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Published in: Orphanet Journal of Rare Diseases 1/2020

Open Access 01-12-2020 | Review

Consensus based recommendations for diagnosis and medical management of Poland syndrome (sequence)

Authors: Ilaria Baldelli, Alessio Baccarani, Chiara Barone, Francesca Bedeschi, Sebastiano Bianca, Olga Calabrese, Marco Castori, Nunzio Catena, Massimo Corain, Sara Costanzo, Giacomo De Paoli Barbato, Santa De Stefano, Maria Teresa Divizia, Francesco Feletti, Matteo Formica, Mario Lando, Margherita Lerone, Fulvio Lorenzetti, Carlo Martinoli, Lorenzo Mellini, Maurizio Bruno Nava, Giuseppe Porcellini, Aldamaria Puliti, Maria Victoria Romanini, Franco Rondoni, Pierluigi Santi, Silvana Sartini, Filippo Senes, Lucia Spada, Luigi Tarani, Maura Valle, Cristina Venturino, Federico Zaottini, Michele Torre, Marco Crimi

Published in: Orphanet Journal of Rare Diseases | Issue 1/2020

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Abstract

Background

Poland syndrome (OMIM: 173800) is a disorder in which affected individuals are born with missing or underdeveloped muscles on one side of the body, resulting in abnormalities that can affect the chest, breast, shoulder, arm, and hand. The extent and severity of the abnormalities vary among affected individuals.

Main body

The aim of this work is to provide recommendations for the diagnosis and management of people affected by Poland syndrome based on evidence from literature and experience of health professionals from different medical backgrounds who have followed for several years affected subjects. The literature search was performed in the second half of 2019. Original papers, meta-analyses, reviews, books and guidelines were reviewed and final recommendations were reached by consensus.

