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Durak H, Çetin M, Emlek N, Ergül E, Özyıldız AG, Öztürk M, Duman H, Yılmaz AS, Şatıroğlu Ö. FIB-4 liver fibrosis index correlates with aortic valve sclerosis in non-alcoholic population. Echocardiography 2024; 41:e15732. [PMID: 38284663 DOI: 10.1111/echo.15732] [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: 06/29/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 01/30/2024] Open
Abstract
AIM Hepatic fibrosis, a progressive scarring of liver tissue, is commonly caused by non-alcoholic fatty liver disease (NAFLD), which increases the risk of cardiovascular disease. The Fibrosis-4 (FIB-4) index is a non-invasive tool used to assess liver fibrosis in patients with NAFLD. Aortic valve sclerosis (AVS), a degenerative disorder characterized by thickening and calcification of valve leaflets, is prevalent in the elderly and associated with increased cardiovascular morbidity and mortality. Recent studies have suggested that AVS may also be linked to other systemic diseases such as liver fibrosis. This study aimed to investigate the relationship between the FIB-4 index and AVS in a non-alcoholic population, with the hypothesis that the FIB-4 index could serve as a potential marker for AVS. METHOD A total of 92 patients were included in this study. AVS was detected using transthoracic echocardiography, and patients were divided into groups according to the presence of AVS. The FIB-4 index was calculated for all patients and compared between the groups. RESULTS A total of 17 (18.4%) patients were diagnosed AVS. Patients with AVS had higher rates of diabetes mellitus, older age, hypertension, angiotensin-converting enzyme inhibitor use, higher systolic blood pressure (BP) and diastolic BP in the office, coronary artery disease prevalence, left atrial volume index (LAVI), left ventricular mass index (LVMI), and late diastolic peak flow velocity (A) compared to those without AVS. Moreover, AVS patients had significantly higher creatinine levels and lower estimated glomerular filtration rate. Remarkably, the FIB-4 index was significantly higher in patients with AVS. In univariate and multivariate analyses, higher systolic BP in the office (OR, 1.044; 95% CI 1.002-1.080, p = .024) and higher FIB-4 index (1.46 ± .6 vs. .91 ± .46, p < .001) were independently associated with AVS. CONCLUSION Our findings suggest that the FIB-4 index is associated with AVS in non-alcoholic individuals. Our results highlight the potential utility of the FIB-4 index as a non-invasive tool for identifying individuals at an increased risk of developing AVS.
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Affiliation(s)
- Hüseyin Durak
- Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Mustafa Çetin
- Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Nadir Emlek
- Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Elif Ergül
- Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Ali Gökhan Özyıldız
- Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Muhammet Öztürk
- Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Hakan Duman
- Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Ahmet Seyda Yılmaz
- Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Ömer Şatıroğlu
- Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
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Novel Insights Into Identifying Patients at Risk for Developing Calcific Aortic Stenosis: Clinical Implications. J Am Soc Echocardiogr 2023; 36:50-52. [PMID: 36402636 DOI: 10.1016/j.echo.2022.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/30/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022]
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Çetin M, Duman H, Özer S, Kırış T, Çinier G, Usta E, Satılmış S, Erdoğan T. Mitral annular calcification predicted major cardiovascular events in patients presented with acute coronary syndrome and underwent percutaneous coronary intervention. Acta Cardiol 2020; 75:767-773. [PMID: 31846583 DOI: 10.1080/00015385.2019.1700337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Despite the presence of several clinical studies evaluating the association of atherosclerosis and MAC, no data is present regarding the value of MAC in predicting CV adverse events in patients with acute coronary syndrome (ACS).Methods: Prospective, observational cohort study including 314 patients presented with ACS and underwent percutaneous coronary intervention (PCI). MAC was defined by increased echodensity located at the junction of the atrioventricular groove and posterior mitral leaflet on the parasternal long-axis, short-axis, or apical four-chamber view. Patients were followed for a median 25.1 (23.1-26.5) months for any occurrence of major adverse cardiovascular events (MACE).Results: Among 316 patients 46 (14%) had MAC. Seventy (22.1%) patients had MACE during the follow-up. Patients with MACE had higher creatinine, white blood cell count (WBC), C-reactive protein (CRP), peak troponin I, glucose level at admission compared to those without MACE. Age (HR = 1.026, 95% CI = 1.004-1.049; p = .023), myocardial blush grade (HR = 0.637, 95% CI = 0.480-0.846; p = .008), MAC (HR = 2.429, 95% CI = 1.126-5.239; p = .026), and WBC at admission (HR = 1.079, 95% CI = 1.007-1.157; p = .031) were independent predictors for MACE.Conclusion: In patients presented with ACS and underwent PCI, MAC detected by TTE was an independent predictor for MACE during the long-term follow-up.
