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Medical-Grade Silicone Coated with Rhamnolipid R89 Is Effective against Staphylococcus spp. Biofilms. Molecules 2019; 24:molecules24213843. [PMID: 31731408 PMCID: PMC6864460 DOI: 10.3390/molecules24213843] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/17/2019] [Accepted: 10/22/2019] [Indexed: 12/15/2022] Open
Abstract
Staphylococcus aureus and Staphylococcus epidermidis are considered two of the most important pathogens, and their biofilms frequently cause device-associated infections. Microbial biosurfactants recently emerged as a new generation of anti-adhesive and anti-biofilm agents for coating implantable devices to preserve biocompatibility. In this study, R89 biosurfactant (R89BS) was evaluated as an anti-biofilm coating on medical-grade silicone. R89BS is composed of homologues of the mono- (75%) and di-rhamnolipid (25%) families, as evidenced by mass spectrometry analysis. The antimicrobial activity against Staphylococcus spp. planktonic and sessile cells was evaluated by microdilution and metabolic activity assays. R89BS inhibited S. aureus and S. epidermidis growth with minimal inhibitory concentrations (MIC99) of 0.06 and 0.12 mg/mL, respectively and dispersed their pre-formed biofilms up to 93%. Silicone elastomeric discs (SEDs) coated by R89BS simple adsorption significantly counteracted Staphylococcus spp. biofilm formation, in terms of both built-up biomass (up to 60% inhibition at 72 h) and cell metabolic activity (up to 68% inhibition at 72 h). SEM analysis revealed significant inhibition of the amount of biofilm-covered surface. No cytotoxic effect on eukaryotic cells was detected at concentrations up to 0.2 mg/mL. R89BS-coated SEDs satisfy biocompatibility requirements for leaching products. Results indicate that rhamnolipid coatings are effective anti-biofilm treatments and represent a promising strategy for the prevention of infection associated with implantable devices.
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Xu B, Wei Q, Mettetal MR, Han J, Rau L, Tie J, May RM, Pathe ET, Reddy ST, Sullivan L, Parker AE, Maul DH, Brennan AB, Mann EE. Surface micropattern reduces colonization and medical device-associated infections. J Med Microbiol 2017; 66:1692-1698. [PMID: 28984233 DOI: 10.1099/jmm.0.000600] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Surface microtopography offers a promising approach for infection control. The goal of this study was to provide evidence that micropatterned surfaces significantly reduce the potential risk of medical device-associated infections. METHODOLOGY Micropatterned and smooth surfaces were challenged in vitro against the colonization and transference of two representative bacterial pathogens - Staphylococcus aureus and Pseudomonas aeruginosa. A percutaneous rat model was used to assess the effectiveness of the micropattern against device-associated S. aureus infections. After the percutaneous insertion of silicone rods into (healthy or immunocompromised) rats, their backs were inoculated with S. aureus. The bacterial burdens were determined in tissues under the rods and in the spleens. RESULTS The micropatterns reduced adherence by S. aureus (92.3 and 90.5 % reduction for flat and cylindrical surfaces, respectively), while P. aeruginosa colonization was limited by 99.9 % (flat) and 95.5 % (cylindrical). The micropatterned surfaces restricted transference by 95.1 % for S. aureus and 94.9 % for P. aeruginosa, compared to smooth surfaces. Rats with micropatterned devices had substantially fewer S. aureus in subcutaneous tissues (91 %) and spleens (88 %) compared to those with smooth ones. In a follow-up study, immunocompromised rats with micropatterned devices had significantly lower bacterial burdens on devices (99.5 and 99.9 % reduction on external and internal segments, respectively), as well as in subcutaneous tissues (97.8 %) and spleens (90.7 %) compared to those with smooth devices. CONCLUSION Micropatterned surfaces exhibited significantly reduced colonization and transference in vitro, as well as lower bacterial burdens in animal models. These results indicate that introducing this micropattern onto surfaces has high potential to reduce medical device-associated infections.
