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Sutar RR, Mapari SV, Gaikwad SB, Khare R, Behera BC. An investigation on the cardioprotective potential of lichen compound protocetraric acid by H 2O 2-induced toxicity in H9c2 rat heart cells through in vitro and in silico analysis. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024:10.1007/s00210-024-03390-3. [PMID: 39172149 DOI: 10.1007/s00210-024-03390-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 08/16/2024] [Indexed: 08/23/2024]
Abstract
Worldwide, cardiovascular diseases (CVDs) are the leading cause of death and require treatment and prevention. Lichens are symbiotic organisms that are known to produce unique secondary metabolites and have been used as folk medicines. The aim of the study is to emphasize the importance of lichens in improving heart health, with the objective of investigating protocetraric acid, a lichen metabolite, for its antioxidant and cardioprotective potential by using in vitro and in silico techniques. Protocetraric acid (PRC) was isolated, characterized, and tested for antioxidant properties using six assays. In cardiovascular investigations, hydroxymethylglutaryl-coenzymeA reductase (HMGCR), angiotensin-converting enzyme inhibitory, and fibrinolytic capacities, along with enzyme inhibitory kinetics studies, were carried out. In silico toxicology and molecular docking analysis were done to determine the binding sites on target proteins. The cytoprotective ability of PRC was evaluated by H2O2-induced toxicity in H9c2 rat heart cells. Out of six lichens, the extract of F. caperata showed comparatively stronger antioxidant activity in terms of 1,1-diphenyl-2-picryl hydrazil (DPPH), scavenging of nitric oxide (SNO), and ferric reducing potential (FRAP) equivalent values. PRC showed significant antioxidant properties, and with respect to cardiovascular studies, PRC exhibited 86% HMGCR and 82% ACE inhibition, while 57% fibrinolysis at 320 µM concentration. Inhibitory kinetic tests of PRC showed competitive and uncompetitive HMGCR and ACE inhibition types respectively. PRC showed minimum binding energies of - 7.9, - 8.9, and - 9.0 kcal/mol with 1HWK, 1O8A, and 4BZS. The H9c2 cell line pre-treated with PRC was found to reduce H2O2 toxicity as well as increase cell viability. Protocetraric acid is a potent compound that has been experimentally shown to have hypocholesterolemic, hypotensive, and cardioprotective properties for treating cardiovascular diseases.
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Affiliation(s)
- Ruchira R Sutar
- Biodiversity-Lichen, Agharkar Research Institute, Pune, Maharashtra, India
- Savitribai Phule Pune University, Pune, Maharashtra, India
| | - Sachin V Mapari
- Biodiversity-Lichen, Agharkar Research Institute, Pune, Maharashtra, India
- Savitribai Phule Pune University, Pune, Maharashtra, India
| | - Subhash B Gaikwad
- Biodiversity-Lichen, Agharkar Research Institute, Pune, Maharashtra, India
- Savitribai Phule Pune University, Pune, Maharashtra, India
| | - Roshni Khare
- Biodiversity-Lichen, Agharkar Research Institute, Pune, Maharashtra, India
| | - Bhaskar C Behera
- Biodiversity-Lichen, Agharkar Research Institute, Pune, Maharashtra, India.