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Affiliation(s)
- Mustafa Çetin
- Medical Faculty, Department of Cardiology, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Hakan Duman
- Medical Faculty, Department of Cardiology, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Savaş Özer
- Department of Cardiology, Rize Education and Research Hospital, Rize, Turkey
| | - Tuncay Kırış
- Department of Cardiology, Katip Çelebi University, Atatürk Education and Research Hospital, İzmir, Turkey
| | - Göksel Çinier
- Department of Cardiology, Kaçkar State Hospital, Rize, Turkey
| | - Ece Usta
- Medical Faculty, Department of Cardiology, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Seçkin Satılmış
- Department of Cardiology, Acıbadem Atakent University Hospital, Istanbul, Turkey
| | - Turan Erdoğan
- Medical Faculty, Department of Cardiology, Recep Tayyip Erdoğan University, Rize, Turkey
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Three-year clinical outcome of unprotected left main coronary artery disease patients complicated with chronic kidney disease treated by coronary artery bypass graft versus percutaneous coronary intervention. Ir J Med Sci 2020; 190:89-96. [PMID: 32529544 DOI: 10.1007/s11845-020-02257-9] [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: 03/18/2020] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND This study aimed to compare the incidence of major adverse cardiac and cerebrovascular events (MACCE) after coronary artery bypass graft (CABG) or after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) in unprotected left main coronary artery disease (ULMCAD) patients complicated with chronic kidney disease (CKD). METHODS Three hundred sixty-eight ULMCAD patients complicated with CKD who underwent first ever CABG (n = 207) or PCI with DES (n = 161) were recruited in this prospective cohort study. Patients were followed up to MACCE occurrence or 36 months after operations, and accumulating MACCE occurrence was calculated. RESULTS Accumulating MACCE occurrence was decreased in CABG group compared with PCI group (P = 0.007). Subgroup analysis showed that CKD stage positively correlated with accumulating MACCE occurrence in total patients (P = 0.006) and in PCI-treated patients (P = 0.018), but not in CABG-treated patients (P = 0.217). Further univariate Cox's regression model displayed that CABG (versus (vs.) PCI) (P = 0.008) was associated with lower accumulating MACCE occurrence, while age (≥ 65 years) (P = 0.048), hyperlipidemia (P = 0.013), diabetes (P = 0.012), previous heart failure (P = 0.011), previous stroke (P = 0.030), LVEF < 50% (P = 0.048), higher CKD stage (P = 0.002), and more diseased vessels (P = 0.022) were associated with increased accumulating MACCE occurrence. Forward stepwise multivariate Cox's regression model disclosed that CABG (vs. PCI) (P = 0.002) independently predicted decreased accumulating MACCE occurrence, whereas hyperlipidemia (P = 0.033), diabetes (P = 0.002), higher CKD stage (P = 0.001), and more diseased vessels (P = 0.009) independently predicted elevated accumulating MACCE occurrence. CONCLUSION CABG could be considered as the preferred treatment strategy compared with PCI with DES in ULMCAD patients complicated with CKD.
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Toutouzas K, Stathogiannis K, Latsios G, Synetos A, Drakopoulou M, Penesopoulou V, Michelongona A, Tsiamis E, Tousoulis D. Biomarkers in Aortic Valve Stenosis and their Clinical Significance in Transcatheter Aortic Valve Implantation. Curr Med Chem 2019; 26:864-872. [PMID: 28748765 DOI: 10.2174/0929867324666170727110241] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 11/30/2016] [Accepted: 12/17/2016] [Indexed: 02/06/2023]
Abstract
Aortic valve stenosis is one of the most common valvular heart disorders and the prevalence will rise as the population ages. Once symptomatic patients with aortic valve stenosis tend to fare worse with high mortality rates. Aortic valve replacement is indicated in these patients and besides the standard surgical replacement, a less invasive approach, transcatheter aortic valve implantation, has gained momentum and has showed promising and solid results in patients with high surgical risk. An important aspect of evaluating patients with aortic valve stenosis is the ability to choose the best possible candidate for the procedure. In addition, predicting the short and long-term clinical outcomes after the valve replacement could offer the treating physicians a better insight and provide information for optimal therapy. Biomarkers are biological parameters that can be objectively measured and evaluated as indicators of normal biological processes and are easily monitored. The aim of this review is to critically assess some of the most widely used biomarkers at present (natriuretic peptides, troponins, C-reactive protein) and provide an insight in novel biomarkers that are currently being investigated (galectin-3, growth differentiation factor-15, microRNAs) for possible diagnostic and prognostic use in aortic valve stenosis and transcatheter aortic valve implantation respectively.