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Affiliation(s)
- Binjie Xu
- Sharklet Technologies, Inc., Aurora, CO, USA
| | - Qiuhua Wei
- Institute of Disease Prevention and Control, Academy of Military Medical Sciences of People's Liberation Army of China, Beijing, PR China
| | | | - Jie Han
- Institute of Disease Prevention and Control, Academy of Military Medical Sciences of People's Liberation Army of China, Beijing, PR China
| | - Lindsey Rau
- PreClinical Research Services, Inc., Fort Collins, CO, USA
| | - Jinfeng Tie
- Institute of Disease Prevention and Control, Academy of Military Medical Sciences of People's Liberation Army of China, Beijing, PR China
| | - Rhea M May
- Sharklet Technologies, Inc., Aurora, CO, USA
- Present address: Medtronics, 6135 Gunbarrel Ave, Boulder, CO, 80301, USA
| | | | | | - Lauren Sullivan
- Veterinarian Teaching Hospital, Colorado State University, Fort Collins, CO, USA
| | - Albert E Parker
- Department of Mathematical Sciences, Center for Biofilm Engineering, Montana State University, Bozeman, MT, USA
| | - Donald H Maul
- PreClinical Research Services, Inc., Fort Collins, CO, USA
| | - Anthony B Brennan
- Department of Materials Science and Engineering and J. Clayton Pruitt Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
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Dell'orto S, Cattò C, Villa F, Forlani F, Vassallo E, Morra M, Cappitelli F, Villa S, Gelain A. Low density polyethylene functionalized with antibiofilm compounds inhibits Escherichia coli cell adhesion. J Biomed Mater Res A 2017; 105:3251-3261. [PMID: 28795783 DOI: 10.1002/jbm.a.36183] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/29/2017] [Accepted: 08/01/2017] [Indexed: 12/18/2022]
Abstract
The present work concerns an efficient strategy to obtain novel medical devices materials able to inhibit biofilm formation. The new materials were achieved by covalent grafting of p-aminocinnamic or p-aminosalicylic acids on low density polyethylene coupons. The polyethylene surface, previously activated by oxygen plasma treatment, was functionalized using 2-hydroxymethylmetacrylate as linker. The latter was reacted with succinic anhydride affording the carboxylic end useful for the immobilization of the antibiofilm molecules. The modified surface was characterized by scanning electron microscope, X-ray photoelectron spectroscopy, attenuated total reflectance Fourier transform infrared and fluorescence analyses. The antibiofilm activity of the modified materials were tested against Escherichia coli biofilm grown in the Center of Disease Control biofilm reactor. The results revealed that the grafted cinnamic and salicylic acid derivatives reduced biofilm biomass, in comparison with the control, by 73.7 ± 10.7% and 63.4 ± 7.1%, respectively. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 3251-3261, 2017.
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Affiliation(s)
- Silvia Dell'orto
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, Via L. Mangiagalli 25, 20133, Milano, Italy
| | - Cristina Cattò
- Department of Food Environmental and Nutritional Sciences, Università degli Studi di Milano, Via Celoria 2, 20133, Milano, Italy
| | - Federica Villa
- Department of Food Environmental and Nutritional Sciences, Università degli Studi di Milano, Via Celoria 2, 20133, Milano, Italy
| | - Fabio Forlani
- Department of Food Environmental and Nutritional Sciences, Università degli Studi di Milano, Via Celoria 2, 20133, Milano, Italy
| | - Espedito Vassallo
- Institute of Plasma Physics «Piero Caldirola», National Research Council (CNR), Via Roberto Cozzi 53, 20125, Milano, Italy
| | - Marco Morra
- Nobil Bio Ricerche S.r.l, Via Valcastellana 28, 14037, Portacomaro, (AT), Italy
| | - Francesca Cappitelli
- Department of Food Environmental and Nutritional Sciences, Università degli Studi di Milano, Via Celoria 2, 20133, Milano, Italy
| | - Stefania Villa
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, Via L. Mangiagalli 25, 20133, Milano, Italy
| | - Arianna Gelain
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, Via L. Mangiagalli 25, 20133, Milano, Italy