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Yu K, Li Z, Shi W, Zhao Z, Yang L. Causal impact of statins on susceptibility to osteoarthritis: insights from a two-sample Mendelian randomization analysis. Int J Clin Pharm 2024:10.1007/s11096-024-01754-6. [PMID: 38990459 DOI: 10.1007/s11096-024-01754-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/12/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Osteoarthritis is a widely prevalent cause of pain and disability among older adults. It is an incurable condition, and most treatments are aimed at alleviating symptoms. AIM This study aimed to investigate the impact of statins on osteoarthritis by using a two-sample Mendelian randomization approach, using genetic variants associated with statin use as instrumental variables. METHOD Information on single nucleotide polymorphisms associated with statin medication was obtained from the FinnGen study, and data on osteoarthritis were sourced from the UK Biobank. The inverse variance weighted method was used as the primary analytical approach for the Mendelian randomization analysis. Sensitivity analyses were conducted to evaluate horizontal pleiotropy and heterogeneity. To examine the genetic relationship between statins and osteoarthritis, linkage disequilibrium score regression-based estimates were used. RESULTS Mendelian randomization analysis indicated a positive effect of statin use on the treatment of osteoarthritis (odds ratio 0.951, 95% confidence interval 0.914-0.99, p < 0.05). This conclusion was supported by various Mendelian randomization methods. Sensitivity analyses revealed no significant directional pleiotropy or influential single nucleotide polymorphisms that could compromise the overall causal inference. Linkage disequilibrium score regression-based estimates suggested a modest genetic correlation between statin use and osteoarthritis (Rg = 0.098, Se = 0.034, p < 0.05), thus reinforcing the robustness of the Mendelian randomization analysis. CONCLUSION Statins reduce the risk of osteoarthritis, aligning with the results of observational studies. Further research is essential to validate these results and explore the underlying mechanisms in detail.
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Affiliation(s)
- Kefu Yu
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China
| | - Ziming Li
- School of Pharmaceutical Sciences, Capital Medical University, Beijing, People's Republic of China
| | - Weizhong Shi
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China
| | - Zhigang Zhao
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China
| | - Li Yang
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China.
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Chen X, Huang X, Liu Y, Zhang Z, Chen J. Assessing the causal associations of different types of statins use and knee/hip osteoarthritis: A Mendelian randomization study. PLoS One 2024; 19:e0297766. [PMID: 38648228 PMCID: PMC11034643 DOI: 10.1371/journal.pone.0297766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/11/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVE This study comprehensively evaluated the causal relationship between different types of statins use and knee/hip osteoarthritis (OA) using a two-sample and multivariate Mendelian randomization (MR) method. METHODS MR analysis was conducted using publicly available summary statistics data from genome-wide association studies (GWAS) to assess the causal associations between total statins use (including specific types) and knee/hip OA. The primary analysis utilized the inverse variance-weighted (IVW) method, with sensitivity analysis conducted to assess robustness. Multivariable MR (MVMR) analysis adjusted for low-density lipoprotein cholesterol (LDL-C), intermediate-density lipoprotein cholesterol (IDL-C), high-density lipoprotein cholesterol (HDL-C), and body mass index (BMI). RESULTS The MR analysis revealed a significant inverse association between genetically predicted total statins use and the risk of knee OA (OR = 0.950, 95%CI: 0.920-0.982, p = 0.002) as well as hip OA (OR = 0.932, 95%CI: 0.899-0.966, p <0.001). Furthermore, this study highlighted a reduced risk of knee/hip OA with the use of atorvastatin and simvastatin. Rosuvastatin use was associated with a decreased risk of hip OA but showed no association with knee OA. MVMR results indicated no correlation between exposure factors and outcomes after adjusting for LDL-C or IDL-C. HDL-C may not significantly contribute to statin-induced osteoarthritis, while BMI may play an important role. CONCLUSION This study provides compelling evidence of the close relationship between statin use and a reduced risk of knee/hip OA, particularly with atorvastatin and simvastatin. LDL-C and IDL-C may mediate these effects. These findings have important implications for the clinical prevention and treatment of knee/hip OA.
