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Frontiers in Physiology 2024The literature has extensively investigated potential factors influencing women's performance, including the menstrual cycle and the circadian rhythm. However, review...
UNLABELLED
The literature has extensively investigated potential factors influencing women's performance, including the menstrual cycle and the circadian rhythm. However, review articles exploring the combined influence of both factors remain lacking in the literature. The study aimed to systematically review the literature on the relationship between the circadian rhythm and menstrual cycle on physical performance in women. The review followed the PRISMA guidelines. The search was performed on the Web of Science, PubMed, Scopus, SPORTDiscus, and Google Scholar databases. Of the 1205 records identified, four articles met the inclusion criteria. From four articles, two studies found a significant interaction between the time of day and phase of the menstrual cycle with physical performance. The isometric strength increased in the afternoon in the mid-luteal phase ( the morning in the mid-luteal phase, < 0.05), and the maximum cycling power was higher in the afternoon in the mid-follicular phase ( the morning in the mid-follicular phase, < 0.01). Our findings suggest that the time of day and the menstrual cycle phase affect physical performance, with the daytime potentially having a more significant influence. However, the results should be interpreted cautiously due to the limited studies and diverse methodologies used to monitor the menstrual cycle phase. This review reinforces the need for further investigation to understand better the combined effects of the circadian rhythm and menstrual cycle on women's physical performance.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=380965, identifier CRD42022380965.
PubMed: 38720785
DOI: 10.3389/fphys.2024.1347036 -
Reproductive Biology and Endocrinology... Feb 2024Biomarker identification could help in deciphering endometriosis pathophysiology in addition to their use in the development of non invasive diagnostic and prognostic... (Review)
Review
Biomarker identification could help in deciphering endometriosis pathophysiology in addition to their use in the development of non invasive diagnostic and prognostic approaches, that are essential to greatly improve patient care. Despite extensive efforts, no single potential biomarker or combination has been clinically validated for endometriosis.Many studies have investigated endometriosis-associated biological markers in specific tissues, but an integrative approach across tissues is lacking. The aim of this review is to propose a comprehensive overview of identified biomarkers based on tissue or biological compartment, while taking into account endometriosis phenotypes (superficial, ovarian or deep, or rASRM stages), menstrual cycle phases, treatments and symptoms.We searched PubMed and Embase databases for articles matching the following criteria: 'endometriosis' present in the title and the associated term 'biomarkers' found as Medical Subject Headings (MeSH) terms or in all fields. We restricted to publications in English and on human populations. Relevant articles published between 01 January 2005 (when endometriosis phenotypes start to be described in papers) and 01 September 2022 were critically analysed and discussed.Four hundred forty seven articles on endometriosis biomarkers that included a control group without endometriosis and provided specific information on endometriosis phenotypes are included in this review. Presence of information or adjustment controlling for menstrual cycle phase, symptoms and treatments is highlighted, and the results are further summarized by biological compartment. The 9 biological compartments studied for endometriosis biomarker research are in order of frequency: peripheral blood, eutopic endometrium, peritoneal fluid, ovaries, urine, menstrual blood, saliva, feces and cervical mucus. Adjustments of results on disease phenotypes, cycle phases, treatments and symptoms are present in 70%, 29%, 3% and 6% of selected articles, respectively. A total of 1107 biomarkers were identified in these biological compartments. Of these, 74 were found in several biological compartments by at least two independent research teams and only 4 (TNF-a, MMP-9, TIMP-1 and miR-451) are detected in at least 3 tissues with cohorts of 30 women or more.Integrative analysis is a crucial step to highlight potential pitfalls behind the lack of success in the search for clinically relevant endometriosis biomarkers, and to illuminate the physiopathology of this disease.
Topics: Humans; Female; Endometriosis; Biomarkers; Endometrium; Prognosis
PubMed: 38341605
DOI: 10.1186/s12958-023-01181-8 -
Women's Health (London, England) 2022Adolescent girls are more likely to develop anemia as a result of physical and physiological changes that place a greater strain on their nutritional needs. Primary... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Adolescent girls are more likely to develop anemia as a result of physical and physiological changes that place a greater strain on their nutritional needs. Primary studies, on the other hand, may not be sufficient to provide a complete picture of anemia in adolescent girls and its major risk factors.
