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Hou R, Lei J, Xue D, Jing Y, Mi L, Guo Q, Xu K, Zhang L. The association of an elevated Th/Ts ratio and lupus anticoagulant with symptomatic osteonecrosis in systemic lupus erythematosus patients. Front Immunol 2024; 15:1288234. [PMID: 38384449 PMCID: PMC10879316 DOI: 10.3389/fimmu.2024.1288234] [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: 09/04/2023] [Accepted: 01/22/2024] [Indexed: 02/23/2024] Open
Abstract
Objective This study aimed to assess the risk factors for symptomatic osteonecrosis (ON) in systemic lupus erythematosus (SLE) and identify clinical characteristics and laboratory markers for predicting symptomatic ON occurrence in SLE patients. Methods Seventy (6.0%) of 1175 SLE patients diagnosed with symptomatic ON were included in this study. An equal number of SLE patients without symptomatic ON, matched in terms of age and gender, were enrolled in the control group. Clinical symptoms, routine laboratory examinations, lymphocyte subsets, and treatments of these patients were retrospectively reviewed and compared between the two groups. Logistic regression analysis was employed to identify risk factors associated with symptomatic ON in SLE. Results Among the 70 cases in the symptomatic ON group, 62 (88.6%) patients experienced femoral head necrosis, with bilateral involvement observed in 58 patients. Bone pain was reported in 32 cases (51.6%), and 19 cases (30.6%) presented with multiple symptoms. Univariate analysis revealed significant differences between the two groups in various factors, including disease duration (months), cumulative steroid exposure time, history of thrombosis, neurological involvement, the number of affected organs, myalgia/myasthenia, and the use of medications such as glucocorticoids, immunosuppressants, aspirin, and statins (P<0.05). Moreover, lupus anticoagulant (LA) levels were significantly higher in the symptomatic ON group than in the control group (P<0.05). Furthermore, notable distinctions were observed in peripheral blood immune cells, including an elevated white blood cell count (WBC), a decreased percentage of Ts cells (CD3+CD8+), and an elevated Th/Ts ratio. Logistic regression analysis revealed that a history of thrombosis, LA positivity, and an elevated Th/Ts ratio remained positive factors associated with symptomatic ON (P<0.05). Conclusion Decreased Ts cells and changes in the T lymphocyte subset play an important regulatory role in the development of symptomatic ON. A history of thrombosis and LA are associated with an increased probability of symptomatic ON in SLE and may serve as potential predictors.
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Affiliation(s)
- Ruihong Hou
- Department of Rheumatology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Tongji Medical College, Huazhong University of Science and Technology, Taiyuan, China
| | - Jiamin Lei
- Department of Rheumatology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Tongji Medical College, Huazhong University of Science and Technology, Taiyuan, China
| | - Dengfeng Xue
- Department of Galactophore Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yukai Jing
- Department of Clinical Laboratory, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Tongji Medical College, Huazhong University of Science and Technology, Taiyuan, China
| | - Liangyu Mi
- Department of Rheumatology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Tongji Medical College, Huazhong University of Science and Technology, Taiyuan, China
| | - Qianyu Guo
- Department of Rheumatology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Tongji Medical College, Huazhong University of Science and Technology, Taiyuan, China
| | - Ke Xu
- Department of Rheumatology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Tongji Medical College, Huazhong University of Science and Technology, Taiyuan, China
| | - Liyun Zhang
- Department of Rheumatology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Tongji Medical College, Huazhong University of Science and Technology, Taiyuan, China
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Hadighi P, Faezi ST, Mortazavi SMJ, Rokni M, Aghaghazvini L, Kasaeian A, Nejadhosseinian M, Haerian H, Fateh HR. Evaluation of core decompression outcome in systemic lupus erythematosus with hip osteonecrosis: a retrospective cohort study. Adv Rheumatol 2024; 64:4. [PMID: 38167574 DOI: 10.1186/s42358-023-00345-9] [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: 07/04/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Osteonecrosis is a major cause of morbidity for patients with systemic lupus erythematosus (SLE). Although core decompression is an approved and trusted technique to prevent further joint deterioration, this surgical method seems to be less beneficial for SLE patients. We aimed to evaluate the outcomes of core decompression in SLE patients with primary stages of femoral head osteonecrosis. METHODS In this study, 23 patients (39 affected hip joints) with osteonecrosis of