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Karam O, Sanchez O, Wildhaber B, Chardot C, La Scala G. Blunt abdominal trauma in children: a score to predict the absence of organ injury. Crit Care 2009. [PMCID: PMC4084307 DOI: 10.1186/cc7585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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252
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Parent F, Deruelle P, Jilwan F, Sanchez O, Wolf M, Jaïs X, Simonneau G. P16 Treatment of VTE during pregnancy with a once-daily regimen of LMWH. Thromb Res 2009. [DOI: 10.1016/s0049-3848(09)70061-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Couturaud F, Pernod G, Pison C, Mismetti P, Sanchez O, Meyer G, Parent F, Girard P, Simonneau G, Drouet L, Gueret P, Jego P, Delaval P, Duhamel E, Gruel Y, Delahousse B, Regina S, Pottier P, Connaud J, Lecomte F, Provost K, Vilmans N, Gosset X, Bura-Rivière A, Meach G, Lacut K, Bosson JL, Guillot K, Mottier D, Leroyer C. [Prolongation of anti vitamin K treatment for 18 months versus placebo after 6 months treatment of a first episode of ideopathic pulmonary embolism: a mutlicentre, randomised double blind trail. The PADIS-EP Trial]. Rev Mal Respir 2008; 25:885-93. [PMID: 18946418 DOI: 10.1016/s0761-8425(08)74358-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND After stopping a 3 to 6 months course of oral anticoagulation for a first episode of idiopathic venous thromboembolism (VTE), the risk of recurrent VTE is high (10% per year). In this setting, international guidelines recommend at least 6 months treatment. However, this recommendation is not satisfactory for the following reasons: (1) no randomized trial has compared 6 months to extended duration (2 years) anticoagulation; and (2), even though the frequency of recurrent VTE is similar after pulmonary embolism (PE) and deep vein thrombosis (DVT), the fatality rate of recurrent VTE after PE is higher than that after DVT. METHODS A French multicentre double blind randomized trial. The main objective is to demonstrate, after a first episode of symptomatic idiopathic PE treated for 6 months using a vitamin K antagonist, that extended anticoagulation for 18 months (INR between 2 and 3) is associated with an increased benefit / risk ratio (recurrent VTE and severe anticoagulant-related bleeding) compared to placebo. The double blind evaluation is ensured using by active warfarin and placebo, and blinded INR. The protocol was approved by the ethics board of the Brest Hospital on the 7th of March 2006. For an alpha risk of 5% and a beta risk of 20%, the estimated sample size is 374 patients. EXPECTED RESULTS This study has the potential to: (1) demonstrate that the benefit / risk ratio of extended anticoagulation for 18 months is higher than that observed with placebo in patients with a first episode of idiopathic PE initially treated for 6 months, during and after the treatment period; and (2) to validate or invalidate the contribution of isotope lung scans, lower limb Doppler ultrasound and D-Dimer at 6 months of treatment as predictors of recurrent VTE (medico-economic analysis included).
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Gut-Gobert C, Couturaud F, Leroyer C, Sanchez O. [Care of acute pulmonary embolism]. REVUE DE PNEUMOLOGIE CLINIQUE 2008; 64:298-304. [PMID: 19084209 DOI: 10.1016/j.pneumo.2008.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Accepted: 09/19/2008] [Indexed: 05/27/2023]
Abstract
Pulmonary embolism (PE) is common and potentially serious. Three stages are described: mild PE, moderate PE (associated with an ultrasound right ventricular dysfunction) and severe PE (associated with a shock). In the first category, the prognosis is highly favourable (mortality under 5%) and the initial phase of anticoagulant treatment is well documented and codified: the treatment is based on heparin therapy (non fractionated or derivatives) and oral anticoagulants. In the severe forms, fibrinolysis is indicated in addition to the heparin therapy, given the very high mortality (up to 50%). However, the optimum care of moderate PE (intermediate mortality between 10 and 15%) remains uncertain, due to the inability to demonstrate a benefits-risk ratio in favour of fibrinolysis. In addition, this entity is still poorly defined. Although cardiac ultrasound data is useful, other parameters, such as pro-BNP, provide a better identification of these forms of intermediate prognosis. Although the evaluation of the new oral and injectable anticoagulants is promising, it mainly concerns mild PE. In addition, trials are currently under way in patients with a gloomier prognosis. The purpose is to validate or invalidate the indication of classic treatments (fibrinolysis) or new treatments (optional caval filters).
