonance Imaging of Atypical Partial Rhombencephalosynapsis with Involvement of the Anterior Vermis: Two Case Reports. Neuropediatrics 2015; 46: 416-419.
Koprivsek KM, Novakov-Mikic AS, Lucic MA, Kozic DB, Till VE, Belopavlovic Z. Partial rhombencephalosynapsis: prenatal MR imaging diagnosis and postnatal follow up. Acta Neurol Belg 2011; 111: 157-159.
Heaphy-Henault KJ, Guimaraes CV, Mehollin-Ray AR, Cassady CI, Zhang W, Desai NK, Paldino MJ. Congenital aqueductal stenosis: Findings at fetal MRI that accurately predict a postnatal diagnosis. Am J Neuroradiol 2018; 39: 942-948.
Haratz KK, Shulevitz SL, Leibovitz Z, Lev D, Shalev J, Tomarkin M, Malinger G, Lerman-Sagie T, Gindes L. Fourth ventricle index: sonographic marker for severe fetal vermian dysgenesis/agenesis. Ultrasound Obstet Gynecol 2019; 53: 390-395.
Dill P, Poretti A, Boltshauser E, Huisman TAGM. Fetal magnetic resonance imaging in midline malformations of the central nervous system and review of the literature IRM foetale dans les malformations de la ligne médiane du système nerveux central et revue de la littérature. J Neuroradiol 2009; 36: 138-146.
Cagneaux M, Vasiljevic A, Massoud M, Allias F, Massardier, Gaucherand P, Guibaud L. Severe second-trimester obstructive ventriculomegaly related to disorders of diencephalic, mesencephalic and rhombencephalic differentiation. Ultrasound Obstet Gynecol 2013; 42: 596-602.
Leibovitz Z, Shkolnik C, Haratz KK, Malinger G, Shapiro I, Lerman-Sagie T. Assessment of fetal midbrain and hindbrain in mid-sagittal cranial plane by three-dimensional multiplanar sonography. Part 1: comparison of new and established nomograms. Ultrasound Obstet Gynecol 2014; 44: 575-580.
Gálvez CV, Huete I, Hernández M. Congenital Hydrocephalus: Gómez-López-Hernández syndrome. An underdiagnosed Syndrome. A clinical case. Rev Chil Pediatr 2018; 89: 92-97.
Kline-Fath BM, Arroyo MS, Calvo-Garcia MA, Horn PS, Thomas C. Prenatal aqueduct stenosis: Association with rhombencephalosynapsis and neonatal outcome. Prenat Diagn 2018; 38: 1028-1034.
Whitehead MT, Choudhri AF, Grimm J, Nelson MD. Rhombencephalosynapsis as a cause of aqueductal stenosis: an under-recognized association in hydrocephalic children. Pediatr Radiol 2014; 44: 849-856.
Napolitano M, Righini A, Zirpoli S, Rustico M, Nicolini U, Triulzi F. Prenatal magnetic resonance imaging of rhombencephalosynapsis and associated brain anomalies: report of 3 cases. J Comput Assist Tomogr 2004; 28: 762-765.
Bernardo S, Vinci V, Saldari M, Servadei F, Silvestri E, Giancotti A, Aliberti C Porpora MG, Triulzi F, Rizzo G, Catalano C, Manganaro L. Dandy-Walker Malformation: is the “tail sign” the key sign? Prenat Diagn 2015; 35: 1358-1364.
Kennedy A, Patel J. 2090497 Prenatal Diagnosis And Outcome in a Series of Fetuses with Rhombencephalosynapsis. Ultrasound Med Biol 2015; 41: S85.
De Keersmaecker B, Albert M, Hillion Y, Ville Y. Prenatal diagnosis of brain abnormalities in Wolf-Hirschhorn (4p-) syndrome. Prenat Diagn 2002; 22: 366-370.
Tan T, McGillivray G, Goergen S, White S. Prenatal magnetic resonance imaging in Gomez-Lopez-Hernandez syndrome and review of the literature. Am J Med Genet A 2005; 138: 369-373.