the femoral head with stage II of the disease, based on the Ficat-Arlet classification system, underwent core decompression. Also, patients demographic characteristics, clinical data, medication history, comorbidities, immunological findings, hip plain radiographs, history of total hip arthroplasty after core decompression, and patients satisfaction with joint function according to the Oxford hip score questionnaire were obtained. RESULTS In the study, 53.8% of affected joints showed signs of radiographic deterioration in follow-up imaging. Sixty-one and a half percent (61.5%) of patients had unsatisfactory joint performance. A third (33.3%) of affected hip joints underwent total hip arthroplasty up to 5 years from core decompression. SLE patients with a history of receiving bisphosphonate were 83.2% less dissatisfied with their joint function than patients without a history of bisphosphonate use (P < 0.02). Of the 23 studied cases, the mean cumulative dose of prednisolone before and after core decompression surgery was 46.41 mg and 14.74 mg respectively. Besides, one case (2.6%) that had a high anti-phospholipid antibodies level during follow-up did not have any radiographic deterioration, and 9 cases (23.1%) had some degrees of radiographic deterioration. CONCLUSIONS The patients group that used bis-phosphonate, had a higher level of satisfaction with joint function after core decompression. Patients with high-level anti-phospholipid antibodies are related to a poor prognosis after core decompression.
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Affiliation(s)
- Pouya Hadighi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Joint Reconstruction Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Seyed Mohammad Javad Mortazavi
- Joint Reconstruction Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Orthopedic Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Rokni
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Immunology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Leila Aghaghazvini
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Kasaeian
- Hematology, Oncology and Stem Cell Transplantation Research Center, Research Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran
- Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Inflammation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Nejadhosseinian
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Joint Reconstruction Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hoda Haerian
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Fateh
- Department of Physical Medicine and Rehabilitation, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Chen Z, Jiang Y, Wu S, Dang M. Comprehensive analysis of femoral head necrosis based on machine learning and bioinformatics analysis. Medicine (Baltimore) 2023; 102:e33963. [PMID: 37335681 DOI: 10.1097/md.0000000000033963] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Osteonecrosis of the femoral head (ONFH) is a kind of disabling disease, given that the molecular mechanism of ONFH has not been elucidated, it is of significance to use bioinformatics analysis to understand the disease mechanism of ONFH and discover biomarkers. Gene set for ONFH GSE74089 was downloaded in the Gene Expression Omnibus, and "limma" package in R software was used to identify differentially expressed genes related to oxidative stress. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyze were performed for functional analysis. We constructed a protein interaction network and identified potential transcription factors and therapeutic drugs for the hub genes, and delineated the TF-hub genes network. Least absolute shrinkage and selection operator regression, support vector machine and cytoHubba were used to screen feature genes and key genes, which were validated by Receiver operating characteristic. CIBERSORT was used to explored the immune microenvironment. Subsequently, we identified the function of key genes using Gene set variation analysis and their relationship with each type of immune cell. Finally, molecular docking validated the binding association between molecules and validated genes. We detected 144 differentially expressed oxidative stress-related genes, and enrichment analysis showed that they were enriched in reactive oxygen species and AGE-RAGE signaling pathway. Protein-protein interaction and TF-hub genes network were conducted. Further exploration suggested that APOD and TMEM161A were feature genes, while TNF, NOS3 and CASP3 were key genes. Receiver operating characteristic analysis showed that APOD, CASP3, NOS3, and TNF have strong diagnostic ability. The key genes were enriched in oxidative phosphorylation. CIBERSORT analysis showed that 17 types immune cells were differentially relocated, and most of which were also closely related to key genes. In addition, genistein maybe potential therapeutic compound. In all, we identified that TNF, NOS3, and CASP3 played key roles on ONFH, and APOD, CASP3, NOS3, and TNF could serve as diagnostic biomarkers.