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Sanchez O. [Chronic thromboembolic pulmonary hypertension]. LA REVUE DU PRATICIEN 2008; 58:2025-2029. [PMID: 19143274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Chronic thromboembolic pulmonary hypertension is characterized by the persistence of obstructive thromboemboli and pulmonary vascular remodelling in the open pulmonary arteries. The consequence is an increase in pulmonary vascular resistance and progressive right heart failure. Diagnosis is based on echocardiography, right heart catheterisation and ventilation-perfusion lung scan. Spiral CT and pulmonary angiography are required to assess operability. Pulmonary endarterectomy represents the treatment of choice. Antiproliferative treatments represent alternatives in the most severe and/or non operable patients.
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Sanchez O, Smadja D, Le Cointre L, Henno P, Douvry B, Gaussem P, Israël-Biet D. Cellules endothéliales et progéniteurs endothéliaux circulants : marqueurs de vasculopathie pulmonaire au cours de l’hypertension artérielle pulmonaire. Rev Mal Respir 2008. [DOI: 10.1016/s0761-8425(08)75063-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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257
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Larrieu S, Stempfelet M, Bonenfant S, Armengaud A, Honoré C, Lozano P, Perron G, Rivière E, Sanchez O, Lefranc A. Étude de faisabilité sur l’estimation de l’exposition individuelle chronique à la pollution atmosphérique dans la cohorte Gazel. Rev Epidemiol Sante Publique 2008. [DOI: 10.1016/j.respe.2008.06.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Revel MP, Sanchez O, Dechoux S, Couchon S, Frija G, Cazejust J, Chatellier G, Meyer G. Contribution of indirect computed tomographic venography to the diagnosis of postpartum venous thromboembolism. J Thromb Haemost 2008; 6:1478-81. [PMID: 18627442 DOI: 10.1111/j.1538-7836.2008.03078.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The diagnostic value of indirect computed tomographic venography (CTV), following thoracic computed tomographic angiography (CTA), has not been specifically evaluated in postpartum patients with suspected pulmonary embolism. OBJECTIVES To assess the diagnostic value of CTV in postpartum venous thromboembolism. METHODS We reviewed all CTA and CTV procedures performed during the last 7 years in our institution for suspected pulmonary embolism during the postpartum period. We focused on the quality of CTA, the rates of positive CTA and isolated positive CTV findings, and alternative diagnoses provided by CTV. RESULTS Fifty-five CTA and 33 CTV procedures were performed for suspected pulmonary embolism in 47 patients referred between 24 h and 2 months after Cesarean (34 patients) or vaginal (13 patients) delivery. Of the 33 patients who had both CTA and CTV, seven had positive CTA findings and four had isolated positive CTV findings. Thus, the absolute increase in the venous thromboembolism detection rate following CTV was 12.1% [95% confidence interval (CI) 4.0-29.1]. Subcapsular hematoma of the liver or spleen was found on CTV in another two patients without venous thromboembolism. Consequently, CTV had a direct impact on clinical management in six of 33 patients (18%). CONCLUSION Our results suggest that postpartum patients with suspected pulmonary embolism have a significant rate of pelvic vein thrombosis and that the use of CTV leads to a 31% relative increase in the detection rate of venous thromboembolism as compared to CTA alone in these patients.