OBJECTIVE
The study aimed to describe the pooled prevalence of adolescent girls' anemia and the factors that contribute.
METHODS
We conducted a systematic review of observational studies using the databases CINAHL (EBSCO), PubMed, Science Direct, Cochrane Library, and Google Scholar. The Newcastle-Ottawa Scale was used to assess the quality of the articles, and studies of fair to good quality were included. We pooled anemia prevalence among adolescents and odds ratio estimates for risk factors. Subgroup analysis employing sample size and study setup was computed to determine the source of heterogeneity, and the test was used to identify the existence or absence of substantial heterogeneity during subgroup analysis. The pooled prevalence of adolescent girls' anemia was calculated using a random-effects meta-analysis model.
RESULTS
The overall pooled prevalence of anemia among adolescent girls in Ethiopia was 23.03% (95% confidence interval: 17.07, 28.98). Low dietary diversity (odds ratio: 1.56; 95% confidence interval: 1.05, 2.32), illiterate mothers (odds ratio: 1.45; 95% confidence interval: 1.13, 1.86), household size greater than five (odds ratio: 1.65; 95% confidence interval: 1.14, 2.38), food-insecure households (odds ratio: 1.48; 95% confidence interval: 1.21, 1.82), and menstrual blood flow more than 5 days (odds ratio: 6.21; 95% confidence interval: 1.67, 23.12) were the identified factors associated with anemia among adolescent girls.
CONCLUSION
The pooled prevalence of anemia among adolescent girls in Ethiopia was moderately high. Therefore, to combat the burden of anemia among adolescent girls offering nutritional education is crucial. Iron supplementation is also recommended for adolescent females who have a menstrual cycle that lasts longer than 5 days.
Topics: Female; Adolescent; Humans; Literacy; Ethiopia; Anemia; Prevalence; Mothers
PubMed: 36345715
DOI: 10.1177/17455057221129398 -
Journal of Clinical Medicine Nov 2019Interest in cardiac vagal activity (CVA; e.g., parasympathetically-mediated heart rate variability) as a biomarker of physical and mental health has increased... (Review)
Review
Interest in cardiac vagal activity (CVA; e.g., parasympathetically-mediated heart rate variability) as a biomarker of physical and mental health has increased exponentially in recent years. However, the understanding of sources of within-person change (i.e., intra-individual variance) in CVA is lagging behind. This systematic review and meta-analysis summarizes and quantifies current empirical evidence of within-person changes in measures of CVA across the menstrual cycle in naturally-cycling premenopausal females. We conducted an extensive literature search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement in five databases to identify observational studies with repeated measures of CVA in at least two menstrual cycle phases. A broad meta-analysis ( = 37; = 1,004) revealed a significant CVA decrease from the follicular to luteal phase ( = -0.39, 95% CI (-0.67, -0.11)). Furthermore, 21 studies allowed for finer-grained comparisons between each of two cycle phases (menstrual, mid-to-late follicular, ovulatory, early-to-mid luteal, and premenstrual). Significant decreases in CVA were observed from the menstrual to premenstrual ( = 5; = 200; = -1.17, 95% CI (-2.18, -0.17)) and from the mid-to-late follicular to premenstrual phases ( = 8; = 280; = -1.32, 95% CI (-2.35, -0.29)). In conclusion, meta-analyses indicate the presence of CVA fluctuations across the menstrual cycle. Future studies involving CVA should control for cycle phase. Recommendations for covarying or selecting cycle phase are provided.
PubMed: 31726666
DOI: 10.3390/jcm8111946 -
The Cochrane Database of Systematic... Aug 2022Ovulation induction may impact endometrial receptivity due to insufficient progesterone secretion. Low progesterone is associated with poor pregnancy outcomes. (Review)
Review
BACKGROUND
Ovulation induction may impact endometrial receptivity due to insufficient progesterone secretion. Low progesterone is associated with poor pregnancy outcomes.
OBJECTIVES
To assess the effectiveness and safety of luteal phase support (LPS) in infertile women trying to conceive by intrauterine insemination or by sexual intercourse.