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Affiliation(s)
- Zheng Chen
- Guangzhou University of Chinese Medicine Third Clinical Medical College, Guangzhou, China
| | - Yuankang Jiang
- Guangzhou University of Chinese Medicine Third Clinical Medical College, Guangzhou, China
| | - Suwen Wu
- Guangzhou University of Chinese Medicine Third Clinical Medical College, Guangzhou, China
| | - Meng Dang
- Department of Anesthesiology, Shenzhen Pingle Orthopedic Hospital, Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Shenzhen, Guangdong, China
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Wang D, Gu L, Zheng J, Zhang Q, Xu Q, Li R, Song D, Ha C, Zhang Q, Yin H, Xu M, Wang H, Li W, Yuan Z, Yang C, Gu M. Germline VWF/MPRIP and somatoplasm FGA variants synergically confer susceptibility to non-traumatic osteonecrosis of the femoral head. Sci Rep 2023; 13:3112. [PMID: 36813871 PMCID: PMC9946931 DOI: 10.1038/s41598-023-30260-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 02/20/2023] [Indexed: 02/24/2023] Open
Abstract
Non-traumatic osteonecrosis of the femoral head (ONFH) relies on multiple pathogenic factors, including intravascular coagulation, osteoporosis and lipid metabolism disorders. Despite extensively explored from various aspects, genetic mechanism underlying non-traumatic ONFH has not been fully elucidated. We randomly collected blood and necrotic tissue samples from 32 patients with non-traumatic ONFH as well as blood samples from 30 healthy individuals for whole exome sequencing (WES). Germline mutation and somatic mutation were analyzed to identify new potential pathogenic genes responsible for non-traumatic ONFH. Three genes might correlate with non-traumatic ONFH: VWF, MPRIP (germline mutations) and FGA (somatic mutations). Germline or somatic mutations in VWF, MPRIP and FGA correlate with intravascular coagulation, thrombosis, and consequently, ischemic necrosis of the femoral head.
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Affiliation(s)
- Dawei Wang
- Department of Orthopedic Surgery, Liaocheng People's Hospital, Liaocheng, 252000, Shandong, China.
| | - Longchao Gu
- grid.415912.a0000 0004 4903 149XJoint Laboratory for Translational Medicine Research, Liaocheng People’s Hospital, Liaocheng, 252000 Shandong China
| | - Juan Zheng
- grid.415912.a0000 0004 4903 149XJoint Laboratory for Translational Medicine Research, Liaocheng People’s Hospital, Liaocheng, 252000 Shandong China
| | - Qiang Zhang
- grid.415912.a0000 0004 4903 149XJoint Laboratory for Translational Medicine Research, Liaocheng People’s Hospital, Liaocheng, 252000 Shandong China
| | - Qi Xu
- grid.415912.a0000 0004 4903 149XDepartment of Orthopedic Surgery, Liaocheng People’s Hospital, Liaocheng, 252000 Shandong China
| | - Rongrong Li
- grid.415912.a0000 0004 4903 149XJoint Laboratory for Translational Medicine Research, Liaocheng People’s Hospital, Liaocheng, 252000 Shandong China
| | - Da Song
- grid.415912.a0000 0004 4903 149XDepartment of Orthopedic Surgery, Liaocheng People’s Hospital, Liaocheng, 252000 Shandong China
| | - Chengzhi Ha
- grid.415912.a0000 0004 4903 149XDepartment of Orthopedic Surgery, Liaocheng People’s Hospital, Liaocheng, 252000 Shandong China
| | - Qianqian Zhang
- grid.415912.a0000 0004 4903 149XJoint Laboratory for Translational Medicine Research, Liaocheng People’s Hospital, Liaocheng, 252000 Shandong China
| | - Han Yin
- grid.415912.a0000 0004 4903 149XDepartment of Orthopedic Surgery, Liaocheng People’s Hospital, Liaocheng, 252000 Shandong China
| | - Mingtao Xu
- grid.415912.a0000 0004 4903 149XDepartment of Orthopedic Surgery, Liaocheng People’s Hospital, Liaocheng, 252000 Shandong China
| | - Hongmin Wang
- grid.415912.a0000 0004 4903 149XJoint Laboratory for Translational Medicine Research, Liaocheng People’s Hospital, Liaocheng, 252000 Shandong China
| | - Wei Li
- grid.415912.a0000 0004 4903 149XDepartment of Orthopedic Surgery, Liaocheng People’s Hospital, Liaocheng, 252000 Shandong China
| | - Zhengfeng Yuan
- grid.415912.a0000 0004 4903 149XDepartment of Orthopedic Surgery, Liaocheng People’s Hospital, Liaocheng, 252000 Shandong China
| | - Cuncun Yang
- grid.415912.a0000 0004 4903 149XJoint Laboratory for Translational Medicine Research, Liaocheng People’s Hospital, Liaocheng, 252000 Shandong China
| | - Mingliang Gu
- Joint Laboratory for Translational Medicine Research, Liaocheng People's Hospital, Liaocheng, 252000, Shandong, China.