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Affiliation(s)
- Konstantinos Toutouzas
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | | | - George Latsios
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Andreas Synetos
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Maria Drakopoulou
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Vicky Penesopoulou
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | | | - Eleftherios Tsiamis
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Dimitris Tousoulis
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
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Xing J, Wang K, Wei H, Jiang W, Wei D. Sudden death in a patient with severe mitral annular calcification and end-stage renal disease during hemodialysis: A case report. Medicine (Baltimore) 2018; 97:e11277. [PMID: 29953006 PMCID: PMC6039686 DOI: 10.1097/md.0000000000011277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Mitral annular calcification (MAC) is a chronic, degenerative cardiac condition. Although MAC is often considered as an incidental finding in clinical and forensic practice, sudden death due to severe MAC with end-stage renal disease (ESRD) during hemodialysis is uncommon. In addition, spontaneous subepicardial hematoma due to rupture of the subepicardial vein is very rare. PATIENT CONCERNS A 65-year-old woman had a history of hypertension, diabetes mellitus, and renal failure. DIAGNOSES Postmortem examination revealed marked MAC with cardiomegaly and ESRD. Spontaneous subepicardial hematoma due to disruption of subepicardial vein was also seen. INTERVENTIONS AND OUTCOMES The patient became short of breath while on hemodialysis and expired en route to the hospital. LESSONS In this case, death was attributed to the effects of the calcified mitral valve annulus. This case highlights that MAC must be considered in any patient with ESRD and fatal cardiovascular events should not be overlooked in these patients.
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Affiliation(s)
- Jingjun Xing
- Zhejiang Key Laboratory of Pathophysiology, Department of Pathology and Pathogen Biology, Medical School of Ningbo University
| | - Ke Wang
- The Affiliated Hospital of Medical School of Ningbo University, Ningbo, Zhejiang Province, China
| | - Hua Wei
- Zhejiang Key Laboratory of Pathophysiology, Department of Pathology and Pathogen Biology, Medical School of Ningbo University
| | - Wenwen Jiang
- Zhejiang Key Laboratory of Pathophysiology, Department of Pathology and Pathogen Biology, Medical School of Ningbo University
| | - Dengming Wei
- Zhejiang Key Laboratory of Pathophysiology, Department of Pathology and Pathogen Biology, Medical School of Ningbo University
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Rajamannan NM. Osteocardiology: Defining the Go/No-Go Time Point for Therapy. Cardiology 2018; 139:175-183. [DOI: 10.1159/000485074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 11/06/2017] [Indexed: 12/14/2022]
Abstract
Recent epidemiological studies have revealed that the risk factors associated with coronary artery calcification (CAC), including male gender, smoking, hypertension, and elevated serum cholesterol, are similar to the risk factors associated with the development of calcific aortic valve disease (CAVD). The results of the experimental and clinical studies demonstrate that traditional risk factors initiate early atherosclerosis which over time differentiates to form bone in the heart causing clinical CAC and CAVD. Understanding the cellular mechanisms of cardiovascular calcification, the end-stage process of the atherosclerosis will help define the specific time point to modify this cellular process of bone formation in the heart termed osteocardiology. This time point between subclinical atherosclerosis and clinical calcification is the go/no-go time point, or the point of no return with severe clinical calcification in the heart. This review will summarize the development of bone formation in the heart termed osteocardiology, to define the go/no-go time point for therapy initiation to slow the progression of cardiovascular calcification.
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Affiliation(s)
- Magnus Bäck
- From the Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (M.B.); INSERM U1116, Université de Lorraine, Nancy, France (M.B., P.-Y.M.); and Pôle Imagerie, Centre Hospitalier Universitaire Nancy, Nancy, France (P.-Y.M.).
| | - Pierre-Yves Marie
- From the Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (M.B.); INSERM U1116, Université de Lorraine, Nancy, France (M.B., P.-Y.M.); and Pôle Imagerie, Centre Hospitalier Universitaire Nancy, Nancy, France (P.-Y.M.)