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Affiliation(s)
- Xin Chen
- Department of Urology, Mindong Hospital Affiliated to Fujian Medical University, Fuan, Fujian Province, People’s Republic of China
| | - Xin Huang
- Department of Orthopedics, Mindong Hospital Affiliated to Fujian Medical University, Fuan, Fujian Province, People’s Republic of China
| | - Youqun Liu
- Department of Nursing, Xiangan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Zhiwei Zhang
- Department of Orthopedics, Mindong Hospital Affiliated to Fujian Medical University, Fuan, Fujian Province, People’s Republic of China
| | - Jiliang Chen
- Department of Orthopedics, Mindong Hospital Affiliated to Fujian Medical University, Fuan, Fujian Province, People’s Republic of China
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Wei G, Lu K, Umar M, Zhu Z, Lu WW, Speakman JR, Chen Y, Tong L, Chen D. Risk of metabolic abnormalities in osteoarthritis: a new perspective to understand its pathological mechanisms. Bone Res 2023; 11:63. [PMID: 38052778 PMCID: PMC10698167 DOI: 10.1038/s41413-023-00301-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/11/2023] [Accepted: 10/27/2023] [Indexed: 12/07/2023] Open
Abstract
Although aging has traditionally been viewed as the most important risk factor for osteoarthritis (OA), an increasing amount of epidemiological evidence has highlighted the association between metabolic abnormalities and OA, particularly in younger individuals. Metabolic abnormalities, such as obesity and type II diabetes, are strongly linked to OA, and they affect both weight-bearing and non-weight-bearing joints, thus suggesting that the pathogenesis of OA is more complicated than the mechanical stress induced by overweight. This review aims to explore the recent advances in research on the relationship between metabolic abnormalities and OA risk, including the impact of abnormal glucose and lipid metabolism, the potential pathogenesis and targeted therapeutic strategies.
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Affiliation(s)
- Guizheng Wei
- Department of Bone and Joint Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
- Research Center for Computer-aided Drug Discovery, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
- Faculty of Pharmaceutical Sciences, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Ke Lu
- Research Center for Computer-aided Drug Discovery, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
- Faculty of Pharmaceutical Sciences, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Muhammad Umar
- Research Center for Computer-aided Drug Discovery, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
- Faculty of Pharmaceutical Sciences, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Zhenglin Zhu
- Department of Orthopedic Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - William W Lu
- Faculty of Pharmaceutical Sciences, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - John R Speakman
- Center for Energy Metabolism and Reproduction, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Yan Chen
- Department of Bone and Joint Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China.
| | - Liping Tong
- Research Center for Computer-aided Drug Discovery, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China.
| | - Di Chen
- Research Center for Computer-aided Drug Discovery, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
- Faculty of Pharmaceutical Sciences, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
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Geng R, Li J, Yu C, Zhang C, Chen F, Chen J, Ni H, Wang J, Kang K, Wei Z, Xu Y, Jin T. Knee osteoarthritis: Current status and research progress in treatment (Review). Exp Ther Med 2023; 26:481. [PMID: 37745043 PMCID: PMC10515111 DOI: 10.3892/etm.2023.12180] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/11/2023] [Indexed: 09/26/2023] Open
Abstract
Knee osteoarthritis (KOA) is a common chronic articular disease worldwide. It is also the most common form of OA and is characterized by high morbidity and disability rates. With the gradual increase in life expectancy and ageing population, KOA not only affects the quality of life of patients, but also poses a burden on global public health. OA is a disease of unknown etiology and complex pathogenesis. It commonly affects joints subjected to greater loads and higher levels of activity. The knee joint, which is the most complex joint of the human body and bears the greatest load among all joints, is therefore most susceptible to development of OA. KOA lesions may involve articular cartilage, synovium, joint capsule and periarticular muscles, causing irreversible articular damage. Factors such as mechanical overload, inflammation, metabolism, hormonal changes and ageing serve key roles in the acceleration of KOA progression. The clinical diagnosis of KOA is primarily based on combined analysis of symptoms, signs, imaging and laboratory examination results. At present, there is no cure for KOA and the currently available therapies primarily focus on symptomatic treatment and delay of disease progression. Knee replacement surgery is typically performed in patients with advanced disease. The current study presents a review of epidemiological characteristics, risk factors, histopathological manifestations, pathogenesis, diagnosis, treatment modalities and progress in KOA research.