SEARCH METHODS
We searched the Cochrane Gynaecology and Fertility Group Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, LILACS, trial registries for ongoing trials, and reference lists of articles (from inception to 25 August 2021).
SELECTION CRITERIA
Randomised controlled trials (RCTs) of LPS using progestogen, human chorionic gonadotropin (hCG), or gonadotropin-releasing hormone (GnRH) agonist supplementation in IUI or natural cycle.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by Cochrane. Our primary outcomes were live birth rate/ongoing pregnancy rate (LBR/OPR) and miscarriage. MAIN RESULTS: We included 25 RCTs (5111 participants). Most studies were at unclear or high risk of bias. We graded the certainty of evidence as very low to low. The main limitations of the evidence were poor reporting and imprecision. 1. Progesterone supplement versus placebo or no treatment We are uncertain if vaginal progesterone increases LBR/OPR (risk ratio (RR) 1.10, 95% confidence interval (CI) 0.81 to 1.48; 7 RCTs; 1792 participants; low-certainty evidence) or decreases miscarriage per pregnancy compared to placebo or no treatment (RR 0.70, 95% CI 0.40 to 1.25; 5 RCTs; 261 participants). There were no data on LBR or miscarriage with oral stimulation. We are uncertain if progesterone increases LBR/OPR in women with gonadotropin stimulation (RR 1.24, 95% CI 0.80 to 1.92; 4 RCTs; 1054 participants; low-certainty evidence) and oral stimulation (clomiphene citrate or letrozole) (RR 0.97, 95% CI 0.58 to 1.64; 2 RCTs; 485 participants; low-certainty evidence). One study reported on OPR in women with gonadotropin plus oral stimulation; the evidence from this study was uncertain (RR 0.73, 95% CI 0.37 to 1.42; 1 RCT; 253 participants; low-certainty evidence). Given the low certainty of the evidence, it is unclear if progesterone reduces miscarriage per clinical pregnancy in any stimulation protocol (RR 0.68, 95% CI 0.24 to 1.91; 2 RCTs; 102 participants, with gonadotropin; RR 0.67, 95% CI 0.30 to 1.50; 2 RCTs; 123 participants, with gonadotropin plus oral stimulation; and RR 0.53, 95% CI 0.25 to 1.14; 2 RCTs; 119 participants, with oral stimulation). Low-certainty evidence suggests that progesterone in all types of ovarian stimulation may increase clinical pregnancy compared to placebo (RR 1.38, 95% CI 1.10 to 1.74; 7 RCTs; 1437 participants, with gonadotropin; RR 1.40, 95% CI 1.03 to 1.90; 4 RCTs; 733 participants, with gonadotropin plus oral stimulation (clomiphene citrate or letrozole); and RR 1.44, 95% CI 1.04 to 1.98; 6 RCTs; 1073 participants, with oral stimulation). 2. Progesterone supplementation regimen We are uncertain if there is any difference between 300 mg and 600 mg of vaginal progesterone for OPR and multiple pregnancy (RR 1.58, 95% CI 0.81 to 3.09; 1 RCT; 200 participants; very low-certainty evidence; and RR 0.50, 95% CI 0.05 to 5.43; 1 RCT; 200 participants, very low-certainty evidence, respectively). No other outcomes were reported for this comparison. There were three different comparisons between progesterone regimens. For OPR, the evidence is very uncertain for intramuscular (IM) versus vaginal progesterone (RR 0.59, 95% CI 0.34 to 1.02; 1 RCT; 225 participants; very low-certainty evidence); we are uncertain if there is any difference between oral and vaginal progesterone (RR 1.25, 95% CI 0.70 to 2.22; 1 RCT; 150 participants; very low-certainty evidence) or between subcutaneous and vaginal progesterone (RR 1.05, 95% CI 0.54 to 2.05; 1 RCT; 246 participants; very low-certainty evidence). We are uncertain if IM or oral progesterone reduces miscarriage per clinical pregnancy compared to vaginal progesterone (RR 0.75, 95% CI 0.43 to 1.32; 1 RCT; 81 participants and RR 0.58, 95% CI 0.11 to 3.09; 1 RCT; 41 participants, respectively). Clinical pregnancy and multiple pregnancy were reported for all comparisons; the evidence for these outcomes was very uncertain. Only one RCT reported adverse effects. We are uncertain if IM route increases the risk of adverse effects when compared with the vaginal route (RR 9.25, 95% CI 2.21 to 38.78; 1 RCT; 225 participants; very low-certainty evidence). 