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Lai NM, Lai NA, O'Riordan E, Chaiyakunapruk N, Taylor JE, Tan K. Skin antisepsis for reducing central venous catheter-related infections. Cochrane Database Syst Rev 2016; 7:CD010140. [PMID: 27410189 PMCID: PMC6457952 DOI: 10.1002/14651858.cd010140.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The central venous catheter (CVC) is a device used for many functions, including monitoring haemodynamic indicators and administering intravenous medications, fluids, blood products and parenteral nutrition. However, as a foreign object, it is susceptible to colonisation by micro-organisms, which may lead to catheter-related blood stream infection (BSI) and in turn, increased mortality, morbidities and health care costs. OBJECTIVES To assess the effects of skin antisepsis as part of CVC care for reducing catheter-related BSIs, catheter colonisation, and patient mortality and morbidities. SEARCH METHODS In May 2016 we searched: The Cochrane Wounds Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations and Epub Ahead of Print); Ovid EMBASE and EBSCO CINAHL Plus. We also searched clinical trial registries for ongoing and unpublished studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA We included randomised controlled trials (RCTs) that assessed any type of skin antiseptic agent used either alone or in combination, compared with one or more other skin antiseptic agent(s), placebo or no skin antisepsis in patients with a CVC in place. DATA COLLECTION AND ANALYSIS Two authors independently assessed the studies for their eligibility, extracted data and assessed risk of bias. We expressed our results in terms of risk ratio (RR), absolute risk reduction (ARR) and number need to treat for an additional beneficial outcome (NNTB) for dichotomous data, and mean difference (MD) for continuous data, with 95% confidence intervals (CIs). MAIN RESULTS Thirteen studies were eligible for inclusion, but only 12 studies contributed data, with a total of 3446 CVCs assessed. The total number of participants enrolled was unclear as some studies did not provide such information. The participants were mainly adults admitted to intensive care units, haematology oncology units or general wards. Most studies assessed skin antisepsis prior to insertion and regularly thereafter during the in-dwelling period of the CVC, ranging from every 24 h to every 72 h. The methodological quality of the included studies was mixed due to wide variation in their risk of bias. Most trials did not adequately blind the participants or personnel, and four of the 12 studies had a high risk of bias for incomplete outcome data.Three studies compared different antisepsis regimens with no antisepsis. There was no clear evidence of a difference in all outcomes examined, including catheter-related BSI, septicaemia, catheter colonisation and number of patients who required systemic antibiotics for any of the three comparisons involving three different antisepsis regimens (aqueous povidone-iodine, aqueous chlorhexidine and alcohol compared with no skin antisepsis). However, there were great uncertainties in all estimates due to underpowered analyses and the overall very low quality of evidence presented.There were multiple head-to-head comparisons between different skin antiseptic agents, with different combinations of active substance and base solutions. The most frequent comparison was chlorhexidine solution versus povidone-iodine solution (any base). There was very low quality evidence (downgraded for risk of bias and imprecision) that chlorhexidine may reduce catheter-related BSI compared with povidone-iodine (RR of 0.64, 95% CI 0.41 to 0.99; ARR 2.30%, 95% CI 0.06 to 3.70%). This evidence came from four studies involving 1436 catheters. None of the individual subgroup comparisons of aqueous chlorhexidine versus aqueous povidone-iodine, alcoholic chlorhexidine versus aqueous povidone-iodine and alcoholic chlorhexidine versus alcoholic povidone-iodine showed clear differences for catheter-related BSI or mortality (and were generally underpowered). Mortality was only reported in a single study.There was very low quality evidence that skin antisepsis with chlorhexidine may also reduce catheter colonisation relative to povidone-iodine (RR of 0.68, 95% CI 0.56 to 0.84; ARR 8%, 95% CI 3% to 12%; ; five studies, 1533 catheters, downgraded for risk of bias, indirectness and inconsistency).Evaluations of other skin antiseptic agents were generally in single, small studies, many of which did not report the primary outcome of catheter-related BSI. Trials also poorly reported other outcomes, such as skin infections and adverse events. AUTHORS' CONCLUSIONS It is not clear whether cleaning the skin around CVC insertion sites with antiseptic reduces catheter related blood stream infection compared with no skin cleansing. Skin cleansing with chlorhexidine solution may reduce rates of CRBSI and catheter colonisation compared with cleaning with povidone iodine. These results are based on very low quality evidence, which means the true effects may be very different. Moreover these results may be influenced by the nature of the antiseptic solution (i.e. aqueous or alcohol-based). Further RCTs are needed to assess the effectiveness and safety of different skin antisepsis regimens in CVC care; these should measure and report critical clinical outcomes such as sepsis, catheter-related BSI and mortality.