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Zheng Y, Zheng Z, Zhang K, Zhu P. Osteonecrosis in systemic lupus erythematosus: Systematic insight from the epidemiology, pathogenesis, diagnosis and management. Autoimmun Rev 2021; 21:102992. [PMID: 34793961 DOI: 10.1016/j.autrev.2021.102992] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/14/2021] [Indexed: 02/08/2023]
Abstract
Osteonecrosis (ON) is one of the serious and well recognized complicationscausing severe pain and disability in patients with systemic lupus erythematosus (SLE), and its manifestation and pathogenesis are only partially understood. This review provide an update of the recent progress in etiology, pathogenesis, diagnosis, and treatment of systemic lupus erythematosus related osteonecrosis (SLE-ON). Despite the concomitant use of corticosteroids, alcohol and obesity, the dysregulated immune micro-environment and the complex pathogenesis of SLE synergistically play important roles in the development of ON. Osteonecrosis of femoral head (ONFH) is the most often involved joint in SLE. The current classification and staging system of ONFH is based on imaging techniques, particularly relating to MRI and CT, for the identification and quantification of necrotic lesions. For SLE-ONFH patients, both SLE specific clinical symptoms and ONFH imaging findings should be comprehensively evaluated. Even though advances concerning bone grafting and arthroplasty procedures have resulted in improved clinical outcomes, early pharmacological treatment at the pre-collapse stage may prevent joint collapse and reduce the joint arthroplasty rate, and this needs to be accounted. Although some progress has been made, considerably more research is needed before we fully understand SLE-ONFH. Future treatments of SLE-ONFH may involve genetic or cell-based therapies that target potential biomarkers, and this will lead to effective measures for saving thefunction of hip joint and preventing osteonecrosis.
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Affiliation(s)
- Yan Zheng
- Department of Clinical Immunology, Xijing Hospital, The Fourth Military Medical University, Shaanxi Province, PR China; National Translational Science Center for Molecular Medicine, Xi'an, Shaanxi Province, PR China
| | - Zhaohui Zheng
- Department of Clinical Immunology, Xijing Hospital, The Fourth Military Medical University, Shaanxi Province, PR China
| | - Kui Zhang
- Department of Clinical Immunology, Xijing Hospital, The Fourth Military Medical University, Shaanxi Province, PR China
| | - Ping Zhu
- Department of Clinical Immunology, Xijing Hospital, The Fourth Military Medical University, Shaanxi Province, PR China; National Translational Science Center for Molecular Medicine, Xi'an, Shaanxi Province, PR China.