Conclusion

Being Poland syndrome a rare syndrome most recommendations here presented are good clinical practice based on the consensus of the participant experts.
Literature
1.
go back to reference Hasson F, Keeney S, McKenna H. Research guidelines for the Delphi survey technique. J Adv Nurs. 2000;32:1008–15.PubMed Hasson F, Keeney S, McKenna H. Research guidelines for the Delphi survey technique. J Adv Nurs. 2000;32:1008–15.PubMed
2.
go back to reference Poland A. Deficiency of the pectoral muscles. Guy’s Hosp Rep. 1841;6:191. Poland A. Deficiency of the pectoral muscles. Guy’s Hosp Rep. 1841;6:191.
3.
go back to reference Gocmen H, Akkas Y, Doganay S. Poland syndrome: rare presentation in two cases. N Z Med J. 2010;123(1321):71–7.PubMed Gocmen H, Akkas Y, Doganay S. Poland syndrome: rare presentation in two cases. N Z Med J. 2010;123(1321):71–7.PubMed
4.
go back to reference Al–Qattan MM. Classification of hand anomalies in Poland’s syndrome. Br J Plast Surg. 2001;54:132–6.PubMed Al–Qattan MM. Classification of hand anomalies in Poland’s syndrome. Br J Plast Surg. 2001;54:132–6.PubMed
5.
go back to reference Catena N, Divizia MT, Calevo MG, Baban A, Torre M, Ravazzolo R, et al. Hand and upper limb anomalies in Poland syndrome: a new proposal of classification. J Pediatr Orthop. 2012;32(7):727–31.PubMed Catena N, Divizia MT, Calevo MG, Baban A, Torre M, Ravazzolo R, et al. Hand and upper limb anomalies in Poland syndrome: a new proposal of classification. J Pediatr Orthop. 2012;32(7):727–31.PubMed
6.
go back to reference Kim YH, Kwon WJ, Park SI. Anesthetic experience during reconstruction surgery of a chest wall defect in a patient with Poland syndrome: a case report. Korean J Anesthesiol. 2009;57(5):652–5.PubMed Kim YH, Kwon WJ, Park SI. Anesthetic experience during reconstruction surgery of a chest wall defect in a patient with Poland syndrome: a case report. Korean J Anesthesiol. 2009;57(5):652–5.PubMed
7.
go back to reference Geeroms B, Breysem L, Aertsen M. An atypical case of Poland syndrome with bilateral features and dextroposition of the heart: in the work-up of Poland syndrome, different imaging modalities are necessary to depict the full extent of the anomalies. J Belg Soc Radiol. 2019;103(1):45.PubMedPubMedCentral Geeroms B, Breysem L, Aertsen M. An atypical case of Poland syndrome with bilateral features and dextroposition of the heart: in the work-up of Poland syndrome, different imaging modalities are necessary to depict the full extent of the anomalies. J Belg Soc Radiol. 2019;103(1):45.PubMedPubMedCentral
8.
go back to reference Baban A, Torre M, Bianca S, Buluggiu A, Rossello MI, Calevo MG, et al. Poland syndrome with bilateral features: case description with review of the literature. Am J Med Genet A. 2009;149A(7):1597–602.PubMed Baban A, Torre M, Bianca S, Buluggiu A, Rossello MI, Calevo MG, et al. Poland syndrome with bilateral features: case description with review of the literature. Am J Med Genet A. 2009;149A(7):1597–602.PubMed
9.
go back to reference Baban A, Torre M, Costanzo S, Gimelli S, Bianca S, Divizia MT, et al. Familial Poland anomaly revisited. Am J Med Genet A. 2012;158A(1):140–9.PubMed Baban A, Torre M, Costanzo S, Gimelli S, Bianca S, Divizia MT, et al. Familial Poland anomaly revisited. Am J Med Genet A. 2012;158A(1):140–9.PubMed
10.
go back to reference Van Steensel MA. Poland anomaly: not unilateral or bilateral but mosaic. Am J Med Genet A. 2004;125A(2):211–2.PubMed Van Steensel MA. Poland anomaly: not unilateral or bilateral but mosaic. Am J Med Genet A. 2004;125A(2):211–2.PubMed
11.
go back to reference Martínez-Frías ML, Czeizel AE, Rodríguez-Pinilla E, Bermejo E. Smoking during pregnancy and Poland sequence: results of a population-based registry and a case-control registry. Teratology. 1999;59:35–8.PubMed Martínez-Frías ML, Czeizel AE, Rodríguez-Pinilla E, Bermejo E. Smoking during pregnancy and Poland sequence: results of a population-based registry and a case-control registry. Teratology. 1999;59:35–8.PubMed