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Affiliation(s)
- Nai Ming Lai
- Taylor's UniversitySchool of MedicineSubang JayaMalaysia
- Monash University MalaysiaSchool of PharmacySelangorMalaysia
| | - Nai An Lai
- Queen Elizabeth II Jubilee HospitalIntensive Care UnitCnr Troughton and Kessels RoadsCoopers PlainsQueenslandAustralia4108
| | - Elizabeth O'Riordan
- The University of Sydney and The Children's Hospital at WestmeadFaculty of Nursing and MidwiferySydneyNew South WalesAustralia2006
| | - Nathorn Chaiyakunapruk
- Monash University MalaysiaSchool of PharmacySelangorMalaysia
- Faculty of Pharmaceutical SciencesCenter of Pharmaceutical Outcomes Research, Department of Pharmacy PracticeNaresuan UniversityPhitsanulokThailand65000
- The University of QueenslandSchool of Population HealthBrisbaneQueenslandAustralia
| | - Jacqueline E Taylor
- Monash Medical Centre/Monash UniversityMonash Newborn246 Clayton RoadClaytonVictoriaAustralia3168
| | - Kenneth Tan
- Monash UniversityDepartment of Paediatrics246 Clayton RoadClaytonMelbourneVictoriaAustraliaVIC 3168
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Bramesfeld A, Wrede S, Richter K, Steen M, Broge B, Pauletzki J, Szecsenyi J. Development of quality indicators and data assessment strategies for the prevention of central venous catheter-related bloodstream infections (CRBSI). BMC Infect Dis 2015; 15:435. [PMID: 26489832 PMCID: PMC4618155 DOI: 10.1186/s12879-015-1200-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 10/12/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The number of catheter related bloodstream infections (CRBSI) could be reduced and the outcome improved if specific standards in the quality of care were maintained. Therefore, the development of quality assurance (QA) procedures was commissioned to be included in the national mandatory QA programme in Germany. METHODS Indicators representing quality deficiencies and potential for improvement of quality in relation to prevention and management of central venous catheters (CVC) were developed by (1) evidence-based literature searches and the compiling of an indicator register; (2) a multi-professional expert panel including patient representatives who selected indicators from this register by using a modified RAND/UCLA Appropriateness Method; (3) defining methods for data assessment, risk adjustment and feedback of indicator results to service providers; and (4) consulting all relevant medical societies and other stakeholders with regard to the QA procedures that had been developed. RESULTS Thirty-two indicators for CRBSI prevention and management were eventually approved by the expert panel. These indicators represent quality of care at predefined points with regard to indication, insertion and care of CVCs, management of sepsis, general hygiene and training of health care personnel. Fourteen indicators represent processes, together with 7 representing structures and 11 outcomes. For assessing these indicators, data was obtained from four sources: claims data from health insurance funds, routine claims data from hospital electronic information systems, case specific longitudinal documentation from service providers and cross-sectional annual assessment of structures. CONCLUSIONS It was possible to develop indicators for mandatory QA procedures on CRBSI that take into account the different perspectives of all stakeholders involved. Despite efforts to use routine data for documentation wherever possible, most indicators required extra documentation.
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Affiliation(s)
- Anke Bramesfeld
- AQUA Institute for applied quality improvement and research in health care GmbH, Maschmühlenweg 8-10, 37073, Göttingen, Germany.
- Institute for Epidemiology, Social Medicine and Health System Research, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Stephanie Wrede
- AQUA Institute for applied quality improvement and research in health care GmbH, Maschmühlenweg 8-10, 37073, Göttingen, Germany.
| | - Klaus Richter
- AQUA Institute for applied quality improvement and research in health care GmbH, Maschmühlenweg 8-10, 37073, Göttingen, Germany.
| | - Mareike Steen
- AQUA Institute for applied quality improvement and research in health care GmbH, Maschmühlenweg 8-10, 37073, Göttingen, Germany.
| | - Björn Broge
- AQUA Institute for applied quality improvement and research in health care GmbH, Maschmühlenweg 8-10, 37073, Göttingen, Germany.
| | - Jürgen Pauletzki
- AQUA Institute for applied quality improvement and research in health care GmbH, Maschmühlenweg 8-10, 37073, Göttingen, Germany.
| | - Joachim Szecsenyi
- AQUA Institute for applied quality improvement and research in health care GmbH, Maschmühlenweg 8-10, 37073, Göttingen, Germany.
- Department of General Practice and Health Services Research, Universitätsklinikum Heidelberg, Voßstraße 2, 69115, Heidelberg, Germany.