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Lazaros G, Drakopoulou M, Toutouzas K, Tousoulis D. Left-Sided Cardiac Valve Calcification: Another Rubik's Cube Puzzle? Cardiology 2016; 134:34-6. [DOI: 10.1159/000444009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 01/12/2016] [Indexed: 11/19/2022]
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Jiang M, Wang L, Xuan Q, Shao Y, Kong X, Sun W. Risk Factors Associated with Left-Sided Cardiac Valve Calcification: A Case Control Study. Cardiology 2016; 134:26-33. [PMID: 26841312 DOI: 10.1159/000443203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 12/08/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To identify risk factors associated with cardiac valve calcification that is easily detectable through routine blood tests in patients who received valve replacement therapy. METHODS Four hundred patients with valvular heart disease who underwent valve replacement surgery between December 2009 and January 2013 were enrolled in this study. Of these, 77 had valve calcification; the other 323 did not. Multivariate logistic regression analysis was used to assess for risk factors associated with valve calcification. RESULTS In our study population, rheumatic valve lesions were the most common reason for valve replacement. Degenerative nonstenotic valve lesion was a protective factor and degenerative stenotic valve lesion was a strong risk factor for valve calcification. Serum levels of gamma-glutamyl transferase (GGT) of between 30 and 46 IU/l and >90 IU/l and total bilirubin (TBIL) of between 15 and 20 μmol/l were positively correlated with valve calcification. Meanwhile, serum calcium (Ca2+) levels of between 2.3 and 2.4 mmol/l were negatively correlated with rheumatic valve calcification. CONCLUSIONS Degenerative stenotic lesion is a risk factor and degenerative nonstenotic lesion a protective factor for cardiac valve calcification. Serum GGT and TBIL levels are positively correlated and serum Ca2+ levels negatively correlated with rheumatic cardiac valve calcification.
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Affiliation(s)
- Minyong Jiang
- Department of Cardiology, Jiangyin Hospital of Traditional Chinese Medicine, Jiangyin, PR China
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Rajamannan NM, Greve AM, Moura LM, Best P, Wachtell K. SALTIRE-RAAVE: targeting calcific aortic valve disease LDL-density-radius theory. Expert Rev Cardiovasc Ther 2015; 13:355-67. [PMID: 25797901 DOI: 10.1586/14779072.2015.1025058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
SALTIRE and RAAVE were the first two studies to evaluate the use of statin therapy for impeding calcific aortic valve disease (CAVD). This review presents the findings of low-density lipoprotein (LDL)-density-radius theory as tested using the combined results from the SALTIRE and RAAVE studies. Patients who received statin therapy had a greater degree of LDL cholesterol lowering, seen as the % change in LDL (47 vs 2%, p = 0.012), which in itself was significantly associated with a lesser change in aortic valve area (AVA; p < 0.001 and R(2) = 0.27). The percent change in the AVA for the treated patients was 5% and 15% for the nontreated patients (p = 0.579 and R(2) = 0.03). In summary, these published findings suggest that when applying the LDL-density-radius theory, which combines the cellular biology and the hemodynamics as defined by the continuity equation for AVA, there may be a role for lipid-lowering therapy in contemporary patients with calcific aortic valve disease (CAVD).
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Affiliation(s)
- Nalini M Rajamannan
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, USA
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Lazaros G, Benetos G, Toutouzas K, Tousoulis D. Osteoporosis and Aortic Stenosis: ‘Killing Two Birds with One Stone'? Cardiology 2015; 132:9-10. [DOI: 10.1159/000398788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 04/07/2015] [Indexed: 11/19/2022]
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Rajamannan NM. Myxomatous mitral valve disease bench to bedside: LDL-density-pressure regulates Lrp5. Expert Rev Cardiovasc Ther 2014; 12:383-92. [PMID: 24575776 DOI: 10.1586/14779072.2014.893191] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The myxomatous mitral valve is the most common form of valvular heart disease. The pathologic presentation of myxomatous mitral valve disease varies between valve thickness, degree of leaflet prolapse and the presence or absence of flail leaflets. Recent molecular biology studies have confirmed that the myxomatous changes in mitral valve prolapse equals a cartilage phenotype, which is regulated by the Lrp5 receptor. Clinically, echocardiography defines the valve pathology to determine the surgical approach to valve repair or replacement. Furthermore, the timing of surgical valve repair is controversial and is the subject of a current multicenter trial. The results will resolve the timing of whether watchful waiting versus early surgical valve repair decreases morbidity and mortality of this disease process. This review will summarize the current understanding of the cellular and hemodynamic mechanisms of myxomatous mitral valve disease, which may have future implications in the targeted therapy of this disease process.
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Affiliation(s)
- Nalini M Rajamannan
- Division of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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