12.
go back to reference Senrui H, Egawa T, Horiki A. Anatomical findings in the hands of patients with Poland’s syndrome. J Bone Joint Surg Am. 1982;64:1079–82.PubMed Senrui H, Egawa T, Horiki A. Anatomical findings in the hands of patients with Poland’s syndrome. J Bone Joint Surg Am. 1982;64:1079–82.PubMed
13.
go back to reference Ribeiro RC, Saltz R, Mangles MG, Koch H. Clinical and radiographic Poland syndrome classification: a proposal. Aesthet Surg J. 2009;29(6):494–504.PubMed Ribeiro RC, Saltz R, Mangles MG, Koch H. Clinical and radiographic Poland syndrome classification: a proposal. Aesthet Surg J. 2009;29(6):494–504.PubMed
14.
go back to reference Mazzola MA, Boccalini S, Fisci E, Rolla Bigliani C, Tagliafico A, Martinoli C. US evaluation of Poland syndrome. European Society of Musculoskeletal Radiology conference. 2012;Poster No.:P-007. Mazzola MA, Boccalini S, Fisci E, Rolla Bigliani C, Tagliafico A, Martinoli C. US evaluation of Poland syndrome. European Society of Musculoskeletal Radiology conference. 2012;Poster No.:P-007.
15.
go back to reference Paladini D, D'Armiento MR, Martinelli P. Prenatal ultrasound diagnosis of Poland syndrome. Obstet Gynecol. 2004;104(5 Pt 2):1156–9.1123.PubMed Paladini D, D'Armiento MR, Martinelli P. Prenatal ultrasound diagnosis of Poland syndrome. Obstet Gynecol. 2004;104(5 Pt 2):1156–9.1123.PubMed
16.
go back to reference Jeung MY, Gangi A, Gasser B, Vasilescu C, Massard G, Wihlm JM, Roy C. Imaging of chest wall disorders. Radiographics. 1999;19(3):617–37.PubMed Jeung MY, Gangi A, Gasser B, Vasilescu C, Massard G, Wihlm JM, Roy C. Imaging of chest wall disorders. Radiographics. 1999;19(3):617–37.PubMed
17.
go back to reference Wright AR, Milner RH, Bainbridge LC, Wilsdon JB. MR and CT in the assessment of Poland syndrome. J Comput Assist Tomogr. 1992;16(3):442–7.PubMed Wright AR, Milner RH, Bainbridge LC, Wilsdon JB. MR and CT in the assessment of Poland syndrome. J Comput Assist Tomogr. 1992;16(3):442–7.PubMed
18.
go back to reference Bainbridge LC, Wright AR, Kanthan R. Computed tomography in the preoperative assessment of Poland's syndrome. Br J Plast Surg. 1991;44(8):604–7.PubMed Bainbridge LC, Wright AR, Kanthan R. Computed tomography in the preoperative assessment of Poland's syndrome. Br J Plast Surg. 1991;44(8):604–7.PubMed
19.
go back to reference Inaloz HS, Gursoy S, Madenci E, Kirtak N. Minor Poland’s syndrome mimicking localized lipoatrophy. J Dermatol. 2002;29(12):815–7.PubMed Inaloz HS, Gursoy S, Madenci E, Kirtak N. Minor Poland’s syndrome mimicking localized lipoatrophy. J Dermatol. 2002;29(12):815–7.PubMed
20.
go back to reference Dillman JR, Sanchez R, Ladino-Torres MF, Yarram SG, Strouse PJ, Lucaya J. Expanding upon the unilateral hyperlucent hemithorax in children. Radiographics. 2011;31(3):723–41.PubMed Dillman JR, Sanchez R, Ladino-Torres MF, Yarram SG, Strouse PJ, Lucaya J. Expanding upon the unilateral hyperlucent hemithorax in children. Radiographics. 2011;31(3):723–41.PubMed
21.
go back to reference Wasilewska E, Lee EY, Eisenberg RL. Unilateral hyperlucent lung in children. AJR Am J Roentgenol. 2012;198(5):W400–14.PubMed Wasilewska E, Lee EY, Eisenberg RL. Unilateral hyperlucent lung in children. AJR Am J Roentgenol. 2012;198(5):W400–14.PubMed
22.
go back to reference Baas M, Burger EB, Sneiders D, Galjaard RH, Hovius SER, van Nieuwenhoven CA. Controversies in Poland syndrome: alternative diagnoses in patients with congenital pectoral muscle deficiency. J Hand Surg Am. 2018;43(2):186.e1–186.e16. Baas M, Burger EB, Sneiders D, Galjaard RH, Hovius SER, van Nieuwenhoven CA. Controversies in Poland syndrome: alternative diagnoses in patients with congenital pectoral muscle deficiency. J Hand Surg Am. 2018;43(2):186.e1–186.e16.
23.
go back to reference Karnak I, Tanyel FC, Tunçbilek E, Unsal M, Büyükpamukçu N. Bilateral Poland anomaly. Am J Med Genet. 1998;75(5):505–7.PubMed Karnak I, Tanyel FC, Tunçbilek E, Unsal M, Büyükpamukçu N. Bilateral Poland anomaly. Am J Med Genet. 1998;75(5):505–7.PubMed
24.
go back to reference Maroteaux P, Le Merrer M. Bilateral Poland anomaly versus thoracic dysplasia. Am J Med Genet. 1998;80(5):538–9.PubMed Maroteaux P, Le Merrer M. Bilateral Poland anomaly versus thoracic dysplasia. Am J Med Genet. 1998;80(5):538–9.PubMed
25.
go back to reference Yiyit N, Işıtmangil T, Öksüz S. Clinical analysis of 113 patients with Poland syndrome. Ann Thorac Surg. 2015;99(3):999–1004.PubMed Yiyit N, Işıtmangil T, Öksüz S. Clinical analysis of 113 patients with Poland syndrome. Ann Thorac Surg. 2015;99(3):999–1004.PubMed
26.
go back to reference Cetin II, Aktaş D, Tunçbilek E. Ipsilateral foot and contralateral hand anomalies in a patient with Poland-Moebius syndrome. Eur J Med Genet. 2005;48(2):183–7.PubMed Cetin II, Aktaş D, Tunçbilek E. Ipsilateral foot and contralateral hand anomalies in a patient with Poland-Moebius syndrome. Eur J Med Genet. 2005;48(2):183–7.PubMed
27.
go back to reference Der Kaloustian VM, Hoyme HE, Hogg H, Entin MA, Guttmacher AE. Possible common pathogenetic mechanisms for Poland sequence and Adams-Oliver syndrome. Am J Med Genet. 1991;38(1):69–73. Der Kaloustian VM, Hoyme HE, Hogg H, Entin MA, Guttmacher AE. Possible common pathogenetic mechanisms for Poland sequence and Adams-Oliver syndrome. Am J Med Genet. 1991;38(1):69–73.
28.
go back to reference Erol M, Caksen H, Tan O, Atik B, Unal O, Odabaş D. Report of a girl with Klippel-feil syndrome and Poland anomaly. Genet Couns. 2004;15(4):469–72.3.PubMed Erol M, Caksen H, Tan O, Atik B, Unal O, Odabaş D. Report of a girl with Klippel-feil syndrome and Poland anomaly. Genet Couns. 2004;15(4):469–72.3.PubMed
29.
go back to reference Cobben JM, van Essen AJ, McParland PC, Polman HA, ten Kate LP. A boy with Poland anomaly and facio-auriculo-vertebral dysplasia. Clin Genet. 1992;41(2):105–7.PubMed Cobben JM, van Essen AJ, McParland PC, Polman HA, ten Kate LP. A boy with Poland anomaly and facio-auriculo-vertebral dysplasia. Clin Genet. 1992;41(2):105–7.PubMed
30.
go back to reference Guion-Almeida ML, da Silva Lopes VL. Frontonasal dysplasia, Poland anomaly and unilateral hypoplasia of lower limb: report on a male patient. Clin Dysmorphol. 2003;12(4):233–6.PubMed Guion-Almeida ML, da Silva Lopes VL. Frontonasal dysplasia, Poland anomaly and unilateral hypoplasia of lower limb: report on a male patient. Clin Dysmorphol. 2003;12(4):233–6.PubMed
31.
go back to reference Dufke A, Riethmüller J, Enders H. Severe congenital myopathy with Möbius, Robin, and Poland sequences: new aspects of the Carey-Fineman-Ziter syndrome. Am J Med Genet A. 2004;127A(3):29–3. Dufke A, Riethmüller J, Enders H. Severe congenital myopathy with Möbius, Robin, and Poland sequences: new aspects of the Carey-Fineman-Ziter syndrome. Am J Med Genet A. 2004;127A(3):29–3.
32.
go back to reference Di Gioia SA, Connors S, Matsunami N, Cannavino J, Rose MF, Gilette NM, et al. A defect in myoblast fusion underlies Carey-Fineman-Ziter syndrome. Nat Commun. 2017;8:16077.PubMedPubMedCentral Di Gioia SA, Connors S, Matsunami N, Cannavino J, Rose MF, Gilette NM, et al. A defect in myoblast fusion underlies Carey-Fineman-Ziter syndrome. Nat Commun. 2017;8:16077.PubMedPubMedCentral
33.
go back to reference Baldelli I, Gallo F, Crimi M, Fregatti P, Mellini L, Santi P, et al. Experiences of patients with Poland syndrome of diagnosis and care in Italy: a pilot survey. Orphanet J Rare Dis. 2019;14(1):269.PubMedPubMedCentral Baldelli I, Gallo F, Crimi M, Fregatti P, Mellini L, Santi P, et al. Experiences of patients with Poland syndrome of diagnosis and care in Italy: a pilot survey. Orphanet J Rare Dis. 2019;14(1):269.PubMedPubMedCentral
34.
go back to reference Pelentsov LJ, Fielder AL, Laws TA, Esterman AJ. The supportive care needs of parents with a child with a rare disease: results of an online survey. BMC Fam Pract. 2016;17(1):88.PubMedPubMedCentral Pelentsov LJ, Fielder AL, Laws TA, Esterman AJ. The supportive care needs of parents with a child with a rare disease: results of an online survey. BMC Fam Pract. 2016;17(1):88.PubMedPubMedCentral
35.
go back to reference Baumbusch J, Mayer S, Sloan-Yip I. Alone in a crowd? Parents of children with rare diseases’ experiences of navigating the healthcare system. J Genet Couns. 2019;28(1):80–90. Baumbusch J, Mayer S, Sloan-Yip I. Alone in a crowd? Parents of children with rare diseases’ experiences of navigating the healthcare system. J Genet Couns. 2019;28(1):80–90.
36.
go back to reference Black AP, Baker M. The impact of parent advocacy groups, the internet, and social networking on rare diseases: the IDEA league and IDEA league United Kingdom example: the impact of parent advocacy groups. Epilepsia. 2011;52:102–4.PubMed Black AP, Baker M. The impact of parent advocacy groups, the internet, and social networking on rare diseases: the IDEA league and IDEA league United Kingdom example: the impact of parent advocacy groups. Epilepsia. 2011;52:102–4.PubMed
37.
go back to reference Baldelli I, Santi P, Dova L, Cardoni G, Ciliberti R, Franchelli S, et al. Body image disorders and surgical timing in patients affected by Poland syndrome: data analysis of 58 case studies. Plast Reconstr Surgy. 2016;137(4):1273–82. Baldelli I, Santi P, Dova L, Cardoni G, Ciliberti R, Franchelli S, et al. Body image disorders and surgical timing in patients affected by Poland syndrome: data analysis of 58 case studies. Plast Reconstr Surgy. 2016;137(4):1273–82.
38.
go back to reference Vaccari CM, Romanini MV, Musante I, Tassano E, Gimelli S, Divizia MT, et al. De novo deletion of chromosome 11q12.3 in monozygotic twins affected by Poland syndrome. BMC Med Genet. 2014;30:15–63. Vaccari CM, Romanini MV, Musante I, Tassano E, Gimelli S, Divizia MT, et al. De novo deletion of chromosome 11q12.3 in monozygotic twins affected by Poland syndrome. BMC Med Genet. 2014;30:15–63.
39.
go back to reference Vaccari CM, Tassano E, Torre M, Gimelli S, Divizia MT, Romanini MV, et al. Assessment of copy number variations in 120 patients with Poland syndrome. BMC Med Genet. 2016;17(1):89.PubMedPubMedCentral Vaccari CM, Tassano E, Torre M, Gimelli S, Divizia MT, Romanini MV, et al. Assessment of copy number variations in 120 patients with Poland syndrome. BMC Med Genet. 2016;17(1):89.PubMedPubMedCentral
40.
go back to reference Romanini MV, Calevo MG, Puliti A, Vaccari C, Valle M, Senes F, et al. Poland syndrome: a proposed classification system and perspectives on diagnosis and treatment. Semin Pediatr Surg. 2018;27(3):189–1999. Romanini MV, Calevo MG, Puliti A, Vaccari C, Valle M, Senes F, et al. Poland syndrome: a proposed classification system and perspectives on diagnosis and treatment. Semin Pediatr Surg. 2018;27(3):189–1999.
41.
go back to reference Waters PM, Bae DS. Pediatric hand and upper limb surgery: a practical guide. Lippincott Williams & Wilkins (LWW); 2012. p. 12–25. Waters PM, Bae DS. Pediatric hand and upper limb surgery: a practical guide. Lippincott Williams & Wilkins (LWW); 2012. p. 12–25.
42.
go back to reference Landi A, Garagnani L, Leti Acciaro A, Lando M, Ozben H, Gagliano MC. Hyaluronic acid scaffold for skin defects in congenital syndactyly release surgery: a novel technique based on the regenerative model. J Hand Surg Eur. 2014;39(9):994–1000. Landi A, Garagnani L, Leti Acciaro A, Lando M, Ozben H, Gagliano MC. Hyaluronic acid scaffold for skin defects in congenital syndactyly release surgery: a novel technique based on the regenerative model. J Hand Surg Eur. 2014;39(9):994–1000.
43.
go back to reference Baldelli I, Vappiani M, Santori G, Ciliberti R, Santi P. Letter to the editor: response to Manzano Surroca et al. “Poland sequence: retrospective analysis of 66 cases”. Ann Plast Surg. 2020;84(3):341–2.PubMed Baldelli I, Vappiani M, Santori G, Ciliberti R, Santi P. Letter to the editor: response to Manzano Surroca et al. “Poland sequence: retrospective analysis of 66 cases”. Ann Plast Surg. 2020;84(3):341–2.PubMed
44.
go back to reference Romanini MV, Torre M, Santi P, Dova L, Valle M, Martinoli C, Baldelli I. Proposal of the TBN classification of thoracic anomalies and treatment algorithm for Poland syndrome. Plast Reconstr Surg. 2016;138(1):50–8.PubMed Romanini MV, Torre M, Santi P, Dova L, Valle M, Martinoli C, Baldelli I. Proposal of the TBN classification of thoracic anomalies and treatment algorithm for Poland syndrome. Plast Reconstr Surg. 2016;138(1):50–8.PubMed
45.
go back to reference Wood L, Williams C, Billings J, Johnson S. The role of psychology in a multidisciplinary psychiatric inpatient setting: perspective from the multidisciplinary team. Psychol Psychother. 2019;92(4):554–64. Wood L, Williams C, Billings J, Johnson S. The role of psychology in a multidisciplinary psychiatric inpatient setting: perspective from the multidisciplinary team. Psychol Psychother. 2019;92(4):554–64.
46.
go back to reference Epstein NE. Multidisciplinary in-hospital teams improve patient outcomes: a review. Surg Neurol Int. 2014;5(Suppl 7):S295–S303.3.PubMedPubMedCentral Epstein NE. Multidisciplinary in-hospital teams improve patient outcomes: a review. Surg Neurol Int. 2014;5(Suppl 7):S295–S303.3.PubMedPubMedCentral
47.
go back to reference Block A, Sarwer DB. Presurgical psychological screening: understanding patients, improving outcomes: American Psychological Association (APA); 2013. Block A, Sarwer DB. Presurgical psychological screening: understanding patients, improving outcomes: American Psychological Association (APA); 2013.
48.
go back to reference Uhlenbusch N, Löwe B, Härter M, Schramm C, Weiler-Normann C, Depping MK. Depression and anxiety in patients with different rare chronic diseases: a cross-sectional study. PLoS One. 2019;14(2):e0211343.PubMedPubMedCentral Uhlenbusch N, Löwe B, Härter M, Schramm C, Weiler-Normann C, Depping MK. Depression and anxiety in patients with different rare chronic diseases: a cross-sectional study. PLoS One. 2019;14(2):e0211343.PubMedPubMedCentral
49.
go back to reference Honigman RJ, Phillips KA, Castle DJ. A review of psychosocial outcomes for patients seeking cosmetic surgery. Plast Reconstr Surg. 2004;113(4):1229–37.PubMedPubMedCentral Honigman RJ, Phillips KA, Castle DJ. A review of psychosocial outcomes for patients seeking cosmetic surgery. Plast Reconstr Surg. 2004;113(4):1229–37.PubMedPubMedCentral
50.
go back to reference Nuzzi LC, Cerrato FE, Webb ML, Faulkner HR, Walsh EM, DiVasta AD, et al. Psychological impact of breast asymmetry on adolescents: a prospective cohort study. Plast Reconstr Surg. 2014;134(6):1116–23.PubMed Nuzzi LC, Cerrato FE, Webb ML, Faulkner HR, Walsh EM, DiVasta AD, et al. Psychological impact of breast asymmetry on adolescents: a prospective cohort study. Plast Reconstr Surg. 2014;134(6):1116–23.PubMed
Metadata
Title
Consensus based recommendations for diagnosis and medical management of Poland syndrome (sequence)
Authors
Ilaria Baldelli
Alessio Baccarani
Chiara Barone
Francesca Bedeschi
Sebastiano Bianca
Olga Calabrese
Marco Castori
Nunzio Catena
Massimo Corain
Sara Costanzo
Giacomo De Paoli Barbato
Santa De Stefano
Maria Teresa Divizia
Francesco Feletti
Matteo Formica
Mario Lando
Margherita Lerone
Fulvio Lorenzetti
Carlo Martinoli
Lorenzo Mellini
Maurizio Bruno Nava
Giuseppe Porcellini
Aldamaria Puliti
Maria Victoria Romanini
Franco Rondoni
Pierluigi Santi
Silvana Sartini
Filippo Senes
Lucia Spada
Luigi Tarani
Maura Valle
Cristina Venturino
Federico Zaottini
Michele Torre
Marco Crimi
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Orphanet Journal of Rare Diseases / Issue 1/2020
Electronic ISSN: 1750-1172
DOI
https://doi.org/10.1186/s13023-020-01481-x

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