Macé P, Ville Y, Bessiere B, Quarello E. Early diagnosis of rhombencephalosynapsis: the limits of intracranial translucency at first trimester screening and a plea for an assessment of the aqueduct of Sylvius. Ultrasound Obstet Gynecol 2021; 57: 846-848.
Sergi C, Hentze S, Sohn C, Voigtländer T, Jung C, Schmitt H. Telencephalosynapsis (synencephaly) and rhombencephalosynapsis with posterior fossa ventriculocele (‘Dandy-Walker cyst’): an unusual aberrant syngenetic complex. Brain Dev 1997; 19: 426-432.
di Vera E, Liberati M, Celentano C, Liberati M, Celentano C, Calabrese G, Guanciali-Franchi PE, Morizio E, Rotmensch S. Rhombencephalosynapsis in a severely polymalformed fetus with non-mosaic tetrasomy 9p, in intracytoplasmic-sperm-injection pregnancy. J Assist Reprod Genet 2008; 25: 577-580.
Gursoy Erzincan S, Karamustafaoglu Balci B, Tokgoz C, Kalelioglu I. Incidence of an Aberrant Right Subclavian Artery on Second-Trimester Sonography in an Unselected Population. J Ultrasound Med 2017; 36: 1015-1019.
Gupta A, Fazal TS, Kumar A, Mehta S, Saini P. Prenatal Diagnosis of Rhombencephalosynapsis. J Fetal Med 2017; 4: 41-45.
Isaac M, Best P. Two cases of agenesis of the vermis of cerebellum, with fusion of the dentate nuclei and cerebellar hemispheres. Acta Neuropathol 1987; 74: 278-280.
Viñals F, Ruiz P, Quiroz G, Guerra FA, Correa F, Martínez D, Puerto B. Two-Dimensional Ultrasound Evaluation of the Fetal Cerebral Aqueduct: Improving the Antenatal Diagnosis and Counseling of Aqueductal Stenosis. Fetal Diagn Ther 2017; 42: 278-284.
Achiron R, Kivilevitch Z, Lipitz S, Gamzu R, Almog B, Zalel Y. Development of the human fetal pons: in utero ultrasonographic study. Ultrasound Obstet Gynecol 2004; 24: 506-510.
Hill L, Martin J, Fries J, Hixson J. The role of the transcerebellar view in the detection of fetal central nervous system anomaly. Am J Obstet Gynecol 1991; 164: 1220-1224.
Tilea B, Alberti C, Adamsbaum C, Armoogum P, Oury JF, Cabrol D, Sebag G, Kalifa G, Garel C. Cerebral biometry in fetal magnetic resonance imaging: new reference data. Ultrasound Obstet Gynecol 2009; 33: 173-181.
Garel C, Fallet-Bianco C, Guibaud L. The Fetal Cerebellum. J Child Neurol 2011; 26: 1483-1492.
Birnbaum R, Parodi S, Donarini G, Meccariello G, Fulcheri E, Paladini D. The third ventricle of the human fetal brain: Normative data and pathologic correlation. A 3D transvaginal neurosonography study. Prenat Diagn 2018; 38: 664-672.
Malinger G, Ginath S, Lerman-Sagie T, Watemberg N, Lev D, Glezerman M. The fetal cerebellar vermis : normal development as shown by transvaginal ultrasound. Prenat Diagn 2001; 21: 687-692.
Obersteiner H. Ein Kleinhirn ohne Wurm. Arb Neurol Inst 1914; 21: 124-136.
Truwit C, Barkovich A, Shanahan R, Maroldo T. MR imaging of rhombencephalosynapsis: report of three cases and review of the literature. AJNR Am J Neuroradiol 1991; 12: 957-965.
Guleria S, Kelly TG, Maheshwari M, Segall HD. An Atypical Case of Chiari II Malformation Mimicking Partial Rhombencephalosynapsis. Neuroradiol J 2012; 25: 528-532.