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Sanchez O. Thrombose veineuse et voyages aériens. Rev Med Interne 2008; 29:445-8. [DOI: 10.1016/j.revmed.2007.10.421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Accepted: 10/28/2007] [Indexed: 10/22/2022]
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Sanchez O. Right ventricular dysfunction for prognosis in haemodynamically stable patients with acute symptomatic pulmonary embolism: reply. Eur Heart J 2008. [DOI: 10.1093/eurheartj/ehn402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Fabregate R, Fabregate M, Marin E, Garcia-Prieto V, Haurie J, Sanchez O, De La Torre N, Saban-Ruiz J. UNUSUAL CLINICAL PRESENTATION WITH TACHYCARDIA IN A PATIENT WITH LATENT AUTOINMUNE DIABETES ADULT. ATHEROSCLEROSIS SUPP 2008. [DOI: 10.1016/s1567-5688(08)70870-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Righini M, Le Gal G, Aujesky D, Roy PM, Sanchez O, Verschuren F, Rutschmann O, Nonent M, Cornuz J, Thys F, Le Manach CP, Revel MP, Poletti PA, Meyer G, Mottier D, Perneger T, Bounameaux H, Perrier A. Diagnosis of pulmonary embolism by multidetector CT alone or combined with venous ultrasonography of the leg: a randomised non-inferiority trial. Lancet 2008; 371:1343-52. [PMID: 18424324 DOI: 10.1016/s0140-6736(08)60594-2] [Citation(s) in RCA: 304] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Multislice CT (MSCT) combined with D-dimer measurement can safely exclude pulmonary embolism in patients with a low or intermediate clinical probability of this disease. We compared this combination with a strategy in which both a negative venous ultrasonography of the leg and MSCT were needed to exclude pulmonary embolism. METHODS We included 1819 consecutive outpatients with clinically suspected pulmonary embolism in a multicentre non-inferiority randomised controlled trial comparing two strategies: clinical probability assessment and either D-dimer measurement and MSCT (DD-CT strategy [n=903]) or D-dimer measurement, venous compression ultrasonography of the leg, and MSCT (DD-US-CT strategy [n=916]). Randomisation was by computer-generated blocks with stratification according to centre. Patients with a high clinical probability according to the revised Geneva score and a negative work-up for pulmonary embolism were further investigated in both groups. The primary outcome was the 3-month thromboembolic risk in patients who were left untreated on the basis of the exclusion of pulmonary embolism by diagnostic strategy. Clinicians assessing outcome were blinded to group assignment. Analysis was per protocol. This study is registered with ClinicalTrials.gov, number NCT00117169. FINDINGS The prevalence of pulmonary embolism was 20.6% in both groups (189 cases in DD-US-CT group and 186 in DD-CT group). We analysed 855 patients in the DD-US-CT group and 838 in the DD-CT group per protocol. The 3-month thromboembolic risk was 0.3% (95% CI 0.1-1.1) in the DD-US-CT group and 0.3% (0.1-1.2) in the DD-CT group (difference 0.0% [-0.9 to 0.8]). In the DD-US-CT group, ultrasonography showed a deep-venous thrombosis in 53 (9% [7-12]) of 574 patients, and thus MSCT was not undertaken. INTERPRETATION The strategy combining D-dimer and MSCT is as safe as the strategy using D-dimer followed by venous compression ultrasonography of the leg and MSCT for exclusion of pulmonary embolism. An ultrasound could be of use in patients with a contraindication to CT.