3. GnRH agonist versus placebo or no treatment No trials reported live birth. The evidence is very uncertain about the effect of GnRH agonist in ongoing pregnancy (RR 1.10, 95% CI 0.70 to 1.74; 1 RCT; 291 participants, very low-certainty evidence), miscarriage per clinical pregnancy (RR 0.73, 95% CI 0.26 to 2.10; 2 RCTs; 79 participants, very low-certainty evidence) and clinical pregnancy (RR 1.00, 95% CI 0.68 to 1.47; 2 RCTs; 340 participants; very low-certainty evidence), and multiple pregnancy (RR 0.28, 95% CI 0.11 to 0.70; 2 RCTs; 126 participants). 4. GnRH agonist versus vaginal progesterone The evidence for the effect of GnRH agonist injection on clinical pregnancy is very uncertain (RR 1.00, 95% CI 0.51 to 1.95; 1 RCT; 242 participants). 5. HCG injection versus no treatment The evidence for the effect of hCG injection on clinical pregnancy (RR 0.93, 95% CI 0.40 to 2.13; 1 RCT; 130 participants) and multiple pregnancy rates (RR 1.03, 95% CI 0.22 to 4.92; 1 RCT; 130 participants) is very uncertain. 6. Luteal support in natural cycle No study evaluated the effect of LPS in natural cycle. We could not perform sensitivity analyses, as there were no studies at low risk of selection bias and not at high risk in other domains.
AUTHORS' CONCLUSIONS
We are uncertain if vaginal progesterone supplementation during luteal phase is associated with a higher live birth/ongoing pregnancy rate. Vaginal progesterone may increase clinical pregnancy rate; however, its effect on miscarriage rate and multiple pregnancy rate is uncertain. We are uncertain if IM progesterone improves ongoing pregnancy rates or decreases miscarriage rate when compared to vaginal progesterone. Regarding the other reported comparisons, neither oral progesterone nor any other medication appears to be associated with an improvement in pregnancy outcomes (very low-certainty evidence).
Topics: Abortion, Spontaneous; Chorionic Gonadotropin; Clomiphene; Coitus; Female; Gonadotropin-Releasing Hormone; Humans; Insemination; Letrozole; Lipopolysaccharides; Live Birth; Luteal Phase; Pregnancy; Pregnancy Rate; Progesterone
PubMed: 36000704
DOI: 10.1002/14651858.CD012396.pub2 -
Biomedicines Jul 2023A better understanding of interindividual differences and the development of targeted therapies is one of the major challenges of modern medicine. The sex of a person... (Review)
Review
A better understanding of interindividual differences and the development of targeted therapies is one of the major challenges of modern medicine. The sex of a person plays a crucial role in this regard. This systematic review aimed to summarise and analyse available evidence on the mutual interactions between non-invasive brain stimulation and sex/polypeptide hormones. The PubMed database was searched from its inception to 31 March 2023, for (i) studies that investigated the impact of sex and/or polypeptide hormones on the effects induced by non-invasive brain stimulation, or (ii) studies that investigated non-invasive brain stimulation in the modulation of sex and/or polypeptide hormones. Eighteen studies (319 healthy and 96 disabled participants) were included. Most studies focused on female sex hormone levels during the menstrual cycle. The later follicular phase is associated with a weak between hemispheric and intracortical inhibition, strong intracortical facilitation, and high stimulation-induced neural and behavioural changes. The opposite effects are observed during the luteal phase. In addition, the participant's sex, presence and/or absence of real ovulation and increase in oestradiol level by chorionic gonadotropin injection influence the stimulation-induced neurophysiological and behavioural effects. In Parkinson's disease and consciousness disorders, the repetitive application of non-invasive brain stimulation increases oestradiol and dehydroepiandrosterone levels and reduces disability. To date, male hormones have not been sufficiently included in these studies. Here, we show that the sex and/or polypeptide hormones and non-invasive brain stimulation methods are in reciprocal interactions. This may be used to create a more effective and individualised approach for healthy individuals and individuals with disabilities.
