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Tao Z, Feng Y, Wang J, Zhou Y, Yang J. Global Scientific Trends in Continuous Renal Replacement Therapy from 2000 to 2023: A Bibliometric and Visual Analysis. Blood Purif 2024; 53:436-464. [PMID: 38310853 DOI: 10.1159/000536312] [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: 09/14/2023] [Accepted: 01/08/2024] [Indexed: 02/06/2024]
Abstract
INTRODUCTION Continuous renal replacement therapy (CRRT) is one of the most widely used blood purification and organ support methods in the ICU. However, the development process, the current status, hotspots, and future trends of CRRT remain unclear. METHOD The WoSCC database was used to analyze CRRT research evolution and theme trends. VOSviewer was used to construct coauthorship, co-occurrence, co-citation, and network visualizations. CiteSpace is used to detect bursts for co-occurrence items. Several important subtopics were reviewed and discussed in more detail. RESULTS Global publications increased from 56 in 2000 to 398 in 2023, a 710.71% increase. Blood Purification published the most manuscripts, followed by the International Journal of Artificial Organs. The USA, the San Bortolo Hospital, and Bellomo were the most productive and impactful institution, country, and author, respectively. Based on co-occurrence cluster analysis, five clusters emerged: (1) clinical applications and management of CRRT; (2) sepsis and CRRT; (3) CRRT anticoagulant management; (4) CRRT and antibiotic pharmacokinetics and pharmacodynamics; and (5) comparison of CRRT and intermittent hemodialysis. COVID-19, initiation, ECOMO, cefepime, guidelines, cardiogenic shock, biomarker, and outcome were the latest high-frequency keywords or strongest bursts, indicating the emerging frontiers of CRRT. CONCLUSIONS There has been widespread publication and citation of CRRT research in the past 2 decades. We provide an overview of current trends, global collaboration patterns, basic knowledge, research hotspots, and emerging frontiers.
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Affiliation(s)
- ZhongBin Tao
- Department of Pediatrics, The First Hospital of Lanzhou University, Lanzhou, China
| | - YanDong Feng
- Department of Pediatrics, The First Hospital of Lanzhou University, Lanzhou, China
| | - Jie Wang
- Department of Pediatrics, The Second People's Hospital of Gansu Province, Lanzhou, China
| | - YongKang Zhou
- Department of Pediatrics, The First Hospital of Lanzhou University, Lanzhou, China
| | - JunQiang Yang
- Department of Pediatrics, The First Hospital of Lanzhou University, Lanzhou, China
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2
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Wang E, Kim S, Wang A, Jiang W, Shah A. Peritoneal dialysis in the setting of acute brain injury: an underappreciated modality. Hosp Pract (1995) 2023; 51:175-183. [PMID: 37491156 DOI: 10.1080/21548331.2023.2241340] [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: 04/01/2023] [Revised: 07/12/2023] [Accepted: 07/24/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Dialysis is complicated in the setting of acute brain injury (ABI) due to several factors including acute solute shifts, acid base changes, need for anticoagulation, and changes in intracranial pressure. For these reasons, continuous renal replacement therapy (CRRT) is often the chosen modality for renal replacement needs in these patients. Peritoneal dialysis (PD) is less discussed but shares many of the benefits often attributed to CRRT. We describe, from both nephrology and neurosurgical perspectives, a case successfully managed with PD. CASE A 25-year-old male with history of end-stage kidney disease (ESKD) secondary to focal segmental glomerulosclerosis on continuous cycling PD for 5 years presented to the hospital with headache and altered mental status. Initial imaging revealed a large intraventricular hemorrhage extending to the fourth ventricle. He underwent an emergent right depressive hemicraniectomy and clot evacuation. Post-operative imaging revealed worsening cerebral edema, intraventricular hemorrhage, and hydrocephalus. The decision was made to continue PD, noting that it retains many of the benefits of CRRT (which it is in fact, a form of) which he tolerated well until the need for a percutaneous gastrostomy tube arose. He was transiently transitioned to hemodialysis but returned to PD once his gastrostomy healed. He continued PD for 1 year without complication and eventually received a kidney transplant. DISCUSSION In managing patients with ABI undergoing dialysis, a number of considerations must be undertaken including avoidance of hypotension to maintain cerebral perfusion pressure and minimize ischemia reperfusion injury, avoidance of anticoagulants that can precipitate or worsen bleeding, the potential for cerebral edema due to rapid solute clearance and osmotic dissipation of therapeutic hypernatremia, and the mitigation of intracellular acidosis from bicarbonate delivery. Although underutilized, PD may potentially serve as a viable option for dialysis in the setting of ABI as demonstrated by the case presented.