Bell BD, Stanko HA, Levine RL. Normal IQ in a 55-year-old with newly diagnosed rhombencephalosynapsis. Arch Clin Neuropsychol 2005; 20: 613-621.
Poretti A, Alber FD, Bürki S, Toelle SP, Boltshauser E. Cognitive outcome in children with rhombencephalosynapsis. Eur J Paediatr Neurol 2009; 13: 28-33.
Bonnetain M-F, Rougeot-Jung C, Sarret C, Lion-François L, Olivier R, Peyric E, Velazquez-Dominguez J, Miret A, Rossi M, Massoud M, Laurichesse - Delmas H, Guibaud L, Portes V. Normal intellectual skills in patients with Rhombencephalosynapsis. Eur J Paediatr Neurol 2020; 29: 92-100.
Salomon LJ, Alfirevic Z, Berghella V, Bilardo C, Hernandez-Andrade E, Johnsen SL, Kalache K, Leung KY, Malinger G, Munoz H, Prefumo F, Toi A, Lee W. Practice guidelines for performance of the routine mid-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol 2011; 37: 116-126.
Peter G. Barth. Rhombencephalosynapsis: new findings in a larger study. Brain 2012; 135: 1344-1347.
Poretti A, Boltshauser E. Fetal Diagnosis of Rhombencephalosynapsis. Neuropediatrics 2015; 46: 357-358.
Triulzi F, Parazzini C, Righini A. Magnetic resonance imaging of fetal cerebellar development. Cerebellum 2006; 5: 199-205.
Manegold-Brauer G, Oseledchyk A, Floeck A, Berg C, Gembruch U, Geipel A. Approach to the sonographic evaluation of fetal ventriculomegaly at 11 to 14 weeks gestation. BMC Pregnancy Childbirth 2016; 16.
Kline-Fath BM, Arroyo MS, Calvo-Garcia MA, Horn PS, Thomas C. Congenital aqueduct stenosis: Progressive brain findings in utero to birth in the presence of severe hydrocephalus. Prenat Diagn 2018; 38: 706-712.
Mak CCY, Doherty D, Lin AE, Vegas N, Cho MT, Viot G, Dimartino C, Weisfeld-Adams JD, Lessel A, Joss S, Li C, Gonzaga-Jauregui C, Zarate YA, Ehmke, N Horn, D Troyer, C Kant SG, Lee Y, Ishak GE, Leung G, Barone Pritchard A, Yang S, Bend EG, Filippini F, Roadhouse C, Lebrun N, Mehaffey M G, Martin PM, Apple B, Millan F, Puk O, Hoffer MJV, Henderson LB, McGowan R, Wentzensen IM, Pei S, Zahir FR, Yu M, Gibson WT, Seman A, Steeves M, Murrell JR, Luettgen S, Francisco E, Strom TM, Amlie-Wolf L, Kaindl AM, Wilson WG, Halbach S, Basel-Salmon L, Lev-El N, Denecke J, Vissers LELM, Radtke K, Chelly J, Zackai E, Friedman JM, Bamshad MJ, Nickerson DA, Reid RR, Devriendt K, Chae JH, Stolerman E, McDougall C, Powis Z, Bienvenu T, Tan TY, Orenstein N, Dobyns WB, Shieh JT, Choi M, Waggoner D, Gripp KWJ, Parker M, Stoler J, Lyonnet S, Cormier-Daire V, Viskochil D, Hoffman TH, Amie J, Chung BHY, Gordon CT. MN1 C-terminal truncation syndrome is a novel neurodevelopmental and craniofacial disorder with partial rhombencephalosynapsis. Brain 2020; 143: 55-68.
Yachnis AT. Rhombencephalosynapsis with massive hydrocephalus: case report and pathogenetic considerations. Acta Neuropathol 2002; 103: 301-304.
Sarnat HB. Molecular genetic classification of central nervous system malformations. J Child Neurol 2000; 15: 675-687.
Weaver J, Manjila S, Bahuleyan B, Bangert BA, Cohen AR. Rhombencephalosynapsis: embryopathology and management strategies of associated neurosurgical conditions with a review of the literature. J Neurosurg Pediatr 2013; 11: 320-326.