PubMed: 37509620
DOI: 10.3390/biomedicines11071981 -
Frontiers in Public Health 2022Poor menstrual hygiene management (MHM) is linked to adverse health, and quality of life, particularly during emergencies. Although in recent times increased emphasis is...
BACKGROUND
Poor menstrual hygiene management (MHM) is linked to adverse health, and quality of life, particularly during emergencies. Although in recent times increased emphasis is being laid upon MHM during humanitarian crises-pandemics, disasters and conflicts, the essential components of complete MHM during an emergency are not clearly spelt out. We conducted a systematic review to examine, analyse and describe the existing evidence related to the challenges experienced by women and girls in practicing MHM during humanitarian crises and / or public health emergencies.
METHODS
We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines and registered in PROSPERO (CRD42022328636). We searched online repositories: PubMed, Embase, and PsycINFO for articles published between January 2000 and April 2022. For presenting key findings, we used the descriptive statistics and thematic analysis approach.
RESULTS
We identified a total of 1,078 published articles, out of which 78 were selected for a full-text review, and finally 21 articles were included. The pooled prevalence of lack of access to sanitary pads during humanitarian crises was 34 percent (95 percent CI 0.24-0.45). The prevalence of safe and proper sanitary pad disposal practices ranged from 11 to 85 per cent, with a pooled prevalence of 54 per cent (95 per cent CI 0.21-86). Qualitative analyses projected three themes that emerged on MHM during humanitarian crises (1) Availability and affordability of menstrual products, and accessibility to water, sanitation and health (WASH) services, (2) Availability of support system and coping with "period poverty," and (3) Gender dimensions of menstrual hygiene management. Most studies reported non-availability of MHM products and WASH services during emergencies. Existence of barriers at systemic and personal level posed challenges in practicing menstrual hygiene. Privacy was identified as a common barrier, as emergency shelters were reportedly not women-friendly.
CONCLUSION
Availability of limited evidence on the subject is suggestive of the need to invest resources for strengthening primary research in low- and middle-income countries and more specifically during emergencies. Context-specific state level policies on MHM during emergencies would help to guide district and sub-district managers in strengthening systems and address barriers for the provision of MHM services during emergencies.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022328636, identifier CRD42022328636.
Topics: Developing Countries; Emergencies; Female; Humans; Hygiene; Menstruation; Quality of Life; Relief Work; Water
PubMed: 36249215
DOI: 10.3389/fpubh.2022.1018092 -
Expert Reviews in Molecular Medicine Dec 2023In vitro fertilization (IVF) and embryo transfer and intracytoplasmic sperm injection (ICSI) have allowed millions of infertile couples to achieve pregnancy. As an... (Meta-Analysis)
Meta-Analysis Review
Live birth rate of gonadotropin-releasing hormone antagonist versus luteal phase gonadotropin-releasing hormone agonist protocol in IVF/ICSI: a systematic review and meta-analysis.
In vitro fertilization (IVF) and embryo transfer and intracytoplasmic sperm injection (ICSI) have allowed millions of infertile couples to achieve pregnancy. As an essential part of IVF/ICSI enabling the retrieval of a high number of oocytes in one cycle, controlled ovarian stimulation (COS) treatment mainly composes of the standard long gonadotrophin-releasing hormone agonist (GnRH-a) protocol and the gonadotrophin-releasing hormone antagonist (GnRH-ant) protocol. However, the effectiveness of GnRH-ant protocol is still debated because of inconsistent conclusions and insufficient subgroup analyses. This systematic review and meta-analysis included a total of 52 studies, encompassing 5193 participants in the GnRH-ant group and 4757 in the GnRH-a group. The findings of this study revealed that the GnRH-ant protocol is comparable with the long GnRH-a protocol when considering live birth as the primary outcome, and it is a favourable protocol with evidence reducing the incidence of ovarian hyperstimulation syndrome in women undergoing IVF/ICSI, especially in women with polycystic ovary syndrome. Further research is needed to compare the subsequent cumulative live birth rate between the two protocols among the general and poor ovarian response patients since those patients have a lower clinical pregnancy rate, fewer oocytes retrieved or fewer high-grade embryos in the GnRH-ant protocol.