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Affiliation(s)
- Ruizhi Geng
- Graduate School, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
- Institute of Traumatology and Orthopedics, 920th Hospital of Joint Logistics Support Force of The People's Liberation Army, Kunming, Yunnan 650051, P.R. China
| | - Jiayi Li
- Graduate School, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
- Department of Anatomy and Histology, and Embryology, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
| | - Chen Yu
- Graduate School, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
- Department of Orthopedics, The First People's Hospital of Yunnan Province, Kunming, Yunnan 650034, P.R. China
| | - Chaoqun Zhang
- Graduate School, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
- Institute of Traumatology and Orthopedics, 920th Hospital of Joint Logistics Support Force of The People's Liberation Army, Kunming, Yunnan 650051, P.R. China
| | - Fei Chen
- Graduate School, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
- Institute of Traumatology and Orthopedics, 920th Hospital of Joint Logistics Support Force of The People's Liberation Army, Kunming, Yunnan 650051, P.R. China
| | - Jie Chen
- Graduate School, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
- School of Public Health, Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Haonan Ni
- Graduate School, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
| | - Jiaxu Wang
- Graduate School, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
- Institute of Traumatology and Orthopedics, 920th Hospital of Joint Logistics Support Force of The People's Liberation Army, Kunming, Yunnan 650051, P.R. China
| | - Kaiqiang Kang
- Graduate School, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
- Institute of Traumatology and Orthopedics, 920th Hospital of Joint Logistics Support Force of The People's Liberation Army, Kunming, Yunnan 650051, P.R. China
| | - Ziqi Wei
- Graduate School, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
- Department of Anatomy and Histology, and Embryology, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
| | - Yongqing Xu
- Graduate School, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
- Institute of Traumatology and Orthopedics, 920th Hospital of Joint Logistics Support Force of The People's Liberation Army, Kunming, Yunnan 650051, P.R. China
| | - Tao Jin
- Graduate School, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
- Institute of Traumatology and Orthopedics, 920th Hospital of Joint Logistics Support Force of The People's Liberation Army, Kunming, Yunnan 650051, P.R. China
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Jiménez-Muro M, Soriano-Romaní L, Mora G, Ricciardelli D, Nieto JA. The microbiota-metabolic syndrome axis as a promoter of metabolic osteoarthritis. Life Sci 2023; 329:121944. [PMID: 37453577 DOI: 10.1016/j.lfs.2023.121944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/03/2023] [Accepted: 07/12/2023] [Indexed: 07/18/2023]
Abstract
The relation between obesity and osteoarthritis (OA) development has been traditionally explained as consequence of the excessive joint effort derived of overweight. However, in the last two decades a metabolic OA has been suggested through diverse molecular mechanism implying metabolic syndrome, although more investigation must be conducted to elucidate it. Metabolic syndrome is responsible of the release of diverse inflammatory cytokines, specially the increased adipokine in obesity, causing a chronic low-grade inflammatory status that alters the joint homeostasis. In this scenario, the microbiota dysbiosis contribute by worsening the low-grade chronic inflammation or causing metabolic disorders mediated by endotoxemia generated by an increased lipopolysaccharides intake. This results in joint inflammation and cartilage degradation, which contributes to the development of OA. Also, the insulin resistance provoked by type 2 Diabetes contributes to the OA development. When intake patterns are considered, some coincidences can be pointed between the food patterns associated to the metabolic syndrome and the food patterns associated to OA development. Therefore, these coincidences support the idea of a molecular mechanism of the OA development caused by the molecular mechanism generated under the metabolic syndrome status. This review points the relation between metabolic syndrome and OA, showing the connected molecular mechanisms between both pathologies as well as the shared dietary patterns that promote or prevent both pathologies.
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Affiliation(s)
- Marta Jiménez-Muro
- Institute of Traumatology and Advanced Regenerative Medicine (ITRAMED), Calle Escultor Daniel 3, Logroño 26007, La Rioja, Spain
| | - Laura Soriano-Romaní
- ainia Technological Centre, Calle Benjamin Franklin 5-11, Parque Tecnológico de Valencia, E46980 Paterna, Valencia, Spain
| | - Gonzalo Mora
- Institute of Traumatology and Advanced Regenerative Medicine (ITRAMED), Calle Escultor Daniel 3, Logroño 26007, La Rioja, Spain
| | - Diego Ricciardelli
- Institute of Traumatology and Advanced Regenerative Medicine (ITRAMED), Calle Escultor Daniel 3, Logroño 26007, La Rioja, Spain
| | - Juan Antonio Nieto
- ainia Technological Centre, Calle Benjamin Franklin 5-11, Parque Tecnológico de Valencia, E46980 Paterna, Valencia, Spain; Bioactivity and Nutritional Immunology Group (BIOINUT), Faculty of Health Science, Universidad Internacional de Valencia (VIU), Calle Pintor Sorolla 21, E46002, Valencia, Spain.