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Sanchez O, Marié E, Lerolle U, Wermert D, Israël-Biet D, Meyer G. Hypertension artérielle pulmonaire féminine. Rev Mal Respir 2008. [DOI: 10.1016/s0761-8425(08)71604-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sanchez O, Marié E, Lerolle U, Wermert D, Israël-Biet D, Meyer G. Hypertension artérielle pulmonaire féminine. Rev Mal Respir 2008. [DOI: 10.1016/s0761-8425(08)71598-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Millet A, Morel H, Sanchez O, Meyer G, Le Roy Ladurie F, Dartevelle P, Dulmet E, Goarant E, Curran Y. [Invasion of the pulmonary artery by an undifferentiated carcinoma]. Rev Mal Respir 2008; 25:63-7. [PMID: 18288053 DOI: 10.1016/s0761-8425(08)70468-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The diagnosis of chronic obstruction of the pulmonary artery is difficult. We present the case of a woman with an invasive, undifferentiated carcinoma of the pulmonary artery. CASE REPORT A 61 year old woman complained of increasing dyspnoea. This was evaluated by computed tomography which showed a defect in the main pulmonary artery. There was no clinical or radiological improvement following anticoagulant treatment for two months. A repeat CT scan showed a persisting intravascular defect and the diagnoses considered included post-embolic pulmonary arterial hypertension and angiosarcoma. A surgical biopsy was performed and pericardial and aortic tumour nodules were found during the operation. The pathological examination revealed undifferentiated carcinoma. Further investigations failed to reveal the primary site. CONCLUSION Invasion of the pulmonary artery by angiosarcoma or other tumour is part of the differential diagnosis of chronic thromboembolic disease. The diagnosis rests on histology obtained by an intravascular or surgical procedure. Complete surgical excision may be possible in angiosarcoma but it was impossible in our patient. The patient died despite two courses of chemotherapy and targeted therapy with erlotinib.
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Sanchez O, Trinquart L, Colombet I, Durieux P, Huisman MV, Chatellier G, Meyer G. Prognostic value of right ventricular dysfunction in patients with haemodynamically stable pulmonary embolism: a systematic review. Eur Heart J 2008; 29:1569-77. [DOI: 10.1093/eurheartj/ehn208] [Citation(s) in RCA: 378] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sanchez O, Marcos E, Perros F, Fadel E, Tu L, Humbert M, Dartevelle P, Simonneau G, Adnot S, Eddahibi S. Role of Endothelium-derived CC Chemokine Ligand 2 in Idiopathic Pulmonary Arterial Hypertension. Am J Respir Crit Care Med 2007; 176:1041-7. [PMID: 17823354 DOI: 10.1164/rccm.200610-1559oc] [Citation(s) in RCA: 157] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Inflammatory cytokines may affect pulmonary vascular remodeling in idiopathic pulmonary arterial hypertension (IPAH). CC chemokine ligand 2 (CCL2) is synthesized by vascular cells and can stimulate monocyte/macrophage migration and smooth muscle cell (SMC) proliferation. OBJECTIVES To investigate the role of CCL2 in IPAH. METHODS CCL2 levels in plasma, monocytes, lungs, and medium from pulmonary endothelial cell (P-EC) or pulmonary artery SMC (PA-SMC) cultures were measured by ELISA and Western blot analysis. CCL2 receptor CCR2 mRNA levels in monocytes, P-ECs, and PA-SMCs were measured by real-time polymerase chain reaction. Effect of CCL2 on PA-SMC proliferation and migration was assessed using [3H]thymidine incorporation and a modified Boyden's chamber. The effect of endothelial cell-derived CCL2 on monocyte migration was measured using a modified Boyden's chamber. MEASUREMENTS AND MAIN RESULTS Compared with control subjects, we found the following in patients with IPAH: elevated CCL2 protein levels in plasma and lung tissue, whereas monocyte CCL2 levels were similar between patients and control subjects, and elevated CCL2 release by P-ECs or PA-SMCs. P-ECs released twice as much CCL2 than did PA-SMCs. Monocyte migration was markedly increased in the presence of P-ECs, and the increase was larger with P-ECs from patients with IPAH. CCL2-blocking antibodies reduced P-ECs' chemotactic activity by 60%. Compared with controls, PA-SMCs from patients exhibited stronger migratory and proliferative responses to CCL2, in keeping with the finding that CCR2 was markedly increased in PA-SMCs from patients. CONCLUSIONS These results suggest that CCL2 overproduction may be a feature of the abnormal P-EC phenotype in IPAH, contributing to the inflammatory process and to pulmonary vascular remodeling.