Topics: Female; Humans; Male; Pregnancy; Birth Rate; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Hormone Antagonists; Luteal Phase; Meta-Analysis as Topic; Ovulation Induction; Semen; Sperm Injections, Intracytoplasmic; Systematic Reviews as Topic
PubMed: 38095077
DOI: 10.1017/erm.2023.25 -
Frontiers in Psychology 2021We review original papers on ovarian-hormone status in two areas of emotional processing: facial emotion recognition and emotional memory. Ovarian-hormone status is... (Review)
Review
BACKGROUND
We review original papers on ovarian-hormone status in two areas of emotional processing: facial emotion recognition and emotional memory. Ovarian-hormone status is operationalized by the levels of the steroid sex hormones 17β-estradiol (E2) and progesterone (P4), fluctuating over the natural menstrual cycle and suppressed under oral contraceptive (OCs) use. We extend previous reviews addressing single areas of emotional processing. Moreover, we systematically examine the role of stimulus features such as emotion type or stimulus valence and aim at elucidating factors that reconcile the inconsistent results.
METHODS
We followed the (PRISMA) guidelines and included papers published until September 2020 indexed in PubMed and Web of Science databases. Search terms were MeSH terms (emotional OR emotion) AND () AND (estrogen OR progesterone OR menstrual cycle OR oral contraceptives) with () representing our separately searched areas, resulting in (processing OR recognition OR empathy), and (memory OR recall). To be included, articles had to (1) be written and published in English, (2) examine healthy, non-pregnant adult women in their reproductive age, and (3) measure or at least estimate levels of E2 and P4. In , the search was (4) limited to humans and (5) to the search term present in the title or abstract.
RESULTS
Features of the provided stimulus material (emotion type and/or valence) constitute a relevant influence that interacts with E2- and P4-related ovarian-hormone status. For instance, recognition of basic emotions appears to be more related to P4- than E2-levels. Quite consistent, OC intake (vs. natural menstrual cycling) was accompanied by impaired recognition accuracy of basic and also complex emotions, although not in a recent large-sample study assessing complex emotions. Memory recall of negative content was mainly enhanced by P4, especially after having been stressed.
DISCUSSION AND CONCLUSION
We document the methodological diversity in the field, presumably contributing to the heterogeneity of results. More studies explicitly contrasting the early follicular phase, mid-cycle phase, mid-luteal, and OC intake while standardizing tasks are needed. Research would take advantage of using within-subject designs and accounting for the recognition of complex emotions.
PubMed: 34093322
DOI: 10.3389/fpsyg.2021.641250 -
International Journal of Women's... Dec 2019Sex hormones are important in female sexual physiology, growth, and homeostasis. Through skin receptors, sex hormones contribute to the dermatologic pathology known as... (Review)
Review
BACKGROUND
Sex hormones are important in female sexual physiology, growth, and homeostasis. Through skin receptors, sex hormones contribute to the dermatologic pathology known as catamenial dermatoses.
OBJECTIVE
This study aims to summarize the literature on catamenial dermatoses and menses-induced exacerbations of chronic dermatoses.
METHODS
This systematic review used the PRISMA method. PubMed was searched using the terms "menses" and "skin" in July 2018, and an assessment was conducted of the relevant literature on skin diseases related to non-pathologic menstruation, such as polycystic ovarian syndrome. Pathology associated with androgenetic acne was excluded from the study.
RESULTS
A total of 102 studies with 1269 female patients were included. The most commonly reported primary catamenial dermatoses were autoimmune progesterone dermatitis and autoimmune estrogen dermatitis. The most commonly reported chronic skin disorders exacerbated by menses were psoriasis, Behcet's disease, and eczematous dermatoses.
CONCLUSION
Physicians should be aware of the nature of catamenial dermatoses and their presentation with normal sexual physiology. Patients with chronic dermatoses should be appropriately counseled on menstruation-related exacerbations. Further research needs to be conducted to determine the interplay between immune regulation and sex hormones in catamenial dermatoses and to elucidate effective therapies.
PubMed: 31909158
DOI: 10.1016/j.ijwd.2019.09.008