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6
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Kaneko K, Chen H, Kaufman M, Sverdlov I, Stein EM, Park‐Min K. Glucocorticoid-induced osteonecrosis in systemic lupus erythematosus patients. Clin Transl Med 2021; 11:e526. [PMID: 34709753 PMCID: PMC8506634 DOI: 10.1002/ctm2.526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 07/21/2021] [Accepted: 07/25/2021] [Indexed: 12/24/2022] Open
Abstract
Osteonecrosis (ON) is a complex and multifactorial complication of systemic lupus erythematosus (SLE). ON is a devastating condition that causes severe pain and compromises the quality of life. The prevalence of ON in SLE patients is variable, ranging from 1.7% to 52%. However, the pathophysiology and risk factors for ON in patients with SLE have not yet been fully determined. Several mechanisms for SLE patients' propensity to develop ON have been proposed. Glucocorticoid is a widely used therapeutic option for SLE patients and high-dose glucocorticoid therapy in SLE patients is strongly associated with the development of ON. Although the hips and knees are the most commonly affected areas, it may be present at multiple anatomical locations. Clinically, ON often remains undetected until patients feel discomfort and pain at specific sites at which point the process of bone death is already advanced. However, strategies for prevention and options for treatment are limited. Here, we review the epidemiology, risk factors, diagnosis, and treatment options for glucocorticoid-induced ON, with a specific focus on patients with SLE.
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Affiliation(s)
- Kaichi Kaneko
- Arthritis and Tissue Degeneration Program, David Z. Rosensweig Genomics Research CenterHospital for Special SurgeryNew YorkNew York10021USA
| | - Hao Chen
- Arthritis and Tissue Degeneration Program, David Z. Rosensweig Genomics Research CenterHospital for Special SurgeryNew YorkNew York10021USA
- Department of OrthopedicsBeijing Friendship HospitalBeijing100050China
| | - Matthew Kaufman
- Arthritis and Tissue Degeneration Program, David Z. Rosensweig Genomics Research CenterHospital for Special SurgeryNew YorkNew York10021USA
- Case Western Reserve School of MedicineClevelandOhio44106USA
| | - Isaak Sverdlov
- Arthritis and Tissue Degeneration Program, David Z. Rosensweig Genomics Research CenterHospital for Special SurgeryNew YorkNew York10021USA
- Tuoro College of Osteopathic Medicine‐New York CampusNew YorkNew York10027USA
| | - Emily M. Stein
- Endocrinology Service, Hospital for Special SurgeryNew YorkNew YorkUSA
- Metabolic Bone Disease Service, Hospital for Special SurgeryNew YorkNew YorkUSA
| | - Kyung‐Hyun Park‐Min
- Arthritis and Tissue Degeneration Program, David Z. Rosensweig Genomics Research CenterHospital for Special SurgeryNew YorkNew York10021USA
- Department of MedicineWeill Cornell Medical CollegeNew YorkNew YorkUSA
- BCMB allied programWeill Cornell Graduate School of Medical SciencesNew YorkNew York10021USA
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Guggenbuhl P, Robin F, Cadiou S, Albert JD. Etiology of avascular osteonecrosis of the femoral head. Morphologie 2021; 105:80-84. [PMID: 33451882 DOI: 10.1016/j.morpho.2020.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/06/2020] [Accepted: 12/07/2020] [Indexed: 06/12/2023]
Abstract
Avascular osteonecrosis of the femoral head (ONFH) is one of the causes of hip pain that clinicians need to know about. In many cases, it is a fortuitous discovery when pelvic X-rays is performed for another reason. In the other cases, pain reveals the disease. For the rheumatologist, a major part of the job is to look for a cause. An etiology can be found to ONFH in about 70% of the cases. Some of them are evident and the context give the diagnosis (corticosteroids, alcohol abuse…). However, in many cases, additional tests to imaging are required to make the causal diagnosis. In some cases, the treatment of the cause can prevent the recurrence of the disease.
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Affiliation(s)
- P Guggenbuhl
- Université de Rennes, INSERM, CHU Rennes, institut NUMECAN (Nutrition Metabolisms and Cancer), UMR 1241, 35000 Rennes, France.
| | - F Robin
- Université de Rennes, INSERM, CHU Rennes, institut NUMECAN (Nutrition Metabolisms and Cancer), UMR 1241, 35000 Rennes, France
| | - S Cadiou
- Université de Rennes, CHU Rennes, 35000 Rennes, France
| | - J D Albert
- INSERM, CHU Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), UMR 1241, 35000 Rennes, France
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