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Affiliation(s)
- Elaina Wang
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Steven Kim
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Aaron Wang
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Winston Jiang
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Ankur Shah
- Warren Alpert Medical School, Brown University, Providence, RI, USA
- Division of Kidney Disease and Hypertension, Rhode Island Hospital, Providence, RI, USA
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Barea-Mendoza JA, Chico-Fernández M, Quintana-Díaz M, Serviá-Goixart L, Fernández-Cuervo A, Bringas-Bollada M, Ballesteros-Sanz MÁ, García-Sáez Í, Pérez-Bárcena J, Llompart-Pou JA. Traumatic Brain Injury and Acute Kidney Injury-Outcomes and Associated Risk Factors. J Clin Med 2022; 11:jcm11237216. [PMID: 36498789 PMCID: PMC9739137 DOI: 10.3390/jcm11237216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Our objective was to analyze the contribution of acute kidney injury (AKI) to the mortality of isolated TBI patients and its associated risk factors. Observational, prospective and multicenter registry (RETRAUCI) methods were used, from March 2015 to December 2019. Isolated TBI was defined as abbreviated injury scale (AIS) ≥ 3 head with no additional score ≥ 3. A comparison of groups was conducted using the Wilcoxon test, chi-square test or Fisher's exact test, as appropriate. A multiple logistic regression analysis was conducted to analyze associated risk factors in the development of AKI. For the result, overall, 2964 (30.2%) had AIS head ≥ 3 with no other area with AIS ≥ 3. The mean age was 54.7 (SD 19.5) years, 76% were men, and the ground-level falls was 49.1%. The mean ISS was 18.4 (SD 8). The in-hospital mortality was 22.2%. Up to 310 patients (10.6%) developed AKI, which was associated with increased mortality (39% vs. 17%, adjusted OR 2.2). Associated risk factors (odds ratio (OR) (95% confidence interval)) were age (OR 1.02 (1.01-1.02)), hemodynamic instability (OR 2.87 to OR 5.83 (1.79-13.1)), rhabdomyolysis (OR 2.94 (1.69-5.11)), trauma-associated coagulopathy (OR 1.67 (1.05-2.66)) and transfusion of packed red-blood-cell concentrates (OR 1.76 (1.12-2.76)). In conclusion, AKI occurred in 10.6% of isolated TBI patients and was associated with increased mortality.
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Affiliation(s)
- Jesús Abelardo Barea-Mendoza
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - Mario Chico-Fernández
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - Manuel Quintana-Díaz
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, 28029 Madrid, Spain
| | - Lluís Serviá-Goixart
- Servei de Medicina Intensiva, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRBLleida, 25198 Lleida, Spain
| | - Ana Fernández-Cuervo
- Servicio de Medicina Intensiva, Hospital Universitario Puerta del Mar, 11009 Cádiz, Spain
| | - María Bringas-Bollada
- Servicio de Medicina Intensiva, Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
| | | | - Íker García-Sáez
- Servicio de Medicina Intensiva, Hospital Universitario de Donostia, 20014 Donostia, Spain
| | - Jon Pérez-Bárcena
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d’Investigació Sanitària Illes Balears (IdISBa), 07120 Palma, Spain
| | - Juan Antonio Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d’Investigació Sanitària Illes Balears (IdISBa), 07120 Palma, Spain
- Correspondence:
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Morgan MC, Waller JL, Bollag WB, Baer SL, Tran S, Kheda MF, Young L, Padala S, Siddiqui B, Mohammed A. Association of intermittent versus continuous hemodialysis modalities with mortality in the setting of acute stroke among patients with end-stage renal disease. J Investig Med 2022; 70:1513-1519. [PMID: 35680177 DOI: 10.1136/jim-2022-002439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2022] [Indexed: 11/03/2022]
Abstract
Patients with end-stage renal disease (ESRD) are 8-10 times more likely to suffer from a stroke compared with the general public. Despite this risk, there are minimal data elucidating which hemodialysis modality is best for patients with ESRD following a stroke, and guidelines for their management are lacking. We retrospectively queried the US Renal Data System administrative database for all-cause mortality in ESRD stroke patients who received either intermittent hemodialysis (IHD) or continuous renal replacement therapy (CRRT). Acute ischemic stroke and hemorrhagic stroke were identified using the International Classification of Diseases 9th Revision (ICD-9)/ICD-10 codes, and hemodialysis modality was determined using Healthcare Common Procedure Coding System (HCPCS) codes. Time to death from the first stroke diagnosis was the outcome of interest. Cox proportional hazards modeling was used, and associations were expressed as adjusted HRs. From the inclusion cohort of 87,910 patients, 92.9% of patients received IHD while 7.1% of patients received CRRT. After controlling for age, race, sex, ethnicity, and common stroke risk factors such as hypertension, diabetes, tobacco use, atrial fibrillation, and hyperlipidemia, those who were placed on CRRT within 7 days of a stroke had an increased risk of death compared with those placed on IHD (HR=1.28, 95% CI 1.25 to 1.32). It is possible that ESRD stroke patients who received CRRT are more critically ill. However, even when the cohort was limited to only those patients in the intensive care unit and additional risk factors for mortality were controlled for, CRRT was still associated with an increased risk of death (HR=1.32, 95% CI 1.27 to 1.37). Therefore, further prospective clinical trials are warranted to address these findings.