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May RM, Magin CM, Mann EE, Drinker MC, Fraser JC, Siedlecki CA, Brennan AB, Reddy ST. An engineered micropattern to reduce bacterial colonization, platelet adhesion and fibrin sheath formation for improved biocompatibility of central venous catheters. Clin Transl Med 2015; 4:9. [PMID: 25852825 PMCID: PMC4385044 DOI: 10.1186/s40169-015-0050-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 01/27/2015] [Indexed: 02/03/2023] Open
Abstract
Background Catheter-related bloodstream infections (CRBSIs) and catheter-related thrombosis (CRT) are common complications of central venous catheters (CVC), which are used to monitor patient health and deliver medications. CVCs are subject to protein adsorption and platelet adhesion as well as colonization by the natural skin flora (i.e. Staphylococcus aureus and Staphylococcus epidermidis). Antimicrobial and antithrombotic drugs can prevent infections and thrombosis-related complications, but have associated resistance and safety risks. Surface topographies have shown promise in limiting platelet and bacterial adhesion, so it was hypothesized that an engineered Sharklet micropattern, inspired by shark-skin, may provide a combined approach as it has wide reaching anti-fouling capabilities. To assess the feasibility for this micropattern to improve CVC-related healthcare outcomes, bacterial colonization and platelet interactions were analyzed in vitro on a material common for vascular access devices. Methods To evaluate bacterial inhibition after simulated vascular exposure, micropatterned thermoplastic polyurethane surfaces were preconditioned with blood proteins in vitro then subjected to a bacterial challenge for 1 and 18 h. Platelet adhesion was assessed with fluorescent microscopy after incubation of the surfaces with platelet-rich plasma (PRP) supplemented with calcium. Platelet activation was further assessed by monitoring fibrin formation with fluorescent microscopy after exposure of the surfaces to platelet-rich plasma (PRP) supplemented with calcium in a flow-cell. Results are reported as percent reductions and significance is based on t-tests and ANOVA models of log reductions. All experiments were replicated at least three times. Results Blood and serum conditioned micropatterned surfaces reduced 18 h S. aureus and S. epidermidis colonization by 70% (p ≤ 0.05) and 71% (p < 0.01), respectively, when compared to preconditioned unpatterned controls. Additionally, platelet adhesion and fibrin sheath formation were reduced by 86% and 80% (p < 0.05), respectively, on the micropattern, when compared to controls. Conclusions The Sharklet micropattern, in a CVC-relevant thermoplastic polyurethane, significantly reduced bacterial colonization and relevant platelet interactions after simulated vascular exposure. These results suggest that the incorporation of the Sharklet micropattern on the surface of a CVC may inhibit the initial events that lead to CRBSI and CRT.
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Affiliation(s)
- Rhea M May
- Sharklet Technologies, Inc, 12635 E. Montview Blvd. Suite 155, Aurora, CO 80045, CO USA
| | - Chelsea M Magin
- Sharklet Technologies, Inc, 12635 E. Montview Blvd. Suite 155, Aurora, CO 80045, CO USA
| | - Ethan E Mann
- Sharklet Technologies, Inc, 12635 E. Montview Blvd. Suite 155, Aurora, CO 80045, CO USA
| | - Michael C Drinker
- Sharklet Technologies, Inc, 12635 E. Montview Blvd. Suite 155, Aurora, CO 80045, CO USA
| | - John C Fraser
- Sharklet Technologies, Inc, 12635 E. Montview Blvd. Suite 155, Aurora, CO 80045, CO USA
| | | | - Anthony B Brennan
- Departments of Materials Science and Engineering and Biomedical Engineering University of Florida, Gainesville, FL 32611 USA
| | - Shravanthi T Reddy
- Sharklet Technologies, Inc, 12635 E. Montview Blvd. Suite 155, Aurora, CO 80045, CO USA
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Francolini I, Donelli G. Prevention and control of biofilm-based medical-device-related infections. ACTA ACUST UNITED AC 2010; 59:227-38. [DOI: 10.1111/j.1574-695x.2010.00665.x] [Citation(s) in RCA: 322] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Catapano G, Klein JB. It's the end of the world as we know it - An era comes to a close. Int J Artif Organs 2009; 32:831-5. [DOI: 10.1177/039139880903201201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Gerardo Catapano
- Department of Chemical Engineering and Materials, University of Calabria, Rende - Italy
| | - Jon B. Klein
- Kidney Disease Program, University of Louisville, Louisville, Kentucky - USA
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