Auteurs

K Krajden Haratz (K)

Fetal Neurology Multidisciplinary Group, Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

P Oliveira Szejnfeld (P)

Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro, Brazil.
DDI UNIFESP, São Paulo, Brazil.
Fundação Instituto de Pesquisa e Estudo de Diagnostico por Imagem, São Paulo, Brazil.

M Govindaswamy (M)

Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

Z Leibovitz (Z)

Ultrasound in Obstetrics and Gynecology Unit, Bnai-Zion Medical Center, Haifa, Israel.
Technion Faculty of Medicine, Haifa, Israel.
Fetal Neurology Clinic, Ultrasound in Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel.

L Gindes (L)

Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Fetal Neurology Clinic, Ultrasound in Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel.

M Severino (M)

Neuroradiology Unit, IRCCS Istituto Giannini Gaslini, Genoa, Italy.

A Rossi (A)

Neuroradiology Unit, IRCCS Istituto Giannini Gaslini, Genoa, Italy.
Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.

D Paladini (D)

Fetal Medicine Unit, IRCCS Istituto G. Gaslini, Genoa, Italy.

R Garcia Rodriguez (R)

Complejo Hospitalario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain.

L Ben-Sira (L)

Fetal Neurology Multidisciplinary Group, Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Pediatric Radiology Unit, Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.

T Borkowski Tillman (T)

Fetal Neurology Multidisciplinary Group, Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.

R Gupta (R)

Sunehri Devi Hospital, Sonepat India, Indraprastha Apollo Hospital, New Delhi, India.

G Lotem (G)

Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel.

N Raz (N)

Technion Faculty of Medicine, Haifa, Israel.
Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hedera, Israel.

T E N K Hamamoto (TENK)

Departamento de Obstetrícia da Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil.

D Kidron (D)

Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Pathology, Meir Medical Center, Kfar Saba, Israel.

A Arad (A)

Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Pathology, Bnai Zion Medical Center, Haifa, Israel.

R Birnbaum (R)

Fetal Neurology Multidisciplinary Group, Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

M Brussilov (M)

Fetal Neurology Multidisciplinary Group, Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

L Pomar (L)

Ultrasound and Fetal Medicine Unit, Department Woman-Mother-Child, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland.

Y Vial (Y)

Ultrasound and Fetal Medicine Unit, Department Woman-Mother-Child, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland.

R J Leventer (RJ)

Department of Neurology, The Royal Children's Hospital, Murdoch Children's Research Institute and University of Melbourne Department of Pediatrics, Melbourne, Australia.

G McGillivray (G)

Royal Women's Hospital, Mercy Hospital for Women and Murdoch Children's Research Institute, Melbourne, Australia.

M Fink (M)

Department of Medical Imaging, The Royal Children's Hospital and Perinatal Unit, The Mercy Hospital for Women, Melbourne, Australia.

W Krzeszowski (W)

Salve Medica, Lodz, Poland.

A Fernandes Moron (A)

Departamento de Obstetrícia da Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil.

D Lev (D)

Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Fetal Neurology Clinic, Ultrasound in Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel.
Institute of Genetics, Wolfson Medical Center, Holon, Israel.

M Tamarkin (M)

Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Fetal Neurology Clinic, Ultrasound in Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel.

J Shalev (J)

Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Fetal Neurology Clinic, Ultrasound in Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel.
Institute of Genetics, Wolfson Medical Center, Holon, Israel.

J Har Toov (J)

Fetal Neurology Multidisciplinary Group, Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

T Lerman-Sagie (T)

Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Fetal Neurology Clinic, Ultrasound in Obstetrics and Gynecology Unit, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel.
Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel.

G Malinger (G)

Fetal Neurology Multidisciplinary Group, Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female
Humans United States Aged Cross-Sectional Studies Medicare Part C
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH