Radiología 63 (2021) 456---465

www.elsevier.es/rx

HUMANITIES IN RADIOLOGY

Marie Curie: How to break the glass ceiling in science

and in radiology夽
R. Sánchez-Oro ∗ , J. Torres Nuez, M.L. Fatahi Bandpey, G. Martínez-Sanz

Servicio de Radiodiagnóstico, Hospital General de Teruel Obispo Polanco, Teruel, Spain

Received 22 January 2021; accepted 12 April 2021

KEYWORDS Abstract Marie Curie was born in Warsaw in1867. She graduated first in her class in her under-
Radiology; graduate programs in physics and mathematics at Sorbonne University, and she was one of the
X-rays; first women to earn a PhD. She was the first woman to win a Nobel prize (in physics, together
Radiography; with her husband, Pierre Curie), and she was also the first person to win a second Nobel prize
First World War in another category (chemistry).
Her life is an example of dedication to science based on altruism, personal growth, and
tenacity. Being the first woman to break through so many barriers in a totally male-dominated
science makes her an emblematic figure in the fight for equal opportunities and human rights.
This article reviews her most important contributions to science in general and to diagnostic
radiology in particular through her participation in the French military’s radiological plan during
the First World War.
© 2021 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

PALABRAS CLAVE Marie Curie: Cómo romper el techo de cristal en la ciencia y en la radiología
Radiología;
Rayos X; Resumen Marie Curie nació en Varsovia en 1867, se licenció en Física y Matemáticas en la
Radiografía; Universidad de la Sorbona, siendo la primera de su promoción, y fue una de las primeras mujeres
Primera Guerra en tener un doctorado. Fue la primera mujer en ganar un premio Nobel, en Física, junto a su
Mundial marido Pierre Curie, y también la primera persona en obtener un segundo Nobel y en otra
categoría: Química.
Su vida es un ejemplo de dedicación a la ciencia desde el altruismo, de superación personal
y tenacidad. Fue la primera mujer en romper tantas barreras, en una ciencia hasta entonces
masculina, que su figura constituye un hito en la lucha por la igualdad de oportunidades y los
derechos humanos.

夽 Please cite this article as: Sánchez-Oro R, Torres Nuez J, Fatahi Bandpey ML, Martínez-Sanz G. Marie Curie: Cómo romper el techo de
cristal en la ciencia y en la radiología. Radiología. 2021;63:456---465.
∗ Corresponding author.

E-mail address: raquel sanchez oro@hotmail.com (R. Sánchez-Oro).

2173-5107/© 2021 SERAM. Published by Elsevier España, S.L.U. All rights reserved.
 Radiología 63 (2021) 456---465
En este trabajo se revisan sus principales aportaciones a la ciencia y, en particular, al radiodiag-
nóstico a través de su participación en el plan radiológico militar francés de la Primera Guerra
Mundial.
© 2021 SERAM. Publicado por Elsevier España, S.L.U. Todos los derechos reservados.
Origins, childhood and youth
Maria Sklodowska-Curie was born in Warsaw on 7 Novem-
ber 1867 and spent her entire childhood in that city, then
occupied by Imperial Czarist Russia. Since 1795, Poland had
ceased to exist as a state. The internal destabilisation of the
Commonwealth of Nations that it had upheld with Lithuania
for two centuries gave way to anarchy and territorial vulner-
ability. After several partitions, it was ultimately annexed,
carved up and distributed among Russia, Austria and Prussia.
The Russian Czarist regime exercised despotic power over
the Polish population, whose autonomy was reduced to a
minimum; efforts were even made to wipe the country’s
name off the map and replace it with Vistula Land. The Polish
language was forbidden, and Russian was imposed as the
language of administration, justice and secondary school.1
With this attempt at cultural assimilation, a strong Pol-
ish nationalist sentiment arose with historicist and religious
(Catholicism) hallmarks deeply rooted in intellectuals and
the middle classes, including the Sklodowski family.
Maria was the youngest of five siblings. Her mother, Bro-
nislawa, studied education and came to direct an important
boarding school for young ladies. She had to leave this posi-
tion following the birth of the oldest of her daughters. Her
father, Wladislaw, who had studied sciences at the University
of Warsaw and directed two important secondary schools for
boys in the capital, was tried in 1866 for his connection to
nationalist circles that instigated the 1863−64 anti-Russian
January Uprising. Accused of rebellion, he was relieved of
any position of significance and relegated to a job as a
physics and mathematics teacher at a secondary school in
Warsaw. This represented a substantial loss of earnings for
the family.2
The death of Maria’s sister Zofia in 1876, two years after
that of her mother, from tuberculosis, spurred her to grow
up quickly. Her mother’s death submerged her in a profound
crisis of faith and led her to declare herself agnostic.
The young Sklodowski siblings completed their primary
education at a semi-clandestine school where, alongside
their required studies, they learned the Polish language as
well as Polish history and culture. In 1878, Maria was admit-
ted to the Sikorska boarding school. Later on, she studied
at the Warsaw III Lyceum, where she graduated with highest
marks (she was awarded a gold medal) in June 1883, a year
early.
In the Russian Empire, women were barred from access
to university. Maria was able to circumvent this ban through
the Flying University (Uniwersytet Latajacy) of Warsaw, a
private institution of higher education that had exclusively
Polish teachers and students, and admitted female students.
457
It was also founded by a woman: teacher, writer and activist
Jadwiga Szczawinska-Dawidowa.3
As the name suggests, the Flying University was con-
stantly relocating its clandestine classrooms, hidden in
private homes, as a risky form of resistance to suffocating
Russian cultural oppression. The university taught classes
in Polish and instilled in its students ideas such as gender
equality in education and abolition of class privileges. This
institution taught thousands of students without resources
and, in particular, women who had no other access to higher
education. The Flying University and the courage of its
instructors had a great impact on Maria, in particular on
the development of her intellectual and philosophical ide-
ology, helping to shape an enlightened and positivist spirit
of activism for equal opportunities, without discrimination
based on class or gender.4
In other countries in Europe, universities as illustrious as
Sorbonne University in Paris, the University of Edinburgh and
the Martin Luther University of Halle-Wittenberg had barely
begun to accept women. Sorbonne University, founded in
1257 by Robert de Sorbonne and reformed by Cardinal Riche-
lieu, did not open the doors of its then five faculties to
women until 1860, six centuries after men.
Maria aspired to study in Paris to become a scientist,
while her sister Bronia leaned towards medicine. As their
family could not cover the costs of university and living
outside of Warsaw for the two daughters, Maria and Bro-
nia hatched a plan. First, Maria would remain in Warsaw
and work as a private tutor to help pay for her older sister’s
degree. Then, once Bronia had completed her studies, she
would use her own earnings to help cover the costs of Maria’s
studies.5
First years in France and research beginnings
Following this plan, Maria arrived in Paris in autumn 1891
(Fig. 1), six years after Bronia had moved there and earned
her degree in medicine with a specialisation in obstetrics and
gynaecology. Maria was one of seven women enrolled that
year in the Faculty of Sciences at Sorbonne University. Of the
1800 students at the university, 23 were women and most
of these were studying medicine. She therefore entered a
world that was doubly restricted for women: that of the
university, and that of the sciences.
Just two years of study later, in July 1893, with her given
name already gallicised, Marie not only became the first
woman to receive a degree in physics from Sorbonne Univer-
sity, but also graduated at the top of her class. Not satisfied
with that, and aware that a solid approach to any research
 R. Sánchez-Oro, J. Torres Nuez, M.L. Fatahi Bandpey et al.
Figure 1 Image of Maria Skłodowska. Source: Wikipedia,
https://commons.wikimedia.org/wiki/File:Marie Curie 1900
- DIG17379.jpg.
in physics required a good foundation in mathematics, she
set about earning a second degree in mathematics within
a single year. The primary obstacle was, once again, eco-
nomic, but that summer, she would travel to Poland, where
she had been awarded the Alexandrovich Scholarship for the
best Polish students abroad. The 600 roubles in award money
enabled her to spend another year in Paris and earn her
mathematics degree without hardship.6
When she returned to Paris in the autumn, her lecturer
Gabriel Lippmann (one of the most respected physicists
of the time and a future Noble prize winner) received
her with the news that she had got her first paid job as
a researcher. Under his tutelage, Marie was to study the
magnetic properties of steel for the Society for the Devel-
opment of National Industry (Société d’encouragement pour
l’industrie nationale), for which she would be rewarded with
600 roubles, the exact amount she had received for the
Alexandrovich Scholarship. The youngest Sklodowski broke
the mould once again, becoming the first Polish student
to give up the scholarship and refund the amount so that
somebody else could benefit from it.7
As a result of her work for the Society for the Develop-
ment of National Industry and problems of limited workspace
at the Sorbonne laboratory, Marie would meet Pierre Curie
(Fig. 2). Her future husband was a lecturer at the City of Paris
Industrial Physics and Chemistry Higher Educational Institu-
tion (École supérieure de physique et de chimie industrielles
458
de la Ville de Paris) and as such had a laboratory that the
young lady from overseas requested to use for conducting
research.8
The attraction between the two was immediate. They
shared their passion not only for science and the scientific
method as a true source of knowledge, but also their convic-
tion that science should be used to dominate nature for
humanitarian purposes and thus improve the lives of people;
this philosophical position is known as positivism.9,10
The couple married in Paris on 26 July 1895. This year
was, of course, significant in the history of medicine for
another reason. German physicist Wilhelm Conrad Röntgen’s
experimentation with cathode rays led him to discover a new
form of light capable of passing through objects. He himself
called them X-rays, referencing their unknown nature.
After he analysed their properties and published his dis-
covery, which would earn him the first Nobel Prize in Physics
in 1901, the news spread throughout the world and X-rays
became a popular phenomenon, primarily due to their recre-
ational applications. The public paid to have X-rays taken
of them for fun at carnivals and fairs, before their harmful
effects on the body became clear. At the same time, the first
medical applications of X-rays did not take long to develop,
starting with the use of X-rays to examine bone fractures
and, shortly thereafter, chest diseases. Barely a year after
Bertha Röntgen’s hand was X-rayed, nearly 50 books and
more than 1000 articles on the new discipline of medical
radiology had already been published.
As a result of Röntgen’s discovery, French physicist and
chemist Antoine-Henri Becquerel started to study phospho-
rescent substances to determine whether they, too, emitted
X-rays when exposed to sunlight. To do this, he used uranium
salts on photographic plates. He discovered that these not
only emitted radiation, but also did not require accumulated
solar energy to do so. This went in the face of the knowledge
of the time. According to the principles of classical physics,
expressed in Parmenides’ maxim ex nihilo nihil fit (n̈othing
comes from nothing¨), radiation could not emanate directly
from the salts without a power source.11
Marie Curie saw in this discovery a fascinating topic for
her doctoral dissertation. In December 1897, she began
researching those uranium rays with the goal of tearing down
a new barrier and becoming the first woman to earn a doc-
torate degree in physics.12,13
The Nobel Prizes
Marie discovered that the intensity of radiation did not
depend on the structure of the compound, nor did it result
from a chemical reaction between its molecules; rather, it
was proportional only to the quantity of the element, since
it was an intrinsic quality characteristic of the atom itself.
Marie christened this property r̈adioactivity¨, a term of Latin
origin meaning ëmitting rays¨.14,15
Her observation that the crude form of uranium oxide
known as pitchblende produced radioactivity 300 times
greater than corresponded to its uranium content led
the scientist to deduce that pitchblende must contain
small amounts of some other highly radioactive element
that was unknown. Following arduous chemical analyses,
she managed to purify small traces of the new, highly
 Radiología 63 (2021) 456---465

Figure 2 Marie and Pierre Curie working in the laboratory. Source: Wikipedia,
https://commons.wikimedia.org/wiki/File:Pierre and Marie Curie at work in laboratory Wellcome L0001761.jpg.

radioactive metal element. Marie and Pierre gave an
account of their finding at the French Academy of Sciences
(Académie des sciences) in Paris in July 1898, and proposed
that it be named polonium, in honour of Marie’s native
country.16
The Curies carried on with their efforts to chemically sep-
arate pitchblende, and in early November they recognised
the presence of a second unknown substance with radioac-
tivity thousands of times greater than that of uranium.
They called the new element radium (from the Latin radius,
meaning ray) and reported its existence to the Academy in
December 1898.17
With her work, Marie Curie earned not only a doctorate
degree, but also the Nobel Prize. She defended her doctoral
dissertation in June 1903 and earned the degree of Doctor of
Physics cum laude. The telegram from Stockholm announc-
ing that they and Becquerel had been awarded the Nobel
Prize in Physics for their work on radioactivity reached the
Curies’ home in November of that year. Marie was the first
female scientist to be awarded a Nobel Prize by the Royal
Swedish Academy of Sciences.18
Pierre Curie died on 18 April 1906 when he was run over
by a carriage. His daughters Irène and Ève were eight and
two years old, respectively.19

459
 R. Sánchez-Oro, J. Torres Nuez, M.L. Fatahi Bandpey et al.
In November 1911, a new telegram arrived from Swe-
den informing Marie that she had been awarded the Nobel
Prize in Chemistry in recognition of her work isolating pure
radium.20
Between 1902 and 2020, this prize, conferring maximum
international prestige, was awarded to 873 men and 57
women. The first woman to receive it was Marie Curie in
1903. She is also the only woman to have won it more than
once. Of the 57 women awarded a Nobel Prize, just 11 have
received one in physics or chemistry. One of them was Irène
Joliot-Curie, the older daughter of Pierre and Marie, who
received the Nobel Prize in Chemistry in 1935 along with her
husband Frédéric Joliot for their synthesis of new radioac-
tive elements. Marie and Irène are the only mother and
child to have received a Nobel Prize. At present, Marie Curie
remains the only person in the history of the Nobel Prizes to
have been awarded two in different areas of science: physics
in 1903 and chemistry in 1911.20
World War I and radiology
When World War I began in 1914, the altruistic Polish
researcher, who, like Röntgen, had decided not to patent
her experiments so that any interested party could make use
of them freely, wondered how a scientist like her could help
now. Between two possible pathways, seeking new scien-
tific applications to war needs and contributing to efforts to
organise already available resources, she chose the latter.21
This decision inaugurated a new, frenetic stage in her life
and led her to figure among the memorable pioneers of diag-
nostic radiology, in addition to her above-mentioned merits.
The French Ministry of War named Marie director of the Radi-
ology Department of the Red Cross; in that capacity, she
decided to comb Paris for all the radiology equipment she
could find. Her work was to consist of organising radiology
departments in war hospitals.22
At the beginning of the last century, surgeons at field hos-
pitals did piecework, attempting to operate blindly on truly
gory wounds in a race against the clock. The benefits of X-
rays in war were obvious from the outset. Thanks to X-rays,
surgeons knew, before beginning the operation, the location
and type of bone lesion, and the number and location of bul-
lets and pieces of shrapnel without first probing the soldiers’
wounds. This reduced intraoperative time, minimised harm
and decreased mortality.
The problem was that it was very difficult to move X-ray
equipment to the front lines, as Antoine Béclère, another
pioneer of radiology remembered for his work on fluo-
roscopy and for having coined the term r̈adiologieïn France,
explained to Marie in 1914. For that reason, and because
there was not enough X-ray equipment to cover all the front
lines, its use was limited.23
Installation of radiology equipment at rear hospitals and
even at field hospitals was also not a solution for many
wounded soldiers, especially the most seriously injured, who
were at risk of losing their lives in transfer. These soldiers
had to be cared for on the front lines themselves; this
required not only moving equipment to the trenches, but
also connecting it to electricity for it to work. The inven-
tiveness of a Spanish engineer proved opportune in resolving
this double bind.
460
Figure 3 Marie Curie in a ¨petit Curiem̈obile X-ray unit.
Source: Wikipedia, https://commons.wikimedia.org/wiki/
File:Marie Curie - Mobile X-Ray-Unit.jpg.
Mónico Sánchez, born in Piedrabuena (Ciudad Real) in
1880, was an electrical engineer and a prolific inventor
who broadened his professional training and experience
in New York and became head engineer of the Collins
Wireless Telephone Company. He and his company par-
ticipated in international fairs alongside Edison’s General
Electric and Tesla’s Westinghouse. He eventually returned
to Spain and founded his own company. Despite being lit-
tle known, Sánchez shares with these figures a prominent
place among the pioneers of wireless telecommunications
and electromedicine.
The La Mancha engineer’s most outstanding invention was
a portable X-ray device that owed its worldwide success to
both its qualities and the historical circumstances of the
time. The device, which was easy to transport and handle
and weighed barely 10 kg, was capable of powering a con-
ventional X-ray tube. In 1914, France commissioned more
than 50 of them to be installed in the ambulances that served
the front lines during World War I.
Marie grasped their enormous potential for diagnosing
wounds on the front lines and endorsed, extended and sys-
tematised their use. In September, the first X-ray unit cared
for wounded soldiers in the First Battle of the Marne against
the German army (in which 400,000 died). In an affectionate
nod and tribute to Madame Curie, those peculiar trucks were
called ¨petites Curie¨(little Curies) (Fig. 3). The vehicles,
simple, light and easy to drive, were fitted with X-ray equip-
ment, a darkroom for processing and a dynamo to generate
the electricity required using the truck’s petrol engine. Fully
loaded, their top speed was no more than 30 km/h.
Between October 1914 and late 1916, Marie visited
dozens of hospitals with her petites Curie. However, radi-
ology departments lacked qualified technicians. This new
hurdle started to come down in 1916, when she got the
green light from the Health Department to begin training
technical personnel. After a few months at a provisional
centre, classes were then taught at the Radium Institute.
This institute, planned shortly before World War I, had been
reconverted thanks to Marie’s hard work and grace into
a radiology school, where she taught lessons on X-rays.
Another effect of the conflict was that the hospital---school
was filled with women, since most men had been drafted.
 Radiología 63 (2021) 456---465
Figure 4 Marie and her daughter Irène. Source: Wikipedia,
https://commons.wikimedia.org/wiki/File:Marie Irene Curie.jpg.
One of the most valuable sources of support among these
women, both at school and on expeditions with petites
Curie, was her older daughter Irène, who joined the team
despite being only 17 years old (Figs. 4 and 5).24
Marie’s endeavours were not limited to transporting
equipment; she also worked as a technician and trained
military personnel. She herself completed more than 1200
Figure 5 Curie with a group of nurses and radiology technicians. Source: Wikipedia, https://commons.wikimedia.org/
wiki/File:Marie Curie with nurses and physician.jpg.
461
radiological examinations. In view of the lack of drivers,
she got a driving licence and learned the fundamentals of
mechanics in 1916, when she was 49 years old. On one of
her trips, she suffered an accident that left her battered
and bruised. "I can never forget that destruction¨, she wrote.
M̈en and boys covered in a mix of mud and blood."25
However, the military looked unfavourably on civilians
prowling the front lines, and more unfavourably still on
those who were women. The arrival of Marie and Irène
was not always well received. Moreover, the doctors of the
time, especially the most experienced, remained reluctant
to use X-rays as a diagnostic tool, especially with a young
woman like Irène operating the device. She determined the
location of the bullet or shrapnel on X-ray and performed
mathematical calculations to determine its spatial location
in the affected anatomical region, then showed them to
surgeons and made suggestions as to where to operate.
These suggestions were often met with rejection or suspi-
cion. However, the efficacy of X-rays managed to erase any
trace of objection.26
When the war ended in November 1918, the fleet
of petites Curie totalled 20 vehicles and 175 operators.
Between 1917 and 1918, 1,100,000 documented X-rays were
taken.27
Marie Curie left a testimony to the contributions of
radiology in those dramatic years, which also served as a
definitive consolidation of those contributions, in a new book
entitled L̈a radiologie et la guerre¨[Radiology and War].28 In
this book, she set out the problems in radiology that were
encountered during the war and their solutions, such as the
assembly of mobile posts that could be transported from
the hospitals to the front lines, the training of specialised
personnel and the ways in which fractures and locations of
projectiles were examined.
In L̈a radiologie et la guerre¨, Marie reflected on locating
foreign bodies, diagnosing fractures and radiology in general
(Figs. 6---10):
"This is a wonderful method of observation, indeed----one
that enabled us for the first time to examine the inside
 R. Sánchez-Oro, J. Torres Nuez, M.L. Fatahi Bandpey et al.