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Sanchez O, Dewachter L, Guignabert C, Fadel E, Marcos E, Humbert M, Simonneau G, Adnot S, Eddahibi S. 086 Altered Endothelin-1 (ET1) synthesis and ET1 receptors expression and function in idiopathic pulmonary hypertension: influence of BMPRII mutations. Rev Mal Respir 2007. [DOI: 10.1016/s0761-8425(07)74377-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Matta M, Wermert D, Podglajen I, Sanchez O, Buu-Hoï A, Gutmann L, Meyer G, Mainardi JL. Molecular diagnosis of Kingella kingae pericarditis by amplification and sequencing of the 16S rRNA gene. J Clin Microbiol 2007; 45:3133-4. [PMID: 17634294 PMCID: PMC2045294 DOI: 10.1128/jcm.00809-07] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Kingella kingae is a fastidious gram-negative bacillus that is considered an emerging pathogen in pediatric settings but remains less common in adults. Here we describe a case of pericarditis in an immunocompetent adult host. The microorganism was identified directly from the clinical sample by molecular techniques, i.e., 16S rRNA gene amplification and sequencing.
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Roux A, Helley D, Wermert D, Fischer A, Sors H, Meyer G, Sanchez O. RISK FACTORS AND CLINICAL SIGNIFICANCE OF RESIDUAL PERFUSION DEFECTS AFTER SYMPTOMATIC PULMONARY EMBOLISM. J Thromb Haemost 2007. [DOI: 10.1111/j.1538-7836.2007.tb01715.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Roy P, Guillemette P, Righini M, Le Gal G, Sanchez O, Gourdier A, Howarth N, Revel M, Perrier A. USEFULNESS OF MULTIDETECTOR COMPUTED TOMOGRAPHY IN PATIENTS WITH SYMPTOMS SUGGESTING PULMONARY EMBOLISM. J Thromb Haemost 2007. [DOI: 10.1111/j.1538-7836.2007.tb03071.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Redondo S, Fabregate M, Sanchez O, Masjuan J, Fabregate R, Alonso De Lecinana M, Saban-Ruiz J. PO17-490 INTIMA-MEDIA THICKNESS, ANKLE-BRACHIAL PRESSURE INDEX AND TRANSCRANIAL DOPPLER SONOGRAPHY IN HYPERTENSIVE PATIENTS. ATHEROSCLEROSIS SUPP 2007. [DOI: 10.1016/s1567-5688(07)71500-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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De La Torre N, Coca-Robinot D, Fabregate R, Sanchez O, Redondo S, Fabregate M, Saban-Ruiz J. PO9-262 CHANGES IN MICROCIRCULATION IN PATIENTS WITH HIGH SENSITIVITY C-REACTIVE PROTEIN. ATHEROSCLEROSIS SUPP 2007. [DOI: 10.1016/s1567-5688(07)71272-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Saban-Ruiz J, Fabregate R, Fabregate M, Sanchez O, Redondo S, De LaTorre N, Campoy J. PO14-379 RELATION BETWEEN THE STIFFNESS OF LARGE/SMALL ARTERIES AND ENDOTHELIUM-DEPENDENT AND NON-ENDOTHELIUM DEPENDENT VASODILATION. ATHEROSCLEROSIS SUPP 2007. [DOI: 10.1016/s1567-5688(07)71389-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Sanchez O, Fabregate R, Fabregate M, Coca-Robinot D, Amador A, Saban-Ruiz J. PO14-378 PREVALENCE OF STIFFNESS OF LARGE AND SMALL ARTERIES IN PATIENTS WITH ELEVATED CARDIOVASCULAR RISK. ATHEROSCLEROSIS SUPP 2007. [DOI: 10.1016/s1567-5688(07)71388-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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