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Affiliation(s)
- Michael C Morgan
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Jennifer L Waller
- Department of Population Health Science, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Wendy B Bollag
- Department of Physiology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA .,Research, Charlie Norwood VA Medical Center, Augusta, Georgia, USA
| | - Stephanie L Baer
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA.,Infection Control and Epidemiology, Charlie Norwood VA Medical Center, Augusta, Georgia, USA
| | - Sarah Tran
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | | | - Lufei Young
- Department of Physiological and Technological Nursing, Augusta University, Augusta, Georgia, USA
| | - Sandeep Padala
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Budder Siddiqui
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Azeem Mohammed
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
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Cruz-Llanos L, Molano A, Rizo-Topete L. Continuous Renal Replacement Therapy in Acute Brain Injury. FRONTIERS IN NEPHROLOGY 2022; 2:853677. [PMID: 37675018 PMCID: PMC10479622 DOI: 10.3389/fneph.2022.853677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/14/2022] [Indexed: 09/08/2023]
Abstract
Acute brain injury is the sudden and reversible loss of brain self regulation capacity as a disruption of the blood-brain barrier that conditions metabolic and inflammatory disorders that can exacerbate acute kidney injury in a critical setting; specifically it has been described that the alterations of the internal environment that come from the severity of the acute kidney injury increases the risk of endocranial hypertension and cerebral edema; in this context, injuries should be identified and treated in a timely manner with a comprehensive approach. Continuous renal replacement therapy is an extracorporeal purification technique that has been gaining ground in the management of acute kidney injury in critically ill patients. Within its modalities, continuous venous venous hemofiltration is described as the therapy of choice in patients with acute brain injury due to its advantages in maintaining hemodynamic stability and reducing the risk of cerebral edema. Optimal control of variables such as timing to start renal replacement therapy, the prescribed dose, the composition of the replacement fluid and the anticoagulation of the extracorporeal circuit will have a significant impact on the evolution of the neurocritical patient with acute kidney injury. There are limited studies evaluating the role of hemofiltration in this context.
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Affiliation(s)
- Luis Cruz-Llanos
- Nephrology Service, National Cardiovascular Institute “Carlos Alberto Peschiera Carrillo”, Lima, Peru
| | - Alejandra Molano
- Renal Therapy Service, Cardioinfantil Foundation, Bogotá, Colombia
| | - Lilia Rizo-Topete
- Department of Nephrology, University Hospital “Dr. José Eleuterio González”, Universidad Autonoma de Nuevo León (UANL), Monterrey, Mexico
- Department of Internal Medicine, Hospital Christus Muguerza Alta Especialidad, Universidad de Monterrey (UDEM), Monterrey, Mexico
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6
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Ghoshal S, Freedman BI. Renal Replacement Therapy and Dialysis-associated Neurovascular Injury (DANI) in the Neuro ICU: a Review of Pathophysiology and Preventative Options. Curr Treat Options Neurol 2021. [DOI: 10.1007/s11940-020-00661-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Akiu M, Yamamoto T, Fujikura E, Okamoto K, Nakagawa A, Yoshida M, Nakamichi T, Fukushi T, Nagasawa T, Oe Y, Nakayama M, Sato H, Tominaga T, Ito S, Harigae H, Miyazaki M. Questionnaire survey on the prescription of renal replacement therapy for acute phase patients on maintenance dialysis who developed cerebrovascular disease. Clin Exp Nephrol 2020; 24:821-828. [PMID: 32451751 DOI: 10.1007/s10157-020-01905-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/12/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND There is limited information about acute phase renal replacement therapy (RRT) for maintenance hemodialysis patients after the onset of cerebrovascular disease. This study aimed to investigate which modality of renal replacement therapy is currently selected in practice. METHODS We conducted a mail-based survey in 317 dialysis facilities that were certified by three academic societies that focus on dialysis, neurology, and neurosurgery in Japan. RESULTS We received responses from 103 facilities (32.5%). In cases of cerebral infarction (CI) and intracerebral hemorrhage (ICH), more than 80% of the facilities selected only intermittent RRT, and 22.3% (CI)/8.7% (ICH) of the facilities selected intermittent HD which is the same setting in normal conditions. Although continuous hemodiafiltration and peritoneal dialysis are recommended in the Japanese guidelines, these were selected in only a few facilities: 16.5% and 0% in CI, 16.5% and 1% in ICH, respectively. RRT on the day of onset tended to be avoided, irrespective of the duration following the last HD session. Furthermore, physicians preferred to modify anticoagulants and reduce dialysis performance in the acute phase. CONCLUSION This questionnaire survey uncovered a gap between guidelines and actual practice, even in hospitals accredited as educational facility, which is a novel and important finding. Further studies with larger sample sizes are needed to determine the optimal modality of RRT for the acute phase of cerebrovascular disease.