Figure 6 X-ray of a shoulder from the book L̈a radiologie et la
guerre¨. The book describes the image thus: "The parts closest
to the plate produce sharp, narrow shadows; the parts farthest
from the plate produce less sharp, broad shadows."28
of the human body without the help of surgery. [. . .] If
a metal object has entered the body after an injury (a
bullet or shrapnel), the presence of this object inside
the body is revealed on fluoroscopic or X-ray imaging
through the shadow that it casts. [. . .] If a broken bone
appears on the image, the X-ray will reveal the details of
Figure 8 X-ray of a forearm. Radius fracture with loss of
substance.28
the accident. [. . .] This creates a wonderful opportunity
for diagnosis by direct visualisation, which benefits the
patient and relieves the physician of some responsibil-
ity."
Later, she reiterated the importance of removing foreign
bodies to prevent complications and anticipated the role of
radiological imaging in planning surgical procedures:

Figure 7 X-ray of a leg in a cast. Fracture of both bones (tibia and fibula) with displacement.28

462
 Radiología 63 (2021) 456---465

Figure 9 X-ray of a forearm. Consolidated radius fracture callus.28

"In fact, foreign bodies in the body are a common cause
of abscesses, either because they carry infectious germs
or contaminated dirt or debris from clothing, or even
simply because contact with them irritates tissue and
prevents healing. On the other hand, when the wound is
new, the open path often makes removal very easy; the
surgeon can follow the path without further damage,
aided by radiological examination; in many cases, the
surgeon can remove one or more foreign bodies from the
wound within a couple of minutes."
She also mentioned technical matters, such as the use-
fulness of two orthogonal projections in bone X-rays, and
touched on organisational considerations, such as the utility
of image archiving and radiological monitoring over time:
"To arrive at a correct opinion on bone fractures, it is
useful to take two X-rays on different planes----for exam-
ple, a frontal view and a lateral view, when the injured
can be moved. The X-rays obtained are stored as docu-
ments. It is also useful to take a new X-ray from time to
time to monitor the progress of healing, or to demon-
strate the outcome of surgery in clearing the fracture
site of foreign bodies and to correct the position of the
bones. All of these X-rays reproduce the history of the
injury. Sometimes it is painful history, but more often it
is comforting because persistent effort greatly improves
seemingly hopeless cases."
Ultimately, based on this application of radiology to a
specific area, she reached a general conclusion that the pas-

463
 R. Sánchez-Oro, J. Torres Nuez, M.L. Fatahi Bandpey et al.
Figure 10 X-ray of a hand. The X-ray revealed the presence
of a large piece of shrapnel. Fractures of carpal and metacarpal
bones.28
sage of time has but corroborated its use and increased its
validity up to the present. Marie concluded:
"Radiology is essential. This truth, which was not widely
known at the beginning of the war, is no longer ques-
tioned by anyone today, and no surgeon would agree to
begin surgery in the present day without being aware of
the information provided by the radiologist."28
She died of aplastic anaemia in 1934, when she was 66
years old. For decades, it was believed that this disease had
been caused by her prolonged exposure to radiation.29
However, when a decision was made to transfer her
remains, along with those of Pierre, to the Panthéon in Paris
in 1995, technical reports indicated that her disease was
p̈robablym̈ore related to her work with X-rays during the
war. She is said to have performed hundreds of tests with-
out wearing proper protection, despite always advising her
colleagues and students to do so.30
If true, this would only increase her honour along with
those who, in the words of Béclère, sacrificed their lives to
fight disease and suffering with the wonderful weapon that
Röntgen contributed to medicine.
Conclusions
The life of Marie Curie is an exceptional example of altruistic
dedication to science in the 20th century, an era of extraor-
dinary and revolutionary discoveries, including her own. To
464
do this, she had to use her courage, intelligence and tenac-
ity to overcome highly unfavourable conditions as a Pole, as
a scientist and, above all, as a woman. With the firm and
vital conviction that nothing was impossible to achieve by
mere virtue of being a woman, she was the first to break so
many barriers in an up-to-then male-dominated science. Her
life therefore represents a milestone in the fight for equal
opportunities and human rights.
This study reviewed her primary contributions to science
and, in particular, the definitive dissemination of diagnostic
radiology through her participation in the French military
radiology plan in World War I. The small vehicles equipped
with portable X-ray equipment travelled paths of mud and
blood to care for victims. In many instances, they were
driven by a woman of mature age who had received two
Nobel Prizes. They are pieces of radiology history.
Authorship
1 Responsible for study integrity: RSO, JTN, MLFB, GMS.
2 Study concept: RSO, JTN.
3 Study design: RSO, JTN, MLFB, GMS.
4 Data collection: not applicable.
5 Data analysis and interpretation: not applicable.
6 Statistical processing: not applicable.
7 Literature search: RSO, JTN, MLFB.
8 Drafting of the study: RSO, JTN, MLFB, GMS.
9 Critical review of the manuscript with intellectually sig-
nificant contributions: RSO, JTN, MLFB, GMS.
10 Approval of the final version: RSO, JTN, MLFB, GMS.
Conflicts of interest
The authors declare that they have no conflicts of interest.
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