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Holik H, Krečak I, Lucijanić M, Samardžić I, Pilipac D, Vučinić Ljubičić I, Coha B, Kitter Pipić A, Miškić B, Zupančić-Šalek S. Hip and Knee Osteoarthritis in Patients with Chronic Myeloproliferative Neoplasms: A Cross-Sectional Study. Life (Basel) 2023; 13:1388. [PMID: 37374170 PMCID: PMC10300951 DOI: 10.3390/life13061388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/01/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Osteoarthritis (OA) is a progressive degenerative disease with an inflammatory background. Chronic myeloproliferative neoplasms (MPN) are clonal hematopoietic disorders characterized by chronic inflammation and a tendency for connective tissue remodeling. AIM This study aimed to investigate the prevalence and associated risk factors of symptomatic OA (sOA) in MPN patients. PATIENTS AND METHODS A total of 100 consecutive MPN (39 essential-thrombocythemia, 34 polycythemia-vera, 27 myelofibrosis) patients treated in two community hematologic centers were cross-sectionally evaluated. Patients were required to have both symptoms attributable to hip and/or knee OA and radiographic confirmation to be considered as having sOA. RESULTS The prevalence of hip and/or knee sOA was significantly higher among MPN patients than the previously reported prevalence in the general population of similar age (61% vs. 22%, p < 0.001). Hip sOA was present in 50%, knee sOA in 51% and sOA of both localizations in 41% of patients. A high proportion of MPN patients had radiographic signs of hip OA (94%) and knee OA (98%) in the presence of attributable symptoms. Among the other factors, sOA was univariately associated with the presence of JAK2 mutation, myelofibrosis phenotype, older age, higher body weight, and higher MPN-SAF score (p < 0.050 for all analyses). In the multivariate analysis, older age (odds ratio = 1.19, 95% confidence interval-CI 1.06-1.33) and higher body weight (OR = 1.15, 95% CI 1.06-1.25) were recognized as independent risk factors for sOA. On the other hand, cytoreductive treatment was a protective factor for sOA (OR = 0.07, 95% CI 0.006-0.86). CONCLUSIONS The prevalence of sOA in MPN patients was higher than that in the general population and seems to correlate with older age, increased myeloproliferation and a higher inflammatory state. Whether cytoreductive treatment may postpone OA development in MPN patients warrants additional confirmation.
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Affiliation(s)
- Hrvoje Holik
- Department of Internal Medicine, Dr. Josip Benčević General Hospital, 35000 Slavonski Brod, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Ivan Krečak
- Department of Internal Medicine, General Hospital of Šibenik-Knin County, 22000 Šibenik, Croatia
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Marko Lucijanić
- University Hospital Dubrava, 10000 Zagreb, Croatia
- Faculty of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Ivan Samardžić
- Department of Orthopaedic Surgery, Dr. Josip Benčević General Hospital, 35000 Slavonski Brod, Croatia
| | - Danijel Pilipac
- Department of Orthopaedic Surgery, General Hospital of Šibenik-Knin County, 22000 Šibenik, Croatia
| | - Ivana Vučinić Ljubičić
- Department of Internal Medicine, Dr. Josip Benčević General Hospital, 35000 Slavonski Brod, Croatia
| | - Božena Coha
- Department of Internal Medicine, Dr. Josip Benčević General Hospital, 35000 Slavonski Brod, Croatia
| | - Alma Kitter Pipić
- Department of Laboratory Diagnostics, General Hospital ‘Dr Josip Benčević’, 35000 Slavonski Brod, Croatia
| | - Blaženka Miškić
- Department of Internal Medicine, Dr. Josip Benčević General Hospital, 35000 Slavonski Brod, Croatia
- Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Silva Zupančić-Šalek
- Department of Hematology and Coagulation, University Hospital Holy Spirit, 10000 Zagreb, Croatia
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