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Affiliation(s)
- Maho Akiu
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.,Division of Blood Purification, Tohoku University Hospital, Sendai, Japan
| | - Tae Yamamoto
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.,Division of Internal Medicine, Sendai City Hospital, Sendai, Japan
| | - Emi Fujikura
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.,Division of Blood Purification, Tohoku University Hospital, Sendai, Japan
| | - Koji Okamoto
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Atsuhiro Nakagawa
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mai Yoshida
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Nakamichi
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.,Division of Nephrology, Japanese Red Cross Ishinomaki Hospital, Ishinomaki, Japan
| | - Taro Fukushi
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tasuku Nagasawa
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yuji Oe
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masaaki Nakayama
- Research Division of Chronic Kidney Disease and Dialysis Treatment, Tohoku University Hospital, Sendai, Japan.,Division of Nephrology, St. Luke's International Hospital, Tokyo, Japan
| | - Hiroshi Sato
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.,JR Sendai Hospital, Sendai, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Sadayoshi Ito
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.,Katta Public General Hospital, Shiroishi, Japan
| | - Hideo Harigae
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mariko Miyazaki
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan. .,Division of Blood Purification, Tohoku University Hospital, Sendai, Japan.
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Consensus guidelines for management of hyperammonaemia in paediatric patients receiving continuous kidney replacement therapy. Nat Rev Nephrol 2020; 16:471-482. [PMID: 32269302 PMCID: PMC7366888 DOI: 10.1038/s41581-020-0267-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2020] [Indexed: 12/29/2022]
Abstract
Hyperammonaemia in children can lead to grave consequences in the form of cerebral oedema, severe neurological impairment and even death. In infants and children, common causes of hyperammonaemia include urea cycle disorders or organic acidaemias. Few studies have assessed the role of extracorporeal therapies in the management of hyperammonaemia in neonates and children. Moreover, consensus guidelines are lacking for the use of non-kidney replacement therapy (NKRT) and kidney replacement therapies (KRTs, including peritoneal dialysis, continuous KRT, haemodialysis and hybrid therapy) to manage hyperammonaemia in neonates and children. Prompt treatment with KRT and/or NKRT, the choice of which depends on the ammonia concentrations and presenting symptoms of the patient, is crucial. This expert Consensus Statement presents recommendations for the management of hyperammonaemia requiring KRT in paediatric populations. Additional studies are required to strengthen these recommendations. This expert Consensus Statement from the Pediatric Continuous Renal Replacement Therapy (PCRRT) workgroup presents recommendations for the management of hyperammonaemia requiring kidney replacement therapy in paediatric populations. Additional studies are needed to strengthen these recommendations, which will be reviewed every 2 years.
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Chousterman BG, Jamme M, Tabibzadeh N, Gaugain S, Damoisel C, Barthélémy R. Delaying Renal Replacement Therapy Could Be Harmful in Patients with Acute Brain Injury. Am J Respir Crit Care Med 2020; 200:645-646. [PMID: 31091956 PMCID: PMC6727164 DOI: 10.1164/rccm.201903-0527le] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Benjamin G Chousterman
- Assistance Publique - Hôpitaux de ParisParis, France.,Sorbonne Paris CitéParis, France.,Inserm U942Paris, France
| | - Matthieu Jamme
- Poissy Saint Germain HospitalPoissy, Franceand.,Versailles Saint-Quentin-en-Yvelines UniversityVillejuif, France
| | - Nahid Tabibzadeh
- Assistance Publique - Hôpitaux de ParisParis, France.,Sorbonne Paris CitéParis, France
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10
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Rebuttal From Drs Niemi and Stoff. Chest 2017; 152:1115-1116. [PMID: 28911911 DOI: 10.1016/j.chest.2017.08.1161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 08/23/2017] [Indexed: 11/21/2022] Open
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Rebuttal From Drs Osgood and Muehlschlegel. Chest 2017; 152:1114-1115. [PMID: 28911912 DOI: 10.1016/j.chest.2017.08.1156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 08/23/2017] [Indexed: 11/23/2022] Open
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